HomeMy WebLinkAbout20071745.tiff Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission(Core)Funds
Type of Action Contract Award No.
X Initial Award FY07 07-CORE-0038
Revision (RFP-FYC-07005; 006-LS-07)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2007 and Transitions Psychology Group
Ending 05/31/2008 Lifeskills
804 11th Avenue
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial Assistance
Programs include mentoring and visitation services.The Award is based upon your Request for Proposal(RFP). The
Mentoring program is a structured program,beginning RFP specifies the scope of services and conditions of award.
with an assessment of needs,that helps the family to Except where it is in conflict with this NOFAA in which case
enhance strengths and fmd solutions to problems,by the NOFAA governs,the RFP upon which this award is based
using instruction,practice, support and referrals. is an integral part of the action.
Therapeutic Visitation blends various counseling Special conditions
modalities and evidenced-based parenting models with 1) Reimbursement for the Unit of Services will be based
supervised visitation. The maximum monthly capacity on an hourly rate per child or per family.
is 50 family units.Bilingual/bicultural services and 2) The hourly rate will be paid only for direct face-to-
South County services. face contact with the child and/or family, as
evidenced by client-signed verification form,and as
Cost Per Unit of Service specified in the unit of cost computation.
Hourly Rate per 3) Unit of service costs cannot exceed the hourly and
Treatment Package Intensive $100.06 yearly cost per child and/or family.
Hourly Rate per Court Testimony $150.00 4) Payment will only be remitted on cases open with,and
referrals made by the Weld County Department 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
X 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.
6) The Contractor will notify the Department of any
changes in staff at the time of the change.ApByP1°C <�J •
Pr
ogram
By
David E. Long„ Chair Jud . Grieg° Direct°
Board of
Weld
C 0x.omr"t oners Wel o} ty H� partment of Social Services
Date: Date:
( J�� 2007-1745
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
(After receipt of order) BID MUST BE SI ED 1N INK
Program Area: LA(S, I t 5
TYPE OR PRINTED SIGNATURE
VENDOR TrdD5iflO1\5 F5 Ica EA CT. LILt levle Moe--F 4VtwValn M/k LPL,
(Name) -JU1 Handwritten Signature By Authorized
Officer or Agent of Vendor
ADDRESS 42,O4 Ave., TITLE C4�-4i r j"r
wee I e r 6-O 9)O( 3! DATE 3/ -(
PHONE# (fl o)'3'3(o-I 19-3
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
1 ,
Program Area Supervisor/Provider Meeting
Verification/Comment Form
Date of Meeting: 3/W
Program Area: , k'/}-/C7%
Comments (to be completed by Program Area Supervisor):
U , S ( S C"-� q g /1 -, r,
1 w occ� l
' Fay O
id.,,,,,,__-
C'
Signature of Program Area Supervisor
OR!G!N!L
•
4 Life Skills Bid Proposal, 2007-08
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Transitions
P 9YCMOLP$Y 6IIOUP. LLC
ABSTRACT
Transitions Psychology Group, LLC (Transitions) is a team of counseling,
consulting and assessment professionals working together to provide innovative,
effective behavioral health services to children, adults and families.
The mission of the Life Skills programs offered by Transitions is to improve
parents' ability to nurture and protect their children in order to sustain the family
and help abused and neglected children develop a solid foundation for nurturing
their own children, thereby breaking the cycle of abuse. The purpose of the Life
Skills program is to establish a safe environment and enhance family functioning
through the development of skills, reduction in stress, access to resources and
involvement in recreational activities.
Transitions' Mentoring program is a structured training program that begins with
an assessment of the family's strengths and needs. The Life Skills therapist,
family members and caseworker all contribute to the development of specific,
attainable goals for the family. The overall goal of the program is to prevent the
out-of-home placement of the child or to facilitate reunification. To this end,
Transitions counselors help the family enhance strengths and find solutions to
problems, using instruction, practice, support and referrals.
Transitions' Therapeutic Visitation program blends various counseling modalities
and evidenced-based parenting models with supervised visitation. Family
therapy, couple's therapy, play therapy and/or Parent-Child Interaction Therapy
(PCIT) are utilized to facilitate warm and safe relationships between parents and
their children. The overall goal of the program is to maintain family connections
while protecting the child. Transitions uses observation and intervention by
master's level counselors to record and evaluate changes in parent-child
interactions, develop skills, improve relationships and address safety issues.
Therapists are able to make professional recommendations to facilitate family
service planning. They are also qualified to provide expert testimony in court to
facilitate permanency planning for children when parents are not able to provide
safe, nurturing care for their children following the interventions.
TABLE OF CONTENTS
I. Target/Eligibility Populations...... ... ..................... ... ............ ... ... ....3
II. Project Narrative/Supportive Documentation. .3
A. Types of Services Provided. .3
B. Measurable Objectives. .5
C. Service Objectives 6
D. Workload Standards 7
E. Staff Qualifications. 8
F. Program Capacity by Month............ ..................... ..................9
G. Internal Tracking and Billing Process. 9
III. Budget.. ................ 13
IV. Appendices...... ...... ...... ............... ........................ ......... 13
A. Appendix 1: Resumes 13
B. Appendix 2: Data Collection Instruments/Protocols. 15
C. Appendix 3: Sample Consent Forms.
TARGET/ELIGIBILITY POPULATIONS
> Total number of clients to be served: 280
> Total family units: 70
> Sub-total of individuals who will receive bicultural/bilingual services: 90
> Sub-total of individuals who will receive services in South Weld County:
50
> The monthly maximum program capacity per group: 40 family units
> The monthly average capacity: 30 family units
> Average stay in the program (weeks): 24
> Average groups per week in the program: 2
PROJECT NARRATIVE/SUPPORTING DOCUMENTATION
A. Types of Services Provided
1. Mentorinq:
a. Teach, model and coach adaptive strategies: Transitions'
counselors teach a variety of skills to parents and families through
written information, videos, demonstrations, practice and feedback.
This skills may include planning, scheduling and stress
management.
b. Model and influence parenting practices: Transitions' counselors
work with families to identify and enhance their parenting strengths.
They utilize a variety of proven parenting systems (e.g. 1-2-3 Magic,
Common Sense Parenting) to introduce new skills. Transitions
counselors interact with parents and children in their home and
community environments to demonstrate appropriate parenting
behaviors.
c. Teach relational skills: Transitions counselors teach and model
communication and conflict resolution skills, boundary setting and
other strategies to improve the client's interactions with others.
d. Teach household management(prioritizing, finances, cleaning and
leisure activities): Transitions counselors teach parents how to
budget and manage their finances. They also identify and assist
with cleaning concerns in order to promote a safe, healthy home
environment. Counselors work with the family to identify interests in
positive activities; counselors also participate in community activities
with the family.
e. Actively help to establish community connections and resources:
Transitions routinely refers parents to various community services to
help them access housing, employment, training, counseling,
advocacy, medical care and financial assistance. Transitions'
counselors assist parents with scheduling and travel to
appointments with other service providers as needed.
f. Encourage goal setting and pro-social values: Transitions
counselors will work with the parent to set specific, achievable goals
each week and evaluate the outcomes at the end of each month.
Counselors model and discuss pro-social values and provide
opportunities for parents to practice these values in the sessions
and in the community.
2. Visitation:
a. Monitor parent/child interactions for physical and emotional safety:
Therapeutic visits by Transitions are continuously monitored by a
master's level counselor, either directly or via a dual camera
monitoring system. Counselors observe and evaluate family
interactions and intervene promptly when a child's emotional or
physical safety is compromised. Counselors further address any
concerns with parents after the visit and develop a plan to prevent
the situation from recurring. Counselors work with parents to
create a healthy emotional and physical environment for their
children. Transitions promptly reports serious safety concerns to
the children's caseworker.
b. Document clinical observations: Transitions counselors maintain
records of each session, utilizing their clinical skills and judgment to
evaluate the interactions in the visit and parent cooperation with
interventions. Some visit sessions are also recorded on DVD with
the parent's permission.
c. Strategize for teaching and modeling parenting skills: Transitions
counselors will evaluate the parent's current parenting strengths
and concerns, working in collaboration with the parents to choose
an appropriate system to utilize for disciplining their children. Some
of the choices available include the Common Sense Parenting
models developed by Girl's and Boy's Town and Parent Magic
models developed by Dr. Thomas Phelan. Parent information is
available in written and video formats; materials are also available
in Spanish. Transitions counselors use the RealCare Baby, a
computerized doll that simulates parenting experiences and records
parent responses to the doll, for work with parents of infants.
Counselors participate in the sessions to model parenting skills and
provide opportunities for the parents to observe and practice their
parenting skills. Video review of visitation sessions is utilized to
identify areas where skill development is needed, correct attempts
at utilizing new skills and reinforce proper use of skills.
d. Teach relational skills: Transitions' counselors will use the
previously mentioned parenting models to teach and practice
relational skills. Counselors will also utilize marital and family
therapy techniques and communication skills models to develop a
therapeutic relationship with the parents and address relational
difficulties.
e. Encourage goal setting and pro-sodal values:Transitions
counselors will work with the parent to set a specific, achievable
goal for each session and evaluate the outcome after the session.
Counselors model and discuss pro-social values and provide
opportunities for parents to practice these values in the sessions
and in the community.
f. Plan structured activities in visitation to help achieve the objectives
of the treatment plan: Transitions counselors work with parents to
plan activities for each session and discuss the purpose and
desired outcome of the activity with the parent. Counselors review
the effectiveness of the planned activities after the visit and make
adjustments as needed for subsequent visits.
FYC resources will not supplant existing available services in the
community. Transitions provides customized therapeutic visitation and in-
home mentoring services that promote healthy family interactions. These
services are designed to meet court requirements and address goals
identified by caseworkers and supervisors in the family service plan.
These Life Skills services are not covered by mental health capitation,
ADAD or other funding sources for professional services. Furthermore,
Transitions encourages collaboration with other providers in order to
provide a continuum of care (e.g. therapeutic visitation—supervised
visitation—monitored visitation) for families.
B. Measurable Outcomes
1. Improvement of household management competencies: Transitions
counselors will assess the parent's ability to clean and maintain their
home, develop and follow their budget, and manage appointments and
document their progress in the Monthly Report.
2. Improvement of parental competencies: Transitions will provide
instruction, modeling and opportunities to practice parenting skills. The
counselor will document the parents ability to demonstrate these skills
with their children in the Monthly Report and through DVD recording.
3. Parents can work independently with other sources in the community
and within the local, state and federal governments: Transitions will
document the parent's contacts with other resources and services in
the Monthly Report. Transitions will contact the other agencies to
substantiate parent reports and address any difficulties the parent may
have accessing services.
4. Families receiving Life Skills services will remain intact six months after
their discharge from the services. Transitions will develop an
individualized transition plan for each family to help them adjust from
intensive to minimal levels of service. Transitions will contact
discharged families six months after services end and record whether
or not the family is intact at that time.
5. Families who complete the Life Skills services will have improved
competency level or reduced risk on a standardized assessment:
Parents will each complete the FACES IV, Addiction Severity Index
(ASI), Risk Assessment and/or Parental Stress Index (PSI) at the
beginning and end of Life Skills services.
C. Service Objectives
1. Mentorinq
a. Improve household management competency: Transitions
counselors will instruct, encourage and support parents to maintain
a clean and safe home, manage finances so that basic needs of all
family members are met, ensure children attend school
consistently, manage the family schedule so all members attend
necessary appointments and develop positive leisure activities.
Household management competencies will be measured through
documented observations, spending reports, school records and
collateral information from other agencies.
b. Improve parental competency: Transitions counselors will provide
instruction, encouragement and support to help parents progress
through a parent training system and demonstrate skills presented
to nurture, teach and supervise their children. They will address the
parent's ability to provide care, nutrition, protection and hygiene for
their child. Parental competency will be measured through
documented observations, video demonstrations, meal plans and
collateral information.
c. Improve goal setting and pro-sodal values: Parents will set and
work towards goals with their life skills counselor. They will identify
actual and ideal family values and model positive behaviors for their
children. Goal setting and pro-social values will be measured
through documented observations, background checks and
collateral information.
2. 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: Transitions will provide individualized instruction,
modeling and support to assist parents to complete a parent
training system. Parents will have opportunities to observe,
practice and review on DVD the skill being learned. Transitions will
utilize PCIT to document specific categories of parent-child
interactions, providing feedback, modeling and demonstrations to
assist parents to increase positive interactions and decrease
negative interactions. Transitions provides continuous monitoring
by a masters level counselor to assess behaviors and provide for
the children's physical and emotional safety. Counselors intervene
immediately if a safety risk is identified and further discuss the risk
with the parent after the session in order to prevent the risk from
recurring. Transitions will utilize treatment plan objectives to help
the parent identify goals for their visitation sessions.
b. Improve goal setting and pro-social values: Parents will set a
specific goal for each session and evaluate their progress after the
session. They will model positive behaviors for their children during
their visits.
3. Mentorina and Visitation:
a. Improve ability to access resources: Transitions will refer parents
to relevant agencies and assist them to access these resources in
order to improve self-sufficiency and family functioning. Transitions
will document the resources obtained by the family in the Monthly
Report.
b. Address specific referral issues: Transitions will assist parents to
translate referral issues into specific goals to address in Life Skills
services and monitor their progress towards these goals. Goals will
be written for each month and progress rated; both will be
documented in the Monthly Report.
c. Improve outcomes in the Performance Improvement Plan:
i. Placement changes: Transitions will meet with all parties
involved to discuss issues surrounding any recommendation
to move a child in placement, addressing how the move will
meet the child's permanency goal and be in the best interest
of the child. Transitions will work to retain children in their
placements until they can be reunified with their families.
ii. Maintaining cultural and racial connections: Transitions will
provide the caseworker with information regarding children's
family traditions and cultural connections in order to provide
support to the children. Transitions will continue to include
additional family members and other significant persons in
therapeutic visitation sessions as appropriate and assist the
family to integrate their traditions into the visits.
D. Workload Standards
1. Number of hours per day/week/month: 250 hours of direct service per
month, 62 per week, 12 per day.
2. Number of individuals providing the services: Seven. Transitions has
two co-directors, two full-time employees and three contractors
providing direct Life Skills services.
3. Maximum caseload per worker: The maximum Life Skills caseload for
a full-time counselor is 10 families.
4. Modality of treatment: Life Skills services are family-based
interventions. Some work is done with just the parent or couple, in
order to provide feedback, parenting instruction or address therapeutic
issues without the children present. Visitation services are primarily
delivered in the Transitions offices, although a variety of venues are
utilized based on providing services in the most natural, least
restrictive setting that can assure the safety of the child. Transitions
provides visitation services in the most restrictive settings (e.g.
community correction facility; social services offices) to the least
restrictive(e.g. family home, community venues), depending on family
needs and safety concerns. The majority of mentoring services are
provided in the family home, although some may occur in the office to
address therapeutic issues or in other community venues to assist the
parent to access services or involve the family in leisure activities.
5. Total number of hours per day/week/month: 250 per month/62 per
week/12 per day.
6. Maximum caseload per supervisor: Transitions has one clinical
consultant, who is a Licensed Psychologist, to supervise all Life Skills
cases. The maximum caseload for the supervisor is 50.
7. Insurance: Transitions co-directors and employees are insured
through Healthcare Providers Service Organization Purchasing Group
(HPSO). The limits of liability are $1,000,000 per occurrence and
$6,000,000 aggregate. Contract counselors maintain their own
policies, each with a minimum of$1M/$3M liability. Current contracted
counselors are insured through HPSO and the Philadelphia Indemnity
Insurance Company.
E. Staff Qualifications
1. Minimum Qualifications: All counselors and supervisors providing
direct services will meet minimum qualifications in education and
experience as defined in Staff Manual Volume VII, Section 7.303.17,
and Section 7.0006 Q, Colorado Department of Human Services. All
staff and supervisors contracting with Transitions have a minimum of a
bachelor's degree in a human services related field and two years of
related experience. Therapeutic visitation providers have at least a
Master's degree in a human service field and the majority is licensed
professional counselors.
2. Staff available for the project: Eight. Transitions has four full-time
counselors, three contractors and one part-time supervisor providing
Life Skills services.
3. Mandated New Caseworker Training: One full-time Transitions
counselor has received mandated new caseworker training. Other
counselors will not receive this training.
4. Risk Assessment: All Transitions counselors have experience and
professional training in risk assessment. Many of the providers are
licensed and thus able to determine whether or not a person is a
danger to himself or others and in need of hospitalization. One
Transitions counselor is trained in Family Risk Assessment for
caseworkers.
F. Program Capacity per Month
Transitions utilizes a combination of full-time employees and
contracted therapists to address fluctuations in referrals to the program.
The minimum client capacity to support the program is 10 family units; the
maximum capacity is 50 family units.
G. Internal Tracking and Billing Process
1. Transitions receives new referrals via email from the CORE services
coordinator. Once a new referral is received, Transitions emails the
CORE coordinator and the primary caseworker to confirm that the
referral has been received. Transitions' administrative assistant
records the referral, including the number of hours approved and the
dates of approval. The referral is then assigned to a primary counselor
by a co-director, the primary counselor records the hours of service on
the verification form and has the client sign after each face-to-face
contact. The administrative assistant tracks the number of hours
utilized each month and to date for each referral monthly and records
this information on the billing form.
2. Transitions follows a structured billing process in order to maintain
prompt billing for services. Transitions staff members are required to
submit all signed and dated verification forms for Life Skills services by
the 1st workday of the month following the month services were
provided. All documentation, including original signed monthly reports
for coaching and for therapeutic visitation are due by the 5'h workday of
the month. The administrative assistant reviews all verification forms
and completes all invoices, Authorization Forms, and Core Service
Forms by the 5th workday of the month. The forms are audited by a co-
director for accuracy and signed. The billing, which includes all signed
documentation, is then hand delivered to the Department of Social
Services
H. Literature Citations
Abidin, R. R. (1995). Parenting Stress Index. Psychological Assessment
Resources, Inc.
Barnes , B.A. and York, S.M. (2001). Common Sense Parenting of Toddlers and
Preschoolers. Boys Town Press.
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Bell, S., & Eyberg, S.M. (2002). Parent-child interaction therapy. In L.
VandeCreek, S. Knapp, &T.L. Jackson (Eds.). Innovations in Clinical
Practice: A Source Book(Vol. 20; pp. 57-74). Sarasota, FL: Professional
Resource Press.
Borrego, J., Jr., Urquiza, A.J., Rasmussen, R.A., Zebell, N. (1999). Parent-child
interaction therapy with a family at high risk for physical abuse. Child
Maltreatment, 4, 331-342.
Bradley, S.J., Jada, D., Brody, J. et al. (2003). Brief psychoeducational parenting
program [1-2-3- Magic]: An evaluation and 1-year follow-up. Child and
Adolescent Psychiatry, 42:10, October, 2001
Burke, R., Herron, R. and Schuchmann, L. (1996). Common Sense Parenting.
Boys Town Press.
Chaffin, M. et.al. (2004). Parent-child interaction therapy with physically abusive
parents: Efficacy for reducing future abuse reports. Journal of Consulting
and Clinical Psychology, 72, 500-510.
Eyberg, S.M., & Robinson, E. (1982). Parent-child interaction training: Effects on
family functioning. Journal of Clinical Child Psychology, 11, 130-137.
Herschell, A., Calzada, E., Eyberg, S.M., & McNeil, C.B. (2002). Parent-child
interaction therapy: New directions in research. Cognitive and Behavioral
Practice, 9, 9-16.
Olson, D.H. (2004). Family Satisfaction Scale (FSS). Minneapolis, MN: Life
Innovations.
Olson, D.H. & Barnes, H. (1985). Family communication. Minneapolis, MN: Life
Innovations.
Olson, D.H. & Goral, D.M. (2003). Circumplex model of marital and family
systems. In F. Walsh (Ed.). Normal Family Processes (3'" ed.). New
York: Guilford (pp. 514-47).
Olson, D.H. & Gorall, D.M. (2004). FACES IV; Innovation and Applications.
Minneapolis, MN: Life Innovations.
Olson, D.H., Gorall, D.M. &Tiesel, J.W. (2006). FACES IV package:
Administration manual. Minneapolis, MN: Life Innovations.
Peterson, J.L., Kohrt, P.E. et al. (1995). Building skills in high-risk families: the
boys town family preservation model that teaches skills and builds
relationships to prevent out-of-home placements and reunify families.
Boys Town Press.
Phelan, T. (2003). 1-2-3 Magic: Effective Discipline for Children Ages 2-12 (3r°
ed.). Illinois: Child Management Inc.
Phelan, T. (1998). Surviving Your Adolescents: How to Manage and Let Go Of
Your 13-18 Year Olds (2s ed.). Illinois: Child Management Inc .
Thompson, R.W., Grow, C.R., Ruma, P.R. et al. (1993). Evaluation of a practical
parenting program with middle and low-income families. Family Relations,
42, 21-25.
Ware, L.M., Fortson, B.L., & McNeil, C.B. (2003). Parent-Child Interaction
Therapy: A promising intervention for abusive families. The Behavior
Analyst Today, 3, 375-378.
I. Confidentiality and Participant Protection
1. Protect Clients and Staff from Potential Risks
Transitions counselors explain privacy rights in the State of Colorado and
give informed consent to all client participants in our programs (see
Appendix 2). The forms are signed by the clients. In order to protect
confidentiality, a release of information is always requested and signed by
clients (see Appendix 2).
There are no foreseeable physical, medical, psychological, social or legal
risks that would be caused by the program. It is possible the family would
not be able to successfully complete the program, which could have legal
and psychological implications. In the best interests and protection of
children, there are times when family reunification is not possible. To
mitigate the effects of this, families are informed in the intake that they are
continuously being evaluated and that these evaluations will be shared
with social services and may affect treatment planning and court
decisions. Families are also routinely advised to seek legal advice when
they have question of a legal matter. Furthermore, the results of the
evaluations are reviewed with parents and when necessary, risk
assessment and appropriate referrals for counseling and other services
are made by the counselor.
2. Fair Selection of Participants
Participants for the project are not selected by Transitions. We accept
referrals from DSS and do not discriminate for age, gender, racial/ethnic
background or other reasons.
3. Absence of Coercion
Often referrals are made for Transitions' social service programs as a
result of a court order. In these cases, clients are essentially being
required to participate in order to see their children. Transitions
counselors recognize this dynamic and try to encourage open interaction
with the clients and help them to feel motivated to make positive changes
in their lives. Clients are informed that they may seek a second opinion
from another counselor, request an alternate referral from their
caseworker or may terminate services at any time. Transitions is always
willing to refer to other counselors and agencies as needed. Furthermore,
Transitions discusses treatment alternatives with the referring caseworker.
Nevertheless, Transitions recognizes our duty to help protect the well-
being of children and to consider child safety when making
recommendations for treatment.
