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Home My WebLink About20071686.tiff RESOLUTION RE: APPROVE THREE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR FOSTER PARENT TRAINING PROGRAMS WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with three Notification of Financial Assistance Awards for Foster Parent Training Programs, between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and various providers, listed below, commencing June 1, 2007, and ending May 31, 2008, with further terms and conditions being as stated in said awards: 1. Julie Box, LCSW 2. Lori Kochevar, MS, LPC, LLC 3. Transitions Psychology Group, LLC WHEREAS, after review, the Board deems it advisable to approve said awards, copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, ex-officio Board of Social Services, that the three Notification of Financial Assistance Awards for Foster Parent Training Programs between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and various providers, listed above be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said awards. 2007-1686 SS0034 g : SS 07-id-D7 THREE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR FOSTER PARENT TRAINING PROGRAMS PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 18th day of June, A.D., 2007, nunc pro tunc June 1, 2007. --. B. A 'D OF COUNTY COMMISSIONERS NTY, COLORADO ATTEST: ', „/�� !,♦ � ' '�'1 �� E. Long, Chair Weld County Clerk to the Bea M 1t6' �� nI E . Jerke Pro-Tem BY: Deputy Cle to the Board Will F. Garcia APPROV AS TO \ Robert D. Masden ty Attorney Douglas ademacher�� ^ ate of signature: 7 -9 7 2007-1686 SS0034 a AITWELD COUNTY 1141 COMISSIS DEPARTMENT OF SOCIAL SERVICES 2��1 JUN 12 P 4 5'1 P.O. BOX A ige. GREELEY, CO. 80632 R� - + Website:www.co.weld.co.us E C�L—I v nistration and Public Assistance(970)352-1551 WI Fax Number(970)353-5215 COLORADO MEMORANDUM TO: David E. Long, Chair Date: June 8, 2007 Board of County Commissioners ,)FR: Judy A. Griego, Director, Social Services/ ( (,:I �il, �i� RE: Notification of Financial Assistance Award with Various Contractors— Foster Parent Training Enclosed for your approval are Notification of Financial Assistance Awards with Various Contractors for Foster Parent Training. The Department and the Families, Youth, and Children (FYC) Commission are recommending approval of these Awards. These Awards were reviewed at the Board's work session of June 6, 2007. The major provisions of these Awards are as follows: 1. The Award period is June 1, 2007 through May 31, 2008. 2. The source of funding is Core Services or Child Welfare Administration. 3. The Contractors will provide Foster Parent Certification Tanning. 4. The Contractors include: Contractor Training Package Rate A. Julie Box, Private Practice $3,600; $75 court testimony B. Lori Kochevar, MS, LPC, LLC $3,957.28;$150 court testimony C. Transitions Psychology Group, LLC $3,700; $150 court testimony If you have any questions, please telephone me at extension 6510. 2007-1686 Weld County Department of Social Services Notification of Financial Assistance Award for Core Funds Type of Action X Initial Award PY 07-08-CORE-89 Revision (PY 07-08 RFP-FYC-006-00C; 003-FPT-07) Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Transitions Psychology Group, LLC Ending 05/31/2008 Foster Parent Training 804 11 Avenue Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Foster Care Certification Training to foster parents in Assistance Award is based upon your Request for Weld county,using a comprehensive and experiential Proposal(RFP). The RFP specifies the scope of training curriculum that directly improves parents' services and conditions of award. Except where it ability to provide quality care for foster children. The is in conflict with this NOFAA in which case the training satisfies all training requirements of the State NOFAA governs,the RFP upon which this award is of Colorado Volume VII and those required by Weld based is an integral part of the action. County Social Services.Trainings are completed in Special conditions 27-hour blocs,no more than four weeks in length. 1) Reimbursement for the Unit of Services will be Trainings are scheduled at the Department of Social based on an episode rate for trainings, and hourly Services discretion, and are open capacity. Bidder rate for court testimony. estimates that 30 clients will be served by this 2) Rates will only be remitted on cases open with, and program during the contract year. Trainings will last referrals made by the Weld County Department of an average of four weeks. Bilingual and South Social Services. County services are available. 3) Requests for payment must be an original and submitted to the Weld County Department of Cost Per Unit of Service Social Services by the end of the 25th calendar Per Episode per Training day following the end of the month of service. Treatment Package $3,700.00 The provider must submit requests for payment Per Hourly Rate on forms approved by Weld County Treatment Package Low(Court Testimony) $150.00 Department of Social Services. Requests for payments submitted 90 days from the date of service,and thereafter, will not be paid. Enclosures: 4) Requests for payment must include original client X Signed RFP: Exhibit A verification signatures (blue or red ink preferred) X Supplemental Narrative to RFP: Exhibit B and dates and hours of service. 5) The Contractor will notify the Department of any Recommendation(s) change in staff at the time of the change. X Conditions of Approval Approvals. PBrogr O fici l By By CA l) David E. ong, Chair Ju (riri o, Dire t r BoardalteldlyiStk Commis oners W 1 /Co r Department of Social Services /^ pplt Date: Date: Li U7 07007 — /clicP6 • 9 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 Kline: Friday.March 30.2007. 10:00 am. (MST) The Families,Youth and Children Commission, an advisory commission to Social Services, announces that competing applications will be accepted for approved providers pursuant to the Board of Weld County Commissioners'authority under the Colorado Family Preservation Act(C.RS.26-5.5-101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.RS. 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 SIGNED IN INK Program Area: FOSter Pa rehf Core Trait/1114 `J TYP OR PRINTED SIGNATURE VENDOR Trunsil-ians Psycl ologq esp.t.,1-c- Tam; Pace'Harftna. n , MAIL PG (Name) Handwritten Signature By Authorized Officer or Agent of Vendor ADDRESS 00I{ I ItL' Pcve., TITLE Co- Di�rccfvy GYeele► i co 43011931 DATE 3/2 o 1 O'- PHONE# o) 33(. —I l 2a7 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Program Area Supervisor/Provider Meeting ��,� Verification/Comment Form Ti?'9 hd e y td.--7 • Date of Meeting: 7/ 7/6 '7 Program Area: Zc,'&it elleet [ORE T exile ,r c{ Comments(to be completed by jProgram Area Supervisor): dC £ 's ct/cs ecQ oN irs tOWe- wt/ee_ re-se ? I h t e. iire _ 1e.ccy Ala sett d-2sesiRe /!tsg4+,e c. CanelGO I1//y1 , C-I 9At/1cu/AOC Ins 4 a#,vcce /J "he- t�s £Iv/t t y /Lo fide* /k Comp//stir et_ Rep i/tetawJf Wye- ante 4s c 3 wc• spnavess i- 11/49,vim Arsss:14Ord e y 4 Zj., td 1c-S,-Vt ?e ve-R ia eat A/3D A/ fwff.v4 tJ>as Rote- 1 Ptht eat et tin / deleif r HA/1� Liz reseal-41/S '� !air c O t?r1/t l/�+P+r less D l r�A7�r r� 441; Signature of Program Area pervisor A s s Foster Parent Core Training, 2007-08 atirkt A _ a qqes a vu i e Transitions PSY cx of o4V GROUP, Ltc 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 agency attracts creative, experienced professionals who are inspired to help others fulfill their potential. Transitions utilizes their diverse team of talented professionals with varying areas of expertise to create a dynamic training opportunity and information resource for foster parents. The mission of the program is to prepare quality families to care for foster children and enable them to rebuild children's lives. TABLE OF CONTENTS 1. Target/Eligibility Populations. .............2 II. Project Narrative/Supportive Documentation......... ... ... ... ... ......... ....2 A. Types of Services Provided... ......... .............................. ... ......2 B. Measurable Objectives......... ... ......... ............ ............... ... ... ...3 C. Service Objectives. .4 D. Workload Standards...... ............... ......... ......... ... ... ................4 E. Staff Qualifications... ......... ......... ... ......... ............ ... ... ......... ...4 F. Program Capacity by Month... ......... ... ............ ............... .........5 G. Internal Tracking and Billing Process......... ............ ... ...............6 III. Budget. .7 IV. Appendices.. .8 A. Appendix 1: Resumes B. Appendix 2: Data Collection Instruments/Protocols C. Appendix 3: Sample Consent Forms • TARGET/ELIGIBILITY POPULATIONS Services are limited to Weld County foster parents and foster parent applicants. > Total number of clients to be served: 30 > Total family units: 17 > Sub-total of individuals who will receive bicultural/bilingual services: 10. Bicultural applicants will be included in the regular training sessions. If there is significant need, Transitions has three bilingual therapists and could provide the entire training in Spanish. > Sub-total of individuals who will receive services in South Weld County: 10. Transitions will offer at least one training rotation per year in South Weld County. > The monthly maximum program capacity per group: 10 > The monthly average capacity: 10 > Average stay in the program (weeks): 4 > Average groups per week in the program: 2. PROJECT NARRATIVE/SUPPORTING DOCUMENTATION A. Types of Services Provided Transitions provides Foster Parent Certification Training and uses a comprehensive and experiential training curriculum that directly improves the foster parents' ability to provides quality care for foster children. Training is provided in Weld County and is limited to applicants for Weld County foster care certification. The training will satisfy all training requirements of the State of Colorado Volume VII and those required by Weld County Social Services. A. Basic Training a. Weld County Foster Parent Handbook b. Attachment/bonding issues c. Loss and grief issues d. Adoption as a life-long issue e. Key concepts of child growth and development f. Boundary setting and discipline g. Parenting a child of different cultural or racial background h. Dealing with historical information regarding the child and birth parents i. Understanding adoption laws and procedures, including termination of parental rights and the expedited relinquishment process pursuant to Section 19-5-103.5, C.R.S. j. Ongoing contact and communication of child and adoptive family with biological family and/or significant others k. Use of community resources, including assistance with parenting techniques 2. Specific Training a. Infant care b. Fetal alcohol/substance abuse syndrome c. The possibility of misleading or incorrect historical information about the child and/or the biological family d. Special medical and emotional issues e. Parenting the abused child f. Parenting the physically and/or emotionally challenged child g. Accessing available resources and benefits 3. Training Schedule Training will consist of 27 hours, divided among three weekday evenings and one weekend; the training bloc will be completed in less than four weeks. 4. Communication with Social Services a. Transitions therapists providing the training will assess the general functioning of each foster parent applicant participating in the training, identifying their potential strengths and weaknesses relative to caring for children with special needs. b. Transitions therapists will comply with 19-1-123 C.R.S., maintaining the strict confidence of reports of child abuse and any identifying information in the reports. FYC resources will not supplant existing available services in the community. Foster Parent Core Training services are a specialized service that is not covered by mental health capitation, ADAD or other funding sources for professional services. Transitions intends to offer an additional training option to complement other Core Training currently available in the community, alternating training cycles with other providers. B. Measurable Outcomes A. 90% of all applicants enrolled in training will complete the course. Transitions will track the number of participants who begin and complete the course. C. Service Objectives A. Improve family conflict management B. Improve household management competency C. Improve ability to access to resources D. Address specific referral issues E. Improve outcomes in the Performance Improvement Plan (PIP) a. placement changes-Transitions will focus on the permanency needs of children in out-of-home placements, providing supportive services for foster parent applicants geared to preserve placements for children. Transitions therapists will NOT advise or give permission for a child to be removed from placement. b. independent living Transitions will cooperate with a child's case plan for independent living and teach foster parents to provide daily life skills instruction to children to facilitate these efforts. c. maintaining cultural and racial connections-Transitions will assist foster parents to maintain the cultural and racial identify of children in their care by providing training on cultural resources, holidays, community connections and spiritual needs. d. monthly face-to-face visits with caseworkers-Transitions will train foster parents on the importance of pro-active communication with caseworkers in order to facilitate monthly face-to-face contact between caseworkers and children in the custody of the Department. e. timely initial assessment within two weeks of placement-Transitions will train foster parents to access medical care through identified Medicaid providers, scheduling appointments promptly at the time of placement in order to meet timeline requirements for medical and dental appointments for children in foster care. f. health needs identified and services provided-Transitions' training will address the role of foster parents in working with caseworkers to identify health needs and services. Transitions will emphasizes assertive communication and clarification of mutual responsibilities and expectations between caseworkers and foster parents. D. Workload Standards A. Number of groups per month/hours per day/week/month: Foster parent applicants will participate for a minimum of three hours per week. Training blocs will be divided into three 3-hour sessions and three 6-hour sessions for a total of six groups and 27 hours per month. B. Number of anticipated requests for training each month: 14. Transitions will accept the first 10 foster parent applicants for each training session; 4 alternate applicants will be placed on a waiting list. C. Number of individuals providing services: 10. Transitions is an eclectic group of counselors and psychologists, each with different areas of expertise. Transitions will utilize the knowledge and skills of various team members to provide the most dynamic, informative training opportunities. • D. Maximum caseload per worker: Each training session will serve a maximum of 10 applicants. E. Total number of hours per day/week/month: 27 hours per month. F. Maximum caseload per supervisor: 10. Transitions has one clinical consultant, who is a Licensed Psychologist, to supervise Foster Parent Core Training. G. 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 and psychologists maintain their own policies, each with a minimum of$1 M/$3M liability. Current contracted counselors are insured through HPSO and the Philadelphia Indemnity Insurance Company. E. Staff Qualifications A. 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. Current providers are Master's level counselors, licensed professional counselors and PhD level counselors and psychologists. B. Staff available for the project: 10. Transitions has two co-directors, two full-time employees and six contractors available for the project. C. Mandated New Caseworker Training: One full-time Transitions counselor has received mandated new caseworker training. Other counselors will not receive this training. D. 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 can accommodate up to 10 applicants per month in the four- week training program. G. Internal Tracking and Billing Process A. 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. B. 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 5th 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 Baker, C.B., Burke, R.V., et al. (1997). Rebuilding children's lives: A blueprint for treatment foster parents. Boys Town Press. Barnes , B.A. and York, S.M. (2001). Common sense parenting of toddlers and preschoolers. Boys Town Press. 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. 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, 2003. Burke, R, Herron, R. and Schuchmann, L. (1996). Common Sense Parenting. Boys Town Press. Herschel!, 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. Phelan, T. (2003). 1-2-3 Magic: Effective Discipline for Children Ages 2-12 (3t° ed.). Illinois: Child Management Inc. Phelan, T. (1998). Surviving Your Adolescents: How to Manage and Let Go Of Your 13-18 Year Olds (2n°ed.). Illinois: Child Management Inc . Shelov, S.P., Hannemann, R.E. (Eds.). Caring for your baby and young child (1991). American Academy of Pediatrics. I. Confidentiality and Participant Protection A. Protect Clients and Staff from Potential Risks Transitions counselors explain privacy rights in the State of Colorado and give informed consent to alt 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 that an applicant would not successfully complete training, which could have psychological implications. In order to serve the best interests of foster children and relative children, there are times when a family would not be recommended as kinship or foster care providers despite program goals to develop community resources. To mitigate these potentially negative effects, families are informed at the outset of training that they are being evaluated. Families are also routinely advised to seek legal advice when they have question of a legal matter. When necessary, risk assessment and appropriate referrals for counseling are made by the counselor. B. 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. Training participants must be Weld County Foster parent applicants/parents per social services requirements. C. Absence of Coercion Foster parents are required to complete Core Training. However, interested families must apply to be foster parents and this process is fully voluntary. Transitions is always willing to refer to other counselors and agencies as needed and recognizes our duty to help protect the well-being of children and to consider child safety when making recommendations for treatment. D. Data Collection Data is collected directly from families, from the referring agency, and from other corroborative sources (e.g. home study evaluator) as necessary to complete training. A release of information from the client is always requested and signed prior to participation in training. Transitions collects data directly from the participants during training. Each participant completes a brief intake and educational worksheets during the course. E. 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 to verify that training has been completed and provide feedback to the Department about the applicant's ability to provide quality care for children. 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. F. 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. G. Risk/benefit Discussion Completing Core training is necessary for a family to become a foster family, adopt children or to be considered for a relative placement. Thus, it is a choice of the family/individual to complete the process. Considering the well-being and safety of children, it is well worth the risk to require applicants to complete training. BUDGET See attached form. APPENDICES Appendix 1: Resumes for key staff members Appendix 2: Data collection instruments/protocols Appendix 2: Sample consent forms / \ _ c § § I 0 C.-) E e § § k % R / 2 / tai \ 0 ri GO k co vs _ 2 k vs CO i 2 § p ° / Zr—) 2 § t § p k _ - - _ k k c k ± 2 > ' W 8 8 n 0 n o " \ CO-2 ■ k G 2 _ � W1 \ 00 0 k F § k c' S ® k 2 k _ ® 2 k CO 2 OD CIO N- CO \ 80 CO O 8 4 $ m S It,© 8 d @ eG CL f co coo + : s - 47> - k 2 k _ _ E ) 7 o 2 w i 0 E E 8 � / § 3 x � CC & % % / B + i o § 3 7 § § / k ca cc cc m o a 2 0 w < k i ° § W k \ LI } } 2 { - 5 a 2 k cc w R ' 6 0 m u, w // 2 k Cl) in 0 w w Cr N.., 0 w ~ w w a - < ° z E 0 u, 8 > a re c a u_ m = 0 CC U- > 7 . 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IIDIO oI! iilhilii 6 0 U 0 - Dennette Janus 1633 37" Ave., Greeley, CO 80631 970-576-2923 - hopscotchD@comcast.net )Education& Certifications Master of Arts, Community Counseling/Professional Psychology University of Northern Colorado, Greeley, CO May 2003 Bachelor of Science,Human Rehabilitative Services University of Northern Colorado, Greeley, CO May 1997 Certified Counselor,National Board of Certified Counselors,August 2003 Bilingual: English&Spanish Professional Experience Therapist: Transitions Psychology Group,Greeley,CO 4/2006-present • Provide in-home and in-office therapeutic services across a broad range of needs and populations: individual counseling,family therapy,supervised/therapeutic visitation,home studies(using the SAFE model), vocational assessments,parent coaching, and co-parenting education and interventions • Professional testimony as requested • Document services as required • Participate in collaboration with other community agencies in efforts to engage and work with clients as needed Caseworker III: Child Protection: Investigations and Ongoing Weld County Department of Social Services,Greeley, CO 2/2004-3/2006 • 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 nncafe practices • Completed initial treatment plans and family service plans for the children and parents in cases filed with the Court,provided ongoing monitoring of treatment plan completion and barrier removal for completion • Participated in staffings within the Department and between other community agencies. Dennette Janus pg 2 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 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 • cl 41 44 0 444 a CIa 804 11th Avenue Greeley, CO 80831 "�7 Phone (970)338-1123 ai Fax(970)351-0182 Consent/Release Transitions I TCHOLO 6! 6 I authorize Transitions to release the information indicated to the agency or persons listed below for the purpose of service coordination of care,and case management. Circle YES NO. I authorize Transitions to obtain the information indcated from the agency or persons listed below for purposes of service,coordination,continuity of care,and case management. Circle YES NO. This is the indcated information-circle every item YES or NO YES NO Treatment information to include history,attendance,dagnosis,progress in treatment,prognosis, treatment prognosis,treatment a oproac hestplan/goals,medcation Intervention and prescriptions, status at dscharge. YES NO Psychological evaluation and testing summaries. YES NO Clinical evaluation/assessment summaries. YES NO Alcohol and drug treatment information. YES NO Physical exam,lab etudes,and dagnostic evaluation,EKG,EEG. YES NO Other(specify) The release pertains to:(Please Print) Client Name: Date of Birth: Name: Date of Birth: Name: Date of Birth: List complete names of no more than five(5)agencies ar individuals regardng this release: Name of Agency or Person Address/Phone 1. 2. 3. 4. 5. I understand that my records andror those of any individual(s) listed above are protected under federal and state confidentiality regulations. I understand that if I have authorized the release of drug abuse anNar alcohol abuse information that the confidentiality of this information is protected by Federal Law(42 CFR,part 2). This information cannot be disclosed without my written consent,unless otherwise specifically provided form the regulations. I understand that t may remlce this consent at any time. Copies of this form may be used in lieu of the aright 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) (Date) (ParentlO ardan Signature) (Date) (Witness Signature) (Date) EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP s 804 11th Avenue • s 6 _ Greeley,CO 80631 ' _ Tel.