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Home My WebLink About20071685.tiff RESOLUTION RE: APPROVE FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR LIFE SKILLS PROGRAMS WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with four Notification of Financial Assistance Awards for Life Skills Programs between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and various providers, listed below, commencing June 1, 2007, and ending May 31, 2008, with further terms and conditions being as stated in said awards: 1. Reflections for Youth, Inc. 2. Lori Kochevar, MS, PLC, LLC 3. Transitions Psychology Group, LLC 4. Child Advocacy Resource and Education, Inc. 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 four Notification of Financial Assistance Awards for Life Skills Programs between the County of Weld,State of Colorado, by and through the Board of County Commissioners of Weld County,on behalf of the Department of Social Services, and various providers, listed above be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said awards. 2007-1685 SS0034 FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR LIFE SKILLS PROGRAMS PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 18th day of June, A.D., 2007, nunc pro tuns June 1, 2007. BOARD OF COUNTY COMMISSIONERS �� WE COUNTY, COLOO ATTEST: /I� i��'l/� � fL�� OA c1) In1,'d E. Long, Chair Weld County Clerk to the Boar. 11861 H. Je r Tern BY: ��►%✓ ��% :? Deputy Cler o the Board 1 „ m`�i F. Garcia A O DASTO�� ' � : th \\ - Robert D. Masden un y Attorney _ 7 �ougl. Rademach-r / Date of signature: 7-7-C7 2007-1685 SS0034 , ,, ,in COMMISSIONERS aiii, ill JUN 1 2 P 4: Sb DEPARTMENT OF SOCIAL SERVICES P.O. BOX A Il R' R g R{t GREELEY, CO. 80632 E V E 15 E Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 OFax Number(970)353-5215 • MEMORANDUM COLORADO TO: David E. Long, Chair Date: June 8, 2007 Board of County Commissioners FR: Judy A. Griego, Director, Social Services.,/1A t \U ( L1 d't(' RE: Notification of Financial Assistance AwaiVl/ s withh Various Contractors— Life Skills Programs Enclosed for your approval are Notification of Financial Assistance Awards with Various Contractors for Life Skills Programs. 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 life skills programs to families involved in the child welfare system. 4. The Contractors include: Contractor Hourly Rate A. Reflections for Youth, Inc. $56.26 life skills Parenting Skills $80.00 court testimony B. Lori Kochevar,MS, PLC, $89.00 life skills-visitation LLC $150.00 court testimony Parenting SkillsNisitation C. Transitions Psychology $100.06 life skills services Group, LLC $150.00 rate court testimony Mentoring/Therapeutic Visitation D. c.a.r.e $42.15 hourly rate per monitored/safe exchange Visitation & $77.94 interactional, Exchange/Home Based $71.39, home based parent education, Parent Advocate $35.0otransportation $50 court testimony If you have any question, please telephone me at extension 6510. 2007-1685 Weld County Department of Social Services Notification of Financial Assistance Award for Core Funding Type of Action Contract Award No. X Initial Award FY07-PAC-6000 Revision (RFP-FYC-07005;002-LS-07) Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Child Advocacy Resource&Education Ending 05/31/2008 Lifeskills 3700 Golden Street Evans,CO 80620 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Award Provides two programs of service: (1)The Supervised is based upon your Request for Proposal(RFP). The RFP Visitation and Exchange Program provides regularly specifies the scope of services and conditions of award. scheduled supervised visits or exchanges for children with Except where it is in conflict with this NOFAA in which case their parents or other caregivers at the Card-louse facility. the NOFAA governs,the RFP upon which this award is based The program offers two levels of visitation;Monitored(low is an integral part of the action. intensity)and Interactional Supervised Visitation(involves more concentrated assistance,including parent education). Special conditions (2)The Home Based Parent Advocate Program is designed 1) Reimbursement for the Unit of Services will be based to provide in-home services to promote healthy child on an hourly rate per child or per family. development,assist children and families to resolve crisis, 2) The hourly rate will be paid for only direct face-to- connect with appropriate and necessary services,and remain face contact with the child and/or family or as specified or return safely together in their homes. Average monthly in the unit of cost computation. capacities and duration of stays are(1) Supervised 3) Unit of service costs cannot exceed the hourly and Exchanges,two exchanges, 15+weeks; (2)Monitored yearly cost per child and/or family. Visitation,two families,two weeks; (3) Interactional 4) Payment will only be remitted on cases open with,and Visitation,five families,two weeks; (4)Home Based Parent referrals made by the County Department of Social Education,eight families, 11 weeks. Transportation is Services. available at a separate cost.Bicultural-bilingual services and 5) Requests for payment must be an original form and South County services are available. submitted to the Weld County Department of Social Cost Per Unit of Service Services by the end of the 25th calendar day following Hourly Rate Per the end of the month of service.The provider must Visitation (Monitored/Safe Exchange) $42.17 submit requests for payment on forms approved by Treatment Package High(Interactional) $77.94 Weld County Department of Social Services.Requests Treatment Package Moderate(Home Based for payments submitted 90 days from the date of Parent Education) $71.39 service,and thereafter,will not be paid. Transportation $35.00 5) The Contractor will notify the Department of any Treatment Package Low (Court Testimony) $50.00 changes in staff at the time of the change. Enclosures: X Signed RFP: Exhibit A X Supplemental Narrative to RFP: Exhibit B _Recommendation(s) X Co itions of Approval Approvals: Program fficial: I / tacic)-- By <a By t 11� David E. Long,Chair Judy . riega irector Board pf Weld co qj Commi ioners Weld C u, ty Department of Social Services Date: J LU Date: (a j'/ (/17 oc7-/6J'S EXHIBIT A SIGNED RFP 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 � 74-G4- '-er (After receipt of order) BID MUST BE SIGNED IN INK U • Program Area: L II( Ski/ls Gs/Cr) M• 5choo/ty) fl/rdor TYPED OR PRINTED SIGNATURE C1 % !d Advocacy n . VENDOR Resource and 6d✓ca-Pron,lnc. (Name) Handwritten By Authorized Officer or Agent of Vendor ADDRESS 3700 Go lden 5 -f. TITLE Chair , Board of Ditto/ors E✓any, CO 1104 A O DATE 3- ap -o7 PHONE # 970— 3S(o —(0751 X 3o( The above bid is subject to Terms and Conditions as attached hereto and incorporated. Abstract Child Advocacy Resource and Education Inc. (c.a.r.e.) is a private,non-profit agency whose professional staff have been working in the area of child abuse and neglect for 30 years. Founded in 1976,c.a.r.e.provides many programs to individuals and families via community education and direct services,on-site,in the schools,community and home. Our organization has maintained these quality programs through community collaboration to fulfill the c.a.r.e.mission: To strengthen and preserve families while protecting children from abuse and neglect Through a cooperative relationship with area agencies,c.a.r.e.has been at the forefront of child advocacy issues. c.a.r.e. currently provides programs addressing nurturing parenting skills,family violence, sexual assault and child victimization including presentations on mandated child abuse reporter training. Our current programs include Parent Education,Children's Programs,The SafeTouch Program,Young Parent Program and the Supervised Visitation Program. This proposal highlights our two Lifeskills programs: The Supervised Visitation and Safe Exchanges Program and The Home-based Parent Advocate Program. The Supervised Visitation and Exchange Program provides regularly scheduled supervised visits or exchanges for children with their parents or other caregivers at the careHouse facility in Evans. Services are designed to assist children and families in maintaining a relationship during this time of crisis. In addition to Safe Exchanges,two levels of visitation are offered: Monitored(Low Intensity) Visits are under the control of a Visit Supervisor and designed to supervise a visit,both verbally and physically, for appropriate interactions,with only limited intervention as necessary for the safety and supervision of the children.Interactional Supervised Visits involves more concentrated assistance- the development and enhancement of parenting skills,a directive and interactive approach facilitated by a parent educator.The educator provides coaching and skills training to parents with the goal of giving them the opportunity to practice new skills,improving positive relationships between parents and children.The Parent Educator will interact with the family during the actual visit as well as have time with family before and after the visit as deemed necessary to work on the related parenting and life skills issues.The parent educator staff will utilize a variety of teaching modalities to achieve the goal of a healthier functioning family,the core of which is The Nurturing Program. Topics include stress and anger management,behavior management for children and other pertinent topics taught through written materials,videos and homework;role modeling and practicing of new skills in the family environment.Transportation is available at a separate cost when needed. Both programs have the ability to increase the services provided as referrals fluctuate. The Home-Based Parent Advocate Program works with families struggling with issues of abuse or neglect.Families who mistreat their children,although in dire need of services,have trouble remaining in treatment because of their own difficulties in establishing relationships.By providing services in the home,families can be more comfortable which increases their ability to make necessary behavioral changes. When parents are able to learn skills and practice them in the environment they live in,they increase their ability to maintain new skills through the coaching of the parent educator.Home-based services help to decrease the isolation prevalent in child maltreatment.Developing a relationship with the parent educator can increase the family member's ability to transfer that comfort level to other entities such as schools,neighbors,medical personnel and friends. Finally,because of the parent educator's frequent visits to the home,they are in a position to become aware of any increased instances of further abuse or neglect. Services are designed to promote healthy child development, assist children and families to resolve crisis,connect with appropriate and necessary services, and remain or return safely together in their homes,avoiding unnecessary out-of-home placement of children and helping children already in out- of-home care to be returned to and maintained with their families. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 2 TABLE OF CONTENTS I. Application to Bid 1 II. Abstract 2 III. Table of Contents 3 IV. Target/Eligibility Populations 4 V. Project Narrative Section A: Types of Service provided 5-6 Section B: Measurable Outcomes 7 Section C: Service Objectives 8-9 Section D: Workload Standards 10 Section E: Staff Qualifications 11 Section F: Program Capacity Per Month 12 Section G: Internal Tracking and Billing Process 13 Supporting Documentation Section I: Confidentiality, etc 14-15. Evaluation 16 VI. Budget 17-20 VII. Appendices 1. Resumes Tammy Davis 21 Suzanne Goodrick 22 Jennifer Petersen 23 Myrna Reese-Stevens 24 2. Data Collection Instruments/Protocols Parent Stress Index Short Form 25 AAPI 26-27 Nurturing Quiz page 1 28 3. Sample Consent Forms careHouse Consent Form 29 Home Based Consent Form 30 Other Insurance 31 DSS Supervisor Verification Form 32 Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 3 TARGET/ELIGIBILITY POPULATIONS The Lifeskills Programs are designed to work with any Weld County family referred through the Department of Social Services who can benefit from targeted parent skills training,coaching and/or supervision to increase their ability to be a nurturing parent. Families eligible for this program can vary in age from pregnant/parenting teens through grandparents or other specific caregivers. The figures below are approximate,not every family utilizes the program for a uniform amount of hours. The program has the capacity to expand as needed. A. Total number of clients to be served: Supervised Exchange: 10 adults,7 children Monitored Visitation: 8 adults,6 children Interactional Visitation: 27 families Home Based Parent Advocate: 25 adults, 15 children. B. Total family units: Supervised Exchange: 5 Monitored Visitation:4 Interactional Visitation: 2 Home Based Parent Advocate: 20 C. Sub-total of individuals who will receive biculturaUbilingual services: Supervised Exchanges: 15 Monitored Visitation: 6 Interactional Visitation: 15 Home Based Parent Advocate: 8 D. Sub-total of individuals who will receive services in South Weld County: Supervised Exchanges: 0 Monitored Visitation: 0 * Interactional Visitation: 0 * Home Based Parent Advocate: 5 families per year * Children living in south Weld County can be transported to our facility in Evans. E. The monthly program capacity per group: Supervised Exchanges: 3 Monitored Visitation: 2 Interactional Visitation: 8 Home Based Parent Advocate: not applicable F. The monthly average capacity per group: Supervised Exchanges: 2 Monitored Visitation: 2 Interactional Visitation: 5 Home Based Parent Advocate: 8 families G. Averages stay in the program(weeks): Supervised Exchanges: 15 weeks+ Monitored Visitation: 2 Interactional Visitation: 2 Home Based Parent Advocate: H. Average groups per week in the program: Supervised Exchanges: Supervised Visits(Low Intensity): 2 Interactional Visitation(High Intensity: 9 Home Based Parent Advocate: 11 weeks Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 4 PROGRAM NARRATIVE/SUPPORTING DOCUMENTATION SECTION A: TYPES OF SERVICE PROVIDED Each of the following services could be provided to any family enrolled in the program;however all families do not need all services. Services provided would be determined by the c.a.r.e.Program Coordinator,c.a.r.e.Parent educator and DSS caseworker. MENTORING: Focus Area: Home Based Parent Advocate Program 1. Teach,model and coach adaptive strategies: Role modeling,teaching and coaching of appropriate interactions with the family.The parent educator will utilize a variety of teaching modalities,the core of which is The Nurturing Program to achieve the goal of a healthier functioning family. Topics include stress and anger management,behavior management for children and other pertinent topics taught through written materials,videos and homework;role modeling and practicing of new skills in the family environment. 2. Model and influence parenting practices: Provide home-based parent education utilizing ongoing education,support and encouragement.This is accomplished while directly intervening with the family to change maladaptive parenting styles and replace them with a more appropriate interaction. 3. Teach relational skills: The parent educator will model and teach a nurturing parent role with a focus on parent/child self esteem.The goal is to increase positive family relationships.Topics include conflict resolution,appropriate family roles,and use of praise among other areas of focus. 4. Teach Household Management including prioritizing,finances,cleaning,and leisure activities: Home-based training in household management,especially as it pertains to safe and nurturing child rearing. When it is identified that the family needs to increase their skills in this area,the parent educator will problem solve and coach the family in keeping a home environment adequate to the safety of family members. The parent educator will also work with the family on prioritizing other elements of family life especially as they pertain to leisure and family budgeting. 5. Actively help to establish community connections and resources: Provide information,training and role modeling in accessing community resources, including United Way 211,as well as follow through in using resources. The parent educator could accompany the family on appointments to community resources, schools,medical offices and other locations when necessary and appropriate. 6. Encourage goal-setting and pro-social values: The parent educator will educate the family about setting short and long term goals and a plan to attain them. They will work toward goals that would be within a socially acceptable value system and examine barriers to achieving healthy goals. Quantitative Measures: Each service can be offered to each family enrolled in the program,depending on need. Therefore,there is a potential for up to 20 families per year. The program can be expanded when needed,depending on the number of referrals.The program employs hourly personnel to work with families and the staff can be expanded when the need arises. VISITATION Focus Area: Monitored Visitation (Quantitative Measure,3 families per year) 1. Monitor parent/child interactions for physical and emotional safety: Supervision of a visit,both verbally and physically,for appropriate interactions,with only limited intervention as necessary for the safety and supervision of children. Supervisor keeps a low profile to enable the focus to be on the child and parent interactions. 2. Document clinical observations: Brief documentation regarding activities of visit and critical situations or incidents. 3. Strategize for teaching and modeling parenting skills:No formal parent coaching or training. Intervention is limited to basic safety and logistical issues. 4. Teach relational skills:No formal parent coaching or training. 5. Encourage goal setting and pro-social values:No formal parent coaching or training. 6. Plan structured activities in visitation to help achieve the objectives of the treatment: Parents will be encouraged to provide and initiate activities as part of their interaction with child(ren). Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 5 Focus Area: Interactional Visitation A. Monitor parent/child interactions for physical and emotional safety: Parent Educator will supervise visitation between parent and child,help parent maintain appropriate and positive interaction and conversation all the while insuring the emotional and physical safety of the child B. Document clinical observations: Documentation consists of observational documentation: appearance of child,noticeable bruises/scratches,activities during visit,general tone of parent/child interaction,and any further comments or concerns related to visit.Documentation will also include progress toward client treatment plan and activities employed by the parent educator to address these goals. C. Strategize for teaching and modeling parenting skills: Parent education in the form of coaching and modeling will occur during the supervised visits. The Parent Educator will utilize a directive and interactive approach as well as a variety of teaching modalities to achieve the goal of a potentially healthier functioning family. This includes education through written materials,videos,and homework,role modeling and practicing of new skills during supervised visits. There is an opportunity for more education before and after the supervised visit which will address progress as well as concerns in a direct manner in order to aid the family during future visit times. This will include parental support and guidance,along with communication and feedback about parenting progress and goals. D. Teach relational skills: The parent educator will model and teach a nurturing parent role with a focus on parent/child self esteem. The goal is to increase positive family relationships.Topics include conflict resolution,appropriate family roles,use of praise,through ongoing education,support,and encouragement. Parents are educated on ways to: -Increase their ability to understand and implement non-physical methods of child discipline. -Increase their ability to understand the stages of development of their children and appropriate ways to manage their children's behavior at each stage. -Increase empathic awareness of their child's needs. -Decrease parent/child role reversal. -Increase stress and anger management skills -Increase ability to implement a"problem solving"model. -Increase positive communication and conflict resolution skills among family members. -Increase ability to access resources in the community when needed. E. Encourage goal setting and pro-social values: The parent educator will educate the family about setting short and long term goals and a plan to attain them. They will work toward goals that would be within a socially acceptable value system and examine barriers to achieving healthy goals. F. Plan structured activities in visitation to help achieve the objectives of the treatment: Structuring visits in ways that enhance opportunities for parents to practice and enhance their caregiving skills.The Parent Educator will provide and educate the parent on appropriate age level activities. The parents will also be encouraged to provide and initiate activities as part of their demonstration of parenting techniques. QUANTITATIVE: Services are offered to each family enrolled in the program,depending on need. Therefore, there is a potential for 27+families per year. These figures are based on the previous year. The program can be expanded when needed,depending on the number of referrals. SAFE EXCHANGES: Safe transport of a child between parents where there is the propensity for conflict and/or family violence.The supervised time is limited to the actual transfer between parties with the remainder of the parent/child contact occurring One parent or caregiver will drop the children off at the careHouse facility and leave.The children will then be in the care of a staff person for 15 minutes.During that time,the children may be occupied in various activities with the staff person,providing the child with a neutral time to prepare for their time with the other parent or caregiver. OTHER COMMUNITY SERVICES: The Home-based Parent Education Program is the only home-based program of its kind in Weld County,working with this population of families that are at risk of children's placement. We do not provide mental health services, substance abuse treatment or other professional services that are funded by another source.The Supervised Visit and Exchange Program is the only safe exchange program offered in Weld County.There are supervised visitation services offered through the Department of Social Services and Lutheran Family Services. c.a.r.e. services are available off-hours and during weekends. c.a.r.e. does not provide mental health,substance abuse or other professional services that are funded by another source. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 6 SECTION B: MEASURABLE OUTCOMES Focus Area: Home-Based Parent Advocate Outcome#1 90%of up to 20 families enrolled in the program will increase their ability to provide a safe home environment as measured by staff report and observation. Outcome#2 90%of up to 20 families enrolled in the program will increase their parental competency scores as exhibited by pre and posttest scores on the Nurturing Quiz and the Adult Adolescent Parenting Inventory(AAPI). Outcome#3 90%of families will increase their ability to access resources in the community when needed as documented by parent educator report and observation of the family's progress toward goals and use of community resources. Outcome#4 85%of families receiving services will remain intact six months after discharge of the services as determined by a follow-up contact with WCDSS six months after the family's completion of the program. Outcome#5 90%of the parents receiving services in the program will show reduced risk as exhibited by an increase in their score on the pre and post Parent Stress Index Short Form. Focus Area: Monitored Visitation: 90%of the families enrolled in the Monitored Visitation Program will increase their positive contact with family members. This will be documented by program staff from observational methods. The average number of families available for measurement of outcomes is 3. Focus Area: Interact ional Visitation Outcome#1 90%of the families enrolled in the Interactional Visitation Program will show an improvement in Household management skills as exhibited during their visitation time with their children.This will be measured by staff observation and documentation. Outcome#2 90%of the 27 families enrolled in the program will increase their parental competency scores as exhibited by pre and posttest scores on the Nurturing Quiz and the Adult Adolescent Parenting Inventory(AAPI). Outcome#3 90%of the families in the program will exhibit increased utilization of applicable community resources,measured by program documentation and client self report. Outcome#4 85%of families receiving services will remain intact six months after discharge of the services as determined by a follow-up contact with WCDSS six months after the family's completion of the program. Outcome#5 90%of the parents receiving services in the program will show reduced risk as exhibited by an increase in their score on the pre and post Parent Stress Index Short Form. