HomeMy WebLinkAbout20112486.tiff RESOLUTION
RE: APPROVE SEVENTEEN (17) CHILD PROTECTION AGREEMENTS FOR SERVICES
WITH VARIOUS PROVIDERS 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 seventeen (17)Child Protection Agreements
for Services 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 providers
listed within Exhibit"A", commencing June 1, 2011,and ending May 31, 2012,with further terms and
conditions being as stated in said agreements, and
WHEREAS, after review,the Board deems it advisable to approve said agreements, copies
of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the seventeen (17) Child Protection Agreements for Services 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 providers listed within Exhibit "A",
be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreements.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 21st day of September, A.D., 2011, nunc pro tunc June 1, 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST a EXCUSED
Barbara Kirkmeyer, Chair
Weld County Clerk to the (ar
1861 f't'L {�
.ean P. Con Pro-Tem BY:Deputy Clerk to the Boar
'�r..�►� il�F. Gar
APPROVED AS:TdM: EXCUSED
c David E. Long
='Count ttorney
oug Rademache
Date of signature: 9/50
L� 145111 2011-2486
iD -3- i I HR0082
1861 - 2011 MEMORANDUM EXHIBIT
• DATE: September 13, 2011
WELDCO NTY
Y TO: Barbara Kirkmeyer, Chair, Board of Commissioner
FROM: Judy A. Griego, Director, Human S ices epart
SUBJECT: Child Protection Agreements for Services between the Weld
County Department of Human Services and Various Providers
Enclosed for Board approval are Child Protection Agreements for Services between the
Department and Various Providers. These Agreements were presented at the Board's June 20,
2011, Work Session.
The major provisions of these Agreements are as follows:
Program Area/Funding
Provider Source PY11-12 Rate(s)
Collaborative Services for Mental Health Services $75.00/Episode(Individual, Couples and
Change, P.C. Family Therapy, Court Staffings/Facilitation)
Core $75.00/Mth/Case(Case Management)
06/01/11 - 05/31/12
Collaborative Services for Foster Parent Consultation $75.00/Hour(Face-to-Face Consultation)
Change, P.C. $75.00/Mth (Case Management)
Core
06/01/11 -05/31/12
Collaborative Services for Sex Abuse Treatment $75.00/Hour(Offense-specific Evaluation, not
Change, P.C. to exceed $1,050.00.)
Core $75.00/Hour(Intake Assessment, not to
06/01/11 -05/31/12 exceed $400.00.)
$75.00/Episode (Individual or Family
Therapy)
$50.00/Episode/Client(Group Therapy)
$75.00/Episode(Specialty Services for
Disabled Youth)
$100.00/Episode(Field/Off-site Therapy)
$75.00/Mth/Case(Case Management)
Counseling Services of Anger/Domestic Violence, $25.00/15 Contact Segments (Antabuse, Daily
Longmont, Inc. Monitored Sobriety, Breathalyzers and Random Breathalyzers)
Substance Abuse Treatment $20.00/15 Contact Segments (Twice Daily
06/01/11 -05/31/12 Breathalyzers)
CW Admin $13.00/Episode(UA - 1 Drug Panel)
$15.00/Episode(UA -2 Drug Panel)
$16.00/Episode(UA - 3 Drug Panel)
$18.00/Episode (UA -4 Drug Panel)
$19.00/Episode(UA - 5 Drug Panel)
$35.00/Episode (Ethyl Glucuronide Test-EtG)
$25.00/Episode (Saliva Test- 5 Drug Panel)
$15.00/Episode (Saliva Retest/Drug)
2011-2486
$10.00/Episode (Saliva Test- Minors, 1-4
Drug Panel)
$15.00/Episode (Saliva Test-Minors, 8 Drug
Panel)
$3.00/Episode (BA -One Time)
$175.00/Episode (Drug and Alcohol
Evaluation w/intake when necessary)
$120.00/Episode (Domestic Violence Intake)
$175.00/Episode (Domestic Violence Intake
with Drug and Alcohol Evaluation)
$100.00/Episode (Anger Management
Assessment w/ intake when necessary)
$60.00/Episode (Anger Management Intake)
$30.00/Episode (Standard Session Fee)
$75.00/Episode (Individual Session)
Jonathan W. Garson, LCSW Mental Health Services $100.00/Episode(Individual and Family
Therapy)
06/01/11 -05/31/12 Core $55.00/Episode (Group Therapy)
North Range Behavioral Anger/DV $144.00/Episode(Evaluation, Anger or DV)
Health $35.00/Episode (Group Session)
CW Admin $17.50/15 minutes(Individual Session)
06/01/11 -05/31/12
Peaceful Solutions Substance Abuse Treatment $35.00/Episode (Intake, Individual)
$25.00/Episode (Group)
06/01/11 -05/31/12 CW Admin $75.00/Episode (Drug and Alcohol
Evaluation)
$20.00/Month (BAs)
$15.00/Episode(UA - 8 panel)
$45.00/Episode(Individual)
$45.00/Hour(Court Facilitation or Staffing)
Perklen Center for Anger/DV $210.00 (Anger/DV Evaluation)
Psychotherapy(fka $575.00 (Anger or DV Eval. - In office)
Individual Group &Therapy CW Admin $20.00 (DV Education Session)
Services) $37.50 (Group)
$70.00 (Ind. or Couples Session)
06/01/11 -05/31/12 $65.00 (Intake Sessions)
$90.00 (Family Session)
Perklen Center for Mental Health Services $575.00 (MHA - In office)
Psychotherapy(fka $195.00 (MMPI-II w/written report)
Individual Group& Therapy Core $70.00 (Ind./Cpl Session)
Services) $85.00 (Ind. Session -Off Site)
$90.00 (Fam. Session)
06/01/11 -05/31/12
Perklen Center for Sex Abuse Treatment $900.00/Episode (Adult SO Eval w/PPG/
Psychotherapy(Wa Abel - In office, Juvenile SO Eval w/
Individual Group & Therapy Core PPG/Abel &testing)
Services) $950.00/Episode (Adult Eval w/PPG/Abel -
Out of Office)
06/01/11 -05/31/12 $600.00/Episode(Adult Eval w/o PPG/Abel
& Testing, Adult SO Eval-Update)
$800.00/Episiode (Adult Eval w/o PPG/Abel
Testing)
$450.00/Episode (Juvenile w/o Testing/=<13)
$250.00/Episode (PPG)
$70.00/Hour(Intake, Adult or Juvenile)
$70.00/Hour(Ind. Session)
$85.00/Hour(Ind. Session - Off Site)
$37.50/Person/Group (Phase 1, 3 or 4—Adult
Groups, Education Group)
$42.00/Person/Group (Phase 2—Adult Group)
Reflections for Youth, Inc. Home-Based Services $532.00/Week(10 Hours/Week w/Therapy)
$748.00/Week(20 Hours/Week w/Therapy)
06/01/11 -05/31/12 Core $991.00/Week(30 Hours/Week w/Therapy)
$301.00/Week(10 Hours/Week w/o Therapy)
$485.00/Week(20 Hours/Week w/o Therapy)
Shiloh Home, Inc. Day Treatment $1,625.00/Mth
06/01/11 -05/31/12 Core
Shiloh Home, Inc. Mental Health Services $75.00/Hr(Ind. Therapy, Fam. Therapy)
$45.00/Hr(Group Therapy)
06/01/11 -05/31/12 Core $95.00/Hr(In-Home Fam. Therapy)
$75.00/Hr(Psychological Evaluations)
Shiloh Home, Inc. Sex Abuse Treatment $75.00/Hr(Ind. Therapy, Fam. Therapy)
$45.00/Session(Group Therapy)
06/01/11 -05/31/12 Core $95.00/Hr(In-Home Fam. Therapy)
$75.00/Hr(Offense-Specific Psychological
Evaluations)
Turning Point Center for Foster Parent Consultation $82.00/Hr(Greeley Metro Area to include
Youth and Family Evans, La Salle, Eaton, & Windsor)
Development, Inc. Core $120.00/Hr(Outside Greeley Metro Area)
$40.00/Hr(24/7 Crisis Support)
06/01/11 -05/31/12
Turning Point Center for Day Treatment $85.00/Day (w/In-home Therapy)
Youth and Family $75.00/Day (w/o In-home Therapy
Development, Inc. Core
06/01/11 -05/31/12
Turning Point Center for Home-Based Services $25.00/Hr(Coaching)
Youth and Family $82.00/Hr(Intensive Services—Greeley Metro
Development, Inc. Core Area to include Evans, La Salle, Eaton, &
Windsor)
06/01/11 -05/31/12 $120.00/Hr(Intensive Services—Outside
Greeley Metro Area)
If you have any questions, give me a call at extension 6510.
PY-I I-12-CORE-0135
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COLLABORATIVE SERVICES FOR CHANGE,PC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Collaborative Services for Change,PC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS, required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services; and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June I,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
PY-I I-12-CORE-0135
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—I a seq.and its implementing
regulation,45 C.F.R.Part 80 a seq.'and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-1 1-12-CORE-0135
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR, shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its
employees and agents, shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0135
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals, insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
Il. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department unless the
Contractor has previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
The Provider will,on behalf of its employees and/or officers,accept any subpoena for testimony from the
Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If
the Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data, special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-I I-12-CORE-0135
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Marci Brewer,LCSW Clinical Director/Co-Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego, Director Marci Brewer,LCSW
P.O.Box A 2480 W.26th Avenue,#130-B
Greeley,CO 80632 Denver,CO 80211
(970)352-1551 (303)433-0188
I8. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CORE-0135
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-I2-CORE-0135
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and figr first
above written.
en
rn
ATTEST: ��" " '
WELD COUNs' � � I OF COUNTY N
CLERK TO T I B ISSIONERS WELD
Y,COLORADO
By: v ��/14. i� :�'� 4�~, -- `NCO
Deputy Cle % I � /Sean P. Conway, Chair Pro—'Pew
♦., CEP 21 2011-
APP A RM: CONTRACTOR:
BY _
Cou A ontractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
u .Griego, erector
aai/- ar(P‘,
PY-11-12-CORE-0135
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide mental health services to clients referred by the Department,in the Denver area.
Services include individual,couples and family therapy to address specific problematic issues that may include,
but are not limited to,abuse recovery, anger management,trauma recovery,behavior disorders,mood disorders
and social skills interventions.
2. All services will be provided by Marci Brewer, LCSW,and/or JeffKisicki, LCSW.
3. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
5. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
7. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
8
PY-1 1-12-CORE-0135
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$75.00/Episode(Individual/Couples/Family Counseling,Face-to-Face Contact)
$75.00/Month(Case Management)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
9
PY-I I-12-CORE-0135
EXHIBIT C
ASSURANCES
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County,its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection, paragraph, sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause, and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current, separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
10
PY-1 I-12-CORE-0135
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification; and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest,it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition.During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination,for cause,of its contract with CONTRACTOR.
11
PY-1 I-12-CORE-0135
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department, if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(6). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
12
PY-1 1-12-CORE-0135
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
13
PY-1 I-12-CORE-0135
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made,in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional, educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
14
PY-1 I-12-CORE-0214
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COLLABORATIVE SERVICES FOR CHANGE,PC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Collaborative Services for Change,PC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Foster Parent Consultation;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June 1,2011, upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
l
aDi/-1 L/oz,
PY-11-12-CORE-0214
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R. Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986, P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-1 1-12-CORE-0214
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than SI million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0214
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals, insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
I1. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department. The
Contractor may be required to attend additional training at the request of the Department. The cost of such
training will be paid for the Department. The Department will not compensate the Contractor for the time
spent attending the required trainings.