4. Data Collection
Data is collected directly from families, from the referring agency, and from
other corroborative sources as necessary to provide Life Skills services. A
release of information from the client is always requested and signed prior
to obtaining data.
Transitions collects data from the families directly during Life Skills
sessions through direct contact, observations and assessments. The
forms include the Life Skills intake and Parental Stress Inventory.
5. Privacy and Confidentiality
Transitions adheres to privacy and confidentiality laws and statutes in
Colorado and the ACA (American Counseling Association) code of ethics.
All data collected is used for the compilation of the home study report,
update or relinquishment counseling report. The data is stored in a
password protected database with a backup system and/or physical charts
which are secured and maintained for seven years.
6. Adequate Consent Procedures
Informed consent (see Appendix 2) is used according to the ACA code of
ethics. The program is not a research project and does not require assent
forms for youth. It is sufficient and ethical to have parents agree to
consent and to sign release forms.
7. Risk/benefit Discussion
Participating in Life Skills services is recommended by the caseworker
and sometimes ordered by the court when they endorse the Family
Service Plan. The parents have a choice whether or not to complete the
Family Service Plan, but often are required to participate in order to have
contact with their children (therapeutic visitation) or in order to successfully
complete their Family Service Plan and end social services involvement
with their family. Considering the well-being and safety of children as the
primary benefit, it is worth some risk to require parents to participate in
services.
BUDGET
See attached form.
APPENDICES
Appendix 1: Resumes for key staff members
Appendix 2: Data collection instruments/protocols
Appendix 2: Sample consent forms
Jami Moe-Hartman, MA, LPC
Transitions Psychology Group, LLC
804 le Avenue
Greeley, CO 80631
(970)336-1123
Licensed Professional Counselor August 1999 to present
State of Colorado, License#2296
National Board Certified Counselor April 1999 to present
American Counseling Association Member 2002 to present
EDUCATION
Master of Arts in Community Agency Counseling August 1995
University of North Dakota, Grand Forks, ND
• ND Board of Higher Education Tuition Waiver Scholarship
• G.P.A. 4.0/4.0
Bachelor of Arts in Psychology May 1991
University of North Dakota, Grand Forks, ND
• Minors in Chemical Use/Abuse Awareness and Visual Arts
• Phi Beta Kappa
PROFESSIONAL EXPERIENCE
Counselor/Co-Director October 2001 to present
Transitions Psychology Group, LLC, Greeley, CO
• Develop and implement agency programs
• Conduct assessments of foster and adoptive homes
• Provide expert testimony in court
• Provide individual and family therapy
• Specialize in treatment of children, including play therapy
• Provide therapeutic parent training, parenting education and life skills training
• Coordinate services with multidisciplinary team and other agencies
• Serve on community boards
Therapist March 1999 to September 2001
North Range Behavioral Health/Child&Family Services Team, Greeley, CO
• Provide individual, group and family therapy, including intensive in-home family
therapy and outpatient services
• Develop and implement treatment plans
• Coordinate services with other agencies
• Provide court testimony
Substance Abuse Counselor July 1998 to October 1999
ARC Counseling Center, Greeley, CO
• Facilitate substance abuse education, anger management and relapse prevention
therapy groups for court ordered adults (July 1998-March 1999)
• Substitute as facilitator of relapse prevention groups (March 1999—October 1999)
• Provide progress reports to law enforcement and courts.
Mental Health Therapist August 1996- March 1999
North Range Behavioral Health/Children's Acute Treatment Unit, Greeley, CO
• Provide intensive individual, group and family therapy to children and adolescents in
a residential setting.
• Coordinate services with other agencies
• Develop and implement treatment plans
• Assist in the development and management of the therapeutic milieu
• Supervise clinical care assistants
Family Advocate February 1995 -July 1996
Domestic Violence and Rape Crisis Center, Dickinson, ND
• Assist in the development of policies, procedures and program services
• Facilitate education/therapy groups for children and adolescents
• Recruit, train and supervise children's group volunteers
• Conduct public education seminars
• Assist with grant writing and the compilation of statistics and reports
• Develop, plan and execute fundraising events
• Serve as the local coordinator for statewide criminal justice system monitoring
project
• Represent agency on community boards
• Provide case management services to families utilizing the shelter facility
• Provide crisis intervention services, information, referrals and advocacy to victims of
physical/emotional/sexual abuse
Victim Advocate July 1994-February 1995
Community Violence Intervention Center, Grand Forks, ND
• Provided individual therapy to victims of physical/sexuaUemotional abuse
• Facilitated an education/therapy group for victims of domestic violence
• Screened and assisted persons applying for protection orders and disorderly conduct
restraining orders; provided court advocacy; drafted permanent orders
• Conducted public education seminars and assisted in training volunteers
Gregory S Creed
Transitions Psychology Group, LLC
804 11th Avenue, Greeley, CO 80631
Tel (970) 336-1123 FAX(970) 351-0182 Cell(970) 590-1424
e-creed@comcastnet
Highlights of Qualifications
• Doctoral level marriage and family therapist with over 8 years experience
• Licensed Professional Counselor&National Certified Counselor
• Professional training in family systems therapy
• Proficient in Spanish and Japanese with highly develop cultural competencies.
Relevant Experience
Sept 1999-Pres Agency Co-Director& Marriage and Family Therapist,
Transitions Psychology Group,LLC
• Provide high quality marital and family therapy
• Supervise counselors on several programs
• Perform administrative functions for the agency
Jan 99-Aug 99 Counselor/Case Manager,North Range Behavioral Health,
1306 11th Avenue, Greeley, CO 80631
• Provided in-home therapy services for family preservation
referrals from DSS and for an interagency collaborative
program
• Maintained productive working relationships with caseworkers
from DSS
• Conducted therapy with Spanish speaking families
• Produced positive outcomes with families and individuals
Jan 98-Dec 98 Internship, North Range Behavioral Health, 1306 11th
Avenue, Greeley, CO 80631
• Family, group and individual therapy with children,
adolescents, and adults
• Experience with family preservation, HeadStart and outreach
programs
• Case consultation with parents, teachers and program directors.
1996-1998 Program Coordinator, Center for International Education,
UNC, 1945 10th Avenue, Greeley, CO 80639
• Coordinate cross-cultural programming campus-wide
• Facilitate retention programs for international students
• Direct home stay program for Japanese students
1994-1996 Assistant Language Teacher, Kyoto City Board of Education,
Oike-Teramachi,Nakagyo-ku, Kyoto 616, Japan
• Taught English to high school students in team-teaching format
wit Japanese teachers
• Encouraged Japanese teachers to be model learners of English
and to explore new methods of teaching
• Designed teaching materials and teaching plans
• Helped team to develop new pilot English course
1990-1996 Owner& Instructor, Gregory's English School, Kyoto, Japan.
• Taught 35 sutdents weekly in small groups, parent/child classes
and in individual sessions
• Helped demystify the learning process for students and helped
them to develop a taste for self-guided learning
1989-1990 Spanish Instructor, Aims Community College, Greeley, CO
198-1988 Assistant English Teacher, Japan Exchange and Teaching
Program, Kyoto Prefectural Research and Training Center,Nishi-
machi, Morinagato,Momoyama, Fushimi-ku, Kyoto, Japan
• Presented seminars and training workshops to Japanese
educators
• Taught English to high school students
• Regional representative for Assistant English Teacher
Association
Education
Ph.D., Counselor Education& Supervision, 2006
M.A., Community Counseling, Marriage&Family Emphasis,
University of Northern Colorado, 1999
B.A.,McPherson College, McPherson, Kansas, Business Management & Spanish, 1986
Junior Year Study Abroad, University of Granada, Granadad, Spain, 1983-84
Certification & Licensure
Licensed Professional Counselor, #2869
National Certified Counselor
Presentations
A Balancing Act: Strengths& Stressors for Families in Cross-Cultural Transitions FIGT
(Families in Global Transitions)Annual Confence, March 29-30, 2007,Houston, Texas
The Mystery of Parenting Teens, Parent Training Seminar, St Mary Catholic Church Fall
2004 and St Peter Catholic Church Fall 2005
International Relocation: Implications for Families Poster Session, Rocky Mountain
ACES annual meeting, Oct 5-7, 1989,Jackson, Wyoming
• 000 0
• 804 11th Avenue
' Greeley, CO 80631
.w w A Phone (970)338-1123
•
•a. :4",- Fax(970)351-0182
•a
ConsentlRelease
Transitions
I authorize Transitions to release the information indcated to the agency or persons listed below for the purpose of
service coordnation of care,and case management. Circle YES NO.
I authorize Transitions to obtain the information indcated fan the agency or persons listed below for purposes of
service,coordination,continuity of cans,and case management Circle YES NO.
This is the hxiceted information-circle every item YES or NO
YES NO Treatment information to include history,attendance,dapnoeis,progress In treetrnent,prognosis,
treatment prognosis,treatment approaches/plan/goals,medcation Intervention and prescriptions,
status at dscharge.
YES NO Psychological evaluation and testing summaries.
YES NO Clinical evaluaUaVassessment saixneries.
YES NO Alcohol and chug treatment information.
YES NO Physical exam,lab etudes,and dagnoalc evaluation,EKG,EEG.
YES NO Other(specify)
The release pertains to:(Please Print)
Client Name: Date cf Birth:
Name: Date of Birth:
Name: Date of Birth:
List complete names of no more than five(5)agencies or indviduais regardng this release:
Name of Agency or Person Acbress/Phone
1.
2.
3.
4.
5.
I understand that my records ardor those of any irdvidual(s)listed above are protected under federal and state confidentiality regulations. I
understand that if I have authorized the release of drug abuse a dfvr alcohol abuse eurormation that the confidentially of this information is protected
by Federal Law(42 CFR,part 2). This information cannot be dbclosed without my written consent,unless otherwise specifically provided for in the
regulations. I understand that I may revoke this consent at any time. Copies of this form may be used in lieu of the original. I understand and agree
that this release form may be sent to the agencies and persons identified above.
This consent expires and cannot be used past the following date:
(Not more than one year).
(Client Signature) (pate)
(Parent/Guile:Ian Signature) (Date)
(witness Signature) (Date)
CLIENT'S RIGHTS
w 804 11th Avenue
•",• 4 !° Greeley, CO 80631
a� Phone (970)336.1123
•w• Fax(970)351-0182
seats
•0
Transitions
Transitions Psychology Group provides an interdscipinary treatment approach tat utilizes a broad range of experlise
and therapeutic modalities. You are encouraged to dscuss your treatment with your therapist,and you have the right
to receive more information regardng the following items:
• Your we entitled to receive information regaling credentials,professional background and theoretical
approach used by the therapist involved In your treatment
• You are entitled to receive an estimate of the average treatment dhsation for issues or concerns similar to
yours,even though an exact length of treatment is hard to predct
• You will be provided with a general plan that vril identify the specific therapeutic goals you chose to
accomplish.
• You may seek a second opinion from another therapist or may teminate therapy at any time.
The Colorado State Department of Regulatory Agendas regulates the practice of both licensed and unlicensed
persons in the field of psychotherapy. My questions,concerns,a complaints regardng the practice of mental health
may be drected to the State Board listed Below
THE STATE DEPARTMENT OF REGULATORY AGENCIES
1560 Broadway,Suite 1340
Denver,Colorado 80202
(303)0047766
In the majority of situations client information is legally confidential and shall be held in the strictest of confidence and
only with written pemiarion of the client or legal guardan will treatment information be dsdosed In certain situations,
the law requires that information gathered doing therapy be revealed without the octant's permission:
• If you threaten bodiy harm or death to yourself or other persons
• If you reveal information relative to physical abuse,sexual abuse,or neglect of a child
• If a court of law issues a legitimate subpoena
• If you are in therapy by order of court of law
• If you are involved in a criminal or delinquency procreating
Sexual Intimacy between therapist and client is illegal and not a part of any recognized therapy. It this occurs It should
be reported to the grievance board identified above.
I have read and understand the preceding information,Including my rights as a client I agree to all the above
polities and procedures. I have received a copy of this form.
CLIENT SIGNATURE DATE TIME
SIGNATURE OF THERAPIST DATE TIME
. THERAPEUTIC VISITATION GUIDELINES
• : .:• . ,
•• • . Therapeutic visits are designed to maintain, develop and/or improve the
•� .: • relationship between you and your child. The following guidelines are
.2• intended to help you reach this goal.
Transitions
PSYCHOLOGY GROUP,LLC
1. Transitions visitation program is therapeutic in nature. You will be provided with
feedback and guidance before, during and/or after your visits. Please be aware that
your visits may be recorded at any time. Your visit therapist may enter the visitation
room at any time.
2. No unauthorized persons will be allowed to participate in the visits. Other family
members or guests will need prior written approval from the caseworker before
participating in visits. Cell phones are not permitted during visits.
3. Please allow ample time for foster parents or other providers to leave the building before
exiting. Do not extend your visit outside of the building.
4. Consistent attendance is important. You must call at least 24 hours in advance if you
are not able to attend your visit. If you cancel your visit, it will not be rescheduled. If you
do not show for two visits within a 60 day period, or cancel four visits within the same
time period, you will be required to attend a consultation with your visitation therapist and
sign a participation contract. Your caseworker will be notified of all missed visits and
further action may be taken.
5. Please bring any items needed to properly care for your child during the visit (e.g.
diapers, wipes, bottles, healthy snacks). If your visit is scheduled during a regular meal
time for your children, you will also be expected to provide the meals for them. You may
bring suitable activities, games or toys with you for the visit. No weapons or other violent
toys will be permitted. Please clean up after your family when you leave and dispose of
any diapers or food containers in the outdoor trash bins.
6. Visits will be cancelled and not made up in the event of the following:
a) If the therapist suspects that drugs or alcohol have been consumed and you are
not able to provide verification of sobriety.
b) If you bring any weapons on the premises (the police will also be notified).
c) If you are more than 15 minutes late for the visit.
d) If you become verbally or physically aggressive with your child, family members,
guests or the therapist, or the therapist determines that your behavior is in any
other way detrimental to your child.
My signature below acknowledges that I understand the guidelines and agree to abide by them.
I have received a copy of the Therapeutic Visitation Guidelines.
Parent Date
Witness Date
03/05
• • • •• Permission for Videotaping during Life Skills
••
•• 4 . : Services
. S.. -•
•••� •
0 . .• Agencies: Transitions Psychology Group, LLC (Transitions)
Transitions 804 11th Ave.
PSYCHOLOGY GROUP,LLC Greeley Co 80631
Weld County Department of Social Services (WCDSS)
P.O. Box A
Greeley Co. 80632
Client Name
Client ID
I (we) Authorize the two agencies, Transitions and WCDSS, to use any audio-visual
recordings made at Transitions offices or in my home of myself(us) and my (our) family,
for the purposes of:
1. Evaluation by the Transitions counselor, child protective service's team,
supervisors and consultants.
2. Supervision by supervisor and consultants
Upon written notice, I (we) may have any or all audiovisual recordings erased, and/or
restrict their use to one or more of the above stated purposes. If no written notice is
received, Transitions will maintain audio visual recordings for a period of seven years, at
which time the recordings will be erased.
I (we)understand that all audiovisual recordings are available for viewing by me (us).
Parent Date
Parent Date
Witness Date
DYADIC PARENT-CHILD INTERACTION CODING SYSTEM (DPICS)
CLINICALLY MODIFIED RECORDING FORM
Child's name Observer's name
Parent's name Date _
Intake Treatment sessions Boosters
A B 1 2 3 4 5 6 7 8 9 10 11 12 AB CD
Parent behaviors Child behaviors
Direct command followed by . . . No opportunity
Compliance
Noncompliance
Indirect command followed by. . . No opportunity
Compliance
Noncompliance
Descriptive statement Disruptive behavior . .
Ignored
Responded to
Reflective statement Other child behavior
Unlabeled praise Clinical notes
Labeled praise
Question
Critical statement
Other‘,/rbalization
EXHIBIT B
SUPPLEMENTAL NARRATIVE TO RFP
804 11th Avenue
• ! 0 Greeley,CO 80631
• Tel.(970)336-1123
`° FAX(970)351-0182
Transitions
PG.tX0L0G, GROUP, LLG
May 18, 2007
Tobi Vegter, Core Services Coordinator
Weld County Department of Social Services
P.O. Box A, Greeley, CO, 80632
Re: Bid # 006-LS-07 (RFP 05005) Lifeskills
Bid # 003-FPT-07 (RFP 006-00C) Foster Parent Training
Bid # 008-HS-07 (006-00B) Home Study, Relinquishment Counseling
Bid # 006-MH-07 (RFP 006-00)
Dear Ms. Vegter:
I am writing in response to the award letter dated May 11, 2007 for the 2007 RFP
process. We greatly appreciate the awards for our programs and would like to respond
to questions on our bids.
• Bid #006-LS-07 (RFP#07005), Lifeskills. Responses:
Recommendation: The approved bidder will pursue bilingual
interpreters/translators/staff in order to better serve bilingual and monolingual
clients. This may include offering incentives, accommodations, and
encouragement to Spanish bilingual interpreters, translators, and staff.
Transitions currently has three bilingual providers available for this program.
We continually seek out experienced bilingual therapists. In addition, we
supply educational materials in Spanish for clients.
Conditions: The bidder must clarify and submit information that was not
addressed or included with the original bid submission.
1. Provide a copy of insurance. See enclosures.
2. Provide staffing information, including resumes and education levels of
staff. See enclosures.
3. Address mandated caseworker training for staff. This was addressed in
Section E, 3; "Mandated New Caseworker Training: One full-time
Page 2
Transitions Psychology Group/Results of RFP Process for 2007-2008
Transitions counselor has received mandated new caseworker training.
Other counselors will not receive this training? Additional providers would
attend New Caseworker Training if required by the Department.
4. Address bilingual/bicultural services. Transitions has three
Spanish/English bilingual therapists. All master level counselors have had
coursework and training in multicultural competencies.
5. Provide rates for levels of service (parent education and therapeutic
visitation). We do not have different levels of service on this program.
Transitions Lifeskills services are all therapeutic and as such are provided
by Master's level clinicians. The rate for services is $100.06 per hour.
6. Address step-down services. Transitions works with an internal
consultation team to tailor and adjust the level of service according to the
family's needs and progress. We attend Core Review Team meetings
monthly to ensure the level of service is appropriate for each case.
Transitions regularly refers families to less intensive services after
therapeutic services. We transition visits from the more restrictive office
environment to the less restrictive home environment when possible.
Hours of service are decreased gradually to phase out treatment.
• Bid #003-FPT-07 (RFP#006-00C), Foster Parent Training. Responses:
1. Bidder must address and clarify class size. The evaluating committee
requests that the bidder not limit class size. Transitions will not limit class
size. Transitions determined class size in order to provide optimal
training. We have since understood that class size normally does not
exceed 20 participants and that it is critical not to delay certification for
funding purposes.
2. Bidder must address whether there is a lead"trainer. Address the
consistency and continuity of trainers/training. Dennette Janus, MA, NCC,
a therapist and former child protection caseworker, is the designated lead
trainer for Transitions. Other profressional staff and consultants will
provide training on various topics in order offer additional expertise and
maintain the interest of participants.
3. Provide a curriculum as requested in the RFP. See enclosure.
4. Provide a copy of insurance. See enclosure.
• Bid #008-HS-07 (RFP#006-00B), Home Studies, Updates, and
Relinquishment Counseling. Repsonses:
1. All staff must attend Core Caseworker Training. All staff attended the
required SAFE training and three staff attended an additional training for
SAFE supervisors to satisfy the vendor requiremenets. In a discussion
with Dave Aldridge, we were told that the Core Caseworker Training
requirement is waived for home study providers.
2. The bidder must address the Program Improvement Plan (PIP). The PIP
Page 4
Transitions Psychology Group/Results of RFP Process for 2007-2008
out qualified, experienced, bilingual therapists and psychologists. The
acquisition of psychological testing materials in another language is
difficult due to limited availability and cost. It is not ethical to translate the
standardized tests as they have not been nonmed on multicultural
populations. The program has had no referrals for psychological
evaluations last year and only two in the previous program year. As the
program progresses, this service could be developed.
Conditions: The bidder must submit information that was not addressed or
submitted with the original bid submission, including:
2. Evidenced-based Practices: Transitions utilizes only norm-referenced
psychological tests. All are nationally recognized and have been
extensively researched in order to develop the norms required to interpret
the tests. Transitions uses Parent-Child Interaction Therapy as an
evidenced-based component of the interactional assessments.
Transitions uses the Parent Stress Index as an evidence-based
component of the mental health assessment. Please see reference
section of the bid for additional research information.
3. Bilingual services: Transitions has one bilingual provider, a licensed
professional counselor, available for mental health assessments and
interactional assessments with Spanish-speaking clients. Psychological
Assessments are not available in Spanish for this program year.
4. Program Improvement Plan (PIP),
a. placement changes: Transitions providers are experienced in assessing
children and adolescents and will make written recommendations in the
reports for psychological evaluations, mental health assessments and
interactional assessment to help maintain a child in their placement.
Alternately, if this is not appropriate, providers will delineate how a change
in placement will advance the child's permanency goals. If a child is free
for adoption, providers will include specific recommendations to assist the
Department in how to prepare the child for an adoptive home as well as
identify when a goal of adoption is not appropriate for a child.
5. Copy of insurance. See enclosures.
Sincerely,
Gregory S Creed, PhD, LPC
Co-Director, Transitions Psychology Group, LLC
Page 3
Transitions Psychology Group/Results of RFP Process for 2007-2008
was addressed in the bid proposal in the narrative. However, the following
summarizes that content:
• Placement Changes: Transitions will never advise or give
permission for a child to be removed from a placement. Our role is
to assess the home and make recommendations that will help
establish permanency and help foster parents and relative
placements access the supportive services they need in order to
preserve placements.
• Independent Living: Transitions home study providers will assess
the prospective parents capacity to develop independent living
skills with children in their care. In addition, the home study makes
appropriate recommendations for the education and support of
foster parents to development new capacities that will encourage
independent living skills in children.
• Maintaining Cultural and Racial Connections: Transitions home
study providers will assess the family's ability and willingness to
maintain the cultural and racial identity of the children in their care.
Transitions will help prospective foster care providers access
community resources where applicable through recommendations
and conditions.
• Monthly Face-to-Face Visit with Caseworkers: Transitions home
study providers will emphasize to prospective foster famlilies the
importance of communication and collaboration with the
Department . Home study providerrs will reinforce the requirement
of monthly face-to-face contacts between caseworkers and foster
children and encourage foster parents to be proactive in
maintaining this contact with the Department.
• Timely Initial Assessment within Two Weeks of Placement:
Transitions will assess the potential foster family's ability and
willingness to complete medical and dental appointments for each
child placed in their care within the alloted time (2 weeks for
medical and 8 weeks for dental).
• Health Needs Identified and Services Provided: Transitions will
assess the potential foster family's awareness and willingness to
communicate with caseworkers in identifying health needs and
services of children and adolescents in their care.
