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Home My WebLink About20071687.tiff RESOLUTION RE: APPROVE TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR FOSTER PARENT CONSULTATION PROGRAMS 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 Notification of Financial Assistance Awards for Foster Parent Consultation Programs, 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 Social Services, and various providers, listed below, commencing June 1, 2007, and ending May 31, 2008, with further terms and conditions being as stated in said awards: 1. Julie Box, Private Practice 2. Jubilee Retreat Center- Lori Kochevar, LLC WHEREAS, after review, the Board deems it advisable to approve said awards, 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, ex-officio Board of Social Services, that the two Notification of Financial Assistance Awards for Foster Parent Consultation Programs 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 Social Services, and various providers, listed above be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said awards. 2007-1687 et' 55 SS0034 TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR FOSTER PARENT CONSULTATION PROGRAMS PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 18th day of June, A.D., 2007, nunc pro tunc June 1, 2007. BO D OF COUNTY COMMISSIONERS WE OUNTY, C ,DO ATTEST: ct..� LOfjQ M ;f Long, Chair Weld County Clerk to the Boar. . c1 ., mH. J- �-, o-Te I BY: ' Deputy CI to the Bbard� Iliam:F. Garcia APP D AS T \y\t. Robert D. Masden �u y A orneyy A orney ouglas ademac r Date of signature: 7 9—O'7 2007-1687 SS0034 d..... ft WELD CUUNTY owscs,,NERS DEPARTMENT OF SOCIAL SERVICES P.O. BOX A W ' 2n01 JUN 12 P 4' 5b GREELEY, CO. 80632 Website:www.co.weld.co.us ED Administration and Public Assistance(970)352-1551 OV` al6 t.J Fax Number(970)353-5215 • MEMORANDUM COLORADO TO: David E. Long, Chair Date: June 8, 2007 Board of County Commissioners '' FR: Judy A. Griego, Director, Social Services„L t ( (r tar f RE: Notification of Financial Assistance Awards with arious Contractors— Foster Parent Consultation Enclosed for your approval are Notification of Financial Assistance Awards with Various Contractors for Foster Parent Consultation. The Department and the Families, Youth, and Children(FYC)Commission are recommending approval of these Awards. These Awards were reviewed at the Board's work session of June 8, 2007. The major provisions of these Awards are as follows: 1. The Award period is June 1, 2007 through May 31, 2008. 2. The source of funding is Core Services or Child Welfare Administration. 3. The Contractors will provide consultation to County Certified Foster Parents. 4. The Contractors include: A. Julie Box, Private Practice $58.33 group rate per foster parent $90.00 per hour per individual rate $75 court testimony B. Lori Kochevar, LLC $58.33 group rate per foster parent $90.00 per hour per individual rate $75 court testimony If you have any questions, please telephone me at extension 6510. 2007-1687 Weld County Department of Social Services Notification of Financial Assistance Award for Core Funds Type of Action Contract Award No. X Initial Award FY07-CORE-71 Revision (PY 07-08 RFP-FYC-006-00A; 001-FPC-07) Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Julie Box,Private Practice Ending 05/31/2008 Foster Parent Consultation 1702 68th Avenue Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Program provides foster care consultation services Assistance Award is based upon your Request for and foster parent support groups around placement Proposal(RFP). The RFP specifies the scope of issues,behavioral management, foster home issues services and conditions of award. Except where it involving biological children in home, interpretation is in conflict with this NOFAA in which case the and implementation of treatment plans,discipline in NOFAA governs,the RFP upon which this award is the home, group training,visitation issues,legal risk based is an integral part of the action. and commitment issues,and solution oriented Special conditions planning.Groups are open capacity,with an 1) Reimbursement of services for group consultations estimated two groups per week, a maximum of eight will be based on per person/per episode rates. groups per month, two hours per group. Group Individual consultations will be based on an hourly participation is limited to one group session per foster rate per individual consultation,as determined by parent per month.Individual consultation services the Department of Social Services. will only be provided when approved by the Resource 2) Rates will only be remitted on cases open with, and Services Manager or Child Welfare Administrator of referrals made by the Weld County Department of Social Services.Bilingual-Bicultural and South Social Services. County services are available. 3) Requests for payment must be an original and Cost Per Unit of Service submitted to the Weld County Department of Per individual foster parent Social Services by the end of the 25th calendar participant per episode day following the end of the month of service. Treatment Package(Groups) $58.33 The provider must submit requests for payment Per hourly rate on forms approved by Weld County Treatment Package Intensive(Individual) $90.00 Department of Social Services. Requests for Other Services(Court Testimony) $75.00 payments submitted 90 days from the date of Enclosures: service, and thereafter, will not be paid. X Signed RFP: Exhibit A 4) Requests for payment must include original client X Supplemental Narrative to RFP: Exhibit B verification signatures(blue or red ink preferred) Recommendation(s) and dates and hours of service. X Conditions of Approval The Contractor will notify the Department of any change in staff at the time of the change. Approval : _ a Program ffNial: -k By c By dr ��l_ l41/'J David E. Long, Chair Judy A. rie o,Director Board of Weld C Co sioners Weld urlty men of Sock al Services Date: JUN 18 °L' Date: / (U/ O7OO 7 -ia;P% EXHIBIT A SIGNED RFP � 1. F r � . INVITATION TO BID BID 001-07 DATE: February 28,2007 BID NO: 001-07 RETURN BID TO: Monica Mika,Director of Administrative Services 915 10th Street,P.O. Box 758,Greeley,CO 80632 Third floor,Centennial Building,Purchasing Department SUMMARY Request for Proposal for: Colorado Family Preservation Act—Core Services Program Deadline: Friday,March 30,2007, 10:00 a.m. (MST) The Families,Youth and Children Commission,an advisory commission to Social Services, announces that competing applications will be accepted for approved providers pursuant to the Board of Weld County Commissioner's authority under the Colorado Family Preservation Act (C.R.S. 26-5.5-101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.R.S.26-5.3-101). The Families,Youth and Children Commission wishes to approve services targeted to run from June 1,2007,through May 31, 2008,at specific rates for different types of service,the County will authorize approved providers and rates for services only. This program announcement consists of the following documents, as follows: • Invitation to Bid • Main Request for Proposal(All program areas) • Addendum A—Program Improvement Plan Requirements(by program area) • Addendum B—Scope of Services(by program area) • Core Budget Form Delivery Date (d) 2.1.Z. 1 (After receipt of order) BID MUST BE SIGNED IN INK Program Area: Foster Parent Consultation Julie Box TYPED OR PRINTED SIGNATURE VENDOR Julie Box,LCSW (Name) Handwritten Signature By Authorized Officer ent of Vendor ADDRESS 1702 68th Avenue TITL Greeley,CO 80634 DATE ` ti 7 PHONE# _970.302.1471 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 June 2007 Bid No: 001-07 Colorado Family Preservation Act— Foster Parent Consultation, Emergency Assistance Program Julie Box, LCSW Private Practice ABSTRACT Julie Box(Bidder) is a Licensed Clinical Social Worker offering a wide range of services to children, families and adults. Bidder has been providing human services to the Northern Colorado area since 1986. During the past 2lyears, Bidder has provided services as a counselor, a caseworker and a therapist in the field of child welfare. Bidder has provided services to all individuals without consideration of religious beliefs, race, culture, gender, sexual preference, age or economic status. From June of 2004, Bidder has provided consultation services to the Weld County Department of Social Services. Bidder assures that she 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 the approved RFP/Bid. Bidder will provide consultation services to the Weld County Department of Social Services and families providing foster care services for the Department for the express purpose of providing consultation services and foster parent support groups around placement issues, behavioral management, foster home issues involving biological children in the home, transition and loss issues,working with foster parents and caseworkers around interpretation and implementation of treatment plans, discipline in the home, group training for foster parent access to training materials, working with foster/adopt parents on legal risk and commitment issues, visitation issues, and solution oriented planning. Bidder will provide services to prevent the placement of children and/or to reunify the children with their families as soon as safely possible. Bidder will promote constructive communication between foster/adopt families and the Department by using techniques such as reframing, positive connotation, separating people from the problem, metaphoric storytelling and establishing ground rules for dialogue. Bidder will provide individual foster parent consultation on a time-limited basis,which will be provided only with approval of the Department. Bidder will provide mandated training for foster parents under the corrective action plans and she will provide follow-up services when referred by the Department. Bidder will also provide training to satisfy the State training requirements for foster/adopt parents by offering a minimum of one training credit per month, which will be recorded for each critical care foster parent participating in the mandated monthly consultation group. Bidder acknowledges that all additional foster parent training will be approved by Department staff; i.e., Foster Care Coordinators or Resource Services Managers. Bidder also acknowledges that all training will be offered to all Weld County foster parents,whether they are involved in the Consultation Program or not. The flat fee for conducting such training will be agreed upon between Bidder and the Department on a per event hacis. 2 TABLE OF CONTENTS A. Invitation to Bid page 1 B. Abstract page 2 C. Table of Contents page 3 D. Target/Eligibility Populations page 4 • Total number of clients to be served • Total family units • Sub-total of individuals who will receive bicultural/bilingual services • Sub-total of individuals who will receive services in South Weld County • Monthly program capacity per group • Average stay in the program (weeks) • Average groups per week in the program E. Project Narrative/Supporting Documentation pages 5-8 • Types of service provided • Measurable outcomes • Service objectives • Workload standards • Staff qualifications • Program capacity per month • Internal tracking and billing process F. Budget page 9 G. Appendices: • Appendix 1: Resume for Julie Box, LCSW pages 10-12 • Appendix 2: Data Collection Instruments/Protocols page 13 • Appendix 3: Sample Consent Forms pages 14-16 3 TARGET/ELIGIBILITY POPULATIONS The population to be served under this contract includes Weld County foster/adoptive parents' certified in Weld County. These include consultation groups, individual consultations and corrective-action consultations and are limited to Weld County foster care/adoption certification applicants only. A. Total Number of Clients to be served: Each consultation group is'worth'2 hours and will be spread over a one-week period of time. Bidder estimates she could complete 96 group consultations per year. Individual consultation and corrective action consultations are accepted only on a time-limited basis, with specific permission from the Department. Bidder estimates that she can provide individual consultation and corrective action consultation services as referred by the Department with no maximum hours given. B. Total family units. Bidder has no limits regarding the number of individuals attending per group. C. Subtotal of individuals who will receive biculturaVbilingual services Unfortunately, Bidder is not bilingual; however, Bidder would be able to contract with a qualified Spanish speaking clinician to provide translation as referred. Bidder would not refuse any bicultural services. D. Subtotal of individuals who will receive services in South Weld County. Bidder does not limit her services to specific geographical areas so Bidder will provide services in the Southem part of Weld County as they are referred. E. The monthly program capacity per group. Bidder has no limits regarding the number of individuals attending per group. Bidder will provide one-on-one individual consultation and corrective action services as arranged by the Department. F. The monthly average capacity per group. Bidder has no limits regarding the number of individuals attending per group. Bidder will provide one-on-one individual consultation and corrective action services as arranged by the Department. G. Average stay in the program (weeks) Bidder estimates that the average stay in the program as measured by weeks, would be dependent upon the needs of the foster/adopt families as well as the needs of the Department. Bidder would not limit weekly groups, but would provide weekly services as needed. H. Average groups per week in the program. Bidder estimates that she can provide 2 group consultation services per week. 4 PROJECT NARRATIVE/SUPPORTING DOCUMENTATION Foster Parent Consultation A. Types of services provided: Bidder will provide group, one-on-one and corrective action consultation services. Bidder will provide consultation and foster parent group support around placement issues, behavioral management, foster home issues involving biological children in the home, transition and loss issues, work with the foster parents and caseworkers around interpretation and implementation of treatment plans, discipline in the home, group training for foster parents with access to training materials, work with foster/adopt parents on legal risk and commitment issues, visitation issues and solution oriented planning. Bidder will also provide individual foster parent consultation on a time-limited basis only with approval of the Department. Bidder will provide mandated training for foster parents under corrective action plans as well as referring foster parents to follow-up services as referred by the Department. Bidder will provide training to foster parents to satisfy State training requirements within the following guidelines: one training credit per month will be recorded for each critical care foster parent participating in the mandated monthly consultation group; all additional foster parent training will be pre-approved by Department staff, i.e., Foster Care Coordinators or Resource Services Manager. Bidder stipulates that all training will be offered to all Weld County foster parents, whether they are involved in the consultation program or not. The flat fee for conducting such training will be agreed upon between the provider and the Department on a per event basis. Contracted individual and group consultation rates cannot be charged for training. It is expected that post training testing will be part of the training component. Consultation groups follow a topical format, allowing for consultation time in the form of questions and answers prior to closing the session. Bidder intends on providing a topic specific group for each group consultation. These topics will be gathered from the foster parents as well as other relevant issues to foster children and placement retention. Bidder will not be providing foster parent group consultation if Bidder is also providing therapeutic services for a child in the same home. Bidder will provide all actessments, clinical recommendations and other opinions directly to the assigned caseworker of the children involved in consultations. If there is disagreement over the implementation of the treatment plan with the caseworker, a meeting shall be held with this Bidder, assigned caseworker, foster parents and the caseworker's supervisor. The objective will be to determine a unified response for the court. Bidder will not use the legal system to oppose the Department's recommendations. Bidder agrees to comply with 19-1-120 C.R.S., which requires that reports of child abuse and any identifying information in those reports are strictly confidential. Bidder assures the FYC Commission and the Department that Bidder's resources will not supplant existing and available services in the community; e.g., mental health capitation services, ADHD and professional services otherwise funded. B. Measurable outcomes: Bidder will provide improvement of household management competency as measured by pre and post assessment instruments. Bidder will also provide improvement of parental competency as measured by pre and post assessment instruments. Bidder will assess foster parents ability to 5 independently work with other sources in the community and within the local, state and federal governments by direct observation. Bidder will assess whether foster parents are able to demonstrate higher skill and competency levels in fulfilling their designated function for children in out-of-home placement by direct observation as well as discussion with Foster Parent Coordinator about the foster parents required training hours. Bidder will observe foster parents' ability to positively meet their biological children's needs in adjusting to and coping with the presence of foster children in the home. Bidder will measure, evaluate and monitor measurable outcomes by the retention of foster children in the foster