KK-4464 RFB document

KK-4464 RFB document
State of Wisconsin
Wis. Statutes s.16.75
DOA-3070 (R08/2003)
BIDS MUST BE SEALED AND ADDRESSED TO:
AGENCY ADDRESS:
Remove from bidder list for this commodity/service. (Return this page only.)
DEPARTMENT OF CORRECTIONS
KATHY KAEDING/ PURCHASING SERVICES SECTION
3099 E WASHINGTON AVENUE
P.O. BOX 7991
MADISON, WI 53707-7991
REQUEST FOR BID
Bid envelope must be sealed and plainly marked in lower corner with due date and Request for Bid
# KK-4464. Late bids will be rejected. Bids MUST be date and time stamped by the soliciting
purchasing office on or before the date and time that the bid is due. Bids dated and time stamped
in another office will be rejected. Receipt of a bid by the mail system does not constitute receipt of
a bid by the purchasing office. Any bid which is inadvertently opened as a result of not being
properly and clearly marked is subject to rejection. Bids must be submitted separately, i.e., not
included with sample packages or other bids. Bid openings are public unless otherwise specified.
Records will be available for public inspection after issuance of the notice of intent to award or the
award of the contract. Bidder should contact person named below for an appointment to view the
bid record. Bids shall be firm for acceptance for sixty (60) days from date of bid opening, unless
otherwise noted. The attached terms and conditions apply to any subsequent award.
Bids MUST be in this office no later than
THIS IS NOT AN ORDER
March 6, 2014 at 3:00 PM CT
BIDDER (Name and Address)
______________________________
______________________________
______________________________
______________________________
Name (Contact for further information)
Kathy Kaeding
Phone
Date
608-240-5587
February 11, 2014
Quote Price and Delivery FOB
Destination
Item
No.
Quantity
and Unit
Fax bids and Email bids are not accepted
Price
Total
Per Unit
Description
The Department of Corrections (DOC), Division of Community Corrections
(DCC) requesting bids for Secular, Non-Residential Certified Alcohol and
Other Drug Abuse (AODA) Services in Sheboygan, WI, per attached terms,
conditions and specifications and meeting Wisconsin Administrative Code
Chapter DHS 75 Community Substance Abuse Service standards.
1.
2.
100 each
48 groups
AODA Assessment, Section 4.4.3
AODA Outpatient Groups, Section 4.4.4
$
$
$
$
$
$
$
$
$
$
(1 session/week x 12 weeks = 12 groups x 4 cycles = 48 groups)
3.
240
groups
AODA Intensive Outpatient Groups, Section 4.4.5
(3 sessions/week x 10 weeks = 30 groups x 8 cycles = 240 groups)
4.
48
groups
AODA Aftercare Groups, Section 4.4.6
(1 session/week x 16 weeks = 16 groups x 3 cycles = 48 groups)
5.
125 groups
AODA Relapse Prevention Groups, Section 4.4.7
(1 session/week x 25 weeks = 25 groups x 5 cycles = 125 groups)
BID TOTAL $
Before submitting this bid be sure to include all requirements listed in Section 2.4 and 9.
Payment Terms Net 30
Delivery Time: per specifications
We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Minority Business Enterprises. Proposer must be
certified by the Wisconsin Office of Business Development. If you have questions concerning the certification process, contact the Wisconsin Department of Administration, 101 E. Wilson St.,
Madison, Wisconsin 53703, (608) 261-2510. Does not apply to printing bids.
W e claim disabled veteran-owned business preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Disabled Veteran-Owned
Businesses. Proposer must be certified by the Wisconsin Office of Business Development. If you have questions concerning the certification process, contact the Wisconsin Department of
Administration, 101 E. Wilson St., Madison, Wisconsin 53703, (608) 261-2510. Does not apply to printing bids.
We are a work center certified under Wis. Stats. s. 16.752 employing persons with severe disabilities. Questions concerning the certification process should be addressed to the Work Center
Program, State Bureau of Procurement, 6th Floor, 101 E. Wilson St., Madison, Wisconsin 53702, (608) 266-2605.
Wis. Stats. s. 16.754 directs the state to purchase materials which are manufactured to the greatest extent in the United States when all other factors are substantially equal. Materials covered in our
bid were manufactured in whole or in substantial part within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial part in the United States.
Yes
No
Unknown
In signing this bid we also certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in
restraint of free competition; that no attempt has been made to induce any other person or firm to submit or not to submit a bid; that this bid has been independently
arrived at without collusion with any other bidder, competitor or potential competitor; that this bid has not been knowingly disclosed prior to the opening of bids to any
other bidder or competitor; that the above statement is accurate under penalty of perjury.
We will comply with all terms, conditions and specifications required by the state in this Request for Bid and all terms of our bid.
Name of Authorized Company Representative (Type or Print)
Title
Signature of Above
Date
Phone
(
)
Fax
(
)
Email
Website
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 2 of 73
STATE OF WISCONSIN
REQUEST FOR BID (RFB) # KK-4464
FOR: Secular, Non-Residential Certified Alcohol and Other Drug Abuse (AODA) Services
in Sheboygan, Wisconsin
TABLE OF CONTENTS
DEFINITIONS
1.0
INTRODUCTION, PURPOSE, AND SCOPE
2.0
BID PROCEDURE AND INSTRUCTIONS
3.0
BID ACCEPTANCE, EVALUATION AND AWARD
4.0
TECHNICAL REQUIREMENTS
5.0
PERFORMANCE REQUIREMENTS
6.0
SUPPORT REQUIREMENTS
7.0
COST INFORMATION
8.0
STANDARD AND SUPPLEMENTAL TERMS AND CONDITIONS
9.0
REQUIRED FORMS AND ATTACHMENTS
ATTACHMENTS
EXHIBIT 1
……………………………………. DCC Administrative Directive 01-10
EXHIBIT 2
……………………………………. Referral for Services (DOC-1336)
EXHIBIT 3
……………………………………. Offender Report - Monthly (DOC-1088)
EXHIBIT 4
……….…………………………… Unit Service Monthly Report (DOC-1026)
EXHIBIT 5
……….…………………………… Limits of Confidentiality of Health Information (DOC-1923)
EXHIBIT 6
……….…………………………… Evidenced-Based Correctional Program Checklist (CPC)
EXHIBIT 7
……….…………………………… Program Guidelines
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 3 of 73
DEFINITIONS:
The following definitions are used throughout the bid:
Bidder:
Firm submitting a bid in response to this Request for Bid
Contractor:
Successful vendor awarded the contract
DAI:
Division of Adult Institutions, administration of all state correctional incarceration facilities except those
juvenile facilities operated by Division of Juvenile Corrections – headquartered at DOC Central
Offices, 3099 E Washington Ave., Madison, WI 53704
DCC:
Division of Community Corrections, supervises offenders outside secure facilities
DJC:
Division of Juvenile Corrections, operates the correctional ‘schools’ – headquartered at DOC Central
Offices, 3099 E Washington Ave., Madison, WI 53704
DOA:
Department of Administration has statutory authority [WI Stats. Chapter 16] to define, regulate and
delegate all aspects of procurement of commodities and services for state agencies.
DOC:
Department of Corrections, also referred to as the department or the DOC – headquartered at DOC
Central Offices, 3099 E Washington Ave., Madison, WI 53704
DVB:
Disabled Veteran-Owned Business
MBE:
Minority Business Enterprise
Offender:
Person under the custody or supervision of the Wisconsin Department of Corrections
P-Card:
Procurement Card (State credit card)
Purchasing: Department of Corrections’ Purchasing Services Section
RFB:
Request for Bid
State:
State of Wisconsin
Vendor:
Firm submitting a bid in response to this Request for Bid
Must:
Requirement is mandatory
Shall:
Requirement is mandatory
Should:
Desirable but not mandatory
Administrative and Fiscal Services: Tasks and responsibilities such as preparation and management of operational
budget; personnel management; program planning and evaluation; supervision and evaluation of staff;
labor/management relations; public relations; ensuring compliance with Affirmative Action requirements; development,
implementation, and monitoring of policies/practices for information and technology, space, staff/offender health,
safety and security.
Alcohol and Other Drug Abuse (AODA):
The below listing is not inclusive of all Definitions as defined in Wisconsin Administrative Code DHS 75. Other
definitions as referenced in DHS 75 for Community Substance Abuse Service Standards are applicable as written for
the purpose of this Bid. http://legis.wisconsin.gov/rsb/code/dhs/dhs030.html
AODA Assessment: The process and procedures by which a counselor or service identifies and evaluates an
individual’s strengths, weaknesses, problems and needs in order to develop the offender’s individual treatment
plan or to make recommendations for the offender’s continuing care per Wisconsin Uniform Placement Criteria
(UPC).
Intensive Outpatient: A structured, non-residential AODA treatment consisting of regularly scheduled sessions
of various treatment modalities such as counseling case management, group or individual therapy, medical
services, and mental health services, as indicated, by interdisciplinary contractors for a scheduled number of
sessions per day and week. This is the most intensive level of outpatient counseling.
Aftercare or Continuing Care: Aftercare and Continuing Care are interchangeable terms and refer to treatment
provided after the offender has completed the goals of a primary care program and no longer requires counseling
at that intensity level. Aftercare is a less intensive treatment that tapers the treatment process in order to sustain
and extend the offender’s recovery by reinforcing the concepts learned in the primary program. Aftercare is
usually offered on an outpatient basis for a limited time
Relapse Intervention/Prevention: AODA treatment to which an offender is referred due to exhibiting signs of
relapse/destabilization. The goal of such a “booster” form of treatment is to re-stabilize and return the offender to
community living following a structured re-exposure to program elements designed to address the issues the
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 4 of 73
offender was having difficulty within the community. Typically, this might occur through an alternative to revocation
process with the needed elements identified in the treatment plan. Relapse Prevention can also be combined with
Outpatient AODA Counseling as elements of an individual treatment plan.
Alternative to Revocation (ATR) is a written and signed agreement between DOC and the offender.
Clinical Supervision: Management of the treatment aspects of the program. Tasks and responsibilities include
development, implementation, and functional oversight of programs; maintaining current knowledge of research,
literature, evidence based practices, program theories and models relevant to target populations served by the
program; ensuring ethical and professional standards are maintained in program delivery.
It also requires the periodic direct observation and analytic review of ongoing assessment, counseling, motivational
interviewing, treatment plan development, implementation, discharge planning and case management by the
contractor staff with the purpose of evaluating and improving service delivery and assuring quality of care.
Clinical Supervisor: The person designated to be responsible for the clinical supervision of the staff delivering
clinical services in an AODA treatment program. This person is knowledgeable and experienced about the provision
of substance abuse services, the change process and working with criminal offenders.
Cognitive Interventions: A program which teaches specific strategies or techniques to enable offenders to (1)
identify for themselves the specific thoughts that support their criminal behavior (self-observation); (2) see and
appreciate the pattern and consequences of their thinking; (3) utilize reasoning and problem solving, self-talk, social
interaction skills as a means of controlling and changing their thinking; (4) recognize that they have choices and can
make a conscious decision to change or not to change. The Department stresses programming that combines two
types of cognitive interventions: cognitive restructuring (changing the thinking patterns, attitudes, and beliefs that lead
persons to offend) and cognitive skills training (teaching reasoning, problem solving, and social skills).
COMPAS: Northpointe COMPAS is a single statewide DOC system of risk/needs assessment and case planning for
an offender's lifecycle.
Correctional Client includes city, county, state or federal clients served in a correctional setting. The DOC will make
sole determination of who meets these criteria.
Criminogenic Risk Factors: Those features that research has demonstrated are related to criminal behavior. At
least two types are recognized. Static risk factors are offender characteristics that cannot change but are predictive of
an offender’s propensity for future criminal activity - for example, the offender’s age at the time of first offense.
Dynamic risk factors are offender characteristics that may be altered by effective intervention. Examples of dynamic
risk factors are substance abuse; identification with criminal companions; low tolerance for frustration; impulsivity;
conflicts with authority; poor use of leisure time; conning and manipulation; thrill seeking; egocentrism; blaming others;
dissatisfaction with conventional, mainstream activities; poor skills in identifying alternative choices; etc.
Culturally Diverse Programming: Programming which accommodates the learning styles of African American,
Hispanic, American Indian, Caucasian and other ethnic backgrounds. This is accomplished through diverse staff and
program materials.
Evidence-Based Practices (EBP): Encompasses the principle of making decisions about how to provide care by
integrating the best available evidence with practitioner expertise and other resources, and with the characteristics,
state, needs, values, and preferences of those who will be affected. Using EBP implies that (1) there is a definable
outcome(s); (2) that the outcome is measurable; and (3) it is defined according to practical realities.
Gender Specific: Programming designed specifically to address male and female offenders’ needs and learning
styles.
Guided Self-Discovery: This methodology proposes that to take a cognitive approach and then try to argue
offenders out of their habits of thinking is ineffective and even counterproductive. Despite the fact that cognitive
interventions involve learning new beliefs and behaviors, these are not taught through lectures or preaching. In guided
discovery, questioning and exploration are used to help participants discover what they think, guide them to pinpoint
the source of their problems, assist them in seeing new perspectives, and help them find their own solutions to their
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 5 of 73
problems. When using guided discovery, facilitators model a process that offenders can use, on their own, to explore,
evaluate and challenge their beliefs and thoughts rather than continually relying upon facilitators to pinpoint the
sources of their problems and find solutions for them. Asking questions also helps the facilitator keep track of a
participant’s progress in understanding cognitive concepts and making cognitive changes.
The guided discovery approach is also used to maximize participant involvement in the group sessions. When
responding to questions, the participant is doing most of the work rather than being a passive recipient listening to
statements from the facilitator. Guiding participants to pinpoint the source of their problems and find their own
solutions also minimizes the possibility of the participant believing that the facilitator is attempting to impose his or her
own ideas on the participant. Participants often adopt new perspectives more readily when they are allowed to form
their own conclusions than when they are persuaded to adopt the facilitator’s conclusions.
The facilitator’s role is to work with participants to help them recognize their cognitions and other risk factors that
cause problems for them; to test the validity of the thoughts, beliefs and assumptions that prove important; and to
make changes in both cognition and behaviors. By actively collaborating with the offender, facilitators minimize the
resistance and opposition that is often elicited by taking an authoritarian role, yet they still remain in a position to
structure each session and the overall course of the program in a way that is as efficient and effective as possible.
This methodology tends to increase feelings of self-efficacy and empowerment in participants by encouraging them to
adopt an internal focus of evaluation.
Motivational Interviewing (MI): MI is a client-centered, directive method for enhancing intrinsic motivation to change
by exploring and resolving ambivalence. A form of counseling that is more goal-directed yet less confrontational than
conventional methods.
Program Evaluation: The identification of quantifiable behavioral indicators of response to the planned intervention
used to determine program efficacy.
Program Statement: The written statement of a program’s philosophy and model of treatment; the research basis for
selection of the treatment model; the problem and the population to be served; the goals, objectives, and activities to
be employed to achieve the desired outcomes; and the plan for determining the efficacy of the services provided.
Punishers: Involves the application of a stimulus to decrease behavior.
Reinforcer: Involves the application of a stimulus to increase behavior.
Responsivity: Refers to the learning style and characteristics of the offender which can effect their engagement in
treatment.
Screening: The process which identifies whether an offender has an AODA problem (in this case) and if so, a
recommendation for the most appropriate type of treatment. A screening is a “first cut” done quickly, without the
detailed, in-depth, current information that would be gathered for an assessment. A screening should not be confused
with an assessment, which is a lengthier, much more definitive process.
Secular Programming: A program that is free of religious components (Exhibit 1).
Staffings: Verbal communication and information shared by DOC staff and contractor about a specific offender which
usually involves a face-to-face meeting, but may take place over the telephone. The offender may or may not be
present at the meeting or time of telephone call.
Special Populations: Offenders that may present particular characteristics such as the following – cognitively
challenged (low functioning), non-English speaking, learning challenged, mentally ill or physically challenged
(hearing/visual/mobility impaired).
Urinalysis (UA): Analysis of urine, used to detect the presence of a specific substance, such as an illegal drug.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
1.0
Due Date: March 6, 2014 at 3:00PM
Page 6 of 73
INTRODUCTION, PURPOSE, AND SCOPE
1.1
PURPOSE OF THIS REQUEST FOR BID
The Department of Corrections, hereinafter referred to as the "DOC", through its Purchasing Services
Section, hereinafter referred to as "Purchasing," on behalf of the Division of Community Corrections
hereinafter referred to as "DCC", requests bids for Secular, Non-Residential Certified Alcohol and
Other Drug Abuse (AODA) Program(s) in Sheboygan, WI. The program must provide services to
offenders convicted in adult court and under the supervision of the Wisconsin Department of Corrections
(DOC) with specified alcohol and other drug abuse treatment services.
Other DCC Regions, DOC Divisions and State agencies may use the resulting contract, if agreeable to both
the DOC and the vendor, to obtain the benefits of volume purchases and/or reduction in administrative
expenses.
The Wisconsin Department of Corrections (DOC) is changing its organizational culture to become a more
evidence-based organization to meet the mission of reducing recidivism. With the completion of the
statewide implementation of COMPAS (Northpointe COMPAS), a web based risk/needs assessment and
case planning tool, the DOC now has quantitative tools for identifying those offenders with the highest risk
to re-offend. The Division of Community Corrections (DCC) will be providing as much information as
possible regarding each referred offender’s COMPAS assessment results. This COMPAS information will
guide the awarded contractor in providing the best services possible.
For some time, the DOC has strongly emphasized the importance of evidence-based practices (EBP).
The Department has worked with and trained its staff and contractors on how to implement EBP within
DCC programs. The studies that have been done on various programs delivery and curriculums serving
correctional or similar clients all support very specific steps in the program delivery, along with quality staff
and administrative support, to maintain contract fidelity. DOC is looking for EBP to be evident in the
supporting information included in your bid response. This offers you the opportunity to explain the impact
affecting the program participant by including the studies that have been done with correctional or similar
clients. In your bid response reference the specific studies rather than simply stating ‘studies have been
done’. Place the best available evidence from research at the heart of your program by including the EBP
definable outcome(s); illustrate that outcomes are measurable; and show that outcomes are practical as
they relate to the program participants. Awarded contractor and DOC shall work together in coordinating
outcome data with DOC minimum outcome requirements identified in Section 4.8.4.4 Program
Evaluation of this RFB.
The Corrections Program Checklist (CPC) is included as Appendix 5 to assist bidders in understanding
this concept and its role in helping the Department move its staff and contractors together towards the
main goal of the Wisconsin Department of Corrections – reduction in recidivism.
As the Department moves forward with integrating EBP, it is important that DOC include providers in the
discussion. We must work together. While our goals may not always align, we all share a common goal
of helping offenders to improve their lives by remaining crime free. The Department values all of you as
our partners and we look forward to making sure our programs accomplish reduction in offender
recidivism, fewer victims, and fewer crimes.
1.1.1
PROGRAM GOALS
The goals and objectives of the Non-Residential, Secular, Certified Alcohol and Other Drug Abuse
(AODA) Program are to:



Provide a range of quality programs to meet offender's control, supervision and treatment
needs per Wisconsin Administrative Code DHS 75.
Provide a means to screen and assess the level of programming that would most
effectively address individual AODA treatment needs.
Provide group and/or other individual treatment for offenders that focuses on:
1.
Promoting abstinence from mood-altering chemicals and recovery from addiction.
2.
Promoting positive lifestyle changes to avoid further legal difficulties.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI


