HomeMy WebLinkAbout20091861.tiffRESOLUTION
RE: APPROVE TWO 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 two 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 below, commencing June 1, 2009, and ending May 31, 2010, with further terms
and conditions being as stated in said agreements, and
1. Poudre Valley Health Care, Inc., dba Poudre Valley Hospital
2. Arapahoe House, Inc.
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 two 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 above be, and hereby are,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreements.
2009-1861
HR0080
TWO CHILD PROTECTION AGREEMENTS FOR SERVICES WITH VARIOUS PROVIDERS
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 5th day of August, A.D., 2009, nunc pro tunc June 1, 2009.
ATTEST:
Weld County Clerk to the Boa
BY.
OARD OF COUNTY COMMISSIONERS
LD CO n COLORADO
am' Garcia, Chair
'1 _ ' r' Dougl
De',uCler t• the Board
APPR
unty orney
Date of signature `d/I/lO9
Rademacher, Pro-Tem
EXCUSED
Se- P. Conway
-/Barbar,
4C4
David E. Long
2009-1861
HR0080
MEMORANDUM
#(t';Tig DATE:
• FROM:
COLORADO RE:
August 3, 2009
William F. Garcia, Chair, Board of ounty Commissioners
Judy A. Griego, Director, Human Services epartn en tr` j
Child Protection Agreement for Services between the Weld
County Department of Human Services and Various
Providers
Enclosed for Board approval are Child Protection Agreements between the Department and
Various Providers. These Agreements were presented at the Board's April 27, 2009, and June
22, 2009, Work Sessions.
The major provisions for the Agreement presented on April 27, 2009, is as follows:
No
Provider/Term
Program Area/Funding
Rates
I
Poudre Valley Health Care,
Inc. dba Poudre Valley
Hospital
June 1, 2009- May 31, 2010
Wraparound Aftercare
Services (Home -Based
Services)
Core
$1,700.00/Month (Flat Base Rate)
$56.50/Day (Daily fee for partial
months of service)
The major provisions for the Agreement presented on June 22, 2009, is as follows:
No
Provider/Term
Program
Area/Funding
Rates
1
Arapahoe House, Inc.
June 1, 2009- May 31, 2010
Substance Abuse
Treatment and
Monitored Sobriety
Core — Substance
Abuse Treatment
CW Admin —
Monitored Sobriety
$163.90 - This includes a two to
three hour assessment and a baseline
Urine Analysis.
-Detoxification $110.00 per day
-Intensive Residential— Adult
$182.00 per day
-Transitional Residential $155.00
per day
-Individual Session $75.90 per hour
-Group Session $43.73 per hour
-Family Session $81.40 per hour
2009-1861
- UA/Treatment $27.10 up to three
times per week per UA(11 panel:
Alcohol, Amphetamines,
Barbiturates, Benzododiazepines,
Cocaine, Opiates, THC (marijuana)
Phencyclidine, Methadone,
Creatinine, Propoxyphene)
-Antabuse Monitoring
$3.02 per monitoring five loading
days, followed by three days per
week of monitoring.
- Intensive Residential — Adolescent
$218.90 per day
-Aspen Center for Women
$182.00 per day
- New Directions for Families
$182.00 per day
- Court Testimony $65.72 per hour
-Intake Fee $15.40 each
-Breathalyzer $15.40
- UA Confirmation (GCMS)
$33.00 per positive substance
- UA w/o Treatment (diagnostic)
$33.27 per UA (11 panel)
- Day Treatment — Adolescent
$106.43 per day
-Drug Patch Monitoring $44.00 each
-Drug Patch Confirmation
$27.50 per positive substance
- Antabuse $66.00
if you have questions, please give me a call at extension 6510.
PY-09-10-CORE-0174
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND POUDRE VALLEY HEALTH CARE, INC. dba POUDRE VALLEY HOSPITAL
This Agreement, made and entered into the day of 5,- y// 2009, 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 Poudre Valley Health Care, Inc. dba Poudre
Valley Hospital, hereinafter referred to as "Contractor".
