1. Technical Proposal - Volume I
Solicitation No. 06N2405509AA-DP
Title: Technical Assistance for Domestic Violence Assessment
and Intervention
Prepared by: José A. Rivera, President & CEO
Rivera, Sierra & Company, Inc.
32 Court Street, Suite 1200
Brooklyn, NY 11201-4404
Telephone: 718-858-0066
The signature above is a certification that this proposal is firm for 180 days
from the date of receipt by the government.
Prepared For: Department of Health and Human Services
Health Resources and Services Administration
Division of Procurement Management
Parklawn Building, Room 13A-19
5600 Fishers Lane
Rockville, MD 20857
MARK FOR: 06N2405509AA--DP
Requesting HHS/HRSA/MCHB/DHSPS
Agency:
3. I. Statement and Understanding of the Project Purpose
Rivera, Sierra & Company, Inc. (RSC) is a health and human services consulting
firm certified by the Small Business Administration as an 8(a) Minority Business
enterprise and HUBZone company. RSC specializes in providing subject matter
expertise, training and technical assistance (TA) to Federal, State and Tribal agencies
and their grantees in all areas related to the delivery of health and human services.
As a firm which is both minority and women-majority owned, RSC brings cultural
and gender competence to the complex problem of how to assist Healthy Start grantees
to address the correlation between domestic or family violence and providing a truly
healthy start for children.
The purpose of this acquisition, as stated, is to develop and provide technical
assistance to enhance the capacity of primary care and perinatal care providers at
Healthy Start sites and community-based intervention programs to assess perinatal
clients for current or past exposure to intimate partner violence and to
effectively convey information about risk reduction and intervention services
that are culturally relevant and specific to their target population.
About Healthy Start
The Healthy Start program makes grants that use
community-designed and evidence-supported
strategies aimed at reducing infant mortality and
improving perinatal outcomes in project areas with
high annual rates of infant mortality.
In its report to Congress, the Health Resources
Services Administration (HRSA) noted that: “Major and
persistent racial and ethnic disparities exist in the
proportion of pregnancy-related maternal death, in
preterm birth, and in infant mortality. Despite
considerable research efforts to understand and
prevent these adverse outcomes, the factors that
make some pregnancies more vulnerable than others
have not been clearly defined. Emerging research
indicates that environmental, biological and behavioral
stressors occurring over the life span of the mother
from her earliest life experiences until she delivers her
own child may account for a significant portion of the
disparities.”
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4. About Domestic Violence
One of the most recurrent of these stressors is the issue of domestic violence or
intimate partner violence (IPV).
In a fact sheet issued by the Center for Disease Control (CDC)1, the Center noted
that Intimate Partner Violence (IPV) falls into four main types:
Physical violence is the intentional use of physical force with the potential for
causing death, disability, injury, or harm. Physical violence includes, but is not
limited to, scratching; pushing; shoving; throwing; grabbing; biting; choking;
shaking; slapping; punching; burning; use of a weapon; and use of restraints or
one’s body, size, or strength against another person.
Sexual violence is divided into three categories: 1) use of physical force to
compel a person to engage in a sexual act against his or her will, whether or not
the act is completed; 2) attempted or completed sex act involving a person who
is unable to understand the nature or condition of the act, to decline
participation, or to communicate unwillingness to engage in the sexual act, e.g.,
because of illness, disability, or the influence of alcohol or other drugs, or
because of intimidation or pressure; and 3) abusive sexual contact.
Threats of physical or sexual violence use words, gestures, or weapons to
communicate the intent to cause death, disability, injury, or physical harm.
Psychological/emotional violence involves trauma to the victim caused by acts,
threats of acts, or coercive tactics. Psychological/emotional abuse can include,
but is not limited to, humiliating the victim, controlling what the victim can and
cannot do, withholding information from the victim, deliberately doing something
to make the victim feel diminished or embarrassed, isolating the victim from
friends and family, and denying the victim access to money or other basic
resources. It is considered psychological/emotional violence when there has been
prior physical or sexual violence or prior threat of physical or sexual violence.
IPV is a serious problem that is common in our society. Violence by an intimate
partner is linked to both immediate and long-term health, social, and economic
consequences. Factors at all levels—individual, relationship, community, and
societal—contribute to the perpetration of IPV. Preventing IPV requires a clear
understanding of those factors, coordinated resources, and empowering and
initiating change in individuals, families, and society.
1
http://www.cdc.gov/ncipc/factsheets/ipvoverview.htm.
2
5. What is true about the partner is likewise as true about the impact of violence on
children. In a report issued by the Administration for Children and Families through the
National Clearinghouse on Child Abuse and Neglect Information, the following
relationship was made between domestic violence and healthy start for children:
Children who live with domestic violence face increased risks: the risk of
exposure to traumatic events, the risk of neglect, the risk of being directly
abused, and the risk of losing one or both of their parents. All of these
may lead to negative outcomes for children and may affect their well-
being, safety, and stability (Carlson, 2000; Edleson, 1999; Rossman,
2001). Childhood problems associated with exposure to domestic violence
fall into three primary categories:
• Behavioral, social, and emotional problems. Higher levels of
aggression, anger, hostility, oppositional behavior, and disobedience;
fear, anxiety, withdrawal, and depression; poor peer, sibling, and
social relationships; and low self-esteem.
• Cognitive and attitudinal problems. Lower cognitive functioning,
poor school performance, lack of conflict resolution skills, limited
problem solving skills, pro-violence attitudes, and belief in rigid gender
stereotypes and male privilege.
• Long-term problems. Higher levels of adult depression and trauma
symptoms and increased tolerance for and use of violence in adult
relationships.2
As the Friends Committee in California appropriately put it:
Families with children, especially children ages five and under, are more
prone to domestic violence, and child development experts agree that
birth to age five are the crucial formative years when most brain
development takes place. Children exposed to domestic violence are more
likely to suffer behavioral problems such as aggression, phobias, insomnia,
low self-esteem, and depression. Men who witnessed domestic violence as
children are twice as likely to abuse their own wives. Exposed children are
more likely to become substance abusers and are more likely to attempt
suicide. Sleep disorders such as bed-wetting, insomnia, and nightmares
are common. Academic performance and problem solving skills also suffer.
They may also lack empathy, and chronic exposure to abuse may result in
2
Administration for Children and Families, National Clearinghouse on Child Abuse and Neglect
Information. Available online at http://nccanch.acf.hhs.gov/pubs/factsheets/domesticviolence.cfm.
3
6. post-traumatic stress disorder, which include symptoms of emotional
numbing, avoidance of painful reminders of violent episodes, or obsession
with the violent events.3
The National Center on Domestic and Sexual Violence described it in the following
diagram which speaks for itself:
3
Friends Committee on Legislation (2002). Available online at www.fdca.org/junenews/june02.html.
4
7. It is important to note that, even in the earliest conceptual models for the Healthy
Start program, the issue of domestic violence was not very clearly on the radar screen3
More recent evidence, borne out by the experience of Healthy Start grantees
themselves, demonstrates the direct correlation between domestic violence and key
birth outcomes. And the literature supports this anecdotal conclusion. In an article to
be published in July 2006 issue of the American Journal of Obstetrics and Gynecology, it
states pointedly:
In the first national study of the effects of intimate partner violence on the
health of women during pregnancy and the health of newborn children,
researchers from the Harvard School of Public Health (HSPH)
demonstrated that violence from male partners, both in the year prior to
and during a woman's pregnancy, increases her risk of serious health
complications during pregnancy. Such abuse also increases a woman's risk
of delivering prematurely and that her child will be born clinically
3
Devaney, et al. (2000). Reducing Infant Mortality: Lessons Learned from Healthy Start. Cited online at
http://www.mathematica-mpr.com/publications/PDFs/healthyfinal.pdf.
