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Home My WebLink About20071691.tiff RESOLUTION RE: APPROVE TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR DAY TREATMENT SERVICES WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with two Notification of Financial Assistance Awards for Day Treatment Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,on behalf of the Department of 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. Reflections for Youth 2. Shiloh Home 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 Day Treatment Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of 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. 2007-1691 SS0034 /27-//-K2 7 TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR DAY TREATMENT SERVICES 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. BOARD OF COUNTY COMMISSIONERS ,,�o WEL` OUNTY COLORADO ATTEST: J�E 'l n.J%% & (3k w L_ 'c vid E. Long, Chair Weld County Clerk to the Bo ?. ..� W I am H. erke, Rro:Tem BY: Deputy Cl- k to the Boar.� "Sr;,w �J rI illjam F. Garcia APP D AS TO • ~� 4 ��` Robert D. sden ounty ttorney — )- Thx,r CT-71,Qszrne., ' iougla1Rademach Date of signature: 7_ U7 2007-1691 SS0034 0 ;Nst A DEPARTMENT OF SOCIAL SERVICES P.O. BOX A IGREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 W I p O Fax Number(970)353-5215 • MEMORANDUM COLORADO TO: David E. Long, Chair Date: June 14, 2007 Board of County Commissioners FR: Judy A. Griego, Director, Social Services 0 (/11,(,( 71 RE: Notification of Financial Assistance Awards with arious Contractors— Day Treatment Services Enclosed for your approval are Notification of Financial Assistance Awards with Various Contractors for Day Treatment Services. 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 6, 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 day treatment services for youth involved in the child welfare system. 4. The Contractors include: A. Reflections for Youth $100.76 daily rate $80 per hour court testimony B. Shiloh Home $1,546 monthly rate $75 per hour court testimony $75 per hour professional meetings*affings -;13 -' C.D* If you have any questions, please telephone me at extension 6510. fYi " i rn CtrS oc rirt in-4 C), IV 2007-1691 Weld County Department of Social Services Notification of Financial Assistance Award for Core Funds Type of Action Contract Award No. X Initial Award PY 07-08-CORE-91 Revision (RFP-FYC-07006; 003-DT-07) Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Shiloh Home Ending 05/31/2008 Day Treatment Program 6400 W. Coal Mine Avenue Littleton,CO 80123 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Day Treatment services,based on a cognitive- Assistance Award is based upon your Request for behavioral phase system, involving a variety of Proposal(RFP). The RFP specifies the scope of interventions, including interpersonal dynamics, services and conditions of award. Except where it is mental health needs, family dynamics,affect in conflict with this NOFAA in which case the regulation, and academic success.Youth process NOFAA governs,the RFP upon which this award is through the phase system as safety,treatment based is an integral part of the action. curriculum,progress in therapy and improved school behaviors are achieved. Group counseling is offered Special conditions daily,and status or accountability groups are offered 1) Reimbursement for the Unit of Services will be based two times daily. Offense specific treatment is provided on an hourly/daily rate per child or per family. when appropriate.This program will serve up to 12 2) The hourly/daily rate will be paid only for direct face- male youth,ages 12-18, and their families who reside to-face contact with the child and/or family,as in the southwest Weld county region. Services are specified in the unit of costs computation. provided year round, five days a week, a minimum of 3) Unit of service costs cannot exceed the hourly/daily six-hour days. Average length of stay is three to six and yearly cost per child and/or family. months. Clients must be English speaking. In instances 4) Payment will only be remitted on cases open with, where a family member does not speak English, efforts and referrals made by the Weld County Department will be made to provide an interpreter. of Social Services. Cost Per Unit of Service 5) Requests for payment must be an original submitted Per Monthly Rate to the Weld County Department of Social Services Treatment Package $1,546.00 by the end of the 25th calendar day following the end Per Hourly Rate of the month of service. The provider must submit Treatment Package Low (Court Testimony) $75.00 requests for payment on forms approved by Weld Staffings Professional Meetings $75.00 County Department of Social Services.Requests for Enclosures: payments submitted 90 days from the date of service, X Signed RFP:Exhibit A and thereafter,will not be paid. X Supplemental Narrative to RFP: Exhibit B 6) The Contractor will notify the Department of any X Recommendation(s) change in staff at the time of the change. X Conditions of Approval Approv l_ 1 Program fficial: /� BY cal ��<V By , IVI� ten/ David E. Long, Chair / Judy riego,)rector Board p$yeid�c }'Commi�, 'iioners Weld ounty De rtment ofiSocial Services Date: �UI� Date: I `1 1(� EXHIBIT A SIGNED RFP 02/14/2007 DYED 13:43 FAX 9703467662 ' e CT- 4002/002 Program Area Supervisor/Provider Meeting Verification/Comment Form Date of Meeting: 03/14/2007 Program Area: Shiloh House Day Treatment Comments(to be completed by Program Area Supervisor): Shiloh House has the capacity to provide day treatment services to 10-12 adolescent males. The service provider meets the needs of youth and their families,preventing out of home placement and in order to expedite the reunification of youth with their families from residential treatment. The provider has been providing day treatment services to the county since September 2006. There have been no concerns related to treatment goals. The agency is dedicated to helping the county meet their PIP goals. Bilingual services are available with r ards f ' eatment. Sigaturc ofProgam cvis PQQe • 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 am. (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.RS. 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 v ( 30 \ O1 (After receipt of order) BID MUST BE SIGNED IN INK g7bec�rMe 11 Program Area: g uy J -},,� An—, re /:�.,,, I TYPED OR`PRRINTED SIGJIIATURE VENDOR Sly L oh *ovc r), (Name) Handwritten Signature By Authorized Officer or Agent of Vendor ADDRESS (.0(400 l,U . Coci,X MO.e A-ue. TITLE et, c) L11l4Jow , Cv --()1d3 DATE 'fin c-ot PHONE# 303 - I The above bid is subject to Terms and Conditions as attached hereto and incorporated. Shiloh Home, Inc. Page 2 Overview of Day Treatment Program Mission Statement: Shiloh Home, Inc. offers a nurturing, therapeutic and educational environment to those lives impacted by abuse, neglect and trauma. It is through guidance, clinical intervention and advocacy that Shiloh Home strives to meet the needs of the individual, while respecting the diversity of youth and families. The Shiloh Home Day Treatment Program, accredited by the Council on Accreditation (COA), is designed for youth that are at risk for out-of-home placement, expulsion from or difficulty in the public school system, ore continued legal involvement or consequences. Day Treatment is also useful as a less restrictive therapy and educational alternative as youth transition out of residential, group home, or foster care. Day Treatment offers and intensive therapeutic regimen and a specialized on-site school program designed to help youth learn social and behavioral skills necessary to cope successfully at home, school and in the community. The Day Treatment Program is based on a cognitive-behavioral phase system, which involves a variety of interventions. These interventions address not only cognitive and behavioral issues, but also interpersonal dynamics, mental health needs, family dynamics, affect regulation and academic success. The youth progresses through the phase system as safety, treatment curriculum, progress in therapy and improved school behaviors are achieved. The development of an effective, pro-social therapeutic milieu is a key component to the day treatment program. Group counseling is offered daily within the day treatment program. A master's level clinician facilitates at least two groups a week. These groups address a variety of independent living, coping skills/tools, cognitive restructuring, and many others. Lastly, the peer culture has also benefited from the addition of status, or accountability(participation in treatment) groups twice daily. The daily groups promote development and maintenance of a positive peer culture, teach accountability skill, address progress and enhance containment for the youth. This has improved the investment and ownership of day treatment youth in their day to day, overall progress through treatment and their connection to healthy, pro-social choices in the real world. Offense specific treatment is also provided when appropriate. The guidelines for offense specific treatment as set by the Colorado Sex Offender Management Board(SOMB) are followed. Clinicians providing such therapy are listed with the SOMB. Shiloh Home, Inc. Page 3 Request For Proposal Table of Contents Invitation for Bid Page 1 Overview of Day Treatment Program Page 2 Table of Contents Page 3 Target/Eligibility Page 4 Types of Services Provided Pages 5-7 Measurable Outcomes Pages 7-8 Service Objectives Page 8 Workload/Staff Qualifications Pages 8-9 Internal Tracking/Billing Process Page 9 Confidentiality/Ethical Practices Pages 10-11 Appendix 1 Page 12 Staff Resumes Pages 13-18 Appendix 2 (Data Collection) Page 19 Wide Range Achievement Test Page 20 Appendix 3 Page 21 Treatment Consent Form Page 22 Request for Information Page 23 Disclosure Statement Page 24 Notice of Privacy Practices Pages 25-28 Research Policy Page 29 Day Treatment License Page 30 501 C 3 Pages 31-35 Budget Shiloh Home, Inc. Page 4 Target/Eligibility Population Shiloh's Day Treatment Program will serve up to 10 male youth ages 12 through 18 and their families who reside in the south west Weld county region. The program addresses and provides treatment to youth with a variety of mental health and sexual offending issues. The program does not serve physically disabled youth, mentally retarded, developmentally disabled or deaf/blind. Shiloh Home does not subscribe to a particular religious philosophy nor affiliation. Shiloh does not use religious interventions to control behavior. Shiloh Home is considerate and respectful of the religious background of all clients and their families. Each client is encouraged to celebrate his particular religious holidays. The Utilization Committee reviews the referral information to determine appropriateness of placement. The primary considerations are 1) community safety and 2) the ability to be maintained safely in the family home or home environment. Other significant considerations include, but are not limited to: level of risk to family, victim and community, typology of juvenile, level of denial, age, intellectual functioning and secondary diagnostic features. The program operates year around with a minimum of six-hour days, five days a week (with exceptions for holidays/teacher in-service days). The average length of stay in the program is three to six months. Clients must be English speaking. In situations where a family member does not speak English, efforts will be made to provide an interpreter of the language in question. The interpreter will be involved in the on-going treatment and planning of the client/family. Shiloh Home, Inc. Page 5 Project Narrative Types of Services Provided > Shiloh Day Treatment Program provides education and therapeutic services to male youth ages 12 through 18. The program operates year around with a minimum of six hour days, five days a week(with exceptions for holidays/teacher in-service days). > An initial treatment plan is completed for each client at intake. This plan is refined and expanded within the first ten days of a client's stay in the program. Goals and objectives are developed bases on the client's presenting problems as determined by the screening and assessment process, input from the client, his assigned therapist, family, caseworker, and other involved parties such as probation officers, guardian ad litems and school district representatives. This makes up the multidisciplinary team who work closely together throughout the clients program to ensure successful transition to public school and/or less restrictive setting. ➢ Program Components: 1). Education—the program provides educational experiences that remediate, maintain and improve academic, intellectual and social functioning. Education goals are as follows: a. an individual assessment of achievement level, social functioning and in cases where deemed appropriate, perceptual motor functioning and learning disabilities; b. prescriptive educational experiences for youth who demonstrate deficiencies in academic achievement related to specific learning disabilities, truancy or other impediments to their learning symptomatic of their emotional disturbances; c. educational experiences designed to maintain and increase the academic achievement and intellectual development of youth who demonstrate no problems in learning or deficiencies in achievement level; d. an individual educational plan for each student (for students who enter already identified as disabled under PL 94-142, the Individuals with Disabilities Education Act, the existing Individual Educational Program (IEP) developed by the home school district will be implemented; e. liaison services between Shiloh personnel, Weld County caseworker and home school district as needed; f. documentation will be included in each student's record of periodic, ongoing evaluations of academic achievement in relation to development level, age, special handicaps, medication and therapeutic needs; g. when appropriate, GED will be coordinated with community schools during the discharge process; h. all educational documentation (IEP, transcripts, etc.) will be provided at discharge. Shiloh Home, Inc. Page 6 Project Narrative 2). Therapy—The focus of treatment sessions is both cognitive(teaching new, healthy, empathic and reality-based way of thinking) and behavioral (teaching and rehearsing healthy ways to behave when overwhelmed by feelings and perceived needs). The following therapy services are provided: a. individual psychotherapy is typically offered weekly by a master's level therapist to clients. The frequency of individual therapy will be determined at intake with Shiloh Intake Coordinator and Weld County caseworker; b. family therapy is typically offered weekly by a master's level clinician who is supervised by a licensed professional. The family therapy services to be provided and the frequency will be determined at intake with Shiloh, family and the caseworker. Therapy sessions will be available to the family in the late afternoon and early evenings. c. group therapy is provided up to two times weekly that is facilitated by a master's level clinician (supervised by a licensed professional). These groups address the following, but is not limited to: symptom management, anger management, social skills, independent living, coping skills/tools and cognitive restructuring. The peer culture has also benefited from the addition of status or accountability (participation in treatment)groups twice daily. The daily groups promote development and maintenance of a positive peer culture,teach accountability skills, address progress and enhance containment for the youth. 3). Behavior—The program is specifically designed for the behavior-disordered adolescent. A skills focused treatment program in which the youth (1)recognizes his problems and how thinking errors contribute to irresponsible behavior; (2) develops adaptive social skills; (3) develops new healthy coping skills, i.e. new behavioral "tools" and learns to use these tools to manage difficult feeling states, especially anger and hopelessness. The youth then practices these new cognitive and behavioral skills with peers and teachers in the Shiloh program, in group therapy and with their family. Progression through the program is assisted by a privilege system in which the youth's behavior and quality of work on Phase projects as Shiloh and at home is tied to his program privileges. Movement forward through the program toward graduation is also dependent on successful completion of written and behavioral assignments and development of a relapse prevention plan. 4). Recreation—Recreation is a vital part of the client's treatment program. Indoor and outdoor recreational and leisure activities are regularly scheduled. Recreational outings require staff supervision(1:5 ratio) and all activities are reviewed on a monthly basis to ensure safety for clients and the community. Activities are based on the clients' interests (with personal and treatment needs being considered) and community resources are utilized. Shiloh Home, Inc. Page 7 Project Narrative 5). Vocational/Independent Living—Vocational interests of clients are assessed at admission. Shiloh Home will provide life skills and will work in conjunction with the caseworker to help ensure a successful transition. The following are some of the vocation/emancipation programming offered through Our educational program or in the Day Treatment milieu: a. provide life skill to clients b. assist client to interview for and secure employment and/or financial assistance c. assist client to secure medical/mental health care d. educate client on the public transportation system e. link client to support groups in these areas; legal service, cultural, religious and recreational activities f. educate client regarding human sexuality g. link client to community resources when vocational and technical training is indicated Shiloh will utilize community resources to enhance services and ensure client's vocational goals are adequately met. 6). Treatment Planning—The client/guardian and caseworker will participate in the formulation, review and revision of the treatment plan. The treatment plan is reviewed with the client and the multidisciplinary team at monthly intervals. The plan is modified and updated according to the progress the client makes in meeting the stated goals and objectives and observed changes in his clinical condition and needs. The overall goal of each plan is to return the client to less restrictive level of mental health care and to participate in the community more appropriate for his age and social and educational needs as soon as possible. Transitions back to home school and family are assisted by coaching of the family in Techniques to maintain the youth's behavioral self-control. ➢ Measurable Outcomes: Discharge planning begins at admission and continues throughout the client's Participation in the program. At each monthly review, the multidisciplinary team meets to discuss progress toward treatment goals, client needs and resources and the form of and modifications to the discharge and aftercare plan. At the final monthly review, representatives of the client's next public school and his prospective outpatient therapist (when indicated)are invited to join the multidisciplinary team to make sure the discharge and aftercare plan is complete and that the necessary services for the client will continue without interruption. Shiloh Home, Inc. Page 8 Project Narrative • Successful transition to public school upon completion of program • Completion of GED when indicated • Client will remain in the family home or less restrictive setting for up six months following discharge (shiloh will work in conjunction with the county to assist client and family post discharge) • Academic improvement as evidenced by WRAT (Wide Range Achievement Test) administered at intake and discharge • Completion of mental health and/or offense specific goals as in treatment plan • Link client and families to identified community resources (mental health, medical, dental, community support centers etc.) prior to discharge • Increase parenting competency as evidenced by pre and post test utilizing MFG curriculum • Parent compliance with Informed Supervision Criteria(when indicated) ➢ Service Objectives: 1). Completion of a comprehensive intake assessment 2). Ongoing assessment of function evident in milieu staff feedback, educational feedback and therapist feedback 3). An initial treatment plan developed within 10 days of placement and updated at monthly 4). Family involvement evident in participation in intake process, attendance and contribution at all staffings, and participation in scheduled family therapy sessions 5). Evidence of improved adaptive functioning evident in consistently appropriate/ pro-social behavior in the program, adaptive behavior displayed during off-site activities 6). Evidence of improved adaptive functioning at home as reported by youth and family 7). Coordinate with local school districts for the timely completion of the triennial Individual Education Plan (IEP) ➢ Workload Standards/Staff Qualifications: Shiloh will provide services for up to 12 youth and their families. The average length of stay is three to six months and the program operates year around, six hours a day, five days a week (with the exception of holidays and teacher in-service days). All staff employed at Shiloh Home meet or exceed the standard for minimum qualifications in education and experience. Services are provided by master's level therapist supervised by a licensed level professional. The therapists' caseloads do not exceed 10. The classroom ratio is 1:10 teacher/student with an overall ratio of 1:4. Shiloh Home, Inc. Page 9 Project Narrative Day Treatment Staff are as follows: • Chief of Direct Services/LCSW W • Clinical Manager/LPC • Therapists/Master's Level • Education Director/MA Special Education • Teachers/Special Education Endorsement • Treatment Counselors/school aids/highly qualified/advanced degree/24 hour semester hours of college/or passed the Work Keys Test ➢ Internal Tracking and Billing Process: The Financial Services Department generates monthly reports(balance sheet and income statement)by the 15th of the month. These are submitted to the Chief Operating Officer for review. The following are the procedures