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MEMORANDUM121920047625WINSTON-SALEM/FORSYTH COUNTY SCHOOLSDepartment of Student ServicesWINSTON-SALEM/FORSYTH COUNTY SCHOOLSDepartment of Student Services347625To:Mental Health Service ProvidersFrom:Sheila D. ThorpDirector of Social WorkDate:June 23, 2021Re:Request to Provide Mental Health Services within the Winston-Salem/Forsyth County SchoolsWinston-Salem/Forsyth County Schools (WS/FCS) is seeking applicants for agency-provided mental health services in its schools. WS/FCS is dedicated to ensuring the utmost quality out-patient services are available in our schools.If you would like for your practice or agency to be considered for the provision of School-based Mental Health Services within WS/FCS during the school year of 2021-2022, you must submit a packet in writing that addresses all guidelines and procedures. See accompanying information below entitled “Mental Health Service Provider Criteria” and “Responsibilities of the Agency” for details. If you have questions, you may contact Sheila Thorp at 336-413-8386. All applicants must be able and eligible to bill Medicaid. You must include the original application and six (6) copies. All applications must be received by close of business on Friday, July 30, 2021 to: Sheila Thorp, Director of Social WorkWS/FCS School Social Work OfficeWinston-Salem/Forsyth County Schools601 N Cherry Street, Suite 230Winston-Salem, NC 27101Winston-Salem/Forsyth County SchoolsMental Health Service Providers Criteria 2021-2022INTRODUCTION The Winston-Salem/Forsyth County School System (WS/FCS) is currently requesting Letters of Intent from appropriately licensed and certified providers of Mental Health Services who desire to provide outpatient therapy services within the WS/FCS during the 2021-2022 school year.The WS/FCS system has 81 schools and a student population of approximately 55,000. All applicants must be able and eligible to bill Medicaid. Applicant(s) approved will be eligible to provide services for one (1) academic calendar year. Dates will be provided to approved mental health providers after the completion of the selection and interview process. Step 1: Interested providers should submit a Letter of Intent by Friday, July 30, 2021 with their request for proposal. Identifying Information: The Letter of Intent must include:Agency NameMailing Address (local address if different from headquarters)Telephone NumberEmail AddressWebpageName of Primary Contact Name of Executive Director/CEORequest for Proposal: The RFP should include the following:IntroductionOverview of agency’s goals for providing school-basedmental health servicesExplanation of benefits to WS/FCS students and families in selecting your agencyPersonnel List of all clinical staff and supervisors (by name if known and position) that will be involved in the delivery of services with WS/FCSInclusion of brief vita (see required components) for all individuals that have currently been identified to work in the programEducationLength of employment with the applicant’s agencyDocumentation of appropriate credentials – Clinicians must be at least master’s level with one or more of the following certifications: LCSW, LCMHC, LPA, or provisional license.Documentation of compliance with training in:Successful completion of other agency required training components andBlood borne pathogen training (OSHA)Documentation of compliance with drug screen & criminal background procedures acceptable to the WS/FCSDocumentation of negative TB test for all individuals that will be involved in the delivery of services within the WS/FCSIntake/Assessment/Referral Process Description of the process for collaborating with school staff to identify students in need of services Description of how agency expects to conduct the referral, intake, and assessment process, including expected time frames for referral to intake and assessmentDescription of referral resources and procedures established for children who need a higher level of care. Description of Services and SupportsRange of services and the types of therapies Description of services providedDescription of agency’s specialty and concentration areasCapacity Evidence of agency’s capacity to provide high quality in-school services such as: serve multiple schools simultaneouslymaintaining a regular schedule at school siteattending individual student meeting consultation and feedback to school staffDocumented history or record of past performance at schools or school-related settingDocumentation of staff training Evidence of agency’s ability to provide telehealth services, including clinician training, use of a HIPAA-compliant platform, parent notification of limitations and consent, continuation of services to students, and consultation with school staff Responsibilities of the Agency● Provide appropriately licensed and credentialed clinicians. If clinicians are provisionally licensed, provide name and contact information of the clinical supervisor or head of the clinical department, to address any concerns that might arise.● Maintain a regular schedule at each school being served. Changes in schedule should be communicated to the Designated School Contact (DSC).● Work collaboratively with student support staff, teachers and other school staff to support identified students. This may include teacher consultation, classroom observation and feedback to teachers, support staff, and administrators, as well as attending student-center meetings when appropriate.● Maintain contact with the student and school as appropriate when a student is placed in juvenile detention/jail, PRTF, partial hospital, or day treatment munication● Communication with parent/guardian● Agency clinician will communicate with the parent/guardian by telephone and/or face to face visits, as often as indicated by the student’s age and/or treatment plan.● Agency clinician will secure and maintain all necessary consents and authorizations signed by parent/guardian to provide services.● Agency clinician will inform and provide written information on how the parent/guardian can access care when their clinician is not available.● Communication with school personnel● Agency clinician will communicate regularly with the identified school personnel regarding the student’s treatment plan and goals as appropriate.● Agency clinician will have an authorization of release of information signed by the parent/guardian.● Expected communication with school staff should include regular check ins with student support staff.● Agency clinician will provide consultation to school personnel with the knowledge of the student and the student’s parent/guardian. ................
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