12. Subpoenas
The Provider will,on behalf of its employees and/or officers,accept any subpoena for testimony from the
Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If
the Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-l I-12-CORE-0214
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Marci Brewer,LCSW Clinical Director/Co-Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Marci Brewer,LCSW
P.O. Box A 2480 W.26,h Avenue,#130-B
Greeley,CO 80632 Denver,CO 80211
(970)352-1551 (303)433-0188
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CORE-0214
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-I 1-12-CORE-0214
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: y
WELD CO Sk 2 I OF COUNTY
CLERK TO T�1 � ..g�:�' '��1d�L ISSIONERS WELD
TY,COLORADO ! ras
Deputy Clerk./ Sean P. Conway, Chair Pro—Te ,r'
CEP 21 2011
AP D A •
ACONTRACTOR:
BY
ntractor
CO
Cr1
WELD COUNTY DEPARTMENT CO
OF HUMAN SERVICES
By:
Jud .Griego, irector
7
au//- 4716
PY-11-12-CORE-0214
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide face-to-face Foster Parent Consultation services to clients referred by the
Department, in the Denver area.
2. All services will be provided by Matti Brewer,LCSW,and/or Jeff Kisicki,LCSW.
3. CONTRACTOR will work collaboratively with children,foster parents,caseworkers,foster care coordinators
and other service providers to identify and address issues, in a solution-focused manner that could potentially
disrupt placements.
4. CONTRACTOR will make recommendations to foster family following assessment of the child.
CONTRACTOR will document recommendations and follow through of foster family with regard to
recommendations.
5. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for
the foster children in their home and report this information on a monthly basis to the Department.
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
8
PY-11-12-CORE-0214
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2, below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$75.00/Hour(Face-to-face Consultation Services)
$75.00/Month/Case(Case Management)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
9
PY-I I-12-CORE-0214
EXHIBIT C
ASSURANCES
1. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current, separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request, for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
10
PY-I 1-12-CORE-0214
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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, loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition. During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination, for cause,of its contract with CONTRACTOR.
II
PY-1 1-12-CORE-0214
I6. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors, if any, sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department, if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates, but does not include information(1) lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.) 26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101,et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(6). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
12
PY-11-12-CORE-0214
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance,potential,prospect) for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
13
PY-I I-1 2-CORE-0214
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made, in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being I Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate, providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
14
PY-I 1-12-CORE-0158
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COLLABORATIVE SERVICES FOR CHANGE,PC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners, sifting as the Board of Human Services,on behalf of the Weld County Department of
Human Services, hereinafter referred to as the"Department,"and Collaborative Services for Change,PC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Offense Specific Treatment);and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011, upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7"day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
PY-1 I-12-CORE-0158
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—I et seq.and its implementing
regulation,45 C.F.R.Part 80 a seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-I I-12-CORE-0158
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
I. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0158
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals, insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department. The
Contractor may be required to attend additional training at the request of the Department. The cost of such
training will be paid for the Department. The Department will not compensate the Contractor for the time
spent attending the required trainings.
12. Subpoenas
The Provider will,on behalf of its employees and/or officers,accept any subpoena for testimony from the
Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If
the Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215,x6503, and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-1 1-12-CORE-0158
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Marci Brewer,LCSW Clinical Director/Co-Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Marci Brewer,LCSW
P.O. Box A 2480 W.26th Avenue,#130-B
Greeley,CO 80632 Denver,CO 80211
(970)352-1551 (303)433-0188
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-1 1-12-CORE-0158
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-12-CORE-0158
IN WITNESS WHEREOF,the parties hereto -.ul executed the Agreement as of the day,month,and year first
above written. Sit, rta
CD
----3ATTEST: J �r(',_�;j �►�-�,q., rri
WELD COUNTY 1961 I't E ) F COUNTY -12
CLERK TO THE :J \ C SIONERS WELD ro
� at itni ,COLORADO
Deputy Cler Sean P. Conway, Chair Pro-Ter Ca
CEP 21 2011 co
APP AS TO CONTRACTOR: //
BY �J�
un y \ C tractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
.Gr. go, hector
7 7 yU
�-1'€J/7.,;75/(?
PY-1 1-12-CORE-0158
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide offense specific services to clients referred by the Department, in the Denver
area. Services include intake assessments,offense specific evaluations,individual,family and group therapy,
specialty services for special needs and developmentally disabled youth, field(in-home)therapy in the
community,healthy sexuality curriculum and informed supervision training.
2. All services will be provided by Marci Brewer, LCSW,and/or Jeff Kisicki,LCSW.
3. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
5. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
7. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
8
PY-I I-12-CORE-0158
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$75.00/Hour(Offense Specific Evaluation. Not too exceed$1,050.00.)
$75.00/Episode(Intake. Not to exceed$400.00.)
$75.00/Episode(Individual or Family Therapy,50-minute Session)
$50.00/Episode/Client(Group Therapy,90-minute Session)
$75.00/Episode(Specialty Services for Disabled Youth,50-minute Session)
$100.00/Episode(Field/Off-site Therapy,50-minute Session)
$75.00/Month/Case(Case Management)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
9
PY-11-12-CORE-0158
EXHIBIT C
ASSURANCES
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
10
PY-1 I-12-CORE-0158
10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
I I. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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, loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest,it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition. During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination, for cause,of its contract with CONTRACTOR.
11
PY-1 1-12-CORE-0158
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(6). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
12
PY-1 I-12-CORE-0158
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
13
PY-1 l-12-CORE-0158
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made,in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate, providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
14
PY-II-I2-CPS-0119
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COUNSELING SERVICES OF LONGMONT,INC.
?u11 SEP 8
fin
This Agreement, made and entered into the + da of 2011,by and between the Board of 1�' 3U
Weld County Commissioners,sifting as the Board of uman Services,o behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Counseling Services of Longmont, Inc.,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Anger/Domestic Violence Evaluation and Treatment;Monitored Sobriety Services;
and Substance Abuse Evaluation and Treatment;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A "Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
O//-c 1
PY-I1-12-CPS-0119
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-11-12-CPS-0119
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CPS-0119
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
ll. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department unless the
Contractor has previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
The Provider will,on behalf of its employees and/or officers,accept any subpoena for testimony from the
Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If
the Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-11-12-CPS-0119
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Yolanda Cavazos-Pond,MA,CAC III Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Yolanda Cavazos-Pond,MA,CAC III
P.O.Box A 1129 Francis Street
Greeley,CO 80632 Longmont,CO 80501
(970)352-1551 (303)772-3853
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CPS-0119
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-12-CPS-0119
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD OU� �' „ �!! !� OUNTY
CLERK TO THE BO ' tl 1t w �� 1 �,-y! ERS WELD
Y t LORADO
By: �>� i sasS ✓_�i_��. ��I� P C
deputy Cle �.. an P. Conway, Chair Pro-Te?�
APP D A ORM: CONTRACTOR; CEP 21 2011
BY �IyyL-
Cod y ontractoa e Ul t4 GLin1J€4,1 , C.e.6 (, -1Of1.ginA.f
WELD COUNTY DEPARTMENT
OF HUMAN SERVICE
By:
J A.G'ie ,Director
7
for/- 41*21
PY-1 1-12-CPS-0119
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide Anger/Domestic Violence Evaluation and Treatment; Substance Abuse
Evaluation and Treatment;and Monitored Sobriety Services to clients referred by the Department.
2. CONTRACTOR can currently serve adult clients for Anger/Domestic Violence and Substance Abuse
issues,and both adults and adolescents for Monitored Sobriety Services. CONTRACTOR is seeking
certification through ADAD to provide adolescent Substance Abuse services in the future.
3. CONTRACTOR will provide services primarily at 1129 Francis Street, in Longmont,CO.
CONTRACTOR also has a small satellite office at 555 alter St.,#19D, in Broomfield,CO.
4. Monitored sobriety results will be reported through Sterling Laboratories and will be available within 48
hours. Both positive and negative results will be faxed to the Department at(970)346-7667 since results
cannot be accessed directly online. Additionally,the referring caseworker will be notified immediately by
phone call,e-mail or fax if results are positive.
5. Minors receiving monitored sobriety services must attend their first monitoring session with a legal
guardian. The legal guardian must sign consent forms.
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services.If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department,unless otherwise directed by
the Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
8
PY-11-12-CPS-0119
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$25.00/15 Contact Segments(Antabuse,Daily Breathalyzers and Random Breathalyzers)
$20.00/15 Contact Segments(Twice Daily Breathalyzers)
$13.00/Episode(UA - 1 Drug Panel)
$15.00/Episode(UA-2 Drug Panel)
$16.00/Episode(UA -3 Drug Panel)
$18.00/Episode(UA-4 Drug Panel)
$19.00/Episode(UA- 5 Drug Panel)
$35.00/Episode(Ethyl Glucuronide Test-EtG)
$25.00/Episode(Saliva Test-5 Drug Panel)
$15.00/Episode(Saliva Retest/Drug)
$10.00/Episode(Saliva Test-Minors, 1-4 Drug Panel) F
$15.00/Episode(Saliva Test-Minors,8 Drug Panel)
$3.00/Episode(BA-One Time)
$175.00/Episode(Drug and Alcohol Evaluation w/intake when necessary)
$120.00/Episode(Domestic Violence Intake)
$175.00/Episode(Domestic Violence Intake with Drug and Alcohol Evaluation)
$100.00/Episode(Anger Management Assessment w/intake when necessary)
$60.00/Episode(Anger Management Intake)
$30.00/Episode(Standard Session Fee)
$75.00/Episode(Individual Session)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
9
PY-1 1-12-CPS-01 19
a. All billings are to be submitted by the 7th day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
PY-11-12-CPS-0119
EXHIBIT C
ASSURANCES
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph, sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
11
PY-11-12-CPS-0119
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs, legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of finds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest,it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition.During the term of the Contract, CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination,for cause,of its contract with CONTRACTOR.
12
PY-II-I2-CPS-0119
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(6). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
13
PY-11-12-CPS-0119
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
14
PY-11-12-CPS-0119
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made, in the providers'opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being I Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
•Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
PY-11-12-CORE-0138 2011 SEP 6 Fl s 58
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND JONATHAN W.GARSON,LCSW
This Agreement,made and entered into the 30 day of/1eus r2011,by and between the Board of
Weld County Co►nissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Jonathan W.Carson,LCSW,hereinafter referred
to as"Contractor".
W1TNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by tcfcacm.e_
"Payment Schedule"shall establish the naaximinn reimbursement,which will be paid from
Core Services fording during the duration of this Agreement
b_ CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7 day of the month following the month the cost was inclined If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c Payments of costs incurred pursuant to this Agreement is expressly contingent upon tlw avai ly
of Core Services to the Department.
d_ The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement
PY-11-12-CORE-0138
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Color. The required annual audit of all funds
expended under Core Serrrice funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR sisal provide proper monthly invoices and itemisation of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Managtement Requirements,program objectives,contractual terms,or reporting
requirements. In the event ora forfeiture ofreimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Hunan Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials(hat have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
- Title VT of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 ei sect.and its implementing
regulation,45 CFR.Part 80 et.seq.and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
- the Age Discrimlotion in Employment Act of 1967;and
- the Equal Pay Act of 1963;ad
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 CFR Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial procdings airy efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
f Y-11-12-CORE-0138
Included is 45 CYR Pat 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when passible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose ose of off any and all
federal and/or state financial assistance.
Any person who feels that s/be has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S_Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program improvement Plan(PiP)will be implemented for the state to enhance
services to families.
