HomeMy WebLinkAbout20092397.tiffRESOLUTION
RE: APPROVE REVISION TO THE THREE YEAR PLAN FOR CORE SERVICES
PROGRAM AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Revision to the Three Year Plan for Core
Services Program from 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, to the Colorado
Department of Human Services, Division of Child Welfare Services, with terms and conditions
being as stated in said revision to plan, and
WHEREAS, after review, the Board deems it advisable to approve said revision to plan, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado that the Revision to the Three Year Plan for Core Services Program from 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, to the Colorado Department of Human
Services, Division of Child Welfare Services, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said revision to plan.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 9th day of September, A.D., 2009, nunc pro tunc June 1, 2009.
BOARD OF COUNTY COMMISSIONERS
WELD COUNCOLORADO
Weld County Clerk to the B
Deputy Clerk to the Boar
ounty orney
Date of signature /0///o?
illiam F. Garcia, Chair
David E. Long
t fsC19D
2009-2397
H R0080
/%q%cj
MEMORANDUM
atCrit
DATE: August 31, 2009
IW� TO: William F. Garcia, Chair, Board of County Commissioners `� C FROM: Judy A. Griego, Director, Human Service4ep rt1AA 1
COLORADO RE:
Core Services Plan for 2009-2010 between the Weld County
Department of Human Services and the Colorado Department
of Human Services' Division of Child Welfare Services
Enclosed for Board Approval is the Core Services Plan for 2009-2010 between the
Department and the Colorado Department of Human Services' Division of Child Welfare
Services. This was presented at the Board's August 31, 2009, Work Session.
The 2009-2010 Core Services Plan being presented is the third and final plan submitted for
the current three-year plan cycle. Weld County's total Core Services allocation for 2009-
2010 is $1,421,439.00 Within this allocation, Weld County received a slight increase in
100% funding; however, the overall allocation was decreased from 2008-2009 due to the
elimination of Administrative Case Management (ACM) funds from the Core Services
Program budget.
The Plan is effective from June 1, 2009 through May 31, 2010.
If you have any questions, give me a call at extension 6510.
2009-2397
CORE SERVICES PROGRAM
THREE YEAR PLAN
(Changes/Modifications)
2009 - 2010
FOR
WELD
COUNTY(IES)
REQUEST FOR STATE APPROVAL OF PLAN
If the three year Core Services Plan is ONLY being submitted for changes/modifications, this page does not have to be
signed by required signatures.
This Core Services Plan is
plan], for the period June 1
4,
0
4,
4,
4,
4,
4,
4,
4
hereby submitted for Weld [Indicate county name(s) and lead county if this is a multi -county
, 2009, through May 31, 2010. The Plan includes the following:
Completed "Statement of Assurances";
Completed Statement of the eight (8) required Core services to be provided or purchased
and a list of county optional services, County Designed Program Services, to be provided
or purchased;
Completed program description of each proposed "County Designed Service";
Completed "Information on Fees" form;
Completed "Reunification Issues" form;
Completed "Direct Service Delivery" form;
Completed "Purchase of Service Delivery" form;
Completed "Projected Outcomes" form;
Completed "Overhead Cost" form;
Completed "Final Budget Page" form;
Completed "State Board Summary"; and,
Completed "100% Funding Summary" form.
This Core Services Program Plan has been developed in accordance with State Department of Human Services rules
and is hereby submitted to the Colorado Department of Human Services, Division of Child Welfare Services for
approval. If the enclosed proposed Core Services Program Plan is approved, the Plan will be administered in
conformity with its provisions and the provisions of State Department rules.
The person who will act as primary contact person for the Core Services Plan is, Tobi Veqter and can be reached at
telephone number 970-352-1551, x6392, or e-mail at vegterta(rilco.weld.co.us.
If two or more counties propose this plan, the required signatures below are to be completed by each county, as
appropriate. Please attach an additional signature page as needed.
Si
Signature, CHAIR, LA EA�ENTALTERNATIVES COMMISSION
(7/q/3
PARTMENT OF HUMAN/SOCIAL SERVICES D TE
qi
DA E
SEP 0 9 2009
Signature, CHAIR, BEARD OF COUNTY COMMISSIONERS DATE
2
O7a69- &3 97
CORE SERVICES
STATEMENT OF ASSURANCES
Weld County(ies) assures that, upon approval of the Core Services Program Plan the following will be adhered to in the
implementation of the Plan:
Core Services Assurances:
• Operation will conform to the provisions of the Plan;
• Operation will conform to State rules;
• Core Services Program Services, provided or purchased, will be accessible to children and
their families who meet the eligibility criteria;
• Operation will not discriminate against any individual on the basis of race, sex, national
origin, religion, age or mental/physical disability who applies for or receives services
through the Core Services program;
• Services will recognize and support cultural and religious background and customs of
children and their families;
• Out-of-state travel will not be paid for with Core Services funds;
• All forms used in the completion of the Core Services Plan will be State prescribed or State
approved forms;
• Core FTE/Personal Services costs authorized for reimbursement by the State Department
will be used only to provide Core Services authorized in the county(ies)' approved Core
Services Plan;
• The purchase of services will be in conformity with State purchase of service rules
including contract form, content, and monitoring requirements; and
• Information regarding services purchased or provided will be reported to the State
Department for program, statistical and financial purposes.
