HomeMy WebLinkAboutCOM 0041.023 2008-2010 William T. Takaba
■gib Managing Director
• William P. Kenoi •' 11 ���'s -. ��
Mayor
Walter K.M. Lau
. Deputy Managing Director
f or AO .
County of Hawaii
Office of the Mayor
25 Aupuni Street, Suite 2603 • Hilo, Hawaii 96720 • (808) 961 -8211 • Fax (808) 961 -6553
KONA: 75 -5722 Hanama Place, Suite 102 • Kailua -Kona, Hawaii 96740
(808)327 -3602 • Fax (808)326 -5663
DATE: April 20, 2010 •
TO: J Yoshimoto, Council Chairman and
Council Members °
On
VIA: Kay Oshiro, Controller xj
rn
FROM: Kalani Kahalioui�Ti�'(
RE: NOTIFICATION OF GRANT AWARD = Ti
Compliance with Ordinance No. 09 -64, Section 7(1) C
1V
Name of Grant Program: Strategic Prevention Framework — State Incentive Grant
Grantor: State Department of Health
County Grantee Department or Agency: Office of Management
Grant No. (IF KNOWN):
Amount of Grant: $2,103,140.28
Amount of County Match: $0.00
County Revenue & Expenditure Account Numbers: • 3308.59 & 010.111.5111.68
Grant Period (Commencement & Completion): April 1, 2010 to September 29, 2011
Purpose of Grant: To implement and evaluate evidence based underage drinking
prevention activities in Hawai`i County.
Is final report required by grantor? ® Yes 0 No
Notification attached: ® Yes 0 No, because
Comm. No. I "( • 2 3
• Ref. To:
Ref. Pole APR 22 201m
County of Hawaii is an Equal Opportunity Provider and Employer. Form NGA 09/09
•
•
Department of Finance F -111 (7/201/7)
Contract Routing. Form •
Date: 3/23/10
Department: Office of Management/Mayor's Office •
Contact: Kalani Kahalioumi 8860 •
•
(Name) - (telephone Extension)
Name of Contractor: State Department of Health
(If none, complete Form V-8 and forward to Accounts for
Vendor Number: 00091 assignment of vendor number before processing contract)
To receive funds for Strategic Prevention Framework for Underage
Purpose /Title of Contract: Drinking Prevention Plan (SPF -SIG)
• ❑Employment or /ilInter- Government
Account No. to Charge: 0-10.111.511.67115 Fiscal Year : 2009 -10
Amount of Contract: $2,103,141:28 FRESH Req. No.: N/A
( •\ •
Procurement Approval: \ / Contract No.:
•
For contracts requiring multi -year comm '• ents,
acceptance of federal funds or funds in a future FY:
Council Resolution Number: Date Approved:
(Attach copy of resolution)
Route to: Contractor (Review and sign contract before notary public)
�! Date completed & forwarded to next: • MnD 2 3 znttt
IV Department Head(s) (Signature(s) recommending approval)
• Date completed & forwarded to next: MAR 2 2 2010 •
(Additional Dept.)
n Human Resources (Director of Human Resources' certification,
required for a contract for services which are exempt pursuant to
HRS §76 -77 (7), (8) or (12) only. Director of Human Resources review
required for requests for exemption under HRS §76 - 77(16))
Date completed & forwarded to next:
• r--- n Purchasing Agent (Procurement review and reporting) •
cv Date completed & forwarded to next: 3I 44 •
d.
[1 Controller/Director of Finance (Certification offunds) •
- Date completed & forwarded to next:
ni • O •
c■
- r n Corporation.Counsel (Approve as to form and legality •
Date completed & forwarded to next: 4-a 3 -'O 4 --
Mayor (Review, notarized signature and date) •
MAR 3
Date completed & returned to originating Dept.: 2 2019 •
RETURN TO DEPARTMENT REQUESTING CERTIFICATION
for issuance of notice to proceed and distribution of contract copies to
affected parties and Controller
After execution of contract, retain this form in procurement file with all required attachments • Page . 1 of 4
Department of Finance • F -111 (7/2007)
Checklist for Contracts
Initial Date
Included in the contract:
Sec. 103D -310 (see also HAR §3 -122 -112)
Sec. 104 prevailing wages for construction exceeding $2,000
Sec. 103 -55 wage certificate requirement (services over $25,000)
Inclusion of current applicable general conditions by reference
Inclusion of federally mandated terms or use of federal forms' if
federal funding involved
On the contract:
Departmental recommendation of approval
Notarized signature of authorized representative of contractor
Notarized signature of bonding agent (if applicable)
Corporate seal of contractor (if applicable)
Appropriate clause for procurement exemption under HAR
§3- 120 -4(g) (if applicable)
Appropriate clause regarding exemption from civil service
(if applicable)
Attached to contract:
State /IRS Tax Clearance Certificate - Form A -6 (Rev. 2003) (valid for
•
6 months from issuance) (if over $25,000 or price agreement likely to
exceed $25,000) or Certificate of Vendor Compliance
Department of Labor and Industrial Relations Certificate -
Form L1R 427 (12/03/03) (valid for 6 months from issuance)* or
Certificate of Vendor Compliance
Department of Commerce and Consumer Affairs Certification BREG -
Certificate of Good Standing (valid for 6 months from issuance)* or
Certificate of Vendor Compliance
Bond (if non - construction or under $25,000, attach chief procurement
officer's approval to require bond)
Finance Director's certification of availability of funds
Resolution of corporate or partnership authority
Sec. 103 -55 wage certificate (if services over $25,000)
Insurance certificate(s) (if applicable)
* Note: Only applicable to contracts of $25,000 or more acquired under Sec. 103D -302, 303,
304 or 306. If less than S25,000, State Tax Clearance, DLIR and DCCA -BREG) or Certificate of Vendor
Compliance are optional.
After execution of contract, retain this form in procurement file with all required attachments Page 2 of 4
Department of Finance F -111 (7/2007)
Procurement Information
The information below is required so that Purchasing Division and.Corporation Counsel can
determine if proper procurement procedures were followed in selection of contractor.
Bid No.: (IFB or RFP) Job No.:
Vendor selected by:
n Competitive sealed bidding (IFB) (HRS §103D -302) *Attach certified cost and
pricing data from vendor if
n Competitive sealed proposals (RFP) (HRS § 103D -303) $700,000 or more.
❑ Professional services procurement (HRS § 103D -304)
(complete and attach Professional Services Data - Form F- 111P)*
❑ Small purchases (under $25,000) (HRS §103D-305)
❑ Sole source procurement (attach approval) (HRS §103D-306)*
❑ Emergency procurement (attach approval) (HRS §103D -307)*
® Exempt from State Procurement Code:
Reason: Grow+ - r � - 1/4. ,01/ -6 1 ( Awte,w
Statutory /H.A.R. Authority: IWS 10?D 10)-0
Required Website Posting: State County
(Date) (Date)
Optional Advertising: ❑ Hawai`i Tribune - Herald ❑ West Hawaii Today
n Other:
Date(s) advertised:
Date of Pre -Bid Conference (if any):
Bid opening date or deadline for receipt of proposals:
Number of responses: (Attach recap of responses to IFB, RFP, or quotation requests)
(If only one response, see Procurement Rules, Sec. 3- 122 -35 for IFBs -or 3- 122 -59 for RFPs)
Was awardee lowest dollar offer? Yes n No n
If no, explain award (use extra page if more space needed):
Award made to lowest responsive and responsible bidder(s). In the case of items where only one bidder responded, the
price submitted is fair and reasonable, and other prospective bidders had reasonable opportunity to respond, as per HAR,
section 3- 122 -35.
I, William T. Takaba , am employed by the County of Hawai`i
(print name)
in the capacity of Managing Director and hereby verify that the
(position)
information stated above is true and accurate in the best of my knowledge.
MAR 2 3 2010 -
Male ignature -' xtension O.
After execution of contract, retain this form in procurement file with all required attachments Page 3 of 4
•
Department of Finance F411 (7/2007)
• Department Head Certification
Regarding Civil Service Exemption:
CHOOSE ONE ONLY!
❑ I certify that to the best of my knowledge, this contract is for goods only and any services
provided are incidental to the delivery, installation and/or warranty /maintenance of said
goods.
Department Head Date
— or--
® I certify that to the best of my knowledge, services to be performed under this contract have
•
not beep customarily and historically performed by Hawai`i County civil servants.
tiffn AlZ MAR 2 3 2014
1'$epartment Head Date
—or—
.
n I certify that the services to be performed under this contract are exempt from civil service
pursuant to §76 -77( ), Hawai`i Revised Statutes,
Department Head Date
(This box is NOT to be checked for exemption under §76- 77(7), (8), or (12): For exemptions under
Section 76- 77(7), (8) or (12) complete Attachment A, B or C of Department of Human Resources
Procedures on "Contracting Services and Civil Service Exemptions" and submit to Director of
Human Resources for approval with appropriate clause on signature page of contract.)
n I certify that the services to be performed under this contract are exempt from civil service
pursuant to §76-77(16), Hawaii Revised Statutes, as it is for positions or contracts for
personal services with private persons or entities for services lasting no more than one year
and at a cost of no more than $750,000.
Department Head Date
(Note: Attachment D ofDepartment of Human Resources Procedures on "Contracting Services
and Civil Service Exemptions "must be completed and included with the Contract Routing Forum
for review by the Director of Human Resources.)
(lf more than one department or agency involved, complete a copy of this page for each.)
After execution of contract, retain this form in procurement file with all required attachments Page 4 of 4
LINDA LINGLE ` '1e4 I i CHIYOME LEINAALA FUKINO, M.D.
GOVERNOR OF HAWAII : ;l } 4g DIRECTOR OF HEALTH
\' \��1...-' pPd
'
•
STATE OF HAWAII
DEPARTMENT OF HEALTH
P.O. BOX 3378 In reply, please refer to
HONOLULU, HAWAII 96801 - 3378 Fllo:
•
MAR 18 2010
County of Hawaii
Office of the Mayor
25 Aupuni Street
Hilo, Hawaii 96720 -4252
Dear Provider:
Subject: Notice of Award
ADM. SERV. OFFICE LOG NO. 10 -189
This is to inform you that you are awarded a contract for the subject solicitation.
The award is conditioned upon your executing the attached contract per the
accompanying Instructions. Should you have any questions on the execution of
the contract, please contact our contracts processing unit, phone no. (808) 586-
4558 (fax no. 586 - 4649).
Please return the agreement, fully executed, to the Administrative Services Office
as soon as possible from receipt of this notice.
Sincerely,
. VANESSA LAU
Fiscal Officer
Administrative Services Office
c: ADAD
•
INSTRUCTIONS
1. Signature by an authorized official of your organization is required on:
a. The sixth page, and
b. Exhibit "B," "E," "F," and "G."
2. Return the signed agreement and required documents to the State
Department of Health, Administrative Services Office, P. O. Box 3378,
Honolulu, Hawaii 96801 -3378.
CONTRACT NO.
' R hqk
C/ STATE OF HAWAII
CONTRACT FOR HEALTH AND HUMAN SERVICES:
TRANSACTIONS EXEMPT FROM CHAPTER 103F, HRS
This Contract, executed on the respective dates indicated below, is effective as of
April 1 , 20 10 between the
Department of Health
(Name of the state department, agency board or commission)
State of Hawai`i ( "STATE "), by its Director of Health
(Tide of person signing for the STATE)
whose address is: 1250 Punchbowl Street, Honolulu, Hawaii 96813
and County of Hawaii
(Name of PROVIDER)
( "PROVIDER "), a municipal corporation
(Legal form of PROVIDER i.e.. Corporation, Limned Liability Company, etc.)
under the laws of the State of Hawaii whose business street address and taxpayer
identification numbers are as follows:
Business street address:
Office of the Mayor
25 Aupuni Street, Hilo, Hawaii 96720 -4252
Mailing address if different than business street address:
N/A
F ederal employer identification number: 99- 6000567
Hawaii general excise tax number: W40893544 -01
AG Form 103F6 (02/09)
Page 1
ADM. SERV. OFFICE
LOG NO. 10 -189
•
CONTRACT NO.
RECITALS
1. This Contract is for a purchase of health and human that is exempt from the
requirements of chapter 103F, Hawai`i Revised Statutes, ( "HRS "), because:
• this Contract is between or among government agencies as provided in
Section 103F- 101(a)(2), HRS;
❑ this Contract is to award grants or subsidies of state funds appropriated
by the legislature to a specific organization as provided in section 103F-
101(a)(1), HRS, and section 3- 141- 503(a)(2), Hawaii Administrative
Rules, or to award subawards and subgrants to specific organizations
directed by the funding source as provided in section 3- 141- 503(a)(1);
❑ this Contract is wholly or partly funded from federal sources that conflict
with the procedures and requirements established by chapter 103F, HRS,
and its implementing regulations;
❑ this Contract is wholly or partly funded from federal sources that (1)
identifies a target class of beneficiaries, (2) defines the requirements for a
provider to be qualified to participate in the federal program, and (3) has
the price of the provided health and human services dictated by federal
law;
❑ this Contract is for an affiliation agreement with hospitals and other
health care providers required for University of Hawaii clinical programs;
❑ this Contract is for the services of psychiatrists or psychologists in
criminal or civil proceedings as required by a court order or by the rules
of the court;
❑ this Contract is for a transaction covered by a written exemption
from the Chief Procurement Officer for the STATE dated
,20
2. The STATE needs the health and human services described in this Contract and
its attachments ( "Required Services ") and the PROVIDER agrees to provide the Required
Services.
AG Form 103F6 (02/09)
Page 2
ADM. SERV, OFFICE
LOG NO. 10 -189
CONTRACT NO.
3. Money is available to fund this Contract pursuant to:
(1) Item E -15, Act 162, 2009 HSL 506
(Identify state sources)
in the amount of - 0 - , or
(state funding)
(2) Strategic Prevention Framework —State Incentive Grant
(Identify federal sources)
in the amount of $2,103,140.28 , or both.
(federalfunding)
D. The STATE is authorized to enter into this Contract pursuant to:
section(s) 334 -3 and 334 -8, HRS
(Legal authorttyfor Contracts)
E. The undersigned representative of the PROVIDER represents, and the STATE
relies upon such representation, that he or she has authority to sign this Contract by virtue of
(check any or all that apply):
❑ corporate resolutions of the PROVIDER or other authorizing documents
such as partnership resolutions;
❑ corporate by -laws of the PROVIDER, or other similar operating
documents of the PROVIDER, such as a partnership contract or limited
liability company operating contract;
❑ the PROVIDER is a sole proprietor and as such does not require any
authorizing documents to sign this Contract;
® other evidence of authority to sign:
The PROVIDER is a government entity, and the undersigned _
representative of the PROVIDER is duly- authorized to execute contracts
on behalf of such government entity.
F. The PROVIDER has provided a "Certificate of Insurance" to the STATE that
shows to the satisfaction of the STATE that the PROVIDER has obtained liability insurance
which complies with paragraph 1.4 of the General Conditions of this Contract and with any
relevant special condition of this Contract.
G. The PROVIDER produced, and the STATE inspected, a tax clearance certificate
as required by section 103 -53, HRS.
AG Form 103F6 (02/09)
Page 3
ADM. SERV. OFFICE
LOG NO. 10 -189
CONTRACT NO.
NOW, THEREFORE, in consideration of the promises contained in this Contract, the
STATE and the PROVIDER agree as follows:
1. Scope of Services. The PROVIDER shall, in a proper and satisfactory manner as
determined by the STATE, provide the Required Services set forth in Attachment "1" to this
Contract, which is hereby made a part of this Contract, and the Request for Proposals ( "RFP "),
and the PROVIDER's Proposal, which are incorporated in this Contract by reference. In the
event that there is a conflict among the terms of this Contract, and either the Proposal or the
RFP, or both, then the terms of this Contract shall control.
2. Time of Performance. The PROVIDER shall provide the Required Services from
April 1 , 2010, to September 29 , 2011, as set
forth in Attachment "2" to this Contract, which is hereby made a part of this Contract.
3. Compensation. The PROVIDER shall be compensated
in a total amount for all required services not to exceed
TWO MILLION, ONE HUNDRED THREE THOUSAND, ONE
HUNDRED FORTY AND 28/100 DOLLARS
($ 2,103,140.28 ), which amount includes all fees and costs
incurred and any federal, state and local taxes as set forth in attachment
"3" to this Contract, which is hereby made a part of this Contract.
❑ based upon referrals to the PROVIDER from the STATE, payment
for each such referral shall be made according to Attachment "3 ".
The STATE shall provide a minimum of referrals to
the PROVIDER.
4. Reporting Requirements. In addition to whatever other reports may be required
elsewhere in this Contract, the PROVIDER shall also submit a Final Project Report, by (date)
October 29 , 20 11 . No amendment to the PROVIDER's
Final Project Report shall be considered after (date) November 5 , 20 11 .
5. Certificate of Exemption from Civil Service. The Certificate of Exemption from
Civil Service is attached and made a part of this Contract.
6, Standards of Conduct Declaration. The Standards of Conduct Declaration of the
PROVIDER is attached and made a part of this Contract.