homes, by the retention of foster families and by the relief of concerning or corrective actions given by the Department. C. Service objectives: The service objectives are the same as the measurable outcomes, that is: the provision of quality foster parent consultation, assessment of foster families and support of foster families in a timely manner. In addition to the measurable outcomes, Bidder will address specific referral issues. Services will be solution focused and address issues specified by the Department. Bidder will work with the foster parents to improve family conflict management, improve household management competency, improve the foster parents'ability to access resources and to improve outcomes in the Performance Improvement Plan. At no time would Bidder advise or give permission for a child to be removed from placement. Bidder encourages foster parents to cooperate with the case plans for independent living as well as to provide daily life skills instruction. Bidder supports and encourages providers to maintain children's cultural and racial identities. Bidder works with providers to encourage open, honest and consistent communication with the WCDSS. D. Workload standards: Bidder estimates that she will be able to run 2, two-hour consultation groups per week, approximately two consultation groups per month, with no limit to the number of individuals attending. Bidder is currently the only staff providing training services. However, Bidder may choose to invite a trained clinician to address specific topics. Bidder intends on working to provide monthly consultation groups that include various professionals that work with foster children and their families. Such individuals would include child psychiatrists, Guardian ad Litems, caseworkers and psychotherapists. Bidder estimates that she can provide, at a minimum, 48 consultation groups per year and a maximum of 96 group consultations per year. Bidder estimates a minimum total of 2 hours of direct service,with 2 hours of indirect service every week. Bidder is a Licensed Clinical Social Worker with a private practice and does not have a supervisor. Please see attached insurance coverage form. . Bidder encourages providers to comply with the WCDSS requirements of scheduling medical and dental appointments as required by State Regulations(two weeks from time of placement for physicals and eight weeks from time of placement for dental). Bidder addresses the role of foster parents in working with caseworkers in identifying health needs and services for the children in their care. Bidder emphasizes the importance of providers working as part of a team with the WCDSS caseworkers toward meeting the best interests of the child, stressing the importance of preservation of placements and communication. E. Staff qualifications: Bidder has a bachelor's degree in Psychology(BA),a Masters degree in Social Work(MSW)and is a Licensed Clinical Social Worker(LCSW)since January 21, 2003(license number. 992996). 6 Bidder has her own private practice and is the only staff available. However, Bidder can provide a qualified professional that can translate during consultations as needed. As an LCSW, Bidder does not have a clinical supervisor. Bidder secures a minimum of 8 hours per year of continuing education training. Bidder has not received the mandated new caseworker training. Bidder has extensive knowledge of risk assessment. F. Program capacity per month: Bidder can provide consultation services at a maximum of 8 groups per month, 2 hours per group. Bidder does not have a limit to the individual or corrective action services she could provide. G. Internal tracking and billing process: Please refer to the attached budget for computation of direct service rate. Bidder will use the Departments Monthly Request for Reimbursement-PY 2006-2007, as well as the Department's Provider Attendance Sheet for all billing purposes. Bills will be submitted on or about the 10th day of the month following the month the services were provided. The following hourly rate is what Bidder will charge for each hour of direct service of group consultation, individual consultation and corrective action consultation provided. Group consultation: $58.33 per person in the group, per group. Individual consultation: $90.00 per hour. Corrective action consultation: $90.00 per hour. Bidder estimates that she can provide 7 to 8 groups per month at two hours per group, maximum. H. Literature citations: NA: Bidder did not refer to any literature citations within this application. I. Confidentiality and participant protection: • Protect clients and staff from potential risks: Covered by Bidder's Disclosure Statement on pagesl4-16. • Fair selection of participants: Bidder accepts all referral's from the WCDSS regardless of age, gender, raciaUethnic background, children of substance abusers, foster children, pregnant women, religious preference, sexual preference or disabilities. Bidder does not recruit or select participants, the WCDSS makes such decisions. • Absence of coercion: Covered by Bidder's Disclosure Statement on pages 14-16. • Data collection: Covered by Bidder's Disclosure Statement on pages 14-16. • Privacy and confidentiality: Covered by Bidder's Disclosure Statement on pages 14-16. • Adequate consent procedures: Covered by Bidder's Disclosure Statement on pages 14- 16. 7 • Risk/benefit discussion: Bidder collects information during the course of a home study to assess risk to children, provide expedient placement of children and to provide preservation of placements for children. Risk to the applicants in sharing their personal information is that their application to provide foster/adopt care for children may be denied due to some of the information disclosed. For example, if an applicant shares a history of sexual abuse that currently causes them a great deal of distress their application may be denied until they have addressed this issue. These risks are explained to applicants and therefore reasonable expected benefits to the applicants are that their application would be approved and that they would be able to provide these services to the children, the biological family members and the community. 8 BUDGET Please refer to the attached budget forms and Unit of Rate Computation. APPENDICES 1 THROUGH 3 • Appendix 1: Resume for Bidder • Appendix 2: Data Collection Instruments/Protocol • Appendix 3: Sample Consent Forms 9 APPENDIX 1: RESUME Julie Box, LCSW 1702 68 Avenue Greeley, CO, 80634 970.339.9036 or 970.302.1471 Education: Adams State College;BA in Psychology. Graduated 1984. Colorado State University;MSW;Masters in Social Work. Graduated in 1996. Licensed Clinical Social Worker as of January of 2003;License#992996. Work History: Private Practice: June 01, 2004, to present This clinician currently has a contract with the Weld County Department of Social Services (WCDSS)to complete home studies for individuals applying as foster/adoptive parent(s) in Weld County. Responsibilities include the use of the SAFE, Structured Analysis Family Evaluation,a written,narrative home study provided to the WCDSS,with recommendations,background checks through the Department of Motor Vehicles and local law enforcement,four letters of reference for the applicant parent(s)and SAFE Questionnaires one and two,completed by the applicant parent(s). The WCDSS completes other background checks through the CBI as well as the Colorado Central Registry,on their own. Clinician at Lutheran Family Services May 11, 1998, to January 13, 2006. Program Manager for Family Preservation Program. Home Study Program and Relinquishment Counseling Program for Lutheran Family Services June of 2003 to January of 2004. The rest of the time was a position as clinician. Responsibilities as a clinician include crisis intervention,therapeutic services for foster children dealing with grief and loss issues in LFS homes,case management services for foster children,foster parents,birth parents and county caseworkers,attending and testifying at court hearings, completion of home studies for Lutheran Family Services homes as well as for the Weld County Department of Social Services,completion of all related paperwork including but not limited to monthly reports,ongoing progress notes, interactional assessments,monthly staffing notes and development of treatment plans. Responsibilities as a program manager included responsibility for clinical and administrative oversight of the three programs listed above,assisting in selecting staff, assisting in program development and definition, identifying community resources to supplement program activities and ensure that consistently high quality clinical care and case management services are provided for each program consumer. 10 Social Caseworker III: Child Protection for the Boulder County Department of Social Services August 05, 1996, to May 11, 1998 Responsibilities include family assessments,family and individual therapy,updated written reports on case progress,written court reports, attendance and testimony at court hearings, school stuffing's,therapeutic stuffing's,crisis intervention,written social histories,attending interagency stuffing's, development of treatment plans and general case management. Supervisor for Work Release and Home Detention Inmates for the Weld County Sheriffs Department December of 1994 to July of 1996 Responsibilities include direct supervision of inmates in the work release and home detention programs, daily record keeping of inmate activities,home visits to verify the inmates whereabouts, crisis intervention and counseling of inmates. Counselor II/Assistant Program Director for the Weld County Shelter Home and Alternative Homes for Youth November of 1986 to August of 1994 Responsibilities included all financial management, supervision of adjudicated delinquent youth aged twelve to eighteen,counseling youth with a focus on grief and loss issues,development of treatment plans,USDA liaison,supervision of staff;training for all new staff and interns, assumption of the program directors duties when the director was absent, communicating effectively with all other professionals and the upkeep of statistics. Continuing training Family Group Decision Making:November 1998 Understanding Anxiety: October 1999 Play Therapy and Therapeutic Care of Children in Foster Care and Adoption: October 1999 Oppositional Behavior and ODD: 2000 Attachment and Bonding: January 2001 Verbal De-escalation and Personal safety: February 2002 Psychiatric Medications in Children Placed in Foster or Adoptive Care: March 2002 Building Skills in High Risk Families: June 2002 Confirming Safe Environments: September 2002 Foster Family Assessment Training: September 2002 EMDR; Basic Training: November 2002 Attachment and Bonding: February 2003 Understanding and Responding to the Sexual Behavior of Children: May 2003 Advanced Training for Special Advocates: September 2003 Helping Grieving Children and Teens: October 2003 Mediation Course: June 2006 References: Lutheran Family Services Human Resources Department: 1.800.579.9496; 363 S. Harlan, Suite 200,Denver,CO., 80226-3552. 11 Sharon Thomas: Supervisor at LFS from May of 1998 to December of 2003: 970.663.1039; 3733 Lincoln Court,Loveland,CO, 80538. Email: Skt1225@aol.com Diane Baird: LCSW Consultant: Private Practice. 720.217.9352. Maria Baladez: Co-worker at the Boulder County Department of Social Services: 303.250.1484; 640 Gooseberry Drive,#402, Longmont,CO., 80503. Email: mbass@co.boulder.co.us. 12 APPENDIX 2: Data Collection Instruments/Protocol Currently,Bidder uses face-to-face discussion to gather data regarding the needs of the foster children,the foster parents and the retention of placements for children in foster care. Bidder is actively seeking data collection instruments that provide a more quantitative measurement of the issues in the families and the needs of the families and children. 13 APPENDIX 3: Sample Consent Form Julie Box,LCSW Private Practice 1702 68th Avenue,Greeley, CO 80634 970.302.1471 Fax: 970.339.9036 Disclosure Statement Colorado law requires the following information be provided to all clients. Julie Box, Licensed Clinical Social Worker: License#: 992996 The Department of Regulatory Agencies regulates the practice of licensed and unlicensed persons in the field of psychotherapy. Concerns or complaints regarding the practice of psychotherapy may be directed to the State Grievance Board at 1560 Broadway, Suite 1370, Denver,Colorado, 80202,or call 303.894.7766. Confidentiality: Generally speaking, information provided by clients during treatment is legally confidential. Exceptions occur when a client is at imminent danger to self or others,when gravely disabled,when there is suspected child abuse or neglect,when the client's case is reviewed in supervision,consultation and training,or when ordered by a court of law. Regarding home studies,families are not"clients"as such and,although Ms. Box cannot discuss family information with individuals not involved with the case,the information gathered in the course of a home study is not confidential. The information gathered in the course of a home study is shared with the Weld County Department of Social Services(WCDSS)case coordinators,various caseworkers interested in placing a child in the home,the courts and, possibly,various attorney's involved in the child's case. Possible psychological, social and legal risks for the home study applicants include the sharing of personal information with strangers that may express some objection to a specific child being placed in or remaining in the applicant's home. Ms. Box attempts to minimize such risks by relating this information to the applicants. Regarding foster parent consultations, including individual,corrective action or group consultations,foster parents are not"clients"and,again,although Ms. Box cannot discuss information shared with individuals not involved with the case, information shared may be passed on to the WCDSS case coordinators and/or the child's caseworker. Ms.Box mitigates any risks to the foster parents by discussing the information to be shared with the foster parents prior to sharing information with the WCDSS case coordinators and/or the child's caseworker. Regarding relinquishment counseling,all information gathered in the course of the relinquishment counseling is recorded in the relinquishment counseling report and is then forwarded to the WCDSS caseworker and then to the courts and various attorneys involved in the child's case. Fair Selection of Participants: Ms. Box does not discriminate in any manner regarding selection of participants. She does not select or recruit participants. The WCDSS refers potential applicants and Ms.Box accepts all referrals from the WCDSS. 14 Absence of Coercion: All participation by the applicant(s)is voluntary. There is no required participation for home studies,relinquishment counseling, individual or group consultation. At any time,participants may withdraw from the process. However, regarding corrective action consultations,the WCDSS requires that identified foster parents participate with individual consultation. If the foster parents refuse to participate in individual consultation under a corrective action request,the WCDSS may revoke the foster parent's license. Foster parents are given the right to seek intervention of these services through the caseworker's supervisor. Collection of Information and Record Keeping: All recorded information, treatment plans,notes and reports are kept in locked filing cabinets at Ms. Box's office and kept on file for seven years. After seven years,the files are destroyed. Ms.Box's office computer and her laptop are password protected. Fee Statement: All Department of Social Services contractual fees are paid by DSS. Families in the process of a home study are required to pay fees for Colorado Bureau of Investigations(CBI)and Federal Bureau of Investigations(FBI)background checks. Private home study fee's are as arranged. Releases of Information: Parents will sign releases of information regarding the treatment of their children. Regarding home studies,consumers will sign any necessary releases of information as discussed with Ms. Box. Gifts: It is inappropriate and unethical for Ms.Box to accept any form of gift so please do not offer gifts. In addition, Ms. Box is required to provide consumers with the following information from the Division of Child Care, Colorado Department of Human Services, 1575 Sherman Street First Floor, Denver, Colorado, 80203-1714,phone, and 303.886.5958: 1. To review the licensing file of an adoption/child placement agency call: 303.866.5088. 2. To obtain a copy of all licensed adoption/child placement agencies in the state of Colorado call: The Division of Child Welfare,303.866.3228 or the Division of Child Care at 303.866.5958. I have read through the above disclosure statement with Julie Box and been informed of the proper procedure to fde a complaint to the Colorado State Grievance Board. Julie Box explained areas that were unclear to me and I understand clearly all of the preceding information. I have been informed of the degrees,credentials and licenses held by Julie Box. I have read all of the preceding information and understand my rights as a consumer and I have received a copy of this Disclosure Statement. By initialing here,I/we give consent for Ms.Box to email our completed home study to the referring WCDSS case coordinator/caseworker. 