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 7 • SECTION C: SERVICE OBJECTIVES MENTORING A. Improve Household Management Competency: Intensive home-based household management techniques taught by parent educators to improve the capacity of parents to provide a safe,nurturing environment. This will include but not be limited to cleaning,budgeting, purchasing,safety,and maintenance. This will be measured through parent educator report and observation. B. Improve Parental Competency: The program will provide home-based parent education including coaching,instructing,problem-solving,role modeling,and supervision that will help improve the parent's ability to provide sound relationships within the family. This will include but not be limited to nutrition,hygiene, discipline and protection. This will be measured by advocate record and observation;as well as pre and post scores on the Nurturing Quiz which tests knowledge of parenting,and the AAPI which documents changes for families. The program will provide parent skills training as part of a treatment plan. During visits,the parent educator will interact with the family,demonstrating ways of setting and following through with appropriate behavior management techniques in a directive manner before,during, and/or after the visit. During the supervised visit, parents have an opportunity to test and improve the skills they may be learning either with the parent educator or in other settings such as parenting classes or counseling. C. Improve goal-setting and pro-social values The parent educator will set monthly goals with the family according to the parent's needs and treatment plan and work with the parent on achievement,implementation and incorporation of goals during future visits. These goals will fall within our socially acceptable value system.The Parent Educator will also demonstrate educate,and encourage the parent in regards to pro-social values. VISITATION: A.Improve parenting skills,parent/child interactions and relational skills for physical and emotional safety through structured activities in,and documentation of,visitations to achieve the objectives of the treatment plan. The program will provide parent education including coaching,instructing,problem-solving,role modeling,and supervision that will help improve the parent's ability to provide sound relationships within the family in order to achieve their treatment plan. The Parent Educator will monitor and document visitation between parent/child while maintaining appropriate and positive interaction as well as conversation. Structured activities and debriefmg will be discussed between the Parent Educator and the parent prior to the visit to insure the physical and emotional safety of the child. B. Improve goal setting and pro-social values. The Parent Educator will work with the family to set monthly goals according to the parent's needs and the treatment plan,work with the parent on achieving goals and implementing them during future supervised visits. The Parent Educator will demonstrate,educate and encourage the parent in regards to pro-social values FOR BOTH MENTORING AND VISITATION SERVICES: A. Improve Ability to Access Resources: Parent educator will provide information,training, and follow-through to families to enable them to effectively learn to access appropriate community resources,including those on the local,state,and federal level. Outcomes will be measured by staff record and observation. B. Address specific referral issue(s)-services shall be solution focused and addresses issues specified by the Department of Social Services. The parent educator will review goals with the client(s)as set by the caseworker and work with the client to prioritize and/or rank issues and goals to work on.It is important to keep the family forward focused on the solution to the problems rather than a rehashing of the problems.Looking at exceptions,times when the"problem"is not occurring,what the family interactions will look like,what will they be doing when things are"better"all can lead to hope and increased confidence as a parent. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 8 • C. Improve outcomes in the Performance Improvement Plan(PIP). Focus Areas: Home Based Parent Advocate,Safe Exchanges,Monitored and Interactional Visitation: A. Placement Changes: • c.a.r.e. staff will have limited input into decisions regarding placement changes however staff will consult with caseworker about any concerns about placement and will facilitate meetings if needed. • There is a decrease in placement changes when a child can be kept safely in their own home, while their parents work with a parent educator and other pertinent professionals. • Continued effort on the part of the c.a.r.e. staff to be available at any case management meetings/staffmgs. • There is an increased well being of child(ren)with weekly visits from the parent educator or at careHouse where any concerns will be noted and addressed with the appropriate parties. B. Maintaining Cultural and Racial Connections: • There is an increase of family connections when children can have extended family members present at supervised visitations engaged in important and culturally relevant family activities like cooking,holidays,birthdays,etc. • Supervised visitation at careHouse strives to be a home-like setting where normal family activities can take place: cooking a meal,playing at the park or in the gym. • Support of the child and family's cultural development through bilingual/bicultural staff. • Increase of family connections for children in a facility that allows for supervised visits in evenings and on the weekends,thus increasing frequency of visits. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 9 SECTION D: WORKLOAD STANDARDS (Each of the four program areas has the ability to expand as referrals fluctuate.) A. Number of hours per day,week,or month. Supervised Exchange: up to 10 hours per month Monitored Visitation: 2 housr per week Interactional Visitation: 3 hours per week Home Based Parent Advocate: Up to 20 hours for each family unit for entire length of stay in the program. This number changes depending upon DSS request,contracted hours with the family and any periodic changes due to the progress and needs of the family. B. Number of individuals providing services: Supervised Exchange: 5 Monitored Visitation: One part time Program Coordinator,Hourly Visit Supervisors Interactional Visitation: One part time Program Coordinator, Hourly Parent Educators Home Based Parent Advocate: 5 part-time hourly Parent Educators, 1 (one)25 hr.per week Program Coordinator, 1(one)2 hr.per week Support Staff,I(one)2 hr.per week Administrative Support C. Maximum caseload per worker: Supervised Exchange: 2 Monitored Visitation:2 Interactional Visitation:4 Home Based Parent Advocate: Each part-time Parent Educator could work with from 1-4 families,depending upon skill level,amount of contracted hours per family,and personal work preference.Due to our use of hourly workers,they do not carry a specific caseload. D. Modality of Treatment: Center-based supervision of family visits and exchanges: Safe Exchanges,Monitored Visitation at a lower level of intensity or Interactional Visitation at a higher level of intensity,utilizing parent skills training in the form of education,coaching and structured education when needed. Home-based instruction and/or supervision,coaching,role modeling,practicing,and support. E. Total number of hours per day/week/month: Supervised Exchanges: 10 per month Monitored Visitation: 2 hour per week Interactional Visitation(High Intensity): 8 hours per week Home Based Parent Advocate:From 1-25 hours per month,depending upon needs of the family. On the average,each family works directly with a parent educator for up to 8 hours per month in the program. F. Total number of individuals providing this service: Supervised Exchange: 10 adults,7 children Monitored Visitation: 2 Interactional Visitation: 6 Home Based Parent Advocate: 5 part-time hourly Parent Educators, 1 (one)25 hr.per week Program Coordinator, I(one)2 hr.per week Support Staff, 1 (one)2 hr.per week Administrative Support G. The maximum caseload per supervisor: Supervised Exchange: 5 Monitored Visitation: 5 Interactional Visitation: 10 Home Based Parent Advocate: 5 families per month. H. Insurance: Child Advocacy Resource and Education,Inc. carries a commercial general liability policy with Alliance for Non-Profits Risk Retention Group,Inc. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 10 SECTION E: STAFF QUALIFICATIONS A. Minimum qualifications in education and experience: Home Based Parent Advocate Program: Program staff meets the minimum requirements of a Case Services Aide II. In addition,they have experience working with families and children in environments such as a day care or school.All of the 5 part time parent advocates have worked at our agency for over 3 years. One advocate is bilingual/bicultural.All of them have had experience as a parent skills trainer both in a group and individual setting. The Program Coordinator holds a Bachelor's degree in Psychology and Criminology. She has over 6 years experience in the human service field. Visitation:Program staff meets the minimum requirements of a Case Services Aide II. In addition,they have experience working with families and children in environments such as a day care or school. 3 of the 6 part time visit supervisors have worked at our agency for over 3 years.Two of them are bilingual/bicultural.The Program Coordinator holds a Bachelor's degree in Psychology and Criminology. She has over 6 years experience in the human service field.Three staff provide program support and back-up.Two part-time support staff have a Bachelor's degree and appropriate experience,the other has an Associate's Degree. Providing oversight,the Executive Director has a Master's in Agency Counseling with an emphasis in Marriage and Family Therapy. She has seven years experience as a Home-Based Parent Educator and four years experience as a Program Coordinator. B. Total number of staff available for the project: Home Based Parent Advocates: 5 part time parent advocates and one part time Coordinator Visitation: 6 part time parent educators(visit supervisors),3 part time back-up support staff and one full time coordinator. C. Will your staff have received mandated new caseworker training? The staff has not had this training available to them in the past.We would make this mandatory if made available to our staff. D.Will your staff have knowledge in risk assessment? Our staff has limited training in this area but will avail themselves of any specific pertinent training specified by the Department of Social Services. Most staff have attended the 3-part Safety Training for Home Visitors Training provided by the Home Visitation Committee of Promises for Children. E. How will your staff receive training regarding the Program Improvement Plan(PIP)? Staff will be trained at a group meeting with ongoing monitoring of activities as it pertains to each family in the programs. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 11 • SECTION F: PROGRAM CAPACITY PER MONTH Home Based Parent Advocate Program: To support this program we would optimally need a minimum average capacity of 2 families or 25 hours per month.Our maximum capacity can range much higher as we employ hourly parent educators and can increase hours or add new staff as needed.We have experienced a large drop in referrals this past year. Supervised Visitation Program: To support all of the Visitation Programs we would optimally need a minimum average capacity of 8 families or 25 hours per month. Our maximum capacity can range much higher as we employ hourly parent educators and can increase hours or add new staff as needed. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 12 • SECTION G: INTERNAL TRACKING AND BILLING PROCESS Billing Process:Hourly staff compiles their paperwork which includes client signature sheets throughout the month which is then handed in to the Program Coordinator at the end of the month. The Program Coordinator then checks each person's paperwork for accuracy,accurate signatures,etc. She fills out the compiled monthly billing form which is then submitted to the Department with original paperwork and reports by the approved date. Client records and copies of documentation are kept in binders which are housed in a locked cabinet. The Executive Director tracks records of billings in Quick Books. The Board of Directors provides monthly oversight with financial records. A yearly audit is done in the summer for the previous fiscal year. FISCAL PROVISION Audit available in August 2007. STANDARDS OF RESPONSIBILITY The Home-Based Parent Education Program and the Interactional Visitation Program utilize The Nurturing Parenting Program published by Family Developmental Resources,Inc.It is one of approximately 23 programs nationwide that are recognized by the National Registry of Effective Programs and Practices(NREPP)and by the Substance Abuse and Mental Health Services Administration(SAMSHA).The Program is also recognized by the Child Welfare League of America,(CWLA)the Office of Juvenile Justice and Delinquency Prevention (OJJDP)and the Center for Substance Abuse Prevention(CSAP).The program treats child and adolescent maltreatment,prevents its recurrence,and builds nurturing parent skills in at-risk populations.The materials are available in Spanish and for special needs families. The program has been designed and field tested for families at risk of abuse and neglect,families identified by social services as abusive or neglectful,families at risk for delinquency and families in recovery for substance abuse among others. In this program we are utilizing the home based program,a family centered program to help parents care for themselves and each other and to replace old unwanted abusive interactions with newer more nurturing ones. Due to the variety of treatment plans among families referred to the program and their presenting problems,we are not able to offer the program in its entirety or intended schedule.We are also adding additional information and lessons as needed from other materials when necessary.Therefore,we have adapted the Nurturing Quiz,a pre and post test of parenting knowledge to better reflect the program content. A Step/down Program is planned while working with family to ensure successful transitions.Recommendations are made to other community agencies or programs,including those offered at c.a.r.e.to help the family in their transition when possible. We do not have any Medicaid services offered at c.a.r.e. in this program. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 13 • SUPPORTING DOCUMENTATION SECTION I: CONFIDENTIALITY AND PARTICIPANT PROTECTION/HUMAN SUBJECTS: 1. Protect Clients and Staff from Potential Risks: • Foreseeable risks that can be attributed to the project for staff includes any risks that may occur doing home visits in any high crime community or just in being alone in a client home. Risks to visitation staff at careHouse might include encountering angry family members with a propensity for violence.Risks for clients include social or psychological effects and/or risks as a result of having a staff person come to their home or having to attend a visitation at careHouse. • Our policies that will help us minimize risk to program participants include staff training on confidentiality(see#5 below),safety,dealing with angry clients and positive relationship with clients. • We have a relationship with the local Evans Police Department who are very aware of our services. 2. Fair Selection of Participants • The target population for the project includes parents and children ages birth to 17 in Weld County who have an open child protection case with the Department of Social Services.Dynamics of children and families include children of substance abusers,pregnant women,foster children,children in kinship care,grandparents raising grandchildren.Ethnic groups include Caucasian,Hispanic and American Indian. • These groups mentioned above are included if they are referred through the Department of Social Services. • The only groups or individuals that might be excluded are those who we feel would pose a risk to staff or other program participants.This is determined through consulting with the caseworker, seriousness of past incidents and adherence to program policies. • Program participants are recruited and selected by direct referrals from DSS. 3. Absence of Coercion • Participation in the program is strictly voluntary although most if not all are attending the program as part of their court ordered treatment plan.Our program is not able to force any individual to participate,in the case of non-compliance we will work with the DSS caseworker to inform them of the situation and problem-solve any future client participation. • 4. Data Collection • Data is initially collected through the referral sent by DSS.Our programs then do an initial client interview and orientation to the program with each client. Observational data is collected as it pertains to the client goals. This is done in the client home in the home-based program and in our agency setting in a private room during visitation. • Data Collection Instruments/Interviews Protocols are included in Appendix 2. 5. Privacy and Confidentiality • Privacy and confidentiality are important to this program.The program coordinator and parent educator working with the family are responsible for data collection. It is collected in a private setting and stored in a separate binder for the family or individual.The binder is kept in a locked file cabinet in our offices. Each month, documentation is sent to the caseworker at DSS with copies kept in our files. ▪ Describe: o Data collection Instruments are used to set goals,plan future work with the client and look at progress in the program. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 14 o Data is stored in a separate binder in a locked cabinet. Older files are stored in a locked closet in our building.Computer files,if any are stored in a password protected computer and backed up weekly. o Access to the information is limited to the program coordinators and pertinent program staff. There is also group supervision with program staff where cases will be discussed. o The identity of program participants is kept private by limiting access to client records and regularly reviewing agency confidentiality procedures. Oversight to this issue is provided by the agency director. 6. Adequate Consent Procedures • Clients who participate in the project will be given initial program and agency information regarding the program. We will review with them their goals for the program as set by the caseworker and court ordered treatment plan. Each client will sign a form consenting to their participation in the program. Again,this data is stored with their client information in a separate binder in a locked cabinet. • State: o Participation in the program is always voluntary.As mentioned above,we cannot force a client to participate and if there are problems or concerns that we cannot solve,we refer the client back to their caseworker for further problem solving around that issue. o Clients may curtail services at any time. o Possible risks from participating in the program may be limited to social ramifications for some clients particularly with a home visit.Our agency location in Evans limits that problem with visitation clients except in the case of concurrent visits that are in the facility where there is a risk of a client seeing someone they might know in the course of their time in the program.There are also physical risks involved with children playing.We are careful to keep a safe environment at careHouse and help parents learn how to have a safe home environment,but on occasion a child might stumble or fall while playing. We have a critical incident report for this occurrence.In the case of transportation of children to visitation with their parent(s)there is the added risk of traveling in a vehicle. o Protecting clients from these risks is done by using discretion about leaving any phone messages, entrance in and out of homes in the community,staff confidentiality standards,keeping a safe environment and helping parents see how to keep their children safe while playing and interacting. We role model safety measures for families while they are in our programs. This might include use of sunscreen,nutritional food choices,monitoring children on the playground or in play,use of car seats among others. In the case of transportation we make sure proper seat restraints are utilized and proper insurance is in force. • Consent for Spanish speaking clients is done with the use of a Spanish speaking staff person and written materials in Spanish.People with limited reading skills will have the forms read to them and a discussion to make sure they understand the forms they are being asked to sign.Copies of forms are given to the participants. Children and youth do not sign consent forms because they are in the program with their parents or other guardians. • Informed consent • Sample consent forms found in Appendix#3. • One consent form is used for their entire time in the program.If in the course of work with the family an additional person or entity needs to be added to the consent for exchange of confidential information,we will have them fill out a new form with the current date. • If a client does not agree to consent to sharing information with a certain entity they will still be allowed to participate although we will refer this to the DSS caseworker in case this impacts the treatment plan for the participant. 7. Risk Benefit Discussion • Risks are reasonable because the ultimate benefit is to help build a more functioning family. Knowledge gained and family connections maintained from this service in the short term will enable parents to provide a healthier and more nurturing environment for their children in the long term. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 15 • EVALUATION: The Home-Based Parent Education Program or"Parent Advocate Program"has been successfully working with Weld County families for the past 18 years.We bring a wealth of professional and community experience to the families.Many families stay connected with the c.a.r.e.agency,accessing other services to help strengthen their family,such as parenting classes,children's groups and support groups. The Supervised Visitation Program started at c.a.r.e. about 9 years ago and has slowly grown into a large program. We have worked hard to provide the program in the manner that is most helpful to the families we serve through guidance from DSS. Recent advances has been made in the area of documentation, We have designed a survey to have our clients fill out as they leave the program regarding their experience with the program. We also meet regularly with the Department of Social Services to review cases on the Child Protection Team and other meetings as necessary. Child Advocacy Resource and Education, Inc. Core Services Life Skills 2007 16 § U | o co ! k! 11 ° ' I ! E ; - 2 8 J| \ \ 0-as�!! < I | ■ ! § . | , - !! / / ` a ■2 ! | $N. P • N a ® 7 r ■ a # § , § \ o | e ; a # ! a L a3 , 0!\ § ! 77 n | J ) | ) - § ! 0. )\ . 0 522 'lc - !;y ! &' 133 0 a ; €/ a § _ \ § „: | O | IL IMI � �! / 7 ! o , } } co \ } | / / ) \ 3 �/ ca ® 0 cc a. 5 4*. 7 al Lu re ) U § ) 0 — u.u. . 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' ,|! §2 !!; ' _e ! i/ a w !I. ■ | | | | ; ( : tE § § E | I § } | | 5 2 | E | WI § i | § 2 ) ) |!., | ll: 0 ) a Tammy Davis Employment History 813 39th Avenue Homebased Parent Advocate Program Coordinator Greeley, CO Child Advocacy Resource and Education, Evans, CO 80634 January, 2007 to Present • Administer the Home Based Parent Advocate Program. • Maintain communication, both written and verbal, with the Director and other professionals on issues pertinent to the program including attending staffings, reporting suspected child abuse and neglect and providing appropriate documentation as requested. • Participate in agency activities as directed by the Executive Director including staff meetings, trainings, speaking engagements, fundraising, and participation community committees. Core Services Visitation Program Coordinator Child Advocacy Resource and Education, Evans, CO 1999 to Present • Administer the Core Services Visitation Program. • Maintain communication, both written and verbal, with the Director and other professionals on issues pertinent to the program including attending staffings, reporting suspected child abuse and neglect and providing appropriate documentation as requested. • Participate in agency activities a directed by the Executive Director including staff meetings, trainings, speaking engagements, fundraising, and participation community committees. Home Based Parent Advocate Child Advocacy Resource and Education Evans, CO 1997 to 1999 • Effectively implement parenting and rife skills education to at-risk families. • Develop activity plans for families according to the established goals and objectives as stated in the case plan. • Communicate with coordinator in both written and verbal format for required documentation and supervision. Education 1998 Aims Community College,Greeley, CO • MS in Criminal Justice&Liberal Arts • President's and Dean's List Other Experience Member of the Weld County Domestic Violence Coalition Member of the Weld County Child Protection Team al 2321 33rd Avenue Greeley, CO 80634 Suzanne Goodrick Experience June 1999 to Present Child Advocacy Resource and Education Evans, CO Visitation and Safe Exchanges Program Coordinator • Administer the Visitation and Safe Exchanges Program. • Maintain communication with the Director and other professionals on issues pertinent to the program including reporting any suspected child abuse and neglect. • Participate in agency activities such as staff meetings fundraising, speaking engagements and participation in community committees. 2000 to Present Child Advocacy Resource and Education Evans, CO Parent Educator • Implement parent education,in structured parenting groups,both at c.a.r.e.and other locations in the community on issues of non-violent discipline,nurturing parents,child development,effective communication,anger management and other related issues. • Maintain responsible records for clients including evaluation tools. • Attend appropriate trainings and supervision as required by the Program Coordinator. 