(970)336-1123 FAX(970)351-0182 9* ¢ . Transitions •G•LROLOG♦ GROUR, LLftl 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 interp►etersitranslators✓staflin 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 bilinguaUbicultural services. Transitions has three Spanish/English bilingual therapists. All master level counselors have had courseworic 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 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 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. 1. Transitions has one bilingual provider available for mental health assessments and interaction assessments. Transitions continues to seek '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 normed 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, tab- Gregory S Creed, PhD, LPC Co-Director, Transitions Psychology Group, LLC • * sot Foster Parent Certification Training Curriculum tt • oft �• Transitions rn{xeuar fUY,. .LC Lead Trainer: Dennette Janus, MA, NCC Training Dates/Times: Topic Areas: 1. General overview of foster care a. Review Weld County Parent Handbook b. Share foster care experiences, expectations, assumptions and realities 2. Administrative and legal issues a. Understanding adoption laws and procedures, including terminations of parental rights and the expedited relinquishment process pursuant to Section 19-5-103.5, C.R.S. b. Review Weld County Parent Handbook c. Maintaining Records and Paperwork d. Child Abuse Reporting Laws and Statutes e. Dealing with Complaints 3. Why children get placed in out-of-home care a. Abuse and Neglect in Families b. Child Safety and well-being 4. Parenting and family dynamics a. Maintaining positive parent/child interaction b. Boundary setting and discipline c. Daily routines • d. Care and hygiene e. Infant care f. Use of community resources g. Adoption as a life-long issue h. Parenting the abused child i. Parenting the physically and/or emotionally challenged child j. Parenting sexually abused children k: The parentified child 5. Key concepts of child growth and development a. Childhood Development 101 b. Family lifecycle 101 c. Attachment and bonding issues d. Loss and grief issues 6. Importance of the team approach a. Identification of key players b. Communication and cooperation with agencies and providers 7. Individual differences, such as ethnicity and culture a. Cultural Competencies b. Helping kids stay connected; Parenting a child of different cultural or racial background c. Community resources 8. Discipline a. Common Sense Parenting: Effective parenting for foster children b. Magic 123; time out system and other parenting techniques 9. Effects of fostering on the foster family a. Family system dynamics b. Resiliency in foster families: Keeping it all together through stress and strains c. How to effectively handle transitions d. Taking care of yourself as a foster parent e. Dealing with personal issues 10.Working with the biological family a. Attitudes and approaches with biological family members b. Compassion and boundary setting c. Talking with kids about their biological families d. Ongoing contact and communication of child and adoptive family with biological family and/or significant others Gllent#:47194 TRAPS ACORD. CERTIFICATE OF LIABILITY INSURANCE D0ATE E(MM!D Y) TYY PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood 8.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 80632 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Insurance Company TRANSITIONS PSYCHOLOGY GROUP,LLC INSURER IT: Plnnaeol Assurance 804 11TH AVE NSURER C: GREELEY,CO 80631 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. ILTRNsaASDRl TYPE OF INSURANCE POLICY NUMBER SATE IMWLDIri) POLICYTE�EXPIRATION UNITS A GENERAL LIABILITY I6804808C710COF07 05/04/07 05/04/08 EACH OCCURRENCE $1,000,000 X COMM NBER ERCW.GENERAL LY PRFFMIEs IF occurrence) 5300,000 CLAIMS MADE El OCCUR MED EXP(My as parson) :5,000 PEP cabal f ADV INJIJar $1.000,000 GENERAL AGGREGATE $2,000,000 GEN.AGGREGATE L*ry*pIIT APPLIES PER: PRODUCTS-COMP/OPAGG 82,000,000 PDUCY A AUTOMOBILELIABRITT BA42110612-07-SEL 05/04/07 05/04/08 COMBINED SINGLE LIMIT X AweAUrO (Eeeccident) $1,000,000 ALL OWNED AUTOS BODILY NJIxRY SCHEDULED AUTOS (Per moon) $ X HIRED AUTOS BODEY INJURY X NON-OWNED AUTOS (Pm so:MG M PROPERTY DAMAGE $ (Per Pf414enD GARAGE GAI LIABILITY AUTO ONLY-EA ACCIDENT $ I ANY AUTO OTHER THAN EA ACC f ll AUTO ONLY: AGO EXCESS$JMSRELLA UABWTY EACH OCCURRENCE $ -I OCCUR rI CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ B WORMERS COMPENSATION ANO 4104451 05/01/07 05/01/08 X I ORMTS I I°R EMPLOYERS'UABRITY ANY PROPRIETIXLPARTNEREXECUTNE EL EACH ACCIDENT f1OO,000 OFFICER/MEMBER MFaS EXCLUDED? EL DISEASE-EA EMPLOYEE $100,000 SPECW.PROVISIONS below EL DISEASE-POLICY UNIT :500,000 OTHER DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES I 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 _Bt. 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 LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Greeley,CO 80632 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE F/aoot r "440 o..J r ,s-.i'.P.L' , roc, ACORD 25(2001108)1 of 2 #380507 VLG 0 ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER • The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AC0RD 25-S(2001/08) 2 of 2 #380507 _ Gllent#:47)94 TRAPS ACORDP, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 05/09/07 PRODUCER 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 80632 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Insurance Company TRANSITIONS PSYCHOLOGY GROUP,LLC INSURER e: Plnnacol 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. INaH ADOL POLICY EFFECTIVE POLICY EXPIRATION LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE IMMIPDIYY1 DATE MMIDOI•'Yl LIMITS A GENERALLIABILRY I6804808C710COF07 05/04/07 05/04/08 EACH OCCURRENCE :1.000.000 X COMMERCIAL GENERAL LMBILRY War s fl oeon,nrel $300.000 C LIMS MADE n OCCUR MED EXP(My ape person) 15,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE 12,000.000 GGEEINL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 12,000,000 I POLICY j 17E& n LOC A AUTOMOBX meILEaccident) LIABILITY BA-02110612-07S EL 05/04/07 05/04/08 COMBINED SINGLE LIMIT :1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (PAt pwaa+) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (P«wcBAM) PROPERTY DAMAGE $ (Per eaMeM) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 1 ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGO f EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE n f 1 OCCUR CLAIMS MADE ACIGarGATE $ f DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND 4104451 05/01/07 05/01/08 X I70O10R I IGFR EMPLOYERS'LIABILITY ANY PROPRIETORPARTNEWEXECVTNE EL EACH ACCIDENT 1100,000 OFFICER/MEMBER EXCLUDEDT EL DISEASE-EA EMPLOYEE $100,000 ISKCIAL ws.*nabs wiler PROVISia E.L DISEASE•POLICY LIMIT :500,000 OTHER . DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES I 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 ..SO,,. 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 LIABILITY Of ANY KIND UPON THE INSURER ITS AGENTS OR Greeley,CO 80632 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE F/aed. r /.V_JC.'ionJ .2Z4,S.tote a+JCA .Zuc. ACORD 25(2001/08)1 of 2 #380507 VLG O ACORD CORPORATION 1988 _ Client*:47194 TRAPS ACORD. CERTIFICATE OF LIABILITY INSURANCE DATu9roiDNYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood 8 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 80632 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Insurance Company TRANSITIONS PSYCHOLOGY GROUP,LLC INSURER B: Pinnacol Assurance 804 11TH AVE INSURER C: GREELEY,CO 80631 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. 1NSN AUU'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSRCDATE IMWDDA'YI DATE IMMIDO/YY) UNITS A GENERAL LIABILITY I6804808C710COF07 05/04/07 05/04/08 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE RA MISES(Pa ocarenal 3300.000 CLAWS MADE n OCCUR MED EXP(My one person) 35,000 PERSONAL&ADV INJURY 31,000,000 GENERAL ArrarGATE 32,000,000 GEM_AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $2,000,000 7 POLICY in JPF O- n LOC A AUTOMOBILELMBIUTY BA-62110612-07SEL 05/04/07 05/04/08 COMBINED SINGLE LIMIT X ANY AUTO (Ea SOOdenl) $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY Person) 3 X HIRED AUTOS BODILY INJURY f X NON-OWNED AUTOS (Par aWdant) PROPERTY DAMAGE f (Per accident) 'GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ I ANY AUTO OTHER THAN FA ACC $ AUTO ONLY: M,G $ EXCESSRINBRELLA LIABILITY EACH OCCURRENCE 3 —I OCCUR n CLAWS MADE AGGREGATE 3 DEDUCTIBLE 3 _ f RETENTION $ f B WORKERS COMPENSATION AND 4104451 05/01/07 05/01/08 X I TQRW i IM Ti s I I eR EMPLOYERS'LIABRJTY ANY PROPRIETOR/PARTNERIEXECUTNE EL.EACH ACCIDENT f100,000 OFFICER/MEMBER FFInICEER BERa EXCLUDED? EL.DISEASE-EA EMPLOYEE 3100,000 SPEC PROVISIONS bebw EL DISEASE.POLICY LIMIT 3500,000 OTHER . DESCRIPTION OF OPERATIONS'LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I 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 SL_ 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 LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Greeley,CO 80632 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE y� no Oa. r /3 .t 0 N ZAnsAr,A.I4JLA r TJAJc. ACORD 25(2001108)1 of 2 #380507 VLG O ACORD CORPORATION 1988 it Healthcare Providers Service j CNA • Organization Purchasing Group LIHPSO CNA Plaza, Certificate uE PI/ neural-tee wr+.,R bunko s..an.�a. Chicago,IL 60685 OCCURRENCE POLICY FORM Producer Branch Prefix Policy Number Policy Period from: 12:01 AM Standard Time on: 12/01/06 018098 970 1 HPG 272935313-8 _ to: 12:01 AM standard Time on: 12/01/07 Named Insured and Address Program Administrator Healthcare Providers Service Organization NORMA A ALKIRE 159 East County Line Road 4913 W 12TH STREET RD Hatboro, PA 19040-1218 GREELEY CO 80634-2216 Medical Specialty: Code: Insurance Provided by maCounselor 72990 Marriage/FamilyAmerican 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 510,000.00 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 parr 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 1 None Total Premium $120.00 - - Premium reflects emOloved,MI-time rate. Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 ---- - 6-121500-C G-121501-C G-121503—C G-145184—A G-147292—A G-144872=A'G-123846—00S- - ttaa hcare Providers Service Organization is a division of Affinity Insurance Selvicet.Inc.:in NY and NH.AIS Affinity mama cur Agency,in MN end OK.MS Affinity Insurance Agency,Inc.;and in CA.AIS Affinity Insurance Agency.Inc.sine Aim Meet Insurance Administrators License#0795465. Master Policy: 188711433 ' Keep this document in a safe place. This and / (� your cancelled check act as proof of coverage. AYtt �e n Chairman of the Board Secretary b Healthcare Providers Service >----, �NA . Oyrgaanizaation Purrchasinng{G��rooull�yy�rA ®HPSO CNA Plaza, `Lt.I-t l�f Lcate iii 4 nzuA.auce a•r-••••••b•••�•o..r._- Chicago,IL 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 80634-9375 Medical Specialty: Code: Insurance Provided by ClinialCoaaaelor/LPCC 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, IL 60685 COVERAGE PARTS LIMITS OF LIABIIITY ,. . A.PROFESSIONAL LLABILI TY _ Professional Liability $1,000,000.00 each claim 83,000,000.00 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 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.GENER AL LIABILITY Coverage part D.does not apply if Coverage part C. is made part of thus policy. ..Workplace Liability -- -- — — - - None` — None Hired Auto & Non Owned Auto None Fire & 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 Health=Provide,Snvica°titillation is a d&vidoa of Affiaky bummed Services,11c4 e:NY sod tat AIS Milady Noce Agency in MN ad OK.AIS Amody Ioaoaa Agency.Inc.:midis CA.AIS Milady loao<mce Awry.Inc.dba AonlMect laesmce Adm®mnton Llama/0795165. Master Policy: 188711433 iheit. ^ J - yKeepour this document a safe plaf o Thcove and 44.-0..- `� l\rJ►r�V Y`s"L your cancelled check act as proof of coverage. 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. 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 Policy#:PHCP039718 Effective Date:(6/18/2006) "Expiration Datefftelitala 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. Limits of Liability Each Occurrence Aggregate (Per individual claim) (Total amount per policy year) Coverage Part _ $1,000,000.00 $3,000,000.00 I Professional Liability 51,000,000.00 S3,000,000.00 Supplemental Liability ' - Includes: A)Bodily Injury and Property Damage B) Personal Injury Unlimited Unlimited Defense Expense Coverage $25,000 _ $25,000 State Licensing Board 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 A _ $2,500 r First Aid Coverage Certificate Holder Cancellation Proof of Coverage \Sh0uld 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 or liability of any kind upon the insurer,its agents or representatives. Holder has also been added to the policy as an !Authorized Representative additional insured:** _Yes/)(NO C.Philip Hodson **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 i endorsement(s). 1 { 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 CNAOrganization Purchasing Group ®HPSO ray+ �y �y of r yy �ty�y yy n CNA Plaza, (Certificate ;11 ns. x auce H.me.,.e..ie.ris..:.om.» - Chicago, IL 60685 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 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 G-121500-C G-121501-C G-121503-C G-145184-A G-147292-A G-144872-A G-123846-005 Healthcare Providers service organization is a division of Affinity Insurance Services,Inc.:in NY and NH,Ms Affinity Insurance Agency,in MN and OK,MS Affinity Insurance Agency.Inc.:and in CA.MS Affinity Insurance Agency.Inc.dba Aon Direct Insurance Admnditrmom License 1/079S14S. Master Policy: 188711433 t1 �'9� Keep this document in a safe place. This and ; f . i �, e your cancelled check act as proof of coverage. YY4-t �a� (el�1b Chairman of the Board Secretary `CL i Ai 9A1,"=a r7>7rioi N" '6o4 xK' 0000066-R 070326 RENRf74/06 R1N7HMCSE 07085 Healthcare Providers Service • CNA Organization �Pyurchasinngg Group ®1 11 JO CNA Plar-., (Ce t i f raft .V f J 4 fr z u.1.auce Cluc:.go,IL 60685 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 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 Eire 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-A G-123846-005 Healthcare Providers Service Organization is a division of Affinity Insurance Services,Inc;in NY and NH.MS Affinity Insurance Agency,in MN and OK,MS Affinity Insurance Agency.Inc.:and in CA MS Affinity Insurance Agency.Inc.dln Aon Direct Insurance Administrators License#0795465. Master Policy: 188711433 (� t �.�` Keep this document in a safe place. This and (/�)Yf/—t / �b f'V �/l T your cancelled check act as proof of coverage. Chairman of the Board - - Secretary -" 'G-}41241-A ;17/2001p ., .604:XX 0000049-R 070102 RENHCP4/06 R1M7HNCSE 07002 Healthcare Providers Service CNA / Organization��yy #�•Yy� �aPyyusr�chas/innyggyQaG��rooup�t�yyy��a�a� 1 11 SO CNA Plaza. TErtLftratc o Nn%urancG- nax..,.1r....u11Jw Chicago,IL 60685 OCCURRENCE POLICY FORM Producer Branch Prefix Policy Number Policy Period from: 12:01 AM Standard Time on: 07/04/07 018098 970 HPG 270170'198-8 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 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 $317.00 Premium reflects self-employed,full-time rate. Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 G-121500-C G-121501-C G-121503-C G-145184-A G-147292-A 0-144872-A G-123846-005 Healthcare Providers Service Organization is a division of Affinity Insurance Services.Inc.:in NY and N$MS Affinity Insurance Agency,in MN and OK.MS Affinity Insurance Agency.Inc.:and in CA.AIS Affinity Insurance Agency.Inc.dba Aon Direct Insurance administrators License#0795465. Master Policy: 188711433 AA J yourKeep this document in a assafe ofe.o The and T4- - your cancelled check act proof of coverage. /Lea-till Chairman of the Board Secretary -, -ls_i'd i-rn�ca 'r'7 l9 nn t\ `..604 O000047-R 0.74326`AENNCP4/06.R7n7HMCSE.:o7o85 � _ 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 COVERAGE(S) 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 Certificate of Ins .ante (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: CPU 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#: PHCP061477 Effective Date: 01/17/06 Expiration Date: 01/17/07 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE)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. 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 upon the insurer,its agents or representatives. Holder has also been added to the policy as an Authorized Representative additional insured:** Rte"•/Q J _Yes/1No C . **If the certificate holder is an ADDITIONAL INSURED,the policv(ies)must be endorsed. A statement on this certificate does not C. Philip Hodson confer rights to the certificate holder in lieu of such endorsentent(s). 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 CNAy Organization Y�(try � �Pyu�tr`'cha,�st(inngyaG�roouyp�yyyr HPSO I CNAPIz , L.erttf ratt of Nnsu.1.ancz Chicago,IL 60CS5 ----- 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: 12:01 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 CNA Plaza 265 Chicago, IL 60685 COVERAGE PARTS LIMITS OF LIABILITY A. PROFESSIONAL LIABILITY professional, Liability 81,000,000.00 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 S12,500.00 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 S5.040.09 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 Organization is a division of Affinity Insurance Services.Inc;in NY and NH,MS Airinity Insurance Agency,in MN and OP MS Affinity Insurance Agency.Inc.;and in CA MS Affinity Insurance Agency.Inc.dba Aon Direct Insurance Administrators License#0795465. Master Policy: 188711433 youpr canceldoled in a assafe plroof Ths and `�J,, AA/ your cancelled check act proof of coverage. �aat ill- Chairman of the Board Secretary .. . _ I1..1, +,...c ..v nnnnni9-R' ncdln7 RF.NHCP5/05 R1N6HN 05311 Vaflfl PURCHASING GROUP CERTIFICATE OF INSURANCE OCCURRENCE POLICY FORM .,.:-.7..-------- —_ . — -- - -- 018098 970 HPG 0 : 0. $0 from:12:01 AM Standard Tinton-00/o1/os to: 12:01 AM Standard Time on: •: a1 •6 Carmen SGhlierkamp Healthcare Providers Service Organization 24634 3rd Ave 159 East County Line Road Eaton, CO 80615 Hatboro, PA 19040-1218 Medical Spedalty Code: Mental Health Counselor Student 72990 American Casualty Co. Of Reading, PA CNA Plaza 26S Chicago, IL 60685 A. PROFESSIONAL LIABILITY Professional Liability(PL) $ 1,000,000 each claim $ 3,000,000 aggregate Good Samaritan Liability included above ��r�_ �� _ Personal Injury Liability Induded above mr ar<°° w C.Psaa T—Lt awed®= Malplacement Liability included above t'a: B. COVERAGE EXTENSIONS: License Protection $ 0 r edf $ 0 a ate Defendant Expense Benefit 10,000 aggregate Deposition Representation $ per on $ 5,000 aggregate Assault $ 10,000 per incident $ 25,000 aggregate Medical Payments $ 0 •:r • rson S 0 aggregate First Aid =-E.-- - $ 2,500 aggregate Damage to Property of Others $ 500 per incident! $ 10,000 aggregate C. WORKPLACE LIABILTY Coverage part C.Workplace Liability does not apply if Coverage part 0 General liability is made pad OfWs WWI- Workplace Liability none Fire&Water Legal Liability none Personal Liability n' at.r 4 Zs- none D. GENERAL LIABILITY Coverage part D.General Lability does not apply rcaverage pen C.Workplace L'reblity is made pad arias polity. General Liability(GL) none none Hired Auto&Non Owned Auto none r `c- Ar =o-, - E -y Fire&Water Legal Liability none none Personal Liability _ R none Total Premium:$ 29 .00 QUESTIONS?CALL: 1.800-982-9491 • - G-121500 CG-121501-C G-145184-A G-147292-A G-144872-A G-123846-005 Master Policy#168711433 Keep this document innate sate place. n and proof of payment are evidence of your insurance coverage. Chairman of the Board 7A, Secretary G-141241-A(07/2001) Coverage Change Date: Endorsement Change Date: Jami Moe-Hartman, MA, LPC Transitions Psychology Group, LLC 804 11th 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/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(a,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,Nisbi- 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 It 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 assessments of students ages preschool through high school ♦ Consulted with parents and teaches 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 necessary • Provided consumes with resources to access mental health services • Responded,assessed,and made appropriate referrals for crisis phone calls Wamygora,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,Cnc eley,Colorado(8/95-6/00) • Coordinated national testing program including administrations of the ACT, SAT,and GRE • Trained hired and supervised testing 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. 33rd Annual NASP Convention. Davis,A.&Wamygora,N.(2001). Utilizing a comprehensive neuropsychological assessment in the schools.Poster Presentation at 32nd 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(Fds.) 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(FAs.)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 ofArts 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, MA • 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 staffmgs 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 12i°St Rd.Greeley,Co. 80634 PHONE 970-590-9861 • E-MAIL normaalkire@hotmail.COM Jan 2004-July 2004 NCMC/Psychcare Greeley,Colorado Therapist(Intern) Supervisor,Stacey Blank,M4,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:ptugicss 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 1 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@hotmai].COM July 2006—Present Platte Valley Youth Services Center Greeley,Co.80631 Social Work Counselor II 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 staffings,Parole Board hearings,Community Review Boards (CAB'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 SOMB 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, SWIll,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 12th 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 clink 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 Vidtim'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 I 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 s 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 starlings 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 staffmg 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 CM 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 262718"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:-- 'v d Career Experience Adoption Worker Sept. 1999 to Present Adoptions:Advocacy&Alternatives, Ft. Collins, 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 a 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 identlfr potential leaders;promoted assisted with, and led exploratory meetings; fonned 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 Swell, MSW, Former Director Joanne Gallagher,LCSW,Director Tu Casa,Inc.Alamosa Adoptions:Advocacy 8 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,Alms 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 Former 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 Gree/ey 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 vrivera2i:lamar.colostate.edu 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 IIE. 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, Jarniftry—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. 4 ""...q..1“*.A.0 "+a%.JL.All:Ii%; W ii:iu OUL iiiy'u!S, otnaViurs, !ever of tuiowteage, tacit or 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 jeef 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. program in Counselor 2002-2003 Education and Supervision -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 TRAININGIWORKSHOPS (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.O. 