3
CORE SERVICESTO BE PROVIDED/PURCHASED
Place an "X" to indicate which of the following Core Services Program Services will be provided/purchased in
accordance with State Department rules:
X Home Based Intervention
X Intensive Family Therapy
X Sexual Abuse Treatment Services
X Day Treatment
X Life Skills
X Special Economic Assistance
X Mental Health Services
X Substance Abuse Treatment Services
List below "County Designed Service" that will be provided/purchased in accordance with State Department rules:
Foster Parent Consultation Program (F.P.C.)
- Jubilee Retreat Center
- Milestones Counseling Center
- Strong Foundations, LLC
- Turning Point Center for Youth and Family Development, Inc.
Functional Family Therapy (F.F.T.)
- North Range Behavioral Health
- Savio House
Additional Funding for Evidenced Based Services for Adolescents
- Teamwork, Innovation, Growth, Hope and Training (T.I.G.H.T.)
- Multi -Systemic Therapy (M.S.T.)
Additional Funding for Evidenced Based Services to Adolescents
If the county received additional funding from the additional $4,028,299 million dollars appropriated to fund
evidenced based services to adolescents, and would like to continue to receive the same funding for the same
expansion or created of the evidenced based county designed program to adolescents, please indicate that on the
Core Plan under County Designed. The county must also document historical outcomes with regard to how these
specific County Designed services demonstrate effectiveness in reducing the need for higher costs of residential
services. The county must follow the requirements set forth in Agency Letter CW-03-21-A, page 6 of the Request
for Proposal, under the Needs Assessment, County Designed Description and Projected Outcomes section.
The County Designed Program may be renewed/re-approved at the sole discretion of the State Department,
contingent upon funds being appropriated, budgeted and otherwise made available and other contract
requirements, if applicable, being satisfied.
If the county did not receive an award or did not apply, the county is welcome to apply by following the requirement
set forth in Agency Letter CW-03-21-A. Please submit the Request For Proposal with the Core Services Plan, due
August 14th, 2009.
4
FAMILY STABILITY SERVICES TO BE PROVIDED/PURCHASED
Due to budget reallocations for state fiscal year 2008-2009, funding is not available for the Family Stability Services
(FSS) based on Senate Bill 01-012. If a county would like to provide Family Stability Services as outlined in Colorado
Department of Human Services Staff Manual Volume 7, at 7.310, with Child Welfare Block, Temporary Assistance to
Needy Families (TANF), or county only funds, please contact Melinda Cox at 303.866.5962 for details and plan
requirements.
A. Respite Care: a service to provide temporary care to children who are not in an out -of -home placement
through the county departments of social/human services and to their families who request a short break in
parenting in order to stabilize family environment. Respite may occur outside of the home and in the home
settings for less than 24 hours. The family may choose appropriate respite care providers including, but not
limited to, kin, friends and licensed providers depending on the needs of the family and available resources.
B. In -home Services: short-term, solution -focused services provided to children who are not in an out -of -
home placement through the county departments and to their families, based on their unique needs in
order to strengthen the home environment so that children do not need a higher level of intervention or out -
of -home placement.
C. Reintegration Services: transition services to assist children and families to reintegrate following an out -
of -home placement. Service elements would prepare children and their families for successful reunification.
5
CORE SERVICES
COUNTY DESIGNED SERVICE
Service Name: Foster Parent Consultation (F.P.C.)
Optional services approved as a part of the county's Core Services Plan are approved on an annual basis. For a
County Designed Service to be extended beyond one year, this portion of the plan must be submitted and approved
annually by the State Department.
Given that County Designed programs are not standardized across counties, it is important to provide detailed
information as outlined below. This information can be use to justify continued funding of the program with the
legislature. The information listed below is to be completed for each County Designed Service to be included in the
County(ies)' Core Services Program Plan.
Describe the service and components of the service; define the goals of the program.
This program provides foster care consultative services in the areas of (1) consultation and foster
parent support, (2) mandated corrective action consultation, and (3) mandated critical care
consultation. Through foster parent consultation the children are maintained at a lower level of care
so the children can return home and avoid imminent risk of out -of -home placement.
2. Indicate if a new Trails service detail is necessary for this County Designed Program or is the service detail
already an option in Trials.
This service is already open in Trails.
3. Define the eligible population to be served.
This program is open to all Weld County children placed in Weld County foster homes.