AG Form 103F6 (02/09)
Page 4
ADM. SERV. OFFICE
LOG NO. 10 -189
CONTRACT NO.
7. General and Special Conditions. The General Conditions for Health and Human
Services Contracts ( "General Conditions ") and any Special Conditions are
attached hereto and made a part of this Contract. In the event of a conflict
between the General Conditions and the Special Conditions, the Special
Conditions shall control.
8. Notices. Any written notice required to be given by any party under this
Contract shall be (a) delivered personally, or (b) sent by United States first class
mail, postage prepaid.
Notice required to be given to the STATE shall be sent to:
State Department of Health, Administrative Services Office, Room 312, P.O. Box 3378,
Honolulu. Hawaii 96801 -3378
Notice to the PROVIDER shall be sent to the mailing address as indicated on page 1. A notice
shall be deemed to have been received three (3) days after mailing or at the time of actual
receipt, whichever is earlier. The PROVIDER is responsible for notifying the STATE in writing
of any change of address.
IN VIEW OF THE ABOVE, the parties execute this Contract by their signatures below.
STATE
By
(Signature)
Print Name Chiyome Leinaala Fukino, M.D.
Print Title Director of Health
Date
FUNDING AGENCY (to be signed by head of funding
agency if other than the Contracting Agency)
By
(Signature)
Print Name
Print Title
Date
AG Form 103F6 (02/09)
Page 5
ADM. SERV. OFFICE
LOG NO. 10 -189
CONTRACT NO.
CORPORATE SEAL
- (if available) PROVIDER
By
Cs-- -�
(Signature)
Print Name - WILLIAM KENOI
Print Title MAYOR
Date MAR 2 3 2010
APPROVED AS TO FORM:
Deputy Attorney General
AG Form 103F6 (02/09)
Page 6
ADM. SERV. OFFICE
LOG NO. 10 -189
STATE OF HAWAII )
) SS.
COUNTY OF HAWAII )
On this e day of L1t\61k- , 2010, before me personally appeared
WILLIAM P. KENOI, to me personally known, who, being by me duly sworn, did say that
WILLIAM P. KENOI is the Mayor of the County of Hawai`i., a municipal corporation of the
State of Hawai`i; that the seal affixed to the foregoing instrument is the corporate seal of said
County of Hawai`i; that the foregoing instrument was signed and sealed in behalf of the County
of Hawaii by authority given to said Mayor of the County of Hawai`i by Section 5- 1.3(g) of the
County Charter, County of Hawaii (2000), as amended; and said WILLIAM P. KENOI
acknowledged said instrument to be the free act and deed of said County of Hawaii.
(2741124e) J1`
NADINE H. POMROY
Notary Public, State of Hawai`i
My Commission Expires: 7/12/2013
Doc. Date: March 23 , 2010 # Pages: 74,enrhX-1c
Name: Nadine H. Pomroy Third Circuit
1 S Doc. Description: Contract between Department of Health and County of
Hawaii.
05 ,t MAR 2 3 2010
Signature Date
MY COMMISSION EXPIRES 7/12/2013
CONTRACT NO.
PROVID3WS
STATE OF )
) SS.
COUNTY OF )
On this day of , 20 , befo
me appeared
and , to me know-, to be the
person(s) described in and, who, being by me duly sworn, did say that he /she /t ey is /are the
and
of
the PROVIDER named in the foregoing instrument, and that he /she /they i• are authorized to sign said
instrument on behalf of the PROVIDER, and acknowledges that he /sh: they executed said instrument
as the free act and deed of the PROVIDER.
By
(Notary Seal) (Signature)
P '" t Name
Date
Notary Public, State of
My commission expires:
Doc. Date: # Pages:
Notary Name: Circuit
Doc. Description:
(Nrxary or Seal)
-
Not. Signature Date
AG Form 103F6 (02/09)
Page 7
ADM. SERV. OFFICE
LOG NO. 10 -189
Attachment 1
SCOPE OF SERVICES
The PROVIDER shall, in a proper and satisfactory manner as determined by the STATE,
perform all work described in this Scope of Services in strict accordance with the terms and
conditions of this Contract.
I. Purpose of Service and Target Population
The purpose of the contracted services is to reduce and prevent alcohol consumption by
youth ages 12 -17 years old on the island of Hawaii by implementing a County Underage
Drinking Prevention Plan ( "Plan "). This Plan shall outline the use of evidence -based
programs that address contributing factors and consequences of underage drinking as
identified and documented during an earlier assessment of county specific
epidemiological data.
The target population for services is youth ages 12 -17 years old and their families,
schools, and communities. All services shall be provided in the County of Hawaii.
II. Program Activities
A. Service Requirements
The PROVIDER shall:
1. Provide services in accordance with the requirements of the STATE's
Hawaii Strategic Prevention Framework Phase II Funding Request for •
Proposals ( "HI -SPF's Phase II Funding RFP "), dated October 21, 2009
("REP"). A copy of the RFP is on file at the STATE's Alcohol and Drug
Abuse Division ( "ADAD "), Kakuhihewa Building, 601 Kamokila
Boulevard, Room 360, Kapolei, Hawaii, 96707, and by reference is hereby
made a part of this Contract.
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 1
Attachment 1
2. Provide services in accordance with the provisions of the PROVIDER's
Purchase of Service Application ( "County Application "), dated November
16, 2009. A copy of the County Application is on file at the STATE's
ADAD, Kakuhihewa Building, 601 Kamokila Boulevard, Room 360,
Kapolei, Hawaii, 96707, and by reference is hereby made a part of this
Contract. If there is any conflict between the STATE's RFP and the
PROVIDER's Application, the former shall control.
3. Implement the Plan as indicated in the County Application either directly
or through subcontracts with partner organizations. Implementation
activities shall consist of evidence -based programs that address the
prevention and /or reduction of alcohol consumption by youth ages 12 -17
years old. Identification and selection of evidence -based programs shall
be conducted by following the guidance provided in the Identifying and
Selecting Evidence -Based Interventions, Revised Guidance Document for
the Strategic Prevention Framework State Incentive Grant Program, dated
January 2009, attached hereto as Exhibit "A" and made a part hereof.
Furthermore, the programs selected shall logically connect with incidence
and prevalence data, risk and protective factors, and service needs in the
county and aim to improve National Outcome Measures.
4. Conduct in each contract period a minimum of one (1) evidence -based
environmental program related to the prevention and reduction of
underage drinking of youth ages 12 -17 years old. Environmental
approaches shall aim to establish or change written and unwritten
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 2
Attachment 1
community standards, norms, and attitudes, thereby influencing the
incidence and prevalence of substance abuse in the general population.
This program includes both activities that center on legal and regulatory
initiatives and those activities that relate to service and action - oriented
initiatives.
5. Maintain ongoing communication and collaboration among members of
the County Advisory Council ( "CAC ") including, at a minimum,
organizing and documenting four (4) CAC meetings during the contract
period. The PROVIDER shall aim to ensure that CAC membership
consists of representatives from twelve (12) sectors: Youth (persons 12 -17
years of age), Parents, Business Community, Media, Schools, Youth
Serving Organizations, Law Enforcement, Faith Community, Civic and
Volunteer Groups, Healthcare Professionals, State, Local, or Tribal
Governmental Agencies, and Other Community Organizations Engaged in
Substance Abuse Prevention.
6. For subcontracted services, the PROVIDER shall:
a. Identify the partner organization, services to be provided, number
of participants to be served, specific prevention outcomes to be
achieved, and allowable expenses. Additionally, the PROVIDER
must demonstrate how it verified that the subcontracted services
are in accordance with the Substance Abuse Mental Health
Services Administration's ( "SAMHSA ") definition of evidence
based programs as identified in Exhibit "A."
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 3
Attachment 1
b. Prior to the start of any subcontracted services the PROVIDER
shall submit a request to subcontract to ADAD for review, receive
the STATE'S prior written approval, and comply with
• subparagraph 3.2, Subcontracts and Assignments, of the General
Conditions for Health and Human Services Contracts. The
approved subcontractor shall submit a valid tax clearance, current
within six (6) months from the issuance date, to the STATE prior
to providing any services.
c. Monitor the operation of all prevention programs and activities
funded under this Contract to ensure that all subcontractors provide
services and expend funds in accordance with the terms of this
Contract and their subcontracts.
d. Require all subcontractors to participate in evaluation activities as
indicated by the STATE.
13. Other Service Requirements
The PROVIDER shall:
Provide and maintain participant, fiscal, statistical, and administrative
records pertaining to services as specified by the STATE.
2. Submit to the STATE on a quarterly basis on forms and in the format
required by the STATE, documentation of the implementation of Strategic
Prevention Framework —State Incentive Grant ( "SPF- SIG ") program
activities.
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 4
Attachment 1
3. Submit Quarterly and Period -End Reports to the STATE in the format
required by the STATE. The Quarterly and Period -End Reports shall
summarize and analyze outcome data, accomplishments, and challenges.
Quarterly reports are due ten (} days after the end of each quarter. The
Period -End Reports are due thirty (30) days after the end of the contract
period.
4. Assure that a minimum of one (1) key representative attend three (3)
mandatory semi - annual contractor meetings and any other meeting as
determined by the STATE.
5. Assure that a minimum of one (1) key representative attend three (3)
mandatory required trainings and technical assistance sessions as
determined by the STATE.
6. Provide training and technical assistance to key stakeholders within the
county after the completion of any STATE - sponsored Train the Trainer
session.
7. Submit the Technical Assistance Request Form to request technical
assistance from HI -SPF.
III. Administrative and Management Requirements
A. Personnel
The PROVIDER shall:
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 5
Attachment 1
1. Comply with the Management Requirements relating to Personnel
Management Requirements which is attached hereto as Exhibit `B" and
made a part hereof.
2. Engage in workforce development activities as approved and directed by
the STATE.
13. Administrative Requirements
The PROVIDER shall comply with the Management Requirements relating to
Administrative Management Requirements in Exhibit `B."
C. Evaluation Specifications
The PROVIDER shall:
1. Comply with the Management Requirements relating to Evaluation
Specifications in Exhibit `B."
2. Utilize quantitative and qualitative evaluation tools approved by the
STATE to demonstrate the effectiveness of the services in reducing or
preventing alcohol consumption by youth ages 12 -17 years old. The
evaluation shall focus on the achievement of proposed tasks and goals
within the appropriate timeframe as indicated in the County Application.
3. Measure information and skills gained through participation in the
prevention activity by utilizing evaluation tools approved by the STATE,
relative to the population(s) served. Evaluations focusing on the peer and
individual or family domains shall include but are not limited to, pre- and
post- tests.
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 6
Attachment 1
4. Track and report to the STATE outcomes achieved by participants who
complete the prevention services through a standard outcome reporting
format approved by the STATE. The PROVIDER shall review with the
STATE the results of the outcomes report and make any necessary
corrections recommended by the STATE. Performance Measures to be
achieved are listed in the County Application.
5. Assist in the collection of relevant data for the National Outcome
Measures as required by SAMHSA and as directed by the STATE.
6. Participate in the evaluation of the HI -SPF which may include, but not be
limited to, conducting surveys and focus groups, documenting reviews
collected from entities such as the CAC, service providers, and other
groups, or through other methods as identified by the STATE.
7. Participate in and meet the requirements of the HI -SPF cross -site
evaluation as required by the STATE.
8. Attend mandatory trainings as required by the STATE on HI -SPF
evaluation procedures and processes.
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 7
Attachment 2
TIME OF PERFORMANCE
1. Time of Performance. The PROVIDER shall provide the required services from April
1, 2010 to September 29, 2011, unless this Contract is sooner terminated as hereinafter
provided. The first contract period shall be from April 1, 2010, to and including
September 29, 2010. The second contract period shall be from September 30, 2010, to
and including September 29, 2011.
2. Extension of Contract. This Contract may be extended as provided in paragraph 8 of
Attachment 7, Special Conditions.
•
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 1
Attachment 3
COMPENSATION AND PAYMENT SCHEDULE
1. Sum to be Paid. In full consideration for the services satisfactorily performed by the
PROVIDER under this Contract, the STATE agrees, subject to the receipt of federal,
funds under the Federal Grant and subject to allotments to be made by the Director of
Finance, State of Hawaii, pursuant to Chapter 37, Hawaii Revised Statutes, to pay to the
PROVIDER a total sum of money not to exceed TWO MILLION, ONE HUNDRED
THREE THOUSAND, ONE HUNDRED FORTY AND 28/100 DOLLARS
($2,103,140.28) of federal funds for the Contract term.
2. Method of Payment. Payments shall be made in accordance with and subject to the
following:
a. Payments shall be made in monthly installments upon the monthly submission by
the PROVIDER of an original invoice and two (2) copies for the services
provided in accordance with Attachment 1, "Scope of Services," and in
accordance with the costs identified in the Budget Summary, attached hereto as
Exhibit "C" and made a part hereof, and the Budget, attached hereto as Exhibit
"D" and made a part hereof. Failure to submit a STATE approved detailed
Budget may result in the withholding of payments to the PROVIDER. Upon
submission of a STATE approved detailed Budget, the detailed Budget shall
become a part of Exhibit "D." Upon the request of the PROVIDER, the first
payment shall be an advance installment of a total sum of money not to exceed
ONE HUNDRED SIXTEEN THOUSAND EIGHT HUNDRED FORTY -ONE
AND 12/100 DOLLARS ($116,841.12). The advance installment payment shall
be an option available to the PROVIDER and is based upon the PROVIDER's
ADM, SERV. OFFICE
LOG NO. 10 -189 Page 1
Attachment 3
request for an advance installment payment and the submittal of an original
invoice and two (2) copies for the advance installment payment. There shall be
only one (1) advance installment payment during the time of performance of this
Contract. The advance installment payment shall be reconciled by September
2010. The STATE shall withhold the final monthly payment not to exceed ONE
HUNDRED SIXTEEN THOUSAND EIGHT HUNDRED FORTY -ONE AND
12/100 DOLLARS ($116,841.12) until final settlement of this Contract.
b. After the first monthly installment made in advance, monthly payments shall be
made on a cost reimbursement basis. Invoices shall be accompanied by
expenditure reports for the billing month and certified by the PROVIDER to
contain expenditures actually incurred for the services provided under this
Contract. Invoices, together with expenditure reports, supporting documents, and
program reports of the performance of services shall be reviewed by the STATE
and shall be subject to the STATE's preliminary determination of appropriateness
and allowability of the reported expenditures. Invoices and expenditure reports
shall be on forms approved by the STATE.
c. Monthly invoices shall be submitted within thirty (30) calendar days after the last
day of each calendar month. Corrections to invoices shall be submitted to the
STATE no later than ninety (90) calendar days after the last day of the billing
month. If the PROVIDER is unable to submit a corrected invoice within the
ninety (90) calendar -day period, the PROVIDER shall request in writing for an
extension to the ninety (90) calendar -day period. The request for extension shall
provide justification for the delay and the anticipated submission date of the
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 2
Attachment 3
invoice. If a request for an extension is not received by the STATE prior to the
end of the ninety (90) calendar -day period or is not adequately justified as
determined by the STATE, the STATE may deny the request for extension.
d. The Federal Grant requires the STATE to expend funds in a timely manner;
therefore, the PROVIDER shall submit the final invoice for federal funds within
forty -five (45) days after the end of each Contract period, to prevent lapsing of
federal funds. Invoices received by the STATE later than forty -five (45) days
after the end of each Contract period shall not be processed for payment due to
lapsing of federal funds.
e. The expenditure reports shall be reviewed by the STATE and shall be subject to
the STATE's preliminary determination of appropriateness and allowability of the
reported expenditures in accordance with Office of Management and Budget
( "OMB ") Circular A -122, Cost Principles for Nonprofit Organizations. The
STATE's preliminary determination of appropriateness and allowability of the
reported expenditures shall be subject to later verification and subsequent audit.
f If an amount of reported expenditures is preliminarily determined by the STATE
to be inappropriate and unallowable with OMB Circular A -122, the STATE may
deduct an equivalent amount from the next payable installment and may withhold
payment of the amount of moneys equivalent to the questioned expenditures until
later resolution of the discrepancy by audit or other means. If, after payment of
the last installment prior to the final payment, investigation and examination
reveal additional expenditures that are determined by the STATE to be
inappropriate and unallowable, the STATE may require that an equivalent amount
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 3
Attachment 3
of moneys be refunded by the PROVIDER notwithstanding the STATE's
preliminary determination of appropriateness and allowability. An amount of
moneys to be refunded by the PROVIDER may be offset against the amount of
moneys withheld by the STATE in determining the amount of the final payment
to be made to the PROVIDER in final settlement of this Contract. Final
settlement of this Contract shall include submission and acceptance of all reports
and other materials to be submitted by the PROVIDER to the STATE, resolution
of all discrepancies in expenditures or performance of services, and completion of
all other outstanding matters under this Contract.
g. Allowable expenses for necessary travel authorized in advance by the STATE
shall be determined in accordance with Chapter 10, titled "Travel Rules," of Title
3 of the Hawaii Administrative Rules, as administered and interpreted by the
Department of Accounting and General Services, State of Hawaii.