CONTRACTORS providiing services to the Department families and children nee*continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense;and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shelf be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease_covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider mast purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be reamed as additional insured on each comprehensive general
liability policy.
5_ Certificate of insurance to be provided to Weld County and must be attached to the
contract.
b_ Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0138
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has cuunently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract_ Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any couhact_
11. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department unless the
Contractor has previously attended the training_ The Contractor may be required to attend additional
training at the request of the Drpartni id. The cost of such training will be paid for the Department. The
Department will not compensate the Contractor for the time spent attending the required irainings.
12. Subpoenas
The Contractor will,on behalf of its employees and/or officers,accept any subpoena for testimony from the
Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If
the Contractor receives a subpoena via facsimile but will only accept personal service,the Contractor will
contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Deportment_ The results of the monitoring and
evaluation shall be orovi.Jed to the Board of Weld County Commissioners_the Department and
CONTRACTOR.
CONTRACTOR shalt permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the karts of this Art_ As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonahte procedures. Alt such
monitoring shall be performed in a mower that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scone of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR_ These remedial actions are as follows:
4
PY-11-12-CORE-0138
a Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR carrot be performed or if
perforated would be of no value to the Department Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payme nto CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department oroihemise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties_ Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Jonathan W.Carson,LCSW Private Practice
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the add esses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Grieco,Director Jonathan W.Caesar,LCSW
P_O_Boa A 229 Terry Street
Greeley-CO 80632 Longmont CO 80501
(970)352-1551 1303)494-1634
15. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days alter being served with a!unmans,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any the by either party given thirty(30)days written notice and is
subject to the availability of finding_CONTRACTOR reserves the right to suspend services to clients if
hurling is no longer available.
5
PY-11-12-CORE-0138
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-12-CORE-0138
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day.month.and year first
above written.
ATTEST: sar
-
WELD CO y� � OF COUNTY
CLERK TOT I :O•t ��'r�y t � IONERS WELD
,COLORADO
By:
Deputy CI I IIA can P. Conway, Chair T21z
011
(S^ '
Co o or
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
A.Grigg , or
PY-11-12-CORE-0138
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide offense-specific mental health treatment services to youth referred by the
Department.
2. Treatment services will be provided utilizing group sessions,individual sessions and family sessions.
3. Services will only be provided under the terms of this contract by Jonathan W.Carson,LCSW.
4. CONTRACTOR is sensitive to multicultural issues and will utilize interpretive services as necessary.
5. CONTRACTOR will bill the Department on a monthly basis per the terms of this contact
6. CONTRACTOR will identify in detail areas of continued concern n and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas ofconceru may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report
8. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services if after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately-
9_ CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online brmA required by the Department,unless otherwise directed by
the Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staff-nags and Utilization Review Team(URT)and are not considered billable hours.
8
PY-11-12-CORE-0138
EXHIBIT B
PAYMENT SCHEDULE
i. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from at the rate specified in Pa.ag aph 2,below. The total amount to be paid to CONTRACTOR during the
term of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contractor amend it accordingly.
2. Fees for Services
$100.00/Hour(Individual Therapy)
$100.00/Hour(Family Therapy)
$55.00/Hour(Group Therapy)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'°day of the month following the month of
service.. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
9
PY-11-12-CORE-0138
EXHIBIT C
ASSURANCES
i. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Coimnissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County,its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,.sentences,clauses.or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of or be otherwise subjected to discrimination under this approved Contract
S. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
amurate,current,separate,and complete disclosure of the status of the funds received cinder the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social.
Services upon its request,for a period of seven(7)years from the date of final payment hider this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
10
PY-l1-12-CORE-0138
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with finds under this Contract to ensure compliance
with the terms of this Agreement Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. "This Contract shall be binding upon the parties hereto,their successors.heirs,legal representatives,and
assigns_ CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of
Coigress 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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state paws_
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a_ Arc not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. I lave not.,within a three-year period preceding this Agreement,been convicted of or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection with
obtaining,att.esnpting to obtain,or performing a public(federal,state,or local)transaction or
contract undo-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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,stag or local)with commission of any of the offer enumerated in paragraph 12 of this
certification;and
d_ Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in.
opposition. In order to create the appearance of a conflict of interest,it is not nc-vcssary for the contractor
to gain from knowledge of these opposing interests It is only rrc+crssary that the contractor know that the
two relationships are in apposition_During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest_ Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination, for cause,of its contract with CONTRACTOR.
I
PY-11-12-CORE-0138
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/K.44 rrt in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient on
a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they am subject to these confidentiality requirement& CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(I)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed imkpwriartiy-Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Coati act will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(CRS-)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors-
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes(C.ILS.) 8-17.5-
101,et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work nit this
Contract. Contractor represents,warrants,and agrees that it(a) has verified that it does not employ any
illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Admoisbation and apartment of Homeland Security, and(b)otherwise will comply
with the requirements of CJts. 8-175-102(2)(b). Contractor shall comply With all reasonable requests
made in the course of an investigation under C.R_S.8-175-102 by the Colorado Department of Labor and
Employment If Contractor fails to comply with any requirement of this provision or C.R.S.8-175-101,et
seq.,the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department
Except where exempted by federal law and except as provided in CRS. 24-76.5-103(3), if Contractor
receives federal or state finds under this Contract, Contractor must confirm that any individual natural
person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
765-103(4) if such individual applies for public benefits provided under this Contract- If Contractor
operates as a sole proprietor,it hereby swears or affirms under penalty of perjury that it(a)is a citizen_of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and(c)shall produce
one of the forms of identification required by C.R.S.24-765-103 prior to the effective date of this Contract.
12
PY-I I-12-CORE-0138
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanent'and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I Children are,first and foremost,protected from abuse and neglect
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered sate when there are no present dangers or impending danger threats,or the
caregivers'protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns_
Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the D..p r tnent's providers:.
Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
13
PY-1 1-12-CORE-0138
Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made,in the providers'opinion.
Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues,
Providersmust document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being I Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
Providers must engage in ongoing assessments of the parents'capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
14
PY-11-12-CPS-0094
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
•
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and North Range Behavioral Health,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Anger Management/Domestic Violence;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7`h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration funding to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
PY-11-12-CPS-0094
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-1 I-I 2-CPS-0094
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
L As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CPS-0094
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext.6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-11-12-CPS-0094
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Larry D.Pottorff Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Larry D.Pottorff,Executive Director
P.O.Box A 1300 North 17th Avenue
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 970-347-2373
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement maybe terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CPS-0094
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-12-CPS-0094
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
SILa
ATTEST:
WELD CO T k � ,+'?.$O iy'7�7'l COUNTY
CLERK TO THE B ; iI ��' c �� ONERS WELD
��+++ O COLORADO
By: �.a/4:.� LI�� : /iy� �
DeputyCl can P. Conway, Chair Pro—Te
SEP 1 2011
APP D RM: CONTRACTQR:
r7
BY !1
Co mey Con a r
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
7u A.Gnego Director
7
&C//— 47yj)4
PY-11-12-CPS-0094
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Anger Management and Domestic Violence services to males and females, 18
years and older,in the Greeley.
2. CONTRACTOR will provide the following services under this contract:
Anger Management • Group Process and Skills
(Minimum 20 Weeks of Treatment) • Cognitive-Behavioral Skills
• Passive,Aggressive and Assertive
Domestic Violence Behaviors
(Minimum 36 Weeks of Treatment) • Victim Empathy
• Treatment Goals
• Substance Abuse
• Stages of Change
• Parenting
• Men's Issues/Women's Issues(as
applicable)
• Effects on Children (DV only)
• Steps to Problem Solving
• Steps to Conflict Resolution
• Characteristics of Assaultive Adults
• Attitudes Toward the Opposite Sex
• Sex Role Training
• Socio-cultural Basis for Violence
• Provocation
• Appropriate Containment and
Expressions of Anger
• Experiencing Emotions and Feelings
Beyond Anger
• Grief and Loss
• Depression and Anxiety
• Stress Management
• Relapse/Recidivism Prevention
• Healthy Relationships
• Sexuality
• Spirituality
• Resources
3. Anger Management and Domestic Violence Intakes will be completed with recommendations before the
client is placed into treatment. The intake will determine the best placement for the client in regards to
treatment. CONTRACTOR will provide a copy of the intake to the caseworker.
4. Individual sessions may be determined necessary at intake but will only be utilized under one or more of the
following circumstances:
• The referred client's individual treatment needs cannot be adequately addressed in a group setting.
• The client is not currently appropriate for a group setting and requires a limited number of
individual sessions to prepare for a group setting.
• The client's job requirements make it impossible to attend regularly scheduled group sessions and
individual sessions are the only option for the client to comply with their treatment plan.
• When assessed for a DV track in which an additional contact is required.
8
PY-11-12-CPS-0094
5. CONTRACTOR will comply with the Colorado Domestic Violence Offender Management Board's
Standards and Guidelines.
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services.If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child of
a parent whom the CONTRACTOR is working with under an active referral. Areas of concern may
include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern
should be reported immediately AND on the required monthly report.
9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department,unless otherwise directed by
the Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-11-12-CPS-0094
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed -
from at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the
term of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$144.00/Episode(Anger Management or Domestic Violence Evaluation)
$35.00/Episode(Group Session)
$17.50/15 Minutes(Individual Session)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
PY-11-12-CPS-0094
EXHIBIT C
ASSURANCES
1. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County,its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as maybe necessary to resolve any matters which maybe pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
11
PY-11-12-CPS-0094
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with the Department when
the contractor also maintains a relationship with a third party and the two relationships are in opposition. In
order to create the appearance of a conflict of interest,it is not necessary for the contractor to gain from
knowledge of these opposing interests. It is only necessary that the contractor know that the two
relationships are in opposition. During the term of the Contract,CONTRACTOR shall not enter any third
party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a full
disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to
promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination, for cause,of its contract with CONTRACTOR.
12
PY-11-12-CPS-0094
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101,et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18)years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
13
PY-11-12-CPS-0094
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department's contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concems and the
interventions that are being offered by the provider to ameliorate those concems.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
14
PY-1 1-12-CPS-0094
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made, in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
r-77\- =:.ter--r^,
1 l: a; �y �/ 'i--
PY-1 l-12-CPS-0I 25
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PEACEFUL SOLUTIONS
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners, sitting as the Hoard of Human Services,on behalf of the Weld Count Department of
Human Services,hereinafter referred to as the"Department,"and Peaceful Solutions,hereinafter referred to as
"Contractor".
WITN11,SSE'TI I
WHEREAS,required approval. clearance,and coordination have been accomplished from and with
appropriate agencies:and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Substance Abuse:Evaluation and Treatment;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to am.person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit H;"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement
b. CONTRACTOR shall submit an itemized monthly hill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'h day of the month following the month the cost was incurred. It the
pilling is not submitted within twenty-live(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. The Department shalt not be billed liar,and reimbursement shall not be made for time involved in
activities outside of those del inex!in Exhibit A. Work perlimncd prior to the execution of this
Contract shall not he reimbursed or considered part of this Agreement
-I. Financial Management
I
02. //— 1/4126
PY-I 1-12-CPS-0125
At all times from the effective date of this Contract until completion of this Contract,CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurrtd in the pertionnance of the agreement.
h. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-I et seq.and its implementing
regulation,45 C.F.R.Part 8i)et seq.;and
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963:and
- the Education Amendments of I 972;and
Immigration Reform and Control Act of 1986,P.L. 99-603,
42 C.F.R.Part
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex..religion and handicap;,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions.covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary..CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
2
PY-I I-12-CPS-0125
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance
Any person who feels that s/he has been discriminated against has the right to tile a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage:
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents, shall be named as additional named insured on the insurance,where permissible by
the insurance provider
a. Standard Workman's Compensation and Employer's Liability.