Contractor operations Mountain Crest Behavioral Healthcare Center, a licensed behavioral health care
facility located at 4601 Corbett Drive, Fort Collins, CO 80528. Mountain Crest offers Residential Wraparound
Services.
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 funding to the Department for
Wraparound Aftercare Services (Home -Based 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, 2009, upon proper execution of this Agreement and shall
expire May 31, 2010, 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.
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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.
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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.
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PY-09-10-CORE-0174
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. 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. 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.
13. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
14. 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;
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;
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PY-09-10-CORE-0174
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.
15. 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
Name
For CONTRACTOR:
Shari Simmons, LCSW
Name
16. Notice
Social Services Administrator
Title
Residential Coordinator
Title
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
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
17. Litigation
To: CONTRACTOR
Shari Simmons, LCSW
4601 Corbett Drive
Fort Collins, CO
(970) 207-4867
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.
18. 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.
19. 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 13 herein.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above
written.
ATTE
By:
my Attorney
o-�
1( BY
WELD COUNTY DEPARTMENT
OF HUMANS RVICES
By:
BOARD OF COUNTY
COMMISSIONERS WELD
COUNTY, COLORADO
By:
Chair, William F. Garcia
AUG 0 5 2009
CONTRACTO3
6
aQeCu.A or
Contractor
Rir`%-/y&o/
PY-09-10-CORE-0174
EXHIBIT A
SCOPE OF SERVICES
1. The goal of the Wraparound Aftercare Services Program is to bring the residential program to the youth's home
and community by providing needed support and services that the Wraparound team has agreed upon. The
intent of the "Wraparound Aftercare Services" is to solidify the work begun in residential placement and
empower families to implement what is needed for their own unique circumstances, ultimately allowing for self-
sufficiency.
2. The CONTRACTOR will provide the following in the home/community to those clients referred by the
Department:
a. Team development — Support team for the family consisting of both professional and non-professional
members.
b. Monthly team meetings.
c. Practice of the Crisis/Safety Plan.
d. Facilitation of both formal and informal resources to address the family's unique needs.
e. On -call availability.
f. Weekly face-to-face contact with the family by the Wraparound Facilitator.
g. Individual and family therapy if needed by the same therapist the family worked with in residential
placement.
h. Attendance at court appointments and staffings as needed.
i. Required documentation for High Fidelity Wraparound, the Department and the court.
3. Timeline for Wraparound Services:
a. Upon Intake: Preliminary Intake Assessment
b. Within 24-72 Hours: Evaluation and Comprehensive Assessment; Initial Risk Assessment; Psychiatric
Assessment; and Health/Physical Assessment
c. Within One Week: First Family Interview, First Individual Interview; Basic Strengths, Needs, Cultural
Discovery (SNCD); Basic Functional Assessment (FA); Safety/Crisis Plan (CP); Basic Wrap Team
Development; and Psychosocial
d. Within 10 Days: initial Team Meeting -Care Plan Development; Case manager begins working with
youth on goals
e. Within 30 Days: Comprehensive Team Meeting
f Within 30-45 Days: Decision on Wraparound Aftercare made by team (Intensive Wrap or Basic
Wrap).
4. Under Intensive Wrap, CONTRACTOR will provide the following:
a. Comprehensive SNCD
b. Comprehensive FA
c. Comprehensive CP
d. Monthly Team Meetings
e. Identified needs coming out of assessments/recommendations are; new techniques are practiced and
strengths built upon.
f. Wrap Facilitator works with the family building team development in their community.
g. Wrap Facilitator teaches the family how to build natural supports in their community.
h. Wrap team meetings are held in the family's community to assist the team in practicing treatment plan
recommendations.
i. Pass check -ins.
j. Wrap will go to the home and practice in -home techniques that are being identified in therapy.
k. Available via telephone for crisis assistance.