15 Signature of consumer Date Signature of consumer Date Julie Box, LCSW Date 16 Account Number: CO BOXJ 1700 Date: 2/20/07 Initials: DMM CERTIFICATE OF INSURANCE AMERICAN HOME ASSURANCE CO. C/O: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 This is to certify that the insurance policies specified below have been issued by the company indicated above to the insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the lamed insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Insured: Additional Named Insureds: JULIENNE E. BOX 1702 68TH AVE GRERT.FY CO 80634 Type of Work Covered: PROFESSIONAL SOCIAL WORKER Location of Operations: N/A (If different than address listed above) Claim History: Policy Effective Expiration Limits of Coverages Number Date Date Liability PROFESSIONAL/ 1, 000, 000 LIABILITY SWL-1919252 2/20/07 2/20/08 1, 000, 000 NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS POLICY AND HE OR SHE SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Convents: This Certificate Issued to: Name: JULIENNE E. BOX 1702 68TH AVE Address: GREELEY CO 80634 Au orized Representative gre„ Program Area Supervisor/Provider Meeting Verification/Comment Form Date of Meeting: 7 S" Program Area: 5/e2 /(24t/t att r f�;re.,647%tt Comments (to be completed by Program Area Supervisor): SAvsfeeP We/Z.L foe II e_ et/giro/40,cCl t% Rfnf4Am tt. 4itnCnnup5 mc..e t rezliviifonclic •J- is fin Pc.71ly t 672/IA ii�t/bnr1 • 41;o d g Sc .j flea' W.Q.2e 672/tA ?Ayam c e_Sirre/dive ,v-,ems (/ 1411 /fS a es Reg o t +e,Q P ' �&c- 9c cP, v- 51119-e rit-tt c at*Ali /law Rd nit *it•`s,e /ln.'ei A e•. pia en /l .n 7 yo v nt A. eiannc-, *iveii/ Set (/f An rot,e,.�f/�-. Pot me( /.ac Pa es/s 714/2a v;z1 f,as .e l"''/ /t' eQ I./eta/an /9..ed Signature of Program Area Su m• isor § , 88888888888888 8 888888 8 8 2#k;#k;aage■## # asaasa a a § Is x 8 } „| ! Sc,. X8888888888888 a 88.888 8 8 § #;a2;:asasssag ; ;...## ■ - §&/ �� ,!| § §o| 88888888888888 8 888888 e 2 § l2;a2a;#e##g#; g: §'■a; K ! | & & 69 69 _ ! 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Co ■ 88588„88888888888 @ 8 8 , || . §napaaaassasa#a■a 7 ■ lit | § | \ e -- 0 §§ |§|§ a gg 727 \882;2==========z \ 8 Re £4III § 2 \ | r k § | ■ & k § § , § kk5 § § | ii � ( | | § 1 | \ S W . al _ \ =� || � j ) k| _ o | k EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP 05.17.2007 Julie Box,LCSW 1702 68th Avenue Greeley, CO, 80634 970.302.1471 Re: Response to recommendations made on: Bid#01-IFT-07(RFP 07008)Mediation and Facilitation under IFT Bid#007-FPC-07(RFP006-00A)Foster Parent Consultation Bidder accepts recommendations made and will meet recommendations in the following fashion: Response to recommendations from Weld County DSS for Mediation: • This bidder offers a bilingual translator for any Spanish speaking clients at no extra charge to the County. This bidder pays a set amount for interpretations as agreed upon by bidder and translator. • This bidder will meet all PIP requirements included in the initial bid from the Weld County DSS. This includes meeting placement changes by focusing on the needs of permanency for children in out-of-home-placement,maintaining cultural and racial connections and encouraging communication between families and the Department caseworkers. Response to recommendations from Weld County DSS for Foster Parent Consultations: • Bidder assures that all Program Improvement Plan requirements under the Foster Parent Consultation program will be met. These PIP requirements include: Placement changes, independent living,maintaining cultural and racial connections,monthly face-to-face visits with caseworkers,timely initial assessment within two weeks of placement and health needs identified and services provided. Please refer to this section addressed in bidder's initial bid for more detail. • Literature citations used with Foster Parent Consultations include Parenting with Love and Logic by Foster Cline and Jim Fay; Adopting the Hurt Child by Keck and Kupecky; Fostering Changes by Richard Delaney as well as bidder's System's Based approach to supporting foster families,the children in their home and the preservation of placements for children placed out of their homes. As stated in the initial bid,bidder has a BA in Psychology, a Master's degree in Social Work and is a Licensed Clinical Social Worker in Colorado. Bidder has 21 years of experience in working with foster families,children in out-of-home placement and birth families. All of this experience is tapped to help support the permanency of placements. Please feel free to contact bidder at the above number to clarify any questions. Sincerely, Julie Box,LCSW • (111H- DEPARTMENT OF SOCIAL SERVICES P.O. BOX A 1 GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 OFax Number(970)353-5215 COLORADO May 11, 2007 Julie Box, Private Practice 1702 68 Avenue Greeley, CO 80634 Re: Bid#01-IFT-07(RFP 07008)Mediation&Facilitation under IFT Bid#001-FPT-07(RFP 006-00C)Foster Parent Training Bid#007-FPC-07(RFP 006-00A)Foster Parent Consultation Bid#004-HS-07(RFP 006-00B)Home Studies and Relinquishment Counseling Dear Ms. Box: The purpose of this letter is to outline the results of the Bid process for PY 2007-2008 and to request written information or confirmation from you by Monday, May 21, 2007. The Families,Youth,and Children Commission appreciates your interest in providing services for families in Weld county.This year,strides were made in structuring an RFP that is clear and concise,and more user friendly, for both prospective bidders and evaluators. It is important to stress the value of following formatting guidelines and addressing the required sections concisely and appropriately. A. Results of the Bid Process for PY 2007-2008 • The Families, Youth and Children(FYC)Commission recommended approval of your Bid# 01-FPT-07,Foster Parent Training program area,and your Bid#004-HS-07,Home Studies, Updates,and Relinquishment Counseling for inclusion on our vendor list.No conditions or recommendations were attached to these bids. • The Families,Youth and Children(FYC)Commission recommended approval of your Bid# 01-IFT-07, Mediation&Facilitation under the Intensive Family Therapy program area with the following recommendations. Recommendations: 1. The approved bidder will pursue bilingual interpreters/translators/staff in order to better serve bilingual and monolingual clients.This may include offering incentives, accommodations, and encouragement to Spanish bilingual interpreters,translators, and staff. 2. The bidder will provide more information relating to PIP requirements. • The Families,Youth and Children(FYC)Commission recommended approval of your Bid# 007-FPC-07,Foster Parent Consultation program area with the following conditions. Page 2 Julie Box,Private Practice/Results of Bid Process for PY 2007-2008 Conditions: The bidder must clarify and submit information that was not addressed or included with the original bid submission, including; 1. Program Improvement Plan(PIP); 2. Literature citations for evidenced-based practices. B. Required Response by FYC Bidders: Concerning FYC Commission Recommendations: You are requested to review the FYC Commission recommendations and to: 1. accept the recommendation(s)as written by the FYC Commission;or 2. request alternatives to the FYC Commission's recommendation(s); or 3. not accept the recommendation(s)of the FYC Commission. Please provide in writing how you will incorporate the recommendation(s)into your bid. If you do not accept the recommendation, please provide written reasons why.All approved recommendations under the NOFAA will be monitored and evaluated by the FYC Commission. Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the conditions, you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and conditions.Please respond in writing to Tobi Vegter, Core Services Coordinator,Weld County Department of Social Services,P.O.Box A, Greeley,CO, 80632,by Monday, May 21, 2007, close of business. . If you have questions concerning the above,please call Tobi Vegter,970.352.1551,extension 6392. Sincerely, a. J A. Gri o,Dir or cc: Juan Lopez, Chair, FYC Commission Tobi Vegter, Core Services Coordinator Gloria Romansik, Social Services Administrator Weld County Department of Social Services Notification of Financial Assistance Award Core Funds Type of Action Contract Award No. X Initial Award FY07-CORE-0007 Revision (PY 07-08 RFP-FYC-006-00A; 002-FPC-07) Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Jubilee Retreat Center-Lori Kochevar,LLC Ending 05/31/2008 Foster Parent Consultation 1024 81h Street Greeley,CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial This program provides foster parent consultative Assistance Award is based upon your Request for services in the areas of(1)specialized consultation Proposal(RFP). The RFP specifies the scope of training groups, (2)individual foster parent services and conditions of award. Except where it consultation,(3)mandated corrective action is in conflict with this NOFAA in which case the consultation, (4)trainings as identified by the NOFAA governs,the RFP upon which this award is Department, (5)and team-building staffing at the based is an integral part of the action. discretion of the caseworker. Foster parent consultations will be provided through group Special conditions consultation services. Capacity is 10 groups per 1) Reimbursement for the Unit of Services will be month, an average of eight participants per group. based on a per group rate. Group participation is limited to one group session 2) Rates will only be remitted on cases open with, and per foster parent per month. Individual consultation referrals made by the Weld County Department of services will only be provided when approved by the Social Services. Resource Services Manager or Child Welfare 3) Requests for payment must be an original and Administrator of Social Services.Bilingual-Bicultural submitted to the Weld County Department of services are available to all families. South County Social Services by the end of the 25th calendar day services are available. following the end of the month of service.The Cost Per Unit of Service provider must submit requests for payment on forms approved by Weld County Department of Per individual foster parent Social Services.Requests for payments submitted participant per episode Treatment Package(Groups) $58.33 90 days from the date of service,and thereafter, Per Hourly Rate will not be paid. Treatment Package Intensive(Individual) $90.00 4) Requests for payment must include original client Other Services (Court Testimony) $75.00 verification signatures(blue or red ink preferred) and dates and hours of service. Enclosures: X Signed RFP: Exhibit A 5) The Contractor will notify the Department of any X Supplemental Narrative to RFP: Exhibit B change in staff at the time of the change. Recommendation(s) X Conditions of Approval Approvals: Progra O icial: By By � /U David E.Long, Chair Ju . G e ,Directp Board of Weld Count Commiss ners We County Dfpartment of Social Services Date: JUN 18 200/ Date: (9/KI E1 �JD7-/6ci27 EXHIBIT A SIGNED RFP D C- " � INVITATION TO BID BID 001-07 DATE: February 28,2007 BID NO: 001-07 RETURN BID TO: Monica Mika, Director of Administrative Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 Third floor, Centennial Building, Purchasing Department SUMMARY Request for Proposal for: Colorado Family Preservation Act—Core Services Program Deadline: Friday, March 30,2007, 10:00 a.m. (MST) The Families, Youth and Children Commission, an advisory commission to Social Services, announces that competing applications will be accepted for approved providers pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2007,through May 31,2008, at specific rates for different types of service,the County will authorize approved providers and rates for services only. This program announcement consists of the following documents,as follows: • Invitation to Bid • Main Request for Proposal (All program areas) • Addendum A—Program Improvement Plan Requirements(by program area) • Addendum B—Scope of Services (by program area) • Core Budget``Form Delivery Date 3) ) r1 O (After receipt of order) //� � 1�'� I� BID MUST BE SIGNED IN INK /y Program Area: 8).404 I'� C t�1?�4 JCt/fL+�') ( 2( thext/)TYP ORED SIGNATURE VENDOR Lori Kochevar Handwritten Signature By Authorized Officer or Agent of Vendor 1024 8th Street /� ADDRESS Greeley, CO 80631 TITLE CO(j.YlE2— DATE 51 161 07 PHONE# C1-O 35 - 2.3 7 .3 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Foster Parent Consultation Program Purpose: The purpose of the Foster Parent Consultation Program is to provide on-going training and consultation to foster parents so that they are better able to provide positive healing relationships for the children they serve. Design: This program is designed on a strength based family preservation model of service. This model is proactive as well as promptly responsive to the foster parents in order to decrease placement disruption for foster children. This program provides a variety of training group tailored to meet the individual needs of the foster parent. In addition, when requested by the department, prompt individual consultation by phone or appointment will be available to work with foster parents in accordance to their needs. In our experience, during a crisis the need for intense consultation decreases after the initial solution orientated planning sessions. This program can provide training opportunities to help foster parents meet the state requirements for on-going professional development. The information discussed during consultation services is shared with the department of Social Services and appropriate releases are sighned. Why Services are Important- Foster Parents have the difficult role of providing a loving relationship and a structured home environment to children whom have most often been severely abused and or neglected. These children often have a distorted sense of self. Children in the Foster Care system often act out their feelings of unworthiness by displaying behavior that is destructive to self and others. Foster parents need to be able to access consultation services quickly to assist them in better understanding what the child/children are going through and how to respond to their behavior. As caretakers they also need awareness and skills to address their own issues in order to not repeat maladaptive interactions behavior with the foster children. Consultation - Specialized Consultative Training will consist of short-term, solution orientated training that facilitate empowerment of the foster parents. Services will be able to be accessed through a call to the specific provider and will be provided in an expedient manner. It is common for caregivers to feel anxious, overwhelmed, depressed and or resentment when working with children that are experiencing all of these same feelings. Receiving a response from an objective consultant in a timely manner can help the foster parents to regain their composure and confidence to act instead of react to the challenging behavior exhibited by many foster children. 2 Table of Contents —Foster Parent Consultation I. Invitation to Bid 1 II. Abstract 2 III. Table of Contents 3 IV. Target/Eligibility Populations 4 V. Project Narrative and Supporting Documentation A. Types of Services Provided 5 B. Measurable Outcomes 8 C. Service Objectives 11 D. Workload Standards 12 E. Staff Qualifications 13 F. Program Capacity per Month 15 G. Internal Tracking and Billing Process 16 Supporting Documentation H. Literature Citations 17 I. Confidentiality and Participant Protection/Human Subjects 19 VI. Budget Forms 23 VII. Appendices 1 —Resumes 27 2 —Data Collection Instruments/Protocol 31 3 —Consent Forms 35 3 Target/Elegibility Populations A. Number of clients to be served We would be able to provide up to ten training groups a month. We estimate that there would be an average of eight participants at each training group. We anticipate that on the individual component of this program that we would spend two hours a week providing services for foster parents. Henceforth, 2 hours a week x 52 weeks provides 108 client hours a year. We anticipate that the average foster parent using our services would attend 11 hours of training group a year, which would mean that we would serve 80 individual foster parents a year. We anticipate that individual crisis consultation would be available to 40 families for 6 hours of individual service a week. B. Families Served. We anticipate serving 40 foster families, 80 foster parents. C. Sub total who will receive bicultural / bilingual services. All services provided will be in a manner which is sensitive to the culture of origin of the family. All of the therapist have extensive training in cultural competency issues. In addition, Lori Kochevar was the chair of the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. Lorenza Perezerdia, a bilingual provider would be available for any Spanish speaking families and written program materials will also be available in Spanish. D. Consultation services will be available in South Weld County. Currently We are running two training groups in South Weld County. Services will be available where the foster parents live. E. The monthly program capacity per group would be 10 foster parents per group. Currently we are running 8 groups that would be able to served 80 foster families. If needed, we could expand the number of hours we are available to do 10 groups a month. F. The monthly average capacity per group would be 8 foster parents per group. G. Average stay in the program - The average stay in this program would be 12 months. 