5
8. underweight and in need of intensive care.4
This finding is consistent with the ecological model developed by Heise in 1998
which demonstrates that partner abuse does not exist in a vacuum but rather is part of
a relationship that involves the victim and other members of the immediate family. This
family is in turn a part of community and part of a larger society. Thus, the extent to
which one’s society relationship and community relationship is impacted by issues such
as poverty, discrimination, racial and ethnic disparities in health care, the more pressure
there is on the relationship and the more likely is the perpetrator to take out
environmental frustrations on a family partner or member.
Even factors that seem neutral on their face have relevance - a good example being
immigration. Research studies report that violence against women increases upon
immigration. Dutton, Orloff and Aguilar-Hass (2000) noted that “48% of Latina’s
reported that their partner’s violence against them had increased since they immigrated
to the United States.”5 In fact immigration status is a key weapon used against women
by their partners and others. Although a woman may have immigrated legally her
status may be conditional based on her married status this provides a mechanism for
forcing the woman to remain in the violent relationship. It is clear that violence against
women is not just an individual problem but a societal one as well.
4
See http://www.eurekalert.org/pub_releases/2006-06/hsop-vfm062806.php.
5
Dutton, M., Orloff, L., Aguilar-Hass, G. (2000). “Characteristics of help-seeking behaviors, resources and
services needs of battered immigrant latinas: legal and policy implications.” Georgetown Journal on
Poverty Law and Policy. 7(2).
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9. The models below illustrate another important dimension of the problems associated
with domestic/intimate partner violence and Healthy starts for children. Figure 1
represents the classic power and control wheel. Figure 2 is a modification for medical
professionals.
Figure 1 Figure 2
Figure 3
In Figure 1, the classic power and control paradigm clearly shows the relationship
between domestic violence and their victims: women and children. Women are used.
Children are used. The goal is power and control. In Figure 2, the medical professional
and, by extension, any staff person involved with a domestic violence victim, can play a
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10. devastating role in perpetuating victimization and exercising similar forms of power and
control by, among other things:
• ignoring the victim’s need for safety
• normalizing victimization;
• violating confidentiality;
• trivializing and minimizing abuse;
• blaming the victim; and
• not respecting the victim’s autonomy.
While this is not true of all medical professionals, the wheel is illustrative of the need of
medical and social services professionals to understand the realities of domestic
violence in order to avoid aggravating victimization through inappropriate conduct. This
wheel is, therefore, useful as a way to help Healthy Start grantees understand how to
address issues of domestic or family violence.
Interestingly enough, the concepts do not change radically across racial/ethnic lines
with modifications perhaps for unique cultural attributes. Thus, the American Indian
Power Wheel might be shaped as a teepee and include uniquely Indian Country issues.
But, the issues that need to be addressed continue to be the same.
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11. The long term answer to domestic violence lies in the effective utilization of an
empowerment model where what was once a control wheel and turns into an
empowerment wheel. To empower a person who is a victim of domestic violence is to
steadily move a person from total reliance on advocacy to a place where they can be
their own effective self-advocate. To do this is to reverse the power and control wheel
and replace it with an empowerment wheel. That paradigm is reflected in Figure 3
above.
That paradigm is likewise reflected in a training piece used by RSC in its training
programs. The diagram below shows the relationship between advocacy and self-
advocacy. Using the left side of the diagram to describe a person entering into a
counseling relationship, she enters needing 90-95% advocacy and being capable of only
5-10% self-advocacy (measured by where the line starts). As time moves on (to the
right), the goal of the DV counselor, the social worker, the counseling professional is to
move the woman from a position of reliance on advocacy to a place where she is
empowered to be her own self-advocate. It is this empowerment that leads to the
ability of a formerly battered woman to truly say “never again.”
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12. The Washington State Department of Health in its Guidelines entitled Domestic
Violence and Pregnancy noted that “The prevalence of women who reported physical
violence by a husband or partner around the time of pregnancy (12 months prior to
pregnancy through postpartum visit) in Washington State is estimated to be 6.4% or
approximately 5,184 women.” 6 Even a modest multiplier for all States demonstrates
that the number of potential victims of domestic violence during and around pregnancy
is staggering. Nationally, domestic or intimate partner assaults against pregnant
women range from 1 - 20% depending upon the definitions used and the populations
studied.7 Gazmaraian similarly reports that figure as being between .9% and 20%.8
Factoring in child abuse, Appel & Holden suggested that, once again, depending upon
defintions, a co-occurrence of domestic violence child abuse ranges from 30% to 60%.9
And the implications for healthy babies is enormous. Women who experience
physical abuse are at higher risk for miscarriages and low birth weight babies.10
This is consistent with the citation referenced in the technical proposal taken from
the July 2006 issue of the American Journal of Obstetrics and Gynecology:
... violence from male partners, both in the year prior to and during a
woman's pregnancy, increases her risk of serious health complications
during pregnancy. Such abuse also increases a woman's risk of delivering
prematurely and that her child will be born clinically underweight and in
need of intensive care.11
About Cultural Competence
The issue of cultural competence is of significant importance to RSC and deserves
separate analysis. Having provided HRSA with technical assistance in developing a
Minority Faculty Development Model and having headed up a two year series of
minority health lectures for the HRSA Office of Minority Health, RSC is well positioned to
6
http://www.doh.wa.gov/CFH/mch/documents/dv_for_web.pdf.
7
Saltzman, LE, Johnson, CH, Gilbert BC, Goodwin MM Physical abuse around the time of pregnancy: An
examination of prevalence and risk factors in 16 states: Maternal Child Health Journal 2003; pp 31-43.
8
Gazmariaian, et al “Violence Against Women, Family Planning and Pregnancy” in Maternal and Child
Health Special Issues: Violence and Family Planning Conference Proceedings, 1999. MCH Clearing House.
9
Appel ,A. E. Holden G.W. The co-occurrence of spouse and physical child abuse: A review and
appraisal. Journal of Family Psychology (1998) 12 (4), pp 578-599.
10
Murphy, CC, Schei, B, Myhr. T. DuMont, J. Abuse: A risk factor for low birth weight? A systematic
review and meta-analysis. Canadian Medical Association Journal, 2001, May 164 (11) pp 1567-1572.
11
See http://www.eurekalert.org/pub_releases/2006-06/hsop-vfm062806.php.
10
13. address this project in a way that is culturally competent and appropriate.
Cultural competence is about adapting care to meet the needs of consumers from
diverse cultures. One key aim is to improve their access to care. Others are to build
trust and to promote their engagement and retention in care. Above all, cultural
competence aims to improve the quality of care and to help consumers
address their needs quicker and better. Its broader societal purpose is to reduce or
eliminate health disparities affecting disenfranchised groups.
A culture is broadly defined as a common heritage or set of beliefs, norms, and
values shared by a group of people. People who are placed, either by census
categories, or through self-identification, into the same racial or ethnic group are often
assumed to share the same culture; however, not all members grouped together in a
given category will share the same culture. There is great diversity within each of these
broad categories and individuals may identify with a given racial or ethnic culture to
varying degrees. Others may identify with multiple cultures, including those associated
with their religion, profession, sexual orientation, region, or disability status.
Culture is dynamic. It changes continually and is influenced both by people’s beliefs
and the demands of their environment. Immigrants from different parts of the world
arrive in the United States with their own culture but gradually begin to adapt and
develop new, hybrid cultures that allow them to function within the dominant culture.
This process is referred to as acculturation. Even groups that have been in the United
States for many generations may share beliefs and practices that maintain influences
from multiple cultures. This complexity necessitates an individualized approach to
understanding culture and cultural identity in the context of mental health services.