• Bid#006-MH-07 (RFP#006-00), Mental Health, Responses:
Recommendation: The approved bidder will pursue bilingual
interpretersAranslators/staff in order to better serve bilingual and monolingual
clients. This may include offering incentives, accommodations, and
encouragement to Spanish bilingual interpreters, translators, and staff.
1. Transitions has one bilingual provider available for mental health
assessments and interaction assessments. Transitions continues to seek
•
COent#:47194 TRAPS
ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE
PRODUCER E(MMDOPITY )
009107
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood&Peterson Ins.Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O.Box 578 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W.18th Street
Greeley,CO 60632 _INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Travelers Insurance Company
TRANSITIONS PSYCHOLOGY GROUP,LLC INSURER B: Pinnaeol Assurance
804 11TH AVE
GREELEY,CO 80631 INSURER C:
INSURER D:
INSURER E:
COVERAGES
•
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
'MN ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR N5RCDATEIMMIDDIy]1
DATE NAMIQO/YYI LIMITS
A GENERAL LIABILITY I6804808C710COF07 05/04/07 05/04/08 EACHOCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY PRA MSFS(R RENTED
a 1 $300,000
CLAIMS MADE nOCCUR MED EXP(My we person) $5,000
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE :2,000,000
GENT AGGREGATE^ LIMIT APPLIES PER, PRODUCTS-COMP/OP AGO $2,000,000
7 POLICY` I n LOC
A AUTOMOBILE LIABILITY BA-62110612-07SEL 05/04/07 05/04/08 COMBINED SINGLE LIMIT
X ANY AUTO (Ee accitlenl) $1,000,000
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS $
Wee fro/Ion)
X HIRED AUTOS
X NON-OWNED AUTOS BODILY INJURY
(Per ILY IeJ)
PROPERTY DAMAGE $
(Per oxidant)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
1 ANY AUTO
OTHER THAN EA ACC S
AUTO ONLY: AC+G $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR n CLAIMS MADE AGGREGATE $
S
DEDUCTIBLE $
RETENTION S
B WORKERS COMPENSATION AND 4104451 05/01/07 05/01/08 X I TtWitai I I FR EMPLOYERS'LIABILITY
ANY PROPRIETORJPARTNEFVEXECUTNE E.L EACH ACCIDENT f1OO,000
OFFICER/MEMBER EXCLUDED?
U dosalbe p,aer EL.DISEASE-EA EMPLOYEE 5100,000
SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE.HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Weld County Department DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _in_ DAYS WRITTEN
Department of Social Services NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
PO Box A IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
Greeley,CO 80632 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25(2001108)1 of 2 #380507 - VLG.-. o ACORD CORPORATION 1988
Healthcare Providers Service I'
c(�
CNA Organization Purchasing Group III CNA Plaza, Certificate ofJnurauci -- — .—
Chicago,IL 60685
OCCURRENCE POLICY FORM
Producer I Branch I Prefix 1 Policy Number Policy Period
from: 12:01 AM Standard Time on: 12/01/06
018098 970 HPG 272935313-8 to: 12:01 AM Standard T3lse on: 12/01/07
Program Administrator
Named Insured and Address Healthcare Providers Service Organization
NORMA A ALKIRE
4913 W 12Th STREET RD
GREELEY CO 80634-2216
159 East County Line Road
Hatboro, PA 19040-1218
Codc• Insurance Provided by
Medical Specialty: 72990 American Casualty Co. of Reading, PA
Marriage/Family Counselor
333 Wabash Avenue Chicago, IL 60604
l COVERAGE PARTS
LIMITS OF LIABILITY I
A.PROFESSIONAL LIABILITY
Professional Liability $1,000,000.00 each claim $3,000,000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B. Coverage Extensions
License Protection $10,000.00 per _Aroceedinct $25,,000.00 aggregate
Defendant Expense Benefit
$10,000.00 aggregate
Deposition Representation $2,500.00 per deposition $5,000.00 aggregate
Assault $10,000.00 per incident $25,000.00 aggregate
Medical Payments $2,000.00 per person $2,500.00$100000.00 aggregate
aggregate
First Aid
Damage to Property of Others $500.00 per incident $10,000.00 aggregate _
C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy.
Workplace Liability Included in A. Professional Liability Limit shown above
Fire and Water Legal Liability Included above subject to $150,000 sub-limit
Personal Liability 1 $1,000,000.00 aggregate
D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of i is policy.
Workplace Liability None
Hired Auto & Non Owned Auto None
Fire & Water Legal Liability
None None
None
Personal Liability
Total Premium $120.00 Premium reflects employed,full-time rate.
Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 - •
G-121500-C 0-121501-C 0-121503-C G-145184-A 0-147292-A G-144872=A'G-123846-COS-
IioaULcara Providers Service Orgartiz>don is a division of Affinity
Insurance Services.Inc-;in NY and NH.MS Affinity Inannttce Agency in JAN and OK.MS Affinity insurance
Agency,Inc.;and in CA.MS Affinity Insurance Agency,Inc.dbe Aon Direct Insurance Adminiatrda[a License 1$0795465.
Master Policy: 188711433
Yievutit/04-k- Keep this document in a safe place. This and
your cancelled check act as proof of coverage.
CI-h./L. kil.Alte 4(
Chairman of the Board Secretary
,r--. Healthcare Providers Service -,,
4 NA Orgganization Purchasing Grout ®HPSO
CNA Plaza, (lerttfttafle of �u$urauce .i.r...a..w+'..wwo.r ..es-
Ctaic.aga u.60685
OCCURRENCE POLICY FORM
Producer Branch Prefix Policy Number Policy Period
from: 12:01 AM Standard Time on: 07/04 06
018098 970 HPG 270360326-8 to: 12:01 AM Standard Time on
Named Insured and Address Program Administrator
Healthcare Providers Service Organization
CHRISTINA H HIRATZKA 159 East County Line Road
7205 POUDRE RIVER RD UNIT 3 Hatboro, PA 19040-1218
GREELEY CO 80 634-937 5 Code: Insurance Provided by
Medical Specialty:
Ctieialtammwkr/LPCC 72990 American Casualty Co. of Reading, PA
CNA Plaza 26S Chicago, IL 60685
COVERAGE PARTS LIMITS OF LLABI 1TY
A.PROFESSI -�,r._�---— --
Professional Liability $1,000,000.00 each claim $3,000,000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B.Coverage Extensions
License Protection $5,000.00 per proceeding $12,500.00 aggregate
Defendant Expense Benefit $5,000.00 aggregate
Deposition Representation $1,250.00 per deposition $2,500.00 aggregate
Assault $5,000.00 per incident $12,500.00 aggregate
Medical Payments $1,000.00 per person $50,000.00 aggregate
First Aid $1,250.00 aggregate
Damage to Property of Others $250.00 per incident $5,000.00 aggregate
C. WORKPLACE LIABILITY CoveraF part C. does not apply if Coverage part D. is made part of this policy.
Workplace Liability Included in A. Professional Liability Limit shown above
Fire and Water Legal Liability Included above subject to $150,000 sub-limit
Personal Liability I $500,000.00 aggregate
D.GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy.
-Workplace Liability -- -— — - - None— ._ - — None
Hired Auto & Non Owned Auto None
Eire & Water Legal Liability •
None None
Personal Liability I None
Total Premium $158.00
Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491
G-121500C G-121501C G-121503C G-145184-A G-147292-A G-144872-A G-123846C-05
Healthcare Providers Service Organization is a&viron of Affinity lunuaone Services.loc.:9t NY and NIL MS Affinity immance Agency.in MN ad OK.AIS Affinity tamaa
Agency.Inc;and in CA.MS Minty leatrance Agency.Inc.as Aon Direct aamace Admmi.tllatLicense#0795065.
Master Policy: 188711433
� J Keep this document in a safe place. This and
Vlrh_,hii/ 1`+"L your cancelled check act as proof of coverage.
ktwt.
Chairman of the Board Secretary
Certificate of Insurance(Proof of Coverage) Date Issued:(6/29/2006)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
1 Insured Name and Mailing Address* Program Administrator
Name Charles A.Howard Administered By:CPH and Associates
Street 804 Eleventh Ave 711 S.Dearborn,Suite 205
Chicago,IL 60605
City Greeley Underwritten By:
State CO Philadelphia Indemnity Insurance Company
Zip 80631 __ _ _
*Additional insured locations are often requested by individual business owners who have more than one office.
Your coverage is portable,meaning that you are covered at any location for practice under the occupation(s)listed on your policy.
- Coverage
olicy#:PHCP039718 -lE festive Date:(6/18/2006) --_ `Expiration Date
POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
ICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
SPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES
ESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS
HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Limits of Liability
Each Occurrence Aggregate
(Per individual claim) (Total amount per policy year) Coverage Part
$1,000,000.00 $3,000,000.00 Professional Liability
$1,000,000.00 $3,000,000.00 Supplemental Liability
Includes:
A)Bodily Injury and Property Damage
B) Personal Injury
Unlimited Unlimited Defense Expense Coverage
$25,000 p $25,000 State Licensing Board Investigation Expense Coverage i
S5,000 _ $5,000 —�— Assault Coverage
$5,000 i 515,000 Deposition Expense Benefit
S2,500/person1.$25,000 _ Medical Expense Coverage i
•
_•
$2,500 $2 500 First Aid Coverage j
Certificate Holder Cancellation 1
Proof of Coverage hould any of the above described policy be cancelled before the expiration date
hereof,the issuing insurer will endeavor to mail 30 days written notice to the i
ertificate holder named to the left,but failure to do so shall impose no obligation
r liability of any kind upon the insurer,its agents or representatives.
Holder has also been added to the policy as an �Aathorized Representative
additional insured:** i i
_Yes/XN0 IC.Philip Hodson
**If the certificate holder is an ADDITIONAL INSURED,the i 1
policy(ies)must be endorsed.A statement on this certificate i I
does not confer rights to the certificate holder in lieu of such i i
endorsement(s). i
DISCLAIMER:The Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,
and the certificate holder,nor does it affirmatively or negatively amend,extend,or alter
the coverage afforded by the policies listed thereon.
Healthcare Providers Service
CNA ( Organization Purchasing Group ®1 11 SQ
ChicagCNA o ` rttft.cat.e Df 3lt curauc.�
OCCURRENCE POLICY FORM
Producer Branch Prefix Policy Number Policy Period
from: 12:01 AM Standard Time on: 07/04/07
018098 970 HPG 270170686-8 to: 12:01 AM Standard Time on: 07/04/08
Named Insured and Address Program Administrator
Healthcare Providers Service Organization
GREGORY S CREED 159 East County Line Road
804 11TH AVE Hatboro, PA 19040-1218
GREELEY CO 80631-3246
Medical Specialty: Code: Insurance Provided by
Clinical Counselor/LPCC 72990 American Casualty Co. of Reading, PA
333 Wabash Avenue Chicago, IL 60604
COVERAGE PARTS LIMITS OF LIABILITY
A. PROFESSIONAL LIABILITY
Professional Liability $1,000,000.00 each claim $3,000,000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B. Coverage Extensions
License Protection $10,000.00 per proceeding $25,000.00 aggregate
Defendant Expense Benefit $10,000.00 aggregate
Deposition Representation $2,500.00 per deposition $5,000.00 aggregate
Assault $10,000.00 per incident $25,000.00 aggregate
Medical Payments $2,000.00 per person $100,000.00 aggregate
First Aid $2,500.00 aggregate
Damage to Property of Others $500.00 per incident $10,000.00 aggregate
C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy.
Workplace Liability Included in A. Professional Liability Limit shown above
Fire and Water Legal Liability Included above subject to $150,000 sub-limit
Personal Liability I $1,000,000.00 aggregate
D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy.
Workplace Liability None - None
Hired Auto & Non Owned Auto None
Fire & Water Legal Liability None None
Personal Liability j None
Total Premium $317.00 Premium reflects self-employed,full-time rate.
Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491
G-121500-C G-121501-C G-121503-C G-145184-A G-147292-A G-144872-A G-123846-005
Heakhcare Providers Service Organization is a division of Affinity Insurance Services,Inc.:in NY and NIL AIS Affinity Insurance Agency,in MN and OK,AIS Affinity Insurance
Agency,Inc.;and in CA.AIS Affinity Insurance Agency.Inc.dba Aon Direct Insurance Administrators License#0795465.
Master Policy: 188711433
9V_ ,/L/LA 4- Keep this document in a safe place. This and
frYL.
/ im^p your cancelled check act as proof of coverage.
.asp• Chairman of the Board ,, Secretary‘M'_Ta7761'-A' !7 '604 XX 0000D66-R 070321 RENHCP4/06'.R1N7Rl1CSE 07085 - ' -
Healthcare Providers Service
CNA Organization Purchasing+Group
{y+� P ®uPCO
CNA Plat.'., Certificate i f J rn ■r ■ ,c M.a4f<.nlPwwlder.5•r.J
Cl�i•:ugo,IL 60685 i� K i
OCCURRENCE POLICY FORM
Producer Branch Prefix Policy Number Policy Period
from: 12:01 AM Standard Time on: 04/10/07
018098 970 HPG 289232788-8 to: 12:01 AM Standard Time on: 04/10/08_
Named Insured and Address Program Administrator
Healthcare Providers Service Organization
DENETTE JANUS 159 East County Line Road
804 11TH AVE Hatboro, PA 19040-1218
GREELEY CO 80631-3246
Medical Specialty: Code: Insurance Provided by
Mental Health Counselor 72990 American Casualty Co. of Reading, PA
333 Wabash Avenue Chicago, IL 60604
COVERAGE PARTS LLMITS OF LIABILITY
A. PROFESSIONAL LIABILITY
Professional Liability $1,000,000.00 each claim $3,000,000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B.Coverage Extensions
License Protection $10,000.00 per proceeding $25,000.00 aggregate
Defendant Expense Benefit $10,000.00 aggregate
Deposition Representation $2,500.00 per deposition $5,000.00 aggregate
Assault $10,000.00 per incident $25,000.00 aggregate
Medical Payments $2,000.00 per person $100,000.00 aggregate
First Aid $2,500.00 aggregate
Damage to Property of Others $500.00 per incident $10,000.00 aggregate
C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy.
Workplace Liability Included in A. Professional Liability Limit shown above
Fire and Water Legal Liability Included above subject to $150,000 sub-limit
Personal Liability I $1,000,000.00 aggregate
D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy.
Workplace Liability None None
Hired Auto & Non Owned Auto None
Fire & Water Legal Liability None None
Personal Liability I None
Total Premium $120.00 Premium reflects employed,full-time rate.
Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491
G-121500-C G-121501-C G-121503-C G-145184-A G-147292-A G-144872;4 G-123846-005
Healthcare Providers Service Organization is a division of Affinity Insurance Services,Inc.;in NY and NH,AIS Affinity Insurance Agency,in MN and OK.AIS Affinity Insurance
Agency,Inc.;and in CA,AIS Affinity Insurance Agency.Inc.dba Ann Direct Insurance Administrators License#0795465.
Master Policy: 188711433
20-4/A Keep this document in a safe place. This and
Ay4.
7 jv`11 your cancelled check act as proof of coverage.
• Chairman of the Board Secretary
• " G-T4F24T-A '1'74200 1 1 ,.. 604 'XX' 0000049-R 070102 RENHCP4/06 R1N7NNCSE 07002 •
CNA Healthcare Providers Service
�� y. Organization yy of
QG�roouupyy�.yr ®HPSO
CNA Plaza, �./e t l�L `sate it f 4 L 7J.41.L-anre ••�•,.r....:�..s ao-.,..,..-
Chicago,IL 60585
OCCURRENCE POLICY FORM
I Producer Branch Prefix Policy Number Policy Period
from; 12:01 AM Standard Time on: 07/04/07
018098 970 HPG 270170798-8 to: 12:01 AM Standard Time on: 07/04/08
Named Insured and Address Program Administrator
Healthcare Providers Service Organization
JAMI MOE HARTMAN 159 East County Line Road
804 11TH AVE Hatboro, PA 19040-1218
GREELEY CO 80631-3246
Medical Specialty: Code: Insurance Provided by
Clinical Counselor/LPCC 72990 American Casualty Co. of Reading, PA
333 Wabash Avenue Chicago, IL 60604
COVERAGE PARTS LIMITS OF LIABILITY
A. PROFESSIONAL LIABILITY•
Professional Liability $1,000,000.00 each claim $3,000,000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B. Coverage Extensions
License Protection $10,000.00 per proceeding $25,000.00 aggregate
Defendant Expense Benefit $10,000.00 aggregate
Deposition Representation $2,500.00 per deposition $5,000.00 aggregate
Assault $10,000.00 per incident $25,000.00 aggregate
Medical Payments $2,000.00
First per person $100,000.00 aggregate
Aid
$2,500.00 aggregate
Damage to Property of Others $500.00 per incident $10,000.00 aggregate
C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy.
Workplace Liability Included in A. Professional Liability Limit shown above
Fire and Water Legal Liability Included above subject to $150,000 sub-limit
Personal Liability
$1,000,000.00 aggregate
D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy.
Workplace Liability None None
Hired Auto & Non Owned Auto None
Fire & Water Legal Liability None None .
Personal Liability I None
Total Premium $317.00
Premium reflects self-employed,full-time rate.
Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491
I
G-121500-C G-121501-C G-121503-0 G-145184-A G-147292-A G-144872-A G-123846-005 j
Healthcare Providers Service Organization is a division of Affinity Insurance Services,Inc.:m NY mid NIL AIS Affinity Insurance Agency,in MN and OX.MS Affinity Insurance
Agency,Inc.;and in CA,AIS Affinity Iasunnce Agency,Inc.dba Aon Direct Insurance Administrator;License#0795465-
Master Policy: 188711433
(6)4/1/ill
\ a .l f Keep this document in a safe place. This and
kV}y �}�V //v your cancelled check act as proof of coverage.
Chairman of the Board Secretary
' J._1A ill'A l_a' to in-i 11 y" .404 .XX 0000067-R 070326 RENHCP4/06 R1H7HHCSE 07085
•
Account Number: CO NOBC 2620 Date: 10/04/06 Initials: DMM
CERTIFICATE OF INSURANCE
AMERICAN HOME ASSURANCE CO.
C/O: American Professional Agency, Inc.
95 Broadway, Amityville, NY 11701
This is to certify that the insurance policies specified below have been issued by the company indicated
above to the insured named herein and that, subject to their provisions and conditions, such policies afford
the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s)
as stated.
THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR
ALTERS THE COVERAGES) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE.
Name and Address of Insured: Additional Named Insureds :
CAROLE JEAN NOBLITT
2627 18TH AV
GREELEY CO 80631
Type of Work Covered: PROFESSIONAL SOCIAL WORKER
Location of Operations: N/A
(If different than address listed above)
Claim History:
Policy Effective Expiration Limits of
Coverages Number Date Date
Liability
PROFESSIONAL/
1, 000, 000
LIABILITY SWL-0957031 10/01/06 10/01/07 3, 000, 000
NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS
POLICY AND HE OR SHE SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING
OR RECEIVING NOTICE OF CANCELLATION.
Comments:
This Certificate Issued to:
Name: CAROLE JEAN NOBLITT
2627 18TH AV _..
Address:
GREELEY CO 80631
Au orized Representative
Healthcare Providers Service
CNAOrganization Purchasig Group p H PSO
CNA Plaza, (Certificate o f ;01-teuraxtre H.rnK.m r...u..,s.nio.Orpri.,naa-
Chicago,IL 60665
OCCURRENCE POLICY FORM
Producer Branch Prefix Policy Number Policy Period
from: 12:01 AM Standard Time on; 02/01/06
018098 970 HPG 281668374-8 to: 1201 AM Standard Time on: 02/01/07 _
Named Insured and Address Program Administrator
Healthcare Providers Service Organization
ROSANN M ROSS 159 East County Line Road
3931 PUEBLO ST Hatboro, PA 19040-1218
EVANS CO 80620-3006
Medical Specialty: Code: Insurance Provided by
Licensed Professional Counselor 72990 American Casualty Co. of Reading, PA
i
CNA Plaza 265 Chicago, IL 60685
COVERAGE PARTS LIMITS OF LIABILITY
A. PROFESSIONAL LIABILITY
Professional Liability $2.000.000.00 each claim 53,000,000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B. Coverage Extensions
I4 cense Protection 55.000.00 per proceeding $12,500.00 aggregate
Defendant Expense Benefit $5,000.00 aggregate
Deposition Representation $1,250.00 per deposition $2,500.00 aggregate
Assault 55.000.00 per incident 512.500.00 aggregate
Medical Payments $1,000.00 per person $50,000.00 aggregate
First Aid $1,250.00 aggregate
Damage to Property of Others $250.00 per incident 55.000.09 aggregate
C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy.
Workplace Liability Included in A. Professional Liability Limit shown above
Fire and Water Legal Liability Included above subject to $150,000 sub-limit
Personal Liability I $500.000.00 aggregate
D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy.
Workplace Liability None None
Hired Auto & Non Owned Auto None
Fire & Water Legal Liability None None
Personal Liability I None
Total Premium $100.00
Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491
G-121500C G-121501C G-121503C G-145184-A G-147292-A G-144872-A G-123846C-05
Healthcare Providers Service Organisation is a division of Affinity Insurance Services,Inc.;in NY and Nit AIS Affinity Insurance Agency,in MN and OK,AIS Affinity Insurance
Agency,Inc.;and in CA MS Affinity Insurance Agency,Inc.dba Aon Direct Insurance Administrators License#0795465.
Master Policy: 188711433
9J- 44ii/I n' Keep this document in a safe place. This and
(� your cancelled check act as proof of coverage.
.AY6. e.0,. ill
Chairman of the Board Secretary
' .: . . Vv.
Annnn1o_o ncftn7 RRNHCP5/05 R1N6HM 05391 .
__ _
Certificate of Instaiance (Proof of Coverage) Date Issued: 1/19/2006
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Insured Name and Mailing Address* Program Administrator
Veronica Rivera Administered By:
CPI and Associates
1400 W. Elizabeth St Apt 146 711 S. Dearborn, Suite 205
Fort Collins, CO 80521 Chicago, IL 60605
`Additional insured locations are often requested by individual
business owners who have more than one office. Your coverage is Underwritten By:
portable,meaning that you are covered at any location for practice Philadelphia Indemnity Insurance Company
under the occupation(s)listed on your policy.
