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Home My WebLink About20132894.tiffRESOLUTION RE: APPROVE THREE YEAR PLAN FOR CORE SERVICES PROGRAM AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Three Year Plan for the Core Services Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and the Colorado Department of Human Services, Division of Child Welfare Services, commencing June 1, 2013, and ending May 31, 2016, with further terms and conditions being as stated in said plan, and WHEREAS, after review, the Board deems it advisable to approve said plan, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Three Year Plan for the Core Services Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and the Colorado Department of Human Services, Division of Child Welfare Services, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said plan. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 14th day of October, A.D., 2013, nunc pro tunc June 1, 2013. BOARD OF COUNTY COMMISSIONERS Weld County Clerk to the Board BY: Deputy CI=rk to the Board APPROVy. AS unty Attorney Date of signature: OCT 2 2 2013 l9 RD arbara Kirkmeyer CG.ffsb rafria- 2013-2894 HR0084 MEMORANDUM DATE: October 10, 2013 TO: William F. Garcia, Chair, B;jard f CAIty zhmissioners FROM: Judy A. Griego, Director, vices ent RE: Weld County Department of Human Services' 2013- 2014 Core Plan Enclosed for Board approval is the Department's 2013-2014 Core Plan. This Core Plan was reviewed under the Board's Pass -Around Memorandum dated October 2, 2013, and approved for placement on the Board's Agenda. This Plan is for year one of a three-year period. The Department's allocation for year 2013-14 is $2,219,288. This year's Plan includes an anticipated overage of $595,766.10, due primarily to the inclusion of the Direct Service Delivery by the Parent Education Staff. The distribution of the allocation is based upon prior years' data and anticipated usage. The Department is not submitting a waiver to increase the SEA amount per family maximum. We are maintaining the $400.00 per family per year maximum. The State gave the option this year to increase the amount from $400.00 to up to $800.00; however, the Department cannot expend beyond the allocation ($14,016.00). The increase to $800.00 would decrease our funds much quicker and serve fewer families. The Department is not submitting a plan for PA3 at this time. We will consider PA3 services once Trails functionality is in place. The Department is not submitting a Core II Plan as there are no additional monies available at this time. If you have any questions, give me a call at extension 6510. 2013-2894 CORE SERVICES PROGRAM FIRST OF A THREE-YEAR PLAN SFY 2013 - 2014 SFY2014-2015 SFY 2015 -2016 FOR Weld COUNTY(IES) All Counties: Entire Plan Modifications — Budget and/or County Designed Programs have changed. (Please proceed to complete signature page, all corresponding Core Services Plan and budget pages, and then submit for approval.) REQUEST FOR STATE APPROVAL OF PLAN Since this is the first of a the three-year Core Services Plan, this page needs to be signed by a Core Service Program county representative. This Core Services Plan is hereby submitted for Weld (Indicate county name(s) and lead county if this is a multi - county plan], for the period contract years June 1, 2013, through May 31, 2016, fiscal years July 1, 2013, through June 30, 3016. The Plan includes the following: ➢ Completed "Statement of Assurances"; ➢ Completed Statement of the eight (8) required Core services to be provided or purchased; a list of county optional services, County Designed Program Services (indicate Evidenced Based Services to Adolescents Awarded County Designed Programs), to be provided or purchased; ➢ Completed program description of each proposed "County Designed Service"; ➢ Completed "Information on Fees" form; ➢ Completed "Reunification Issues" form; ➢ Completed "Direct Service Delivery" form; ➢ Completed "Purchase of Service Delivery" form; > Completed "Projected Outcomes" form; ➢ Completed "Overhead Cost" form; ➢ Completed "Final Budget Page" form; ➢ Completed "State Board Summary'; and, > Completed "100% Funding Summary" form. This Core Services Program Plan has been developed in accordance with State Department of Human Services rules and is hereby submitted to the Colorado Department of Human Services, Division of Child Welfare Services for approval. If the enclosed proposed Core Services Program Plan is approved, the Plan will be administered in conformity with its provisions and the provisions of State Department rules. The person who will act as primary contact person for the Core Services Plan is, Tobi Vegter and can be reached at telephone number 970-352-1551, x6392, and e-mail at vegterta(a..weldgov.com. If two or more counties propose this plan, the required signatures below are to be completed by each county, as appropriate. Please attach an additional signature page as needed. 'D . 