4. Define the time frame of the service.
Duration of service is determined by the Foster Care Coordinator based upon the needs of the foster
child and the foster parent in relation to that child.
5. Define the workload standard for the program:
• number of cases per worker,
Foster Parent Consultation services are provided through several independent
agencies that have contracted with Weld County.
• number of workers for the program, and
Jubilee Retreat Center (1)
Milestones Counseling Services (1)
Sionnach Counseling (1)
Strong Foundations, LLC (1)
Turning Point Center for Youth and Family Development, Inc. (1)
• worker to supervisor ratio.
Jubilee Retreat Center (1:1))
Milestones Counseling Services (1:1)
Sionnach Counseling (1:1)
Strong Foundations, LLC (1:1)
6
Turning Point Center for Youth and Family Development, Inc. (1:1)
Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for
guidelines.
• Define the performance indicators that will be achieved by the service, see 7.303.18. - - ---
- Family Conflict Management
- Personal and Individual Competency
- Academic, Behavioral and Emotional Competency
• Identify the service provider.
Jubilee Retreat Center
Milestones Counseling
Sionnach Counseling
Strong Foundations, LLC
Turning Point Center for Youth and Family Development, Inc.
• Define the rate of payment (e.g., $250.00 per month).
Rate per hour is between $65.00-120.00.
Service Name: Functional Family Therapy (F.F.T.)
1. Describe the service and components of the service, define the goals of the program.
FFT is an intensive family -based treatment that addresses the pervasive patterns of relational
dysfunction known to be determinants of conduct disorder, violent acting, out, and substance abuse
among youth 10-18 years old. FFT addresses the multiple factors known to be related to delinquency
and therefore strives to enhance both the safety of the individual and family directly receiving FFT
services as well as the safety of the greater community in which the youth resides.
2. Indicate if a new Trails service detail is necessary for this County Designed Program or is the service detail
already an option in Trials.
This service is already open in Trails.
3. Define the eligible population to be served.
This program is open to families referred by the Department.
4. Define the time frame of the service.
Duration of service is two (2) to six (6) months.
5. Define the workload standard for the program:
• number of cases per worker,
North Range Behavioral Health (12-15)
Savio House (FT: 10, PT: 4-5)
• number of workers for the program, and
North Range Behavioral Health (3)
Savio House (FT: 6, PT: 2)
7
• worker to supervisor ratio.
North Range Behavioral Health (1:3, can not exceed 8)
Savio House (1:8)
6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for
guidelines.
FFT therapists will be, at a minimum, Master's level clinicians or the equivalent. All therapists will have
completed the nationally recognized FFT training program and adhere to the program's accepted
model.
• Define the performance indicators that will be achieved by the service, see 7.303.18.
- Family Conflict Management
- Parental Competency
- Personal and Individual Competency
- Academic, Behavioral and Emotional Competency
- Competence in Maintaining Sobriety
• Identify the service provider.
North Range Behavioral Health
Savio House
• Define the rate of payment (e.g., $250.00 per month).
North Range Behavioral Health ($650.00/month)
Savio House ($780.00/month)
Service Name: Multi -Systemic Therapy (M.S.T.j
1. Describe the service and components of the service, define the goals of the program.
MST is a short-term and goal -oriented treatment that specifically targets those factors in each
youth's social network that are contributing to his or her antisocial behavior. MST interventions
typically aim to improve caregiver discipline practices, enhance family affective relations, decrease
youth association with deviant peers, increase youth association with prosocial peers, improve
youth school or vocational performance, engage youth in prosocial recreational outlets, and
develop an indigenous support network of extended family, neighbors, and friends to help
caregivers achieve and maintain such changes. Specific treatment techniques used to facilitate
these gains are integrated from those therapies that have the most empirical support, including
cognitive behavioral, behavioral, and the pragmatic family therapies.
2. Indicate if a new Trails service detail is necessary for this County Designed Program or is the service detail
already an option in Trials.
This service is already open in Trails.
3. Define the eligible population to be served.
This program is open to families referred by the Department.
4. Define the time frame of the service.
Duration of service is two (2) to five (5) months.
5. Define the workload standard for the program:
8
• number of cases per worker,
North Range Behavioral Health (Avg.: 5, Max.: 6)
Savio House (5)
• number of workers for the program, and
North Range Behavioral Health (5)
Savio House (18)
• worker to supervisor ratio.
North Range Behavioral Health (1:4)
Savio House (1:4)
6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for
guidelines.
MST therapists will be, at a minimum, Master's level clinicians or the equivalent. All therapists will
have completed the nationally recognized MST training program and adhere to the program's
accepted model.
• Define the performance indicators that will be achieved by the service, see 7.303.18.
- Family Conflict Management
- Parental Competency
- Personal and Individual Competency
- Academic, Behavioral and Emotional Competency
- Competence in Maintaining Sobriety
• Identify the service provider.