Coverage
Policy#: PHCT061477 Effective Date: 01/17/06 Expiration Date: 01/17/07
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
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Limits of Liability
EACH OCCURRENCE AGGREGATE Coverage Part
(Per individual claim) (Total amount per policy year)
$1,000,000 $3,000,000 Professional Liability
Supplemental Liability
$1,000,000 $3,000,000 Includes:
A)Bodily Injury and Property Damage
B) Personal Injury
Unlimited Unlimited Defense Expense Coverage
State Licensing Board
$25,000 $25;000
Investigation Expense Coverage
$5,000 $5,000 Assault Coverage
$5,000 $15,000 Deposition Expense Benefit
$2,500/person $25,000 Medical Expense Coverage
$2,500 $2,500 First Aid Coverage
Description/Special Provisions:
Certificate Holder Cancellation
Should any of the above described policy be cancelled before the expiration date
thereof,the issuing insurer will endeavor to mail 30 days written notice to the
certificate holder named to the left,but failure to do so shall impose no obligation
PROOF OF COVERAGE or liability of any kind u on the insurer,its agents or representatives.
Holder has also been added to the policy as an Authorized Representative
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DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or
producer,and the certificate holder,nor does it affirmatively or negatively amend,extend,or alter the coverage afforded by the policies
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VaS®IPIOA PURCHASING GROUP
CERTIFICATE OF INSURANCE
OCCURRENCE POLICY FORM
018098 970 I-1PG 0 8�0 002 tram:12:O1 AM SYarutard rime or,-oajot/n6
to: 12:01 AM Standard Time on: 1/06
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Eaton, CO 80615 Hatboro, PA 19040-1218
Medical Specialty:
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CNA Plaza 263 Chicago, IL 60685
A. PROFESSIONAL LIABILITY
Professional Liability(PL) $ 1,000,000 each claim $ 3,000,000 aggregate
Good samaritan Liability included above _-- - . ..�..._=-.�--� rte-;_ -:
Personal Injury Liability— ^
on - included above _
a aceme la 1 1 included above k"-== =y--< =_'
B. COVERAGE EXTENSIONS:
License Protection $ -0- _- .•r oceedi -
Defendant � --- -- 1-.10,000
_-_aggregate _
Deposition Representation $ • g per .eposition $ 5,0C aggregate
Assault $ 10,000 per inadent S 25,000 aggregate
Medical Payments $ O _r . rson $ 0 aggregate
First Aid 2,500 aggregate
Damage to Property of Others $ 500 _-_ per inadent $ 10,000 aggregate
C. WORKPLACE LIABILITY Coverage part C.workplaoe Liability does not apply if Coverage part D.General Liabltity is made pert of this policy.
Workplace Liability _-- none - - - -
Fire&Water Legal Liability none -- -
Personal Liability :a-= :;_ � -T,� r one
D. GENERAL LIABIUTY COVintagte par D.General Liability does not apply if Coverage pert C.Workplace Liability is made pert of this policy.
General Liability(GL) none --__ __ none _--. --______
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Total Premium: $ '2 9 . 0 0 QUESTIONS?CALL: 1-800-b82-9491 —
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Keep this document in a safe place. tt and proof of payment are evidence ot your insurance coverage.
ify")„,----(4._ kaz_......t.,„ ilf
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Chairman of the Board ?
Secretary
G-141241-A (07/2001) Coverage Change Date: Endorsement Change Date:
Jami Moe-Hartman, MA, LPC
Transitions Psychology Group, LLC
804 11"'Avenue
Greeley, CO 80631
(970)336-1123
Licensed Professional Counselor August 1999 to present
State of Colorado, License#2296
National Board Certified Counselor April 1999 to present
American Counseling Association Member 2002 to present
EDUCATION
Master of Arts in Community Agency Counseling August 1995
University of North Dakota, Grand Forks, ND
• ND Board of Higher Education Tuition Waiver Scholarship
• G.P.A. 4.0/4.0
Bachelor of Arts in Psychology May 1991
University of North Dakota, Grand Forks, ND
• Minors in Chemical Use/Abuse Awareness and Visual Arts
• Phi Beta Kappa
PROFESSIONAL EXPERIENCE
Counselor/Co-Director October 2001 to present
Transitions Psychology Group, LLC, Greeley, CO
• Develop and implement agency programs
• Conduct assessments of foster and adoptive homes
• Provide expert testimony in court
• Provide individual and family therapy •
• Specialize in treatment of children, including play therapy
• Provide therapeutic parent training, parenting education and life skills training
• Coordinate services with multidisciplinary team and other agencies
• Serve on community boards
Therapist March 1999 to September 2001
North Range Behavioral Health/Child& Family Services Team, Greeley, CO
• Provide individual, group and family therapy, including intensive in-home family
therapy and outpatient services
• Develop and implement treatment plans
• Coordinate services with other agencies
• Provide court testimony
Substance Abuse Counselor July 1998 to October 1999
ARC Counseling Center, Greeley, CO
• Facilitate substance abuse education, anger management and relapse prevention
therapy groups for court ordered adults (July 1998- March 1999)
• Substitute as facilitator of relapse prevention groups (March 1999—October 1999)
• Provide progress reports to law enforcement and courts.
Mental Health Therapist August 1996 - March 1999
North Range Behavioral Health/Children's Acute Treatment Unit, Greeley, CO
• Provide intensive individual, group and family therapy to children and adolescents in
a residential setting.
• Coordinate services with other agencies
• Develop and implement treatment plans
• Assist in the development and management of the therapeutic milieu
• Supervise clinical care assistants
Family Advocate February 1995 July 1996
Domestic Violence and Rape Crisis Center, Dickinson, ND
• Assist in the development of policies, procedures and program services
• Facilitate education/therapy groups for children and adolescents
• Recruit, train and supervise children's group volunteers
• Conduct public education seminars
• Assist with grant writing and the compilation of statistics and reports
• Develop, plan and execute fundraising events
• Serve as the local coordinator for statewide criminal justice system monitoring
project
• Represent agency on community boards
• Provide case management services to families utilizing the shelter facility
• Provide crisis intervention services, information, referrals and advocacy to victims of
physical/emotionalsexual abuse
Victim Advocate July 1994 -February 1995
Community Violence Intervention Center, Grand Forks, ND
• Provided individual therapy to victims of physical/sexual/emotional abuse
• Facilitated an education/therapy group for victims of domestic violence
• Screened and assisted persons applying for protection orders and disorderly conduct
restraining orders; provided court advocacy; drafted permanent orders
• Conducted public education seminars and assisted in training volunteers
CONTINUING EDUCATION
Child Family Investigator Training Program, Katz and Loizeaux Forensic Services, LLC,
October, 2006, 40 hours.
Training areas included CFI standards, legal foundations, attachment, child development,
divorce research, overnights and relocation, assessment, high conflict and parent alienation,
child abuse, domestic violence, substance abuse, adult psychopathology and parenting,
developing parenting plans, courts and expert testimony, and ethics.
Preserving Connections for Children:How to Develop Effective Visits, Colorado
Department of Human Services, September 2005, 14 hours.
Training areas included legal, benefits, child development, parenting skills, concurrent planning,
abuse, attachment and treatment.
Structured Analysis Family Evaluation(SAFE),October, 2005, 14 hours.
SAFE Supervisor Training, April, 2006, 7 hours.
Training on the state mandated instrument for home assessments, including practice values,
psychosocial inventory and home study. Supervising other using the SAFE assessment.
Juvenile Sex Offenders, The Juvenile Sex Offender Resource Committee/Progressive
Therapy Services, April, 2005, 3 hours.
The Hard Luck Life: A New Approach to Understanding Bonding and Relationships,
Charles Howard, PhD, March 2004, 1.5 hours
Annual Play Therapy Conference, Colorado Association for Play Therapy, April 2004, 15
hours.
Using Play Therapy for Critical Incident Debriefing with Children and Families, Symbolism and
Metaphors in Play Therapy, Release Play Therapy,
Gregory S Creed
Transitions Psychology Group, LLC
804 11th Avenue, Greeley, CO 80631
Tel(970) 336-1123 FAX(970) 351-0182 Cell (970) 590-1424
e-creed@comcast.net
Highlights of Qualifications
• Doctoral level marriage and family therapist with over 8 years experience
• Licensed Professional Counselor&National Certified Counselor
• Professional training in family systems therapy
• Proficient in Spanish and Japanese with highly develop cultural competencies.
Relevant Experience
Sept 1999-Pres Agency Co-Director& Marriage and Family Therapist,
Transitions Psychology Group, LLC
• Provide high quality marital and family therapy
• Supervise counselors on several programs
• Perform administrative functions for the agency
Jan 99-Aug 99 Counselor/Case Manager,North Range Behavioral Health,
1306 11th Avenue, Greeley, CO 80631
• Provided in-home therapy services for family preservation
referrals from DSS and for an interagency collaborative
program
• Maintained productive working relationships with caseworkers
from DSS
• Conducted therapy with Spanish speaking families
• Produced positive outcomes with families and individuals
Jan 98-Dec 98 Internship,North Range Behavioral Health, 1306 11th
Avenue, Greeley, CO 80631
• Family, group and individual therapy with children,
adolescents, and adults
• Experience with family preservation, HeadStart and outreach
programs
• Case consultation with parents,teachers and program directors.
1996-1998 Program Coordinator, Center for International Education,
UNC, 1945 10th Avenue, Greeley, CO 80639
• Coordinate cross-cultural programming campus-wide
• Facilitate retention programs for international students
• Direct home stay program for Japanese students
1994-1996 Assistant Language Teacher,Kyoto City Board of Education,
Oike-Teramachi,Nakagyo-ku, Kyoto 616,Japan
• Taught English to high school students in team-teaching format
wit Japanese teachers
• Encouraged Japanese teachers to be model learners of English
and to explore new methods of teaching
• Designed teaching materials and teaching plans
• Helped team to develop new pilot English course
1990-1996 Owner&Instructor,Gregory's English School,Kyoto,Japan.
• Taught 35 sutdents weekly in small groups,parent/child classes
and in individual sessions
• Helped demystify the learning process for students and helped
them to develop a taste for self-guided learning
1989-1990 Spanish Instructor,Aims Community College, Greeley, CO
198-1988 Assistant English Teacher, Japan Exchange and Teaching
Program,Kyoto Prefectural Research and Training Center,Nishi-
machi,Morinagato,Momoyama,Fushimi-ku, Kyoto,Japan
• Presented seminars and training workshops to Japanese
educators
• Taught English to high school students
• Regional representative for Assistant English Teacher
Association
Education
Ph.D.,Counselor Education& Supervision,2006
M.A., Community Counseling,Marriage&Family Emphasis,
University of Northern Colorado, 1999
B.A., McPherson College,McPherson, Kansas,Business Management& Spanish, 1986
Junior Year Study Abroad,University of Granada,Granadad, Spain 1983-84
Certification & Licensure
Licensed Professional Counselor,#2869
National Certified Counselor
Presentations
A Balancing Act: Strengths& Stressors for Families in Cross-Cultural Transitions,FIGT
(Families in Global Transitions)Annual Confence,March 29-30,2007,Houston,Texas
The Mystery of Parenting Teens,Parent Training Seminar, St Mary Catholic Church Fall
2004 and St Peter Catholic Church Fall 2005
International Relocation: Implications for Families,Poster Session,Rocky Mountain
ACES annual meeting, Oct 5-7, 1989,Jackson, Wyoming
•
Nicole R. Warnygora
Transitions Psychology
EDUCATION Doctor of Philosophy: School Psychology,2004
University of Northern Colorado,Greeley, Colorado 'Graduate Deans Citation for Excellence'
Master of Arts:Agency Counseling: Marriage and Family Therapy,August 1997
University of Northern Colorado, Greeley,Colorado
Bachelor of Arts: Major: Psychology Minor: Political Science, May, 1993
Augsburg College, Minneapolis,Minnesota
EXPERIENCE Licensed Professional Counselor
Transitions Psychology Group, Greeley, Colorado (11/03 —Present)
• Developed a program to provide therapeutic supervised visitation Weld County Department of
Social Services using the State of Colorado Program Improvement Plan
• Provided therapeutic supervised visitation and documentation of client progress
• Conducted comprehensive home studies to evaluate prospective adoptive and foster homes for
the State of Colorado
• Conducted comprehensive psychological evaluations
• Coordinated services with social services agencies across the state of Colorado
School Psychologist
Poudre School District,Fort Collins,Colorado(08/02—05/2005)
• Conducted comprehensive psychological as--r sments of students ages preschool through high
school
• Consulted with parents and teachers to best meet the educational needs of students
• Counseled students with a variety of concerns
• Actively participated in Student Teacher Assistant Team
• Participated in the Poudre School Districts Multicultural Assessment Team
School Psychologist Intent
Poudre School District,Fort Collins, Colorado(8/01- 08/02)
• Assessed students with leaning disabilities,traumatic brain injuries,developmental disabilities
and emotional disturbances ranging in age from preschool through high school
•
• Facilitated a social skills group for students with emotional disturbances
• Conducted a program evaluation of a twice-exceptional program to determine program
efficacy
• Participated in the Poudre School District Multicultural Assessment Team
Licensed Professional Counselor
Poudre Valley Hospital, Fort Collins,Colorado(Summer,2002; Summer, 2003; Summer, 2004)
• Conducted emergency psychiatric assessments to determine if hospitalization was nerPcsary
• Provided consumers with resources to arrP_ss mental health services
• Responded, assessed, and made appropriate referrals for crisis phone calls
Warnygora,Page#2
Licensed Professional Counselor
•
Ackerman and Associates,Greeley, Colorado (5/99-8/01)
• Counseled children and families who were involved with Weld County Department of Social
Services
• Assessed children and families as a part of child custody evaluations
• Developed and presented foster parent training workshops
• Provided court ordered mediation services to couples and families
Mental Health Therapist
North Range Behavioral Health, Carson Children's Center/Children's Acute Treatment Unit,
Greeley,Colorado(6/97-7/99)
• Provided individual therapy to children in day treatment and residential treatment
• Evaluated, diagnosed,and created treatment plans for children and families
• Facilitated children's groups and parent support groups
• Testified as an expert witness in court
Child and Family Therapist Intern
North Range Behavioral Health,Greeley, Colorado (1/97-7/97)
• Provided individual therapy to children and provided family therapy
• Provided services to a diverse population including deaf clients
• Counseled clients in crisis
Graduate Assistant/Test Supervisor
Career Services,University of Northern Colorado, Greeley,Colorado(8/95-6/00)
• Coordinated national testing program including administrations of the ACT, SAT, and GRE
• Trained hired and supervised nine personnel
Habilitation Counselor/Coordinator
Paragon Services Incorporated, Duluth, Minnesota(1/94-8/95)
*Developed programs to assist dual diagnosis clients to achieve independence
• Supported families with children with emotional disturbances or developmental delays to
remain in their family home
• Supervised and trained staff
Program Coordinator
Nekton Services Incorporated,Duluth,Minnesota(7/93-12/93)
• • Coordinated the set-up of a group home for three autistic young women
• Developed program plans and daily activities
• Supervised,scheduled,and trained staff
• Designed a training manual and trained staff people in functional American Sign Language
PRESENTATIONS/
WORK SHOPS Davis,A. &Wamygora,N. (2002). Utilizing a comprehensive neuropsychological
assessment in the schools. 33'"Annual NASP Convention.
Davis,A.&Wamygora,N. (2001). Utilizing a comprehensive neuropsychological
assessment in the schools. Poster Presentation at 32°°Annual NASP Convention.
Wamygora, Page#3
•
Ackerman,J.,Jaromillo,E.,&Wamygora,N. (2001). Family group decision-making:
Model,Purpose,and Practice. Department of Social Services Training: Greeley,Colorado.
Wamygora,N. (2001). Love and Logic Parenting. Presented at Foster Parent Training:
Greeley, Colorado.
Ackerman,J., Bromley, S., Wamygora,N.,&Yackley,C. (2000).Team Building: Foster
Parents and Caseworkers. Social Worker Training: Greeley,Colorado.
Bromley, S. & Wamygora,N. (2000). Grief and loss in children and adults. Foster Parent
Workshop: Greeley, Colorado.
Ackerman,J.,Wamygora,N.,Yackley, C. &Jaromillo,E.(2000).Behavior modification
in preschool children: Creating a safe head start. Weld County Head start Fall Training: Greeley,
Colorado
Davis,A. &Wamygora,N.(2000).Neuropsychological Assessment for Intervention: A
step-by-step approach to integrating a neuropsychological approach into an IEP.Colorado
Society of School Psychologists: Breckenridge,Colorado.
Ackerman,J. &Wamygora,N. (2000). Discipline strategies that comply with state foster
parent regulations. Social Worker Training: Greeley, Colorado.
Wamygora,N. (1999). Attention Deficit Hyperactivity Disorder: What it is and what it is
not. Foster Parent Training Workshop: Greeley, Colorado.
Wamygora,N. (1999). Foster Parent Problem Solving Workshop.Foster Parent Training
Workshop: Greeley, Colorado.
Wamygora,N.,Palencia, B.,Amato,R.C. (1999). How Neuropsychology can help
school psychologists. Colorado Society of School Psychologists: Vail, Colorado.
PUBLICATIONS
Wamygora,N.R. (2001 In Press).Hemiplegia. In C.R.Reynolds, &E. Fletcher-Janzen(Eds.)
Diagnostic manual of childhood disorders: Clinical and special education applications.New York,NY:
Wiley.
Wamygora,N.R.,&D'Amato,R.C. (2001 In Press). Chorea. In C.R.Reynolds,&E. Fletcher-
Janzen(Eds.)Diagnostic manual of childhood disorders: Clinical and special education applications.
New York,NY: Wiley.
GRANTS Wamygora,Nicole R. (1998).Special Needs Childcare, United Way of Weld County Grant
$25,000.
TEACHING Teaching Assistant: Practicum in Individual Counseling(Summer 2001)
EXPERIENCE Invited Speaker: Learning Disabilities and Traumatic Brain Injuries(Summer 2001)
Invited Speaker: Practicum in Personality Assessment(Fall 2000)
Teaching Assistant: Learning Disabilities and Traumatic Brain Injuries(Summer 1999)
Teaching Assistant: Practicum in Cognitive Assessment(Spring 1999)
Invited Speaker: Tests and Measurement(Spring 1999)
Wamygora,Page#4
CERTIFICATION/
LICENSES Licensed Professional Counselor, State of Colorado#2304
Nationally Certified Counselor,National Board of Certified Counselors
School Psychologist Professional License,Colorado Department of Education
NORMA ALKIRE , MA , LPC , CACIII
EDUCATION
1995- 1997 Aims Community College Greeley,Colorado
AA Degree,Liberal Arts
1997-1998 University of Northern Colorado Greeley,Colorado
Bachelor of Arts Degree, Sociology Major,Psychology Minor
1999-2001 University of Northern Colorado Greeley,Colorado
Master of Arts Degree, Rehabilitation Counseling/Vocational Evaluation
2002-2004 University of Northern Colorado Greeley,Colorado
Masters of Arts Community Counseling/Marriage&Family Therapy
LICENSURES AND CERTIFICATIONS
CVE Certified Vocational Evaluator #00058987 Exp.3/31/09
NCC National Certified Counselor #89888 Exp.8/31/10
CAC III Certified Addiction Counselor #ACC6430 Exp.6/30/07
LPC Licensed Professional Counselor #LPC4453 Exp.6/30/07
PROFESSIONAL EXPERIENCE
1999-2000 North Range Behavioral Health Greeley,Colorado
Clinical Care Assistant Supervisor,Alice McPherson, M4
• Assisted Master's level counselors with the care and treatment of chronic
mentally ill adults
• Assisted in answering and counseling on a 24-hour crisis line
Nov 2001-April 2003 Transitions Psychology Group
Greeley,Colorado
Mentoring Coordinator Supervisor, Greg Creed,MA,LPC
• Mentored TANF clients
• Provided encouragement and support to clients re-entering the workplace
• Worked with case managers and TANF technicians
• Attended stafrmgs and other relevant meetings
• Completed monthly progress reports
May 2003-April 2004 North Range Behavioral Health—Frontier House
Greeley,Colorado
Rehabilitation Counselor Supervisor,Jennifer Euler, MA
• Assisted adults with mental illness in seeking employment
• Completed monthly summaries with clubhouse members
• Helped clubhouse members in finding community resources
• Provided job coaching
• Developed jobs in the community for clubhouse members
• Attended daily and weekly meetings
4913 12th St Rd. Greeley,Co. 80634
PHONE 970-590-9861 • E-MAIL nonnaalkire@hotmail.COM
Jan 2004-July 2004 NCMC/Psychcare
Greeley,Colorado
Therapist(Intern) Supervisor, Stacey Blank, MA LPC, CAC III
• Facilitated and Co-facilitated adult drug and alcohol groups for both in and
out patients
• Administered Social Assessments to both mental health and substance
abuse adult and adolescent inpatients
• Attended staffings and case conferences with psychiatrists,psychologist and
therapists
• Completed progress notes and other relevant paper work
• Facilitated and Co-facilitated family discharge planning meetings
• Taught parenting classes
• Co-facilitated continuing care group
June 2004—September 2005 Island Grove Regional Treatment Center
Greeley,Colorado
Youth&Family Services Counselor/Research Assistant Supervisors,
Rochelle Galey, MSW, CAC III
Katherine Bryant, MS, CAC II
John Wilde,MA,LAC
• Facilitated adolescent substance abuse and anger management groups
• Conducted substance abuse evaluations,intakes,and discharges
• Completed all relevant paperwork ie:progress notes,substance abuse
evaluations,intakes,discharge summaries,letters,etc.
• Case management
• Collaborated with other treatment and community agencies to meet the
individual needs of clients
• Attended staffings
• Participated in community meetings
• Attended trainings relevant to certification requirements for Certified
Addictions Counselor(CAC)and Clinical Trials Network(CTN)
• Administered baseline and follow-up assessments for CTN research
protocol
• Contacted research participants for follow-up appointments
September 2005-July 2006 Platte Valley Youth Services Center
Greeley,Co.80631
Youth Services Counselor I Supervisor, Gail White, MS
• Provide drug and alcohol treatment for adolescent males committed to DYC
• Facilitate drug and alcohol groups
• Complete all relevant paperwork including TRAILS documentation
• Attend staffings,Parole Board hearings,and other relevant meetings
• Provide case management and transitional services as needed
• Communicate with Parole Officers/Client Manager's,families,and other
counselor's with regard to youth's disposition
• Facilitate family therapy
• Provide(Eye Movement Desensitization and Reprocessing)EMDR therapy
for youth with trauma and substance abuse issues
• Supervise CSO I and CSO II(security officers)pod staff
• Complete PMAP evaluations
• Attend(Sex Offender Management Board)SOMB and other trainings
relevant to job duties
4913 12th St Rd. Greeley,Co.80634
PHONE 970-590-9861 • E-MAIL normaalkire@hotmail.COM
July 2006—Present Platte Valley Youth Services Center
Greeley,Co. 80631
Social Work Counselor I/ Supervisor, Kevin Powell, PhD
• Provide drug and alcohol treatment for adolescent males committed to DYC
• Facilitate drug and alcohol treatment groups
• Complete all relevant paperwork including TRAILS documentation
• Attend stuffings,Parole Board hearings,Community Review Boards
(CRB's),and other relevant meetings
• Provide case management and transitional services as needed
• Communicate with Parole Officers/Client Manager's, families,and other
counselor's with regard to youth's disposition
• Facilitate family therapy
• Provide EMDR therapy for youth with trauma and substance abuse issues
• Monitoring and documentation of youth on suicide watch
• Attend SOME and other trainings relevant to job duties
• Participate in the hiring process of counseling and other staff
• Implement and maintain treatment planning process
• Training of staff in utilization of mandated documents
• Compliance of audit standards with regard to upkeep and maintenance of
clinical records
COMMUNITY ACTIVITIES AND AWARDS
2000-2003 University Schools Greeley,Colorado
Board of Governors, Board Member
• Founding member of the Charter School Board of Governors
• Participated in decision making process for new charter school
• Member of Public Relations committee
• Member of School Advisory committee
• Recording Secretary of Board for 1 '4 years
Recipient of the Weld County Stars of Excellence Award for 2002 in the
category of Education
PROFESSIONAL REFERENCES
Dr.Theresa McDevitt,Professor,UNC
• McKee 405
Greeley,Colorado 970-351-2621
Dr.Eugene P. Sheehan,Dean,College of Education,UNC
McKee 125
Greeley,Colorado 970-351-2817
James Schultz,MA,LPC,Therapist,Psychcare Family Recovery Center
Greeley,Colorado 970-691-1112
Rochelle Galey,MSW,CACIII, SWIM,Platte Valley Youth Services Center
Greeley,Colorado 970-304-6258
Stacey Blank,MA, LPC,CACIII,Therapist,Psychcare Family Recovery Center
Greeley,Colorado 970-352-1056
4913 12s'St Rd. Greeley,Co. 80634
PHONE 970-590-9861 • E-MAIL normaalkire@hotmail.COM
•
Charles A. Howard, Ph.D.