3 O( 9≥ Si nature I' ECTOR, OUNTY . : PARTM JNT OF HUMAN/SOCIAL SERVICES / DATE Lr an, Signat %e, CHAT LACEMENT ALTERNATIVE OMMISSION DATE OCT 14 2013 Signature, CHAIR, BOARD OF COUNTY COMMISSIONERS DATE Please check here if your county does not have a Placement Alternative Commission: ❑ 2 ay/- da'sc/ CORE SERVICES STATEMENT OF ASSURANCES Weld County(ies) assures that, upon approval of the Core Services Program Plan the following will be adhered to in the implementation of the Plan: Core Services Assurances: • Operation will conform to the provisions of the Plan; • Operation will conform to State rules; • Core Services Program Services, provided or purchased, will be accessible to children and their families who meet the eligibility criteria set forth in Rule Manual Volume 7, at 7.303.13; • Operation will not discriminate against any individual on the basis of race, sex, national origin, religion, age or mental/physical disability who applies for or receives services through the Core Services program; • Services will recognize and support cultural and religious background and customs of children and their families; • Out-of-state travel will not be paid for with Core Services funds; • All forms used in the completion of the Core Services Plan will be State prescribed or State approved forms; • Core FTE/Personal Services costs authorized for reimbursement by the State Department will be used only to provide Core Services authorized in the county(ies)' approved Core Services Plan; • The purchase of services will be in conformity with State purchase of service rules including contract form, content, and monitoring requirements; and • Information regarding services purchased or provided will be reported to the State Department for program, statistical and financial purposes. CORE SERVICES TO BE PROVIDED/PURCHASED Place an "X" to indicate. which of the following Core Services Program Services will be provided/purchased in accordance with State Department rules: X Home Based Intervention X Intensive Family Therapy X Sexual Abuse Treatment Services X Day Treatment X Life Skills X Special Economic Assistance X Mental Health Services X Substance Abuse Treatment Services List below "County Designed Service" that will be provided/purchased in accordance with State Department rules. Please indicate which, if any, of the County Designed Service are provided through the Evidenced Based Services to Adolescents earmarked funding: - Family Empowerment (Facilitator) - Foster Parent Consultation Program (F.P.C., Various Providers) Functional Family Therapy (F.F.T., Various Providers) Multi -Systemic Therapy (M.S.T., Various Providers) (Evidenced Based Services to Adolescents Funding) Teamwork, Innovation, Growth, Hope and Training (T.I.G.H:T.) (Evidenced Based Services to Adolescents Funding) Additional Funding for Evidenced Based Services to Adolescents If the county received additional funding from the additional $4,028,299 million dollars appropriated to fund evidenced based services to adolescents, and would like to continue to receive the same funding for the same expansion or created of the evidenced based county designed program to adolescents, please indicate that above, as well as on the Core Plan under County Designed. The County Designed Program may be renewed/re-approved at the sole discretion of the State Department, contingent upon funds being appropriated, budgeted and otherwise made available and other contract requirements, if applicable, being satisfied. If the county did not receive an award or did not apply, the county is welcome to apply by following the requirement set forth in Agency Letter CW-03-21-A. Please submit the Request For Proposal with the Core Services Plan, due September 6, 2013. FAMILY STABILITY SERVICES TO BE PROVIDED/PURCHASED Due to budget reallocations for state fiscal year 2013-2014, funding is not available for the Family Stability Services (FSS) based on Senate Bill 01 012. If a county would like to provide Family Stability Services as outlined in Colorado Department of Human Services Rule Staff Manual Volume 7, at 7.310, with Child Welfare Block, Temporary Assistance to Needy Families (TANF), or county only funds, please contact Melinda Cox at 303.866.5962 for details and plan requirements. A. Respite Care: a service to provide temporary care to children who are not in an out -of -home placement through the county departments of social/human services and to their families who request a short break in parenting in order to stabilize family environment. Respite may occur outside of the home and in the home settings for less than 24 hours. The family may choose appropriate respite care providers including, but not limited to, kin, friends and licensed providers depending on the needs of the family and available resources. B. In -home Services: short-term, solution -focused services provided to children who are not in an out -of - home placement through the county departments and to their families, based on their unique needs in order to strengthen the home environment so that children do not need a higher level of intervention or out - of -home placement. C. Reintegration Services: transition services to assist children and families to reintegrate following an out - of -home placement. Service elements would prepare children and their families for successful reunification. 