1.1.2
Due Date: March 6, 2014 at 3:00PM
Page 7 of 73
Reduce jail and prison overcrowding by providing options/diversions to offenders who are
experiencing problems as a result of their alcohol and other drug abuse.
Reduce crime/recidivism by targeting dynamic criminogenic risk factors.
TARGET POPULATION
The program shall serve male and female offenders convicted in adult court as referred by the
Department of Corrections and are under DOC supervision for the duration of services. A special
population group of offenders may present particular characteristics that should be addressed by
reasonable accommodations in the program.
Factors considered in referrals will include risk to re-offend, convicting offense behavior(s), prior
record, other prior history, indicators of imminent relapse, availability of resources, or other case
contingencies. Priority placement shall be given to offenders scoring highest on risk to re-offend
based upon Northpointe COMPAS. DCC staff will determine priority offenders.
1.2
CONTRACT TERM
The contract term will be for one (1) year that will start upon receipt of formal contract and/or State of
Wisconsin purchase order by the awarded bidder. The Calendar of Events (Section 2.3) provides the
approximate contract start date.
Options to renew the contract are available for three (3) additional one-year terms. Renewal(s) beyond
the initial contract term is contingent upon the performance of the contractor during the contract period
and upon availability of funds. These are not automatic renewals. Contracts will be reviewed by the DOC
before a decision is made. Any renewal(s) must be authorized by mutual written agreement of the vendor
and the state.
1.3
EXECUTED CONTRACT TO CONSTITUTE ENTIRE AGREEMENT
In the event of contract award, the contents of this RFB (including all attachments), RFB addenda and
revisions, and the bid of the successful bidder, and additional terms agreed to, in writing, by DOC and the
contractor shall become part of the contract. Failure of the successful bidder to accept these as a
contractual agreement may result in a cancellation of award.
The following priority for contract documents will be used if there are conflicts or disputes.
State of Wisconsin standard terms and conditions
Final Signed Contract including amendments
Official State of Wisconsin Purchase Order
Bidder’s written bid document
State of Wisconsin Request for Bid, including any amendments;
Other exhibits/attachments
Successful bidder(s) should retain a copy of this DOC Request for Bid document and their own response
to the RFB solicitation, as it becomes part of the awarded contract.
1.4
CANCELLATION AND TERMINATION
This Contract may be terminated for the following conditions:
1.4.1
The DOC may terminate the Contract at any time, with or without cause and without penalty by
delivering thirty (30) days written notice to the Contractor.
1.4.2
The DOC has a Vendor Performance Evaluation process for soliciting feed-back from contract
users about vendor performance and compliance with contract specifications.
Vendor
noncompliance with the terms, conditions or specifications that is persistent and/or significantly
impacts the quality and performance provided pursuant to the contract may be considered in
breach of contract. Negative Vendor Performance Evaluation Surveys may result in non-renewal
or termination of contract.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
1.5
Due Date: March 6, 2014 at 3:00PM
Page 8 of 73
1.4.3
If at any time the Contractor performance threatens the health and/or safety of the DOC, the DOC
has the right to cancel and terminate the Contract without notice.
1.4.4
Failure to maintain the required Certificates of Insurance, Permits and Licenses shall be cause for
Contract termination. If the Contractor fails to maintain and keep in force the insurance as
provided in #23 of the Standard Terms and Conditions, the DOC has the right to cancel and
terminate the Contract without notice.
1.4.5
If at any time a petition in bankruptcy shall be filed against the Contractor and such petition is not
dismissed within 90 calendar days, or if a receiver or trustee of Contractor's property is appointed
and such appointment is not vacated within 90 calendar days, the DOC has the right, in addition to
any other rights of whatsoever nature that it may have at law or inequity, to terminate the Contract
by giving 10 calendar days notice in writing of such termination.
1.4.6
Failure of the DOC to comply with contract terms, conditions or specifications shall provide the
sole cause for which the Contractor is entitled to terminate the contract. The Contractor shall notify
the Department in writing within thirty (30) days after the Contractor becomes aware of the alleged
noncompliance with a complete description of the same. If the DOC does not, within forty-five (45)
days after its receipt of the Contractor’s notice, either (1) effect a cure or (2) if the noncompliance
is not one that can reasonably be cured within forty-five (45) days, develop a plan to cure the
noncompliance and diligently proceed according to that plan unto a cure is effected, then the
Contractor may terminate the Contract for cause by written notice to the DOC. The Contractor may
not terminate the Contract without cause unless express written consent to do so is provided by
the DOC.
VENDORNET REGISTRATION
Department of Administration and State Bureau of Procurement policies no longer require maintenance of
bidders’ lists or individual notification of vendors on bidder’s lists. In addition, there is no requirement to
post solicitations for bids/proposals in the Legal Notices of the Official State Newspaper. Section 16.75,
Wisconsin Statutes, allows for use of the Internet to post due notice for certain procurements:
http://publicnotices.wi.gov.
Vendors who fail to register with VendorNet or who register or change/add commodity codes after the
posting of a solicitation may not receive notification of procurement solicitations including amendments or
cancellations.
The State of Wisconsin’s purchasing information and vendor notification service, VendorNet, is available
to all businesses and organizations that want to sell to the state. Anyone may access VendorNet on the
Internet at http://vendornet.state.wi.us to get information on state purchasing practices and policies,
commodities and services that the state buys, and tips on selling to the state. Vendors may use the same
Web site address for inclusion on the bidders list for commodities and services that the organization wants
to sell to the state. A registration with notification guarantees the organization will receive an e-mail
message each time a state agency, including any campus of the University of Wisconsin System, posts a
request for bid or a request for proposal in their designated commodity/service area(s) with an estimated
value over $50,000. Organizations without Internet access receive paper copies in the mail. Increasingly,
state agencies also are using VendorNet to post simplified bids valued at $50,000 or less. Vendors also
may receive e-mail notices of these simplified bid opportunities.
To obtain information on the state’s bidder registration, visit the VendorNet Web site at
http://vendornet.state.wi.us or call the VendorNet Information Center (1-800-482-7813). In the Madison
area, call 608-264-7898.
Make sure to select all the appropriate NIGP (Commodity) Codes. Bid lists are generated by NIGP codes.
Consider using a generic email address that is accessed or delivered to multiple recipients (example:
[email protected]). This will insure that the bid notice is received.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
2.0
Due Date: March 6, 2014 at 3:00PM
Page 9 of 73
BID PROCEDURES AND INSTRUCTIONS
2.1
REASONABLE ACCOMMODATIONS
The DOC will provide reasonable accommodations, including the provision of informational material in an
alternative format, for qualified individuals with disabilities upon request. If accommodations at a bid
opening/vendor conference are needed, contact Kathy Kaeding via telephone at 608-240-5587 or email at
[email protected]
2.2
BID SUBMITTAL
Bidders must submit
 an original bid response (marked as such); and
 one (1) additional paper copy of bid response; and
 a CD-ROM of the bid response that is an exact duplicate of the above two paper copies.
Bidders should refer to Sections 2.4 and 9 for information on what should be included in their bid
response. Bidders need to make sure that both paper copies and the CD-ROM of the bid response
all match each other.
For the purposes of this RFB, receipt of a bid by the State mail system does not constitute receipt of
a bid by the Purchasing Services Section. The Bid(s) must be received at the Purchasing Services
Section, at the office listed below, no later than Thursday, March 6, 2014 at 3:00 PM.
Any bids received after this time and date will be rejected.
Use one of the options below for submitting bid(s):
USPS ADDRESS
KATHY KAEDING/PURCHASING SERVICES SECTION
DEPARTMENT OF CORRECTIONS
PO BOX 7991
MADISON, WI 53707-7991
*NOTE: Allow an extra day for deliveries to the PO Box address.
COMMON CARRIER ADDRESS
KATHY KAEDING/PURCHASING SERVICES SECTION
DEPARTMENT OF CORRECTIONS
3099 EAST WASHINGTON AVE.
MADISON, WI 53704-4338
FAXING: Faxed bids are NOT accepted.
E-MAILING: Emailed bids are NOT accepted.
All bids must be packaged, sealed, and show the following information on the outside of the package:
Vendor’s Name and Address
Request for Bid Title: Certified AODA Services in Sheboygan, WI
Request for Bid Number: RFB KK-4464
Bid Due Date and Time: March 6, 2014 at 3PM
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
2.3
Due Date: March 6, 2014 at 3:00PM
Page 10 of 73
CALENDAR OF EVENTS
Listed below are important dates and times by which actions related to this Request for Bid (RFB) must be
completed. In the event that the State finds it necessary to change any of these dates and times it will do
so by issuing an amendment to this RFB to be posted on VendorNet, unless the event is listed as
estimated or approximate.
DATE
EVENT
February 11, 2014
February 18, 2014
February 20, 2014
RFB posting date
Last day for submitting written questions
Answers to questions posted on VendorNet (estimated)
March 6, 2014 at 3:00pm
Bids due from vendors
March 21, 2014
April 28, 2014
Estimated award date
Approximate Contract Start date
(estimated—earlier contract start date preferred, if possible)
2.4
FORMAT OF BID
Responses to this RFB must comply with the following format requirements (reference Section 9).
2.4.1
SIGNED REQUEST FOR BID FORM DOA-3070 – Cover sheet of this RFB
Include here the signed Request for Bid form included with the bid and those certifications
required for submittal of a bid. Bids submitted in response to this RFB must be signed by the
person in the vendor's organization who is responsible for the decision as to the prices being
offered in the bid or by a person who has been authorized in writing to act as agent for the person
responsible for the decision on prices.
2.4.2
COST SUBMITTAL INFORMATION
Bidders must submit cost on the Request for Bid form (DOA-3070), complete and sign, including
a price per unit for each service item, an extended total for each service item (Quantity X
Unit Price), and a total price (Bid Total). The Bid Total includes the total extended amounts for
the AODA Assessments (line item 1), AODA Outpatient Groups (line item 2), AODA Intensive
Outpatient Groups (line item 3), AODA Aftercare Groups (line item 4) and the AODA Relapse
Prevention Groups (line item 5). Bidder must provide all services requested in this RFB. Cost
must include labor, travel and insurance. All costs to furnish the service(s) included in the bid, in
accordance with the terms and conditions of this RFB, must be included.
2.4.3
VENDOR INFORMATION DOA-3477
Provide Vendor Company contact information as requested on the form.
2.4.4
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION DOA-3027
Information submitted as part of the bid document which is proprietary and confidential in nature
and which qualifies as a trade secret may be kept confidential under the Wisconsin Open Records
Law – Section 19.36(5), Wis. Stats. Complete and sign the attached form.
2.4.5
WISCONSIN’S COOPERATIVE PURCHASING SERVICE DOA-3333
Vendors are encouraged to extend the contract resulting from this RFB to local governments in
Wisconsin. Indicate your willingness to allow Wisconsin municipalities to participate in this
contract by completing Form DOA-3333, Wisconsin’s Cooperative Purchasing Service.
2.4.6
VENDOR REFERENCE DOA-3478
Complete the Vendor Reference form with four vendors that your company has done business
with providing services. Include the company name, address, contact person and telephone
number along with a brief description of the service.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 11 of 73
References may be contacted to confirm the Bidder’s abilities, qualifications, and experience as
stated in the Bidder’s Response. The Department of Corrections may perform due diligence by
contacting any applicable business reference, including references within the Department or other
state agencies. The Department of Corrections reserves the right to disqualify any Bidder whose
references do not support their stated claim of qualifications and experience in their bid response.
2.4.7
ADDITIONAL INFORMATION
A listing of required forms and additional required information, including supporting
documentation, is provided in Section 9 Required Forms and Attachments.
Bids that do not include all items listed on this checklist (Section 9) may be rejected.
Italics note all required documentation in the Request for Bid.
The information requested is to verify bidder can meet bid specifications
2.4.8
STATE OF WISCONSIN TERMS AND CONDITIONS
The standard (DOA-3054) and supplemental (DOA-3681) terms and conditions shall govern this RFB
and subsequent award.
Vendor must accept these terms and conditions or submit point-by-point exceptions along with
proposed alternative or additional language for each point, including any vendor contracts.
Submission of any standard vendor contracts as a substitute for language in the terms and
conditions is not a sufficient response to this requirement and may result in rejection of the
vendor’s proposal. The state reserves the right to negotiate contractual terms and conditions
other than those in the State of Wisconsin Contract when it is in the best interest of the State to do
so.
2.5
MULTIPLE BIDS
Multiple bids from a vendor will be permissible, however each bid must conform fully to the requirements
for bid submission. Each such bid must be separately submitted and labeled as Bid #1, Bid #2, etc. on
each page included in the response. Alternate acquisition plans do not constitute multiple bids.
2.6
JOINT BID
The DOC requires each bid to have one Prime Contractor designated. See RFB Sections 8.1 and 8.2. A
bid submitted from two or more entities that intend to either share or split responsibilities under the
awarded contract may be submitted.
If submitted, the joint bid shall include requested information for each participant, as well as for the entity
(i.e., partnership, joint venture, consortium, new company, etc.) that will be the primary contact for, and
responsible to, the State and the DOC under the awarded contract.
Bidder must clearly indicate within the bid response the specifics of any division or allocation of
responsibilities for each participant.
2.7
INCURRING COSTS
The State of Wisconsin is not liable for any cost incurred by a vendor in the process of responding to this
RFB.
2.8
QUESTIONS, CLARIFICATIONS AND/OR REVISIONS THROUGH DESIGNATED CONTACT
All communications and/or questions regarding this request must be written and submitted via FAX, email, USPS mail or hand delivery to the Purchasing Services Section.
If a Bidder discovers any significant ambiguity, error, conflict, discrepancy, omission, or other deficiency in
this RFB, they have five 5 business days after the bid posting date to notify, in writing, the Purchasing
Agent at the address shown below of such error and request clarification of the RFB document. All written
questions will be responded to in writing and provided to all bidders.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
USPS ADDRESS*
Kathy Kaeding/Purchasing Services Section
DEPARTMENT OF CORRECTIONS
PO BOX 7991
MADISON, WI 53707-7991
Due Date: March 6, 2014 at 3:00PM
Page 12 of 73
COMMON CARRIER ADDRESS
Kathy Kaeding/Purchasing Services Section
DEPARTMENT OF CORRECTIONS
3099 EAST WASHINGTON AVENUE
MADISON, WI 53704-4338
*NOTE: Allow an extra day for deliveries to the PO Box address. Please note that February 17, 2014 (Presidents’
Day/Washington’s Birthday) is a postal holiday; however, the Department of Corrections central office,
including the Purchasing Services Section, is OPEN on this day.
EMAIL (preferred): [email protected]
FAX: (608) 240-3342
From the date of release of this RFB through the entire RFB process, all contacts with the DOC regarding
this RFB shall be made through the Purchasing Services Section. Violation of this condition may be
considered sufficient cause for rejection of a bid, irrespective of any other considerations.
In the event that it becomes necessary to provide additional clarifying data or information, or to revise any
part of this RFB, as applicable, addendum(s) and/or amendment(s) will be posted on VendorNet.
Each bid shall stipulate that it is predicated upon the terms and conditions of this RFB and any
addendum(s) and/or amendment(s) thereof.
3.0
BID ACCEPTANCE, EVALUATION AND AWARD
3.1
BID OPENING
Bids will be opened on the date and time indicated on the Request for Bid Form (DOA-3070) at 3099 East
Washington Ave. Madison, WI 53704 Purchasing Services Section room. Names of the bidders shall be
read aloud at that time.
3.2
BID ACCEPTANCE
Bids which do not comply with instructions or are unable to comply with specifications contained in this
RFB may be rejected by the State. The State retains the right to accept or reject any or all bids, or accept
or reject any part of a bid deemed to be in the best interest of the State. The State shall be the sole judge
as to compliance with the instructions contained in this RFB.
3.3
BID EVALUATION
Bids will be evaluated by the DOC's purchasing agent and program manager to verify that they will meet
all specified requirements in this RFB. This verification may include requesting reports on the vendor's
financial stability, conducting demonstrations of the vendor's proposed service(s) and reviewing results of
past awards to the vendor by the State of Wisconsin.
FAILURE TO MEET A MANDATORY REQUIREMENT SHALL DISQUALIFY THE BID.
However, if no bidder is able to comply with a given specification, condition of bid or provide a specific
item, Purchasing Services reserves the right to delete that specification, condition of bid or item.
3.4
METHOD OF AWARD
Award(s) shall be made on the basis of the Lowest BID TOTAL from a responsive, responsible bidder
meeting bid specifications and requirements, which is judged to be in the best interest of the DOC.
The DOC reserves the right to accept or reject any and all bids in whole or in part. Bids that state the
DOC shall guarantee a specific quantity or dollar amount will be disqualified. The Department also
reserves the right to negotiate price with the lowest responsive and responsible bidder. The Department
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 13 of 73
reserves the right to adjust the number of units and/or to add or move locations within the designated area
if in its best interest.
In the event of bidder error in calculation, unit price shall prevail in award.
If a responsive, responsible State qualified work center meets the fair market price and other work center
program criteria, the award will be made to the work center (Wisconsin State Statute 16.752).
Any award without an accepted site after one (1) month will be reviewed for status weekly for one
(1) additional month. Un-sited program or insufficient staff hires after two (2) months may be
considered for rescinding of award unless otherwise authorized by Contract Administrator.
3.5
MINORITY BUSINESS ENTERPRISE
Bids from certified Minority Business Enterprises may be provided up to a five percent (5%) bid preference
in accordance with Wis. Stats. s. 16.75(3m).
3.5
DISABLED VETERAN-OWNED BUSINESS
Bids from certified Disabled Veteran-Owned Businesses may be provided up to a five percent (5%) bid
preference in accordance with Wis. Stats. s. 16.75(3m).
3.6
NOTIFICATION OF INTENT TO AWARD
Any vendors who respond to this RFB, with a bid, will be notified in writing of the State’s intent to award
the contract(s) as a result of this RFB.
After notification of the intent to award is made, under the supervision of Department of Corrections,
copies of bids will be available for public inspection 8:30 a.m. to 3:30 p.m. at 3099 East Washington Ave.,
Madison WI. Vendors shall schedule reviews with purchasing agent to ensure that space is available for
the review.
3.7
APPEALS PROCESS
The appeals procedure applies to only those Requests For Bids for Services that are $50,000.00 or
greater. Notices of intent to protest and protests must be made in writing. Protesters should make their
protests as specific as possible and shall identify statutes and Wisconsin Administrative Code provisions
that are alleged to have been violated.
The written notice of intent to protest the Intent to Award a Contract must be filed with:
EDWARD F.WALL SECRETARY, DEPARTMENT OF CORRECTIONS
P.O. BOX 7925
MADISON, WI 53707-7925
And be received in the office above within five (5) working days after the notice of intent to award is
issued. The written protest must be received in the office above within ten (10) working days after the
notice of intent to award is issued.
Copies of the notice of intent to protest and the written protest should be sent to the Purchasing
Section Chief at the same address.
The decision of the head of the procuring agency may be appealed to the Secretary of the Department of
Administration within five (5) working days of issuance, with a copy of such appeal filed with the procuring
agency, provided the appeal alleges a violation of statute or a provision of a Wisconsin Administrative
Code.
4.0
TECHNICAL REQUIREMENTS
The following requirements are the minimum specifications of the service(s) required. All requirements shall
meet standards as required in DHS 75 for a certified AODA program.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 14 of 73
Failure by a bidder to respond to any specific requirement or question shall be the basis for elimination from
consideration. However, if no bidder is able to comply with a given specification, condition of bid or provide a
specific item, Purchasing Services reserves the right to delete that specification, condition of bid or item.
Revisions to this RFB, if any, will be made in the form of an official amendment(s) issued by the Department of
Corrections, Purchasing Services Section. Refer to RFB Section 2.8.
The number of service units listed on the Request for Bid Form (DOA-3070) is for bidding purposes only.
4.1
FACILITY REQUIREMENTS
Secular Non-residential Certified AODA treatment services are required to be located in the City of
Sheboygan, WI. The facility shall have an appropriate physical space use plan to reasonably
accommodate individual treatment, group programming, and space to conduct offender interviews, intake
and assessments. The Department of Corrections will make sole determination of an appropriate physical
space use plan. The facility in which services are provided must meet all applicable federal, state and
local codes, regulations and requirements. Proposed facility shall allow for programming and service
delivery according to DHS 75 standards.
The location must be accessible to public transportation.
 Bidder must submit a description of the physical spaces, which details the space plan. Bidder
must indicate distance each proposed facility is from public transportation.
4.2
BIDDER AGENCY EXPERIENCE
The bidder agency shall have experience levels that meet DHS 75 requirements plus experience providing
AODA groups to correctional clients and/or human services programs.
Bidder shall provide a list of past contracts, DOC and others, within the last three (3) years that are of a
similar size and service to this bid. Include service description, date(s) and location of service, number of
clients served, outcome evaluation, and contact person with a phone number. DOC reserves the right to
contact any or all persons listed. Past contract quality may impact this award.
 Bidder must provide documentation demonstrating that their organization meets the
experience requirements, including past contract information. The information submitted for
each past contract is to include Service Description, Dates Service Provided, Location of
Service, Number of Clients Served, Outcome Evaluation, and contact person with a
phone number.
4.3
STAFF REQUIREMENTS
All staff facilitating groups will have completed required training prior to providing specified services. DOC
shall have final approval of all program staff related to any contract resulting from this RFB.
4.3.1
STAFF QUALIFICATIONS
4.3.1.1 ADMINISTRATIVE AND FISCAL:
The Bidder staff responsible for providing
administrative and fiscal services for the program shall have at least a Bachelors Degree
in human services or business related field. Administrative staff levels shall meet DHS 75
requirements.
4.3.1.2 STAFF SUPERVISION: Person(s) providing supervision of direct-service staff under this
contract shall 1) Meet education levels as specified in DHS 75 and 2) Have a minimum of
three (3) year(s) providing supervision to staff in a correctional or human services
program. Supervision of AODA staff requirements noted in 4.3.1.3 AND 4.3.2.2.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 15 of 73
4.3.1.3 DIRECT SERVICE: All AODA staff must comply with the Department of Safety and
Professional Services (SPS) Administrative Code 167 to have professional liability
insurance. Staff providing program services under the contract resulting from this RFB
must have a documented education history of no less than an Associates Degree in a
human service related field and meets DHS 75 qualifications in addition to the following:
4.3.1.3.1
AODA FACILITATORS: Bidder staff delivering any of the direct AODA
services is required to be: 1) certified as a Substance Abuse Counselor or 2)
certified to conduct AODA treatment per MPSW 1.09.
The DOC will not allow for sole direct service delivery by a Substance Abuse
Counselor in-Training (SAC-IT). Under the contract resulting from this RFB,
a SAC-IT will be allowed to co-facilitate program groups as long as the other
facilitator meets all requirements stipulated. Allowing the SAC-IT to cofacilitate will help that person gain experience.
If a bidder plans on using co-facilitators, the bidder must figure the cofacilitation costs into the bid unit cost per group and submit their bid
accordingly. DOC will not accept bids submitted with a separate add-on cost
for co-facilitators.
4.3.1.3.2
CLINICAL SUPERVISION: In all instances, a staff member with supervisory
designation shall provide overall clinical supervision as required and outlined
in DHS 75 to ensure program integrity and a professional level of practice by
treatment delivery staff per SPS regulations on Substance Abuse
Counselors.
Access to a licensed psychologist for assistance/staff consultation regarding
clinical issues shall be available as needed.
4.3.2
STAFF EXPERIENCE AND TRAINING
4.3.2.1 ADMINISTRATIVE AND FISCAL: The Bidder staff for this program shall have at least
three (3) years of administrative and fiscal services experience.
4.3.2.2 STAFF SUPERVISION: Experience requirements as required in DHS 75.
4.3.2.3 DIRECT SERVICE:
All AODA staff person(s) performing individual and group program services are required
to have a minimum of:
1) Two (2) years of experience providing program services to correctional clients utilizing
cognitive behavioral methodology; and
2) trained in Motivational Interviewing; and
3) the proven ability to deliver services to individuals from various racial, religious, and
ethnic backgrounds, as well as individuals with a disability; and
4) understanding of implementing and delivering evidence-based practices; and
5) documented completed training in the proposed curriculum within the past three (3)
years.
Proven ability may be documented by one (1) year of job or volunteer experience and
completion of eight (8) hours of cultural sensitivity training. Motivational Interviewing (MI)
training for facilitators shall consist of at least sixteen (16) documented hours of
classroom instruction during which MI skills are practiced. Because the skill must be
correctly applied in order to be effective, watching training videos will not meet contract
standards. Bidders shall supply documentation of training attendance as well as contact
information of instructor for DOC to verify.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 16 of 73
 Bidder must provide a list of staff and documentation demonstrating that program staff meets
the qualifications, experience, and training requirements for delivering AODA treatment services
as specified and described in this Staff Requirements Section 4.3, to include submission of:
 Name(s) of staff person(s), dates and locations of experience and training, and
the names and phone numbers of persons who can verify the experience
and training.
 List of staff that clearly identifies direct service staff, person(s) responsible for
providing administrative and fiscal services, person(s) providing supervision of
direct staff, person(s) providing clinical supervision, and the licensed
psychologist(s) to be used for assistance/staff consultation regarding clinical
issues.
 Staff resumes that identify specific dates, company (including address and
phone number), position description and job responsibilities to verify all staff
meets the qualifications and experience requirements.
 Copies of current certification, licensing, insurance and/or training including
supervision plan, if applicable.
 If staff positions are pending hire, Bidder must submit recruitment plan and job description of
those pending positions.
NOTE: Any staff listed as pending hire will be required to be on staff within 4 weeks
from date of award unless otherwise authorized. Any staff terminated during the
contract period shall be replaced within four (4) weeks of termination unless otherwise
authorized.