The culture someone comes from influences many aspects of care, starting with
whether the person thinks care is needed or not. Culture influences what concerns that
person brings to the clinical setting, what language is used to express those concerns,
and what coping styles are adopted. Culture affects family structure, living
arrangements, and how much support someone receives in time of difficulties. Culture
also influences patterns of help-seeking, i.e. whether someone starts with a primary
care doctor, a mental health program, or goes to a minister, spiritual advisor, or
community elder. Finally, culture affects how much stigma someone attaches to mental
health problems, and how much trust is placed in the hands of providers. It’s easy to
think of culture as only belonging to consumers without realizing how it also applies to
providers and administrators. Their professional culture influences how they organize
and deliver care. Some cultural influences are more obvious than others, like the
manner in which clinicians ask questions or interact with consumers. Less obvious but
equally important are what hours a clinic has, the importance the staff attaches to
reaching out to family
members and community leaders, and the respect they accord to the culture of each
consumer entering their doors. Knowing how culture influences so many aspects of
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14. health care underscores the importance of adapting programs to respond to, and be
respectful of, the diversity of the surrounding community.
A good example of how cultural competence plays out in the arena of domestic
violence is set forth in a report entitled “Community Insights on Domestic Violence
among African Americans” prepared by Pennsylvania State University.12 (2002).
Their Summary of Findings indicated that:
• A high level of domestic violence was but one of many disturbing trends in
violence that occur in the African American community. African Americans in
the San Francisco/Oakland area were concerned about the prevalence, rather
than the type, of violence in their community. Domestic violence spilled into
the community and community violence forced its way into residents’
neighborhoods and families’ homes.
• Domestic violence was part of a continuum of violence that links the
community to the family. Domestic violence in the home did not occur in
isolation, and its prevalence almost mirrored the various forms of community
violence. To participants, this parallel evidenced the coexistence of violence
inside and outside the home, highlighted linkages between stressors inside
and outside the home, and connected violence witnessed to violence
committed.
• Many participants noted that the prevalence of domestic violence in the
African American community flowed directly from the deficit of leadership, in
general, and positive models for nonviolence, specifically, in the African
American community. Too, the lack of leadership highlighted the absence of
credible individuals, families, and African American subcommunities who
practiced and exemplified the cultural principles valued by many African
Americans, such as those celebrated during Kwanza.
• Racism and social oppression were inextricably linked to violence and
domestic violence in the African American community. Whether in the form of
restricting economic opportunities, marginalizing the unique cultural aspects
of African Americans’ lives, or perpetuating negative racial stereotypes, social
oppression and racism fueled a hopelessness that contributed to violence in
the community.
• Community deterioration and negative intergenerational impacts were the
inevitable outcomes of the ongoing, pervasive, and unaddressed violence and
12
Pennsylvania State University (2002). Community Insights on Domestic Violence among African
Americans. Available online at http://www.dvinstitute.org/comm_assess/idvaac.sanfran.pdf.
12
15. domestic violence in the African American community. Violence has eaten
away at community life by decimating the ranks of leadership and creating a
communal sense of helplessness. Domestic violence has added to this
disintegration by isolating those who are directly involved in the violence from
those who witness it, ignore it or feel impotent to stop it. The
intergenerational impacts of violence and domestic violence alienated the
young from the elderly, and African American children from their family
members.
• Competitiveness between those entrusted with the task of addressing
domestic violence was a major barrier to mounting an effective community
response. Overwhelmingly, participants cited the African American
community’s inability to mount a collective response to the issues of domestic
violence as a major barrier to addressing the issue. In part, competitiveness
was based on lack of a common vision and limited funding streams.
• Inadequate resources were also a barrier to mounting an effective community
response to domestic violence. Succinctly put, inadequate resources
produced inconsistent and haphazard services. An important area where the
lack of resources significantly impacted the African American community was
in the area of culturally-specific services, for both victims and barterers.
• Solutions to domestic violence in the African American community must be
systemic and holistic. Collective community response begins with a
community commitment to action. Systemic solutions bring together the
major stakeholders important to the issue of addressing domestic violence,
offer multiple strategies, as well as integrate a life course perspective.
This same perspective, perhaps more pointedly comes from Indian Country as well.
The following is a synopsis from a 2001 report from the Inter-Tribal Council of
Michigan, a HRSA Healthy Start grantee:
[Domestic Violence is] considered to be a silent epidemic in tribal communities.
Tribal Victims of Crime Advocates (VOCA workers) estimate that about 25% of all
women in tribal communities are in an abusive situation at any given time.
Women are very hesitant to disclose abuse; living in small communities where
“everybody knows everyone” creates a perceived high social risk in
acknowledging the abuse to anyone. Despite this hesitancy, 10% of all 1998-
2000 Healthy Start participants reported currently being in a domestic violence
situation. Fourteen percent (14%) reported feeling “unsafe at home” in the past,
and 18% reported experiencing physical abuse. In tribal communities, high rates
of domestic violence are thought to be associated with inter-generational abuse
and post traumatic stress resulting from the great disruption of families and
communities inflicted by Indian Assimilation policies and practices. As recently as
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16. the 1960's and 1970's, children were removed from their homes and adopted out
into the majority culture, or sent away to boarding schools where they were
punished for speaking their native language. Poverty and substance abuse are
also thought to be significant exacerbating factors in domestic violence as well.
It is this understanding and expertise that RSC and its team brings to the
task of providing quality TA to Healthy Start grantees. As will be shown
within, the goal of RSC viz a viz the Healthy Start grantees is to build
infrastructure which supports a domestic violence counseling effort, to build
capacity within grantees to address the issue of domestic and family
violence; and to provide examples of best practices for both screening and
assessment and intervention with respect to the issue of domestic violence in
Healthy Start programs.
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17. II. Technical Approach to Task
The RFP indicates that technical assistance (TA) to be provided shall include the
following three components:
• A needs assessment of the Healthy Start site that must include but not be
limited to identifying the local prevalence of domestic violence and sexual
abuse, strengths/weaknesses of current services provided at the site,
screening rates, identification of personnel currently conducting domestic
violence assessments and the Healthy Start site process of linking domestic
violence screening to intervention services, current gaps in services that may
be linked via technical assistance activities, identification of the appropriate
staff to receive the TA training and assess the need for cultural diversity
among the site providers and materials.
• Development of a TA plan for enhancement of provider capacity to assess for
domestic violence and for effective linkages between domestic violence
assessment, perinatal services, primary care services and essential
community intervention programs that are tailored to the population and
practice setting. To represent the consortium that must be present at the TA
trainings, community intervention programs must include but not limited to
women’s shelters, linkages with consortia that is representative of the target
community, justice system, employee assistance programs, animal protection
organizations and dental providers13.
• Two days of on-site TA to implement the TA plan with all the consortia
represented. The TA must be provided by at least one staff member with
cultural expertise related to the majority population(s) served by the grant
receiving TA. The contractor will assist each site in drafting a 90-day site
action plan and provide follow-up via phone, on-site and/or electronic
consultation to each site that receives TA.
The following represents: first, an analysis of the essential differences between the
concept of screening and assessment; and second, a task by task analysis of the RFP
itself.
Screening and Assessment
Based upon RSC’s experience in this area, there are certain fundamentals that need
to be underscored. First and foremost is the difference between “screening” and
“assessment.” Unfortunately, in the domestic violence field, the words are often used
13
To this list, RSC would add substance abuse and mental health treatment providers as well.
15
18. interchangeably. And, as often, the word assessment is paired with safety in order to
address the need for “safety assessment.”
RSC subscribes to the basic definitions used by the Center for Substance Abuse
Prevention for a solid, working definition of screening and assessment.14
Screening.
This is a brief procedure used to:
1. Determine the presence of a problem (e.g., mental health disorder,
substance abuse)
2. Substantiate that there is a reason for concern
3. Identify the need for further evaluation
Screening is done early in the process of collecting information. It may be
done by a questionnaire or checklist. Screening tools are not meant to provide
a mental health or substance abuse diagnosis. Instead, they are used to collect
initial information that will help in further assessing the problem.
Assessment.