1993 to 1999 Child Advocacy Resource and Education Evans, CO Home Based Parent Advocate • Effectively implemented parenting and life skills education to at-risk families. • Maintained communication with the Program Coordinator and other professionals on issues pertinent to the program in both a written and verbal format. • Maintained up to date documentation on families and attended case staffings as necessary. Other Experience Advisory Board of Promoting Safe and Stable Families Member of The National Supervised Visitation Network Member of DOVIA(Directors of Volunteers in Agencies). Education Associate of Arts Degree in Liberal Arts Aims Community College Greeley, CO American Institute of Foreign Study: England,France,Italy&Greece as .1---I I— I —I Jennifer D. Petersen Work History February,2007 to Present Child Advocacy Resource and Education Evans, CO Supervised Visitation Parent Educator • Implement a safe and supportive supervised visit or exchange for at-risk family members. • Communicate with the Program Coordinator in both verbal and written format to maintain up to date documentation and assess any concerns that may arise. • Assist family members with resources or referrals as necessary. March, 2007 to Present Child Advocacy Resource and Education Greeley, CO Young Parent Program Coordinator • Administer the Young Parent Home Based Education Program • Maintain contact with the Director and other relevant professionals providing both written and oral information in order address pertinent issues and appropriately document families. • Participate in agency activities including staff meetings, fundraising, public speaking and trainings as necessary. August, 2004 -August, 2006 Center for Family Care Ft. Collins, CO Therapist • Provided group,individual and family counseling for children and families. • Collaborated with school staff and other community professionals for treatment development. • Co-facilitated parenting classes. March, 1999 -July, 2004 Latimer Center for Mental Health Ft. Collins 8c Loveland, CO Mental Health Counselor • Provided counseling for children and families in various programs including out patient and play therapy. • Performed intake and diagnostic evaluations, case management, crisis intervention and treatment development. Education May, 1996 Adams State College Alamosa, CO Master of Arts, Community Counseling May, 1992 Colorado State University Ft. Collins,CO Bachelor of Science,Psychology Credentials Licensed Professional Counselor,May 1999 Family Preservation Specialist,July 1997 National Certified Counselor, October 1996 3808 Ironhorse Drive Evans, CO 80620 a5 • 4313 Wapiti Way Evans, CO 80620 Myrna Reese-Stevens Experience 2005 to Present Child Advocacy Resource and Education Evans, CO Supervised Visitation Supervisor • Back up parent educators during supervised visitation and exchanges to ensure compliance and safety of all family members and staff. • Implement a safe and supportive supervised visit or exchange for at-risk family members. • Communicate with the Program Coordinator in both verbal and written format to maintain up to date documentation and assess any concerns that may arise. • Assist family members with resources or referrals as necessary. 2004 to Present Child Advocacy Resource and Education Evans, CO Supervised Visitation Parent Educator • Implement a safe and supportive supervised visit or exchange for at-risk family members. • Communicate with the Program Coordinator in both verbal and written format to maintain up to date documentation and assess any concerns that may arise. • Assist family members with resources or referrals as necessary. 2006 to Present Weld County Rural Legal Services Greeley, CO Administrator • Match low income clients with Pro-bono attorneys • Responsible for financial duties and record keeping • Refer clients to outside resources as necessary 2004 -2006 A Woman's Place Greeley, CO Victim Advocate • Victim Advocate for woman in the domestic violence shelter • Facilitated parenting classes for the residents of the shelter • Volunteer Coordinator Other Experience Victim Advocate for the Greeley,CO Police Department March 1999 to Present Name Gender Date of birth Ethnic group.__Marital status Child's name Child's gender Child's date of birth Today's date SA=Strongly Agree A=Agree NS=Not Sure D a Disagree SD=Strongly Disagree I. I often have the feeling that I cannot handle things very well. SA A NS D SD 2. I find myself giving up more of my life to meet my children's needs than I ever expected. SA A NS D SD 3. I feel trapped by my responsibilities as a parent. SA A NS D SD 4. Since having this child,I have been unable to do new and different things. SA A NS D SD 5. Since having a child,I feel that I am almost never able to do things that I like to do. SA A NS D SD 6. I am unhappy with the last purchase of clothing I made for myself. SA A NS D SD '7. There are quite a few things that bother me about my life. SA A NS D SD 8. Having a child has caused more problems than I expected in my relationship with my spouse (or male/female friend). SA A NS D SD 9. I feel alone and without friends. SA A NS D SD 10. When I go to a party,I usually expect not to enjoy myself. SA A NS D SD 11. I am not as interested in people asl used to be. SA A NS D SD 12. I don't enjoy things as I used to. SA A NS D SD 13. My child rarely does things for me that make me feel good. SA A NS D SD 14. Sometimes I feel my child doesn't like me and doesn't want to be close to me. SA A NS D SD 15. My child smiles at me much less than I expected. SA A NS D SD 16. When I do things for my child,I get the feeling that my efforts are not appreciated very much. SA A NS D SD 17. When playing,my child doesn't often giggle or laugh. SA A NS D SD 1B. My child doesn't seem to learn as quickly as most children. SA A NS D SD 19. My child doesn't seem to smile as much as most children. SA A NS D SD 20. My child is not able to do as much as I expected. SA A NS D SD 21. It takes a long time and it is very hard for my child to get used to new things. SA A NS D SD For the next statement,choose your response from the choices"1"to"5"below. 22. .1 feel that I an: 1. not very good at being a parent 1 2 3 4 5 2. a person who has some trouble being a parent 3. an average parent 4. a better than average parent 5. a very good parent 23. I expected to have closer and warmer feelings for my child than I do and this bothers me. SA A NS D SD 24. Sometimes my child does things that bother me just to he mean. SA A NS D SD 26. My child seems to cry or fuss more often than most children. SA A NS D SD 26. My child generally wakes up in a bad mood. SA A NS D SD 27. I feel that my child is very moody and easily upset. SA A NS D SD 28. My child does a few things which bother me a great deal. SA A NS D SD 29. My child reacts very strongly when something happens that my child doesn't like. SA A NS D SD 30. My child gets upset easily over the smallest thing. SA A NS D SD 31. My child's sleeping or eating schedule was much harder to establish than 1 expected. SA A NS D SD For the next statement,choose your response from the choices"1"to"6"below. 32. I have found that getting my child to do something or stop doing something is: 1 2 3 4 5 1. much harder than I expected 2. somewhat harder than I expected 3. about as hard as I expected 4. somewhat easier than I expected 5. much easier than I expected For the next statement,choose your response from the choices"10+"to"1-3." 33. Think carefully and count the number of things which your child does that bother you. 10+ 8-9 6-7 4-5 1-3 For example:dawdles,refuses to listen,overactive,cries,interrupts,fights,whines,etc. 34. There are some things my child does that really bother me a lot. SA A NS D SD 35. My child turned out to be more of a problem than I had expected. SA A NS D SD 36. My child makes more demands nn me than must children. SA A NS D SD PAR Psychological Assessment Resources,Inc.•16204 N.Florida Avenue•Wu,FL 33549.1.800.331.8378•www.parinc.com Copyright C 1996 by Psychological Assessment Resources,Inc.All rights reserved.May not be reproduced in whole or in part in any form or by any means without written permission of Psychological Assessment Resources,Inc.This form is printed in blue ink on carbonless paper.Any other version is unauthorized. B 8 7 Reorder eRO-1096 Printed in the U.S.A. 036 • Form A Strongly Strongly • Agree Agee Uncertain Disagree Diaree 1. Young children should be expected to comfort sA . A U D SD their mother when she is feeling blue. 2. Parents should teach their children right from SA A U D SD wrong by sometimes using physical punishment 3. Children should be the main source of comfort SA A U D SD and care for their parents. 4. Young children should be expected to hug their SA A U D SD. mother when she is sad. 5. Parents will spoil their children by picking them SA A U D SD up and comforting them when they cry. 6. Children should be expected to verbally express i SA A U D SD themselves before the age of one year. 7. A good child will comfort both of his/her parents SA A U D SD . after the parents have argued. 8. Children learn good behavior through the use of SA A U D SD physical punishment 9. Children develop good,strong characters through SA A U D SD very strict discipline. 10. Parents should expect their children who are SA A U D SD under three years to begin taking care of them- selves. 11. Young children should be aware of ways to corn- SA A U D SD fort their parents after a hard day's work. 12. Parents should slap their child when s/he has done SA A U D SD something wrong. 13. Children should always be spanked when they SA A U D SD misbehave. 14. Young children should be responsible for much of SA A U D SD the happiness of their parents. 15. Parents have a responsibility to spank their SA A U D SD children when they misbehaves,• Please go to next page. •01984 Family Eh—Jur..`at Resourzv.Inc.All Rights Reserved This test or pans thereat may not be'reproduced in any form without penntsann of the publisher. r2(+9 • Form A ' S. Strongly Strongly _ Agree Agree Uncertain Disagree Disagree 16. Parents should expect their children to feed them- SA A U D SD selves by twelve months. 17. Parents should expect their children to grow SA A U D SD physically at about the same rate. 18. Young children who feel secure often grow up SA A U D SD expecting too much. 19. Children should always "pay the price" for mis- SA A U I) SD behaving. 20. Children under three years should be expected to SA A U D SD feed,bathe, and clothe themselves. 21. Parents who are sensitive to their children's feel- SA A U D SD ings and moods often spoil their children. 22. Children deserve more discipline than they get. SA A U D SD. 23. Children whose needs are left unattended will SA A U D SD often grow up to be more independent. 24. Parents who encourage communication with their SA A U D SD children only end up listening to complaints. 25. Children are more likely to learn appropriate be- SA A U D SD havior when they are spanked for misbehaving. 26. Children will quit crying faster if they are ignored. SA A U D SD 27. Children five months of age ought to be capable SA A U D SD of sensing what their parents expect. 28. Children who are given too much love by their SA A U D SD parents often grow up to be stubborn and spoiled. 29. Children should be forced to respect parental SA A U D SD authority. 30. Young children should try to make their parent's SA A U D SD life more pleasurable. 31. Young childrenwho are hugged and kissed usually SA A U D SD grow up to be"sissies." 32. Young children should be expected to comfort SA A U D SD their father when he is upset. 01984 Family.Development Resources.Inc All rights rverVed. This test or Para thereof may not be reproduced in any form without penniaion of the publisher. M a / I Nurturing Program For Parents and Children 4-12 Years Nurturing Quiz • Name: Date: Circle the response you feel best completes the statement. There is only one. 1. Behavior management is a general term used to 4. Which of the following statements is the correct describe way to praise a child? a. Techniques to help children learn desirable a. Sally, you washed the dishes. What a great behaviors. kid you are. b. A way to get children to behave periectiv. b. You washed the dishes. but I oniy wish you could have put them away. c. A way of punishing children_ c. You sure did a great lob in washing those d. A way to help parents control the feelings of dirty dishes. their children. d. Washing dishes is a tough job. Mammy real- e. I'm 1101 sure. ly loves you. 2. Which of the following statements best defines e. I'm not sure. the concept of discipline? 5. Parents should praise themselves in front of a- Spanking children. their children when the parents do something b. Rewarding children. good. c. Ignoring children. a. True d. Establichina family rules. b. False c. I'm not sure. c. I'm not sure. 3. How does punishment differ from discipline? 6. Family rules are rules mainly fon a. Punicnmrnc is establishing rules for a child: a. Parents discipline is what a child receives after P b. Grandparents breaking the rules. c. Children • b. Discipline is establishing rules for a child: pnnichmr'a is what a child receives after d. All family members breaking the rules. Spanking is a good way to let children know you c. They don't differ—they're the same. are angry. d. Punishment is what a child gets for following a. True the rules. There is no discipline. b. False e. I'm not sure. c. I'm not sure. ©1986 Family Development Resources.Inc • as INTAKE CareHouse Service Agreement , agree to (Please initial after item signifying that you understand and agree to comply) 1. Provide application and court order. (date provided): 2. Provide a copy of all modifications of court orders or parenting time as they occur. 3. Give my consent for information to be released to and from: My attorney ( Social Services in Weld, and , counties. Colorado Bureau of Investigation City and County Court, (Case# Applicable Law Enforcement Agencies 4. Contact CareHouse office a full 24 hours prior to each and every visit/exchange to confirm or cancel my visit or the visit will be automatically canceled and a cancellation fee of will be assessed before visits can continue. 5. Pay for each visit/exchange at the time of service or provide signatures for DSS 6. Observe the neutral time, be on time (or a fee of$l/minute will be assessed), and have NO CONTACT with the other parent at CareHouse. 7. Abide by the following CareHouse rules: I. Do not discuss scheduling or other concerns with visit/ex supervisor(call the office during business hours and speak with the coordinator). 2. Do not pass notes or attempt to communicate with the other parent through your child/ren or CareHouse staff. (Please contact your attorney or mediator). _ 3. Do not use physical punishment, threats or profanity at CareHouse. (Nurturing discipline is strongly encouraged; help available upon request). 4. Do not make inquiries or derogatory comments about the other parent, foster home or situation. (Keep the conversation light and positive). 5. Do not use drugs or alcohol prior to your visit. (Visit will be terminated immediately upon suspicion of use). 6. Do not bring pets, violent toys, cell phones, medication or tobacco products to your visit. 7. Visiting parent should provide snacks, diapers, sunscreen, and age appropriate activities during visit. (CareHouse has a limited selection of supplies). 8. Visitors must be pre-approved 7 days before each visit. (Contact the office and/or caseworker to arrange). 9. Do not whisper or speak in a language not understood by your supervisor during your visit. (Visit supervisor must be able to hear all conversations). 10. Respect when your child says "No". Do Not tickle or play rough or toss children in the air. II. Do not go into parking lot,near street or near vehicles during visit. Signature Date: Witnessed by Title: For Staff Use Only Evaluation done? Staff Person: Custodial: Visiting referred by: Reason for Referral Amount Paid - - Z 5 oL. Ai 21 • (Child advocacy resource and education, Inc c.a . r.e. I, , have read, understand and agree to the following conditions: 3700 Golden Street Evans, CO 80620 I. I will schedule and keep appointments with the Parent Educator provided to me by Child Advocacy Resource and Education (c.a.r.e.). (970)356-6751 FAX(970)506-2726 2. Should I need to cancel or reschedule I will make every effort to let the Parent careweld@gwest.net Educator know prior to the time of the scheduled appointment. 3. The Parent Educator visiting my home or supervising visits is there to assist Programs: and support me with my parenting skills and responsibilities,and to support my Parent Education children and family. This may include spending time with just the children and time Children and Youth with just the parents. The Parent Educator is not to be used as a babysitter. SafeTouch 4. There will not be other individuals or guests present in my home during the Supervised visits ' time the Parent Educator is scheduled to work with me and my family. and Exchanges 5. I may be given assignments to complete and specific goals will be developed Home-Egged Parent to measure improvement in my parenting knowledge and abilities. Education 1' Communi66Awaregess'' 6. I will refrain from smoking while the Parent Advocate is in my home. If need be,cigarette breaks will be arranged. • 7. I will turn off the television and radio or stereo while visiting with the Parent Educator °} 8. I will contact the Parent Educator supervisor with any problems, concerns or ilregries dad- `- questions regarding the program that I have been unable to resolve with the erviasirffr - Educator first. fry* r atiK4W14Wik ade Date Y , xF Parent Signature • Parent Signature :, Parent Educator • i: Parent Educator Supervisor intlidWag' an afiiiateaagency Handed Way-.. ..weld Cau'fily - . 30 Allianceof ALLIANCE OF NONPROFITS FOR INSURANCE C Nonprofits RISK RETENTION GROUP P.O. Box 8546, Santa Cruz, CA 95061 for Insurance Risk Retention Group P: (800) 359-6422 F: (831) 459-0853 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS PRODUCER: POLICY NUMBER: 2006-11741 Nonprofit Resources 455 Sherman Street Ste 207 RENEWAL OF NUMBER: 2005-11741 Denver, CO 80203 NAME OF INSURED AND MAILING ADDRESS: Child Advocacy Resource And Education 3700 Golden Street Evans, CO 80620 POLICY PERIOD: FROM 07/23/2006 TO 07/23/2007 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Child Advocacy Services IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. LIMITS OF COVERAGE: GENERAL AGGREGATE LIMIT(OTHER THAN PRODUCTS-COMPLETED OPERATIONS) $3,000,000 PRODUCTS -COMPLETED OPERATIONS AGGREGATE LIMIT $3,000,000 PERSONAL AND ADVERTISING INJURY LIMIT $1,000,000 EACH OCCURRENCE LIMIT $1,000,000 DAMAGE TO PREMISES RENTED TO YOU $100,000 any one premises MEDICAL EXPENSE LIMIT 10,000 any one person ADDITIONAL COVERAGES: SOCIAL SERVICE PROFESSIONAL LIABILITY AGGREGATE LIMIT $3,000,000 EACH OCCURRENCE LIMIT $1,000,000 CLASSIFICATION(S) SEE ATTACHED SUPPLEMENTAL DECLARATIONS SCHEDULE G PREMIUM $4,427 FORMS AND ENDORSEMENTS APPLICABLE TO THIS POLICY ARE INCLUDED IN COMMERCIAL LINES COMMMON POLICY DECLARATIONS 07/21/2006 BY (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDmONS,COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. "NOTICE : This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State.State insurance insolvency guaranty funds are not available for your risk retention group." ANI - RRG -GL (02258) 31 Program Area Supervisor/Provider Meeting Verification/Comment Form 3 - �Date of Meeting: 4..AAAS Program Area: Comments to be completed by Program Area Supervisor): S 051 eliztV6h "{-e129-0k— L7 Oa/ on & Signature of Program Area Supervisor 3� • EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP c • a • r • e (Child advocacy rosourca and education, Inc. f t May 16,2007 Ms.Tobi Vegter Weld County Department of Social Services RO.Box A Greeley,CO 80632 Re: Bid 0002-LS07(RFP 07005)Lifeskills,Parent Advocate/Visitation Dear Ms.Vegter, Child Advocacy Resource and Education,Inc.(c.a.r.e.)act is the results of the RFP Bid Process for 2007-2008 and will provide further information addressing areas shown below. Condition#1: case.will clarify their response to evidence based practices. (Please see following Attachment) Condition#2: c.a.r.e.will address the Measurable Outcomes section in the RFP. (Per review of above condition with Tobi Vegter on 5/16/07,we were told that we ,: had sufficiently addressed this area pending any further notification.) c.a.r.e.accepts the recommendations outlined by the FYC Commission. Thank you for your consideration and approval of our programs for inclusion on ;, your vendor list We look forward to meeting the needs of children and families in Weld County during the 2007-2008 year. ., Sincerely, 2/1< e�GwM.A. r Executive Director Child Advocacy Resource and Education,Inc. Attachment A Bid 0002-LS 07 Life Skills,Parent Advocate/Visitation Condition#1: c.a.r.e.will clarify their response to evidence based practices. Our proposal focuses on two Lifeskills programs: The Supervised Visitation and Safe Exchanges Program,(at two levels of intensity) and The Home-based Parent Advocate Program. SERVICES PROVIDED Supervised Visitation with Parent Education and Home Based Parent Education primarily employ the use of The Nurturing Program by Family Developmental Resources. The Nurturing Parent Programs are validated family-based programs.The program has been field tested with families at risk for abuse and neglect,families identified by social services as abusive or neglectful,families in recovery for alcohol and other drug abuse,families at risk for delinquency,incarcerated parents and adults wishing to become adoptive or foster parents.As such,primary use of the Nurturing Program is to treat child and adolescent maltreatment,prevent its recurrence and build nurturing parent skills in at-risk populations. The Nurturing Programs are one of 23 parenting programs nationwide that are recognized by the National Registry of Effective Programs and Practices(NREPP)and by the Substance Abuse and Mental Health Services Administration(SAMSHA).The Nurturing Programs are also recognized by the Child Welfare League of America(CWLA),the Office of Juvenile Justice and Delinquency Prevention (OJJDP)and the Center for Substance Abuse Prevention(CSAP). The foundation of the program,that parenting is a learned behavior; is based on the following assumptions: 1)The family is a system,2)empathy is the single most desirable quality in nurturing parenting, 3)parenting exists on a continuum,4)learning is both cognitive and effective,5)children who feel good about themselves are more likely to become nurturing parents and 6)no one truly prefers abusive interactions. EVIDENCE—BASED PRACTICE Effectiveness Studies: (2 of many) Cowen,P.S.,"Effectiveness of a Parent Education Intervention for St-Risk Families."Journal of the Society for Pediatric Nursing,6(2),73-82,2001. Summary:This study explored whether parents who completed the Bavolek Nurturing Program improved their parenting attitudes.On the pretest,parazents demonstrated scores associated with maladaptive parenting practices.Posttest scores were consistent with nurturing parenting attitudes. Devall,E.,"Positive Parenting for High Risk Families."Journal of Family and Consumer Sciences,96 (4),2004. Summary: Parents in the program showed significant increases in empathy and knowledge of positive discipline techniques,and significant decreases in parent-child role reversals, inappropriate expectations,belief in corporal punishment and oppression of children's independence following the learning experiences. Child Advocacy Resource and Education,Inc. Core Services Response 2007 ADAPTATIONS/MODIFICATIONS OF SERVICES The Nurturing Program lessons are being adapted for use in the Home based parent education program and Supervised Visitation Program with Parent Education.Ideally,the program would consist of up to 40 1.5 hour lessons. Due to the variety of treatment plans and situations for families referred to our programs,and the limited time we might have to spend meeting one-on- one with parents,our staff modify/customize the program curriculum materials to address the specific needs of the family as directed by the treatment plan,caseworker recommendations and presenting issues of the parent(s)while visiting with their children.In this case, each of the lessons can be presented as a stand-alone topic and those topics are hand picked to best help the family meet their individual needs and challenges. In addition,we also will bring other specific topics or methods of instruction into the lesson(s)when needed.For instance,another method of parenting instruction,the 1-2-3-Magic model,or the RETHINK: Anger Management for Parents lessons might be included. The consistent themes of nurturing,non-physical methods of parent discipline are paramount.The elements of instruction are then brought into the visit time or family times with the whole family,through on-going coaching of the methods learned. Monitored(Low Intensity)Visits are under the control of a Visit Supervisor and designed to supervise a visit,both verbally and physically, for appropriate interactions,with only limited intervention as necessary for the safety and supervision of the children.While the elements and philosophy of the Nurturing Program are evident in the interactions of our staff,there is no direct instruction occurring on an ongoing basis. Child Advocacy Resource and Education,Inc. Core Services Response 2007 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 OFax Number(970)353-5215 • COLORADO May 11, 2007 Gwen Schooley, Director c.a.r.e. 3700 Golden Evans, CO 80620 Re: Bid 0002-LS-07 (RFP 07005) Lifeskills, Parent Advocate/Visitation Dear Ms. Schooley: The purpose of this letter is to outline the results of the Core Bid process for PY 2007-2008 and to request written information and confirmation from you by Monday, May 21, 2007. The Families, Youth, and Children Commission appreciates your interest in providing services for families in Weld county. This year, strides were made in structuring an RFP that is clear and concise, and more user friendly, for both prospective bidders and evaluators. It is important to stress the value of following formatting guidelines and addressing the required sections concisely and appropriately. A. Results of the Bid Process for PY 2007-2008 Through the 2007-2008 bid evaluation process, the Families,Youth and Children(FYC) Commission recommended approval of Bid.