North Range Behavioral Health
Savio House
• Define the rate of payment (e.g., $250.00 per month).
North Range Behavioral Health ($1,720.00/month)
Savio House (MST: $1,575.00/month, MST-PSB: $2,537.00/month)
Service Name: Teamwork, Innovation, Growth, Hope and Training (T.I.G.H.T.I
Describe the service and components of the service, define the goals of the program.
T.I.G.H.T. is a collaborative effort involving the Weld County Department of Human Services and
Weld County Employment Services (now a department of Human Services). The goal of
T.I.G.H.T. is to delay/eliminate the need for out of home placement by exposing participating
youth to a variety of worthwhile projects within their communities. These activities promote
growth in self- esteem and a sense of community, while demonstrating to participating youth
that there are positive alternatives to them and that they can impact their community in a positive
way.
Indicate if a new Trails service detail is necessary for this County Designed Program or is the service detail
already an option in Trials.
Service detail already exists and is open in Trails.
3. Define the eligible population to be served.
9
The population to be served are youth ages 12-18 who are at risk of out of home placement. Most
youth involved have delinquent behaviors, truancy issues and other maladaptive behaviors.
4 Define the time frame of the service.
Six months.
6. Define the workload standard for the program:
number of cases per worker,
12-15
number of workers for the program, and
3
worker to supervisor ratio.
1:3
6. Define the staff qualifications for the service, e.g., minimum caseworker III or equivalent, see 7.303.17 for
guidelines.
Staff providing the therapeutic component of the service are all masters level clinicians with
training and experience in the FFT model. Supervision is provided by licensed clinicians with
training in supervising FFT therapists.
Define the performance indicators that will be achieved by the service, see
7.303.18.
Performance indicators will include family conflict management, parental
competency and personal and individual competency.
Identify the service provider.
North Range Behavioral Health
Define the rate of payment (e.g., $250.00 per month).
$650.00/month
10
INFORMATION ON CORE SERVICE FEES
Please check all that apply:
X Fees will not be assessed for Core Services Program Services.
If above line is checked, STOP. Remainder of information does not need to be completed.
The following fees apply for the programs checked above.
Fees will be assessed for the following services: Check those that apply:
Home Based Intervention
Intensive Family Therapy
Sexual Abuse Treatment
Day Treatment
Life Skills
Special Economic Assistance
Mental Health Services
Substance Abuse Treatment Services
County Designed Service (List Services Below)
Fee assessment formula is the same for all services. State the formula here (attach additional sheets as
needed).
Fee assessment formula varies with service. State formula used for each service.
1I
Reunification and Family -to -Family
os d
a) co 7 d
•ta 00 N L
C N O d
13 CO e y
CD N d C
_
d T
E 0 c
a)
w E
C d .C 15
a
L1 «7 m
•a 2 E as
la E
U c a d
cu r d O
`yL
O cc
Li-) O C
C C
= I,'!
CD
=
7
N
N d0 3
O aa) 3 V`
9- 0 T
(C C r U
0 ° 0 d
W 0 an >
C F L
7 c 0 0
d 3
a> o c o
c 1noE
N 0.0
N aEO
T.
•a 000
CO C N.c
° c =
y N E 3
O v V
N L j
C 0 O
7 CO V >
O O. C •C
U: L N
w U 7
r d o m
in w )-
0 C alp
.C as
w
d
CD �Nz
o 6, o w
.C 0 C0
C
O
d E°
+O+ 0 t as in
m
U U m pa 1-E
'a 00 0,
cC .L°
• — CO C • a
0 0 e.
0 O r0 12
d 0 d 0 cdi
aU 3aR
C_
U N
'a, 'E i
d
>3/4. -
to
N = w
E m
C
= F
325
OF- v
v mR
c c c
d C d
d
D
C
U
oC
C o
a:
a 2 a
L L
3 O
d >,
`a-
�toi
•
a7
a
C drn
C C
7
L
0
L E
O m E
A
10 a 0
0O7 a
U
U c
0 0 L
E
A es
7 O
aLL
E d LL
1`- d T 4—
OI,0 a al
ol—
. vi
6d d
To N L O
E TC
If) liss
E.2
v 1i U
d d _ .-
C — C 7
E E
d 3 C o
U
E C LL a
w 2.13 C
A 'E C i+
L 10 aC,
C
Ea) 6•a
R d O
O co
oN1aaC,
d E d d
H -c L.