3. Decrease Funds. The STATE reserves the right to decrease funds under this Contract if,
after three (3) months into each Contract year, there is a monthly pattern of
underutilization such that it appears the PROVIDER is unable to expend all allocated
funds by the end of the Contract year.
4. Additional Funds. In the event that additional funds become available for similar
services, the STATE reserves the right to increase funding amounts.
5. Adjustments to Method of Payment. The STATE may, at its discretion, revise all or
part of the pricing structure from a cost reimbursement pricing structure to a fixed unit
rate pricing structure, or to a combination of both unit rate and cost reimbursement
pricing structure.
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 4
• CONTRACT NO.
Attachment 4
CERTIFICATE OF EXEMPTION FROM CIVIL SERVICE
1. By Heads of Departments or Agencies as Delegated by the Director of Human
Resources Development'.
•
Pursuant to the delegation of the authority by the Director of Human Resources
Development, I certify that the services provided under this Contract, and the person(s)
• providing the services under this Contract are exempt from the civil service, pursuant to §76 -16,
Hawai`i Revised Statutes ( "HRS ").
•
(Signature) (Date)
Chiyome Leinaala Fukino, M.D.
(Print Name)
Director of Health
(Print Title)
This part of the form may be used by all department heads and others to whom the Director of Human
Resources Development (DHRD) has delegated authority to certify §76 -16, HRS, civil service exemptions. The
specific paragraph(s) of §76 -16, FIRS, upon which an exemption is based should be noted in the contract file.
NOTE: Authority to certify exemptions under §§ 76- 16(2), 76- 16(12), and 76- 16(15), HRS, has not been
delegated; only the Director of DHRD may certify § §76- 16(2), 76- 16(12), and 76- 1605) exemptions.
2. By the Director of Human Resources Development, State of Hawaii.
•
I certify that the services to be provided under this Contract, and the person(s) providing
the services under this Contract are exempt from the civil service, pursuant to §76 -16, HRS. •
•
(Signature) (Date)
(Print Name)
(Print Title, if designee of the Director of DHRD)
ADM. SERV. OFFICE AG Form 103F(9/08)
LOG NO. 10 -189 Competitive
Page 1
•
CONTRACT NO.
Attachment 5
PROVIDER'S
STANDARDS OF CONDUCT DECLARATION
For the purposes of this declaration:
"Agency" means and includes the State, the legislature and its committees, all executive dep. ments,
boards, commissions, committees, bureaus, offices; and all independent commissions :nd other
establishments of the state government but excluding the courts.
"Controlling interest" means an interest in a business or other undertaking which is s . ficient in fact to
control, whether the interest is greater or Tess than fifty per cent (50 %).
"Employee" means any nominated, appointed, or elected officer or employ of the State, including
members of boards, commissions, and committees, and employees under es tract to the State or of the
constitutional convention, but excluding legislators, delegates to the con tutional convention, justices,
and judges. (Section 84 -3, HRS).
On behalf of:
(Name of PROV /DLRJ
PROVIDER, the undersigned does declare as follows:
1. PROVIDER ❑ is n is not a legislator .r an employee or a business in which a legislator
or an employee has a controlling interest. (Se• ion 84- 15(a), HRS).
2. PROVIDER has not been represented or silted personally in the matter by an individual who has
been an employee of the agency aware ing this Contract within the preceding two years and who
participated while so employed in th' matter with which the Contract is directly concerned. (Section
84- 15(b), HRS).
3. PROVIDER has not been a isted or represented by a legislator or employee for a fee or other
compensation to obtain t 's Contract and will not be assisted or represented by a legislator or
employee for a fee or o er compensation in the performance of this Contract, if the legislator or
employee had been i• olved in the development or award of the Contract. (Section 84 -14 (d),
HRS).
4. PROVIDER :s not been represented on matters related to this Contract, for a fee or other
consideratio• by an individual who, within the past twelve (12) months, has been an agency
employee, or in the case of the Legislature, a legislator, and participated while an employee or
legislate on matters related to this Contract. (Sections 84 -18(b) and (c), HRS).
PROVID ' understands that the Contract to which this document is attached is voidable on behalf of the
STATE f this Contract was entered into in violation of any provision of chapter 84, Hawai'i Revised
Statu - s, commonly referred to as the Code of Ethics, including the provisions which are the source of the
Reminder to agency: If the "is" block is checked and if the Contract involves goods or services of a value in excess of S10,000, the
Contract may not be awarded unless the agency posts a notice of its intent to award it and files a copy of the notice with the State
Ethics Commission. (Section 84- 15(a), HRS).
ADM. SERV. OFFICE AG Form 103F (10/08)
LOG NO. 10 -189 Standards of Conduct Declaration
Page 1 of 2
CONTRACT NO.
declarations above. Additionall , an fee coin sensation . i I • • • - - .. - • • _ _ _ _ - _-
a vio ation of the Code of Ethics may be recovered by the STATE.
PROVIDER
By
. (Signature)
Print Name
Print Title
Date
•
•
•
•
•
ADM. SERV. OFFICE AG Form 103F(10/08)
LOG NO. 10-189 Standards of Conduct Declaration
• Page2of2
Attachment 6
GENERAL CONDITIONS FOR HEALTH & HUMAN SERVICES CONTRACTS
TABLE OF CONTENTS
Page(s)
1. Representations and Conditions Precedent 1
1.1 Contract Subject to the Availability of State and Federal Funds 1
1.1.1 State Funds 1
1.1.2 Federal Funds 1
1.2 Representations of the PROVIDER 1
1.2.1 Compliance with Laws 1
1.2.2 Licensing and Accreditation 1
1.3 Compliance with Laws 1
1.3.1 Smoking Policy 1
1.3.2 Drug Free Workplace 1
1.3.3 Persons with Disabilities 2
1.3.4 Nondiscrimination 2
1.4 Insurance Requirements 2
1.5 Notice to Clients 2
1.6 Reporting Requirements 3
1.7 Conflicts of Interest 3
Documents and Files 3
Confidentiality of Material 3
Proprietary or Confidential Information 3
Uniform Information Practices Act 3
2.2 Ownership Rights and Copyright 3
2.3 Records Retention 3
3. Relationship between Parties 3
3.1 Coordination of Services by the STATE 4
3.2 Subcontracts and Assignments 4
3.3 Change of Name 4
Independent Contractor Status and Responsibilities, Including Tax Responsibilities 4
Independent Contractor 4
ADM. SERV. OFFICE i AG Form 103F(IO /08)
LOG NO. 10 -189 General Conditions
Attachment 6
Contracts with other individuals and entities 4
PROVIDER's employees and agents 4
PROVIDER's Responsibilites 5
Personnel Requirements 5
Personnel. 5
Requirements 5
4. Modification and Termination of Contract 6
4.1 Modifications of Contract 6
4.1.1 In writing 6
4.1.2 No oral modification 6
4.1.3 Tax clearance 6
4.2 Termination in General 6
•
4.3 Termination for Necessity or Convenience 6
4.4 Termination by PROVIDER 6
4.5 STATE's Right of Offset 6
Indemnification 7
5.1 Indemnification and Defense 7
5.2 Cost of Litigation 7
6. Publicity 7
6.1 Acknowledgment of State Support 7
6.2 PROVIDER's publicity not related to contract 7
7. Miscellaneous Provisions 7
7.1 Nondiscrimination 7
7.2 Paragraph Headings 8
7.3 Antitrust Claims 8
7.4 Governing Law 8
7.5 Conflict between General Conditions and Procurement Rules 8
7.6 Entire Contract 8
7.7 Severability 8
7.8 Waiver 8
7.9 Execution in Counterparts 8
11 AG Form 103F(10 /08)
General Conditions
Attachment 6
8. Confidentiality of Personal Information 8
8.1 Definitions 9
8.1.1 Personal Information 9
8.1.2 Technological Safeguards 9
8.2 Confidentiality of Material 9
8.2.1 Safeguarding of Material 9
8.2.2 Retention, Use, or Disclosure 9
8.2.3 Implementation of Technological Safeguards 9
8.2.4 Reporting of Security Breaches 9
8.2.5 Mitigation of Harmful Effect 9
8.2.6 Log of Disclosures 9
8.3 Security Awareness Training and Confidentiality Agreements 10
8.3.1 Certification of Completed Training 10
8.3.2 Certification of Confidentiality Agreements 10
8.4 Termination for Cause 10
8.5 Records Retention 10
8.5.1 Destruction of Personal Information 10
8.5.2 Maintenance of Files, Books, Records 10 ,
111 AG Form 103F(10 /08)
General Conditions
Attachment 6
GENERAL CONDITIONS FOR HEALTH & HUMAN SERVICES CONTRACTS
1. Representations and Conditions Precedent
1.1 Contract Subject to the Availability of State and Federal Funds.
1.1.1 State Funds. This Contract is, at all times, subject to the appropriation and allotment of
state funds, and may be terminated without liability to either the PROVIDER or the
STATE in the event that state funds are not appropriated or available.
1.1.2 Federal Funds. To the extent that this Contract is funded partly or wholly by federal
funds, this Contract is subject to the availability of such federal funds. The portion of this
Contract that is to be funded federally shall be deemed severable, and such federally
funded portion may be terminated without liability to either the PROVIDER or the
STATE in the event that federal funds are not available. In any case, this Contract shall
not be construed to obligate the STATE to expend state funds to cover any shortfall
created by the unavailability of anticipated federal funds.
1.2 Representations of the PROVIDER. As a necessary condition to the formation of this Contract,
the PROVIDER makes the representations contained in this paragraph, and the STATE relies
upon such representations as a material inducement to entering into this Contract.
1.2.1 Compliance with Laws. As of the date of this Contract, the PROVIDER complies with
all federal, state, and county laws, ordinances, codes, rules, and regulations, as the same
may be amended from time to time, that in any way affect the PROVIDER'S performance
of this Contract.
1.2.2 Licensing and Accreditation. As of the date of this Contract, the PROVIDER holds all
licenses and accreditations required under applicable federal, state, and county laws,
ordinances, codes, rules, and regulations to provide the Required Services under this
Contract.
1.3 Compliance with Laws. The PROVIDER shall comply with all federal, state, and county laws,
ordinances, codes, rules, and regulations, as the same may be amended from time to time, that in
any way affect the PROVIDER'S performance of this Contract, including but not limited to the
laws specifically enumerated in this paragraph:
1.3.1 Smoking Policy. The PROVIDER shall implement and maintain a written smoking
policy as required by Chapter 328K, Hawaii Revised Statutes (HRS), or its successor
provision.
1.3.2 Drug Free Workplace. The PROVIDER shall implement and maintain a drug free
workplace as required by the Drug Free Workplace Act of 1988.
Page 1 AG Form 103F(10108)
General Conditions
Attachment 6
1.3.3 Persons with Disabilities. The PROVIDER shall implement and maintain all practices,
policies, and procedures required by federal, state, or county law, including but not
limited to the Americans with Disabilities Act (42 U.S.C. §12101, et sec.), and the
Rehabilitation Act (29 U.S.C. §701, et seq.).
1.3.4 Nondiscrimination. No person performing work under this Contract, including any
subcontractor, employee, or agent of the PROVIDER, shall engage in any discrimination
that is prohibited by any applicable federal, state, or county law.
1.4 Insurance Requirements. The PROVIDER shall obtain from a company authorized by law to
issue such insurance in the State of Hawai`i commercial general liability insurance ( "liability
insurance ") in an amount of at least TWO MILLION AND NO /100 DOLLARS ($2,000,000.00)
coverage for bodily injury and property damage resulting from the PROVIDER's performance
under this Contract. The PROVIDER shall maintain in effect this liability insurance until the
STATE certifies that the PROVIDER's work under the Contract has been completed
satisfactorily,
The liability insurance shall be primary and shall cover the insured for all work to be performed
under the Contract, including changes, and all work performed incidental thereto or directly or
indirectly connected therewith.
•
A certificate of the liability insurance shall be given to the STATE by the PROVIDER. The
certificate shall provide that the STATE and its officers and employees are Additional Insureds.
The certificate shall provide that the coverages being certified will not be cancelled or materially
changed without giving the STATE at least 30 days prior written notice by registered mail.
Should the "liability insurance" coverages be cancelled before the PROVIDER's work under the
Contract is certified by the STATE to have been completed satisfactorily, the PROVIDER shall
immediately procure replacement insurance that complies in all respects with the requirements of
this section.
Nothing in the insurance requirements of this Contract shall be construed as limiting the extent
of PROVIDER's responsibility for payment of damages resulting from its operations under this
Contract, including the PROVIDER's separate and independent duty to defend, indemnify, and
hold the STATE and its officers and employees harmless pursuant to other provisions of this
Contract.
1.5 Notice to Clients. Provided that the term of this Contract is at least one year in duration, within
180 days after the effective date of this Contract, the PROVIDER shall create written procedures
for the orderly termination of services to any clients receiving the Required Services under this
Contract, and for the transition to services supplied by another provider upon termination of this
Contract, regardless of the circumstances of such termination. These procedures shall include, at
the minimum, timely notice to such clients of the termination of this Contract, and appropriate
counseling.
Page 2 AG Form 103 F(10 /08)
General Conditions
Attachment 6
1.6 Reporting Requirements. The PROVIDER shall submit a Final Project Report to the STATE
containing the information specified in this Contract if applicable, or otherwise satisfactory to the
STATE, documenting the PROVIDER's overall efforts toward meeting the requirements of this
Contract, and listing expenditures actually incurred in the performance of this Contract. The
PROVIDER shall return any unexpended funds to the STATE.
1.7 Conflicts of Interest. In addition to the Certification provided in the Standards of Conduct
Declaration to this Contract, the PROVIDER represents that neither the PROVIDER nor any
employee or agent of the PROVIDER, presently has any interest, and promises that no such
interest, direct or indirect, shall be acquired, that would or might conflict in any manner or
degree with the PROVIDER's performance under this Contract.
2. Documents and Files
2.1 Confidentiality of Material.
2.1.1 Proprietary or Confidential Information. All material given to or made available to the
PROVIDER by virtue of this Contract that is identified as proprietary or confidential
information shall be safeguarded by the PROVIDER and shall not be disclosed to any
individual or organization without the prior written approval of the STATE.
2.1.2 Uniform Information Practices Act. All information, data, or other material provided by
the PROVIDER to the STATE shall be subject to the Uniform Information Practices Act,
chapter 92F, HRS, and any other applicable law concerning information practices or
confidentiality.
2.2 Ownership Rights and Copyright. The STATE shall have complete ownership of all material,
both finished and unfinished that is developed, prepared, assembled, or conceived by the
PROVIDER pursuant to this Contract, and all such material shall be considered "works made for
hire." All such material shall be delivered to the STATE upon expiration or termination of this
Contract. The STATE, in its sole discretion, shall have the exclusive right to copyright any
product, concept, or material developed, prepared, assembled, or conceived by the PROVIDER
pursuant to this Contract.
2.3 Records Retention. The PROVIDER and any subcontractors shall maintain the books and
records that relate to the Contract, and any cost or pricing data for three (3) years from the date
of final payment under the Contract. In the event that any litigation, claim, investigation, audit,
or other action involving the records retained under this provision arises, then such records shall
be retained for three (3) years from the date of final payment, or the date of the resolution of the
action, whichever occurs later. During the period that records are retained under this section, the
PROVIDER and any subcontractors shall allow the STATE free and unrestricted access to such
records.
3. Relationship between Parties
Page 3 AG Form 103F(10/08)
General Conditions
Attachment 6
3.1 Coordination of Services by the STATE. The STATE shall coordinate the services to be
provided by the PROVIDER in order to complete the performance required in the Contract. The
PROVIDER shall maintain communications with the STATE at all stages of the PROVIDER's
work, and submit to the STATE for resolution any questions which may arise as to the
performance of this Contract.
3.2 Subcontracts and Assignments. The PROVIDER may assign or subcontract any of the
PROVIDER's duties, obligations, or interests under this Contract, but only if (i) the PROVIDER
obtains the prior written consent of the STATE and (ii) the PROVIDER's assignee or
subcontractor submits to the STATE a tax clearance certificate from the Director of Taxation,
State of Hawai`i, and the Internal Revenue Service showing that all delinquent taxes, if any,
levied or accrued under state law against the PROVIDER's assignee or subcontractor have been
paid. Additionally, no assignment by the PROVIDER of the PROVIDER's right to
compensation under this Contract shall be effective unless and until the assignment is approved
by the Comptroller of the State of Hawaii, as provided in section 40 -58, I-IRS.
3.3 Change of Name. When the PROVIDER asks to change the name in which it holds this
Contract, the STATE, shall, upon receipt of a document acceptable or satisfactory to the STATE
indicating such change of name such as an amendment to the PROVIDER's articles of
incorporation, enter into an amendment to this Contract with the PROVIDER to effect the
change of name. Such amendment to this Contract changing the PROVIDER's name shall
specifically indicate that no other terms and conditions of this Contract are thereby changed,
unless the change of name amendment is incorporated with a modification or amendment to the
Contract under paragraph 4.1 of these General Conditions.