Bids that do not include all items listed on this checklist may be rejected.
4.4 PROGRAM DESCRIPTION
The primary goal of these treatment groups is to establish a pattern of abstinence from alcohol and other
drugs of abuse. This requires the integration of the individual into the group, stabilization of individual
functioning, and identification of long standing problems obscured or exacerbated by substance abuse.
Treatment groups are also to address denial and defense mechanisms, personal indicators of dependency
and abuse, the impact of using on major life areas, personal belief systems/values, recognition of the need to
change, the recovery process and lifestyle changes, coping skills, appropriate interpersonal functioning and
enhancement of positive social supports.
4.4.1
AGENCY CERTIFICATION
Agencies providing alcohol and other drug abuse services are required to be in compliance with
program certification requirements, DHS 75. Questions concerning program certification should
be directed to the following person:
Mr. Mark Hale
Behavioral Health Certification Section
Division of Quality Assurance
Department of Health Services
PO Box 2969
Madison WI 53701-2969
Telephone: (608) 264-9894
[email protected]
RFB # KK-4464
Certified AODA Services in Sheboygan, WI

4.4.2
Due Date: March 6, 2014 at 3:00PM
Page 17 of 73
Before any contract resulting from this RFB is implemented, the AODA program
(including staff) delivered at this site must be licensed by the Department of Health
Services.
GROUP REQUIREMENTS
The following provisions are required for all program service groups
1. At the onset of offender program participation, the contract staff shall inform offenders of the
contractor’s duty to warn and communication obligation to DOC. The contractor shall have the
offender sign a waiver of confidentiality to allow information to be shared with DOC or other
criminal justice/social service agencies that have a need to know.
2. The contract staff shall be willing to address community safety issues and cooperate with DOC
staff to monitor risk. The contractor shall report lapses, violations, and when the offender is in a
high-risk situation to the referring agent within 24 hours.
3. The contract staff shall agree to accept subpoenas and sign admissions of service of such
subpoenas to appear at revocation and court hearings if requested by the Department of
Corrections or its employees or agents.
4. For evaluation purposes, the contract staff shall be willing to have group treatment observed and
evaluated by a DOC representative.
5. All groups shall follow the characteristics consistent with program efficacy per Exhibit 6.
6. Contractor is responsible to develop strategies to address gender responsivity.
7. The contract staff shall demonstrate an ability to be assertive and non-punitive toward offenders.
Staff shall have a written policy addressing the implementation and use of punishers and
reinforcers, as well as an electronic system for tracking the delivery of the behavioral
modification methods. Staff training in the application of these behavior modification tools shall
be documented.
8. Groups will NOT be co-facilitated with a staff person from DOC.
9. Group size shall not be less than four (4) and no more than eight (8) participants. Exceptions to
the minimum group size requirement will require prior approval from DOC staff.
When
attendance is below 6 offenders, contract staff shall contact the DOC Program Analyst within 24
hours to discuss options for increasing group size at predetermined entry points based upon the
intent of the researched curriculum.
10. The program shall be open-ended to provide the ability to enroll offenders at various points
throughout the treatment group cycle.
11. Group services may be required to be offered during non-traditional business hours and on
Saturday. Actual group starting time shall be negotiated with the DOC Contract Administrator of
designee but changes in class dates and starting times shall not be implemented sooner than 30
days from written approval of DOC to avoid offender scheduling conflicts.
12. Accommodations may be required for specific populations of offenders based upon the following:
intelligence under IQ of 80, gender, race/ethnicity, and motivation to change, personality or
mental disorder.
13. Groups shall be comprised of only offenders supervised by DOC.
14. All referrals will be individually screened by the referring agent. Treatment placement will be
consistent with DSM V and WI-UPC criteria as determined by the bidder’s formal assessment, as
applicable. Sources of information to be considered shall include offender interviews, and
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 18 of 73
collateral contacts with professional (referring agent) and significant others as appropriate.
Treatment plan will be developed based on the screening and written with offender input.
15. All program services shall be secularly based. Program content, materials and self-help support
groups employed in the delivery of treatment to the offender must comply with the requirements
of Kerr v. Farrey, 95 f.3d 472 (1996) and DCC Administrative Directive 01-10, attached as
Exhibit 1.
16. The contractor shall prepare and provide all necessary program materials/equipment to include,
but not limited to, the following:
o TV/DVD/VCR
o Flipchart stand, paper and other office supplies
o Chalkboard or whiteboard with markers
o Lesson plans
o Copy machine and other office equipment as needed
o Computer and software to include Internet access
17. No break times shall be implemented for groups lasting 90 minutes or less.
18. Multiple cycles may run concurrently at the same location. In the event that groups are provided
in succession by the same facilitator, there must be adequate time between groups and at a
minimum, not less than 15 minutes apart.
19. When services are cancelled or delayed due to inclement weather or other circumstances as
deemed appropriate by DOC, contract staff shall make all reasonable efforts to notify group
participants of group cancelation prior to start time. Cancellation policy shall be approved by
DOC and provided to group participants within program rules.
20. Contractor staff shall develop urinalysis, breathalyzer, and oral screening procedures in
cooperation with DOC staff in order to obtain observed samples from program participants. DHS
75 shall be referenced to ensure offender privacy is protected. Testing for substance abuse will
be conducted by contract staff using urinalysis screens supplied by the Department in the form of
5, 8, or 12 panel on-site test kits or other screens determined by the Department. Provider will
supply breathalyzer or similar alcohol testing equipment.
The type and frequency of testing for each offender will depend on a plan developed during the
assessment by the provider with input from the agent of record. Offenders will be tested a
minimum of once per month and a maximum of four (4) times per month, depending on their
individualized plan. Providers will be required to set up random testing procedures using a daily
(at least 5 days per week) call-in system. Providers will be required to enter collection/testing
and results immediately into a database (to be developed by the Department) that will be
accessible to the Department.
For bidding purposes, include the cost of alcohol/drug testing at 2.5 tests per
month per each offender enrolled in the program.
At the request of the Department, provider staff shall participate in Department of Corrections
training (no more than one time annually) regarding the collection, handling, and storage of
specimens, as well as any changes in the screening products used by the Department. If
requested by DOC, the contractor shall cover all expenses to have staff participate in this
DOC provided training.
21. Separate gender groups may be conducted, however if not enough referrals justify separate
gender groups, the groups shall be non-gender specific groups. If genders are mixed in groups,
no less than two (2) females or two (2) males shall be placed in groups. Female groups must
include a focus on relationship of trauma with addiction issues.
NOTE: When groups have females mixed with males, DOC usually provides some individual
one- on-one (1:1) counseling separate from the group to address specific female issues. The
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 19 of 73
awarded contractor may be requested by DOC to provide individual counseling by separate
agreement after consultation with the agent of record and the contract administrator.
22. Contractor shall have the capability to accept offender referral forms and related documents
electronically.
23. DOC Contract Administrator or designee shall have access to all DCC Offender files and
program groups as they deem necessary. This includes both announced and unannounced
visits.
4.4.3
AODA ASSESSMENT
Assessment refers to the procedures through which a certified AODA counselor determines an
offender’s needs for supervision, control and service with regard to substance addiction/abuse,
consistent with DSM V and Wisconsin Uniform Placement Criteria (WI-UPC). This shall include
matching the offender to an appropriate treatment group. The sources of information to be
considered at a minimum shall include: offender interview(s), collateral contacts with professional
and significant others as appropriate, review and evaluation of existing information, and testing.
It is estimated that the contractor selected under this solicitation shall conduct 100 units of
assessment services.
A. Assessment and Report
The assessment must be approved by DOC and report shall include, but is not limited to:
A. Preparation
1. Review available file material from institution and community
2. Identify offender’s tested reading level
3. Select standardized instrument(s) to be administered
B. Administer, score, interpret assessment instrument(s)
C. Clinical interview
1. Focus on recent/current offender functioning as related to dynamic criminogenic
factors.
2. Describe nature and severity of drug use and impact upon offender’s life
3. Identify victim(s) of committing offense(s)
4. Describe nature and severity of criminal history and impact upon offender’s life
5. Explore offender’s life areas: physical health, mental health, family, friends,
school, work, spiritual, financial, legal
6. Determine need for collateral contact information and secure necessary
release(s)
7. Discuss offender’s perspective regarding perceived need for change and benefits
of treatment
8. Secure informed consent to treatment
D. Develop treatment plan with offender input
1. Consider information from all sources
2. Identify and record dimensions of offender’s condition or status including
withdrawal potential, physical/mental health conditions, emotional/behavioral
conditions, relapse potential and recovery environment.
3. Identify specific level of care consistent with WI-UPC
4. Develop plan for urinalysis, breathalyzer, or oral testing which identifies specific
type and frequency of testing with agent input. Each offender will have an
individualized plan for testing based on their history of substance abuse.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 20 of 73
 Bidder must provide a detailed description of the AODA Assessment
component of their program, to include assessment instruments recommending
for use.
4.4.4
AODA OUTPATIENT GROUPS
Outpatient counseling shall address chemical dependence using a cognitive behavioral approach
for the purpose of assisting offenders in modifying their behaviors, cognitions and emotions in
order to promote recovery from addiction. Groups will include alcohol as well as drug education.
Twenty-four (24) total program hours shall be considered completion standard for each cycle of
AODA Outpatient Group conducted. The contractor selected under this solicitation shall conduct
one (1) session each week for twelve (12) weeks, each session will be two hours (2) hours
in length.
Four (4) cycles of twelve (12) groups/cycle = 48 total groups will be conducted annually.
A. Program Content for Outpatient Groups
 Within this contract period and upon approval of DOC AODA Program Standards, you
may be required to submit a Program Abstract as a first step in the Department’s
program approval process.
 The services provided must have research support
 Must target dynamic criminogenic risk factors
 Program materials and presentations must be culturally relevant to the population
served
 Performance measures must be established that objectively gauge offender treatment
progress
 Use of self-help groups (e.g. SOS, Rational Recovery, etc.) must comply with the
requirements of Kerr v. Farrey. 95 f.3d 472 (1996). (See DCC Administrative Directive
01-10, attached as Exhibit 1.)
B. Core Content Required for Outpatient Groups
 Alcohol and other drug education for offenders with no prior treatment experience and
if clinically indicated, for those who previously have been involved in treatment.
 Cognitive behavioral techniques are recommended and must meet the Department’s
approval.
 Communication, problem solving and life skills.
 A written, individualized treatment plan must be developed within fourteen days of
commencement of services and must be sent to the supervising agent.
 Relapse prevention planning and a detailed personal, written Relapse Prevention Plan
is required and, within 5 working days of program completion, a copy must be
submitted to the referring agent.
C. Program Completion Requirements for Outpatient Groups
 Complete goals of the Individual Treatment Plan
 Performance measures objectively gauge treatment progress and program completion
 Complete assignments to an acceptable standard
 Demonstrate that the skills taught have been learned
 Pass Required tests to an acceptable standard
 Produce an acceptable relapse prevention plan
 Bidder must provide a detailed description of the Outpatient Group components
including approach and methods of service delivery along with pre/mid/post
testing that will be a part of the program. Submit a curriculum and be sure to
include topic areas to be covered along with attachment of referenced research
showing components are evidence-based.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 21 of 73
 Bidder must provide a copy of the test to be administered for successful
completion for each of the group components.
REMINDER: Bids that do not include all items listed on the Section 9 checklist may be rejected.
4.4.5
AODA INTENSIVE OUTPATIENT (IOP) GROUPS
Treatment and intervention strategies using a cognitive intervention approach are to include, at a
minimum: chemical dependence and substance abuse education, the effects dependency/abuse
have had on offender’s life, social skills training, self-control training, the development of a
recovery plan, and relapse prevention skills as detailed below.
Ninety (90) total program hours shall be considered completion standard for each cycle of AODA
Intensive Outpatient Group conducted. The contractor selected under this solicitation shall
conduct three (3) sessions each week for ten (10) weeks, each session will be three (3)
hours in length.
Eight (8) cycles x 30 groups/cycle = 240 total groups conducted annually.
A. Program Content for Intensive Outpatient Groups

Program materials and presentations must be culturally relevant to the population
served.

Performance measures must be established that objectively gauge offender
treatment progress.
B. Core Content Required for Intensive Outpatient Groups

Alcohol and other drug education for offenders with no prior treatment experience
and, if clinically indicated, for those who have previously been involved in treatment.

A written individualized Treatment Plan must be developed within fourteen days of the
commencement of services and be shared with the supervising agent.

Relapse prevention activities and a written, detailed Personal Relapse Prevention
Plan to be shared with the supervising agent and/or (if applicable) the drug court
coordinator at program completion.
C. Program Completion Requirements for Intensive Outpatient Groups

Complete goals of the Individual Treatment Plan.

Demonstrate increased knowledge of substance use, abuse, dependence and their
impact.

Complete assignments to an acceptable standard.

Pass required tests to an acceptable standard.

Produce an acceptable relapse prevention plan.
 Bidder must provide a detailed description of the AODA Intensive Outpatient
Group component including approach and methods of service delivery along with
pre/mid/post testing that will be a part of the program. Submit a curriculum and
be sure to include topic areas to be covered along with research showing
components are evidence-based.
 Bidder must copy of the test to be administered for successful completion for
each of the group components.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
4.4.6
Due Date: March 6, 2014 at 3:00PM
Page 22 of 73
AODA AFTERCARE
Aftercare shall focus upon the continued evaluation of the offender’s relapse prevention plan with
respect to effectiveness through the feedback of oneself, peers, family, and professionals. In
addition, the practice of learned skills and techniques is emphasized as well as the maintenance
of supportive relationships with professionals, peers and family.
Thirty-two (32) total program hours shall be considered completion standard for each cycle of
AODA Aftercare Group conducted. The contractor selected under this solicitation shall conduct
one (1) session each week for sixteen (16) weeks, each session will be two hours (2) hours
in length.
Three (3) cycles x 16 groups/cycle = 48 total groups conducted annually.
A. Core Content Required for Aftercare Groups
 Aftercare programming must be consistent with the treatment model offered to the
offender in primary care, e.g., offenders who completed programs that used a cognitive
behavioral treatment model should receive extensions of these approaches in Aftercare.
 Communication, problem solving and life skills.
 Aftercare is AODA treatment at a lower intensity and one goal must be to assist the
offender to maintain and expand on the gains made in primary care.
 The focus of Aftercare must be the individualized Relapse Prevention Plan developed at
discharge from the offender’s primary care program. This plan must be updated or
modified depending on the problems the offender exhibits or encounters in community
living and, when updated or modified, must be submitted to the agent of record.
 Relapse prevention planning continues as needed.
B. Program Completion Requirements for Aftercare Groups

Complete goals of the individual treatment plan

Exhibit growing self-awareness and acceptance of need to correct negative behaviors.
 Demonstrate increased knowledge of substance use, abuse, dependence and its
impact.
 Complete assignments to an acceptable standard.
 Demonstrate that the skills taught have been learned.
 Bidder must provide a detailed description of the Aftercare Group components
including approach and methods of service delivery along with pre/mid/post
testing that will be a part of the program. Submit a curriculum and be sure to
include topic areas to be covered along with attachment of referenced research
showing components are evidence-based.
 Bidder must provide copy of the test to be administered for successful
completion for each of the group components.
4.4.7
AODA RELAPSE PREVENTION GROUPS
Relapse Prevention can be combined with Outpatient AODA Groups as elements of an individual
treatment plan. It can also be a response to signs of relapse/destabilization. The goal of this
“booster” form of treatment is to re-stabilize and return the offender to community living following a
structured re-exposure to program elements designed to address the issues the offender was
having difficulty within the community. Typically, this might occur through an alternative to
revocation process with the needed elements identified in the treatment plan.
Fifty (50) total program hours shall be considered completion standard for each cycle of AODA
Relapse Prevention Group conducted. The contractor selected under this solicitation shall
conduct one (1) session each week for twenty-five (25) weeks, each session will be two (2) hours
in length.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 23 of 73
Five (5) cycles x 25 groups/cycle = 125 total groups conducted annually.
A. Core Content Required for Relapse Prevention Groups
 Relapse Prevention programming must be consistent with the treatment model offered to
the offender in primary care, e.g., offenders who completed programs that used a
cognitive behavioral treatment model should receive extensions of these approaches in
Relapse Prevention.
 Communication, problem solving and life skills.
 The focus of Relapse Prevention must be the individualized Relapse Prevention Plan.
This plan must be responsive to the problems the offender exhibits or encounters in
community living and, when updated or modified, must be submitted to the agent of
record.
 Relapse prevention planning continues as needed.
B. Program Completion Requirements for Relapse Prevention Groups

Complete goals of the individual treatment plan.

Exhibit growing self-awareness and acceptance of need to correct negative behaviors.
 Demonstrate increased knowledge of substance use, abuse, dependence and its
impact.
 Complete assignments to an acceptable standard.
 Demonstrate that the skills taught have been learned.
4.5

Bidder must provide a detailed description of the Relapse Prevention Group components
including approach and methods of service delivery along with pre/mid/post testing that
will be a part of the program. Submit a curriculum and be sure to include topic areas to
be covered along with attachment of referenced research showing components are
evidence-based.

Bidder must provide a copy of the test to be administered for successful completion for
each of the group components.
INTAKE/TREATMENT/DISCHARGE PROCEDURES
4.5.1
INTAKE PROCEDURES
The contractor staff shall develop referral/intake procedures in cooperation with DOC staff. If the
contractor rejects an offender, this must be discussed with DOC staff to determine if the program
can be modified to address the specific offender needs. The contractor staff shall send copies of
the intake summary and recommendations to the referring DOC staff person within 10 working
days of intake interview.
The contractor shall have each offender complete the necessary releases of information and
shall give each offender a copy of the program rules and expectations.
Intake shall include, but is not limited to:
A. An interview focusing on recent/current offender functioning as related to criminogenic
factors.
B. The nature and severity of drug use and impact upon offender’s life as evidenced by a
completed assessment.
C. Describe nature and severity of criminal history and impact upon offender’s life (i.e. physical
health, mental health, family, friends, school, work, spiritual, financial and legal)
D. Secure informed consent to treatment.
E. Consider information from all sources including DOC case file and direct communication with
the referring agent.
4.5.2
TREATMENT PLAN
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 24 of 73
The contractor shall prepare an individualized treatment plan for each offender accepted into the
program. The plan shall include measurable goals and objectives, as well as activities/services
needed to achieve successful discharge from the program. The plan shall be shared in a written
format with the referring DCC Agent and specify specific ways to lower risk and needs of the
offender.
4.5.2.1 TREATMENT PLAN FORMAT
Treatment plans may be reviewed and modified as needed.
A. Require offender input
B. Identify offender’s assets/strengths
C. Identify offender’s problem areas
D. Describe offender’s readiness to change
 Use of the Prochaska, J.O., and Diclemente, C.C., Stages of Change Model or
other Department accepted tool
E. Identify offender’s short/long term goals
 Specify steps to be taken to achieve goal(s)
 Identify time frame for each step
 Identify offender responsibilities
 Identify contractor responsibilities
F. Specify next progress review date
G. Identify plan for urinalysis, breathalyzer, or other substance abuse testing.

4.5.3
4.6
Bidder must provide a completed ‘sample’ treatment plan which
specifically addresses items A thru G in RFB Section 4.5.2.1.
DISCHARGE/TERMINATION
The contractor shall develop termination and discharge procedures in cooperation with DOC staff
for offenders completing or exiting group services. The contractor shall inform the referring DOC
staff of the intent to “unsuccessfully” terminate an offender from treatment prior to termination.
Within three (3) days of termination, the contractor shall provide a discharge summary including a
description of offender’s progress in programming which includes additional program
recommendations as well as recommendations to assist the agent in supervising the offender’s
subsequent activities. Refer to Section 4.8.2.3 for a complete listing of what is required to be
included in the discharge summary report.
LENGTH OF PROGRAM PARTICIPATION
4.6.1
AODA ASSESSMENT
It is anticipated that each offender referred for evaluation will participate in one (1) assessment.
The extent of the assessment and need for further evaluation will be based on individualized
need. Further assessment or evaluation may be negotiated by the therapist with DOC staff.
4.6.5
AODA OUTPATIENT GROUPS
It is anticipated that offenders will participate in no less than 24 program hours. Participation for
any longer or shorter period of time may be negotiated with DOC staff based on treatment goals.
4.6.2
AODA INTENSIVE OUTPATIENT GROUPS
It is anticipated that offenders will participate in no less than 90 program hours. Participation for
any longer or shorter period of time may be negotiated with DOC staff based on treatment goals.
4.6.3
AODA AFTERCARE GROUPS
It is anticipated that offenders will participate in no less than 32 program hours. Participation for
any longer or shorter period of time may be negotiated with DOC staff based on treatment goals.
4.6.4
AODA RELAPSE PREVENTION GROUPS
It is anticipated that offenders will participate in no less than 50 program hours. Participation for
any longer or shorter period of time may be negotiated with DOC staff based on treatment goals.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
4.7
4.8
Due Date: March 6, 2014 at 3:00PM
Page 25 of 73
NUMBER OF SERVICE UNITS
Under any agreement resulting from this solicitation, units of service are defined as follows:
4.7.1
AODA ASSESSMENT
One completed written summary based on activities as defined in 4.4.3 with documentation to
the referring DOC staff.
4.7.2
AODA OUTPATIENT GROUPS
One 2 hour group session of direct service to DCC offenders participating in activities as
defined in 4.4.4 with documentation to referring DOC staff.
4.7.3
AODA INTENSIVE OUTPATIENT GROUPS
One 3 hour group session of direct service DCC offenders participating in activities as defined in
4.4.5 with documentation to referring DOC staff.
4.7.4
AODA AFTERCARE GROUPS
One 2 hour group session of direct service to DCC offenders participating in activities as defined
in 4.4.6 with documentation to referring DOC staff.
4.7.5
AODA RELAPSE PREVENTION GROUPS
One 2 hour group session of direct service to DCC offenders participating in activities as
defined in 4.4.7 with documentation to referring DOC staff.
REPORTING REQUIREMENTS
4.8.1
4.8.2
EXPECTATIONS FOR PREPARATION, RECORD KEEPING, AND REPORTING
A. Agent of record, program liaison, and/or other designees must be included in distribution of
written reports
B. An individual intake assessment must be completed within fourteen days of referral.
C. Development of an individual treatment plan that is:
1. Individualized according to assessment of each offender
2. Completed and submitted within first fourteen days of admission
3. Reviewed at least every thirty days and modified as needed
D. Progress reports completed and submitted within seven (7) days of report completion.
E. Written personal, detailed Relapse Prevention Plan completed and submitted within 5 days
of program completion.
F. Develop Aftercare Plan recommendations.
G. Cooperate fully in Department efforts to evaluate and improve AODA programming (See
Program Evaluation Requirements).
H. Contractor shall provide a weekly written, legible copy or e-mail listing of the attendance for
each group within 24 hours from the start of each group.
REPORTING ON INDIVIDUAL OFFENDERS
4.8.2.1 ASSESSMENT SUMMARY
The program shall provide the referring DOC staff person with an assessment/evaluation
summary within seven (7) working days following the offender’s assessment interview(s).
4.8.2.2 PROGRESS REPORTS
The contractor shall document attendance and progress of the offender in the AODA
groups. Documentation of offender progress will be submitted to the referring DOC staff
person on a Monthly (every 30 days) basis for AODA Outpatient groups and bimonthly
(every 14 days) basis for AODA IOP, Aftercare and Relapse groups. The program shall
provide the referring DOC staff person with the progress report within seven (7) working
days following the report due date.
Monthly Progress Report Format
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 26 of 73
Progress reports must address the following areas:
1) Attendance
2) Participation
3) Homework completion
4) Demonstrate knowledge acquisition
5) Demonstrate skill in applying knowledge through role-play
6) Performance in completing treatment plan elements
7) Drug tests administered and results in past month
8) Note progress/modifications to treatment plan in past month

Bidder must provide a copy of the format to be used for the Progress reports
which specifically addresses items 1 thru 8 in RFB Section 4.8.2.2.
4.8.2.3 DISCHARGE SUMMARY- The program shall provide the referring DOC staff person with
a discharge summary within ten (10) days of offenders successful and within three (3)
days of offender’s unsuccessful discharge from the program.
PROGRAM DISCHARGE SUMMARY REPORT FORMAT
a. Discharge status
b. Program entry and discharge dates
c. Brief description of program
d. Offender’s alcohol/drug use patterns, negative impact on life and prior treatment
history
e. Identification of offender’s assets/strengths
f. Account of offender’s effort and progress toward goals
g. Identification of significant problem areas not addressed in program
h. Identification of any continuing treatment needs and recommendations to address
them
i. Relapse Prevention Plan including aftercare recommendations
j. Prognosis/Risk for further use and criminality as a result of offender participation