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 (9701 351-2879 (9701 351-2133 (9701 351-2544 LindtBlack 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 Schiierkamp 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 Sheriff's 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). • Choraugraphing 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 Giece•Pn 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 Learning 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, M.&, 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 14t 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 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(o≥bw.edu cferitt ►'�� DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 oMay 11,2007 Fax Number(970)353-5215 • 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 reconunended 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, V� J y A. 'ego,D. for 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 Child Welfare General Administration Funds Type of Action Contract Award No. X Initial Award FY07-CORE-0067 Revision (PY 07-08 RFP-FYC-006-00C; 002-FPT-07) Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Lori Kochevar,MS, LPC,LLC Ending 05/31/2008 Foster Parent Training 1024 8`°Street Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial This program provides Foster Parent Certification Assistance Award is based upon your Request for Training and uses a comprehensive experiential Proposal(RFP). The RFP specifies the scope of training curriculum that directly improves the foster services and conditions of award. Except where it is parents' ability to provide quality care for children in in conflict with this NOFAA in which case the foster care.Training consists of 27 hours of NOFAA governs, the RFP upon which this award is experiential interactive learning.Trainings are based is an integral part of the action. scheduled at the Department of Social Services discretion. Trainings are set at open capacity; and Special conditions estimated at providing services to 48 foster families, 1) Reimbursement for the Unit of Services will be 96 foster parents per year.Trainings will last an based on a per training rate. average of four weeks. Provider offers bilingual and 2) Rates will only be remitted on cases open with, and monolingual services,and access to South County referrals made by the Weld County Department of foster parents. Social Services. Cost Per Unit of Service 3) Requests for payment must be an original and Treatment Package $3,957.28 submitted to the Weld County Department of Social Treatment Package Low (Court Testimony) $150.00 Services by the end of the 25th calendar day following the end of the month of service. The Enclosures: provider must submit requests for payment on forms X Signed RFP: Exhibit A approved by Weld County Department of Social X Supplemental Narrative to RFP: Exhibit B Services. Requests for payments submitted 90 days from the date of service, and thereafter,will not be Recommendation(s) paid. X Conditions of Approval 4) Requests for payment must include original client verification signatures (blue or red ink preferred) and dates and hours of service. 5) The Contractor will notify the Department of any change in staff at the time of the change. Approvals: P Progr Offi ial: By 3 / Ctd l C404 By ; David E. Long, Chair Jud . Grieg , Director Board of Weld County Commis oners We 4 ounty epartment of Social Services Date: JUN 1 8 2007 Date: (� <�S I L�7 67007—/6�� 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 33 lg 1 O-2 (After AA__ receipt of order) BID MUS BE SIGNED IN INK Program Area:ctifii eatI2/z-Q,ioIVTE ( 0, (J TYPED R PR D SIGNATURE VENDOR Lori Kochevar Handwritten Signature By Authorized Officer or Agent of Vendor 1024 8th Street ADDRESS Greeley, CO 80631 TITLE DATE 5119/D7 PHONE# C170 35-a - 'BS-73 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Foster Parent Core Certification Training Purpose: The purpose of the Foster Parent Core Training Program is to provide exceptionally well trained foster homes that can deal with a myriad of difficult behavioral issues. This directly decreases liability issues as well as decreases the cost of the out of home placement budget by minimizing the use of Residential Treatment Centers. Why Quality Training is Important- foster parents have the difficult role of providing a loving relationship and a structured home environment to children whom have most often been severely abused and or neglected. These children often have a distorted sense of self. Children in the foster care system often act out their feelings of unworthiness by displaying behavior that is destructive to self and others. Foster parents need to be well trained in ways to work with this difficult behavior in better understanding what the child/children are going through and how to respond effectively to their behavior. Better trained foster parents are the more likely to avoid disruptions in placement (PIP) and/or the use of an RTC (significant cost savings). In addition, a well trained foster home is often the most clinically appropriate and effective form of treatment for children in the foster care system. Design: We offer a variety in the presenters and viewpoints available to the foster parents during the Foster Parent Core Training Certification. Our trainers are uniquely qualified to provide this training because of the wealth of professional and personal experience they hold. In addition, this program provides a comprehensive experiential training curriculum that directly improves the foster parents' ability to provide quality care for the children they are entrusted with. Meals are provided to increase group cohesiveness. In the field of Child welfare it is imperative that the potential foster parents that complete Core: are motivated and committed to providing this service, master new skills and abilities that make them a more effective resource family and can transfer the skills they learn to multiple settings and situations. In addition, because the information they need to know can be overwhelming and or traumatizing it is also very important that the teaching strategies utilized help the foster parents learn about and prepare participants to work with trauma. Knowles (19890) indicates that adult learners are self directed with numerous and varied experiences. Adults are prepared to learn as a result of being at a developmental transition, and need to see a clear purpose for learning. Additionally, adults prefer experiential and task centered learning. 2 Table of Contents—Foster Parent Core Certificate Training I. Invitation to Bid 1 II. Abstract 2 III. Table of Contents 3 IV. Target/Eligibility Populations 4 V. Project Narrative and Supporting Documentation A. Types of Services Provided 5 B. Measurable Outcomes 15 C. Service Objectives 18 D. Workload Standards 19 E. Staff Qualifications 20 F. Program Capacity per Month 21 G. Internal Tracking and Billing Process 22 Supporting Documentation H. Literature Citations 23 I. Confidentiality and Participant Protection/Human Subjects 25 VI. Budget Forms 29 VII. Appendices 1 —Resumes 33 2 — Data Collection Instruments/Protocol 37 3 —Consent Forms 44 3 Target/ Eligibility Populations A. Total number of clients to be served in the twelve month program has been calculated as follows. We would provide eight trainings a year. We estimate that there would be an average of 12 participants at each training. Henceforth, at eight trainings a year x 27 hours per training this program would provide 216 hours of service a year. At a cost of$12.33 per foster parent per hour of training. B. Families Served. We anticipate serving 48 foster families, 96 foster parents. C. Sub total who will receive bicultural / bilingual services. All services provided will be in a manner which is sensitive to the culture of origin of the family. All of the therapist have training in cultural competency issues and one of our therapists is bi-lingual. In addition, Lori Kochevar was the chair of the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. In that the training is presented in English to meet the needs of most participants in the group, we need to hire an interpreter for any mono-lingual applicants. Previously the interpreter has been hired by the department, as suggested by DSS we will hire the interpreter and build it in to the cost of the program. D. Training services will be available to South Weld County foster parents. Typically the trainings are held in Greeley because it is the central location for most applicants. However, if a majority of the class is from South County, we would be willing to teach there. E. The monthly program capacity per group - If needed, we could expand the number of trainings done a year up to 12. F. Average stay in the program - The average stay in this program would be 4 weeks. G. Average hours per week in the program would be 6.75 hours a week. Typically the program is set up on two Friday evenings and all day Saturday separated by a week off to complete homework. 4 Section A — Types of Service Provided The following research supports that the use of an Experiential Training Model that is responsive to what participants need and flexible enough to teach key concepts as it relates to the direct experience of the participants is superior to a lecture based or highly directed(pre-packaged programs) approach of teaching the Foster Parents CORE training. Research on the use of experiential learning in the university classroom has shown that student motivation and satisfaction is increased through active participation in learning (Acosta 1991 ; Cranton 1989; Saslow and Byrne 1993). Cantor (1995) states that experiential learning activities are natural motivators. This can be seen in terms of a feedback loop. Students participate in an activity that helps link theory and practice. As students begin to understand concepts and apply them, they become excited and motivated to learn, thus spurring on new experiential activities. Walter and Marks (1981) further this position, stating that the natural tendency of human curiosity is often excited through experiences and that the social nature of experiential learning in the classroom is both satisfying and motivating. Jernstedt (1995) discusses a qualitative and quantitative research study in which participants from a post-secondary institute were introduced to experiential learning. These subjects participated in a four-day laboratory that provided a planned experience in a prescribed environment with a focus on learning about nature. In his statistical evaluation of the laboratory, Jernstedt found that individuals who participated in experiential learning activities were significantly more efficient workers and achieved higher grades than those who were taught passively (lecture) or through highly directed learning (most pre-packaged programs). Mother benefit of using experience in the classroom is the increased ability of students to transfer salient learning to other settings and situations. One of the fundamental problems of traditional lecture teaching is that students are required to memorize isolated pieces of information without understanding its practical application (Cantor 1995). Students who are involved in their learning through experiential techniques are better able to make connections between their education and their daily lives (Cantor 1995; Crantori 1989; Knowles 1977). Experiential education, the physical memory of mastering a skill promotes the transference of knowledge. This increases the probability that under stressful circumstances that foster parents will be able to access and utilize concepts taught in the Foster Parent Core training. 5 Recent research in state-dependent memory and learning (Janov, 1996; Pert, 1997; Rossi, 1986) shows that a person who learns a task while under the influence of a particular emotional state will repeat the task most efficiently when again under the influence of the same emotional state. Therefore, within the safety of the training session we use experiential learning to simulate the types of stressful reaction that may occur for a child in the foster care system so that in the heat of the moment/on their own foster parents they are more likely to recall how to implement co- modulation and co-regulation strategies to deal with behavioral issues the foster children exhibit. Assisting the person to reconnect with the state in which the state-dependent learning will be needed, increases their ability to access that skill later. In addition, research on secondary trauma indicates that workers who have not heard information about clients that is traumatic reported more negative effects upon being exposed to this information then worker that have been in the field for a long time (Chrestman, 1995; Cunningham, 2003; Pearlman & MacIan, 1995). Typically, potential foster parents often have little or no professional exposure to traumatic material before core training. Therefore, many of the potential foster parents may feel overwhelmed by the material regarding why children are placed in the custody of social services and the types of behavior these children may exhibit. Furthermore, feelings and reactions that are evoked by the information may be unfamiliar and disturbing to the new foster parent and may cause them to question their newly emerging identity as a"professional foster parent "(Neumann & Gamble, 1995). Similar to Stress Inoculation Theory (SIT; Meichenbaum & Fitzpatrick, 1993), this model of training introduces new foster parents to sensitive material in a manner where they immediately learn how to modulate and regulate their response. The purpose of this is multifaceted, by giving them a method to integrate the traumatic material we increase their ability to; learn the information, develop coping skills, and increase confidence in their ability to be effective foster parents. Ultimately, learning an experiential model of modulation will significantly increase the likely hood that the foster parents will respond with an effective strategy versus react to the symptoms of the child behavior (Post & Forbes, Shore 1994). Conclusion Experiential learning is a student-centered approach that focuses on process and the development of independent thought. It stresses the relevance of learning activities to the lives of adult students and encourages critical thinking. It reinforces the objectives of a healthy system, allowing for the development of 6 skills, the acquisition of knowledge, and the growth and maturation of an understanding for the needs of foster children and their families. In addition, exposing students to trauma material within the safe environment of the core training in a modulated manner reduces the risk that they will be negatively affected by the traumatic material, as well as increases their ability to respond effectively. By helping foster parents understand the interaction of trauma work, the work environment, the societal context, and their own personal issues (Pearlman & Saakvitne, 1995), instructors can normalize their reactions and encourage them to learn appropriate professional strategies to deal with the effects of working with trauma. Trainers- • Lori Kochevar our lead trainer has 20 years of experience in child welfare. She is also a master therapist and a powerful trainer. She has fostered and adopted two children from the social service system and knows the system from the inside out. In addition, Lori has been providing this training for the last six years and is highly rated as a trainer by the participants who have taken her course, see appendix 2. She also has extensive training in trauma, attachment and child welfare. • Sharon Benson has worked with support service organizations for over twenty years in the areas of Domestic Violence, adolescent offenders, disabilities and family preservation. For the past 10 years Sharon has taught classes in the Psychology, Business and Emergency Service departments at Aims Community College. Currently she is in the Early Childhood field where she has received specialized training in assessment, behavior management, positive parenting and services to children with disability or mental health issues. In addition, the following people from the community come to share their time: • Julie Hoskins, who has experience as a Foster Parent, GAL, Respondent parents Attorney, and Magistrate in our community comes to share her expertise with the foster parent's regarding the legal system. • Mary Camp, who is an experienced GAL as well as Occupational therapist, comes to share her expertise regarding the legal system when Magistrate Hoskins is not available. • Marsha Stohl and Elaine Romero who are currently supervisors for the CASA program and previously where CASA volunteers, also are available to share their experience and expertise with the foster parents. Topical Curriculum Outline Training Curriculum Design- Training will consist of 27 hours of experiential interactive learning. It is common for caregivers to feel anxious, overwhelmed, and depressed and or resentment when working with children that are experiencing all of these same feelings. Receiving in depth comprehensive training from trainers that have been there can help the foster parents to gain confidence in their ability to act instead of react to the challenging behavior exhibited by many foster children. In addition, this curriculum provides: • Well supported efficacious treatment- research support that the use of an Experiential Training Model is superior to a lecture based or highly structured pre-packaged program approach as documented in Section H. • Experiential strategies to access multi-dimensional learning of information to increase participant's ability to recall and implement strategies across time and in non-ideal circumstances. • Comprehensive - coverage of all mandated and necessary information. This curriculum uses progressive skill sets with multiple review of core material in different areas to increase retention and ability. • Transformative— motivates and brings couples together in their commitment to provide quality care and access their circles of support to provide this service. They leave with a better understanding of themselves and how their parenting will directly effect the children's long term well being. • Empowering—helps potential foster parents see how they can transfer applicable existing skills into this role while building new role specific skills. The curriculum helps the foster parents focus on what skill set will help them be successful depending on which age of children, or specific special needs they choose to serve. • Realistically prepares the potential foster parent for what being a foster parent is versus their preconceived, often unrealistic expectations. • Accountability- holds the foster parent response-able to continue learning and growing to meet the needs of this rewarding and demanding role. 8 • Community building process that occurs between each core training group gives the foster parents a built in form of support, of other foster parents. • Cohesive - all pieces of the training work smoothly and build upon each other to motivate and prepare potential foster parents and decrease liability. • Evaluation /Screening component to decrease risk of inadequate homes and liability risks. We will assess perceived strengths and weaknesses of general functioning of applicants relative to caring for children with Special Needs. The design of this curriculum allows us to see how the foster parent deals with stress, pressure and group dynamics. In addition, we have an opportunity to explore in depth family of origin issues and note the degree to which these have been resolved. Areas of concern will be shared with the Foster Care Certification Staff. • Corrective interventions- to the interactive nature of the curriculum we are able to evaluate address and often resolve specific concern noted by the foster care coordinators regarding specific behavior of potential foster parents. Foster Parent Core -Topical Outline Content Area for Core Training: A. General overview of foster care • Review Weld County Foster Parent Handbook • Review family foster home emergency and safety procedures. • Facilitate current/future use of community resources. Local, national, and website resource list provided. • Instructions of how to access available benefits and/or resources. • DSS administrative procedures and overall program goals. B. Administrative and Legal Issues • Dealing with history regarding the child, birthparents and adoptive family. • Confidentiality • Mandated reporter status • Understanding adoption laws and procedures, including termination of parental rights and the expedited relinquishment process. • Significant events child welfare history • Judicial and social service processes in a dependency & neglect case in Colorado. • Investigations- information on the process and resources, including 9 encouragement to attend semi-annual panel training at the department. • Procedure to resolve conflict between team members. C. Why children are placed in out of home care • Parenting the emotionally, physically, and/or sexually abused child. • The psychological, physical, and spiritual effect of being abused. • Definitions of abuse and how to assess impact. • What to do if a child reports abuse to the foster parent. • Guidelines to follow if your child has been sexually abused. • Behaviors related to sex and sexuality, what is normal, of concern, need seek help immediately in different age brackets. o How to provide appropriate supervision o Types of behavior to discuss/report to the therapist/caseworker o Recognize potentially liable situations o How to teach corrective boundaries with victims of sexual abuse — if the victim attempts to reenact the victimization. • Suicide, warning signs and how to respond. • Domestic Violence- what is it and negative messages children are taught. • Risk Factor Intake Assessment used by DSS. D. Parenting and family dynamics • Developmentally appropriate principals and practices of child care. • Parenting the physically, mentally, emotional challenged child. • Parenting a child exposed to alcohol/substance in uetero and beyond. • Effectively parenting a child that has adopted a survival role to cope with the use of substance abuse by a parent. • Infant care, feeding, bonding, sleep issues. • Special medical and or emotional issues. • Attachment/bonding issues. • Long range effects of attachment issues and how to effectively parent to promote a secure attachment. • Possibility of misleading or incorrect information about the child and or biological family. • Loss and grief issues, in foster care and adoption- process, factor's that influence, and experiential exercise. • Adoption as life long process, for all parties. • Possibility of on-going contact of child and adoptive family with biological family when in the child's best interest. • Why foster parents need awareness and skills to manage their own issues. • De-escalation and grounding exercise. to • Post Traumatic Stress Disorder, common responses to trauma and coping strategies. • Brain development- how the brain develops, organizes, and develops across time. Recognizing critical periods of optimum growth opportunities and the effect of trauma. E. Key concepts of child growth and development • Developmental assets- building blocks of healthy development. • Pediatric Inventory of Neurobehavioral Symptoms. • Typical childhood developmental needs. • Integration of Eriksson's developmental stages with Maslow's hierarchy. • How an unskilled childhood role model affects a child. • Normal childhood development, physical, emotional, and intellectual. How development is affected by trauma. • Characteristics of children who have experienced inconsistent parenting. F. Importance of team approach • Roles and responsibilities of each team member and how they work together to meet the needs of each child in care. • Roles and responsibilities of foster parents • Placement, what to ask before you decide if this is a good fit. • Placement, how to help a child feel comfortable. • Physical touch • Documentation • Understanding the roles of the caseworker. • Helping teachers to understand your child's needs. • House procedures, structure for success. • Why a team approach is needed for a successful outcome. G. Individual differences such as ethnicity and culture • Parenting a child of a different cultural/racial background. • Spiritual healing for survivors of childhood trauma. • Effective cross cultural relationships. • Stages of cultural competency. • Possible barriers to accepting differences in others. H. Discipline • Boundary setting and discipline • Acceptable and effective behavior management techniques. 