3.4 Independent Contractor Status and Responsibilities, Including Tax Responsibilities.
3.4.1 Independent Contractor. In the performance of services required under this Contract, the
PROVIDER is an "independent contractor," with the authority and responsibility to
control and direct the performance and details of the work and services required under
this Contract; however, the STATE shall have a general right to inspect work in progress
to determine whether, in the STATE's opinion, the services are being performed by the
PROVIDER in compliance with this Contract.
3.4.2 Contracts with Other Individuals and Entities. Unless otherwise provided by special
condition, the STATE shall be free to contract with other individuals and entities to
provide services similar to those performed by the Provider under this Contract, and the
PROVIDER shall be free to contract to provide services to other individuals or entities
while under contract with the STATE.
3.4.3 PROVIDER'S Employees and Agents. The PROVIDER and the PROVIDER's
employees and agents are not by reason of this Contract, agents or employees of the State
for any purpose. The PROVIDER and the PROVIDER's employees and agents shall not
be entitled to claim or receive from the STATE any vacation, sick leave, retirement,
workers' compensation, unemployment insurance, or other benefits provided to state
employees. Unless specifically authorized in writing by the STATE, the PROVIDER and
Page 4 AG Form 103F(10/08)
General Conditions
Attachment 6
the PROVIDER's employees and agents are not authorized to speak on behalf and no
statement or admission made by the PROVIDER or the PROVIDER's employees or
agents shall be attributed to the STATE, unless specifically adopted by the STATE in
writing.
3.4.4 PROVIDER'S Responsibilites. The PROVIDER shall be responsible for the accuracy,
completeness, and adequacy of the PROVIDER's performance under this Contract.
Furthermore, the PROVIDER intentionally, voluntarily, and knowingly assumes the sole
and entire liability to the PROVIDER's employees and agents, and to any individual not
a party to this Contract, for all loss, damage, or injury caused by the PROVIDER, or the
PROVIDER's employees or agents in the course of their employment.
The PROVIDER shall be responsible for payment of all applicable federal, state, and
county taxes and fees which may become due and owing by the PROVIDER by reason of
this Contract, including but not limited to (i) income taxes, (ii) employment related fees,
assessments, and taxes, and (iii) general excise taxes. The PROVIDER also is
responsible for obtaining all licenses, permits, and certificates that may be required in
. order to perform this Contract.
Taxation, State of Ilawai`i, in accordance with section 237 9, HRS, and shall comply
with all requirements thereof. The PROVIDER shall obtain a tax cl arance certificate
from the Director of Taxation, State of Hawaii, and the Internal Revenue Service
showing that all delinquent taxes, if any, levied or accrued under state law against the
performance under this Contract. The PROVIDER shall also be solely responsible for
final payment under section 103 53, HRS, and these Cenral Conditions.
the PROVIDER and the PROVIDER' s employees and agents that is or may be required
by law, and for payment of all premiums, costs, and other liabilities associated with
securing the insurance coverage.
3.5 Personnel Requirements.
3.5.1 Personnel. The PROVIDER shall secure, at the PROVIDER'S own expense, all personnel
required to perform this Contract, unless otherwise provided in this Contract.
3.5.2 Requirements. The PROVIDER shall ensure that the PROVIDER's employees or agents
are experienced and fully qualified to engage in the activities and perform the services
required under this Contract, and that all applicable licensing and operating requirements
imposed or required under federal, state, or county law, and all applicable accreditation
and other standards of quality generally accepted in the field of the activities of such
employees and agents are complied with and satisfied.
Page 5 AG Form 103F00 /08)
General Conditions
Attachment 6
4. Modification and Termination of Contract
4.1 Modification of Contract.
4.1.1 In Writing. Any modification, alteration, amendment, change, or extension of any term,
provision, or condition of this Contract permitted by this Contract shall be made by
written amendment to this Contract, signed by the PROVIDER and the STATE.
4.1.2 No Oral Modification. No oral modification, alteration, amendment, change, or
extension of any term, provision or condition of this Contract shall be permitted.
4.1.3 Tax Clearance. The STATE may, at its discretion, require the PROVIDER to submit to
the STATE, prior to the STATE's approval of any modification, alteration, amendment,
change, or extension of any term, provision, or condition of this Contract, a tax clearance
from the Director of Taxation, State of Hawaii, and the Internal Revenue Service
showing that all delinquent taxes, if any, levied or accrued under state and federal law
against the PROVIDER have been paid.
4.2 Termination in General. This Contract may be terminated in whole or in part because of a
reduction of funds available to pay the PROVIDER, or when, in its sole discretion, the STATE
determines (i) that there has been a change in the conditions upon which the need for the
Required Services was based, or (ii) that the PROVIDER has failed to provide the Required
Services adequately or satisfactorily, or (iii) that other good cause for the whole or partial
termination of this Contract exists. Termination under this section shall be made by a written
notice sent to the PROVIDER ten (10) working days prior to the termination date that includes a
brief statement of the reason for the termination. If the Contract is terminated under this
paragraph, the PROVIDER shall cooperate with the STATE to effect an orderly transition of
services to clients.
4.3 Termination for Necessity or Convenience. If the STATE determines, in its sole discretion, that
it is necessary or convenient, this Contract may be terminated in whole or in part at the option of
the STATE upon ten (10) working days' written notice to the PROVIDER. If the STATE elects
to terminate under this paragraph, the PROVIDER shall be entitled to reasonable payment as
- determined by the STATE for satisfactory services rendered under this Contract up to the time of
termination. If the STATE elects to terminate under this section, the PROVIDER shall cooperate
with the STATE to effect an orderly transition of services to clients.
4.4 Termination by PROVIDER. The PROVIDER may withdraw from this Contract after obtaining
the written consent of the STATE. The STATE, upon the PROVIDER's withdrawal, shall
determine whether payment is due to the PROVIDER, and the amount that is due, If the STATE
consents to a termination under this paragraph, the PROVIDER shall cooperate with the STATE
to effect an orderly transition of services to clients.
4.5 STATE's Right of Offset. The STATE may offset against any monies or other obligations that
STATE owes to the PROVIDER under this Contract, any amounts owed to the State of Hawai`i
Page 6 AG Form 103F(1O /08)
General Conditions
Attachment 6
by the PROVIDER under this Contract, or any other contract, or pursuant to any law or other
obligation owed to the State of Hawai`i by the PROVIDER, including but not limited to the
payment of any taxes or levies of any kind or nature. The STATE shall notify the PROVIDER
in writing of any exercise of its right of offset and the nature and amount of such offset. For
purposes of this paragraph, amounts owed to the State of Hawai`i shall not include debts or
obligations which have been liquidated by contract with the PROVIDER, and that are covered by
an installment payment or other settlement plan approved by the State of Hawaii, provided,
however, that the PROVIDER shall be entitled to such exclusion only to the extent that the
PROVIDER is current, and in compliance with, and not delinquent on, any payments,
obligations, or duties owed to the State of Hawaii under such payment or other settlement plan.
5. Indemnification
5.1 Indemnification and Defense. The PROVIDER shall defend, indemnify, and hold harmless the
State of Hawai`i, the contracting agency, and their officers, employees, and agents from and
against any and all liability, loss, damage, cost, expense, including all attorneys' fees, claims,
suits, and demands arising out of or in connection with the acts or omissions of the PROVIDER
or the PROVIDER's employees, officers, agents, or subcontractors under this Contract. The
provisions of this paragraph shall remain in full force and effect notwithstanding the expiration
or early termination of this Contract.
5.2 Cost of Litigation. In case the STATE shall, without any fault on its part, be made a party to any
litigation commenced by or against the PROVIDER in connection with this Contract, the
PROVIDER shall pay any cost and expense incurred by or imposed on the STATE, including
attorneys' fees.
6. Publicity
6.1 Acknowledgment of State Support. The PROVIDER shall, in all news releases, public
statements, announcements, broadcasts, posters, programs, computer postings, and other printed,
published, or electronically disseminated materials relating to the PROVIDER's performance
under this Contract, acknowledge the support by the State of Hawaii and the purchasing agency.
6.2 PROVIDER's Publicity Not Related to Contract. The PROVIDER shall not refer to the STATE,
or any office, agency, or officer thereof, or any state employee, or to the services or goods, or
both provided under this Contract, in any of the PROVIDER'S publicity not related to the
PROVIDER' s performance under this Contract, including but not limited to commercial
advertisements, recruiting materials, and solicitations for charitable donations.
7. Miscellaneous Provisions
7.1 Nondiscrimination. No person performing work under this Contract, including any
subcontractor, employee, or agent of the PROVIDER, shall engage in any discrimination that is
prohibited by any applicable federal, state, or county law.
Page 7 AG Form 103F(10/08)
General Conditions
Attachment 6
7.2 Paragraph Headings. The paragraph headings appearing in this Contract have been inserted for
the purpose of convenience and ready reference. They shall not be used to define, limit, or
extend the scope or intent of the sections to which they pertain.
7.3 Antitrust Claims. The STATE and the PROVIDER recognize that in actual economic practice,
overcharges resulting from antitrust violations are in fact usually borne by the purchaser.
Therefore, the PROVIDER hereby assigns to the STATE any and all claims for overcharges as to
goods and materials purchased in connection with this Contract, except as to overcharges which
result from violations commencing after the price is established under this Contract and which
are not passed on to the STATE under an escalation clause.
•
7.4 Governing Law. The validity of this Contract and any of its terms or provisions, as well as the
rights and duties of the parties to this Contract, shall be governed by the laws of the State of
Hawaii. Any action at law or in equity to enforce or interpret the provisions of this Contract
shall be brought in a state court of competent jurisdiction in Honolulu, Hawaii.
7.5 Conflict between General Conditions and Procurement Rules. In the event of a conflict between
the General Conditions and the Procurement Rules or a Procurement Directive, the Procurement
Rules or any Procurement Directive in effect on the date this Contract became effective shall
control and are hereby incorporated by reference.
7.6 Entire Contract. This Contract sets forth all of the contracts, conditions, understandings,
promises, warranties, and representations between the STATE and the PROVIDER relative to
this Contract. This Contract supersedes all prior agreements, conditions, understandings,
promises, warranties, and representations, which shall have no further force or effect. There are
no contracts, conditions, understandings, promises, warranties, or representations, oral or written,
express or implied, between the STATE and the PROVIDER other than as set forth or as referred
to herein.
7.7 Severability. In the event that any provision of this Contract is declared invalid or unenforceable
by a court, such invalidity or unenforceability shall not affect the validity or enforceability of the
remaining terms of this Contract.
7.8 Waiver. The failure of the STATE to insist upon the strict compliance with any term, provision,
or condition of this Contract shall not constitute or be deemed to constitute a waiver or
relinquishment of the STATE's right to enforce the same in accordance with this Contract. The
fact that the STATE specifically refers to one provision of the Procurement Rules or one section
of the Hawai`i Revised Statutes, and does not include other provisions or statutory sections in
this Contract shall not constitute a waiver or relinquishment of the STATE's rights or the
PROVIDER's obligations under the Procurement Rules or statutes.
7.9 Execution in Counterparts. This Contract may be executed in several counterparts, each of
which shall be regarded as an original and all of which shall constitute one instrument.
8. Confidentiality of Personal Information
Page 8 AG Form !03F(10 /08)
General Conditions
Attachment 6
8.1 Definitions.
8.1.1 Personal Information. "Personal Information" means an individual's first name or first
initial and last name in combination with any one or more of the following data elements, when
either name or data elements are not encrypted:
1) Social Security number;
2) Driver's license number or Hawaii identification card number; or
3) Account number, credit or debit card number, access code, or password that
would permit access to an individual's financial information.
Personal information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
8.1.2 Technological Safeguards. "Technological safeguards" means the technology and the
policy and procedures for use of the technology to protect and control access to personal
information.
8.2 Confidentiality of Material.
8.2.1 Safeguarding of Material. All material given to or made available to the PROVIDER by
the STATE by virtue of this Contract which is identified as personal information, shall be
safeguarded by the PROVIDER and shall not be disclosed without the prior written approval of
the STATE.
8.2.2 Retention, Use, or Disclosure. PROVIDER agrees not to retain, use, or disclose personal
information for any purpose other than as permitted or required by this Contract.
8.2.3 Implementation of Technological Safeguards. PROVIDER agrees to implement
appropriate "technological safeguards" that are acceptable to the STATE to reduce the risk of
unauthorized access to personal information.
8.2.4 Reporting of Security Breaches. PROVIDER shall report to the STATE in a prompt and
complete manner any security breaches involving personal information.
8.2.5 Mitigation of Harmful Effect. PROVIDER agrees to mitigate, to the extent practicable,
any harmful effect that is known to PROVIDER because of a use or disclosure of personal
information by PROVIDER in violation of the requirements of this paragraph.
8.2.6 Log of Disclosures. PROVIDER shall complete and retain a log of all disclosures made
of personal information received from the STATE, or personal information created or received
by PROVIDER on behalf of the STATE.
Page 9 AG Form 103F(10/08)
General Conditions
Attachment 6
8.3 Security Awareness Training and Confidentiality Agreements.
8.3.1 Certification of Completed Training. PROVIDER certifies that all of its employees who
will have access to the personal information have completed training on security awareness
topics related to protecting personal information.
8.3.2 Certification of Confidentiality Agreements. PROVIDER certifies that confidentiality
agreements have been signed by all of its employees who will have access to the personal
information acknowledging that:
1) The personal information collected, used, or maintained by the PROVIDER will
be treated as confidential;
2) Access to the personal information will be allowed only as necessary to perform
the Contract; and
3) Use of the personal information will be restricted to uses consistent with the
services subject to this Contract.
8.4 Termination for Cause. In addition to any other remedies provided for by this Contract, if the
STATE learns of a material breach by PROVIDER of this paragraph by PROVIDER, the
STATE may at its sole discretion:
1) Provide an opportunity for the PROVIDER to cure the breach or end the violation; or
2) Immediately terminate this Contract.
In either instance, the PROVIDER and the STATE shall follow chapter 487N, HRS, with respect to-
notification of a security breach of personal information.
8.5 Records Retention.
8.5.1 Destruction of Personal Information. Upon any termination of this Contract, PROVIDER
shall, pursuant to chapter 487R, HRS, destroy all copies (paper or electronic form) of
personal information received from the STATE.
8.5.2 Maintenance of Files, Books, Records. The PROVIDER and any subcontractors shall
maintain the files, books, and records, that relate to the Contract, including any personal
information created or received by the PROVIDER on behalf of the STATE, and any cost
or pricing data, for three (3) years after the date of final payment under the Contract. The
personal information shall continue to be confidential and shall not be disclosed without
the prior written approval of the STATE. After the three (3) year retention period has
ended, the files, books, and records that contain personal information shall be destroyed
pursuant to chapter 487R, HRS.
Page 10 AG Form 103F(lO /08)
General Conditions
Attachment 7
SPECIAL CONDITIONS
1. The Certification of Exemption from Civil Service is attached hereto as
Attachment 4 and made a part hereof.
2. PROVIDER's Standard of Conduct Declaration.
a. The PROVIDER's Standards of Conduct Declaration is attached
hereto as Attachment 5 and made a part hereof.
b. Deletion of Portions of Contract. For purposes of this Contract,
paragraph 6 on page 4 of the Contract, "Standards of Conduct
Declaration," together with the attached Standards of Conduct
Declaration form, Attachment 5, are hereby deleted and the parties
agree that paragraph 6 of the Contract and Attachment 5 are not
operative.
3. The General Conditions is attached hereto as Attachment 6 and made a
part hereof.
4. The Special Conditions is attached hereto as Attachment 7 and made a
part hereof.
5. Deletion of General Conditions. For purposes of this Contract, the
following General Conditions are hereby deleted from the General
Conditions and have no operative effect between the parties:
a. Subparagraph 1.4
b. Subparagraphs 3.4.3
c. Subparagraphs 4.1.3 and 4.5
d. Paragraph 5 and subparagraphs 5.1 and 5.2
e. Subparagraph 6.1.
6. If this Contract is terminated with cause or without cause or at the
scheduled expiration of the time of performance specified in this Contract,
all equipment and unused supplies and materials leased or purchased
with funds paid to the PROVIDER under this Contract shall become the
property of the STATE as it so specifies and shall be disposed of as
directed by the STATE, except, if applicable, as otherwise may be
provided under the Federal Grant.
• 7. Modifications to Contract. The STATE may modify, pursuant to
subparagraph 4.1, Modification of Contract, of the General Conditions for
Health and Human Services Contracts, any section of this Contract
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 1
Attachment 7
including, but riot limited to, the scope of services, target population, time
of performance, geographic area served, and total award amounts.
Unique circumstances may require these modifications be made to
continue programs, improve services, as well as to adjust to budgetary
circumstances. In addition, the STATE reserves the right to increase or
decrease funds at its discretion in order to best meet the needs of the
STATE as well as operate within budgetary limitations.
8. Option to Extend Contract. Unless terminated, this Contract may be
extended by the STATE for specified periods of time not to exceed one (1)
year or for not more than one (1) additional twelve (12) -month period,
upon mutual agreement and the execution of a written agreement.