4.8.3
Bidder must provide a copy of the format to be used for the Discharge Summary
which specifically addresses items a thru j in RFB Section 4.8.2.3.
OTHER REPORTS
4.8.3.1 LAW VIOLATIONS- The contractor shall notify the referring DOC staff or other available
DOC staff if a participant is in violation of the law. This notification shall take place as
soon as possible, and no later than 24 hours, subsequent to receiving information
concerning the law violation.
4.8.3.2 SERIOUS PROGRAM VIOLATIONS- Serious program rule violations, including failure to
attend shall be reported to the referring DOC staff or other available DOC staff within
one working day.
4.8.3.3 AD HOC REPORTS- Upon request, the contractor shall provide to DOC staff reports on
offenders served in the program when needed by the courts, for revocation procedures
and/or other Departmental processes.
4.8.3.4 FEDERAL REPORTS- Resulting contracts using Federal Block Grant funds will be
required to complete additional state and federal reports, as necessary.
4.8.4
PROGRAM REPORTING
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 27 of 73
4.8.4.1 REFERRAL FOR SERVICES (DOC 1336), Part B Intake Decision - The contractor shall
submit a completed Referral for Services form for each offender referred by DOC for
service. These forms with Part B Intake Decision completed shall be submitted with the
first DOC-1088 Offender Report Monthly following offender’s rejection or acceptance into
the program. A copy of the form is attached as Exhibit 2.
4.8.4.2 OFFENDER REPORT MONTHLY (DOC 1088) - The contractor shall submit a completed
Offender Report Monthly to report data on offenders served each month. This report shall
be submitted within five (5) days of the last day of the month during which service was
provided. A copy of this form is attached as Exhibit 3.
4.8.4.3 UNIT SERVICE MONTHLY REPORT (DOC 1026) - The contractor shall submit a
completed Unit Service Monthly Report to report and certify the number of units of service
provided each month and the amount of offender fees collected each month. This report
shall be submitted within five (5) working days of the last day of the month during
which service was provided. A copy of this form is attached as Exhibit 4.
4.8.4.3 Limits of Confidentiality of Health Information (DOC 1923): The contractor shall
review the DOC-1923 with the offender prior to providing any services to the offender.
The completed form, signed by the offender, shall be submitted to the referring
agent/liaison within the five (5) days of offender’s admission to the program. A copy of this
form is attached as Exhibit 5.
4.8.4.4 PROGRAM EVALUATION
4.8.4.4.1
Program evaluation is intended to return useful information to program sites
for the purpose of program improvement. Contractors delivering services to
offenders shall prepare for and cooperate with evaluation efforts initiated by
the Department including long-term results of offenders discharged from the
program. The Correctional Program Checklist (CPC) will be used as the
evaluation tool to assess the extent to which correctional treatment programs
adhere to the known principles of effective intervention. It is designed to
evaluate the integrity of a program, not outcomes. It is not the intent of the
evaluation process to terminate any program, however, lack of improvement
action may result in notice of termination. CPC steps are attached as Exhibit
5.
4.8.4.4.2
Contractors will be expected to collect and maintain similar data on offenders
and their participation in the treatment process in an electronic database.
Requirements include computer capabilities with internet access, e-mail, and
Windows applications. Data will be reviewed at the end of each year and
submitted in a report providing details to show how the program reduced
recidivating. Outcome reports shall be submitted annually, at a minimum,
with a summary page explaining report outcomes. At minimum the report will
include  Program overview including outcome goals and relationship to reducing
recidivism.
 Number of offenders participating in each program level.
 Number of offenders completing the level of program.
 Number of offenders completing all programming as assessed.
 Number of offenders who do not complete the program and why.
 Number of offenders returning to the program including the period of time
after leaving the program.
Contractor is expected to survey offenders currently active in group services.
These written surveys shall be completed at least one (1) time for every cycle
of service delivered, not to include at discharge. Feedback surveys are
expected to examine (at minimum) on:
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
Due Date: March 6, 2014 at 3:00PM
Page 28 of 73
1.
2.
3.
4.
Targeted behaviors
Dynamic risk factors
Using validated instruments
Utilizing the information to drive programming and add information to
dynamic case plans.
A written summary specifically addressing these requirements shall be sent to
the Department within ten (10) days of the implemented offender survey.
 Bidder must indicate whether your organization has an existing system for
documenting and managing client-level information. If your organization has
any existing system(s), bidder must provide an overview of the system,
including details on the established internal standards of practice regarding
service delivery and intake/completion, what pre/mid and post testing scoring is
gathered, and whether it is in electronic or paper format.
 Bidder must provide the name of your staff person who will be the contact
person responsible for coordinating with DOC and evaluation staff.
5.0
6.0
PERFORMANCE REQUIREMENTS
5.1
STAFF PERFORMANCE
The contractor shall utilize, on this contract, only workers that are skilled in the tasks to which they are
assigned. During the contract period, Provider agrees to submit updates on staff changes and
staffing patterns to the Contract Administrator. The DOC retains the right to require the reassignment
of an employee or employees, as the Department may deem necessary. Reasons for this request may be
but are not limited to incompetence, carelessness, disruptive or otherwise objectionable behavior. The
request for reassignment is in no way a call for dismissal. It is just a request for the individual to be
reassigned out of the contracted program.
5.2
TRAINING OBSERVATION AND GROUP ACCESS
DOC Contract Administrator shall be allowed observation of training sessions and attendance during any
group session as deemed necessary by DOC.
SUPPORT REQUIREMENTS
6.1
COLLECTION OF OFFENDER FEES
6.1.1
Contractor shall collect fees from program participants or via third party payments. Program
participants who are employed or who receive other public or private funds will be expected to
contribute toward program costs. Collection should take place outside of group session hours.
The DCC Contract Administrator shall provide the scale for determining the amount of offender
fees.
NO OFFENDER WILL BE DENIED SERVICES BECAUSE OF INABILITY TO PAY.
6.1.2
Offenders shall be provided written fee collection requirements at the program start including the
specific total amount of fees required while in program. Offenders shall receive a written receipt
from contract staff whenever a fee is paid and contractor will balance that fee receipt book
monthly in order to show individual monthly totals for DCC invoicing purposes.
6.1.3
The amount of these collections will be reported and certified on the DOC-1026 Unit Service
Monthly Report, for the month in which the fee was paid, and deducted from the amount
reimbursable to the contract agency by the DCC.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
6.2
Due Date: March 6, 2014 at 3:00PM
Page 29 of 73
INVOICING / PAYMENT REQUIREMENTS
Contractor must agree that all invoices shall reflect the prices and client fees collected for the duration of
any contract resulting from this bid.
The DOC must meet a statutory mandate to pay or reject invoices within 30 days of receipt by DOC
Accounts Payable (Note exemption of aids payments to individuals and organizations which is a funding
source for this service). Before payment is made, it also must verify that all invoiced charges are
correct as per this Contract. Only properly submitted invoices will be officially processed for payment.
Prompt payment requires that contractor invoices be clear and complete in conformity with the instructions
below. All invoices must be itemized showing:





Contractor name
remit to address
purchase order number
date of service(s)
prices per the Contract
The original invoice and two copies must be sent to the DOC address listed on the Purchase Order.
Final payment may not be made until work has been accepted by the DOC.
7.0
8.0
COST INFORMATION
7.1
FIRM PRICES
Prices must remain firm for the initial contract term.
7.2
PRICE INCREASE REQUESTS
Price increase requests proposed after the initial Contract term must be received by Purchasing in writing
90 calendar days prior to the beginning of the next contract term for acceptance or rejection. Proposed
price increases are limited to fully documented cost increases submitted with the request. If Purchasing
deems cost increases are not acceptable, it reserves the right to rebid the contract in whole or part.
Acceptance of the price increases shall be in the form of an amendment to the contract. Price increases
must be labeled with the contract number and be submitted in the same format as the original RFB. Any
price increase requested that is not submitted in the proper format may be rejected.
7.3
Bidders must submit cost on the Request for Bid Form (DOA-3070). Refer to RFB Section 2.4.2 for Cost
Submittal Information.
STANDARD AND SUPPLEMENTAL TERMS AND CONDITIONS
The Standard Terms and Conditions (DOA-3054, R10/2005)) and Supplemental Standard Terms and Conditions for
Procurements for Services (DOA-3681, R01/2001) are made part of this RFB. The State of Wisconsin reserves the
right to incorporate standard State contract provisions into any contract negotiated with any bid submitted
responding to this RFB (Standard Terms and Conditions, DOA-3054). Failure of the successful bidder to accept
these obligations in a contractual agreement may result in cancellation of the award.
SPECIAL TERMS AND CONDITIONS
8.1
SUBCONTRACTING
Any Contract resulting from this bid shall not be, in whole or in part, subcontracted, assigned/referred, or
otherwise transferred to any other Contractor without prior written approval by Purchasing Services.
8.1.1
The Contractor shall be directly responsible for any subcontractor’s performance and work quality
when used by the Contractor to carry out the scope of the job.
8.1.2
Contractor must assure subcontractors abide by all terms and conditions under this Contract.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
8.1.3
8.2
Due Date: March 6, 2014 at 3:00PM
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If subcontractors are to be used, the Contractor must clearly explain their participation.
PRIME CONTRACTOR: MINORITY BUSINESS SUBCONTACTORS AND DISABLED VETERANOWNED BUSINESS SUBCONTRACTORS
The prime contractor will be responsible for contract performance when subcontractors are used.
However, when subcontractors are used, they must abide by all terms and conditions of the contract. If
subcontractors are to be used, the bidder must clearly explain their participation.
The State of Wisconsin is committed to the promotion of minority business in the state's purchasing
program and a goal of placing 5% of its total purchasing dollars with certified minority businesses.
Authority for this program is found in ss. 15.107(2), 16.75(4), 16.75(5) and 560.036(2), Wisconsin
Statutes. The contracting agency is committed to the promotion of minority business in the state's
purchasing program.
The State of Wisconsin policy provides that minority-owned business enterprises certified by the
Wisconsin Office of Business Development should have the maximum opportunity to participate in the
performance of its contracts. The supplier/contractor is strongly urged to use due diligence to further this
policy by awarding subcontracts to minority-owned business enterprises or by using such enterprises to
provide goods and services incidental to this agreement, with a goal of awarding at least 5% of the
contract price to such enterprises.
The supplier/contractor shall furnish appropriate quarterly information about its effort to achieve this goal,
including the identities of such enterprises certified by the Wisconsin Office of Business Development and
their contract amount.
The Wisconsin Office of Business Development also certifies disabled veteran-owned businesses and
supplier/contractor should also include the identities of such businesses in their quarterly information.
Quarterly reports shall be due fifteen (15) calendar days after the end of the quarter, 9/30, 12/31, 3/31 and
6/30. The form for submitting this information is available from the VendorNet Department of
Administration Forms Page: http://vendornet.state.wi.us/vendornet/doaforms/doa-3234.doc .
The report shall be submitted even if there is no activity.
Submit to:
e-mail: [email protected]
post:
MBE Purchasing Report
PO BOX 7991
Madison, WI 53707-7991
The State reserves the right to request additional reports from the Contractor at no additional cost.
Contractor shall use every effort to provide such reports in a reasonable timeframe, but no later than thirty
(30) calendar days from the time the request was submitted. These reports shall be in a form approved in
advance in writing by the State.
A listing of certified minority businesses, as well as the services and commodities they provide, is available
from the Department of Administration, Minority Business Program, (608) 267-3293. The listing is
published on the Internet at: http://www.doa.state.wi.us/mbe/report2.asp?locid=0 .
A directory of certified disabled veteran-owned business can be accessed via this website:
http://commerce.wi.gov/BusinessDirectory/. Information about the Disabled Veteran-Owned Business
Program is available from the Department of Administration, (608) 267-3293.
8.3
AFFIRMATIVE ACTION
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All contracts of more than Twenty Five Thousand Dollars ($25,000) require the submission of a written
affirmative action plan. Contractors with an annual workforce of less than twenty-five employees are
excluded from this requirement. Within fifteen (15) days after the award of the contract, the written
affirmative action plan, or statement requesting exception, shall be submitted to the Department’s
Contract Compliance Office. Address plan to:
DEPARTMENT OF CORRECTIONS
AFFIRMATIVE ACTION MANAGER
PURCHASING SERVICES SECTION
3099 E. WASHINGTON AVE.
PO BOX 7991
MADISON, WISCONSIN 53707-7991
Contractors are encouraged to contact this office at, (608) 240-5419, for technical assistance on equal
opportunity.
"Affirmative Action Plan" is a written document that details an affirmative action program. Key parts of an
affirmative action plan are: (1) a policy statement pledging nondiscrimination and affirmative action
employment, (2) internal and external dissemination of the policy, (3) assignment of key employee as the
equal opportunity officer, (4) a workforce analysis that identifies job classification where representation of
women, minorities and the disabled is deficient, (5) goals and timetables that are specific and measurable
and that are set to correct deficiencies and to reach a balance of work force, (6) revision of all employment
practices to ensure that they do not have discriminatory effects, (7) establishment of internal monitoring
and reporting systems to measure progress regularly.
Failure to comply appropriately with these requirements can lead to bidder being banned from doing
business with any agency of the State of Wisconsin. Additionally, failure to comply can result in
termination of this contract, or withholding of payment. On the Vendor Information Sheet provide the
requested information. For additional information see Section 19.0 of the Standard Terms and Conditions.
8.4
WISCONSIN SALES AND USE TAX REGISTRATION
The State of Wisconsin shall not enter into a contract with a vendor, and reserves the right to cancel any
existing contract if the vendor or contractor has not met or complied with the requirements of s. 77.66,
Wis. Stats., and related statutes regarding certification for collection of sales and use tax.
If you have not established a certification for Collection of Sale and Use Tax status with the Wisconsin
Department of Revenue, the DOC and any other state agency can not issue any purchase orders to your
firm. For additional information see http://www.dor.state.wi.us/html/vendlaw.html
8.5
EMPLOYEE IDENTIFICATION
All contractors’ employees, while working on DOC property, must wear a clearly displayed photo
identification badge (provided by the Contractor at the Contractor’s cost) showing they are employees of
the contractor. Badges must be available but will not be required to be worn when protective clothing and
respiratory protection is required.
8.6
CONFIDENTIALITY
In addition to Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations on medical
record privacy (45 CFR, parts 160 & 164), the department considers all personally identifiable information
relating to offenders to be confidential, and such data is not to be released unless approved by the DOC.
8.7
LIQUIDATED DAMAGES
This shall be surety for fulfillment of the contract(s) including quality, performance and delivery under the
terms of this Request for Bid. Liquidated damages shall consist of the cost per group or service unit for
failure to deliver according to the requirements of this bid. Liquidated damages will be deducted from the
invoice, if the invoice is of sufficient amount to cover the liquidated damages. If the invoice is not of a
sufficient amount to cover the liquidated damages, the agency will request cancellation of the invoice and
a credit to cover the balance.
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EMPLOYMENT OF CURRENT OFFENDERS AND EMPLOYMENT AND RETENTION OF
INDIVIDUALS ARRESTED, CHARGED OR CONVICTED OF CRIMINAL OFFENSE
8.8.1
Contractor shall not employ a person who is on probation, parole or an inmate who is supervised by
Intensive Sanctions for any position where the primary duties and responsibilities involve the
supervision or treatment of inmates, probationers or parolees or involve access to offenders' records
or funds.
8.8.2
Contractor will implement policies and procedures to ensure that:
Job applicants or current employees shall be dealt with as follows:
a) For a job applicant who has a pending criminal charge: Where the circumstances of said
criminal charge substantially relate to the circumstances of a particular job or licensed
activity, the applicant will not be hired for that job;
b) For a current employee who has a pending criminal charge: Where the circumstances of
said criminal charge substantially relate to the circumstances of the job or licensed
activity, the employee will not be continued in that particular job;
c) For a job applicant who is convicted of a criminal offense: Where the circumstances of
said conviction of a criminal or other offense that substantially relates to the
circumstances of a particular job or licensed activity, the applicant will not be hired for that
job; and
d) For a current employee who is convicted of a criminal offense: Where the circumstances
of said conviction of a criminal or other offense that substantially relates to the
circumstances of the current job or licensed activity, the employee will not be retained in
that particular job; and
e) For a job applicant who is required to use an Ignition Interlock Device (IID): Where the
circumstances of said court ordered requirement substantially relate to the circumstances
of a particular job or licensed activity, the applicant will not be hired for that job; and
f)
For a current employee who is required to use an Ignition Interlock Device (IID): Where
the circumstances of said court ordered requirement substantially relate to the
circumstances of a particular job or licensed activity, the employee will not be retained in
that particular job.
Nothing in this contract prohibits the Contractor from reassigning or suspending the employee or,
in the case of a conviction, terminating the employee.
8.9
8.8.3
In hiring and retention decisions, Contractor may consider records of pending criminal charges
and convictions when it can be demonstrated that the circumstances of the offense substantially
relate to the circumstances of the job or licensed activity. When determining whether the
circumstances of a pending charge or conviction are substantially job related, Contractor should
take into consideration elements related to the position, the offense, and the individual.
8.8.4
To make determinations on substantial relationships to the circumstances of the job, Contractor
shall have written policies on how the applicant for employment and the employee will be
reviewed. To guide the development of the policy, the Contractor may obtain a copy of Chapter
301 of the Department of Corrections Supervisor's Manual from the Contract Administrator.
FRATERNIZATION
8.9.1
Contractor agrees to have a written policy on fraternization that prohibits the forming of improper
relationships between Contractor's employees and offenders. The policy must be substantially
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equivalent to the Department of Corrections' policy as expressed in Executive Directive 16, May
1991 - Revised January 1997, Further Revised August 2004. A copy of Executive Directive 16
may be obtained from the Contract Administrator.
8.9.2
Contractor shall address at the minimum the policy required in Sub. A: definitions of employee,
relationships and offender; a statement of prohibited relationships; duty of employee to inform
Contractor of unplanned contacts with offenders; a statement that Contractor-directed contacts or
those which are part of the employee's job duties are exempt from the policy; an exception
procedure which may be carried out by the Executive Director or designee; and a standard
employee statement indicating that each employee has read a copy of the Contractor's policy on
fraternization.
8.9.3
Contractor shall also agree to have a written policy which prohibits Contractor’s employees from
engaging in any sexual contact or sexual intercourse with offenders under the custody and control of
the Department of Corrections. The policy must be substantially equivalent to the Department of
Corrections’ policy as expressed in Executive Directive 16-A, August 2006. A copy of Executive
Directive 16-A may also be obtained from the Contractor Administrator.
Contractor shall maintain a copy of the signed employee statement on fraternization and sexual
contact in each employee's personnel file.
8.9.4
8.10
CONTRACTOR AUDIT REQUIREMENT
8.10.1 Governmental entities shall comply with the Single Audit Act of 1984, OMB Circular A-128 and the
State Single Audit Guidelines issued by the Department of Administration. They shall also comply
with the Department of Health and Family Services' Allowable Cost Policy Manual. Single audit
reports are due to the Department within 30 days from issuance of the report, but no later than
one year after the end of the audit period.
8.10.2 Non-profit agencies that have been certified under USC 501(c)(3) shall comply with OMB Circular
A-133, the Department's Contractor Agency Audit Guide, the Allowable Costs Policy Manual and
ss. 301.08. Audits are due to the Contractor within one year of the close of the contract.
8.10.3 Profit agencies shall comply with the Department's Contractor Agency Audit Guide, the Allowable
Costs Policy Manual, and ss. 301.08. Audits are due to the Contractor within one year of the
close of the contract.
8.10.4 If a Contractor agency's audit is based on a calendar rather than state fiscal year (July 1 through
June 30), the Contractor and/or auditor shall submit a worksheet which reconciles the
expenditures based on the state fiscal year and the relevant purchase orders within one year of
the close of the contract.
8.10.5 DOC shall notify Contractor within 90 days of receipt of the audit completed by the independent
certified auditor, whether or not the audit meets the requirements of DOC's audit guidelines. DOC
shall initiate resolution of audit findings with Contractor within 180 days following notification of the
audit's acceptance. If the audit is not complete or is acceptable only in part, DOC shall rely upon
the acceptable portion of the audit and any additional audit work shall build upon the work already
done.
8.10.6 DOC reserves the right to conduct an independent audit of Contractor if Contractor fails to secure
an audit covering all funds, or a follow-up review of selected areas is determined to be necessary.
In the event that Contractor fails to secure an audit, DOC's costs for completing an audit will be
charged back to Contractor.
8.10.7 Contractor agrees that it is responsible to assure that all purchase of service contracts of $25,000
or more meet the requirements of the Office of Management and Budget Circulars A-133 and A128 that pertain to sub-recipient audits.
8.11
FAITH-BASED AND CHARITABLE ORGANIZATIONS
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8.11.1 A faith-based or charitable organization is eligible to be a contractor on the same basis as any
other private organization. If Contractor is a faith-based or charitable organization it shall retain its
independence from the State of Wisconsin, including without limitation Contractor’s control over
the definition, development, practice, and expression of its charitable or religious beliefs. Except
as otherwise provided by state or federal law, Purchaser shall not interpret this Contract to require
a charitable or faith-based organization to alter its form of internal governance or remove religious
art, icons, scriptures, or other symbols.
8.11.2 A religious organization does not, by contracting with the State of Wisconsin, lose the exemption
provided under Section 702 of the Civil Rights Act (42 U.S.C. 2000e-1(a)) regarding its
employment practices. Furthermore, if a faith-based or charitable organization segregates the
government funds provided under the Contract, then only the financial assistance provided by
these funds will be subject to audit.
8.11.3 Neither Purchaser’s selection of a charitable or faith-based contractor to provide the Services
described herein nor the expenditure of funds under this Contract is an endorsement of the
Contractor’s charitable or religious character, practices, or expression. The purpose of this
Contract is the provision of Services; none of Purchaser’s expenditures have as their objective the
funding of sectarian worship, instruction, or proselytization. As such, a faith-based or charitable
Contractor of Services under this Contract shall post at its place(s) of business the following
written notice and personally apprise all assisted inmates of the same:
Neither the State of Wisconsin’s selection of a Charitable or faith-based Contractor of
services or the expenditure of funds under any contract with said Contractor is an
endorsement of that Contractor’s charitable or religious character, practices, or
expression. No Contractor of services may discriminate against you on the basis of
religion, a religious belief, or your refusal to actively participate in a religious practice. If
you object to a particular Contractor because of its religious character, you may request
assignment to a different non-sectarian Contractor by contacting your Agent.
8.11.4 To ensure an inmate is informed of the foregoing, a faith-based or charitable Contractor shall
require that each inmate receiving Services under this Contract signs an acknowledgment form
prepared by the Contractor containing the aforementioned notice and verifying the offender’s
receipt of the same. A copy of all signed acknowledgment forms shall be promptly provided to
Purchaser. Finally, Purchaser will require that each inmate sign the Purchaser’s “Voluntary Choice
and Waiver” form, which will be provided by Purchaser, prior to receiving any Services from a
faith-based or charitable Contractor under this Contract. A faith-based or charitable Contractor
agrees to refrain from providing Services hereunder to an inmate until it receives a copy of a fully
executed Voluntary Choice and Waiver form from Purchaser for that respective offender.
8.12
AMERICANS WITH DISABILITY ACT
The contractor agency must complete or currently have on file a facility self-survey and a program and
policy self-evaluation to address compliance with the Americans with Disability Act. (Public Law 101-336,
July 26, 1990, 104 Stat. 327 and Title 42, U.S.C.A., ss. 12101 to 12213). During the course of the
contract, the contractor must take action to comply with the facility, program and employment provisions of
the Americans with Disability Act. Applicants may obtain information on the Americans with Disability Act
by contacting the Director of the Office of Diversity and Employee Services, Wisconsin Department of
Corrections, 3099 E. Washington Avenue, PO Box 7991, Madison, Wisconsin 53707-7991.
8.13
CONFIDENTIALITY AND HEALTH INSURANCE PORTABILITY ACCOUNTABILITY
In addition to Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations on medical
record privacy (45 CFR, parts 160 & 164), the department considers all personally identifiable information
relating to offenders to be confidential, and such data is not to be released unless approved by the DOC.
8.13.1 DEFINITIONS
Designated Record Set:
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(1) A group of records maintained by or for a covered entity that is:
(i) The medical records and billing records about individuals maintained by or for a covered health
care provider;
(ii) The enrollment, payment, claims adjudication, and case or medical management record systems
maintained by or for a health plan; or
(iii) Used, in whole or in part, by or for the covered entity to make decisions about individuals.
(2) For purposes of this Contract, the term record means any item, collection, or grouping of information
that includes protected health information and is maintained, collected, used, or disseminated by or for
a covered entity.
Disclosure - the release, transfer, provision of access to, or divulging in any other manner of information
outside the entity holding the information.
Incident - a use or disclosure of PHI by the Contractor or subcontractor not authorized by this Contract or
in writing by the Department. This definition includes any attempted, successful or unsuccessful,
unauthorized access, modification, or destruction of PHI, including electronic PHI, or interference with the
operation of any information system that contains PHI.
Individual - the person who is the subject of PHI or the personal representative of the individual, as defined
and provided for under applicable provisions of HIPAA.
Protected Health Information or “PHI” - Individually identifiable health information in any form or medium,
including demographic information, created, received, maintained, or transmitted by the Contractor, on
behalf of the Department, where such information relates to the past, present, or future physical or mental
health or condition of an individual, the provision of health care to an individual, or the payment for the
provision of health care to an individual, and where such information identifies the individual or provides a
reasonable basis to believe that it can be used to identify an individual.
PHI excludes individually identifiable health information in education records covered by the Family
Educational Rights and Privacy Act (FERPA) and employment records held by the Department in its role
as employer.
8.13.2 Prohibition on Unauthorized Use or Disclosure of PHI
The Contractor shall not use or disclose any PHI except as permitted or required by the Contract
or this Agreement, as permitted or required by law, or as otherwise authorized in writing by the
Department.
8.13.3 Permitted Use and Disclosure of PHI
The Contractor may use or disclose PHI only:
a. For the delivery of the services, program management, activities, or functions contracted for in
the Contract; or
b. For meeting contractual or legal obligations as established in any agreements between the
parties evidencing their business relationship; or
c. As permitted by HIPAA if such use or disclosure were made by the Department or otherwise
required by applicable law, rule or regulation; or
d. For use in the operations of the Contractor as provided in paragraph 4 of this Contract; or
e. As otherwise authorized by the Department in writing; or
f. For data aggregation for the health care operations of the Department.
8.13.4 Use of PHI in Contractor Operations
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The Contractor may use or disclose PHI as necessary for the delivery of the services or programs
provided for in the Contract, including appropriate management and administration of programs or
services, or to fulfill the contractual or legal obligations of the Contractor provided:
a. The disclosure is permitted or required by law; or
b. The Contractor obtains reasonable assurances, evidenced by a written contract, from any
person or organization to which the Contractor will disclose PHI that such person or
organization shall:
(i) Hold all PHI in confidence and use or further disclose it only for the purpose for which the
Contractor disclosed it to the person or organization, or as required by law; and
(ii) Notify the Contractor, who will in turn promptly notify the Department, of any instance of
which the person or organization becomes aware that PHI was improperly disclosed.
8.13.5 Safeguarding and Maintenance of PHI
a. The Contractor will develop, implement, maintain, and use:
(i) Reasonable and appropriate administrative, technical, and physical safeguards to prevent
improper use or disclosure of PHI, in any form or medium; and,
(ii) Reasonable and appropriate administrative, technical, and physical security measures that
protect the confidentiality, integrity and availability of electronic PHI that it creates,
receives, maintains, or transmits on behalf of the Department.
b. The Contractor will document PHI safeguards and security measures and agrees to provide the
Department with access and review of this documentation if requested by the Department or an
agent of the Department. Security measures employed by the Contractor must be sufficient to
ensure that the Department is compliant with the HIPAA privacy and security requirements for
those covered services, activities, or functions performed on behalf of the Department on or
before the date such requirements become effective.
c. The Contractor agrees to conduct an accurate and thorough assessment of the potential risks
and vulnerabilities to the confidentiality, integrity, and availability of electronic PHI held by the
Contractor. The Contractor and the Department agree that all costs associated with
performance of these activities will be the responsibility of the Contractor unless the
Department agrees to be responsible for some or all of the costs associated with the
performance of these activities.
8.13.6 Use or Disclosure of PHI by Subcontractors and Agents of the Contractor
The Contractor agrees to require any agent, including subcontractors, to whom the Contractor
provides PHI to comply with the same restrictions and conditions applicable to the Contractor with
respect to PHI. Contractor further agrees to ensure that any agents or subcontractors, to whom
the Contractor provides PHI received from, or created or received by the Contractor on behalf of
the Department agrees to the same restrictions and conditions applicable to the Contractor with
respect to such information. This provision does not apply to the use or disclosure of PHI by
subcontractors that provide health care treatment to individuals or to other persons or
organizations that have entered into an Organized Health Care Arrangement (OHCA) as provided
for under the provisions of HIPAA.
8.13.7 Compliance with Electronic Transactions and Code Set Regulations
If the Contractor conducts any HIPAA-covered standard electronic transactions on behalf of the
Department, the Contractor will comply with the applicable provisions of HIPAA for such standard
transactions. The Contractor will likewise require any subcontractor or agent conducting any
standard electronic transactions on behalf of the Contractor, for services or programs covered by
the Contract, to comply with the applicable provisions of HIPAA relating to standard transactions.
a. General requirements.
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(i) If any entity requests the Contractor to conduct any of the standard electronic transactions,
the Contractor must comply with the request
(ii) The Contractor may not delay or reject a transaction, or otherwise adversely affect or
impact the other entity or the transaction submitted, because the transaction is a standard
electronic transaction
(iii) The Contractor may not reject a standard electronic transaction on the basis that it contains
data elements not needed or used by the Contractor (e.g., coordination of benefits data
elements)
(iv) The Contractor may not offer an incentive to a health care provider to conduct a covered
transaction through direct data entry rather than as a standard electronic transaction
(v) The Contractor, which is operating as a health care clearinghouse, or requiring an entity to
use a health care clearinghouse to receive, process, or transmit standard electronic
transactions, may not charge fees or impose costs in excess of the fees or costs for
normal telecommunications that the entity incurs when it directly transmits, or receives, a
standard electronic transaction to, or from, the Contractor.
b. The Contractor will not enter into, or permit its subcontractors or agents to enter into, any
contract related to the conducting of standard electronic transactions for or on behalf of the
Department that:
(i) Changes or modifies the definition, data condition, or use of a data element or segment in
an implementation specification; or
(ii) Adds any data elements or segments to the maximum defined data set; or
(iii) Uses any code or data elements that are marked “not used” in the implementation
specification or are not contained within the implementation specification; or
(iv) Changes the meaning or intent of any implementation specification.
c. If the Contractor receives a standard electronic transaction and coordinates benefits with
another health plan, it must store the coordination of benefits data it needs to forward the
standard electronic transaction to the other health plan.
8.13.8 Access to PHI
At the request of the Department, the Contractor agrees to provide access to PHI held by the
Contractor that the Department has determined to be part of the Designated Record Sets of the
programs covered by the Contract. Access to PHI will be provided to the Department or to an
individual as directed by the Department to comply with applicable HIPAA requirements. The
Department may delegate to the Contractor responsibility for performing any or all obligations
related to the Designated Record Set, including those activities required under HIPAA to permit an
individual to exercise his or her HIPAA privacy rights.
8.13.9 Amendment or Correction to PHI
At the direction of the Department, the Contractor agrees to amend or correct PHI that the
Department determines is included in the Designated Record Set held by the Contractor. The
Contractor agrees to complete any amendment or correction to PHI in accordance with HIPAA
requirements.
8.13.10 Reporting of Incidents to the Department by Contractor
The Contractor agrees to inform the Covered Entity of any incident covered by this Contract within
five (5) business days of becoming aware of the incident. The Department, at its discretion, may
require a written report. If the Department requests a written report, the Contractor agrees to
forward the report to the Department not more than five (5) business days after such request is
made. Written and verbal reports of incidents will include:
a. A complete description of the circumstances of the incident;
b. The name of persons assigned to review and investigate the incident;
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c. A description of all PHI used or disclosed during the incident;
d. The names of persons and organizations involved in the incident;
e. The actions the Contractor has undertaken or will undertake to mitigate any harmful effect of
the incident; and,
f. A corrective action plan that includes steps the Contractor has taken or will take to prevent
future similar incidents from occurring.
8.13.11 Mitigating Effect of Unauthorized Disclosures or Misuse of PHI
The Contractor agrees to mitigate, to the extent practicable, any harmful effect known to the
Contractor created by an improper use or disclosure of PHI by the Contractor in violation of the
requirements of this Contract.
8.13.12 Statutory Duty of the Department to Report Material Breaches by Contractor to Secretary
of United States Department of Health and Human Services (HHS)
Contractor and the Department agree that if the Contractor engages in a pattern of activity or
practice that constitutes a material breach or violation of this Contract, and the Department
becomes aware of such pattern or practice, the Department is required to take reasonable steps
to cure the breach or end the violation, as applicable, and, if such steps are not successful and
termination of the Contract is not feasible, the Department is required to report the problem to the
Secretary of HHS.
8.13.13 Tracking and Accounting of Disclosures of PHI by the Contractor
a. The Contractor agrees to track disclosures of PHI as required by the applicable provisions of
HIPAA and applicable Wisconsin laws. Specifically, the Contractor agrees that it will maintain
a record of all PHI disclosures made to third parties, except as provided for by the subsections
to this paragraph below. The Contractor agrees that the following information will be recorded:
(i) The date the PHI was disclosed;
(ii) The name and address, if known, of the person or entity that the PHI was disclosed to;
(iii) A brief description of the PHI disclosed; and
(iv) A brief statement describing the purpose for the disclosure.
b. For repetitive disclosures that the Contractor makes to the same person or entity for a single
purpose the Contractor will provide:
(i) The disclosure information as specified in paragraph 13(a)(i-iv) of this Contract for the first
of such repetitive disclosures;
(ii) The frequency, periodicity or number of such repetitive disclosures; and
(iii)The date of the most recent of such repetitive disclosures.
c. The Contractor will make the record of disclosures available to the Department within five (5)
business days after receiving a request by the Department.
d. Exceptions from Disclosure Tracking.
The Contractor is not required to track or record disclosures of PHI, or to provide an accounting
of disclosures for PHI meeting the following conditions:
(i) Disclosures of PHI that are permitted under this Contract, or otherwise expressly authorized
by the Department in writing; and
(ii) Disclosures of PHI for the following:
(1) For purposes of treatment, payment or health care operations activity of the
Department;
(2) In response to a request from an Individual who is the subject of the disclosed PHI, or
to that individual’s personal representative;
(3) Made to persons involved in health care or payment for health care of the individual;
(4) For disaster relief notification purposes;
(5) For national security or intelligence purposes; or,
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(6) To law enforcement officials or correctional institutions regarding individuals in
custodial situations.
e. Agreement to Obtain Valid Authorization or Informed Written Consent Prior to Disclosure of
PHI. Contractor agrees to obtain a valid authorization or informed written consent from the
individual that is the subject of the PHI disclosure or a personal representative of such
individual except for those exceptions listed in this Contract or otherwise required by law.
f. Disclosure Tracking Time Periods. Contractor agrees to maintain and make available to the
Department upon its request information on disclosures of PHI made by the Contractor for the
six-year period preceding the request, but not including disclosures made prior to April 2005, or
the date that the Contractor began performing covered services, activities, or functions on
behalf of the Department, whichever is later.
8.13.14 Accounting to the Department and to Government Agencies
The Contractor agrees to make its internal practices, books, and records relating to the use and
disclosure of PHI available to the Department, or to the Secretary of HHS in a time and manner
determined by the Department or the Secretary or designee, for purposes of determining
compliance by the Department with the requirements of HIPAA. Further, the Contractor agrees to
promptly notify the Department of communications with HHS regarding PHI and will provide the
Department with copies of any PHI or other information the Contractor has made available to HHS
under this provision.
8.13.15 Return or Destruction of PHI
Upon termination, cancellation, expiration or other conclusion of this Contract, the Contractor will:
a. Return to the Department or, if return is not feasible, destroy all PHI and any compilation of PHI
in any medium or form. The Contractor agrees to ensure that this provision also applies to PHI
in possession of subcontractors and agents of the Contractor provided to the agent or
subcontractor by the Contractor. The Contractor agrees that any original record or copy of PHI
in any medium is included in and covered by this provision, as are all original or copies of PHI
provided to subcontractors or agents of the Contractor by the Contractor. The Contractor
agrees to complete the return or destruction as promptly as possible, but not more than five (5)
business days after the effective date of termination of this Contract. The Contractor will
provide written documentation evidencing that return or destruction of all PHI has been
completed. Contractor agrees to extend the requirements of this provision to contracts entered
into with subcontractors and agents that create, receive, or maintain PHI on behalf of the
Contractor.
b. If the Contractor believes that the return or destruction of PHI is not feasible, the Contractor
shall provide written notification of the conditions that make return or destruction not feasible. If
the Contractor and the Department agree that return or destruction of PHI is not feasible, the
Contractor shall extend the protections of this Contract to PHI and prohibit further uses or
disclosures of the PHI of the Department without the express written authorization of the
Department. Subsequent use or disclosure of any PHI subject to this provision will be limited to
the use or disclosure that makes return or destruction not feasible.
8.14
CONTRACTOR MAJOR STRUCTURAL CHANGE
The Contractor is required to provide the Department with a minimum of 90 days written advance notice of
any planned or potential structural change (merger, buyout, acquisition, consolidation, etc.). Contract may
not be automatically assigned to the new entity (since the underlying procurement may be affected).
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
8.15
Due Date: March 6, 2014 at 3:00PM
Page 40 of 73
CARRYING A CONCEALED WEAPON
Contractor agrees to have a written policy addressing the concealed carry law which prohibits the
possession of any weapon by Contractor's employees while providing services to DOC offenders. The
policy must be substantially equivalent to the Department of Corrections' policy as expressed in Executive
directive 80, signed October 31, 2011. A copy of Executive Directive 80 may be obtained from the
Contract Administrator.
A.
Contractor must maintain a copy of the signed employee statement on concealed carry in each
employee's personnel file.
B.
Contractor will prohibit firearms/weapons in any owned, leased/rented, or available location in
which program services are provided for DOC. Signs shall be posted at every public entrance.
Each sign must be at least five inches by seven inches state the restriction on carrying a firearm,
and inform people that weapons or firearms are prohibited. Sample signage will be available
through the Contract Administrator.
RFB # KK-4464
Certified AODA Services in Sheboygan, WI
9.0
Due Date: March 6, 2014 at 3:00PM
Page 41 of 73
REQUIRED FORMS AND ATTACHMENTS
The following forms must be completed and submitted with the bid response.
Bids that do not include all items listed on this checklist may be rejected.
FORMS:
Request for Bid Form (DOA-3070) - cover sheet, first page of this RFB
Vendor Information Form (DOA-3477 1/08)
Designation of Confidential and Proprietary Information Form (DOA-3027), if applicable.
Wisconsin’s Cooperative Purchasing Service Form (DOA-3333)
Vendor Reference Form (DOA-3478)
ADDITIONAL REQUIRED INFORMATION TO BE SUBMITTED WITH BID:
 Documentation of facility and physical space use plan as specified in 4.1.