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5. Under Basic Wrap, CONTRACTOR will provide the following:
a. Monthly team meetings
b. Assessments and recommendations are given to the caseworker for community referrals.
c. Wrap will make recommendations to assist the family in developing a team of natural supports.
d. Pass check -ins once every two weeks.
6. CONTRACTOR will submit reports on a monthly basis for each active referral. 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 requested.
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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 Core Services funding, not to exceed $75,000.00.
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, if Core Services funds, 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
$1,700.00/Month (Flat Base Rate)
$56.50/Day (Daily fee for partial months 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 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. Billings must be submitted with the attached required forms, Authorization for Contractual
Services, Request for Reimbursement, Client Verification Form and monthly report. The
Authorization for Contractual Services and Client Verification Form must be submitted
with original signatures.
c. For monitored sobriety, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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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 theseven (7)•yearperiod, 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.
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FY -09 -10 -CORE -0174
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:
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.
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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 forma of identification required. by C.R.S. 24-765.101, 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.
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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.
• Providers should continually provide recommendations about whether any out -of -home placement continues
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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.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND ARAPAHOE HOUSE, INC.
lr
This Agreement, made and entered into the 1 day of 5'4N4 2009, 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 Arapahoe House, 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 Substance Abuse Treatment and Child Welfare Administration funding to the Department for
Monitored Sobriety; 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, 2009, upon proper execution of this Agreement and
shall expire May 31, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR within its capacity 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 or 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 71h 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 and 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 effective date of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-09-10-CORE-0164
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.
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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.
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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. 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. 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.
13. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
14. 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;
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;
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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 agre.,ments between the Department and CONTRACTOR, or by the Department as a debt due to
the Department or otherwise as provided by law.
15. 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
Name
For CONTRACTOR:
Cathy Hoich
Name
16. Notice
Social Services Administrator
Title
Director of Program Services
Title
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
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
17. Litigation
To: CONTRACTOR
Floyd Hodge, Contract Administrator
8801 Lipan Street
Thornton, CO 80260
(303) 412-3678
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.
18. 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.
19. 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 13 herein.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first
above written.
ATTEST:
By:
Attorney
WELD CO
CLERK TO
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
OF COUNTY
SSIONERS WELD
Y, COLOR4D
Chair, William F. Garcia
CONTRACTOR:
BY
6
AUG 0 5 2009
Contractor
.ui.4 c
C it, 1.-c<C e c c C/fS6 C
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PY-09-10-CORE-0164
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR shall provide services including client evaluations, outpatient, intensive outpatient,
transitional residential, day treatment, residential, adolescent TRCCF services, social mode V
detoxification, sobriety monitoring, case consultation and testimony in court for adults and adolescent
clients referred by The Department. Each client's treatment needs will be assessed on an individual basis,
and the level or modality of treatment provided by CONTRACTOR will be based on the client's needs, in
accordance with the American Society of Addiction Medicine's (ASAM) patient placement criteria.
2. The Department shall refer to CONTRACTOR only those child welfare cases that comply with the
following criteria:
A. The case is active on the TRAILS computerized tracking system;
B. The case meets Colorado Department of Human Services program category criteria 4, 5,or 6;
C. The case meets the definition of `imminent risk for out of home placement/reunification," as
defined by the laws or rules of the State of Colorado.
3. Services include:
A. Alcohol and Drug Abuse Assessment - Assessment will evaluate alcohol/drug involvement as
well as mental health status, history of mental health issues, sexual history, legal history, and
certain standard tests (GAIN,ASAP, ASAM PPC-2, ASI, SOCRATE, AODUI, Drinking History
Questionnaire, Family Environment Scale) may be given. CONTRACTOR will provide two
collateral contacts as part of the assessment. CONTRACTOR substance abuse evaluator will
complete the assessment within 10 working days of the face-to-face interview.
CONTRACTOR agrees to include a Baseline Urinalysis Testing (11 -Panel) as part of the
assessment.