#002-LS-07 (RFP 07005) Lifeskills. The Families,Youth and Children's Commission attached the conditions described below to your bid. Conditions: 1. c.a.r.e. will clarify their response to evidence-based practices; 2. c.a.r.e. will address the Measurable Outcomes section in the RFP. B. Required Response by FYC Bidders Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award (NOFAA). If you do not accept the condition(s), you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the conditions, you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. Page 2 c.a.r.e./Results of 2007-2008 Bid Process 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. You may fax your response to us at 970.346.7662. If you have questions concerning the above, please call Tobi Vegter, 970.352.1551 extension 6392. Sincerely, J d, A. t' -go, Dir tor cc: Juan Lopez, Chair, FYC Commission Tobi Vegter, Core Services Coordinator Gloria Romansik, Administrator Weld County Department of Social Services Notification of Financial Assistance Award for Core Funds Type of Action Contract Award No. X Initial Award 07-CORE-LS 0004 Revision (RFP-PAC-07005; 003-LS-07) Contract Award Period Name and Address of Contractor Lori Kochevar MS, LPC, LLC Beginning 06/01/2007 and Life Skills Program Ending 05/31/2008 1024 8th Street Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal(RFP). The Supervised visitation for the family during the time the RFP specifies the scope of services and conditions of award. bonding specialist is working with them. The focus of Except where it is in conflict with this NOFAA in which case the program is to teach parents how to create an the NOFAA governs,the RFP upon which this award is emotionally safe and secure environment for their based is an integral part of the action. children in the home.The overall goal of the program is Special conditions to keep children with their biological parents. Service to 1) Reimbursement for the Unit of Services will be based children 0-12,an average capacity of 60 families during on an hourly rate per child or per family. a year, monthly capacity of six to eight families,and 2) The hourly rate will be paid for only direct face-to- average hours per week per family is two; average stay face contact with the child and/or family,as in program is six months. Bilingual/bicultural and South evidenced by client-signed verification fonn,and as Weld County services. specified in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly and Cost Per Unit of Service yearly cost per child and/or family. Hourly Rate Per 4) Payment will only be remitted on cases open with, Treatment Package $89.00 and referrals made by the Weld County Department Treatment Package Low (Court Testimony) $150.00 of Social Services. 5) Requests for payment must be an original submitted to Enclosures: the Weld County Department of Social Services by the X Signed RFP: Exhibit A end of the 25th calendar day following the end of the X Supplemental Narrative to RFP: Exhibit B month of service.The provider must submit requests Recommendation(s) for payment on forms approved by Weld County X Conditions of Approval Department of Social Services. Requests for payments submitted 90 days from the date of service, and thereafter,will not be paid. 5) The Contractor will notify the Department of any changes in staff at the time of the change. Approv • Program Official: By _ r n By David E. Long,Chair Judy Grieg ,Diref r Board of we d Co sioners Wel o,int epart nt ofSocial Services Date: JUN Date: L/ 0/c-7 oleo PS EXHIBIT A SIGNED RFP • C L S c ,1 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 3119 ) o 7 (After receipt of order) BID MUST BE SIGNED IN INK Program Area: rv�QQ f'1t k� ,J}, { (� ` ' r� L LI TYPE OR NTED SIGNATURE VENDOR Lori Kochevar Handwritten Signature By Authorized Officer or Agent of Vendor 1024 8th Street ADDRESS Greeley, CO 80631 TITLE 'U2iL- DATE 741 /f?`7 PHONE# LI-Ja 362- S37 3 The above bid is subject to Terms and Conditions as attached hereto and incorporated. THE BONDING PROGRAM Purpose: The purpose of the Bonding Program is to provide support and information in order to assist parents in building a stronger emotional relationship with their children. The focus of this program is to teach parents how to create an emotionally safe and secure environment for their children in the home. The overall goal of this program is to keep children with their biological parents. The Bonding home-visitation program also has these broad goals: 1)to improve health and safety related behaviors; 2)to improve the health and development of the child by helping parents provide more competent care giving; and 3)to enhance parents' personal development by helping them plan future pregnancies, continue their education, and find work. In addition, bonding specialist is able to adapt the program to the specific needs and interests of families referred. Design: This program will provide supervised visitation for the family during the time the clinician is working with them. An extensive review of the research on child development and family functioning, indicate that the four domains that define emotional health are the development of positive attachment, healthy interactions, mastery of skills and an available network of social support(Call et al, 1987). The AIMS: Developmental Indicator of Emotional Health was developed as an assessment/intervention system to identify strengths and concerns about the emotional health of children and their families in the four areas of; Attachment, Interaction, Mastery and Social Support. An in depth definition of these constructs,the bibliography of all research reviewed as well as a flow chart describing the system taken from the AIMS user manual and Handbook for Practitioners (Partridge et al, 2001) can be found in Appendix 2. Research indicates that children that do well despite severe stressors in their environment have a strong relationship with at least one primary caretaker (Werner and Smith, 1982). Interventions provided by Social Services can not address all the current and or future stressors in a family's life. However,by focusing on strengthening the bond between the parents and the child we can positively influence the parent's motivation to reunite as well as their long term ability to provide safety for their children. A longitudinal randomized controlled treatment study (Olds 2004) indicates that the results of home visitation program are effective in both short term and long term change. In contrast to the comparison group, women involved in a home visitation program had fewer subsequent pregnancies and births, longer intervals between births of the first and second children, and longer relationships with current partners. At the follow-up evaluation 4.5 years after receiving services these families had fewer months of using welfare and food stamps, and were more likely to have enrolled children in formal out-of- home care. In addition, children in the home visitation program demonstrated higher intellectual functioning and receptive vocabulary scores and fewer behavior problems in the borderline or clinical range. These children also exhibited higher arithmetic achievement test scores and expressed less aggression and incoherence in response to story stems. This research clearly demonstrates that the home visiting program continued to improve the lives of women and children 4.5 years after the program ended. These findings are in line with other research(Lyons-Ruth, 2004; Old, 2002). 2 • Table of Contents— Bonding Program I. Invitation to Bid 1 II. Abstract 2 III. Table of Contents 3 IV. Target/Eligibility Populations 4 V. Project Narrative and Supporting Documentation A. Types of Services Provided 5 B. Measurable Outcomes 8 C. Service Objectives 10 D. Workload Standards 13 E. Staff Qualifications 15 F. Program Capacity per Month 16 G. Internal Tracking and Billing Process 17 Supporting Documentation H. Literature Citations 18 I. Confidentiality and Participant Protection/Human Subjects 20 VI. Budget Forms 23 VII. Appendices 1 —Resumes 27 2 — Data Collection Instruments/Protocol 35 3 — Consent Forms 44 3 TARGET/ELIGIBIILITY POPULATION A. Total Number of clients to be served: The program will serve a total of 60 families during the twelve-month period. Each clinician will serve eight to ten families at a time with each family receiving 24 hours of one-on-one supervised visitation. This provides 27 hours of intervention with families per week, 120 hours per month. Total number of client hours provided per year would be 1440 hours. B. Total number of families served: A total of 60 families will be served during the year. C. Sub-total of individuals who will receive bilingual/bicultural services: All services provided would be in a manner that is sensitive to the family's culture of origin. The program manager and specialists have extensive training in cultural competency issues. Lori Kochevar chaired the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Barb Jetley has worked with families from various cultural roots. She has a sense of respect for the family's cultural beliefs and practices. Lorenza Perezverdia is a bicultural bilingual provider who will be available for any translation for Spanish speaking families. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. E. Sub-total of individuals who will receive services in South County: The program could serve three to eight families in South County during a given time period. We currently have providers that live in the south and we would like to increase our referral base in this area. Services will be provided for families where they reside as determined by Social Services. F. The monthly maximum program capacity: If needed, we could expand the number of hours we are available for services to 35 hours per week, which would make available 140 hours per month. G. The monthly average capacity: The monthly average capacity of this program is six to eight families. H. Average stay in the program: The average stay in the program would be six months. I. Average hours per week in program: Initially, each family would receive two to four hours per week. After the first twelve weeks, sessions will decrease as recommended by the treatment team. 4 SECTION A- TYPES OF SERVICE PROVIDED Why Services are Important: Bonding is a deep and lasting relationship which typically develops between the caregiver and the child during the first two years of life. The strength of this bond has a profound affect on every aspect of the child's nature. The child,who develops a strong sense of nurturing from his mother,will develop: a sense of trust, a good self-esteem, positive reciprocal interaction with others and an ability to function as a healthy adult. A child who does not experience the development of a strong bond with the parents will be prone to difficulties with relationships, antisocial behavior and learning difficulties. When these children grow up, they are often unable to regulate their emotions or their behavior(Easterbrooks and Goldberg, 1990). Difficulties with bonding often relates directly to unregulated and aggressive behavior in the future. Johnson and Walker(1987) found that children from impoverished families who received early interventions were rated as less aggressive and disruptive in elementary school. Lally et al. (1988) reported that, among children of young African-American single mothers, a program of early home visitation and early day care showed long-term effects in reducing later criminal acts,with 22%of un-served versus 6% of served 16-year-olds having contact with the probation department. Any event that separates the child from the mother either physically or emotionally during the first three years of life, places the child at risk for inadequate bonding(i.e. Placement in foster care, frequent moves within a foster care system,parents who suffer from depression or are involved in substance abuse or domestic violence). Children who are not well bonded do not learn to trust. They have a difficult time building strong meaningful relationships throughout life. This may be reflected across their lifespan through angry, defiant and controlling behavior. Due to the impact inadequate bonding may have on the future of the child and our community, it is imperative that intervention begin as early as possible in the child's life. A. Services provided in this bid will address the following key core values: • Assuring the safety of children • Preventing family disruption with services to strengthen and preserve families and/or reunifying children with families whenever safety is possible • Engaging parents to participate in service. • Assuring the collaboration of all formal and non-formal services and supports provided to children and families to maximize the achievement of goals. Mentoring,the program will address the following areas: • Teach, model and coach adaptive strategies: The clinician will teach through use of visual aides, demonstration and verbal interaction with the parents and child. She will use demonstration of bonding behaviors. She will guide the 5 parents and child through activities that utilize bonding skills and encourage a positive emotional interaction between the parents and child. She will support the parents with encouragement and recognition of positive changes. • Model and influence parenting practices: During the visits with the parents and child, the clinician will influence and direct parenting practices through education of the parents. The parents will be given opportunity to gain increased awareness of the child's developmental level and have a better understanding of expectations which are appropriate to the child's age. The clinician will have opportunity to model for and guide the parents during the visitation. • Teach relational skills: The parents will receive information and guidance regarding nurturing behaviors which, when put into practice, will enhance relationships. The clinician will guide and support the parents as they make efforts to utilize new skills. As the mother and father make changes in their efforts to bond with their child,there is often not an immediate positive response from the child. Often the clinician is intricately involved with helping the child to trust the parents, at the same time they are teaching the parents how to provide an environment and relationship the child can trust. • Teach household management, including prioritizing,finances, cleaning, and leisure activities: The program will address everyday living concerns faced by the family through observation and initial assessment. The clinician will address issues such as the safety and health of the family as related to hygiene and care of the living quarters. The clinician will increase the parent's awareness of the importance of structure and consistency in the home routine for the children and the parents. This will be a process of education presented through verbal and written materials. • Actively help to establish community connections and resources: Clinicians are well informed about community resources. Clinicians will be able to direct the client to resources as needed and to assist with accessing those resources. This would include offering the information to the client, setting up an initial appointment, and possibly meeting the parents at a designated appointment as a support person. This could also include guiding the parents to Play Groups or other activities that would offer opportunities for social interaction for the child and parents. A Resource Guide will be used in the intervention with each family. • Encourage goal setting and pro-social values: When working with the family in the above areas, the clinician will assist the parents in developing goals that the parents recognizes as important to the welfare of the child and the family. Goals will be developed with the parents and put into writing, to be reviewed periodically together. Through this experience, the client would develop a greater awareness of how to function successfully in society. VISITATION,the program will address the following areas: 6 • Monitor parents-child interactions for physical and emotional safety: Supervised visitation by the clinician will be made in the home of the client, or in a location designated by the Department of Social Services. During the visitation, the clinician will be attuned to the interactions between the child and parents. She will guide, direct and model behavior with the parents and child as a means of increasing parents' awareness regarding ways to provide an emotionally and physically safe environment. • Document clinical observations: The clinician will utilize The Family Visitation Evaluation Form (Appendix 2), DC: 0-3R,NCAST as appropriate to document clinical observations. The clinician reviews a copy of all observations with the client at the end of the visit or at the beginning of the visit. The clinician submits a monthly report to the caseworker, the supervisor of Life Skills Programs and a billing person. • Strategize for teaching and modeling parenting skills: Demonstration is most often the most effective strategy for increasing parents' awareness and teaching new skills. As events unfold during a visit, it is effective to be able to point out emotional or physical safety concerns as the issues arise. It is also effective to offer support and positive feedback to the parents and the child as positive events occur during the visit. It is through this process of redirecting and recognition of a parent's efforts that the parents begin to understand their own sense of success. • Teach relational skills: Parents will be educated through visual aides and verbal information about ways the parents can enhance their relationship with the child. During visitation, the clinician will point out specific behaviors of the child that indicate an insecure bond and direct the parents to ways they can offer the child more support. The clinician will use demonstration and modeling to assist the parent's understanding of her child's needs and healthy responses to those needs. • Encourage goal setting and pro-social values: During the visitation, much of the focus will be on the emotional interactions between parents and child. As the parents come to a better understanding of their child's needs and how their own behaviors affect the child they will understand pro-social values. The clinician will assist the parents to delineate their goals. Those goals will be reviewed with the client periodically and enhanced or changed as the parent's progress. Through the increased awareness of their responsibilities as parents and their success, the parents become more invested in participating in a fruitful way with society. • Plan structured activities in visitation to help achieve the objectives of the treatment plan: The clinician will plan and implement activities that will enhance the interactions between parents and child. These activities encourage the basic modes of emotional connection; holding, touching, rocking, eye contact, talking, pleasant facial expression and feeding. 7 • Throughout the structured activities the clinician will be evaluating the child's capacities for emotional and social functioning. Activities will be planned to encourage the child to function at an age-appropriate level under all conditions and with a full range of affect states. We will assess the child's ability to; 1. Hold attention and regulate their affect 2) form relationships through mutual engagements, 3)participating in intentional two-way communication, 4)use complex gestures and problem solving, 5)use symbols to express thoughts/feeling, 6) connect symbols for logic and abstract thinking skills. • In addition we will be planning activities to: teach parent's sensitivity to cues, how to respond to a child's distress, how to foster social-emotional growth, and how to foster cognitive growth. As we work with parents and their children, typically the clarity of cues the child gives becomes stronger. The child becomes more responsive to the caregiver who has become more responsive to them. • Emphasis will be placed on assisting parent's response to the child's behavior through modeling and guiding at the time of the behavior. Through these interactions, the clinician will be able to offer education and demonstration to increase the parent's awareness of appropriate expectation of the child at their current developmental stage. Other activities would be to practice making physical contact and face-to-face posturing. Parents will also be encouraged to read books to the child to encourage closeness. Activities will be practiced according to the age of the child and the parents/child relationship at a particular point in the intervention. SECTION B- MEASURABLE OUTCOMES Assessment tools for this program include Bonding Assessment Tool, AIMS Assessment Program DC: 0-3R,NCAST Feeding Scale, Impact of Event Scale-PTSD and Depression Screening (Appendix 2). . In evaluating each family,we will use additional tools when appropriate to assess level of bonding the child has experienced and identify behaviors that indicate areas of concern. The clinician will discuss concerns with the parents and develop a Case Management Plan. This will be an outcomes-based plan that will be shared and reviewed periodically with the parents. The goal of this program is that families who receive services will remain intact six month after discharge, will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. A. After involvement in this program the parents will be able to provide a safe secure home for the children. This includes health, safety, and provision for every day needs. The parents will have: • Resources to provide for the child's basic needs, such as adequate housing and resources for providing food and clothing on a consistent reliable basis. • Increased awareness of daily planning for the child's needs and providing a stable environment by establishing routines around mealtime, after school activities, bath time and bedtime. 8 • Increased understanding of the nutritional needs of the family and a means of providing for those needs. • Increased awareness of the exposure of the children to health and safety risks when the home is not well maintained. • The ability to focus spending on the basic needs of the family as a priority over other expenditures. B. After involvement in this program parents will be able to realize increased competency in their parenting. Parents will demonstrate through their behaviors: • Increased awareness of the emotional needs of the child and demonstrate nurturing behaviors meant to enhance their bonding. • Increased demonstration of nurturing behaviors in parents-child interactions. • Increased awareness of the emotional and physical developmental age of the child and responses that are fitting for that child. • Increased knowledge and understanding of child's behavior as related to bonding issues. • Increased use of discipline measures that are effective (not damaging to the relationship) and is consistent in the use of those measures. o After involvement in this program,the child will: Indicate through his behavior that he has an increased sense of security and trust in the parents. Demonstrate an increased emotional bond with the parents. Behave appropriately in social situations. Show developmental progress. C. After involvement in the program the parents will have increased ability to access resources in the community independently in order to better meet the needs of the child and family. • This program will empower the parents to access community resources by providing information and initial support and guidance. The parents will have an increased knowledge of resources available and show confidence in seeking out resources independently, making appointments, keeping appointments and following up with services. D. Parents who complete the program will obtain higher skill and competency levels in order to provide the child with a safe, secure home. The Parents will provide the nurturing needed to enhance the child's sense of security. Parents will be able to identify factors that have a positive effect on the security of their family. In order to keep the family together after six months from discharge,the parents will: • Be able to prioritize the needs of the children over the parent's own needs. • Will recognize and have ways of meeting their own needs. • Maintain awareness of enhanced family relationships and continue to utilize skills gained during the program. • Have in place identified and used sources of support in the community. 