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Home My WebLink About20070730.tiff RESOLUTION RE: APPROVE APPLICATION FOR FEDERAL ASSISTANCE FOR WELD COUNTY JAIL DIVERSION PROJECT 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 an Application for Federal Assistance for Weld County Jail Diversion Project from the County of Weld, State of Colorado,by and through the Board of County Commissioners of Weld County,to the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, commencing January 1,2008,and ending December 31,2011,with furtherterms and conditions being as stated in said application, and WHEREAS,after review,the Board deems it advisable to approve said application,a copy of which is attached hereto and incorporated herein by reference. NOW,THEREFORE,BE IT RESOLVED by the Board of County Commissioners of Weld County,Colorado,that the Application for Federal Assistance for Weld County Jail Diversion Project from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,to the United States Department of Health and Human Services,Substance Abuse and Mental Health Services Administration be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said application. The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 21st day of March, A.D., 2007. BOARD OF COUNTY COMMISSIONERS WELOUNTY, COLO ADO ATTEST: at), +'P vid E. Long, Chair Weld County Clerk to the B tell BY: C� / / � H rk , Pro-Tem 3 �,r Deputy Clerk to the Board -,_1 '' 7 William F. Garcia APPROVED A RM: EXCUSED ✓ Robert D. Masden County Attorney mrap ., -- c�_ 11-0-7 Douglas ademac Date of signature: 2007-0730 BC0037 (p ,. )(Vic ilICCr c) oy-D6.2.o7 Application for Federal Assistance SF-424 Version 02 "1.Type of Submission: •2.Type of Application: "If Revision,select appropriate letter(s): ❑Preapplication ®New ®Application 0 Continuation *Other(Specify) ❑Changed/Corrected Application 0 Revision I "3.Date Received: 4.Applicant Identifier: 5a. Federal Entity Identifier "5b.Federal Award Identifier: 84-60000813 State Use Only: 6. Date Received by State: 7.State Application Identifier:I 8.APPLICANT INFORMATION •a.Legal Name: Weld County Colorado *b. Employer/Taxpayer Identification Number(EIN/TIN): "c.Organization DUNS: 84-60000813 075757955 d.Address "Street l:: 915 10th Street Street2: •city: Greeley County: Weld "State: CO Province: 'Country: USA *Zip/Postal Code:80631 e.Organizational Unit Department Name: Division Name: Administration and Finance n/a f.Name and contact information of person to be contacted on matters involving this application: Prefix: Mr. "First Name: Donald Middle Name:Dean 'Last Name: Warden Suffix: I Title:Director of Finance and Administration Organizational Affiliation: Weld County Government/North Range Behavioral Health Center 'Telephone Number:970-356-4000 Fax Number: 970-352-0242 "Email: dwarder@co.weld.co.us aCC r-c,3f' Page I of 70 Application for Federal Assistance SF-424 Version 02 9.Type of Applicant 1:Select Applicant Type: B- County Government Type of Applicant 2:Select Applicant Type: n/a Type of Applicant 3:Select Applicant Type: n/a *Other(specify) n/a 10.Name of Federal Agency: Substance Abuse and Mental Health Services Administration 11.Catalog of Federal Domestic Assistance Number 93.243 CFDA T@le: Targeted Capacity Expansion Grants for Jail Diversion Programs *12.Funding Opportunity Number: Jail Diversion- SM-07-004 'Tale: Targeted Capacity Expansion Grants for Jail Diversion Programs 13.Competition Identification Number: n/a Title: n/a 14.Areas Affected by Project(Cities,Counties,States,etc.): Weld County Colorado including the county seat, Greeley and all other communities within the county 15.Descriptive Title of Applicant's Project: Weld County Jail Diversion Project Attach supporting documents as specified in agency instructions. Application for Federal Assistance SF-424 Version 02 16.Congressional Districts Of: 'a.Applicant CO 002 b.Program/Project CO 002 Attach an additional list of Program/Project Congressional Districts if needed: Senate District 13 and House District 50 17.Proposed Project: 'a.Start Date:October 2007 b. End Date: September 2010 Page 2 of 70 'a.Federal $361,900.00 •b.Applicant $36,000.00 'c.State $20,000.00 'd.Local 0.00 •e.Other $41,290.00 'f.Program Income 0.00 •g.TOTAL $454,190.00 •19.Is Application Subject to Review By State Under Executive Order 12372 Process? ❑a.This application was made available to the State under the Executive Order 12372 Process for review on ❑b. Program is subject to E.O. 12372 but has not been selected by the State for review. c. Program is not covered by E.O. 12372. •20. Is the Applicant Delinquent on Any Federal Debt?(If"Yes",provide explanation.) ❑ Yes ❑ No (NA) 21. *By signing this application,I certify(1)to the statements contained in the list of certifications`*and (2)that the statements herein are true,complete and accurate to the best of my knowledge. I also provide the required assurances**and agree to comply with any resulting terms if I accept an award. I am aware that any false,fictitious, or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties(U.S.Code,Title 218,Section 1001) -IAGREE **The list of certifications and assurances,or an internet site where you may obtain this list,is contained in the announcement or agency specific instructions. a.Authorized Representative Prefix: *First Name: David Middle Name: E. Last Name: Long Suffix: *Title: Commissioner *Telephone Number: 970-356-4000 ext 4208 Fax Number: 970-336-7204 `Email:dlong@co.weld.co.us 1 *Signature of Authorized Representative: Date Signed: 03/21/2007 Page 3 of 59 Application for Federal Assistance SF-424 Version 02 Applicant Federal Debt Delinquency Explanation The following field should contain an explanation if the Applicant organization is delinquent on any Federal Debt. Maximum number of characters that can be entered is 4,000. Try and avoid extra spaces and carriage returns to maximize the availability of space. Page 4 of 70 ABSTRACT: The purpose of this application is to secure funding for developing and supporting the Weld County Jail Diversion Project, a program designed to divert men and women with substance abuse, mental health issues or both, from the legal system and into appropriate evidenced based care and treatment. Diversion will occur at various stages in the legal proceedings, from the moment of initial police response to when the individual is booked and incarcerated or as part of sentencing. The population we plan to serve is individuals incarcerated or at risk of incarceration with Mental Health and/or Substance Abuse issues residing in Weld County, Colorado. Weld is a largely rural area, with the largest city having less than 100,000. The Weld County Jail has more than doubled the number of available beds in the last seven years and is still having difficulty meeting the demands. The number of individuals in the jail with mental health and/or drug and alcohol issues is at or above the national averages. These people are likely to languish longer and recidivate more frequently than the average inmate. This scenario has prompted leaders in the community to begin discussions to develop appropriate and effective diversion programming to serve more appropriately individuals facing minor criminal charges with treatment rather than incarceration. Planning for a diversion program has continued for a number of months. This grant gives our community the opportunity to gain start-up funding to implement the programming these stakeholders have planned. In the first year, we expect to provide intensive services to at least 50 people. We will identify people as early in the process as possible and engage them in effective treatment rather than holding them in custody. The goals of the project are as follows: 1. Reduce the average jail days served by inmates identified as having substance abuse/mental health issues per year by 30% 2. Reduce recidivism of substance abuse/mental health inmates by 30% 3. Successfully engage 80% of enrolled clients in the project as measured by consistent attendance and/or successful termination 4. Provide comprehensive integrated dual disordered treatment to a minimum 50 former inmates Page 5 of 70 TABLE of CONTENTS Section Page Abstract 5 Budget Information: Form SF242A 7 Project Narrative Section A: Statement of Need 9 Section B: Proposed Service/Practice 11 Section C: Proposed Implementation Approach 16 Section D: Staff and Organizational Experience 21 Section E: Performance Assessment and Data 22 Supporting Documentation Section F: Literature Citations 24 Section G: Budget Justification and Narrative 26 Section H: Biographical Sketches and Job Descriptions 30 Section I: Confidentiality and Participant Protection 40 Appendixes Appendix 1: Statement of Assurance and Letters of Commitment 41 Appendix 2: Data Collection Instruments/Interview Protocols 55 Appendix 3: Sample Consent Forms 58 Appendix 4: Letter to SSA 62 Appendix 5: Letter from County Indicating Project Priority 63 Other Assurances 64 Certifications 66 Disclosure of Lobbying Activities 69 Checklist 70 Page 6 of 70 0 0 0 0 0 0 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 0 0 0 O O O O O O O O O O O O O O O N � O ICI 7 00 O OC O O N 01,, V1 1D O in 'D .-' To vi en- oo N 7 N O N I. 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Q re W ❑ Z ❑ 2 0 N 6A V9 u9 N9 6A I 69 69 69 Q 44 69 b9 69 6A 0 rn UJ N Uy Ce O O O O O 0 O z O co Z 21 -J Q o O O O o ❑ 0 N a OOi H & E O O W d ❑ . 4 W e ON W a ‘.0 M N w it in LL R = N Q m LL — 0 J CL Q W Q 6A 69 69 6R 6.1 0 69 69 69 Ce 6A 69 69 69 6A I LL W Z ❑ 1.- 0 0 0 W O U ❑ 0 0 0 LL y Z o O o LL O O > O LI Z O _0 O 0 - W �' H c W I- O 0 (n cn o Q .n N 2 v H a 69 69 69 W ❑ C :x H w E .�I — W0s. 0 O I s ? a ❑ $ ❑ C W m y a o I W c9 co A. N 4. 00 •� tad o4co CO H W `^ c 7 y �0 G CO U 4T �qqn W c.O C N WU G % t.O b4 O C o o N ed O rn a s. a> E I E U E rn g 41 es cG d oCO y u O O N O w o O tttl H v E r' UZ '.-i U F LL z F H FO O K F 00 01 — .--i a CO (O N CO CO O M N N N PROJECT NARRATIVE: Section A: Statement of Need The Environment: Weld County is a geographically large rural area of 4,004 sq miles and a population of 207,732. The County's two largest cities are Greeley, population of 82,000, and an adjacent city Evans population, 9,514. The county lies north and east of Denver, Colorado. The ethnicity of the county is white 81.7%, Hispanic 29.5% (2000 Census). The surrounding area consists largely of numerous small farming communities. There is a large permanent Hispanic population, which is significantly increased when migrant farm workers arrive during the growing season. The project will address the inmates and prospective inmates at the Weld County Jail, located north of Greeley. Weld County and Colorado like most of the United States is struggling to manage the increasing demand for jail and prison beds. The Weld County Jail census has increased far beyond the increase in population for the region. Weld County operated 180 secure beds in 1997. Another 160 beds were added in 1998, and by 2004, there were 405 beds. Current bed capacity is 425 beds but the average daily census was 628 in 2006. In 2006, Weld County housed more than 100 offenders a day in other counties at an annual cost of more than $1.5 million. Construction of an additional 374 beds is underway at a cost of$17 million. If current incarceration trends continue, all 799 beds will be filled within a year after they will be available in February of 2008. As the demand in general goes up so does the percentage of the incarcerated population with serious Mental Illness and/or Substance Addiction. The Bureau of Justice Statistics Special Report, September 2006 reports that 62% of people incarcerated in local jails have mental health problems. 