ࡱ> q` mbjbjqPqP t:: 3  """8"tV# 0d$%%%%')z*`CcEcEcEcEcEcEc$8fhh~ic *'@'**ic%%cT-T-T-*dV% %CcT-*CcT-T-#Zl _% $ "@">+d\8`d00dS\i+Tip_i _**T-*****icic,^***0d****   "   "    A N N E X A PROGRAM COMMITMENTS BI-LINGUAL, BI-CULTURAL COMMUNITY AND OUTREACH SERVICES  NAME OF AGENCY:  FORMTEXT       CONTRACT NUMBER:  FORMTEXT       CONTRACT TERM:  FORMTEXT       T0  FORMTEXT       BUDGET MATRIX CODE: 19BUDGET MODIFICATION NO: (0 = Original)  FORMTEXT        2. Of the New Enrollees and Transfers (Item #2 - Level of Service Summary Sheet), how many are: g. Clients referred or outreached from Bi-lingual, Bi-cultural community-based agencies  FORMTEXT      h. Clients referred or outreached from non-Bi-lingual, Bi-cultural community-based agencies  FORMTEXT      i. Clients self-referred  FORMTEXT      3. Number of face-to-face contacts clients will have with staff on-site.  FORMTEXT      4. Number of face-to-face contacts clients will have with staff off-site. FORMTEXT       The following is a breakdown by MODALITY of the number of face-to-face client contacts with staff (both on-site and off-site): TOTAL # OF STAFF FACE-TO-FACE CONTACTS TO BE PROVIDED: A.Individual Therapy A.  FORMTEXT      B.Group Therapy B.  FORMTEXT      C.Family Therapy C.  FORMTEXT      D.Psycho-Social Education D.  FORMTEXT      E.Medication Maintenance E.  FORMTEXT      F.Intake/Clinical Assessment/Treatment Planning F.  FORMTEXT      G.Outreach to Individuals Residing in Independent Living G.  FORMTEXT      H.Outreach to Individuals Residing in Boarding Homes H.  FORMTEXT      I.Outreach to Individuals Residing in Nursing Homes I.  FORMTEXT      J.Outreach to Individuals Linked to a Bi-Lingual, Bi-Cultural Community-Based Agency J.  FORMTEXT      K.All Other Contacts Not Classified Above (i.e. non-Bi-Lingual, Bi-Cultural Community-Based Agency) Specify:  FORMTEXT       K.  FORMTEXT       Total Number of Contacts (Sum of lines 5A through 5K) (  =SUM(Above) 0 6. Units of Service will be provided. (Sum of lines 3 and 4).  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Group Therapy: 1 contact is 30 continuous minutes of face-to-face with the consumer. Do not count excess Medicaid maximum group size. Family Therapy: 1 contact is 30 continuous minutes of face-to-face with the consumer. Do not count each family member. Medication Monitoring: 1 contact is 15 continuous minutes of face-to-face with the consumer. Intake/Clinical Assessment/Treatment Planning: 1 contact is 30 continuous minutes of face-to-face contact with the consumer. Outreach and Other: 1 contact is 15 continuous minutes of face-to-face with the consumer. Psychosocial Education: 1 contact is 30 continuous minutes of face-to-face contact with the consumer. For the therapies and psychosocial education, please note that the face-to-face time can include up to 5 minutes per 30 minute session for the completion of progress notes, limited to a maximum of 10 minutes for a 90 minute session (3 QCMR units). PSYCHOSOCIAL EDUCATION: Interventions that bestow therapeutic, cognitive and social benefits by challenging thinking patterns and interactions through education, goal setting,andskillteaching.     7/07 ANNEX A 7/07 ANNEX A The following client-centered staff skills, agency modalities, and policies provide major components of bi-lingual, bi-cultural services: Staff has knowledge of and can speak and write the native language of the clients; Staff knowledge, attitude and behaviors are sensitive to the cultural nuances of the client population (i.e. recent immigrants do not have the same experiences as earlier arrivals); Staff background represent those of the client population(s); Treatment modalities reflect the cultural values and treatment needs of the client population (i.e. incorporating American-Indian rituals into the treatment program; Representatives of the client population participate in decision-making and policy implementation so that outsiders are not imposing their values. abb~ccretevegggg g ggggggg"g$g&g(gFg $ !$|)a$$a$ j^ $]^a$*gDgFgHgJgLgngpgrggmmmhPMMOJQJhPMMCJaJh$h(#5OJQJhPMM5OJQJhPMMhPMM5CJOJQJhPMM5CJOJQJh FgHgJgngpgrgtgvgxgzg|g~ggggh>ij&krlmmmmmmm & F >^`>$a$} 0&P+p,p-p.p/R4567:pa|/ =! 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