This is a more comprehensive diagnostic and treatment planning process
typically based on screening information. A detailed assessment may take
hours to complete and should help to prepare a treatment plan. Some goals of
assessment are to:
1. Examine the scope and/or severity of mental health or substance abuse
problems
2. Identify other possible psychosocial problems that may need to be
addressed further
3. Provide a foundation for treatment
4. Identify possible strengths of the woman that can become part of the
treatment planning process
Making these definitions fit for domestic violence is relatively easy and provides the
system with a tested “best practice” paradigm. It also helps to define what level of
practitioner should be doing screening as opposed to assessment. Thus, screening
becomes a process that any person receiving technical assistance can do. The same is
true about a safety assessment. However, a clinical assessment is a professional
14
http://pathwayscourses.samhsa.gov/vawp/vawp_7_pg2.htm.
16
19. determination made by someone who is a trained professional or diagnostician. In
short, a screening is an activity that can occur as part of a routine perinatal health exam
or history, during an initial visit or intake, during every new meeting, at any time that a
case manager becomes aware of an intimate relationship or even during periodic
comprehensive visits. The purpose is to determine that a referral for further
examination or assessment is appropriate.
A clinical assessment examines, as indicated above, the scope and severity of the
domestic/family violence problem and its correlation to other related or co-occurring
issues or disorders.
A risk or safety assessment was best defined by ACF in its treatise “Child Protection
in Families Experiencing Domestic Violence.”15
The purpose of performing a risk assessment for domestic violence with a
family entering the CPS system is to gather critical information regarding:
• The nature and extent of the domestic violence;
• The impact of the domestic violence on adult and child victims;
• The risk to and protective factors of the alleged victim and children;
• The help-seeking and survival strategies of the alleged victim;
• The alleged perpetrator’s level of dangerousness;
• The safety and service needs of the family members;
• The availability of practical community resources and services
The purpose of this analysis is to illustrate how, utilizing best practices approaches
to screening and assessment, one can effectively integrate domestic violence
counseling, screening and assessment into a broader healthcare scheme for addressing
the preconceptional, interconceptional and perinatal needs of women and their children.
15
Bragg, H. Lien (2003). “Child Protection in Families Experiencing Domestic Violence.” Adm inistration
for Children and Families. Adm inistration on Children, Youth and Families. Children’s Bureau, Office on
Child Abuse and Negled. Available online at
http://nccanch.acf.hhs.gov/pubs/usermanuals/domesticviolence/domesticviolence.pdf
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20. Task by Task Analysis
Task 1. At the beginning of each option year, the contractor shall meet with the Project Officer within
15 calendar days of the effective date of contract either via conference call or at the office of
the project officer in Rockville, Maryland. The purpose of the meeting shall be to identify
eighteen (18) sites of the 97 Healthy Start grantees that require technical assistance (TA) for
enhancement of effective assessment for domestic violence and linkages between perinatal
services, primary care services and essential community intervention programs for women
during their preconceptional, prenatal, and interconceptional time period. The TA needs
assessments shall provide a review of the local prevalence of domestic violence and sexual
abuse, strengths/weaknesses of current services provided at the site, screening rates,
personnel currently conducting domestic violence assessments, the Healthy Start site process
of linking domestic violence screening to intervention services, current gaps in services that
may be linked through this TA contract activities, past programs 16 implemented in previous
year(s) of this TA contract with attention to recommendations for enhancing TA under this
contract and improving the TA process including the pre-TA assessment, on-site TA, TA
follow-up, and TA evaluation methods.
Task 2. The contractor will revise the technical assistance process based on Task 1 and obtain
approval from the Project Officer of the finalized TA process.
RSC considers this one of the most important steps in creating a successful project.
Thus, RSC proposes that the start-up conference be held in person and that the two key
personnel (Dr. José Rivera, project director and Dr. Patricia McManus, deputy project
director) both be present.
RSC proposes that, prior to the start-up meeting, the GPO should forward to RSC a
copy of each grantee’s program narrative (excerpted from their original proposal) and a
copy of their latest report indicating current progress and status. In this way, project
staff will be able to enter the start-up conference with developed intelligence regarding
the grantees and would be able to better participate in making TA recommendations.
RSC would also propose that, prior to the start-up conference, the contractor should
also be provided with a copy of all work previously done by MayaTech under contract to
HRSA, again for the same purpose, namely to make the start-up conference more
profitable for all concerned.
Based upon a cursory review of the present list of grantees, it is the considered
opinion of RSC that the first priority for TA in Year One should be free-standing and
smaller community based organizations (CBOs), those located in Indian Country, Alaska
and Hawaii. The reason for this opinion is that RSC’s experience in providing TA
demonstrates that these agencies, more than those affiliated with governments or
larger institutions, often have infrastructure, organizational and developmental deficits
16
This addition added on June 20, 2006 makes it clear that, in years 2-4 of the contract, a grantee may
receive further TA on the DV issue and that this should serve the dual purpose of enhancing the grantee’s
capacity while, at the same time, improving the project’s ability to provide TA to Healthy Start grantees.
18
21. and thus represent the best candidates for TA. Using this yardstick, RSC proposes that
Round 1 TA should be allocated to the following agencies:
Grantee City and State
Aunt Martha's Youth Service Center, Inc. Chicago Heights, IL
Baptist Children's Home San Antonio, TX
Center for Black Women's Wellness, Inc. Atlanta, GA
Charles Drew Health Center, Inc. Omaha, NE
Community Health Centers, Inc. Oklahoma City, OK
Family Road of Greater Baton Rouge, Inc. Baton Rouge, LA
Great Lakes Inter-Tribal Council Inc Lac Du Flambeau, WI
Health Care Coalition of Southern Oregon, Inc. Medford, OR
Healthy Start, Inc. (Allegheny County) Pittsburgh, PA
Inter-Tribal Council of Michigan, Inc. Sault Ste. Marie, MI
La Clinica de Familia Las Cruces, NM
Mississippi County Arkansas EOC, Inc Blytheville, AR
Missouri Bootheel Regional Consortium Sikeston, MO
Neighborhood Centers, Inc. Bellaire, TX
Northeast Florida Healthy Start Coalition Jacksonville, FL
Northern Manhattan Perinatal Partnership New York, NY
Prevention Partnerships for Children West Palm Beach, FL
Richmond Healthy Start Initiative Richmond, VA
Shields for Families Project Inc. Los Angeles, CA
This list adds up to 19 grantees17 based upon all those grantees listed online who
qualify as CBOs. RSC would work with the Division to pare down this list to 18 as
required by the revised Scope of Work (SOW).
17
While the Black Health Coalition of Wisconsin would normally be on the list, their name is omitted on
this round since the Executive Director of that organization is the deputy project director for this proposal.
19
22. The Technical Assistance Process
While, from a grants management perspective, TA should not be considered
“mandatory” or the equivalent of an “unfunded mandate,” there are ways of making the
type of TA covered by this project both palatable for and desired by the grantees. For
this reason, RSC considers it important to convene, under the auspices of HRSA and the
Division, a national teleconference with all grantees who are being “invited” to
participate in TA.18 Since the decision in Round 1, if RSC’s proposal is accepted, would
be that all CBOs are being invited to participate, there will be no adverse inference
drawn by the fact that all CBOs are being asked to participate in TA. Additionally, if
framed correctly (e.g. as free continuing education with C.E.U.s available for
participants), there should be adequate support from the grantees to warrant their full
participation.
For RSC, the process for conducting TA consists, at the minimum, of the following
discrete steps:
• Pre-TA Assessment Stage. This would consist of the activities set forth in
Task 3 below and would, via telephone, e-mails and document exchanges,
document the readiness of the grantee for TA, its Strengths, Weaknesses,
Opportunities and Threats,19 its staff development training activities, its use
and relationship with consumers and their families, and all the other elements
set forth in Task 1 above.
• GPO Consultations. Critical to the process is a stage where the project
meets with the GPO and other Division staff in order to make critical
judgment calls regarding the appropriate scope of TA, revisions in the process
and any other information which might surface as a result of the initial needs
assessments.
• Creation of a TA Plan. Each grantee site would have its own TA plan which
reflects the issues coming out of the needs assessment plus such judgments
which might be added after consultations between project and Division staff.