89.9% of those also use alcohol or drugs regularly. Of those without a mental health problem, 78.7% use alcohol or drugs regularly. These statistics are consistent with the presentation at the Weld County Jail. The jail admitted 12,341 people in 2006; an increase of over 19.4% in only two years. Approximately 6% of the people booked are charged with simple drug possession charges and many more for distribution of drugs or for other criminal behavior related to addiction. Currently at the Weld County Jail, 17.5% of the inmates are prescribed Psychotropic medications for an annual cost of$113,058. Approximately 15% admit to being intoxicated when booked and we suspect the actual number is much higher. The state of Colorado has faced some very difficult times financially in the past five years. Severe budget cuts occurred in both the substance abuse and mental health systems resulting in significant cuts in Mental Health and Substance Abuse treatment funding, this at a time when jail and prison populations are at an all time high. The result was an increase in the number of un-served and underserved individuals with Substance Abuse and Mental Health disorders. Funding is improving but there are already so many people in the justice system that additional measures are necessary to make up for lost ground. Currently the largest mental health provider in the state of Colorado is the Department of Corrections where a disproportionate number of individuals are incarcerated that have significant behavioral health issues. The target population of this project relates to two primary issues: decreasing the criminalization of individuals with substance abuse and/or mental health issues, and relieving the general overcrowding of the jail. Individuals with behavioral health issues are draining the resources of the community and not getting their treatment needs met which perpetuates the Page 9 of 70 drain. Law enforcement officials report that some of these targeted individuals have been arrested 20 and 30 times in a span of several years, an example of the"revolving door" aspects of the jail. Weld County has been planning with the two primary treatment agencies in the region, Island Grove Regional Treatment Center(IGRTC) and North Range Behavioral Health(NRBH) to develop a continuum of care that will address the needs of this target population for some time. As part of the project,NRBH and IGRTC will cross train staff to evaluate and assess individuals as potential candidates for diversion and engage them in treatment. Both agencies are committed to overcoming the "stovepipe funding" of the two treatment systems and effectively integrate the care for dual disordered individuals involved in the criminal justice system. Both programs, along with representatives from the legal community will participate in the assessment and treatment planning process for the individuals considered for diversion. Diversion will occur at various stages of the legal system, including prior to booking when the individual is picked up for a minor offense or during incarceration. Island Grove Regional Treatment Center is the primary agency that provides treatment for individuals with substance abuse and addictions in Weld County. It is a not-for-profit substance abuse treatment agency serving the Northeastern Colorado region since 1974. Island Grove provides a wide variety of substance abuse treatment including, DUI education and treatment, Outpatient, Intensive Outpatient, Transitional Residential, Detoxification, Youth and Family and Gender-Specific Treatment for Women. North Range Behavioral Health Center is a well-established comprehensive mental health treatment agency. It is a private, not-for-profit company and is the largest mental health Medicaid provider in the county. The agency consists of numerous programs ranging from a brief therapy and intake team to an Assertive Community Treatment Team working with the severe and persistent mentally ill in the community on an intensive basis. There is also a full continuum of residential options, ranging from an Acute Treatment Unit providing intensive service 24 hour, 7 days a week to independent apartments. It is the policy of both organizations to provide equal treatment opportunity to all without regard to race, color, religion,national origin, sex, age,veteran status, or disability. Island Grove Regional Treatment Center works very closely with the jail. Many of our Detox clients have had some form of legal involvement including DUI and DWAI charges. Island Grove works with the jail staff to ensure that Weld County residents receive needed and necessary detox and treatment services where warranted. IGRTC's outpatient and residential treatment services provide a wide range of care for people with addiction issues. Approximately 85% of the clients served have involvement with the legal system in one form or another, so Island Grove has close working relationships with probation, parole, law enforcement and the judicial system. NRBH has an exemplary relationship with the jail and with the staff in the jail's counseling department. There is already daily contact with the jail, coordinating treatment and following up of inmates due to be released to the community. The presence of these existing relationships will allow for an easy transition to a more formalized relationship as our community identifies, assesses and engages these dual disordered inmates into this the Weld County Jail Diversion Project. A critical part of the project is the intent for jail staff to work together with project staff to identify inmates that might be appropriate for diversion, who might have a mental illness or substance abuse or both. Jail staff currently provide a basic mental health screening for everyone Page 10 of 70 who is booked into the jail to determine risk to self or others. The project will expand upon that screen to identify people with substance abuse, mental health and/or dual disorders. Jail staff will refer such individuals for assessment. The District Attorney has a very positive working relationship with both agencies, which enables the development of the Weld Diversion Project. Mr. Ken Buck, Weld County District Attorney is a board member of the mental health center. The D.A.'s office has coordinated the ongoing collaborative community meetings to discuss the development of this diversion program. These meetings include most of the key players in Weld County; including the DA, Weld County Jail staff, the Greeley Police Department, Island Grove Regional Treatment Center, North Range Behavioral Health, The Villa (Weld County's Community Corrections Provider), the Public Defenders Office and other key stakeholders. The current jail population consists of 529 inmates, 455 males, and 74 females. The designed capacity of the jail is 425 and there is considerable over-crowding. The racial makeup consists of 41% Caucasian, 56%Hispanic, <1%Native American, 1% Asians, 2%African Americans and a few inmates from other countries. It should be noted that while Hispanics make up roughly 29% of the population in Weld County, they comprise 56% of the jail population. As indicated previously, there are a considerable number of arrests and re-arrests of individuals who have either substance abuse issues or mental health problems or both. Of the 529 inmates currently incarcerated in the Weld County jail, 51 current inmates have been identified as being appropriate for assessment and evaluation for consideration within the Project. The project is exceptionally timely for Weld County. Community leaders have been meeting for months to develop an effective response to the ever-increasing need in our community to address the over-crowding in our jail and the over-representation of individuals with mental health and substance abuse among those that are incarcerated. In Appendix 5, you will find letters of support from the Weld County commissioners as well as Weld County District Attorney Ken Buck and other community members within the justice system. Section B: Proposed Service/Practice Referral to the diversion project will only be considered when a treatable mental health and/or substance abuse issue is identified. The intent of the project is to build upon the close working relationship with the jail staff and the treatment providers to identify people with substance abuse and/or mental health issues and engage them in treatment in lieu of continued incarceration. The project staff will coordinate and arrange an assessment of the individual in question to determine whether he or she is appropriate for treatment. The assessment will involve an extensive search of the individual's history for involvement with the legal system as well as other agencies such as North Range and Island Grove for possible involvement with previous treatment. In addition, available family members will be queried regarding any information pertaining to past and present criminal behavior as well as substance abuse or mental health concerns. A critical issue for both the treatment team and the community at large is the potential for risk to the community. Assessment of inmates or potential inmates will determine the potential risk level of the individual. In this context, "dangerous" has to do with the potential for physical violence or dangerous behavior towards self or others. Project staff is engaging the Colorado Mental Health Institute at Pueblo (CMHI-P), the primary provider for forensic treatment in Colorado, for consultation in the development of a screening model to determine risk and dangerousness of individuals. Once finalized,the Page I I of 70 screening tool will include a number of criteria considered significant in predicting the potential for re-offending and for subsequent violence. Among the criteria that will be used: • Current age • Violent episodes or cycles • Stability of relationships • Age of 1st Conviction • Stability of family with significant others • Age of 1St Violent upbringing • Community Supports Conviction • Abuse/Neglect as child • Living environment upon • Number of Juvenile • Mental disorders and release Convictions treatment history • Violent lifestyle • Prior release failures • Substance abuse history • Criminal personality style • Escapes • Frequency/Intensity/ • Criminal attitude • Compliance with Duration of substance • Impulsivity community supervision abuse • Cognitive distortions Results of the assessment subsequently determine not only the readiness of the individual for treatment but also clarifies what forms of treatment will be necessary to meet the needs of the diverted individual. A similar process will occur when the DA's office identifies an individual who might be diverted through the Diversion Project. Utmost in the process is ascertaining whether the individual is choosing voluntarily to participate in treatment, as well as whether the treatment plan will adequately serve the individual's needs. Treatment will be tailored to the individual's state of change, cultural background, and learning style. There will not be an assumption that one size fits all. Hispanic, bi-lingual, bi-cultural individuals will get assistance from staff that have similar language, cultural values and experiences. Diversion will proceed only if the individual voluntarily chooses to participate in the treatment program, the treatment program can adequately provide for his or her