2186 44th Avenue
Greeley,CO 80634
Cell:(970)302-7661
DrChuckHoward@hotmail.com
Licenses&Certifications
Licensed Psychologist: Colorado#2124,Nebraska#308
Marriage and Family Therapist Supervisor: State of Colorado,LMFT Board
Certificate of Professional Qualification (CPQ);Association of State&Provincial Psychology Boards
Education
M.S. Alliant International University
California School of Professional Psychology
San Francisco,CA
Clinical Psychopharmacology,Post-doctoral degree,2004
Ph.D. Texas A&M University
College Station,TX
Counseling Psychology, 1991
M.A. University of Northern Colorado
Greeley,CO
Agency Counseling, 1984
B.S. Sam Houston State University
Huntsville,TX
Law Enforcement and Police Science, 1981
Clinical Experience
North Colorado Medical Center,Behavioral Health Services,Greeley,Colorado.
Supervising Psychologist-August, 2001 to present
Supervise provision of clinical services in outpatient and day treatment programs to children,adolescents and
adults. Direct and train professional staff, including, LPCs,LCSWs,MFTs,CACs,RNs and technicians. Co-
admitting(treating)Physician for the outpatient unit. Intricately involved in the planning and development of
the adolescent and adult day treatment programs,along with the inpatient therapy program. Developed and
implemented outcome measurement and satisfaction surveys. Provide evaluations and psychotherapy to
outpatient and day treatment clientele. Administer psychological evaluations to children,adolescents, and adults
for the hospital, courts, social services, school district, special education providers, and other community
agencies.Bariatric presurgical evaluations(ASBS Center of Excellence).
Transitions Psychology Group,LLC,Greeley,Colorado.
Co-Founder and principal- 1998 to 2003.
Clinical Consultant/Supervisor-2003 to present.
Developed screening/mentor program for Weld County Department of Social Services clientele.Provide clinical
supervision to numerous masters and doctorate level mental health professionals. Perform psychological
evaluations(ages 10 to 65),custody evaluations, and parenting evaluations. Supervise home studies of potential
foster and adoptive families.Provide short-term psychotherapy to individuals and families.
Charles A.Howard
Page 2 of 3
Larimer Center for Mental Health,Intake/Adult Unit, Fort Collins,Colorado.
Staff Psychologist-April,2000 to August, 2001
Responsibilities included supervision of new clinicians,patient intake interviews,crisis counseling, individual
psychotherapy,and psychological evaluations of adults and children.
North Range Behavioral Health,Child &Family Services,Greeley, Colorado.
Staff Psychologist-December, 1995 to January, 1999
Program Director-January, 1999 to April, 2000
Managed 16 clinicians in three service units. Responsibilities included program management,budgeting,
planning,employee supervision, and administrative oversight. Supervised and trained psychotherapists and
psychology doctoral interns. Provided individual therapy and family therapy. Conducted psychological
evaluations of adults,adolescents, children, and families.
The Family Center, Scottsbluff&Alliance,Nebraska.
Founder and principal-August, 1992 to July, 1996
Psychological provider for the Newell Children's Center,Burlington Northern Railroad, West Nebraska Juvenile
Services,Human Services Inc.,Nebraska Department of Social Services, Disability Determination Services,
Nebraska Department of Education. Provided individual,marital, family and group psychotherapy to children,
adolescents,adults,and older adults.Performed psychological evaluations and custody evaluations.
Regional West Medical Center,Psychiatric Unit, Scottsbluff,Nebraska.
Psychology Resident-July, 1991 to January, 1993.
Staff Psychologist-January, 1993 to September, 1993
Planned,developed and operated a satellite outpatient office. Provided individual,group, family,and marital
therapy and evaluations with adults,elderly,adolescents, and children. Created and coordinated community
education workshop series.
Ulster County Community Mental Health Services,Kingston,New York.
Doctoral Intern-July, 1990 to July, 1991
Clinical psychology internship, fully approved by the American Psychological Association.Provision of
outpatient therapy and evaluation/testing services for the Child and Adolescent Unit,as well as services to the
Adult and Chronic Adult Units. Completed custody evaluations and parent psychological evaluations for the
Ulster County Family Court.
Texas A&M University,Athletic Department, College Station, Texas.
Graduate Assistant- September, 1987 to March, 1990
Counseled athletes. Conducted educational,vocational,and psychological testing. Provided academic skills
education and career counseling. Provided performance enhancement techniques and information.
Panhandle Mental Health Center, Scottsbluff,Nebraska.
Professional Counselor-February, 1985 to August, 1987
Provided individual,marital, family and group psychotherapy to adults, elderly,children and adolescents.
Performed mental health evaluations and consulted with a wide variety of state agencies and local businesses.
Texas Department of Corrections,Psychiatric Unit,Huntsville, Texas
Graduate Intern-January, 1982 to July, 1982
Contracted and reimbursed position. Provided counseling and assisted with psychological testing.
Charles A.Howard
Page 3 of 3
Teaching Experience
Graduate Chadron State College
Theories of Personality
Undergraduate The Consortium,Inc.&Nebraska Western College
Nebraska Addictions Counselor licensure courses:
Counseling Techniques and Theories
Group Counseling
Nebraska Western College
Social Psychology Depression across the Lifespan
Understanding Adolescence Attention Deficit Disorder
Bipolar Disorder The Psychology of Prejudice
Attachment Disorder Stress Management
State University of New York,New Paltz
Lecturer on topics of adolescent development,family dynamics, and multicultural
issues.
Professional Presentations
(Partial list)
Adolescent Development and Child&Adolescent Mental Health Overview.Crisis Intervention Certification;
Colorado School Resource Police Officers(2005, 2006,2007)
Post Traumatic Stress. Crisis Intervention Certification for Police Officers(2004, 2005, 2006, 2007)
Bariatric Expert Panel;Psychologist representative.Bariatric surgery clinic public presentations(2004, 2005)
Hidden Influences:Neurodevelopment and Genetic Disorders among Behaviorally Disturbed Youth.Colorado
Juvenile Council Conference(2002,2005)
Suicide. Professional guest appearance;KFKA radio talk show,This Week at NCMC
Empty Nest Syndrome and The Role of Fathers. Professional guest TV appearances;Off the Record with Lea
Jungle Law: The Role of Trauma and Attachment Issues in Understanding Delinquent Behavior. Colorado
Juvenile Council Conference(2000)
Understanding Trauma And Helping Victim's Families. 2000 Colorado Radiologic Technicians Conference
Research and Publications
Howard, C.A. (1992).Relationship of anxiety to performance among police cadets in
crime scene situations(Doctoral dissertation,Texas A&M University, 1991).
Professional Organizations
American Psychological Association
Society of Clinical Child and Adolescent Psychology
American Society for the Advancement of Pharmacology
Dennette Janus
Education & Certifications
Master of Arts, Community Counseling
University of Northern Colorado, Greeley, CO May 2003
Bachelor of Science, Human Rehabilitative Services/Psychology Minor
University of Northern Colorado, Greeley, CO May 1997
Certified Counselor,National Board of Certified Counselors,August 2003
Bilingual: English& Spanish
Professional Experience
Caseworker III: Child Protection: Investigations and Ongoing
Weld County Department of Social Services, Greeley, CO 2/2004-present
• Investigated allegations of all types of child abuse and neglect, including
fatalities, made recommendations to the Courts, law enforcement and families
• Developed safety plans for acute circumstances and counseled children and
families regarding immediate concerns
• Provided testimony and evidence at emergency and adjudication hearings, for
jury trial, termination hearings and criminal proceedings
• Explained the role and process of child protection to families as assigned,
educated children and families regarding safe and unsafe practices
• Completed initial individual treatment plans and family service plans for the
children and parents in cases filed with the Court, ongoing monitoring of
treatment plan completion and barrier removal for completion
• Participated actively in staffings within the Department and between other
•
community agencies.
Drug &Alcohol Evaluator: Social Services Case Manager
Island Grove Regional Treatment Center, Greeley, CO 8/2003 -2/2004
• Performed substance abuse evaluations for clients referred by Social Services,
primarily on site, at incarceration facility, or at Island Grove Treatment Center
• Provided liaison case management between Social Services and Island Grove
programs and staff;Documentation and tracking as appropriate to both
agencies
• Staffing and consultation with staff and supervisors within both agencies
• Professional testimony as requested
Dennette Janus pg 2
Graduate Internship: Outpatient Counselor
Island Grove Regional Treatment Center, Greeley, CO 8/02-5/03
• Co-Facilitated education and therapy groups specific to drug& alcohol abuse
and/or domestic violence issues, English and Spanish-speaking
• Provided individual counseling sessions and treatment planning/case
management
• Completed intake interviews, interpretive summaries, and staffing of clients
for treatment recommendations
• Accountable for documentation to agency and referral sources as needed
Therapist/Case Manager
North Range Behavioral Health, Greeley, CO 11/99-6/00
• Accepted clients as assigned from agency for individual counseling,primarily
related to persistent severe mental illness
• Assessed ongoing progress of clients, adjusted treatment plans as necessary.
• Advocated for client needs and goals, case management as needed,referrals as
indicated, staffing
• Submitted appropriate documentation to agency and state regulatory boards
Legal Advocate
A Woman's Place, Greeley, CO 4/98-9/98
• Provided support/services for victims of domestic violence
• Educated regarding legal and emotional aspects of domestic violence
• Assisted with paperwork and accompanied client for court proceedings
• Performed general shelter duties: crisis line, intake processing, referrals
Residential Support/Intensive Case Manager
North Range Behavioral Health, Greeley,CO 10/96-12/97
• Provided residential support for clients with severe persistent mental illness
• Assisted and encouraged clients in community integration activities •
• Monitored and assessed medications,activities, interactions,responsibilities
• Provided intervention/advocacy with Primary Therapists as needed
Volunteer Experience
Red Cross Mental Health Professional,Baton Rouge, LA 9/9/05-9/25/05
Provided all aspects of mental health assessment, intervention and support for evacuees/
survivors of Hurricane Katrina Disaster Relief Effort in shelter of approximately 2000
people. Also served as Red Cross staff and military staff debriefing support.
Dennette Janus pg 3
Volunteer Experience, continued
Crisis Line Advocate, A Woman's Place, Greeley, CO 9/98-2/01
Provided on-call support to victims of domestic violence from contacts through crisis line
call or emergency personnel referral. Relayed information to Weld County District
Attorney's office for use in prosecution if appropriate. Documentation as necessary.
Court Appointed Special Advocate, Greeley, CO 10/99-2/01
Offered bi-weekly interaction with child of Dependency&Neglect case for duration of
case (16 months). Reported to all parties involved: Weld County Courts, Dept. of Social
Services, family of child, Guardian ad Litem.
Assessor and Tutor,Right to Read of Weld County, Greeley, CO 3/92-5/97
Other Work History: Office Management/Dental
Treatment Coordinator,Richard Boyes,DMD, Greeley, CO 8/00-8/03
Responsible for all aspects of patient care: initial contact, information management,
communicating patient needs/desires to Dr.,treatment planning and presentation,
financial arrangements, follow-up and continued care. Fill in regularly for Office
Manager and Lead Chairside Assistant. Training and delegation of tasks as needed.
Orthodontics Coordinator,Dental Health Centers of America, Greeley,CO 9/98-11/99
Helped initiate an orthodontics specialty within existing practice;provided all aspects
of patient care: examinations,treatment planning, case presentation, financial
arrangements, insurance, ongoing patient communication. Also performed
administrative duties as needed for general dentistry Doctors.
Expanded Duties Dental Assistant,James Shaddock, DDS, Greeley, CO 9/93-9/96
Performed chairside duties to assist Dr. with patient care: x-rays,room and supply
preparation,patient comfort, procedure assistance. Assisted front-office staff.
•
•
•
Training, certification,and re-certification numerous times in CPR, basic first aid,
and medication administration throughout employment history
Awards & Recognition
Golden Key and Psi Chi Academic Honor Societies Member
Grand Achiever,Mary Kay Cosmetics, 1998
JC Penney Golden Rule Volunteer Award Finalist, 1997
Professional and Personal references available
Carole Jean Noblitt (Jean) LCSW
2627 irk Avenue
Greeley, CO 80631
970-378-9419
Education
Masters of Social Work 1996
Colorado State University, Ft. Collins, CO 80523
Post Graduate Course Work-Marriage&Family Therapy Program 1995, 1996, 2000
University of Northern Colorado, Greeley, CO 80639 1996
Bachelor of Science in General Business 1988
University of Northern Colorado, Greeley, CO 80639
Associate of Applied Science in information Systems 1983
Aims Community College, Greeley, CO 80634
Bachelor Level Course Work—Family&Child Development- 1960-62
Nursing,Kansas State University, Manhattan, KS 66502
Continuing Education
How to Help Dying People Attain Dignity and Peace;Douglas Smith, MA, MS, MDiv.
EMDR Part 1 Basic Training;EMDR Institute, Inc., July 19-21, 2002, Englewood, CO.
Treating Sexual Abuse:From Victim to Surviving to Creating; Carolyn M. Ball, MA, LPC
Grief Counseling&Clinical Practice;John R. Jordan, PhD, CMi Education institute, Inc.
Psychopharmacology Made Simple: The Basics&Beyond;John Preston, Psy.D.
Domestic Violence Risk Assessment Training;Amend, Alamosa, CO, September 11, 1999
Identification and intervention in Sexually Abusive Behavior, Gail Ryan, MA, Kempe Center
Living Well is the Best Revenge:Moving Beyond the Survivor Identity; Yvonne Dolan, MA
Evaluation and Treatment of Child Sex Abuse; Richard A. Gardner, MD.
Ethics, Colorado law, and General Standards of Practice for Psychotherapists
Why People Don't Heal:Understanding the Intimate Language of Wounds; Carolyn Myss,
Exploring Psychology, Spirituality, &Creativity; 15th Annual Common Boundary Conference
Paralegal Certificate, University of Northern Colorado, Greeley, CO 1993
Non-Profit Funds Management Certificate Aims Community College, Greeley, CO 1992
RECEIVED
OCT 2 0 2003
BY:_11SYVIA,
Career Experience
Adoption Worker Sept. 1999 to Present
Adoptions:Advocacy&Alternatives, Ft. Coffins, CO 80525, 970-493-5868
Work directly under Placement Supervisor and Birth Mother Counselor in private, non-profit
agency providing placement services for infants.Family&individual assessments, homestudies,
•
research,public relations, and outreach on a contract basis.
Medical Social Worker March 2000 to Jan 2003
Hospice of Northern Colorado, Greeley, CO 80634 970-352-8487
Provide support services to patients and their families in their homes and at the in-patient unit.
Psycho/social assessment&care plan development;plan and lead Care Conference;
Interdisciplinary Team reports;provide individual grief counseling, education and support;
connect patient with community resources, and facilitate groups
Crisis&Support Counselor June 1997 to October 1999
Tu Casa, Inc., P.O. Box 473, Alamosa, CO 81101 719-589-5291
Provide individual and group crisis and on going counseling to victims/survivors of domestic
violence and/or sexual assault in the San Luis Valley of Southern Colorado. This includes
assessment,planning, and follow-through;often working with treatment plans from other area
agencies. Clients are predominately adult women;children and teens are also involved with our
program. Work closely with area human service agencies and law enforcement.
Education Project Director/Outreach Counselor February 1997 to Sept. 1998
Tu Casa, Inc., P.O. Box 473, Alamosa, CO 81101 719-589-5291
Director of San Luis Valley Sexual Assault Prevention Education Project, a "model program"
funded by the Colorado Department of Public Health&Environment&the Colorado Coalition
Against Sexual Assault. Designed implemented and taught prevention education programs
aimed at students ages 11-19 in the San Luis Valley school districts. Goal: to facilitate
understanding of the root causes of interpersonal violence and through awareness, develop skills
to protect themselves&to promote a violence free environment at home, at school, and with their
peers.
Community Organizer August 1995 to June 1996
Congregations Building Community, 427 Main, Windsor, CO 80550 970-686-0162
Intern in organization of 18 institutional members, representing approximately 20,000 persons.
Facilitated grassroots organizing:conducted one-to-one meetings with over 100 persons to listen
to concerns and identifr potential leaders;promoted, assisted with, and led exploratory meetings;
formed and trained local organizing committee members;assisted with research actions and
public meetings;conducted ongoing evaluations.
Care Coordinator January 1996 to May 1996
First Steps of Weld County, 1024 9th Ave., #3, Greeley, CO 80631 970-353-4192
Intern in small,private, non-profit agency offering no-cost case management services to pregnant
women. Duties included providing information, education, referral, counseling, and support to
high risk pregnant women and new mothers.
Family Caseworker June 1995 to August 1995
Catholic Charities Northern, Ft. Collins, CO 80521
Case management intern at homeless shelter working with families to prevent reoccurrence
of circumstances that caused loss and to establish stable environment for the children.
Women's Counselor September 1994 to May 1995
Longmont Coalition for Women in Crisis, P.O. Box 231, Longmont, CO 80502-0231
Intern in non-profit agency offering outreach services and emergency shelter to battered women
&children. Duties:co-facilitated women's groups, crisis line callbacks, client intake and
assessment, education and referrals, and shelter work 303-772-0432
Noblitt, Carole Jean
References
Maria Swall, MSW, Former Director Joanne Gallagher, LCSW, Director
Tu Casa,Inc.Alamosa Adoptions:Advocacy it Alternatives
3024 Cortez St. 2500 S. College Avenue
Ft. Collins, CO 80525 Ft Collins, CO 80525
970-282-8679 970-493-5868
Robert Shellenberger, Ph.D.,Retired Mike Kromrey, MSW, Director
Dept of Psychology,Aims Community College Metropolitan Organization of People
20627 Catclaw Ct. 2517 Birch
Johstown, CO 80534 Denver, CO 80207
970-587-2543 303-399-2425
Ann Lundquist,MSW
Fonner Director of Support Services Sandy Brown,MSW,Director
Hospice of Northern Colorado Congregations Building Community
2726 West 11"'Street Road 1218 W. Ash
Greeley, CO 80634 Windsor, CO 80550
970-352-8487 970-686-0162
Home: 970-663-9315
'Note:Ann is leaving Hospice in Greeley
for a new position with the hospice in
Estes Park effective 10-13-03
VERONICA RIVERA
905 W. Laurel St. Apt 116 Fort Collins, CO 8052
vrivera::a::larnar.coiostatc.cdiu Phone: (970) 492-9122
A certified,bilingual, marriage and family therapist, with skills in areas of child and family
therapy,multicultural competence; problem solving, and communication. Seeking for a
position in your organization, where my skills can be of value.
COMPETENCIES
• Aware of the issues that affect individuals and families.
• Strong understanding of the complexities among individual's relationships.
• Apply bilingual skills to assist Spanish speaking families.
• Promote a safe and pleasant environment for individuals to explore their thoughts
and feelings.
• Adapt appropriate therapeutic interventions,based on the needs of the client.
EDUCATION
Colorado State University July 2005
Master in Science in Human Development and Family Studies,Family and Developmental
Studies and Marriage and Family Therapy mayor.
University of El Salvador, San Salvador, El Salvador. December 2003
Master in Science, Methods and Techniques in Social Research, qualitative research major.
Swinburne University. Melbourne, Australia. September 1998
Bachelor of Arts, Sociology and Political Science major.
Swinburne University. Melbourne, Australia. December 1995
Associate Degree in Social Sciences, Social Sciences major.
PROFESSIONAL DEVELOPMENT
Graduate Certificate in Women Studies May 2005
Colorado State University
Graduate Diploma in Gender Theory and Human Development March 2001
University of Central America, El Salvador.
Graduate Diploma in Victimology and Victims Assistance January 2001
The World Society of Victimology and the University of Central America
RELEVANT AWARDS
Harriet Patsy Boyer, awarded a scholarship to continue with my Interest in Human
Development and Women Studies. May 2005
Granted with a two year Fulbright scholarship. by The Institute of International Education
TIE. August 2003
RELATED EXPERIENCE
Internships
Psychotherapist intern, Child Safe,Fort Collins,CO. January—July 2005
Supporting with children who have survived different types of abuse.
Psychotherapist intern,The Center for Community Partnership, January—July 2005
Fort Collins, CO.
Supporting adolescents in their personal complexities and emotional health.
MOST RECENT EXPERIENCE
Colorado State University. May 2004--May 2005
Research assistant and facilitator, working in a Study on myths and realities about breast
cancer among Hispanic Women.
Colorado State University. August 2003-May 2005
Research and teaching assistant, department of human development and family studies.
WORK EXPERIENCE
Project Change, Academy for Educational Development(AED), Jan. 2002-Jul. 2003
San Salvador,El Salvador.
Researcher and facilitator
• Researched on the myths,knowledge, and the practices followed by members of
urban neighborhoods in San Salvador, as well as in rural communities, to prevent
the dengue fiber that kill people in outbreaks suffered by the country every two
years.
• Participated as a facilitator in the presentation of preventive programs based on
local education through workshops to teachers,public health servants,and state
officers. Later the prevention methods and practices were presented to the society
through formal education at elementary and secondary schools.
Institute for women and children development(ISDEMU), Nov. 1998—Jul. 2003
San Salvador, El Salvador.