B. Treatment Options
1) American Society of Addition Medicine (ASAM) Level of Care
CONTRACTOR's treatment options will be dependent upon the American Society of
Addiction Medicine (ASAM) level of care that is formulated at the completion of the
substance abuse assessment. Through group, family, and individual counseling, the
methods used to create change are generated through cognitive and behavioral therapy,
Gestalt, problem solving techniques, motivation enhancement, and solution focused
therapy. These methods will be used in conjunction with or alone depending upon the
client's needs. CONTRACTOR agrees to provide the ASAM level of care as follows:
Level of Care
Description
.5 = Evaluation
Two to Three Hours coupled with a urinalysis
test.
1.0 = 1 to 8.5 hours per week
This includes individual, family and group
sessions depending on the clients needs.
2.1 = nine or more hours a week
2.5
This includes a combination of individual,
family and group sessions dependent on the
clients needs.
Day treatment
3.7 Residential2
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2) Adult Detoxification Services
Adult Detoxification services through CONTRACTOR focuses on detoxification
programs that facilitates a safe withdrawal from alcohol and drugs and engages
appropriate clients in treatment. These services will be available to The Department'
clients through its various site locations in Aurora, Wheat Ridge, and Commerce City,
CO, locations. CONTRACTOR operates three adult social -model detoxification
programs in Adams, Arapahoe, and Jefferson Counties. The Aurora Emergency
Treatment Unit located at 1290 S. Potomac Street, Aurora, CO, contains 30 licensed
beds. The Wheat Ridge facility in Jefferson County, Detox West, located at 4643
Wadsworth Boulevard, Wheat Ridge, CO, holds 50 licensed beds. Serving Adams
County, the Washington House facility located at 7373 Birch Street, Commerce City,
CO, contains 40 licensed beds. Together these three programs provide approximately
16,000 episodes of detoxification annually.
3) Adult Residential and Day Treatment
CONTRACTOR's Adult Intensive Residential Treatment service located at 8801 Lipan
Street, Thornton, CO, offers flexible length -of -stay and individualized care to clients
who are 18 years of age or older. Its purpose is to provide treatments to individuals
whose substance use and /or co-occurring mental illness have resulted in disruption of
their emotional, mental, physical, and/or socioeconomic functioning. This program is
designed for those clients whose treatment in a less restrictive setting would be unlikely
to result in changes in attitude and motivation sufficient to maintain abstinence from
alcohol and other drugs. The program is limited to those individuals who do not need a
locked environment and who do not have a physical, emotional, or psychiatric
impairment, which would require the availability of 24 -hour medical staff.
4) The Wright Center
The Wright Center is an innovative transitional housing program located at 6195 W. 38th
Avenue, Wheat Ridge, CO, for homeless clients who have completed intensive treatment.
Encompassing 22 beds for males and females, the program emphasizes relapse
prevention, and the acquisition of employment through job placement assistance. The
length of stay in this program, with its focus on transitional alcohol -and -drug -free
housing, may extend up to two years.
5) Stepwise Adolescent Program
The adolescent residential program is licensed as a Therapeutic Residential Child Care
Facility and Residential Child Care Facility (RCCF), as well as licensed by the Alcohol
and Drug Abuse Division. The program is designed to afford a sheltered, but structured,
treatment environment to adolescents with mental health and substance abuse problems.
Treatment is tailored to the individual needs of each young person. The program can
serve 20 youth, both male and female. An accredited on -site school is provided for
clients who have not received a high school diploma or are working towards their GED.
Job skills training services are available to age appropriate clients.
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6) Specialized Services for Individuals With Co -Occurring Mental Illness
CONTRACTOR offers specialized services for individuals with co-occurring mental
illness. The Adult and Adolescent Residential programs, New Directions for Families,
and the central Denver Adult and Adolescent Outpatient clinics are licensed as mental
health clinics and provide integrated treatment of co-occurring mental illness and
substance abuse. Psychiatric evaluation and treatment is available and individual and
group sessions address issues of the interaction of mental illness and substance abuse and
dependence. For clients who are also homeless or have other special needs, a case
manager is assigned to coordinate linkage to other services and systems on behalf of the
client. The residential programs are located at 8801 Lipan Street, Thornton, CO. The
Denver Outpatient Clinic is located at 55 W. Fifth Avenue, Denver, CO. The New
Directions for Families location is not listed for security reasons.