needs and the appropriate representatives from legal system (i.e. the D.A., defendant's attorney,judge, probation,parole) agree to the plan. An array of services will be made available to participants,based on the outcome of the initial assessment and consequent recommendations. IGRTC and NRBH have extensive experience with the recovery of adults involved in the criminal justice system. Both provide such services as individual, family and group therapy, case management, support groups, community based services, residential services, peer-led support/recovery groups, and individualized, strengths-based, recovery-oriented services. In addition,NRBH provides medication evaluation and treatment and Island Grove provides substance abuse screening through urine analysis and breathalyzers and a social "detox"program. Risk factors will be the primary focus of the assessment, with the goal of reducing recidivism through reduction of and treatment for the contributing behaviors and cognitive distortions that tend to accompany criminal behaviors. The goal of treatment will be to reduce recidivism, and enhance community involvement to include residential placement, seeking benefits and/or assistance with vocational rehabilitation and job placement. There will be further development of community-based options for methamphetamine abusers and for other substance abusers. Repeat offenders of petty crimes will be identified by the jail, police or judicial system. Those offenders who have been arrested three or more times in the past year for minor infractions and who do not pose a risk to the community will be considered first for diversion. Page 12 of 70 Criteria have been established for determining the appropriateness of prospective clients. Such criteria will help to differentiate between individuals with identifiable and treatable substance abuse and/or mental health issues that can be addressed from the individuals that are more sociopathic or criminal in nature. Of equal importance is to assure as much as possible the safety of the community into which the individuals are diverted. Those individuals determined to be treatable and who volunteer to participate in the treatment program will be offered voluntary diversion to substance abuse/mental health treatment. Initially, the individual is seen for an intake and then are eligible for a wide range of services based upon their needs. The results of the assessment enable staff to match the services to the needs of the diverted individuals. The staff develops the necessary services through an initial service plan written in conjunction with the consumer, his or her family and the appropriate justice system participants; probation, parole, pre-trail supervisor, etc.. The service plan, once established, contains the comprehensive elements of treatment designed to meet the specific needs of the individual, including goals that are measurable and behavioral. Best practices: Treatment through Island Grove and North Range Behavioral Health utilizes several best practice models of care. Integrated Dual-Disordered Treatment, Illness Recovery Management, Assertive Community Treatment, Motivational Enhancement,Relapse Prevention and the Matrix Model. Island Grove currently uses three primary best practice models of care including Motivational Enhancement, Relapse Prevention and the Matrix Model. Motivational Enhancement is a client-centered counseling approach initiating behavior change by helping clients to resolve ambivalence about engaging in treatment and stopping drug use. Relapse Prevention is a cognitive behavioral therapy that was developed for the treatment of problem drinking and adapted later for cocaine addicts. Cognitive-behavioral strategies are based on the theory that learning processes play a critical role in the development of maladaptive behavioral patterns. Individuals learn to identify and correct problematic behaviors. Relapse Prevention encompasses several cognitive-behavioral strategies that facilitate abstinence as well as provide help for people who experience relapse. The Matrix Model provides a framework for engaging stimulant abusers in treatment and helping them achieve abstinence. Patients learn about issues critical to addiction and relapse, receive direction and support from a trained therapist, become familiar with self-help programs, and are monitored for drug use by urine testing. The program includes education for family members affected by the addiction. The SAMHSA Illness Recovery Management best practice model is utilized within the NRBH programming for individuals with severe and persistent mental illness at North Range Behavioral Health. What we call the `recovery model' is outlined in the "Psychiatric Rehabilitation: The Need for a Specialized Approach"by Connie J. McReynolds, Ph.D. McReynolds cites a variety of research that demonstrates that the adult recovery in psychiatry is most successful in community based treatment, with the emphasis on re-education of basic living skills, and with a heavy emphasis on assisting the individual with as much"normalization" as possible, whether in the work setting, with relationships, on in general level of functioning. Assertive Community Treatment, recognized by the National Alliance for the Mentally Ill or"NAMI", as the preferred approach in working with the chronically mentally ill and another SAMHSA best practice model will be used and coordinated within Integrated Dual Disorder Treatment to provide intensive case management and community based support and treatment. The model uses a truly team approach within the community, meeting the clients where they live work, or hang out. The ACT team at NRBH provides services to a core group of persons who are Page 13 of 70 experiencing reoccurring severe mental illness 60-80 percent of whom have co-occurring substance abuse issues. The multi-disciplinary team consists of clinicians, prescribers, nurses, case managers and group facilitators. The team has regular and frequent contact with clients in order to insure that, as much as possible, crises are prevented from occurring, and when a crisis does occur, there is sufficient support and assistance to avoid hospitalization or incarceration. Clinicians and case managers have sufficient information about the clients to know ahead of time when the client is beginning to have problems. Clients recover faster and suffer less debilitation through early detection and subsequent treatment of their illnesses. The diversion program will incorporate the ACT model for providing treatment services to diverted individuals who require that level of intervention. A primary element of treatment of the diverted has to do with medications. Perhaps nowhere else is the significance of psychiatric medications more relevant than in treating people with severe and persistent mental illness with co-occurring addictions. The project includes specialized psychiatric professionals who are equipped to respond rapidly to the needs of those in the program. The medical staff will have the task of ascertaining the appropriateness of current medications and consequent procurement of medications. Newer medications and medication management is considered another element of evidence-based practices, as indicated in Promising best practice: Mental Health: A Report of the Surgeon General, 287-288. Case management is an integral part of the treatment approach and noted in Evidence Based Practice: Mental Health:A Report of the Surgeon General, 284-289. Case managers assist those in the program in seeking benefits such as SSI or SSDI, assistance with residential needs,transportation where either none exists or clients are not capable of navigating public transportation. Case managers will assist with such basic levels of care as procurement of food, shelter and clothing. Whether mentally ill or fighting addictions,the diverted generally need help in following through with requirements of their diversion agreement or probation. Integral in deterring revocation of probation is to make sure that they comply with probation requirements including treatment requirements and visits with their pre-trial/probation officer. Case managers will assist in arranging for medical follow up for them, whether in community health settings or other health services. Case managers will have contact with them from the time they volunteer for treatment until treatment is completed. Vocational rehabilitation is another integral part of the treatment process. Frontier House is certified as meeting the criteria of the National Organization of Clubhouses. The Frontier House works in close association with the state vocational rehabilitation department. The Frontier House provides an environment where individuals with mental or emotional illnesses are encouraged to develop their strengths and talents that can lead them to greater participation as valuable members of the community. The clubhouse provides opportunities for individuals to experience work-related activities that are narrowly defined, supervised, and carefully engineered to be within the capabilities of the member attempting the task. Members increase their level of confidence through success experiences. The clubhouse has a number of supervised positions in the community in which members can be placed for additional work experience in the "real world" Referred to previously, Dr. McReynolds states that"supported employment.....emphasizes direct placement in a community job, assistance in locating the job with the consumer, and ongoing job-related problem-solving and support after consumers obtain work." She goes on to state that clients were able to exercise more control over their career choices due to the client-centered approach used in SE (supported employment) . Supported Page 14 of 70 employment is included in the Evidence Based Practice: Mental Health: A Report of the Surgeon General, 287. As indicated previously, the Weld County jail has 75 female prisoners currently. Of those 75 females, 40% have been identified to have a co-occurring substance abuse/addiction issue. In addition, it is estimated that 75% of the women have been sexually abused at some point prior to the present incarceration. When diversion assessments are performed with the female inmates, along with the evaluation of possible drug use and abuse, special care will be made to assess the possibility of a history of sexual abuse. Given the probability that the woman has been sexually abused in some way,the project will provide gender-specific treatment to assist them with the impact of these issues on their mental illness and/or addiction. Integrated mental health and substances abuse treatment will be provided by the combined efforts of Island Grove Regional Treatment Center and North Range Behavioral Health. There is considerable support for the efficacy of combined efforts, treating the individual with both a mental health disorder and substance addictions using dual diagnosis groups. The book Criminal Conduct and Substance Abuse Treatment by Wanberg and Milkman support an approach using cognitive behavioral therapy along with dual diagnosis groups. Wanberg and Milkman suggest that the use of cognitive behavioral therapy in a group setting can be effective in treating the criminal with substance abuse issues. Another issue in treating the dual disordered is sensitivity to any cultural issues as well as the needs specific to the genders of each client. Integrated Dual Disorders Treatment, an established approach for working with dual diagnosed individuals