Sociologist and counselor
• Increased the effectiveness of the intervention programs by assessing the program's
goals.
• Participated as member of a team developing new prevention programs and
interventions.
• Counseled and supported battered women. Also worked with abused and neglected
children in the shelter of the institution.
A uaa...i LVu 111 4%.J�.t].1.1.4 :.J Lt.) 11110 0Ln stiyu?s, oenz.vlors, level in tGnowieage, tack oI
regional resources, and social risks in urban as well as rural communities.
AFILIATIONS
Student_American Association of Marriage and Family Therapy May 2003
Member of the Salvadorian Association of Sociology July 2002
•
ROSANN M. ROSS, M.A., L.P.C., N.C.C.
BUSINESS: Department of Psychology HOME: 3931 Pueblo Street
University of Northern Colorado Evans, Colorado 80620
Greeley, Colorado 80639 (970) 506-4125
(970) 351-2485
Email: rosann.ross@unco.edu Email: rosieross@earthlink.net
EDUCATION: 2002-current Ph.D. Student, Counselor Education & Supervision
25 credit hours completed - 4.0 GPA
1994 Master of Arts, Agency Counseling:
Marriage and Family Emphasis
University of Northern Colorado
1990 Bachelor of Arts, Psychology
University of Northern Colorado
CERTIFICATION/ 1994-2005 National Certified Counselor
LICENSES National Board for Certified Counselors
Certificate #34131
1996 Licensed Professional Counselor; State of Colorado
Regulatory Agency
License #1436 - current
PERSONAL PHILOSOPHY
My philosophy of life as it relates to the work environment stems from the family systems
therapeutic perspective which holds that all things are interrelated; what affects one member of the
system affects all members of the system. Therefore, the system, which can be a family, a group
of individuals or an organization, holds the power for change and has the ability to find solutions to
any problems that may arise by examining the relationships within that system. Using this
framework, I work to maximize the system's power in its ability to change by looking at the unique
web woven by these relationships. As each member's contribution to both the problem and the
solution, as well as openness for change are assessed, the system can be brought together in such
a way where everyone becomes an active member in searching for and finding creative answers
for a more permanent change.
PROFESSIONAL EXPERIENCE
August 1997 - Position: Full Time Lecturer in Psychology
present Department of Psychology
University of Northern Colorado
Primary responsibility: Teaching 15 credit hours each semester.
Classes taught:
Psy 120 - Introduction to Psychology
Psy 265 - Social Psychology
Psy 350 - Theories of Personality
Psy 344 - Group Roles & Processes
Psy 407 - Introduction to Theories of Counseling
Psy 455 - Abnormal Psychology
Psy 491 - Field Experience
HESA 220 - Death & Dying
ROSANN M. ROSS, M.A., L.P.C., N.C.C.
PROFESSIONAL EXPERIENCE (continued)
Additional responsibilities: Minor academic advising of undergraduate psychology
majors; promote psychology department to incoming freshmen; providing guidance
counseling to graduating seniors regarding graduate school choices; revising &
coordinating the undergraduate field experience program (an on-site psychology
experience for the student); performing liaison duties with community agencies in
placing students at work sites.
January 1996 - Position: Mental Health Therapist
April 2000 Acute Treatment Unit (ATU)
North Range Behavioral Health
Greeley, Colorado
The ATU is a residential treatment facility for persons with chronic mental illness. Duties
included the supervision of three to four clinical care assistants and psychiatric nurses; individual
and group therapy sessions; crisis intervention; hospital evaluations; managing emergency phone
lines for northeastern Colorado; milieu management and supervision of charting and case
management.
August 1995 - Position: Part Time Instructor
June 1997 Department of Psychology
University of Northern Colorado
Primary responsibility: Teaching undergraduate courses. Classes taught:
Psy 120 - Introduction to Psychology
Psy 350 - Theories of Personality
Psy 407 - Introduction to Theories of Counseling
Psy 455 - Abnormal Psychology
July 1994 - Position: Partner in Private Practice
December 1996 Counseling Clinic
Family Physicians Building
2520 W. 16th Street
• Greeley, Colorado 80631
I counseled individuals, couples and families facing emotional difficulty arising from a
number of diverse life changes. I focused my practice on working with chronic illness, the
aging population, the mind-body connection, the final stages of life, and rief and
bereavement
January 1995 - Position: Group Co-Facilitator
December 1996 Northern Colorado AIDS Project
Fort Collins, Colorado
As co-facilitator for a heterosexual couples' group living with full-blown AIDS, I addressed
the unique and often forgotten issues that these couples face on a day-to-day basis.
-2-
ROSANN M. ROSS, M.A., L.P.C., N.C.C.
PROFESSIONAL EXPERIENCE (continued)
April 1995 - Position: Interim Program Director
May 1995 Greeley Transitional House
1202 6th Street
Greeley, Colorado 80631
As interim Program Director, my duties included facilitating interpersonal staff relations,
intake interviews and crisis intervention with homeless families, liaison with other
community agencies on behalf of the families, and managing the daily affairs of the
program.
October 1993- Position: Intern Therapist
August 1994 Weld Mental Health Center
1306 11th Avenue
Greeley, Colorado
As part of the externship requirement for my Master's Degree, I worked as an intern
therapist at the Mental Health Center seeing individuals and couples. When my externship
requirement was completed, I worked pro bono for three months.
June 1993 - Position: Intern Therapist
May 1994 North Colorado Medical Center
Oncology Floor
1801 16th Street
Greeley, Colorado
As part of the externship requirement for my Master's Degree, I worked on the Oncology
Floor at the hospital. My responsibilities included: in- and outpatient counseling, co-
facilitator of the Cancer Support Group, and the development of community outreach
services.
November 1987 - Position: Administrative Assistant to the Dean
July 1992 College of Health and Human Sciences
•
University of Northern Colorado
Greeley, Colorado
Duties included, but certainly were not limited to: Liaison between Dean and five
department chairpersons, problem solving with same, managing student complaints,
designing and planning college public relations events, college class scheduling, working
with Provost's office in maintaining policy revisions, resource utilization on campus.
February 1985 - Position: Administrative Aide
November 1987 Office of Academic Affairs
University of Northern Colorado
Greeley, Colorado
Duties included front-line interaction with faculty, deans, and other administrative officers,
managing record keeping, intermediary between Provost and students.
-3-
ROSANN M. ROSS, M.A., L.P.C., N.C.C.
PRESENTATIONS:
Spring 1999: Personality and Personal Development: Spirituality in the Classroom
Rocky Mountain Psychological Association
Fort Collins, Colorado
Fall 1998: Guest Lecturer - Psy 407: Theories of Counseling
"Family Systems - A Live Role Play"
University of Northern Colorado
Fall 1998: Guest Lecturer - Psy 240: Maturity and Aging
"Stress and Its Effect on Health"
University of Northern Colorado
October 1996: Guest Lecturer - Psychology 120: Principles of Psychology
"Current Views on Death & Dying"
University of Northern Colorado
October 1995: Guest Lecturer - Psychology 407: Theories of Counseling
"Family Systems Perspective"
University of Northern Colorado
Guest Lecturer - Psychology 450: Abnormal Psychology
"The Mind/Body Perspective"
University of Northern Colorado
Guest Lecturer - Psychology 433: Health Psychology
"AIDS and You"
University of Northern Colorado
March 1995: Guest Lecturer - Sociology 221
"Infidelity and Gender Role Differences"
University of Northern Colorado
April 1995: Guest Lecturer - Sociology 221
"Religious Institutions and Gender Role Differences"
University of Northern Colorado
November 1994 Business Aspects of Counseling
Full- Day Workshop Presented to Division of Professional Psychology
Graduate Student Association
University of Northern Colorado
ADDITIONAL TRAINING/WORKSHOPS:
September 2004 Completed 24 hours of continuing education - home study program
Academic Year Supervised Individual Thera
Therapy practicum; Supervised Group Facilitation
Practicum; Practicum in Supervision - Ph.D. Program in Counselor
Education and Supervision
Academic Year Supervised practicum/Advanced practicum - Ph.D.
2002-2003 Education and Supervision Program in Counselor
-4-
ROSANN M. ROSS, M.A., L.P.C., N.C.C.
ADDITIONAL TRAINING/WORKSHOPS (continued):
January 2002 Aggressive & Defiant Behavior: The Latest Assessment and Treatment
Strategies
Home Study Course: Compact Clinicals
Borderline Personality Disorder: The Latest Assessment & Treatment
Strategies
Home Study Course: Compact Clinicals
December, 2001 PTSD: The Latest Assessment & Treatment Strategies
Home Study Course: Compact Clinicals
Obsessive-Compulsive Disorder: The Latest Assessment & Treatment
Strategies
Home Study Course: Compact Clinicals
April, 1999 Rocky Mountain Psychological Association Regional Conference
Fort Collins, Colorado
September, 1995 AIDS: The Second Decade
Teleconference
University of Northern Colorado
May, 1995: Alternative Health Care: What is Reasonable?
Workshop by Dr. Scott Shannon
North Colorado Medical Center
Greeley, Colorado
April, 1995: Hot Monogamy
Workshop by Dr. Patricia Love
American Counseling Association National Conference
Denver, Colorado
April, 1995: American Counseling Association National Conference
Denver, Colorado
•
April, 1995: Chronic Fatigue Syndrome
Presentation by Dr. Scott Pace
Northern Colorado Mental Health Network
Greeley, Colorado
Feb., 1995: How We Choose Our Mates: A Jungian Perspective
Workshop by Dr. Neil Scott
Mountain Crest Hospital
Fort Collins, Colorado
Oct., 1994: Pet Loss and Grief Counseling
Mountain Crest Hospital
Fort Collins, Colorado
-5-
ROSANN M. ROSS, M.A., L.P.C., N.C.C.
ADDITIONAL TRAINING/WORKSHOPS (continued):
February 1994 Marriages from Hell
Workshop by Dr. Frank Pittman
Mountain Crest Hospital
Fort Collins, Colorado
April 1993: Colorado Association of Marriage & Family Therapists Conference
Denver, Colorado
April 1992: Colorado Association of Marriage & Family Therapists Conference
Greeley, Colorado
SERVICE:
Spring, 2004 College of Arts & Sciences - Committee to organize undergraduate
internships
July, 2004 Discover UNC - meeting incoming freshmen and orienting them to the
University and helping them build their class schedules
June, 2003 Discover UNC - meeting incoming freshmen and orienting them to the
University and helping them build their class schedules
May 2003 Reviewed proposed Counseling Theory text for Allyn & Bacon Publishers
November 2002 General Education Review for PSY 265, Social Psychology
February 2002 Participant in the application and selection process for the National Student
Exchange Program
July 2002 Discover UNC
August 2001 Discover UNC
November 2001 Presenter: Women & Spirituality
Celebrating Women
Harrison Residential Hall
October 2001 Debriefing in Turner Residential Hall
regarding two students' death
November 2000 - Committee Member - Community Seminar Planning Committee
March 2001 John Fox, Sociology, Chair
February 1999 - Faculty Mentor
May 2000 McNair Scholarship Program
August1998 Faculty Representative
May 1999 State Personnel Employees Executive Council
University of Northern Colorado
-6-
ROSANN M. ROSS, M.A., L.P.C., N.C.C.
SERVICE (continued):
February 1996 Volunteer Therapist
"Tears for the Children" Sexual Abuse Exhibit
University of Northern Colorado
March 1995- Pro Bono Therapist
December 1996 Pro Bono Project of Weld County
Greeley, Colorado
October 1995 Intake Interviewer
National Depression Disorders Screening Day
North Colorado Medical Center
Greeley, Colorado
May 1995 Intake Interviewer National Anxiety Disorders Screening Day
North Colorado Medical Center
Greeley, Colorado
June 1994 - Pro Bono Therapist
August 1994 Weld Mental Health
1306 11th Avenue
Greeley, Colorado
August 1990- Hospice Volunteer
May 1994 Hospice of Weld County
AWARDS/RECOGNITIONS
February 2002 Favorite Professor Distinction - UNC Mortar Board
Nominated by Jessica Biel
April, 2001 Nominated for Women's Recognition Award
February, 2001 Favorite Professor Distinction - UNC Mortar Board
Nominated by Shanti Pepper
February, 2000 Favorite Professor Distinction - UNC Mortar Board
Nominated by Amy Barnett
April, 1999 Nominated for Women's Recognition Award
February, 1999 Favorite Professor Distinction - UNC Mortar Board
Nominated by Lexi Rigg
February, 1999 Favorite Professor Distinction - UNC Mortar Board
Nominated by Gregg Pederson
-7-
ROSANN M. ROSS, M.A., L.P.C., N.C.C.
REFERENCES:
Vincent A. Scalia, Ed.D. Thomas Gavin, Ph.D. Tracy Baldo, Ph.D.
Associate VP of Academic Affairs Director Professor of Counseling Psychology
University of Northern Colorado Institutional Research & Planning Division of Professional Psychology
Greeley, Colorado 80639 University of Northern Colorado University of Northern Colorado
Greeley, Colorado 80639 Greeley, Colorado 80639
(970) 351-2879 (970) 351-2133 (970) 351-2544
LindtBlark Ph.D.
Associate Professor of Counseling Psychology
Division of Professional Psychology
University of Northern Colorado
Greeley,Colorado 80639
(970)351-1638
24634 3rd Ave (970) 834-2302
Eaton,CO 80615
Carmen Schlierkamp
Objective To secure employment or independent contractor work in the field of
counseling psychology to further my experience and knowledge of
assessments and counseling, and to expand my horizon by working with
a new population. At the same time I hope to utilize my clinical,
counseling, and assessment skills.
Experience 2005-2006 Weld County Sheriffs Department Greeley, CO
Internship 600 hours(Counseling Department)
• Responsible for Full Scale Assessments (Diagnostic Interviews) and
treatment planning.
• Record keeping(case plans, case notes, narratives, assessments)
• Training new officer's(research and training on the subjects of ADHD
Psychotic Disorders, and Female Offenders)
• Individual Psychotherapy (Crisis Intervention, CBT, Brief Therapy,
and monitoring of pharmacological treatment progress)
• Consultation with the medical team and outside agencies.
• Psychoeducational Group Therapy (with co-therapist and
independent). Group Therapy topics include substance abuse, anger
management,cycle of abuse,and communication.
• Deep muscle and imagery relaxation classes.
• Populations served:female and male offenders age 18-60 with Hispanic
and European American ethnic backgrounds.
2005-2006 Home Instead Senior Care Greeley, CO
Home Care Provider(week ends)
• Provide assistance with everyday living(cooking, hygiene,medication,
and safety).
• Provide companionship, utilizing listening skills.
2005 (June/July) Medicine Horse Program Boulder,CO
Volunteer
• Office assistant in a non profit organization maintaining records.
• Assist with care of therapy horses.
1997-2003 Guntermania, Inc Pearblossom,CA
Management.(Vice President and Secretary)
• Responsible for finances, accounting and bookkeeping, sales and
marketing.
• Designing and overseeing the production of fan products.
• Handling all professional correspondence.
• Booking and negotiating personal appearances.
• Contract negotiations with sponsors and lawyers.
• Web design, programming and development of GunterS.net(includes
also: designing recipes, writing articles on nutrition and workout
information,consulting on supplements, nutrition and training).
• Choreographing posing routines, editing music, make up and
wardrobe for Gunter at photo shoots, develop workout and nutrition
plans for Gunter.
1996-1997 Powerhouse Gym Fairfield, NJ
Nutrition Counseling and Personal Trainer
• Started behind the counter in memberships.
• Teaching Aerobic Classes.
• Finished my personal trainer certificate and moved up to nutrition
counseling and personal training with some management
responsibilities.
1991-1996 Top Sports Buseck Germany
Aerobic Instructor
• 3-4 courses a week.
• Continuing education twice a year.
Education 2003—Present Capella University Minneapolis Minnesota
• Currently in the last Semester of the Master's Program in Counseling
Psychology;4.0 GPA
1991-1996 Justus Liebig University (JLU) Giessen Germany
• 1994-1995 B. S. in Nutrition and Dietetics. JLU Giessen Germany.
• 1991-1994 Fulfilled the requirements for the B. S. in Biology but did
not participate in final exam.JLU Giessen Germany.
Certifications • 2005 Equine Assisted Psychotherapy I—Equine Assisted Growth and
Leaming Association(EAGALA)
• 1997-1999 Certified Personal Trainer - World Instructor Training
School,Virginia Beach,VA
• 1998 Adult CPR American Red Cross.
• 1998 Standard First Aid American Red Cross.
Interests • Painting, horse back riding, member of the Chamber of Commerce in
Greeley with the goal to get more involved with the Greeley
community. I am also interested in providing Equine Assisted
Psychotherapy for diverse populations.
• Well organized.
Strengths • Independent learner and self-starter.
• Compassionate and spiritual.
• Flexible to work in groups or alone.
Languages • Fluent in English and German.
References If requested reference letters can be produced.
• Rosann M. Ross, MA, L.P.C., N.C.C.
Lecturer in Psychology
University of Northern Colorado
Greeley, Colorado 80639
(970)351-2485
• W.D. Farr
Farr WD&Company
1914 14'"Ave
Greeley, CO 80631
(970)356-1914
• Alice McPherson, MA, L.P.C.
Clinical Director Weld County Sheriffs Department
2110 O Street
Greeley, CO 80631
(970)356-4015 Ext3937
amcpherson@co.weki.co.us
• James Michael Nolan, Ph.D.
Director of health&Counseling Services
Baldwin-Wallace College
275 Eastland Ave.
Berea, Ohio44017
(440)263-1769
jnolan(a�bw.edu
Languages • Fluent in English and German.
References If requested reference letters can be produced.
• Rosann M. Ross, MA, L.P.C., N.C.C.
Lecturer in Psychology
University of Northern Colorado
Greeley, Colorado 80639
(970)351-2485
• W.D. Farr
Farr WD&Company
1914 14th Ave
Greeley,CO 80631
(970)356-1914
• Alice McPherson, M.A., L.P.C.
Clinical Director Weld County Sheriffs Department
2110 O Street
Greeley, CO 80631
(970)356-4015 Ext 3937
amcpherson@co.weld.co.us
• James Michael Nolan, Ph.D.
Director of health&Counseling Services
Baldwin-Wallace College
275 Eastland Ave.
Berea, Ohio 44017
(440)263-1769
jnolan@bw.edu
DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
viige Fax Number(970)353-5215
May I I, 2007
COLORADO
Jami Moe-Hartman, Co-owner
Transitions Psychology Group, LLC
804 11 Avenue
Greeley, CO 80631
Re: Bid#006-LS-07 (RFP 05005)Lifeskills
Bid#003-FPT-07 (RFP 006-00C)Foster Parent Training
Bid#008-HS-07(006-00B)Home Study,Relinquishment Counseling
Bid#006-MH-07 (RFP 006-00)Mental Health Services
Dear Ms. Moe-Hartman:
The purpose of this letter is to outline the results of the Bid process for PY 2007-2008 and to request
written confirmation from you by Monday,May 21, 2007.
The Families, Youth, and Children Commission 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 2006-2007
• The Families,Youth and Children(FYC)Commission recommended approval of your
Bid#006-LS-07(RFP#07005),Lifeskills for inclusion on our vendor list.The FYC
Commission attached the following recommendations and conditions to your bid.
Recommendation:The approved bidder will pursue bilingual interpreters/translators/staff in
order to better serve bilingual and monolingual clients.This may include offering incentives,
accommodations, and encouragement to Spanish bilingual interpreters,translators,and staff.
Conditions: The bidder must clarify and submit information that was not addressed or
included with the original bid submission.
1. Provide a copy of insurance,
2. Provide staffing information, including resumes and education levels of staff,
3. Address mandated caseworker training for staff,
4. Address bilingual/bicultural services,
5. Provide rates for levels of service(parent education and therapeutic visitation),
6. Address step-down services.
Page 2
Transitions Psychology Group/Results of RFP Process for 2007-2008
• The Families,Youth and Children(FYC)Commission recommended approval of your
Bid#003-FPT-07 (RFP#006-00C),Foster Parent Training, for inclusion on our vendor
list.The FYC Commission attached the following conditions to your bid.
1. Bidder must address and clarify class size. The evaluating committee requests that the
bidder not limit class size.
2. Bidder must address whether there is a"lead"trainer. Address the consistency and
continuity of trainers/training.
3. Provide a curriculum as requested in the RFP,
4. Provide a copy of insurance.
• The Families, Youth and Children(FYC)Commission recommended approval of your
Bid#008-HS-07(RFP#006-00B), Home Studies,Updates, and Relinquishment
Counseling for inclusion on our vendor list. The FYC Commission attached the
following conditions to your bid.
1. All staff must attend Core Caseworker Training,
2. The bidder must address the Program Improvement Plan(PIP).
• The Families, Youth and Children(FYC)Commission recommended approval of your
Bid#006-MH-07(RFP#006-00),Mental Health, for inclusion on our vendor list. The
FYC Commission attached the following recommendation and conditions to your bid.
Recommendation: The approved bidder will pursue bilingual interpreters/translators/staff in
order to better serve bilingual and monolingual clients.This may include offering incentives,
accommodations,and encouragement to Spanish bilingual interpreters, translators, and staff.
Conditions: The bidder must submit information that was not addressed or submitted with
the original bid submission, including:
1. Evidenced-based Practices,
2. Bilingual services,
3. Program Improvement Plan(PIP),
4. Copy of insurance.
B. Required Response by FYC Bidders Concerning FYC Commission Conditions and
Recommendations:
Recommendations: You are requested to review the FYC Commission recommendations and to:
1. accept the recommendation(s) as written by the FYC Commission; or
2. request alternatives to the FYC Commission's recommendation(s); or
3. not accept the recommendation(s) of the FYC Commission.
Please provide in writing how you will incorporate the recommendation(s) into your bid. If you
do not accept the recommendation,please provide written reasons why. All approved
recommendations under the NOFAA will be monitored and evaluated by the FYC Commission.
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
Page 3
Transitions Psychology Group/Results of RFP Process for 2007-2008
your mitigating circumstances. If you do not accept the condition,you must provide in writing
reasons why. A meeting will be arranged to discuss your response. Your response to the above
conditions will be incorporated in the Bid and Notification of Financial Assistance Award.
The Weld County Department of Social Services is requesting your written response to the FYC
Commission's conditions and recommendations.Please respond in writing to Tobi Vegter, Core Services
Coordinator,Weld County Department of Social Services, P.O. Box A, Greeley,CO, 80632,by Monday,
May 21, 2007,close of business.
If you have questions concerning the above, please call Tobi Vegter, 352.1551, extension 6392.
Sincerely,
J y A. 'ego,D. ctor
cc: Juan Lopez, Chair,FYC Commission
Gloria Romansik, Social Services Administrator
Tobi Vegter, Core Services Coordinator
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-68
Revision (FY-FYC-07005; 004-LS-07)
Contract Award Period Name and Address of Contractor
Beginning 07/01/2007 and Reflections for Youth, Inc.