4 Section A- Types of Service Provided A. Specialized Consultive Training Groups- will be provided around these and other key issues that will assist foster parents: initial placement adjustment, transition, separation and loss, effective discipline for children raised with inconsistent parenting, behavioral management, child development, the effects of visitation, legal risk and commitment issues, importance of documentation , work with foster parents and caseworkers around interpretation and implementation of treatment plans, solution oriented planning, and balancing your own /couples/biological children's /birth families/ systems/foster children's needs. Both consumer elicited and mandated consultation for critical care foster parents and corrective action plans will be provided. Content of the consultation will be shared with the department staff to work toward placement planning for children. . We anticipate providing eight groups a month with an average of eight foster parents per group, total number of client hours provides over one year would be 1912 hours. B. Individual Foster Parent Consultation- on a time limited basis will be provided with a sighned referral from social services. Content of the consultation will be shared with the department staff to work toward placement planning for children. Number of anticipated reguests for individual consultation services per month is between 3-8 depending on the occurance of specialized issues in the foster homes C. Mandated training's for foster parents under corrective action plans will be provided as directed by the Department of Social Services D. Training's - Training needs will be identified by the department. The consultation group participants will receive two training credit per month. Before training's are offered they will be approved and or requested by the department. The budget for training will be determined on a per participant - event basis. All foster parents in Weld County will be invited to participate in each event. Evaluations of training's provided will be conducted. E. Therapeutic services for foster children will not be provided in a home where consultation services are in place. F. Team building staffing - At the foster parents request and if the caseworker is willing, a team building meeting with the foster parent and the caseworker will 5 be held to address ongoing concerns and to develop a solution oriented plan. This will be coordinated with the administration at DSS. This will help develop a unified plan and address any miscommunication or differences in opinion before court. This will increase the probability that the systems involved are able to work together for the best interest of the foster children in their collective care. All assessments and recommendations will be shared directly with the children's caseworker. G. Agree to comply with 19-1-120 CRS., which requires that reports of child abuse and any identifying information in those reports are strictly confidential. All federal laws will be followed including the confidential reporting of suspected child abuse. H. Proffesional Objectivity - will be used at all times a trainer is in contact with foster parents. Trainers will focus on providing psychologicl consultation and parenting support to foster parents that improves the foster parents competency, family conflict management and ability to effectively access resources in the community. Providers will meet with all interested parties to discuss any disagreements over the implementation of a treatment plan if beneficial for the case. I. Program supervizer agrees to meet with the Department staff on a monthly basis to receive program feedback. In this program consultation funds will not be used to fund therapy or drug and alcohol services for foster parents. Interanaly we meet weekly to determine the appropriateness of all services being provided and to staff if additional referrals would be helpful in this case. If deemed appropriate a referral to a mental health provider, or ADAD professional will be made. Program Components: A. Consultation - Both foster parent elicited and mandated consultation for critical care foster parents and corrective action plans will be provided. Short term, problem solving services will facilitate personal empowerment of the consumer. It is imperative that foster parents have access to a variety of resources to support their own psychological well being and to prevent burnout. B. Specialized Consultive Training groups - will follow a topical format that leaves time for questions and answers prior to ending the session. The topics 6 will be provided by the department of Social Sevices, and the cirriculum will be in alighnment with the goals and objectives of Weld Conty Social Services. Underlying focus will include collaborative team work with all parties working toward serving the best interest of the child in placement, i.e. DSS, GAL, Therapist, etc. C. Resource and Referrals - This program will facilitate the development of internal and external resources to enhance the foster parents ability to meet the demanding requirements of their role. Foster parents will be able to access written information on specific diagnostic, behavioral, and developmental issues specific to the foster children's special needs. See appendix A for a partial listing of topics available. In addition, it is important to link foster parents to appropriate community resources and with each other. We will facilitate knowledge of and encourage use of available community resources , and make appropriate referrals. See Appendix A for listing of current community resources available to foster parents. D. Team building staffing - When requested by the foster parent and agreed upon by the caseworker the consultant will facilitate a group meeting with the foster parent and the case worker. This staffing will be coordinated with the administration at DSS. The focus of the team building will always be on the foster child's needs. We will address ongoing concerns and develop a solution oriented plan. This will increase the probability that we are able to work together for the best interest of the foster children in the systems care. E. Performance 'improvement Plan (PIP) compliance- Facilitators will be oriented to and focus upon all PIP goals throughout entire training. 1. Retention of children in placement will be focused upon to maintain the permanency needs of children in out-of-home placement. We will provide trainingive services for foster parents to help maintain placements. At no time shall a Trainer provider advise for a child to be removed from placement. 2. Independent Living - Trainers will provide specific instruction on the importance of cooperating with a child's case plan for independent living and coach Foster Parents how to mentor and teach foster children daily life skills. 3. Maintaining Cultural and Racial Connections — Trainers will teach the importance of maintaining the cultural and racial identify of children in their care. We will encourage the foster parents encourage the foster childs cultural , resources, holidays,community connections, spiritual needs, etc., We will also train to document these events for the caseworker. 4. Monthly Face-to-Face Visits with Caseworkers —Foster Parent Core Training will include instruction on effective communication tools to enhance the relationship between foster parents and caseworkers. Better communication will enable monthly visits to occur in spite of schedule changes, illness, vacations, etc. Foster parents are to be trained to be proactive, contacting the caseworker and supervisor if need be if children in their care are not being contacted as required for the monthly face-to face meeting. 5. Timely Initial Assessment within Two Weeks of Placement— Training curiculum will address the importance of foster parents setting up medical and dental appointments at the time of placement (two weeks for medical/eight weeks for dental for children over three years). A Lists of Medicaid providers is provided at each training. Assertive communication with caseworkers at the time of placement will clarify mutual responsibilities and expectations. 6. Health Needs Identified and Services Provided—Foster Parent Core Training curriculum will address the role of foster parents in working with caseworkers in identifying health needs and services. Also training will include assignment of caseworker/foster parent responsibilities. Section B - Measurable Outcomes When clients are self-referred to this program they will choose training's, goals, and objectives according to their perceived needs. In the case where the foster parent is sent for disciplinary action or critical care, the consultant and the foster care coordinators will help design specific outcome measures appropriate to the situation. It is important to understand that as in any consultation process that these skills, concepts, and techniques need to be understood and practiced before foster parents will be able to consistently apply them with the children they serve. A. After involvement in this program component foster parents will be able to identify an improvement in their ability to deal competently with household management issues, as measured by a pre and post assessment inventory - Volume 7 Compliance Checklist. • Increase knowledge of and understanding of Volume 7 requirements for foster parents. 8 • Increase understanding of importance of documentation and timelines concerning medical, dental and, medication monitoring • Increase awareness of state and federal requirements in Volume 7 regarding higher standards of care required by foster homes. • Increase awareness of and adherence to household cleaning, safety, and maintenance requirements outlined in Volume 7. • Increase awareness of resources available to assist with budgeting and purchasing resources for foster children. B. After involvement in this program component foster parents will be able to identify an improvement in their parental competency as measured by a pre and post assessment of skills needed to implement non-power based parenting effectively. • Increase adherence to and understanding of state and federal requirements regarding discipline policies. • Increase understanding of characteristics of children raised with inconsistent parenting. • Increase ability to use and identify alternative discipline strategies. • Increase ability to acknowledge and listen to the child's concerns with empathy. • Increase recognition of communication barriers. • Increase ability to set effective limits using choices and enforceable statements. • Increase ability to use empathy and consequences effectively. • Increase ability to facilitate problem solving skills in foster children. • Increase understanding of the importance of positive relationship message when delivering negative content message. • Increase ability to redirect mis-behavior. • Increase understanding of foster children's need to learn about cause and effect thinking in an emotionally neutral non blaming environment. C. Foster parents will increase ability to access community, state local and federal government resources independently so that they are able to improve their ability to meet the specialized needs of each individual foster child they serve. This will be measured by self report on evaluations completed by foster parents after consultation and tracking the number of referrals made by this program. • This program will facilitate empowerment for foster parents by providing clear user friendly information about the resources available in the community and within the local, state, and federal government. 9 D. .Foster parents will obtain higher skills and competency levels in fulfilling their role in providing a healing relationship for children in out of home placement. This will be measured and monitored through the development of individualized consultation service objectives which will be evaluated at the exit interview by the foster parent and the consultant. • Increase ability to accept the child as s/he is • Increase ability to deal with child's behavior in the context of a healing relationship. • Increase ability to support what the foster child is going through. • Increase understanding of dynamics of child abuse and neglect. • Increase understanding of developmentally appropriate expectations and the effects of trauma on development. • Increase understanding of the factors influencing the child's reaction to parent separation and loss. • Increase understanding of cultural competency issues that effect foster parenting. • Increase understanding of roles and dynamics of children that grow up in homes where parents have substance abuse issues. • Increase ability to anticipate special emotional needs. • Increase attunement to attachment and bonding issues. • Increase understanding of the need for foster children to have empowering corrective experiences. • Increase understanding of regressive behavior and the need for reparative bonding within the relationship. • Increase understanding of the need for consistency and structure to establish trust. • Increase understanding of the effects severe boundary violations have on children and how to facilitate the development of health boundaries in children. E. Foster parents will positively meet their own and the needs of their biological children's in adjusting to and dealing with the presence of foster children in the home. This will be measured and monitored through the development of individualized consultation service objectives which will be evaluated at the exit interview by the foster parent and the consultant. • Increase ability to set and maintain outside interests and relationships. • Increase ability to communicate effectively with the multiple systems involved in foster children lives. • Increase ability to set and teach children how to set effective physical and emotional boundaries. • Increase awareness of symptoms of burnout. to • Increase understanding of the importance of knowing when to access training. • Increase awareness of grief and loss issues for foster families when foster child reunifies with family of origin. • Increase awareness of inappropriate coping strategies (i.e , substance use, denial, eating, fault-finding, passivity, revenge, withdrawal or excessive worry, etc...). • Increase ability to use appropriate coping strategies (i.e , diversions, balance, conflict resolution, flexibility, networking, affirmations, assertiveness, contact, enforceable limits, linking, organization, problem solving, re-labeling, providing choices, time management, relaxation, self- care, exercise, commitment, prayer, worship, surrender, etc...). F. Foster Parents will clearly understand and be able to support the Performance Improvement Plan goals set by the department. • Increase awareness of the effect of placement changes on the childs well being. • Increase understanding of the importance of Indepentant Living skills for foster children. • Increase understanding of the importance of culturaul and racial connections for the well being of the child placed in their home. • Increase in communication skills needed to communicate willingness and receptivity to monthly face to face contact with caseworker. • Clear understanding of the requirement to set up appointments - medical with in 2 weeks and dental with in eight weeks for children over 3. • Increase understanding of roles and responsabilities in working with caseworker to identify health needs for child. Section C - Service Objectives We have the following service objectives: A. Improvement of family conflict management. It is imperative that foster parents are aware of and uphold regulations outlined in Volume 7 regarding the need to maintain a safe household environment, that is adequately cleaned and maintained. In addition, foster parents need to be able to budget their resources so that they are able to provide for the children they serve. Specific aspects on this service objective may include the following; consultation and referrals. This component will be measured through the foster parents ability to reach specific individualized consultation goals, a pre and post assessment tool and program evaluations. 1I B. Improved parental competencies in household management. Foster parents need to have the capacity to maintain a solid relationship with each other, with their own biological children and with the foster children they serve. In addition, foster parents need to provide developmentally appropriate care, nutrition, hygiene, discipline, protection, guidance and supervision. This service objective will be met through training groups and consultation. This component will be measured through the foster parents ability to reach specific individualized consultation goals, a pre and post assessment tool and program evaluations. C. Improve ability to access resources. Foster parents shall be empowered to access resources in the community, as well as resources available thorough the local, state and federal government. This program will encourage networking with other foster parents. This service objective will be provided through training groups, linking, consultation, and referrals. This component will be measured through foster parent evaluations, ability to reach specific individualized consultation goals, and record of number of referrals made. D. Address specific issues outlined in referral- all services shall be solution focused and address the specific issues specifed by the Department of Social Services on the referral form. This component will be measured through foster parent evaluations. E. Performance Improvement Plan- MI components of the PIP will be addressed in training. This component will be measured through the foster parents ability to reach specific individualized consultation specifically related to the PIP, a pre and post assessment tool and program evaluations. Section D - Workload Standards A. The program has the capacity to serve 80 foster parents. Consultants would spend up to forty four hours a month providing services. With an average of eight foster parents per group, total number of client hours provides over one year would be 1912 hours. B. Number of anticipated reguests for individual consultation services per month is between 3-8 depending on the occurance of specialized issues in the foster homes. 