7) Specialized Women's Services
CONTRACTOR offers a continuum of specialized services for women, including
gender -specific groups and individual counseling in outpatient and residential settings.
Services include intensive dyadic case management to engage and coordinate the linkage
to multiple systems appropriate to the needs of pregnant women and women with
dependent children. Residential treatment programs provide parenting skills groups,
supervised visits, and designated areas for children who are visitors. Family planning
services have been made available on -site at the Lipan Residential and New Directions
for Families programs.
8) Adult Outpatient Clinics
CONTRACTOR operates six outpatient clinics providing services to individuals assessed
appropriate for that level of placement in the continuum of care. Our outpatient
programs
provide individual and group counseling, specialized offender and women's services and
education, and therapy groups for clients referred for a DWAI or DUI offense. The
locations of such clinics are: Aurora Outpatient Clinic located at 3005 South Parker
Road, Suite C-330, Aurora, CO; Lakewood Outpatient Clinic located at 730 Simms St.,
Lakewood, CO; North Metro Outpatient Clinic located at 720 West 841° Avenue, Suite
224, Thornton, CO; Washington House Outpatient Clinic located at 7373 Birch St.,
Commerce City, CO; Denver Outpatient Clinic located at 55 West Fifth Avenue, Denver,
CO; and Wheat Ridge Outpatient Clinic located at 4643 Wadsworth Blvd., Wheat Ridge,
CO.
Adolescent outpatient services also are available at some of Contractor's outpatient
clinics.
9) Strategies for Self -Improvement and Change (SSC)
CONTRACTOR's Strategies for Self -Improvement and Change (SSC) is a traditional
outpatient program for male offenders structured around three phases of treatment:
Phase I- Challenge to Change; Phase II- Commitment to Change; and Phase III- Taking
Ownership of Change. The program is designed to motivate clients to take responsibility
for their actions, to change negative self -concepts, and to break patterns of substance
abuse and criminal conduct. The program is located at Detox West, 4643 Wadsworth
Blvd, Wheat Ridge, CO.
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10) Cultural Services - Outpatient Services
CONTRACTOR implements a structured Cultural Services program. The program has
been designed to expand and enhance the outpatient services previously offered by
CONTRACTOR with a primary focus on providing linguistic and culturally appropriate
treatment services to the Latino population. Programmatic services include: individual
and group counseling, specialized offender services and education; abstinence
monitoring; and DUI Level II Education and Therapy. In addition, program staff is able
to complete alcohol and Drug Assessment for monolingual Spanish speaking clients
upon request by referring agencies. CONTRACTOR hires bi-lingual counselors,
receptionist, and Information and Access (I&A) team member(s) to overcome the
language and socio-economic barriers. These services are offered at the Denver
Outpatient Clinic located at 55 W. Fifth Ave., Denver, CO, and Washington House
Outpatient Clinic located at 7373 Birch St., Commerce City, CO.
II) The Aspen Center for Women
The Aspen Center for Women program provides gender specific services for
pregnant/postpartum women with drug and alcohol dependence and other co-occurring
issues. This Intensive Residential Treatment program is for women 18 and older and has
a 60 day, flexible length of stay. ACW has capacity to simultaneously serve a total of 16
women and their dependant children at a given time. Services offered include parenting,
family therapy, case management, healthcare and integrated treatment for substance
dependence, mental illness and trauma related issues.
12) New Directions For Families
CONTRACTOR's New Directions for Families is a comprehensive residential program
that has the capacity to simultaneously serve 16 women and their dependent children.
The program has an on -site licensed childcare center for infants, toddlers, and
preschoolers. Children in treatment with their mothers receive individual assessment,
treatment, and case management for problems associated with having experienced
familial substance, mental health, and violence.