regarding maintenance of payment: • Payment information comes from different funding sources and is separately billed • Billing is compared with the agency rosters indicating clients and the counties from where they were referred • Daily census is used to verify clients' presence on a day to day basis to ensure correct billing • The net term for billing is approximately 45 days • Depending on the specific type of billing and from where it originates, billings/invoices are submitted either via mail or electronically and subsequently confirmations of receipt of payment are received either through electronic deposit or through general mailing • Once monthly figures have been determined, they are listed on the Estimated Income sheet. As payment are received and/or verified, they are removed from the Estimated Income sheet • In the event that a payment from a specific funding stream is not received within the net term, the CFO will contact the specific entity to obtain payment • In the event of over payment, the CFO will notify the specific entity to inform of the over payment Shiloh has internal accounting controls and are reviewed and evaluated annually by the CPA firm and the Board of Directors. Shiloh has a formal audit annually. Each facility or department is individually examined and is presented separately within the audit and the agency budget. Each department maintains its own budget and is submitted monthly to the CFO. The CFO and COO with the consultation of the CPA closely monitor revenues and expenses. All revenues and expenses are reflected within the audit. Shiloh Home, Inc. Page 10 ➢ Confidentiality/Ethical Practice, Rights and Responsibilities: Shiloh Home has policies and procedures addressing the ethical practices and respecting the rights of clients and their families who Shiloh provides services. All clients/families are provided with written information regarding their rights at intake and staff receive training during their orientation. The eligibility criteria is described in the admissions policies and Shiloh ensures all clients/families understand this criteria at intake and the services that Shiloh provides. The client rights are posted in each facility, as well as the grievance procedure. All clients and families are informed of Shiloh's grievance procedure and sign a statement at intake that they have received the information and understand the process. Grievance forms are available at each facility. Grievances are reviewed by the appointed grievance representative within 72 hours of the grievance being submitted and a response is given back to the client/family. Grievances are filed in the case record and reviewed quarterly by the Safety Risk Committee. Shiloh protects the confidential information on all clients/families and has policies and procedures that all staff are trained on during orientation training and are in daily practice. All staff sign a confidentiality statement that is filed in their personnel file. In addition to Shiloh' policies and procedures, HIPPA manual is maintained and client/family is given HIPPA disclosure at intake. Client case records are stored in a locked area. Shiloh accepts male youth ages 12—18 from any racial/ethnic background. Clients must be English speaking. Once a youth is referred by Weld County Human Services, the Utilization Review Committee reviews the specific case in order to determine the appropriateness of placement. The primary considerations for the appropriateness of placement in day treatment services are 1) community safety and 2)the ability to be maintained safely in the family home or home environment. Other significant considerations include, but are not limited to: level of risk to family, victim, and community, typology of juvenile, level of denial, intellectual functioning and secondary diagnostic features. Following the review of referral material and admission criteria a face to face interview may be arranged with the youth and family. During this part of the interview by the Intake Coordinator treatment and program expectations are outlined. Shiloh considers clients who demonstrate some willingness to receive treatment and a commitment to community safety and completion of their entire treatment program. This direct contact is also used for final determination of appropriateness for placement. Intake information is requested at intake. A release of information is signed by parent/guardian and a copy filed in client's case record. Outcomes measures are utilized by the agency to inform and provide feedback on the quality of treatment. Shiloh Home, Inc. Page 11 Project Narrative The ultimate goal of outcome measure is to help ensure that high quality standards are implemented that will ensure interventions success. Outcomes are assessed at various identified key points in the treatment process to include, but are not limited to the following; 1) family participation as measured by attendance in monthly staffing and level of participation in family therapy; 2) client discharge to lower level of care 3) client and family satisfaction surveys at discharge. Shiloh Home, Inc. Page 12 Project Narrative Appendix 1 (Staff Resumes) 2ct9 e, 3 ERIN HALE 204 Teller Street Lakewood, Colorado 80226 303-274-9461 Qualifications and Experience Taught Special Education for twenty-five years offering a diverse continuum of services, was a middle school assistant principal for three years and a Special Education Staffing Coordinator for two years. • Developed self-contained and resource programs at the middle school and high school. • Wrote curriculum and developed delivery systems. • Tutored students. • Teamed and consulted with mainstream teachers. • Supervised teachers by using the school district evaluation process. • Chairperson for staffing teams that developed programs for special education students. • Developed and presented workshops for teachers. • Followed and implemented federal and state guidelines directing services for special needs students. • Developed the position of Special Education Staffing Coordinator at Jefferson Hills Treatment Center. • Developed a communication network with school districts throughout Colorado. • Used standardized assessments to determine student's ability. • Wrote "Individual Education Plans" for all students. • Scheduled and was chairperson for Special Education staffings. • Used computer programs; Windows 98', Word 2000, Excel and Internet. Work History 2001-2002 Science and Special Education Teacher Adams District#12, Crossroads Alternative,Northglenn, Colorado 1998-2000 Special Education Staffing Coordinator Jefferson Hills Treatment Center,Lakewood, Colorado 1997-1998 Case manager and Special Education Teacher Adams District#1, York Middle School, Denver, Colorado 1990-1997 Special Education Teacher Adams District#1, Skyview High School, Denver,Colorado 1987-1990 Assistant Principal and Special Education Case Manager Adams District#1,John Dewey Middle School, Denver, Colorado 1986-1987 Special Education Teacher Adams District#1, Mapleton High School, Denver, Colorado 1985-1986 Graduate Student, Sabbatical Leave University of Colorado, Boulder, Colorado 1972-1985 Special Education Teacher Adams District# 1,Mapleton High School,Denver, Colorado 01/20/05 17:04 iD:U A T MFD FAX:3033750066 PAGE 2 -FQ9e I `) KIMBERLY A. STYLES, LCSW 1520 Redlail Court. Longmont, Colorado 80501 (307) 774-9:83 OBJECTIVE To provide nerviens to individual:. and families to improve their quality of life. FINICATI0N/l ICEN I3R14 LC::3W 4 992988 UNIVERSITY OF DENVER, DENVER, COLORADO Master of Social Work received June 1997 UN I:VF:RS1TY OF MASSACHUSETTS, AMHE'IRST, MASSACHUSETTS Bachelor of Arta - Psychology received May 1993 EXPERIENCE TRINITY CHILDREN AND FAMILY SIM/TOES Colorado Director Westminster, Colorado 9/00 to 12/04 Developed new foster n,Ire Child Placement Agency in Colorado. Prepared and compiled all nneaassary policies for licensing and operation. Responsible for recruitment, training, and certification of loafer parents, training and supntv.isiou of master's level clinical vtatf, billing, administration, developing donation resources, public relations with service contractors, and community relations. Supervising Social Worker V.icLurville, California 8/99 to 9/00 Provided both individual and group clinical and administrative supervision to a team of Foster Care Social Workers. Assisted Director in daily operations of office. OLher responsibilities included public relations, assessment and certification of new homes, staff training, and interface with liconsiug analysts and continuing ease management . Trained staff and families in CPR and First. Aid. Poster Care .Social Worker Vi.ctorv.ill e, California 7/98 - 8/99 Menitoreri caseload nt foster children and their foster families. Developed individualized treatment plans, provided parenting training ( including First Aid and CPR) , actor' as a liaison between the piecing agency and the foster family, coordinated and supervised natural family vi:i.ls, attended court hearings, assisted with permanency planning. 010/05 17:04 ID:U A F MFD FAX:3033750066 PAGE 3 l�rse 5 2 OASIS COUNSELING CENTERS Contract Therapist Barstow, California 12/99 In 8/00 Serve as independent contractor, providing initial assessments and counseling for children, adolescents and their tami.Lion. Assisted in restructuring or services to bettor serve the c:lient population and referral sources. Cl1:0 WALLACE CENTER, WESTMINSTER, COLORADO Residential Clinician 9/96 - 6/98 Conducted individual, family, and group therapy with childien and adolescents, managing a variety of local and out-ol-state contracts. Responsibilities included case management , treatment planning, co- facilitation of the sex oitoncler and substance ahuno prevention groups, ongoing treatment and utilization reviews, coordination nt out-of-stale vis.Lial ion and therapy, clinical on-call, and provision of care on residential, inpatient., and day treatment levels. Held position as Clinical Intern and por ,lien therapist. from 9/96 to 1/9'l. ARAPAHOE ROUSE, INC. , THORNTON, COLORADO Adolescent Unil. Family Therapist .1/97 - 9/97 Treated adolescents recovering from substance abuse and addiction, while including the family i.n tho rehabilitation and recovery process. Redeveloped and implemented the tamily therapy program, increasing it to an H0'1 participation rate. Facilitated weekly parent support and education groups, and conducted family annegaments and therapy sessions. DENVER PUBLIC SCHOOLS, DENVER, COLORADO School Sec:.i al Worker - Clinical intern 9/9S - 6/96 Provided case management and counseling to high school student:; rogarding individual , educational, and family Issues, co-facilitated group therapy, assisted with atlenrlonce filings and special education starting, made ret errals to community resources, and attended Hroa meetings. ARC OF SOMERSET COUNTY, SOMERVTLLN, NEW JERSEY Alternate Living Program Manager 11/94 .• 8/9'> Coordinated and supervised all daily operations and activities of suppof Led living apartments, including development of individualized Habitation Plans, scheduling and training of staff, budget maintenance and comnun i.ly involvement. Group Home Assistant Manager g 12/y3 - 11/94 Ansi.sled manager with daily operations. Managed group home finances and coordinated appointments and year Ly IIIP'n. Encouraged and coordinated 0120/05 17:05 ID:U A F MFD FAX:3033750066 PAGE 4 '(4ty- l(p participation i,n community activil..icu, including the New Jurrr'ey Special Olympicr:, Residential. Counselor 1/93 - 12/4'.3 Provided perconal care, structl,rwl weekly activities, and living skili:2 training fu, residents in a supported living environment. IIF ERt•INCE;; Furnished upon request. Pc4 c�e 1 7 Martha B. Beatley 414 West Spruce Lane Louisville, CO 80027 (303) 673-9366 (303) 818-7280 martha.beatlevQyahoo.corn OBJECTIVE: Teacher of Special Education EDUCATION: University of Northern Colorado, Greeley, CO MA, Education 1990 University of Georgia, Athens, GA BS, Education 1987 CERTIFICATIONS: Teacher Lb Severe Needs Affective, K-12 Teacher I: Moderate Handicapping Conditions, K-12 Qualified Language Arts Instructor in compliance with No Child Left Behind WORK EXPERIENCE: Broomfield High Teacher, SIED 2003-2006 • SIED self-contained all subjects • Team taught Math and Language Arts in general classroom Self Employed Proprietor, Koalabeny Kids, LLC 2001-2004 • owned and operated children's resale clothing store Fairview High School Teacher, SIED 1999-2001 • SIED, self-contained all subjects • Team taught Science and Language Arta in general classroom • Member of Child Resource Team Substitute Boulder Valley/Stay Home Mom 1997-1999 Adopted second child January 1998 Centaurus High School Teacher, SIED 1995-1997 • SIED, self-contained all subjects • Team taught Language Arts in general classroom • Member of Emergency Response Team • Member of Child Resource Team Substitute Boulder Valley/ Stay Home Mom 1994-1995 • Adopted first child June 1994 Heatherwood Elementary School Special Education Teacher 1991-1994 • Wrote and Received a Grant Variance for total inclusion model • Worked with students of all handicapping conditions in regular classroom Jefferson County Schools Special Education Teacher 1987-1990 Red Rocks Elementary and Normandy Elementary half time at each school • Resource Teacher, all handicapping conditions small group pull out plus assistance in general classroom pct e l 8 Lawrence Allan Green 9700 K Miff Ave. Denver,CO 80231 (303)283-7863 Education: *Colorado Professional Teaching License:: II 029003A, Expires 03/16/09 Endorsements: Ages 5-21 Special ED II- Severe Needs-Affective and Secondary Social Studies *University of Northern Colorado: MA Special Education Severe-Affective Needs,2004, 4.0 GPA *Regis University: Colorado Teaching License Secondary Social Studies, 1994, 4.0 GPA *Benedictine College: BA History, 1989 Experience: Denver Public Schools(2004-Present). Special Education Teacher for K-3`d grade Center Program. Work to instruct and support both mainstreamed and self-contained ED/LD/PD students and implement their IEP's. Aurora Mental Health-Metro Children's Center(2003-2004). Special Education teacher for primarily 4t- 7th grade ED/LD/PD students in all academic subjects. Implemented Individual Education Plans and treatment plans for students in Day Treatment milieu. Mount Saint Vincent's Home for Children(2000-2003). Special Education teacher for primarily 5t°-7th grade ED/LD/PD students in all academic subjects. Implemented Individual Learning Plans,IEP's,and treatment plans for students in school and residential milieus. Also worked as an on-call and part-time Mental Health Worker for the therapeutic pre-school and residential programs. Pathways Alternative Middle School(Littleton Public Schools, 1998-2000). Taught Science and Social Studies courses to At-Risk middle school students. Also helped facilitate community, extra-curricular and exploratory experiences, and wrote and received six grants totaling $2,700 that funded several exploratory education projects. Sheridan High School (1996-1998). Alternative Education and Social Studies teacher. Worked with At- Risk students facilitating conflict mediation and helping meet individual needs. Helped students find alternative education programs to attend, GED preparation, and arrange for other personal and vocational services for them and their families. Worked with a team that improved the graduation rate to over 90%, and managed the In-School Suspension Program. Elizabeth Alternative High School(1995-1996): Taught all academic courses and implemented Individual Learning Plans and IEP's for At-Risk and Special Education high school students. Also helped arrange community,experiential and vocational experiences for these students. Englewood High School (1994-1995): Alternative Education Teacher. Taught Extra-Curricular, Math, and Social Studies courses to At-Risk 9t°grade students. Also helped to facilitate counseling and arranged for other services that they and their families needed. Additional Experience: Have worked previously as a private tutor for students in GED, Language Arts,Mathematics, Science, Social Studies,and study skills. I have learned and implemented a number of different Mathematic, Reading, and Writing curriculums in various positions with student success. Shiloh Home, Inc. Page 19 Project Narrative Appendix 2 (Date Collection Instrument/Protocols) Wide Range Achievement Test Revision 3 (WRAT3) Summary Report • by Gary S.Wilkinson,PbD,and PAR Staff General Information Client Name : Age ' ID Number - Gender Referred By , Education , School Test Date . Prepared For : Birth Date : Tan Test Results as r r • Raw Standard Grade Absolute .Score $core Percentile Score Score Reading. Spelling Arithmetic Blne Test Results -/rS E yes r Raw Standard Grade Absolute Score Score Percentile Scare Sdore Reading 40 104 61 8 511 Spelling 36 107 68 7 512 Arithmetic 34 94 34 6 508 Combined Test Results Raw Standard Grade Absolute Score Score Percentile Score Score Reading Spelling Arithmetic • WRAT3 Copyright O 1993 by Wide Range,Inc. • WRAT3 Scoring Program Copyright®1996 by PAR,Inc. All rights are reserved Shiloh Home, Inc. Page 21 Project Narrative Appendix 3 (Sample Consent Forms) 4qe as SHILOH HOME,INC. 6400 West Coal Mine Avenue Littleton, Colorado 80123 Phone: (303) 932-9599 TREATMENT CONSENT FORM g:\admissio\CCC I, (We) certify that I(we) give and grant my(our) consent for my/our child to participate in and receive treatment(individual, family, group, milieu therapies)within a Shiloh Home, Inc. program. It is understood that will be expected to participate fully in the therapeutic program outlined by the Treatment Team. In addition, I(we) agree to assist the Treatment Team to the fullest extent possible in achieving the goals established for my/our child during his placement at SHILOH HOME, INC. It is understood that refusal to participate in treatment may result in termination from the program. Signature of(Parent) or Guardian/Date Signature of(Parent) or Guardian/Date Witness/Date Signature of Client/Date Pal-e a3 SHILOH HOME, INC. 6400 West Coal Mine Avenue Littleton, Colorado 80123 AUTHORIZATION TO RELEASE/ Phone: (303) 932-9599 Fax: (303) 973-1269 REQUEST FOR INFORMATION G:/Admission/Release I, authorize staff member of Shiloh Home,Inc., 6400 West Coal Mine Avenue,Littleton, Colorado 80123,to obtain from,and share information with: Name: Address: Phone#: Regarding: 1 Client's name Client's DOB Parent/Guardian Signature Date Information may include: Social History Dental Psychological Evaluation Immunizations Hosnitalization Note/Summaries Medical Records Progress Notes Other Court Renons/Tnvestigative Renorts Treatment Summary Academic Records Offense Specific Placement History Information to be used for: Assessment Leaving School D. Service Planning Entering the School D. Continuity of Care College Admission Other I understand that I may revoke this authorization to release/request information at any time by giving written notice to Shiloh Home,Inc. Without such revocation,this authorization shall expire on / / (date). (If left blank,ninety(90)days from the date of my signature). I also herewith release Shiloh Home,Inc., from all liability for releasing such information. NOTICE TO WHOM THIS INFORMATION IS GIVEN: This information has been disclosed to you from records whose confidentiality is protected by Federal Law. Federal regulations prohibit you from making further disclosure of this information without the specific written consent of the person to whom it pertains. I hereby revoke this Authorization to Release/Request for Information: SIGN HERE ONLY IF REVOKING THIS RELEASE Client: Date: Witness: Date: A copy of this Authorization is as valid as the original. DISCLOSURE STATEMENT Shiloh Home,Inc. 6400 West Coal Mine Avenue Littleton,Colorado 80123 2. Shiloh employs licensed and unlicensed psychotherapists to do therapeutic work with clients,individually,in groups and in family therapy. 3. The Colorado Department of Regulatory Agencies has the general responsibility of regulating the practice of licensed psychologists,licensed clinical social workers,licensed professional counselors,licensed marriage and family therapists,certified school psychologists,and unlicensed individuals who practice psychotherapy. The agency within the Department that has responsibility specifically for licensed and unlicensed psychotherapists is the State Grievance Board, 1560 Broadway,Suite#1340,Denver,Colorado 80202,(303)894-7766. 4. Client Rights and Important Information: a. You are entitled to receive information regarding methods of therapy,the techniques used,the duration of your therapy (if it can be determined),and the fee structure. Please ask if you would like to receive this information. b. You can seek a second opinion from another therapist to terminate therapy at any time. c. In a professional relationship,sexual intimacy between a therapist and a client is never appropriate. If sexual intimacy occurs,it should be reported to the State Grievance Board. (FOR LICENSED PSYCHOTHERAPISTS OR UNLICENSED PSYCHOTHERAPISTS PRACTICING UNDER SUPERVISION—see state Grievance Board Rule 12(e).) Generally speaking,the information provided by and to client during therapy sessions is legally confidential if the therapist is a certified school psychologist,a licensed clinical social worker,a licensed marriage and family therapist,a licensed professional counselor,a licensed psychologist,or an unlicensed psychotherapist practicing under the supervision of a licensed psychotherapist. If the information is legally confidential,the therapist cannot be forced to disclose the information without the client's consent. Information disclosed to an unlicensed psychotherapist not practicing under the supervision of a licensed psychotherapist is not legally confidential. There are exceptions to the general rule of legal confidentially. These exceptions are listed in the Colorado Statues(see Section 12-43-218,C.R.S.,in particular). You should be aware that,except in the case of information given to a licensed psychologist,legal confidentiality does not apply in a criminal or delinquency proceeding. There are other exceptions that I will identify to you as the situations arise during therapy. 