11 • Positive and constructive parenting strategies, structuring the environment and de-escalation of crisis. • Siblings without rivalry, integrating children into the family. • Positive effects of foster parenting on birth children and concerns to address to avoid pitfalls. • Therapeutic parenting with love and logic. • Attitudes that make parenting easier. • The development of a conscience, how foster parents can support this process. • Communication skills to handle resistance, emotional outbursts, and roadblocks to being heard. • Teaching values. I. Effects of fostering on the foster family • Appropriate boundaries (physical and emotional) between foster parents and foster children while in placement and after discharge. • Secondary trauma- compassion fatigue • Stress reactions to children with difficult behavior • Stress test- what currently in the foster parents' life is statistically stressful. • Negative and positive coping strategies • Guidelines of when foster parents need to ask for help • Normal development- family stages of development • Developmental indicators of emotional health • Individualized Stress Management Plan—Mission statement, goals, resources, expectations, complaints, and potential problems for each potential foster home. • Solution orientated planning to facilitate empowerment of the foster parents. J. Working with the biological family • Helping children explain their placement • The Life Book • The Sibling Bond: Its importance in foster care and adoptive placements • How the foster parents attitude (even what they do not say) affects visitations with birth families. • Foster family involvement with birth families- definitions of foster parents role and caseworkers' role. • The importance of natural parents to the child in placement. • Parents in the shadow, how foster parents behavior could effect the birth parents. 12 K. Library-additional articles, reading materials. • Parenting 101- effective ways to deal with control issues. • Suicide in children and adolescents- what can I do. • Physical abuse- • Sexual abuse of children and adolescents- • Anxiety in children- • Self Esteem- suggestions for helping a child develop. • Trauma and children- • Stress in children- symptoms and how to alleviate. • Depression in children- how to help them overcome. • Methamphetamines- effects and dangers on anyone who is in contact with. A. Foster Parent Core Certification Training - Training will satisfy all training requirements of the State of Colorado Volume VII and the Weld County Department of Social Services. In addition, there will be a complete review of the Weld County Foster Parent Handbook which comprehensively describes the county's policies and procedures on Volume VII requirements for foster homes. Volume VII regulations pertinent to a licensed foster home in the State of Colorado will also be address with potential new foster homes during the training. This 27 hour training will be completed in a block covering no more than four weeks in length. Trainings will generally take place every four weeks throughout the year, in twelve cycles. • Evaluation/Screening component to decrease risk of inadequate homes and liability risks. We will assess perceived strengths and weaknesses of applicants relative to caring for children with Special Needs. The design of this curriculum allows us to see how the foster parent deals with stress, pressure and group dynamics. In addition, we have an opportunity to explore in depth family of origin issues and note the degree to which these have been resolved. • Corrective interventions- Due to the interactive nature of the curriculum we are often able to evaluate address and often resolve specific concern noted by the foster care coordinators regarding specific behavior of potential foster parents. B. Resource and Referrals - This program will facilitate the development of internal and external resources to enhance the foster parents' ability to meet the demanding requirements of their role. Foster parents will be able to access 13 written information on specific diagnostic, behavioral, and developmental issues specific to the foster children's special needs. In addition, it is important to link foster parents to appropriate community resources and with each other. We will facilitate knowledge of and encourage use of available community resources, and make appropriate referrals. C. Agree to comply with 19-1-120 CRS., which requires that reports of child abuse and any identifying information in those reports are strictly confidential. All federal laws will be followed including the confidential reporting of suspected child abuse. • In this program consultation funds will not be used to fund therapy or drug and alcohol services for foster parents. If deemed appropriate a referral to a mental health provider or ADAD professional will be made. D. Performance Improvement Plan (PIP) compliance—Facilitators will be oriented to and focus upon all PIP goals throughout entire training. • Retention of children in placement will be focused upon to maintain the permanency needs of children in out-of-home placement. We will provide training services for foster parents to help maintain placements. At no time shall a trainer provider advise for a child to be removed from placement. • Independent Living—Trainers will provide specific instruction on the importance of cooperating with a child's case plan for independent living and coach foster parents how to mentor and teach foster children daily life skills. • Maintaining Cultural and Racial Connections —Trainers will teach the importance of maintaining the cultural and racial identity of children in their care. We will encourage the foster parents to encourage the foster child's cultural resources, holidays, community connections, spiritual needs, etc. We will also train to document these events for the caseworker. • Monthly Face-to-Face Visits with Caseworkers —Foster Parent Core Training will include instruction on effective communication tools to enhance the relationship between foster parents and caseworkers. Better communication will enable monthly visits to occur in spite of schedule changes, illness, vacations, etc. Foster parents are to be trained to be proactive, contacting the caseworker and supervisor if need be if children in 14 their care are not being contacted as required for the monthly face-to-face meetings. • Timely Initial Assessment within Two Weeks of Placement—Training curriculum will address the importance of foster parents setting up medical and dental appointments at the time of placement (two weeks for medical/eight weeks for dental for children over three years). A list of Medicaid providers is provided at each training. Assertive communication with caseworkers at the time of placement will clarify mutual responsibilities and expectations. • Health Needs Identified and Services Provided—Foster Parent core training curriculum will address the role of foster parents in working with caseworkers in identifying health needs and services. Also training will include assignment of caseworker/foster parent responsibilities. Section B - Measurable Outcomes Clients will choose training goals, and objectives according to their perceived needs. It is important to understand that as in any training process that this training serves as a beginning point and that these skills, concepts, and techniques need to be understood and practiced before foster parents will be able to consistently apply them with the children they serve. In addition, 90% of the foster parents will complete this certification training. A. After involvement in this program foster parents will be able to identify an improvement in their ability to deal competently with household management issues, as measured by a pre and post assessment inventory - Volume VII Compliance Checklist. • Increase knowledge of and understanding of Volume VII requirements for foster parents. • Increase understanding of importance of documentation and timelines concerning medical, dental and, medication monitoring. • Increase awareness of state and federal requirements in Volume VII regarding higher standards of care required by foster homes. • Increase awareness of and adherence to household cleaning, safety, and maintenance requirements outlined in Volume WI. • Increase awareness of resources available to assist with budgeting and purchasing resources for foster children. I5 B. After involvement in this program component foster parents will be able to identify an improvement in their parental competency as measured by a pre and post assessment inventory of skills needed to implement non-power based parenting effectively. • Increase adherence to and understanding of state and federal requirements regarding discipline policies. • Increase understanding of characteristics of children rose with inconsistent parenting. • Increase ability to use and identify alternative discipline strategies. • Increase ability to acknowledge and listen to the child's concerns with empathy. • Increase recognition of communication barriers. • Increase ability to set effective limits using choices and enforceable statements. • Increase ability to use empathy and consequences effectively. • Increase ability to facilitate problem solving skills in foster children. • Increase understanding of the importance of positive relationship message when delivering negative content message. • Increase ability to redirect miss-behavior. • Increase understanding of foster children's need to learn about cause and effect thinking in an emotionally neutral non blaming environment. C. Foster parents will increase their ability to access resources independently so that they are able to improve their ability to meet the specialized needs of each individual foster child they serve. This will be measured by self report on evaluations and tracking the number of referrals made by this program. • This program will facilitate empowerment for foster parents by providing clear user friendly information about the resources available in the community and within the local, state and federal government. D. Foster parents will obtain higher skills and competency levels in fulfilling their role in providing a healing relationship for children in out of home placement. This will be measured and monitored through the development of individualized training service objectives which will be evaluated at the end of training. • Increase ability to accept the child as s/he is • Increase ability to deal with child's behavior in the context of a healing relationship. • Increase ability to support what the foster child is going through. • Increase understanding of dynamics of child abuse and neglect. 16 • Increase understanding of developmentally appropriate expectations and the effects of trauma on development. • Increase understanding of the factors influencing the child's reaction to parent separation and loss. • Increase understanding of cultural competency issues that effect foster parenting. • Increase understanding of roles and dynamics of children that grow up in homes where parents have substance abuse issues. • Increase ability to anticipate special emotional needs. • Increase attunement to attachment and bonding issues. • Increase understanding of the need for foster children to have empowering corrective experiences. • Increase understanding of regressive behavior and the need for reparative bonding within the relationship. • Increase understanding of the need for consistency and structure to establish trust. • Increase understanding of the effects severe boundary violations have on children and how to facilitate the development of healthy boundaries in children. E. Foster parents will positively meet their own and the needs of their biological children's in adjusting to and dealing with the presence of foster children in the home. This will be measured and monitored through perceived capacity on the self report on the post evaluation tool. • Increase ability to set and maintain outside interests and relationships. • Increase ability to communicate effectively with the multiple systems involved in foster children lives. • Increase ability to set and teach children how to set effective physical and emotional boundaries. • Increase awareness of symptoms of burnout. • Increase understanding of the importance of knowing when to access support. • Increase awareness of grief and loss issues for foster families when foster child reunifies with family of origin or is moved to an adoptive home. • Increase awareness of inappropriate coping strategies (i.e , substance use, denial, eating, fault-finding, passivity, revenge, withdrawal or excessive worry, etc...). • Increase ability to use appropriate coping strategies (i.e , diversions, balance, conflict resolution, flexibility, networking, affirmations, assertiveness, contact, enforceable limits, linking, organization, problem 17 solving, re-labeling, providing choices, time management, relaxation, self- care, exercise, commitment, prayer, worship, surrender, etc...). F. Foster Parents will clearly understand and be able to support the Performance Improvement Plan goals set by the department. • Increase awareness of the effect of placement changes on the child's well being. • Increase understanding of the importance of Independent Living skills for foster children. • Increase understanding of the importance of cultural and racial connections for the well being of the child placed in their home. • Increase in communication skills needed to communicate willingness and receptivity to monthly face-to-face contact with caseworker. • Clear understanding of the requirement to set up appointments —medical within two weeks and dental within eight weeks for children over three years. • Increase understanding of roles and responsibilities in working with caseworker to identify health needs for child. Section C - Service Objectives We have the following service objectives: A. Improvement of household management competencies. It is imperative that foster parents are aware of and uphold regulations outlined in Volume VII regarding the need to maintain a safe household environment, which is adequately cleaned and maintained. In addition, foster parents need to be able to budget their resources so that they are able to provide for the children they serve. Specific aspects on this service objective may include the following training. This component will be measured through the foster parents' perceived ability to reach specific individualized goals, on a post assessment tool. B. Improved parental competencies. Foster parents need to have the capacity to maintain a solid relationship with each other; with their own biological children and with the foster children they serve. In addition, foster parents need to provide developmentally appropriate care, nutrition, hygiene, discipline, protection, guidance, and supervision. This service objective will be met initially through training. This component will be measured through the foster parents self perceived ability in the post evaluations. 18 C. Improve ability to access resources. Foster parents shall be empowered to access resources in the community, as well as resources available through the local, state and federal government. This program will encourage networking with other foster parents. This service objective will be provided through support groups, linking, consultation, and referrals. This component will be measured through foster parent perceived ability to reach specific individualized training goals, and record of number of referrals made. D. Address specific issues outlined in referral- all services shall be solution focused and address the specific issues specifed by the Department of Social Services on the referral form. This component will be measured through foster parent coordinator feedback and foster parent evaluations. E. Performance Improvement Plan —All components of the PIP will be addressed in training. This component will be measured through the foster parents' ability to reach specific individualized consultation specifically related to the PIP, a pre and post assessment toll and program evaluations. Section D - Workload Standards A. The program has the capacity to serve 144 foster parents. At maximum capacity, trainers would spend up to 27 hours a month providing services. With an average of twelve foster parents per group, total number of client hours provides over one year would be 3888 hours. B. Anticipated requests for training would be one training every six weeks. C. Trainers - There are three trainers available for this program. Lori Kochevar M.S., L.C.., LLC will serve as a provider and the program supervisor for Sharon Benson, M.A., and Lorenza Perezverdia, B.S. All providers have extensive experience in Family Services as documented in the attached resumes. D. The caseload will be between 2-13 hours of training per therapist per training requested. The caseload of each trainer will depend on trainers' availability, expertise, and matching the specific needs of the referred group with the therapist area of specialty. E. Hours - Total number of clinical time devoted to this program equals one hour a day, five hours a week, and eighteen hours a month. 19 F. Supervisor-This contract would be supervised part time by Lori Kochevar M.S. L.P.C. who would monitor the other 2 trainers for program compliance and clinical excellence. G. Insurance - - Lori Kochevar M.S., L.P.C., LLC carries one million/six million liability on the company and each one of the independent contractors connected to this bid. In addition, Lori Kochevar M.S., L.P.C., LLC carries a general liability policy related to accident or injury on the premises. The State of Colorado is named as an additional insured on this policy. Each individual provider also carries at least a one million/three million liability insurance policy. The general liability coverage is attached in Appendix 3. All therapist providing services are self employed and choose to be exempt from workman's compensation and employer's liability insurance. Section E - Staff Qualifications A. All the providers exceed the minimum qualifications needed for both education and experience. All providers have their Bachelors or Master's Degree in Counseling. In addition, the therapists have between 8-20 years a piece providing services for families. See Resumes in Appendix 1. B. Staff available for this project consists of three experienced specialists that have a similar core value of clinical excellence. We believe in providing strength-based, services that empower the families we serve. Another strength of our staff is our diverse areas of specialties. • Lori Kochevar a licensed professional counselor has extensive experience and training in providing services and supervision using the family preservation model. She has been working in the field for over twenty years and has been in child welfare for the last ten of those. She has specialized training in substance abuse, attachment and bonding, trauma, grief, and domestic violence. In the last fifteen years Lori has developed and facilitated multiple training's that emphasize experiential learning opportunities. Many of these training's were developed specifically for foster parents, while others were created for families, school personnel, and service providers across the state. • Sharon K. Benson graduated in 1985 with her masters in Professional Psychology with an emphasis in trauma. She has worked with support service organizations for over twenty years in the areas of Domestic 20 Violence, adolescent offenders, disabilities and family preservation. For the past 10 years Sharon has taught classes in the Psychology, Business and Emergency Service departments at Aims Community College. Currently she is in the Early Childhood field where she has received specialized training in assessment, behavior management, positive parenting and services to children with disability or mental health issues. C. New Caseworker Training- Lori Kochevar, M.S. L.P.C. the supervisor for this bid has attended the Core training for Supervisors through the State of Colorado, she will oversee the work of all other staff to make sure it is in compliance with requirements. In addition, Jenna Reed who is working on bids submitted from this agency has successfully completed new caseworker training. D. Risk assessment knowledge is taught during the foster parent core training; in addition all staff is versed in multiple levels of risk assessment and are able to address risk issues as they occur during interventions. Along with being skilled trainers, due to our extensive background as caseworkers and therapists we are knowledgeable of the systems (i.e... biological families, social services, mental health services, legal services, etc...) that foster parents need to interface with as advocates for the children that are placed with them. Section F — Program Capacity per Month H. Total number of clients to be served in the twelve month program has been calculated as follows. We would provide eight trainings a year. We estimate that there would be an average of 12 participants at each training. Henceforth, at eight trainings a year x 27 hours per training this program would provide 216 hours of service a year. At a cost of$12.33 per foster parent per hour of training. I I. Families Served. We anticipate serving 48 foster families, 96 foster parents. Distribution of clients. On average most foster parents provide services for approximately four foster children a year. Each foster child is in placement an average of 6 months. By providing training for approximately 48 foster families these services improve that quality of care for approximately 384 children this year in the placement system. J. Sub total who will receive bicultural / bilingual services. All services provided will be in a manner which is sensitive to the culture of origin of the 21 family. All of the therapist have training in cultural competency issues and one of our therapists is bilingual. In addition, Lori Kochevar was the chair of the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. In that the training is presented in English to meet the needs of most participants in the group, we need to have an interpreter for any mono-lingual applicants. Previously if we have had a mono lingual applicant an interpreter has been hired by the department. We have needed to hire an interpreter two times in the last five years. K. Training services will be available to South Weld County foster parents. Typically the trainings are held in Greeley because it is the central location for most applicants. However, if a majority of the class is from South County, we would be willing to teach there. L. The monthly program capacity per group - If needed, we could expand the number of trainings done a year up to 12. M.Average stay in the program - The average stay in this program would be 4 weeks. Average hours per week in the program would be 6.75 hours a week. Typically the program is set up on a Friday evening, all day Saturday, and then 4 consecutive Wednesday evenings after work. Section G — Internal Tracking and Billing Process A. Description of process is as follows; • All records for the month (i.e. contact notes, client verification form with signature, and billing to DSS) are kept in the same file. These are organized as follows: Left pocket has contact notes, client verification form with signature in the order that they are billed. All group and training session signatures are at the back. Right pocket has monthly billing submitted and receipt of payment. • Time with the client is only billed for face-to-face contact. On face-to-face contact the client signs the verification sheet provided by DSS which indicates the date and amount of time seen. 22 • This program is billed at the negotiated rate per training completed for up to twelve foster parents in each training. This price includes most meals and materials. • Subcontractors are responsible for sending an original copy of contact notes and client verification form with signature by the 5th of the month. This information is kept in an individual consultant file for the year. Subcontractors are paid by LLC when the payment for services is received from DSS. This is tracked in with the consultant's file. • The bill for the county is prepared monthly using the following guidelines from the RFP (page 20 of 30 a, b-1, 2 & 3): o Report expenditures and case disbursement at agreed upon times. o Submit monthly FYC completed billing forms to Ms. Andrea Shay, Core/PRT Caseworker, on or about the 10th day of the month after the month following the month the services were provided. o The provider shall furnish the following deliverables required to verify services provided during the service month. The completed deliverables must be received by Social Services no later than the 25`h day of the month following the dates of service. o The required deliverables are 1.) Authorization for Contractual Services, 2.) Request for Reimbursement, and 3.) Client Verification Form. The Authorization for Contractual Services will include provider name, address, and phone number, provider billing contact and phone number. It will also include the program area, dollars ($) billed, original signature and month of service. Request for Reimbursement will include the client information (TRAILS or case ID number when available, rate, units billed and date(s) of service. The Client Verification Form will include the client's name, date, time of service, hours per service, and original client signatures signed at the time of service. Section H - Literature Citations Acosta, V. (1991). Integrating Experiential Learning and Critical Inquiry in Health Education. Paper presented at the annual meeting of the American Educational Research Association, Chicago. 