This Contract may be extended provided that the Contract price shall
remain the same or is adjusted per the Contract Price Adjustment
provision stated herein.
The STATE may terminate the extended agreement at any time in
accordance with paragraph 4, Modification and Termination of Contract, of
the General Conditions.
9. Contract Price Adjustment. The Contract price may be adjusted prior to
the beginning of the extension period and shall be subject to allotment and
the availability of federal funds.
10. Confidentiality Requirements. The PROVIDER shall comply with the
requirements of sections 334 -5, Hawaii Revised Statutes, and 42 Code of
Federal Regulations, Part 2, Confidentiality of Alcohol and Drug Abuse
Patient Records. The PROVIDER shall comply with the requirements of
the Health Insurance Portability and Accountability Act of 1996 ( "HIPAA ")
as applicable to the program and paragraph 8, Confidentiality of Personal
Information, of the General Conditions for Health and Human Services
Contracts.
11. Failure to Comply. If the PROVIDER materially fails to comply with the
terms and conditions of this Contract, the STATE may, as appropriate
under the circumstances:
a. Temporarily withhold payments pending correction of a deficiency
or delinquency in submission of required reports by the
PROVIDER;
b. Disallow all or part of the invoice submitted by the PROVIDER; or
c. Suspend or terminate this Contract.
12. Federal Citation. Pursuant to Section 516 of the Public Health Services
Act, as amended, the Center for Substance Abuse Prevention of the
Substance Abuse and Mental Health Services Administration of the United
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 2
Attachment 7
States Department of Health and Human Services has granted federal
funds to the STATE under a Hawaii Strategic Prevention Framework State
Incentive Grant, Grant No. 5U79SP013944 -04, dated July 13, 2009, for
the budget period from September 30, 2009 through September 29, 2010,
Catalog of Federal Domestic Assistance No. 93.243, which notice of
award, grant application, and other applicable documents and conditions
are hereinafter collectively referred to as the "Federal Grant."
13. Adherence to Federal Certifications. The CONTRACTOR shall comply
with and shall require all subcontractors to comply with all required federal
certifications including, but not limited to: (a) Debarment and Suspension;
(b) Drug -Free Workplace Requirements; (c) Lobbying; and (d) Program
Fraud Civil Remedies Act and by signing the "Certifications," attached
hereto as Exhibit "E," and made a part of this Contract, acknowledges that
it is a sub grantee of federal funds to be received under the Federal Grant.
14. Certification Regarding Environmental Tobacco Smoke. The PROVIDER
shall comply with the requirements of the Pro - Children Act of 1994 and by
signing the "Certification Regarding Environmental Tobacco Smoke,"
attached hereto as Exhibit "F" and made a part hereof, acknowledges that
it is a subgrantee of federal funds to be received under the Federal Grant.
15. Assurances Regarding Non - Construction Programs. The CONTRACTOR
shall comply with and shall require all subcontractors to comply with
assurance regarding non - construction programs and by signing the
"Assurances — Non - Construction Programs," attached hereto as Exhibit
"G" and made a part of this Contract, acknowledges that it is a subgrantee
of federal funds to be received under the Federal Grant.
16. Nondiscrimination. The PROVIDER shall comply with all Federal statutes
relating to nondiscrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88 -352) which prohibits
discrimination on the basis of race, color or national origin; (b) Title IX of
the Education Amendments of 1972, as amended (20 U.S.C. § §1681-
1683, and 1685 - 1686), which prohibits discrimination on the basis of sex;
(c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.
§ §794), which prohibits discrimination on the basis of handicaps; (d) the
Age Discrimination Act of 1975, as amended (42 U.S.C. § §6101- 6107),
which prohibits discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L.92 -255), as amended, relating to
nondiscrimination on the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91 -616), as amended, relating to nondiscrimination on
the basis of alcohol abuse or alcoholism; (g) § §523 and 527 of the Public
Health Service Act of 1912 (42 U.S.C. § §290 dd -3 and 290 ee -3), as
amended, relating to confidentiality of alcohol and drug abuse patient
records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. § §3601 et
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 3
Attachment 7
seq.) as amended relating to non - discrimination in the sale, rental or
financing of housing; (i) any other nondiscrimination provisions in the
specific statute(s) under which application for Federal assistance is being
made; and (j) the requirements of any other nondiscrimination statute(s)
which may apply to the application.
ADM. SERV. OFFICE
LOG NO. 10 -189 Page 4
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ADM. SERV. OFFICE Y
LOG NO. 10 -189 Exhibit "A"
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1
Identifying and Selecting
Evidence -Based Interventions
Revised Guidance Document for the Strategic Prevention
Framework State Incentive Grant Program
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health ServicesAdministraiton
Center for Substance Abuse Prevention
www.samhsa.gov
ADM. SERV. OFFICE
LOG NO. 10 -189 Exhibit "A"
•
Page 2
•
•
PUBLIC DOMAIN NOTICE
All material appearing in this report is in the public domain and may be reproduced or copied
without permission from SAMHSA /CSAP. Citation of the source is appreciated. However,
this publication may not be reproduced or distributed for a fee without the specific, written
authorization of the Office of Communications, SAMHSA /CSAP and HHS.
ELECTRONIC ACCESS AND COPIES OF PUBLICATION
•
This publication may be downloaded or ordered at www.samhsa.gov /shin.Or, please call
SAMHSA's Health Information Network at 1- 877 - SAMHSA -7 (1- 877 - 726 -4727) (English and
Espanol).
RECOMMENDED CITATION
Center for Substance Abuse. Prevention. Identifying and Selecting Evidence -Based Interventions
Revised Guidance Document for the Strategic Prevention Framework State Incentive Grant
Program. HHS Pub. No. (SMA)09 -4205. Rockville, MD: Center for Substance Abuse Prevention,
Substance Abuse and Mental Health Services Administration, 2009.
•
ORIGINATING OFFICE
Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services
Administration,1 Choke Cherry Road, Rockville, MD 20857 HHS Publication No. (SMA)09 -4205
2009
•
ADM. SERV. OFFICE
LOG NO. 10 -189 Exhibit "A"
Page 3
Contents
Executive Summary 1
I. Introduction 3
A. Background and Context 3
B. Purpose of the Guidance 4
II. SPF Implications for Community Planning to Identify
and Select Evidence -Based Interventions 5
A. Local Needs and Resource Assessment:
Key Data Tool to Guide Community Planning 5
B. The Community Logic Model: Key Conceptual Tool
for Community Planning 5
Examples of Community Logic Models 7
III. Using the Community Logic Model and Assessment
Information to Identify Best Fit Interventions 9
A. Establishing Conceptual Fit: Is It Relevant? 9
B. Establishing Practical Fit: Is It Appropriate? 10
Utility and Feasibility Checks 11
IV. Using Public Resources and Review Processes to Identify
Evidence -Based Interventions and Determine Their
Evidence Status 12
Evidence -Based Interventions and Evidence Status 12
SPF Definitions of Evidence -Based 13
A. Using Federal Registries 14
B. Using Peer - Reviewed Journals 16
Assessing Elements of Evidence Reported in
Peer - Reviewed Journals 16
Identifying and Selecting Evidence -Based Interventions V
ADM. SERV. OFFICE
LOG NO. 10 -189 Exhibit "A"
Page 4
C. Using Other Sources for Documenting Effectiveness 18
SPF SIG Program Guidelines for Documented Effectiveness 18
V. Summary Process Description:
Selecting Best Fit Prevention Interventions 20
VI. SPF SIG Program Guidance: Roles and Expectations 22
A. Federal Role 22
B. State /Jurisdiction Role 22
C. Community Role 23
Concluding Comments 24
GLOSSARY 25
Table of Figures
Figure 1. Community Logic Model, Outcomes -Based Prevention 6
Figure 1A. Community Logic Model for Preventing Alcohol -
Involved Traffic Crashes, (15- to 24- year -olds) 7
Figure 1 B. Community Logic Model for Preventing Illicit Drug Use 8
Figure 2. Human Environmental Framework 10
Figure 3. Process Description:
Selecting Best Fit Prevention Interventions 21
ADJV1'. Altfr!rtmcite#cting Evidence -Based Interventions
LOG NO. 10 -189 Exhibit "A"
Page 5
Executive Summary
The purpose of this guidance is to assist State and community planners in applying the
Substance Abuse and Mental Health Services Administration's (SAMHSA's) Strategic Prevention
Framework (SPF) to identify and select evidence -based interventions that address local needs
and reduce substance abuse problems.
•
Section I. Summarizes the'five steps of SAMHSA's SPF and sets the stage for selecting
evidence -based interventions to include in a comprehensive strategic plan.
Section II. Focuses on two analytic tasks included under the SPF: assessing local needs,
resources, and readiness to act; and developing a community logic model. Explains the
importance of these tasks in community planning to identify the best evidence -based
interventions for specific local needs.
Section 11I. Details how prevention planners can apply the community logic model to
determine the conceptual fit or relevance of prevention strategies that hold the greatest
potential for affecting a particular substance abuse problem. Also discusses how to examine
candidate interventions from the perspective of practical fit or appropriateness for local
circumstances, cultural contexts, and populations.
Section IV. Discusses the importance of strength of evidence to inform and guide intervention
selection decisions. Presents the three definitions of "evidence- based" provided under the
SPF SIG Program and the advantages and challenges of using each one to select prevention
interventions.The three definitions of "evidence - based "are as follows:
• Inclusion in Federal registries of evidence -based interventions;
• Reported (with positive effects on the primary targeted outcome) in peer- reviewed
journals; or
• Documented effectiveness supported by other sources of information and the
consensus judgment of informed experts, as described in the following set of
guidelines,all of which must be met:
Guideline 1: The intervention is based on a theory of change that is documented in a
clear logic or conceptual model; and
Guideline 2: The intervention is similar in content and structure to interventions that
appear in registries and /or the peer- reviewed literature; and
Guideline 3: The intervention is supported by documentation that it has been
effectively implemented in the past, and multiple times, in a manner attentive to
Identifying and Selecting Evidence -Based Interventions 1
ADM. SERV. OFFICE
LOG NO. 10 -189 Exhibit "A"
Page 6
scientific standards of evidence and with results that show a consistent pattern of
credible and positive effects; and
Guideline 4: The intervention is reviewed and deemed appropriate by a panel of
informed prevention experts that includes: well- qualified prevention researchers who
are experienced in evaluating prevention interventions similar to those under review;
local prevention practitioners; and key community leaders as appropriate, e.g., officials
from law enforcement and education sectors or elders within indigenous cultures.
Section V. Summarizes the process of working through three considerations that determine
the best fit of interventions to include in comprehensive prevention plans:
• Conceptual fit to the logic model:Is the candidate intervention relevant to the
targeted problem and outcomes?
• Practical fit to the community's needs and resources:Is it appropriate to the
community's population, cultural context, and local circumstances, including
community readiness?
• Strength of evidence:Is there sufficient documented effectiveness to support a
decision to select the particular intervention and include it in a comprehensive
community prevention plan?
Section VI. Discusses the respective roles and expectations for SAMHSA/CSAP and SPF SIG
States and their sub - recipient communities, jurisdictions, and Federally recognized tribes
and tribal organizations to ensure the identification and selection of best fit, evidence -based
prevention interventions for each community.
tip eEting Evidence -Based Interventions
AD1�VI KN
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Page 7
•
(.Introduction •
A. Background and Context
The Substance Abuse and Mental Health Services Administration (SAMHSA) envisions "a life
in the community for everyone "and has as its mission "building resilience and facilitating
recovery. "SAMHSA strives to achieve its mission through programs supported by three goals:
accountability, capacity, and effectiveness.The Center for Substance Abuse Prevention (CSAP)
helps to create healthy communities. SAMHSA/CSAP helps States to provide resources and
assistance to communities so that communities, in turn, can prevent and reduce substance
abuse and related problems.SAMHSA /CSAP also provides training, technical assistance, and
funds to strengthen the State prevention systems that serve local communities. SAMHSA/CSAP
works with States to identify programs, policies, and practices that are known to be effective in
preventing and reducing substance abuse and related problems.
All of SAMHSA's mission and goals are driven by strategic planning to align, manage, and
account for priority programs and issues across the three Centers. Chief among SAMHSA's
priorities is the Strategic Prevention Framework (SPF) —a five -step planning process to guide
the work of States and communities in their prevention activities.
Step 1. Assess population needs (nature of the substance abuse problem; where it occurs,
whom it affects, how it is manifested); the resources required to address the problem,
and the readiness to act;
Step 2. Build capacity at State and community levels to address needs and problems identified
in Step 1;
Step 3. Develop a comprehensive strategic plan. At the community level, the comprehensive
plan articulates a vision for organizing specific prevention programs, policies, and
practices to address substance abuse problems locally
Step 4. Implement the evidence -based programs, practices, and policies identified in Step 3;
and
Step 5. Monitor implementation, evaluate effectiveness, sustain effective activities, and
improve or replace those that fail.
Throughout all five steps, implementers of the SPF must address issues of cultural competence
and sustainability. Cultural competence is important for eliminating disparities in services
and programs offered to people of diverse racial, ethnic, and linguistic backgrounds, gender
and sexual orientations, and those with disabilities. Cultural competence will improve the
effectiveness of programs, policies, and practices selected for targeted populations.
•
Identifying and Selecting Evidence -Based Interventions 3
ADM. SERV. OFFICE
LOG NO. 10 -189 Exhibit "A"
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Sustainability of outcomes is a goal established at the outset and addressed throughout each
step of the SPF. Prevention planners at both State and local levels need to build systems and
institutionalize the practices that will sustain prevention outcomes over time, beyond the life
of any specific program.
Under the SPF State Incentive Grant (SIG) Program, prevention planners are specifically
required to select and implement evidence -based interventions. SAMHSA /CSAP recognized
that this requirement necessitates the availability of a broad array of evidence -based
interventions and further must allow prevention planners the flexibility to decide which
options best fit their local circumstances.To assist the field in meeting this requirement,
SAMHSA/CSAP convened an Expert Workgroup during 2005 to develop recommendations and
guidelines for selecting evidence -based interventions under the SPF SIG Program.
The Expert Workgroup was composed of nationally recognized substance abuse prevention
experts from a wide spectrum of academic backgrounds and theoretical research perspectives.
The guidance presented in this revised document is grounded in the thinking and
recommendations of the SAMHSA /CSAP Expert Workgroup and incorporates feedback from
the field, including prevention scientists, to clarify guidelines for documented effectiveness
and the process for applying them.
B. Purpose of the Guidance
This guidance is directed toward prevention planners working through SPF Steps 3 and 4 and
to help them select and implement evidence -based interventions successfully.The guidance
lays out an analytic process with a few key concepts to apply in selecting interventions that are
conceptually and practically fitting and effective.
AD1VlIat✓R'v. "pfl ; tin Evidence -Based Interventions
LOG NO. 10 -189 Exhibit "A"
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II. SPF Implications for Community Planning to
Identify and Select Evidence -Based Interventions
A. Local Needs and Resource Assessment: Key Data Tool to Guide Community
Planning
Prevention experts agree that substance abuse problems are usually best addressed locally —
at the community level— because they are manifested locally.Yet some prevention approaches
may be most effective when implemented on a larger scale, perhaps through a statewide
change in laws (e.g., change in the alcohol index for driving under the influence). Experts
also agree that substance abuse problems are among the most difficult social problems to
prevent or reduce. Substance abuse problems require comprehensive solutions —a variety of
intervention approaches directed to multiple opportunities.
The challenge of selecting the optimal mix of strategies is complicated by the limited
availability of public resources on evidence -based interventions. In practice, practitioners
seeking to reduce substance abuse problems will need to put together their own mix of
interventions.An optimal mix of interventions will fit the particular needs of the community–
its population, cultural context, and unique local circumstances, including community
readiness.Some interventions in the comprehensive plan may be deemed "evidence- based"
through inclusion in Federal registries or reported findings in the peer- reviewed literature,
while others may document effectiveness based on other sources of information and empirical
data. An optimal mix of strategies will combine complementary and synergistic interventions.
The needs and resource assessments in Step 1 will guide development of the comprehensive
prevention plan, from profiling the problem /population and the underlying factors /conditions
that contribute to the problem, to checking the appropriateness of prevention strategies to
include in the plan. It is crucial to use local data and information to identify effective strategies
that fit local capacity, resources, and readiness. However, finding local data is often difficult.
Creative approaches to data sources, including the use of proxy measures and information
gleaned through focus groups, may be necessary.
B.The Community Logic Model: Key Conceptual Tool for Community Planning
The community logic model reflects the planning that needs to take place to generate
community level change. Building the logic model begins with careful identification or
mapping of the local substance abuse problem (and associated patterns of substance use
and consequences among the population affected) to the factors that contribute to them.
Developing the logic model starts with defining the substance abuse problem, not choosing
the solutions - -that is, the programs, practices, or policies already decided upon by States or
communities.
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Given that comprehensive plans combine a variety of strategies, it is important to understand
the relationships between these problems and the factors or conditions that contribute to
them. Few substance abuse problems are amenable to change through direct influence or
attack. Rather, they are influenced indirectly through underlying factors that contribute to the
problem and its initiation, escalation, and adverse consequences.