5. If you have any questions or would like additional information,please feel free to ask. I have read the preceding information and understand my rights as a client/patient. Client/Resident/Date Parent/Guardian/Date Therapist/Date g:\admissio\disclose Paae as Notice of Privacy Practices Shiloh Home,Inc. Effective Date: 4114/2003 THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about this notice, please contact the Privacy Official, Maureen Grey, by dialing 303-932-9599 x308. During a client's stay at Shiloh Home, a record of care is maintained. Typically, this record contains information regarding behavioral/emotional symptoms, a client's reported thoughts and feelings, results of assessments at Shiloh Home, diagnostic information, information about treatment, educational information, a plan for future care or treatment, and billing-related information. Information about a client's family members may also be contained in the record, as such information pertains to the client's treatment. This notice applies to all of the records of your care generated by Shiloh Home, whether made by Shiloh Home staff,your Shiloh Home clinician or any Shiloh Home employee. Our Responsibilities We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice and notify you if we cannot agree to a requested restriction. We will accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. Uses and Disclosures How we may use and disclose Medical/Mental Health Information about you. The following categories describe examples of the way we use and disclose medical information: For Treatment: We may use medical/mental health information about you in the provision of treatment or services. We may disclose medical/mental health information about you to treatment counselors, clinicians, administrators and teachers who are involved in your care and are Shiloh Home employees. For example: treatment counselor staff may need to know information about behavioral and/or emotional information about you in order to determine the amount of freedoms/privileges while you are living in a Shiloh Home residence. This would be done to that an appropriate amount of structure and supervision could be in-place to better ensure your safety and that of other clients and staff. We may also provide other mental health providers, department of human services representatives, probation officers and the courts with copies of various reports that should assist these people in their work with you. Please understand that such releases of information are only with informed consent allowing for the sharing of information. Exceptions to obtaining informed consent would be in case of medical/mental health emergency, the commission of criminal behavior on the part of the client or by court order. In addition, the department of human services has the right to review records for the purposes of licensing. For Payment: We may use and disclose medical/mental health information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example,we may need to give your insurance company information about your care so they will pay us or reimburse you for your treatment at Shiloh Home. For Health Care Operations: Shiloh Home staff may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to Pa%e_ a_b continually improve the quality of care for all clients we serve. For example, we may combine information about many clients to evaluate the need for new services or treatment.We may disclose information to outside entities educational purposes. The disclosure of such information will not identify any clients. We may combine medical/mental health information we have with that of other treatment providers to see where we can make improvements. We may remove information that identifies you from this set of medical information to protect your privacy. We may also use and disclose medical/mental health information: To business associates we have contracted with to perform the agreed upon service and billing for it; To assess your satisfaction with our services; To tell you about possible treatment alternatives; As part of fund raising efforts; For Population based activities relating to improving program outcomes or reducing treatment costs; and For conducting training programs or reviewing competence of mental health care professionals. Business Associates: There are some services provided in our organization through contracts with business associates. Examples include our accrediting body, which serves to support Shiloh Home in maintaining high standards of care. When Shiloh Home works with its accrediting body, we may disclose your health information to our business associates so that they can perform the job we've asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information. Individuals Involved in Your Care or Payment for Your Care: We may release medical/mental health information about you to a parent, county caseworker, guardian ad litem and/or probation officer who is involved in your treatment. In addition, we may disclose medical information about you to an entity assisting in an emergency situation so that your family can be notified about your condition, status and location. Such disclosures, except in cases of emergency, court order, or where existing laws mandate disclosure, are only done with appropriate consent. Research: We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research. Organized Health Care Arrangement: This practice is presenting you this document as a notice. Information will be shared as necessary to carry out treatment, payment and health care operations. Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time. Affiliated Covered Entity: Caregivers at other facilities or practices may have access to protected health information at their locations to assist in reviewing past treatment information as it may affect treatment at this time. Please contact the facility or practice Privacy Official for further information on the specific sites included in this affiliated covered entity. As required by law,we may also use and disclose health information for the following types of entities, including but not limited to: Food and Drug Administration Public Health or Legal Authorities charged with preventing or controlling disease, injury or disability Law Enforcement Officials Pee%e a, State and County Departments of Human Services The Courts Health Oversight Agencies Law Enforcement/Legal Proceedings: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. State-Specific Requirements: Colorado Department of Human Services requires access to all records as part of its role in oversight of day treatment and residential treatment centers. Your Health Information Rights Although your client record is the physical property of Shiloh Home that compiled it, you have the Right to: Inspect and Copy: You have the right to inspect and copy information that may be used to make decisions about your care. Usually, this is certain mental health and billing records, but does not include psychotherapy notes or other notes which we are legally forbidden to disclose. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to mental health information, you may request that the denial be reviewed. Another mental health care professional chosen by Shiloh Home will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Amend: If you feel that mental health/medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Shiloh Home. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial. An Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of the disclosures we make of medical information about you. Request Restrictions: You have the right to request a restriction or limitation on the mental health/medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the mental health/medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could request that information shared about family members not be shared with those family members. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. Request Confidential Communications: You have the right to request that we communicate with you about mental health/medical matters in a certain way or at a certain location. We will agree to the request to the extent that it is reasonable for us to do so. For example, you can ask that we not leave messages on an answering machine, or that notices of treatment staffings be mailed to an alternative location. A Paper Copy of This Notice: You have the right to a paper copy of this notice.You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To exercise any of your rights, please obtain the required forms from the Privacy Official and submit your request in writing. Pale .1%- CHANGES TO THIS NOTICE We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future.The current notice will be posted on the practice's website and include the effective date. In addition, each time you visit the practice for treatment or health care services,we will have available a copy of the current notice in effect. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with Shiloh Home by contacting the main number and asking for Shiloh Home's Privacy Official or with the Secretary of the Department of Health and Human Services. To file a complaint with Shiloh Home, contact the Privacy Official. All complaints must be submitted in writing. You will not be penalized for filing a complaint. OTHER USES OF MEDICAL INFORMATION Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you. PRIVACY OFFICIAL Name: Maureen Grey Telephone Number: 303-932-9599 X308 Address: 6400 W. Coal Mine Ave. Littleton, CO 80123 94 a a9 SHILOH HOME, INC. RESEARCH POLICY REV:5/15/06 Research will receive Board, CEO, and parent/guardian approval and adhere to the following guidelines: 1) The consent of participation in the research is voluntary and informed, without any implied deprivation or penalty for refusal to participate, and with due regard for participant's privacy and dignity. 2) The participants will be protected from unwarranted physical or mental discomfort, distress, harm, danger or deprivation. 3) The evaluation of services or cases will only be discussed with persons directly and professionally concerned with the information. 4) All information about the participants in the research will be treated strictly confidential. P ale 3`' �w° � STATE OF COLORADO „. DEPARTMENT OF HUMAN SERVICES tom *,, DIVISION OF CHILD CARE gar 1575 SHERMAN STREET DENVER, COLORADO 80203-1714 • PERMANENT CHILD CARE LICENSE Provider ID: 1539981 . Service Type: DAY TREATMENT LOCATION: SHILOH DAY TREATMENT- LONGMONT 0745 HIGHWAY 119 6400 WEST COALMINE AVENUE ' LONGMONT, COLORADO 80504 LITTLETON, COLORADO 80123 COUNTY:WELD License Effective Date:08-22-2006 The licensee must comply at all times with the Child Care Act and the rules and standards of the Department of Human - Services.The licensed premises and its records must be available for inspection at all times by the Department of Human Services or its authorized representatives.This license Is valid only for the location address listed above and is. not transferable to any other person;organization or location.The licensee must surrender this license to the Department of Human Services upon denial,revocation or suspension. Numbers and ages of children cared for at the licensed premises must not at any time exceed: - 112 children of the age 7 years 0 months to 18 years O months ' Other conditions and restrictions: May accept persons 18 21 years old Unique conditions: - r*'` _ Place Stickers Below ' CbLOMDO { r r x', DEPARTIT OF 1. ` : a Y4, t HUMAN SeRVICSSI I f e iv AU '3 - - - ANNIVERSARY DATE ". <; :EXECUTIVE DIRECTOR THIS LICENSE MUST BE POSTED IN A PROMINENT:LOCATION ON THE LICENSED PREMISES Page St • Internal Revenue Service Department of the Treasury P. O. Box 2508 Date: May 12, 2004 Cincinnati, OH 45201 Person to Contact: Shiloh Home, Inc. Steve Brown 31-07422 6400 W. Coal Mine Ave Customer Service Representative Littleton, CO 80123 Toll Free Telephone Number: 8:00 a.m.to 6:30 p.m.EST 877-829-5500 Fax Number: 513-263-3756 Federal Identification Number: 84-0978992 Dear Sir or Madam: This is in response to your request of May 12, 2004, regarding your organization's tax-exempt status. In October 1985 we issued a determination letter that recognized your organization as exempt from federal income tax. Our records indicate that your organization is currently exempt under section 501(c)(3) of the Internal Revenue Code. Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of$20 a day, up to a maximum of$10,000, when a return is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of$100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations are not automatically exempt from other federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. (Page_ 3a -2- Shiloh Home, Inc. 84-0978992 Your organization is not required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code. Section 6104 of the Internal Revenue Code requires you to make your organization's annual return available for public inspection without charge for three years after the due date of the return. The law also requires organizations that received recognition of exemption on July 15, 1987, or later, to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. Organizations that received recognition of exemption before July 15, 1987, and had a copy of their exemption application on July 15, 1987, are also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. For additional information on disclosure requirements, please refer to Internal Revenue Bulletin 1999 - 17. Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records. If you have any questions, please call us at the telephone number shown in the heading of this letter. Siinnceereely,itY * Janna K. Skufca, Director, TE/GE Customer Account Services Pine 33 Internal Revenue Service Department of the Treasury District Director FFN: 750109595 Date: Employer Identification Number: ilAR j 7 1988 84-0978992 Case Number: 757322050E0 Person to Contact: E0 Technical Assistor Shiloh Homes , Inc. Contact Telephone Number: 6884 S. Marshall St. , Suite 9 (214) 767-3526 E0: 7213:4913:JS Littleton, CO "80123 Our Letter Dated: October 16, 1985 Caveat Applies: N/A — Dear Sir or Madam: This modifies our letter of the above date in which we stated that you would be treated as an organization that is not a private foundation until the expiration' of your advance ruling period. Based on the information you submitted, we have determined that you are not a private foundation within the meaning of section 509(a) of the Internal Revenue Code because you are an organization of the type described in section 170(b) (1) (A) (vi) !r . Your exempt status under Code section 501(c) (3) is still in effect. 509(a) (1) Grantors and contributors may rely on this determination until the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a) (1) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act that resulted in your loss of such status, or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section 509(a) (1) organization. -- — If the--heading of this letter--indicates that-a--caveat applies, the- caveat- below or-an ---- the enclosure is an integral part of this letter. Because this letter could help resolve any questions about your private foundation status, please keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown above. Sincerely yours, Glennl n Cagle Glenn Cagle District Director District Director, Dallas District Letter 1050(DO) (Rev. 3-86) Pace 3`f • internal Revenue Service Department of the Treasury District Director Me: Employer Identtfieation Number. pCT 1 X985 84-0978992 Accounting Period Ending. September 30 Foundation Status Classification: 170(b) (1) (A) (vi) and 509(a) (1) p Shiloh Home, Inc. Advance Ruling Period Ends: 7201 S . Sheridan Court September 30, 1987 Littleton, CO 80123 PersontoContact: HO Technical Assistor Contact Telephone Number. (214) 767-3526 E0: 7213:4913:DAL:JS Dear Applicant: Based on information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from Federal income tax under section 501(0) (3) of the Internal Revenue Code. Because you are a newly created organization, we are not now making a final determination of your foundation status under section 509(a) of the Code. However, we have determined that you can reasonably be expected to be a publicly supported organization described in section 170(b) (1) (A) (vi) and 509(a}(1) . Accordingly, you will be treated as a publicly supported organization, and not as a private foundation, during an advance ruling period. This advance ruling period begins on the date of your inception and ends on the date shown above. Within 90 days after the end of your advance ruling period, you must submit to us information needed to determine whether you have met the requirements of the applicable support test during the advance ruling period. If you establish that you have been a publicly supported organization, you will be classified as a section 509(a) (1) or 509 (a) (2) organization as long as you continue to meet the requirements of the applicable support test. If you do not meet the public support requirements during the advance ruling period, you will be classified as a private foundation for future periods. Also, if you are classified as a private foundation, you will be treated as a private foundation from the date of your inception for purposes of sections 507(d) and 4940. Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period. If you submit the required information within the 90 days, grantors and donors may continue to rely on the advance determination until the Service makes a final determination of your foundation status. However, if notice that you will no longer be treated as a section 509(a) (1) organization is published in the Internal Revenue Bulletin, grantors and donors may not rely on this determination after the date of such publication. Also, a grantor or donor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act that rEsulted in your loss of section 509(a) (1) status, or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section 509(a) (1) organization. (over) Past 3'7 If your sources of support, or your purposes, character, or method of operation change, please let us know so we can consider the effect of the change on your exempt status and foundation status. Also, you should inform us of all changes in your name or address. As of January 1, 1984, you are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA) , Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, you are not automatically exempt from other Federal excise taxes. If you have any questions about excise, employment, or other Federal taxes, please let us know. Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. You are required to file Form 990, Return of Organization Exempt from Income Tax, only if your gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. The law imposes a penalty of $10 a day, up to a maximum of $5,000, when a return is filed late, unless there is reasonable cause for the delay. You are not required to file Federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990—T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your present or proposed activities are unrelated trade or business as defined in section 513 of the Code. You need an employer identification number even if you have no employees. If an employer identification number was not entered on your application, a number will be assigned to you and you will be advised of it. Please use that number on all returns you file and in all correspondence with the Internal Revenue Service, Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. 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H p 888888888888888888 8 8 8 U Oal aaaaaaaaaaaaaaasea a a a s a o $H x8 C 888888888888888888 8 8 8 Ogl I s 8 V§ggg0110aaaaaaaaa g a g $ l a 9 ri „aaa»o » a 4 iR $ s a H8 ggggggggg ssg9A8s2v C0 si- go 992 r 99222 2299 828888888 8 8 lig@ V Aayaaa a 8 `s 2 » 4 0 i gZI I Iuaa 'Ili Iii 9F p of pO Y■ ^sc/ pe Oo O F F ( L � �� F F 2 c m o 0 - EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP RE: Bid#003-DT-07(RFP) Day Treatment 1. Group counseling is offered daily within the day treatment program. A master's level clinician facilitates at least two groups a week. These groups address a variety of independent living, coping skills/tools, cognitive restructuring and many others. The daily groups promote development and maintenance of a positive peer culture, teach accountability skill, address progress and enhance containment for the youth. This helps improve the investment and ownership of day treatment youth in their day to day, overall progress through treatment and their connection to healthy pro-social choices. 2. Shiloh will work with the parents in scheduling the necessary medical/dental/vision appointments clients. Psychiatric services may be contracted for if needed. Medical conditions which require intensive maintenance or current substance addiction which require intensive maintenance will not be accepted to the program. 3. All clients must be English speaking. In situations where parents are Spanish Speaking only, Shiloh will contract services of a translator. In addition, Shiloh has a bilingual therapist on staff at the Adams program that we may access. Shiloh also continues to seek a bilingual therapist for the Longmont Day Treatment program. 