C
C
p
U >
CD
w
.C ja
d '> Si
U w
0
w d a
N
E a/
as
a Y
LI
CO 7
O.c
E O w
7 a7
w 7 d
cN E
:. 0 0
0 L •-
U d
o N C
d
V —
> 0
o d C
LJ.t
°•° 0
L C
10
N C
d U E
y 0 t
N U
a E a1
d t •-
>
c
a '�
y >
L C d
d d .L,.
ay0
> c o
W C
3 47
dU d
C
N
N 7
at L
ea I— c
� o
Y d F
E
3 U C
° •c
1.0
Ea
L d C
E
m o E
ELv
�. 4 co
o. c
p 0 r
n w o
v
c-
0 •E C
Oda
L
L
LL `a7
C
O
C
N
C d
r =
y 0,
E
7 d
d V u)
2 d
O Q-
C
O O >•1
i L E
a co •
>+CLL.c
• 3 �r
o. >. d
LL Y •-
92 C O U
1 7 LL C)
�. £ arc
c c C w
o
LL U c (6
r r c Q.
.+ 3 m_
C _
aci c
E >.E
c. o a
E m E
r y o
a1 £ N a)
c o 1, c
U
C 7 7 C
moons
y alt O
Y
— L 61
7 N
C
7 tl1
N C N 7
O
W C C CD
CD Y L r
(-0 O
�Ea
C
o w co
(OA LL O
<voa
C_
O d
C
w 10
C !
L 1a
NAs C T
d 3
ca
CI) N
y d A
TO
E 2 5
CO Y
LL d C
2 L 7,
. d
lL C
7
o_
OU._
9
d
en
C C
d >
y y CO
L
.F Y
C 7 C
v c
C '— d
CO d V
w L
CC
10
U
N V
Y U a7
d0 E
as
d 40.0
=0.13
cc C .C
Lam'
Na
C0 ewa E H
C N O
C L 0
d aY
.c d 0
N .— o a
n C
C a d
yt'-
E
d nu"O
3 °O .°.
d >._
rnE T
N d to
_
E 313
2 o.d-.LL
d C C
v E
O c d
C C
CCE
C C '°
7 O,_ LL
•U A ?�
°EC'3
E
.Od
c,oE
V
d C
Et)
w`°, >
O
ay
jj a o
la' Eli
d 1'
w d 3
0 r d
C, 0 C,
a >.
rIII
CO
� cu
2 Nt.
d L
U
.173 yL
3
C 2 r
C L j
dy E
-a+R
a7 U d
_CI -
C y
•. ° d
E 0ce
0
c c
at N-
d C N
E d-
dE`'
a7
c o w
C N T
.0 d
CC 0
dU
N .2
.L+
m`o 0
7
O r
L C a
0 .-
E
d 'a d C
- O a d
C a >, E
a .: • d
C
L' 2d !o
E
E U C
E t a E.
0 R.! d
"L= c
V C i
C L •p
C'
CD d U V E.
Y - U
L
°U3
C
d
w
ea
U
>
.: o
d N a
EC
d o
C E
C O C
rc C
C
C 3g
C >
E o `
0 - O
co w 'y
a'vH
c E
3 E
L O
c a U
C t
c I-
C
d T
w y C
a E
Ew E
E
o co 0
E
VC°
L
L y y
U `I
C `I w
at •O
0
7 a N
07c
> d c
V 7
a)E
N 000
1
c
d w 0
47
d N d
C E
aE=
E°al
L
L .c •
y I-
=
ry .. 0-
E c
t dca E
d d L
473
al Cr y
V ` C
d
>gE
C o O
.2'Em
Ea
0
QU a
.0 2
0 O
v ao..3 0
N 'D
d E aN, A d
18 r o 0v a
• £
0 cm
Zo ai
d d
u 2 N N m £
wEc A
N
N N I'Mc
0 O N
2 d c o l A
m o o a o m c
a o.0 a E T u l d
ec a' w C c .L.a N
a o N O o 7 e"a m
0. « d
m0 E ti.'
o = Zd,°o 0
A «dN. W y 0 >, r E
3• m c o EE mt.
c Eo'`� y 0
1" o d ad= a Y
c
d O c« D)7 d .so
c d
a a E t c E N ›:,-g
o £ d . r 8" > N2
0
d— c N c O
>` ACK2 c oam
N 7 d E N E C V H
y V E Y `o do 4 3
£ o cc' 6 E •'> a `O
t d ' 07 O O d a
n m c °U c a d2
d 0 ad i+ O dp
p 3 OcYa .. cH
Y A E y TY Y A
CI m= co - E
3 N 9 =' N •- d N L
N d 'E> 7 o 'D N co .Or
0 �O c w c C is d A
3 .d.. a O to 10 d c)
ac Gc
0 fit c E d =
c p
c
d O N.6 v( X al a
a `y:E d cE_
`p d Y c
N O LL T� .a O
'D N O d d C t C07
.d. 10 +d-. r t.. C r c c
G_
N E c O w co ED.