23 Baslow, IL, & Byrne, M. (1993). Internship Expectations and Learning Goals. Journalism Educator, 47(4), 48-54. Cantor, J. (1995). Experiential Learning in Higher Education: Linking Classroom and Community. (Report No. 7). Washington, DC: The George Washington University, Graduate School of Education and Human Development. Chrestman, K. (1995). Secondary exposure to trauma and self-reported distress among therapists. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 29-36). Lutherville, MD: Sidran Press. Cranton, P. (1989). Planning Instruction For Adult Learners. Toronto, Canada: Wall & Thompson. Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social Work, 48, 451-459. Janov, A. (1996). Why You Get Sick, How You Get Well. West Hollywood, CA: Dove Books. Jernstedt, G.C. (1995). Experiential Components in Academic Courses. In R. Kraft, & J. Kielsmeier (Eds.), Experiential Learning In Schools Of Higher Education (pp. 357-371). Dubuque, Iowa: Kendall/Hunt Publishing Company. Knowles, M. (1977). The Modem Practice of Adult Education: Andragogy Versus Pedagogy. New York: Association Press. Knowles, M. (1980). The Modem Practice of Adult Education: Andragogy Versus Pedagogy. (2nd ed.). Chicago: Follett. Meichenbaum, D., & Fitzpatrick, D. (1993). A constructivist narrative perspective on stress and coping: Stress inoculation applications. In L. Goldberger& S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (2nd ed., pp. 706-723). New York: The Free Press. Neumann, D. A., & Gamble, S. J. (1995). Issues in the professional development of psychotherapists: Countertransference and vicarious traumatization in the new trauma therapist. Psychotherapy, 32, 341-347. Pearlman, L. A., & Saakvitne, K. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W. W. Norton. 24 Pearlman, L. A., & Madan, P. S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 588-565. Pert, C. (1997). Molecules of Emotion. New York: Scribner. Post, Bryan & Forbes, H., (2006) Beyond Consequences. Logic and Control. A Love Based Approach to Helping Attachment- Challenged Children with Severe Behaviors. Florida; Beyond Consequences Institute. Rossi, E. L. (1986). The Psychobiology of Mind-Body Healing: New Concepts of Therapeutic Hypnosis. New York: W. W. Norton. Rossi, E. L., & Cheek, D. (1988). Mind-Body Therapy: Ideodynamic Healing in Hypnosis. New York: W. W. Norton. Ryan, R. M., & Lynch, J. H. (1989). Emotional autonomy versus Schore, A. N. (1994). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. Walter, G., & Marks, S. (1981). Experiential Learning and Change. New York: John Wiley & Sons Section I - Confidentiality and Participant Protection A. Protect Clients and Staff from Potential Risks • The foreseeable physical, medical, psychological, social, and legal risks to participating in skills building parenting work are minimal. All documents will be kept confidential as outlined in the confidentiality section of this document. Since this work often involves discussing unpleasant aspects of the client's life, clients may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. Clinicians are trained to watch for signs of traumatic recall that would indicate the client is outside of the zone where they are able to modulate their responses. In the event that a traumatic memory is retriggered clinicians involved are trained to help a client re-assimilate into the present moment before ending a session. If it becomes apparent that the client is in need of additional therapy services the clinician will address this issue with the treatment team. In addition, if a clinician assessed that during a session a client is a danger to them self's or others, they would take the appropriate steps to ensure safety. This may include a referral to the emergency room evaluation team to access the need 25 for higher level care through the Medicaid mental health program at Northrange Behavioral Health Care. B. Fair Selection of Participants • In this program we would never exclude or discriminate participation on the basis of age, gender, religion, or racialethnic background. We are open to families that have children between the ages of 0-12 as well as referrals of homeless youth, foster children, children of substance abusers, pregnant women, and fathers. • In that this is an early intervention, working with children 6 and under as the identified client with siblings up to the age of 12 is the most appropriate population for us to work with. Mother appropriate population would be a teenage mother with an infant or pre-natal bonding. • We will recruit and select participants from referrals provided through social services. Opened to all referrals that are not deemed inappropriate for services due to danger to others or inability to benefit form services provided. C. Absence of Coercion • Participants in this program will be selected through the referral source and participants willingness to be involved. Even with court ordered clients it is up to their own volition if they will choose to participate in any particular program. • Ultimately all participation is voluntary. It is our responsibility to report participation and progress to the referring agency. Volunteer's participants will be told that they are welcome to receive services through or program our one that best meets their needs. D. Data Collection • We will collect data from participants themselves, family members, teachers, and other parties connected to the case. We will obtain a specific release of information from the participant for any one we obtain data from. During each case as deemed appropriate to the needs of the family we may collect data from school records, interviews, psychological assessments, questionnaires, and observation from other parties privy to the case information. 26 • Our information is collected in professional, home-based and natural settings facilitating observational techniques and environmental assessments. When collecting data through questionnaires or interviews, we are sure to obtain a private space to secure confidentiality • Provided in Appendix 2, are all Data Collection Instruments/Interview Protocols and releases. E. Privacy and Confidentiality • Clinician assigned to the case will centralize all data in a file. The data collection instruments will be used in case planning, documenting progress, recommendations, and program evaluation. The identity of participants will be kept private by limiting access to records. Data will be stored in a locked file case, behind a door that is locked at all times. From our office only those people trained in confidentiality and will have access to information. Subject to clinical judgment and client preference those with a signed release by the client will also have access to records. F. Adequate Consent Procedures • Data that will be collected may include 1) Family information- clinical intake form, 2) AIMS: Developmental Indicators of Emotional Health- as appropriate per age of child being parented. 3) Impact of Event Scale (screening for PTSD) 4) Depression Screening 5) Client Satisfaction 6) Program progress in the form of Clinical Case Managing, Monthly Progress Report and Transition Plan. All information will be kept in secure location as described in privacy and confidentiality section and only limited access to these records will be allowed. Records and tools will be used for reporting progress and program evaluation. Participation in this program is always voluntary. Participant always have the right to leave the project at any time without any sanctions being imposed by the program. • Possible risks from participation in the project include the possibility that uncomfortable feelings will arise from the process. Plans to protect clients from these risks are outlined in the protecting clients from Potential risk section of this document. 27 • This program will must have consent from participants (their parents) or legal guardians. Consent from the legal guardian will be obtained in the form of a referral from the Department of Social Services of Weld County and from the parents/participants in the form of their signature on the (1) Consent for Services - informed consent for participation in service intervention; (2) Privacy-Policies - informed consent for participation in the data collection component of the project- HIPPA; and (3) Release of Information - informed consent for the exchange (releasing or requesting) of confidential information. These forms are located in Appendix 3 "Sample Consent Forms". We will read the consent forms with the participants and ask prospective participants questions to be sure they understand the forms. We will also give them a copy of what they signed for future reference. • All releases will be obtained at the beginning of the project, with the understanding that the participant may choose to relinquish permission to use their information at any time. The consents to release information to others or gather information and the HIPPA form are standardized forms that include all information necessary to meet HIPPA guidelines as well as the guidelines for the practice of psychotherapy. For research purposes Clients can decline participation in any data collection process and still receive services. G. Risk/Benefit Discussion • Since this work often involves discussing unpleasant aspects of the clients life, clients may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness Most often the potencial benefits of participation in this program far out weight the risks. Participation in this program often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. While there are no guarantees on what a client will experience, many participants have experienced an increased effectiveness and satisfaction in many areas of their life. The importatnce of gaining parenting knowledge to enhance both their lives and the lives of their children is a solid benefit that helps them care for their children. 28 PROGRAM BUDGETS COMPUTERIZED BUDGET PROGRAM Outside DSS FP Core TX Boning A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 1 24 B TOTAL CLIENTS TO BE SERVED 8 80 C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X R) 8 1,410 D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $2,300.00 $45.01 E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $0 $18,100 $84,809 F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCAM F TO PROGRAM $2,189 $3,985 $51,001 G OVERHEAD COSTS ALLTICARI F TO PROGR/M $10,763 $7,782 $10,763 H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $12,952 $30,176 $128,573 I ANTICIPATED PROFITS CONTRIBUTED BY THIS PROGRAM $0 $1,182 $1,587 J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $12,852 $31,658 $128,180 K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 8 1.440 L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE TO BE CHARGED TO WELD COUNTY SOCIAL SERVICES(J/K) $3,957.28 18900 COURT TESTIMONY FOR ALL PROGRAMS PER HOUR $150.00 ic �ju G ° 8@ # @@ ; 888@ 8 888888 8 8 2#aaaaa2aaa 2 aaaaaa 2 § 2 - - § p. ce & iu8 co pt / a@8@@@88888 ° 8m8@ § $ 8 ) § § R7aaaaasaaacy3 _,._._ .6 0 ui a # k aoA m S 861k ■ } k2 a k I-- k 66666666 69 69 666 8 d6 § O ! 6 8 % 03 / 22 }°2}" CO 4949 4949- , et § ( a ` © to u) a ! 8 2 - � r • E u- a a 111 ° 838888888 3 888888 8 4 et $ e § § &J° 8888888 . ___a2 6 ai IA 0 ` 7 a a a k § k $ & � 2 $ Q , & a. o a a au k -I * * at a alt 4 i & 88888888888 a 8 8 6 ! ti / aa-- - 4969--6349 - . -6 6 - § ) �NT % s lir t o 8 8 § 17 § ■ it w2 0 w et . 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CI , 2 e a. , _ X le ! 8888 § $ ] | Rages § I. * g _ © 8 8888 88888888gg88 w @ q iR2�§aaaaaasaaaaaa § § ) cool 4-.!T.- \ \ § g8 §2§§ § | , at 4- 0 » WWW » � 22am8B229222222222 2 4 $ E a ■ ■ a88 8 8 § » . , § }222$ § # §—$—§ a a B if. if IX et Ill In 0 § Er uj 0- 00 0 z } In ft m \ § aWC° § [ M § - § a k O re } 4 4 B I 0 a a E § k § 0a. cow! ) E. k O O - Lori J. Kochevar M.S. L.P.C. 1024 8t Street Greeley, CO 80631 (970) 352-8873 lorik@aspacetogrow.com Clinical Facilitation Skills: • Ability to provide an energetically clear environment for conflict resolution. • Facilitate a creative process that allows knowledge to be integrated on multiple levels of awareness. • Clear understanding of when family members are physiologically able to negotiate differences. • Ability to assist family in synthesizing large amounts of sensitive information to reach a consensus. • Skill in facilitating resolution of issues in a manner that is respectful and sensitive to individual differences in culture,agendas, and desired outcomes. • Unique ability to teach physiological self-regulation through use of mirror-neurons. • Extensive training and experience in group/family dynamics, spirituality, trauma, child welfare, and body-centered psychotherapy. • Ability to assess and mitigate physiological effects of trauma on current functioning. • Proven skills in identifying multi-faceted family dynamics, psychological, and social issues for families involved in the child welfare system. Training&Curriculum Development Skills: • Trained colleagues in multiple agencies on strength-based,family-focused models: Family Preservation Services and Family Group Decision Making. • Have provided training across the state for schools, agencies,and the general public. • Use of experiential strategies to access multi-dimensional learning of information which increases participant's ability to recall and implement strategies across time and in non-ideal circumstances. Training Approach: o Present comprehensive coverage of all essential information, in the moment as dictated by the group dynamics and specific training needs. o Build cohesive curricula which employ progressive skill sets with multiple review of core material in different areas to increase retention and ability. o Facilitate a transformative process that motivates participants to take action in order to improve their life situation. o Encourage self-exploration and understanding of how a participant's thoughts,words,feelings and actions affect their own and other's well being. o Empower participants by seeing how they can transfer applicable existing skills into their new role,while building additional role-specific skills. o Use transfer-of-learning strategies to increase participant's ability to utilize the skills taught. Program Development&Community Organizational Strengths: • Developed and direct the following bid programs with Social Services: Family Preservation Services, Family Group Decision Making, Foster Parent Core Training, Foster Parent Consultation, and Home-Studies. • Currently serve as program administrator and grant writer for the Bonding Program. • In a director level position,guided 18 agencies in collaborative efforts in fundraising, program expansion,and community development. • Spearheaded community efforts to fundraise for and build a Boys and Girls Club in the San Luis Valley,which currently has three sites and are serving over 1,500 youth. • 33 • Organized Philanthropy Days: brought in philanthropists,foundation directors, and trustees to visit and enjoy the Valley's multiple cultures, learn of its services and strategize in partnership with the Valley for short and long term financial successes. • Successfully completed the Colorado Leadership Program to learn all phases of fund raising, management,and board development. • Develop and maintain solid working relationships within the community. • Participated in the El Pomar Community Leadership Program to increased awareness of personal leadership style, strengths, and developmental edge. Supervision&Consultation Skills: • Program Supervisor of Independent Contractors for grant compliance, agency/client satisfaction, and clinical excellence. • Provide program and clinical consultation to Program Directors at the Child Advocacy Resource Education(CARE)agency,and independent therapists. • Participated in Mastering the Art of Child Welfare Supervision training to achieve high standards of supervisory practices in order to assure the effective and efficient delivery of child welfare services. Work History: 1995—Present Private Therapist Contracted with Departments of Social Services in the San Luis Valley and Weld County, Hospice,Ackerman and Associates, Child Advocacy Resource Center, Prevention Project, and Mountain Trails Youth Ranch. 1995—1996 Director-Grant writer San Luis Valley Community Fund 1992—1995 Family Preservation San Luis Valley Mental Health Center Specialist 1992—1995 Wilderness Therapist San Luis Valley Mental Health Center 1989—1991 Disabilities Consultant University Affiliated Program, USM 1989 Teaching Assistant University of Northern Colorado 1986—1989 Supervisor Boys and Girls Club, Greeley, CO Education: University of Southern Mississippi, M.S. Counseling Psychology GPA: 3.8 University of Northern Colorado, B.A. Professional Psychology GPA: 3.5 Involvement: Member,Weld County Child Welfare Committee Founding Board Member, Boys and Girls Club of Alamosa Member, San Luis Valley Coalition for Youth Services Chairperson, San Luis Valley Multicultural Task Force. .4 TRAININGS FACILITATED: CHILD WELFARE 02/07/03 How Trauma and Neglect Effect Children's Development 2000-2005 Investigations:Rules,Roles and Resources 1998 Family Group Decision Making 1998 Creating Health/Balance in Relationships 1997—2005 Foster Parent Support Groups 1997 Family Preservation Services 05/30/97 Team Building for Families—Healthy Families 05/30/97 Finding Balance: Multicultural Dynamics with Clients and Foster Families FOSTER PARENTING 2000-Present Core Training—Foster Parents 2001 State Foster Parent Annual Conference—Trauma in the Body 03/10/00 Healthy Transitions for Foster Children 02/26/00 What Does a Foster Child Hear? Messages Underlying Discipline 03/02 Working with Trauma in the body;Empowering Children 1999 Enhancing Communication Skills 07/10/99 ADHD—How to Create Peaceful Moments 1999 Effective Parenting for Foster Parents 03/27/99 Helping Foster Parents Deal with Attachment Issues 01/12/99 Multicultural Diversity—A Celebration of Differences 1998 Love and Logic Parenting for Foster Parents 08/08/98 Understanding Differences 04/04/98 Stress Management 101 04/04/97 Interpersonal Effectiveness for Foster Parents INTERPERSONAL EFFECTIVENESS 05/15/97 Goal Setting 101 02/07/97 Effective Communication for Mental Health Workers 1997 Young Women's Group:A therapeutic self discovery group 06/21/96 Stress Management for Health Care Professionals 04/13/96 Interpersonal Effectiveness and Team Building 01/23-25/96 Interpersonal Effectiveness for School Personnel 07/13/94 Multicultural Diversity Training of Facilitators(TOF) 03/1-7/92 Career Exploration DRUG AND ALCOHOL PREVENTION 03/11/00 There's an Elephant in the Living Room 03/27-28/95 Family Preservation Services:Motivational Interviewing 1994 Teen Baseline:Drug Prevention 05/13-14/94 Impact of Sexual Addiction on Families:Family Sculpting 1993 Baseline:Drug Prevention COMMUNITY DEVELOPMENT 09/23/05 Conscious Parenting—Resolving Conflict from Within 10/19/04 State Farm Lunch and Learn;Consciousness from Within 09/15/03 Spiritual Parenting 11/10/04 Diet and Emotions 35 SHARON K. BENSON, M.A. 2201 2nd Street**Greeley, CO 80631 970-351-8246 FORMAL EDUCATION Graduated University of Northern Colorado,Greeley,Colorado 1985 Master of Arts degree in Professional Psychology Graduated California State University at Northridge,California 1978 Bachelor of Arts degree in Psychology Graduated Moorpark Community College,Moorpark,California 1975 Associate of Arts degree Studied University of Northern Colorado,Greeley,Colorado 1982-1984 Special Education,Secondary Graduate program WORK EXPERIENCE 11/04 to Present—Disability and Mental Health Specialist,FENWC Head Start,Greeley,CO 1/97 to Present—Adjunct Instructor,Aims Community College,Greeley,CO Courses taught in the Psychology,Business and Emergency Medical Academy department& 3/98 to Present—Financial Advisor,Waddell&Reed,Greeley,CO Professional financial advisor,planner,and educator. Series 6 and Life insurance liceacrfl 1/93 to 6/98 -Consultant,self-employed,Greeley,CO Contractual work with court ordered families,private and public companies. Specialization:Critical Incident Stress and Trauma 1/85 to 12)96 - Licensed Psychotherapist,self-employed,Greeley,CO Psychotherapy counseling in a private practice with families and individuals. Specialization:Trauma. 