1_ As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PI,&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$50QIX)D.
-1. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract
6. Insurance shall include provisions preventing cancellation without 61)days prior notice
by certified mail to Weld County.
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
3
PY-11-12-CPS-0125
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has cunently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract
11. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department unless the
Contractor has previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
The Provider will,on behalf of its employees and/or officers,accept any subpoena for testimony from the
Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If
the Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work bound in this Agreement. Substantial
failure to satisti'the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
4
PY-11-12-CPS-0125
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Randall Baker Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A Griego,Director Randall Baker,Director
P.O.Box A 710 I la'Avenue,L-30
Greeley,CO 80632 Greeley,CO 80631
f 970)352-1551 (970)515-5066
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-I 1-12-CPS-0125
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-12-CPS-0125
IN WITNESS WHEREOF.the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: •
WELD COUNTY, '� � F COUNTY
CLERK TO THE�: - : .... ..TONERS WELD
GYP COLORADO
61
B}:
Deputy Cle �' r ,�+ .� Chair _
OaIv..'AQI, an P. Conway, Pro-Te SEP 2 2011
APP D AS'C 11�� NTRACTOR:
co BY Colfh'actot `� / `7
WELD COUNTY DEPARTMENT
OF HUMAN, .,R VICES
By:
J . Griego, ector
4
7
cYoi/-&Yc%
PY-11-l 2-CPS-0125
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Substance Abuse Evaluation and Treatment.
2. All services under this contract will be provided by Thomas Gonzalez only.
3. CONTRACTOR is bilingual(Spanish).
4. CONTRACTOR will provide services primarily at 710 1 ls'Avenue,L-30,in Greeley,CO.
CONTRACTOR can also serve clients at 1.301 !;ridge Street..Suite 1(),in Brighton,CO.
5. CONTRACTOR will he available Monday through Friday,and Saturdays if needed. Hours will usually
begin after 1 p.m.on workdays and extend into the evening as needed.
6. An evaluation will consist of two(2)to three(3)session totaling INS(2)to three(3)hours of face-to-face
contact.
7. Both positive and negative results will be faxed to the 1)cpartrramt within 45 hours at(970)3.6-7667 since
results cannot be accessed directly online. Additionally,the referring caseworker will be notified
immediately by phone call,e-mail or fax if results arc positive.
8. CONTRACTOR can currently scot c adult clients ha Substance Abuser issues,and both adults and
adolescents for Monitored Sobriety Services. CONTR ACTOR is seeking certification through AT)AT3 to
provide adolescent Substance Abuse treatment s rviocs in the riitiue. ('.t+tiitk:irtinn is pending
11lllt Ji lf\u•i'Gi'.N+�+111 rr l+ii}1,1'11 NIt/;!:•t1 �t'1�1/'{'�11!1411.ilila:I$111JCli oil at+iii III 1I ling SC5.514111 with is iegal
guardian. The legal guardian must sign consent dorms
)0. CONTRACTOR trill make at if.Jst three(3)attempts to eonktet the client and set rip services The first
attempt will occur within 2-f hours of receiving the referral(excluding weekend":and holiday s)
CONTRACTOR will document ctloristo engage client iu ictcized scivi.a-s. it fl.ticl Once(3)altcuipts the
client does not tespoixl the C(IN I'RAC l'OR will ncitity the caseworker and the Cole!and Service('ontrael
CM, 1' .111,1 ill tttt1YlI:1iC1}
1 (:t)i3Fi::ii''t'i)1? 1.>iltiticnlih in.delsit;,erriot'caluticucd'aineeIndiotmatteroc:c►ttuntttttiationstothe
Th•tuiiment ret?:Jrrlinp emmtin ,ti,N7 si!,is...-ief:s,irleihk'tltt'need tiw ad l iii oral sorviens
12. CONTRACTOR will dor:tam:id iu detail inn wtd ali 0b'tt:n x+101 vet1''rliirct col!i P171,I(Vi rflin}:sin', Chilrl
v.triint the C'()N'IRAC I'Ol' i::working with;Wei ;:it ai:tip::1;ta.,..:1 ?::.....:I.t,.,..1,..... ,c.:tci:il: but...
;:51. ..11/,1 t:a'1f.lc.J.I if c'. )la'\ Jtl!'sirs ill I II I4A•r 15\i 1(I/Ill!iit�
reported immediately AM)on 11w required nioruhl report.
t i. .NI RAt:'ft)R will:nslsmil sr..lkkt.s surd naumthlt basis tior&Jrh as'rit s`iv-filial for onvoinn servi.re:
Reports will be submitted per the online him runt rc. !!Used h) 11w I)c•partniciii.. ;Aka laixt stirs cLc:a b'
flue i)+rilatrit '.tlt
:". ,,.i1 t• ..l:, +:.:i'..:i. I;ti.. ...... .. .................... i.. ti:l i liii':r.:. _
include:stattings and Ihlilizatuon Review Team(I J13 l)and are not considered hillatllc hours.
PY-1 l-12-CPS-0125
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rale specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said hinds for the purposes hereof In the event that said funds,or any part
thereof,become unavailable as determined by the Department,nt,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$2,00/Episode(Breathalyzer)
$15.00/Episode(8-Panel Urinalysis)
$25.00/Episode(Group)
$35.00/Episode(Intake. Only applies if evaluation is not completed through Contractor.)
$45.00/Episode(Individual Session)
$45.00/Elour(Court Facilitation or Stalling)
$75.00/lipisoxde(Drug and Alcohol Evaluation)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit.the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7m day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may n.sult in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the l) paarlmcnt for all costs
incurred and services provided pursuant to Exhibit.A of this Agreement in accordance
with criteria established by the Department
o:. For mot litia ed sobriety,proofmmi civices rendered shall be a sign-in sheet with client
signatures or the test result.
9
PY-I1-12-CPS-0125
EXHIBIT C
ASSURANCES
1. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees. as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRAC'l'ORcontracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County_its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the pertermance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph se ntenc:e,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,card,color,sex,or national origin,be excluded from participation in,
be denied the benefits of;or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3))ears or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal.and State auditors,and representatives to audit and monitor
CONTRACTOR_
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary,to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
10
PY-1 1-12-CPS-0125
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of hinds to be used under this Contract is
Child Welfare Administration funds.
IA. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,been convicted of or had a civil
judgment rendered against them liar 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. Arc not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,slate,and local)terminated for cause or default.
1 S. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest,it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition.During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a
full disclosure statement setting firth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination,for cause,of its contract with CONTRACTOR.
!l
PY-f 1-12-CPS-0125
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to;
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they arc subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents„and subcontractors,if any;with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties.(2)
that which is in the public domain,or(3)that which is developed independently.Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary intixmation concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar inli'rmation in the course of its own
busine ss.
l8. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,.and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes(C.R.S.)8-17.5-
101,et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it(a)has verified that it does not employ any
illegal aliens,, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security. Administration and Department of Homeland Security,.and(b)otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(h). Contractor shall comply with all reasonable requests
made in the course of an investigation under C R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101,et
seq.. the Department may lerminate this Contract for breach and Contractor shall be liable for a shoal and
consequuatial damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 2-1-76.5-103(3)., if Contractor
icscives federal of state funds autdei this Contract.. Cotnfidant must conlirm that any individual natural
person eighteen(18)years of age or older is lawfully present in tlx:_ 1lnited States put stout tt. C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. IF Contractor
operates as a sole proprietor; it hereby swears or adorns urslcr penalty of per.µuy that it (a) is a citron t�f
the United States or is otherwise lawfully present in the.1lnitext States pursuant to federal, law.(b) shall
produce one of the forms of identification required by C R S. 24-76 5-101.. et seq., and(c) shall produce
one of taw fnrni ul identifucatuon required by C. R S .',I-7!,s-101 prior to Ow elThctive date of this Contract.
12
PY-11-12-CPS-0125
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children arc considered safe when there are no present dangers or impending danger threats,or the
caregivers'protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
13
PY-I 1-I2-CPS-0125
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make rexommendatioru regarding when changes in this area should
be made,in the providers'opinion
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being I Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents'capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate- Reports should
also document what barriers may he impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
14
mikwid
ar
PY-II-I2-CPS-0093
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PERKLEN,INC. DBA PERKLEN CENTER FOR PSYCHOTHERAPY
This Agreement,made and entered into the day of 2011, by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Perklen, Inc.,dba Perklen Center for
Psychotherapy,hereinafter referred to as"Contractor".
WITNESSETH
WHEREAS,required approval, clearance,and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Anger Management/Domestic Violence;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June I, 2011, upon proper execution of this Agreement and shall
expire May 31,2012, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A "Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
aoi/ ai(3'‘
PY-11-I 2-CPS-0093
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et. seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-I 1-12-CPS-0093
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-1 1-12-CPS-0093
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext. 6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-I 1-12-CPS-0093
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Kim Ruybal,MA,LPC,NCAC❑ President
Name CD—) Title
Lc
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Kim Ruybal,MA,LPC,NCAC II
P.O.Box A 1020 8th Street
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 {970)353-8171
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CPS-0093
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-I I-I2-CPS-0093
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: /. ��_ . 'w.,• , ���t`
ELD COUNTY , `•► - �A'•pOF COUNTY
CLERK TO THE ' '� �"' CSL %7IONERSWELD
u�• �/ COLORADO
Deputy Cle •'�r J �n P. Conway, .'hair Pro-Tern
, SEP 2 1 2011
AP V A R • •NTRACTOR:
t) Pe-.
BY L
Con o rey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICE
By:
J A.Grie ,Director.
7
PY-11-12-CPS-0093
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Anger Management and Domestic Violence services to male and female
adults and juveniles, including developmentally disabled individuals and same sex,in Weld County.
2. CONTRACTOR will provided Anger Management and Domestic Violence services utilizing assessment
tools including the Shipley Institute of Living Scale,Millon Clinical Multiaxial Inventory(MCMI),
Minnesota Multiphasic Personality Inventory-II (MMPI-II), STAXI-2,SASSI Questionnaire,Jesness
Inventory and the Hare PCL-R.
3. CONTRACTOR will complete an intake on each referred client prior to development of a treatment plan.
4. CONTRACTOR will submit a written document outlining recommendations for treatment,further
assessment,and risk to repeat similar behavior. The evaluation will determine the best placement for the
client in regards to treatment. CONTRACTOR will provide a copy of the evaluation to the caseworker.
5. CONTRACTOR will comply with the Colorado Domestic Violence Offender Management Board's
Standards and Guidelines. Domestic Violence services include a minimum of thirty-six(36)90-minute
sessions.Groups meet weekly.
6. Anger Management services include a minimum of thirty(30) 90-minute sessions. Groups meet weekly.
8
PY-11-12-CPS-0093
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$575.00/Episode(DV Assessment)
$210.00/Episode(Anger/DV Evalution)
$20.00/Hour(DV Education)
$90.00/Hour(Family Session)
$70.00/Hour(Individual or Couples Session)
$65.00/Hour(Intake Sessions)
$37.50/Group(Group Session)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
9
PY-1 I-I2-CPS-0093
EXHIBIT C
ASSURANCES
1. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County,its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request, for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
10
PY-11-12-CPS-0093
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs, legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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, loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with the Department when
the contractor also maintains a relationship with a third party and the two relationships are in opposition. In
order to create the appearance of a conflict of interest, it is not necessary for the contractor to gain from
knowledge of these opposing interests. It is only necessary that the contractor know that the two
relationships are in opposition.During the term of the Contract,CONTRACTOR shall not enter any third
party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a full
disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to
promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination,for cause,of its contract with CONTRACTOR.