These underlying factors include the following:
• Risk and protective factors that present themselves across the course of human
development and make individuals and groups either more or less prone to substance
abuse in certain social contexts.
• Contributing conditions and environmental factors implicated in the development
of the problems and consequences associated with substance abuse. Examples may
include specific local policies and practices, community realities, or population shifts.
Identifying the underlying factors that drive changes in the targeted substance abuse problem
and outcomes is essential to determining which programs, practices, and policies will best
address that problem and its initiation, progression, and pattern and consequences of use.
Linking the substance abuse problem to the underlying factors, and ultimately to potentially
effective prevention strategies, requires analysis and a conceptual tool.The logic model in
Figure 1 serves as the conceptual tool to map the substance abuse phenomenon and the
factors that drive it.
Figure 1. Community Logic Model, Outcomes -Based Prevention
Substance abuse
I •Risk and Programs, k ,
& related protective ; p oli c i es & x•
problems r factors /conditions, practices ^?
.y aNM A , 7. 47 i
•
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•
Logic models lay out the community substance abuse problem and the key markers leading
to that problem.They represent systematic plans for attacking local problems within a specific
context.The community logic model makes explicit the rationale for selecting programs,
policies, and practices to address the community's substance abuse problem. Used in this
way, the logic model becomes an important conceptual tool for planning a comprehensive and
potentially effective prevention effort.
Examples of Community Logic Models
The sample community -level logic models in Figures 1 A and 1B illustrate the relationships
between an identified substance abuse problem or consequence in an identified population
and the salient risk and protective factors /conditions that contribute to the problem. Each
risk and protective factor /condition, in turn, highlights an opportunity —or potential point of
entry —for interventions that can lead to positive outcomes in the targeted problem.
While different communities may show similar substance abuse problems, the underlying factors
that contribute most to them will likely vary from community to community. Communities will
tailor the logic model to fit their particular needs, capacities, and readiness to act.
Figure 1A. Community Logic Model for Preventing
Alcohol - Involved Traffic Crashes (15- to 24- year -olds)
Substance Rtskandprotective E , ! Strategies ,
abuse -related (` factors /conditions a i. (Examples)
I
(EXample) ^ Retailer education'
` 7, Easy retail access to i,
t. Alcohol Involved . alcohol for out "
3- i Compliance checks /sobriety ' ;•
traffic [rashes [. Low enforcement of "checkpoints',* t
alcohol laws `' v
' 5-to 24 year olds) +'s S Parent education /parental
�,. , , • Easy social access to alcohol' I monitoring
Low perceived risk of Youth education programs
* alcohol use Il i
a Social norms accepting and/or • Community education ' Et
encouraging yeuthddnking h Restrictions on advertising
• Promotion of alcohol use - to youth
(advertising movies musicetc)
Restncnons on
Low or discount pricing "happy hours, etc. , s
on alcohol
i Other evidence -based
• Other factors from the 'interventions t }`-
research literature ' i
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i
Figure 1B. Community Logic Model for Preventing Illicit Drug Use Among Adolescents
Substance abuse : < Risk and protective i Strategies
i problem t factors /conditions 1 (Examples)
(Example) ; ` (Examples)
1 Family/Parenting
g - 's Disrupted parent/ %
Illicit drug use s skills training
y child relations �
I Social skills
Alienation from I training
i pro - social peers
r Tutoring'
Academic failure
- s = Changing school
Positive school environment' ? P ", ' climate-
Social competence , Communication
; decision- making'
Other factors from the _
and problem solving
, research literature skills training
g •Other evidence-
based interventions
-'- c Irma'
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III. Using the Community Logic Model and
Assessment Information to Identify Best Fit
Interventions
A. Establishing Conceptual Fit:Is It Relevant?
Relevance: If the prevention intervention does not address the underlying risk and protective factors
and conditions that drive or contribute to the targeted substance abuse problem, then it is unlikely
to produce positive outcomes or changes in that problem.
The community logic model can be used to guide the identification and selection of types
of programs, practices, and policies for substance abuse prevention that are relevant for a
particular community. Community logic models are tailored to reflect and meet the unique
circumstances of a particular community. SAMHSA /CSAP expects SPF SIG States to develop
an epidemiological profile and create an initial generic logic model. In turn, each community
participating in the program will tailor the generic logic model to its needs.
Because substance abuse problems are complex, multiple factors and conditions will be
implicated —some more strongly than others. Communities are encouraged to identify a
comprehensive set of interventions directed to their most significant risk and protective
factors and conditions and targeted to multiple points of entry. Figure 2 illustrates the Human
Environmental Framework, one tool available to guide thinking about multiple points of entry
for interventions directed to risk and protective factors across the life span and across social
environments as well as to defining points of entry for interventions in different life sectors.
The community logic model can be used to check the conceptual fit of interventions considered
for the comprehensive community plan. The logic model screens for the types of interventions
most likely to affect positive changes in the targeted substance abuse problem in a particular
community, population, and cultural context.
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Figure 2. Human Environmental Framework
Time a
frItii”I �� Elwrrop�
Envtro
rh
g , 4 Sc he
tfifice F „ Peers
v
m
o w
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ttirrO ^ Work ; = Religious ,�
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)u A
t Bronfenbrenner U.(1979).The ecology
v of human development: Experiments
by nature and design. Cambridge, MA:
Harvard University Press.
This figure depicts social environments or spheres of influence in concentric circles that
flare outward, moving progressively away from direct influence on the individual toward
increasingly indirect influence and advancing over time. A comprehensive intervention plan
should identify a mix or layering of interventions that target salient risk and protective factors
in multiple contexts across the life span.
B. Establishing Practical Fit: Is It Appropriate?
Appropriateness: If the prevention program, policy, or practice does not fit the community's
capacity, resources, or readiness to act then the community is unlikely to implement the
intervention effectively.
A second important concept in selecting prevention interventions is practical fit with the
capacity, resources, and readiness of the community itself and the organizations responsible
for implementing interventions. Practical fit is assessed through a series of utility and
feasibility checks that grow out of the needs and resource assessment and capacity - building
activities conducted in SPF Steps 1 and 2.
SAMHSA/CSAP encourages practitioners to use their community assessment findings to
judge the appropriateness of specific programs, policies, and practices deemed relevant to
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the factors and conditions specified in the community logic model. Below is a list of utility and
feasibility checks to consider in selecting prevention strategies.
Utility and Feasibility Checks
Utility Checks
• Is the intervention appropriate for the population identified in the community needs
assessment and community logic model? Has the intervention been implemented
successfully with the same or a similar population? Are the population differences
likely to compromise the results?
• Is the intervention delivered in a setting similar to the one planned by the community?
In what ways is the context different? Are the differences likely to compromise the
intervention's effectiveness?
• Is the intervention culturally appropriate? Did members of the culturally identified
group participate in developing it? Were intervention materials adapted to the
culturally identified group?
• Are implementation materials (e.g., manuals, procedures) available to guide
intervention implementation? Are training and technical assistance available to
support implementation? Are monitoring or evaluation tools available to help track
implementation quality?
Feasibility Checks
• Is the intervention culturally feasible, given the values of the community?
• Is the intervention politically feasible, given the local power structure and priorities of
the implementing organization? Does the intervention match the mission, vision, and
culture of the implementing organization?
• Is the intervention administratively feasible, given the policies and procedures of the
implementing organization?
• Is the intervention technically feasible, given staff capabilities,time commitments, and
program resources?
• Is the intervention financially feasible, given the estimated costs of implementation
(including costs for purchase of implementation materials and specialized training or
technical assistance)?
Each of the points in the checklist warrants thoughtful consideration among those involved
in planning, implementing, and evaluating the prevention strategies in the comprehensive
community plan.
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IV. Using Public Resources and Review Processes to
Identify Evidence -Based Interventions and Determine
Their Evidence Status
Evidence -Based Interventions and Evidence Status
The preceding sections defined logic models and detailed their usefulness in the prevention
planning process.This section addresses how those logic models can be translated into action
once a problem or set of problems has been identified through the needs - assessment process.
Our expectation is that intervention selection is grounded in a well- defined conceptual
model (e.g.,the community logic model) that includes malleable behaviors, environments,
or other factors (referred to as underlying factors in Section II) that can be targeted over the
course of development in.a variety of contexts.This section presents guidance for selecting
interventions from:A. Registries of evidence -based programs; B.The peer- reviewed research
literature; and C.Other documentation supporting effectiveness (used in the absence of a
registry listing or direct support from the peer- reviewed literature).
The strength of evidence for tested interventions falls along a continuum from strong to weak.
Strength of evidence is assessed using established scientific standards and criteria for applying
those standards and comprises four major elements:
1. Rigor of the evaluation design (e.g., use of appropriate intervention and control
or other comparison groups, group assignment strategy, control of dosage and
contextual factors that can provide an alternative explanation of the results or
findings).
2. Rigor and appropriateness of the methods used to collect and analyze the data (e.g.,
use of appropriate data collection designs, use of measures that match outcomes
targeted by the intervention, data collection without bias, and use of appropriate
statistical tests).
These two elements directly affect the inferences that can be drawn about cause and
effect — the - degree to which the results obtained from an evaluation can be attributed to the
intervention exclusively rather than to other factors.
3. The magnitude and consistency of the effects of the intervention on targeted
outcomes. Magnitude refers to the amount of change or impact that an intervention
produces for a given outcome —that is, its "effect size." Equally important is consistency
in the pattern of positive effects reported on the targeted outcomes.
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4. The extent to which findings can be generalized to similar populations and settings.
This element refers to the likelihood that the same pattern of positive findings will
hold for similar populations under similar conditions.
Taking into account these four methodological elements, strong evidence means that
the evaluation of an intervention generates consistently positive results for the outcomes
targeted under conditions that rule out competing explanations for effects achieved (e.g.,
population and contextual differences). Experts agree that evidence for the effectiveness
of an intervention becomes "stronger "with replication and field testing under a variety of
circumstances. However,there is less agreement about the threshold of evidence or cut -off
point below which evidence should be considered insufficient. Ultimately, prevention planners
and practitioners must judge the merits of the evidence supporting the selection of one
intervention relative to another.
In some cases, planners may not be able to find an intervention that meets their needs in the
Federal registries or the peer- reviewed research literature. In these instances, other sources
of information such as articles in non -peer- reviewed journals, book chapters,or unpublished
program evaluation reports may be available.These sources may provide weaker support for
effectiveness; thus, they should be reviewed as specified in the guidelines.
In general, we recommend using the following decision rules when considering these other
sources of supporting information:
1. Out of two similar interventions that address the targeted needs equally well, choose
the one for which there is stronger evidence of effectiveness, both in terms of the
consistency and strength of effects on the desired outcomes and quality or rigor of the
evaluation methodology utilized.
2. Reserve the option to select an intervention with little or weak evidence of
effectiveness for circumstances in which there are no interventions with stronger
evidence that appropriately address the needs identified for a particular population,
culture, or local context.
SPF Definitions of Evidence - Based
The SPF SIG Program specifically requires implementation of evidence -based interventions.
Evidence -based interventions are defined in the SPF SIG Program by inclusion in one or more
of the three categories below:
A. Included in Federal registries of evidence -based interventions;
B. Reported (with positive effects on the primary targeted outcome) in peer- reviewed
journals; or
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C. Documented effectiveness supported by other sources of information and the
consensus judgment of informed experts (as specified in the Guidelines that follow).
Each of the three definitions helps identify interventions appropriate to targeted needs and
each has its own advantages and challenges. Prevention planners and practitioners must be
prepared to consider the relative adequacy of evidence when deciding to select a particular
prevention intervention to include in their comprehensive community plan.
A. Using Federal Registries
Federal registries are readily accessible and easy -to -use public resources for identifying
interventions that reduce substance use risk factors and consequences or increase protective
factors thought to be associated with reduced potential for substance abuse. Many registries
use predetermined criteria and a formalized rating process to assess the effectiveness of
interventions reviewed. Some registries apply quality scores to the intervention.These
quality scores are indications of the strength of evidence according to the ratings applied.
Thus, inclusion of an intervention in a registry can be viewed as providing some evidence
of effectiveness. However, the level of evidence required by registries varies considerably.
When choosing among interventions that have been reviewed by registries, we generally
recommend selecting the one with the highest average score, provided that it demonstrates
positive effects on the outcomes targeted for the population identified. Ultimately, while
selecting interventions from registries may seem easier in some respects, it still requires
planners and practitioners to think critically and make reasoned judgments about intervention
selection, taking into account the degree of congruence with the particular cultural context
and local circumstances.
Advantages
Federal Registries—
• Provide concise descriptions of the interventions.
• Provide documented ratings of the strength of evidence measured against defined
and accepted standards for scientific research.
• Present a variety of practical information,formatted and categorized for easy access
and potentially useful to implementers.
• Offer "one- stop "convenience for those seeking quick information on the interventions
included.
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Challenges
Federal Registries—
• Include a limited number of interventions depending on how they are selected.
• Include interventions most easily evaluated using traditional scientific methods.
Consequently, registries include predominantly school- and family -based interventions
and relatively few community, environmental, or policy interventions.
• Are based on evidence that may be out of date if the registry does not provide a
process for incorporating new evidence.
• May be confusing to consumers seeking to compare the relative strength of evidence
for similar programs included on different registries since the criteria and rating
procedures may vary from one registry to another.
Federal registries include:
• SAMHSA National Registry of Evidence -Based Programs and Practices (NREPP)
http://www.nrepp.samhsa.gov
•
Provides descriptions of and rates evidence for various interventions related to
substance use and abuse and mental health problems.
• OJJDP Model Programs Guide
http://www.dsgonline.com/mpg2.5/mpg_index.htm
Provides descriptions of and rates evidence for youth- oriented interventions, many of
which are relevant to the prevention of substance use and abuse.
• Exemplary and Promising Safe, . Disciplined and Drug -Free Schools Programs
Sponsored by the U.S. Department of Education
http: / /www.ed.gov /ad m in s/ lead / safety /exemplary01 /exem pla ry0l .pdf
Provides descriptions of and rates evidence for educational programs related to
substance use.
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• Guide to Clinical Preventive Services
Sponsored by the Agency for Healthcare Research and Quality [AHRQ]
http://www.ahrq.gov/clinic/cps3dix.htm
Provides recommendations regarding screening and counseling in clinical settings to
prevent the use of tobacco, alcohol,and other substances.
• Guide to Community Preventive Services
Sponsored by the Centers for Disease Control and Prevention [CDC]
http://www.thecommunityguide.org
Provides recommendations regarding generic programs and policies to prevent and
reduce tobacco use and alcohol- impaired driving.
• A list of other registries may be found at SAMHSA'S website:
http://www.samhsa.gov/ebpWebguide/appendixB.asp.
B. Using Peer - Reviewed Journals
The research literature constitutes another primary resource for identifying evidence -based
prevention interventions, including those not listed in Federal registries. When the literature is
used to determine strength of evidence, all articles relevant to the specific intervention should
be considered. In other words, it is not sufficient to garner support for an intervention from
a single document selected from a larger body of work. We recommend careful review of all
documents that have been published on a particular intervention to ensure that the outcomes
reported comprise a consistent pattern of positive effects on the target outcomes.
Unfortunately, using the primary literature is not easy and can be very time consuming and
resource intensive, particularly for practitioners without ready access to university libraries
or electronic copies of journal articles. Additionally, a healthy degree of skepticism and
considerable technical expertise is required to review articles and interpret results, as the
quality of the study reported depends on many factors such as the conceptual model or
theory on which the intervention is based, the measurement and design strategies used to
evaluate it, and the findings that are presented.
Assessing Elements of Evidence Reported in Peer - Reviewed Journals
Listed below are key elements addressed in most peer- reviewed journal articles, along with
some questions to consider.
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• A defined conceptual model that includes definitions and measures of intermediate
and long -term outcomes. Does the article describe the theory or provide a conceptual
model of the intervention and link the theory or model to expectations about the way
the program should work? Does the article describe the connection of the theory or
the conceptual model to the intervention approach, activities, and expected outcomes
in sufficient detail to guide your decision?
• Background on the intervention evaluated. How closely does the problem targeted
by the intervention match the identified needs of your community? Does the article
adequately describe the proposed mechanism of change of the intervention? Are the
structure and content of the intervention described in enough detail? Is the context
or setting of the intervention described to an extent that allows you to make an
informed decision concerning how well it might work in the communities targeted?
• A well- described study population that includes baseline or "pre- intervention"
measurement of the study population and comparison or control groups included in
the study. Does the article describe in detail the characteristics of the study population
and the comparison or control groups used? How well does the study population
match your local target group?
• Overall quality of study design and data collection methods. Does the article describe
how the study design rules out competing explanations for the findings? Are issues
related to missing data and attrition addressed and satisfactorily resolved? Did the
study methodology use a combination of strategies to measure the same outcome
using different sources (e.g., child, parent, teacher, archival)?
• Analytical plan and presentation of the findings. Does the article specify how the
analytical plan addresses the main questions posed in the study? Do the analyses
take into account the key characteristics of the study's methodology? Does the article
report and clearly describe findings and outcomes? Are the findings consistent with
the theory or conceptual model and the study's hypotheses? Are findings reported for
all outcomes specified?