3 Y
O w O d N 'N C
C $ m N d£ a d w 3
O as 7 r w 2 m D
N
d 16 N C00 H
C V d 02 w° ato c
co co"- (� N .O R 7 d {p
d c y d d c .- u
'c L N 07 o c
o a° gig acit 3 E c
d 10 c d L! d p`
.c o c •c V 9 C .F. +.,
T >.0 7 7—d O) c
l�0 V V L .�. O
To `nE c y ,Z• cC
7 C 7 d
CO Wm- O.C N« ati O3
mU a.E CGHw 0 O is
rn
HOME BASED INTERVENTION SERVICES
DIRECT SERVICE DELIVERY - CORE SERVICES PROGRAM
CFMS — Function Code 1700, 1800
N
V
y
Y
y
J
C
O
V
y
u
u
J
y
G
c
L_
Y
a
3
V
C
m
u
V
t
v
u
LI
0
v
q
>
oa
▪ _'
c E
a .�
II
a
y
E
E o
a b
a
Y y
a ,
o ▪ c
O C
6 O
J
V >
• L)
`y S
V
r.
•
V
•
y
O
Y
F
O
V
Home Based Interventio
o<
C M
k O
Y M
▪ r
amounts that are to be
c
LI
c
ro
G
G
O
Y
o n
L C
,O
a • a
a m
0
6
0
1.1
c >.
C G
E
y
u
> m
• c
V O
Y 'r
O NO
U
E
OC >.
0
o 4 E
O y
a
c N
� Y
▪ O
C U
LC 9 L
E
E o
✓ y
= a
a
0 y
C P
C V
C
• • -t
O
It CA
✓ C
j O
O
y 6
C_ "
ro
V ✓A
Y
c • .V
• L
▪ Y
E
E `o
o U
=g
Y a
m m
V
a O
• V
,
z,
A
6,
f,
zs
49
w
4,
fA
6,
V1
(A
n
(A
n
with all family members to improve family communication, functioning, and relationships.
v: 'Iherapeutic intervention typic
Sn
sv
Sq
sq
LA/
sq
CAI
sq
EA
sq
EA
Sq
EA
Sq
EA
Sq
EA
Sq
w
Sq
«n
EA
w
C
C ey
Lca
❑ r
EA
Sn
0
Sn
EA
Sn
En
EA
Eq
Vi
N
EA
Sn
EA
EPA
ER
Vi
EA
Vi
EA
EA
EA
N
EA
Sn
EA
69
U)
Q
U)
N
U
0
S
0
S
Day Treatment: Comprehensive, highly structured services that provide therapy and education for children.
be
w
ss
be
are
bet
be
be
be
be
be
w
age
w
be
yr
toe
be
be
be
be
us
J
O
F
C
Vi W
U (i4
..
z W g
F � r
4• w—
t
U
F'I C4 u
U I -II
aw• l
W W
F
U
E
V
J
V
C
-
Cca
V M
O r
ned Services: innovative and/or otherwise unavailable s
b4
b4
s4
sq
EA
sq
sq
CA
sq
fie
EA
sq
EA
Yi
sq
sq
sq
W
vi
69
Vi
vi
W
sq
N
Vi
tO
J
0 O
s
N
L6
Lei
WI'
E �
H
8
co
bi
x
U
•
t
O
to
e
J
O
0
M= Month E= Episode
0
CY
M =Month. E = Episode
0
W
ion for each Trails provider from whom Core services are propo
44,
co
an
:
49
444)
m
an
toisPi
en
0
641
a
Sea
2
2
E
/!
0
444
anIS
0
05
co
aal
O
cation of unit is: H = Hour, D = Day, W = Week M — Month, E — Episode
U
U CG
Z14 tx
6• 4j 0.
LL
L4 1-1
d 64
o te64
a
0. °
U
Indicate information for each Trails provider from whom Core services are proposed to be purchased
a
w
a
a
a
a
N
N
N
N
N
N
a
a
a
a
w
w
co
co
n
O
th
M
Co
O
O
r
C
a
3
N
C
Z
To
ce
C
0
S
W
m
0
U o
0
N
O
S
v
W
N
w
a
co
O
CO
m
r
a) o
Co
O
3
a
W
Day Treatment
69
69
69
49)
04
69
69
9 ED
oo
CD
CD
co
\ra
)
O)
{\}GH CD
69
69
ori
at
O
- Identification of unit is
Day Treatment
SEXUAL ABUSE TREATMENT
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
w
w
6
N
N
O
O
O
T
a
0
F -
N
O
O
O
w
w
w
w
w
w
w
w
69
w
N
N
N
N
N
N
N
N
N
N
N
69
69
69
69
S
69
H
W
O
O
O
h
O
O
N
r
O
O
O
h
O
O
N
r-
0
0
O
O
0
O
O
O
O
O
O
O
N
O
O
O
O
co
O
O
O
N
T
a
N
F-
O
0
d E
co
E
co
C
0
Sexual Abuse Treatment
69
M
1!l
to
W
V)
V)
V)
dEP
. �9na
�',"�e'��
fH
Vi
V)
IA
69
69
Vi
Vi
N
N
Cl
N
N
N
N
N
N
N
N
N
N
N
N
N
(1)
V)
V)
U)
V)
Vi
V)
Vi
U)
V)
69
Vi
69
69
Vi
Vi
0
O
0
O
O
O
0
U)
O
O
0
)
0
O
6
v
0
O
o
c)
O
0
0
(0
0
0
0
(. i
0
0
0
O
.