Ending 05/31/2008 Lifeskills
1000 S. Lincoln Avenue#190-200
Loveland, CO 80537
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Program offers assistance in parenting skills, Assistance Award is based upon your Request for
milestone information, employment,household Proposal (RFP). The RFP specifies the scope of
management, finances,relationship building, services and conditions of award. Except where it is
education planning,transportation, prevention in conflict with this NOFAA in which case the
planning, and overall support to families. NOFAA governs, the RFP upon which this award is
Workload of eight families concurrently, for a based is an integral part of the action.
total of 16 hours per week,with an average of 24 Special conditions
weeks of services per family. 1) Reimbursement for the Unit of Services will be
based on an hourly rate per child or per family.
2) The hourly rate will be paid only for direct face-to-
Cost Per Unit of Service face contact with the child and/or family or as
Hourly Rate Per specified in the unit of cost computation.
Treatment Package $56..25 3) Unit of service costs cannot exceed the hourly and
Treatment Package Low (Court Testimony) $80.00 yearly cost per child and/or family.
4) Payments will only be remitted on cases open with,
and referrals made by the Weld County Department
of Social Services. Requests for payment must be an
original submitted to the Weld County Department
of Social Services by the end of the 251°calendar day
Enclosures: following the end of the month of service. The
X Signed RFP: Exhibit A provider must submit requests for payment on forms
Supplemental Narrative to RFP: Exhibit B approved by Weld County Department of Social
Recommendation(s) Services. Requests for payments submitted 90 days
Conditions of Approval 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.
Approval c \ Progra Of ial:
By ' \ By
David E. Long, Chair Judy . Griego Directq
Board of Weld County Co sioners Wel ounty epartment of Social Services
Date: JUN 1 8 2007 Date: & rip
dodgy-/7515
EXHIBIT A
SIGNED RFP
COPY
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 03�30104-
(After eceipt of order) BID MUST BE SIG�K
Program Area: U\Q-SYaus
TYPED L 4TED SIGNATURE
VENDOR 1`(t-1'W `er{1S \)0.83/41 V1f-
(Name) I ' Handwritten Signature By Authorized
Officer or Agent of Vendor
ADDRESS '000 S. L1tiL(M.) tSf(j }#- P-2.00 TITLE ( i 1)\,ccj L
�t:AAA1 iC.O fj�stfl- DATE 0; ,Vi' .0*
PHONE # Len `Rci,,A \40
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Program Area Supervisor/Provider Meeting
Verification/Comment Form
Date of Meeting: 3 —
Program Area:
Comments (to be completed by Program Area Supervisor):
V A .5 /l Gelen vi Z Cr2'ce_t_l
den/4 btgneel
agelm,
Signature of Program Area Supervisor
,
Table of Contents
Life Skills
Invitation to Bid no page number
Verification/Comment Form no page number
Abstract/Program Description 1
Target/Eligibility Populations 2
Projective Narrative/Supporting Documentation 2
Types of Service Provided 2-4
Measurable Outcomes 4
Service Objectives/P.I.P 5-6
Workload Standards 6
Staff Qualifications 6-7
Program Capacity per Month 7
Internal Tracking and Billing Process 7
Supporting Documentation 7
Evidenced-based Outcomes/Literature Citation 7-8
Confidentiality and Participant Protection/Human Subjects 8-11
Budget 11
Unit of Rate Computation 11-12
Program Budgets 13
Direct Service Costs 14
Admin Costs Non-Face-to-Face 15
Overhead Costs and Profits 16
Appendix 1 Resumes for key staff members 17-22
Appendix 2 Data Collection Instruments/Protocols 23
Appendix 3 Sample Consent Form 24-25
Attachments following
Evaluation Plan following
Certificate of Insurance following
Reflections for Youth, Inc.
"Discovering the Power of Positive Choice"
Weld County Life Skills Program
RFY-FYC-001-07
03-30-06
(Services from 06/01/07 through 05/31/08)
Abstract/Project Description
Title of Project: Life Skills Program
Mission and Purpose
Reflections for Youth will provide life skills to children and their families which are in
crisis and are in an imminent risk of children being removed and placed out of the home.
The life skills program will also offer assistance in transitioning a child back into home
from placement. Life Skills program will offer assistance in the areas of parenting skills,
milestone information, employment, household management, finances, relationship
building, education planning, transportation, prevention planning, and overall support to
the family. Children who are transitioning home after completion of placement will
transaction with an Aftercare Agreement/Plan. The Aftercare Agreement/Plan includes
weekly visits for the first two weeks, bi-weekly visits for two weeks, and final visit in a
month. If at any time during Aftercare Agreement/Plan the family appears to struggle, a
request for an extension will be filed with Weld County.
Design
All Life Skills visits will occur in the home,unless otherwise determined not safe. If not
safe visits will occur in the community or in the office of a Reflections for Youth, Inc.
worker. Families will be assessed through the NCFAS-R: North Carolina Family
Assessment Scale-Reunification to determine strengths and needs of the family, as well
as provide a base line for development and progress through the program. Reflections
will provide services for up to 8 families at a time. There may be a potential to serve
more families as resources become available. Reflections will provide an average of 2
hours of service per week for an average of 24 weeks.
All service providers and supervisors under the umbrella of Reflections for Youth, Inc.
meet the requirements as listed in staff manual volume VII section 7.307.17 and section
7.3006 q. The supervisor for the program will also carry a caseload. All Lifeskills
Workers and supervisor(s)will either have a master's degree with two years experience
or a bachelor's degree with three years experience in the field. In addition, our program
also has a staff person with several years experience as a Family Support Worker in
Nebraska and as a Case Aide in the Lifeskills Unit at Larimer County. She has an AA
degree and is working toward completion of her bachelor's degree. If possible, she
would be a wonderful support to our agency and the youth and families of Weld County
if she could carry a caseload as well.
1
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Target/Eligibility Populations
Reflections for Youth agrees to work with a total of 8 families at a time with at least one
child at risk of out of home placement or transitioning back to the family. Family
consolations may include one child age 5 years or older up to an underdetermined
number of children in the family. Based on our program description it is our plan to
provide all services within an average of 2 hours per week for an average of 24 weeks. It
is understood that based on orders from the court, services and first visitation may need to
occur within 48 hours of the court date.
Reflections will provide for a total of 16 families per calendar year, with an average of 24
weeks in the Life Skills program. All families will be able to receive bicultural services.
Bilingual services can be provided for one family at any given time. Reflections has two
contracted interpreters on staff and again the percentage has potential to rise if resources
become available.
Services will be offered as often as possible on a 24-hour basis to client families living in
all parts of Weld County, provided they are within one hour of the city of Loveland. On-
call support is available for all families at all times through the Reflections for Youth,
Inc. on-call support system.
PROGRAM NARRATIVE/SUPPORTING DOCUMENTATION
I. Types of Services to be Provided
Mentoring
Life Skills Workers will teach and coach all members of the family by role modeling
appropriate effective communication skills and working to develop improved overall
household management and finance skills. The Life Skills Worker will set goals each
week for the family based the NCFAS-R Assessment. In addition the Life Skills Worker
will bring related material for the family to go over and discuss. The goals will be worked
on with the Life Skills Worker and the follow up will be up to the family. This will be
one form of measurement for the program. As the program progresses the Life Skills
Worker will next focus on community resources and connections by finding community
centers for the children, finical assistance programs, low-income child care, etc. In
addition the Life Skills Worker will assist the family with appropriate employment,
benefits, and education as applicable. The Life Skills Worker will place emphasis on
career goal setting as well establishing healthy connections and relationships.
Visitation
When Life Skills Workers are providing supervised visits the worker will be observing,
listening and documenting the visit. The worker will step in when necessary to role
model and teach effective and safe communication. The visit will be documented each
time after the visit has taken place. The worker will not be documenting throughout the
visit as this may make the family uncomfortable and unable to act as they normally
would. The worker may write down a brief note if needed. After the visit the worker will
2
J 9 '
call parents to discuss how the visit went and will set goals for the following visit.
Examples of goals could be dinner needs to be arranged for the next visit, find out what
game the children are fond of and have the game ready, how to effectively use a time out
if needed, etc.
• Housing Search
• Job Search/Financial Planning
• Parenting Skills
• Housekeeping Skills
• Supervise Visits
• Therapeutic Intervention Visits
• Using Community Resources
• Affordable and Appropriate Leisure Activities
Reflections for Youth, Inc. currently works in collaboration with the Weld County
Department of Social Services to provide residential treatment services, day treatment
services, home-based intensive family intervention services and life skills, including
visitation, mentoring and support services. Our routine collaboration occurs with the
caseworker asking for the services, Weld County CORE service caseworker, PRT team
as needed and other individual's involved in the child's and/or family's life.
If a client is receiving or will receive services from North Range Behavioral Health, we
will make every effort to communicate with them regarding therapeutic needs and work
to involve them in aftercare planning, including obtaining a release(example attached)
and forwarding on a discharge summary including continuing recommendations for the
clients served.
If needed, referral information for Greeley/Weld Housing Authorities and Employment
Services of Weld County is provided.
• Phone call messages have been left to the Housing Authority(Marsha) to gain their
cooperation in referral process.
• Message left for Salvation Army to gain cooperation in referral process in case of
emergency housing need.
• Provide transportation to and from Housing Authority and other housing options to
fill out applications.
• Set weekly goals with clients on follow-up with housing applications.
Job services/resource provision
• Message left with Weld County Employment Office to gain cooperation in referral
process; waiting for a call back.
• Assistance in job search by looking through newspapers and providing transportation
to pick up and turn in applications if necessary.
• Picking appropriate and realistic employment options.
• Checking into service positions which offer schooling and educational assistance.
• Checking into benefits and helping to explain the best options for the individual.
3
• Assisting with resume writing to gain the best possible opportunities.
• Assisting clients with mock interviews,to include helping to put together interview
outfits.
• Set a weekly goal with clients on follow through with applications and resumes.
Other referral/resources
• Community activities with low or no cost for adults and children.
• Low-income child care. CCAP eligible.
• Health and Dental providers
• Habitat for Humanity for start up items for a home, clothing, etc.
Reflections for Youth, Inc, will work to ensure that available services and resources do
not supplant available resources in the community during the time of the life skills
support being offered and also assist the family in developing connections and access to
other services in the community that are already being funded, e.g. mental health
capitation services, ADAD and professional services otherwise funded.
Reflections agrees to provide court testimony. The costs of providing court testimony is
$80.00/hr.
II. Measurable Oucomes
• The NCFAS-R Assessment tool will be used at initial visits to assess strengths
and needs. Goals will be set with family, Life Skills Worker and Life Skills
Supervisor. Family's acceptance or resistance to the goals will be one form of
measurement and documented in weekly progress notes. A pre and post-test -2
document will be utilized to monitor and track overall progress in household
management competency.
• Life Skills program will be considered successful if child remains in home-and the
family is intact hopefully permanently, put for a minimum of six months
following the service, parents provide a safe environment and parents are
employed for a minimum of 12 months after Life Skills services have been
provided.
• Improvements in- iarenting, household management, relationships, and finances
eeobserbed consistently by the Life Skills Worker and self reported by the
family.
• Family is utilizing the community connections which have been provided through
the assistance of the life skills worker and goal setting and the parents have
demonstrated the knowledge and ability to competently and independently work
with these sources in the community and within the local, state and federal
governments.
• NCFAS-R will be completed at end of program to be used as a comparison for the
family and measure for the Life Skills Worker.
4
k
III. Service Objectives
Mentoring
• Life Skills worker will improve the household management by assisting and role
modeling how to clean properly, organize, laundry and an overall schedule for a
healthy environment for a child. Worker will connect family with low cost
maintenance for the house as well as assistance with community churches and other
non-profit organizations in the area.
• Life Skills worker will assist with the family budget by researching the family bills
and debts, assisting the family by setting a schedule of when bill are due. Prioritizing
past due bills. Connecting the family with community churches and non-profit
agencies, which help families with scholarships and grants.
• Life Skills worker will assist the family in employment search. Worker will help
prepare family for employment search by helping find appropriate clothing and
conduct mock interviews.
• Life Skills worker will assist family budget by researching family income and balance
out with needs. Life Skills program will begin a drive for start up items for families
such as household products and hygiene products. Woker will connect family with
area food banks as well as other community connections that provide assistance with
items and scholarships.
• Life Skills worker will have an on-going goal of relationship skill building within the
family to promote pro-social and healthy communication.
Visitation
• Worker will observe visits for safety concerns and will document in weekly progress
note.
• Worker will contact parents by phone after visit to discuss strengths and concerns.
• Worker will address concerns and will set goal with parents in order for parent to
understand where improvement needs to occur and the rationale for why those
improvements are important.
• Workers will role model by providing structured activities when necessary; follow-up
phone call will address any concerns for lack of structured activity. Goal will be set of
expectation of parent to be responsible for a structure activity for all future visits.
• Worker will promote pro-social and healthy relationships by stepping in and assisting
in the visit when needed and discussing all concerns with parents in follow up phone
call.
Performance Improvement Plan (PIP)
The life skills program at Reflections for Youth, Inc. will work to improve outcomes in
the Performance Improvement Plan is several key ways. (1) The life skills program will
work to provide additional parenting and support skills for the families, with the overall
goal of increasing the parents' ability to cope in better, safer and healthier ways with the
child (children) and reducing the length of out of home stay or increasing the chances that
out-of-home care won't be necessary in the future. (2) Assessment and aftercare support
5
L
are part of the overall services offered by the life skills program. Reflections will
complete needs assessments for the families that are comprehensive enough to identify as
many underlying problems as possible and address them as thoroughly as possible over
the life of the life skills program contract and contact with the family. (3) A fair amount
of the PIP in both the larger categories of Permanency and Child and Family Well-
Being discusses the issue of visitation. Reflections will work to insure that visitation
between children and their siblings and their mothers and fathers is sufficient enough to
meet the needs of the children and the parents and to ensure that all cultural and racial
connections are maintained. Life Skills Workers will prove the caseworker with nay
information regarding family and cultural connections that support the child. Prior to
setting up the visits we will collaborate with the caseworker to insure that the visit is used
to focus on issues relevant to the case plan, service delivery and achieving the child's
permanency goal. We will also work to make the visits of sufficient quality to promote
safety and well-being of the child and enhance the attainment of the case goals. If based
on overall lack of progress or imminent risks and potential safety issues a Life Skills
Worker makes a decision that a move of the child (children) may be necessary,they agree
to facilitate meetings with all parties involved to discuss any issues surrounding a
recommendation to move the child. It is agreed that these meetings will address how a
move would be in the best interest of the child and how the move will be in line with the
child's permanency goal.
IV. Workload Standards
Based on a workload of 8 families at a time, Reflections will provide a minimum of 16
hours per week of lifeskills program support. This equates to 2 hours per week, per
family over the course of a six month (24 week) contract.
Reflections for Youth will provide a minimum of two licensed therapists, master's level
counselors with two years experience or bachelor's level counselors with three years
experience all working under the umbrella of Reflections for Youth, Inc. Maximum
caseload per staff in the program would be four(4); preferred amount would be no more
than two (2). Maximum caseload per supervisor would be eight(8)
All insurance coverage for Reflections for Youth, Inc. is shown on the enclosed
Certificate of Liability Insurance and exceeds the amount requested in the bid proposal.
Insurance coverage includes general liability, automobile liability, comp and collision,
worker's compensation and employer's liability and professional liability. Weld County
has been named as a certificate holder.
V. Staff Qualifications
All services provided under the umbrella of Reflections for Youth, Inc. will meet the
requirements as listed in Staff Manual volume VII Section 7.303.17 and section 7.3006 q.
The supervisor of the program may also carry a caseload. Total number of staff,
including supervisor available for the project is between(3)three and (4) four. The
supervisor has received the mandated caseworker training and all other staff working
6
within the life skills program would be willing to attend the trainings when offered. Base
on my limited knowledge, the trainings are county-based and are conducted for counties
and CDHS staff. All staff involved directly in the Life skills program have knowledge of
risk assessment and in some cases very thorough and complete knowledge of risk
assessment. All Reflections for Youth, Inc. staff are required to have an annual full-day
class on assessing risk and suicide prevention/intervention.
VI. Program Capacity by Month
The minimum number of clients per contract (based on a 24 week contract)to support the
program would be two. Reflections for Youth, Inc. is in the process of providing
additional training and support for the life skills program staff from a current Reflections
employee that has several years experience as a Family Support Worker in Nebraska and
more recently as a Case Aide in the life skills unit of a local county. It is our hope that
we will be serving a minimum of four families at a given time throughout the year. The
maximum number of families that Reflections can serve per year is 16 (no more that 8 at
any given time throughout the year).
VII. Internal Tracking and Billing Process
It is understood that Reflections for Youth, Inc. is responsible for all program costs,
including start-up costs, facility,personnel, operating, travel, equipment, audit and capital
items. Reflections for Youth, Inc. will submit original monthly billing forms to the
appropriate Department staff person on or about the 10th of the month following the
service month. It is further understood that all billings must be date-stamped by Social
Services by the 25th day of the month following service to be eligible for reimbursement.
It is understood that Reflections for Youth, Inc. will include all of the deliverables listed
in order to verify services on our monthly billing. Although not anticipated, in the event
that it becomes necessary, Reflections for Youth, Inc will work with families to prepare
to pay for the services beyond the established time frame and out of the scope contracted
with Social Services.
VIII. Evidence Based Outcomes/Literature Citations
Reflections for Youth, Inc. as an agency and the Life Skills Workers working under the
umbrella of Reflections for Youth, Inc. use evidenced-based therapies and interventions
as part of providing quality services to the clients served. Parent training programs have
been developed and found effective to improve child-parent interactions, enhance
parenting effectiveness and reduce coercive and"unsafe" interactions. Psychoeducation
is a specialized form of education aimed at helping people learn about a broad range of
emotional and behavioral difficulties, their effects and strategies to deal with them.
Psychoeducation is not therapy and it is designed to stand alone or to complement
psychotherapy. Psychoeducation is an important part of home-based services because
knowledge is crucial. With appropriate knowledge and techniques, undesirable behaviors
occur less often and are less severe in duration and intensity. Knowledge and awareness
result in more control over that behavior. What follows is a bibliography highlighting
7
L
some of the research as it relates to the interventions used in the course of providing life
skills support.
1. California Youth Connections littrillAww.caleouthcann.or
2. Child Development Institute(research and articles on child development)
http:/7www.chI Iddevelopmentinfb.com
3. Bavolek, Stephen J., PhD The Nurturing Parenting Programs, Washington DC, U.S.
Department of Justice Office of Juvenile Justice and Delequincy Prevention, 2000
4. Beyer, Marty, "Parent-Child Visits as an Opportunity for Change."Prevention Report
1999 #1, National Resource Center for Family Centered Practicepp. 1-12
5. Fahlberg, Vera I. M.D.,A Child's Journey Through Placement, Prospective Press,
Indianapolis, IN,1991
6. Feldman, J. & Kazdin, A.E. (1995). Parent management training for oppositional and
conduct problem children. The Clinical Psychologist, 48(4), 3 —5.
7. Webster-Stratton, C., & Herbert, M. (1994). Troubled Families-problem children:
Working with parents: a collaborative process. Chichester, England: John Wiley.
Assessment
NCFAS-R
IX. Confidentiality and Participant Protection/Human Subjects
1. Protect Staff and Clients from Potential Risk—There do not appear to be any
foreseeable risks or potential adverse effects as a result of the project itself or any data
collection activity. RFY will follow procedures to minimize participants(youth and
families in day treatment program)against potential risks, including risks to
confidentiality. Risks to confidentiality will be minimized by having therapy take place
in designated therapy rooms and offices and with the use of a sound machine as
necessary. All records, including background and intake information, education
information and treatment/clinical information will be stored in locked filing cabinets
and/or in locked rooms with specific access being granted for specific individuals on a
need to know basis. Although not anticipated, in the event of adverse effects,the Weld
County Caseworker would be contacted and a special meeting would/could be held to
discuss what has occurred and the most appropriate method of dealing with the situation.
All treatment and methods used within the day treatment program have previously been
described.
2. Fair Selection of Participants—Target populations for the proposed project have
been previously described an include youth between the ages of 11 — 18 that are in need
8
9
I �
of a structured day treatment program involving special education and therapeutic
components. Other populations include siblings of the referred youth (if applicable) and
bio and/or foster families members of the youth being served. The other information in
this section applies to research type studies and projects and is not applicable for the
purposes of the day treatment program offered to Weld County DSS by Reflections for
Youth, Inc.
3. Absence of Coercion—If a referred youth and his/her family is accepted into the
day treatment program at Reflections then participation is required for a successful
discharge and return to a lower level of care (foster home, public school, family home,
etc). Without participation it is highly unlikely that any progress would be shown. In
addition, it is possible that youth would be court ordered into our day treatment program.
I am unclear on part II of this section and I do not believe that it applies to the day
treatment services offered.
4. Data Collection—Date will be collected from the referring caseworker prior to
placement and throughout the placement on an as needed basis. Data may also be
collected from probation officers,previous therapists or evaluators, other professionals
with involvement in the case of the youth and family being referred, past school districts
and other placements if applicable. Data for testing may be collected based on the
needs/requirements of the IEP with classroom observation, test taking, assignments,
instruments such as the Woodcock Johnson, PIAT, BASC, etc. Prior to intake, our
Educational Director, Treatment Coordinator or Day Treatment Coordinator will conduct
an intake interview and collect data in order to make a decision about the overall
appropriateness of the referral and to ensure that RFY can meet the needs of the youth
and family being referred. All data collection instruments can be accessed by contacting
RFY directly but for page limit and and voluminous reasons, have not been copied. The
intake interview packet alone is 10-plus pages in length.
5. Privacy and Confidentiality—The privacy and confidentiality of youth and their
families will be ensured by having limited number of professionals having access to
records and by having records stored in a locked confidential place at all times. Access
to the information collected and information gained prior to intake will be granted only
on a need to know basis and in general will include the Special Education Teacher,
Educational Director, Treatment Coordinator, Day Treatment Coordinator, Executive
Director and assigned Therapist. Consent and releases are signed at intake by the family
(youth if age of consent and applicable) and referring caseworker. A coding system is
not used but access to the records is limited and at all times records are kept in a locked
filing cabinet and/or in a locked room at the administration offices of Reflections for
Youth, Inc.
6. Adequate Consent Procedures—Again, most of what is covered in this section has
been previously answered or is not applicable to the day treatment program at Reflections
for Youth, Inc. It applies more to research studies in general than it does to providing
treatment to youth and families in a structured day treatment setting. A Day Treatment
Handbook and Parent Packet will be given to all program participants outlining the key
9
components of the program, contact numbers, rights and responsibilities, consequences
and rewards, expectations, phase system information, therapy information and transition
from the program at program completion. Participation is voluntary in the sense that a
youth is not going to be physically restrained for attempting to physically leaving the
program in the course of the day and if a youth refuses to attend the program once
accepted, a decision will be made about the continued involvement of that youth in the
program. It is likely that for most youth being referred there would be "problems" if they
chose to not participate and top leave the project. Problems would occur in the nature of
a visit from a probation officer, referral to more restrictive placement or additional
requirements through the court.