• A summary and discussion of the findings. Does the discussion draw inferences and
conclusions that are clearly related to the data and findings reported?
Advantages
Peer - Reviewed Journals—
• Typically present detailed findings and analyses that document whether or not the
program, practice, or policy has an adequate level of evidence that the intervention
works.
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• Provide authors' contact information that facilitates further discussion about the
appropriateness of the intervention to the target need.
• In some cases, report and summarize meta - analyses and other types of complex
analyses (e.g., core components) that examine effectiveness across interventions
or intervention components.These types of analyses are potentially very useful to
prevention planners.
Challenges
Peer - Reviewed Journals—
• Leave it to the reader to interpret results and assess the strength of the evidence
presented and its relevance and applicability to a particular population, culture, or
community context.
• Describe in limited detail the activities and practical implementation issues pertinent
to the use of the intervention.
C. Using Other Sources for Documenting Effectiveness
When no existing evidence -based interventions are available in registries or the research
literature to address the problem, then empirical support for other interventions may be
found in unpublished reports (e.g., doctoral theses) or published, non -peer- reviewed sources
(e.g., book chapters, evaluation reports, and Federal reviews). We recommend caution when
relying on these other sources of support because they usually have not been subjected to
the methodological scrutiny provided by registries and peer - reviewed journals. Ultimately,
the "burden of proof "for documented effectiveness lies with the program planners and
practitioners making the selection decision. Under what conditions is it appropriate to select
an intervention that is not included in an established Federal list of evidence -based programs
or reported with positive effects in the peer- reviewed journal literature? When no appropriate
• interventions are available through these primary resources on evidence -based interventions,
then prevention planners may need to rely on other, weaker sources of information to identify
an intervention that is appropriate for the assessed community need, the population served,
and the cultural and community context in which it will be implemented.
When selecting interventions based on other sources of supporting information, all four of the
following guidelines should be met:
• Guideline t :The intervention is based on a theory of change that is documented in a
clear logic or conceptual model;
• Guideline 2: The intervention is similar in content and structure to interventions that
appear in registries and /or the peer- reviewed literature;
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•
• Guideline 3: The intervention is supported by documentation that it has been
effectively implemented in the past, and multiple times, in a manner attentive to
scientific standards of evidence and with results that show a consistent pattern of
credible and positive effects; and
• Guideline 4: The intervention is reviewed and deemed appropriate by a panel of
informed prevention experts that includes:well- qualified prevention researchers who
are experienced in evaluating prevention iriterventions similar to those under review,
local prevention practitioners, and key community leaders as appropriate (e.g., officials
from law enforcement and education sectors or elders within indigenous cultures).
These guidelines are intended to assist prevention planners by expanding the array of
interventions available to them. In a comprehensive prevention plan, these interventions
should be considered supplements, not replacements, for traditional scientific standards used
in Federal registry systems or peer - reviewed journals.
Advantages
Other Sources for Documenting Effectiveness —
• Enable State and community planners to consider interventions that do not currently
appear on a Federal list or in the peer- reviewed literature but which have the potential
to address the problem targeted.
• Provide opportunities for State and community planners to use locally developed or
adapted interventions, provided they are supported by adequate documentation of
effectiveness.
Challenges
Other Sources for Documenting Effectiveness —
• Place substantial responsibility on prevention planners and practitioners for
intervention selection decisions.
• Require prevention planners and practitioners to develop and implement decision -
making and documentation processes.
• Require prevention planners and practitioners to assemble additional documentation
and assess its adequacy to support using a particular intervention as part of the larger
comprehensive community prevention plan.
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V. Summary Process Description: Selecting Best Fit
Prevention Interventions
The process described here is rooted in the work conducted by local communities during SPF
steps 1 and 2.It begins with creating a community logic model to map the local substance
abuse picture and draws from the findings of local needs and resource assessment. Prevention
planners apply the logic model and assessment findings in a process of thinking critically and
systematically about three considerations that determine best fit interventions to include in a
comprehensive community prevention plan:
• Conceptual fit with the community's logic model: Does the candidate intervention
target the identified problem and the underlying factors that drive or contribute to
changes in the problem or outcomes?
• Practical fit with the community's needs, resources, and readiness to act: Is the
candidate intervention appropriate for the particular population, cultural context, and
set of local circumstances?
• Evidence of effectiveness: Is there sufficient evidence or support for documented
effectiveness to select the intervention and include it in the comprehensive
community prevention plan?
Figure 3 depicts the process for thinking through these key considerations.
Identify types of programs, practices, and strategies that:target the identified problem, address
the relevant underlying factors, target opportunities in multiple life domains.
Select specific programs, practices, and strategies that are: appropriate for the community's
population, cultural context, and feasible, given local circumstances, including resources,
organizational resources, and readiness to act, and that demonstrate sufficient evidence or
support for documented effectiveness.
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•7 • ,
Figure 3. Process Description: Selecting Best Fit Prevention Interventions
Identify types of
interventions that - Select specific prograrhs,
practices, and strategies that AND
• address a community's
•are adequately
salient risk and Best fit
• are feasible
protective factors given a community's supported by theory,
resources, capacities, and empirical data, and the Prevention interventions
and contributing readiness to act consensus Judgment
conditions . to include in
-
of informed experts comprehensive
• • target opportunities for
add to /reinforce other strategies - and community community plan
intervention in multiple -: in the community - synergistic vs. prevention leaders
life domains duplicative or stand -alone efforts
drive positive outcomes ` in one or more substance Demonstrate
abuse problems, "Evidence of
consumption patterni, or Effectiveness'
consequences
Demonstrate •
"Practical Fit" Effective?
Demonstrate Appropriate?
"Conceptual Fit"
Relevant?
Identifying and Selecting Evidence -Based Interventions 21
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VI. SPF SIG Program Guidance: Roles and Expectations
Collaboration and partnership across all levels — Federal, State, and community or local
grantee —are essential for successful and flexible implementation of the guidance provided
in this document.The guidance details an analytical process and a few key concepts —what
needs to be done to think through the selection of best fit, evidence -based prevention
interventions. How this is accomplished will be determined by States and jurisdictions, and will
vary from one to another. SAMHSA/CSAP's technical assistance providers are available to work
with States and jurisdictions to apply the process and concepts detailed in the guidance.
A. Federal Role
SAMHSA /CSAP will provide leadership and technical assistance to States and jurisdictions
and will work with them to strengthen prevention systems in order to improve substance use
outcomes and achieve targeted community change.
Expectations
• SAMHSA/CSAP will partner with States to develop and implement a plan that
facilitates application of the guidance.
• SAMHSA /CSAP has directed its Center for the Application of Prevention Technologies
(CAPT) with its five Regional Expert Teams, to allocate substantial technical assistance
resources for States to apply the concepts in this guidance. At the request of States,
the CAPT will conduct workshops and activities to help States work with communities
to identify and select suitable and effective evidence -based interventions.
B. state /Jurisdiction Role
The role of the States and jurisdictions is to provide capacity - building activities, tools, and
resources to communities to foster the development of sound community prevention systems
and prevention strategies.
Expectations
• SAMHSA /CSAP expects States funded under the SPF SIG Program to strengthen
their infrastructure and capacity to assist communities in identifying and selecting
appropriate evidence -based interventions for their comprehensive plans.To assure
accountability for this role, SAMHSA /CSAP expects States to establish a technical panel
• of informed prevention experts that includes:well- qualified prevention researchers
who are experienced in evaluating prevention interventions similar to those under
review, local prevention practitioners, and key community leaders as appropriate (e.g.,
officials from law enforcement and education sectors and elders within indigenous
?�
� responsibilities of this technical panel are to:1) review comprehensive
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•
community plans and the justification for interventions included in each community
plan, 2) identify issues and problematic intervention selections to be addressed prior
to plan,approvai, and 3) target technical assistance to work with communities to
improve and strengthen their community plans.
• As part of their work, we expect the State -level technical expert panels to assess
whether chosen interventions included in the sub - recipient, comprehensive
•
community plans meet one or more of the definitions of "evidence - based "for the SPF
SIG Program: included in Federal registries of evidence -based interventions; reported
(with positive effects on the primary targeted outcome) in peer- reviewed journals;
or documented effectiveness supported by other sources of information and the
consensus judgment of informed experts.
In thinking about the implications of this guidance, States should consider the questions
below:
How might the State engage informed experts, including community
leaders, in applying the concepts in the guidance for funding comprehensive
community plans (programs, practices, and policies) selected by communities?
How might the State communicate its policies regarding funding and
implementation of evidence -based programs, practices, and policies to
community coalitions and organizations and other key stakeholders?
• SAMHSA /CSAP expects States, with their technical assistance providers, to work closely
with communities in identifying and selecting evidence -based interventions.SAMHSA /
CSAP and its technical assistance providers will work directly with States on this task.
• SAMHSA/CSAP expects States to develop capacities to assist communities on all key
SPF topics, including:assessing needs and resources, using data to detail the substance
abuse problem and underlying factors and conditions, building a community logic
model, and examining intervention options for relevance and appropriateness.
C. Community Role
The role of SPF SIG sub recipient communities is to develop a comprehensive and strategic
community prevention plan based on local needs and resource assessment. Following the
steps of the SPF, communities use the findings from these activities to develop a logic model
specific to the community and its substance abuse problem.Each community logic model
reflects and maps the local substance abuse phenomenon. An effective logic model may serve
as the primary tool to guide the selection of evidence -based programs, practices, and policies
to include in a comprehensive plan.
Identifying and Selecting Evidence -Based Interventions 23
ADM. SERV. OFFICE
LOG NO. 10 -189 Exhibit "A"
Page 28
Expectations
• SAMHSA/CSAP expects communities to partner with the State and its technical
assistance providers,who in turn will partner with SAMHSA /CSAP and CSAP's technical
assistance providers.
Concluding Comments
As in all steps of SAMHSA's Strategic Prevention Framework,the application of critical thinking
skills is vital to selecting programs, practices, and policies to include in a comprehensive
strategic plan.Those selected must be relevant, appropriate, and effective to meet community
needs and address the community substance abuse problem.SAMHSA /CSAP and its technical
assistance providers welcome the opportunity to partner with SPF SIG States,jurisdictions,and
Federally recognized tribes and tribal organizations through technical assistance workshops
and "science -to- service "learning communities to think through the selection of best fit,
evidence -based prevention interventions.
ADM cktvi Vlap r t ectin g Evidence -Based Interventions
NE
LOG NO. 10 -189 Exhibit "A"
Page 29
GLOSSARY
Best fit interventions Interventions that are relevant to the community logic
model 0.6., directed to the risk and protective factors
most at play in a community) and appropriate to the
community's needs, resources, and readiness to act.
Community logic model A graphic depiction or map of the relationships between
the local substance abuse problem, the risk/protective
factors and conditions that contribute to it, and the
interventions known to be effective in altering those
underlying factors and conditions.
Conceptual fit The degree to which an intervention targets the
community's identified substance abuse problem and the
underlying factors that contribute to the problem.
Documented effectiveness Defined under the SPF SIG Program by guidelines for using
other sources of information and support to document
intervention effectiveness.
Epidemiological profile A summary and characterization of the consumption
(use) patterns and consequences of the abuse of alcohol,
tobacco, marijuana, heroin, cocaine, methamphetamines,
inhalants, prescription drugs, or other substances.The
epidemiological profile identifies the sources of data on
consumption patterns as well as the indicators used to
identify consequences (e.g., morbidity and mortality). It
should provide a concise, clear picture of the burden of
substance abuse in the State using tables,graphs,and
words as appropriate to communicate this burden to a
wide range of stakeholders.
Evidence -based interventions Evidence -based interventions are defined in the SPF SIG
SPF SIG Program Program by inclusion in one or more of the three
categories below:
A. Included in Federal registries of evidence -based
interventions;
B. Reported (with positive effects on the primary targeted
outcome) in peer - reviewed journals; or
Identifying and Selecting Evidence -Based Interventions 25
ADM. SERV. OFFICE
LOG NO. 10 -189 Exhibit "A"
Page 30
•
C. Documented effectiveness supported by other sources
of information and the consensus judgment of
informed experts (as specified below).
Evidence status or strength Refers to the continuum of evidence quality, which
ranges from weak to strong. Strong evidence means that
the positive outcomes assessed are attributable to the
intervention rather than to extraneous events, and that the
intervention reliably produces the same pattern of positive
outcomes in similar populations and contexts.
External validity The extent to which evaluation outcomes will be achieved
in populations, settings, and timeframes beyond those
involved in the study;,the likelihood that the same pattern
of outcomes will be obtained when the intervention is
implemented with similar populations and in similar
contexts.
Guidelines for Guideline 1: The intervention is based on a theory of
Documented Effectiveness change that is documented in a clear logic or conceptual
SPF SIG Program model; and
Guideline 2: The intervention is similar in content and
structure to interventions that appear in registries and /or
the peer- reviewed literature; and
Guideline 3:The intervention is supported by
documentation that it has been effectively implemented
in the past, and multiple times, in a manner attentive to
scientific standards of evidence and with results that show
a consistent pattern of credible and positive effects; and
Guideline 4: The intervention is reviewed and deemed
appropriate by a panel of informed prevention experts that
includes:well- qualified prevention researchers who are
experienced in evaluating prevention interventions similar
to those under review; local prevention practitioners;and
key community leaders as appropriate, e.g., officials from
law enforcement and education sectors or elders within
indigenous cultures.
ADMr lden fvii}gpp1V(ect Evidence -Based Interventions
LOG NO. 10-189 110 -189 Exhibit "A"
Page 31
Internal validity The extent to which the reported outcomes can be
unambiguously attributed to the intervention rather than
to other competing events or extraneous factors.
Interventions Interventions encompass programs, practices, policies, and
strategies that affect individuals, groups of individuals, or
entire communities.
Outcomes -based prevention An approach to prevention planning that begins with
a solid understanding ofa substance abuse problem,
progresses to identify and analyze factors and conditions
that contribute to the problem, and finally matches
intervention approaches to these factors and conditions
that ultimately lead to changes in the identified problem
(i.e., behavioral outcomes).
Practical fit The degree to which an intervention is appropriate for
the community's population, cultural context, and local
circumstances including its resources, capacities, and
readiness to take action.
Protective factors Conditions for an individual, group, or community that
• decrease the likelihood of substance abuse problems and
buffer the risks of substance abuse.
Risk factors Conditions for an individual, group, or community that
increase the likelihood ofa substance abuse problem.
Identifying and Selecting Evidence -Based Interventions 27
ADM. SERV. OFFICE
LOG NO. 10 -189 Exhibit "A"
Page 32
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ADM. SERV. OFFICE
HHS Publication No. (SMA) 09-4205 . '
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Exhibit "A" °
LOG NO. 10 -189 page 33��
MANAGEMENT REQUIREMENTS
1. Personnel
The PROVIDER agrees to comply with the Personnel Management Requirements as indicated
below.
The PROVIDER shall:
❑ Maintain and update annually, or as changes occur, a description of its organization -
staffing pattern, including an organization chart showing lines of authority and
supervision for prevention services.
❑ Assure that the PROVIDER's workforce and that of any partnering organizations meets
the minimum qualifications set forth by the organization that employs them.
❑ Attend ongoing training(s) approved by ADAD, including but not limited to the
Substance Abuse Prevention Specialist Training (SAPST), Evidence -based
Strategies /Programs, Data Collection, and other topics related to SPF -SIG.
Documentation of such training shall be included in the personnel file for each staff
employed by this program.
❑ Ensure that staff receive training in the ADAD Hawaii Prevention System and in
ADAD's procedures for reporting fulfillment of the contract requirements and
evaluations of capacity, process, and outcomes. Documentation of such training shall be
included in the personnel file for each staff employed by this program.
❑ Attend mandatory meetings as scheduled by ADAD.
❑ Supervise staff and volunteers (if used by the PROVIDER) and train them in client
confidentiality issues and program quality assurance requirements.
❑ Develop and implement a written safety plan which includes policies and procedures for
handling personal injury, threats, emergencies, or disasters. Post evacuation routes in
facilities used by the program.
❑ Implement a no- smoking policy.
2. Administrative
The PROVIDER agrees to comply with the Administrative Management Requirements of this
contract.
ADM. SERV. OFFICE Exhibit `B"
LOG NO. 10 -189 Page 1
i1
The PROVIDER shall:
❑ Develop and maintain fiscal, statistical, and administrative records pertaining to services
as specified by the DEPARTMENT.
❑ Review all written and/or audio visual prevention material, at a minimum, biannually by
staff and by an advisory board or ad hoc committee to assure that it is relevant, current,
and age and culturally appropriate.
❑ Implement procedures for handling complaints and grievances.
❑ Familiarize staff with materials available at the Regional Alcohol and Drug Awareness
Resource (RADAR) Center.
❑ Acknowledge the DEPARTMENT and ADAD as the PROVIDER's program sponsor by
displaying the DEPARTMENT's logo and the following statement on displays, public
service announcements, or written material distributed by the program: "Funded by the
State of Hawaii Department of Health, Alcohol and Drug Abuse Division through the
Substance Abuse and Mental Health Services Administration — Center for Substance
Abuse Prevention Strategic Prevention Framework —State Incentive Grant."