4. Service Objectives: a). Completion of a comprehensive intake assessment b). Ongoing assessment of function evident in milieu staff feedback, educational feedback and therapist feedback c). An initial treatment plan developed within 10 days of placement and updated monthly d). Family involvement evident in participation in intake process, attendance and contribution at all staffings, and participation in scheduled family therapy sessions e). Evidence of improved adaptive functioning evident in consistently appropriate/ pro-social behavior in the program, adaptive behavior displayed during off-site activities 0. Evidence of improved adaptive functioning at home as reported by youth and family g). Coordinate with local school districts for the timely completion of the triennial Individual Education Plan(IEP) Discharge planning begins at admission and continues throughout the client's participation in the program. At each monthly review, the multidisciplinary team meets to discuss progress toward treatment goals, client needs and resources and the form of and modifications to the discharge and aftercare plan. At the final monthly review, representatives of the client's next public school and his prospective outpatient therapist(when indicated) are invited to join the multidisciplinary team to ensure the discharge and aftercare plan is complete and that the necessary services • for the clients will continue without interruption. Outcome Measures and Monitoring will include the following: 1). Successful transition to public school upon completion of program 2). Completion of GED when indicated 3). Client will remain in the family home or less restrictive setting for up to six months following discharge(Shiloh will work in conjunction with the county to assist client and family post discharge) 4). Academic improvement as evidenced by WRAT(Wide Range Achievement Test) administered at intake and discharge 5). Completion of mental health and/or offense specific goals as in treatment plan 6). Link client and families to identified community resources (mental health, medical, dental, community support centers etc.)prior to discharge 7). Increase parenting competency as evidenced by pre and post test utilizing MFG curriculum 8). Parent compliance with Informed Supervision Criteria(when indicated) 5). Evidenced based services include the following: The program is specifically designed for the behavior-disordered adolescent. A skills focused treatment program in which the youth (1)recognizes his problems and how thinking errors contribute to irresponsible behavior; (2) develops adaptive social skills; (3) develops new coping skills, i.e. new behavioral "tools" and learns to use these tools to manage difficult feeling states, especially anger and hopeless- ness. The youth then practices these new cognitive and behavioral skills with peers and teachers in the Shiloh program, in group therapy and with their family. Progression through the program is assisted by a privilege system in which the youth's behavior and quality of work on Phase projects at Shiloh and at home is tied to his program privileges. Movement forward through the program toward graduation is also dependent on successful completion of written and behavioral assignments and development of a relapse prevention plan. 6). Day Treatment staff include the following: Licensed Clinical Social Worker(1 full-time, 1 part-time) Clinicians are Master's level Education Director/Master's in Special Education Teachers/Special Education Endorsement Treatment Counselors/school aids are highly qualified with advanced degrees 7). The Day Treatment monthly rate is $ 1546.00. "..**; a DEPARTMENT OF SOCIAL SERVICES P.O. BOX A ' GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 111e Fax Number(970)353-5215 May 11,2007 COLORADO Steven Rameriz, CEO Shiloh Home, Inc. 6400 W. Coal Mine Avenue Littleton, CO 80123 Re: Bid#003-DT-07 (RFP 07006)Day Treatment Bid#004-SAT-07 (RFP 07007) Sex Abuse Treatment Dear Mr. Ramirez: The purpose of this letter is to outline the results of the Bid process for PY 2007-2008 and to request written confirmation from you by Monday,May 21, 2007. The Families, Youth,and Children Commission appreciate 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# 003-DT-07, (RFP 07006)Day Treatment, for inclusion on our vendor list.The FYC Commission attached the following recommendation and conditions to your bid. Recommendation: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. Conditions: Bidder must submit information that was not addressed or submitted with the original bid submission,including; 1. Provide information relating to groups under the Target Eligibility section, 2. Address medical eligibility, 3. Provide a statement related to how Bilingual services are being addressed, 4. Describe specific service objectives, including the methods the bidder will use to measure, evaluate,and monitor services. 5. Provide information as required relating to evidenced-based services, 6. Provide the educational background of staff under Staff Qualifications, 7. Provide the program rate under Budget Information. • , Page 2 Shiloh Home of RFP Practice 2007-2008 • The Families, Youth and Children(FYC)Commission recommended approval of your Bid# 004-SAT-07, (RFP 07007)Sex Abuse Treatment, for inclusion on our vendor list.The FYC Commission attached the following recommendation to your bid. Recommendation: 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. 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 accepts 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, 352.1551, extension 6392. Sincerely, dy A. Gr ego,Dir r cc: Juan Lopez, Chair,FYC Commission Tobi Vegter, Core Services Coordinator Gloria Romansik, Social Services Administrator Weld County Department of Social Services Notification ofFinancial Assistance Award —for Core Funds Type of Action Contract Award No. X Initial Award FY07-CORE-53 Revision (RFP-FYC-07006; 002-DT-07) Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Reflections for Youth Ending 05/31/2008 Day Treatment Program 1000 S. Lincoln Avenue#190-200 Loveland,CO 80537 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Community-based day treatment program is open to Assistance Award is based upon your Request for youth ages 11-18 (can admit youth 18-21 if admitted Proposal(RFP). The RFP specifies the scope of prior to their 181°birthday)requiring a well-structured services and conditions of award. Except where it is and secure program,consistent supervision,therapeutic in conflict with this NOFAA in which case the mental health services,and extra support educationally, NOFAA governs,the RFP upon which this award is both academic and behavioral. Services are provided up based is an integral part of the action. to eight client families at any one time. Clients will be Special conditions assessed for bicultural/bilingual services. Average hours 1) Reimbursement for the Unit of Services will be based per week include 30 hours classroom/education, and on an hourly/daily rate rate per child or per family. three to five hours therapeutic services per week, 2) The hourly/daily rate will be paid only for direct face- average length of stay is four-six months. to- face contact with the child and/or family, as specified in the unit of costs computation. Cost Per Unit of Service 3) Unit of service costs cannot exceed the hourly/daily Per Daily Rate and yearly cost per child and/or family. Treatment Package $100.76 4) Payment will only be remitted on cases open with, Per Hourly Rate and referrals made by the Weld County Department Treatment Package Low (Court Testimony) $80.00 . of Social Services. 5) Requests for payment must be an original submitted to the Weld County Department of Social Services Enclosures: by the end of the 25th calendar day following the end X Signed RFP:Exhibit A of the month of service.The provider must submit X Supplemental Narrative to RFP: Exhibit B requests for payment on forms approved by Weld Recommendation(s) County Department of Social Services.Requests for payments submitted 90 days from the date of service, X Conditions of Approval and thereafter,will not be paid. 6) The Contractor will notify the Department of any change in staff at the time of the change. Approv (p Program fficial: By l ��-.en By L A�- David . ong, Chair Judy riego\ erector Board W d%ouut?Commissioe,�s Weld o of bI' artmen f Soci Services Date: LW 1— Date: t I y JLt1 EXHIBIT A SIGNED RFP ORIGINAL • 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 (After receipt of order) BID MUST BE SIG ED IN INK Program Area: \Cix l I f T C p� "1I' r- ' �A TYPED P _ D SIGN TURE VENDOR W-rec\1� [Dl Nc ck\ N. • (Name) I Handwritten Signature By Authorized Officer or Agent of Vendor ADDRESS tOQb S• &tg E- t --7-CO TITLE kil ti _i'E j )\A�'� KA/ I 61 r1kl.() Eh go Seri- DATE Q .Lo .01" PHONE# 3\‘\k 1380 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Program Area Supervisor/Provider Meeting Verification/Comment Form Date of Meeting: 03/07/2007 Program Area: Day Treatment /6 1 /j-c ) 72- tc ,. -Fj Comments (to be completed by Program Area Supervisor): The service provider meets the needs of youth and their families, preventing out of home placement and in order to expedite the reunification of youth with their families from residential treatment. The provider continues to provide good services. There have been no concerns related to treatment goals. The agency is dedicated to helping the county meet their PIP goals. Bilingual services have been available and translation services continue to be available. Signature of Program Area Supervisor Table of Contents Day Treatment Program Proposal Invitation to Bid no page number Verification/Comment Form no page number Abstract/Program Description 1 -2 Target/Eligibility Populations 2 -3 Projective Narrative/Supporting Documentation 4 Types of Service Provided 4 -11 Measurable Outcomes 11-13 Service Objectives/P.I.P 13-14 Workload Standards 14-15 Staff Qualifications 15 Program Capacity per Month 15 Internal Tracking and Billing Process 15-16 Supporting Documentation 16 Evidenced-based Outcomes/Literature Citation 16-17 Confidentiality and Participant Protection/Human Subjects 17-19 Budget 19 Unit of Rate Computation 19 Program Budgets 20 Direct Service Costs 21 Admin Costs non-Face-to-Face 22 Overhead Costs and Profits 23 Appendix 1 Resumes for key staff members 23-35 Appendix 2 Data Collection Instruments/Protocols 36 Appendix 3 Sample Consent Forms 37-44 Attachments following Evaluation Plan following Certificate of Insurance following Reflections for Youth, Inc. "Discovering the Power of Positive Choice" Weld County Day Treatment Program RFP-FYC-001-07 03-30-07 (Currently begin offered and to continue services through 05-31-08) Abstract/Program Description Reflections for Youth, Inc. is a non-profit, community based residential treatment program and day treatment program for females and males ages 11-18 (can admit youth 18-21 provided they are admitted before there 18th birthday) regardless of race, color or religious preference. All residential programs and our day treatment program are licensed by Colorado Department of Human Services State Child Care Licensing. The license numbers are as follows: Prairie View RTC license#1530128, Grismore RTC license#1530130, Wilderness RTC license#1530131, and Day Treatment license #1545846. Services provided for the purposes of this bid proposal include a full-day day treatment program incorporating three full academic semesters throughout a calendar year. RFY's day treatment program has been utilized as a"step-down"program for youth being served residentially and needing a transition period and extra support before returning to a public school environment, and as an option for counties and school districts needing an appropriate learning and therapeutic setting for at-risk youth living in the home of the family or in a foster home situation. The day treatment program operates out of a centralized location in Loveland, CO. The address is 1000 S. Lincoln Avenue#190-200, Loveland, CO 80537. Each of the four classrooms employs a full-time special education teacher licensed in the area of Special Education: Affective Needs and a certification to meet the requirements of No Child Left Behind. Each classroom also employs a full-time paraprofessional educated at the Bachelor's level with a state substitute teaching license. The school program is licensed to serve a total of 40 youth(28 residential and up to 12 day treatment). Day treatment students are expected to participate in a phase system similar to residentially placed students, follow classroom and program rules, adhere to an academic curriculum designed for them to meet their home school district's graduation requirements, contribute to the writing and follow-through of their I.E.P. (if applicable) or program-generated goals, and be willing to participate in individual, group and family therapy. Each day treatment only student receives daily communication/behavior sheets completed by their teachers to be brought home and signed by parents or guardians for regular contact regarding their student's progress. It is the goal of Reflections for Youth to educate students in both a traditional and non- traditional manner by making certain each student receives core and elective classes needed to graduate or by aiding in the attainment of a GED, and by offering community- based activities to enhance their learning experience. The school uses the local library 1 and recreation center one time per week as a class, participates in frequent filed trips designed by the teachers to supplement current classroom lessons, are involved in service-learning opportunities such as Meals-on-Wheels, Open Space and other service- learning as available. In the event a student and his guardian and professional team choose to allow the youth to prepare for the GED, Reflections for Youth, Inc. educational staff arranges for he/she to take a GED locator test where their strengths and needs will be identified, and then designs a daily educational plan incorporating core classes in their deficit areas and regular study time geared towards passing the GED. In addition, RFY is committed to assisting older students nearing discharge in locating appropriate community-based programs, such as the county workforce centers and Americorp, where career exploration and job training and placement are addressed, Day treatment students are required to participate in individual, group and family therapy unless contraindicated by the placement worker and/or school district referring the youth. The clinical services of the day treatment program are the overall responsibility of the Clinical Director in coordination with the Executive Director and therapist(s)providing the services. This includes the development, implementation and coordination of the treatment program. Testing and psychiatric medication evaluations and appointments are conducted as needed. These evaluations aid in case planning and assure that the appropriate treatment is utilized for the youth's maximum growth and benefit. Reflections for Youth, Inc. therapists are all masters' level and have specific training in at least one of the following: EMDR, Dialectic Behavioral Therapy, Cognitive Behavioral Therapy and/or Reactive Attachment Disorder. Reflections' treatment team evaluates each day treatment youth's plan twice monthly. Monthly treatment progress reports are submitted to the appropriate agencies representing the youth and monthly (or as needed) staffings are scheduled to discuss the youth's progress in detail. A discharge plan and aftercare services are designed by the Day Treatment Coordinator, assigned therapist, guardian and placement worker. Target/Eligibility Populations Reflections for Youth's day treatment program is open to any youth requiring a well- structured and secure program, consistent supervision, therapeutic/mental health services, and extra support educationally, both academic and behavioral. An I.E.P. is preferred but not required. Typically such youth will demonstrate behavioral and emotional difficulties and have a history that may involve one or more of the following: family conflict and discord, physical abuse, sexual abuse, running away and/or truancy issues, oppositional defiant behavior, self-defeating behaviors, delinquent acts and certain adjudications and learning/emotional disorders/disabilities. RFY, Inc. employs a contracted child psychiatrist and accepts youth currently taking or in need of psychotropic medications. RFY's centralized school accepts up to twelve day treatment youth once the centralized school is in place. Ages range from 11-18. Arrangements are made to provide therapy sessions to all appropriate family members of split families if in the best interest in of the youth in day treatment and recommended by the placement worker or school district referring the youth. The needs for biculturaUbilingual services will be assessed by 2 individual/family need and RFY will make every effort to employ a paraprofessional and a therapist that can speak a second language. At this time we do not currently employ any bilingual staff members in the day treatment setting. Reflections does contract with two interpreters that are available for regular family communication, communication with treatment planning,progress and therapeutic involvement including attendance at family therapy sessions on an as needed basis. We are working to employ a bilingual staff that is available during all school-based day treatment hours; approximately 30 hours a week. The Reflections for Youth, Inc. Academy School is located in Southern Loveland, approximately five miles west of 1 -25. Approximately 20%of our referral base for our residential program is currently from Weld County and we currently have two of our current 10 day treatment slots filled by Weld County. A third slot is filled by a district 6 youth and a third Weld County DSS youth will be referred to our day treatment program following his successful discharge from the residential program. RFY's monthly maximum capacity for Weld County youth not in our residential program will be eight (8) youth. All youth in the program have access to 24-hour support through our day treatment coordinator and Reflections on-call therapeutic support system. The location of the day treatment program is approximately 20—30 minutes from most families in the Weld County/Greeley area and also families living in the Southern Weld County area. The average stay of a client depends upon daily/weekly progress, individual/family needs and availability of funding. All areas are important topics of discussion at the monthly staffing meetings that occur for all day treatment youth. Currently,the youth attending Reflections for Youth, Inc. day treatment program are in the program for approximately one to two school semesters, or an average of four to six months. Average hours per week that a client participates in the day treatment program can be broken down into the following: 30 hours a week classroom/education hours, and approximately three to five hours a week for therapeutic services (one individual, one family and three group sessions per week). This does not include the time for transportation. Transportation is provided by Reflections for Youth, Inc. unless other arrangements are made by the family and/or caseworker. Reflections for Youth, Inc. will not reject any referral solely on the basis of the youth's psychiatric/emotional history, committed delinquent acts or other problematic behavior. Youth with an extensive history of aggression to self and/or others (requiring restraint for the protection of others) as well as adjudicated sexual offenders will be assessed on a case-by-case basis and may not be admitted depending upon a pre-placement interview and evaluation. Reflections for Youth, Inc. day treatment program will accept referrals for juveniles who have committed sexual crimes and works with a contracted provider that becomes part of our treatment team/multidisciplinary team once the youth is admitted to our program. We can also offer Informed Supervision to the family of the referred youth on an as needed basis. Youth with a full-scale IQ below 70 and youth requiring routine medical assistance (diabetes, seizure disorders, etc.)will also be assessed on a case-by-case basis. 3 PROGRAM NARRATIVE/SUPPORTING DOCUMENTATION I. Types of Services to Be Provided A. Site based services. Reflections for Youth, Inc. will provide a minimum of 6 hours/day and 30 hours/week of educational services to the youth it serves. In addition RFY will provide approximately three to five hours of therapeutic service per week. The educational services will be provided by a state licensed special education teacher in the area of affective needs, a paraprofessional and a master's level therapist/therapist intern. The centralized school meets the requirements of No Child Left Behind with each special education teacher either being certified or working on a certification(highly qualified teacher) in one of the core subjects; English, social studies, science or mathematics. A master's level educational director and a day treatment coordinator will provide administrative over sight and supervision. RFY employs a Title I reading specialist who works full-time and provides reading and mathematic support and specialized classes for those youth needing extra support in either subject or both subjects. B. Community collaboration efforts. Reflections for Youth, Inc. maintains a professional working relationship with the Colorado Department of Education's Special Services Unit. Each of RFY's facility schools must comply with CDE's teacher and administrator licensing requirements, state and national curriculum standards,the administration of CSAP testing each calendar year, October 1 and December counting reports, Title I compliance,No Child Left Behind, Special Education Law and FAPE (Free and Public Education). Reflections for Youth, Inc, is committed to providing excellent educational experiences for the youth it serves and welcomes frequent communication with members of CDE's Special Services Unit for the constant improvement of its educational program. The educational program at RFY is in full compliance with the Colorado Department of Education. Reflections for Youth, Inc. currently works in collaboration with the Weld County Department of Social Services to provide residential treatment services, day treatment, life skills and Home-based option B services for adolescents and their families receiving services through the social service system. RFY receives referrals from caseworkers for the placement of adolescents 11-18 years of age. After placement, RFY and the caseworkers meet on a monthly basis to discuss progress, struggles, home passes, current and future planning and aftercare plans for the youth being served. The facility manager, therapist, counseling and administration staff communicate with the caseworker regularly to discuss any educational,therapeutic or residential issues that arise while the youth is placed. The same type of collaboration takes place for the current day treatment youth that RFY serves from Weld, Larimer and Boulder Counties and St. Vrain, Boulder Valley, District 6, Adams 12 and Thompson Unified school districts. 