emphasizes work through a multidisciplinary team such as an ACT team,to model healthy behaviors,to teach issues such as relapse prevention, as well as strategies for change that do not involve self medicating. Research by Shafer, Arthur and Franczak, in"An Analysis of Post-Booking Jail Diversion Programming for Persons with Co-Occurring Disorders"p 14, suggests "post-booking jail diversion programs offer a safe and viable alternative to the prosecution and incarceration of individuals with co-occurring disorders who have been charged with committing low-level offenses". While the authors identify difficulties with some of the methodology of the study,they also indicate that the research demonstrated that there is reason to believe that"diverted participants displayed no significant increased risk of subsequent criminal behavior than their non-diverted counterparts." P 13. Page 15 of 70 WELD COUNTY JAIL DIVERSION LOGIC MODEL Resources Program Outputs Outcomes (Inputs) Components (Objectives) (Goals) (Activities) People Outreach Objectives In program: Jail Counseling Staff Identification of potential Decrease LOS for Community safety Behavioral health clients SA/MH inmates Stakeholder satisfaction clinicians Screening Tool Reduce Recidivism Client satisfaction Nurse Prescriber Intake/Assessment Stable housing Reduced Jail Days Residential staff Client Interview Clean and sober clients Reduced Recidivism Public Defenders,Judges Client commitment Secure benefits or and DAs Judicial/law enforcement employment for In or post program: Community Staffing agreement Reduced substance use— Group self reports,urine, Treatment Planning Number of Clients: hair Funds Community Staffing Group Assess 125 potential Employment/school Grant Funding Finalize Diversion Plan clients progress Medicaid Funding Serve at least 50 clients Decrease MH Symptoms Possible County Treatment by type: Graduate at least 25 in Medication compliance Contribution from Acute Residential first year Increased independence Cost Savings Detox Vocational skill Block grant funding for Intensive Community Number of Sessions: development MH and SA Treatment—IDDT/ACT 5-30 hours per client per Booking Fee Medication Management month contribution Counseling sessions 30 total bed days in Relapse prevention detox/residential per Other resources/ Crisis intervention month Facilities In-kind contribution of Special Training Other resources office space at Life skills required Island Grove and Vocational skills Collaborative efforts of North Range Decision-making community members In kind Utilities Money management Mileage In-kind vehicle Other Services In-kind electronic health Independent Housing record Vocational Services and In-kind administrative Job Placement costs Program Support Equipment Long-range planning Laptop computers Administration Cell phones Public Relations Office furniture Resources of two solid Printer treatment providers Community services Jail and police assessment Judicial Referrals Page 16 of 70 Section C: Proposed Implementation Approach Necessary Groundwork: The Diversion Planning Committee will continue to meet monthly to oversee the project and monitor progress. This group has been meeting consistently for months prior to the application and already has a good working relationship. Participants in this ongoing committee include Ken Buck, District Attorney; Kendall Alexander, Executive Director, Island Grove Regional Treatment Center; Jacki Kennedy, North Range Behavioral Health; Kevin Strobel, Public Defender; Rick Dill, Commander, Weld County Jail; Matthew Brucklacher, The Villa,(Community Corrections) and other key members of the above agencies. Many of the participants were selected by the D.A. as representatives in the community with vested interest in looking for alternatives to the overcrowding of the jail as well as preventing the criminalization of individuals with substance abuse/mental illness issues. (APPENDIX 1 LETTERS) This group will oversee the development of and approve the admission-screening tool used by jail staff or police officers in the community. They will approve the admission criteria and treatment planning process. They will oversee the collection and analysis of data and generally act as an advisory group to the project. This group will come to agreements regarding the types information will consistently be released vs. what will be held in confidence in the treatment process. This group will develop the protocols for charges being dropped,deferred or prosecuted based on compliance/noncompliance with the program. Should the individual fail to follow the treatment plan, he or she will be referred back to the court within established parameters. Confirmation from the judge will be sought for both the choice of individuals picked for diversion as well the recommendations for treatment and estimated treatment duration when the case progresses to court. Once the individual has agreed to enter treatment and support is received from his/her attorney or public defender, and approval is given by the presiding judge,the individual becomes involved in treatment according to the recommendations of the assessment team. Appropriate housing becomes the immediate consideration for the homeless as well as for those whose return to previous living situations that are likely to increase the risk of re-offense due to associations with drug users and known criminals. Where housing assistance is necessary, individuals may not be released until appropriate housing could be secured. Outreach will occur to law enforcement, attorneys,judges, probation and parole to orient and educate them regarding the program and work to gain their support and assistance. Periodic meetings will be held with representatives of the legal community, including the D.A.'s office, the Public Defender's office, Depts. of Probation and Parole, and the judges. They will be made aware of the services and treatment options that are to be offered as an alternative to incarceration as well as reviewing the treatment outcomes of those individuals who have volunteered for treatment. Two factors must be nurtured for the program to succeed: there must be ongoing collaboration with the judges, district attorneys, public defenders' office and the jail officials, and there must be a high level of respect for the confidentiality of the individual in treatment. One of the requirements for an individual deciding for treatment is that they make an agreement that there be a release to the legal entities regarding general level of functioning, treatment compliance, and criminal behavior while in the program. Every effort will be made to respect the confidentiality beyond those topics. Jail staff and project staff will communicate at least weekly to ensure a thorough understanding of the screening and diversion process. One possibility being considered is to establish an office to which the police can bring non-violent offenders for evaluation rather than Page 17 of 70 the jail. If the individual is determined to be inappropriate for treatment, or if he/she chooses not to participate in the diversion program,they will proceed through the legal system. The offender will be assessed by staff of the treatment team, and a decision made as to the appropriateness for treatment. The initial emphasis will be two-fold: emphasis will be placed on current inmates identified by the counseling department or other jail staff as having a current psychiatric illness or a history of mental illness or substance abuse/addiction. At the same time, efforts will be directed to the earliest point of contact with the legal system, with the view in mind of decriminalizing the identified individuals and instituting treatment instead. Psychological testing may also play a part in assessing the individual to not only make an informed judgment as to the presence of a mental health disorder, but also assist the evaluating team in making recommendations regarding treatment. We will augment the current Assertive Community Team with people who are dually credentialed in Substance Abuse and Mental Health treatment. Staff will have experience and training in working with criminal justice involved clientele. This will make possible the more intensive treatment approach necessary to reach the goals of reducing recidivism and decreasing criminalization of dual disordered clients. Case managers who are available to assist in accessing benefits for those individuals without resources and unable to access services and benefits on their own will be trained in working with legally involved individuals to ensure they understand the affect of incarceration on benefits and access to resources within the community. Individuals coming out of the legal system, especially those that have been incarcerated for over 30 days have often lost such benefits as SSDI, assistance with rent, etc, and frequently have few resources and little or no financial support in the community. Many others where homeless at the time of arrest or have become homeless and require assistance with housing;NRBH will use their extensive array of residential settings to meet the needs of the forensic population. The initial goal is to use beds at the Acute Treatment Unit for placement of individuals referred by the DA or jail who need that level of care. Another item in the grant budget will be monies set aside for temporary housing for the diverted when immediate housing is needed. In the past,NRBH and IGRTC have frequently worked with the same clients, but in separate facilities and often with different treatment plans and disparate approaches. Over the last four years, the two agencies have made increasing efforts to collaborate and share efforts to the benefit of their shared clients. Dual diagnosis groups are now jointly staffed by both agencies for treatment of individuals with both problems. The two agencies have committed to the next step, which is to cross-train the staff of both agencies to ensure understanding of both disorders and have the staff function as a collaborative team that addresses an individual's issues simultaneously in a truly integrated fashion. This cross training is planned in calendar year 2007, regardless of whether the grant is funded or not. Paramount in the process of implementation is the safety of the community. Stakeholders will be involved in the development of each step in the diversion program and will have veto power over the determination of eligibility of each client. While inmates will be evaluated for appropriateness of treatment once incarcerated, it is preferable to provide the alternative of treatment at the point of booking. To bypass jail altogether, law enforcement will be encouraged to bring non-violent offenders contacted for nuisance crimes to the assessment setting in lieu of booking. Weld County does not have a drug or mental health court. The stakeholders including the district attorney, public defender and judges are developing the necessary legal provisions for this process to work effectively within the existing court system. Page 18 of 70 The Weld County Jail has an established"Special Needs"pod that houses inmates identified as having mental health and/or substances abuse issues and require special protection and supervision. As part of the project, Weld County will bring consultants into the jail to assist in the development of additional expertise of jail personnel in recognizing the emotional needs of the inmates. As the awareness of the jail staff increases, identification of potential diversion inmates will become