1/86 to 12/89 -Executive Director,Greeley Resources for Independent People,Greeley,CO Not for profit center for people with disabilities providing independent daily living skill training and equipment LICENSE,CERTIFICATIONS,MEMBERSHIPS&AWARDS 1998 Licensed *National Association of Security Dealers Series 6—Securities License 1998 Licensed *Insurance—Life 1992-1997 Licensed *Licensed Professional Counselor 1995-present Certified *Hypnotherapist 1993-present Certified *Critical Incident Stress Management—Advanced Training 1997-2002 Credential *Colorado State Board for Community Colleges&Occupational Education-Vocational Credential in Business&Health Occupations 1985-present Certified *Mediation/Conflict Resolution 1992-present Member/ *Centennial Critical Incident Stress Management(CISM)Team Director *Clinical Director CISM Team from 1997 through 2000 2000 Award *Aims Community College Award for Excellence in Adjunct Teaching 31a Jubilee Center for Families -AUGUST'06 Training Foster Parent-core Lori Kochevar,Sharon Benson 1 -Strongly Disagree 5-Strongly Agree Scores(Average) The program met my expectations 4.50 out of 5.00 I received new information 4.50 out of 5.00 The training was helpful and relevant to my needs 4.75 out of 5.00 The training was presented effectively and in a well-organized manner 4.25 out of 5.00 1 -Very Negative 5-Very Positive My general reaction to the training was 4.75 out of 5.00 1 -Too Short 3-Just Right 5-Too Long The length of the program was 3.00 During groups the most beneficial information presented was: Remembering what the child has been through before they came into our house and how to react to that. Refereshing parenting skills for Foster Kids and also to understand what these kids are going through. Knowing about the system. Leaming exactly where these kids are coming from. Learning what they have gone throught. During group the least beneficial infonnaion presented was: All information is interesting It was all beneficial All Information needed for foster parenting/parenting c s During groups I learned and/or relearned: How to conscience parent again and again,and that mistakes can be made,and we can try again Things or series I did not know came into play in this field. The kids arent"acting out*because they don't like you. They just don't know what its like not being hit, abused,etc. I will learn just as much from the kids as they will learn from me. Things which might have increased my learning are: Nothing is coming to me at this time. All the information is helpful to releam and hear again. Mabey add another day to shorten the length of the classes. Same amount of information in a longer period of time. Other Comments: I enjoyed the two instructors it was a nice change of pace to leam from two different teaching patterns. I also enjoy the small groups! Both very great teachers and they make it a very comfortable place to team. No more Friday nights. Lori and Sharon are great teachers. I learned so much and I know what I am about to do is right for me. I know I'm doing the right thing. 5 7 Jubilee Center for Families -OCT'06 Training Foster Parent-core Lori Kochevar, Sharon Benson 1 -Strongly Disagree 5-Strongly Agree Scores(Average) The program met my expectations 5.00 out of 5.00 I received new information 5.00 out of 5.00 The training was helpful and relevant to my needs 5.00 out of 5.00 The training was presented effectively and in a well-organized manner 4.88 out of 5.00 1 -Very Negative 5-Very Positive My general reaction to the training was 5.00 out of 5.00 1 -Too Short 3-Just Right 5-Too Long The length of the program was 3.25 During groups the most beneficial information presented was: Accepting the child if he/she comes to you Conscious parenting Understanding the chikt's perspective Respecting and understanding the child's needs especially when they are different from my needs All of what was taught was very informational Resource and support are there for the asking To get more information During group the least beneficial infonation presented was: All was beneficial Can't think of one There was none There was none During groups I learned arni/or relearned: The strength of attachment/non-attachment To listen to my experience How to keep myself calm;Not react to the kid's trauma How to center myself A good start to the joumeyh we are beginning How the children feel but don't talk about it About the child's needs Things which might have increased my learning are: More breaks Understanding of what to expect during the actual"adoption"process. I know this doesn't apply to all attendees Learn to take a time out for yourself To help the children and have time for yourself Other Comments: This course exceeded my expectgations. Thank you for all your hard work! Thank you for everything it was great Jubilee Center for Families -DEC.'06 Training Foster Parent-core Lori Kochevar, Sharon Benson 1 -Strongly Disagree 5-Strongly Agree Scores(Average) The program met my expectations 4.67 out of 5.00 I received new information 5.00 out of 5.00 The training was helpful and relevant to my needs 5.00 out of 5.00 The training was presented effectively and in a well-organized manner 5.00 out of 5.00 1 -Very Negative 5-Very Positive My general reaction to the training was 4.67 out of 5.00 1 -Too Short 3-Just RigM 5-Too Long The length of the program was 3.33 During groups the most beneficial information presented was: Role Playing What is best for the child To remember how these kids feel coming in to your home During group the least beneficial informaion presented was: Nothing During groups I learned and/or Seamed: The effect of grief and loss to foster kids On how to become more relaxed to traumatic events,or behavioral problems To Tree Things which might have increased my teaming are: The grief exercise and the role playing The five things we had to give up test All of it Other Comments: We really enjoyed the class and look forward to joining support groups Jubilee Center for Families-FEB.'07 Training Foster Parent-core Lori Kochevar, Sharon Benson 1 -Strongly Disagree 5-Strongly Agree Scores(Average) The program met my expectations 4.86 out of 5.00 I received new information 5.00 out of 5.00 The training was helpful and relevant to my needs 471 out of 5.00 The training was presented effectively and in a well-organized manner 5.00 out of 5.00 1 -Very Negative 5-Very Positive My general reaction to the training was 4.86 out of 5.00 1 -Too Short 3-Just Right 5-Too Long The length of the program was 3.14 During groups the most beneficial information presented was: Children's reactions to every day things,which may be traumatic for them. To be open minded and that there is always help and way's to deal with situations. How to help kids in need, and how to offer the care they might need in different ways. Be sure to do documentation;foster children"belong"to the State. There is hope. Learning the insights of the foster child. Seeing situations more from the child's point of view. During group the least beneficial infomaion presented was: All was beneficial. Our coping strategies. All was beneficial. During groups I learned and/or releamed: Tree is a wonderful tool. Grieving process and how even children will go through loss over and over again. Have learned things I never heard of,or understood before,"Child Abuse". How to"tree". Parenting Skills. Parenting Skills,the"Tree" Relaxation technique,"Tree",to help let go of stressful reactions. Things which might have increased my learning are: How to deal with children that are brutualty sexually abused. More about what each"team member will help with. To use the tree. Child abuse trauma. Other Comments: I have had previous training and found this much more informational about the children's point of view,and their feelings and reactions. Both ladies were very knowledgeable and helpful. Thank you! I really appreciate the teaching of the child's view point. Other trainings I have had dealt more with rules and legal issues,than the child's well being. LID Individualized Training Plan for I. Foster parents will be able to identify an improvement in their parental competency as measured by a pre and post assessment of skills needed to implement non-power based parenting effectively. • Increase adherence to and understanding of state and federal requirements regarding discipline policies. • Increase understanding of characteristics of children rose with inconsistent parenting. • Increase ability to use and identify alternative discipline strategies. • Increase ability to acknowledge and listen to the child's concerns with empathy. • Increase recognition of communication barriers. • Increase ability to set effective limits using choices and enforceable statements • Increase ability to use empathy and consequences effectively. • Increase ability to facilitate problem solving skills in foster children. • Increase understanding of the importance of positive relationship message when delivering negative content message. • Increase ability to redirect miss-behavior. • Increased understanding of foster children's need to learn about cause and effect thinking in an emotionally neutral non blaming environment. 2. Foster parents will increase their ability to access resources independently so that they are able to improve their ability to meet the specialized needs of each individual foster child they serve. • Increase understanding of the importance of knowing when to access support. • Increase awareness of resources available. • Increase ability to access resources available in the community and within the local, state and federal government. 3. Foster parents will obtain higher skills and competency levels in fulfilling their role in providing a healing relationship for children in out of home placement. • Increase ability to accept the child as s/he is. • Increase ability to deal with child's behavior in the context of a healing relationship. • Increase ability to support what the foster child is going through. • Increase understanding of dynamics of child abuse and neglect. • Increase understanding of developmentally appropriate expectations and the effects of trauma on development. • Increase understanding of the factors influencing the child's reaction to parent separation and loss. • Increase understanding of cultural competency issues that effect foster parenting. • Increase understanding of roles and dynamics of children that grow up in homes were parents have substance abuse issues. • Increase ability to anticipate special emotional needs • Increase attunement to attachment and bonding issues • Increase understanding of the need for foster children to have empowering corrective experiences. • Increase understanding of regressive behavior and the need for reparative bonding within the relationship. • Increase understanding of the need for consistency and structure to establish trust. L4k • Increase understanding of the effects severe boundary violations have on children and how to facilitate the development of health boundaries in children. 4. Foster parents will positively meet their own and the needs of their biological children's in adjusting to and dealing with the presence of foster children in the home. • Increase ability to set and maintain outside interests and relationships. • Increase ability to communicate effectively with the multiple systems involved in foster children lives. • Increase ability to set and teach children how to set effective physical and emotional boundaries. • Increase awareness of symptoms of burnout. • Increase understanding of the importance of knowing when to access support • Increase awareness of inappropriate coping strategies (i.e. ...., substance use, denial, eating, fault-finding,passivity, revenge, withdrawal, or excessive worry.) • Increase ability to use appropriate coping strategies(i.e. ...., diversions,balance,conflict resolution, flexibility,networking, affirmations, assertiveness, contact, enforceable limits, linking,organization,problem solving,re-labeling,providing choices,time management, relaxation, self-care, exercise,commitment, prayer,worship, surrender, etc...) A. Foster Parents will clearly understand and be able to support the Performance Improvement Plan goals set by the department. • Increase awareness of the effect of placement changes on the childs well being. • Increase understanding of the importance of Indepentant Living skills for foster children. • Increase understanding of the importance of culturaul and racial connections for the well being of the child placed in their home. • Increase in communication skills needed to communicate willingness and receptivity to monthly face to face contact with caseworker. • Clear understanding of the requirement to set up appointments-medical with in 2 weeks and dental with in eight weeks for children over 3. • Increase understanding of roles and responsabilities in working with caseworker to identify health needs for child. The areas checked above would assist me in serving the needs of foster children and the areas circled are where improvement has occurred. Sign Date (Pre&post) Li Household Management Issues 1. Foster parents will identify an improvement in their ability to deal competently with household management issues. • Increase knowledge of and understanding of Volume VII requirements for foster parents. • Increase understanding of importance of documentation and timelines concerning medical, dental and, medication monitoring. • Increase awareness of state and federal requirements in Volume VII regarding higher standards of care required by foster homes. • Increase awareness of and adherence to household cleaning, safety,and maintenance requirements outlined in Volume VII. • Increase awareness of resources available to assist with budgeting and purchasing resources for foster children. (-43 Lori Kochevar,MS LPC Sharon Benson MA JUBILEE CENTER FOR FAMILIES 1024 8TH ST. GREELEY,CO 80631 970-397.6521 RELEASE OF INFORMATION / / - - Participants Name Date of Birth Social Security No. / / Participants Name Date of Birth Social Security No. / / - - I participant,authorize information to be exchanged between Lori Kochevar and/or the Jubilee Center for families and following agencies or programs as listed below(initial all that apply): CASA—Court Appointed Special Advocate Child care provider Child Find North Range Behavioral Health Weld County Combined Courts _x Weld County Department of Social Services Physician other other other Information Disclosed Assessment/diagnosis _Social history/background _Updates and discharge summaries _x_Progress notes The disclosed information will be used for the following purposes: At the request of the client x_Multi-a e Continuity of care _Obtaining services for client services Evaluation purposes _Reports to courts or other agencies I understand the information released may be written,verbal or electronic form and may include date(s)of contact, locations and reasons for contact,symptoms presented,treatment progress,outcome information,prescriptions written referrals, education records,tests performed and or diagnosis. I understand that released information may include psychological/psychiatric,medical,shelter and case management,alcoholism,drug and/or alcohol abuse information. I understand that the purpose of this release of information is to allow the individuals/agencies chosen in the section above to access and use the information to establish and maintain continued care,collaborate services better assess the needs of the client,and/or improve program services based on evaluation studies. I understand that I may refuse to sign this authorization and that if I refuse to sign this authorization,I will not be eligible for services through the Foster Parent Education Program. I may still have access to other community services,however. There is no guarantee that recipients of the information disclosed through this authorization will not re-disclose to another party. Except in situations legally required or permitted, information about me cannot be disclosed to unauthorized persons without my written permission. I understand that I may cancel this authorization at any time by giving written notice to the agencies or programs selected above. I understand information exchanged prior to cancellation is excepted. Unless canceled this release will expire on / / or one year from my signature date. Foster Parent Signature Foster Parent Signature Witness signature Date 1� The Jubilee Center for Families 1024 81h Street Greeley, CO 80631 970-352-8873 Disclosure Statement Lori Kochevar, MS LPC Sharon Benson, MA Lori Kochevar has a Bachelor's Degree in Psychology and a Master's Degree in Guidance and Counseling. She is Colorado Licensed Professional Counselor #1199. Sharon Benson has a Bachelor's Degree in Psychology and a Master's Degree in Agency Counseling. She is an educator and works full time in an early childhood setting. She is not licensed as a Counselor. The practice of Licensed and unlicensed persons and Certified School Psychologists in the field of psychotherapy is regulated by the Department of Regulatory Agencies. A client of a psychotherapist is entitled to information about methods of therapy, techniques used, the duration of therapy, if known, and the fee structure. A client may seek a second opinion or terminate therapy at any time. In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that regulates, registers, or licenses such unlicensed psychotherapist, registrant or licensee, also known as the Grievance Board. The information provided by the client during therapy sessions is legally confidential in the case of licensed marriage and family therapists, social workers, professional counselors, psychologists, and unlicensed psychotherapists, except as provided in section 12-43-218 and except for certain legal exceptions that will be identified by the licensee, registrant, or unlicensed psychotherapist should any such situation arise during therapy. Exceptions include but are not limited to dangerousness to self or other*, grave disability, child abuse or neglect, suspected child abuse or child neglect, and lawsuits. The Grievance Board has the right to review charts. Please address all complaints about Foster Parent Training program to her first, at 970)352-8873 or with the Department of Regulatory Agencies, Colorado Mental Health Section at(303)894-66. Client/ Parent/Guardian Staff Date JUBILEE CENTER FOR FAMILIES CONSENT FOR MENTAL HEALTH AND ACKNOWLEDGEMENT OF INFORMATION RECEIVED ❑ CLIENT RIGHTS ANI)RESPONSIBILITES: I have received the Client Rights handout and relevant handouts outlining my responsibilities as a client of Jubilee Center for Families. I understand that it is my right to ask questions if I need clarification or have concerns. ❑ ACKNOWLEDGMENT OF PRIVACY RIGHTS: I have received a copy of the current Notice of Privacy Practices. I may refer to the Notice for more information about how Jubilee Center for Families may use or disclose my personal health information. I may refer to the Notice for more information about my rights in regards to such information. I may speak to the Privacy Officer for more information. ❑ DISCLOSURE STATEMENT: I have been given information about how to file a complaint or appeal a decision made by Jubilee Center for Families regarding my services. I may refer to the Privacy Notice or the Clients Rights handout for additional information. I understand that I may make a complaint or obtain the assistance of a Client Advocate without jeopardizing my care. ❑ FOLLOW-UP CONTACT AND SURVEYS: I understand Jubilee Center for Families or their representatives may contact me during or after my treatment to obtain follow-up information or ask about my satisfaction with treatment or services. Such information is confidential and will be used for quality assessment. I May choose to participate in these surveys or not without jeopardizing my treatment. ❑ RELEASE OF INFORMATION: I understand it may be necessary for Jubilee Center for Families to communicate protected health information about me to other providers who may need to know it for coordination of care or crisis management. Releases will be obtained. ❑ CONSENT TO TREAT: I understand Barbara Jetley and The Jubilee Center for Families provides mental health and bonding services. I agree to treatment for ❑Myself ❑My child ['The person for whom I am legal guardian/custodian Client signature Client guardian/custodian Witness signature Date To Obtain Payment We may include your mental health information with an invoice used to - ,cC r ;, .� fi2r s'J •�. ' _ collect payment for treatment you receive in our office. We may do this with sub` f z < S -� insurance forms filed for you in the mail or sent electronically. The s { 'i9 .g z.4 i information provided to insurers and other third party payers may include ,-�N�t�'" s J Ir �� `ii 't" information that identifies you,as well as your diagnosis,type of service,date 4 , < , rat §t a r rk ''7 4 of service,provider nameldentifier,and other information about your e.,0 ,,t.• a condition and treatment . i.S 3 x{ I Iz F' A-.. To Conduct Health Care Operations ? ,.f, ,} ;.,, , e o Health Care Operations refers to activities undertaken by the Center that are MIN NMI regular unctions of management and administrative activities. For example, the Center may use your health information in monitoring of service quality, strain and evaluation,medical reviews,legal service,auditing Our Promise! functions,compliance programs,business planning,and accreditation, certification,licensing and credentialing activities. Dear Client: Business Associates This is meant to communicate to you that we are taking the new Federal(HIPPA—Health Insurance Portability and Some of the services we offer may be provided by contracts with business Accountability Act)laws written to protect the confidentiality associates. For example,some of the billing,legal,auditing,and practice of your health information seriously. We do not ever want management services may be provided by contracting with outside entities to you to delay treatment because you are afraid your personal those services. In those situations,protected health information will health history might be unnecessarily made available to others be provided to those contractors as is needed to perform their contracted tasks. Business associates are required to enter into an agreement maintaining the outside of our office. privacy of the protected health information released to them. What has changed? Why a privacy policy now? In Client Reminders The most significant variable that has motivated the Federal government to Regular care is very important to your general health and because we believe legally enforce the importance of the privacy of health information is the rapid this we will remind you of a scheduled appointment or that it is time for you evolution of computer technology and its use in healthcare. The government to contact us and make an appointment. Additionally,we may contact you to has appropriately sought to standardize and protect the privacy of the follow up on your care and inform you of treatment options or services that electronic exchange of your health information. This has challenged us to may be of interest to you or your family. review not only how your health information is used within our computers but also wit the Internet,phone,faxes,copy machines,and charts. We believe These communications are an important part of our philosophy of partnering this has been an important exercise for us because it has disciplined us to put with our clients to be sure they receive the best preventive and curative care in writing the policies and procedures we use to ensure the protection of you we can provide. They may include postcards,folding postcards,letters, health information everywhere it is used. telephone reminders or electronic reminders such as email(unless you tell us that you do not want to receive these reminders). We want you to know about these policies and procedures which we developed to make sure your health information will not be shared with Abuse or Neglect anyone who does not require it Our office is subject to State and Federal law regarding the confidentiality of your health information and in keeping with We will notify government authorities if we believe a client is the victim of these laws;we want you to understand our procedures and your rights as our abuse,neglect or domestic violence. We will make this disclosure only when valuable client we are compelled by ethical our judgment,when we believe we are specifically required or authorized by law or with the client's agreement. We will use and communicate your HEALTH INFORMATION only for the purposes of providing your treatment,obtaining payment and conducting ,: 'f; For Law Enforcement health care operations. Your health information will not be used for other purposes unless we have asked for �• a We will disclose protected health information when required by law or necessary for health-care oversight This includes,but is not limited to:(a) and been voluntarily given your written