4 If a student receives services from a local mental health center, Reflections for Youth, Inc. makes every effort to communicate with the center and determine the student's current therapeutic and medication needs. We have developed a good relationship with North Range Behavioral Health, Larimer Center for Mental Health and the Mental Health Center of Boulder County. Prior to discharge we do and will continue to make every effort to assist in the arrangement of continued therapeutic and/or psychiatric services as needed by individual youth and families. C. Program Components 1. Reflections for Youth, Inc's. educational program consists of a minimum of a six hour day and is offered year-round. Teacher's work year-round with a short period off during the summer semester for continued education and traditional holidays off during the school year. 240 days of education are offered per year. Upon entering the program, requests are immediately made for past school records, including the current I.E.P. (if applicable). Students are administered the P.I.A.T. (Peabody Individual Achievement Test) if valid and current grades and achievement levels can not be established and if deemed necessary by the educational team. In the event the referred youth is a special education student,the I.E.P. is reviewed for compliance and used as-is if appropriate. When a special education student is admitted with an out-of-date I.E.P., RFY's educational team will hold either an annual or triennial meeting as necessary and with proper notification/communication being given to the student's home district. If a triennial review is appropriate,the home district will be asked to collaborate with RFY for needed testing requirements. RFY's educational team can and does administer the Woodcock-Johnson III, P.I.A.T., BASC and host or attend I.E.P. meetings as agreed upon by the home district and RFY. RFY will ask that a school psychologist and speech/language pathologist from the home district be available for the remaining portions of triennial I.E.P. testing. 2. The therapeutic components of the day treatment program at Reflections for Youth, Inc. include individual, family and group therapy. Drug and Alcohol Therapy can also be provided and is offered for one hour per week during the school day and one evening per week (after school hours). Dependency (drug and alcohol) services are offered by a LCSW and a CAC I taking classes to complete her CAC III by September 2007. RFY will be applying for ADAD licensure within three (3)months. Therapy techniques used by therapist include Structural Family Therapy, Cognitive Behavioral Therapy, Solution- Focused Therapy and Dialectic Behavioral Therapy (DBT). Therapists provide flexibility in scheduling family sessions in order to facilitate full involvement in the treatment process. The day treatment coordinator, clinician, educational director and teacher develop treatment plans to target behavioral, social, emotional and family goals in both therapy and program. The day treatment coordinator participates in treatment planning meetings to review goal progress and facilitate new interventions or target goals as needed, and also participates in monthly staffings. RFY also provides psychiatric/medication evaluations and monitoring to the youth being served. RFY contracts with Dr. Scott Shannon, certified child and adolescent psychiatrist to provide 5 these services on an as needed basis and within 30 days of intake for each youth in day treatment program. 3. The day treatment program of Reflections for Youth, Inc. utilizes a behavior management phase system that is peer driven,but with extensive staff support and involvement. When students meet the expectations of the day treatment program they move up the phase system, gain more responsibility and earn"better"privileges unique to the level. Each student is given goals developed by educational,therapeutic, counseling staff and him or herself. The goals may be current I.E.P. goals, if appropriate, or "school/program goals" depending upon individual academic,therapeutic or behavioral needs. Students must meet a certain percentage on each goal before they can reach a higher phase. At the end of each school day,teachers fill out daily communication logs that include information regarding points for the day,positive accomplishments, and/or areas needing improvement. It is our hope that parents see this information each day and the expectation is for the students to have it signed at the end of each week and given to the classroom teacher. Responsibilities and earned privileges are outlined for incoming students in the Day Treatment Handbook. 4. Day treatment students are able to participate in any recreational activity or event scheduled during the school day, as long as rules and expectations are being met to ensure safety. All students have access to the Chilson Recreational Center. A minimum of one time per week they can swim, workout with weights, run on an indoor track or play basketball for physical education. With the addition of our centralized school in January 2007, the local health club located in the same complex as our school building has provided time to use their facilities as part of our physical education program. Outdoor classroom activities, including educational field trips are planned on a regular basis. D. Parent/Caretaker involvement in all program components as indicated in the case plan and as required. Parents/Caretakers are expected to be involved in monthly staffing meetings, family therapy, I.E.P. meetings and other educational meetings, and through weekly communication with the educational staff through written materials and phone calls. During intake, parents/caretakers and students are given an orientation packet that described the program components and given access phone numbers for the educational, clinical and administration staff. Parents/Caretakers receive copies of all treatment plans and progress reports. The educational or administration staff contacts parents/caretakers of severe behavioral difficulties and other significant concerns that may arise during the day treatment day. Homework and treatment goals progress are shared daily with the parent/caretaker through daily reports and a signed copy must be turned into the teacher at the end of each week to ensure communication and continuity between home and placement. E. Assessment and plan to meet the needs of child and family. 6 1. All teachers employed by Reflections for Youth, Inc are licensed through Colorado Department of Education's educator licensing unit. All RFY teachers are required to possess or be working towards a Master's Degree in Special Education: Affective Needs. In addition all classroom teachers are required to be in the process of becoming highly qualified teacher in one (or more) of the core subjects to meet the requirements of No Child Left Behind. Special education teachers at RFY have historically moved into a teaching position after working as a counselor or paraprofessional within the agency, giving them more experience with the behavior management system and overall program philosophy. 2. Any youth being served through Reflections for Youth, Inc. will have a school/therapeutic services aftercare plan upon discharge. Most students either return to a public or alternative school within their home district or continue the preparation to take the GED. For students needing work skills or job training, RFY is committed to helping the student find the appropriate resources within their community to receive assistance in these areas. RFY currently works with county workforce agencies, local community colleges,probation departments, mental health centers and other community-based services offering assistance to youth. RFY also employs are part-time vocational/transitional specialist that works with all youth 16 years of age or older, and in particular,those in the GED program and not planning on returning to traditional public school education. 3. Reflections for Youth, Inc. offers flexibility in scheduling family therapy sessions to encourage and provide opportunity for all family members to be involved. All individual and family therapy sessions are run by therapists with experience in adolescent, family, group and individual therapy (LCSW, LMFT or LPC or Intern in any one of the three licensure areas). Group education sessions are run by bachelor's level counseling or education staff with training in running the groups being offered. 4. Reflections for Youth, Inc. provides a structured recreational activities schedule for all residential and day treatment residents in placement. Recreational activities for day treatment students most often take place at a local recreation center and include swimming, weight training, walking or jogging on an indoor track, basketball and any aerobic activities offered. The recreational activities that take place are documented daily on an Activity Log Sheet and the document details each activity that takes place in the designated time slot(s). Reflections for Youth, Inc works with USDA and in collaboration with a registered dietician who designs each facilities menu(lunch menu for day treatment students). Reflections provides a snack and lunch for each youth in the day treatment program. The menu is posted in the school, is seasonal and rotates every other week. It details each food item and amount to be served at each meal and snack time. The meal and the number of youth receiving a meal are documented on a Daily Food Production Record Form(USDA). 7 The facility manager in each of RFY's three programs is responsible for ensuring that each youth's medical and dental appointments are completed and properly documented. In the case of day treatment youth, RFY has typically not been involved with medical and dental appointments unless a medical emergency occurs in the course of a day that the youth is present in program. Day treatment youth taking psychotropic medications or in need of a psychiatric/medication evaluation will have an appointment scheduled with RFY's psychiatrist within 30 days of intake. Ongoing appointments will occur on an as needed basis. Typically appointments occur every 30 days unless the psychiatrist has specifically stated he wants to see the youth more or less frequently or in the event of an emergency. RFY has the ability to administer medications at school provided a prescription is on file at school and medications are being administered from a current labeled bottle that matches the written prescription. Within the day treatment setting, RFY, Inc. offers sex education as an elective course. Presentations by the Larimer County Department of Health and Planned Parenthood take place regularly and include topics of safe sex, sexually transmitted diseases, contraception and HIV. Educational groups are also offered and are documented on a Daily Schedule Form. 5. Reflections for Youth, Inc. provides psychiatric services to all of our day treatment youth. The students are seen by our contracted psychiatrist, Dr. Scott Shannon, MD, a Board Certified Child and Adolescent Psychiatrist. He will complete an initial evaluation within the first 30 days of placement. Emergency appointments generally can occur within two weeks of intake. The student(s)then see the psychiatrist on a regular basis to monitor mental health status,progress and medications. The psychiatrist is also available in emergencies for consultation and medication management. Prior to discharge and in conjunction with social services and the family, all efforts will be made to have psychiatric services in place prior to a youth's discharge on an as needed basis. At discharge Dr. Shannon will provide prescriptions that will assure a 30-day supply of medications. F. Proactive planning for transition to public school setting or independent living 1. Prior to a student leaving RFY's day treatment program, educational staff will schedule a transition meeting with the receiving school's or program's counseling or special education department. This meeting will serve as a"change of placement" meeting for special education students. Topics of discussion will be the I.E.P. (if applicable), current progress and grades and recommendations. The student leaving RFY can also tour the new school or setting at that time. 2. Prior to a student leaving RFY's day treatment program, a discharge planning meeting will take place with the clinical and administrative staff representing RFY, the caseworker, youth and family, and any other wanted/needed professionals to discuss aftercare and what services are needed. Needed services can include individual therapy, family therapy, drug and alcohol therapy, community-based NA/AA, mental health/psychiatric through North Range Behavioral Health or similar provider. 8 Individual therapy, family therapy and home-based services can be provided by RFY if decided upon as necessary at the discharge planning meeting and if so desired. 3. A date for discharge will be set by the team of people involved with the student's case plan. If the student is a non-GED student, Reflections for Youth, Inc. will advocate for a date that least upsets the transition back to public school. Students can lose valuable clock hours/credits if expected to return to public school in the middle of a semester or academic quarter. 4. A key area that will be addressed throughout the course of placement but certainly during a transition meeting is overall student progress. For special education students this will be a discussion of the I.E.P. goals and objectives and outcomes. Teachers will be able to give the receiving school information regarding the progress students made towards achieving their I.E.P. goals and their present level of functioning. Teachers and clinicians will also report on effective behavioral and academic interventions and modifications used within the classroom and throughout the day treatment day to assist the student as they move forward. 5. Students who have consistently attended school,retained acceptable or above-average grades, actively participated in the therapeutic program offered, and have followed the rules and expectations of the program are considered"being successful". Quantitative measurements of success include satisfactory progress on individual academic, behavioral and/or I.E.P. goals, progress and attainment of individual and family therapeutic goals and satisfactory compliance with rules and expectations of the program, including expectations for the home environment while in the program. We will measure and evaluate improvement in attendance, classroom participation, grades, behavioral interactions with teachers, clinical staff and peers, and consistency of positive family interactions and outcomes (communication, conflict resolution, limit setting and follow through). This is accomplished through monthly treatment plan and update reports including assessment and measurement of progress in the areas of social, emotional, family,recreational and educational (drug and alcohol if applicable); daily goals and percentages; reports from therapist regarding therapy progress in terms of positive decision making, conflict resolution and communication; and parental feedback and compliance and completion of treatment plan and goals related to the home environment. Students are evaluated and monitored weekly in improving their grades and consistently have access to teachers and can expect that appropriate accommodations will be made to aide in their overall success. RFY uses a wide range of assessment materials in evaluating student progress and performance. Teachers are trained in administering individual achievement tests and behavior rating scales and they are consistently used to measure and evaluate where a student is, what is needed and how to provide what is needed. When a student enters RFY he/she will be given formal assessments in the areas of reading and written language by the Title I reading specialist and informal assessments by the classroom teacher. Each student's needs will be assessed using past school records, I.E.P. goals and objectives, discharge summaries and educational history. Goals will be set to measure and evaluate that the student's true needs are being met. 9 Reflections for Youth holds annual and triennial reviews for special education students as indicated by the I.E.P. and teachers report on annual goals at each grading period. In addition a monthly education summary, including the measurement and evaluation of behavioral, emotional and/or academic goals (depending upon assessed need) is completed by the Special Education Teacher. All youth served in the day treatment program are involved in all service components; education, therapy,behavior and recreation. The number of youth to be served at a single time is (8) eight based on availability at the time the referral is made. All services discussed are available for all youth served in the program. So that services offered at RFY will not supplant available services in the community,the daily rate of service for a day treatment youth can be adjusted if a psychiatrist or therapist is already in place through North Range Behavioral Health or a drug and alcohol counselor is in place through Island Grove as examples. Reflections for Youth, Inc. maintains a professional working relationship with the Colorado Department of Education's Special Services Unit. Each of RFY's facility schools must comply with CDE's teacher and administrator licensing requirements, state and national curriculum standards, the administration of CSAP testing each calendar year, October 1 and December counting reports, Title I compliance,No Child Left Behind, Special Education Law and FAPE. Reflections for Youth, Inc, is committed to providing excellent educational experiences for the youth it serves and welcomes frequent communication with members of CDE's Special Services Unit for the constant improvement of its educational program. Reflections for Youth, Inc. currently works in collaboration with the Weld County Department of Social Services to provide residential treatment services, day treatment and In-home Intervention Services for adolescents and their families receiving services through the social service system. RFY receives referrals from caseworkers for the placement of adolescents 11-18 years of age. After placement, RFY and the caseworkers meet on a monthly basis to discuss progress, struggles,home passes, current and future planning and aftercare plans for the youth being served. The Facility Manager, Therapist, counseling and administration staff communicate with the caseworker regularly to discuss any educational,therapeutic or residential issues that arise while the youth is placed. The same type of collaboration takes place for the current day treatment youth that RFY serves from Weld, Larimer and Boulder Counties, Larimer Center for Mental Health,North Range Behavioral Health), and St. Vrain, Boulder Valley and Thompson Unified school districts. If a student receives services from a local mental health center, Reflections for Youth, Inc. makes every effort to communicate with the center and determine the student's current therapeutic and medication needs. We have developed a good relationship with North Range Behavioral Health, Larimer Center for Mental Health, Jefferson Center for Mental Health and the Mental Health Center of Boulder County. Prior to discharge we do and will continue to make every effort to assist in the arrangement of continued therapeutic and/or psychiatric services as needed by individual youth and families. 