more efficient. The services outlined in the grant proposal are already largely in place. Money from the grant will allow for expansion and specialization of the services. Staffing of the assessment team has already begun, with identification of the individuals who will participate as part of the team. The jail has identified appropriate inmates for assessment. The project can be up and running with the delivery of services in a period of two months following announcement of the award. Timeline for Project Activities/Responsible Staff Project months for first year Recruiting/hiring of staff 1 2 3 Responsible: Project Director Finalize MOUs between stakeholders 1 2 3 Responsible: Community Advisory Group Develop Key Processes 2 3 4 Responsible: Community Advisory Group Training of project staff and jail personnel 2 3 4 Responsible: Consultants and/or supervisory staff Consultation and Project Development with Jail 2 3 4 5 6 7 Staff Responsible: Project Director and Staff Develop Screening Tool 1 2 Responsible: Project Director Develop IT system for data requirements 1 2 3 Responsible: IT department Identify necessary adjunct services (Housing, 1 2 3 benefits, etc.) Responsible: Project Staff Referral of candidates for diversion 2 3 4 5 6 7 8 9 10 11 12 Responsible: Jail staff, Judicial representatives Assessment of referred individuals 3 4 5 6 7 8 9 10 11 12 Responsible: Clinical staff Implement IT system 6 7 8 9 Responsible: IT department Stakeholder review of project 3 6 9 12 Responsible: Community review team and project director Page 19 of70 Key Activity Beyond Year One Timeline Activity Responsible Staff Monthly Review progress Project Director and Director of Evaluation Ongoing Data Planning and Evaluation Quarterly Review of LOS and Recidivism data Director of Planning and Evaluation Review of feedback from Legal System on Director of Planning and Evaluation enrolled clients and impact to jail system Annually Attend annual grantee meeting Project Director Director of Planning and Evaluation Team Members Compile Annual Report Project Director Evaluation of Staff Project Director Data Analysis and Necessary Modifications Project Director and Director of to Program Goals Planning and Evaluation Unduplicated Numbers Annually Three years of grant Individuals Individuals Individuals Individuals Type of Service Screened Served Screened Served Intensive IDDT Services IDDT/ACT Services 50 40 200 150 Residential Services Housing/Residential Care 50 20 150 50 Acute Residential Treatment 15 12 45 36 Detox Services 25 20 75 60 Outpatient Medication Management 60 45 180 135 Traditional Outpatient Services 70 30 210 90 Total Unduplicated Clients 100 75 350 225 Cultural Factors: As stated earlier, Hispanics are about 29% of the general population of the county but represent 56%of the jail population. Given this over representation of Hispanics considerable attention will be given to addressing the needs of the Hispanic population within the diversion project. Special emphasis will be paid to ensure culturally competent and relevant services are available for these individuals. Bi-cultural, bi-lingual staff will provide the care whenever appropriate. Family members will be involved in treatment and cultural values and norms about substance abuse and mental health will be valued. As stated earlier, it is the policy of both organizations to provide equal treatment opportunity to all without regard to race, color, religion, national origin, sex, age,veteran status, or disability. The primary target population will be individuals who encounter the legal system and who have substance abuse and/or mental health issues. Many but not all will lack of resources and may be homeless or at risk of homelessness. Housing, while limited in availability, will be made available to those most in need. Many inmates have few marketable skills and/or very sporadic work histories. Education levels tend to be limited to elementary and some high school. Some will speak Spanish or Page 20 of 70 another language other than English. The project will individualize the assessment and consequent treatment approach to the abilities, needs, wishes and the level of intellectual functioning of the diverted to be treated. Potential Policy, Legal and Social Barriers: Many of the potential barriers have to do with opposing and potentially conflicting agendas of the DA's office and the Public Defender's office. As with much of Colorado, the community tends to have a mindset that breaking the law should result in consequences, and that imprisonment is the preferred consequence. The stakeholder group understands this dynamic and will provide education and supporting education to help people understand the benefits of the project to the well-being and safety of the community. Barriers will be addressed through frequent contact by project staff with assurances that not only is treatment occurring, regular contact will provide oversight and additional guarantees of safety. The shared goal of reducing overcrowding at the jail and recidivism will help motivate the community to overcome concerns. Continuation of Project after Grant Period: As previously stated,the community has been working on this project for some time. The success of the grant will positively affect the jail census, which will in turn create cost savings that can be put toward expansion and continuation of the program. Current support from the county comes from Booking Fees which are a fees collected at the time of arrest that are earmarked for mental health treatment in the criminal justice system. The county anticipates that those funds may increase over time as collection procedures improve which will help to support the program after the grant period. Additional support will be sought from a variety of other sources. We will actively seek other grant opportunities and state and local resources that could assist with the expansion and continuation of the project. Section D: Staff and Organizational Experience The capability and experience of the applicant organizations and community leaders is extensive. As discussed earlier,the project advisory committee is comprised of the key stakeholders who include Ken Buck, Weld County District Attorney, Kendall Alexander Executive Director of Island Grove Regional Treatment Center, Jacki Kennedy, Director of Adult Services,North Range Behavioral Health, Kevin Strobel, Public Defender's Office, Rick Dill, Commander, Weld County Sheriff's Dept, county Jail and Matthew Brucklacher, The Villa, (Correctional Services). All these individuals have ten to twenty-five years experience working in their capacity within the legal system or the behavioral health field. Many have experience working with collaborative efforts in this or other communities and that experience will go far in the development of the Diversion Project. The county has developed a similar system of care for juvenile offenders. Many of the participating agencies have worked on that project as well. Thus,the relationships and systems discussions have laid an excellent groundwork for this project. We hope to borrow much from that infrastructure of that project to implement this adult diversion project. North Range Behavioral Health and Island Grove Regional Treatment Center have extensive experience with program development and outcome analysis. Administrative oversight of the project will be provided by John Wilde, IGRTC and Jacki Kennedy,NRBH who will ensure the two agencies successfully integrate services and the team works as a single entity regardless of the agency by which they are employed. Page 21 of 70 Responsible Staff Staff Member Job Title Role Bilingual John Wilde, MA LAC Director OP Services, IGRTC Administrator Jacki Kennedy, LPC, CACIII Director Adult Services,NRBH Administrator Dana Wellman, M.Div. Forensics Coordinator,NRBH Project Director Carolina Belloso, BA, MA Counselor, IGRTC and Intern, Clinician Spanish Intern, CACIII NRBH Joe Carlisle, MA, LPC Clinician,NRBH Clinician Maria Diaz, MA, LPC Clinician,NRBH Clinician Spanish Jose Vasquez, APN Prescribing Nurse,NRBH Prescriber Spanish Linda Baum, PhD Psychologist,NRBH Psychologist Alice McPherson, LPC Counselor, Weld Jail Screener All project staff will receive training in Criminal Conduct and Substance Abuse Treatment, a program created by Kenneth W. Wanberg and Harvey B. Milkman. The team will also utilize the SAMHSA implementation resource kit, Co-occurring Disorders: Integrated Dual Disorders Treatment. Additionally, IGRTC and NRBH each have extensive training plans in place for all staff. Both agencies are currently identifying key topics that will be offered for staff from both agencies. Examples include: Motivational Interviewing, Treating the Resistive Client, Best Practice Models of Care, Treatment of Forensic Populations and Treating Addictions. Additionally,both agencies will be providing cross-supervision to ensure further development of Mental Health skills for Substance Abuse professionals and Substance Abuse skills for Mental Health professionals to bring both to a level of competency to provide effective and properly integrated dual disorder treatment. Recognizing the ethnic diversity in the community North Range Behavioral Health established the Multicultural Services Program, a model copied around the state. The program was developed in response to a North Range Behavioral Health Board-sponsored collaboration with key Hispanic leaders and agencies that serve Hispanics. The agency successfully acquired a grant to fund the graduate school education(Psychology or Social Work) for Spanish-Speaking individuals wishing to work in the counseling field. The program nurtures them through their education and offers paid internships with an agreement that they will work for the agency after graduation. Carolina Belloso is one of the interns in that program and will be one of the three members of the project team that are bicultural and bilingual. The services provided by this Project will be delivered in the homes and communities of the clients as well at the offices of North Range Behavioral Health and Island Grove Regional Treatment Center. The buildings are ADA compliant and convenient to public transportation. Section E: Performance Assessment and Data The Jail Diversion Project will have the ability to collect and report on the required performance measures which include: morbidity; employment/education; crime and criminal justice; stability in housing; social support/social connectedness; as well as access number and characteristics of the persons served by: age, gender, race, ethnicity and rate of readmission to psychiatric hospitals. Additionally,the project will track data to analyze the projects progress toward the stated goals listed below. The project will use the North Range Behavioral Health electronic medical record. NRBH utilizes Netsmart's, CMHC/MIS suite of software which provides a comprehensive set of applications that are designed to assist in the delivery of behavioral healthcare, public healthcare and substance abuse treatment. The aforementioned Page 22 of 70 required data resides in the database that is the repository for the CMHC applications. The data is collected at the point in time when individuals begin substance abuse or mental health treatment and continues to be collected throughout the treatment process up until the time of discharge. North Range Behavioral Health also has a skilled data processing staff that uses Business Object's, Crystal Reports to extract data from the CMHC database in a format