12 C. Staff- There are four Family Preservation Specialists. Lori Kochevar M.S., L.C.., LLC will serve as a provider and the program supervisor for Sharon Benson, M.A., Barb Jetley, M.A. Lorenza Perezerdia is available specifically for spanish speaking foster parents. All providers have extensive experience in Family Services as documented in the attached resumes. D. The caseload will be between 2-10 families per therapist. The caseload of each therapist will depend on matching the specific needs of the referred family with the therapist area of specialty. E. Hours - Total number of clinical time devoted to this program equals two hours a day, eleven hours a week, and forty four hours a month. F. Supervisor- This contract would be supervised part time by Lori Kochevar M.S. L.P.C. who would monitor the project for program compliance and clinical excellence. G. Insurance - - Lori Kochevar M.S., L.P.C., LLC carries one million three million liability on the company and each one of the independent contractors connected to this bid. In addition, Lori Kochevar M.S., L.P.C., LLC carries a general liability policy related to accident or injury on the premises. The State of Colorado is named as an additional insured on this policy. Each individual provider also carries a one million three million liability insurance. Both general and group liability coverage's are attached. All therapist providing services are self employed and choose to be exempt from workman's compensation and Employer's liability insurance. Section E - Staff Qualifications A. All the providers meet the minimum qualifications needed for both education and experience. All providers have their Master's Degree or Bachorlate Degree's in Counseling. In addition, the therapists have between 6-12 years a piece providing services for families. See Resumes in Appendix C. B. Staff available for this project consists of four experienced consultants that have a similar core value of clinical excellence. We believe in providing strength-based, family-focused services that empower the families we serve. Another strength of our staff is our diverse areas of specialties. 13 • Lori Kochevar a licensed professional counselor has extensive experience and training in providing services and supervision using the family preservation model. She has specialized training in substance abuse, trauma, grief, and domestic violence. In the last ten years Lori has developed and facilitated multiple training's that emphasize experiential learning opportunities. Many of these training's were developed specifically for Foster Parents, while others were created for families, school personnel, and service providers across the state. • Sharon K. Benson has been in Greeley since 1979. After graduating in 1985 with her masters in Professional Psychology with an emphasis in trauma, she began a private psychotherapy practice and provided consultation to a number of local non-profit agencies. She has worked with support service organizations for over twenty years in the areas of Domestic Violence, adolescent offenders, disabilities and family preservation. For the past 10 years Sharon has taught classes in the Psychology, Business and Emergency Service departments at Aims Community College. The most recent turn in her career has led into the Early Childhood field where she has received specialized training in assessment, behavior management, positive parenting and services to children with disability or mental health issues. • Barb Jetley is a licensed professional counselor. She received her Master's degree from the Adams State University. Barb has been in the field for the last sixteen years and has extensive experience working with many different clinical populations. Most recently, she serves as the clinical coordinator for children under six and their families for Project BLOOM. She has worked as a family preservation specialist, domestic violence counselor and an outpatient clinician. Along with being skilled consultants, due to our extensive background as therapists we are knowledgeable of the systems (i.e.. biological families, social services, mental health services, legal services, etc..) that foster parents need to interface with as advocates for the children that are placed with them. C. New Caseworker Training- Lori Kochevar, M.S. L.P.C. the supervisor for this bid has attended the Core training for Supervisors through the State of Colorado, she will oversee the work of all other staff to make sure it is in compliance with requirements. In addition, Jenna Reed who is working on bids submitted from this agency has successfully completed new caseworker training. 14 D. Risk assessment knowledge is taught during the foster parent core training; in addition all staff is versed in multiple levels of risk assessment and are able to address risk issues as they occur during interventions. Section F — Program Capacity per Month A. Total number of clients to be served in the twelve month program has been calculated as follows. We would be able to provide up to ten training groups a month. We estimate that there would be an average of eight participants at each training group. Henceforth, at ten training group a month, x twenty hours, x eight participants, x 11 months this part of the program would provide 1600 hours of service a year. We anticipate that on the individual component of this program that we would spend two hours a week providing services for foster parents. Henceforth, 2 hours a week x 52 weeks provides 108 client hours a year. We anticipate that the average foster parent using our services would attend 11 hours of training group a year, which would mean that we would serve 80 individual foster parents a year. We anticipate that individual crisis consultation would be available to 40 families for 6 hours of individual service a week. Total number of client hours provides over one year would be 1912 hours. B. Families Served. We anticipate serving 40 foster families, 80 foster parents. C. Sub total who will receive bicultural / bilingual services. All services provided will be in a manner which is sensitive to the culture of origin of the family. All of the therapist have extensive training in cultural competency issues. In addition, Lori Kochevar was the chair of the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. Lorenza Perezerdia, a bilingual provider, would be available for any Spanish speaking families and written program materials will also be available in Spanish. D. Consultation services will be available in South Weld County. Currently We are running two training groups in South Weld County. Services will be available where the foster parents live. E. The monthly program capacity per group would be 10 foster parents per group. Currently we are running 8 groups that would be able to served 80 15 foster families. If needed, we could expand the number of hours we are available to do 10 groups a month. F. The monthly average capacity per group would be 8 foster parents per group. G. Average stay in the program - The average stay in this program would be 12 months. Average groups per week in the program would be 2 per week, spread throughout the month. Section G — Internal Tracking and Billing Process A. Description of process is as follows: • All records for the month (i.e. contact notes, client verification form with signature, and billing to DSS) are kept in the same file. These are organized as follows: Left pocket has contact notes, client verification form with signature in the order that they are billed. All group and training session signatures are at the back. Right pocket has monthly billing submitted and receipt of payment. • Time with the client is only billed for face-to-face contact. On face-to-face contact the client signs the verification sheet provided by DSS which indicates the date and amount of time seen. • Subcontractors are responsible for sending an original copy of contact notes and client verification form with signature by the 5th of the month. This information is kept in an individual consultant file for the year. Subcontractors are paid by LLC when the payment for services is received from DSS. This is tracked in with the consultant's file. • The bill for the county is prepared monthly using the following guidelines from the RFP (page 20 of 30 a, b-1, 2 & 3): We report expenditures and case disbursement at agreed upon times. 16 Submit monthly FYC completed billing forms to Ms. Andrea Shay, Core/PRT Caseworker, on or about the 10t day of the month after the month following the month the services were provided. • The provider furnishes the following deliverables required to verify services provided during the service month. The completed deliverables must be received by Social Services no later than the 25th day of the month following the dates of service. • The required deliverables are 1.) Authorization for Contractual Services, 2.) Request for Reimbursement, and 3.) Client Verification Form. The Authorization for Contractual Services will include provider name, address, and phone number, provider billing contact and phone number. It will also include the program area, dollars ($) billed, original signature and month of service. Request for Reimbursement will include the client information (TRAILS or case ID number when available, rate, units billed and date(s) of service. The Client Verification Form will include the client's name, date, time of service, hours per service and original client signatures signed at the time of service. Section H — Literature Citations Acosta, V. (1991). Integrating Experiential Learning and Critical Inquiry in Health Education. Paper presented at the annual meeting of the American Educational Research Association, Chicago. Baslow, R., & Byrne, M. (1993). Internship Expectations and Learning Goals. Journalism Educator, 47(4), 48-54. Cantor, J. (1995). Experiential Learning in Higher Education: Linking Classroom and Community. (Report No. 7). Washington, DC: The George Washington University, Graduate School of Education and Human Development. Chrestman, K. (1995). Secondary exposure to trauma and self-reported distress among therapists. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 29-36). Lutherville, MD: Sidran Press. Cranton, P. (1989). Planning Instruction For Adult Learners. Toronto, Canada: Wall & Thompson. Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social Work, 48, 451-459. 17 Janov, A. (1996). Why You Get Sick, How You Get Well. West Hollywood, CA: Dove Books. Jernstedt, G.C. (1995). Experiential Components in Academic Courses. In R. Kraft, & J. Kielsmeier(Eds.), Experiential Learning In Schools Of Higher Education (pp. 357-371). Dubuque, Iowa: Kendall/Hunt Publishing Company. Knowles, M. (1977). The Modern Practice of Adult Education: Andragogy Versus Pedagogy.New York: Association Press. Knowles, M. (1980). The Modern Practice of Adult Education: Andragogy Versus Pedagogy. (2nd ed.). Chicago: Follett. Meichenbaum, D., & Fitzpatrick, D. (1993). A constructivist narrative perspective on stress and coping: Stress inoculation applications. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (2nd ed., pp. 706-723). New York: The Free Press. Neumann, D. A., & Gamble, S. J. (1995). Issues in the professional development of psychotherapists: Countertransference and vicarious traumatization in the new trauma therapist. Psychotherapy, 32, 341-347. Pearlman, L. A., & Saakvitne, K. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W. W. Norton. Pearlman, L. A., & MacIan, P. S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 588-565. Pert, C. (1997). Molecules of Emotion. New York: Scribner. Post, Bryan & Forbes, H., (2006) Beyond Consequences. Logic and Control. A Love Based Approach to Helping Attachment- Challenged Children with Severe Behaviors. Florida; Beyond Consequences Institute. Rossi, E. L. (1986). The Psychobiology of Mind-Body Healing: New Concepts of Therapeutic Hypnosis. New York: W. W. Norton. Rossi, E. L., & Cheek, D. (1988). Mind-Body Therapy: Ideodynamic Healing in Hypnosis. New York: W. W. Norton. Ryan, It M., & Lynch, J. H. (1989). Emotional autonomy versus 18 Schore, A. N. (1994). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Hillsdale,NJ: Lawrence Erlbaum Associates, Inc. Walter, G., & Marks, S. (1981).Experiential Learning and Change. New York: John Wiley & Sons Section I— Confidentiality and Prticipant Protection A. Protect Clients and Staff from Potential Risks • The foreseeable physical, medical, psychological, social, and legal risks to participating in skills building parenting work are minimal. All documents will be kept confidential as outlined in the confidentiality section of this document. Since this work often involves discussing unpleasant aspects of the client's life, clients may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. Clinicians are trained to watch for signs of traumatic recall that would indicate the client is outside of the zone where they are able to modulate their responses. In the event that a traumatic memory is retriggered clinicians involved are trained to help a client re-assimilate into the present moment before ending a session. If it becomes apparent that the client is in need of additional therapy services the clinician will address this issue with the treatment team. In addition, if a clinician assessed that during a session a client is a danger to them self's or others, they would take the appropriate steps to ensure safety. This may include a referral to the emergency room evaluation team to access the need for higher level care through the medicade mental health program at Northrange Behavioral Health Care. B. Fair Selection of Participants • In this program we would never exclude or discriminate participation on the basis of age, gender, religion, or racial/ethnic background. We are open to families that have children between the ages of 0-12 as well as referrals of homeless youth, foster children, children of substance abusers, pregnant women, and fathers. • In that this is an early intervention, working with children 6 and under as the identified client with siblings up to the age of 12 is the most appropriate population for us to work with. Mother appropriate population would be a teenage mother with an infant or pre-natal bonding. 19 + We will recruit and select participants from referrals provided through social services. Opened to all referrals that are not deemed inappropriate for services due to danger to others or inability to benefit form services provided. C. Absence of Coercion • Participants in this program will be selected through the referral source and participants willingness to be involved. Even with court ordered clients it is up to their own volition if they will choose to participate in any particular program. • Ultimately all participation is voluntary. It is our responsibility to report participation and progress to the referring agency. Volunteer's participants will be told that they are welcome to receive services through or program our one that best meets their needs. D. Data Collection • We will collect data from participants themselves, family members, teachers, and other parties connected to the case. We will obtain a specific release of information from the participant for any one we obtain data from. During each case as deemed appropriate to the needs of the family we may collect data from school records, interviews, psychological assessments, questionnaires, and observation from other parties privy to the case information. • Our information is collected in professional, home-based and natural settings facilitating observational techniques and environmental assessments. When collecting data through questionnaires or interviews, we are sure to obtain a private space to secure confidentiality • Provided in Appendix 2, are all Data Collection Instruments/Interview Protocols and releases. E. Privacy and Confidentiality • Clinician assigned to the case will centralize all data in a file. The data collection instruments will be used in case planning, documenting progress, recommendations, and program evaluation. The identity of participants will be kept private by limiting access to records. Data will be stored in a locked 20 file case, behind a door that is locked at all times. From our office only those people trained in confidentiality and will have access to information. Subject to clinical judgment and client preference those with a signed release by the client will also have access to records. F. Adequate Consent Procedures • Data that will be collected may include 1) Family information- clinical intake form, 2)AIMS: Developmental Indicators of Emotional Health- as appropriate per age of child being parented. 3) Impact of Event Scale (screening for PTSD) 4) Depression Screening 5) Client Satisfaction 6) Program progress in the form of Clinical Case Managing, Monthly Progress Report and Transition Plan. All information will be kept in secure location as described in privacy and confidentiality section and only limited access to these records will be allowed. Records and tools will be used for reporting progress and program evaluation. Participation in this program is always voluntary. Participant always have the right to leave the project at any time without any sanctions being imposed by the program. • Possible risks from participation in the project include the possibility that uncomfortable feelings will arise from the process. Plans to protect clients from these risks are outlined in the protecting clients from Potential risk section of this document. • This program will must have consent from participants (their parents) or legal guardians. Consent from the legal guardian will be obtained in the form of a referral from the Department of Social Services of Weld County and from the parents/ participants in the form of their signature on the (1) Consent for Services - informed consent for participation in service intervention; (2) Privacy-Policies - informed consent for participation in the data collection component of the project- HIPPA; and (3) Release of Information - informed consent for the exchange (releasing or requesting) of confidential information. These forms are located in Appendix 3 "Sample Consent Forms". We will read the consent forms with the participants and ask prospective participants questions to be sure they understand the forms. We will also give them a copy of what they signed for future reference. • All releases will be obtained at the beginning of the project, with the understanding that the participant may choose to relinquish permission to use their information at any time. The consents to release information to others or gather information and the HIPPA form are standardized forms 21 that include all information necessary to meet HIPPA guidelines as well as the guidelines for the practice of psychotherapy. For research purposes Clients can decline participation in any data collection process and still receive services. G. Risk/Benefit Discussion • Since this work often involves discussing unpleasant aspects of the clients life, clients may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness Most often the potencial benefits of participation in this program far out weight the risks. Participation in this program often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. While there are no guarantees on what a client will experience, many participants have experienced an increased effectiveness and satisfaction in many areas of their life. The importatnce of gaining parenting knowledge to enhance both their lives and the lives of their children is a solid benefit that helps them care for their children. 