10 If needed, referral information for Greeley/Weld Housing Authorities and Employment Services of Weld County is provided. II. Measurable Outcomes Students attending Reflections for Youth's day treatment program will receive clinical and educational services by licensed staff. Educational services include small structured classrooms (1:5 or 1:6 ratios) with a certified special education teacher, a full-time paraprofessional,two part-time `roving"aides and no more than 14 students in a classroom. RFY schools provide a safe environment for youth to grow and experience functional and healthy relationships with adults and other students. Basic expectations tracked daily and evaluated weekly, include the relationship virtues of trust, responsibility, acceptance and accountability. RFY staff members teach social skills as well as academic skills and are role models of positive and appropriate behavior for the youth served. Students are asked to begin to take personal responsibility for passing core and elective classes with support from RFY's educational and therapeutic staff. This is measured and evaluated by each student's level of organization, responsibility for assignments and homework completion. RFY, Inc. teachers work with students to achieve I.E.P. goals if applicable or individualized learning goals if a student does not have an I.E.P. Each semester teachers switch elective class offerings to give students different options to gain elective credit. RFY students earn clock hours for each class while in the day treatment program. Upon leaving the program, a comprehensive educational and therapeutic discharge summary is written including total clock hours earned. The receiving school/district will convert the earned clock hours into credits depending upon their credit system. RFY assures a continuity care for each of the youth served in its day treatment program by providing educational experiences which remediate,maintain and improve academic, intellectual and social functioning. Students receive highly individualized instruction and attention, supportive mental health/therapeutic intervention and complete, comprehensive transition and aftercare plans. All transition and aftercare plans include input from all current and future professionals involved with the youth. These students are more successful upon transition back to their homes and public school systems and it is the goal of Reflections for Youth, Inc to serve each of its youth in this manner. The success of RFY, Inc. will be monitored, measured and evaluated through compliance with the written Day Treatment Policy and Procedures and through classroom observations and educational and therapeutic staff supervision and support. To date, it has been our experience that all but two of our day treatment students have returned to their family or to a foster home if family was not available. With the two exceptions all were residing in their own home immediately after discharge. It is our goal that this trend continue with the goal of all youth served returning to their home as soon as possible after discharge, hopefully immediately, and in no longer than six months 11 barring any safety (D &N) issues. The majority of students who discharge from RFY day treatment program have entered public school or an alternative, non-day treatment school managed by their home district. Decisions have been made for some students attending day treatment that earning their GED is a better option. When deemed appropriate by the professionals involved with the youth(age, credit situation, etc.) RFY staff will schedule the student for a GED locator test. Based on the results of the test,the student will continue to take classes in his/her areas of need (reading, math, etc.) and be given daily preparation time for the GED as well. In addition to preparation time the student will be evaluated by suitable community-based programs to assist in the areas of career exploration and job training/placement. RFY also employs a part-time vocational/transitional specialist to assist in this process. If the GED is not completed while at RFY,the student, guardian and placement worker will be notified of formal GED preparation class offerings within his/her community to further prepare for taking and passing the GED. It is also our goal that unless another approved plan is put into place prior to discharge from day treatment(i.e. GED,vocational education, etc.), all youth served will enter public school upon completion of the day treatment program. Quantitative measurements of success include satisfactory progress on individual academic,behavioral and/or I.E.P. goals,progress and attainment of individual and family therapeutic goals and satisfactory compliance with rules and expectations of the program, including expectations for the home environment while in the program. We will measure and evaluate improvement in attendance, classroom participation, grades, behavioral interactions with teachers, clinical staff and peers, and consistency of positive family interactions and outcomes(communication, conflict resolution, limit setting and follow through). This is accomplished through monthly treatment plan and update reports including assessment and measurement of progress in the areas of social, emotional, family,recreational and educational (drug and alcohol if applicable); daily goals and percentages; reports from therapist regarding therapy progress in terms of positive decision making, conflict resolution and communication; and parental feedback and compliance and completion of treatment plan and goals related to the home environment. Students are evaluated and monitored weekly in improving their grades and consistently have access to teachers and can expect that appropriate accommodations will be made to aide in their overall success. RFY uses a wide range of assessment materials in evaluating student progress and performance. Teachers are trained in administering individual achievement tests and behavior rating scales and they are consistently used to measure and evaluate where a student is,what is needed and how to provide what is needed. When a student enters RFY he/she will be given formal assessments in the areas of reading and written language by the Title I reading specialist and informal assessments by the classroom teacher. Each student's needs will be assessed using past school records, I.E.P. goals and objectives, discharge summaries and educational history. Goals will be set to measure and evaluate that the student's true needs are being met. Reflections for Youth holds annual and triennial reviews for special education students as indicated by the I.E.P. and teachers report on annual goals at each grading period. In addition a monthly education summary, including the measurement and evaluation of behavioral, emotional and/or academic goals (depending upon assessed need)is completed by the Special Education Teacher. 12 III. Service Objectives Reflections for Youth, Inc. will work diligently to assure that all youth attending its day treatment program will have a successful transition upon completion of the program. It is currently our experience that nearly all of our day treatment youth are living with their families at the time of placement. The exception has been for youth in which the parental rights are terminated or a family or even appropriate family member is not available to reunify with. In those cases the youth is with a foster family at the time of placement and remains with that family after completion of the day treatment program. As previously stated, our average length of placement in day treatment has been for one or two semesters. Our longest stay in day treatment has been nine (9) months and was based on some extenuating circumstances that neither RFY nor the placement worker had control of. The vast majority of students that have discharged from RFY's day treatment program have returned to public school or a non-day treatment school that the home school district manages. To date, over 90%of the day treatment youth have returned to public school. Decisions have also been made for some students attending day treatment that after completion of the program,the GED is a better and more realistic option when compared to public school settings. All youth and families in the day treatment program at RFY participate in staffings, family therapy and case plan meetings in which resources and available services are discussed. Comprehensive educational and therapeutic discharge plans are written and an aftercare plan is put together prior to the referred youth completing treatment. The aftercare plan is very community resource based and discusses in detail services that are available and may be helpful. Access to those services is discussed during regular staffings and case planning meetings with the family, youth, caseworker and program present. Specific referral issues will be addressed in discharge/case planning meetings with solution-focused services put in place on an as needed basis. The day treatment program at RFY will help improve the outcomes for the Performance Improvement Plan ( P.I.P.) in several key ways. First, the program will work to reduce the need for any kind of out-of-home placement for any youth that has not yet been placed out of home, and it will work to increase the likelihood that a youth will not need to be removed from the home a second (or more)time if the youth had been previously placed out of the home. Through family therapy and family support and based on the family constellation, needs of all family members to include mother, father and child (children)will be addressed. Secondly, the day treatment program will work to lessen some of the behavioral problems the youth faces through individual and group therapy, psychiatric support, including identification of mental health needs as needed, specialized education support and more positive attention and supervision overall. The program will also work to provide additional skills and new ways of looking at old problems for the caregivers and families, with the overall goal of increasing the caregiver or parent's ability to cope better with the child; less chance of asking the youth to be removed to be 13 placed in an out-of-home placement or higher level of care. Thirdly, assessments and an aftercare plan are part of the overall services offered by the day treatment program. RFY has developed and Aftercare plan to be used as part of the discharge process and to be used once the child has successfully completed the day treatment program and is at home with fewer services. Case planning will occur, and crisis intervention and support will be part of the plan. Since Reflections for Youth, Inc. also offers in-home family intervention services, this may be used as a step down when needed,to again,reduce the need for out-of-home placement. Lastly, RFY holds regularly scheduled staffing with all parties involved and in particular with the caseworker, family member(s), and the youth receiving the services. In this way, it is assured that the youth and guardian participate in all case planning and that the treatment plan is offering services that will result in the child's continuing stay with the family or reunification with the family if the child is not living with the family while in the day treatment program at RFY. IV. Workload Standards Reflections for Youth, Inc. will have the capacity to serve eight(8) youth and their families in day treatment at any one time. Program capacity per month is eight(8) youth and their families. The length of time in the day treatment program is currently averaging four to six months and there is no reason to expect that there would be a significant increase or decrease in terms of length of time in the program. Total number of hours per week, including transportation would be approximately 38-40 and includes 30 hours of educational instruction,three to five hours of therapy services and approximately one hour a day of transportation. Given that RFY is planning on serving eight (8) youth at any one time the total number of hours per week would be 304 to 320 hours per week. RFY offers 240 days of instruction per year or approximately 48 weeks of instruction in a calendar year. Over the course of the calendar year with eight (8) youth in the day treatment program, RFY will offer 14,592 hours of service per calendar year. The individuals offering the direct and non-direct services for the youth in the day treatment program and their families will include Special Education Teachers, Title 1 Teacher,paraprofessionals, classroom aides, Therapists/Case Managers, Educational Director, Executive Director, Day Treatment Coordinator, Clinical Director, Transportation Coordinator, and Financial Administrator. This is approximately 17 individuals that will either directly or indirectly be involved with the day treatment program at RFY. Maximum caseload per Therapist/Case Manager is (8) eight. Maximum caseload for supervisor would be (12)twelve. All insurance coverage for RFY is shown on the enclosed Certificate of Liability Insurance and exceeds the amounts asked for in the bid proposal. Insurance coverage includes general liability, automobile liability, comp and collision,workers compensation 14 and employer's liability and professional liability. Weld County has been named as a certificate holder. V. Staff Qualifications All staff, including supervisors, providing direct services have the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17 and Section 7.0006, Q Colorado Department of Human Services. All therapists involved in the project are master's level and fully licensed as a LCSW, LMFT or LPC or working toward licensure as one of the above. All Special Education Teachers are either fully licensed with a master's degree in special education: affective needs or are an emergency licensed special education teacher in the area of affective needs. Based on the requirements of No Child Left Behind,the Special Education teachers are also working on certification in one of the four core areas to include written language, science, social studies and/or mathematics. The paraprofessionals employed within the classroom of RFY all have a minimum of a bachelor's degree and are state substitute certified. The two part-time classroom aides have an associate's degree or a minimum of two years experience in a related field. The Day Treatment Coordinator has nearly ten years experience providing services in educational and residential settings and the current Lead Therapist is in her final semester of study working towards licensure as a LPC. She has over eight years experience working with pre-adolescent and adolescent youth in a day treatment and/or residential setting. The Educational Director is a professionally licensed special education teacher, grades K-12 and a provisionally licensed special education director with 6 years experience in public school and residential/day treatment classrooms. She also has 4 years experience in an educational administrative role. Total number of staff, including supervisors, available for the project is 15, excluding the Transportation Coordinator(bachelor's level) and Financial Administrator(Master's level and also a LMFT). The minimum ratio offered in the program is 1 qualified staff member to 5 children. A few of the youth placed are 11 and 12 years old but historically the majority have been 13 years old or older to date. VI. Program Capacity per Month Maximum Weld County DSS youth to be admitted to our program per month is(8)eight. Minimum Weld County DSS youth per month to support RFY's program is (2)two. VII. Internal Tracking and Billing Process It is understood that Reflections for Youth, Inc. is responsible for all program costs, including start-up costs, facility,personnel, operating,travel, equipment, audit and capital items. Reflections for Youth, Inc. will submit original monthly billing forms to the appropriate Department staff person on or about the 10th of the month following the service month. It is further understood that all billings must be date-stamped by Social Services by the 25th day of the month following service to be eligible for reimbursement. It is understood that Reflections for Youth, Inc. will include all of the deliverables listed 15 in order to verify services on our monthly billing. Although not anticipated, in the event that it becomes necessary, Reflections for Youth, Inc will work with families to prepare to pay for the services beyond the established time frame and out of the scope contracted with Social Services. SUPPORTING DOCUMENTATION VIII. Evidenced-Based Outcomes/Literature Citations Reflections for Youth, Inc. makes every effort to utilize evidenced-based therapies in working with the youth and families that are served. The best-supported psychotherapy interventions in youth are Cognitive Behavioral Therapy(to include Dialectical Behavioral Therapy, assertiveness training and relaxation training), parent training and psycho-educational strategies. Cognitive-behavioral therapies are helpful because it (they) focus on the "here and now"rather than the past,they are brief and time limited. The sessions are structured, goal-oriented, skill-based and directive,the sessions are instructional in nature, relapse prevention is built into the treatment so high risk situations can be anticipated and planned for and the end goal is having the youth and family become their own "therapist" so to speak so down the road they can deal with life's challenges, rewards and up and down nature without necessarily needing to go back to treatment each time. Cognitive Behavioral Therapy has been found helpful for depression, anxiety, PTSD and conduct problems. Parent training programs have been developed and found effective to improve child-parent interactions, enhance parenting effectiveness and reduce coercive and "unsafe" interactions. The following bibliography relates to the types of therapies and services that are offered by the clinical staff at Reflections for Youth, Inc. 1. Juvenile Justice Bulletin—April 2000—Brief Strategic Family Therapy. Comparing Structural Family Therapy with Other Types of Therapy. www.nyrs.gov./ojjdp/I j bul 2000. 2. Szapocznik, J., Williams, R.A. (2000, June). Brief Strategic Family Therapy: Twenty-Five Years of Interplay Among Theory, Research and Practice in Adolescent Behavior and Drug Abuse. Clinical Child and Family psychology Review, 3 (2), 117-134. 3. Corcoran, J. (1997) Solution-oriented approach to working with juvenile offenders. Child and Adolescent Social Work Journal, 14 (4), 277-288. 4. Seagram, B.C. (1997) The efficacy of solution-focused therapy with young offenders. Doctoral Dissertation, York University, New York, Ontario. 5. Durrant, M. (1995) Creative Strategies for School Problems: Solutions for Psychologists and Teachers. New York: Norton. 6. Gingerich, W.J., & Wabeke, T. (2001)A solution-focused approach to mental health intervention in school settings. Children and Schools., 23, 33-47. 7. Evidenced-Based Counseling and Psychotherapy,National Association of Cognitive-Behavioral Therapists (2005). www.nacbt.or /evidenccd-hased-therapy.htm 16 8. Chambless, D.L., Baker,M., Baucom, D., et al. (1998). Update on empirically validated therapies, II. Clinical Psychologist 51:3-16. 9. Brestan EV, Eyberg SM (1998), Effective psychosocial treatments of conduct- disordered children and adolescents: 29 years, 82 studies and 5,272 kids. Journal of Clinical Child Psychology 27 (2): 180-189. 10. Compton SN, March JS, Brent D et al. (2004), Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidenced-based review. Journal of American Academy Child Adolescent Psychiatry 43 (8): 930-959. 11. Rathus, J.H.., Miller,A.L. (2002). Dialectical Behavior Therapy adapted for youths at risk for suicide. Suicide and Life Threatening Behavior, 32(2), 146-157. 12. Trupin, E.W., Stewart, D.G., Beach, B., Boesky, L. (2002) Effectiveness of a dialectical behavior therapy program for female juvenile offenders. Child and Adolescent Mental Health, 7, 121-127. IX. Confidentiality and Participant Protection/Human Subjects 1. Protect Staff and Clients from Potential Risk—There do not appear to be any foreseeable risks or potential adverse effects as a result of the project itself or any data collection activity. RFY will follow procedures to minimize participants (youth and families in day treatment program)against potential risks, including risks to confidentiality. Risks to confidentiality will be minimized by having therapy take place in designated therapy rooms and offices and with the use of a sound machine as necessary. All records, including background and intake information, education information and treatment/clinical information will be stored in locked filing cabinets and/or in locked rooms with specific access being granted for specific individuals on a need to know basis. Although not anticipated, in the event of adverse effects, the Weld County Caseworker would be contacted and a special meeting would/could be held to discuss what has occurred and the most appropriate method of dealing with the situation. All treatment and methods used within the day treatment program have previously been described. 2. Fair Selection of Participants—Target populations for the proposed project have been previously described an include youth between the ages of 11 — 18 that are in need of a structured day treatment program involving special education and therapeutic components. Other populations include siblings of the referred youth(if applicable) and bio and/or foster families members of the youth being served. The other information in this section applies to research type studies and projects and is not applicable for the purposes of the day treatment program offered to Weld County DSS by Reflections for Youth, Inc. 3. Absence of Coercion—If a referred youth and his/her family is accepted into the day treatment program at Reflections then participation is required for a successful discharge and return to a lower level of care (foster home,public school, family home, etc). Without participation it is highly unlikely that any progress would be shown. In 17 addition, it is possible that youth would be court ordered into our day treatment program. I am unclear on part II of this section and I do not believe that it applies to the day treatment services offered. 4. Data Collection—Date will be collected from the referring caseworker prior to placement and throughout the placement on an as needed basis. Data may also be collected from probation officers, previous therapists or evaluators, other professionals with involvement in the case of the youth and family being referred, past school districts and other placements if applicable. Data for testing may be collected based on the needs/requirements of the IEP with classroom observation, test taking, assignments, instruments such as the Woodcock Johnson, PIAT, BASC, etc. Prior to intake, our Educational Director, Treatment Coordinator or Day Treatment Coordinator will conduct an intake interview and collect data in order to make a decision about the overall appropriateness of the referral and to ensure that RFY can meet the needs of the youth and family being referred. All data collection instruments can be accessed by contacting RFY directly but for page limit and and voluminous reasons, have not been copied. The intake interview packet alone is 10-plus pages in length. 5. Privacy and Confidentiality—The privacy and confidentiality of youth and their families will be ensured by having limited number of professionals having access to records and by having records stored in a locked confidential place at all times. Access to the information collected and information gained prior to intake will be granted only on a need to know basis and in general will include the Special Education Teacher, Educational Director, Treatment Coordinator, Day Treatment Coordinator, Executive Director and assigned Therapist. Consent and releases are signed at intake by the family (youth if age of consent and applicable) and referring caseworker. A coding system is not used but access to the records is limited and at all times records are kept in a locked filing cabinet and/or in a locked room at the administration offices of Reflections for Youth, Inc. 6. Adequate Consent Procedures—Again, most of what is covered in this section has been previously answered or is not applicable to the day treatment program at Reflections for Youth, Inc. It applies more to research studies in general than it does to providing treatment to youth and families in a structured day treatment setting. A Day Treatment Handbook and Parent Packet will be given to all program participants outlining the key components of the program, contact numbers, rights and responsibilities, consequences and rewards, expectations, phase system information,therapy information and transition from the program at program completion. Participation is voluntary in the sense that a youth is not going to be physically restrained for attempting to physically leaving the program in the course of the day and if a youth refuses to attend the program once accepted, a decision will be made about the continued involvement of that youth in the program. It is likely that for most youth being referred there would be "problems" if they chose to not participate and top leave the project. Problems would occur in the nature of a visit from a probation officer, referral to more restrictive placement or additional requirements through the court. 