that will be used to report National Outcome Measures. North Range Behavioral Health also has staff experienced in using HUD's HMIS, a Web- based system used for collecting statistics related to the homeless. This staff will assist in using the TRAC Web-based system to report GPRA data when that system is available. Using statistics provided by the jail, prior year counts will be used to establish a baseline from which to measure the project goals. The data will be extracted monthly and accumulated year-to-date and then compared to the project goals. Data will be used to make course corrections as necessary. The required GPRA data will also be extracted monthly and its validity reviewed. The data collected will be used to manage the project and assure continuous quality improvement. The data will include treatment plans as well as treatment outcomes to ensure not only the success of the project but also the success of the individual client. The individual's goals will result in a strength-based treatment plan for achieving those goals. Each time an individual meets with a clinician the results of that session will be entered into the system. The clinician will monitor the treatment taking place as to appropriateness for the individual's goals. The plans will be reviewed and updated whenever a significant change in the individual's status occurs or at least every six months. At that time the goals will be reevaluated based on data collected. When appropriate, new strength-based goals will be entered developed. On a monthly basis, individuals will be selected at random and their data reviewed by a Quality Improvement Committee to ensure the treatment is evidenced based and in compliance with agency policy and procedures. When necessary, adjustments in treatment will be made. The project will be monitored monthly by the project administrators and directors through a thorough review of regular reports. The project advisory group will review outcome data and goals at least quarterly and recommend any changes to the treatment system. They will also review and address any problems with the various systems working well together. The goals for the project are: 1. Reduce the average jail days served by inmates identified as having substance abuse/mental health issues per year by 30% 2. Reduce recidivism of substance abuse/mental health inmates by 30% 3. Successfully engage 80% of enrolled clients in the project as measured by consistent attendance and/or successful termination. 4. Provide comprehensive integrated dual disordered treatment to a minimum of 50 former inmates The unit cost per person over three years, serving 200 people is approximately $4,872. The amount charged to the grant(minus matched funds) is 3,845. Page 23 of 70 Section F: Literature Citations "An Analysis of Post-Booking Jail Diversion Programming For Persons with Co-Occurring Disorders" Michael S. Shafer, Ph.D., Brian Arthur, M.A. , Michael J Franczak,Ph.D. Behavioral Sciences and the Law(in revision), May 14, 2004 Barton, R Psychosocial Rehabilitation Services in Community Support Systems: A Review of Outcomes and Policy Recommendations. Psychiatric Services. 50:4, 525-534, April, 1999. Mental Health Problems of Prison and Jail Inmates, Bureau of Justice Statistics, Special Report, September 2006,NCJ 213600 Colorado Department of Corrections, Adult Inmate Population at DOC facilities as of September 30, 2006 Retrieved on February 16, 2007 from http://www.doc.state.co.us/Statistics/7GeneralStatistics.htm#Adult%20Inmate%20Population; Colorado Department of Corrections Crossing the Quality Chasm: A New System for the 21s' Century(2001). Washington, DC: Institute of Medicine. Evidence based practice: Mental Health:A Report of the Surgeon General, 287-288. Evidence based practice: Mental Health:A Report of the Surgeon General, 284-285, and listed by the Implementing Evidence-Based Practices for Severe Mental Illness Project. "Evidence-Based Practices: Shaping Mental Health Services Toward Recovery"Assertive Community Treatment. February 27, 2007. Evidence Base Practices Implementation Website. www.mentalhealthpractices.org. "Evidence-Based Services and Emerging Best Practices for Treating Mental Disorders in Adults and Children" The Campaign for Mental Health Reform 3/8/07. Hawthorne, W.B., et el. "Comparison of outcomes of acute care in short-term residential treatment and psychiatric hospital settings." Psychiatric Services. 50:4, 516-522, April 1999. Julian, D.A. (1997). Utilization of the logic model as a system level planning and evaluation device. Evaluation and Planning 20(3), 251-257. Levin, Aaron"SAMHSA Encourages Development of Jail-Diversion Programs" APA 2007 Annual Meeting San Diego, CA May 19-24 Psychiatric News June 2, 2006 Vol. 41,Number 11, page 9, 2006 American Psychiatric Association. "Massachusetts Clubhouse Coalition- Expanding Opportunities". Massachusetts Coalition Web Site McReynolds, Ph.D. Psychiatric Rehabilitation: The Need for a Specialized Approach International Journal of Psychosocial Rehabilitation 7, 61-69. Mental Health: A Report of the Surgeon General, 1999 "OMHAS Adult Case Management" (Evidence Based Practice Conceptualization for SB 267 Implementation)Draft for Discussion Only: May 10, 2005. Phillips, S.D., et al. Illness management and recovery: A review of the research. Psychiatric Services. 53:10. 771-779, June 2001 Page 24 of 70 Promising best practice: Mental Health:A Report of the Surgeon General, 289-291,President's New Freedom Commission on Mental Health, p. 68. Reyes, Jose, Ed.D., L.P.C. "The Role of Cultural Competence in Behavioral Health" Cultural Competency Consulting, LLC www.culturalcompetencyconsulting.com. Copyright 2006. Wanberg, Kenneth W,_Milkman, Harvey B. Criminal Conduct and Substance Abuse Treatment SAGE Publications Thousand Oaks London New Delhi 1998. Wholey, J.S., Hatry, H.P.,Newcome, K.E. (Eds.) (1994). Handbook of Practical Program Evaluation. San Francisco, CA: Jossey-Bass Inc. 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N V O n . e7 a a ‘t: ‘.6' C9 C•1 Ni .-1 69 69 n M —4 N it ---- M en O� `O .y '1 7 en 69 VI 69 69 69 69 69 EA69 V) V3 Vi 00 C C y � r 1 o F x Al riin, a �3 a .5 .n v W o x u U i C7 M io a O n `O' a. y d p o t O 3 O VC 00 'yp N Co L M y yit ~' Q 7 Q '. C O w w. F'" 'D Q b) 'O w < W d O C x y gciEt • C G F d O 4 C7 C C w U L 0 o- a q 0 a oon=oocooO E U .0 C :+ V �+ O .V. C b0 a mn C W C r CyJ O L 'C U M •Et,ti . y C) I:0 Z C 'O ≤or. + 7 C C 'O O 6 F .i�. 4 A R A 3 0 ( F F Budget Narrative Personnel: Administrators—One senior level director from each of the two key providers, IGRTC and NRBH to oversee programming and community collaboration Project Director- The Project Director is an employee of NRBH who is responsible for overall project administration, including hiring/managing of core staff, budget and oversight of programmatic and administrative policies and procedures to attain project goals and objectives. He also will coordinate/develop a referral process and coordinate outcome assessment. Prescribing Nurse—An advanced practice nurse with prescriptive authority who will offer medication management and clinical expertise to the project in consultation with the Medical Director of NRBH who is a Psychiatrist Secretary Support—The clerical staff providing operational support and day-to-day data management for the project. Will assist in data collection for outcome and evaluation. Program Clinician—The Program Clinicians are master's level therapists providing assessment, diagnostic evaluation and service planning. Each person will carry a caseload of about 13. These staff members will work within the ACT multi-disciplinary team to provide assistance with benefits, resources and skill development for individuals with substance abuse, mental health and co-occurring disorders. Program Clinical Evaluator—The clinician responsible for assessing potential clients at the jail or in the community. He will also develop the initial diversion plan with the client and the involved agency and legal representatives. Fringe Benefits: Twenty-three percent(23%) fringe benefit rate includes a comprehensive benefits package, including health/dental coverage, life insurance, FICA, Workers Compensation, long-term disability, and 401K contribution. Equipment: Equipment includes laptop computers for staff to access the electronic medical record while in the community, one additional printer, the purchase of five cellular phones and five additional desks and chairs Supplies: This category includes office supplies and computer/copy supplies for program staff. Therapy supplies include drug screening, the purchase of breathalyzer equipment and supplies and supplies for group and case management care. Travel: Travel is primarily mileage reimbursement for program staff working in the field and bus passes/taxi vouchers for clients not yet employed are included. Also,travel cost for three attendees at SAMHSA training conferences. Contractual: Evaluation includes the Program Evaluator and Evaluation Consultant—The Program Evaluator will be responsible for administration of the data outcome instruments and analysis of the outcome data. Also included is an Evaluation Consultant (0.05 FTE)who will provide consultation on collection and statistical analysis of program data. Other: Group Home Residential Group House costs at $60 per day for a total of 730 days. Substance Abuse Transitional Residential Treatment - $120 per day for a total of 730 days Acute Treatment Residential - $ 120 per day for a total of 550 days Page 29 of 70 Communications—Telephone and cellular phone monthly charges Staff Training Includes additional training in mental health intended for staff with primarily a substance abuse treatment background and in substance abuse for staff with primarily a mental health treatment background. Medication - Includes the cost of psychotropic medications for clients that are not yet eligible for benefits and have no other resources. Indirect Cost Rate: Weld County will retain an indirect rate of 6%to offset the cost of managing the grant funds and oversight of providers. Cash and In-Kind Match: State Substance Abuse funding paid to IGRTC to help cover the cost of Transitional Residential Treatment at$300 per month per client enrolled. State Mental Health funding paid to NRBH to pay for services to uninsured individuals. NRBH Matching Funds—the cost of salary and fringe of the 0.05FTE administrator and 0.45FTE of the Project Director. Client Rent 30% of earned income while in the group home will go toward rent; the grant will cover the cost of those not yet employed or not yet receiving benefits. IGRTC Matching Funds - The cost of the 0.05FTE administrator salary and fringe. Section II: Biographical Sketches and Job Descriptions Administrators: John Wilde,MA, LAC Director of Outpatient Services; Island Grove Regional Treatment Center John Wilde MA LAC has work in the substance abuse field in Colorado for 26 years. Mr. Wilde has been has been employed with Island Grove for 26 years and the Director of Outpatient Services for the Island Grove Regional Treatment Center for 10 years. He has been the Principle Investigator for two National Institute on Drug Abuse Clinical Trials. Mr. Wilde is currently on the Weld County Child Protection Team and the 19th Judicial District Juvenile Services Planning Committee. Job title: Director of Outpatient Services Position Classification: Exempt Direct Supervisor: Executive Director Salary Range $51,604.80 to $66,040.00 Annually Positions Supervised : Program Manager of Women's Services Program Manager of Structured Therapy Clinical Coordinator The above positions in turn supervise other staff, however the Director is ultimately responsible for the entire staff in the Department. Job Summary Responsible for overseeing and insuring the operation of the Programs in Outpatient Services in accordance with contract conditions, agency policy and procedures, Alcohol and Drug Abuse Division Licensure Standards and Regulation, Standards of Practice, and State, Federal and local regulations and laws. Responsible for grant writing to secure Page 30 of 70 program funding, developing and initiating other funding streams as well as negotiate additional contracts for services, and client fee collection. Responsible for the development and maintenance of practices of any licensing or accrediting entity, including development and maintenance of client outcome data. Prepare and monitor Department budget. Responsible for program reporting to the Executive Director and outside sources as appropriate. Develop and maintain positive public relationships within the community, region, and state. Minimum Requirements 1. MA in Human Services field and CAC III/LAC 2. 