Documentation of agency experience requirements, including past contracts information, as specified in 4.2.

Documentation of staff qualifications, experience and training as specified in 4.3. If staff positions are pending
hire, submit recruitment plan and job description of those pending positions.

Documentation, if available at time of bid submittal, of AODA Program Certification per DHS 75 as specified in
4.4.1

A detailed description of the AODA Assessment component of the AODA program, to include assessment
instruments recommending for use per specifications described in 4.4.3.

A detailed description of the AODA Outpatient Counseling group component to be delivered by the bidder in
accordance with specification described in 4.4.4, including documentation that curriculum and program to be
administered are supported by evidence-based research. Include a copy of the test to be administered for
successful completion for each of the group components.

A detailed description of the AODA Intensive Outpatient Group component to be delivered by the bidder in
accordance with specifications described in 4.4.5, including documentation that curriculum and program to be
administered are supported by evidence-based research. Include a copy of the test to be administered for
successful completion for each of the group components.

A detailed description of AODA Aftercare Group component to be delivered by the bidder in accordance with
specification described in 4.4.6, including documentation that curriculum and program to be administered are
supported by evidence-based research. Include a copy of the test to be administered for successful completion
for each of the group components.

A detailed description of AODA Relapse Prevention Group component to be delivered by the bidder in
accordance with specification described in 4.4.7, including documentation that curriculum and program to be
administered are supported by evidence-based research. Include a copy of the test to be administered for
successful completion for each of the group components.

A sample completed treatment plan as specified in 4.5.2.

Copy of format used for the Progress Reports in 4.8.2.2.

Copy of format used for Discharge Summary in 4.8.2.3.

Indicate whether your organization has an existing system for documenting and managing client-level information
as outlined in RFB Section 4.8.4.5. If so, provide details on the established internal standards of practice
regarding service delivery and assessment, what pre and post testing scoring is gathered, and whether it is in
electronic or paper format.