11
PY-11-12-CPS-0093
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any, sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101,et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
12
PY-11-12-CPS-0093
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department's contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I Children are,first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social, emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
13
PY-I I-12-CPS-0093
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made,in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being I Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
"Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
14
I
V d 4
PY-1 1-12-CORE-0140
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PERKLEN,INC.,DBA PERKLEN CENTER FOR PSYCHOTHERAPY
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Perklen,Inc.,dba Perklen Center for
Psychotherapy,hereinafter referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on June I,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
PY-11-12-CORE-0140
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et. seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-1 I-12-CORE-0140
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
I. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than $1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-I 1-12-CORE-0140
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Trainine
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext. 6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
'fhe Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-1 I-12-CORE-0140
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Kim Ruybal,MA,LPC,NCAC II President
Name t/, - . Title
17. Notice l�C�
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judv A.Grieco,Director Kim Ruybal,MA,LPC,NCAC 11
P.O.Box A 1020 8' Street
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)353-8171
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-17-12-CORE-0140
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-1 I-12-CORE-0140
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
Ii
ATTEST:
ELD COU T � �. " •F COUNTY
CLERK TO THE A'.tp M�ti.IONERS WELD
/ 1TM � 7 1 T j COLORADO
BY _.� _✓. ww�e.� 'r te:' , ��Il�eputyCleCon-way, --�
� r` l7 -k \ `�n P. Chair Pro-Tern
SEP 21 2011
AP V AST R : CONTRACTOR:
BY � frac a 1rXS �.—/�
Co A o Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju y .Griego, irector
7
PY-1 I-12-CORE-0140
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide mental health services to male and female adults and juveniles,including
developmentally disabled individuals, in Weld County,as referred by the Department. Services include:
a. Evaluation Services-Consisting of two(2)to four(4)hours of face-to-face interview followed by
psychometric assessment. Assessment tools include the Shipley Institute of Living Scale,Millon
Clinical Multiaxial Inventory(MCMI),Minnesota Multiphasic Personality Inventory-II (MMPI-II),
STAXI-2,SASSI Questionnaire,Jesness Inventory and the Hare PCL-R.
b. Individual,Couples and/or Family Counseling—Face-to-face contact to address specific identified
areas of concern,trauma and/or conflict.
2. CONTRACTOR will complete an intake on each referred client prior to development of a treatment plan.
3. For evaluation services,CONTRACTOR will submit a written document outlining recommendations for
treatment,further assessment,and risk to repeat similar behavior.CONTRACTOR will provide a copy of
the evaluation to the caseworker.
4. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services.If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
5. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
6. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
7. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department, unless otherwise directed by
the Department.
8. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
8
PY-I 1-12-CORE-0140
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$575.00/Episode(Mental Health Evaluation -In-office)
$195.00/Episode(MMPI-11 Administration only with written report)
$70.00/Hour(Individual or Couples Session)
$85.00/Hottr{iodiyi4g$Session-Off Site
$90.00/Hour(Family Session)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 71h day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
9
PY-I I-12-CORE-0140
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
I0
PY-I 1-12-CORE-0140
EXHIBIT C
ASSURANCES
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed, color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
11
PY-I l-12-CORE-0140
10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs, legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with the Department when
the contractor also maintains a relationship with a third party and the two relationships are in opposition. In
order to create the appearance of a conflict of interest,it is not necessary for the contractor to gain from
knowledge of these opposing interests. It is only necessary that the contractor know that the two
relationships are in opposition. During the term of the Contract, CONTRACTOR shall not enter any third
party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a full
disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to
promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination,for cause,of its contract with CONTRACTOR.
12
PY-1 I-12-CORE-0140
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employess,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(I)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101,et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(6). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
13
PY-1 I-12-CORE-0140
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations
and tasks which must be addressed by the Department's contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect) for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
14
PY-1 I-12-CORE-0140
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made,in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being I Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
i
PY-1 1-12-CORE-0160
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PERKLEN CENTER FOR PSYCHOTHERAPY
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department," and Perklen Center for Psychotherapy,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Offense Specific);and
NOW TI IEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
0,w)-ays�
PY-1 1-12-CORE-0160
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
- Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 a seq.and its implementing
regulation,45 C.F.R. Part 80 et.seq.;and
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et. seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-11-12-CORE-0160
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0160
c. Automobile Liability(Minimum) for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals, insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext. 6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-11-12-CORE-0160
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Kim Ruybal,MA,LPC,NCAC C I� President
fin—
Name k( o , `, y 1 - --C Title
17. Notice U
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Kim Ruybal,MA,LPC,NCAC II
P.O. Box A 1020 8'" Street
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)353-8171
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of finding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-1 1-12-CORE-0160
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-1 1-12-CORE-0160
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
r`.
WELD COUNTY A# ` �RD OF COUNTY
CLERK TO THE '�� .`, !le /• ISSIONERS WELD
Y,COLORADO
•
a!p,By: /,1> itgY �J
%nn
DeputyCle� .�:n P. conway; Chair Pro-Tern
�; g ♦ SEP 21 2011
T ,AP' °O D AS e' : C 1' a.J '\S��RACTOR:
•
• ' BY k,LL:� • Ir-mcL/
Co rtto r' Contractor
WELD COUNTY DEPARTMENT
OF HUMAN S RVICES
By:
Ju .Griego, irector
7
C9O//-69
PY-I I-12-CORE-0160
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide offense specific evaluation and treatment services to male and female
juveniles and adults,including developmentally disabled individuals,in Weld County,as referred by the
Department. Services include:
a. Evaluation Services-Consisting of two(2)to four(4)hours of face-to-face interview with the referred
client,and/or parents when necessary, followed by psychometric assessment. Assessment tools may
include the Shipley Institute of Living Scale,Millon Clinical Multiaxial Inventory(MCMI), Minnesota
Multiphasic Personality Inventory(MMPI),Minnesota Multiphasic Personality Inventory(MMPI)-
Juvenile Version, STAXI-2, SASSI Questionnaire,Jesness Inventory,Jesness Inventory-Juvenile
Version, Multiphasic Sex Inventory(MSI),Multiphasic Sex Inventory(MSI)-Juvenile Version,Penile
Plethysmograph(PPG), Wilson Sex Fantasy Questionnaire,and the Hare PCL-R,Hare PCL-Youth
Version.
b. Penile Plethysmograph(PPG)—An assessment used to determine sexual arousal patterns and identify
potential treatment needs related to deviant sexual arousal. Services include administration of the PPG
and a written statement of the findings.
c. Arousal Management—An assessment used to help deter deviant arousal patterns and used in
conjunction with the PPG and clinical interpretation of healthy sexual fantasies.
d. Sex Abuse Individual,Couples and Family Treatment—Face-to-face contact with the individual,
couple or family to address specific identified areas of concern,trauma and/or conflict.
e. Sex Abuse Group Therapy for Adults—Gender-specific groups with curriculum that addresses,but is
not limited to,cognitive restructuring, anger management,assertive communication,the cycle of
sexually violent behavior,core beliefs,victim impact and empathy,stress management,how children
and families are impacted by personal choices and formulation of a relapse prevention plan.Treatment
is conducted in four phases that meet one to two times per week.
f Juvenile Sex Offense Specific Treatment and Groups—Treatment for youth who have been convicted
of a sexual assault and have been found appropriate for community based treatment. Curriculum
includes,but is not limited to,cognitive restructuring,consent,types of violence, sex education,victim
empathy,sexual offense cycle, assessing deviant vs.non-deviant thoughts and behaviors,covert
sensitization,prevalence of sexual offending,and power and control dynamics related to sexual
offending.
2. All evaluations will be conducted under the supervision of by Kim Ruybal, MA,LPC,NCAC II. Ms.
Ruybal will also review and sign all evaluations.
3. The following Perklen staff are approved by the Department to conduct SOMB evaluations:
• Kim Ruybal,MA,LPC,NCACII(SOMB Full Operating Level Supervisor)
• Jodie Goter,MA,LPC(SOMB Full Operating Level Treatment Provider)
• Aaron Henderson,MA(SOMB Associate Level)
• Victoria Cordova,MS(SOMB Associate Level)
4. All services will comply with the Colorado Sex Offender Management Board's Standards and Guidelines for
for juveniles,adults and developmentally delayed offenders.
5. For evaluation services,CONTRACTOR will submit a written document outlining recommendations for
treatment, further assessment, and risk to repeat similar behavior.CONTRACTOR will provide a copy of
the evaluation to the caseworker.
8
PY-1 I-12-CORE-0160
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department, unless otherwise directed by
the Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-1 1-12-CORE-0160
EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2. below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contractor amend it accordingly.
2. Fees for Services
$900.00/Episode(Adult Evaluation with PPG/Abel -In-office,Juvenile SO Eval with PPG/Abel and
Testing)
$950.00/Episode(Adult Evaluation with PPG/Abel -Out of Office)
$600.00/Episdoe(Adult Evaluation without PPG/Abel and Testing, Updated Evaluation)
$800.00/Episode(Adult Evaluation without PPG/Abel and Testing)
$450.00/Episode(Juvenile Evaluation without Testing, 13 years and Younger)
$250.00/Episode(Penile Plethysmograph aka PPG)
$70.00/Hour(Intake,Adult or Juvenile)
$70.00/Hour(Individual Session)
$85.00/Hour(Individual Session -Off Site)
$37.50/Per Person/Group(Phase One,Three or Four -Adult Sex Abuse Group,Education Group)
$42.00/Per Person/Group(Phase Two - Adult Sex Abuse Group)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'h day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
I0
PY-1 1-I 2-CORE-0160
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
11
PY-1 I-12-CORE-0160
EXHIBIT C
ASSURANCES
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color, sex,or national origin, be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
12
PY-I 1-12-CORE-0160
10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs, legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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, loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement, 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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification; and
d. Have not,within a three-year period preceding this Contract, had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with the Department when
the contractor also maintains a relationship with a third party and the two relationships are in opposition. In
order to create the appearance of a conflict of interest, it is not necessary for the contractor to gain from
knowledge of these opposing interests. It is only necessary that the contractor know that the two
relationships are in opposition. During the term of the Contract, CONTRACTOR shall not enter any third
party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a full
disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to
promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination, for cause,of its contract with CONTRACTOR.
13
PY-1 I-12-CORE-0160
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department, if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
14
PY-I 1-I2-CORE-0160
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being, followed by specific considerations
and tasks which must be addressed by the Department's contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I Children are, first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers'protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
15
PY-1 l-12-CORE-0160
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made, in the providers'opinion.
• Providers should continually assess family relationships(parent/child, sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical, emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
16
./ ID
PY-11-12-CORE-0206
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERA ES
AND REFLECTIONS FOR YOUTH,INC. 44/11 /rG J
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners, sifting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Reflections for Youth, Inc., hereinafter referred to
as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Youth and Family Advocate(Behavioral Coach)Support Program (Home Based Intensive Services);
and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June I,2011, upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A "Scope of Services."a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7`h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
,9o//— VS
PY-11-12-CORE-0206
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-1 I-I 2-CORE-0206
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR, shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0206
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorneys Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext.6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-I I-12-CORE-0206
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Jeffrey J.Johnson,MA,LPC Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Jeffrey J.Johnson,MA,LPC
P.O.Box A P.O.Box 1860
Greeley,CO 80632 Berthoud,CO 80513
(970)352-1551 (970)344-1380,x202
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-1 I-12-CORE-0206
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-I2-CORE-0206
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
LD COUN \� ��'B►t. OF COUNTY
CLERK TOT ' O is ` ISSIONERS WELD
+ .N°r'; :t � Y,COLORADO
t/
By:
•eputyC i �� •�
can P. Conway, Chair Pro-Tem
r "`" ♦ SEP 21 2011
VED AS O � CONTRACTOR:
BY r.