❑ Refund to the DEPARTMENT any funds unexpended or expended inappropriately.
❑ Under the actual expenditure method of reimbursement, assure that all equipment and
unused supplies and materials purchased with funds paid to it shall become the property
of the DEPARTMENT upon completion or termination of the contract.
❑ Under the actual performance method of reimbursement, assure that program income
and /or surplus earned during the contract period shall be used to further the program
objectives; otherwise the DEPARTMENT will deduct the surplus from the total contact
amount in determining the net allowable cost on which the state's share or cost is based.
3. Evaluation specifications
The PROVIDER agrees to comply with the Evaluation Management Requirements of this
contract.
The PROVIDER shall:
ADM. SERV. OFFICE Exhibit `B"
LOG NO. 10 -189 Page 2
❑ Use the standard evaluation procedures determined by ADAD to ensure a uniform
evaluation plan.
❑ Use the quantitative and qualitative evaluation tools provided by ADAD to demonstrate
the effectiveness of the services in assessing, building capacity and planning. The
evaluation shall focus on the achievement of proposed tasks /goals within the appropriate
timeframe as indicated in the Funding Application submitted by the PROVIDER.
❑ Participate in evaluation activities of the HI -SPF including but not limited to surveys,
focus groups, document reviews collected from entities such as the CAC, service
providers, and other groups or through other methods as identified by ADAD.
The undersigned (authorized official signing for the applicant organization) certifies that the
statements herein are true, complete, and accurate to the best of his or her knowledge, and that he
or she is aware that any false, fictitious, or fraudulent statements or claims may subject him or
her to criminal, civil, or administrative penalties. The undersigned agrees that the applicant
organization shall comply with the terms and conditions of the contract if a contract is awarded
as a result of this application.
County of Hawaii
Organization Name
WILLIAM P. KENOI MAYOR
Name of authorized Representative Title
MAR 2 3 201H
Signature Date
WILLIAM P. KENOI
• MAYOR
ADM. SERV. OFFICE Exhibit `B"
LOG NO. 10 -189 Page 3
BUDGET SUMMARY
April 1, 2010 to September 29, 2011 .
Service Title: Underage Drinking Prevention Plan Under Hawaii's Strategic
Prevention Framework -State Incentive Grant Phase II Funding RFP for
the County of Hawaii
SOURCE OF FUNDS:
April 1, 2010 to June 30, 2010
S 10 203 H 000479 10 576 $350,523.36
July 1, 2010 to September 29, 2010
S 11 203 H 000479 10 576 $350,523.36
September 30, 2010 to June 30, 2011
S 11 203 H 000479 11 576 $1,051,570.08
July 1, 2011 to September 29, 2011
S 12 203 H 000479 11 576 $350,523.48
Contract Total $2,103,140.28
ADM. SERV. OFFICE Exhibit "C"
LOG NO. 10 -189 Page 1
BUDGET
April 1, 2010 to September 29, 2011
Underage Drinking Prevention Plan under $2,103,140.28
•
Hawaii's Strategic Prevention Framework —State
Incentive Grant Phase II Funding RFP for the
County of Hawaii
SOURCE OF FUNDS: 2/25/10
S 10 203 H 000479 10 576 $350,523.36
S 11 203 H 000479 10 576 $350,523.36
S 11 203 H 000479 11 576 $1,051,570.08
S 12 203 H 000479 11 576 $350,523.48
ADM. SERV. OFFICE Exhibit "D"
LOG NO. 10 -189 Page 1
Certification Regarding Debarment and Suspension
The undersigned (authorized official signing for the applicant organization) certifies to the best of his or
her knowledge and belief, that the applicant, defined as the primary participant in accordance with 45
CFR Part 76, and its principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal Department or agency;
(b) have not within a 3 -year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or
contract under a public transaction; violation of Federal or State antitrust statutes or commission
of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
(c) are not presently indicated or otherwise criminally or civilly charged by governmental entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (b) of
this certification; and
(d) have not within a 3 -year period preceding this application/proposal had one or more public
transactions (Federal, State, or local) terminated for cause or default.
Should the applicant not be able to provide this certification, an explanation as to why should be placed
after the assurances page in the application package.
The applicant agrees by submitting this proposal that it will include, without modification, the clause
titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion —Lower
Tier Covered Transactions" in all lower tier covered transactions (i.e., transactions with sub - grantees
and /or contractors) and in all solicitations for lower tier covered transactions in accordance with 45 CFR
Part 76.
County of Hawaii
Organization Name
WILLIAM P. KENOI MAYOR
Name of Authorized Representative Title
ell ° MAR 2 3 2010
Signature Date
ADM. SERV. OFFICE Exhibit "E"
LOG NO. 10 -189 Page 1
CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS
The undersigned (authorized official signing for the applicant organization) certifies that the
applicant will, or will continue to, provide a drug -free workplace in accordance with 45 CFR Part
76 by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be taken against employees for violation of
such prohibition;
(b) Establishing an ongoing drug -free awareness program to inform employees about- -
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance
programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations
occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the
grant be given a copy of the statement required by paragraph (a) above;
(d) Notifying the employee in the statement required by paragraph (a), above, that, as a
condition of employment under the grant, the employee will —
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal
drug statute occurring in the workplace no later than five calendar days after
such conviction;
(e) Notifying the agency in writing within ten calendar days after receiving notice under
paragraph (d)(2) from an employee or otherwise receiving actual notice of such
conviction. Employers of convicted employees must provide notice, including position
title, to every grant officer or other designee on whose grant activity the convicted
employee was working, unless the Federal agency has designated a central point for the
receipt of such notices. Notice shall include the identification number(s) of each affected
grant;
(f) Taking one of the following actions, within 30 calendar days of receiving notice
under paragraph (d) (2), with respect to any employee who is so convicted —
ADM. SERV. OFFICE Exhibit "E"
LOG NO. 10 -189 Page 2
(1) Taking appropriate personnel action against such an employee, up to and
including termination, consistent with the requirements of the
Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a
Federal, State, or local health, law enforcement, or other appropriate
agency;
(g) Making a good faith effort to continue to maintain a drug -free workplace through
implementation of paragraphs (a), (b), (c), (d), (e), and (f).
For purposes of paragraph (e) regarding agency notification of criminal drug
convictions, the DHHS has designated the following central point for receipt of such
' notices:
Office of Grants and Acquisition Management
Office of Grants Management
Office of the Assistant Secretary for Management and Budget
Department of Health and Human Services
200 Independence Avenue, S.W. Room 517 -D'
Washington, DC 20201
County of Hawaii
Organization Name
WILLIAM P. KENOI MAYOR
Name of Authorized Representative Title
MAR 2 3 2010
Signature Date
ADM. SERV. OFFICE Exhibit "E"
LOG NO. 10 -189 Page 3
CERTIFICATION REGARDING LOBBYING
Title 31, United States Code, Section 1352, entitled "limitation on use of appropriated funds to
influence certain Federal contracting and financial transactions," generally prohibits recipients of
Federal grants and cooperative agreements from using Federal (appropriated) funds for lobbying
the Executive or Legislative Branches of the Federal Government in connection with a SPECIFIC
grant or cooperative agreement. Section 1352 also requires that each person who requests or
receives a Federal grant or cooperative agreement must disclose lobbying undertaken with non -
Federal (non- appropriated) funds. These requirements apply to grants and cooperative
agreements EXCEEDING $100,000 in total costs (45 CFR Part 93).
The undersigned (authorized official signing for the applicant organization) certifies, to the best of
his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or an employee
of a member of Congress in connection with the awarding of any Federal contract, the
making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member in
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying
Activities," in accordance with its instructions. (If needed, Standard Form -LLL, "Disclosure of
Lobbying Activities," its instructions, and continuation sheet are included at the end of this
application form.)
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
under grants, loans and cooperative agreements) and that all subrecipients shall certify and
disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by Section 1352, U.S. Code. Any person who fails to file
the required certification shall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
County of Hawaii
Organization Name
WILLIAM P. KENOI MAYOR
Name of Authorized Representative Title
< 00(2-4 �� MAR 2 3 2010
Signature Date
ADM. SERV. OFFICE Exhibit "E"
LOG NO. 10 -189 Page 4
CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT
(PFCRA)
The undersigned (authorized official signing for the applicant organization) certifies that
the statements herein are true, complete, and accurate to the best of his or her
knowledge, and that he or she is aware that any false, fictitious, or fraudulent statements
or claims may subject him or her to criminal, civil, or administrative penalties. The
undersigned agrees that the applicant organization will comply with the Public Health
Service terms and conditions of award if a grant is awarded as a result of this
application.
County of Hawaii
Organization Name
WILLIAIVI P. KEivui MAYOR
Name of Authorized Representative Title
cyn C 'e MAR 2 3 2010
Signature Date
ADM. SERV. OFFICE Exhibit "E"
LOG NO. 10 -189 Page 5
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103 -227, also know as the Pro - Children Act of 1994 (Act), requires that smoking not be permitted in
any portion of any indoor facility owned or leased or contracted for by any entity and used routinely or regularly for
the provision of health, day care, early childhood development services, education or library services to children
under the age of 18, if the services are funded by Federal programs either directly or through the State or local
governments, by Federal grant, contract, loan or loan guarantee. The law also applies to children's services that are
provided in indoor facilities that are constructed, operated, or maintained with such federal funds. The law does not
apply to children's services provided in private residences; portions of facilities used for inpatient drug or alcohol
treatment; service providers whose sole source of applicable Federal funds is Medicare or Medicaid; or facilities
where WIC coupons are redeemed.
Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to
$1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity.
By signing this certification, the undersigned certifies that the applicant organization will comply with the
requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision
of services for children as defined by the Act.
The applicant organization agrees that it will require that the language of this certification be included in any
subawards which contain provisions for children's services and that all subrecipients shall certify accordingly.
The Public Health Services strongly encourages all grant recipients to provide a smoke -free workplace and promote
the non -use of tobacco products. This is consistent with the PHS mission to protect and advance the physical and
mental health of the American people.
County of Hawaii
Organization Name
WILLIAM P. KENOI MAYOR
Name of Authorized Representative Title
MAR 2 3 2010
Signature Date
ADM. SERV. OFFICE Exhibit "F"
LOG NO. 10 -189 Page 1
OMB Approval No. 0348 -0040
ASSURANCES - NON - CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including 'time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing -this burden, to the Office -of- Management and Budget, Paperwork Reduction
Project (0348 - 0040), Washington, DC 20503.
PLEASE. DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions,
please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to
certify to additional assurances. If such is the case. you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal (e) the Drug Abuse Office and Treatment Act of
assistance, and the institutional, managerial and 1972 (P.L. 92 -255), as amended, relating to
financial capability (including funds sufficient to pay nondiscrimination on the basis of drug abuse; (f) the
the non - Federal share of project costs) to ensure Comprehensive Alcohol Abuse and Alcoholism
proper planning, management and completion of Prevention, Treatment and Rehabilitation Act of
the project described in this application. 1970 (P.L. 91 -616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
2. Will give the awarding agency, the Comptroller alcoholism; (g) § §523 and 527 of the Public Health
General of the United States, and if appropriate, the Service Act of 1912 (42 U.S.C. §§290 dd -3 and 290
State, through any authorized representative, ee -3), as amended, relating to confidentiality of
access to and the right to examine all records, alcohol and drug abuse patient records; (h) Title VIII
books, papers, or documents related to the award; of the Civil Rights Act of 1968 (42 U.S.C. § §3601
and will establish a proper accounting system in et seq.), as amended, relating -to non- discrimination
accordance with generally accepted accounting in the sale, rental or financing of housing; (1) any
standard or agency directives. other nondiscrimination provisions in the specific
statute(s) under which application for Federal
3. Will establish safeguards to prohibit employees from assistance is being made; and (j) the requirements
using their positions for a purpose that constitutes of any other nondiscrimination statute(s) which may
or presents the appearance of personal or apply to the application.
organizational conflict of interest, or personal gain.
7. Will comply, or has already complied, with the
4. Will initiate and complete the work within the requirements of Title 11 and III of the Uniform
applicable time frame after receipt of approval of the Relocation Assistance and Real Property Acqui-
awarding agency. sition Policies Act of 1970 (P.L. 91 -646) which
provide for fair and equitable treatment of persons
5. Will comply with the Intergovernmental Personnel displaced or whose property is acquired as a result
Act of 1970 (42 U.S.C. § §4728 -4763) relating to of Federal or federally assisted programs. These
prescribed standards for merit systems for requirements apply to all interests in real property
programs funded under one of the nineteen statutes acquired for project purposes regardless of Federal
or regulations specified in Appendix A of OPIvl's participation in purchases.
Standard for a Merit System of Personnel
Administration (5 C.F.R. 900, Subpart F), 8. Will comply with the provisions of the Hatch Act (5
U.S.C. § §1501 -1508 and 7324-7328) which limit the
6. Will comply with all Federal statutes relating to political activities of employees whose principal
nondiscrimination. These include but are not limited employment activities are funded in whole or in part
to: (a) Title VI of the Civil Rights Act of 1964 (P.L. with Federal funds.
88 -352) which prohibits discrimination on the basis
of race, color or national origin; (b) Title IX of the 9. Will comply, as applicable, with the provisions of the
Education Amendments of 1972, as amended (20 Davis -Bacon Act (40 U.S.C. § §276a to 276a -7), the
U.S.C. § §1681 -1683, and 1685- 1686), which Copeland Act (40 U.S.C. §276c and 18 U.S.C.
prohibits discrimination on the basis of sex; (c) • §874), and the Contract Work Hours and Safety
Section 504 of the Rehabilitation Act of 1973, as Standards Act (40 U.S.C. § §327- 333), regarding
amended (29 U.S.C. § §794), which prohibits labor standards for federally assisted construction
discrimination on the basis of handicaps; (d) the subagreements.
Age Discrimination Act of 1975, as amended (42
U.S.C. § §6101- 6i07), which prohibits discrimination
on the basis of age:
S' ndard Form 42t8 (Rev,7 -97)
Pres:riea tr OMB Cvcvar A -102
ADM. SERV. OFFICE Exhibit "G"
LOG NO. 10 -189 Page 1
•
10. Will comply, if applicable, with flood insurance 13. Will assist the awarding agency in assuring
'purchase requirements of Section 102(a) of the compliance with Section 106 of the National
Flood Disaster Protection Act of 1973 (Pl. Historic Preservation Act of 1966, as amended (16
93 -234) which requires recipients in a special flood U.S.C. §470), EO 11593 (identification and
hazard area to participate in the program and to protection of historic properties), and the
purchase flood insurance if the total cost of Archaeological and Historic Preservation Act of
insurable construction and acquisition is $10,000 1974 (16 U.S.C. §§ 469a -1 et seq.).
or more.
14. Will comply with P.L. 93 -348 regarding the
11. Will comply with environmental standards which protection of human subjects involved in research,
may be prescribed pursuant to the following: (a) development, and related activities supported by
institution of environmental quality control this award of assistance.
measures under the National Environmental Policy
Act of 1969 (P,L. 91 -190) and Executive Order 15. Will comply with the Laboratory Animal Welfare
(EO) 11514; (b) notification of violating facilities Act of 1966 (P.L. 89 -544, as amended, 7
pursuant to EO 11738; (c) protection of wetland U.S.C. § §2131 et seq.) pertaining to the care,
pursuant to EO 11990; (d) evaluation of flood handling, and treatment of warm blooded animals
hazards in floodplains in accordance with EO held for research. teaching, or other activities
11988; (e) assurance of project consistency with supported by this award of assistance.
the approved State management program
developed under the Costal Zone Management 16. Will comply with the Lead -Based Paint Poisoning
Act of 1972 (16 U.S.C. § §1451 et seq.): (f) Prevention Act (42 U.S.C. § §4B01 et seq.) which
conformity of Federal actions to State (Clear Air) prohibits the use of lead based paint in con -
Implementation Plans under Section 176(c) of the struction or rehabilitation of residence structures.
Clear Air Act of 1955, as amended (42 U.S.C.
§ §7401 et seq.); (g) protection of underground 17. Will cause to be performed the required financial
sources of drinking water under the Safe Drinking and compliance audits in accordance with the
Water Act of 1974, as amended. (P.L. 93 -523): Single Audit Act of 1984.
and (h) protection of endangered species under
the Endangered Species Act of 1973, as 18. Will comply with all applicable requirements of all
amended, (P.L. 93 -205). other Federal laws, executive orders, re- gulations
and policies goveming this program.
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. § §1271 et seq.) related to
protecting components or potential components of
the national wild and scenic rivers system.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
WILLIAM P. KENOI
P. MAYOR
APPLICANT ORGANIZATION MAYOR'S OFFICE DATE SUBMITTED •
COUNTY OF HAWAII MAR 2 3 2010
• 2,5 Aupuni Street
•
SF -424B (Rev. 7-07) Beek
ADM. SERV. OFFICE Exhibit "G"
LOG NO. 10 -189 Page 2