9 • Be aware of the need for continued focus on and attention to the emotional needs of the child. E. Families who participate in the program will develop skills and awareness that will increase their competency as parents. Increased competency will be measured through documentation occurring at each visit through use of an outcomes-based Case Management Plan developed at the time of entry into the program. Risk factors will be identified at the time the initial plan is written using the risk assessment tool. This will be reviewed with the parents and updated as goals are met and as changes occur in the parents-child relationship. F. Families who participate in this program will remain intact six month after discharge, will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. SECTION C - SERVICE OBJECTIVES The program has the following service objectives: MENTORING: A. Improvement of household management competencies: It is imperative that parents understand and show competence in the practice of keeping a clean, well- maintained home for the health and safety of the children. It is expected that parents will manage the household finances in a manner that allows for the children to be nutritionally healthy, clean, and adequately dressed. It is expected that the parents will consider the child's health and emotional safety when planning leisure activities for themselves and the children as they develop increased awareness of health and safety issues. Included in household management is the parent's ability to maintain structure and consistency in the child's life in the home. This objective will be measured through the parent's ability to reach specific goals as defined in the Case Management Plan relating to household concerns. B. Improve parental competency: • Parents will have the capacity to provide a safe environment for the children,both physically and emotionally. Parents will show competency in being able to protect and keep the child safe. Parents must be aware of the need for structure in the home in order to enhance the child's security. • Parents will indicate through their behavior, their understanding of bonding and nurturing behavior that serves to enhance the child's sense of security. It is crucial to the well being of the child that the parents be able to continue to utilize strategies to maintain and enhance the relationship. • The child will show in his responses to the parents that he feels safe and secure. • Parents will demonstrate their understanding and their ability to utilize parenting techniques that are effective and emotionally healthy for the child. This includes 10 use of adaptive strategies for discipline and behavior management, offering age- appropriate activities, and conveying expectations that are age-appropriate. • Parents will recognize the importance of being dependable caretakers for the child. It is necessary to the well-being and emotional growth of the child that the parents be both emotionally and physically available to the child in a consistent manner. The parents must understand that this is the foundation for building and maintaining trust. • Parents will acknowledge their responsibility for providing a healthy diet for the children. They must offer the child healthy and adequate food. • It is important that the parents take responsibility for attending to the child's hygiene. The parents must guide the child in hygiene issues and model good practices. This includes basic everyday hygiene, such as bathing,hand washing, changing clothes and care of teeth. The parents must make every effort to provide the necessary tools for practicing good hygiene. o This service objective will be measured through use of the Case Management Plan objectives(the use of a pre and post assessment tool) and the Family visitation evaluation form. C. Improve ability to access community connections and resources: • After being in this program,parents will have information regarding resources in the community and an understanding of how to access them. Parents will be empowered to make the necessary steps to resolve their concerns. This objective will be measured with use of Case Management Plan objectives and the parent's demonstration of utilizing resources independently, making and keeping appointments. D. Improve goal setting and pro-social values: • Parents will experience a sense of success in their ability to interact with resources and support systems, as they gain mastery and are able to utilize new skills and achieve goals set early in the program. As the parent's mastery of new skills, empathy for their children, connection and ability to interact deepen the parents will realize the value of pro- social behavior and goal setting and be able to apply it to other areas of life. o This objective will be measured through use of Case Management Plan anticipated outcomes and observation which indicate the parent's use of pro social behavior, empathy and goal setting. E. Improved outcomes in the Performance Improvement Plan- • Parents will be supported in maintaining permanency goal for the child. Providers will meet with all parties involved to discuss recommendations that are in the best interest of the child • Providers will support parents in maintaining family and cultural connections that support the child and keep the caseworker abreast of any information regarding these connections. 11 VISITATION: A. Improve parenting skills, parent/child interactions and relational skills for physical and emotional safety throughout structured activities in, and documentation of,visitations to achieve the objectives of the treatment plan: • The parents will show increased ability to put into practice the skills that are demonstrated during the visitation and will use the skills independently, without the continued guidance of the clinician. • The parents will have an understanding of ways to make an emotional connection with the child. It is crucial for the emotional health of the child that the parents be committed to that emotional connection. • The child will show positive response to the parent's efforts to make emotional connection. • The parents will demonstrate their capacity to protect the child from physical harm. They will take the initiative to set limits and follow through in order to protect the child. o These objectives will be measured and progress documented in face-to- face visitation with the family. B. Improve goal setting and pro-social values: • Parents will experience a sense of mastery, as they are able to utilize new skills and achieve goals set early in the program. With that sense of success, the parents will realize the value of goal setting and be able to apply it to other areas of life. o This objective will be measured through use of Case Management Plan anticipated outcomes and observation which indicate the parent's use of goal setting. MENTORING AND VISITATION: A. Improved ability to Access Resources-all services provided will assist parents in learning to obtain resources from the community and within the state, local, and federal government. This objective will be measured with use of Case Management Plan objectives and the parent's demonstration of utilizing resources independently, making and keeping appointments. B. Address specific issues outlined in referral-all services shall be solution focused and address the issues specified by the Department of Social Services on the referral form. This component will be measured through caseworker feedback and parents evaluations. C. We will be involved in improving outcomes in the Performance Improvement Plan in the following sections; • Placement Changes—Clinician will facilitate meetings with all parties involved to discuss any issues surrounding a recommendation to move the 12 child. Meetings will address how a move will be in line with the child's permanency goal and in their best interest. • Maintaining Cultural and Racial Connections—Clinician will provide the caseworker with any information regarding family and cultural connections that support the child. In emphasize the importance of maintaining traditions and connections in all areas. (i.e. neighborhood, community, faith, family, friends, school, and sports activities). These PIP goals will be evaluated by reviewing our cases on a yearly basis for the above components. SECTION D -WORKLOAD STANDARDS A. Number hours per day,week or month: The program has the capacity to serve up to 60 families. The clinicians would spend up to 27 hours a week providing services. Henceforth, 27 hours a week x 52 weeks,provides 1440 client hours a year. B. Staff: There are four clinicians and a program supervisor. Lori Kochevar M.S., L.C.P., LLC will serve as the program supervisor for, Barbra Jetley M.A., L.P.C., Lorenza Perezverdia, and Jenna Reed, BSW. All providers have extensive experience in Family Services and Attachment and Bonding as documented in the attached resumes C. Caseload: The caseload will be between 2-10 families per clinician. The caseload of each specialist will depend on matching specific needs of the referred family with the area of specialty of the clinician. D. Modality of treatment will be supervised visitation that provides a psycho- education regarding of attachment and bonding. Referral and linking services will be provided. E. Hours: Total number of clinical hours devoted to this program equals 6 hours a day, 27 hours a week, and 108 hours a month. F. Supervisor: This contract would be supervised part time by Lori Kochevar M.S., L.P.C., who will monitor the program compliance and clinical excellence. G. Insurance: Lori Kochevar M.S., L.P.C., LLC carries one million three million- liability on the company and each one of the independent contractors connected to this bid. In addition, Lori Kochevar M.S., L.P.C., LLC carries a general liability policy related to accident or injury on the premises. The State of Colorado is named as an additional insured on this policy. Each individual provider also carries one million three million-liability insurance. Both the general and group liability coverage's are attached. All specialists providing services are self-employed and 13 choose to be exempt from workman's compensation and Employer's liability insurance. PROOF OF COLLABERATION A. Methods to Ensure Collaboration: During the initial assessment period we will have all clients sign releases of information for each of the agencies that are potential partners in collaboration to meet the needs of the family. We will be available for placement review team meetings to meet with the family and all professionals involved with this family to evaluate progress. We give all clients a resource list during the intervention. In addition, Lori Kochevar M.S. supervisor for this program serves on the Child Welfare Collaborative Committee to ensure that this agency has connections to all current resources and referrals that are available to the clients we serve. B. Routine Collaborative communication will occur with each family we are working with. We are in close contact with the caseworker by phone or email to inform them of progress and or concerns in-between the monthly case documentation that is submitted monthly. In addition, we routinely get releases for all providers working with the family and would be glad to send all documentation if agreeable with the caseworker and arrange a quarterly meeting to address progress and concerns with the family, caseworker, GAL,therapist and other providers. C. Continuum of care, step down program: We will work diligently at referring clients to available resources in the community from the beginning of our services. In a step down approach often clients are referred to a less intensive and more economical program. Two such recourses that we typically refer to are CARE and a Women's Place. D. North Range Behavioral Health: It has been agreed with NRBH that all clients that are medicade eligible and in need of individual or family therapy will be referred to NRBH. EVIDECE-BASED OUTCOMES A. Bibliographic Information: The AIMS program is a well researched and supported form of providing supervised visits on attachment, interaction,mastery and support. See appendix for a complete list of all the research available to support the use of this program. In addition,home visitation programs have been documented to be a successful form of treatment for the last 25 years. Specifically, there have been several randomized controlled treatment outcome research studies that demonstrate a significant improvement in health outcomes for children(Olds, 2002), continued improvement for both the mother and the child four years after intervention (Olds, 2004) and decrease in aggressive behavior of kindergarteners after a home visitation program was implemented( Lyons-Ruth, 2004). Therefore, use of home 14 visitation with the AIMS program is a Well-supported, efficacious treatment model in that it: • Has a sound theoretical basis in generally accepted psychological principles • Substantial clinical-anecdotal literature • No evidence of risk of harm compared to its likely benefits • A manual exists that specifies the components of the protocol • Two randomized, controlled treatment outcome studies with protocol to be superior to an appropriate comparison treatment. SECTION E- STAFF QUALIFICATIONS A. All the providers exceed the minimum qualifications needed for both education and experience. All providers have their Master's and or a Bachelors Degree in Counseling. In addition, the therapists have between 10-20 years a piece providing services for families. See Resumes in Appendix 1. B. Staff available for this project consists of three experienced clinicians that have a similar core value of clinical excellence. We believe in providing strength-based, services that empower the families we serve. Mother strength of our staff is our diverse areas of specialties. • Lori Kochevar a licensed professional counselor has extensive experience and training in providing services and supervision using the family preservation model. She has been working in the field for over twenty years. She has specialized training in substance abuse,attachment and bonding, trauma, grief, and domestic violence. In the last fifteen years Lori has developed and facilitated multiple training's that emphasize experiential learning opportunities. Many of these training's were developed specifically for foster parents, while others were created for families, school personnel, and service providers across the state. • Lorenza Perezverdia is a Certified Addictions bi-lingual and bi-cultural counselor. She has extensive knowledge of how to provide services for clients addicted to substances and is available on a limited basis for consultation and translation. She has done relapse prevention, individual and group therapy, substance abuse evaluations, anger management groups, groups for victims of sexual abuse and also worked with children with special needs. • Jenna Reed has a bachelor of Social Work and seven years experience in child welfare as a caseworker with ten total years of experience in the Social Work field. She has completed all of the CORE trainings and has performed multiple duties as a caseworker over the years including but not limited to crisis intervention, intake,ongoing, and resource utilization. In addition to her current duties as an emergency child protection worker in Boulder County she is currently teaching a Parenting through Nurturing class focusing on safe and effective parenting of infants and toddlers. 15 • Barb Jetley is a licensed professional counselor. She received her Master's degree from the Adams State University. Barb has been in the field for the last sixteen years and has extensive experience working with many different clinical populations. Most recently, she serves as the clinical coordinator for children under six and their families for Project BLOOM. She has worked as a family preservation specialist, domestic violence counselor and an outpatient clinician. C. New Caseworker Training- Lori Kochevar, M.S. L.P.C. the supervisor for this bid has attended the Core training for Supervisors through the State of Colorado, she will oversee the work of all other staff to make sure it is in compliance with requirements. In addition, Jenna Reed who is working on bids submitted from this agency has successfully completed new caseworker training. D. Risk assessment knowledge is taught during the orientation training; in addition all staff is versed in multiple levels of risk assessment and are able to address risk issues as they occur during interventions. SECTION F-PROGRAM CAPACITY PER MONTH A. Total Number of clients to be served: The program will serve a total of 60 families during the twelve-month period. Each bonding specialist will serve eight to ten families at one given time period. Each family will receive 24 hours of one-on-one supervised visitation with the bonding specialist. This would provide 27 hours of intervention with families per week, 120 hours per month. Total number of client hours provided per year would be 1440 hours. B. Total number of clients and ages: Based on the approximation that the average family is made up of four children and one parent, the total number of clients for the year could be 240 clients. Focus will be on children whose ages are birth to twelve years of age. When the family includes older children, they will be included in the family intervention. C. Total number of families served: A total of 60 families will be served during the year. D. Sub-total of individuals who will receive bilingual/bicultural services: All services provided would be in a manner that is sensitive to the family's culture of origin. The program manager and specialists have extensive training in cultural competency issues. Lori Kochevar chaired the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Becky McMahan has worked with families from various cultural roots. She has a sense of respect for the family's cultural beliefs and practices. Lorenza Perezverdia is a bicultural bilingual provider will be available for any Spanish speaking families. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. 16 E. Sub-total of individuals who will receive services in South County: The program could serve three to eight families in South County during a given time period. We currently have providers that live in the south and we would like to increase our referral base in this area. Services will be provided for families where they reside as determined by Social Services. F. The monthly maximum program capacity: If needed, we could expand the number of hours we are available for services to 35 hours per week, which would make available 140 hours per month. G. The monthly average capacity: The monthly average capacity of this program is six to eight families. H. Average stay in the program: The average stay in the program would be six months. It is felt that clients have adequate opportunity to make positive changes in parenting styles in that period of time. Average hours per week in program: Initially, each family would receive services two hours per week, unless a different number of hours are requested by the caseworker for clinical reasons. After the first twelve weeks, sessions will decrease as recommended by the treatment team. Number of hours of service and length of service vary according to the individual family situation. SECTION G-INTERNAL TRACKING AND BILLING PROCESS A.Description of process is as follows: • All records for the month(i.e. contact notes, client verification form with signature, and billing to DSS) are kept in the same file. These are organized as follows: Left pocket has contact notes, client verification form with signature in the order that they are billed. All group and training session signatures are at the back. Right pocket has monthly billing submitted and receipt of payment. • Time with the client is only billed for face-to-face contact. On face-to-face contact the client signs the verification sheet provided by DSS which indicates the date and amount of time seen. • Subcontractors are responsible for sending an original copy of contact notes and client verification form with signature by the 5th of the month. This information is kept in an individual consultant file for the year. Subcontractors are paid by LLC when the payment for services is received from DSS. This is tracked in with the consultant's file. • The bill for the county is prepared monthly using the following guidelines from the RFP(page 20 of 30 a,b-1, 2 & 3): 17 We report expenditures and case disbursement at agreed upon times. o Submit monthly FYC completed billing forms to Ms. Andrea Shay, Core/PRT Caseworker, on or about the 10th day of the month after the month following the month the services were provided. o The provider furnishes the following deliverables required to verify services provided during the service month. The completed deliverables must be received by Social Services no later than the 25th day of the month following the dates of service. o The required deliverables are 1.)Authorization for Contractual Services, 2.) Request for Reimbursement, and 3.) Client Verification Form. The Authorization for Contractual Services will include provider name, address, and phone number, provider billing contact and phone number. It will also include the program area, dollars($) billed, original signature and month of service. Request for Reimbursement will include the client information (TRAILS or case ID number when available, rate, units billed and date(s)of service. The Client Verification Form will include the client's name, date, time of service, hours per service and original client signatures signed at the time of service. SECTION H- LITITURE CITATIONS Acosta, V. (1991). Integrating Experiential Learning and Critical Inquiry in Health Education. Paper presented at the annual meeting of the American Educational Research Association, Chicago. Baslow, R., & Byrne, M. (1993). Internship Expectations and Learning Goals. Journalism Educator, 47(4), 48-54. Cantor, J. (1995). Experiential Learning in Higher Education: Linking Classroom and Community. (Report No. 7). Washington, DC: The George Washington University, Graduate School of Education and Human Development. Chrestman, K. (1995). Secondary exposure to trauma and self-reported distress among therapists. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 29-36). Lutherville, MD: Sidran Press. Cranton, P. (1989). Planning Instruction For Adult Learners. Toronto, Canada: Wall & Thompson. Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social Work, 48, 451-459. Janov, A. (1996). Why You Get Sick, How You Get Well. West Hollywood, CA: Dove Books. 18 Jemstedt, G.C. (1995). Experiential Components in Academic Courses. In R. Kraft, &J. ICielsmeier(Eds.), Experiential Learning In Schools Of Higher Education(pp. 357-371). Dubuque, Iowa: KendalUHunt Publishing Company. Knowles, M. (1977). The Modem Practice of Adult Education: Andragogy Versus Pedagogy. New York: Association Press. Knowles, M. (1980). The Modem Practice of Adult Education: Andragogy Versus Pedagogy. (2nd ed.). Chicago: Follett. Meichenbaum, D., & Fitzpatrick, D. (1993). A constructivist narrative perspective on stress and coping: Stress inoculation applications. In L. Goldberger & S. Breznitz(Eds.), Handbook of stress: Theoretical and clinical aspects (2nd ed.,pp. 706-723). New York: The Free Press. Neumann, D. A., & Gamble, S. J. (1995). Issues in the professional development of psychotherapists: Counter transference and vicarious traumatization in the new trauma therapist. Psychotherapy, 32, 341-347. Pearlman, L. A., & Saakvitne,K. (1995). Trauma and the therapist: Counter transference and vicarious traumatization in psychotherapy with incest survivors. New York: W. W. Norton. Pearlman, L. A., & MacIan, P. S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 588-565. Pert, C. (1997). Molecules of Emotion. New York: Scribner. Post, Bryan&Forbes, H., (2006)Beyond Consequences. Logic and Control. A Love Based Approach to Helping Attachment- Challenged Children with Severe Behaviors. Florida;Beyond Consequences Institute. Rossi, E. L. (1986). The Psychobiology of Mind-Body Healing: New Concepts of Therapeutic Hypnosis.New York: W. W. Norton. Rossi, E. L., & Cheek,D. (1988). Mind-Body Therapy: Ideodynamic Healing in Hypnosis. New York: W. W. Norton. Ryan, R. M., & Lynch, J. H. (1989). Emotional autonomy versus Schore, A. N. (1994). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Hillsdale,NJ: Lawrence Erlbaum Associates, Inc. Walter, G., & Marks, S. (1981). Experiential Learning and Change. New York: John Wiley& Sons. 19 SECTION I - CONFIDENTIALITY AND PARTICIPANT PROTECTION A. Protect Clients and Staff from Potential Risks • The foreseeable physical, medical,psychological, social, and legal risks to participating in skills building parenting work are minimal. All documents will be kept confidential as outlined in the confidentiality section of this document. Since this work often involves discussing unpleasant aspects of the client's life, clients may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. Clinicians are trained to watch for signs of traumatic recall that would indicate the client is outside of the zone where they are able to modulate their responses. In the event that a traumatic memory is retriggered clinicians involved are trained to help a client re-assimilate into the present moment before ending a session. If it becomes apparent that the client is in need of additional therapy services the clinician will address this issue with the treatment team. In addition, if a clinician assessed that during a session a client is a danger to them self's or others, they would take the appropriate steps to ensure safety. This may include a referral to the emergency room evaluation team to access the need for higher level care through the Medicaid mental health program at Northrange Behavioral Health Care. B. Fair Selection of Participants • In this program we would never exclude or discriminate participation on the basis of age, gender, religion, or raciaUethnic background. We are open to families that have children between the ages of 0-12 as well as referrals of homeless youth, foster children, children of substance abusers, pregnant women, and fathers. • In that this is an early intervention,working with children 6 and under as the identified client with siblings up to the age of 12 is the most appropriate population for us to work with. Another appropriate population would be a teenage mother with an infant or pre-natal bonding. • We will recruit and select participants from referrals provided through social services. Opened to all referrals that are not deemed inappropriate for services due to danger to others or inability to benefit form services provided. C. Absence of Coercion • Participants in this program will be selected through the referral source and participants willingness to be involved. Even with court ordered clients it is up to their own volition if they will choose to participate in any particular program. • Ultimately all participation is voluntary. It is our responsibility to report participation and progress to the referring agency. Volunteer's participants will 20 be told that they are welcome to receive services through or program our one that best meets their needs. D. Data Collection • We will collect data from participants themselves, family members,teachers, and other parties connected to the case. We will obtain a specific release of information from the participant for any one we obtain data from. During each case as deemed appropriate to the needs of the family we may collect data from school records, interviews, psychological assessments,questionnaires, and observation from other parties privy to the case information. • Our information is collected in professional,home-based and natural settings facilitating observational techniques and environmental assessments. When collecting data through questionnaires or interviews, we are sure to obtain a private space to secure confidentiality • Provided in Appendix 2,are all Data Collection Instruments/Interview Protocols and releases. E.Privacy and Confidentiality • Clinician assigned to the case will centralize all data in a file. The data collection instruments will be used in case planning, documenting progress, recommendations, and program evaluation. The identity of participants will be kept private by limiting access to records. Data will be stored in a locked file case, behind a door that is locked at all times. From our office only those people trained in confidentiality and will have access to information. Subject to clinical judgment and client preference those with a signed release by the client will also have access to records. F.Adequate Consent Procedures • Data that will be collected may include 1)Family information-clinical intake form, 2)AIMS: Developmental Indicators of Emotional Health- as appropriate per age of child being parented. 