18 Reflections will work to get consent from the caseworker making the referral,the youth participating in the program and a parent or guardian. Consent for youth under the age of 15 will be given by the parent or guardian. In the vent that a youth at the age of consent has reading, processing or verbal problems, the program and requirements of the program will be described in a manner in which they are able to understand. Our program does require in nearly all cases, an IQ of at least 70 to be accepted into the program. Reflections for Youth, Inc. employs two contracted interpreters to assist youth and families that do not use English as their first language in these situations. Informed consent is obtained for participation in all aspects of the program and a separate informed consent is obtained to access services from our child and adolescent psychiatrist, including prescribing of medications if needed. The consent forms can be read out loud of required and questions are asked to ensure that all parties understand what they are signing. Copies of the entire intake packet, including consents are given to the caseworker and parent or guardian at the time of the intake or as soon as possible after the intake. Again for page limit and voluminous reasons,the entire intake packet, including consents are not provided in the proposal. Again, those forms canbe accessed by contacting Reflections for Youth, Inc. directly. The intake packet for day treatment is approximately 25 pages in length. 7. Risk/Benefit Discussion—Risks for participation in the day treatment program are minimal. Every precaution is taken to ensure that the environment at Reflections for Youth, Inc. fosters trust, accountability and responsibility in a safe and healthy environment. Certainly there are risks in terms of other youth in the program, the possibility of bullying and intimidation, name calling and inappropriate behavior that is experienced through direct or indirect involvement. All of these risks occur in every treatment setting and in most cases, are more prevalent in public school environment and in the community overall. The benefits of the program far outweigh the potential risks and give referred youth the opportunity to make better decisions, gain a new level of trust, show increased responsibility and independence and make it possible for the youth and family to achieve a better life and lasting success. BUDGET X. Unit of Rate Computation The hourly unit rate cost is $13.26 per hour or$100.76 per day for day treatment services. 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CLINICAL, CASE MANAGEMENT AND MANAGERIAL EXPERIENCE Three years experience providing consultation and technical assistance to management level staff on effectively implementing outcomes based system of data collection, summarization and decision making. Three years experience providing daily support,crisis intervention, family collateral sessions, and twice weekly individual therapy for adolescents attending non-public school and living in group home settings. Four years experience directing a residential treatment program including managerial and budgetary responsibilities for all aspects of the clinical, residential and educational aspects of the program. Five years experience as an agency clinical representative for adolescents involved in the court process or placed in juvenile detention centers, and for adolescents placed in a psychiatric hospital during the course of treatment. Six years experience conducting clinical interviews to assess appropriateness of prospective clients for placement within three separate treatment agencies. Eight years experience providing client assessment in the areas of residential placement, education and day treatment, individual and family therapy, goal planning development, discharge planning and any other support services important for the individuals served. Eight years experience of program implementation and hiring,training, and supervising counseling, clinical and management level staff responsible for the care and quality of life of children,adolescents and adults with special needs. Fourteen years experience as a liaison between various programs and families,mental health providers,county probation and child welfare agencies,vocational programs and school districts to ensure the best possible opportunity for client success. �3 EMPLOYMENT HISTORY April '00—present(continuing): Director of Operations,Monarch Youth Homes,Inc. Loveland,C) 80537. Supervisor: Scott Fardulis, CEO July '98—April '00: Mental Health Director, Monarch Youth Homes,Inc. California Deer Park, CA 94576. Supervisor: Bill Cremen,Director of Operations. June '95—July '98: Mental Health Specialist/Day Treatment Mental Health Supervisor, La Cheim Residential Treatment Center and La Cheim School, Inc. Richmond, CA. Supervisor: Bob Garriot,Program Director and Charles Mason, School Director. June '93 —June '95: Associate Program Manager,Ohlson House, La Cheim Residential Treatment Center. Richmond, CA 94804 Supervisor: John Herkenhoff,Program Manager. July '89—March '93: Program Manager,Portland Metro Residential Services, Inc. Portland, OR 97206. Supervisor: Lisa Francolini Nov. '89—Feb. '93: Technical Assistance Consultant,Oregon Technical Assistance Corporation. Salem,OR 97305. Supervisor: Sue Stoner. Feb. '89—Sept. '89: Program Coordinator, EastCo. Diversified Services, Inc. Gresham,OR 97030. Supervisor: Tom Leeland. EDUCATION AND PROFESSIONAL CREDENTIALS University of San Francisco Master of Arts—Counseling Psychology,May 1996 University of Portland Bachelor of Arts—Psychology,May 1988 National Certified Counselor(NCC), April 1998 Licensed Professional Counselor(LPC),July 2000 American Counseling Association,Professional Member,June 1996—present Workshops, Trainings,Continuing Education Classes(not a complete list) CPR/First Aide Training Professional Assault Response Training(PART) rM Crisis Prevention Institute Training(CPI) Medication Administration Training Medications and Medical Management HIV/AIDS Training System of Care Performance Outcomes Training Basic and Advanced Behavior Planning Child Abuse,Assessment,Reporting and Treatment Assessment and Treatment of Alcohol and Drug Problems Human Sexuality Child Sexual Abuse: Assessment and Treatment Child and Family Team Building Workshop(Wraparound Services) Anger Management/Violence Prevention Workshop Music Therapy Colorado Jurisprudence Workshop Foster Home Assessment Safe Environments in Foster Care and Residential Settings Sex Offender Treatment Reactive Attachment Disorder Assessment and Treatment Suicide Prevention References Robert Garriot,PhD. La Cheim Residential Treatment Services (415)485-5416 Bill Cremen,Monarch Youth Homes,Inc(California) (707) 291-2411 Scott Fardulis,Monarch Youth Homes, Inc. (Colorado) (970)613-4385 Mark Suprenand, Colorado Department of Human Services (303) 866-4565 Darcy Niesent 3701 Cedar Dr. LaPorte, CO 80535 (970) 493-0559 EDUCATION UNIVERSITY OF COLORADO AT COLORADO SPRINGS Bachelor of Arts Psychology, May 22, 1998 HONORS Received a one year softball scholarship to Colorado Northwestern Community College (Rangely, CO 08/94 to 05/95) WORK EXPERIENCE Group Counselor- Larimer County Youth SAFE, duties include: Assisting residents therapeutically to maintain progress in the Youth SAFE program, teaching and modeling fundamental skills while living independently, providing behavioral and crisis intervention, participating in group counseling sessions, organizing educational, recreational work activities for residents, and other duties as necessary. (09/03/99 to present) Pre-School Teacher-Southwest Washington Childcare Consortium as Head Teacher, duties included: Organizing academic lesson plans, implementing creative projects, teaching basic social skills, working in a team partnership with two other assistants, and other duties as necessary. (05/10/99 to 08/27/99) Treatment Counselor-The Parry Center for Children, duties included: Monitoring success of basic living skills by means of therapeutic support for emotionally disturbed children, and contributing emotional support for them to obtain individual treatment goals. Other duties included case management of specific children, documenting behavior and amount of success in obtaining treatment goals. (06/23/98 to 08/31/99) Office Support Worker-The University of Colorado at Colorado Springs, duties included: Answering phones at the main switchboard, inserting data using Windows, working with the ISS system, and filing. (09/97 to 05/98) Coach-City of Fort Collins Parks and Recreation Department, duties included: Coaching girls fourth through ninth grade softball and basketball, obtaining equipment, scheduling practices, and other duties as necessary. (03/92 to 08/94) References-Available upon request at, • CAROL S. JOHNSON, MA 132 Yale Avenue Ft. Collins, CO 80525 (970)472-9704 • License Marriage and Family Therapist#578 State of Colorado Marriage and Family Therapist#37606 State of California • Education University of San Francisco MA—Clinical Psychology;Dec 1994 San Francisco State University BA—Economics with a Minor in Business;May 1987 • Experience 2001 —present Grismore Trmt Cntr,Monarch Youth Homes,Loveland,CO Therapist Provide individual and family therapy to emotionally disturbed adolescents and their families. 2000-2001 V-II Logistics, Ft. Collins, CO Controller Responsible for records management; expedite A/R, A/P, payroll, journal posting, and general ledger maintenance. Produced year-end financial reports and reconciled bank statements. 1995-2000 Braun Place, Sunny Hills Children's Garden,Novato, CA Therapist Provide individual,family, group,and milieu therapy to emotionally disturbed adolescents. 1994-1995 Petaluma School District, Petaluma, CA School Counselor Provide counseling for K to 6th graders in individual and group settings. • 1990-1994 Earl's/101=y Love's, San Francisco, CA Controller Responsible for records management; disburse checks, expedite A/R,A/P,payroll,journal posting, and general ledger maintenance. Produced quarterly and year-end financial reports and reconciled bank statements with budget control and supervisory responsibilities. 1979-1990 San Rafael Health Foods Inc., San Rafael,CA Manager/Head Bookkeeper Involved in all aspects of fast-paced retail operations. Strong public contact position included vendor interface, ordering, shipping and receiving health products, and controlling inventory. References available upon request Professional Vitae Mary E. Mills 5904 Harrison Drive Fort Collins,CO 80526 (970)226-6638 Professional Objective: To enhance my interpersonal skills, experience and education while fulfilling a personal goal of becoming a respected professional within the filed of education. Professional Experience: 7/02 -Present Monarch Youth Homes/Academy Schools,Loveland,CO Director of Education Responsible for curriculum development,managing within the guidelines of the Department of Education,hiring, supervision,and retention of quality teachers,continual oversight and development of regular and special education programs, professional development, maintenance of educational records, IEP compliance, maintaining professional relationships with public school districts, parents,mental health care workers, and county human services personnel. 10/00-7/02 Monarch Youth Homes/Academy Schools,Berthoud,CO Special Education Teacher Created and carried out lesson plans meeting Colorado standards, established and upheld appropriate discipline and crisis interventions, supervised a full-time paraprofessional,maintained student records. 8/99-6/00 Lexington Middle School, Lexington, MO Special Education Teacher—Cross Categorical Taught daily IEP related lessons to a wide range of special education students meeting Missouri standards. Administered standard achievement tests for IEP development,worked closely with regular, other special education teachers,and director of special services. 10/98-6/99 Webber Junior High School,Fort Collins,CO Special Education Paraprofessional Aided in the direct teaching of learning,physical, and emotionally disabled children grades seven through nine. 8/97-6/98 Maple Park Middle School,Kansas City, MO Special Education Teacher Planned,organized and taught daily lesson plans meeting Missouri Standards to learning and emotionally disabled children grades six and seven. Administered standard achievement tests to students,classified and organized results. �-9 • - RESUME • • JANE E. WILLIAMS, LCSW 916 Parkview Drive Ft.Collins,CO 80525 970-206-0329 lean Excellent at accessing services,assessing client needs,treatment planning,and developing relationships. Experience in parenting skills, calling on community resources,coordinating with other agencies, organizing and facilitating family participation,providing individual, family and group therapy. Strong understanding of childhood mental health issues. Specialization in play therapy, sandplay therapy,behavior management. Proactive,compassionate,energetic,independent, and resourceful. Work History 5.01 -present Clinical Care Coordinator, Lorimer Center for Mental Health Responsible for case management and discharge planning of all children in higher levels of care. Perform all assessments for clients requesting hospitalization, day treatment, or residential treatment, and those parents requesting residential placement under HB 1116. Work closely with other agencies to assure that appropriate resources are available. Provide individual and family therapy to small caseload. 9/00-4,01 Therapist, Managed Adolescent Care and Hope High School Program Developed treatment plans, provided individual,family and group therapy. Provided interventions for de-escalations and crisis management. Provided case management and facilitated a parent support group meeting once-a-week, 1998-8/2000 Therapist, Pathways Schools at Hyattsville Re-entry Provided individual,family,group therapy and crisis intervention to adolescents. Developed and implemented treatment plans,provided clinical summaries,progress reports and behavioral plans. Managed program in absence of Coordinator, supervised student intern, assumed the role of instructor for certain exploratory subjects. Participated in Student Assistance Program (Substance Abuse)and Alternative Therapies. Recipient of Jim McGeogh Staff Award for the growth and development of Pathways' students. 1997-1998 Senior Clinician, Psychotherapeutic Rehabilitation Services Responsible for school-based therapeutic program providing individual and family therapy to elementary school-aged children. Provided therapeutic services to adults,children,and groups in a community mental health clinic. Supervised two clinicians. 1993-1997 Social Worker 11, P.G.. Co.Health, Division of Mental Health Primary therapist for children(age 7-12), and their families. Performed evaluations, including diagnostic impressions,made referrals,developed and implemented treatment plans,handled crisis situations. Provided case management. Documented and maintained all records, prepared summary reports. Developed and implemented parenting skills classes,parent support groups,family night,etc. Monitored program, supervised staff and responded to other administrative functions in the absence of the coordinator. 1989-1990 Contract Therapist and Volunteer Coordinator/Community Services Advocate,Family Crisis Center Co-led support groups for victims of domestic violence,provided intakes on an as-needed basis,performed case management,led two weekly educational and support groups. Responsible for recruitment, training and supervision of all volunteers,outreach and public speaking engagements to educate community about domestic violence. an 1989 B.A., Summa Cum Laude, Psychology, University of Maryland College Park 1993 M.S.W.,University of Maryland at Baltimore,Child and Family Specialization ISMS LCSW: State of Colorado 20 John R.Kinnaird 419 Ord St. Laramie, Wyoming 82070 (307) 755-5285 CAREER OBJECTIVE To use my personal,academic and work experience to help individuals develop insight and solutions to their psycho-social problems. LICENSE Licensed Clinical Social Worker#LCSW-358,Approved April 2001 by the Mental Health Board of Wyoming. EDUCATION Masters of Social Work,August 1998. GPA 3.75/A=4.0. Arizona State University,Tempe, AZ. Second Degree Student,Health Sciences(Pre-Med.),June 1993 -May 1994. GPA 3.9/A=4.0 University of Wyoming,Laramie, WY. B.A.,Psychology,December 1992. GPA 3.2 (cum.)3.5(psychology)/A=4.0 University of Wyoming,Laramie, WY. WORK EXPERIENCE March 1999-Present Counselor,Cathedral Home tbr Children,Laramie, WY. Provide individual, family and group therapy to adolescents and their parents. Weekly co-facilitation of the campus chemical dependency and sex offender groups. Developed currently used curriculum for adolescent chemical dependency program. Responsible for treatment planning,implementation and documentation for all residents. Insure that documentation for residents is to JCAHO standards. Provide supervision and in-service training for the treatment team staff. Communicate progress of residents to social workers,judges, lawyers and other involved parties. Attend admissions meeting once per week to help decide on future in-takes and to discuss discharge planning with a committee of directors,counselors and physicians. Provide supervision for Masters of Social Work Students. Aug. 1998—.March 1999 Masters Level Therapist,Arizona Youth Associates,Phoenix,AZ. Assessed clients prior to placement in a residential setting for traumatized children.Developed and supervised therapeutic programs used by the Behavioral Health Technicians. Provided individual and family therapy for each child. Conducted therapeutic groups and social skills training. Educated staff and families on client diagnosis and therapeutic methods. Formulated each client's treatment and ensured that the plan was designed to meet the individuals'needs. March 1998—Aug. 1998 M.S.W. Intern and Mental Health Technician,Remuda Life Program,Chandler,AZ. Worked with nurses,therapists, physicians,and dietitians in providing daily needs and long-term case planning for clients in an inpatient setting for eating disorders. Provided individual/group therapy. March 1997-March 1998 Program Director,Developmental Behavioral Consultants, Tempe, AZ. Supervision and training of Residential Managers of three therapeutic residential homes for emotionally and mentally handicapped children and adolescents. The major rote of the Program Director was to oversee the total operations of these therapeutic settings. Development of programs and treatment plans. Sept. 1996—March 1997 M.S.W. Intern and Program Coordinator,Developmental Behavioral Consultants,Tempe, AL The development of the agency motivational/behavior management program for emotionally and mentally handicapped children and adolescents. Other duties included a problem analysis of staff turnover,individual counseling,development of treatment plans,and the production of new agency programs. Dec. 1994-Aug 1996 Residential Manager, Developmental Behavioral Consultants,Tempe,AZ. Supervised the implementation of treatment plans by staff in a residential setting of emotionally and/or mentally handicapped children and adolescents. Educator,therapist and behavioral specialist for the six clients,their families,and all other persons involved in the clients' lives. INTERESTS Running,Golf,Fly Fishing, Health and Nutrition,Scientific Research. REFERENCES Available upon request. 