At this point, the GPO and RSC would determine the best allocation of expert
resources for the TA assignment. In Year One, RSC believes that Dr.
José Rivera should be one of two team members present at each TA
in order to provide leadership, uniformity and accountability for the
TA provided.
18
As part of the Q&A provided by contracting, the SOW has been amended to include such a
teleconference.
19
HRSA will recognize this as a traditional environmental scan utilizing the SW OT test in order to
determine internal strengths and weaknesses plus external opportunities and threats.
20
23. • On Site Entrance Conference and Validation Stage. After the TA has
been approved and consultants are approved for travel, there is an entrance
conference envisioned by RSC which would do two things: validate, if
possible, the preliminary conclusions from the needs assessment stage; and
determine whether there are unexpected issues or barriers to moving forward
based upon direct input from the agency executive.
• The Executive/Managerial Focus Group Meeting. RSC envisions that
each TA will be followed by an informal but structured focus group where the
executive and management staff could provide further insight into the
dynamics of the agency, their relationship to the DV issue, knowledge of past
incidents which might be relevant to training, and the like.
• Walking Tour of Ongoing Activity. The TA team would then tour the
agency to determine whether the physical environment is “safe” and whether
the atmosphere is supportive of domestic violence intervention. In addition,
the team would be able to determine the extent to which privacy is truly
respected and how clients are ultimately treated.
• Training of Agency staff, providers and community partners20. This
would consist of the actual TA provided pursuant to the TA plan over a period
of two days as more fully described herein.
• Development of 90 day Action Plan. The concept of a 90 day Action Plan
is to create a document agreed upon by the agency which commits them to a
series of activities designed to enhance their ability to address the DV issue
within their agency and the community.
• Executive/Managerial Debriefing Meeting. Following the reversal of the
entrance process, the TA team would conduct a focus group of the managers
within the agency in order to assess further TA needs and obtain their
evaluation of the TA provided.
• Exit Conference with Director. Similarly, the exit conference with the
Director would assess the progress made and provide an opportunity to share
Director level information regarding how the agency is or is not prepared to
address the DV issue.
• Follow-up TA as needed. Follow-up TA would be based upon a post TA
20
While no reference to community partners is made in the RFP, RSC feels strongly that the TA must
include, not just identifying community partners (such as domestic violence coalitions or agencies), but
bringing them to the table as well.
21
24. assessment prepared by the TA provider and reflected in a post-TA report.
This would be then reviewed with the GPO and a judgment would be made as
to the type and nature of follow-up TA which is warranted.
• TA Evaluation. This would consist of two levels of evaluation, first, a
written evaluation provided by attendees and a narrative evaluation provided
by the agency director. To this would be added the evaluation by the project
director and all of this would be submitted to the GPO for consideration. The
evaluation itself would follow the format set forth herein.
The nature of this project demands a close working relationship between the project
and the GPO. Hence, each major project work product will undergo the rigorous checks
and balances envisioned by Task 2.
Task 3. The contractor shall conduct a technical assistance needs assessment for each grantee and
program community identified in Task 1. The contractor shall make an initial telephone
contact with each of the eighteen (18) grantees, their subcontractors and affiliated
screening/intervention sites via telephone to ascertain their organizational structure and the
breadth of individuals and entities that should be included in the TA. Next, the contractor
shall send key informants a written needs assessment described in Task 1. The written
needs assessment will be collected from all key informants within two (2) weeks of
dissemination.
In many respects, this is one of the most important tasks within the project. For
RSC, the needs assessment will serve many purposes:
First, the needs assessment will serve that Task requirement to “ascertain their
organizational structure and the breadth of individuals and entities that should be
included in the TA;”
Second, the needs assessment will examine the organizational capacity and
readiness of the grantee to address the issue of domestic violence;
Third, the needs assessment will identify gaps in the program’s service array,
determine organizational priorities based upon past performance, identify
performance, training or educational deficits related to domestic violence,
identify existing and potential collaborations, and identify opportunities for
growth and potential solutions.
Other important but more anecdotal reasons for conducting a needs assessment
include:
• A needs assessment can create “buy-in” within the organization for moving in
a new direction or taking needed strategic action;
• A needs assessment can build staff confidence by focusing on collective
22
25. needs, goals and assets as opposed to individual deficits or faults;
• A needs assessment can be a vehicle for identifying hidden assets or skills
either within the organization or within the community;
• A needs assessment can enhance an understanding of the “lay of the land”
and the organizational climate for addressing issues related to domestic
violence, women’s safety and/or the empowerment of women.
RSC’s philosophical framework for conducting a needs assessment involves its
understanding of the complex interplay between domestic violence and healthcare.
Domestic violence rarely exists in a vacuum. The literature is full of studies showing a
connection between domestic violence in early childhood trauma - some perpetrated
against the victim of domestic violence and sometimes against the batterer. Likewise,
there is growing evidence that women who are victims of domestic violence and are
living a life that is traumatic will “mask” their trauma through self-medication, most
often through drugs and other substances. And, obviously, there is a direct and clear
correlation between domestic violence and the health of both the birth mother and the
future child.
Thus, it is relevant to raise this issue: if an agency is going to address domestic
violence, then is it prepared to create the infrastructure, systems and collaborative
networks to make addressing the problem more than a sham. To do less is to
revictimize a woman who crosses the barrier and discloses domestic or family violence.
There are, in fact, more than one kind of needs assessment utilized to determine TA
needs. Broadly, they break down as follows:
• Organizational training needs are determined by looking at the mission of
the organization, its mandate both to its charter and to the community of
service. Organizational training needs are determined, generally, at the
highest levels of the agency including the executive director, high level
management and the board of directors.
• Occupational training needs are determined by healthcare mandate of the
agency reflected in contracts with funding sources, job descriptions and
licensing requirements.
• Individual training needs are identified by employees, supervisors and
managers and includes training which is needed to effectively perform
assigned or planned duties. This type of training generally produces an
immediate or short-term return on the training investment.
RSC proposes to create a needs assessment process which begins with the very first
national teleconference with the grantees. At that time, the grantees will be asked a
23
26. short list of questions21 which include the following:
1. What is the greatest challenge in addressing domestic violence in your
community?
2. To what extent are culturally competent domestic violence services available
to your Healthy Start clients?
3. Do you have an existing MOU regarding protocols to be followed with respect
to either screened or revealed domestic violence?
These questions, with perhaps a few others, are designed to inform the more formal
needs assessment process - one which will be conducted by an e-mailable form. The
form which RSC proposes to use is attached in preliminary draft form as Exhibit A.
Also attached as Exhibit B is an organizational self-assessment tool which RSC used for
addressing the special needs of the African American MSM community in Atlanta. It is
submitted in order to begin a dialogue with Division personnel regarding a composite
document that can be used to complete a formal assessment process with each of the
grantees.
While both of these forms are e-mailable, RSC proposes to e-mail them for reference
purposes but have them completed by project staff via teleconference with the
grantee’s director.
The need for a needs assessment is best exemplified in a report from a Healthy
Start site in Richmond, VA.:
In 2000, when the needs assessment was done for the reporting period, the
number of Hispanic women living in Richmond City was very small and perinatal
outcomes for these women were similar to those of white women living in
Richmond. Therefore, Hispanic women and infants were not targeted for
services. However, the number of Hispanic women living in Richmond increased
by 400% and their perinatal outcomes began to worsen during the project
period. The RHSI contractor serving the South Side (where most Hispanic
families live) expanded their target population to include Hispanic women at risk
and added a translator to their staff to assist these families. Major risk factors for
this group are accessing health care and domestic violence. Many Hispanic
women coming to Richmond are undocumented and fearful of the health care
system. RHSI has also noticed that domestic violence is an issue for many
Hispanic women seeking services. It is not known if perinatal Hispanic women
21
In order to avoid having this considered a survey for OMB purposes, each of the grantees will have
already been “enlisted” as sites where TA is going to be provided and, thus, the questions will be part of
the TA and not part of a survey.