Co uy to Con c o
WELD COUNTY DEPARTMENT
OF HUMAN S RVICES
By:
Ju .Grie irector
7
c 2t2//— 1"//70 fc
PY-I 1-12-CORE-0206
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide intensive home and community based behavioral coaching services to youth 10
years of age or older,and their caregiver(s),as referred by the Department,except when any of the following
exist:
a. The referred youth has an IQ below 55.
b. There is active sexual abuse is occurring in the home.
c. There is recent or current domestic violence.
d. A high lethality suicide attempt has occurred within the last 30 days(from the start date of the
referral).
e. There are felony assault charges by youth or family member within the last 30 days(from the start date
of the referral).
f. The youth or another participating family member are actively psychotic.
g. There are any legal or behavioral patterns that present significant issues of danger to staff providing
services.
h. The youth identified for services is younger than six(6)years of age.
2. Services will include treatment and support to the youth and their caregiver(s)to prevent out-of-home
placement or an increase in placement level. Family therapy can also be included. Services are available as
follows:
a. With therapy:
i. Support Level= 10 hours/week.
ii. Stabilization Level=20 hours/week.
iii. Safety Level=30 hours/week.
b. Without therapy:
i. Support Level= 10 hours/week.
ii. Stabilization Level=20 hours/week.
3. The program is designed to be offered in three(3)phases over the course of 12-20 weeks based upon the needs
of the referred youth. The phases are identified as:
a. Assessment and Treatment Planning: This phase encompasses the first two(2)weeks of programming.
The purpose of this phase is to set up behavioral and support plans for the family that outline the
treatment process and recommendations. This phase includes up to six(6)hours of clinical
involvement and in-home support time.
All assessments are scientifically validated and include the SASSI-A2, FACES IV,and DAP.
b. Ongoing Treatment: Implementation of treatment plans.
c. Discharge Phase: Treatment hours are reduced to prepare family and youth for end of services.
Discharge assessments and Aftercare Agreement will be completed during this phase,which will
include an agreed upon plan for reduction of hours and phase out of services.
8
PY-I 1-I2-CORE-0206
4. Services are primarily utilized in preventing out-of-home placement or transitioning child(ren)home. All
services will be provided in the referred youth's home and/or community unless otherwise directed by the
Department.
5. CONTRACTOR will develop a case management plan within 30 days of receiving a referral and provide that to
the referred family,with a copy to the caseworker. The plan will include,at a minimum;goals,goal timelines
and a measurement of success.
6. CONTRACTOR will update the caseworker at least twice(2)per month with updated progress information and
concerns.
7. CONTRACTOR will provide interpretive services,transportation and on-call support on a case-by-case basis as
needed.
8. Services will be provided by therapists with a Master's degree and two years experience in the field or a
Bachelor's degree and three years experience in the field.
9. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
I I. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
12. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
13. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-11-12-CORE-0206
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$532.00/Week(10 Hours/Week with Therapy)
$748.00/Week(20 Hours/Week with Therapy)
$991.00/Week(30 Hours/Week with Therapy)
$301.00/Week(10 Hours/Week without Therapy)
$485.00/Week(20 Hours/Week without Therapy)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
PY-1 I-12-CORE-0206
EXHIBIT C
ASSURANCES
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County,its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph, sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
II
PY-1 I-12-CORE-0206
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs, legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition. During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department, a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination,for cause,of its contract with CONTRACTOR.
12
PY-1 I-12-CORE-0206
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicanUrecipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department, if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101,et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(6). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
13
PY-I I-12-CORE-0206
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
14
PY-1 1-12-CORE-0206
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made, in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
•
41/4PY-1 1-12-CORE-0193 lite 29
CHILD PROTECTION AGREEMENT FOR SERVICES 88 9
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES to
AND SHILOH HOME,INC.
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Shiloh Home, Inc.,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Day Treatment;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'"day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
PY-11-12-CORE-0193
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-12-CORE-0193
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Steven Ramirez Chief Executive Officer
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griet;o,Director Steven Ramirez,Chief Executive Officer
P.O.Box A 6400 W.Coal Mine Avenue
Greeley,CO 80632 Littleton,CO 80123
(970)352-1551 (303)932-9599
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CORE-0193
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext.6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-11-12-CORE-0193
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
I. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0193
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973, as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-11-12-CORE-0193
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
� •�'�' �i _�
WELD CO U Y v ` � • • OF COUNTY
CLERK TO 1 : stir IS I ISSIONERS WELD
1 tt .�! TY,COLORADO
By: �• I. , ,l� ,lr��.Y �'� �_ O Deputy CI �: P7,; y \ / Sean P. Conway, Chair Pro—Tem
ED AST CONTRALTO - SEP 21 2011
BY CXn......sJ
Co At rney Contrac or
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
Ju .Gnego, vector
7
D//-_ //'/
PY-11-12-CORE-0193
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide day treatment services to youth,ages 7-18 years of age,who are proficient in
English,at the Littleton site,located at 6884 S.Marshall Street, and the Longmont site, located at 745 Highway
119,as referred by the Department. Services include:
a. Development of a comprehensive services plan
b. Educational,psychological and clinical assessment services
c. Offense specific treatment services
d. Individual (weekly),family(weekly),group(weekly)and milieu therapies(daily)
e. Case management
f. Academic curriculum credits transferable to public school
g. Transportation to and from school (within a 15-mile radius)
h. In-home services(as needed)
i. Community activities
j. Monthly progress review
k. 24/7 on-call assistance
I. Random urinalysis
m. Transitional services to public school
n. Summer program with an experiential program component
o. Relapse prevention plan
2. Services are specifically designed for those youth who demonstrate a pattern of maladaptive behaviors that
interfere with their adaptive community functioning and who are not at greater risk for out-of-home removal.
3. The program focuses on skills development where the youth recognizes their maladaptive behaviors and
associated thinking errors,and where the use of greater repertoire of positive social skills and adaptive coping
skills is supported. Newly acquired skills are practiced in the program, in group therapy with their family and
in the community at large.
4. Group counseling is offered daily and is facilitated at least twice per week by a master's level clinician. Groups
address a variety of issues,including independent living skills,coping skills/tools,social skills and cognitive
restructuring. Clients are taught accountability, self-monitoring and improved self-control,as well as decision
making skills.
5. Individual therapy is offered weekly and facilitated by a master's level clinician.
6. Recreational activities are scheduled regularly based upon the client's interests and available community
resources.
7. Progression through the program is assisted through a feedback system in which the youth's behavior and
quality of work on phase projects in the program and at home is tied to program privileges. Additionally,
positive progression is measured by successful completion of written and behavioral assignments,and the
development of a relapse prevention plan.
8. Referred youth and adolescents with severely limited cognitive abilities(IQ below 65),ongoing medical issues
that cannot be supervised/managed by staff,an inability or significantly impaired ability to understand and/or
communicate in English,and those who are actively psychotic are generally not considered appropriate for this
program.
9. CONTRACTOR administers program year round,minimum of six(6)hours per day,five days per week
(excluding holidays and teacher in-service days).
8
PY-11-12-CORE-0193
10. CONTRACTOR has identified the following performance outcomes:
a. Successful transition to public school upon completion of program.
b. Successful completion of GED when indicated.
c. Client will remain in the caregiver home or less restrictive setting after discharge.
d. Academic improvement as evidenced by Wide Range Achievement Test(WRAT),which will be
administered at intake and discharge.
e. Client and caregivers will be linked to identified community resources(mental health,medical,dental,
community support,etc.)prior to discharge.
f. Caregivers will increase parenting competency as evidenced by parents ensuring a safe environment
that is free of present dangers or impeding threats.
g. Caregivers will demonstrate compliance with Informed Supervision Criteria(if applicable).
11. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services.If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
12. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
13. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
14. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
15. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-11-12-CORE-0193
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$1,625.00/Month(Pro-rated for any partial month of service)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the T"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
PY-11-12-CORE-0193
EXHIBIT C
ASSURANCES
1. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County,its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
11
PY-11-12-CORE-0193
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
I5. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition.During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination, for cause,of its contract with CONTRACTOR.
12
•
PY-11-12-CORE-0193
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department, if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently.Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
13
PY-1 1-12-CORE-0193
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
14
•
PY-11-12-CORE-0193
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made,in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being I Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
•
0c
PY-11-12-CORE-0213
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SER}p)JIS
AND SHILOH HOME,INC. �'((!/�� /701 OO
This Agreement,made and entered into the day of 2011,by and between the Board of .9
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of •Y4
Human Services,hereinafter referred to as the"Department,"and Shiloh Home,Inc.,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
•
PY-11-12-CORE-0213
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.segz and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et. seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-11-12-CORE-0213
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0213
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Traininv-
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext.6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
•
PY-II-12-CORE-0213
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Steven Ramirez Chief Executive Officer
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Steven Ramirez,Chief Executive Officer
P.O.Box A 6400 W.Coal Mine Avenue
Greeley,CO 80632 Littleton,CO 80123
(970)352-1551 (303)932-9599
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CORE-0213
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-12-CORE-0213
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: / _,�. 11.1®`
LD CO T f :i`r, OF COUNTY
CLERK TO THE 1 O SIONERS WELD
/1 1161 ,}6 'r � COLORADO
By:
Deputy Cle `` i Ilan P. Conway, ,Chair Pro—Tem
APP V D AS TO CONTRACTO SEP 21 2011
• BY
Cou om Contra tor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju .Griego, re or
7
PY-11-12-CORE-0213
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Mental Health Services to youth,and their families,who speak English. In
situations in which a family member does not speak English,efforts will be made to provide an interpreter for
the primary language of the family member.
2. Services will be available at the following locations:
a. 2700 E.Ken Pratt Boulevard,Longmont,CO 80501
b. 8461 Delaware Street,Thornton,CO 80260
c. 6350 West Coal Mine Avenue,Littleton,CO 80123
3. Services will utilize the following evidence-based treatments:
a. Cognitive Behavioral Therapy(Correcting thinking errors;linking thoughts,feelings and behaviors;
and teaching new,healthy empathic and reality-based ways for thinking.)
b. Behavioral Therapy(Teaching and rehearsing healthy ways to behave when overwhelmed by feelings
and perceived needs.)
c. Psycho-education and Family System Theory(Stabilization of the client's mental health diagnoses.)
d. Eye Movement Desensitization and Reprocessing(EMDR)(Treats symptoms of trauma.)
4. Available services include:
a. Individual Therapy: Addresses the impact of mental health disorders,works to lessen the effect of
disorders and restore clients to the best possible level of functioning.
b. Family Therapy: Focuses on improving communication, increasing family member's level of
differentiation and creating a better functioning home environment.
c. Group Therapy: Addresses a variety of issues,symptom management,family issues,anger
management,self-esteem,social skill,independent living,coping skills and cognitive restructuring.
d. Crisis Intervention: Available as needed to assist individuals in dealing with unexpected situations that
may arise between therapy sessions.