3) Impact of Event Scale (screening for PTSD) 4) Depression Screening 5) Client Satisfaction 6)Program progress in the form of Clinical Case Managing, Monthly Progress Report and Transition Plan. All information will be kept in secure location as described in privacy and confidentiality section and only limited access to these records will be allowed. Records and tools will be used for reporting progress and program evaluation. Participation in this program is always voluntary. Participant always have the right to leave the project at any time without any sanctions being imposed by the program. 21 • Possible risks from participation in the project include the possibility that uncomfortable feelings will arise from the process. Plans to protect clients from these risks are outlined in the protecting clients from Potential risk section of this document. • This program will must have consent from participants (their parents)or legal guardians. Consent from the legal guardian will be obtained in the form of a referral from the Department of Social Services of Weld County and from the parents/participants in the form of their signature on the(1) Consent for Services - informed consent for participation in service intervention; (2) Privacy-Policies- informed consent for participation in the data collection component of the project- HIPPA; and(3)Release of Information- informed consent for the exchange (releasing or requesting) of confidential information. These forms are located in Appendix 3 "Sample Consent Forms". We will read the consent forms with the participants and ask prospective participants questions to be sure they understand the forms. We will also give them a copy of what they signed for future reference. • All releases will be obtained at the beginning of the project, with the understanding that the participant may choose to relinquish permission to use their information at any time. The consents to release information to others or gather information and the HIPPA form are standardized forms that include all information necessary to meet HIPPA guidelines as well as the guidelines for the practice of psychotherapy. For research purposes Clients can decline participation in any data collection process and still receive services. G. Risk/Benefit Discussion • Since this work often involves discussing unpleasant aspects of the clients life, clients may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness Most often the potential benefits of participation in this program far out weight the risks. Participation in this program often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. While there are no guarantees on what a client will experience, many participants have experienced an increased effectiveness and satisfaction in many areas of their life. The importance of gaining parenting knowledge to enhance both their lives and the lives of their children is a solid benefit that helps them care for their children. 22 PROGRAM BUDGETS . COMPUTERIZED BUDGET •PROGRAM Outside DSS FP Core TX Belying A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 1 24 B TOTAL CLIENTS TO BE SERVED 8 80 C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X 8) 8 1.440 D COST PER HOURS OR DAYS OF DIRECT SERVICES(E l C) $2,300.00 $45.01 E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $0 $18,400 561,808 F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $2,189 $3.985 551,001 G OVERHEAD COSTS ALLOCABLE TO PROGRAM $10,763 $7,782 $10,763 H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $12,952 $30,178 $126,573 I ANTICIPATED PROFITS CONTRIBUTED BY THIS PROGRAM $0 $1,182 $1,587 J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $12,952 $31,858 $128,180 K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 8 1,440 L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE TO BE CHARGED TO WELD COUNTY SOCIAL SERVICES(J I K) $3,95728 $89.00 COURT TESTIMONY FOR ALL PROGRAMS PER HOUR $16800 23 E 88888888888c a @ ; mama m a o aaaaa° ° ° ° ° ° ° aflaaa a a I' 2 ■ ,- § * ma ` 88888888888 8 8828 § 8 $ ) n Ong a"aa0aa A . .. ___ a 4 W 2; & S § o < S @ ; ; & � § 7 k a ■ , & m a ` 88882888888 8 888888 8 8 § W08 § a § § 2asasaa § 6666__ _ f co al ■ iz a ` 2 © Sr, . , 0 a k2 § ` ° 8 \ W to ass 2 k ; I- ' ma _ # § f8 « @ § tea@@@ 4 m@8aaa 8 4 _m $ 2 ° .. _2;2269 ° 22aaaa _ ` 2 \ } \ Ili Z ; § ° ° o § § * ma 2 §§ UJI E E ' EEE:i ii * WE % ggW WWW % W 88888888888 8 8 8 X- 22 aasaaaaaaaa a g g c * !,- 0 m{/ _.—> i & -ra 2a 8 0 a ) - - °-0—§—_ . g ■ re te 8 a W § w °a. k 2 Z 0o CO m ` re 0 0 a. • < Cr - reo § . 0 } 0 -La sa re - o | " . § \ Z } }77 I-a \ g | 2 e e - sill e e $ . . 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CC a.o \ E 2272§ aeg to 0 I- 858888888888838888 $ 8 # o g | 2 $ 8 $ f2& 7is1.- aa2aaaaa } Lig N § 0 � 2 1 � a - r5 _ w \ | $§ $§ § § sees &# 0 @@a@@am # 8e@ # aamMa # @ 8 0 § § 7 ) PRff�aaaaaaaaaaaaa G gig , § a a 4) .- •-` � 6 - \ ) 2) 222 § k >- >-zzzz 2222222 2 — , 2 � #g ###$ l- al0 • . d f3 s a. \ k f�)�0 _ . _01 / < Ill w a IL 0Ili ca 0 re■ r k r O.FE 2 § 2 § § Z oillW 2 CO kI 2 01 I | I- § § k ( k § § k ) I1V / / / . . < _ O O _ Barbara Jetley Master of Arts Licensed Professional Counselor 1024 8t Sheet 970-397-6521 Greeley, CO 80631 pogojet@hotmail.com 9/06—Present Bonding Program, Jubilee Center for Families, Greeley, CO Under contract with Weld County Department of Social Services, I assist families with children under 6 who are particularly at risk for Attachment Disorders. I assess parent/child interaction,quality of the parent/child bond,early childhood social and emotional disorders using the following instruments: NCAST Caregiver/infant toddler assessment,AIMS Parent Assessment,and the DC 0-3 Diagnostic Manual. I make recommendations regarding parenting time. I provide home based services to families for skill building and parent education to preserve or restore the home placement. 6/05- 9/06 Project BLOOM Clinical Coordinator, Colorado West Mental Health Center, Grand Junction, CO. In collaboration with the Early Childhood Partnership, Project BLOOM, funded by SAMHSA, is developing a System of Care to serve the social and emotional needs of children under age six in Mesa County. As Clinical Coordinator, I work to identify children with mental health needs, to provide direct services to them and their families, and to provide consultation services to partners such as preschools, pediatricians, and human services. We have come to recognize the tremendous need for these services. Within the context of our System of Care, I am working to build capacity with the utilization of wrap around services facilitated by paraprofessionals, peer support,and parent education groups. 7/04-5/05 ADMINISTRATIVE WORK, Kelly Services, Everett, WA I provided temporary administrative work hi insurance, publishing and intellectual property settings. 8/96—3/04 PRIVATE PRACTICE, Pagosa Springs, CO. I provided general counseling services to a variety of clients, both privately and under contract with the Archuleta County Department of Social Services. I provided Family Preservation/Home Based Family Therapy entailing intensive home based services to families with children at risk for out of home placement, individual and family therapy, case management and crisis intervention. Also, with the same contractor, I employed, administered, and was clinical supervisor to a paraprofessional, providing mentoring services to boys with behavior problems. I provided standardized treatment as a Certified Provider for court ordered Domestic Violence Offenders. I provided clinical supervision to two Domestic Valence Counselors in the Twelfth Judicial District I received frequent referrals from Victim's Compensation and Probation. I was elected President of the volunteer Board of the Archuleta County Victim Assistance Program,and served for two years. 1/93-8/96 FAMILY DEVELOPMENT SPECIAUST, Southwest Colorado Mental Health Center, Pagosa Springs, CO. Bringing home based services to families proved to be effective in maintaining the placement of children at risk for out placement 7/92- 1/93 CLINICIAN, Creative Resource Center, Monte Vista, CO. As Certified Domestic Violence Treatment Provider, I was recruited by this agency to take over their Domestic Violence Offender Program. I provided outpatient clinical services to a general population. 2/90-6/92 CLINICIAN, San Luis Valley Comprehensive Community Mental Health Center,Alamosa, CO. I provided counseling services to groups and individuals with major and chronic mental illness, including adults, children, couples and families. My duties included 24 hour crisis intervention, mental status evaluations, assessment diagnosis,treatment planning,charting and peer review. 9/88- 12/89 MASTER OF ARTS, Adams State College, Alamosa, CO. GPA: 4.0. Guidance and Counseling 1/86- 12/88 BACHELOR OF ARTS, Adams State College, Alamosa, CO. GPA: 3.97. Summa Cum Laude, Psychology Major CERTIFICATIONS AND LICENSING Colorado Licensed Professional Counselor#1056 Certified Equine Assisted Psychotherapist Certified Family Development Specialist Certified Teacher of English as a Foreign Language MEMBERSHIPS (former and current) American Counseling Association Colorado Counseling Association Archuleta County Victim Assistance Program Board President President's Honor Society, ASC Dean's Honor Organization, ASC Barbara Jetley Continuing Education Addressing Challenging Behavior in Young Children—Denver, CO—April 28-29, 2006. DC 0-3R Diagnostic Assessment for Early Childhood—Grand Junction,CO—Aug.30-31,2005. NCAST Conference and Mental Health in Pregnant Women—Seattle,WA—Aug. 5-8,2005. Nurse's Child Assessment Satellite Training—Grand Junction,CO—9 days,Jul.Aug. Sept 2005 High Fidelity Wraparound Multi-system Case Management—Grand Junction—July 6-8, 2005. HIVIAIDS Education and Prevention Class—Everett,WA—April 2,2005. Teaching English as a Foreign Language— Net based-Jan to April, 2004. Grant Writing-Pagosa Springs-March 27-28,2003. Art and Play Therapy with Child Victims of Trauma-Denver-2002. Family Group Decision Making-Pagosa Springs-June 25-26,2001. Play Therapy Workshop,A Play Odyssey-Denver-Mar 8-9,2001. Colorado Organization for Victim Assistants-Keystone-Nov 13-15,2000. Tactics of Men who Batter—Duluth, MN-Oct 26-28, 2000. Equine Assisted Psychotherapy Certification-LaVeta-July 12-14,2000. Colorado Child Welfare Conference-Vail-June 7-9,2000. Mental Health and Infants-Ignacio-Apr 14,2000. Ongoing Foster and Adoption Training-Durango-December 8-9, 1999. ACVAP Voluntary Board Training-Pagosa Springs-Sept 19, 1999. Issues of Post Legal Adoption-Douglas Califono-Durango-May 19-21, 1999. Jurisprudence-Larry James-Durango-April 23, 1999. Anti Social Personality Disorders-Stanton Saminow-Denver-Nov 18-20, 1998. Assessment of Lethality-Gary Gibbons-Alamosa-Sept 11, 1998. Child Welfare Conference-Vail-June 10-12, 1998. Colorado Organization for Victim's Assistants Conference-Steamboat Springs-Oct 22-24, 1997. Training in Assessment and Treatment of Domestic Violence-Durango-Oct 15-16, 1997. Custody Evaluations-Breckenridge-Sept 11-13, 1997. Grant Writing-Durango-Feb 21, 1997. Ending Violence Against Women-Pagosa Springs-Aug 19-20, 1996 Child Therapy, Foster Cline-Pagosa Springs-June 14, 1996. Making Sense of Marital Conflict-Denver University-June 10-12, 1996. Secret Crimes-Ft Lewis College-May 16-17, 1996. Family Reunification-Denver-April 22-24, 1996. Colorado Mental Health Conference-Breckenridge-Sept 17-19, 1995. Lori J. Kochevar M.S. L.P.C. 1024 8th Street Greeley, CO 80631 (970) 352-8873 lorik@aspacetogrow.com Clinical Facilitation Skills: • Ability to provide an energetically clear environment for conflict resolution. • Facilitate a creative process that allows knowledge to be integrated on multiple levels of awareness. • Clear understanding of when family members are physiologically able to negotiate differences. • Ability to assist family in synthesizing large amounts of sensitive intonation to reach a consensus. • Skill in facilitating resolution of issues in a manner that is respectful and sensitive to individual differences in culture,agendas,and desired outcomes. • Unique ability to teach physiological self-regulation through use of mirror-neurons. • Extensive training and experience in group/family dynamics, spirituality, trauma, child welfare, and body-centered psychotherapy. • Ability to assess and mitigate physiological effects of trauma on current functioning. • Proven skills in identifying multi-faceted family dynamics,psychological, and social issues for families involved in the child welfare system. Training&Curriculum Development Skills: • Trained colleagues in multiple agencies on strength-based,family-focused models: Family Preservation Services and Family Group Decision Making. • Have provided training across the state for schools,agencies,and the general public. • Use of experiential strategies to access multi-dimensional leaming of information which increases participant's ability to recall and implement strategies across time and in non-ideal circumstances. Training Approach: o Present comprehensive coverage of all essential information, in the moment as dictated by the group dynamics and specific training needs. o Build cohesive curricula which employ progressive skill sets with multiple review of core material in different areas to increase retention and ability. o Facilitate a transformative process that motivates participants to take action in order to improve their life situation. o Encourage self-exploration and understanding of how a participant's thoughts,words,feelings and actions affect their own and other's well being. o Empower participants by seeing how they can transfer applicable existing skills into their new role,while building additional role-specific skills. o Use transfer-of-learning strategies to increase participant's ability to utilize the skills taught. Program Development&Community Organizational Strengths: • Developed and direct the following bid programs with Social Services: Family Preservation Services, Family Group Decision Making, Foster Parent Core Training, Foster Parent Consultation, and Home-Studies. • Currently serve as program administrator and grant writer for the Bonding Program. • In a director level position,guided 18 agencies in collaborative efforts in fundraising, program expansion,and community development. • • Spearheaded community efforts to fundraise for and build a Boys and Girls Club in the San Luis Valley,which currently has three sites and are serving over 1,500 youth. 30 • Organized Philanthropy Days: brought in philanthropists,foundation directors, and trustees to visit and enjoy the Valley's multiple cultures, learn of its services and strategize in partnership with the Valley for short and long term financial successes. • Successfully completed the Colorado Leadership Program to learn all phases of fund raising, management,and board development. • Develop and maintain solid working relationships within the community. • Participated in the El Pomar Community Leadership Program to increased awareness of personal leadership style, strengths, and developmental edge. Supervision&Consultation Skills: • Program Supervisor of Independent Contractors for grant compliance, agency/client satisfaction, and clinical excellence. • Provide program and clinical consultation to Program Directors at the Child Advocacy Resource Education(CARE)agency, and independent therapists. • Participated in Mastering the Art of Child Welfare Supervision training to achieve high standards of supervisory practices in order to assure the effective and efficient delivery of child welfare services. Work History: 1995—Present Private Therapist Contracted with Departments of Social Services in the San Luis Valley and Weld County, Hospice,Ackerman and Associates, Child Advocacy Resource Center, Prevention Project, and Mountain Trails Youth Ranch. 1995—1996 Director-Grant writer San Luis Valley Community Fund 1992—1995 Family Preservation San Luis Valley Mental Health Center Specialist 1992—1995 Wilderness Therapist San Luis Valley Mental Health Center 1989—1991 Disabilities Consultant University Affiliated Program, USM 1989 Teaching Assistant University of Northern Colorado 1986—1989 Supervisor Boys and Girls Club,Greeley, CO Education: University of Southern Mississippi, M.S. Counseling Psychology GPA: 3.8 University of Northern Colorado, B.A. Professional Psychology GPA: 3.5 Involvement: Member,Weld County Child Welfare Committee Founding Board Member, Boys and Girls Club of Alamosa Member, San Luis Valley Coalition for Youth Services Chairperson,San Luis Valley Multicultural Task Force. 31 . TRAININGS FACILITATED: CHILD WELFARE 02/07/03 How Trauma and Neglect Effect Children's Development 2000-2005 Investigations:Rules,Roles and Resources 1998 Family Group Decision Making 1998 Creating Health/Balance in Relationships 1997—2005 Foster Parent Support Groups 1997 Family Preservation Services 05/30/97 Team Building for Families—Healthy Families 05/30/97 Finding Balance: Multicultural Dynamics with Clients and Foster Families FOSTER PARENTING 2000-Present Core Training—Foster Parents 2001 State Foster Parent Annual Conference—Trauma in the Body 03/10/00 Healthy Transitions for Foster Children 02/26/00 What Does a Foster Child Hear? Messages Underlying Discipline 03/02 Working with Trauma in the body;Empowering Children 1999 Enhancing Communication Skills 07/10/99 ADHD—How to Create Peaceful Moments 1999 Effective Parenting for Foster Parents 03/27/99 Helping Foster Parents Deal with Attachment Issues 01/12/99 Multicultural Diversity—A Celebration of Differences 1998 Love and Logic Parenting for Foster Parents 08/08/98 Understanding Differences 04/04/98 Stress Management 101 04/04/97 Interpersonal Effectiveness for Foster Parents INTERPERSONAL EFFECTIVENESS 05/15/97 Goal Setting 101 02/07/97 Effective Communication for Mental Health Workers 1997 Young Women's Group:A therapeutic self discovery group 06/21/96 Stress Management for Health Care Professionals 04/13/96 Interpersonal Effectiveness and Team Building 01/23-25/96 Interpersonal Effectiveness for School Personnel 07/13/94 Multicultural Diversity Training of Facilitators(TOF) 03/1-7/92 Career Exploration DRUG AND ALCOHOL PREVENTION 03/11/00 There's an Elephant in the Living Room 03/27-28/95 Family Preservation Services:Motivational Interviewing 1994 Teen Baseline:Drug Prevention 05/13-14/94 Impact of Sexual Addiction on Families: Family Sculpting 1993 Baseline:Drug Prevention COMMUNITY DEVELOPMENT 09/23/05 Conscious Parenting—Resolving Conflict from Within 10/19/04 State Farm Lunch and Learn;Consciousness from Within 09/15/03 Spiritual Parenting 11/10/04 Diet and Emotions 32\ Jenna W. Reed 1356 Terrace Dr. Longmont CO, 80501 303/ 772-9867 Objective: To obtain a position where I am able to use my education and skills to help clients achieve their full potential. Education: Bachelor of Social Work, Spring 1997, Graduated Summa Cum Laude Minor: Political Science Colorado State University, Fort Collins Colorado Study Abroad: Women and Development: Southern African Perspectives Augsburg College, Windhoek Namibia Spring 1996 Work Experience: Child Protection Caseworker B: Boulder County Department of Social Services, Boulder CO(10/05-Present) - Crisis intervention for families in need of child and adult protection during evening and weekend hours - Risk assessment and placement of children out of home if needed - Weekly instruction of a parenting class focused on nurturing and safe care of children all ages Child Protection Caseworker III: Weld County Department of Social Services, Greeley CO(3/99-3/05) - Treatment and permanency planning for families and children in a home based or foster care setting - Initiating and testifying in Dependency and Neglect actions and routine court review hearings - Ongoing risk assessments and family reunification planning - Investigation of child abuse and interviewing all involved parties Relinquishment Counselor: Small Miracles of the Rockies, Denver CO (9/98-3/99) - Counseled birth parents considering adoption - Facilitated meetings and communication between birth parents and prospective adoptive parents - Prepared relevant court documents and assisted birth parents through the legal process of relinquishment Social Worker: Bessie Burton Sullivan Skilled Nursing Facility, Seattle WA (3/98-9/98) - Completion of initial/quarterly MDS (2.0 version)assessments and mini mental evaluations - Facilitate quarterly"care conferences", interdisciplinary team meetings with staff and family members - Discharge planning for short term residents,responsible for coordination of outside services - Education of families about Medicaid/Medicare regulations and completion of Medicaid applications Internship: Larimer County Community Corrections, Ft Collins CO (1/97-6/97) - Interviewed clients daily at the county detention center and made recommendations for bonds to the court - Performed multi-level assessments and mental health evaluations - Co-Facilitated a cognitive thinking group (Ross Criminal Thinking Group) - Maintained a consistent case load while performing numerous other duties Facility Supervisor: Catholic Community Services, Fort Collins CO (2/95-11/96) - Supervised operation of homeless shelter during evening hours. - Processed incoming clients and made relevant referrals to collateral agencies 33 Lorenza P. Perezverdia B.S. CAC II Bilingual counselor (English-Spanish) Eaton, Co. 80615 (970) 405 4491 lorenzach@hotmail.com Bi-cultural counseling skills • Ability to identify individual's struggle to adapt into the American Culture due to cultural differences • Ability to assist and ease individuals and family's adaptation process. • Extensive knowledge of local public resources • Ability to recognize the kind of public resources and provide information about them to the individual according to their unique needs. • Ability to visualize potential problems/obstacles that the clients might encounter to succeed in their environment. • Ability to recognize common behaviors in the Hispanic culture that represent a major risk for the client or people in the community. • Ability to assist client to recognize such behaviors as potential problems and assist them to find better choices to achieve desired results. Drug and alcohol counseling skills • Knowledge in the use of tools to assess individual's Probability of having Substance Abuse or Substance Dependence Disorder. • Ability to provide knowledge regarding drug and alcohol short and long time effects and consequences in different areas in a person's life. • Great ability to empathize with client's current situation • Ability to provide knowledge in a manner that could be integrated in the individual's daily, practical life. • Habituated in using a extensive variety of tools to provide knowledge (visual, hearing, hands-on, experiential) • Knowledge in Motivational Interviewing and ability to encourage client's major changes in a life style. • Ability to work in team with different State Departments to better assess client's needs and to assist clients to succeed. Training All classes required to be a Certified Addiction Counselor II Sub-cultures Trained in Cognitive-Behavioral based Programs. I sub-developed a Therapy program for DUI Hispanic offenders in Larimer Co Work history 2000 Internship Educational Psychology in a Special School that worked with children with special needs such as learning, development, motor disabilities. Industrial Psychology in a Human Resources/Job placement place. Clinical Psychology in a Victim's Advocacy place. I worked with Sexual Assault Victims. 2000-Present CATS I started as a volunteer and was hired as Contract counselor former Teen Counseling in 2002. I've Worked with adult Hispanics,teenagers and Center I've held Anger Mgmt.Groups. 3� AIMS: Developmental Indicators of Emotional Health (Attachment—Interaction—Mastery—Support) FAMILY INFORMATION Date: / r 0-6 month day year A. IDENTIFICATION t% e., g��,f Phone- tist Nam of Child 'dale last (nirta®e) fast Child's Current Age:La--- o Date of Birth: 5 - D - cc, Gender: ❑Male AFemale Name of Mother. X1/\(iv,/A C C - Name of Father. D-3r-\ C C Ag pg ' Me: r c` \tF�� ku � Mother's Address: A V 1 '\r;`:.i' v Father's Address �c Zip !-- /m Zip With whom does child live?(Check all that apply.) U Mother O Father ❑Other.tp"'h Address Billing Address of Responsible Party: Zip Zip Medicaid a 7 Health Cans Provider: pK Insurance Co. Cat.No. faoup No. Ethnicity of Child:(optional) Religion Current marital status of parents: O Married O Divorced ()Separated *Single O Living together ()Widowed Total number of people living in home:-46t' Ages of Males:" S /, _ — — Ages of Females' 1 3 j. S2 Have there been any changes in the past year of people moving in and out of your hone? O Yes U No Who? R. EMPLOYMENT v�y\0 Father Mother address pie number job tick ess Mk employer addr phone number job M employer C. EDUCATION Father (Cheer one.): Highest grade completed—Mother.