3i • Elisabeth E. Freys PO Box 535 Laporte,CO 80535 970-221-5578 • lizfreys®aol.com Mgt Utilizing my education and practical field experience in working with youth. Front Community College May 8, 2002 Associates Degree in Liberal Arts Ft. Collins, CO Colorado State University May 16, 2003 B.A. in Liberal Arts(concentration in Ft.Collins, CO Social Studies) Colorado State University May 16, 2003 Teacher Certification in Social Studies Ft. Collins, CO --Intel'sl Teach to the Future with Support from Microsoft -Civil War Era (Implanatting Technology into the classroom) -South African History -Methods and Materials in Social Studies -Medieval Middle East -The American West -The"Sixties" -Asian Civilizations Centennial High School loth-12th Grades 1/2003-5/2003 Profession Development School(PDS) -Taught Intonational Business, Macintosh Applications and World History -Organized and created individualized lesson plans -Effectively used cooperative learning strategies -Itnplan nted and directed computer use in the classroom -Imply rented higher level thinking strategies -Utilized effective classroom managanatt techniques -Attended faculty meetings and school functions Preston School 8th Grade Fall of 2002 PDS Responsibilities: -Developed Lesson Plans -Taught U. S. History • -Used experiential teaching to expose students to a multitude of perspectives in U. S. History -Conducted a Case Study -Implemented and directed computer use in the classroom Atedita 1. � the accelgated reading program at Bauder Elementary and assisted with the Bauder Buddy program for at risk-kids. 2. Tutored students at the Tutor Center in Loveland, grades 2-12 in a variety of subjects 3. Teacher of the Year-Scrap booking and nomination proceetcontributing committee member iaiglan T oiurningg Poi nt i Fill-in Counselor Ft. Collins,CO 2mnth. Business Owner L.C.'s Cleaning Ft. Collins, CO 7yr. Collections Officer Trans Union Orlando, FL lyr. Retail Spradley Bar Ft. Collins, CO 2yr. Colorado State University Ft. Collins,CO (970)491-1101 • 13 Nickolas Saimaa 2513 W.Lake St. Fort COQku,C010521, (970)2146244 ,: Mketive; To obtain a job that will fulfill my passion to work with children and be a positive Mutate in the lives otthoae I work with. %daeader: Daebelor of Ana and Sebsea:li btorylSacoadary Education University of Northern Colorado;Greeley, CO Gradation:May 11.2002; OPA: 3.25/4.0 Lioasstgv:CO/Secondary'Mucstion.Social Studies Seadeat Teacher; Social Studies;Skyview High School; Thornton, CO; Spriag 2002;(303)153-1200 Work Trap riaaoa: Camp Counselor;Steen Teen Camp;Fort Collins,CO;Dennis Griffith; June-Aug.,2003; (970)568-0058 • Orgtrrizod and implemented daily activities. • Interacted ooavadretso-wadtan,parents,and students to provide a fun and nt Retail Salta Clark Mervyn Department Store;For Collins„CO; Michele Fergus;May. 1999-Augasr, 2003; (970)229-9888 • Served so a maser to nm a deportment and develop a team of ablikrYant • Worked with vrpwmers to provide tlas best expaieno.possible. SnbaNlott Taaelrer;Fonda School Distrust,Fort Collins,CO; Aug..2002 May,2003 Wareham Atlesdast University of Northam Colorado;Greeley,CO: Tom Sherwood;Oct, 1990-Nov.,2000; (970)351-1903 Referent= Drank Griffith; Owner/Organizer,Teen Camp;(970)566.0058 Deka Moore; Co-Counselor,Teen CampVTeacher,(970)368.4081 Dr.Mlelr— Welsh;Professor/Observer, (970)331-2223 Michele Fan Store Lead,Mervyn'Department Store;(970)229.9888 Bally Maples;PrieudfEat$epervilor,(970)204-0446 • Additional Ishrmatba: Licensed in First Aid, C;P1t.and Life jrdi g,, asap B/Paseenew liomsedbis driver 3y KIM EBERHART OB ECTIVB —� talk char I tern in Social Service that will not only challenge .t, A with my education,but will also allow for growth sad•mod on my tomcat;bills. EXPERIENCE Deadwood SD 2003-Present Sdverada Casino Cocktail Waitress • Interact with people while providing continuos customer support. a toot as a team player with aoto•rous other anpinyesa. Smash,SD 05/02-09/02 Holiday Ian Ngbt Sepaesiar • Supervised • customer service and sales routinely. • Sheeit4n.WY06/99—09/99 State Palm Insurance Inrnean Inspector aid Suntory • Main priority of house inspections. • Written▪ Secretary ill.consisting oo}°'wSng phone and putting information in of houses. to computers. • Dealt with people in highly stressful situations. EDUCATION arB•b SD 2000-2005Black Hills State University aid Spearh,SD • B.A.in psychology with a minor in sociology will beary of 2005. VOLUNTEER EXPEAINECE Straka Mater 2001-2002 • Successfully abPped>.elan�with troubled students. • Suc achieved academic and social goals. Leardsacessfully 2003.2005 ppR/Graradlwrk • DC Booth National Historic Fish Hatchery. • 70Groundskeeper, boors Per��per and snow removal. • Groundakceper, • Many hots of vigorous outdoor walk • k•MAIL IL MN AT 1l. C►tABPISH. SOUTH DAKOTA 5CJa1 •PHONE 0605} 6aS-Itna •say HATCHERY CIRCLE '• 3C Reflections for Youth, Inc. Day Treatment Program Monthly Summary Reporting Period: Student Name: Facility: DOB: DOP: Caseworker: Probation: Axis I Diagnosis: Previous Point Sheet Avg: Daily Point Sheet Avg: Educational: See attached Educational Report. Emotional: Family: Additional Information: Updated discharge concerns/recommendations Reasons Day Treatment level of care should continue: Estimated length of day treatment: 314 School Information Release Reflections for Youth, Inc. &� Reflections Academy Date: RE: (Name of Student) To: (Name of School) (Address) (City,State Zip) I hereby authorize you to release to Reflections Academy any and all information contained in the school record of the above named student, including, but not limited to transcripts of academic record, grade reports, results of psych-educational testing/assessment and evaluation, Individualized Educational Plan/Program, ' attendance records, incident and discipline records, awards, honors, diplomas,etc.. This information is required to assist Reflections Academy in determining this student's ' eflrenti n „ni1 Pr..re;111 ��_1-,gt.iIp2l nr Thd�.. Phank you for providing this information. Signature: Academy: Address: Date: 3 Created on 10/6/2004 1:27 PM Att School Information Release • Consent To Receive Psychotropic Medications Reflections for Youth, Inc. I, , have been informed of the following by the staff prescribing psychotropic medication. 1. The NATURE of my mental condition. 2. The REASONS FOR TAKING MEDICATION, including the likelihood of improving or worsening without such medication. 3. That my taking medication is VOLUNTARY and that CONSENT can be withdrawn at any time by stating such intention to any member of the treating staff. 4. The usual USE of the medication being prescribed. 5. The CONSEQUENCES of not taking the medication. 6. The REASONABLE ALTERNATIVE TREATMENTS, if any. 7. The PROBABLE SIDE EFFECTS of these drugs known to commonly occur and any particular side effects likely to occur in my particular case. I understand the information provided me and have had all my questions answered. I give my consent to the use of: - Name of Medication(s) Signature of Clicnt Date Signature of Parent/Guardian Date I do hereby declare that I have explained the above to the this client. Signature of Physician/Advanced Practice Nurse Date 39 Consent for Medical Treatment Reflections for Youth, Inc. As the Parent, agency Representative or Legal guardian, I hereby give consent to (facility) to provide all emergency dental or medical prescribed by a duly licensed Physician (M.D.), Osteopath (D.O.), or Dentist(D.D.S.)for (Resident) This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent. Child has the following medication allergies: Date • Parent/Agency Representative/Guardian-Signatiure Home Address -- Home Phone Work Phone APO Resident Rights Reflections for Youth, Inc. 1. Every client has the right to freedom of thought, conscience and religion. 2. Every client has the right to reasonable privacy. 3. Every client has the right to have his or her opinions heard and be included, to the greatest extent possible, when any decisions are being made affecting his/her life and treatment. 4. Every client has the right to receive appropriate and reasonable adult guidance, support and supervision. 5. Every client has the right to be free from physical abuse and inhumane treatment. Every client has the right to be protected from all forms of sexual exploitation. 6. Every client has the right to receive adequate and appropriate medical and psychiatric care in the least restrictive setting possible, suited to meet individual needs. 7. Every client has the right to receive adequate and appropriate food, clothing and housing. 8. Every client has the right to live in clean,safe surroundings. 9. Every client has the right to participate in an educational program that may maximize his or her potential. 10. Every client has the right to communicate in privacy, in writing or on the telephone, with "significant others"outside the facility. 11. Every client has the right to have frequent and convenient opportunities to meet with visitors. Each client may see his or her custodial parent or his or her children at any time. 12. Every client has the right to wear his or her own clothes,keep and use his or her own personal possessions, and keep and be allowed to spend a reasonable sum of his or her own money.: 13. . A facility shall not bar a client's attorney, clergyman, physician, client representative, legal rilctroi r- r`r , *,a•�ai ,'rOno I, _ i. - - . No client admitted to or in residence at a Residential Treatment Center shall be fingerprinted unless required by law. 15. A client may be photographed upon admission for identification and administrative purposes of the facility. Such photographs shall be confidential and shall not be released by the facility except pursuant to court order. No other non-medical photographs shall be taken or used without the written consent of the client's parent or legal guardian. 16. Every client has the right to the same consideration and treatment as anyone else regardless of race, color, national origin, religion, age, sex,political affiliation, sexual orientation, financial status or disability. 17. Every client has the right to be given the names and professional status of the staff members responsible for their rare. 18. Every client has the right to receive assistance from the resident representative in making complaints and to receive copies of the complaint procedures. 19. Every client, fifteen (15)years of age and older, has the right to request and to see his or her own medical records, to see the records at reasonable times, and to be given written reasons if the request is denied. 20. Every client, fifteen (15)years of age and older, who is not in the custody of Social Services has the right to accept treatment of his or her own free will and may sign in as a voluntary resident if he or she agrees to being in the facility.The client has the right to refuse to sign the consent for voluntary treatment at the time of admission or may take back the consent at a later date. 41 Crisis Plan Reflections for Youth, Inc. Resident Caseworker,/Guardian County If the above named resident is physically aggressive and/or exhibits any other behaviors that warrant detention and/or hospitalization, please contact the following person/agency for assistance: Name of Persons/Agency Emergency Phone Number Protocol or Procedure for Hospitalization: Any Additional Information or Follow Up: 4a AUTHORIZATION TO RELEASE INFORMATION FORM l , hereby authorize (Print name) , to release (Therapist/Physician/Facility/Probation or Parole/Employer) the information designated below for This authorization is valid only to: Individual: Agency: Reflections for Youth, Inc. Address: P.O.Box 1860, Berthoud, CO 80513 970-344-1394(fax) For the purpose of: Designate which of the following is to be released: Medical Psychiatric/Mental Health Treatment Drug and/or Alcohol Employment Educational Criminal History Financial Social Other (Specify) I understand that some of this information is protected by federal law and that my signature authorizes release of all of the above noted information. I also understand that I may revoke this consent at anytime and that upon fulfillment of the above stated purposes(s),this consent will automatically expire without my express revocation. Date: Signature Printed Name 43 AUTHORIZATION TO RELEASE INFORMATION FORM MINOR CHILD , hereby authorize (Print name) , to release (Therapist/Physician/School/Facility the information designated below for This authorization is valid only to: Individual: Agency: Reflections for Youth, Inc. Address: P.O.Box 1860, Berthoud, CO 80513 970-472-1736(fax) For the purpose of: Designate which of the following is to be released: Summary of Social/Family History Summary of Psychiatric History Summary of Medical History Educational Records Psychological Testing Other (Specify) I understand that I may revoke this consent at anytime and that upon fulfillment of the above stated purposes(s),this consent will automatically expire without my express revocation. Date: Client or Guardian Signature Relationship to Client 44 Reflections for Youth, Inc. "Discovering the Power of Positive Choice" Evaluation Plan Reflections for Youth, Inc. has been providing services for Weld County Department of Social Services since its inception, September 1, 2004. In addition to TRCCF (RTC) services beginning at that time, Home-based Option B and Day Treatment Services have been provided since June 1, 2005 and Life Skills services were added beginning June 1, 2006. Based on comments from Program Area Supervisors and through quarterly quality assurance reviews of our services that began during this current contract year, good, quality services have been provided and RFY has been receptive to feedback and making any necessary adjustments when needed. RFY has in the past and will continue to work with Weld County collaboratively toward the goal of providing quality services for the youth and families served and make every effort to assist Weld County and Colorado Department of Human Services to meet the requirements of the Performance Improvement Plan. The supervisors of all programs included in our bid; Day Treatment(Mary Barron, M.Ed), Home-Based Option B (Carol Johnson, LMFT)and Life Skills (Laura Leah Olsen), agree to meet on a quarterly basis to collect data, monitor and evaluate the process components as outlined. These include the following: * How closely did implementation match the plan as outlined in the proposal? * What types of deviation(if any) from the plan occurred? * What led to the deviations? * What effect did the deviations have on the planned intervention and evaluation? * Who provided the services, what the services actually were (modality, type, intensity, duration)whom were the services provided to (individual, family, characteristics); in what context(system, day treatment,home-based, community) and at what costs (personnel face-to-face and non-face-to-face, facilities, travel, etc.) The supervisors of all programs included in out bid; Day Treatment, Home-Based Option B and Life Skills, agree to meet on a quarterly basis to review the data collected and information gained from the services actually being provided and to address the outcomes components as outlined. These include the following: • What was the effect of the interventions used and overall involvement in the program for the youth and/or families receiving the services? • What program/contextual factors were associated with outcomes? • What individual and/or family factors were associated with outcomes? • Were the effects of the interventions and involvement in the program long lasting? • How did outcomes achieved align with the overall Performance Improvement Plan objectives? rage• uua Cllentlf:52227 SREFLFOR ACORDT. CERTIFICATE OF LIABILITY INSURANCE 0DATE 3127ODawyrY) PROWLER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 720 South Colorado Boulevard ALTER THE COVERAGE AFFORDEDES NBYT AMEND, OR THE POUCIES BELOW. Suite 60011 Denver,CO 80246 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Tudor Insurance Company 37982 Reflections for Youth,Inc. INSURER B: Plnnacol Assurance 10780 P.O.Box 1860 INSURER c Great American Insurance Company 16691 Berthoud,CO 80513 INSURER a INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED CR MAY PERTAN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HFMFIN IS SUBJECT TO AU.THE TERMS,EXCLUSIONS AND CONDmONS OF SUCH POLICES.AGGREGATE LBWS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD. POLICY EFFECTIVE POLICY EXPIRATION UNITS LTR NSF% TYPE OF INSURANCE POLICY NUMBER DATF IMLUDDIT1) DATF IWIDOTYYI A GENERAL LIABILITY PG1739600 09/20/06 09120/07 EACH OCCURRENCE $1,000,000 DAMAGE NTED X COMMERCIAL GENERAL UABILITY PRMRF 0 S(Fa',murrmu $50.000 X I CLAIMS WOE n OCCUR MEG EXP(My one IPNeon) $1,000 PERSONAL ADV INJURY $1.000,000 GENERAL AGGREGATE $3,000,000 GENT AGGREGATE LIMIT APPLES PER: PRODUCTS-COMP/OP AGG $1,000,000 7 POLICY n Pig n we Claims Made Policy C AUTOMOOLEUABILITY CAP5154804 09/20/06 09/20/07 COI.SINED SINGLE 11111 (1,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY NJURY $ SCHEDULED AUTOS (Par Person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per eRIdsS) GARAGE UABILRY AUTO ONLY.EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAINBRELLA LIABILITY EACH OCCURRENCE $ —1 OCCUR El CLAIMS MADE AGGREGATE $ $ 1 DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND 4085O90 10/01/06 10/01/01 X I TORYIINT CI 17::- EMPLOYERS'LIABILITY EL.EACH ACCIDENT $100,000 ANY C OFFICERMBER EXCLUDED?ECUTIVE E.I.DISEASE-EA EMPLOYEE $100,000 II yyes.aeewibe Prater SPECILL PROVISIONS below E.L.DISEASE-POLICY LIAR s500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS The following are Additional Insureds as respects General Liability only to the extent coverage might apply according to the policy terms, conditions and exclusions. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION Weld County,Dept of Social DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Services NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL P.O.Box A 315 North 11th IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER,ITS AGENTS OR Avenue REPRESENTATIVES. Greeley,CO 80632 AUTH REPRESENTATIVE e.(JVI//fLG/�� $. ACORD 2S(2001/08)1 of 3 #8521556/M513076 SLROH a ACORD CORPORATION 1988 _ _ raVet uw IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 254(2001/08) 2 of 3 #S521556/M513076 ____ _...• rave, Un DESCRIPTIONS (Continued from Page 1) Additional Insureds: Certificate Holder&State of Colorado •The following cancellation conditions always apply: -10 days for non-payment of premium -If policy shown,10 days for Workers'Compensation for fraud; material misrepresentation;non-payment of premium;other reasons approved by the Commissioner of Insurance AMS 25.3(2001108) 3 of 3 85521556/M513076 .... ... ._. EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP Reflections for Youth, Inc. "Discovering the Power of Positive Choice" P.O. Box 1860 Berthoud, CO 80513 (970) 344-1380 (p) (970) 344-1394 (0 May 18th, 2007 Tobi Vegter, Core Service Coordinator Weld County DSS P.O. Box A Greeley, CO 80632 Tobi: Here is my response to the letter I received via email on May 16, 2007 regarding Bid 003-OPB-07 Option B, Bid 002-DT-07 Day Treatment and Bid 06LS13 Lifeskills. As it relates to RFP 07006 Dav Treatment,and the caseworker training component, Reflections for Youth, Inc. requires that each employee,regardless of the level of position, is required to have 20 hours of ongoing training per year. In addition to approximately 16 hours of new hire training, Reflections offers the following trainings on a quarterly basis throughout the year: Risk Assessment and Suicide Prevention, 4 hours; Therapeutic Relationships, 2 hours; Policy and Procedure Review, 4 hours; Fire Safety and Emergency Protocols, 2 hours; Crisis Intervention, 4— 8 hours; CPR/Pt Aide, 8 hours; Mediation and Conflict Resolution, 2 hours; Phase System/Behavior Modification, 4 hours; Group Dynamics and running educational/psychoeducational groups, 2 hours; and Professional Relationships, 2 hours. Reflections also offers Medication Certification training on an as needed basis, 8— 12 hours for a staff member to become a QMAP (qualified medication administration person). All teaching, clinical and administrative staff are required to have a minimum of 18 hours per year of professional development/continuing education in their respective field. Examples are Dialectical Behavioral Therapy, Motivational Interviewing, Adolescent Counseling Skills, Risk Assessment and Mental Status Exams, etc. for clinical staff. Working with ADHD/ADD youth, IEP writing, Literacy Models, etc. for teaching staff and Milieu Management, Providing a Safe Working Environment and Employee/Employer Relations for administration staff. As it relates to RFP 07010 Option B, and eligible populations, Reflections for Youth, Inc. will work with any family with one or more children either at risk for out of home placement or returning to the family home from an out of home placement. If required, Reflections for Youth, Inc. can also offer option B services to youth that are in foster care and provide services to the foster family in an effort to maintain the placement and decrease the need for higher level placement. Reflections for Youth, Inc. agrees to work with eight (8) different families at a time, for a three month period of time with each family, and a total of 32 families per year. If additional time after the authorized 20 hours is needed in the three month period of time, then we will adjust the program to meet the need of the family. Services will be provided in a more intense nature in the first weeks of service (2-4 hours a week at the family's convenience as much as possible) and then in a less intense nature as service continues and the time of termination approaches. This is designed so that the family becomes more self-reliant as time progresses and less reliant on the Home-Based Specialist and services being offered. All families will be able to receive bicultural services. Reflections for Youth, Inc. currently employs two interpreters to assist with family communication on an as needed basis. This includes attending meetings, family therapy and other communication between Reflections for Youth, Inc.,Weld County and the family. All families will receive culturally/ethnically specific services,but straight bilingual services can only be provided if Reflections for Youth, Inc. is able to employ a specialist that is able to speak a second language. In terms of family units and based on one family unit being one hour of direct service, Reflections can provide 640 family units per year. As it relates to RFP 07010 Option B, and Evidenced-Based Practices section, I had a conversation with you(Tobi Vegter) and was told to respond that this section was considered sufficient. Reflections for Youth, Inc. has reviewed the FYC Commission recommendations and agrees to accept the recommendations as written. Please call (970) 344-1380 x.202 or (970) 217-4435 or email me at jeffareflectionsforyouth.org if you have any additional questions or need further clarification. I look forward to continuing our relationship with the core services program at Weld County DSS. Sincerely, Jeffery J. Johnson, LPC Executive Director a Kit DEPARTMENT OF SOCIAL SERVICES P.O. BOX A IIIIIDe GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 Fax Number(970)353-5215 COLORADO May 11, 2007 Jeffery Johnson, Executive Director Reflections for Youth 1000 S Lincoln Avenue#190-200 Loveland,CO 80537 Re: Bid 003-OPB-07 Option B Bid 002-DT-07 Day Treatment Bid 06LS13 Lifeskills Dear Mr. Johnson: The purpose of this letter is to outline the results of the Core 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. Results of the Bid Process for PY 2007-2008 A. The Families, Youth and Children(FYC)Commission recommended approval of your Bid#004- LS-07, (07005),Lifeskills, for inclusion on our vendor list.This bid was approved with no recommendations or conditions B. The Families,Youth and Children(FYC)Commission recommended approval of your Bid#002- DT-07,(RFP 07006)Day Treatment, for inclusion on our vendor list.The FYC Commission attached the following condition to this bid. Condition: Bidder must clarify and address the caseworker training component. C. The Families,Youth and Children(FYC)Commission recommended approval of your Bid#003- OPB-07, (07010)Option B, for inclusion on our vendor list.The FYC Commission attached the following conditions to this bid. Conditions: The bidder must submit information that was not addressed or submitted with the original bid submission, including: 1. Bidder must elaborate and expand upon eligible populations, • Page 2 Reflections for Youth/Results of RFP Process for PY 2007-2008 2. Bidder must respond to the Evidenced-based Practices section. Required Response by FYC Bidders Concerning FYC Commission Conditions: 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 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 dy . Griego, for cc: Juan Lopez,Chair,FYC Commission Tobi Vegter,Core Services Coordinator Gloria Romansik, Social Services Administrator Hello