permission. reporting child abuse or neglect;(b)when court ordered to release How your HEALTH INFORMATION may be used information;(c)when there isalegal duty to warn or take action regarding imminent danger to others;(d)when the client is in danger to self or others or gravely disabled;(e)when a coroner is investigating the client's death;or to To Provide Treatment to health oversight agencies for oversight activities authorized by law and necessary for the oversight of the healthcare system,government healthcare We will use your mental health information within our office to provide you benefits,or regulatory compliance. Crimes that are observed by us,crimes with the best health care possible. This may include administrative and that are directed toward us or crimes that occur on the premises will be clinical office procedures designed to optimize •mm reported to law enforcement. scheduling and coordination of care between clinician ->.:`,): : - and business of5cestaff. For example,Center staff I Famil Friendd Care ivers involved with your care may use your information t ,1 y s an g plan your course of treatment and consult with other 't i l ~/ y_ :r'"..l�u• Except for certain minors,incompetent clients,or involuntary clients, staff to ensure the most appropriate methods are being used to assist you. protected health information cannot be provided to family members without the client's consent In situations where family members are present during a discussion with the client,and it can be reasonably inferred from the circumstances that the client does no object,information may be disclosed in Lori Kochevar MS, LPC, LLC 1024 8t Street • Greeley, CO 80631 • (970)352-8873 r 1 the course of that discussion However,if the client objects,pue�d mental Requester Paper Copy of this Notice health information will not be disclosed. You have the right to obtain a copy of this Notice of Privacy Practices Emergencies directly from our office at any time. Stop by or give us a call and we will mail or email a copy to you. In life-threatening emergencies the provider will disclose information necessary to avoid serious harm or death. We are required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of our Privacy Practices. We are requ red to practice Me policies and procedures described in this Data Collection notice but we do reserve the right W amend the Mans of our Notice,and make new notice provisions effective for all protected health information that it Advancing medical knowledge often Foes learning from the careful study maintains. Irv change our privacy practic s we will be sure all of our of the medical histories of prior clients. Formal review and study of health clients receive a copy of the revised Notice. histories as a part of a research study will happen only under the ethical guidance,requirements and approval and of an institutional Review Board. You have the right to express complaints to us m ro the Secretary of Health and Human Services if you believe your privacy rights have been Authorization to Use or Disclose Health Information compromised- We encoruage you to express arty concerns you may have regarding the privacy of your information. Please let us know of your concerns or complaints in writing. Other than is stated above or where Federal,State or Local law requires us,we will not disclose your health information other tlmm�with your writeh authorization. You may revoke that authorization in writing at any time. Client Rights g CZ' y'� � w , r j 4 : '54hn x a ' s st' h a This new law is careful m describe that you have the following rights related 7...''',1,".."”L'.;.... '3a ' �., i € ''w 3 -. § to your health information. - sf 's �'� a , e Restrictions t+�, k zh- , d ' n LL,3q& s t .t tH You have the ht to4'P ₹�'' s r' za' Y. �'e r e' r �x g., rig request restrictions on certain uses and disclosures of h ' � ��t S. IA:::,;°.:A;-'3i ry - your health iufortnation. Our office wit make ev effort m hmor " "� reasonable restriction preferences from our clients �,, Confidential Communications x You have the right to request that we communicate with you at acertainfiz-" ' ' 1 f " y `,i / fg m , way. You may request that we only communicate your health reformation n tin, a'., -',211?:: a iu��,r,,,,gtg b ,, h 7n 3 r,:, pnvately wmh no other family members present or trou marled >ry „s�, 'P Y�f`£t� , _:� $� ' , 'a,hfi t ', 4.zt -40...,1----,-“HK-1.4,,,,,,4„m. s- communications that are sealed. The Center will make_Pe_veffort to honor �, �#t, r� ;1 '. ;rr k k. hit. your reasonable requests for confidential communication. Inspect and Copy Your Health Information You have the right to read and review a summary of your mental health information. If you would like a copy of your health nnformatio n,please let us know. We may need to charge you a reasonable fre m duplicate and assemble your copy. Amend Your Health Information You have the right to ask us m update o modify your records if you believe your health information records are irhcorrect or incomplete. We will be happy to accommodate you as long as our offce maintains this information. In order to standardize am process,please provide us with your request in writing and describe your reason for the change. Your request may be denied if the health information record in question was not created by our office,is not part of our records or if the records containing your health information are determined to be inaccurate and/or not complete. Documentation of Health Information You have the right to ask us fora description of how and where yom health information was used by our office for any mason ether than for treatment, payment or health operations. Please let us know in writing the time period for which you are interested We may need to charge you a reasonable fee for your request. ® HEALTHCARE PROVIDERS GENERAL LIABILITY COVERAGE PART ENDORSEMENT Additional Insured General Liability In consideration of the premium paid,aid subject to the General Liability link of liability shown on the certificate of insurance AN is agreed that the GENERAL LIABILITY COVERAGE PART is amended as fellows: The person or entity named below(the"admlbfls insured")is an insured under this Coverage Pail but only as respects is liability arising out of named i®sured's operations,or premises owned by or rented by the named insured and solely to the extent that 1. ageless!liability claim Is made against the named insured and the additional insured;and 2. M any ensuing litigation alsing out of such claim,the named insured and the additional insured remain as co-defendants. In no event is there my coverage provided tint this policy for an occurrence that is the direct liability of the additional insured. AtNgaha Inured: Stale of Colorado Weld Cowity/Social Services PO Box A Greeley,CO 80634 This endorsement is a pat of your po icy and takes effect on the effective date of your policy,unless another effective date is shown below. AA other previsions of the polio/remain undraped. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy ENOT.NO. POLICY NO. ISSUED TO Dr Is Not to be Effective with the Policy ENDORSEMENT EFFECTIVE DATE 01 I 0273177648 Lod Koc hevur MS LPC LLC 228/2007 0-127827.8(07/2001) Page 1 oft e Prix Date: 01/23/07 HEALTHCARE PROVIDERS CNA SERVICE ORGAIVIZATION CERTIFICATE OF INSURANCE OCCURRENCE POLICY FORTS 018098 970 •0273177648 4mm:12:01 AM Standard Time on:02/26/07 to: 1291 AM Standard Tine on:I.6., Lor Xochevar MS LPC LLC Healthcare Providers Service Organization 1024 8th Street 159 East County Line Road Greeley, CO 80631 Hatboro PA 19040-1278 LPraleasicrel Counselor Arm Code: Bpg co.of CNA Plaza 28S Chicago,IL 808 IL 808855 A. PROFESSIONAL LIABILITY Professional Liability(PI-) S 1,000,000 each dawn S 3,000,000 aggregate Good Peacoatamaritan Liabridy included above included above B. COVERAGE EXTENSIONS: License Protechon S 10000 $ 25,000 DefeDef ndant t m 10,000 aggregate . 10.000 aggregate A4e6raIPaarrenh 0 V.. per incident $ 25,000 aggregate, Mei$cad $ • " $ 100000 agprapate Damage to Property of Others 2,5002500 aggregate Per inddent S 10,000 aggregate C. WORKPLACE LIABILITY cowmen P. 0.rearrio that dome ad,ppr Mosel polo General tYiey b nettle pad alas pdq. Workplace ' Ffra&Water — none none none 0. GENERAL LIABILITY C4+.rppan Ilemialtie6ayAom anti Co++rA pool a waiirp*t:.eaa:ms pen d ter pier General Liability(GL) $7,000,000 each occurrence $1,000,000 aggregate Hired Ado&Non Owned Arlo none Fire 6 Water Legal Liabidy included in GL limit above to t25 — 0.o0o sub k Personal Liability rare Total Premium S 650 00 QUk?SI'7ONS7 CALL: 1-888-288-3634 I G-121500-C G-121501-C G-145184-A G-147292-A G-144872-A G-123846-005 G-121504-C G-123827-B G-123828-B G-141234-A I � Neap aJa OmaniM ma i pleat a and prod dpipiad am S of primulas ants ster Policy•186717/33 'iii ChimeraChimeraorate Board Secretary Zh, G-141241-A(07/2001) Coverage Change Date: Endorsement Change Date: Program Area Supervisor/Provider Meeting C Verification/Comment Form Date of Meeting: 7/1.7A 7 Program Area: /j j'74042. en-Red / ae H/mot f Comments (to be completed by Program Area Supervisor): p� 0tcticsecQ ew As ate_ we-feat O2esert , hel; c-a/MIC,U /UM • 61:-/- 9Atilcr/lsl9C �sir�. a77Nce- /J f - /51,Otte y 's £a/rte. gmarten 1k (Om f IV/A`kec w• >Lhc RepI/t ,ke G 000.wi4wc-C .«pnut1sd- 9"t .pf Mme d,4 Asa try /h..e-- ?sJe a e V-S,-DVe- ?o vet h *eta( , Moo fins s €4.Q ,r n e f'C+c Re It- 1 fit- pas et tin / deleRk,w. ..9 A/t� re« s ! Cott(e� slAjf�,r H/t , � 4„t; --14-9—e 00 its e. pR ece 4?r1/ i 4 s Signature of Program Area pervisor • EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP Page 2 Lori Kochevar, LLC,Results of Bid Process 2007/2008 Assessment tools for this program include Bonding Assessment Tool,AIMS Assessment Program DC: 0-3R, NCAST Feeding Scale, Impact of Event Scale-PTSD and Depression Screening (Appendix 2). . In evaluating each family, we will use additional tools when appropriate to assess level of bonding the child has experienced and identify behaviors that indicate areas of concern. The clinician will discuss concerns with the parents and develop a Case Management Plan. This will be an outcomes-based plan that will be shared and reviewed periodically with the parents. The goal of this program is that families who receive services will remain intact six month after discharge, will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. We have the Manuel for the AIMS Assessment tool as well as individual instrument to measure progress of parent child bond according to the age of the child that we would be happy to bring in. Please see evidences based outcomes section of bid submitted for randomized controlled outcome research. The DC: 0-3R is the standardized unit of measurement to quantitative progress in the field of infant and toddler mental health. The Manuel for this measurement tool is also available for us to bring in for review 4. Tangible evidence relating to Improvement of Household, After involvement in this program the parents will be able to provide a safe secure home for the children. This includes health, safety, and provision for every day needs. The parents will have: • Resources to provide for the child's basic needs, such as adequate housing and resources for providing food and clothing on a consistent reliable basis. • Increased awareness of daily planning for the child's needs and providing a stable environment by establishing routines around mealtime, after school activities, bath time and bedtime. • Increased understanding of the nutritional needs of the family and a means of providing for those needs. • Increased awareness of the exposure of the children to health and safety risks when the home is not well maintained. • The ability to focus spending on the basic needs of the family as a priority over other expenditures. A. Families who participate in the program will develop skills and awareness that will increase their competency as parents. Increased competency will be measured through documentation occurring at each visit through use of an outcomes-based Case Management Plan developed at the time of entry into the program. Risk factors will be identified at the time the initial plan is written using the risk assessment tool. This will be reviewed with the parents and updated as goals are met and as changes occur in the parents-child relationship. A completed narrative of measurable goals reached by the family will be provided to Social Services. F. Families who participate in this program will remain intact six month after discharge, May 19, 2007 Tobi Vegter Core Services Coordinator Weld County Department of Social Services P.O. Box A, Greeley, CO, 80632, Lori Kochevar MS LPC The Jubilee Center for Families 1024 8 Street Greeley, CO 80631 Re: Bid 003-LS-07(RFP 07005), Lifeskills Bid 06FPC04(RFP 006-00A), Foster Parent Consultation Bid 002-FPT-07 (RFP 006-00C),Foster Parent Training Dear Ms. Vegter: Thank you for your letter regarding additional needed information for the Core Bid process for PY 2007-2008, this letter serves a written confirmation that I have received your letter and my response regarding the need for additional information. Please feel free to call me if any further clarification is needed. A. Results of the Bid Process for PY 2007-2008 It is my understanding that The Families, Youth and Children(FYC)Commission recommended approval of my Bids 003-LS-07 (RFP 07005), Lifeskills,002-FPT-07,Foster Parent Training (RFP 006-00C), and 002-FPC-07,Foster Parent Consultation(006-00A) for inclusion on our vendor list after submitting the information requested in each section. Bid#003-LS-07(RFP 07005),Lifeskills A. 1. Program Improvement Plan(PIP); Improved outcomes in the Performance Improvement Plan- • Parents will be supported in maintaining permanency goal for the child. Providers will meet with all parties involved to discuss recommendations that are in the best interest of the child .• Providers will support parents in maintaining family and cultural connections that support the child and keep the caseworker abreast of any information regarding these connections. 2. New caseworker mandatory training. Jenna Reed who has completed this training, is available to take new cases if they become available in South County. In addition, Lori Kochevar program supervisor has taken the New Supervisors mandatory training. When this question was asked of Gloria Romansik two years ago in the bid meeting by Allen Ackerman if this training was a requirement we were told it was not. However, we would be glad to take the caseworker training if this is what you are requiring of all core service providers and contracted positions. Please advise us of your policy. 3. Quantitative measurements for Measurable Outcome Section, Page 2 Lori Kochevar, LLC, Results of Bid Process 2007/2008 will have increased competencies and will show a reduced risk as show by the score on the standardized risk assessment tool used by the department of social services. 5. Eligibility Section. SECTION F-ELIGIBILITY A. Total Number of clients to be served: The program will serve a total of 60 families during the twelve-month period. Each bonding specialist will serve eight to ten families at one given time period. Each family will receive 24 hours of one-on-one supervised visitation with the bonding specialist. This would provide 27 hours of intervention with families per week, 120 hours per month. Total number of client hours provided per year would be 1440 hours. B. Total number of clients and ages: Based on the approximation that the average family is made up of four children and one parent, the total number of clients for the year could be 240 clients. Focus will be on children whose ages are birth to twelve years of age. When the family includes older children, they will be included in the family intervention. C. Total number of families served: A total of 60 families will be served during the year. D. Sub-total of individuals who will receive bilingual/bicultural services: All services provided would be in a manner that is sensitive to the family's culture of origin. The program manager and specialists have extensive training in cultural competency issues. Lori Kochevar chaired the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Becky McMahan has worked with families from various cultural roots. She has a sense of respect for the family's cultural beliefs and practices. Lorenza Perezverdia is a bicultural bilingual provider will be available for any Spanish speaking families. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. E. Sub-total of individuals who will receive services in South County: The program could serve three to eight families in South County during a given time period. We currently have providers that live in the south and we would like to increase our referral base in this area. Services will be provided for families where they reside as determined by Social Services. F. The monthly maximum program capacity: If needed,we could expand the number of hours we are available for services to 35 hours per week, which would make available 140 hours per month. G. The monthly average capacity: The monthly average capacity of this program is six to eight families. • Page 2 Lori Kochevar, LLC, Results of Bid Process 2007/2008 H. Average stay in the program: The average stay in the program would be six months. It is felt that clients have adequate opportunity to make positive changes in parenting styles in that period of time. Average hours per week in program: Initially, each family would receive services two hours per week, unless a different number of hours are requested by the caseworker for clinical reasons. After the first twelve weeks, sessions will decrease as recommended by the treatment team. Number of hours of service and length of service vary according to the individual family situation. Bid 002-FPT-07(REP 006-000,Foster Parent Training I. Clarify and address whether your bid's contents state you will cap the capacity of trainings. I would be glad to let as many applicants as you have into the training and do them at the training center or an alternative location as needed. 2. Clarify and address the$75 hourly rate for court testimony; This is not applicable to this program in that we do not do court testimony for trainings. 3. Address and clarify the cost of interpreter services. Interpreter services for mono lingual speaking clients will be paid by the Jubilee Retreat Center. I will need to be informed two weeks prior to training so that I am able to secure a qualified interpreters schedule for the training. Bid 002-FPC-07(RFP 006-00A),Foster Parent Consultation 1. Clarify the age levels of children served. Foster children are not served directly under this contract as listed in the RFP. Services benefit foster children and biological children of all ages due to secondary effects of training and support provided to the foster families. 2. Clarify who the client is,and to whom services are provided. Services are provided directly to the foster parents and their biological children of any age. If you have questions concerning the above,please feel free to contact me at 352-8873. Sincerely, Lori Kochevar,MS LPC cc: Juan Lopez, Chair, FYC Commission Tobi Vegter, Core Services Coordinator Gloria Romansik, Social Services Administrator • it; DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 O - - Fax Number(970)353-5215 COLORADO May 1 I,2007 Lori Kochevar MS LPC The Jubilee Center for Families 1024 8 Street Greeley, CO 80631 Re: Bid 003-LS-07(RFP 07005),Lifeskills Bid 06FPC04(RFP 006-00A),Foster Parent Consultation Bid 002-FPT-07(RFP 006-00C),Foster Parent Training Dear Ms.Kochevar: The purpose of this letter is to outline the results of the Core Bid process for PY 2007-2008 and to request written confirmation from you by Monday,May 21,2007. The Families,Youth, and Children Commission appreciates your interest in providing services for families in Weld county.This year,strides were made in structuring an RFP that is clear and concise, and more user friendly, for both prospective bidders and evaluators. It is important to stress the value of following formatting guidelines and addressing the required sections concisely and appropriately. A. Results of the Bid Process for PY 2007-2008 The Families,Youth and Children(FYC)Commission recommended approval of your Bids 003- LS-07(RFP 07005), Lifeskills, 002-FPT-07,Foster Parent Training(RFP 006-00C),and 002- FPC-07, Foster Parent Consultation(006-00A)for inclusion on our vendor list, attaching the following conditions to bids according to the program category referenced below. Conditions: The bidder must submit information that was not addressed or submitted with the original bid, as itemized below under each program area. Bid#003-LS-07(RFP 07005),Lifeskills 1. Program Improvement Plan(PIP); 2. New caseworker mandatory training, 3. Quantitative measurements for Measurable Outcome Section, 4. Tangible evidence relating to Improvement of Household, 5. Eligibility Section. Bid 002-FPT-07(RFP 006-OOC),Foster Parent Training 1. Clarify and address whether your bid's contents state you will cap the capacity of Page 2 Lori Kochevar,LLC,Results of Bid Process 2007/2008 trainings; 2. Clarify and address the$75 hourly rate for court testimony; 3. Address and clarify the cost of interpreter services. Bid 002-FPC-07(RFP 006-00A),Foster Parent Consultation 1. Clarify the age levels of children served; 2. Clarify who the client is, and to whom services are provided. Required Response by FYC Bidders Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the conditions,you must provide in writing reasons why. A meeting will be arranged to discuss your response.Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and compliance item. Please respond in writing to Tobi Vegter, Core Services Coordinator,Weld County Department of Social Services,P.O. Box A,Greeley,CO, 80632,by May 21,2007,close of business. You may fax your response to us at 970.346.7662. If you have questions concerning the above,please call Tobi Vegter at 352.1551, extension 6392. Sincerely *$oDt , cc: Juan Lopez, Chair,FYC Commission Tobi Vegter,Core Services Coordinator Gloria Romansik, Social Services Administrator Weld County Department of Social Services Notification of Financial Assistance Award for Core Funds Type of Action 07-CORE-69 X Initial Award (PY 07-08 RFP-FYC-006-00C) Revision Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Julie Box, LCSW,Private Practice Ending 05/31/2008 Foster Parent Training 1702 68th Avenue Greeley,CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Comprehensive Core Certification Training to foster Assistance Award is based upon your Request for care/adoption certification applicants in Weld Proposal(RFP). The RFP specifies the scope of County.Trainings are designed to satisfy all training services and conditions of award. Except where it requirements of State of Colorado Volume VII and is in conflict with this NOFAA in which case the those required by Weld County Department of Social NOFAA governs,the RFP upon which this award is Services,including Weld County Foster Care based is an integral part of the action. Handbook. Trainings are completed in 27-hour blocs, no more than four weeks in length. Bicultural and Special conditions South County services.Trainings are open capacity 1) Reimbursement for the Unit of Services will be Estimated number of trainings is a minimum of six based on an episode rate for trainings,and hourly and maximum of 12 sessions per year. rate for court testimony. 2) Rates will only be remitted on cases open with, and Cost Per Unit of Service referrals made by the Weld County Department of Social Services. Per Episode per Training 3) Requests for payment must be an original and Treatment Package $3,600.00 Per Hourly Rate submitted to the Weld County Department of Treatment Package Low(Court Testimony) $75.00 Social Services by the end of the 25th calendar day following the end of the month of service. The provider must submit requests for payment on forms approved by Weld County Enclosures: Department of Social Services. Requests for ' X Signed RFP: Exhibit A payments submitted 90 days from the date of Supplemental Narrative to RFP: Exhibit B service, and thereafter,will not be paid. Recommendation(s) 4) Requests for payment must include original client Conditions of Approval verification signatures(blue or red ink prefencd) and dates and hours of service. 