5 CORE SERVICES COUNTY DESIGNED SERVICE • Optional services approved as a part of the county's Core Services Plan are approved on an annual basis. For a County Designed Service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. Given that County Designed programs are not standardized across counties, it is important to provide detailed information as outlined below. This information can be use to justify continued funding of the program with the legislature. The information listed below is to be completed for each County Designed Service to be included in the County(ies)' Core Services Program Plan. Service Name: Family Empowerment 1. Describe the service and components of the service; define the goals of the program. The Family Engagement Program (Family Facilitator) will: Focus on family strengths, rather than weaknesses, by directing intensive services that support and fortify the family as whole, while also protecting the child(ren); Prevent out -of -home placement of the child(ren); - Return child(ren) to the family home or unite the child(ren) with their permanent family. The service components of this program will include: Facilitation of the continuum of meetings in line with the Family to Family Model. Such meetings will include Ice Breakers, Team Decision Making (TDM) meetings, and treatment planning meetings; - Promotion of family engagement through a family -centered, strength -based approach; - Tracking and monitoring of outcomes; - Consultation with the diligent search worker; Coordination with the 19`" Judicial District staff, community -based mental health staff, and other community stakeholders to ensure appropriate services for children and families; Integration of established evidence -based practice models including Family to Family and Family Engagement. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trials. The service detail already exists in Trails ("Family Empowerment"). Weld will need to be added as a provider. 3. Define the eligible population to be served. The eligible population for these services will include: Families with an open Child Welfare or Youth in Conflict (YIC) case with Weld County. Children (and their families) identified as eligible for Core Services based on their imminent risk of out -of -home placement due to one or more factors as defined in Volume VII. 6 - Collaterals within the community for the purpose of developing effective treatment and prevention plans for children and/or families. 4. Define the time frame cf the service. Agency participation in family engagement strategies and associated educational opportunities will be ongoing. Individual participation of families will vary based on the referred family's level of involvement with Weld County, and their specific needs. Potential timeframes may range from four (4) to twelve (12) months. 5. Define the workload standard for the program. The position will initially be part-time (max of 32 hours per week) and will support two staff who are conducting meetings at this time. Position will assist with scheduling and facilitation of meetings, as well as treatment planning. 6. Define the staff qualifications for the service, e.g., minimum caseworker ill or equivalent, see 7.303.17 for guidelines. The position will meet the qualifications of a Caseworker Ill or equivalent. 7. Define the performance indicators that will be achieved by the service, see 7.303.18. Families in the Weld County Family Engagement Program will demonstrate improvement in one or more of the following areas based upon their individual Family Services Plan: Locating and accessing community and other resources. - Family Conflict Management. Parental Skills Management. - Household Skills Management. - Personal and Individual Management. - Academic, Behavioral and Emotional Skill Management. Additionally, the Weld County Family Engagement Program will demonstrate: Shortened timeframes for out -of -home placement. Improved scoring on the Child Welfare Scorecard Report. - Participation in Family Engagement will result in fewer children in out -of -home placement and shorter case timeframes. 8. Identify the service provider. The Weld County Department of Human Services will employ one provider for the position of Family Facilitator. 9. Define the rate of payment (e.g., $250.00 per month). The position will be a Caseworker Ill, at a base salary of $23.85/hour or $3,307.20/month (at a max of 32 hours/month). No benefits are anticipated at this time. 7 Service Name: Foster Parent Consultation (F.P.C.) 1. Describe the service.and components of the service; define the goals of the 'program. This program provides foster care consultative services in the areas of (1) consultation and foster parent support specific to a child placed in the home, (2) mandated corrective action consultation specific to a child placed in the home, and (3) mandated critical care consultation specific to a child placed in the home. Through consultation, foster care children are being maintained in the least lowest level of care and least restrictive setting when out -of -home placement is necessary. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trials. The service detail already exists in Trails. 