22 PROGRAM BUDGETS COMPUTERIZED BUDGET PROGRAM Outside DSS FP Cam D( Bonding A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CUENT 1 24 B TOTAL CLIENTS TO BE SERVED 8 BO C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 8 1,440 D COST PER HOURS OR DAYS OF DIRECT SERVICES(El C) $2,300.00 $45.01 E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $0 $18,400 $64,809 F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLO7'SRl F TO PROGRAM $2,189 $3,995 $51,001 G OVERHEAD COSTS ALLOCARI F TO PROGRAM $10,783 $7,782 $10,783 H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $12,952 $30,178 $126,573 I ANTICIPATED PROFITS CONTRIBUTED BY THIS PROGRAM $0 $1,482 $1,587 J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $12,952 $31,858 $128,180 K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 8 1,440 L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE TO BE CHARGED TO WELD COUNTY SOCIAL SERVICES(J/K) $3,95728 $8900 COURT TESTIMONY FOR ALL PROGRAMS PER HOUR 8150.00 a3 117> meig 88888888888 8 888888 8 @ mss _,_,asaaaaa , ..gaga a g 2z Pp § § atom ■ 88888888888 8 888888 8 8 $ / §;222Eaaaaa g 882888 a $ 2 ; K I f § § m B 8 ; . ; 2 I 7 a 2 a [ Sea O § ° e@maamma ° a8@@@a 8 8 u § eo Na ,ig aaaaaE § .Eaaaa a 8 . 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O r § ! - woft re . 2 CO a @ D1119) kli § ) § § \ In § a fl $ 0 ( Ct 0 � § \ ( hi lir 0L. k k / a CO 0 O - Lori J. Kochevar M.S. L.P.C. 1024 8th Street Greeley, CO 80631 (970)352-8873 lorik@aspacetogrow.com Clinical Facilitation Skills: • Ability to provide an energetically clear environment for conflict resolution. • Facilitate a creative process that allows knowledge to be integrated on multiple levels of awareness. • Clear understanding of when family members are physiologically able to negotiate differences. • Ability to assist family in synthesizing large amounts of sensitive information to reach a consensus. • Skill in facilitating resolution of issues in a manner that is respectful and sensitive to individual differences in culture,agendas,and desired outcomes. • Unique ability to teach physiological self-regulation through use of mirror-neurons. • Extensive training and experience in group/family dynamics, spirituality, trauma, child welfare, and body-centered psychotherapy. • Ability to assess and mitigate physiological effects of trauma on current functioning. • Proven skills in identifying multi-faceted family dynamics,psychological, and social issues for families involved in the child welfare system. Training&Curriculum Development Skills: • Trained colleagues in multiple agencies on strength-based, family-focused models: Family Preservation Services and Family Group Decision Making. • Have provided training across the state for schools, agencies,and the general public. • Use of experiential strategies to access multi-dimensional learning of information which increases participant's ability to recall and implement strategies across time and in non-ideal circumstances. Training Approach: o Present comprehensive coverage of all essential information, in the moment as dictated by the group dynamics and specific training needs. o Build cohesive curricula which employ progressive skill sets with multiple review of core material in different areas to increase retention and ability. o Facilitate a transformative process that motivates participants to take action in order to improve their life situation. o Encourage self-exploration and understanding of how a participant's thoughts,words,feelings and actions affect their own and other's well being. o Empower participants by seeing how they can transfer applicable existing skills into their new role,while building additional role-specific skills. o Use transfer-of-learning strategies to increase participant's ability to utilize the skills taught. Program Development&Community Organizational Strengths: • Developed and direct the following bid programs with Social Services: Family Preservation Services, Family Group Decision Making, Foster Parent Core Training, Foster Parent Consultation, and Home-Studies. • Currently serve as program administrator and grant writer for the Bonding Program. • In a director level position,guided 18 agencies in collaborative efforts in fundraising, program expansion, and community development. • Spearheaded community efforts to fundraise for and build a Boys and Girls Club in the San Luis Valley,which currently has three sites and are serving over 1,500 youth. • Organized Philanthropy Days: brought in philanthropists,foundation directors,and trustees to visit and enjoy the Valley's multiple cultures, learn of its services and strategize in partnership with the Valley for short and long term financial successes. • Successfully completed the Colorado Leadership Program to learn all phases of fund raising, management,and board development. • Develop and maintain solid working relationships within the community. • Participated in the El Pomar Community Leadership Program to increased awareness of personal leadership style, strengths, and developmental edge. Supervision&Consultation Skills: • Program Supervisor of Independent Contractors for grant compliance, agency/client satisfaction, and clinical excellence. • Provide program and clinical consultation to Program Directors at the Child Advocacy Resource Education(CARE)agency, and independent therapists. • Participated in Mastering the Art of Child Welfare Supervision training to achieve high standards of supervisory practices in order to assure the effective and efficient delivery of child welfare services. Work History: 1995—Present Private Therapist Contracted with Departments of Social Services in the San Luis Valley and Weld County, Hospice,Ackerman and Associates, Child Advocacy Resource Center, Prevention Project, and Mountain Trails Youth Ranch. 1995—1996 Director-Grant writer San Luis Valley Community Fund 1992—1995 Family Preservation San Luis Valley Mental Health Center Specialist 1992—1995 Wilderness Therapist San Luis Valley Mental Health Center 1989—1991 Disabilities Consultant University Affiliated Program, USM 1989 Teaching Assistant University of Northern Colorado 1986—1989 Supervisor Boys and Girls Club,Greeley,CO Education: University of Southern Mississippi, M.S. Counseling Psychology GPA: 3.8 University of Northern Colorado, B.A. Professional Psychology GPA: 3.5 Involvement: Member,Weld County Child Welfare Committee Founding Board Member, Boys and Girls Club of Alamosa Member, San Luis Valley Coalition for Youth Services Chairperson,San Luis Valley Multicultural Task Force. Z1 . Barbara Jetley Master of Arts Licensed Professional Counselor 1024 8th Stric_4 970-397-6521 Greeley, CO 80631 pogojet@hotmail.com 9/06 Present Bonding Program, Jubilee Center for Families, Greeley, CO Under contract with Weld County Department of Social Services, I assist families with children under 6 who are particularly at risk for Attachment Disorders. I acmes parenichild interaction,quality of the parent/child bond,early childhood social and emotional disorders using the following instruments: NCAST Caregiver/infant toddler assessment,AIMS Parent Assessment,and the DC 0-3 Diagnostic Manual. I make recommendations regarding parenting time. I provide home based services to families for skill building and parent education to preserve or restore the home placement. 6/05- 9/06 Project BLOOM Clinical Coordinator, Colorado West Mental Health Center, Grand Junction, CO. In collaboration with the Early Childhood Partnership, Project BLOOM, funded by SAMHSA, is developing a System of Care to serve the social and emotional needs of children under age six in Mesa County. As Clinical Coordinator, I work to identify children with mental health needs, to provide direct services to them and their families, and to provide consultation services to partners such as preschools, pediatricians, and human services. We have come to recognize the tremendous need for these services. Within the context of our System of Care, I am working to build capacity with the utilization of wrap around services facilitated by paraprofessionals, peer support,and parent education groups. 7/04-5/05 ADMINISTRATIVE WORK, Kelly Services, Everett, WA I provided temporary administrative work in insurance, publishing and intellectual property settings. 8/96—3/04 PRIVATE PRACTICE, Pagosa Springs, CO. I provided general counseling services to a variety of clients, both privately and under contract with the Archuleta County Department of Social Services. I provided Family Preservation/Home Based Family Therapy entailing intensive home based services to families with children at risk for out of home placement, individual and family therapy, case management and crisis intervention. Also, with the same contractor, I employed, administered, and was clinical supervisor to a paraprofessional, providing mentoring services to boys with behavior 2� SHARON K. BENSON, M.A. 2201 2nd Street**Greeley, CO 80631 970-351-8246 FORMAL EDUCATION Graduated University of Northern Colorado,Greeley,Colorado 1985 Master of Arts degree in Professional Psychology Graduated California State University at Northridge,California 1978 Bachelor of Arts degree in Psychology Graduated Moorpark Community College,Moorpark,California 1975 Associate of Arts degree Studied University of Northern Colorado,Greeley,Colorado 1982-1984 Special Education,Secondary Graduate program WORK EXPERIENCE 11/04 to Present—Disability and Mental Health Specialist,FENWC Head Start,Greeley,CO 1/97 to Present—Adjunct Instructor,Aims Community College,Greeley,CO Courses taught in the Psychology,Business and Emergency Medical Academy departments. 3/98 to Present—Financial Advisor,Waddell&Reed,Greeley,CO Professional financial advisor,planner,and educator. Series 6 and Life insurance licensed. 1/93 to 6/98 -Consultant,self-employed,Greeley,CO Contractual work with court ordered families,private and public companies. Specialization:Critical Incident Stress and Trauma 1/85 to 12/96 - Licensed Psychotherapist,self-employed,Greeley,CO Psychotherapy counseling in a private practice with families and individuals. Specialization:Trauma. 1/86 to 12/89 -Executive Director,Greeley Resources for Independent People,Greeley,CO Not for profit center for people with disabilities providing independent daily living skill training and equipment. LICENSE,CERTIFICATIONS,MEMBERSHIPS&AWARDS 1998 Licensed *National Association of Security Dealers Series 6—Securities License 1998 Licensed *Insurance—Life 1992-1997 Licensed *Licensed Professional Counselor 1995-present Certified *l-lypnotherapist 1993-present Certified *Critical Incident Stress Management—Advanced Training 1997-2002 Credential *Colorado State Board for Community Colleges&Occupational Education-Vocational Credential in Business&Health Occupations 1985-present Certified *Mediation/Conflict Resolution 1992-present Member/ *Centennial Critical Incident Stress Management(CISM)Team Director *Clinical Director CISM Team from 1997 through 2000 2000 Award *Aims Community College Award for Excellence in Adjunct Teaching 3D Jubilee Center for Families-Training and Support Group,Foster Parent 2007-core Lori Kochevar,Sharon Benson 1 -Strongly Disagree 5-Strongly Agree Scores(Average) The program met my expectations 4.00 out of 5.00 I received new information 417 out of£00 The training was helpful and relevant to my needs 417 out of 5.00 The training was presented effectively and in a wail-organized manner 4.33 out of 5.00 1 -Very Negative 5-Very Positive My general reaction to the training was 417 out of 5.00 1 -Tao Short 3-Just Right 5-Too Long 3.00 The length of the program was During arouus the most beneficial information presented was: Sharing stories and gathering ideas and strategies that work with our children. Being able to discuss confidential Children dealing with attachment problems Ongoing support and advice for handling attachment and trauma issues I'm always interested in different methods of understanding and dealing with behavorial issues(simple,normal, or complex). This is cometines presented in published material and sometimes in discussions. I also like learning about attachment issues. Attachment issues Being able to hear that others are going through some of what we are and teaming from that. Getting opinions and solutions for chldrens issues The collective experiences. Others insight Sinply Hearing others stories Listening and helping those with similar problems During group the least beneficial informaion presented was: The pages of reading material that I never get tine to read No particular line of training.I'm sure we discussed topics that did not provide help but I tend not to remember those. None-could always use more time More Frequent group meetings.Two times a month instead of one. Going so late into the evening. During aroups I learned andfor relearned: That you're not alone in the system I learned how a parent's actions or behaviors can be so harmful to their children for a lifetime Attachment issues and how to identify trauma issues and how to identify-tips on helping children heal Signs of passive/aggressive. Many different signs that might indicate different types of attachment issues. Testing/safety related behavior patterns. Optional techniques for correcting behavior. How to deal more effectively with attachment issues-how to listen to others and support their concerns as well! Learned more about the issues.Kids in foster care have and how to better deal with them.Relearned a lot that we learned in CORE. How to keep myself at a healthy and therefore helpful happpy foster parent. Acting from a calm center. What happens when children are stressed they go to back brain. Flight or fight. Things which might have increased m v learning am: Being able to discuss specific things that are happening to our children,and receive suggestions from a wealth More real life stories from children More articles-references to utilize Reviewing real situations,effective techniques and comparing to our own situations. Discussing techniques that worked for us. Visuals-dud's-I learn better with visuals How to explain about why some things happen.Why some children go into foster care on a chills level etc... MerrPeldueas. Ways to help our children educationally. Other Comments: Time just flies by so fast-look forward to this support each month and thankful for this resource 31 Individualized Training Plan for 1. Foster parents will be able to identify an improvement in their parental competency as measured by a pre and post assessment of skills needed to implement non-power based parenting effectively. • Increase adherence to and understanding of state and federal requirements regarding discipline policies. • Increase understanding of characteristics of children rose with inconsistent parenting. • Increase ability to use and identify alternative discipline strategies. • Increase ability to acknowledge and listen to the child's concerns with empathy. • Increase recognition of communication bathers. • Increase ability to set effective limits using choices and enforceable statements • Increase ability to use empathy and consequences effectively. • Increase ability to facilitate problem solving skills in foster children. • Increase understanding of the importance of positive relationship message when delivering negative content message. • Increase ability to redirect miss-behavior. • Increased understanding of foster children's need to learn about cause and effect thinking in an emotionally neutral non blaming environment. 2. Foster parents will increase their ability to access resources independently so that they are able to improve their ability to meet the specialized needs of each individual foster child they serve. • Increase understanding of the importance of knowing when to access support. • Increase awareness of resources available. • Increase ability to access resources available in the community and within the local, state and federal government. 3. Foster parents will obtain higher skills and competency levels in fulfilling their role in providing a healing relationship for children in out of home placement. • Increase ability to accept the child as s/he is. • Increase ability to deal with child's behavior in the context of a healing relationship. • Increase ability to support what the foster child is going through. • Increase understanding of dynamics of child abuse and neglect. • Increase understanding of developmentally appropriate expectations and the effects of trauma on development. • Increase understanding of the factors influencing the child's reaction to parent separation and loss. • Increase understanding of cultural competency issues that effect foster parenting. • Increase understanding of roles and dynamics of children that grow up in homes were parents have substance abuse issues. • Increase ability to anticipate special emotional needs • Increase attunement to attachment and bonding issues • Increase understanding of the need for foster children to have empowering corrective experiences. • Increase understanding of regressive behavior and the need for reparative bonding within the relationship. • Increase understanding of the need for consistency and structure to establish trust. 