(Check one.) Highest grade completed— h O w.)hie that t2tb Less titan 12th U high school graduate O higher than 11th Airs than 12th O high school graduate ,r� Currently emolled in school? O yes 4 no Currently enrolled in school? Oyes \Ylno D. TRANSPORTATION Do you have reliable transportation? Oyes 4..no E. SERVICES Does anyone in your family currently receive services from any of the following? all that apply.) Economic Services Child/Family Services AFDC O Public or Community Health Nurse O Uiill Stamps ❑Adoption Services tool ❑Child Day Cast(Foster Care.Preschool) SSI O Employment Services O CILegal Services O Other: Health/Rebabnitatiou Educational/Social Services O WIC O Counseling O Drug/Alcohol Services ❑Housing Assistance O'Faanly Planning O In-home Parent Aid Services O Psychotherapy/Counseling Parenting Classes O Rehabilitation O eschool Education Services Q Therapy(e.g..speak PT/O7) O Special Education Services O Other. • ❑Transportation Assistance O Services Q Other Specify: — rnu+a (Ova,please) 7/116 Et Rgea Mes F. BIRTH HISTORY INFORMATION: 1. PREGNANCY,LABOR AND DELIVERY Pregnancy (Provide as much information as you have available.) Check if adopted O Child's age at adoption C-0:1-tio problems 0 Substance Use(alcohol,drugs or tobacco) 0 Bleeding 0 Prematurity.How early? ❑Infection 0 Other Was the timing of this pregnancy good for you? ❑Yes \i‘No Did you receive regular medical care during this pregnancy? ,Yes A m No What month of the pregnancy did you start to see a medical provider? Where was the child born? \AX C x Hospital \ Town Child's birthweight 4k O5 Circumstances at birth: Labor and Delivery: wborn Status: aginal delivery ka.Healthy,no problem 0 Cesarean delivery O Jaundice 0 Premature ❑Low birth weight "c" at- 0 0 Breech l rreathing problems,how long? Twin(1st born,2nd born) ❑Ventilator,how long? 0 Other. ❑Surgery: 3 ❑Other. Hospital Stay: Child: Ti) days Mother. days v Mother's age at first pregnancy: \� 2. OTHER PREGNANCIES:How many? Problems: ❑Yes 0 No • If yes: 0 Before this child 0 After this child Type of experience: ❑Abortion 0 Miscarriage ❑Stillborn 0 Premature 0 Other. 3. EARLY LIFE WQ CHII.D(birth to six months): Sleeping: o problems 0 Problems If problems,describe: Feeding: ,1nreastfed 0 Bottle fed 0 No Pipbblle�.ms 0 Problems If problems,what kind: Sucl®g ❑Swallowing ng problems(Fussy eater,excessive spitting of food,allergies) ❑Other. How would you describe ympr baby during infancy? 0 Quiet ❑Happy 7rritable 0 Playful U Hard to deal with 0 Easy 0 Active ❑Overactii 0 Other. 4. LATER LIFE WITH CHILD(six months to five years), V1-1 How Would You Describe Your Child Now? 0 Quiet 0 Happy 0 Irritable 0 Playful 0 Hard to deal with 0 Easy 0 Active 0 Overacti 0 Other. 5. Are you happy with your child's health care provider? 0 Yes )410 Comments: This information will be kept private. Thank you. 347 AIMS: Developmental Indicators of Emotional Health (Attachment-Interaction-Mastery-Support) FAMILY CONCERNS INDICATOR Name of child: ^ 1 QC'- Child's age: a Yv\O CO. Relationship to child: .4-V\-127-\V"cr Your name: / Today's date: <"f /O n / O n Child's date of birth: " c /oo / O O month day year month day year Families often have to deal with many different stresses and challenges.Have any of the following occurred to you or anyone in your family?Is this of current concern to you or anyone in your family?If"yes,"please indicate with a check V) next to the item under the appropriate column. Occurred Within Of Concern My Family At This Time Comments PHYSICAL WFI I -BEING Physical Problems/Disabilities ❑ ':-Seekitikt4oliiisiiii Ongoing.(Chronic)Illness .„;-. -:_. :. -❑. _.„....._.: ❑ Learning Difficulties Including Reading or School ❑ O =Speech-Language-Hearing Problems ❑ ❑ Accidents ❑ ❑ vK2 .Emergency-Rgam Visits AZ(' '� Hospitalizations ❑ ❑ SOCIAL SERVICES Legal Problems ❑ ❑ Problems.with'Social:Services or Schools - Xf. , .... Difficulties with Childcare Help or Services ❑ Dy#ficulfes4with:PalentingSloll -- 5-: FAMILY LIFE Marriage or Relationship Troubles Nt Va.h^^- Children lav'rnglOdtside of Family Home ❑' Few Friends or Close Family Members ❑ ❑ "Financial Problems or Difficulties ❑ l Emotional/Mental Health Problems ❑ BehaviorProblems .._ ❑_ ._ .., .- _ ,� Family Violence(physical/emotional) ❑ ❑ Sexual:'Abuse ❑ ❑ Problems with Alcohol or Drugs ❑ ❑ ConcernsAboiirSafety ❑ ❑ Housing Difficulties ❑ Transportation Difficulties ❑ ❑ Frequent or Long Separations ❑ ❑ LIFE CHANGE / Divorce or Change of Marital Status ❑ _is New Child in Family/Recent Pregnancy ❑ L. 1St Change of Residence ❑ ❑ Job/Work Difficulties _ U .. - . Change of Employment ❑ ❑ Unfortunate Life Events-(fire,theft,etc.) .0 ❑ • . Death ❑ ❑ -Incarceration • O O Other Traumatic Stress(specify) ❑ ❑ OTHER CONCERNS' Specify: 12)98 This information will be kept private.Thank you. 37 AIMS: Developmental Indicators of Emotional Health 2 MONTHS Guidelines for Psychosocial Practice (pc) c t, CC INTERVIEW QUESTIONS Strengths Concerns Response etoQuestisnna e Do you want to talk about ATTACHMENT ATTACHMENT anything-from the AIMS ❑ parent is at ease when holding baby parent appears stiff or awkward when holding baby questionnaire? ❑ parent describes baby in positive terms >15,,,, parent is unable to describe baby or uses primarily negative terms Parental Adjustment and ❑ baby is able to be comforted by parent ❑ baby remains distressed despite parental efforts WeA-being: . parent shows contest over baby's crying or distress U parent does not appear to"hear"or react/respond 1. How areyou feeling? to baby's cries 2. Are you getting enough: —sleep? —time to yourself? INTERACTION INTERACTION --help with-your baby? ❑ baby molds to parent's body baby recoils,arches,or stiffens when held by —time with familyand- �.j parent friends? ❑ parent able to calm baby down when distressed parent is unable to calm baby 3. Is there anything on your ❑ baby appears alert socially involved ❑ baby appears lethargic,apathetic,socially mind that you would like to uninvolved talk about today? ❑ parent's stimulation of baby is appropriate parent appears intrusive,over-stimulating,or under-reactive toward baby Basic Care and Relationship parent and baby make eye contact ❑ no eye contact between parent and baby with Baby: parent seeks to protect baby from possible harm ❑ parent appears unaware of possible harm 1. How are things going with (e.g.,covers when cold,comforts after shot,guards your baby? baby from falling off table) 2. How are you and the.baby. -doing witheaehrotbtn'f^ • MASTERY MASTERY 3: Do you have aay Special ❑ parent appears confident in parent role parent appears more anxious,depressed or worries about your baby? overwhelmed than expected Your family? r 4: How does your faraily feel l nt is able to perform basic child care tasks Cl parent is not able to perform basic child care skills about the baby? ,,,,,,___ttt 'l e.g.,putting on clothing,diapering,holding) yi„, parent is prepared for baby's needs(e.g.,brings ❑ parent is ill-prepared for meeting baby's needs bottle,toy,diaper) • SUPPORT SUPPORT ❑ parent asks for help or information parent appears hesitant or unable to ask for help or information ❑ parent is responsive to information,advice or other parent rejects offers of help - — forms of help ❑ parent appears rested and healthy X parent appears overwhelmed.tired.stressed or unhealthy ❑ family appears and/or reports having adequate ® family appears and/or reports having inadequate housing,transportation,finances and child care \ housing,transportation,finances and child care • • 4/96 C copyright,Project AIMS 3� Name: l ` Date:_Session#: 1 Impact of Event Scale - Revised (IES-R) Daniel S.Weiss&Charles R.Marmar Directions The following is a list of difficulties people sometimes have after stressful life events. Please read each item, and then indicat ow distressing each difficulty has loeen for you during the past 7 days. With respect to the particular event (2Nncs\1r4\ \--:,wt —inn which occurred on:oo lrx>leo how much were you distressed or bo ered by each of the following during the past 7 days? \o ✓-t) ri Not at all A little bit Moderately Quite a bit Extremely 1. Any reminder brought back feelings about it. 0 1 2 a_ 4 2. I had trouble staying asleep. 0 1 2 3 3. Other things kept making me think about it. 0 1 2 C----) 4 4. I felt irritable and angry. 0 1 2 '3 4 5. I avoided letting myself get upset when I thought about it or was reminded of it. 0 1 (4,1 3 4 6. I thought about it when I didn't mean to. 0 1 2 L3-' 4 7. 1 felt as if it hadn't happened or wasn't real. 0 V 2 3 4 8. I stayed away from reminders about it. 0 1 LI) 3 4 9. Pictures about it popped into my mind. 0 1 2 C) 4 10. I was jumpy and easily startled. 0 2 3 4 11. I tried not to think about it. 0 6) 2 3 4 12. 1 was aware that I still had a lot of feelings about It but I dtidn't deal with than. 0 1 2 32 4 13. My feelings about it were kind of numb. 0 G 2 3 4 14. I found myself acting or feeling like I was back at that time. 0 2 3 0 15. I had trouble falling asleep. 0 1 2 3 C� 16. 1 had waves of strong feelings about it. 0 1 2 3 4 17. 1 tried to remove it from my memory. 0 1 (`) 3 4 18. I had trouble concentrating. 0 1 2 63) 4 19. Reminders of it caused me to have physical reactions such as sweating,trouble breathing, nausea, or a pounding heart. 1 2 3 4 20. I had dreams about it. 1 2 3 4 21. I felt watchful and on guard. 69 1 2 3 4 22. I tried not to talk about it. 0 1 62) 3 4 MCC:-11/20/1998 Totals: _ + 5 + 8 + 1t8 + la = -3,3 Avoidance Subscale= mean of 5,7,8, 11,12,13,17,22 Intrusion=mean d 1,2,3,6,9,16,20 livoerarousal=mean of 4,10,14,15,18, 19,21 31 DEPRESSION SCREENING CLIENT: C C DATE: 71 a f Nc ,.' I am unable to do the things I used to do. ❑ I feel hopeless about the future. ❑ I can't make decisions. ❑ I feel sluggish or restless. ❑ I am gaining or losing weight. ,e( I get tired for no reason. ❑ I am sleeping too little or too much. ❑ I feel unhappy. ❑ I think about killing myself. If you checked 5 or more of these statements and you've felt this way everyday for several weeks, there's a good chance you are suffering from depression and should see a doctor. If you checked the last item, you should seek help immediately, regardless of your answers to any of the other statements. yid NCASTPerson Observed _Age T Educ. Setting Child's Name FEEDING SCALE ❑Mother❑Feel» ❑Nome Child's Age(Inmonths) Dm. ❑Clinic Major Caregiver ❑Yes ❑No ❑Other Child's Sts Birth to One Year Only Child Birth Order(deck, Type.of Feeding['Breast❑Bottle❑Solid Were Others Present?. 1 2 3 4 S or afore information applies to parent only Usual Feeding Time El Yee O No ❑Yes Child's State at Beginning of Feeding r) No Bag aDrowsfr ) Mother's Ethnic Heritage(gee peck paps) Length of Time Feeding(circle odnrds ❑ quiet Sleep Awtve'SWp Drowsy MarhallPartner Status 0 melded ❑single 10 or less 11-19 20.29 30 or more eyes,sgehy__ Owlet Alert Active Alert Crying 1, SENSmVD Y TO CUES YES NO RI. SOCIAL-EMOTIONAL GROWTH FOSTERING YES NO 1. Caregiver positions child so that child is safe but can move hisfier arms. 28. Caregiver pays more attention to child during feeding than to other people or things in the environment. 2. Caregiver positions child so that the child's head is higher than hips. 29. Caregiver is in"en lace position for more than half of the feeding. 3. Caregiver positions dud so that tnrdeto-tank contact is maintained during more than hall of the breast or bottle feeding(50%). 30 Caregiver succeeds in making eye contact with chid once during feeding. 4. Caregiver positions child so that eye-to-eye contact is possible 31. Caregivers facial expression changes at least twice during feeding 5. Caregiver's face Is at least 7.8 inches or more from the chikfs face during 32. Caregiver engages in social lams of interaction(plays games withdrld)at feeding except when kissing,caressing,hugging,or burping the'chid least once during the feeling. 6. Caregiver smiles,verbalizes,or makes eye contact with child when child is in 33. Caregiver uses positive statements in tatting to child during the feeding. open facegaze posroon. . ^ _ — 34 Caregiver praises child or some quality of the dulls behavior during the 7. Caregiver comments verbally on child's hunger cues prior to feeding. ,.. feeding. 8. Caregiver comments verbally on cild's satiation cues before terminating b „ z a` 35. Caregiver Inns,croons,sings or changes the pitch of his*her voice during the nit. a<>_ 4� � 9. Caregiver varies the intensity of verbal sarniation during feeding. 36. Caregiver laughs or smiles during the feeding. 10. Caregiver varies intensity of rocking or moving the child during the feeding 37. Caregiver uses gentle fours of touching dung the feeding. .y . 11. Caregiver varies the intensity or formof touch during the feeding 38 Caregiver smiles,verbalizes or touches chid withinfive seconds of chid .,e. smiling or vocalizing al caregiver. 12. Caregiver allows pauses in feeding when the child shows potent disengage- ;TTTY:ff menu cues or is in the pause phase of she suck-pause sequence of sucking. , 39. Caregiver avoids mnpressng tips,gnmadng,or frowning when making eye contact with child 13. Caregiver slows the pace of feeding or pauses when child shows subtle ` , disengagement cues. ev s 40. Caregiver avoids slapprg,hitting shaking,or grabbing the child or child's extremities dung the feeding. 14. Caregiver terminates the feeding when the chid shows satiation cues or after 1. ' other methods have proved unsuccessful. ail 11. Caregiver avoids making negative comments or p egi uncomplimentary remarks to the child or home visitor about the child or child's behavior. 15. Caregiver allows child to suck and/or chew without ntemiption. TOTAL YES ANSWERS 16. Caregiver only offers food when the chid is attending. IV. COGNMVE GROWTH FOSTERING TOTAL YES ANSWERS 42. Caregiver provides child with objects,finger bads,toys,and/or utensils. II. RESPONSE TO CHILD'S DISTRESS ❑ Yes ❑ No (Potent Disengagement Cues Observed) 43. Caregiver encourages artierallows the child to explore the breast,battle, food,cup,bowl,utensils,or the caregiver during feeding. 17. Caregiver stops or starts feeding. 44. Caregiver talks to the child using two words at least three times during the 18. Caregiver changes the child's position. Teaching. 19. Caregiver makes positive or sympathetic verbalization. 45. Caregiver verbally describes food or feeding situation to child during leading. 20. Caregiver changes voice volume to softer or higher pitch. 46. Caregiver talks to child about things other than food,eating,or things related to feeding. 21. Caregiver makes soothing non-verbal efforts. 47. Caregiver uses statements that describe,ask questions or explains 22. Caregiver diverts child's attention by playing games,introducing toy,or making consequences of behavior,more than commands,in talking to child. faces. ,. 48. Caregiver verbally responds to child's sound wit in five seconds after child has 23. Caregiver avoids making negative verbal responses. vocalized. 24. Caregiver avoids making negative comments to home visitor about child. 48. Caregiver verbally responds to child's movement within five seconds of child's ®,.s x 'z movement of arms,legs hands,head,trunk 25. Caregiver avoids yelling at child. 50. Caregiver avoids using baby talk 26. Caregiver avoids using abrupt movements or rough handling. TOTAL YES ANSWERS 27. Caregiver avoids slapping,hitting,or spanking the child. TOTAL YES ANSWERS ell V. CLARITY OF CUES YES NO Enter the total yes answers from each subscale and compare It with the 51. Child is awake. possible score: SUBSCALE Items CONTINGENCY Items 52. Child widens eyes and/or shows postural attention to task situation. Possible Actual Possble Actual SENSITIVITY TO CUES 11 53. Child changes intensity or amount of motor activity when task material is presented. RESPONSE TO DISTRESS 11 54. Child's movements are deadly directed toward the task or task material or SOCIAL-EMOTIONAL GROWTH FOSTERING 11 _y: away from the task material(not diffuse). _f COGNITIVE GROWTH FOSTERING 17 55. Child makes clearly recognizable arm movements during the teaching CAREGIVER TOTAL 50 .? _ episode(clapping,reaching,waving,pounding,pointing,pushing away). CLARITY OF CUES 10 56. Child vocalizes while looking at the task materials. RESPONSIVENESS TO CAREGIVER 13 _? - _ 57. Child smiles or laughs during the episode. CHILD TOTAL 23 58. Child grimaces or frowns during the teaching episode. CAREGIVER/CHILD TOTAL 73 59. Child displays potent disengagement cues during the teaching interaction. Check the Potent Disengagement Cues(PDC's)observed during the teaching Interaction(excluding PDC's that terminate the teaching or occur 60. Child displays subtle disengagement cues during the teaching interaction. after the caregiver has terminated the teaching). TOTAL YES ANSWERS Back arching _ Palelred skin VI. RESPONSIVENESS TO CAREGIVER — Choking _ Plating away Coughing _ Pushing away • 61. Child gazes at caregivers face or task materials after the caregiver has _ Crawling away _ Saying'no" shown verbal or non-verbal alerting behavior. Cry face _ Spitting 62. Child attempts to engage caregiver in eye-to-eye contact. .. _ Crying Spitting up Tr Fussing _ Tray pound 63. The child locks at the caregiver's face or eyes when caregiver attempts to — Halt hand _ Vomiting establish eye-to-eye contact. _ Lateral head shake _ Walking Away Maximal lateral gaze aversion Whining 64. Child vocalizes or babbles within five seconds after caregivers Overhand beating movements Withdraw from alert to verbalization. — _ sleep state 65. Child vocalizes or babbles within five seconds after caregiver's gesturing, touching or changing hislher facial expression. Ethnic Heritage. Place a checkmark next to the mother's ethnic heritage and write in her specific group identity. 66. Child smiles at caregiver within five seconds after caregivers African-American — Other Asian verbalization. Asian Indian or Al:American Cuban or Cuban-American 67. Child smiles at caregiver within five seconds after caregiver's gesture, _ Chinese or Chinese-American Mexican,Chicano,or Mex.American touch,or facial expression changes. _ Filipino or Filipino-American Puerto Rican Japanese or Japanese-American Other HispanicAatin 68. When caregiver moves closer than eight inches from the child's lace the _ Korean or Korean-American Native American or Alaskan Native child shows some subtle and/or potent disengagement cues. _ Pacific Islander or PI-American White/Caucasian(non-Hispanic) 69. Child shows subtle and/or potent disengagement cues within five seconds _ Vietnamese or Vietnamese-American Other after caregiver changes facial expression or body movement. Specific group Identity: 70. Child shows subtle and/or potent disengagement cues within five seconds after caregiver's verbalization. Clinical Notes: 71. Child shows potent and/or subtle disengagement cues when caregiver attempts to inhtxle physically in the child's use of the task materials. 72. Child physically resists or responds aggressively when caregiver attempts to intrude physically in child's use of the task materials. 73. The child stops displaying potent disengagement cues within 15 seconds atter caregiver's soothing attempts. TOTAL YES ANSWERS Copyright O1994 by Kathryn Barnard,University of Washington,School of Nursing,Seattle. All Rights Reserved.Printed In the USA. NOTICE:IT IS ILLEGAL TO PHOTOCOPY OR OTHERWISE REPRODUCE THIS ASSESSMENT WITHOUT THE PUBLISHERS WRITTEN PERMISSION. To use this scale for research or clinical practice requires training.For more information write or call: NCAST-AVENUW Programs University of Washington Box 35792O Seattle,WA 98195-792O Date of Observation Phone 2O6-543-8528 www.ncast.org 4 Recorder's Signature I' 'a F_ C �' fC.,, to OFo C C to w v 2 .C A u' e v ICI ° .8 'a C .v. s C Fn a W m :: C .a .E C ° ° lJn F y m a T 0 SJ'Et or C t o b C g 'E ° E C C O C .C C.' m y C A flhii V o ,$�"p 2 ^L 5 C H Iii $ go9EcaE .n .ott ro 32ucev a zobv ,o vo.E c got.'v .o v n go k m 8, 4 c ,...0 o a o 2 C vil '� w .5 " � r:a m a E o 8 E t c o c `k ° 20 m o v 5 y a v v o s° , 0 9 m O E a 2 ti y o o g s v 'z . a 3 W o = 0 m a• 9 c o g .o > ro tc ' E • v 5 u - r c 9 ° . . - , 6 ...4 = . .. ,, r . - C i v .F a x _y 9: u 'v v g & 7 v 5 2 E I t a r� E v v a c y o v '� v n fl .a - o 'c E v . t= a o 5 1 go - 'a v y ' ° Nov c c E c . 5 v yG 5 $ E 'a pqp-p a a,1, 1 ,- a c a v ' v . '5 F J 5 L Nov cc F t 1 8.o '" w v L �5 O u v 'S o n ? 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The Bonding Program The Jubilee Center for Families 1024 8t Street Greeley,CO 80631 970-352-8873 cell 970-397-6521 Disclosure Statement Barbara Jetley, MA Licensed Professional Counselor Barbara Jetley has a Bachelor's Degree in Psychology and a Master's Degree in Guidance and Counseling. She is Colorado Licensed Professional Counselor #1056 and Washington State Licensed Mental Health Counselor#LH00010405. The practice of licensed and unlicensed persons and Certified School Psychologists in the field of psychotherapy is regulated by the Department of Regulatory Agencies.A client of a psychotherapist is entitled to information about methods of therapy,techniques used, the duration of therapy, if known,and the fee structure.A client may seek a second opinion or terminate therapy at any time. In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that regulates, registers,or licenses such unlicensed psychotherapist, registrant or licensee, also known as the Grievance Board. The information provided by the client during therapy sessions is legally confidential in the case of licensed marriage and family therapists, social workers, professional counselors, psychologists, and unlicensed psychotherapists,except as provided in section 1243-218 and except for certain legal exceptions that will be identified by the licensee,registrant,or unlicensed psychotherapist should any such situation arise during therapy. Exceptions include but are not limited to dangerousness to self or others,grave disability,child abuse or neglect,suspected child abuse or child neglect and lawsuits. The Grievance Board has the right to review charts. Complaints about Barbara Jetley can be addressed with the Program Proprietor, Lori Kochevar, at 970)352-8873,or with the Department of Regulatory Agencies, Colorado Mental Health Section at(303)894-7766. Client/ Parent/Guardian Child Staff Date (AL\ • THE BONDING PROGRAM JUBILEE CENTER FOR FAMIUES 10248tH ST. GREE_LEY.CO 80631 970-39745221 RELEASE OF INFORMATION / / - - Participants Name Date of Birth Social Security No. / / Participants Name Date of Birth Social Security No. ! / - - Name of Child Date of Birth Social Security No. / / Name of Child Date of Birth Social Security No. I participant,authorize information to be exchanged between the BONDING PROGRAM and following agencies or programs as listed below(initial all that apply): CASA—Court Appointed Special Advocate Child care provider _Child Find _North Range Behavioral Health Weld County Combined Courts Weld County Department of Social Services _Physician _GAL Foster Parents SU.roul other other _other other Information Disclosed Assessmerd/dragnosis Social history/background _Updates,progress and discharge The disclosed infornwtion will be used for the following purposes: At the request of the client _Multi-agency coordination of care _Continuity of care _Obtaining services for client Evaluation purposes Reports to courts or other agencies I understand the information released may be written,verbal or electronic form and may include date(s)of contact,locations and reasons for contact,symptoms presented,treatment progress,outcome information,prescriptions written referrals,education records,tests performed and or diagnosis. I understand that released information may include psychological/psychiatric,medical,shelter and case management,alcoholism,drug and/or alcohol abuse information. I understand that the purpose of this release of information is to allow the individuals/agencies chosen in the section above to access and use the information to establish and maintain continued care,collaborate services better assess the needs of the client,and/or improve program services based on evaluation studies. I understand that I may refuse to sign this authorization and that if I refuse to sign this authorization,twill not be eligible for services through the Bonding Program. I may still have access to other community services,however. There is no guarantee that recipients of the information disclosed through this authorization will not re-disclose to another party. Except in situations legally required or permitted,information about me cannot be disclosed to persons outside the Bonding Program without my written permission. I understand that I may cancel this authorization at any time by giving written notice to the agencies or programs selected above. I understand information exchanged prior to cancellation is excepted. Unless cancelled this release of information will expire on / or one year from my signature date. Client Signature Parent/Guardian signature Staff/witness signature Date JUBILEE CENTER FOR FAMILIES CONSENT FOR MENTAL HEALTH AND ACKNOWLEDGEMENT OF INFORMATION RECEIVED ❑ CLIENT RIGHTS AND RESPONSIBILITES: I have received the Client Rights handout and relevant handouts outlining my responsibilities as a client of Jubilee Center for Families. I understand that it is my right to ask questions if I need clarification or have concerns. ❑ ACKNOWLEDGMENT OF PRIVACY RIGHTS: I have received a copy of the current Notice of Privacy Practices. I may refer to the Notice for more information about how Jubilee Center for Families may use or disclose my personal health information. I may refer to the Notice for more information about my rights in regards to such information. I may speak to the Privacy Officer for more information. ❑ DISCLOSURE STATEMENT: I have been given information about how to file a complaint or appeal a decision made by Jubilee Center for Families regarding my services. I may refer to the Privacy Notice or the Clients Rights handout for additional information. I understand that I may make a complaint or obtain the assistance of a Client Advocate without jeopardizing my care. ❑ FOLLOW-UP CONTACT AND SURVEYS: I understand Jubilee Center for Families or their representatives may contact me during or after my treatment to obtain follow-up information or ask about my satisfaction with treatment or services. Such information is confidential and will be used for quality assessment. I May choose to participate in these surveys or not without jeopardizing my treatment. ❑ RELEASE OF INFORMATION: I understand it may be necessary for Jubilee Center for Families to communicate protected health information about