3. Define the eligible population to be served. These services are open to any child placed in a Weld County foster home. 4. Define the time frame of the service. Foster children are referred for the service through the assigned County Foster Care Coordinator. Duration is initially three (3) months with the option to review the service for renewal through the staffing team. 5. Define the workload standard for the program: • number of cases per worker, The number of cases per worker varies and is dependent upon the availability of the provider and the need for services at any given time. • number of workers for the program, and Weld County currently contracts with six (6) providers. worker to supervisor ratio. 1:1 6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for guidelines. All contracted providers are Masters level clinicians, or higher, with extensive experience and training in the area of foster care and Child Welfare. 7. Define the performance indicators that will be achieved by the service, see 7.303.18. A. "Family Conflict Management": The foster family shall demonstrate capacity to resolve conflicts and disagreements contributing to child maltreatment, running away, status offenses and delinquent behavior. B. "Parental Competency": Foster parents will show ability to maintain sound relationships with the children placed in the home and provider care, nutrition, hygiene, discipline, protection, instructions, and supervision. F. "Academic, Behavioral and Emotional Competency": Children involved in school or day treatment settings will demonstrate ability to meet school requirements, to control behavior, and to control and communicate feelings. 8 8. Identify the service provider. Various providers. 9. Define the rate of payment (e.g., $250.00 per month). The cost per hour for this service ranges from $56.00 to $120.00. Service Name: Functional Family Therapy (F.F.T.) 1. Describe the service and components of the service; define the goals of the program. F.F.T. is an intensive family -based treatment that addresses the pervasive patterns of relational dysfunction known to be determinants of conduct disorder, violent acting out, and substance abuse among youth 10-18 years of age. F.F.T. address the multiple factors known to be related to delinquency and therefore strives to enhance both the safety of the youth and family directly receiving F.F.T. services as well as the safety of the greater community in which the youth resides. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trails. The service detail already exists in Trails. 3. Define the eligible population to be served. The target population for this service is youth ages 10-18 who are conduct disordered, violent or have issues with substance abuse, and are at risk of out -of -home placement. Youth must meet Core Service Criteria as identified in Volume 7. 4. Define the time frame of the service. The average length of service is two (2) to five (5) months which can be lengthened for youth deemed appropriate for extended services. 5. Define the workload standard for the program: • number of cases per worker, NRBH: 8-10 (Supervisor), 12-15 (FTE), 5-8 (PTE) Savio: 3 (Supervisor), 10 (FTE), 5 (PTE) • number of workers for the program, and NRBH: 4 Savio: 5 • worker to supervisor ratio. NRBH: 3:1 Savio: 5:1 6. Define the staff qualifications for the service, e.g., minimum caseworker ill or equivalent, see 7.303.17 for guidelines. F.F.T. therapists are Masters level clinicians or equivalent. All therapists have completed the nationally recognized F.F.T. training program and strictly adhere to the accepted program model. 9 7. Define the performance indicators that will be achieved by the service, see 7.303.18. A. "Family Conflict Management": The foster family shall demonstrate capacity to resolve conflicts and disagreements contributing to child maltreatment, running away;status offenses and delinquent behavior. B. "Parental Competency": Foster parents will show ability to maintain sound relationships with the children placed in the home and provider care, nutrition, hygiene, discipline, protection, instructions, and supervision. E. "Personal and Individual Competency": Families will show awareness in terms of self-esteem, victim awareness, peer relationships enhancement, establishing appropriate physical and emotional boundaries, demonstrating assertive behavior and assuming responsibility for one's own behavior. 8. Identify the service provider. North Range Behavioral Health Savio House 9. Define the rate of payment (e.g., $250.00 per month). NRBH: $675.00/month Savio: $820.00/month Service Name: Multisystemic Therapy (M.S.T.j 1. Describe the service and components of the service; define the goals of the program. M.S.T. is a nationally recognized evidence, family and community -based program model that focuses on chronic juvenile offenders, ages 12 to 17, who have extensive criminal histories. M.S.T. therapists work closely with families in their home to assist the youth and family in controlling the youth's behaviors, maintaining focus on school, engaging in pro -social activities and obtaining job skills. The program utilizes Cognitive Behavioral Therapy, behavior management training, family therapy and community -based resources. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trails. The service detail already exists in Trails. 3. Define the eligible population to be served. The target population for this service is youth ages 12-17 with antisocial behavior and who have extensive criminal histories. Youth must meet Core Service Criteria as identified in Volume 7. 4. Define the time frame of the service. The average length of service is two (2) to five (5) months which can be extended for youth deemed appropriate for extended services. 5. Define the workload standard for the program: • number of cases per worker, NRBH: 5-6 cases/worker Savio: 4-6 cases/worker 10 • number of workers for the program, and NRBH: 4 workers Savio: 4 workers • worker to supervisor ratio. NRBH: 4:1 Savio: 4:1 6. Define the staff qualifications for the service, e.g., minimum caseworker Ill or equivalent, see 7.303.17 for guidelines. M.S.T. therapists are Masters level clinicians or equivalent All therapists have completed the nationally recognized M.S.T. training program and strictly adhere to the accepted program model. 7. Define the performance indicators that will be achieved by the service, see 7.303.18. A. "Family Conflict Management": The foster family shall demonstrate capacity to resolve conflicts and disagreements contributing to child maltreatment, running away, status offenses and delinquent behavior. B. "Parental Competency": Foster parents will show ability to maintain sound relationships with the children placed in the home and provider care, nutrition, hygiene, discipline, protection, instructions, and supervision. E. "Personal and Individual Competency": Families will show awareness in terms of self-esteem, victim awareness, peer relationships enhancement, establishing appropriate physical and emotional boundaries, demonstrating assertive behavior and assuming responsibility for one's own behavior. 8. Identify the service provider. North Range Behavioral Health Savio House (also M.S.T. Problem Sexual Behavior) 9. Define the rate of payment (e.g., $250.00 per month). NRBH: $1,750.00/month Savio House: $1,575.00/month - MST, $2,537.00/month-MST PSB Service Name: Teamwork, Innovation, Growth, Hope and Training (T.I.G.H.T.) 1. Describe the service and components of the service; define the goals of the program. TIGHT is a collaborative effort involving Youth in Conflict and Employment Services. The goal of the TIGHT is to delay or eliminate the need for out -of -home placement by exposing participating youth to a variety of projects within their community. These include educational opportunities, pro - social activities, and exposure to information on topics such as sexually transmitted diseases, job skills, and other worthwhile information. These projects promote a healthy growth in self esteem and a sense of community, with the hope that participating youth identify and choose positive alternatives in their community. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or that the service detail is already an option in Trails. The service detail already exists in Trails. 11 3. Define the eligible population to be served. Youth ages 15-18 who are at risk of out -of -home placement and who exhibit delinquent/maladaptive behaviors, primarilyttruancy issues and expulsion from school 4. Define the time frame of the service. Youth participate in the program for six (6) months. 5. Define the workload standard for the program: • number of cases per worker, T.I.G.H.T. Crew, 8:1 • number of workers for the program, and 2-FTE (Crew Leaders) .5-FTE (Team Leader) .1-FTE (Coordinator) • worker to supervisor ratio. 2:1 6. Define the staff qualifications for the service, e.g., minimum caseworker Ill or equivalent, see 7.303.17 for guidelines. Staff providing the therapeutic component of the service Master's level clinicians, or higher, with training and experience in program models such as F.F.T. or M.S.T. 7. Define the performance indicators that will be achieved by the service, see 7.303.18. A. "Family Conflict Management": The foster family shall demonstrate capacity to resolve conflicts and disagreements contributing to child maltreatment, running away, status offenses and delinquent behavior. B. "Parental Competency": Foster parents will show ability to maintain sound relationships with the children placed in the home and provider care, nutrition, hygiene, discipline, protection, instructions, and supervision. E. "Personal and Individual Competency": Families will show awareness in terms of self-esteem, victim awareness, peer relationships enhancement, establishing appropriate physical and emotional boundaries, demonstrating assertive behavior and assuming responsibility for one's own behavior. 8. Identify the service provider. Collaborative effort with Employment Services of Weld County 9. Define the rate of payment (e.g., $250.00 per month). Therapeutic component is handled through F.F.T. or M.S.T. and rates are defined under those service areas above. 