C. Reporting - CONTRACTOR will provide monthly reports to The Department concerning the
status of each participant and his/her progress. CONTRACTOR will provide an aggregate
outcome report quarterly as described in Exhibit E. All client progress reports submitted by
CONTRACTOR will in the format provided in Exhibit F. CONTRACTOR will incorporate into
each adult and youth treatment plan the three child welfare objective as identified by the
Department caseworker. These objectives are derived from the Department caseworker's
assessment and state what must be done to undertake behavioral changes, to mitigate safety
concerns, to resolve risks and to result in family continuity and/or permanency. Progress on these
three objectives will be reflected in the monthly progress report and will be provided to The
Department by the tenth day of each month, following month in which services were provided.
4. Measurable Outcomes and Objectives
CONTRACTOR shall abide by the Department outcome indicators of Safety, Permanency and Child and
Family Well -Being, which are provided under Adoption and Safe Families Act (ASFA), 1997;
Colorado Child and Family Services Plan 2000 -2004; and ACF Reviews (Reference: Federal Register,
Volume 65, Number 16: 45 CRF Parts 1355, 1356, and 1357), March 25, 2000.
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A. Outcome Reports as Prescribed by the Department
Quarterly Outcome reports will be provided to The Department and will include the following:
1) Number of clients served;
2) Number of clients currently in each level of care;
3) Number of clients that have successfully completed their treatment goals. This will be
based on D/C DACOD's and broken down into percentages of goal attainment,
4) Number of clients that unsuccessfully discharged (based on D/C goal attain mentor
moved to a higher level of care;
5) Number of clients served whose primary addiction is to methamphetamine;
6) Number of clients served with a dual diagnosis, including the client's primary mental
health diagnosis;
B. Client Objectives
The Department caseworker will identify a maximum of three child welfare objectives that are
relevant to the clients overall plan (see objectives noted below in C) and will submit these
objectives to CONTRACTOR in writing with the referral or by providing them in the family
Service Plan (FSP). CONTRACTOR shall assess the client and develop goals based on their
needs, including action steps to reach the identified child welfare objectives. CONTRACTOR
shall report monthly on each client's progress in meeting their goals and will include information
related to the three identified child welfare objectives. Progress on client goals will be provided
monthly in writing on CONTRACTOR form 172 "Child Welfare Clients- Monthly Report, using
a Likert Scale to determine progress.
C. Overall Program Objectives
CONTRACTOR and The Department agree to assist the client in achieving up to three of the
following objectives as part of the substance abuse services provided by CONTRACTOR.
1) Demonstrate Abstinence with the use of UA/Patch Monitoring Only (Code #100).
2) Improve parental capabilities currently impaired by substance abuse (Code #101).
3) Develop the capacity to ask for help and assistance without resorting back to substance
abuse (Code #102).
4) Develop or increase the ability to recognize, prioritize and meet child(ren)'s needs (Code
#103).
5) Parent will identify how their substance use has affected their parenting (Code #104).
6) Parent will identify how their substance use got them involved with the Department
(Code #105).
7) Parent will identify how their substance use helped them parent (Code #106).
8) Parent will identify relapse triggers and develop a safety plan for their children (Code
#107).
9) Parent will identify whom they consider to be a support in their recovery (Code #108).
10) Parent will identify who will care for their children should they relapse (Code #109).
1 I) Parent will identify what they enjoy about parenting sober (Code #110).
12) Improve parent -child functioning to lower the risk of out of home placement (Code
#201).
13) Parent will support their children in speaking about how living in a substance -effected
family has impacted them (Code #202).
14) Parents will demonstrate increased verbal skills, empathy and accountability
with child(ren) (Code #203).
15) Parent will identify their parenting strengths (Code #204).
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16) Family members including significant other, children and extended family will increase
ability to communicate more effectively (Code #301).
17) Family members will identify how they can support the identified client in their recovery
(Code #302).
18) Family members will identify the positive parenting changes the substance -effected
person is making (Code #303).