Provide the name of your staff person who will be the contact person responsible for coordinating with DOC and
evaluation staff as specified in 4.8.4.5.
Wisconsin Department of Administration
Chs. 16, 19, 51
DOA-3054 (R10/2005)
Page 1 of 3
Standard Terms And Conditions
(Request For Bids / Proposals)
1.0
2.0
3.0
SPECIFICATIONS: The specifications in this request are
the minimum acceptable. When specific manufacturer and
model numbers are used, they are to establish a design,
type of construction, quality, functional capability and/or
performance level desired.
When alternates are
bid/proposed, they must be identified by manufacturer, stock
number, and such other information necessary to establish
equivalency. The State of Wisconsin shall be the sole judge
of equivalency. Bidders/proposers are cautioned to avoid
bidding alternates to the specifications which may result in
rejection of their bid/proposal.
DEVIATIONS AND EXCEPTIONS: Deviations and exceptions from original text, terms, conditions, or specifications
shall be described fully, on the bidder's/proposer's letterhead, signed, and attached to the request. In the absence
of such statement, the bid/proposal shall be accepted as in
strict compliance with all terms, conditions, and specifications and the bidders/proposers shall be held liable.
QUALITY: Unless otherwise indicated in the request, all
material shall be first quality. Items which are used,
demonstrators, obsolete, seconds, or which have been
discontinued are unacceptable without prior written approval
by the State of Wisconsin.
4.0
QUANTITIES: The quantities shown on this request are
based on estimated needs. The state reserves the right to
increase or decrease quantities to meet actual needs.
5.0
DELIVERY: Deliveries shall be F.O.B. destination freight
prepaid and included unless otherwise specified.
6.0
PRICING AND DISCOUNT: The State of Wisconsin qualifies for governmental discounts and its educational institutions also qualify for educational discounts. Unit prices shall
reflect these discounts.
6.1
6.2
6.3
Unit prices shown on the bid/proposal or contract
shall be the price per unit of sale (e.g., gal., cs., doz.,
ea.) as stated on the request or contract. For any
given item, the quantity multiplied by the unit price
shall establish the extended price, the unit price shall
govern in the bid/proposal evaluation and contract
administration.
Prices established in continuing agreements and
term contracts may be lowered due to general market
conditions, but prices shall not be subject to increase
for ninety (90) calendar days from the date of award.
Any increase proposed shall be submitted to the
contracting agency thirty (30) calendar days before
the proposed effective date of the price increase, and
shall be limited to fully documented cost increases to
the contractor which are demonstrated to be industrywide. The conditions under which price increases
may be granted shall be expressed in bid/proposal
documents and contracts or agreements.
In determination of award, discounts for early
payment will only be considered when all other conditions are equal and when payment terms allow at
least fifteen (15) days, providing the discount terms
are deemed favorable. All payment terms must allow
the option of net thirty (30).
7.0
UNFAIR SALES ACT: Prices quoted to the State of
Wisconsin are not governed by the Unfair Sales Act.
8.0
ACCEPTANCE-REJECTION:
The State of Wisconsin
reserves the right to accept or reject any or all
bids/proposals, to waive any technicality in any bid/proposal
submitted, and to accept any part of a bid/proposal as
deemed to be in the best interests of the State of
Wisconsin.
Bids/proposals MUST be date and time stamped by the
soliciting purchasing office on or before the date and time
that the bid/proposal is due. Bids/proposals date and time
stamped in another office will be rejected. Receipt of a
bid/proposal by the mail system does not constitute receipt
of a bid/proposal by the purchasing office.
9.0
METHOD OF AWARD: Award shall be made to the lowest
responsible, responsive bidder unless otherwise specified.
10.0
ORDERING: Purchase orders or releases via purchasing
cards shall be placed directly to the contractor by an
authorized agency.
No other purchase orders are
authorized.
11.0
PAYMENT TERMS AND INVOICING:
The State of
Wisconsin normally will pay properly submitted vendor
invoices within thirty (30) days of receipt providing goods
and/or services have been delivered, installed (if required),
and accepted as specified.
Invoices presented for payment must be submitted in
accordance with instructions contained on the purchase
order including reference to purchase order number and
submittal to the correct address for processing.
A good faith dispute creates an exception to prompt
payment.
12.0
TAXES: The State of Wisconsin and its agencies are
exempt from payment of all federal tax and Wisconsin state
and local taxes on its purchases except Wisconsin excise
taxes as described below.
The State of Wisconsin, including all its agencies, is
required to pay the Wisconsin excise or occupation tax on
its purchase of beer, liquor, wine, cigarettes, tobacco
products, motor vehicle fuel and general aviation fuel.
However, it is exempt from payment of Wisconsin sales or
use tax on its purchases. The State of Wisconsin may be
subject to other states' taxes on its purchases in that state
depending on the laws of that state. Contractors performing construction activities are required to pay state use tax
on the cost of materials.
13.0
GUARANTEED DELIVERY: Failure of the contractor to
adhere to delivery schedules as specified or to promptly
replace rejected materials shall render the contractor liable
for all costs in excess of the contract price when alternate
procurement is necessary. Excess costs shall include the
administrative costs.
14.0
ENTIRE AGREEMENT:
These Standard Terms and
Conditions shall apply to any contract or order awarded as
a result of this request except where special requirements
are stated elsewhere in the request; in such cases, the
special requirements shall apply. Further, the written
contract and/or order with referenced parts and attach-
DOA-3054
Page 2of 3
ments shall constitute the entire agreement and no other
terms and conditions in any document, acceptance, or
acknowledgment shall be effective or binding unless
expressly agreed to in writing by the contracting authority.
15.0
16.0
17.0
18.0
19.0
APPLICABLE LAW AND COMPLIANCE: This contract
shall be governed under the laws of the State of Wisconsin.
The contractor shall at all times comply with and observe all
federal and state laws, local laws, ordinances, and
regulations which are in effect during the period of this
contract and which in any manner affect the work or its
conduct. The State of Wisconsin reserves the right to
cancel this contract if the contractor fails to follow the
requirements of s. 77.66, Wis. Stats., and related statutes
regarding certification for collection of sales and use tax.
The State of Wisconsin also reserves the right to cancel
this contract with any federally debarred contractor or a
contractor that is presently identified on the list of parties
excluded from federal procurement and non-procurement
contracts.
ANTITRUST ASSIGNMENT: The contractor and the State
of Wisconsin recognize that in actual economic practice,
overcharges resulting from antitrust violations are in fact
usually borne by the State of Wisconsin (purchaser).
Therefore, the contractor hereby assigns to the State of
Wisconsin any and all claims for such overcharges as to
goods, materials or services purchased in connection with
this contract.
ASSIGNMENT: No right or duty in whole or in part of the
contractor under this contract may be assigned or delegated without the prior written consent of the State of
Wisconsin.
WORK CENTER CRITERIA: A work center must be certified under s. 16.752, Wis. Stats., and must ensure that
when engaged in the production of materials, supplies or
equipment or the performance of contractual services, not
less than seventy-five percent (75%) of the total hours of
direct labor are performed by severely handicapped
individuals.
Contracts estimated to be over twenty-five thousand
dollars ($25,000) require the submission of a written
affirmative action plan by the contractor. An exemption occurs from this requirement if the contractor has
a workforce of less than twenty-five (25) employees.
Within fifteen (15) working days after the contract is
awarded, the contractor must submit the plan to the
contracting state agency for approval. Instructions
on preparing the plan and technical assistance
regarding this clause are available from the
contracting state agency.
The contractor agrees to post in conspicuous places,
available for employees and applicants for employment, a notice to be provided by the contracting state
agency that sets forth the provisions of the State of
Wisconsin's nondiscrimination law.
19.3
Failure to comply with the conditions of this clause
may result in the contractor's becoming declared an
"ineligible" contractor, termination of the contract, or
withholding of payment.
20.0
PATENT INFRINGEMENT: The contractor selling to the
State of Wisconsin the articles described herein guarantees
the articles were manufactured or produced in accordance
with applicable federal labor laws. Further, that the sale or
use of the articles described herein will not infringe any
United States patent. The contractor covenants that it will
at its own expense defend every suit which shall be brought
against the State of Wisconsin (provided that such
contractor is promptly notified of such suit, and all papers
therein are delivered to it) for any alleged infringement of
any patent by reason of the sale or use of such articles, and
agrees that it will pay all costs, damages, and profits recoverable in any such suit.
21.0
SAFETY REQUIREMENTS: All materials, equipment, and
supplies provided to the State of Wisconsin must comply
fully with all safety requirements as set forth by the
Wisconsin Administrative Code and all applicable OSHA
Standards.
22.0
WARRANTY: Unless otherwise specifically stated by the
bidder/proposer, equipment purchased as a result of this
request shall be warranted against defects by the
bidder/proposer for one (1) year from date of receipt. The
equipment manufacturer's standard warranty shall apply as
a minimum and must be honored by the contractor.
23.0
INSURANCE RESPONSIBILITY: The contractor performing services for the State of Wisconsin shall:
NONDISCRIMINATION / AFFIRMATIVE ACTION: In
connection with the performance of work under this
contract, the contractor agrees not to discriminate against
any employee or applicant for employment because of age,
race, religion, color, handicap, sex, physical condition,
developmental disability as defined in s. 51.01(5), Wis.
Stats., sexual orientation as defined in s. 111.32(13m), Wis.
Stats., or national origin. This provision shall include, but
not be limited to, the following: employment, upgrading,
demotion or transfer; recruitment or recruitment advertising;
layoff or termination; rates of pay or other forms of
compensation; and selection for training, including apprenticeship. Except with respect to sexual orientation, the
contractor further agrees to take affirmative action to
ensure equal employment opportunities.
19.1
19.2
24.0
23.1
Maintain worker's compensation insurance as
required by Wisconsin Statutes, for all employees
engaged in the work.
23.2
Maintain commercial liability, bodily injury and property damage insurance against any claim(s) which
might occur in carrying out this agreement/contract.
Minimum coverage shall be one million dollars
($1,000,000) liability for bodily injury and property
damage including products liability and completed
operations. Provide motor vehicle insurance for all
owned, non-owned and hired vehicles that are used
in carrying out this contract. Minimum coverage shall
be one million dollars ($1,000,000) per occurrence
combined single limit for automobile liability and
property damage.
23.3
The state reserves the right to require higher or lower
limits where warranted.
CANCELLATION: The State of Wisconsin reserves the
right to cancel any contract in whole or in part without
penalty due to nonappropriation of funds or for failure of the
contractor to comply with terms, conditions, and specifications of this contract.
DOA-3054
Page 3of 3
25.0
VENDOR TAX DELINQUENCY: Vendors who have a
delinquent Wisconsin tax liability may have their payments
offset by the State of Wisconsin.
26.0
PUBLIC RECORDS ACCESS: It is the intention of the
state to maintain an open and public process in the solicitation, submission, review, and approval of procurement
activities.
30.0
MATERIAL SAFETY DATA SHEET: If any item(s) on an
order(s) resulting from this award(s) is a hazardous chemical, as defined under 29CFR 1910.1200, provide one (1)
copy of a Material Safety Data Sheet for each item with the
shipped container(s) and one (1) copy with the invoice(s).
31.0
PROMOTIONAL ADVERTISING / NEWS RELEASES:
Reference to or use of the State of Wisconsin, any of its
departments, agencies or other subunits, or any state official or employee for commercial promotion is prohibited.
News releases pertaining to this procurement shall not be
made without prior approval of the State of Wisconsin.
Release of broadcast e-mails pertaining to this procurement
shall not be made without prior written authorization of the
contracting agency.
32.0
HOLD HARMLESS: The contractor will indemnify and
save harmless the State of Wisconsin and all of its officers,
agents and employees from all suits, actions, or claims of
any character brought for or on account of any injuries or
damages received by any persons or property resulting
from the operations of the contractor, or of any of its
contractors, in prosecuting work under this agreement.
33.0
FOREIGN CORPORATION: A foreign corporation (any
corporation other than a Wisconsin corporation) which
becomes a party to this Agreement is required to conform
to all the requirements of Chapter 180, Wis. Stats., relating
to a foreign corporation and must possess a certificate of
authority from the Wisconsin Department of Financial
Institutions, unless the corporation is transacting business
in interstate commerce or is otherwise exempt from the
requirement of obtaining a certificate of authority. Any
foreign corporation which desires to apply for a certificate of
authority should contact the Department of Financial
Institutions, Division of Corporation, P. O. Box 7846,
Madison, WI 53707-7846; telephone (608) 261-7577.
34.0
WORK CENTER PROGRAM:
The successful
bidder/proposer shall agree to implement processes that
allow the State agencies, including the University of
Wisconsin System, to satisfy the State's obligation to
purchase goods and services produced by work centers
certified under the State Use Law, s.16.752, Wis. Stat.
This shall result in requiring the successful bidder/proposer
to include products provided by work centers in its catalog
for State agencies and campuses or to block the sale of
comparable items to State agencies and campuses.
35.0
FORCE MAJEURE: Neither party shall be in default by
reason of any failure in performance of this Agreement in
accordance with reasonable control and without fault or
negligence on their part. Such causes may include, but are
not restricted to, acts of nature or the public enemy, acts of
the government in either its sovereign or contractual
capacity, fires, floods, epidemics, quarantine restrictions,
strikes, freight embargoes and unusually severe weather,
but in every case the failure to perform such must be
beyond the reasonable control and without the fault or
negligence of the party.
Bid/proposal openings are public unless otherwise specified. Records may not be available for public inspection
prior to issuance of the notice of intent to award or the
award of the contract.
27.0
28.0
PROPRIETARY INFORMATION: Any restrictions on the
use of data contained within a request, must be clearly
stated in the bid/proposal itself. Proprietary information
submitted in response to a request will be handled in
accordance with applicable State of Wisconsin
procurement regulations and the Wisconsin public records
law. Proprietary restrictions normally are not accepted.
However, when accepted, it is the vendor's responsibility to
defend the determination in the event of an appeal or
litigation.
27.1
Data contained in a bid/proposal, all documentation
provided therein, and innovations developed as a
result of the contracted commodities or services
cannot be copyrighted or patented. All data, documentation, and innovations become the property of
the State of Wisconsin.
27.2
Any material submitted by the vendor in response to
this request that the vendor considers confidential
and proprietary information and which qualifies as a
trade secret, as provided in s. 19.36(5), Wis. Stats.,
or material which can be kept confidential under the
Wisconsin public records law, must be identified on a
Designation of Confidential and Proprietary Information form (DOA-3027).
Bidders/proposers may
request the form if it is not part of the Request for
Bid/Request for Proposal package. Bid/proposal
prices cannot be held confidential.
DISCLOSURE: If a state public official (s. 19.42, Wis.
Stats.), a member of a state public official's immediate
family, or any organization in which a state public official or
a member of the official's immediate family owns or controls
a ten percent (10%) interest, is a party to this agreement,
and if this agreement involves payment of more than three
thousand dollars ($3,000) within a twelve (12) month
period, this contract is voidable by the state unless appropriate disclosure is made according to s. 19.45(6), Wis.
Stats., before signing the contract. Disclosure must be
made to the State of Wisconsin Ethics Board, 44 East
Mifflin Street, Suite 601, Madison, Wisconsin 53703
(Telephone 608-266-8123).
State classified and former employees and certain
University of Wisconsin faculty/staff are subject to separate
disclosure requirements, s. 16.417, Wis. Stats.
29.0
RECYCLED MATERIALS: The State of Wisconsin is
required to purchase products incorporating recycled materials whenever technically and economically feasible.
Bidders are encouraged to bid products with recycled
content which meet specifications.
State of Wisconsin
Department of Administration
Division of Agency Services
Bureau of Procurement
DOA-3681 (01/2001)
ss. 16, 19 and 51, Wis. Stats.
Supplemental Standard Terms and Conditions
For Procurements for Services
1.0
ACCEPTANCE OF BID/PROPOSAL CONTENT: The contents of the bid/proposal of the successful contractor will
become contractual obligations if procurement action ensues.
2.0
CERTIFICATION
OF
INDEPENDENT
PRICE
DETERMINATION:
By signing this bid/proposal, the
bidder/proposer certifies, and in the case of a joint
bid/proposal, each party thereto certifies as to its own organization, that in connection with this procurement:
2.1
2.2
The prices in this bid/proposal have been arrived at
independently, without consultation, communication,
or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any
other bidder/proposer or with any competitor;
Unless otherwise required by law, the prices which
have been quoted in this bid/proposal have not been
knowingly disclosed by the bidder/proposer and will
not knowingly be disclosed by the bidder/proposer
prior to opening in the case of an advertised procurement or prior to award in the case of a negotiated
procurement, directly or indirectly to any other
bidder/proposer or to any competitor; and
2.3
No attempt has been made or will be made by the
bidder/proposer to induce any other person or firm to
submit or not to submit a bid/proposal for the purpose
of restricting competition.
2.4
Each person signing this bid/proposal certifies that:
He/she is the person in the bidder's/proposer's organization responsible within that organization for the
decision as to the prices being offered herein and that
he/she has not participated, and will not participate, in
any action contrary to 2.1 through 2.3 above; (or)
3.2
4.0
DUAL EMPLOYMENT:
Section 16.417, Wis. Stats.,
prohibits an individual who is a State of Wisconsin employee
or who is retained as a contractor full-time by a State of
Wisconsin agency from being retained as a contractor by the
same or another State of Wisconsin agency where the
individual receives more than $12,000 as compensation for
the individual’s services during the same year.
This
prohibition does not apply to individuals who have full-time
appointments for less than twelve (12) months during any
period of time that is not included in the appointment. It does
not include corporations or partnerships.
5.0
EMPLOYMENT: The contractor will not engage the services
of any person or persons now employed by the State of
Wisconsin, including any department, commission or board
thereof, to provide services relating to this agreement without
the written consent of the employing agency of such person
or persons and of the contracting agency.
6.0
CONFLICT OF INTEREST: Private and non-profit corporations are bound by ss. 180.0831, 180.1911(1), and 181.0831
Wis. Stats., regarding conflicts of interests by directors in the
conduct of state contracts.
7.0
RECORDKEEPING AND RECORD RETENTION:
The
contractor shall establish and maintain adequate records of
all expenditures incurred under the contract. All records must
be kept in accordance with generally accepted accounting
procedures. All procedures must be in accordance with
federal, state and local ordinances.
He/she is not the person in the bidder's/proposer's
organization responsible within that organization for
the decision as to the prices being offered herein, but
that he/she has been authorized in writing to act as
agent for the persons responsible for such decisions
in certifying that such persons have not participated,
and will not participate in any action contrary to 2.1
through 2.3 above, and as their agent does hereby so
certify; and he/she has not participated, and will not
participate, in any action contrary to 2.1 through 2.3
above.
3.0
DISCLOSURE OF INDEPENDENCE AND RELATIONSHIP:
3.1
Prior to award of any contract, a potential contractor
shall certify in writing to the procuring agency that no
relationship exists between the potential contractor
and the procuring or contracting agency that interferes
with fair competition or is a conflict of interest, and no
relationship exists between the contractor and another
person or organization that constitutes a conflict of
interest with respect to a state contract.
The
Department of Administration may waive this provision, in writing, if those activities of the potential contractor will not be adverse to the interests of the state.
Contractors shall agree as part of the contract for
services that during performance of the contract, the
contractor will neither provide contractual services nor
enter into any agreement to provide services to a
person or organization that is regulated or funded by
the contracting agency or has interests that are
adverse to the contracting agency. The Department
of Administration may waive this provision, in writing,
if those activities of the contractor will not be adverse
to the interests of the state.
The contracting agency shall have the right to audit, review,
examine, copy, and transcribe any pertinent records or
documents relating to any contract resulting from this
bid/proposal held by the contractor. The contractor will retain
all documents applicable to the contract for a period of not
less than three (3) years after final payment is made.
8.0
INDEPENDENT CAPACITY OF CONTRACTOR:
The
parties hereto agree that the contractor, its officers, agents,
and employees, in the performance of this agreement shall
act in the capacity of an independent contractor and not as
an officer, employee, or agent of the state. The contractor
agrees to take such steps as may be necessary to ensure
that each subcontractor of the contractor will be deemed to
be an independent contractor and will not be considered or
permitted to be an agent, servant, joint venturer, or partner of
the state.
STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DIVISION OF ENTERPRISE OPERATIONS
BUREAU OF PROCUREMENT
S. 16.765, WIS. STATS.
DOA-3477 (R01/08)
KK-4464
Bid / Proposal #
CERTIFIED AODA SERVICES IN
SHEBOYGAN, WI
Commodity / Service
Vendor Information
1.
BIDDING / PROPOSING COMPANY NAME
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
2.
City
State
Zip + 4
Name the person to contact for questions concerning this bid / proposal.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
3.
City
State
Zip + 4
Any vendor awarded over $50,000 on this contract must submit affirmative action information to the
department. Please name the Personnel / Human Resource and Development or other person responsible
for affirmative action in the company to contact about this plan.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
4.
City
State
Zip + 4
Mailing address to which state purchase orders are mailed and person the department may contact
concerning orders and billings.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
City
5.
State
Zip + 4
CEO / President Name
This document can be made available in accessible formats to qualified individuals with disabilities.
STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DIVISION OF ENTERPRISE OPERATIONS
DOA-3027 (R03/2013)
S. 19.36(5), WIS. STATS
RETURN FORM TO:
STATE BUREAU OF PROCUREMENT
101 E. WILSON ST., 6TH FL
P. O. BOX 7867
MADISON, WI 53707
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION
The attached material submitted in response to Bid/Proposal # KK-4450 Certified AODA Services in Sheboygan,
WI includes proprietary and confidential information which qualifies as a trade secret, as provided in s. 19.36(5), Wis.
Stats., or is otherwise material that can be kept confidential under the Wisconsin Open Records Law. As such, we ask
that certain pages, as indicated below, of this bid/proposal response be treated as confidential material and not be
released without our written approval.
Prices always become public information when bids/proposals are opened, and therefore cannot be kept confidential.
Other information cannot be kept confidential unless it is a trade secret. Trade secret is defined in s. 134.90(1)(c), Wis.
Stats. as follows: "Trade secret" means information, including a formula, pattern, compilation, program, device,
method, technique or process to which all of the following apply:
1. The information derives independent economic value, actual or potential, from not being generally known to, and not
being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or
use.
2. The information is the subject of efforts to maintain its secrecy that are reasonable under the circumstances.
We request that the following pages not be released.
Section
Page #
Topic
In the event the designation of confidentiality of this information is challenged, the undersigned hereby agrees to provide
legal counsel or other necessary assistance to defend the designation of confidentiality and agrees to hold the state
harmless for any costs or damages arising out of the state's agreeing to withhold the materials.
Failure to include this form in the bid/proposal response may mean that all information provided as part of the bid/proposal
response will be open to examination and copying. The state considers other markings of confidential in the
bid/proposal document to be insufficient. The undersigned agrees to hold the state harmless for any damages arising
out of the release of any materials unless they are specifically identified above.
Company Name
Authorized Representative
Signature
Authorized Representative
Type or Print
Date
This document can be made available in alternate formats to individuals with disabilities upon request.
Division of State Agency Services
State Bureau of Procurement
State of Wisconsin
Department of Administration
DOA-3333 (R03/2004)
1.1.1
Vendor Agreement
Wisconsin’s Cooperative Purchasing Service
Wisconsin statutes (s. 16.73, Wis. Stats.) establish authority to allow Wisconsin municipalities to purchase from state
contracts. Participating in the service gives vendors opportunities for additional sales without additional bidding.
Municipalities use the service to expedite purchases. A "municipality" is defined as any county, city, village, town, school
district, board of school directors, sewer district, drainage district, vocational, technical and adult education district, or any
other public body having the authority to award public contracts (s. 16.70(8), Wis. Stats.). Federally recognized Indian tribes
and bands in this state may participate in cooperative purchasing with the state or any municipality under ss. 66.0301(1) and
(2), Wis.Stats.
Interested municipalities:

will contact the contractor directly to place orders referencing the state agency contract number; and

are responsible for receipt, acceptance, inspection of commodities directly from the contractor, and making
payment directly to the contractor.
The State of Wisconsin is not a party to these purchases or any dispute arising from these purchases and is not liable for
delivery or payment of any of these purchases.
The State of Wisconsin will determine the contractor’s participation by checking a box below.
MANDATORY: Bidders/Proposers must agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. Vendors should note any special conditions below.
OPTIONAL: Bidders/Proposers may or may not agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. A vendor’s decision on participating in this service has no effect on awarding this
contract.
A vendor in the service may specify minimum order sizes by volume or dollar amount, additional charges beyond
normal delivery areas, or other minimal changes for municipalities.
Vendor: please check one of the following boxes in response.
I Agree to furnish the commodities or services of this bid/proposal to Wisconsin municipalities with any
special conditions noted below.
I Do Not Agree to furnish the commodities or services to Wisconsin municipalities.
Special Conditions (if applicable):
Signature
Date (mm/dd/ccyy)
Name (Type or Print)
Title
Company
Telephone
(
Address (Street)
City
State
)
ZIP + 4
Commodity/Service
Request for Bid/Proposal Number
Certified AODA Services in Sheboygan, WI
RFB # KK-4464
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DIVISION OF ENTERPRISE OPERATIONS
DOA-3478 (R06/2013)
STATE BUREAU OF PROCUREMENT
101 E. WILSON ST. / P. O. BOX 7867
MADISON, WI 53707-7886
(608) 266-2605 / FAX (608) 267-0600
KK-4464
Bid / Proposal #
Certified AODA Services in
Sheboygan, WI
VENDOR REFERENCE
FOR VENDOR:
Provide information on business reference (name of company/organization/client, address, contact person, telephone
number, email address) and appropriate details on the service(s) provided for four (4) or more references with
requirements similar to those included in this solicitation document. If vendor is proposing any arrangement
involving a third party, the named references should also be involved in a similar arrangement.
Company Name
Address (include Zip + 4)
Contact Person
Email Address
Description and Dates of Service(s) Provided:
Phone No.
Company Name
Address (include Zip + 4)
Contact Person
Email Address
Description and Dates of Service(s) Provided:
Phone No.
Company Name
Address (include Zip + 4)
Contact Person
Email Address
Description and Dates of Service(s) Provided:
Phone No.
Company Name
Address (include Zip + 4)
Contact Person
Email Address
Description and Dates of Service(s) Provided:
Phone No.
This document can be made available in accessible formats to qualified individuals with disabilities.
* IMPORTANT:
References may be contacted to confirm the Bidder’s abilities, qualifications, and experience as stated in the Bidder’s
Response. The Department of Corrections may perform due diligence by contacting any applicable business reference, including references
within the Department or other state agencies. The Department of Corrections reserves the right to disqualify any Bidder whose references do
not support their stated claim of qualifications and experience in their bid response.
Exhibit 1
EFFECTIVE DATE
WISCONSIN
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
July
DOC-1356 (Rev. 05/96)
PAGE 1 OF
2001
New
ORIGINATED BY
Administrative Directive 01-10
Replaces 99-15
1.2
SUBJECT:
DISSEMINATION
X
1
MANUAL REFERENCE
1.1.1.1.1.1.1
x Revision
William J.
Grosshans,
Administrator
Kerr v. Farrey
PRIORITY
All Staff
X
Supervisory Staff Only
X
Policy / Directive
Information
Discuss at Staff Meeting
Read / Route / Post
The purpose of this directive is to ensure the Division of Community Corrections'
procedures comply with the decision of the United States 7t' Circuit Court of Appeals in
Kerr v. Farrey. 95 F.3d 472 (1996). In that decision, the court ruled that it was a violation
of the 1St Amendment of the United States Constitution to order an offender to attend a
treatment program with religious components. The court considered Alcoholics
Anonymous, for example, to be a program with a religious component since the program
refers to a "higher being" and to "God as we understand him."
An agent may order an offender to attend a specific secular (non-religious) treatment or
support program. An agent may not order an offender to attend a specific program with a
religious component. An offender may voluntarily participate in a treatment or
support program with a religious component as long as a non-religious program is
offered.
An agent may write a rule requiring an offender to attend and complete AODA treatment
without naming a specific program. An agent may also provide an offender with a list of
acceptable programs, as long as both secular and non-secular options are clearly
identified. If an offender chooses to participate in a program having a religious
component, the agent should document in the Chronological Log that a secular program
was offered.
________________________________
William J. Grosshans
Administrator
cc - DCC Administrative Directive Group
Executive Staff
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 4/2013)
WISCONSIN
EXHIBIT 2
REFERRAL FOR SERVICES
PART A - REFERRAL FOR SERVICES - Completed by Referring Agent
PROGRAM NAME and LOCATION:
OFFENDER FEE PER GROUP
REFERRAL DATE
PROJECTED ELIGIBILITY DATE FOR SERVICES AGENT NAME
AGENT AREA NUMBER
AGENT TELEPHONE NUMBER (With Area Code)
AGENT EMAIL ADDRESS
AGENT STREET ADDRESS
SID NUMBER
OFFENDER NAME (As Shown on Court Order)
Last:
First:
DOC NUMBER
MI
DOB
SEX
RACE
Male
Female
OFFENDER TELEPHONE NUMBER
(With Area Code):
OFFENDER CURRENT ADDRESS
MARITAL STATUS:
Single, never married
OFFENDER STATUS AT TIME OF REFERRAL:
Felony
Misdemeanor
One Year or Less Probation
Married
Separated
Widow/Widower
Divorced
Probation
Parole
Extended Supervision
980 Case
Habitual
Deferred Prosecution
Reentry from Jail
Reentry from Prison
NGI
SUPERVISION DISCHARGE DATE
Reentry from DAI ATR
EDUCATIONAL ACHIEVEMENT: Highest Grade Level Achieved
DOES INDIVIDUAL HAVE OUTSTANDING WARRANT OR PENDING CHARGES
Yes
No - If Yes, Explain:
REASON FOR REFERRAL (List Problems, Behaviors Evidenced By Offender and Specific Services Requested) :
REFERRAL TYPE (Check All That Apply)
ALTERNATIVE TO REVOCATION (ATR)
RESPONSE TO VIOLATION (NOT AN ATR)
OPERATING WHILE INTOXICATED 2nd /3rd
PAROLE/ES CONDITION
EARNED RELEASE PROGRAM (ERP)
OTHER - Specify:
COURT ORDERED CONDITION
CHALLENGE INCARCERATION PROGRAM (CIP)
COMPAS SUB-SCREENING TOOLS (If Completed )
URICA - University of Rhode Island Change Assessment - STAGE =
VASOR - Vermont Assessment of Sex Offender Risk – RISK LEVEL =
Static 99
– Risk assessment tool designed to predict risk of sexual recidivism – RISK CATEGORY =
OTHER:
ACTUAL SUPERVISION LEVEL :
COMPAS GENERAL RECIDIVISM SCORE:
Results:
Low
Medium
out of 10
High
COMPAS VIOLENT RECIDIVISM SCORE:
out of 10
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
WISCONSIN
CRIMINOGENIC NEEDS IDENTIFIED IN COMPAS AND/OR CURRENT CASE PLAN [Check all that apply]:
“THE TOP FOUR”
Anti-Social Cognition (Criminal Thinking Self Report; Cognitive Behavioral; Criminal Opportunity; Social Isolation; Social Environment; Socialization
Failure; Social Adjustment Problems)
Anti-Social Companions (Criminal Associates and Peers; Cognitive Behavioral; Criminal Opportunity; Social Isolation; Social Adjustment Problems;
Socialization Failure; Social Environment)
Anti-Social Personality (Criminal personality; Criminal Opportunity, Cognitive Behavioral; Social Isolation; Socialization Failure; Social
Adjustment Problems; Anger)
Family/Marital (Family Criminality; Criminal Opportunity; Social Environment; Socialization Failure; Social Adjustment Problems)
“THE OTHER FOUR”
Substance Abuse (Substance Abuse; Social Environment; Social Isolation; Cognitive Behavioral; Leisure and Recreation)
Employment/Financial (Vocation/Education; Financial; Criminal Opportunity)
Vocational/Educational (Vocation/Education; Financial; Criminal Opportunity)
Leisure and/or Recreation (Leisure recreation; social isolation)
SERVICES REQUEST (Check All That Apply and Are Pertinent to the Case Plan)
Type
Abbreviation
Type
Key
Priority (e.g. 1, 2, 3)
Type
(Based on Risk and Need) Abbreviation
Type
Key
AM
Anger Management
DV
Domestic Violence
Programming
Antabuse
Antabuse Treatment
Employ
Employment Services
AODA
AODA (All Types of Tx)
HWH
Halfway Houses
MH
Mental Health Services
AODA Assess AODA Assessment Only
Circles
Circles of Support
Other:
Cog
Cognitive Interventions
Reentry:
CS
Community Service
RJ
Restorative Justice
SOT
Sex Offender
Treatment
PRE
Pre Treatment
Misc Day Tx Services
Day Tx
Drug Court
DC
Dual Diagnosis Programming
DD
TLP
Day Report Center
DRC
VocEd
SPECIAL NEEDS (Check All Relevant Categories)
Yes
No
Alcohol Problems
Yes
(Based on Risk and Need)
Transitional Living
Program
Vocational
Programming
No
History of Violence, attach Description.
Drug Problems - Specify:
History of Committing Sexual Assaults
Health Problems - Specify:
Pregnant
Mental Health Problems - Specify:
Relationship Problems
Developmental or Learning Disabilities
Financial Management Problems
Other - Specify:
IS OFFENDER TAKING MEDICATION (A SIGNED DOC-1163A REQUIRED TO RELEASE THIS INFORMATION)
Yes
Priority (e.g. 1, 2, 3)
No - If Yes , List Reason and Type:
Prescription
Self-Pay
Insurance
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
WISCONSIN
THIS REFERRAL MUST INCLUDE THE FOLLOWING INFORMATION:
Authorization for Use and Disclosure of Protected Health Information (DOC-1163A)
Required for information that involves personal health information, medical, mental health, AODA, or other confidential or services.
Court Order, Criminal Complaint and Prior Conviction Record
Social Information (DOC-179)
Violation Report(s), if applicable (DOC-0005)
Alternative to Revocation Agreement, if applicable (DOC-250)
Information regarding Alcohol, other Drug Problems and Prior Treatment Experience, if applicable.
COMPAS Assessment Narrative and Bar Chart
Priority 1
 High Risk Level AND
 A MINIMUM of 2 of “The Top Four”
Criminogenic Needs
Priority 2
 Medium Risk Level or Higher AND
 A MINIMUM of 1 of “The Top Four”
Criminogenic Needs