24
27. are abused more often than women of other races/ethnicities are, or if Hispanic
women tend to complete appointments regardless of visible signs of abuse
whereas White and Black American women may not. Risk factors for poor
Hispanic perinatal outcomes will be explored further during the 2005-2009
project period.22
RSC proposes to obtain the best information available from each grantee so that the
TA provided is tailored to the actual needs of the grantee and not based upon some
boilerplate or cookie cutter template that is designed as a “one size fits all.”
In the final analysis, the needs assessment process should yield a grid which, in
essence, is best described by a SWOT chart:
It is not lost on RSC that the very act of engaging in this process is actually a part of
long term strategic planning. Therein lies the magic behind this project. To understand
the need to address domestic violence for Healthy Start clients is to understand the
need to see long term Return on Investment (ROI) versus the mere short term goals of
providing for the surface perinatal needs of expectant mothers.
Literally, by working with grantees to address this very important issue, HRSA
assists the grantee to look at issues of strategy, sustainability, collaboration and many
more.
22
Richmond Healthy Start Initiative Impact Report submitted to Health Resources and Services
Administration. Available online at http://www.mchlibrary.info/MCHBfinalreports/docs/5H49MC00124.pdf.
25
28. The RFP calls for the following:
A needs assessment of the Healthy Start site that must include but not be limited
to identifying the local prevalence of domestic violence and sexual abuse,
strengths/weaknesses of current services provided at the site, screening rates,
identification of personnel currently conducting domestic violence assessments
and the Healthy Start site process of linking domestic violence screening to
intervention services, current gaps in services that may be linked via technical
assistance activities, identification of the appropriate staff to receive the TA
training and assess the need for cultural diversity among the site providers and
materials.
RSC did not understand the RFP to require the presentation of the actual needs
assessment which will be used. It was RSC’s sense that the project would be best
served if this were done collaboratively with the Project Officer. After a conference with
contracting as part of the negotiation process, RSC now understands that the needs
assessment will be done collaboratively with the Federal Project Officer (FPO).
The attachments attached to the technical proposal were submitted solely to give
the reviewers an idea of assessment type instruments which RSC has used in other
programs and activities and was not intended to convey the instrument that would be
used in this project.
RSC believes that a good model for developing a needs assessment is that set forth
in the guide created jointly by the Washington Department of Health and the Maternal
Child Health Bureau of HRSA. That document is entitled “Perinatal Domestic Violence
Identification Services: A Guide Toward Culturally Relevant Care in Health Clinics.”23
The relevant section of that document is attached hereto and RSC would recommend it
as a template for addressing the domains and areas covered by the RFP plus others
that are relevant to the project.
Understanding that the needs assessment instrument is going to be a post-contract
collaborative activity, RSC has, nonetheless, attached a sample instrument to this
supplemental submission which RSC believes covers the data points and is structured in
such a way that the use of this document “as a guide” will not require OMB Clearance.
Task 4. Prior to providing any on-site technical assistance, the contractor shall prepare a draft
summary for each of the 20 sites (e.g. 20 separate summaries) to reflect the findings of the
needs assessment process and present a grantee-specific plan of TA to address each
individual grantee’s needs. The report must be submitted to the Project Officer before travel
plans are made with the grantee. Each report shall include the following item s:
a. On-site TA training topics, which shall include:
23
http://www.doh.wa.gov/CFH/mch/documents/PDVIS_Guide_for_web.pdf.
26
29. • Incidence and prevalence of domestic violence including by race/ethnicity and the
importance of domestic violence screening and assessment during primary care and
perinatal care visits. Presentation must include national data and local intimate partner
violence statistics by race/ethnicity. Local statistics on intimate partner violence must be
presented by a Healthy Start staff member.
• Effects of domestic violence on maternal and fetal/infant outcomes by race/ethnicity.
• Effective methods of cross-agency communication and intervention based on client
demographics and available resources in the community. This includes the role and
responsibility of the screening agency as well as each intervention agency in the
community. Further, it includes strategies for effective, ongoing communication,
productive and collaborative linkages across agencies. Presentations shall include
examples from local grantee community presented by grantee staff as well as examples
from other communities presented by TA staff.
• Strategies to address client/staff safety, confidentiality and liability issues. This includes
transfer of inform ation from one agency to another.
• Identification and utilization of a domestic violence counselor within the community-
based system.
• Identification of additional intervention resources within or outside of the community.
b. Culturally appropriate screening/training materials to be utilized during TA training.
c. Identification of the specific role of the grantee in the TA including responsibility for
presenting local family violence statistics, overview of current resources for screening and
intervention and consideration for improving resources within their service area. This
presentation should be a facilitated discussion with all attendees during group TA
training.
d. Agenda for on-site TA which will comprise two (2) full business days. Agenda must
outline presentation role for grantee as well as TA staff. All training provided should
include Continuing Education Units/Credits (CEU) as appropriate.
e. Curriculum vitae of one to two consultants, each of whom has culturally appropriate
expertise in the Healthy Start sites expressed needs. The Project Officer shall have final
approval of the consultant engaged by the contractor.
f. Method of evaluating the effectiveness of the site visit. Evaluation must include, but is
not limited to, data collected on staff motivation and evidence of leveraging funds for
sustainability of the domestic violence assessment component within the Healthy Start
program during the duration of their funding.
g. Preliminary plan for post-technical assistance follow-up with each grantee.
Task 5. The contractor shall revise the draft technical assistance plan completed in Task 4 based on
the Project Officer’s comments. Any changes to a revised plan after it has been accepted by
the Project Officer must be mutually agreed upon by the Project Officer and the contractor.
Tasks 4 and 5 present two different kinds of issues - what RSC will call, for purposes
of analysis “what issues” and “how issues.”
The “what issues” involves the content of the “grantee-specific plan of TA” as set
forth in Task 4. RSC does not dispute the appropriateness of the elements cited by the
government. However, RSC strongly proposes that the content of the “grantee-specific
plan of TA” must be reflective of the needs assessment and not of some boilerplate set
of requirements. Otherwise, the whole purpose of the needs assessment will be lost.
An analysis of each element of Task 4 follows:
27
30. Task 4 Requirement RSC Comments
a. On-site TA training topics, which shall include: RSC urges the Division that this should not be
considered an exclusive list in order to make
allowance for findings emanating from the needs
assessment.
• Incidence and prevalence of domestic RSC believes that this kind of information is
violence including by race/ethnicity and the available prior to making travel arrangements for
importance of domestic violence screening an on-site TA but questions the need for local
and assessment during primary care and statistics being “presented” by a Healthy Start
perinatal care visits. Presentation must staff member. RSC believes it would be sufficient
include national data and local intimate if the local statistics were “provided” by or
partner violence statistics by race/ethnicity. through the Healthy Start “grantee.”
Local statistics on intimate partner violence
must be presented by a Healthy Start staff
member.
• Effects of domestic violence on maternal and RSC believes that this is important information but
fetal/infant outcomes by race/ethnicity. suggests that literature does not support a view
that the “effects of domestic violence” are
different by race/ethnicity but rather that, in
com munities of color, there is a greater incidence
of domestic violence and poor health outcomes.
• Effective methods of cross-agency RSC believes that it is premature to expect a TA
communication and intervention based on Plan to conclude more “effective methods of
client demographics and available resources cross-agency communication and intervention”
in the community. This includes the role and since that is exactly what the TA is supposed to
responsibility of the screening agency as well engender. To create a plan that presupposes the
as each intervention agency in the solutions before going on-site is to create the
community. Further, it includes strategies for exact type of “cookie cutter” solution which this
effective, ongoing communication, productive project appears to be attempting to avoid. It is
and collaborative linkages across agencies. RSC’s view that many, if not most, CBO grantees
Presentations shall include examples from will be unable to present best practice examples
local grantee community presented by which, again, is the very reason why they require
grantee staff as well as examples from other TA.
communities presented by TA staff.