32 • Increase understanding of the effects severe boundary violations have on children and how to facilitate the development of health boundaries in children. 4. Foster parents will positively meet their own and the needs of their biological children's in adjusting to and dealing with the presence of foster children in the home. • Increase ability to set and maintain outside interests and relationships. • Increase ability to communicate effectively with the multiple systems involved in foster children lives. • Increase ability to set and teach children how to set effective physical and emotional boundaries. • Increase awareness of symptoms of burnout. • Increase understanding of the importance of knowing when to acrrss support • Increase awareness of inappropriate coping strategies(i.e. ...., substance use,denial, eating, fault-finding,passivity, revenge,withdrawal, or excessive worry.) • Increase ability to use appropriate coping strategies(i.e. ....,diversions,balance, conflict resolution, flexibility,networking, affirmations, assertiveness,contact, enforceable limits, linking,organization,problem solving,re-labeling,providing choices,time management, relaxation, self-care, exercise,commitment,prayer,worship, surrender, etc...) A. Foster Parents will clearly understand and be able to support the Performance Improvement Plan goals set by the department. • Increase awareness of the effect of placement changes on the childs well being. • Increase understanding of the importance of Indepentant Living skills for foster children. • Increase understanding of the importance of culturaul and racial connections for the well being of the child placed in their home. • Increase in communication skills needed to communicate willingness and receptivity to monthly face to face contact with caseworker. • Clear understanding of the requirement to set up appointments - medical with in 2 weeks and dental with in eight weeks for children over 3. • Increase understanding of roles and responsabilities in working with caseworker to identify health needs for child. The areas checked above would assist me in serving the needs of foster children and the areas circled are where improvement has occurred. Sign Date (Pre&post) I 33 Household Management Issues 1. Foster parents will identify an improvement in their ability to deal competently with household management issues. • Increase knowledge of and understanding of Volume VII requirements for foster parents. • Increase understanding of importance of documentation and timelines concerning medical,dental and,medication monitoring. • Increase awareness of state and federal requirements in Volume VII regarding higher standards of care required by foster homes. • Increase awareness of and adherence to household cleaning, safety, and maintenance requirements outlined in Volume VII. • Increase awareness of resources available to assist with budgeting and purchasing resources for foster children. 3'� THE BONDING PROGRAM JUBILEE CENTER FOR FAMILIES 1024 8TM ST. GREELEY,CO 80631 9704974521 RELEASE OF INFORMATION / / Participants Name Date of Birth Social Security No. I / - - Participants Name Date of Birth Social Security No. / / - Name of Child Date of Birth Social Security No. / / - - Name of Child Date of Birth Social Security No. participant,authorize information to be exchanged between the BONDING PROGRAM and following agencies or programs as listed below(initial all that apply): CASA—Court Appointed Special Advocate Child care provider Child Find North Range Behavioral Health Weld County Combined Courts Weld County Department of Social Services Physician GAL Foster Parents School other _other other other Information Disclosed Assessment/diagnosis _Social history/background Updates,progress and discharge The disclosed information will be used for the following purposes: At the request of the client Multi-agency coordination of care _Continuity of care Obtaining services for client Evaluation purposes Reports to courts or other agencies I understand the information released may be written,verbal or electronic form and may include date(s)of contact,locations and reasons for contact,symptoms presented,treatment progress,outcome information,prescriptions written referrals,education records,tests performed and or diagnosis. I understand that released information may include psychological/psychiatric,medical,shelter and case management,alcoholism,drug and/or alcohol abuse information. I understand that the purpose of this release of information is to allow the individuals/agencies chosen in the section above to access and use the information to establish and maintain continued care,collaborate services better assess the needs of the client,and/or improve program services based on evaluation studies. I understand that I may refuse to sign this authorization and that if I refuse to sign this authorization, I will not be eligible for services through the Bonding Program. I may still have access to other community services,however. There is no guarantee that recipients of the information disclosed through this authorization will not re-disclose to another party. Except in situations legally required or permitted,information about me cannot be disclosed to persons outside the Bonding Program without my written permission. I understand that I may cancel this authorization at any time by giving written notice to the agencies or programs selected above. I understand information exchanged prior to cancellation is excepted. Unless cancelled this release of information will expire on / /_or one year from my signature date. Client Signature Parent/Guardian signature Staff/witness signature Date • 1� The Bonding Program The Jubilee Center for Families 1024 8th Street Greeley,CO 80631 970-352-8873 cell 970-397-6521 Disclosure Statement Barbara Jetley, MA Licensed Professional Counselor Barbara Jetley has a Bachelor's Degree in Psychology and a Master's Degree in Guidance and Counseling. She is Colorado Licensed Professional Counselor #1056 and Washington State Licensed Mental Health Counselor#LH00010405. The practice of Licensed and unlicensed persons and Certified School Psychologists in the field of psychotherapy is regulated by the Department of Regulatory Agencies.A client of a psychotherapist is entitled to information about methods of therapy,techniques used,the duration of therapy, if known,and the fee structure. A client may seek a second opinion or terminate therapy at any time. In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that regulates,registers, or licenses such unlicensed psychotherapist, registrant or licensee, also known as the Grievance Board. The information provided by the client during therapy sessions is legally confidential in the case of licensed marriage and family therapists,social workers, professional counselors, psychologists, and unlicensed psychotherapists,except as provided in section 1243-218 and except for certain legal exceptions that will be identified by the licensee, registrant or unlicensed psychotherapist should any such situation arise during therapy. Exceptions include but are not limited to dangerousness to self or others,grave disability, child abuse or neglect, suspected child abuse or child neglect and lawsuits. The Grievance Board has the right to review charts. Complaints about Barbara Jetley can be addressed with the Program Proprietor, Lori Kochevar, at 970)352-8873,or with the Department of Regulatory Agencies,Colorado Mental Health Section at(303)894-7766. Client/ Parent/Guardian Child Staff Date JUBILEE CENTER FOR FAMILIES CONSENT FOR MENTAL HEALTH AND ACKNOWLEDGEMENT OF INFORMATION RECEIVED ❑ CLIENT RIGHTS AND RESPONSIBILITES: I have received the Client Rights handout and relevant handouts outlining my responsibilities as a client of Jubilee Center for Families. I understand that it is my right to ask questions if I need clarification or have concerns. ❑ ACKNOWLEDGMENT OF PRIVACY RIGHTS: I have received a copy of the current Notice of Privacy Practices. I may refer to the Notice for more information about how Jubilee Center for Families may use or disclose my personal health information. I may refer to the Notice for more information about my rights in regards to such information. I may speak to the Privacy Officer for more information. ❑ DISCLOSURE STATEMENT: I have been given information about how to file a complaint or appeal a decision made by Jubilee Center for Families regarding my services. I may refer to the Privacy Notice or the Clients Rights handout for additional information. I understand that I may make a complaint or obtain the assistance of a Client Advocate without jeopardizing my care. El FOLLOW-UP CONTACT AND SURVEYS: I understand Jubilee Center for Families or their representatives may contact me during or after my treatment to obtain follow-up information or ask about my satisfaction with treatment or services. Such information is confidential and will be used for quality assessment. I May choose to participate in these surveys or not without jeopardizing my treatment. El RELEASE OF INFORMATION: I understand it may be necessary for Jubilee Center for Families to communicate protected health information about me to other providers who may need to know it for coordination of care or crisis management. Releases will be obtained. ❑ CONSENT TO TREAT: I understand Barbara Jetley and The Jubilee Center for Families provides mental health and bonding services. I agree to treatment for :Myself ❑My child ['The person for whom I am legal guardian/custodian Client signature Client guardian/custodian Witness signature Date 57 To Obtain Payment • We may include year mental health information with an invoice used to collect payment for treatment you receive in ow office. We may do this with insurance forms filed for you in the mail or sent electronically. The information provided to insurers and other third party payers may include information that identifies you,as well as your diagnosis,type of service,date F-.„• °..; , , of service,provider namelidentifier,and other information about your condition and tiwb,tint. To Conduct Health Care Operations Health Care Operations refers to activities undertaken by the Center that are regular functions of management and administrative activities. For example, `r the Center may use your health information in monitoring of service quality, staff training and evaluation,medical reviews,legal service,auditing Our Promise! functions,compliance programs,business planning,and accreditation, certification,licensing and credentialing activities. Dear Client: Business Associates This is meant to communicate to you that we are taking the new Federal(HIPPA—Health Insurance Portability and Some of the services we offer may be provided by contracts with business Accountability Act)laws written to protect the confidentiality associates. For example,some of the billing,legal,auditing,and practice of your health information seriously. We do not ever want management services may be provided by contracting with outside entities to you.to delay treatment became you are afraid your personal perform those services. In those situations,protected health information will be provided to those contractors as is needed to perform their contracted tasks. health history might be unnecessarily made available to others Business associates are required to enter into an agreement maintaining the outside of our office. privacy of the protected health information released to them. What has changed? Why a privacy policy now? In Client Reminders The most significant variable that has motivated the Federal government to Regular care is very important to your general health and because we believe legally enforce the importance of the privacy of health infonnation is the rapid this we will remind you of a scheduled appointment or that it is time for you evolution of computer technology and its use in healthcare. The government to contact us and make an appointment Additionally,we may contact you to has appropriately sought to standardize and protect the privacy of the follow up on your care and inform you of treatment options or services that electronic exchange of your health information. This has challenged us to may be of interest to you or your family. review not only how your health information is used within our computers but also wit the Internet,phone,faxes,copy machines,and charts. We believe These communications are an important part of our philosophy of partnering this has been an important exercise for us beca,sP it has disciplined us to put with our clients to be sure they receive the best preventive and curative care in writing the policies and procedures we use to ensure the protection of you we can provide. They may include postcards,folding postcards,letters, health infonnation everywhere it is used. telephone reminders or electronic reminders such as email(unless you tell us that you do not want to receive these reminders). We want you to know about these policies and procedures which we developed to make sure your health information will not be shared with Abuse or Neglect anyone who does not require it. Our office is subject to State and Federal law regarding the confidentiality of your health information and in keeping with We will notify government authorities if we believe a client is the victim of these laws;we want you to understand our procedures and your rights as our abuse,neglect or domestic violence. We will make this disclosure only when valuable client. we are compelled by our ethical judgment,when we believe we are specifically required or authorized by law or with the client's agreement We will use and communicate your Flt:ALI'H INFORMATION only for the purposes of providing ` •^� your treatment,obtaining payment and conducting ,\ r For Law Enforcement health care operations. Your heahh information will w.; r We will disclose protected health information when required by law or not be used for other purposes unless we have asked for � necessary for health-care oversight This includes,but is not limited to:(a) and been voluntarily given your written permission. reporting child abuse or neglect;(b)when court ordered to release How your HEALTH INFORMATION may be used infonnation;(c)when there is a legal duty to warn or take action regarding imminent danger to others;(d)when the client is in danger to self or others or gravely disabled;(e)when a coroner is investigating the client's death;or(t) To Provide Treatment to health oversight agencies for oversight activities authorized by law and necessary for the oversight of the healthcare system,government healthcare We will use your mental health information within our office to provide you benefits,or regulatory compliance. Crimes that are observed by us,crimes with the best health care possible. This may include administrative and that are directed toward us or crimes that occur on the premises will be clinical office procedures designed to optimize • ,r-. reported to law enforcement. scheduling and coordination of care between clinician and business office staff. For example,Center staff i Family, Friends and Caregivers involved with your care may use your infonnation to ; '- plan your course of treatment and consult with other m I i g staff to ensure the most appropriate methods are being 1 -,. v' Except for certain minors,incompetent clients,or involuntary clients, used to assistyou. protected health information cannot be provided to family members without the client's consent. In situations where family members are present during a discussion with the client,and it can be reasonably inferred from the circumstances that the client does not object,information may be disclosed in Lori Kochevar MS, LPC, LLC 1024 8th Street • Greeley, CO 80631 • (970) 352-8873 the course of that discussion. However,if the client objects,protected mental Request a Paper Copy of this Notice health information will not be disclosed. You have the right to obtain a copy of this Notice of Privacy Practices Emergencies directly from our office at any time. Stop by or give us a call and we will mail or email a copy to you. In life-threatening emergencies the provider will disclose information We are required by law to maintain the privacy of your health information and necessary to avoid serious harm or death. to provide to you and your representative this Notice of our Privacy Practices. We are required to practice the policies and procedures described in this Data Collection notice but we do reserve the right to amend the terms of our Notice,and make new notice provisions effective for all protected health information that it Advancing medical knowledge often involves learning from the careful study maintains. If we change our privacy practices we will be sure all of our of the medical histories of prior clients. Formal review and study of health clients receive a copy of the revised Notice. histories as a part of a research study will happen only under the ethical You have the right to express complaints to us or to the Secretary of Health guidance,requirements and approval and of an Institutional Review Board. and Human Services if you believe your privacy rights have been Authorization to Use or Disclose Health Information compromised We encourage you to express any concerns you may have regarding the privacy of your information. Please let us know of your concerns or complaints in writing. Other than is stated above or where Federal,State or Local law requires us,we will not disclose your health information other than with your written authorization. You may revoke that authorization in writing at any time. Client Rights This new law is careful to describe that you have the following rights related to your health information Restrictions r� r You have the right to request restrictions on certain uses and disclosures of your health information. Our office will make every effort to honor reasonable restriction preferences from our clients. Confidential Communications You have the