Priority 3
Low Risk Level or Higher AND
A MINIMUM of 1 of “The Top Four”
Criminogenic Needs
PART B INTAKE DECISION –
Completed by Contracted Provider Agency for Offender Entering, Re-entering or Wait Listed for the Program
INSTRUCTIONS: Attach this completed form to your agency’s “Offender Report Form Monthly" (DOC-386, DOC-1088, or DOC-1088A) for each offender
who is wait listed or enters your program. These forms must be mailed to the regional Program & Policy Analyst along with the completed DOC-1088.
RECOMMENDED PROGRAM NAME/DAY OF WEEK/TIME:
START DATE:
PROJECTED DISCHARGE DATE
RECOMMENDED PROGRAM/DAY OF WEEK/TIME:
START DATE:
PROJECTED DISCHARGE DATE:
RECOMMENDED PROGRAM/DAY OF WEEK/TIME:
START DATE:
PROJECTED DISCHARGE DATE:
INSTRUCTIONS TO VENDOR/LIAISON: Program priority and placement shall be determined by considering an offender’s actual supervision level
recommendation score and criminogenic need.
OFFENDER ACCEPTANCE / PROGRAM RETURN (Check Appropriate Box, Enter Appropriate Data)
(WHEN OFFENDER IS PLACED ON WAIT LIST RETAIN A COPY OF THIS FORM AND RETURN IT WITH APPROPRIATE INFORMATION WHEN
OFFENDER IS READY TO START GROUP)
Offender Accepted as New Intake
Offender Returned to Program
Offender Rejected – Specify For What Reason:
Offender On Wait List – Specify for What Reason And Include Anticipated Start Date:
REASON:
Part B completed by (Name): ___________________________________________
Title: ________________________________________________
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
WISCONSIN
Completing a DOC-1336 Referral for Services
Part A: Agent/DCC responsible for Completion
Program Name and Location:
Name of POGS contracted program and location where referral is being sent to.
Offender Fee per Group: As determined by the agent of record and/or contract language, specify how much of a client
fee per group, week, etc. the offender is responsible to pay and the vendor collect. If unable to pay, please note
WAIVED.
Referral Date:
Enter in the following format XX/XX/XXXX
Projected Eligibility Date for Services:
Agent Name:
SID#:
Enter date offender may start programming XX/XX/XXXX
Enter LAST NAME, FIRST NAME
Enter as determined
Agent Area number: Enter 5 digit number -- 12345
Agent Telephone number: (XXX)XXX-XXXX Enter direct telephone line – not office main line.
Agent email Address:
Example: [email protected]
Agent Street Address:
Enter full address to include Street, City and Zip Code
Offender LAST Name …. First ….. MI: SMITH, JOE K.
DOC Number: 000000
DOB:
Enter as 00/00/0000
Sex:
Check Male or Female
Race: Enter Race as reported by offender
Offender telephone Number: Enter as (000)000-0000 and note if this is offenders line, family member line or if the line
will be disconnected soon. Also include alternate numbers the offender may be contacted at.
Offender Current Address: Enter street, city, zip and any additional addresses offender may be contacted at.
Marital Status: Check appropriate box.
Offender Status at Time of Referral: Check appropriate box
Supervision Discharge Date: Enter as 00/00/0000
Educational Achievement: Highest grade completed
Outstanding Warrants or Pending Charges: If known, enter Reason for Warrant, Agency that entered warrant, contact
information, Warrant/Case Number. Same info for Pending Charges.
Reason for Referral: This should be very detailed. List behaviors demonstrated, recent violations, previous treatment
attempts, case plan drivers/tasks, offender motivation and/or responsivity issues the vendor may need to address.
Referral Type: Check appropriate box(es) Use “Other” box for ES sanction. Include release date.
COMPAS Sub-Screening Tools: Check boxes and provide Results for any screening tools completed prior to referral.
Actual Supervision Level: Check applicable box based upon COMPAS Results and inclusive of DCC override
procedures. Note: Check High for supervision levels such as CIP per policy, ENS, OWI 2,3, INT/SO, etc.
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 10/2013)
WISCONSIN
COMPAS General and Violent Recidivism scores: Enter in the following format (_/10) from COMPAS paperwork.
Criminogenic Needs: After COMPAS intake is complete and Case Plan has been developed, check boxes of
criminogenic needs that are actively being addressed between both the DCC Agent and offender via documented Tasks
and Activities. If no case plan exists use professional judgment to best determine needs.
The criminogenic needs from the COMPAS assessment will not directly correlate to the “Top 4” and “Other 4” needs as
listed in EBP. In fact some needs from COMPAS such as criminal opportunity appear in all of the Top 4. This is an area
where agent professional judgment and critical thinking skills are vital.
For example an offender is assessed as having a highly probably need in the area of criminal opportunity. The agent
then needs to review the Top 4 and Other 4 to determine where criminal opportunity fits in. Is it due to the offenders lack
of problem solving or coping skills? Is it due to risky thinking individually or as part of a group? Is it perhaps due to an
inability to build positive relationships in the community or with family members? The answers to these questions will
directly correlate to a Top 4 or Other 4 need.
Services Request: Check all that are pertinent to the DCC case plan and can be provided by the vendor.
Special Needs: Check as applicable and provide supporting documentation of each “YES”.
Offender Medication: Check as applicable. Agent shall secure a signed DOC-1163 in order to release information about
medications to vendor.
Include the Following information: Check all documents that are attached to the referral packet.
Priority Placement Boxes: Review “Criminogenic Needs” section of the DOC-1336. Consider all checked boxes and
determine how many of “The Top Four” are checked or otherwise listed on the current DCC Case Plan and the offenders
current supervision level to determine Priority 1,2 or 3. Same as with criminogenic needs in regard to the case plan.
PART B: Vendor is Responsible for completion
Created 10/25/2013
Exhibit 3
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1088 (Rev. 4/2010)
WISCONSIN
OFFENDER REPORT – MONTHLY
COMMUNITY - BASED PROGRAMS and SERVICES
AGENCY NAME
TELEPHONE NUMBER
REPORTING PERIOD
(Month/Year)
PURCHASE ORDER NUMBER
PROGRAM NAME
FEDERAL FUNDING
Yes
REPORT COMPLETED BY (Signature/Title)
I Total Number of Offenders
L Other Information
J Total Units Provided
B6
OWI 3rd
B5
OWI 2nd
B4
CER
B3
PAT
B
OFFENDER NAME
B2
ATR
A
DOC #
REPORT REVIEWED BY DCC Staff (Signature)
DATE SIGNED
Use this form for all Community-based programs and services except Halfway House, use DOC-386 and Day Treatment, use DOC-1088A. Letters A through F must be completed; all
other columns may be required in accordance with the agency’s contract/grant agreement or at the direction of the Contract Administrator. An asterisk notes all columns that require a
code. All codes for the completion of this form are listed on the back of the form.
B1
DOB
INSTRUCTIONS:
DATE SIGNED
No
C
AGENT
AREA #
D
ADMISSION
DATE
E*
TYPE OF
SERVICE
G*
STATUS
Discharge
F
SERVICE DATE OR DATES
Date
K Are Alcohol and Other Drug Abuse Services Provided Under This Contract/Grant
Code
Yes
H
OFFENDER FEES
COLLECTED THIS
MONTH
No
Exhibit 3
INSTRUCTIONS AND CODES FOR DOC-1088
A
Enter Offender DOC Number as given to provider on Part A, "Referral for Service Form" (DOC-1336).
B
Enter Offender Last Name, First Name and Middle Initial as given to approver agent on Part A, "Referral of Services Form"
(DOC-1336).
B1
Enter Offender Date of Birth as given by agent on Part A, "Referral of Services Form" (DOC-1336).
B2
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
B3
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
B4
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
B5
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
B6
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all that apply.
C
Enter DOC Agent Area Number as given to provider on Part A, "Referral for Services Form" (DOC-1336).
D
Enter Admission Date.
E
Enter Code number which applies. If your agency provided more than one type of service under the contract/grant during the
month, use a separate line on the form to report each type of service provided to each offender.
(507-30)
Group counseling, outpatient
(606)
Emergency housing
(507-10)
Outpatient counseling, Individual
(607-10)
Employment, on-the-job
(507-20)
Outpatient counseling, family
(607-20)
Employment - evaluation
(603)
Intake assessment
(607-30)
Employment - job placement
(604)
Evaluation
(607-40)
Employment - job preparation
(605)
Sex offender treatment
(608)
Education
F
List each separate date on which service was provided. As an example, if service was provided on May 5, 10 and 16, list 5/5,
5/10 and 5/16. Do not list a range of dates such as 5/5 through 5/10.
G
Enter Status Code for each program participant under the DOC contract or grant. If two codes apply, enter highest
code number. Enter date of Status Change for all codes except 01.
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
H
Continues in program
Completed Service - Significant improvement in most or all areas has occurred and the offender is
approaching or has attained full recovery (Good)
Completed Service - Improvement in some areas has occurred but the degree of improvement is minimal
(Fair)
Completed Service - No positive change has occurred (Poor)
Referred to another Agency
Behavioral Termination - Staff / Program decision to terminate due to breaking internal program rules
Withdrew Against Staff Advice
Funding / Authorization Expired (service not completed)
Program Hold - When offender is temporarily not involved in service. Each program hold incident must
be 30 days or less
Positive urinalysis screen, positive breathalyzer test or other indication of drugs
Absconding
Rules Violation - Other than drug / alcohol use or absconding
New Offense
Hospitalized
Death
Other (specify in Field L "Other Information" at bottom of form)
Enter total amount of offender fees collected this month for each offender. Total amount of fees collected are reflected as a
total monthly offender fee reduction on the “Unit Service Monthly Report” (DOC-1026).
I
Total number of offenders provided direct service this month.
J
Total units of service provided this month.
The total units provided, (for example, number of hours, days or group sessions provided) are dependent upon the
payment arrangement with the Department of Corrections.
K
Are alcohol and drug abuse services provided under this contract/grant? This is necessary to verify confidential status of form.
L
Use this space to note codes which need to be specified from Field E and Field G.
EXHIBIT 4
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1026 (Rev. 2/97)
WISCONSIN
Wisconsin Statutes
Section 301.08
UNIT SERVICE
MONTHLY REPORT
AGENCY NAME
VENDOR ID NUMBER
PURCHASE ORDER NUMBER
PROGRAM NAME
TELEPHONE NUMBER
DOC CONTACT SIGNATURE
REPORTING PERIOD (Month / Year)
As the authorized representative of the above named agency, I request that my
agency is reimbursed for units of service provided to eligible Correctional offenders.
UNIT OF SERVICE(S) PROVIDED
UNIT
DESCRIPTION
NUMBER OF
UNITS
COST PER
UNIT
Less Billing to Other Agencies
Less Offender Fees Collected
NET REIMBURSABLE
TOTAL
=
I understand that my agency is required to submit a Offender Monthly Report within
30 days after the final day of the month for which this Unit Service Report is due.
I certify that the unit of services indicated for claiming State reimbursement are just, true
and correct in the amount stated and have not been reimbursed, and represent actual
services delivered and reimbursable under the laws, rules and regulation of the Wisconsin
Department of Corrections.
CONTRACTOR AGENCY CONTACT SIGNATURE
DISTRIBUTIO
N:
Submit original and 2 copies to Grant/Contract Administrator
DATE SIGNED
Exhibit 5
DEPARTMENT OF CORRECTIONS
OFFICE OF THE SECRETARY
DOC-1923 (Rev. 5/2012)
WISCONSIN
Wisconsin Statutes
§ 48.981, 51.30,146.81-84, 252.15, 938.78
Federal Regulations
42 CFR Part 2
45 CFR Parts 160, 162 and 164
LIMITS OF CONFIDENTIALITY OF HEALTH INFORMATION
NOTE: DAI uses WICS ORPT170/DOC-2468 for inmates upon admission to a DAI facility. DAI Psychological Services Units, DJC facilities
and DCC may use this form, as appropriate.
OFFENDER NAME
DOC NUMBER
THIS FORM EXPLAINS YOUR CONFIDENTIALITY RIGHTS FOR HEALTH CARE INFORMATION. READ IT CAREFULLY
1. Department of Corrections (DOC) health care providers include physicians, nurses, psychiatrists, psychology
staff, dentists, physical therapists, other health professionals, and staff supervised by those providers.
2. Health care providers document every interaction with you in your Health Care Record such as your Medical
Chart, Dental Record and Psychological Services Unit Record, and in limited circumstances in your Social
Services File and Field Case File.
3. You have a right to limited confidentiality of your health information within the DOC. DOC staff with a job-based
“need to know” may have access to health information contained in your Health Care Record, Social Services File,
and Field Case File.
4. Health care providers have the right to access your health information to meet your health care needs.
5. Non-health care staff such as wardens/superintendents, members of the Earned Release Review Commission,
probation/parole agents, Inmate Complaint Examiners and others involved in processing inmate complaints,
social workers, Bureau of Offender Classification and Movement specialists, and security staff may have access
to limited health information in order to make decisions related to your custody level, safety, movement and
release, and to resolve your complaints.
6. Health care providers must report information to the appropriate DOC authorities if it raises concern about a threat to you, a
correctional facility, community corrections operations, and/or public safety. This may include the following:
a. Overt/covert threats or harm to yourself or others.
b. Reports of any alleged sexual activity between an inmate and any other person.
c. Reports of any sexual assault or intimidation between an inmate and any other person.
d. Plans to riot or escape and possession of drugs or weapons.
e. Suspicious or unexplained deaths (homicides, suicides).
f. Unknown past criminal conduct that increases the potential risk to a facility, community corrections
operations and/or the pubic, including self-reported acts of homicide, attempted homicide, or 1st/2nd degree
sexual assault.
7. DOC shall not permit individuals outside the DOC to access health information about you unless one of the
following applies:
a. You sign an Authorization for Use and Disclosure of Protected Health Information (DOC-1163A), or equivalent
form, authorizing the disclosure.
b. A judge issues a valid court order authorizing the DOC to disclose the information.
c. A Wisconsin or federal law permits the access without a signed authorization from you.
I have read (or had read to me) the above information and have been given the opportunity to ask questions. I understand the
limits of confidentiality of my health information explained in this document.
OFFENDER SIGNATURE
DATE SIGNED
WITNESS SIGNATURE (DOC or Contract Agency Staff)
DATE SIGNED
WITNESS JOB CLASSIFICATION / TITLE
DISTRIBUTION:
DOC LOCATION or CONTRACT AGENCY NAME/ LOCATION
Original (DCC) - Field Case File; Copy (DCC) – Contract Agency File (if applicable); Copy - Offender
Original (DJC) - PSU Record, Legal Documents/Consents/Outside Records Section when completed in DJC; Copy - Offender
Original (DAI PSU) - PSU Record, Legal Documents/Consents/Outside Records Section; Copy - Offender
EXHIBIT 6
Evidence-Based
Correctional Program Checklist
The Correctional Program Checklist (CPC) is a tool developed to assess the extent to which
correctional treatment programs adhere to the known principles of effective intervention. It is designed
to evaluate the integrity of a program, not outcomes. The CPC is based on the results of over 500
program assessments and three large outcome studies.
The CPC is divided into two basic areas: Capacity and Content.
The Capacity area is designed to measure whether a correctional program has the capability to deliver
evidence-based interventions and services for offenders. There are three domains in the capacity area:
CAPACITY
1. Quality Assurance
• Program monitoring activities
• Reassessment of offenders
• Evaluation
2. Staff Characteristics
• Education of the staff
• Experience of the staff
• Assessment & training of the staff
3. Leadership & Development
• Involvement and qualifications of program director
• Implementation and design of the program
• Support for the program
The Content area has two domains and focuses on the substantive domains of Offender Assessment
and Treatment Characteristics, and the extent to which the program meets the principles of risk, need,
responsivity, and treatment.
CONTENT
4. Offender Assessment
• Selection of offenders
• Assessment of offenders
5. Treatment Characteristics
• Targeting of criminogenic needs
• Type of interventions used
• How treatment is delivered
• Provision of aftercare
Information is gathered through structured interviews with selected program staff and program
participants and observation of groups and staff. Other sources of information include policy manuals,
program curriculum, schedules review of case files, surveys, & other selected program materials
There are several advantages to the CPC:
1. All of the indicators included in the CPC have been found to be correlated with reductions in
recidivism.
2. The process provides a measure of program integrity and quality; it provides insight into the
“black box” of a program, something that an outcome study alone does not provide.
3. The results can be obtained relatively quickly; usually the process takes a day or two and a
report is generated within a few weeks.
4. It identifies both the strengths and weaknesses of a program and provides recommendations
designed to improve the integrity of the program and to increase effectiveness.
Prepared by the WI Department of Corrections
Office of Research & Project Management
Page 1 of 2
Evaluation Steps
1. Schedule site visit with program and program evaluators.
2. Day of site visit:
 Interview program/treatment director
 Interview staff
 Interview program participants
 Review case files
 Review program manuals and curricula
 Review assessment instruments
 Observe treatment group(s)
3. Day after the site visits the evaluation team meets to determine the final scores for the
program evaluation.
4. Within one or two weeks after the site visit a draft report detailing evaluation results and
recommendations is sent to the program.
5. Program is given 30 days to respond to the draft report in writing, noting any information that
is incorrect or that was missed.
6. Evaluation team takes program’s response into consideration, then compiles a final report
and sends it to program and anyone else who needs to see it.
7. Within 30 days, the program submits to the Department a “corrective action plan” detailing
the steps it will take to address areas needing improvement based on evaluation
recommendations.
8. A follow-up evaluation is done within one year if the program scores below the “effective”
category, within three years if it scores in the “effective” category, and within five years if it
scores in the “highly effective” category.
Prepared by the WI Department of Corrections
Office of Research & Project Management
Page 2 of 2
EXHIBIT 6
Evidence-Based
Correctional Program Checklist
PROGRAM GUIDELINES:
Programs using evidence based curriculum for groups and training the staff in the delivery of that curriculum will increase
program fidelity. Several factors are noted to be essential to program success as measured by the difference in recidivism
between treatment and control groups. The National Institution of Correction’s curriculum Offender Risk Reduction:
Evidence Based Practice and Cognitive Behavioral Interventions Standard Operating Procedures (Dec 2001) were used
as a reference in the development of these guidelines.
Characteristics consistently associated with program efficacy:
1.
Sound Conceptual Model. Programs based on a cognitive-behavioral theoretical model were the most
beneficial when applied in appropriate dosage according to offender risk and need measurements.
2.
Multifaceted Programming. Multifaceted programs, which incorporated a variety of techniques in their
intervention strategy, were more beneficial than those correctional programs that relied on a single
method.
3.
Targeting “criminogenic risk factors.” In successful programs, program targets were factors linked
with recidivism such as social cognitions or antisocial attitudes.
4.
Responsivity Principle. Program efficacy was dependent on matching styles and modes of service to
the learning styles, characteristics and abilities of offenders based upon identified risks and needs.
5.
Role Playing/Modeling. In successful programs, correctional worker/agents modeled anti-criminal
attitudes and behavior. Modeling and role-playing techniques were used to train offenders in empathy,
interpersonal problem solving and social skills, which enabled them to cope pro-socially with adverse or
criminogenic environmental experiences.
6.
Social Cognitive Skills Training. Including program techniques that could have an impact on the
offender’s thinking was of critical importance.
Characteristics that make cognitive behavioral programs effective:
A. Group/Class Setup
1.
The facilitator is present; with the necessary materials adequately organized, and prepared to greet
arriving participants several minutes ahead of the scheduled group time.
2.
Attendance and tardiness are accurately and efficiently documented.
3.
Homework (as required by specific programs) is reviewed, checked, and appropriately reinforced.
4.
Each lesson is introduced so participants have an overview of the session.
5.
The introduction of each lesson should include reasons why content or process should be valued by the
participants and should be tailored to address each participant’s perspective.
B. Specific Skill Development
1.
The facilitator should define the skill or concept being introduced.
2.
The facilitator should explain why the skill or concept is important and how it is related to other material
previously covered.
3.
The facilitator should present the thinking and actions that make up the specific skill.
4.
The facilitator should model the skill correctly.
5.
The facilitator should ask questions and make sure all participants understand the specific skill before
moving on to a new skill.
6.
The facilitator should use examples and scenarios that are simple and easy to follow and directly relevant
to the criminogenic (crime-producing behavior) needs of participants.
7.
The facilitator should allow participants to practice skills as much as possible and devote a significant
portion (at least two-thirds) of a session to practice and exercises.
8.
The facilitator should provide feedback to participants with at least 80% being positive and reaffirming.
9.
During the summary session, the facilitator should include a review of what the group is learning, why the
information is important to participants, and in what specific situations the skills can be used.
10.
The facilitator should always follow the lesson plan and assign homework as directed by the
curriculum.
Prepared by the WI Department of Corrections
Office of Research & Project Management
Page 1 of 2
C. Classroom Management
1.
The facilitator should start the session precisely on time.
2.
The facilitator should identify and address (but not judge) any pro-criminal responses and behaviors
(allowing these responses and behaviors to going on without addressing them undermines the intent of
the curriculum).
3.
The facilitator should maintain a clearly defined set of group participation rules with simple, specific
consequences for violation.
4.
The facilitator should enforce class rules and boundaries.
5.
The facilitator should acknowledge the need for and expect a different level of performance based on
the individual skills and abilities of the participants.