5. Services will be provided by either a licensed clinician or a Master's level clinician supervised by a licensed
clinician. The frequency of therapy will be determined at the time of referral and assessment,and sessions will
be offered throughout the day and evening to accomadate working family members.
6. Performance Outcomes:
a. Youth will improve and manage their presenting problems areas.
b. Family participation as measured by caregiver's attendance in sessions and level of participation.
c. Caregivers will maintain a safe and stable home environment for youth and other family members.
d. Youth will be maintained safely in their home when possible and appropriate.
e. Continuity of family relationships and connections will be preserved by identifying barriers and
providing appropriate interventions.
f. Caregiver will gain the capacity to provide their children's education and mental health needs on an
on-going basis.
7. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
8. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
8
PY-1 1-12-CORE-0213
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
10. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department. Monthly reports will address the following:
11. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-11-12-CORE-0213
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$75.00/Hour(Individual Therapy)
$75.00/Session(Family Therapy)
$45.00/Session(Group Therapy)
$95.00/Hour(In-home Family Therapy)
$75.00/Hour(Psychological Evaluations-To include face-to-face interviews,scoring and report writing.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
PY-11-12-CORE-0213
EXHIBIT C
ASSURANCES
1. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement. CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County,its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph, sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
11
PY-11-12-CORE-0213
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest,it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition.During the term of the Contract, CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon leaming of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination,for cause,of its contract with CONTRACTOR.
12
•
PY-11-12-CORE-0213
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
13
PY-11-12-CORE-0213
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
14
PY-11-12-CORE-0213
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made, in the providers'opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
T-
PY-11-12-CORE-0212
CHILD PROTECTION AGREEMENT FOR SERVICES OIl fee
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES?9
AND SHILOH HOME,INC. '717 S Jn
This Agreement,made and entered into the day of 2011,by and between the Board of J
Weld County Commissioners, sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services, hereinafter referred to as the"Department,"and Shiloh Home,Inc.,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval, clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Offense Specific Services);and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services."a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7t5 day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
PY-11-12-CORE-0212
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
- Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-11-12-CORE-0212
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0212
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals, insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
I1. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will retum a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext.6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-11-12-CORE-0212
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Steven Ramirez Chief Executive Officer
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Steven Ramirez,Chief Executive Officer
P.O.Box A 6400 W.Coal Mine Avenue
Greeley,CO 80632 Littleton,CO 80123
(970)352-1551 (303)932-9599
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CORE-0212
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-1 I-12-CORE-0212
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
7
ATTEST:
LD COUNT BOARD OF
CLERK TO ii 1 t(// OMMISSIONERS WELD
UNTY,COLORADO
Deputy CI ' Sean P. Conway, Chair Pro—TemSEP 2 1 2011
94 )
A y�
D ' 11 , ONTRACTOI
BY
C ty A mey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
jAL(L3Ck
.Gnego, rec[or
7
a2(// ,22/f'�
PY-1 1-12-CORE-0212
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide offense specific treatment services to youth,ages 7-18 years of age, and their
families,who speak English,have an IQ greater than 65,and who can function in a reality based manner.
2. Services will be available at the following locations:
a. 2700 E.Ken Pratt Boulevard,Longmont, CO 80501
b. 8461 Delaware Street,Thornton,CO 80260
c. 6350 West Coal Mine Avenue,Littleton,CO 80123
3. Services will utilize the following evidence-based treatments:
a. Cognitive Behavioral Therapy(Correcting thinking errors; linking thoughts, feelings and behaviors;
and teaching new,healthy empathic and reality-based ways for thinking.)
b. Behavioral Therapy(Teaching and rehearsing healthy ways to behave when overwhelmed by feelings
and perceived needs.)
c. Psycho-education and Family System Theory(Stabilization of the client's mental health diagnoses.)
4. Offense Specific Treatment Objectives:
a. Completion of a comprehensive intake assessment to include identifying relationship concerns and/or
barriers to achieving treatment goals.
b. Ongoing assessment of functioning evident in client,family and therapist feedback.
c. Ongoing review and modification of treatment plan monthly to include ongoing assessment of risk and
safety concerns,and the interventions to address any identified concerns,recommendations for service
and/or safety measures to ensure safety of the client.
d. Consistent participation in scheduled individual,family and group sessions.
e. Functional change in family that does tolerate abusive behavior.
f Evidence of abuse-free functioning by displaying appropriate and pro-social behavior in sessions and
in the home.
g. Recognition of harm done to victim(s).
h. Implementation of relapse prevention plan.
i. Acceptance of responsibility for abusive behavior without blame or externalizing.
j. Overview of interventions/progress/ongoing needs.
k. Recommendations of completion of treatment.
5. Offense Specific Treatment Goals:
a. Full disclosure of abusive behavior.
b. Full disclosure of own victimization.
c. Ability to understand personal cycle of abuse,as well as ways to avoid maladaptive thoughts,feeling
and behavior.
d. Behavioral stability evident in consistent display of safety toward self and others and respect toward
property.
e. Development of parent-child relationship and home environment that supports abuse-free functioning
and does not tolerate abuse behavior.
11 Development of a relapse prevention plan that matches abusive behavior.
g. Recommendations upon completion of treatment to include ongoing needs and supports to increase
likelihood of success to ensure youth maintain in the home.
6. Performance Outcomes:
a. No sexual recidivism.
b. Completion of Sex Offender Management Board(SOMB)standards.
c. Increased parenting competency as evidenced by parents ensuring a safe environment that is free of
present dangers and impending threats.
d. Parental compliance with Informed Supervision criteria.
8
PY-11-12-CORE-0212
e. Successful completion of victim clarification if appropriate measured in conjunction with the victim's
therapist.
f. Maintenance in the community(home,job,public school).
7. Services will be provided by either a licensed SOMB clinician or a Master's level clinician supervised by a
licensed SOMB clinician. The frequency of therapy will b determined at the time of referral and assessment
and will be offered throughout the day and evening to accommodate family schedules.
8. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department. Monthly reports will address the following:
a. Assessment of risk and safety concerns and the interventions to address any identified concerns.
b. Recommendations of services and/or safety measures to ensure safety of the client.
c. Efforts attempted to engage families in counseling services.
d. Goals revised/updated to include clear and measurable objectives with timeframes.
12. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-11-12-CORE-0212
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$75.00/Hour(Individual Therapy)
$75.00/Session(Family Therapy)
$45.00/Session(Group Therapy)
$95.00/Hour(In-home Family Therapy)
$75.00/Hour(Psychological Evaluations-To include face-to-face interviews,scoring and report writing.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
PY-1 l-12-CORE-0212
EXHIBIT C
ASSURANCES
1. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County,its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
11
PY-11-12-CORE-0212
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors, heirs, legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,loan,grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,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 indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition. During the term of the Contract, CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination,for cause,of its contract with CONTRACTOR.
12
PY-1 1-12-CORE-0212
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently.Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes(C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
13
PY-11-12-CORE-0212
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being, followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
14
PY-1 I-12-CORE-0212
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made, in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents'capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
PY-11-12-CORE-0119
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT,INC.
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Turning Point Center for Youth and Family
Development,Inc., hereinafter referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Foster Parent Consultation;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011, upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A ofthis Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthlybillings to
the Department by the 7t°day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month fdlowing service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
PY-11-12-CORE-0119
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws, orders,and all applicable standards,regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et.seq. and its implementing
regulation,45 C.F.R. Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986, P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrune(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-I I-12-CORE-0119
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the rightto file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three seas.
9. Insurance
CONTRACTOR, shall procure, either personally or through its employer as applicable to the Contractor's
business, at its own expense, and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its
employees and agents, shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will notbe less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0119
c. Automobile Liability(Minimum)for any Contrretor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses, approvals,insurance, etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Traininn
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers, accept any subpoena fortestimony from
the Weld County Attorney's Office by facsimile and will return awaiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext.6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data,special
analyses,on-site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement wok.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
4
PY-I I-12-CORE-0119
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work cr deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Stephanie Brown Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego, Director Stephanie Brown, Executive Director
P.O. Box A 1644 S.College Avenue
Greeley,CO 80632 Fort Collins,CO 80525
(970)352-1551 (970)567-6461
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons, complaint,
or other pleading which has been filed in ary federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or-foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of finding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CORE-0119
20. Entire Agreement
This Agreement,together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-I2-CORE-0119
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
ELD COUNT
7 OF COUNTY
' .10 `
CLERK TOTH mO , ._f ISSIONERSWELD
t�l .k .:= •««y�, Y,COLORADO
�eputyCI % Sean P. Conway Chair Pro—Tem
AP ED FORM: CONTRACT : SEP 2 1 2011
/J
/ C By. Xc71 cJT
C my ttomey Con tor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Jud .Gne o, rector
7
PY-I 1-12-CORE-0119
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide consultation services for foster children and youth residing in Weld
County foster homes. The goal of the program is to enhance and improve the quality of care being
provided to Weld County's children and youth,and will focus on the following, in relation to the
referred foster child or youth:
a. Addressing issues prompting the referral.
b. Preserving placement.
c. Limiting negative moves.
d. Decline in youth's maladaptive behaviors.
e. Improved household management competency.
f. Improved parental competency.
R. Improved ability to access resources.
2. CONTRACTOR will work collaboratively with children, foster parents,caseworkers,foster care
coordinators and other service providers to identify and address issues, in a solution-focused manner,
which could potentially disrupt placements.
3. Interventions will be clinical and/or psychoeducational in nature and will aim to target issues including
but not limited to,the following:
a. Fine tune solutions: Solution-focused in working with challenging situations.
b. Developmental appropriateness of expectations.
c. Social skills education.
d. Power struggles.
e. Collaborative work with difficult teens.
f What to do when consequences don't work.
R. De-escalation of anger.
h. Facilitating structure/respect.
Behavior modification.
4. CONTRACTOR will provide on-call, crisis support for those homes with an active foster parent
consultation referral.
a. CONTRACTOR will respond to crises which arise within foster homes on a 24 hour per day/7
day per week basis.
b. Crisis calls from foster parents will be returned within one(I)hour from the time the foster
parent contacts the provider.
5. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker aid the Core and Service Contract
Coordinator immediately.
6. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational orbehavioral issues. Areas of concern should be
reported immediately AND on the required mcnthly report.
8
PY-11-12-CORE-0119
8. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department, unless ctherwise directed by
the Department.
9. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-11-12-CORE-0119
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall notbe reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. En the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$82.00/Hour(Foster Parent Consultation-Greeley Metro area including Evans, LaSalle, Eaton and
Windsor)
$120.00/Hour(Foster Parent Consultation-Outside of Greeley Metro area.)
$40.00/Hour(24/7 Telephone Crisis Support, 15-minute Increments)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher aid certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
PY-I I-12-CORE-0119
EXHIBIT C
ASSURANCES
1. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees, volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees, volunteers, and agents
engaged in the performance of the Agreement upon inquest, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the paties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph, sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall notaffect the validity of the remaining portions. The
parties hereto declare that they would have entered intothis Contract and each and every section,
subsection,paragraph, sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs, sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their goveming bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex, or national origin,be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate, current, separate,and complete disclosure of the status of the funds received unc&r the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications, and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: Ifan audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period, or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
11
PY-11-12-CORE-0119
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall, during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits, all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted byappropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of itsrights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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, ormodification of any Federal contract, loan,grant, or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,been convicted of or had a civil
judgment rendered against them for commission of fraid 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 indicted for or otherwise criminally or civilly charged bya government entity
(federal, state, or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state, and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition. During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grmnds for the
Department's termination,for cause,of its contract with CONTRACTOR.