right to request that we communicate with you in a certain way. You may request that we only communicate your health information privately with no other family members present or through mailed communications that are sealed. The Center will make every effort to honor )4;;,r- r•,o-.a,a. ,. n wlc,I your reasonable requests for confidential communication. Inspect and Copy Your Health Information You have the right to read and review a summery of your mental health information. If you would like a copy of your health information,please let us know. We may need to charge you a reasonable fee to duplicate and assemble your copy. Amend Your Health Information You have the right to ask us to update or modify your records if you believe your health information records are incorrect or incomplete. We will be happy to accommodate you as long as our office maintains this information. In order to standardize our process,please provide us with your request in writing and describe your reason for the change. Your request may be denied if the health information record in question was not created by our office,is not part of our records or if the records containing your health information are determined to be inaccurate and/or not complete. Documentation of Health Information You have the right to ask us for a description of how and where your health information was used by ow office for any reason other than for treatment, payment or health operations. Please let us know in writing the time period for which you are interested. We may need to charge you a reasonable fee for your request. -311 ® HEALTHCARE PROVIDERS GENERAL LABILITY COVERAGE PART ENDORSEMENT Additional Insured General liability In consideration of the premium paid,and subject to the General Utility limit of liability shown on the certificate of insurance,it is agreed that the GENERAL LIABILITY COVERAGE PART is amended as follows: The person or entity named below(the'addMonal insured)is an insured under this Coverage Pan but only as respects its liability arising out of named insured's operations,or premises owned by or rented by the named insured and solely to the extent that: 1. a general liability claim is made against the named insured and the additional ktswaI;and 2. in any ensuing litigation arising out of such claim,the named insured and the additional insured remain as co-defendants. In no event Is there any coverage provided wider this policy for an occurrence that is the direct liability of the additional insured. Additional enured: State of Colorado Weld County/Social Services PO Box A Greeley,CO 80634 This endorsement Sept of your policy and takes effect on the effective date of your policy,unless another effective date is shown below. AM other provision of the policy remain unchanged. Must Be Compered Complete Only When This Endorsement Is Not Prepared with the Policy LIE is Not to be Effective with the Policy ENDT.NO. i POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE 01 10273177848 Lod Kochevar MS LPC LLC 2/26/2007 G-123827-B(07/2001) Page 1 ail Prix Date: 01/23/07 HEALTHCARE PROVIDERS CNAPURCHASING GROUP CERTIFICATE OF INSURANCE OCCURRENCE POLICY FORM 018098 970 HPG 0273177648 from:12:01 AM Standard Time on:02128/07 to: 12:01 AM Standard Time on:80,N. • Lori B�he e vaar MS LPC LLC Healthcare Couo de Providers Service Organization 10rie Greeley, MfaSo g CO 80631 Hatboro,PA 190401218 Code: LicensedPraafess ml Counelor Fim T1990 American Casualty Co.of Reading,PA CNA Plaza 213S Chicago,IL 80885 A. PROFESSIONAL LIABILITY Professional Uability(PL) S 1,000,000 each clean $ 3,000,000 aggregate Good Samaritan Liability included above Personal Injury Liability included above -ldakilacerlent Liability included above IL COVERAGE EXTENSIONS: License Protection $ 10000 ; 25,000 _ aggregate Defendant Expense Benefit 10,000 aggregate Deposiiwl ; 10,000 aggregate ut ; 10,000 per indent 25,000 __ $ 000 $ 100000 a00 Fast Aid 2 500 aggregate Damage to Property of Others 2,500 per incident $ 10,000 aggregate C. WORKPLACE LIABILITY Osman C.w.dela.LabElrmw in onto ttasam.pieta amoral 4maty Is made pat.red.paw. Workplace - none ore&^: , r-?+ an, r . none . Personal Lle,'lity - - - none D. GENERAL LIABILITY coins par DAMNS LSalrmm wliMr+Comae.Mat C.wmybu.WM/is rwm petal tart* General Liability(GL) $1,000,000 eat occurrence $1,000,000 aggregate —Feed Auto&Non Owned Air none Fir e e&Water Legal Liability included it GL limk above- to ..:$250,000 suMfimk Personal Liability Total Premium$ 650.00 QUESTIONS?CALL: 1-888-288-3534 i G-121500-C G-121501-C G-145184-A G-147292-A r 1 G-144872-A G-123846-005 G-121504-C G-123827-B G-123828-B i G-141234-A i 1 I Master Policy A 188711433 wroedamanwiY a sofa gm.It ad rod olramae ee alders d pow Mwae.coverage. '"rc: Zw Ctpainnan oldie Board Secretary G-141241-A(07/2001) Coverage Change Date: Endorsement Change Date: `)1 • Program Area Supervisor/Provider Meeting i fJ(/f! Verification/Comment Form Date of Meeting: Program Area: 7f frft 2g/j/.ml 1 -/,4hotr Comments(to be completed by Program Area Supervisor): arti5f �fl41 en-e- -1-.4e /4?,ese- 'Ohipin r4& // cl /4, ' apt-anal Ate ILK LliRnv�j�' O -* �ri once_ (7914 ft, / nt 4- Es '/?Pc-mint A-el/al lap✓/t/oarJ • 1,6 eta t o c j s t to I '.e2e 624 - Ai ?Mast c e__7; t ee?a a Ac. It" P1411 /rs°of R.e 4 t n oa y .dc_ 9uo., r- 05741-t>, 6041/tftc le *by /saw rdnle arse /lives /c.. plena 4rwl yvvft? 42 cot pore- , *I-nuc It SKt //f Ana tieda.,..f/,, Pot /c�( /AocP,..t s ill a2ay.,ti at e f..f /csyea ✓+ea/.a /914/ Signature of Program Area Su isor EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP May 19, 2007 Tobi Vegter Core Services Coordinator Weld County Department of Social Services P.O. Box A, Greeley, CO, 80632, Lori Kochevar MS LPC The Jubilee Center for Families 1024 8 Street Greeley, CO 80631 Re: Bid 003-LS-07(RFP 07005), Lifeskills Bid 06FPC04(RFP 006-00A), Foster Parent Consultation Bid 002-FPT-07 (RFP 006-00C), Foster Parent Training Dear Ms. Vegter: Thank you for your letter regarding additional needed information for the Core Bid process for PY 2007-2008,this letter serves a written confirmation that I have received your letter and my response regarding the need for additional information. Please feel free to call me if any further clarification is needed. A. Results of the Bid Process for PY 2007-2008 It is my understanding that The Families, Youth and Children(FYC)Commission recommended approval of my Bids 003-LS-07(RFP 07005), Lifeskills,002-FPT-07,Foster Parent Training (RFP 006-00C),and 002-FPC-07, Foster Parent Consultation(006-00A) for inclusion on our vendor list after submitting the information requested in each section. Bid#003-LS-07 (RFP 07005),Lifeskills A. 1. Program Improvement Plan(PIP); Improved outcomes in the Performance Improvement Plan- • Parents will be supported in maintaining permanency goal for the child. Providers will meet with all parties involved to discuss recommendations that are in the best interest of the child .• Providers will support parents in maintaining family and cultural connections that support the child and keep the caseworker abreast of any information regarding these connections. 2. New caseworker mandatory training. Jenna Reed who has completed this training, is available to take new cases if they become available in South County. In addition, Lori Kochevar program supervisor has taken the New Supervisors mandatory training. When this question was asked of Gloria Romansik two years ago in the bid meeting by Allen Ackerman if this training was a requirement we were told it was not. However,we would be glad to take the caseworker training if this is what you are requiring of all core service providers and contracted positions. Please advise us of your policy. 3. Quantitative measurements for Measurable Outcome Section, Page 2 Lori Kochevar, LLC,Results of Bid Process 2007/2008 Assessment tools for this program include Bonding Assessment Tool,AIMS Assessment Program DC: 0-3R, NCAST Feeding Scale, Impact of Event Scale-PTSD and Depression Screening (Appendix 2). . In evaluating each family,we will use additional tools when appropriate to assess level of bonding the child has experienced and identify behaviors that indicate areas of concern. The clinician will discuss concerns with the parents and develop a Case Management Plan. This will be an outcomes-based plan that will be shared and reviewed periodically with the parents. The goal of this program is that families who receive services will remain intact six month after discharge,will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. We have the Manuel for the AIMS Assessment tool as well as individual instrument to measure progress of parent child bond according to the age of the child that we would be happy to bring in. Please see evidences based outcomes section of bid submitted for randomized controlled outcome research. The DC: 0-3R is the standardized unit of measurement to quantitative progress in the field of infant and toddler mental health. The Manuel for this measurement tool is also available for us to bring in for review 4. Tangible evidence relating to Improvement of Household, After involvement in this program the parents will be able to provide a safe secure home for the children. This includes health, safety, and provision for every day needs. The parents will have: • Resources to provide for the child's basic needs,such as adequate housing and resources for providing food and clothing on a consistent reliable basis. • Increased awareness of daily planning for the child's needs and providing a stable environment by establishing routines around mealtime, after school activities, bath time and bedtime. • Increased understanding of the nutritional needs of the family and a means of providing for those needs. • Increased awareness of the exposure of the children to health and safety risks when the home is not well maintained. • The ability to focus spending on the basic needs of the family as a priority over other expenditures. A. Families who participate in the program will develop skills and awareness that will increase their competency as parents. Increased competency will be measured through documentation occurring at each visit through use of an outcomes-based Case Management Plan developed at the time of entry into the program. Risk factors will be identified at the time the initial plan is written using the risk assessment tool. This will be reviewed with the parents and updated as goals are met and as changes occur in the parents-child relationship. A completed narrative of measurable goals reached by the family will be provided to Social Services. F. Families who participate in this program will remain intact six month after discharge, • Page 2 Lori Kochevar, LLC,Results of Bid Process 2007/2008 will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. 5. Eligibility Section. SECTION F-ELIGIBILITY A. Total Number of clients to be served: The program will serve a total of 60 families during the twelve-month period. Each bonding specialist will serve eight to ten families at one given time period. Each family will receive 24 hours of one-on-one supervised visitation with the bonding specialist. This would provide 27 hours of intervention with families per week, 120 hours per month. Total number of client hours provided per year would be 1440 hours. B. Total number of clients and ages: Based on the approximation that the average family is made up of four children and one parent, the total number of clients for the year could be 240 clients. Focus will be on children whose ages are birth to twelve years of age. When the family includes older children, they will be included in the family intervention. C. Total number of families served: A total of 60 families will be served during the year. D. Sub-total of individuals who will receive bilingual/ bicultural services: All services provided would be in a manner that is sensitive to the family's culture of origin. The program manager and specialists have extensive training in cultural competency issues. Lori Kochevar chaired the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Becky McMahan has worked with families from various cultural roots. She has a sense of respect for the family's cultural beliefs and practices. Lorenza Perezverdia is a bicultural bilingual provider will be available for any Spanish speaking families. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. E. Sub-total of individuals who will receive services in South County: The program could serve three to eight families in South County during a given time period. We currently have providers that live in the south and we would like to increase our referral base in this area. Services will be provided for families where they reside as determined by Social Services. F. The monthly maximum program capacity: If needed, we could expand the number of hours we are available for services to 35 hours per week, which would make available 140 hours per month. G. The monthly average capacity: The monthly average capacity of this program is six to eight families. ,Page 2 Lori Kochevar, LLC, Results of Bid Process 2007/2008 H. Average stay in the program: The average stay in the program would be six months. It is felt that clients have adequate opportunity to make positive changes in parenting styles in that period of time. Average hours per week in program: Initially, each family would receive services two hours per week, unless a different number of hours are requested by the caseworker for clinical reasons. After the first twelve weeks, sessions will decrease as recommended by the treatment team. Number of hours of service and length of service vary according to the individual family situation. Bid 002-FPT-07(RFP 006-OOC),Foster Parent Training 1. Clarify and address whether your bid's contents state you will cap the capacity of trainings. I would be glad to let as many applicants as you have into the training and do them at the training center or an alternative location as needed. 2. Clarify and address the$75 hourly rate for court testimony; This is not applicable to this program in that we do not do court testimony for trainings. 3. Address and clarify the cost of interpreter services. Interpreter services for mono lingual speaking clients will be paid by the Jubilee Retreat Center. I will need to be informed two weeks prior to training so that I am able to secure a qualified interpreters schedule for the training. Bid 002-FPC-07(RFP 006.OOA),Foster Parent Consultation 1. Clarify the age levels of children served. Foster children are not served directly under this contract as listed in the RFP. Services benefit foster children and biological children of all ages due to secondary effects of training and support provided to the foster families. 2. Clarify who the client is, and to whom services are provided. Services are provided directly to the foster parents and their biological children of any age. If you have questions concerning the above,please feel free to contact me at 352-8873. Sincerely, Lori Kochevar,MS LPC cc: Juan Lopez,Chair, FYC Commission Tobi Vegter, Core Services Coordinator Gloria Romansik, Social Services Administrator rs DEPARTMENT OF SOCIAL SERVICES P.O. BOX A WIWD GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 OFax Number(970)353-5215 • COLORADO May 11, 2007 Lori Kochevar MS LPC The Jubilee Center for Families 1024 8 Street Greeley,CO 80631 Re: Bid 003-LS-07 (RFP 07005), Lifeskills Bid 06FPC04(RFP 006-00A),Foster Parent Consultation Bid 002-FPT-07 (RFP 006-00C), Foster Parent Training Dear Ms. Kochevar: The purpose of this letter is to outline the results of the Core Bid process for PY 2007-2008 and to request written confirmation from you by Monday,May 21, 2007. The Families, Youth, and Children Commission appreciates your interest in providing services for families in Weld county. This year, strides were made in structuring an RFP that is clear and concise, and more user friendly, for both prospective bidders and evaluators. It is important to stress the value of following formatting guidelines and addressing the required sections concisely and appropriately. A. Results of the Bid Process for PY 2007-2008 The Families,Youth and Children(FYC)Commission recommended approval of your Bids 003- LS-07 (RFP 07005), Lifeskills, 002-FPT-07, Foster Parent Training(RFP 006-00C),and 002- FPC-07,Foster Parent Consultation(006-00A) for inclusion on our vendor list, attaching the following conditions to bids according to the program category referenced below. Conditions: The bidder must submit information that was not addressed or submitted with the original bid,as itemized below under each program area. Bid#003-LS-07(RFP 07005),Lifeskills 1. Program Improvement Plan(PIP); 2. New caseworker mandatory training, 3. Quantitative measurements for Measurable Outcome Section, 4. Tangible evidence relating to Improvement of Household, 5. Eligibility Section. Bid 002-FPT-07 (RFP 006-00C),Foster Parent Training 1. Clarify and address whether your bid's contents state you will cap the capacity of Page 2 Lori kochevar,LLC,Results of Bid Process 2007/2008 trainings; 2. Clarify and address the$75 hourly rate for court testimony; 3. Address and clarify the cost of interpreter services. Bid 002-FPC-07 (RFP 006-OOA),Foster Parent Consultation 1. Clarify the age levels of children served; 2. Clarify who the client is, and to whom services are provided. Required Response by FYC Bidders Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the conditions,you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and compliance item.Please respond in writing to Tobi Vegter,Core Services Coordinator, Weld County Department of Social Services, P.O. Box A,Greeley,CO, 80632,by May 21, 2007,close of business. You may fax your response to us at 970.346.7662. If you have questions concerning the above,please call Tobi Vegter at 352.1551, extension 6392. Sincerely, y A iego,Di for cc: Juan Lopez,Chair,FYC Commission Tobi Vegter,Core Services Coordinator Gloria Romansik, Social Services Administrator Hello