• Strategies to address client/staff safety, While the issue of confidentiality and client/staff
confidentiality and liability issues. This safety can be reduced to some universal rules and
includes transfer of information from one principles, RSC strongly believes that these rules
agency to another. will change dramatically depending upon the
demographics or race/ethnicity of the grantee.
What works in one place may not in another.
• Identification and utilization of a domestic This is a given but RSC would add that a goal of
violence counselor within the community- this project should be to encourage all grantees
based system. to designate one manager/supervisor in the
agency to be the DV Service Coordinator for the
agency responsible for monitoring the effective
implem entation of the agency’s DV strategy.
28
31. Task 4 Requirement RSC Comments
• Identification of additional intervention RSC believes that the TA plan should not conclude
resources within or outside of the community. what the resources are but rather identify that as
a need if, indeed, it is a need. For some
agencies, there may be identified resources but
no collaboration.
• If grantee received family violence TA in a RSC considers this essential and will insure during
previous year and is now receiving additional the “intake” process at the beginning of the
TA to enhance their screening and project that all prior TA will be taken into
intervention capacity, the needs assessment consideration and used as a building block for
and TA should reflect this enhanced enhanced TA.
approach.
b. Culturally appropriate screening/training RSC agrees that this is critical and that these
materials to be utilized during TA training. materials should be identified as part of the TA
plan.
c. Identification of the specific role of the RSC strongly agrees that the on-site TA should
grantee in the TA including responsibility for not be a “talking head” presentation by the
presenting local fam ily violence statistics, project but, to the extent possible, there should
overview of current resources for screening be interactive participation by grantee staff in
and intervention and consideration for order to create participatory and peer training
improving resources within their service area. while, at the same time, enhancing “buy-in.” RSC
This presentation should be a facilitated would propose to utilize grantee staff to engage
discussion with all attendees during group TA in each element of the SWOT analysis described
training. above.
d. Agenda for on-site TA which will comprise two RSC agrees that a two day agenda can and
(2) full business days. Agenda must outline should be presented subject to the following
presentation role for grantee as well as TA caveat, namely, that on-site TA should, by
staff. All training provided should include definition, be flexible enough to change in order
Continuing Education Units/Credits (CEU) as to accommodate newly assessed needs presented
appropriate. on-site. CEU credits are available in most sites.
e. Curriculum vitae of one to two consultants, RSC will have already provided the CVs of all
each of whom has culturally appropriate faculty who will be used in the project and will
expertise in the Healthy Start sites expressed make reference to them as part of the TA plan.
needs. The Project Officer shall have final RSC agrees that the GPO should have final
approval of the consultant engaged by the approval over each assigned consultant upon the
contractor. project director’s recommendation.
f. Method of evaluating the effectiveness of the While more fully explained below, RSC believes
site visit. Evaluation must include, but is not that using a pre-test and post-text coupled with
limited to, data collected on staff motivation an attendee evaluation should provide sufficient
and evidence of leveraging funds for data for the Division. The issue of sustainability is
sustainability of the domestic violence a difficult one since it far exceeds the scope of
assessment component within the Healthy this RFP. RSC believes that sustainability is one
Start program during the duration of their of the weakest links for all grantees and, thus,
funding. RSC will work with the grantee to make sure that
their action plan addresses this important issue.
29
32. Task 4 Requirement RSC Comments
g. Preliminary plan for post-technical assistance RSC suggests that, at best, only a cookie cutter
follow-up with each grantee. template for post-TA follow-up can be presented
prior to the TA. This will consist of a combination
of telephone calls, e-mails and teleconferences as
appropriate. RSC believes that, after the TA and
as part of the TA report, RSC will be able to
provide more detailed and insightful
recommendations regarding sustainability.
Under RFP Task 4, the requirement was stated as: “Method of evaluating the
effectiveness of the site visit. Evaluation must include, but is not limited to, data
collected on staff motivation and evidence of leveraging funds for sustainability of the
domestic violence assessment component within the Healthy Start program during the
duration of their funding.”
RSC indicated in its proposal that it would be “using a pre-test and post-text coupled
with an attendee evaluation.” As stated, RSC’s evaluation approach is divided into two
parts: The pre/post test and traditional TA evaluation instrument (more appropriately
called a customer satisfaction survey).
Upon reflection of the Division comments, RSC believes that this project would be a
good opportunity to use a post-then-pre test focused not so much on the mere
accumulation of knowledge but rather on behavior change and motivation for change.
A post-then-pre evaluation uses the following format:
What is your understanding Now - after completing Back - Before you the start
of: this TA program of the TA program
4 3 2 1 N/A 4 3 2 1 N/A
The literature identifies the strengths of the Post-then-Pre evaluation as follows:
• Response shift bias. Extensive research has shown that response shift can
mask program effectiveness; the retrospective design reduces or eliminates
response shift bias.24
• Validity. Compared with results from the traditional pre- and post design,
results from the retrospective design are more congruent with interview data
24
Howard, G. S. (1980). Response-shift bias a problem in evaluating interventions with pre/post self-
reports. Evaluation Review, 4(1), 93-106.
30
33. collected from program participants and leaders.25
• Versatility. The retrospective method has been used to evaluate many types
of programs for different audiences in varied settings and appears to reduce
response shift bias across contexts.
• Convenience. Responding to both measures at the same time is less
burdensome and intrusive for learners. Collecting responses for both
measures at the same time gives you before and after data for each learner.
Data will only be missing if a learner skips questions or fails to complete the
questionnaire.
RSC submits the post-then-pre test only as a recommendation. RSC is
prepared to use a structured pre-test with a structure post-test - an
approach that can be resolved at the start-up meeting for this contract. The
purpose of the test is to measure two major elements: the increase in knowledge as a
result of the TA and the differences in the participant’s perceptions regarding domestic
violence or the extent to which a participant’s behavior might change as a result of the
TA provided.
With respect to the second part of the evaluation process, RSC is regularly charged
with conducting post-TA evaluations of grantees. This is designed to elicit from the
grantee itself answers to the following questions:
1. Was the TA Provider (TAP) knowledgeable about issues related to domestic
violence generally.
2. Was the TAP knowledgeable about how issues of domestic violence intersect
with preconceptional, perinatal and interconceptional healthcare.
3. Did the TAP keep your attention through the use of varied teaching
techniques (interactive discussion, Q&A periods, powerpoints, exercises, etc.).
4. Did the TAP motivate you to know more about domestic violence and its
impact on the Healthy Start population you serve.
5. Did the TAP provide you some ideas which you will be able to use in your
work within you agency.
6. Was the TA on time and focused on the items reflected in the preliminary
agenda.
7. Was the TAP responsive to questions asked by the audience.
While these data points were not exactly addressed in the RFP, it will be important
to the project, in the long run, if HRSA and the project understands how grantees are
“receiving” the experts provided by or through the project.
25
Howard, G.S., Millham, J., Slaten, S., & O’Donnell, L. (1981). Influence of subject response-style
effects on retrospective measures. Applied Psychological Measurement, 5, 144-150.
31
34. Assuming that HRSA prefers to use a pre-test followed by a post-test, RSC would
recommend a test similar to the following26:
1. Domestic violence is:
A. Usually brought on by alcohol and other drug abuse/use
B. A pattern of assaultive and coercive behaviors that adults or adolescents use against their
current or former intimate partners.
C. Physical abuse or assault by a stranger.
D. A form of abuse which does not have an impact on children
2. The fundamental guiding principle in working with women who is or believes herself to be a
dom estic violence victim is:
A. Getting her to understand she must leave the relationship
B. Safety
C. Working with her to stop any and all drug abuse
D. Getting her to understand the importance of couples counseling
3. Please list the four forms of abuse that encompass domestic violence and give an example of each
form of abuse.
4. Please identify at least four tactics that batters use against their victims:
5. Men who batter are generally “out of control” when they are abusive or violent.
True
False
6. Please identify at least three barriers to leaving an abusive relationship.
7. Please identify three basic services children whose mothers are battered need:
8. Battered women need _______ to move forward and take steps toward maintaining a safer and
healthier life.