12 INFORMATION ON CORE SERVICE FEES Please check all that apply: *X Fees will not be assessed for Core Services Program Services. *Note: Weld County continues to consider the collection of Core Services Fees. If Weld County chooses to assess fees at any point during the course of the year an amendment to the Core Plan will be submitted that will detail the required fee scale, methodology and policy. If above line is checked, STOP. Remainder of information does not need to be completed. Fees will be assessed for the following services: Check those that apply: Home Based Intervention Intensive Family Therapy Life Skills Day Treatment Sexual Abuse Treatment County Designed Service (List Services Below) Special Economic Assistance Mental Health Services Substance Abuse Treatment Services Fee assessment formula is the same for all services. State the formula here (attach additional sheets as needed). Fee assessment formula varies with service. State formula used for each service (attach additional sheets as needed). 13 Reunification Issues Please indicate below how the county is addressing Reunification Issues with the children served in the Core Services Program. Reunification Issues Strategy to Resolve Lack of timely permanency. WCDHS facilitates Family Team Meetings and Team Decision Making Meetings, as well as implementing various other Family Engagement principles to engage families earlier, and continue to engage them throughout the process. Expectations of parents by court WCDHS works collaboratively with our court professionals (GAL, CASA, etc.) that parents professionals to ensure children are must complete all aspects of their treatment returned home timely once safety concerns plan before children can be returned home are resolved, while ensuring parents are even if the safety concerns are resolved. connected with resources that continue to support the family. Lack of intensive services to serve children WCDHS works closely with service and youth who are more behaviorally providers to develop a broad and flexible difficult, developmentally disabled or menu of services that focus on permanency struggling with severe mental health issues. for all children and youth, inclusive of these populations. 14 �7 W U 0 ccs 0 4 a) y 0 � 0 U U 0 ;) O c U O o O .C cq y OL' o 0 itl bo a L C - U f/1 U a) T T a) O b 0. y a1 E o c 0 o a o a) 3 0 v~U, w tn 0 o N E G) y v E cn o•V O N U a g 00i cC 3 o h y u �jS O O V1 .o y o.r C• 0 0 co CC aU c0 U 0 V) U M -0 0 r U • Cd 0. cri C 0 V O CS s. ,7 e. y h C _It d O L O> �. O 4) () O L R L Cad .O a) w •U .G7, rn .. L 0, . .0 •y+: i pp O .. C o d� e.`a C , E C) `-- 0G:i m E = Q 7 vj coo No FA . (A . 69 1 69 1 69 1 69 1 69 1 69 . 69 1 b9 1 69 1 G9 1 69 t Ya L. !F. o 0 c z 4 cv r. 1.1 ..r ..�N " r u :° cu. Fo. q o en en r' C• 69 4) 69 69 69 EA 6A EA b9 s9 69 69 O— d . ,. . 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Co)°', , G s. 00 4,1 60 O 6A 00 O O r) 6A $ 3,984.75 $ 3,939.83 N r 60 00 6A $ 4,621.17 O 0 0000 )0 64 en O O Fit $ 7,337.50 N 60 '""I 6A , 45 o� y.l .� .a b L G )17'.0 y al,); }' _Ii C U o ,a' aCI C6 23'.et as O CT O ON o 0\ a O\ O O C , o 01 O 66 e O\ O, .., .' C 4) Hwy I- V �- a Cf) Li F w r.O v d O e O e O e O o O 0% e O e O e O e O e O 00 ,y >. O OO 'a y e0 C O O .C O O O o O O O O O o O C O C' O O O o O Ir.. .I.. >> .a Q d. R y •N u. R. p. a w w ' 0 .n 0 o o o CT e \ O\ o o 0 e 01 0 o CT o o 01 e e T o e Ll 0 e 01/4 a� 4 O GI . 20 , 6A I GA , 6A I 64 I 64 I EA I 64 I 64 I 64 I 64 v) Z. > 0 0 0 F ,I/CI I E.9 I EA I 69 I 64 I EA I 69 I 64 I 69 I 69 I 6A et �.. .; d C C60 W 3`" - O 00 64 O O rn N V) $ 635.82 $ 641.46 .-. 00 - 64 $ 1,432.67 $ 1,316.07 $ 2,175.32 $ 2,213.72 M N 06 N 64 0.) >>a L C 53 O ,� Caw '4.4! `' p � I+i 69 N r.n 6A Os 00 M r•-; 4A $ 3,298.42 ON ' ,+i 6A M I!, 00 00 I ) 64 00 en r en M 64 O In CT ONO 64 u'I C-- M N Iri 6A N WI 4 O\ er 64 N,, - ",. 0 .. Vistitation Case Aide IV Vistitation Case Aide IV Vistitation Case Aide IV Vistitation Case Aide IV Vistitation Case Aide IV Vistitation Case Aide IV Vistitation Case Aide IV Visitation Caseworker III Visitation Caseworker III Visitation Caseworker III 0 O 44 a ' z- OO 00 u) O CD CO EA - 0 I- -o 6) 0 6) 0 0. cd I- a. sue. 6) a) U U, a) 0 U 0 E CO 6) 0 fl. 0 U 6) N C� C 0 L U "O C ..w 10 Total Cost Per Provider M Cr, N 00 N 69 69 64 69 69 69 69 69 6R 64 69 O 0 o L In y o� E ° U g aY °° la 0 o a Vi. 69 69 EA 69 EA EA 69 69 69 64 69 w �Qo= r E,w c.�li'iro a) w • 0 0 ,,,,, I os is C Z rj C Varies 5 Amount of ContiContrli, ct Funded by TANF, FSS, Other (Circle All That Apply) O rn 00 00 0 00 N 69 4 Amount,of Contract Funded by 100% $ 423,402.36 3 Amount of Contract Funded by 80/20 00 CT N O rn M 64 2 Trails Resouce/Provider Number See Below 2016 0) C) M 1510565 45080 45174 42261 1609468/1545846 48170 1543135 45178 1 PROVIDER NAME Various Providers (Current Contracts Noted Below) Alternative Homes for Youth 0Devereux Cleo Wallace Griffith Centers for Children Lutheran Family Services Mount Saint Vincent Home Mountain Crest Reflections for Youth Savio House Strong Foundations Turning Point Center for Youth and Family Development $ 787,793.64 O I- 6) 0 0 N a 0 0 2 61 N I ro II C II - Identification of unit is: INTENSIVE FAMILY THERAPY PURCHASE OF SERVICE CORE SERVICES PROGRAM b Cd U a) O cn 0 0 cn 0 U 0 0 L 0 rn 0 0 y L ° U 10 Total Cost Per Provider aim, 0 0 0 0 b4 69 69 69 69 67 69 . 69 69 i 69 , 69 74. 0 O L H y 00 a) n O O� V $ 716.67 ! 1 69 1 69 I 69 . b9 . 