me to other providers who may need to know it for coordination of care or crisis management. Releases will be obtained. ❑ CONSENT TO TREAT: I understand Barbara Jetley and The Jubilee Center for Families provides mental health and bonding services. I agree to treatment for ❑Myself ❑My child ['The person for whom I am legal guardian/custodian Client signature Client guardian/custodian Witness signature Date To Obtain Payment We may include your mental health information with an invoice used to collect payment for treatment you receive in our office. We may do this with :0J0 insurance forms filed for in the mail or sent electronically The Youty. ' r r a b• information provided to insurers and other third party payers may include tip s••a x k r ;��. - ,�x4" { ,� information that identifies you,as well as your diagnosis,type of service,date of service,provider name/identifier,and other information about your condition and uaara.m. To Conduct Health Care Operations _> v-dT# Health Care Operations refers to activities undertaken by the Caner that are regular functions of management and administrative activities. For example, IMO I'll the Center may use your health information in monitoring of service quality, staff training and evaluation,medical reviews,legal service,auditing Our Promise! functions,compliance programs,business planning,and accreditation, certification,licensing and credertialing activities. Dear Client: Business Associates This is meant to communicate to you that we are taking the new Federal(HIPPA—Health Insurance Portability and Some of the services we offer may be provided by contracts with business Accountability Act)laws written to protect the confidentiality associates. For example,some of the billing,legal,auditing,and practice of your health information seriously. We do not ever want management services may be provided by contracting with outside entities to you to delay treatment because you are afraid your personal perform those services. In those situations,protected health information will be provided to those contractors as is needed to perform their contracted tasks, health history might be unnecessarily made available to others Business associates are required to enter into an agreement maintaining the outside of our office. privacy of the protected health information released to than. What has changed? Why a privacy policy now? in Client Reminders • The most significant variable that has motivated the Federal government to Regular care is very important to your general health and because we believe legally enforce the importance of the privacy of health information is the rapid this we will remind you of a scheduled appointment or that it is time for you evolution of computer technology and its use in healthcare. The government to contact us and make an appointment. Additionally,we may contact you to has appropriately sought to standardize and protect the privacy of the follow up on your care and inform you of treatment options or services that electronic exchange of your health information. This has challenged us to maybe of interest to you or your family. review not only how your health information is used within our computers but also wit the Internet,phone,faxes,copy machines,and charts. We believe These communications are an important part of our philosophy of partnering this has been an important exercise for us because it has disciplined us to put with our clients to be sure they receive the best preventive and curative care in writing the policies and procedures we use to ensure the protection of you we can provide. They may include postcards,folding postcards,letters, health information everywhere it is used. telephone reminders or electronic reminders such as email(unless you tell us that you do not want to receive these reminders). We want you to know about these policies and procedures which we developed to make sure your health information will not be shared with Abuse or Neglect anyone who does not require it. Our office is subject to State aid Federal law regarding the confidentiality of your health information and in keeping with We will notify government authorities if we believe a client is the victim of these laws;we want you to understand our procedures and your rights as our abuse,neglect or domestic violence. We will make this disclosure only when valuable client. we are compelled by our ethical judgment,when we believe we are specifically required or authorized by law or with the client's agreement We will use and communicate your HI.ALTH INFORMATION only for the purposes of providing " -^ your treatment,obtaining payment and conducting r : x For Law Enforcement health eats operations. Your health information will ��ayrr We will disclose protected health information when required by law or not be used for other purposes unless we have asked for and been voluntarily given your written permission. necessary for health-care oversight This includes,but is not limited to:(a) reporting child abuse or neglect;(b)when court ordered to release How your HEALTH INFORMATION may be used information;(c)when there is a legal duty to Warn or takeactien regarding imminent danger to others;(d)when the client is in danger to self or others or gravely disabled;(e)when a coroner is investigating the client's death;or(I) To Provide Treatment to health oversight agencies for oversight activities authorized by law and necessary for the oversight of the healthcare system,government healthcare We will use your mental health information within our office to provide you benefits,or regulatory compliance. Crimes that are observed by us,crimes with the best health care possible. This may include administrative and that are directed toward us or crimes that occur on the premises will be clinical office procedures designed to optimize .M. reported to law enforcement. scheduling and coordination of care between clinician and business office staff. For example,Center staff j Family, Friends and Caregivers involved with your care may use your information to t N l plan your course of treatment and consult with other i s A i staff to ensure the most appropriate methods are being ( .� q Except for certain minors,incompetent clients,or involuntary clients, protected health information cannot be provided to family members without used to assist you. the client's consent In situations where family members are present during a discussion with the client,arid it can be reasonably inferred from the circumstances that the client does not object,information may be disclosed in Lori Kochevar MS, LPC, LLC 1024 8th Street • Greeley, CO 80631 • (970)352-8873 `T-) the course of that discussion. However,if the diem objects,protected mental Requester Paper Copy of this Notice health information will not be disclosed. You have the right to obtain a copy of this Notice of Privacy Practices Emergencies directly frail'GUI office at any time. Stop by or give us a call and we will mail or email a copy m you. In life-threatening emergencies the provide will disclose information We are required by law to maintain the privacy of you health information and necessary to avoid serious harm a death. to provide to you and your representative this Notice of ow Privacy Practices. We are required m practice the policies and procedures described in this Data Collection notice but we do reserve the right to amend the terms of our Notice,and make new notice provisions effective for all protected health information that it Advancing medical knowledge often involves lemming flan the careful study maintains If we change our p.ivm,y practices we will be sure all of our of the medical histories of prior clients. Formal review and st dy thical th clients receive a copy of the revised Notice. histories asi a pan of a research study win happen only undo the ethical guidance,requirements and approval and of mr Institutional Review Board. You have the right to express complaints to us or m the Secretary of Health and Human Services if you believe your privacy rights have been Authorization to Use or Disclose Health Information compromised. wecncowaritin. oexpress anyconcemsyou may have regarding the privacy of your informmion. Please let us know of your concerns a complaints in writing. Other than issued above or where Federal,Sure or Local law requires us,we will not disclose your health information other than with you written authorization. You may revoke that authorization in writing an any time. Client Rights t r I k This new law is careful m describe that have the followin ri is related h k You g gh .a 5}xx S °rte x r t to your health information. �° i e = Iv 'i gg3�t. { Restrictions �. r�`;E', You have the right to request restrictions on certain uses and disclosures of your health information. Our office will make every effort m honor ' reasonable restriction preferences from ow clients. v" Confidential Communications v you have the right to request that we communicate with you in a certain j r y t; h R way. You may request than we only communicate your health information { �..y .. t }r r4':".1-; rr:�" I 4 ° , privately with no other family members present or through mailed �i l �r � �k, kA r ` e 'A 6+`z, .• communications that are sealed. The Center will make every effort to honor ,,,�„„„�,edsanae4;4 rs c.h, k�. . ,� ,„ , your reasonable requests for confidential communication. Inspect and Copy Your Health Information You Gave the right to read and review a summary of you mental health infommtion If you would like a copy of you health information,please let us know. We may need to charge you a reasonable fee to duplicate and assemble your copy. Amend Your Health Information You have the right m ask us to update a modil&you records if you believe your health information records me imcartect or incomplete. We will be happy to accommodate yon as long as ow office maintains this information In order to standardize our process,Please provide us with your request in writing and desert your reason for the cluanhge. Your request maybe denied if the health information record in question was not created by ow office,is not part of our records or ift a records containing your health information me determined to be inaccurate and/or no complete. Documentation of Health Information You have the right m ask us for a description of how and where your health information was used by our office for any reason other ing for treatment, payment or health operations. Please let us know in writing the time period for which you are interested. We may need m charge y ou a reasonable fee for your request C1 ® HEALTHCARE PROVIDERS GEBtAL LIABILITY COVERAGE PART ENDORSEMENT eel Insured General Liability In wSderellen d Vie premium paid,and seism to the General Liability limit at NadBy shown on the certificate of awraatt.e Is agreed that the GENERAL warn COVERAGE PART is amended as blows: The person or entity named below(la`editions'inured)is an Insured urea iNs Coverage Pat but only as respects Its Nary arising on of named imred'soprrleos,ormrlres owned by or rented by the eased Ward end solely to the read that 1. a general IWb&ty ciao is made egalrot the sawed Wsared and the additional insured:and 2. in aiy ensuing litigation arising out of such deim,the earned Wand and the additional ironed remain 9a m-0swn dais. In no event is there any coverage prodded order this policy for at eaarteace that is the direct Bebity ofthe add lnI reread. Adawrir Insured-. State of Colorado Wed CounO/Socal Services PO Box A Gwen,CO 80634 TIYe a donrnend e a pair your policy and takes effect on the effective den of your policy,unless another effective date Is shorn below. AN other provisions of the policy remelt u ndwaged. Must Be Computed Complete Only Wien This Endorsement Is Not Prepared with the Polity $is Nat to be Effective all the Policy ENDT.NO. i POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE 01 0273177848 Lori Kocfwvr MS LPC LL.C 21262007 04238274(07/2001) Page lot 1 1 HEALTC PRnll Print Dale: 01/23/07 CNA ERVICE ORGAISZATION PURCHASING GROUP CERTIFICATE OF INSURANCE OCCURRENCE POLICY FORM evar Ilea4htate Providers Service Ulglazalion 1O14 8thhStreetMB I,PC I.1.C Greeley, CD 80631 1M We P East 7pWd1 p�LIPATecainsectgalonWCoucebrFinn Code: A.PROFESSIONAL LIABLITY G feesionalrrr4aa' '..(Pt) S 1,000.000 each chin S 5.000.000 aggregate I'arsaaatY UMW Inducted above MNated above S. COVERAGE EXTENSIONS:Benefit ... .:.,.-""l::,:^r.^7•s 10000 yggegae 1 aggregate - Med"ip lPai,.,..Paggregate Aid arade .�,• Damage to Property of en 2,500 per Incident $ 10,000 000 aggregate agWegate C. WORKPLACE LIABILITY Cann.pm C.Myopia LYS n sal spa II Ornesonalo a..r r WOI3 aavw•.wr.vaaa r.e.. Flrs gym rrgre none none D' GFIIERAI QTY ovem.tem saws WWI,*,,-Svartaa.r.+C.wayw„ relarwe.MreeaeirJq.MISG O IAueo&NO Owned AutoT $7.000,000 earl)occurrence $1,000,000 e Fee&Water Legal LEIS i in I A above is WAS Premium$ 650.00 SIT01457 CALL 1-880-288-35.34 G-121500-C G-121501-C G-145184-A G-147292-A G-144872-A G-123846-CD5 G-121504-C G-123827-B G-123828-B G-141234-A v ,Y4 w•.a.a..erp.r „omit. a,.. Mae[er• i 785711433'. RAJ. eCaatmen tithe goad Saeretary 6141241#(872001) Coverage Change pate: Eratorsanma Change Date: Program Area Supervisor/Provider Meeting Verification/Comment Form Date of Meeting: —� Program Area: Comments (to be completed by Program Area Supervisor): �' (_GQ e & LIP 7zr , ci(c Gam_ vpsi , c, O j 2 7,1 Signature of Program Area Supervisor I EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP May 19, 2007 Tobi Vegter Core Services Coordinator Weld County Department of Social Services P.O. Box A, Greeley, CO, 80632, Lori Kochevar MS LPC The Jubilee Center for Families 1024 8 Street Greeley, CO 80631 Re: Bid 003-LS-07 (RFP 07005), Lifeskills Bid 06FPC04(RFP 006-00A),Foster Parent Consultation Bid 002-FPT-07(RFP 006-00C),Foster Parent Training Dear Ms. Vegter: Thank you for your letter regarding additional needed information for the Core Bid process for PY 2007-2008, this letter serves a written confirmation that I have received your letter and my response regarding the need for additional information. Please feel free to call me if any further clarification is needed. A. Results of the Bid Process for PY 2007-2008 It is my understanding that The Families, Youth and Children(FYC) Commission recommended approval of my Bids 003-LS-07(RFP 07005), Lifeskills, 002-FPT-07,Foster Parent Training (RFP 006-00C), and 002-FPC-07, Foster Parent Consultation(006-00A) for inclusion on our vendor list after submitting the information requested in each section. Bid#003-LS-07(RFP 07005),Lifeskills A. 1. Program Improvement Plan(PIP); Improved outcomes in the Performance Improvement Plan- • Parents will be supported in maintaining permanency goal for the child. Providers will meet with all parties involved to discuss recommendations that are in the best interest of the child -• Providers will support parents in maintaining family and cultural connections that support the child and keep the caseworker abreast of any information regarding these connections. 2. New caseworker mandatory training. Jenna Reed who has completed this training, is available to take new cases if they become available in South County. In addition, Lori Kochevar program supervisor has taken the New Supervisors mandatory training. When this question was asked of Gloria Romansik two years ago in the bid meeting by Allen Ackerman if this training was a requirement we were told it was not.However,we would be glad to take the caseworker training if this is what you are requiring of all core service providers and contracted positions. Please advise us of your policy. 3. Quantitative measurements for Measurable Outcome Section, Page 2 Lori Kochevar, LLC,Results of Bid Process 2007/2008 Assessment tools for this program include Bonding Assessment Tool,AIMS Assessment Program DC: 0-3R, NCAST Feeding Scale, Impact of Event Scale-PTSD and Depression Screening(Appendix 2). . In evaluating each family,we will use additional tools when appropriate to assess level of bonding the child has experienced and identify behaviors that indicate areas of concern. The clinician will discuss concerns with the parents and develop a Case Management Plan. This will be an outcomes-based plan that will be shared and reviewed periodically with the parents. The goal of this program is that families who receive services will remain intact six month after discharge, will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. We have the Manuel for the AIMS Assessment tool as well as individual instrument to measure progress of parent child bond according to the age of the child that we would be happy to bring in. Please see evidences based outcomes section of bid submitted for randomized controlled outcome research. The DC: 0-3R is the standardized unit of measurement to quantitative progress in the field of infant and toddler mental health. The Manuel for this measurement tool is also available for us to bring in for review 4. Tangible evidence relating to Improvement of Household, After involvement in this program the parents will be able to provide a safe secure home for the children. This includes health, safety, and provision for every day needs. The parents will have: • Resources to provide for the child's basic needs, such as adequate housing and resources for providing food and clothing on a consistent reliable basis. • Increased awareness of daily planning for the child's needs and providing a stable environment by establishing routines around mealtime,after school activities, bath time and bedtime. • Increased understanding of the nutritional needs of the family and a means of providing for those needs. • Increased awareness of the exposure of the children to health and safety risks when the home is not well maintained. • The ability to focus spending on the basic needs of the family as a priority over other expenditures. A. Families who participate in the program will develop skills and awareness that will increase their competency as parents. Increased competency will be measured through documentation occurring at each visit through use of an outcomes-based Case Management Plan developed at the time of entry into the program. Risk factors will be identified at the time the initial plan is written using the risk assessment tool. This will be reviewed with the parents and updated as goals are met and as changes occur in the parents-child relationship. A completed narrative of measurable goals reached by the family will be provided to Social Services. F. Families who participate in this program will remain intact six month after discharge, • Page 2 Lori Kochevar, LLC, Results of Bid Process 2007/2008 will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. 5. Eligibility Section. SECTION F-ELIGIBILITY A. Total Number of clients to be served: The program will serve a total of 60 families during the twelve-month period. Each bonding specialist will serve eight to ten families at one given time period. Each family will receive 24 hours of one-on-one supervised visitation with the bonding specialist. This would provide 27 hours of intervention with families per week, 120 hours per month. Total number of client hours provided per year would be 1440 hours. B. Total number of clients and ages: Based on the approximation that the average family is made up of four children and one parent, the total number of clients for the year could be 240 clients. Focus will be on children whose ages are birth to twelve years of age. When the family includes older children, they will be included in the family intervention. C. Total number of families served: A total of 60 families will be served during the year. D. Sub-total of individuals who will receive bilingual/ bicultural services: All services provided would be in a manner that is sensitive to the family's culture of origin. The program manager and specialists have extensive training in cultural competency issues. Lori Kochevar chaired the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Becky McMahan has worked with families from various cultural roots. She has a sense of respect for the family's cultural beliefs and practices. Lorenza Perezverdia is a bicultural bilingual provider will be available for any Spanish speaking families. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. E. Sub-total of individuals who will receive services in South County: The program could serve three to eight families in South County during a given time period. We currently have providers that live in the south and we would like to increase our referral base in this area. Services will be provided for families where they reside as determined by Social Services. F. The monthly maximum program capacity: If needed, we could expand the number of hours we are available for services to 35 hours per week, which would make available 140 hours per month. G. The monthly average capacity: The monthly average capacity of this program is six to eight families. Page 2 Lori Kochevar, LLC, Results of Bid Process 2007/2008 will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. 5. Eligibility Section. SECTION F- ELIGIBILITY A. Total Number of clients to be served: The program will serve a total of 60 families during the twelve-month period. Each bonding specialist will serve eight to ten families at one given time period. Each family will receive 24 hours of one-on-one supervised visitation with the bonding specialist. This would provide 27 hours of intervention with families per week, 120 hours per month. Total number of client hours provided per year would be 1440 hours. B. Total number of clients and ages: Based on the approximation that the average family is made up of four children and one parent, the total number of clients for the year could be 240 clients. Focus will be on children whose ages are birth to twelve years of age. When the family includes older children, they will be included in the family intervention. C. Total number of families served: A total of 60 families will be served during the year. D. Sub-total of individuals who will receive bilingual/ bicultural services: All services provided would be in a manner that is sensitive to the family's culture of origin. The program manager and specialists have extensive training in cultural competency issues. Lori Kochevar chaired the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Becky McMahan has worked with families from various cultural roots. She has a sense of respect for the family's cultural beliefs and practices. Lorenza Perezverdia is a bicultural bilingual provider will be available for any Spanish speaking families. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. E. Sub-total of individuals who will receive services in South County: The program could serve three to eight families in South County during a given time period. We currently have providers that live in the south and we would like to increase our referral base in this area. Services will be provided for families where they reside as determined by Social Services. F. The monthly maximum program capacity: If needed, we could expand the number of hours we are available for services to 35 hours per week, which would make available 140 hours per month. G. The monthly average capacity: The monthly average capacity of this program is six to eight families. itit at fit DEPARTMENT OF SOCIAL SERVICES P.O. BOX A IWD 11111De 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 Lori Kochevar MS LPC The Jubilee Center for Families 1024 8 Street Greeley,CO 80631 Re: Bid 003-LS-07 (RFP 07005), Lifeskills Bid 06FPC04(RFP 006-00A),Foster Parent Consultation Bid 002-FPT-07(RFP 006-00C),Foster Parent Training Dear Ms.Kochevar: The purpose of this letter is to outline the results of the Core Bid process for PY 2007-2008 and to request written confirmation from you by Monday,May 21,2007. The Families,Youth,and Children Commission appreciates your interest in providing services for families in Weld county.This year, strides were made in structuring an RFP that is clear and concise,and more user friendly, for both prospective bidders and evaluators. It is important to stress the value of following formatting guidelines and addressing the required sections concisely and appropriately. A. Results of the Bid Process for PY 2007-2008 The Families,Youth and Children(FYC)Commission recommended approval of your Bids 003- LS-07(RFP 07005),Lifeskills, 002-FPT-07,Foster Parent Training(RFP 006-00C),and 002- FPC-07,Foster Parent Consultation(006-00A)for inclusion on our vendor list, attaching the following conditions to bids according to the program category referenced below. Conditions: The bidder must submit information that was not addressed or submitted with the original bid,as itemized below under each program area. Bid#003-LS-07(RFP 07005),Lifeskills 1. Program Improvement Plan(PIP); 2. New caseworker mandatory training, 3. Quantitative measurements for Measurable Outcome Section, 4. Tangible evidence relating to Improvement of Household, 5. Eligibility Section. Bid 002-FPT-07(RFP 006-00C),Foster Parent Training 1. Clarify and address whether your bid's contents state you will cap the capacity of Page 2 Lori Kochevar,LLC,Results of Bid Process 2007/2008 trainings; 2. Clarify and address the$75 hourly rate for court testimony; 3. Address and clarify the cost of interpreter services. Bid 002-FPC-07(RFP 006-00A),Foster Parent Consultation 1. Clarify the age levels of children served; 2. Clarify who the client is, and to whom services are provided. Required Response by FYC Bidders Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA).If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances.If you do not accept the conditions,you must provide in writing reasons why.A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and compliance item. Please respond in writing to Tobi Vegter,Core Services Coordinator, Weld County Department of Social Services,P.O.Box A,Greeley,CO, 80632,by May 21,2007,close of business.You may fax your response to us at 970.346.7662. If you have questions concerning the above,please call Tobi Vegter at 352.1551, extension 6392. Sincerely, y A 'ego,D' for cc: Juan Lopez,Chair,FYC Commission Tobi Vegter,Core Services Coordinator Gloria Romansik, Social Services Administrator • Hello