5 years experience in alcohol/drug field 3. Minimum of 3 years experience in management position 4. Valid Colorado Driver's License 5. Works well in a management team, willing to negotiate, takes direction well 6. Strong inter-personal skills required. Ability to work effectively with a variety of individuals in a positive, supportive, cooperative manner. 7. Able to manage multiple areas of responsibility and possess good organizational and time management skills. 8. Good written and verbal communication skills 9. Ability to effectively work with little direct supervision. 10. Experience working with the public 11. Experience in budget development and monitoring 12. One year free from alcohol or drug abuse and any illicit drug activity. 13. The employee must have successfully completed a Colorado Bureau of Investigation background check, Child Abuse Registry background check, and UA drug screen. Employment is contingent upon passing CBI and Child Abuse Registry background checks, and UA drug screening. 14. Employee is bound by Federal Confidentiality Laws and Regulations; the Colorado Department of Human Services, Standards of Practice for Alcohol and Drug Counselors; and any rules, regulations and policies implementing HIPAA requirements whether now or hereafter existing. Job Duties 1. Responsible for insuring good clinical care for the clients in programs, including program development and implementation that meets the needs of the community we serve. 2. Insure proper clinical supervision of programs and staff in your Department, support staff in achieving clinic, agency, and professional goals through mentoring, skill-building and empowering staff 3. Monitor or attend court hearings pertaining to your Department, as appropriate. 4. Facilitate an annual Department planning and goal-setting meeting, produce an annual plan, follow up on goals and report semi-annually to the Executive Director as to status. 5. Actively participate as a member of the management team in a positive, supportive, and cooperative manner. 6. Participate and initiate contributions to overall agency planning, evaluation, and goal setting as a member of the management team. 7. Attend Board of Directors meetings, management meetings, planning and work sessions, and staff meetings/other required meetings as assigned by the Executive Director. Page 31 of 70 8. Responsible for recruitment and retaining qualified staff 9. Responsible for supervision of performance evaluations of program personnel. 10. Submit required grant proposal(s) for department funding in a timely, professional manner 11. Design data collection plan and outcome evaluation procedures and analyze. Present data in requested reports and staff meetings for ongoing program improvement 12. Inform Executive Director on matters of department functioning pertaining to personnel, legal or agency liability 13. Explore and implement additional revenue producing services/activities 14.Negotiate and maintain contract relations with funding agencies 15. Develop, monitor, and authorize budget expenditures for assigned program areas. 16. Oversee client fee payment procedures and billings and maintenance of department computer systems/programming in coordination with the Director of Business Services as needed 17. Coordinate community presentations and in-services regarding department services, and public relations responsibilities. 18. Represent agency and department programs on related issues in the field within the community,region, and state. 19. Write, insure, and update ongoing procedures for Department(s) Operations Manual 20. Responsible for the development and maintenance of practices that insure the health and safety of persons (employees and clients)under your supervision. 21. Insure that department operations are compliant with or exceed agency, governmental regulations including state, federal, and local laws, all Department of Human Services (ADAD) standards, or any other licensing, accrediting, or contracting entity requirements. 22. Responsible for maintaining or delegation for physical needs of the clinic i.e., repairs, supplies, inventory, educational material, agency vehicles, or delegated needs. 23. Perform any administrative requests/special projects, and other duties as assigned by the Executive Director 24. Actively participate in at least one community human services related committee/board 25. Other duties as assigned by the Executive Director Job Specific Duties Is there any reason why you cannot perform the essential functions of the position with or without reasonable accommodation? (Please initial your response) Yes No If you answered YES, please list and describe reasonable accommodation(s): Jacki Kennedy, MA, LPC, CACIII Adult Services Director; North Range Behavioral Health Jacki Kennedy began working in the behavioral healthcare field in 1980, first as a provider and then as a manager/director. Currently, Ms. Kennedy is the Adult Services Director at North Range Behavioral Health in Greeley, Colorado. She works closely with other service providers in the community. Ms. Kennedy holds a Master's Degree in Counseling Psychology and is licensed as a Professional Counselor and certified as a Senior Addictions Counselor in the state of Colorado. Job Title: Director of Adult Services Program: Adult Programs Reports to: Deputy Director FLSA Status: Exempt Page 32 of 70 Salary Range: $62,000 to 93,000 Annually Position Summary: The Director of Adult Programs directs the development, implementation and evaluation of the full continuum of Adult Programs and services. The Director is the primary consultant to the Executive staff in relation to all Adult Programs and participates in related strategic planning, training and collaborative problem solving. Essential Duties: • Supervises and serves as a resource person to Adult Program Directors. • Prepares and delivers presentations to individuals and groups relating mental illness, program issues and services provided. • Maintains close and cooperative relationships with community agencies and other public agencies in carrying out the mission of the organization • Develops and fosters team values with Adult Directors. • Communicates goals of organization and creates strategy with support from Program Directors to achieve goals. • Communicates policy changes and informs Program Directors of organization wide activities and events • Ensures compliance with regulations,policies and procedures related to employment, program guidelines, and safety • Participates on committees, in meetings, and works on projects. • Performs other duties as assigned Other Duties and Responsibilities: May be called upon occasionally to make formal presentations or public speaking engagements as representation for NRBH, LCMH, NBH. May prepare and monitor budget for designated programs and implement goals to achieve objectives of budget goals. Job Requirements: Skills and Abilities: • Ability to read, analyze, and interpret professional journals,technical procedures or government regulations. • Effective verbal and written communications skills • Able to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems • Time management skills • Supervisory and management skills • Knowledge of psychopathology and methods of therapy • Knowledge of federal, state and local regulations regarding delivery and documentation of mental health services Competencies: • Judgment and decision making Page 33 of 70 • Integrity • Performance Management • Values Diversity Minimum Qualifications: Experience: • Minimum 5 years of supervisory and/or management experience in the Mental Health field serving clientele of varying diagnoses and levels of impairment • Experience in coordinating mental health intervention plans and services with other agencies Education & Licensure: • Masters Degree in psychology, social work or related field from accredited College or University • Colorado Clinical License (LCSW, LPC, LMFT, PhD) Physical Demands: • Employee is regularly required to sit, stand, bend,talk, and hear. • May be required to lift 50 pounds Program Oversight Dana Wellman,M. Div. Project Director Dana Wellman has thirty years experience in mental health working primarily with the severe and persistent mentally ill. He is the forensics coordinator for Weld County; helping individuals from the Forensic Unit of the State Hospital integrate back into the community. Mr. Wellman also serves on the Weld County Criminal Justice Advisory Committee and is NRBH's liaison with the Weld County Jail, Probation and the Public Defenders office. Job Title: Project Director Program: Jail Diversion Project Reports to: Program Director Salary Range: $ 35,918 to 52,081.63 Annually FLSA Status: Exempt Position Summary: Administers program to meet the mental health and substance abuse treatment needs of consumers. Provides direction and supervision to assigned behavioral health service delivery staff. Provides some therapeutic counseling and case management to consumers with mild to severe mental illnesses and/or substance abuse disorders. Manages grant reports and program oversight including the implements program changes, objectives, goals and standards. • Serves as a resource person to other program employees. Supervises, trains, evaluates, disciplines and rewards employees as needed • Assures accurate records relating to service delivery, case management and program management Page 34 of 70 • Analyzes data and prepares a variety of reports to assist with evaluating services, capacity and in response to state inquiries or regulations. • Perform administrative duties such as recruitment, grounds supervision(first impressions)public relations, etc. • Prepares and delivers verbal presentations to individuals and groups relating to program related issues; interprets and explains to community groups the social and emotional factors pertaining to mental illness to provide a better understanding of the various aspects of emotional and psychological problems and how their particular program enhances the lives of our consumers. Conducts facility/program tours • Maintains close and cooperative relationships with community agencies and other public agencies in carrying out the mission of the organization • Resolves consumer concerns or coach staff to address and resolve or propose solutions associated with consumer's issues. Problem solves difficult clinical