69 1 69 I 69 1 69 I 69 69 vw.61, g` d o. E y • L L %Z Varies O tw 0 L O a) d z L a) 1D L Varies 2 3 _ 4 5 Trails Amount of Amount of Amount of Resouce/Provider Contract Contract Contract Number -Fundedby Funded,by Funded by 80/20 1004T TANF or FSS (Circle One) 64 69 0 0 0 0 co 69 I 1526714 -.1 PROVIDER NAME • IHause. W. Troy 0 0 O 0 c0 O 679 J O v cn 0 2 II 0 X - Identification of unit is: LIFE SKILLS PURCHASE OF SERVICE CORE SERVICES PROGRAM 10 Total Cost Per Provider O N N to CR , 6R , E9 1 ER 69 64 ER , ER O O ,O �y C : , N ,. a)� 3s ^^ U'` $ 27,218.42 Er, c.,.. e9 cfi 6,4 t,9 5R a d 4- d y a 0 G7 r-. Ea C i a,ax� Varies w C 0 4.. O I.o C w v Varies w d ° raj G C U i, 0 .n a G,�Zc O G Q� V] w , 4.., o u .o C y "v. '' ° -4. .c a �.-O `,' o fl 'O 0 O 7 00 dVr•TO C C. N � N M 2 Trails Resouce/Provider Number See Below r 1593279 1510565 45080 48170 1543135 1527837 1 PROVIDER NAME Various Providers (Current Contracts Noted Below) Ilo Family Matters of Colorad Griffith Centers for Children Lutheran Family Services Rocky Mountains Savio House Ste in Stones Transitions Ps cholo Grou 0 0 N (0 (0 N M d3 J 0 - Identification of unit is: DAY TREATMENT 10 Total Cost Per Provider $ 255,877.54 69 64 69 64 69 69 64 Q. w O p L q w E O U zx 47 4 00 .7s C U $ 21,323.13 b9 64 69 69 44 69 64 •tia. 0 • 4 E w : '. CI CI W Varies O w p L O E .r�a I..� ., .', z _. CA Varies ap+ u O C.0 ,-, to=c lc �+, V a dU G7 F rn C 64 C:' U 4 a=bo Q U cz ~ r 69 et co a L, "G. r„1 M C p IC 0 0 700 d U s:. $ 255,877.54 r 2 PROVIDER NAME Trails Resouce/Provider Na ber Various Providers See Below (Current Contracts Noted Below) c -- In (7 nt Devereux Cleo 39794 Wallace Mount Saint Vincent 45174 Home Reflections for 1609468/1545846 Youth Shiloh Home 99724 Turning Point 45178 Center for Youth and Family Development Denver Children's 1 Home N CO U) LU N ER a) b 0 II 0 0 4) a) II - Identification of unit is: SEXUAL ABUSE TREATMENT PURCHASE OF SERVICE CORE SERVICES PROG a. a) 4O 'C3 O re; w U 0 U O O b • c) V a) O L z V U_ 10 Total Cost Per Provider 0 © 0 O EA 69 69 69 69 69 , 69 ' 64 ' 69 w 4. 41 O o L H a+ o E g U d '=., il..1 4'Og 00 rn O� = V M 00 O CO vi EA l 69 I 64 ' 6% 1 6.1 I 69 ' 69 I 6R 1 69 4. y.' CI a c Varies' O>'` G L O z� Varies V) 7 aL+ - W � U C Tr v G :� Q . V Wi F ( .. 69 2 = 3 4,, 4,. Trails Amount of � Amount of Resouce/Provider Contract Contract Numbed Funded by Funded by 0 80/20 100% 6R 0 0 0 rn O a 64 See Below 1529918 O) (0 U) 1 CO O (0 - CO 00 (0 ,- 00)) U) 1- 48170 99724 13� PROVIDER NAME a Various Providers (Current Contracts Noted Below) OII U Q) g. o GJ- 0ci OOO`1JJOD c 15 CA ti,� 20 L 0) N c`a '- N a) E E (000) '6 i A flu N L Y U D- • O co C0U) t O fH J 1— O I - - Identification of unit is: b a) cn cv U a a) b 0 0 a. a) cn a) a) a) 0 U E O 0 0) 0 0 cn cri a, 0 E 0) U 00 6 41 ^o 0. o U o i. o °" oO) C:. 44 696969 IIIIIIIII 64, 696469 69 6969 o L H +, 7 O c.% 4r Z -rx. AA w 00 -«+ C a U`° ‘.0 69 i cflv36969ds696469USG9 i i i i i i i 0 p, G 2 a a CC Varies e�w W r+ O 4 p .. L O v y ,O .O a+ z > ,.L ;c �* Varies 1 2 3 4 5 PROVIDER NAME. Trails Amount of Amount of Amount of Resouce/Provider Contract Contract Contract Number Funded by Funded by Funded by 80/20 100% TANF or FSS (Circle k, tOne) Q9 0 O 66 0. 69 64 Various IIVarious Providers 0 0 CO 0 v - Identification of unit is: MENTAL HEALTH SERVICES PURCHASE OF SERVICE CORE SERVICES PROGRAM 1L� O 00 Q) P. O O 0. C) C) U N 0 0 .0 0 0 i U C 0 Ct 0 5 U 0 EA EA 64 69 67 69 EA EA 69 EA 10 Total Cost Per Provider $ 153,928.64 EA 69 te. p A O a p AU a a N 0 O G V M N 69 G9 69 CA 69 EA 69 49 EA 64 EA 69 fA EA CL El 0. o yR ry, Vanes W 0 I., O ,,r V G V L E C V 7 7 a z C Varies O u '2 LO s R aV�p, t.), . c C.0, 4.C 4 .0e O O C ^ 1Uw' 3 v Cs _ 6,3 w a, o C.) R -O O EQ�=,w au4 EA 2 Trails Resouce/Provider Number See Below r n m r 1529918 CO a) 0 u� o m C° 1593279 1525234 ( o 1509772 1529012 1 99724 1527837 co n u) v 1 PROVIDER NAME I CH.r• . F, F.• Various Providers (Current Contracts Noted Below) (Lindstrom, Ph.D., 7 Barry Collaborative Services for Change Cordero, Psy.D., Victor Leahy Neurofeedback Center dba Denver Neurofeedback Family Matters of Colorado Greeley Counseling Center Griffith Centers for Children North Range Behavioral Health Perklen Center for Psychotherapy Shiloh Home ransitions Psychology Grow Turning Point Center for Youth and Family Development co N C) M EE) V> J O -do N .fl O -do 0 0 0 0 1 R rn 0 • a) a) 0 U 0 b 0 v • • F -f cVd 4J O U_ b L 6) Q. y, h d O ,c,) t. L O 0. E„I O O O o 69 I 69 I 64 I 69 1 69 1 59 f 69 f 69 I 64 1 69 1 69 0 O O U; z 7y o 2 4,5 0 a 0 99 I 69 I 69 I 69 f 69 f 69 f 64 I 69 I 69 I 69 f 69 O Q. O U i r:= 6) .CC' at, C4 ':. ... Varies e:‘, 4. c C CO. O :zt3 C ‘4, . - O Z d �. Varies eis) t ^e O ' v) #o c ^gt'Z U a I Trails Amount of Amount of Contract Resouce/Provider Contract Funded by400% Number Funded by 80/20 0 0 0 0 0 0 kri 69 64 27818 1a PROVIDER NAME Various Providers (Signal Behavioral Health Network) J I- 0 I— - Identification of unit is: COUNTY DESIGNED SERVICES PURCHASE OF SERVICE CORE SERVICES PROGRAM 10 Total Coager ;:: Provider:: fn 0 on in W N 0 0 VI D e z a I.'