Reflections will work to get consent from the caseworker making the referral, the
youth participating in the program and a parent or guardian. Consent for youth under the
age of 15 will be given by the parent or guardian. In the vent that a youth at the age of
consent has reading,processing or verbal problems, the program and requirements of the
program will be described in a manner in which they are able to understand. Our
program does require in nearly all cases, an IQ of at least 70 to be accepted into the
program. Reflections for Youth, Inc. employs two contracted interpreters to assist youth
and families that do not use English as their first language in these situations. Informed
consent is obtained for participation in all aspects of the program and a separate informed
consent is obtained to access services from our child and adolescent psychiatrist,
including prescribing of medications if needed. The consent forms can be read out loud
of required and questions are asked to ensure that all parties understand what they are
signing. Copies of the entire intake packet, including consents are given to the
caseworker and parent or guardian at the time of the intake or as soon as possible after
the intake. Again for page limit and voluminous reasons,the entire intake packet,
including consents are not provided in the proposal. Again,those forms canbe accessed
by contacting Reflections for Youth, Inc. directly. The intake packet for day treatment is
approximately 25 pages in length.
7. Rislc/Benefit Discussion—Risks for participation in the day treatment program are
minimal. Every precaution is taken to ensure that the environment at Reflections for
Youth, Inc. fosters trust, accountability and responsibility in a safe and healthy
environment. Certainly there are risks in terms of other youth in the program, the
possibility of bullying and intimidation, name calling and inappropriate behavior that is
experienced through direct or indirect involvement. All of these risks occur in every
treatment setting and in most cases, are more prevalent in public school environment and
in the community overall. The benefits of the program far outweigh the potential risks
and give referred youth the opportunity to make better decisions, gain a new level of
trust, show increased responsibility and independence and make it possible for the youth
and family to achieve a better life and lasting success.
Request for Renewal
10
Family and #: Caseworker:
FSW: Date/Time:
Request to Renew Services:
At the end of 12 weeks Cooper family continues to struggle with arguing and escalated
behavior. The family has utilized FSW to express feelings in a controlled setting;
however they have been unable to transfer the skills into the family while unsupervised.
The family is showing signs of progress and would greatly benefit from continued
support from FSW. FSW observed family needs support with gaining stable employment,
and assistance with Finical Planning which has not been addressed as of date due to
needed to stabilize relationships as a priority.
Monthly Report
Family Name/#: Caseworker:
FSW: Date/Time:
Assessment:
Family Jones has been compliant with follow through of goals set for the family. MOC
has begun to understand the importance of consistency her children need to include
breakfast, clean clothes, and help with homework and family time. FOC continues to
need assistance with understanding how to communicate with the children and not giving
orders with no relationship building. Family needs continued to need assistance in
relationship building, roles of family, limit setting, and organization of house.
Treatment Proposal:
Continue to work with FSW to ensure family is able to practice new skills under
supervision. FOC attends a Parenting Class geared towards Fathers roles on family. Meet
with family every other week rather than twice a week to transition the family to working
less with FSW and more with each other. FSW worker will have close out session at the
end of the 24 weeks and provide the family with a list of community resources should
they need them.
BUDGET
X. Unit of Rate Computation
11
The hourly unit rate computation is $56.25 per hour for 48 hours of life skills intervention
contact(based on two hours per week for a total of 24 weeks). The program budgets
including direct service costs, administrative costs non-face-to-face and overhead costs
and profits is attached.
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RESUME
KAREN HAMANN
STAY TOGETHER COORDINATOR
EDUCATION:
Arada High School Denver Colorado 1975
Front Range Community Associate Degree 1984
College Early Childhood Education
WORK EXPERIENCE:
High Sky Children's Ranch 10/95 to Present Stay Together Coordinator
High Sky Children's Ranch 5/92 to 10/95 Stay Together Consultant
High Sky Children's Ranch 1/91 to 5/92 Family Teacher
Lubbock State School 6/89 to 9/90 Service Assistant
Colorado Christian Home 11/6 to 3/89 Child Care Worker
Care Inc. 1/85 to 10/86 Instructor
Additional Training/Cerdficates
One time certified Family Teacher In the National Teaching Association
Active Parenting Certified
Parent to Parent Certified
Parent/Child Mediation Certified
Chairperson for Winkler County CRCG
' John R.Kinnaird
419 Ord St.
Laramie, Wyoming 82070
(307) 755-5285
CAREER
OBJECTIVE To use my personal,academic and work experience to help individuals develop insight and solutions
to their psycho-social problems.
LICENSE Licensed Clinical Social Worker#LCSW-358,Approved April 2001 by the Mental Health Board
of Wyoming.
EDUCATION Masters of Social Work,August 1998. GPA 3.75/A=4.0. Arizona State University, Tempe, AZ.
Second Degree Student,Health Sciences(Pre-Med.),June 1993-May 1994. GPA 3.9/A=4.0
University of Wyoming,Laramie, WY.
B.A.,Psychology,December 1992. GPA 3.2 (cum.)3.5(psychology)/A=4.0 University of
Wyoming,Laramie, WY.
WORK EXPERIENCE
March 1999-Present Counselor,Cathedral Home for Children,Laramie, WY. Provide individual,family and group
therapy to adolescents and their parents. Weekly co-facilitation of the campus chemical dependency
and sex offender groups. Developed currently used curriculum for adolescent chemical dependency
program. Responsible for treatment planning,implementation and documentation for all residents.
Insure that documentation for residents is to JCAHO standards. Provide supervision and in-service
training for the treatment team staff. Communicate progress of residents to social workers,judges,
lawyers and other involved parties. Attend admissions meeting once per week to help decide on
future in-takes and to discuss discharge planning with a committee of directors,counselors and
physicians. Provide supervision for Masters of Social Work Students.
Aug. 1998—March 1999 Masters Level Therapist,Arizona Youth Associates,Phoenix,AZ. Assessed clients prior to
placement in a residential setting for traumatized children. Developed and supervised therapeutic
programs used by the Behavioral Health Technicians. Provided individual and family therapy for
each child. Conducted therapeutic groups and social skills training. Educated staff and families on
client diagnosis and therapeutic methods. Formulated each client's treatment and ensured that the
plan was designed to meet the individuals'needs.
March 1998—Aug. 1998 M.S.W. Intern and Mental Health Technician,Remuda Life Program,Chandler,AZ. Worked
with nurses,therapists, physicians,and dietitians in providing daily needs and long-term case
planning for clients in an inpatient setting for eating disorders. Provided individual/group therapy.
March 1997-March 1998 Program Director,Developmental Behavioral Consultants, Tempe, AZ. Supervision and training of
Residential Managers of three therapeutic residential homes for emotionally and mentally
handicapped children and adolescents. The major role of the Program Director was to oversee the
total operations of these therapeutic settings. Development of programs and treatment plans.
Sept. 1996—March 1997 M.S.W. Intern and Program Coordinator, Developmental Behavioral Consultants,Tempe, AZ.
The development of the agency motivational/behavior management program for emotionally and
mentally handicapped children and adolescents. Other duties included a problem analysis of staff
turnover, individual counseling,development of treatment plans,and the production of new agency
programs.
Dec. 1994-Aug 1996 Residential Manager, Developmental Behavioral Consultants,Tempe,AZ. Supervised the
implementation of treatment plans by staff in a residential setting of emotionally and/or mentally
handicapped children and adolescents. Educator,therapist and behavioral specialist for the six
clients,their families,and all other persons involved in the clients' lives.
INTERESTS Running,Golf,Fly Fishing, Health and Nutrition, Scientific Research.
REFERENCES Available upon request.
PRAIRIE VIEW PAGE 01/02
t/'
Shanon Aurora Skeen Sfa a S
4700I556111htkbtive 44N1a W,filrltlj/EAI OIL
Fort Collins,Co. 80526
(970)-206-0395
Education:
O51J: Dept. of Arts and Sciences,B.A. Psychology/minor in Philosophy
Oklahoma State University, Stillwater,Olc(fall of'94-spring of'97)(WA 3.67
Tulsa Junior College Tulsa Ok.( of'92-spring of'94)trek3.5
to -Mean* Hvn s '_p ouicnof
Work History: UL9s '
q ,i _t-
CedarO Behavi�o0sl 'r'
'00). Lead mental health worker. Supervision of employees and residents on 2
sexual offender units and 2 conduct disorder units. Extensive documentation
including charting and auditing skills. Cognitive group facilitation.
Implementation of a social model program.
YMCA, Colorado Springs,Co. (Aug'98-tom. '98). Before and after school care
for children ages 5-12. Recreational coordinator and tutoring.
Youth Services of Tulsa, Tulsa,Ok. (Feb. '98-Aug. '98). Intake counselor and
group fhcilitator fbr the Ii&sdemeanant Alternative Program. Trained in
assessment skills,extensive case-management, group facilitation. Worked in
conjunction with the judicial system.
Youth Services Youth Shelter, Tulsa,Ok. (Dec. '97-Feb. '98). Residential
counselor. Intakes, leading groups,coordinating recreational activities, and
contact reports.
Street School,Tulsa,Ok. (June '97-Dec. '97). Tutor/Mentor for 'special needs',
State custody youth ages 12-17.
Pepper's Restaurant, Tulsa, Ok. Aug '90-April '95 &June '97-Mg. '98)
Mexico Joe's, Stillwater,Ok. (Aug`95-May '97)
6 years experience in a high-paced restaurant/club environment. Helped to build
organizational and interpersonal Skills.
Volunteer Work:
Youth Services Payne County Youth Shelter, Stillwater,Ok. (June'96-Aug '96).
Residential counselor(10 hours per week).
rKAIKIL VIEW PAGE 02/02
et
References
(empleYers)
Chris Valdes-Unit Coordinator
2135 Southgate Rd.
Colorado Springs,Co. 80906
(719).633-4114 ex 1514
Larry Dalton-Program Coordinator
2105 Southgate Rd.
Colorado Springs, Co. 80906
(719)-227-0213 ex. 1504
Pamela Rhodes-MAP Program Leader
. 302 S. Cheyenne Rd.
Tulsa, Ok 74105
(918)-582-0061
(per)
John Jones-friend of family (8 yrs.)
706 Knapp
Wolf Point,MT. 59201
(406)-653-17221
--r
ab
, .
Laura Leah Olsen
4137 Stringtown Dr.
Loveland, CO 80538
Home Phone (970) 669-2578 Cell Phone (970) 290-3180
Work History
Reflections for Youth, Inc. September 2005-to present
Client Services Coordinator responsible for facilitating Drug and Alcohol
initial assessments and Education program for all three programs serving
residents 12-18. As CSC responsible for reviewing all referrals,
performing intake interviews with potential residents and performing
intakes into our programs. Also working with families in their homes in
order to follow Family to Family theory and move residents into a
permanent placement within a year of removal.
Facility Manager for a male facility, with up to 10 residents and supervise
10 staff. Responsible for structure and treatment of facility, all resident
and staff files, facilitating weekly meeting, and problem solving.
Children, Youth, and Family Services,
Larimer County October 2004-September of 2005
Facility Investigations Case Aide
Was assigned all Foster Homes, Day Cares and would assist with
investigations in Residential Treatment Centers. As Facility Investigations
Case Aide required to know Foster Care/Day Care regulations when
investigation a report which was placed to Child Protections Services.
Conducted interviews with Foster Parents/Day Care providers, as well as
all children in the facilities. While on site of Foster Homes/Day Cares
would check around facility to insure safety. Worked closely with Foster
Care and Kinship Workers, as well as State of Colorado Licensing.
Monarch Youth Homes,Inc April 2002-October 2004
Human Resource Coordinator as part of the Admin Team. Responsible for
all personnel files of agency, set up and facilitate state required trainings,
Residential Program Director for two facilities, co-facilitate House
Manager Meetings, enroll all staff with insurance, handle all
unemployment claims, and any other tasks assigned.
House Manager for a male facility, with up to 8 residents and supervise 8
staff. Responsible for structure and treatment of facility, all resident and
staff files, facilitating weekly meeting, and problem solving.
Evening Child Care Worker providing daily structure and activities for up
to 8 females at any one time, group facilitator, pass Medications, and
assist with residents evaluations.
Overnight counselor supervising up to 8 girls in a group home setting.
cal
Visinet, Inc April 2001 April 2002
Family Support Worker for parents with children in the foster care system.
Responsibilities included supervising visits with the biological parents and
the children, in home or community, addressing substance abuse issues,
working on parenting skills, setting up schedules, work on appropriate
discipline, attending school with adolescents, providing parents with
community resources.
Cedars Youth Services, Turning Point Treatment Group Home, Youth
Specialist III Oct 2000-March 2001
Responsibilities to be a care giver to up to ten adolescents at one time, a
group facilitator, and passed Medications.
Cedars Youth Services, Unity Girls Group Home, Youth Specialist II
Jan 1999-Oct 2000
Primary caregiver to up to eight young ladies at any one time. The Primary
was responsible for fostering self-sufficiency in the girls and
responsibility. Duties included documentation, organizational skills, phone
contacts, scheduling and facilitating team meetings with parents,
caseworkers, and therapists.
Lincoln Lancaster Health Department, Nursing Assistant Jan 1998-Jan
1999
In the nursing division I was responsible for the computer data of all new
clients, answering phones and filing. When I was an assisting in the WIC
program I would check clients in, answer phones, schedule appointments,
and print WIC checks for the clients.
Education
• CAC I *Certification classes complete—waiting for official
certification through DORA, will have CAC III by June of 2007.
• UNC- Greeley, CO 2003 to present pursuing Sociology Degree
• Southeast Community College, Associates Degree Human
Services, 9/01
• Sidney High School, General Education, 1997
Certifications
Foster Family Assessment
Qualified Medication Administration Person
Therapeutic Care Certified
Institutional Child Abuse
Informed Supervisor Certification
Communication Skills and Crisis Management
CPR/DI Aid
Larimer County Sheriff Department Training
Confirming Safe Environments
Certified CPI Instructor
References available upon request.
aa
Reflections for Youth, Inc.
P.O.Box 1860
Berthoud, CO 80513
970-344-1380 (p)
LIFE SKILLS Monthly Report
Client Name
HH#
Tralls#
Date Family Participants
1 Hr. Session Summary
Mileage:
Date Family Participants
2 Hrs. Session Summary
Mileage:
Date Family Participants
2 Hrs. Session Summary
Mileage:
Date Family Participants
1 Hr. Session Summary
Mileage:
TOTAL HOURS = 6
TOTAL MILEAGE:
AUTHORIZATION TO RELEASE INFORMATION FORM
I• , hereby authorize
(Print name)
, to release
(Therapist/Physician/Facility/Probation or Parole/Employer)
the information designated below for
This authorization is valid only to:
Individual:
Agency: Reflections for Youth, Inc.
Address: P.O.Box 1860, Berthoud, CO 80513 970-344-1394(fax)
For the purpose of:
Designate which of the following is to be released:
Medical
Psychiatric/Mental Health Treatment
Drug and/or Alcohol
Employment
Educational
Criminal History
Financial
Social
Other (Specify)
I understand that some of this information is protected by federal law and that my signature
authorizes release of all of the above noted information. I also understand that I may revoke this
consent at anytime and that upon fulfillment of the above stated purposes(s), this consent will
automatically expire without my express revocation.
Date:
Signature
Printed Name
t ,
AUTHORIZATION TO RELEASE INFORMATION FORM
MINOR CHILD
I, , hereby authorize
(Print name)
(Therapist/Physician/School/Facility to release
the information designated below for
This authorization is valid only to:
Individual:
Agency: Reflections for Youth, Inc.
Address: P.O.Box 1860, Berthoud, CO 80513 970-472-1736(fax)
For the purpose of:
Designate which of the following is to be released:
Summary of Social/Family History
Summary of Psychiatric History
Summary of Medical History
Educational Records
Psychological Testing
Other (Specify)
I understand that I may revoke this consent at anytime and that upon fulfillment of the above
stated purposes(s),this consent will automatically expire without my express revocation.
Date:
Client or Guardian Signature
Relationship to Client
Reflections for Youth,Inc.
"Discovering the Power of Positive Choice"
Evaluation Plan
Reflections for Youth, Inc. has been providing services for Weld County Department
of Social Services since its inception, September 1, 2004. In addition to TRCCF (RTC)
services beginning at that time, Home-based Option B and Day Treatment Services have
been provided since June 1, 2005 and Life Skills services were added beginning June 1,
2006. Based on comments from Program Area Supervisors and through quarterly quality
assurance reviews of our services that began during this current contract year, good,
quality services have been provided and RFY has been receptive to feedback and making
any necessary adjustments when needed. RFY has in the past and will continue to work
with Weld County collaboratively toward the goal of providing quality services for the
youth and families served and make every effort to assist Weld County and Colorado
Department of Human Services to meet the requirements of the Performance
Improvement Plan.
The supervisors of all programs included in our bid; Day Treatment(Mary Barron,
M.Ed), Home-Based Option B (Carol Johnson, LMFT) and Life Skills (Laura Leah
Olsen), agree to meet on a quarterly basis to collect data, monitor and evaluate the
process components as outlined. These include the following:
* How closely did implementation match the plan as outlined in the proposal?
* What types of deviation(if any) from the plan occurred?
* What led to the deviations?
* What effect did the deviations have on the planned intervention and evaluation?
* Who provided the services, what the services actually were (modality, type,
intensity, duration) whom were the services provided to (individual, family,
characteristics); in what context(system, day treatment, home-based, community) and at
what costs (personnel face-to-face and non-face-to-face, facilities, travel, etc.)
The supervisors of all programs included in out bid; Day Treatment, Home-Based Option
B and Life Skills, agree to meet on a quarterly basis to review the data collected and
information gained from the services actually being provided and to address the outcomes
components as outlined. These include the following:
• What was the effect of the interventions used and overall involvement in the
program for the youth and/or families receiving the services?
• What program/contextual factors were associated with outcomes?
• What individual and/or family factors were associated with outcomes?
• Were the effects of the interventions and involvement in the program long
lasting?
• How did outcomes achieved align with the overall Performance Improvement
Plan objectives?
___ _ _ . . . ___ ____ raga. uu•
ClSrS 52227 8REFLFOR
ACORD,R CERTIFICATE OF LIABILITY INSURANCE 03/27/07DATEYYYY)
PROCUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HRH of Colorado ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
720 South Colorado BoulevardHOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600N
Denver,CO 80248 INSURERS AFFORDING COVERAGE NAIC It
INSURED INSURER A Tudor Insurance Company 37982
Reflections for Youth,Inc. INSURER a Plnrmwl Assurance 10780
P.O.Box 1860 INSURER C: Great American Insurance Company 18691
Berthoud,CO 80513 .
INSURER a
INSURER a
COVERAGES
THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME)ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REOUREIENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY TIE POLICES DGRLRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDMCNS OF SUCH
POLICES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LINaR SIRE TYPE OF INSURANCE POLICY NUMBER DATE
EFFECTIVE POLICY EXPRATION
DATE LINIAMYY1 DATE MEMOYYI LIMITS
A GENERAL LIABILITY PGL739600 09/20/06 09/20/07 EACH OCCURRENCE
s1,o00,000
X COMMERCIAL GENERAL UABILITY PRMfuSFS(Fa ni,,qu l *50,000
X I CLAIMS MADE ❑OCCUR MED EXP(My one person) El AN
PERSONAL S Ave INJURY $1,000,000
GENERAL AGGREGATE $3,000,000
GENI AGGREGATE OMIT APPLES PER: PRODUCTS-COMP/OP AGG $1,000,000
n 7 POLICY sr& nu. Claims Made Policy
C AUTOMOBLE UABIUTY CAP5154804 09/20/08 09/20/07 COMSINEO SINGLE LINT
X ANY AUTO (EarrXNMI 51,000,000
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per Poem) S
X HIRED AUTOS
X NON-OWNED NITOS BOOTY INJURY S
Ivor LY ANA)
PROPERTY DAMAGE $
(Par erx4LalU
GARAGE WBILITY AUTO ONLY-EA ACCIDENT I
GA ANY AUTO EA ACC S
OTHER THAN
AUTO ONLY: AGO S
EXCESGIMNRELLA LIABILITY EACH OCCURRENCE $
7 CCCIR n CLAIMS MADE AGGREGATE I
',MUMBLE $
S
RETENTION $
B WORKERS COMPENSATION AND 4085090 10/01/06 10/01/07 X I WCSTATU-I 10TH- S
EMPLOYERS'LIABILITY TOAYIIMR9 RR
ANY PROPRETORIPARTNEUEXECUSVE EL.EACH ACCIDENT Si00,000
OFRCERIEMBER EXCLUDED?
IIFs.saeRllamRr EL.DISEASE-EAEMPLOYEE 5100,000
SPECALL PROVISI NS Wow E.L.DISEASE-POLICY LIMIT 5500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
The following are Additional Insureds as respects General Liability only
to the extent coverage might apply according to the policy terms,
conditions and exclusions.
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
Weld County,Dept of Social DATE THEREOF,THE ISSIJII4G INSURER WILL ESIOCAVOR TO MAIL _jfl_ DAYS WRITTEN
Services NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
P.O.Box A 315 North 11th IMPOSE NO OBLIGATION OR LIAMUTY OF ANY KIND UPON THE INSURER ITS AGENTS OR
Avenue REPRESENTATIVE.
Greeley,CO 80632 AUDI REPRESENTATIVE
.rrIAC aN�aEK/HE' L..
ACORD 25(2001/08)1 of 3 #5521556/M513076 BIRCH a ACORD CORPORATION 1988
--- -- -- ._. _... ..___ a ... .......... rages 003
IMPORTANT
If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder In lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constRute a contract between
the Issuing Insurer(s), authorized representative or producer,and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 254(2001108) 2 of 3 8S521556 M513076
DESCRIPTIONS (Continued from Page 1)
Additional Insureds: Certificate Holder 8 State of Colorado
•The following cancellation conditions always apply:
-10 days for non-payment of premium
-If policy shown,10 days for Workers'Compensation for fraud;
material misrepresentation;non-payment of premium;other reasons
approved by the Commissioner of insurance
MI5 25.3(2001/08) 3 of 3 #3521556/11513076 _.
j ` r DESCRIPTIONS (Continued from Page 1)
Additional Insureds: Certificate Holder 8 State of Colorado
•The following cancellation conditions always apply:
-10 days for non-payment of premium
-If policy shown,10 days for Workers'Compensation for fraud:
material misrepresentation; non-payment of premium;other reasons
approved by the Commissioner of insurance
AMS 25.9(2001/05) 3 of 3 0135215581M513078
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