5) The Contractor will notify the Department of any change in staff at the time of the change. Approvals: Progra Off l: B B Y �' y -. David E. Long, Chair Jud . Grieg ,Directo Board of Weld County Commis oners Wed ounty Depvtme of Social Services Date: JUN 1 8 200/ / Date: �: iCi i / o?C'e —/686 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 Commissioner's authority under the Colorado Family Preservation Act (C.R.S. 26-5.5-101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1,2007,through May 31, 2008,at specific rates for different types of service,the County will authorize approved providers and rates for services only. This program announcement consists of the following documents,as follows: • Invitation to Bid • Main Request for Proposal(All program areas) • Addendum A—Program Improvement Plan Requirements(by program area) • Addendum B—Scope of Services(by program area) • Core Budget Form Delivery Date (1 ',,2 1 ) ( C-1 (After receipt of order) BID MUST BE SIGNED IN INK Program Area: Foster Parent Training Julie Box TYPED OR PRINTED SIGNATURE VENDOR Julie Box,LCSW (Name) Handwritten Signature By Authorized Offficfirer4g\\ent of Vendor ADDRESS 1702 68th Avenue TITLE_ Greeley,CO 80634 DATE ,f -, I 2( ( / PHONE# _970.302.1471 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 • June 2007 Bid No: 001-07 COLORADO FAMILY PRESERVATION ACT-FOSTER PARENT CORE TRAINING, EMERGENCY ASSISTANCE PROGRAM Julie Box, LCSW Private Practice ABSTRACT Julie Box (Bidder) is a Licensed Clinical Social Worker offering a wide range of services to children, families and adults. Bidder has been providing clinical services to the Northern Colorado area since 1986. During the past 21 years, Bidder has provided services as a counselor, a caseworker, a case manager and a therapist in the field of child welfare. Bidder has provided services to all individuals without consideration of religious beliefs, race, culture, ethnicity, gender, sexual preference or economic status. Over the past year, Bidder has provided CORE Foster Parent Training for the Weld County Department of Social Services. Bidder has developed a curriculum that covers all areas required by Colorado State's Volume VII Regulations. The overall mission, purpose and design of this project is for Bidder to provide a comprehensive Core Certification Training to foster care certification applicants in Weld County. These trainings will satisfy all training requirements of the State of Colorado Volume VII and those required by the Weld County Department of Social Services, which will include a complete review of the Weld County Foster Parent Handbook. The trainings will be completed in 27-hour blocs. Covering no more than 4 weeks in length. Training cycles may vary,but trainings will generally take place every four weeks throughout the year. Trainings will follow a specific curriculum, meeting all state and local requirements. 2 • TABLE OF CONTENTS A. Invitation to Bid page 1 B. Abstract. page 2 C. Table of Contents page 3 D. Target/Eligibility Populations. page 4 • Total number of clients to be served • Total family units • Sub-total of individuals who will receive bicultural/bilingual services • Sub-total of individuals who will receive services in South Weld County • Monthly program capacity per group • Average stay in the program (weeks) • Average groups per week in the program E. Project Narrative/Supporting Documentation....................................pages 5-7 • Types of service provided • Measurable outcomes • Service objectives • Workload standards • Staff qualifications • Program capacity per month • Internal tracking and billing process F. Budget page 8 G. Appendices: • Appendix 1: Resume for Julie Box, LCSW pages 9-11 • Appendix 2: Data Collection Instruments/Protocols pages 12-13 3 TARGET/ELIGIBILITY POPULATIONS: The population to be served under this contract includes families that wish to foster and or adopt children through the Weld County Department of Social Services(WCDSS); kinship families that wish to foster or adopt related children and previously certified WCDSS foster families that wish to refresh their training credentials. These training groups are limited to Weld County foster care/adoption certification applicants only. Bidder will provide training for Foster Care applicants through interactive training, breakout groups, and metaphoric stories/reactions to given scenarios, handouts, videos and discussion. The following curriculum outline directly follows the State of Colorado Volume VII Regulations, adding the sexual abuse and sexualized behaviors topics. Curriculum outline for Core Certification Training will include, at a minimum, the following: • A general overview of foster care. • Administrative and legal issues. • Why children get placed in out-of-home care. • Parenting and family dynamics. • Key concepts of child growth and development. • The importance of the team approach. • Individual differences, such as ethnicity and culture. • Discipline. • Effects of fostering on the foster family. • Sexual abuse and sexualized behaviors. A. Total Number of clients to be served: Each training is'worth'27 hours and will be spread over a four-week period of time. Bidder estimates she could complete a minimum of 6 trainings per year and a maximum of 12 trainings per year. B. Total family units: The number of individuals per training is completely dependent on the number of the families referred for services. Bidder does not have a"cap"for the number of families per training. C. Subtotal of individuals who will receive bicultural/bilingual services Unfortunately, Bidder is not bilingual; however, Bidder would be able to contract with a qualified Spanish speaking clinician to translate as necessary. Bidder would not refuse any bicultural services. D. Subtotal of individuals who will receive services in South Weld County. Bidder does not limit her services to specific geographical areas so Bidder will provide services in the Southern part of Weld County as they are referred. E. The monthly program capacity per group: Bidder does not have a limit of clients to be served per training. F. The monthly average capacity per group: Bidder does not have a limit of clients to be served per training. G. Average stay in the program (weeks): Bidder will provide the required 27-hour training per individual/couple. H. Average groups per week in the program: Bidder'estimates providing trainings for referred individuals,with groups meeting for 4 hours every other Friday evening and 9.5 hours every other Saturday. 4 PROJECT NARRATIVE/SUPPORTING DOCUMENTATION FOSTER PARENT CORE TRAINING A. Types of services provided: Bidder will provide Core Certification Training to foster care certification applicants in Weld County(training groups will be limited to Weld County foster care certification applicants only). These trainings will satisfy all training requirements of the State of Colorado Volume VII and those required by the Weld County Department of Social Services, which will include a complete review of the Weld County Foster Parent Handbook. Bidder will provide the required 27 hours for completion of the training and will complete trainings in a bloc covering no more than 4 weeks in length. Training cycles may vary, but trainings will generally take place every 4 weeks throughout the year, in approximately 12 cycles. Bidder agrees to comply with 19-1-120 C.R.S.,which requires that reports of child abuse and any identifying information in those reports are strictly confidential. In addition to providing mandated curriculum, Bidder will assess perceived strengths and weaknesses of general functioning of applicants relative to caring for children with special needs. Areas of concern will be shared with the Department Foster Care Certification staff. Bidder will be available for court testimony, given proper notification. Bidder uses a comprehensive and experiential training curriculum that directly improves the foster parents'ability to provide quality care for foster children. At a minimum, Bidder covers attachment and bonding issues, grief, loss and separation issues, adoption issues, child growth and development, boundary setting and discipline, providing for children of differing races, cultures and ethnicities, confidentiality, understanding adoption laws and procedures, including termination of parental rights, relinquishment and expedited permanency plans, contact and communication with the child's biological family members and the use of community resources. Bidder also specifically addresses infant care, Fetal Alcohol/Substance Abuse Syndrome, the oft times misleading or incomplete historical information foster parents receive regarding the child and their biological family members, special medical or emotional needs, parenting the neglected, emotionally, physically and/or sexually abused child, parenting the physically, mentally or emotionally challenged child and accessing available benefits and resources. B. Measurable outcomes: Outcomes will be measured by confirmation that 90 percent of all applicants enrolled in the trainings have successfully completed the course. Bidder will document any participants not completing the course, reasons why the course was not completed and the Foster Care Certification staff provided with this information. Bidder uses an Evaluation Form at each training to assess Bidder's abilities. C. Service objectives: Bidder specifically works to improve the capacity of foster parents to improve family conflict management through addressing communication skills as well as de-escalation skills. Bidder works with foster families to provide a safe household environment for their children through competent household cleaning and maintenance, budgeting and purchasing. Bidder will work to improve the capacity of parents to maintain sound relationships with their children and foster children and provide care, nutrition, hygiene, discipline, protection, instructions and supervision. 5 Bidder will also work to improve the parent's ability to access resources within the local, state and federal governments. Bidder will work with parents to learn to assess their strengths and weaknesses as foster parents so the Department is better able to make appropriate matches between foster children and families, thereby reducing foster care drift. Bidder will work with parents on the importance of the team approach, working with Department as part of a team with the goal of meeting the best interests of the foster children. Bidder will address any specific referral issues, provide solution-focused services and address any issues identified by the Department. Bidder focuses on the expectation of foster parents to address the permanency needs of the children placed into their homes and to use available resources to maintain placements. Bidder addresses expectations that foster parents cooperate with the development of independent living skills, contributing through daily life skill instructions. Foster parents are informed that it is expected that they maintain the cultural and racial identity of any child placed into their care. Bidder encourages foster parents to communicate openly and frequently with the WCDSS caseworkers as well as to initiate monthly staffing's involving the foster parents, the caseworkers, the child and any other relevant providers. D. Workload standards: Bidder estimates that she will be able to run a 27-hour training every 4 weeks, approximately one training per month. Bidder does not limit the number of individuals attending training sessions. Bidder is currently the only staff providing training services. However, Bidder may choose to invite a trained clinician to address specific topics. Bidder is also able to provide a Spanish speaking translator if the need arises. Bidder encourages providers to comply with the WCDSS requirements of scheduling medical and dental appointments as required by State Regulations (two weeks from time of placement for physicals and eight weeks from time of placement for dental). Bidder informs foster parents that they are required to work with caseworkers in identifying the health needs of the children as well as services available. Bidder estimates that she can provide, at a minimum, 6 trainings per year and a maximum of 12 trainings per year. Bidder estimates a total of 27 hours of direct service,with 10 hours of indirect service every 4 weeks. Bidder is a Licensed Clinical Social Worker with a private practice and does not have a supervisor. Please see attached insurance coverage form. E. Staff qualifications: Bidder has a bachelor's degree in Psychology(BA), a Masters degree in Social Work (MSW) and is a Licensed Clinical Social Worker(LCSW)since January 21, 2003 (license number: 992996). Bidder has her own private practice and is the only staff available. However, Bidder can provide a qualified professional that can translate during mediations as needed. Bidder meets the minimum qualifications in education and experience in Staff Manual Volume VII, and Section 7.0006,Q, Colorado Department of Human Services. As an LCSW, Bidder does not have a clinical supervisor. Bidder secures a minimum of 8 hours per year of continuing education training. Bidder has not received the mandated new caseworker training. Bidder has extensive knowledge of risk assessment. F. Program capacity per month: As outlined in this proposal, Bidder's capacity is based on a direct/indirect service ratio. Bidder estimates that her yearly capacity is a maximum of 12 Core training sessions. This estimate is for one training every 4 weeks. 6 G. Internal tracking and billing process: Please refer to the attached budget for computation of direct service rate. Bidder's charges$3,600.00 per training regardless of how many families attend the training. Bidder submits a statement once the training is complete. Upon submitting a statement, Bidder provides the WCDSS with a copy of the initial HSRI referral; two WCDSS approved billing forms, a copy of Certificates of Completion for each individual completing the training, a copy of an Evaluation Form completed by each individual completing the training and the original WCDSS attendance sheet, confirming each individual's attendance. Bidder informs the WCDSS coordinators immediately if an individual does not show for training they are scheduled to attend, or if an individual does not complete the training. H. Literature citations: NA, Bidder has made no citations to literature in this application. I. Confidentiality and participant protection: • Protect clients and staff from potential risks: Discussed during the course of the training. • Fair selection of participants: Bidder accepts all referral's from the WCDSS regardless of age, gender, racial/ethnic background, children of substance abusers, foster children, pregnant women, religious preference, sexual preference or disabilities. Bidder does not recruit or select participants, the WCDSS makes such decisions. • Absence of coercion: Foster parents are informed during the course of the training that any participation is purely voluntary. • Data collection: NA, there is no data collected during the course of trainings. • Privacy and confidentiality: Covered by Bidder during the course of the training. • Adequate consent procedures: Covered by Bidder during the course of the training. • Risk/benefit discussion: Bidder covers this topic during discussion regarding communication with caseworkers and the sharing of personal information with the WCDSS coordinators. 7 BUDGET Please refer to the attached budget forms and Unit of Rate Computations APPENDICES 1 THROUGH 3 • Appendix 1: Resume for Bidder • Appendix 2: Data Collection Instruments/Protocols 8 APPENDIX 1: RESUME Julie Box, LCSW 1702 68 Avenue Greeley, CO, 80634 970.339.9036 or 970.302.1471 Education: Adams State College; BA in Psychology. Graduated 1984. Colorado State University; MSW; Masters in Social Work. Graduated in 1996. Licensed Clinical Social Worker as of January of 2003; License#992996. Work History: Private Practice: June 01, 2004, to present This clinician currently has a contract with the Weld County Department of Social Services (WCDSS)to complete home studies for individuals applying as foster/adoptive parent(s) in Weld County. Responsibilities include the use of the SAFE, Structured Analysis Family Evaluation, a written,narrative home study provided to the WCDSS,with recommendations,background checks through the Department of Motor Vehicles and local law enforcement, four letters of reference for the applicant parent(s)and SAFE Questionnaires one and two,completed by the applicant parent(s). The WCDSS completes other background checks through the CBI as well as the Colorado Central Registry, on their own. Clinician at Lutheran Family Services May 11, 1998, to January 13, 2006. Program Manager for Family Preservation Program, Home Study Program and Relinquishment Counseling Program for Lutheran Family Services June of 2003 to January of 2004. The rest of the time was a position as clinician. Responsibilities as a clinician include crisis intervention,therapeutic services for foster children dealing with grief and loss issues in LFS homes,case management services for foster children, foster parents,birth parents and county caseworkers,attending and testifying at court hearings,completion of home studies for Lutheran Family Services homes as well as for the Weld County Department of Social Services,completion of all related paperwork including but not limited to monthly reports,ongoing progress notes, interactional assessments,monthly staffing notes and development of treatment plans. Responsibilities as a program manager included responsibility for clinical and administrative oversight of the three programs listed above,assisting in selecting staff, assisting in program development and definition, identifying community resources to supplement program activities and ensure that consistently high quality clinical care and case management services are provided for each program consumer. 9 Social Caseworker III: Child Protection for the Boulder County Department of Social Services August 05, 1996, to May 11, 1998 Responsibilities include family assessments, family and individual therapy,updated written reports on case progress, written court reports, attendance and testimony at court hearings, school stuffing's,therapeutic stuffing's,crisis intervention,written social histories,attending interagency stuffing's,development of treatment plans and general case management. Supervisor for Work Release and Home Detention Inmates for the Weld County Sherds Department December of 1994 to July of 1996 Responsibilities include direct supervision of inmates in the work release and home detention programs,daily record keeping of inmate activities,home visits to verify the inmates whereabouts,crisis intervention and counseling of inmates. Counselor II/Assistant Program Director for the Weld County Shelter Home and Alternative Homes for Youth November of 1986 to August of 1994 Responsibilities included all financial management, supervision of adjudicated delinquent youth aged twelve to eighteen,counseling youth with a focus on grief and loss issues, development of treatment plans, USDA liaison, supervision of staff,training for all new staff and interns, assumption of the program directors duties when the director was absent, communicating effectively with all other professionals and the upkeep of statistics. Continuing training Family Group Decision Making:November 1998 Understanding Anxiety: October 1999 Play Therapy and Therapeutic Care of Children in Foster Care and Adoption: October 1999 Oppositional Behavior and ODD: 2000 Attachment and Bonding: January 2001 Verbal De-escalation and Personal safety: February 2002 Psychiatric Medications in Children Placed in Foster or Adoptive Care: March 2002 Building Skills in High Risk Families: June 2002 Confirming Safe Environments: September 2002 Foster Family Assessment Training: September 2002 EMDR; Basic Training:November 2002 Attachment and Bonding:February 2003 Understanding and Responding to the Sexual Behavior of Children: May 2003 Advanced Training for Special Advocates: September 2003 Helping Grieving Children and Teens: October 2003 Mediation Course: June 2006 References: Lutheran Family Services Human Resources Department: 1.800.579.9496; 363 S. Harlan, Suite 200, Denver, CO., 80226-3552. 10 Sharon Thomas: Supervisor at LFS from May of 1998 to December of 2003: 970.663.1039; 3733 Lincoln Court, Loveland, CO, 80538. Email: Skt1225@aol.com Diane Baird: LCSW Consultant: Private Practice. 720.217.9352. Maria Baladez: Co-worker at the Boulder County Department of Social Services: 303.250.1484; 640 Gooseberry Drive,#402, Longmont,CO., 80503. Email: mbass@co.boulder.co.us. 11 APPENDIX 3: CORE CURRICULUM OUTLINE CORE Foster Parent Training Outline Julie Box, LCSW 1. General Overview of Foster Care A. Breakdown of units B. General process C. Forms D. Questions to ask E. New foster child placement form F. Visitation G. Intake packet 2. Administrative and Legal Issues A. Basic issues B. Adoption reminder C. Licensing D. Levels of care E. Investigations F. Mandatory reporting, confidentiality and travel 3. Why Children Get Placed in Out of Home Care A. Reasons and behaviors B. Discussion C. Behavioral issues D. Managing anger E. Power Relationships F. Reality therapy process 4. Parenting and Family Dynamics A. Roles of children B. Family systems C. General and specialized parenting skills D. Helping form trusting relationships E. Self-esteem 5. Key Concepts of Child Development and Growth A. Key concepts B. Developmental stages—Erik Erikson C. Jean Piaget D. Attachment E. Brain development F. Learning for the child 6. Importance of the Team Approach A. Part of the team B. Communication 7. Individual Differences Such as Ethnicity and Culture A. Quotes B. Definitions C. Questionnaires 12 8. Discipline A. Purpose of discipline B. Positive discipline C. Ineffective forms of discipline D. Hitting children 9. Effects of Fostering on the Foster Family A. Family dynamics B. Foster family stress inventory 10. Working With the Biological Family A. Contact B. Stages of filial deprivation C. Helping foster children make peace with the past 11. Sexual Abuse A. Stats B. Definitions C. How to respond 13 Account Number: CO BOXJ 1700 Date: 2/20/07 Initials: DMM CERTIFICATE OF INSURANCE AMERICAN HOME ASSURANCE CO. C/O: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 This is to certify that the insurance policies specified below have been issued by the company indicated above to the insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the lamed insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Insured: Additional Named Insureds : JULIENNE E. BOX 1702 68TH AVE GREELEY CO 80634 Type of Work Covered: PROFESSIONAL SOCIAL WORKER Location of Operations: N/A (If different than address listed above) Claim History: Policy Effective Expiration Limits of Coverages Number Date Date Liability PROFESSIONAL/ 1, 000, 000 LIABILITY SWL-1919252 2/20/07 2/20/08 1, 000, 000 NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS POLICY AND HE OR SHE SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Comments: This Certificate Issued to: Name: JULIENNE E. BOX 1702 68TH AVE Address: GREELEY CO 80634 Au orized Representative Program Area Supervisor/Provider Meeting - Verification/Comment Form Date of Meeting: --/b 777, /Qn7 Program Area: Start PA—Rest Late r2A7t7i�t� Comments (to be completed by jProgram Area Supervisor): 04 CUSSecQ o 7Hls 0Oi3fe° L✓L/ee_ O/Le-se ? sheet Ae 2 _ Ar e e`H Nitots et_Rat,, ty mss. l,e2c. 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