O
O
0
O
0
o
700.00
250.00
250.00
O
O
ui
N
O
O
,n
(0
O
O
6
(0
m
0
.
T
N
1O
Corder°, Psy.D.,
Victor
(Informed
Supervision) (H)
v
e
2 ii
E St
a
ttiu
Sexual Abuse,
Intervention (H)!
Sex Offender
Treatment Group
(H)
Sex Offender
Treatment Group (6
erson mint E
Informed
Supervision- Group
Format IN_
Informed
Supervision - Group
Format (6 family
min.) (E)
Informed
Supervision -
Individual Format
Informed
Supervision -
Individual Format
(Completed in one
session) (E)
gi
1.
g
1g
Evaluation w! PPG.
on -site (E)
Evaluation wl PPG,
off -site (E)
Evaluation w/o PPG
(E)
Penile
Plethysmograph (E)
Sex History
Polygraph (E)
Maintenance
Polygraph (E)
Arousal Mgnt. (E)
Intake (E)1
N
Sexual Abuse Treatment
V)
CO
V)
V)
V)
U)
V)
Cl)
Cl)
(A
N
N
N
12
N
12
N
N
N
N
69
V)
V)
V)
V)
V)
69
V)
65.00
35.00
0
O
O
0
O
N
O
O
L
O
u)
N
65.00
O
O
oO
..
-
O
O
O
O
co
r
r
Ind . Cples or
Family Coun (H)
Phase I. 3 or 4
Group (E)
I Phase 2 Group (E)1
Chaperones Group
(E)
Juvenile Sex
Offense Specific
Group (E)
Informed
Supervision (E)
Family Reunification
(H)
Court Facilitation or
Staffing (H)
Reflections for
Youth
Informed
Supervision (E)
I
.a
.1
I
Sex Abuse
Intervention
Pro ram IM
(f)
-J
O
F
Identification of unit is. H = Hour, D = Da . \V = Week, M = Month, E = Epi
Sexual Abuse Treatment
U C
Z
• Ucn
4 • ce
C
v
k
O
• U
OU • ce
LaJ
aO
U U
v
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
J
O
H
w
w
0
2
H = Hour, D- Day, W
Special Economic Assistance
N
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
9.1
O
O
O
69
e4
N
N
El;
69
b
O
O
O
O
O
N
Mental Health Services
64
64
64
64
64
64
64
O
O
O
O
O
O
0
O
0
�1s
Si
c.0
o 9
^' o
N
W
Co
g F
a
Group Therapy (H)
64
64
64
6^
64
64
64
64
64
64
0
O
O
O
O
O
O
O
O
'C
O
O
b
0
O
b
O
O
O
O
o
C5s
i
C
U
`o =
a a
U F
T
72 g
Cc
Travel Surcharge (E)
Court Testimony (H)
o` Z
o 00
L C
C
U
Mental Health Services
O
CV
O
h
1.9
O
N
0
LU
W
4,
191
604
44
V3
O
b
N
4,
O
N
w 44
O
O
4,
O
69
4,
O
QC
4,
69
O
O
O
M
N
4,
4,
O
b
69
N
4,
O
O
M
Mental Health Services
69
6,
64
O
O
w
N
FL -
0
a
O
9,1
6,
64
6,
64
64
fat
O
O
= o
Td
0
0 A
W
O
O
W
O
O
O
W
O
O
O
na
64
64
49
64
64
64
N
O
P
O
O
O
N
N�
N
N
64
64
62
64
62
O
O
O
O
O
O
O
O
O
O
O
O
x
o
U
x
s
F
6
x
ce
Ce
W
w
F
Mental Health Services
N
O
O
Noe
O
O
a
0
u
u
s
0
2
3
00
N
Mental Health Services
SUBSTANCE ABUSE TREATMENT SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
69
N
N w
O Y A
o L W
m
a
co Z = — t
L O Z'cm t0
O' o N cc2
O2 Z<
8
05
m
CO
J
0 O
H
Substance Abuse Treatment
to information for each Trails provider from whom Core services are proposed to be purchased.
to
cn
69
in
cn
\21155 12
22
co
u.