A. To be empowered
B. To be told what to do
C. To stop using drugs and/or alcohol
D. To go into couples counseling
9. People who work with domestic violence survivors can expect them to:
A. Leave the relationship within a few months
B. Be in denial about the abuse
C. Go back and forth in the relationship
D. Both B. and C.
10. The most dangerous time for a battered woman is when she attempts to:
A. Make amends with the batterer
B. Leave the relationship
C. Reduce the stress at home
26
Again, this is only an example of something to be discussed with the FPO.
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35. Task 6. The contractor shall provide technical assistance annually to each of the eighteen (18) grantees in
accordance with the grantee-specific technical assistance plan. Prior to traveling to a grantee’s
site to provide the TA, the contractor shall obtain the Project Officer’s approval as to the location
and date of travel.
RSC plans on working with the GPO to create a written protocol for approval of a TA
plan and the location and dates of travel. At the minimum, RSC would provide to the
GPO the following information:
Request for Approval of TA Plan and Logistics Plan
Grantee:
Consultant:
Needs Assessment Completion Date:
TA Plan Submission Date:
Proposed TA Dates:
Estimated Direct Costs: Consultant Airfare:
Consultant Per Diem Fee:
Consultant Lodging/Meals:
Other Expenses: Parking, local travel, etc. as per FAR.
Approved by GPO: Date:
For protocol purposes, RSC is amenable to expanding this form in order to meet the
technical monitoring responsibilities of the GPO and the Division.
Task 7. The contractor shall prepare a draft report within one month of completing each technical
assistance visit. Each report shall include the following:
a. Preliminary findings while conducting the TA at the grantee’s or community site.
b. A recommended plan for follow-up. The follow-up plan must include measures to
evaluate the effectiveness of the initial visit during which the contractor provided
technical assistance. The plan will also include additional consultation to be delivered via
telephone, fax, on site or e-mail to facilitate the grantee’s success in implementing and
sustaining effective linkages between primary care services, perinatal domestic violence
screening sites, and essential community intervention programs for women during or
around the time of pregnancy.
Task 8. The contractor shall revise each draft plan completed in Task 7 based on the Project Officer’s
comments. Any changes to a revised plan after it has been accepted by the Project Officer must
be mutually agreed upon by the Project Officer and the contractor.
While RSC considers the provisions of this task to be generous and, as such, there is
a temptation to demur with agreement, RSC recommends that the TA Report should
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36. include the following elements:
TECHNICAL ASSISTANCE REPORT
Organization/Age
ncy:
Agency Point of
Contact:
Street Address:
City/State/Zip:
Phone:
Fax:
E-Mail for Contact:
I. Introduction
A. Agency Background
1. Grantee Status
2. Client Program Focus
3. Program Size, Capacity, Enrollment, Number of Participants
4. Names and Titles of all Key Personnel to Healthy Start Program
B. Program Design
1. Eligibility Criteria
2. Current Case Status at Time of TA
3. Duration of Program
4. Core Program Services
5. Use of Consumers
6. Use of Community Advisors
7. Unique Program Features
C. Needs Assessment Findings:
D. TA Plan:
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37. E. TA Date and Agenda:
II. TA Findings and Recommendations
A. Results of TA (Post tests, Evaluations, etc.)
B. Overall Impressions of Program’s Domestic Violence Activities
C. Staff Interactions/Dynamics/Attitude and Demeanor
D. External Relationships and Collaborations
E. Printed Materials for Domestic Violence and Related Issues
F. Protocols in Place for Domestic Violence and Related Issues
G. Willingness to Self-Assess Program Efficacy for Domestic Violence
III. Areas Requiring Further Analysis or Technical Assistance
IV.Areas Requiring Attention by the Division
V. Recommendations for Follow-up TA
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38. Task 9. The contractor shall implement each follow-up plan within one (1) month of the Project Officer’s
acceptance of the revised plan.
RSC recommends that this Task include a proviso at the end of the Task stating “unless the
Project Officer directs otherwise.” This will allow for the flexibility associated with
unforseen events. This is necessary because the conduct of 18 TA assignments within one
year basically requires one to be done every two weeks given vacations and federal
holidays. Something might happen with that schedule which would dictate the need for
temporal flexibility.
Task 10. The contractor shall prepare a summ ary report within two months after completing each follow-
up plan and share/send with the contract project officer and Healthy Start project officer. Each
report should include the following:
a. The technical assistance needs identified by the grantee or community during both the needs
assessment and the on-site TA.
b. Type of TA provided and by whom.
c. Level of participation including number and dem ographic profiles of participants.
d. Evaluation of TA and follow-up including, to the extent measurable, changes in referral
practices and utilization of intervention services.
e. Lessons learned by the contractor from conducting the needs assessment and TA at
grantee’s or community’s site.
f. Remaining needs and recommendations for future TA the grantee or community.
See RSC response to Task 7-8 above. RSC will work with the GPO to create a
composite report format that accomplishes all the goals of HRSA plus the accountability
goals of RSC as the TA supervisor.
Task 11. The contractor shall prepare single draft summary report after all follow-up plans have been
implemented and completed. The report shall include summaries of the following:
a. Common and diverse family violence technical assistance needs of all grantee and
community projects served by the contractor under this contract.
b. Strategies found most and least effective in meeting the technical assistance needs.
c. Lessons Learned by the contractor from conducting the needs assessment and TA for these
projects.
d. Remaining needs and recommendations for future technical assistance which may be offered
by Division of Healthy Start and Perinatal Services (DHSPS).
The contractor shall provide an oral presentation of the draft summary report to DHSPS staff in
Rockville, Maryland.
Task 12. The contractor shall revise and subm it the sum m ary report based on the Project Officer’s
comments.
RSC will work with the GPO during the course of the year to create a template which
will be subject to GPO approval that will guide the draft and final report process.
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39. III. Personnel
Background and History
Rivera, Sierra & Company, Inc. (RSC) is a for-profit company corporation incorporated in
the State of New York and in continuous operation since 1990. The firm is a minority
business enterprise comprised of two principals, José A. Rivera and Lizzette Sierra, both
Puerto Rican and both 50% shareholders. There are no other shareholders. The company
is not owned by, the parent of or affiliated with any other company. The principal activities
of the corporation is consulting for government, tribal nations, grantees of government
agencies, non-profit agencies and small businesses. The firm is an 8(a) and HUBZone firm
certified in 2000 by the SBA. The NAICS Codes for which the firm is qualified are 541611,
541612, 541613, and 541618. RSC maintains its headquarters office in New York City and
a Washington area office at 1700 Rockville Pike, Rockville, MD. The primary corporate
office servicing this account will be the New York office jointly with the Maryland office.
The project director, Dr. José Rivera will spend almost equal project time out of both
offices.
The following chart describes the professional personnel who will be associated with
this project. Annexed hereto as Exhibit C is a copy of the vitae for all faculty who will be
associated with the project. As the project moves forward, RSC may receive
recommendations as to other faculty and they will be appropriately submitted to the GPO
for approval.
A. Key Personnel - Project Administration
José A. Rivera, J.D.
Project Director
Dr. José Rivera is CEO of RSC, a company with a long track record in providing TA to
federal agencies either directly or on behalf of their grantees. Dr. Rivera is finishing a two
year contract (in August, 2006) with the ACF Office of Family Assistance as project director
for the Welfare Peer Technical Assistance Network providing TA to TANF agencies and
CBOs throughout the United States. Dr. Rivera has been a HRSA Contractor heading up
a project to create a Minority Faculty Development Model and moderating a two year series
of seminars on Minority Health and Racial/Ethnic Disparities. In the DV field, Dr. Rivera
served as Executive Director of the Center for Human Rights, Inc., a nonprofit agency
providing DV counseling and emergency services. He also served as Project Director for
the Women, Youth and Children’s Task Force within the Center for Substance Abuse
Treatment.
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