19) Family members will identify who will care for the children in the event of a relapse
(Code #304).
20) Family members will identify relapse systems of the identified client (Code #305).
21) Family members will identify how they can reach out for help if a relapse occurs (Code
#306).
22) Increase level of functioning currently impaired by living in a substance affected family
(Code #401).
23) Identify how living in substance affected family has impacted their life (Code #402).
24) Improve level of functioning currently impaired by substance abuse issues (Code #403).
25) Decrease aggressive behaviors at home and/or school and in the community (Code
#404).
26) Learn how to socialize without the use of substances (Code #405).
27) Identify relapse triggers (Code #406).
28) Create a sober support network (Code #407).
5. Staff Qualifications
CONTRACTOR will have credentials and/or certifications as required by the Colorado Department of
Human Services, Colorado Board of Education, Alcohol and Drug Abuse Division, and the Colorado
Board of Medical Examiners.
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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 Child Welfare Administration orCore Services funding, not to exceed $50,000.00.
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, if Core Services or Child Welfare Administration funds, 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
Description of Services
Fee/Cost
Drug and Alcohol Assessments, which
includes, ASAP, ASAM & ASI
$163.90 - This includes a two to three hour assessment
and a baseline Urine Analysis.
Detoxification
$110.00 per day
Intensive Residential - Adult
$182.00 per day
Transitional Residential
$155.00 per day
Individual Session
$75.90 per hour
Group Session
$43.73 per hour
Family Session
$81.40 per hour
UA/Treatment
$27.10 up to three times per week per UA
(11 panel: Alcohol, Amphetamines, Barbiturates,
Benzododiazepines, Cocaine, Opiates, THC (marijuana)
Phencyclidine, Methadone, Creatinine, Propoxyphene)
Antabuse Monitoring
$3.02 per monitoring five loading days, followed by three
days per week of monitoring.
Intensive Residential — Adolescent
$218.90 per day
Aspen Center for Women
$182.00 per day
New Directions for Families
$182.00 per day
Court Testimony
$65.72 per hour
Intake Fee
$15.40 each
Breathalyzer
$15.40
UA Confirmation (GCMS)
$33.00 per positive substance
UA w/o Treatment (diagnostic)
$33.27 per UA (11 panel)
Day Treatment — Adolescent
$106.43 per day
Drug Patch Monitoring
$44.00 each
Drug Patch Confirmation
$27.50 per positive substance
Antabuse
$66.00
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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 7h 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. Billings must be submitted with the attached required forms, Authorization for
Contractual Services, Request for Reimbursement, Client Verification Form and monthly
report, unless otherwise agreed upon. The Authorization for Contractual Services and
Client Verification Form must be submitted with original signatures.
c. For monitored sobriety, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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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.
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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.
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 or
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.
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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.
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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.
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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.
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EXHIBIT E
MONTHLY REPORT
DEPARTMENT OF HUMAN SERVICES
Child Welfare Clients — Monthly Report
County
DSS Caseworker
Treatment Agency
Program
Client Name
Household No.
Counselor
Month & Year of
Report
If Residential/Day
Treatment, Date of
Admission
No. of Days Attended
this Month
If Outpatient Treatment, Please Complete the Following:
Dates of
Sessions
Number of Hours
Individual
Family
Group
Case Mgmt.
Client Monitoring: (UA's, Patches, Antabuse, BAL
Type:
How many scheduled this month:
If Any Missed/Positive Results, Please List Dates, Type and Substance(s).
Date
Type
Substance
Progress in Treatment 1
(Indicate by Number) No Progress Minimal Progress Moderate Progress Good Progress
Excellent Progress
Treatment Goal Number
Treatment Goal #1:
Treatment Goal #2:
Treatment Goal #3:
2
Treatment Goal
3 4 5
Progress
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Additional Comments Regarding Client's Progress:
Contempt citat6ion recommended for non-compliance:
Yes
No
Counselor Signature
Date
Supervisor's Initials
Date
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