\/
� z,
-J
- Identification ofun
County Designed Services
PROJECTED CORE SERVICES OUTCOMES FOR
PERFORMANCE INDICATORS
s. 'npp��p�3�'
"u
uRk. sys
�I
m
e� 5 IA en.w
I2
15
4
�.,. � e96 4:vd
wise en s ^
�rv¢1 � Ed �ySe4, �'R24es6
� ro�� �`^'a`�%��s ®a;
7
°& �,re�ew ess
"aa T w�°wv�'
34
�4€39
1�gasEs
5
4
48
125
15
12
152
' 8 `>e21
45 ky
3
2
26
n s
81f I %11° e'Q
31
4
3
38
aka "
s $
196
24
19
239
-
"
'rte a= see �g0Na a °"w� a�
^-
a
I.
199
24
19
242
n/a
n/a
n/a
0
O. 1�� area
"' `
39
5
4
48
%SFina �l 6�E ly s
�y�yy� qy p$� ee vd R11iNP1� �A x36
h
x
30
4
3
37
50
6
5
61
s
(Refer to NRBH/FFT)
0
§ ro�0
s �Ae ��ai� �.
0
s sa
0
Client meets 86% or more of the treatment goals
a Client meets between 85%-25% of the treatment goals
Client meets 24% or less of the treatment goals
CORE SERVICES PROGRAM
OVERHEAD COSTS
A. Total
Salary/Fringe/Travel/Operating
Cost of LineService Workers and
their Immediate Supervisors
B. Formula Percentag Allowed for
Overhead Cost
C. Provided Service Overhead
Cost (A x B)
15%
A. Purchased Service dollar
Amounts
C. Allowed
Amount for
Overhead Costs
$ 1,732,621.58 (A x B) $ 27,721.95
B. Formula Percentage allowed D. Based
for Overhead Cost
Overhead cost
0.016 Allowed $ 500.00
E. Purchased
Service Overhead
Costs (C +D) $ 28,221.95
28,221.95
ItigraRaigifiggE
Y4 2 e.�9 E e
* Formula to determine overhead cost by service:
Step 1: total provided service cost (by service) x 15% = provided service overhead cost
Step 2: total purchased service cost (by service) x % listed in 2B = V
$500 divided by the number of purchased service = Z, then V + Z = overhead cost
Step 3: Provided service overhead cost plus purchased service overhead cost equals total overhea'
0
N
vi
O
m
N
ES
LO
0
co
••t -
N
1 ---
Ca
0
(h
0
ma -
CO
OD
O)
c
0
E
To
0
F-
C
O
0
M
N
O
O
0
0
0
C
0
F-
-
to
Q
0
O
N
O
O
0
m
N
O
N
0
O)
CO
N
0
S
0
O
Z
(n
To
To
0
O
O
0
co
O
0
(n
E
O
O
0 0
W O
0 0
0 V)
0 co
a to
(o
LO
O
O
co
O
M
ES
H
LL
U-
'
C a
.23 U. p
O C
O CO
~
C N
2N
o 2
0
0
a
0
U
0 O
U
O E
O
c
c
o
a E
•O
0 N
C o
E PA
8 8 d 0
zzam
0 0
Nrn ao
0 0 = M
O O3 N
U U 0 O
O
ow.
9 9 U
Z m
2 w y c_
o N 0
O O
CO w 0
N N
0 0 (n C
O o T
0 0 E 0
U O N N
LL co
°r fa
v d a•
co
U U U
LL
0 CO
000c
O C C
- U O
C C U
w w LL
O
N N
U- U. U O
LL LL LL o
co
5,
L
Y D u.
O
V
a.
E 2 0
C
CO N
C 2 O
CO C.) N
en
9
CO
O
O
b
en
W
oo
col
Go
C
«n
P
N
b
w
O
P
oo
P
n
N
co
00
00
w
00
00
00
bee
O
00
N
EA
N
n
N
N
fen
N
N
b
ken
O
N
n
O
cn
Sn
cati
O
W
P
N
N
EA
O
en
en
en
en
eel
en
O
V
00
n
fel
ten
N
N
N
N
00
co
ry
N
0
O
ro
0
vo
0
to
0
cc
cot
0
I
G
to
i
L
Day Treatment
Sex Abuse Treatment
C
C
G
0
u
Allocation Check:
Total 80/20 Core
at E
E urn
O
O
GI m
C .2
C m N
t
ae
O 06
0
C)
VI
a
C
O
0
O
0'
a`
N
O
P
O
O
0
O
0
O
W
en
n
0
P
N
4.
r
0
oo
V
sq
sq
M
00
4a
4v
en
n
n
4v
O
00
4a
O
IN
O
0
en
M
M
M
N
M
00
r
0
r
r
0
CO
0
co
0
F
0
C,
0 0
CO
ADAD/Substanee Abu
Mental Health
.0
0
0
0
m
0 Q
Day Treatment
Sex Abuse Treatment
a o
o O
O o
N N
N a
0 to
to
EP) N
.4
o
U
o
r. m 0
o
Q
0
Hello