. . , $ 32,364.67 <n 49 sq e. cn v) W v5 trkt C `+ O O la 1 Varies a A' in7 Ls. uv 0 b z k, ,vlTa e T NI C y 2W U O `-C 2 Trails Resouce/Provider.' Number See Below 45080 1562621 48170 1543135 1509772 O N. W V 1509772 O CO V 1 g Q Fnems 0 Various Providers (Current Contracts Noted Below) Lutheran Family Services Rocky Mountains (Foster Parent Consultation) Milestones Counseling ervices (Foster Parent Consultation) Savio House (Foster Parent Consultation) Strong Foundations (Foster Parent Consultation) North Range Behavioral Health (Functional Family hers -EBA) Savio House (Functional Family Therapy - EBA) North Range Behavioral Health (Multisystemic Thera - EBA avio House (Multisystemic harem- EBA1 I 388,376.00 cA F 0 I - ch O N L 2 0 a U) W U W W O V TOTAL FUNDS $ 787, 703.644 a O 00 64 0o0 v'1 N V) CT 69 h N CO00 Vj V) N 69 O O O eh ‘0 69 O �,�oy., O"` d' 69 ' 00 0" M V7) rg". 69 c:,-.:', ri O 0 a 41 '-' 69 •I• ' �D 0\ .. .....CO . tax.. OS t''' a "g \o O M '. • > ' . 10.:..; ' ' , 69 • 69 a 4 O V) —, N 69 Total'yFSS 100% • 69 y R , C t 4.4 Q;; G 7 O - U V ::O e. 'a 0 _ 4+ =5"c) 1* C g $ 423,402.36 I o — a d' b4 'S N Q, M In 64 o a O a Lel 69 of C tn. 69 Tota1Funds 80/20 1700 d.. $ 336,302.98 O 0cn 00\ O 69 O 'Crd' ce 1 69 00 lei N 69 C O -I-' 69 co 0\ d 69 a O M. 00 69 O f d:, 6? L t3 - O PZ : ..- .VC v.. 5 U 00 oto 00 N Eps $ 567,677.80 l 0 VD O\ I.") 603- W.4 cii s- r as c 69 cc e) ,. ,. . V Home Based Intervention Intensive Family Therapy Life Skills Day Treatment ISexual Abuse Treatment Special Economic Assistance Mental Health Services Substance Abuse Treatment Services County Design Services - Purchased Services (Foster Parent Consultation, Family Empowerment) County Design Services - Evidenced Based Services for Adolescents (F.F.T.. M.S.T., T.I.G.H.T.1 J o: Z'�b v : 0 o 00 o oN o CO o s 11720/1820 11730/1830 11740/1840 Sg8I kr1 coo 0 00 N N N IITOTALS tfY Child Welfare Block U y O O) .2 �L 0 0 > . a) c C LCC C C O L w U U N ai �73rn m m a)=_w Uo y vi U) ' •O C c o >,O - �p CD 0 La a OD co = aa)) a) a D , X X L O 0o N o V r r 41) a) N -a -ate a) U U U EL To To (T3 U O O U U c c a LL C Q U U U `o � L E E Oy 3 N w i V R 0 COIs CD (13 i i. O cc t.7 FY 2013-14 80/20 Funding n d Cost per Year oo o N O co M M CO o o O O NO 59 00 o 00 th ON m M CO a In [- 00 CO In N V3 CO cc O ON CO 69 or 00 ON d 69 See Trails See Trails $ 383,076 00 Cost per Child ` Per Month See Trails See Trails See Trails See Trails See Trails See Trails # Children Served Per Month rSee Trails See Trails See Trails See Trails See Trails See Trails # of Families Served Per Month See Trails See Trails. See Trails See Trails See Trails See Trails See Trails Age of Child Age 0-17 Age 0-17 Age 0-17 Age 0-17 lAge 0-17 Age 0-17 Age 10-18 Resource/Provider or Number of FTE Various Providers Various Providers Various Providers ( Various Providers Various Pioviders Various Providers Various Pioviders Services Home Based Intervention Tntensive Family Therapy cn U. w IDay Treatment Sexual Ahuse Treatment County Design Services - Purchased Services (F P C., Family Engagement Program) County Design Services - Evidenced Based Services for Adolescents (FFT,MST.,T.IGHT) 1,477,941.00 80/20 Core $ 100% Funding Summary FY 2013-14 \ / 0 :{ ;0. . .. N , GS o ' 93 - / GS Gl _ Efl > See Trails See Trails See Trails See Trails / glo .0 C See Trails \ up See Trails See Trails • ,\ See Trails See Trails See Trails See Trails f = Child„ co _ 00 CO 8 so .0 4� \ Various Providers f Various Providers Various Providers f Various Providers * Life Skills f Special Economic Assistance Mental Health Services Substance Abuse Treatment Services Total 100% CORE $ WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR NON -CONTRACTUAL CASE SERVICE PAYMENTS 1. Weld County Department of Human Services 3. Jessicca McKeown Name of Payee 5.722 Goodrich Ct. Mailing Address Platteville City Co State 80651 Zip Code 2. Billing for the month of Sept 2013 4. Tax ID of Payee (SSN/FEIN) Provider # 1556968 6. Phone Number (303) 746-1179 Date of Services Household Number Trails Case ID Client Name Explanation of Services Provided and Reason Services Required Amount Due Service Begin Service End 09/01/13 09/31/13 137122 1718120 Elyssia McKeown Respite care reimbursement for child Elyssia McKeown $200 - max reimburse per Adoption Assistance Agreement $ $ $ $ $200.00 Total Due: PLEASE: ® MAIL CHECK ❑ MAIL CHECK WITH ENCLOSURE ❑ RETURN CHECK TO DEPARTMENT (Please complete Hold Request Form) SEPARATE CHECK REQUESTED? ❑YES ZNO CERTIFICATION "I understand the policy of the Department of Human Services concerning discrimination under the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973, which prohibits payment to any vendor providing care and services under federally assisted programs unless such care and service is provided without discrimination on the grounds of race, color, religion, sex, national origin or handicap. I hereby certify that I am in compliance therewith." I certify that this is a true and just statement for services rendered and for which payment has not been received. Approval: Signature of Caseworker 10/03/13 Date Signature of Director/Supervisor Date Jocelyn Florez Lesley Cobb M:\CE{ILD WELFARE\Child Welfare Forms\ADOPTION UNff\Case Services Billing\McKeown\Auth for Noncontractual Case Services 8-13.docx 10/3/13 Hello