12
PY-11-12-CORE-0119
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicart/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents, and subcontractors, if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department, if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include infomnation (1) lawfully obtained from third parties, (2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (IS) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
13
PY-1 I-12-CORE-0I 19
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strivefor
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being, followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever pcssible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing fanilies.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessmert of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures tha the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their livingsituations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal forthe child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of theservice may assist in achieving the goal.
14
PY-l l-12-CORE-0119
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this wea should
be made, in the providers' opinion.
• Providers should continually assess family relationships(parent/child, sibling/sibling,extended
family/child, etc.)and should report any concerning relationship issues which may be a brrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and mdce
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional, educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
PY-11-12-CORE-0175
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT,INC.
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Turning Point Center for Youth and Family
Development, Inc.,hereinafter referred to as"Contractor".
WITNESSETH
WHEREAS,required approval, clearance, and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Day Treatment;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011, upon proper execution of this Agreement and shall
expire May 31,2012, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthlybillings to
the Department by the 7th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
6267/ asVic%
PY-11-12-CORE-0175
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture ofreimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers, documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—I et.seq. and its implementing
regulation,45 C.F.R.Part 80 et. seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 a seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-11-12-CORE-0175
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the rightto file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duraion of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissimers of Weld County, its
employees and agents, shall be named as additional named insured m the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will notbe less than $1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without60 days prior notice
by certified mail to Weld County.
3
PY-1 1-12-CORE-0175
c. Automobile Liability(Minimum)for any Contrwtor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that, at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals, insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext.6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the perfcrmance of this
Agreement shall be conducted by CONTRACTOR and the Department The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data, special
analyses,on-site checking, formal audit examinations, or any otherreasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement wok.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
4
PY-11-12-CORE-0175
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work a deliverables lost to the Department
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the indivichals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Stephanie Brown Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time totime designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Stephanie Brown,Executive Director
P.O. Box A 1644 South College Avenue
Greeley,CO 80632 Fort Collins,CO 80525
(970)352-1551 (970)567-6461
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in aiy federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CORE-0175
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or mcdified except as stated in
Paragraph 14 herein.
6
PY-I I-12-CORE-0175
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
ELD COUNT 'I :'► • I OF COUNTY
CLERK TO THE ,O SSIONERS WELD
C ,COLORADO
/ r
By: ✓i>/L� ����� /i�W�L�.4
Deputy Cle ean Pt Conway, .Chair Pro—Tern
SEP 21 2011
AP DAS. RM: CONTRALTO •
BY Lxce. ve_!J
mey on t
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
J y A.Grie o, hector
7
Y/Aa2 /cii
PY-11-12-CORE-0175
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide comprehensive,highly structured day treatment services to female and male
youth,ages 12-18,as referred by the Department
2. CONTRACTOR will provide day treatment services at 913 11`h Avenue, Greeley,CO 80631, 8:30 a.m.to 4:30
p.m.,Monday through Friday.
3. CONTRACTOR is licensed by the Colorado Department of Human Services State Child Care Licensing.
License number 1553624.
4. Admission criteria include:
a. Adolescents between the age of 12-18,male or female.
b. Youth's needs cannot be met in a less restrictive environment due to emotional, family,behavioral,
mental health,gang, legal and/or substance abuse issues.
c. Youth is motivated and willing to participate in the program.
d. Low to normal range of cognitive functioning. Cognitive levels will be assessed on a case-by-case
basis.
e. History of school failure and/or truancy.
f. Family is willing to participate in treatment.
5. Teacher/Student ratio is 1 to 10.
6. Testing and psychiatric medication evaluations and appointments will be conducted as needed to aid in case
planning and ensure the appropriate treatment is utilized for the referred youth's maximum growth and benefit.
7. Services will be provided by Masters' level therapists.
8. CONTRACTOR will utilize a bilingual Spanish interpreter when needed.
9. Referred youth will receive services for approximately four(4)to six(6)months. Length of services is
dependent upon the referred youth's daily/weekly progress, individual/family needs and availability of funding.
Services will include the following as appropriate:
a. 30 hours per week of education approved by the Colorado Department of Education.
b. Weekly individual therapy.
c. Weekly in-home family therapy.
d. Weekly drug and alcohol groups.
e. Weekly skills group.
f. Weekly community NA groups.
g. Daily recreation activities.
h. Vocational education.
i. Affective education.
j. Door to door transportation to and from program.
10. CONTRACTOR will provide individual,group and/or family therapy to all referred youth unless otherwise
directed by the Department.
11. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
8
PY-11-12-CORE-0175
12. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
13. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical, emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
14. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
15. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-I 1-12-CORE-0175
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof. In the event that said funds,or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$85.00/Day(with In-home Family Therapy)
$75.00/Day(without In-home Family Therapy)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher aid certify that the services
authorized were provided on the date indicated and the charges made were pursuatt to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7`h day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A ofthis Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
PY-11-12-CORE-0175
EXHIBIT C
ASSURANCES
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions ofCONTRACTOR-contracted
CONTRACTOR or its employees, volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers, and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities theparties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph, sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered intothis Contract and each and every section,
subsection,paragraph, sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs, sentences,clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall, on the grounds of race,creed, color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal, and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven (7)period,the materials shall be retained until the resolution of the
audit finding.
11
PY-11-12-CORE-0175
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits, all contract activities, supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation ofthe
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs, legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of itsrights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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, ormodification of any Federal contract, loan, grant,or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,been convicted of or had a civil
judgment rendered against them for commission of fraid 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 indicted for or otherwise criminally or civilly charged bya government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification; and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition. During the term of the Contract,CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation,CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination, for cause, of its contract with CONTRACTOR.
12
PY-11-12-CORE-0175
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents, and subcontractors, if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department, if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers, clients or affiliates,but does not include information(I) lawfully obtained from third parties,(2)
that which is in the public domain, or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(6). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
13
PY-11-12-CORE-0175
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide, systemic factors to determine if the systems necessary toachieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats, or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive, social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures th3 the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their livingsituations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal forthe child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of theservice may assist in achieving the goal.
14
PY-11-12-CORE-0175
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this aea should
be made,in the providers' opinion.
• Providers should continually assess family relationships(rnrent/child, sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoingefforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthlyreports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional, educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
PY-1 I-12-CORE-0208
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT,INC.
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Turning Point Center for Youth and Family
Development, Inc.,hereinafter referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Home Based Services(Coaching, Home-Based Intensive Services);and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011, upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scone of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthlybill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
1
PY-11-12-CORE-0208
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers, documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d-1 a seq. and its implementing
regulation,45 C.F.R.Part 80 et. seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 a seq. and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973, as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
2
PY-11-12-CORE-0208
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of aid for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the rightto file a complaint either with
the Colorado Department of Human Services or with theU.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR, shall procure, either personally or through its employer as applicable to the Contractor's
business, at its own expense, and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its
employees and agents, shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will notbe less than $1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without60 days prior notice
by certified mail to Weld County.
3
PY-11-12-CORE-0208
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to wham
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract, a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return awaiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only acceptpersonal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext. 6503, and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner thi will not unduly interfere with agreement wok
14. Modification of A ePr ement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
PY-11-12-CORE-0208
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for throe services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work cr deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Stephanie Brown Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time totime designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego, Director Stephanie Brown,Executive Director
P.O.Box A 1644 S.College Avenue
Greeley,CO 80632 Fort Collins,CO 80525
(970)352-1551 (970)567-6461
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in aiy federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/cr foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-11-12-CORE-0208
20. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 14 herein.
6
PY-11-12-CORE-0208
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD CO r ' WJ BARD OF COUNTY
CLERK TO E ' '9'' MISSIONERS WELD
aF�r11 NTY,COLORADO
1861
By:
Deputy -rk L:. ‘1 Sean P. Cofiway-;,Chair Pro—Tem
, Lug ,
APP D AS : CONTRACT
BY
Cr�¢JPTb�
Co homey Con or 1y
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
A.Grieg , Directo
7
PY-11-12-CORE-0208
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Home Based Services to individuals and families in Weld County
referred by the Department. Services include Coaching and Home-Based Intensive Services.
2. Coaching services can include,but are not limited to,the following:
a. In-home parenting support and education.
b. Assistance with appointments.
c. Engaging child or youth in recreational and leisure activities in the community.
d. Supervision of child or youth while parents or caregiver is unavailable.
e. Mentoring and positive role modeling.
f. Connect child and/or youth and family with community reources.
g. Lifeskills coaching and education.
3. Home Based Intensive Services will include interventions that combine strength based,solution
focused, family systems and cognitive behavioral to promote pro-social behaviors and increase
functional behavior.
4. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts
the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service
Contract Coordinator immediately.
5. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
6. CONTRACTOR will document in tail any and all observed or verbalized concerns regarding any
child whom the CONTRACTOR is working with under an active referral. Areas of concem may
include,but are not limited to, any physical,emotional, educational or behavioral issues. Areas of
concern should be reported immediately AND on the required monthly report.
7. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department, unless ctherwise directed
by the Department.
8. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
8
PY-11-12-CORE-0208
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
at the rate specified in Paragraph 2,below. The total amount to be paid to CONTRACTOR during the term
of this Agreement shall be reported by the Department in Trails after May 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part, is subject to and contingent upon the
continuing availability of said funds for the purposes hereof In the event that said funds, or any part
thereof,become unavailable as determined by the Department,the Department may immediately terminate
this Contract or amend it accordingly.
2. Fees for Services
$25.00/Hour(Coaching Services. Travel time may be charged from the Greeley office only.)
$82.00/Hour(Intensive Serivces. Greeley Metro area including Evans, La Salle, Eaton and Windsor.)
$120.00/Hour(Intensive Services. Outside Greeley Metro area.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher aid certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A ofthis Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
9
PY-11-12-CORE-0208
EXHIBIT C
ASSURANCES
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers, or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities theparties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall notaffect the validity of the remaining potions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs, sentences, clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex, or national origin,be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate, and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors, and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications, and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until al
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
10
PY-11-12-CORE-0208
10. CONTRACTOR assures that authorized local, federal, and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits, all contract activities, supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation ofthe
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall be binding upon the parties hereto,their successors,heirs, legal representatives,and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid,by or on behalf
of CONTRACTOR,to any person for influencing or attempting to influence an officer or employee of an
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,ormodification of any Federal contract, loan,grant, or cooperative agreement.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment, declared ineligible, or voluntarily
excluded from covered transaction by a federal department of agency.
b. Have not,within a three-year period preceding this Agreement,been convicted of or had a civil
judgment rendered against them for commission of fraid 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 indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state, and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest,it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition. During the term of the Contract, CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an
existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department,a
full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure
to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the
Department's termination, for cause, of its contract with CONTRACTOR.
11
PY-11-12-CORE-0208
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents, and subcontractors, if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties,(2)
that which is in the public domain, or(3)that which is developed independently.Neither party shall use or
disclose directly or indirectly without prier written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees, contractors, and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
12
PY-11-12-CORE-0208
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Perfonnance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and wdl-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing fanilies.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood(chance,potential,prospect)for parenting behaviorthat is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provide-
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their livingsituations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for thechild and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
13
PY-11-12-CORE-0208
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this a-ea should
be made, in the providers' opinion.
• Providers should continually assess family relationships(parent/child, sibling/sibling,extended
family/child, etc.)and should report any concerning relationship issues which may be a bailer to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthlyreports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
14
Hello