6.
The facilitator should take the necessary steps (both structural and situational) to insure each participant
is involved in each session.
7.
The facilitator should use humor appropriately throughout each session.
8.
The facilitator should use the necessary equipment and materials (i.e., flipcharts, chalkboards, overheads,
TV/VCR, workbook, stapler, paper clips, pens, pencils, and paper) appropriately throughout each session
in addition to access to a copy machine in preparation for sessions.
9.
The program participants should have a workbook or folder to hold loose workbook pages or
additional information, additional paper for note taking, and each participant should be provided with a pen
or pencil.
D. Participant Involvement
1.
Participants should be actively and voluntarily engaged and paying attention throughout each session.
2.
Participants should be able to demonstrate their understanding of the content and processes used
throughout each session.
3.
Participants should provide positive and innovative input to the session.
4.
Participants should adequately complete class activities and homework assignments.
5.
Participants should demonstrate some understanding of their individual risk factors.
E.
Documentation and Accountability
The facilitator should have a clear and effective system to document the following items:
__ Intake interview process (in addition to pre-testing instrument)
__ Attendance
__ Tardiness
__ Homework (as required by specific programs)
__ Session participation levels
__ Ongoing motivation, skill and participation issues
__ Exit interview process (in addition to post-testing instrument).
F.
Standards
1.
The specific cognitive based curriculum must be followed exactly within the guidelines of that
individual program.
a.
There will be no addition or deletion of content materials.
b.
The program time frame will be adhered to: e.g., number of sessions suggested completing the
program, and time frame regarding the specific amount of time to complete each session. If the
program suggests twenty-two sessions at 1 1/2 to 2 hours per session, then it shall be delivered in
that manner.
EXHIBIT 1
EFFECTIVE DATE
WISCONSIN
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
July
DOC-1356 (Rev. 05/96)
PAGE 1 OF
2001
1
MANUAL REFERENCE
New
ORIGINATED BY
Administrative Directive 01-10
Replaces 99-15
x Revision
William J. Grosshans,
Administrator
Kerr v. Farrey
SUBJECT:
DISSEMINATION
X
PRIORITY
All Staff
X
Supervisory Staff Only
X
Policy / Directive
Information
Discuss at Staff Meeting
Read / Route / Post
The purpose of this directive is to ensure the Division of Community Corrections'
procedures comply with the decision of the United States 7t' Circuit Court of Appeals in
Kerr v. Farrey. 95 F.3d 472 (1996). In that decision, the court ruled that it was a violation
of the 1St Amendment of the United States Constitution to order an offender to attend a
treatment program with religious components. The court considered Alcoholics
Anonymous, for example, to be a program with a religious component since the program
refers to a "higher being" and to "God as we understand him."
An agent may order an offender to attend a specific secular (non-religious) treatment or
support program. An agent may not order an offender to attend a specific program with a
religious component. An offender may voluntarily participate in a treatment or
support program with a religious component as long as a non-religious program is
offered.
An agent may write a rule requiring an offender to attend and complete AODA treatment
without naming a specific program. An agent may also provide an offender with a list of
acceptable programs, as long as both secular and non-secular options are clearly
identified. If an offender chooses to participate in a program having a religious
component, the agent should document in the Chronological Log that a secular program
was offered.
________________________________
William J. Grosshans
Administrator
cc - DCC Administrative Directive Group
Executive Staff
EXHIBIT 2
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1336 (Rev. 4/2010)
WISCONSIN
REFERRAL FOR SERVICES
PART A
REFERRAL FOR SERVICES
To be Completed by Referral Agent
PROGRAM NAME
PROGRAM LOCATION
REFERRAL DATE (Month/Day/Year)
PROJECTED ELIGIBILITY DATE FOR SERVICES (Month/Day/Year)
AGENT NAME
AGENT AREA NUMBER
AGENT TELEPHONE NUMBER (Include Area Code)
AGENT ADDRESS
REFERRAL TYPE
ALTERNATIVE TO REVOCATION (ATR)
RESPONSE TO VIOLATION (NOT AN ATR)
OPERATING WHILE INTOXICATED 2nd
CERTAIN EARNED RELEASE (CER)
POSITIVE ADJUSTMENT TIME (PAT)
OPERATING WHILE INTOXICATED 3rd
COURT-ORDERED CONDITION
SERVICES REQUEST (Check All That Apply)
Anger Management
PAROLE/ES CONDITION
OTHER - SPECIFY:
Domestic Violence Services
Transitional Living Program
AODA Group Services
Education Services
Other (Specify)
AODA Aftercare Services
Emergency Housing
Other (Specify)
AODA Assessment/Evaluation
Family/Parenting Services
Assigned Co-Pay
AODA Intensive Nonresidential Groups
AODA Relapse Prevention/Aftercare
Case Management
Cognitive Interventions Groups
Crisis Intervention
Day Report Services
OFFENDER LAST NAME (As Shown on Court Order)
Halfway House (CBRF)
Sex Offender Assessment/Evaluation
Sex Offender Denial Focus Group
Sex Offender Education Group
Sex Offender Relapse Prevention/Aftercare
Sex Offender Treatment Group
FIRST
DOB
RACE
SEX
Male
MI
$
DOC NUMBER
OFFENDER TELEPHONE NUMBER (Include Area Code)
Female
OFFENDER CURRENT ADDRESS
MARITAL STATUS
Single, never married
Married
OFFENDER STATUS AT TIME OF REFERRAL
Probation
Parole
Felony
Separated
Widow/Widower
Extended Supervision
980 Case
NGI
SUPERVISION DISCHARGE DATE
Misdemeanor
Habitual
Reentry from Jail
Deferred Prosecution
Reentry from Prison
One Year or Less Probation
Reentry from DAI ATR
DOES INDIVIDUAL HAVE OUTSTANDING WARRANT OR PENDING CHARGES?
Yes
No - If Yes, Explain:
REASON FOR REFERRAL (List Problems Behaviors Evidenced By Offender And Specific Services Requested)
SPECIAL NEEDS (Check All Relevant Categories)
Divorced
EXHIBIT 2
Yes
No
Yes
No
Alcohol Problems
History of Violence, attach description.
Drug Problems (Specify)
History of Committing Sexual Assaults
Health Problems (Specify)
Pregnant
Mental Health Problems (Specify)
Relationship Problems
Developmental or Learning Disabilities
Financial Management Problems
IS OFFENDER TAKING MEDICATION?
OTHER (Specify)
Prescription
Yes
No - If Yes , List Reason:
EDUCATIONAL ACHIEVEMENT
Highest Grade Level Achieved
THIS REFERRAL MUST INCLUDE THE FOLLOWING INFORMATION:
Self-Pay
Insurance
Authorization for Use and Disclosure of Protected Health Information (DOC-1163A)
Only required for information that involves personal health information, medical, mental health, AODA, or other confidential or services.
Court Order, Criminal Complaint and Prior Record
Social Information (DOC-179)
Violation Report(s), if applicable.
Information in Regard to Alcohol, other Drug Problems and Prior Treatment Experience, if applicable.
INSTRUCTIONS:
Attach Part A and Part B to your agency’s “Offender Report Form Monthly" (DOC-386, DOC-1088A and DOC-1088) for each new intake
and each offender who re-enters your program.
PART B
INTAKE DECISION To Be Completed by Provider Agency for Offender Entering or Re-entering The Program
OFFENDER ACCEPTANCE / PROGRAM RETURN (Check Appropriate Box, Enter Appropriate Data)
Offender accepted as new intake
Offender returned to enter program
RECOMMENDED PROGRAM
START DATE
REJECTION
OFFENDER REJECTED - FOR WHAT REASON (Specify):
PROJECTED DISCHARGE DATE
EXHIBIT 3
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1088 (Rev. 4/2010)
WISCONSIN
OFFENDER REPORT – MONTHLY
COMMUNITY - BASED PROGRAMS and SERVICES
AGENCY NAME
TELEPHONE NUMBER
REPORTING PERIOD
(Month/Year)
PURCHASE ORDER NUMBER
PROGRAM NAME
FEDERAL FUNDING
Yes
REPORT COMPLETED BY (Signature/Title)
I Total Number of Offenders
L Other Information
J Total Units Provided
B6
OWI 3rd
B5
OWI 2nd
B4
CER
B3
PAT
B
OFFENDER NAME
B2
ATR
A
DOC #
REPORT REVIEWED BY DCC Staff (Signature)
DATE SIGNED
Use this form for all Community-based programs and services except Halfway House, use DOC-386 and Day Treatment, use DOC-1088A. Letters A through F must be completed; all
other columns may be required in accordance with the agency’s contract/grant agreement or at the direction of the Contract Administrator. An asterisk notes all columns that require a
code. All codes for the completion of this form are listed on the back of the form.
B1
DOB
INSTRUCTIONS:
DATE SIGNED
No
C
AGENT
AREA #
D
ADMISSION
DATE
E*
TYPE OF
SERVICE
G*
STATUS
Discharge
F
SERVICE DATE OR DATES
Date
K Are Alcohol and Other Drug Abuse Services Provided Under This Contract/Grant
Code
Yes
H
OFFENDER FEES
COLLECTED THIS
MONTH
No
EXHIBIT 3
INSTRUCTIONS AND CODES FOR DOC-1088
A
Enter Offender DOC Number as given to provider on Part A, "Referral for Service Form" (DOC-1336).
B
Enter Offender Last Name, First Name and Middle Initial as given to approver agent on Part A, "Referral of
Services Form" (DOC-1336).
B1
Enter Offender Date of Birth as given by agent on Part A, "Referral of Services Form" (DOC-1336).
B2
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all
that apply.
B3
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all
that apply.
B4
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all
that apply.
B5
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all
that apply.
B6
Enter Offender Referral Type as given by agent on Part A, "Referral of Services Form" (DOC-1336). Check all
that apply.
C
Enter DOC Agent Area Number as given to provider on Part A, "Referral for Services Form" (DOC-1336).
D
Enter Admission Date.
E
Enter Code number which applies. If your agency provided more than one type of service under the
contract/grant during the month, use a separate line on the form to report each type of service provided to
each offender.
(507Group counseling, outpatient
(606)
Emergency housing
30)
(507Outpatient counseling, Individual
(607Employment, on-the-job
10)
10)
(507Outpatient counseling, family
(607Employment - evaluation
20)
20)
(603)
Intake assessment
(607Employment - job placement
30)
(604)
Evaluation
(607Employment - job preparation
40)
(605)
Sex offender treatment
(608)
Education
F
List each separate date on which service was provided. As an example, if service was provided on May 5, 10
and 16, list 5/5, 5/10 and 5/16. Do not list a range of dates such as 5/5 through 5/10.
G
Enter Status Code for each program participant under the DOC contract or grant. If two codes apply, enter
highest
code number. Enter date of Status Change for all codes except 01.
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
H
Continues in program
Completed Service - Significant improvement in most or all areas has occurred and the offender is
approaching or has attained full recovery (Good)
Completed Service - Improvement in some areas has occurred but the degree of improvement is
minimal (Fair)
Completed Service - No positive change has occurred (Poor)
Referred to another Agency
Behavioral Termination - Staff / Program decision to terminate due to breaking internal program
rules
Withdrew Against Staff Advice
Funding / Authorization Expired (service not completed)
Program Hold - When offender is temporarily not involved in service. Each program hold incident
must be 30 days or less
Positive urinalysis screen, positive breathalyzer test or other indication of drugs
Absconding
Rules Violation - Other than drug / alcohol use or absconding
New Offense
Hospitalized
Death
Other (specify in Field L "Other Information" at bottom of form)
Enter total amount of offender fees collected this month for each offender. Total amount of fees collected are
reflected as a total monthly offender fee reduction on the “Unit Service Monthly Report” (DOC-1026).
I
Total number of offenders provided direct service this month.
J
Total units of service provided this month.
The total units provided, (for example, number of hours, days or group sessions provided) are
dependent upon the payment arrangement with the Department of Corrections.
K
Are alcohol and drug abuse services provided under this contract/grant? This is necessary to verify
confidential status of form.
L
Use this space to note codes which need to be specified from Field E and Field G.
EXHIBIT 4
DEPARTMENT OF CORRECTIONS
Division of Community Corrections
DOC-1026 (Rev. 2/97)
WISCONSIN
Wisconsin Statutes
Section 301.08
UNIT SERVICE
MONTHLY REPORT
AGENCY NAME
VENDOR ID NUMBER
PURCHASE ORDER NUMBER
PROGRAM NAME
TELEPHONE NUMBER
DOC CONTACT SIGNATURE
REPORTING PERIOD (Month / Year)
As the authorized representative of the above named agency, I request that my
agency is reimbursed for units of service provided to eligible Correctional offenders.
UNIT OF SERVICE(S) PROVIDED
UNIT
DESCRIPTION
NUMBER OF
UNITS
COST PER
UNIT
Less Billing to Other Agencies
Less Offender Fees Collected
NET REIMBURSABLE
TOTAL
=
I understand that my agency is required to submit a Offender Monthly Report within
30 days after the final day of the month for which this Unit Service Report is due.
I certify that the unit of services indicated for claiming State reimbursement are just, true and
correct in the amount stated and have not been reimbursed, and represent actual services
delivered and reimbursable under the laws, rules and regulation of the Wisconsin Department
of Corrections.
CONTRACTOR AGENCY CONTACT SIGNATURE
DISTRIBUTION:
Submit original and 2 copies to Grant/Contract Administrator
DATE SIGNED
EXHIBIT 5
Evidence-Based
Correctional Program Checklist
The Correctional Program Checklist (CPC) is a tool developed to assess the extent to which
correctional treatment programs adhere to the known principles of effective intervention. It is
designed to evaluate the integrity of a program, not outcomes. The CPC is based on the results of
over 500 program assessments and three large outcome studies.
The CPC is divided into two basic areas: Capacity and Content.
The Capacity area is designed to measure whether a correctional program has the capability to
deliver evidence-based interventions and services for offenders. There are three domains in the
capacity area:
CAPACITY
6. Quality Assurance
7. Staff Characteristics
• Program monitoring activities
• Education of the staff
• Reassessment of offenders
• Experience of the staff
• Evaluation
• Assessment & training of the staff
8. Leadership & Development
• Involvement and qualifications of program director
• Implementation and design of the program
• Support for the program
The Content area has two domains and focuses on the substantive domains of Offender Assessment
and Treatment Characteristics, and the extent to which the program meets the principles of risk,
need, responsivity, and treatment.
CONTENT
9. Offender Assessment
• Selection of offenders
• Assessment of offenders
10. Treatment Characteristics
• Targeting of criminogenic needs
• Type of interventions used
• How treatment is delivered
• Provision of aftercare
Information is gathered through structured interviews with selected program staff and program
participants and observation of groups and staff. Other sources of information include policy
manuals, program curriculum, schedules review of case files, surveys, & other selected program
materials
There are several advantages to the CPC:
5. All of the indicators included in the CPC have been found to be correlated with reductions in
recidivism.
6. The process provides a measure of program integrity and quality; it provides insight into the
“black box” of a program, something that an outcome study alone does not provide.
7. The results can be obtained relatively quickly; usually the process takes a day or two and a
report is generated within a few weeks.
8. It identifies both the strengths and weaknesses of a program and provides recommendations
designed to improve the integrity of the program and to increase effectiveness.
Prepared by the WI Department of Corrections
Office of Research & Project Management
EXHIBIT 5
Evidence-Based
Correctional Program Checklist
Evaluation Steps
9. Schedule site visit with program and program evaluators.
10. Day of site visit:
 Interview program/treatment director
 Interview staff
 Interview program participants
 Review case files
 Review program manuals and curricula
 Review assessment instruments
 Observe treatment group(s)
11. Day after the site visits the evaluation team meets to determine the final scores for the program
evaluation.
12. Within one or two weeks after the site visit a draft report detailing evaluation results and
recommendations is sent to the program.
13. Program is given 30 days to respond to the draft report in writing, noting any information that is
incorrect or that was missed.
14. Evaluation team takes program’s response into consideration, then compiles a final report and
sends it to program and anyone else who needs to see it.
15. Within 30 days, the program submits to the Department a “corrective action plan” detailing the
steps it will take to address areas needing improvement based on evaluation recommendations.
16. A follow-up evaluation is done within one year if the program scores below the “effective”
category, within three years if it scores in the “effective” category, and within five years if it scores
in the “highly effective” category.
Prepared by the WI Department of Corrections
Office of Research & Project Management
Dept. of Corrections
Division of Community Corrections
EXHIBIT 6
PROGRAM GUIDELINES:
Programs using evidence based curriculum for groups and training the staff in the delivery of that curriculum will increase
program fidelity. Several factors are noted to be essential to program success as measured by the difference in recidivism
between treatment and control groups. The National Institution of Correction’s curriculum Offender Risk Reduction:
Evidence Based Practice and Cognitive Behavioral Interventions Standard Operating Procedures (Dec 2001) were used
as a reference in the development of these guidelines.
Characteristics consistently associated with program efficacy:
1.
Sound Conceptual Model. Programs based on a cognitive-behavioral theoretical model were the most
beneficial when applied in appropriate dosage according to offender risk and need measurements.
2.
Multifaceted Programming. Multifaceted programs, which incorporated a variety of techniques in their
intervention strategy, were more beneficial than those correctional programs that relied on a single
method.
3.
Targeting “criminogenic risk factors.” In successful programs, program targets were factors linked
with recidivism such as social cognitions or antisocial attitudes.
4.
Responsivity Principle. Program efficacy was dependent on matching styles and modes of service to
the learning styles, characteristics and abilities of offenders based upon identified risks and needs.
5.
Role Playing/Modeling. In successful programs, correctional worker/agents modeled anti-criminal
attitudes and behavior. Modeling and role-playing techniques were used to train offenders in empathy,
interpersonal problem solving and social skills, which enabled them to cope pro-socially with adverse or
criminogenic environmental experiences.
6.
Social Cognitive Skills Training. Including program techniques that could have an impact on the
offender’s thinking was of critical importance.
Characteristics that make cognitive behavioral programs effective:
A. Group/Class Setup
1.
The facilitator is present; with the necessary materials adequately organized, and prepared to greet
arriving participants several minutes ahead of the scheduled group time.
2.
Attendance and tardiness are accurately and efficiently documented.
3.
Homework (as required by specific programs) is reviewed, checked, and appropriately reinforced.
4.
Each lesson is introduced so participants have an overview of the session.
5.
The introduction of each lesson should include reasons why content or process should be valued by the
participants and should be tailored to address each participant’s perspective.
B. Specific Skill Development
1.
The facilitator should define the skill or concept being introduced.
2.
The facilitator should explain why the skill or concept is important and how it is related to other material
previously covered.
3.
The facilitator should present the thinking and actions that make up the specific skill.
4.
The facilitator should model the skill correctly.
5.
The facilitator should ask questions and make sure all participants understand the specific skill before
moving on to a new skill.
6.
The facilitator should use examples and scenarios that are simple and easy to follow and directly relevant
to the criminogenic (crime-producing behavior) needs of participants.
7.
The facilitator should allow participants to practice skills as much as possible and devote a significant
portion (at least two-thirds) of a session to practice and exercises.
8.
The facilitator should provide feedback to participants with at least 80% being positive and reaffirming.
9.
During the summary session, the facilitator should include a review of what the group is learning, why the
information is important to participants, and in what specific situations the skills can be used.
10.
The facilitator should always follow the lesson plan and assign homework as directed by the
curriculum.
1
Dept. of Corrections
Division of Community Corrections
EXHIBIT 6
C. Classroom Management
1.
The facilitator should start the session precisely on time.
2.
The facilitator should identify and address (but not judge) any pro-criminal responses and behaviors
(allowing these responses and behaviors to go on without addressing them undermines the intent of
the curriculum).
3.
The facilitator should maintain a clearly defined set of group participation rules with simple, specific
consequences for violation.
4.
The facilitator should enforce class rules and boundaries.
5.
The facilitator should acknowledge the need for and expect a different level of performance based on
the individual skills and abilities of the participants.
6.
The facilitator should take the necessary steps (both structural and situational) to insure each participant
is involved in each session.
7.
The facilitator should use humor appropriately throughout each session.
8.
The facilitator should use the necessary equipment and materials (i.e., flipcharts, chalkboards, overheads,
TV/VCR, workbook, stapler, paper clips, pens, pencils, and paper) appropriately throughout each session
in addition to having access to a copy machine in preparation for sessions.
9.
The program participants should have a workbook or folder to hold loose workbook pages or
additional information, additional paper for note taking, and each participant should be provided with a pen
or pencil.
D. Participant Involvement
1.
Participants should be actively and voluntarily engaged and paying attention throughout each session.
2.
Participants should be able to demonstrate their understanding of the content and processes used
throughout each session.
3.
Participants should provide positive and innovative input to the session.
4.
Participants should adequately complete class activities and homework assignments.
5.
Participants should demonstrate some understanding of their individual risk factors.
E.
Documentation and Accountability
The facilitator should have a clear and effective system to document the following items:
__ Intake interview process (in addition to pre-testing instrument)
__ Attendance
__ Tardiness
__ Homework (as required by specific programs)
__ Session participation levels
__ Ongoing motivation, skill and participation issues
__ Exit interview process (in addition to post-testing instrument)
F.
Standards
1.
The specific cognitive based curriculum must be followed exactly within the guidelines of that
individual program.
a.
There will be no addition or deletion of content materials.
b.
The program time frame will be adhered to: e.g., number of sessions suggested completing the
program, and time frame regarding the specific amount of time to complete each session. If the
program suggests twenty-two sessions at 1 1/2 to 2 hours per session, then it shall be delivered in
that manner.
2
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