issues with management and implements strategy to resolve issues • Develops and fosters team values with employees • Assures environment is conducive to employees being able to work without harassment, discrimination or retaliation. Reports all alleged incidents to Manager/Human Resources • Communicates goals of organization and creates strategy with support from program employees to achieve goals. Communicates policy changes and informs employees of organization wide activities and events • Enforces policies and procedures related to employment laws, program guidelines, regulatory compliance and safety • Assures evaluation of staff performance; assures performance issues and conduct and ethical issues are resolved; assures disciplinary actions are carried out. Provides technical assistance,training and coaching in clinical and administrative areas as needed. • Initiates 72-hour hold and treat as needed • Acts as case manager in accordance with the State Division of Mental Health's rules and regulations as needed. This includes referral, linkage, monitoring/follow up, advocacy, service planning and crisis management • Participates on committees, in meetings, and works on projects. • Performs other duties as assigned Other Duties and Responsibilities: May provide direct services and case management to clients as needed. May be on call rotation, possibly 24 hour rotation May prepare and manage large budgets of several facilities May deliver vocational program services May inventory supplies & equipment, monitor petty cash and do purchasing May coordinate psychological testing services. May coordinate disaster planning and implementation May be called upon occasionally to make formal presentations or public speaking engagements as representation for NRBH, LCMH,NRB. May prepare and monitor budget for designated programs and implement goals to achieve objectives of budget goals. Job Requirements: Page 35 of 70 Skills and Abilities: • Ability to provide treatment and case management in routine and crisis situations • Ability to read, analyze, and interpret related professional periodicals,journals, technical procedures or government regulations • Effective verbal and written communications skills • Able to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems • Time management • Supervisory and management skills • Knowledge of psychopathology and methods of therapy • Knowledge of federal, state and local regulations regarding delivery and documentation of mental health services Competencies: • Judgment and decision making • Integrity • Performance Management • Values Diversity Minimum Qualifications: Experience: • 3-5 years of increasingly responsible experience in the Mental Health field serving clientele of varying diagnoses and levels of impairment. • Experience in coordinating mental health intervention plans and services with other agencies • Clinical supervision and/or management experience preferred. Education & Licensure: • Bachelor's (BA) Degree or equivalent in counseling, psychology, social work or related field from accredited College or University or equivalent experience • Colorado Clinical License (LCSW, LPC, LMFT) preferred Physical Demands: • Employee is regularly required to sit, stand, bend, talk, and hear. • May be required to lift 50 pounds Working Conditions: This position is exempt(Not eligible for overtime) This position's workload is based on a hour workload This position may include additional hours beyond 40 hours per week % of this positions hours on the job are billable service hours. is the minimum caseload size for this position. Clinicians Joe Carlisle MA, LPC; NRBH Page 36 of 70 Joe Carlisle MA, Professional Counselor has fifteen years in mental health with ten years being a member of the Assertive Community Treatment team working primarily with individuals that are dually diagnosed with alcohol and substance abuse as well as severe mental illness. Maria Diaz,MSW, NRBH Maria Diaz is a member of the Multi-cultural service team where she has experience working with adults and children in a bi-lingual, bi-cultural approach. She provides care for Spanish- speaking adults in the forensic system and the necessary oversight and reporting. Job Title: Mental Health Therapist Reports to: Program Director Salary Range: $31,050 to 47,817 Annually FLSA Status: Exempt Position Summary: Provides on-going assessment, crisis intervention, individual, family, and group therapy as well as case management. Develops and monitors service plans, monitors treatment progress, documents interactions and maintains clinical records and other reporting data for consumers with mild to severe mental illness, disorders and or disabilities. Coordinates with internal as well as external supportive services to deliver needed services to consumer. Collaborates with clinical supervisor and psychiatrist regarding treatment. Essential Duties: • Provide services to clients as assigned by Administrative/Clinical Supervisor. • Provide/facilitate a wide variety of individual, family and group therapeutic and rehabilitative activities to achieve goals of services/treatment plan; • Conduct crisis intervention via telephone, and face-to-face treatment. Intervene and de- escalate crisis situations with clients. Assess risk of harm to self or others and arrange needed resources. • Observe clients in a variety of situations; Assess mental status of consumer; formulate treatment plans and goals; Perform case management services as needed to assist client to meet their goals as stated in their service/treatment plans; Refer clients/consumers to supportive services such as vocational, medical, social services, housing authority, etc. • Advocate for consumers in many different forums including at the federal, state and local court systems,with family, school system etc.; • Assist consumers in improving their well-being and quality of life by training in behavioral skills; educate consumers to make informed choices; develop consumer coping skills; help consumers to problem solve and negotiate tasks of daily living. • Maintain close and cooperative relationships with community agencies and other public agencies in carrying out treatment/service plans. • Perform other duties as assigned Other Duties and Responsibilities: May instruct and supervise students serving internships. May conduct inpatient/outpatient therapy. Page 37 of 70 May visit clients/consumers in their homes. May provide specialized therapy play_music May work with clients in various/specific aged groups to May complete 72 hour hold and provide other 27-10 services as allowed by statute. May be called upon to restrain clients in certain environments May have on call duty or emergency services duty May provide intake, inpatient admissions and Medicaid authorization May use center vehicle to transport consumers May be called upon to occasionally make formal presentations or public speaking engagements as representation for NRBH, LCMH, NBH May do psychological testing May do clinical supervision of unlicensed staff Job Requirements: Skills and Ability: • Ability to provide treatment and case management in routine and crisis situations • Able to visually assess responses to mental illness or reaction to medications such as hand tremors,tongue rolling, color of skin, eyes following hallucinations, size of pupils for substance abuse, etc. • Ability to read, analyze, and interpret related professional periodicals,journals, technical procedures or government regulations. • Strong/effective verbal and written communications skills • Able to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems • Time management and prioritizing of work load Minimum Qualifications: Experience: • 2-5 years experience in the Mental Health Field/Program of application. • Demonstrated ability to plan and use effective interventions with clients. • Solid working knowledge of and demonstrated ability to use current diagnostic system • Experience in coordinating mental health intervention plans and services with other agencies Education & Licensure: • BA Degree or equivalent in bicultural field from accredited College or University, or extended clinical training and applicable experience. • Masters Preferred • Bilingual Preferred • Licensed Professional Counselor in appropriate discipline for Program of application desired. • Valid Colorado Drivers License • Driving record that meets with hiring requirements as set forth for someone that must transport clients/consumers Page 38 of 70 Physical Demands: • Employee is regularly required to sit, stand, bend, talk, and hear. Working Conditions: This position is exempt(Not eligible for overtime) This position's workload is based on a hour workload This position may include additional hours beyond 40 hours per week Direct service hours to be determined with supervisor is the minimum caseload size for this position. Carolina Belloso, BA, CACII, MA Candidate; IGRTC Carolina Belloso has a BA in Psychology and Spanish, a CAC II and is projected to graduate in August 2007 with an MA in Community Counseling. Carolina has training and experience working with domestic violence perpetrators. Ms. Belloso is currently working at Island Grove Treatment Center as a bilingual counselor providing substance abuse treatment, co-facilitating domestic violence groups, and providing Hepatitis C testing for high-risk clients. She is concurrently working on her internship at North Range Behavioral Health where she is gaining experience in the mental health field. Job Title: Counselor II-B Position Classification: Non-Exempt Direct Supervisor: Program Manager for Outpatient Services Position(s) Supervised: None Salary Range: $32,177.60 to $41,204.80 annually Job Summary: The counselor is responsible for providing individual and group counseling, assessments, case management and continued charting of clients' progress. Minimum requirements: 1. BA with two years experience at date of hire or CAC II; or MA with one year experience at date of hire 2. Valid Colorado Driver's License 3. Good communication skills,both oral and written 4. Strong inter-personal skills required. Ability to work effectively with a variety of individuals in a positive, supportive, cooperative manner 5. Knowledge and understanding of addiction and recovery process 6. Employee is bound by Federal Confidentiality Laws and Regulations; the Colorado Department of Human Services, Standards of Practice for Alcohol and Drug Counselors; and any rules, regulations and policies implementing HIPAA requirements whether now or hereafter existing. 7. One year free from alcohol or drug abuse and from any illicit drug activity. 8. Adheres to Employee Conduct/Ethical Standards 9. The employee must have successfully completed a Colorado Bureau of Investigation background check, Child Abuse Registry background check, and UA drug screen. Employment is contingent upon passing CBI and Child Abuse Registry background checks, and UA drug screening. 10. Bilingual, fluent in Spanish Page 39 of 70 Job Duties: 1. Screening, Intakes, and Assessment of clients with required instruments in required format within appropriate time lines 2. Facilitate Counseling Groups as assigned 3. Individual counseling as assigned 4. Develop written treatment plans/updates and continuing care plans and make appropriate referrals 5. Crisis intervention with clients 6. On-call duties as required 7. Monitoring Antabuse, Breathalyzers, and other medication as required 8. Case management as indicated 9. Charting in accordance with ADAD regulations and Signal procedures 10. Complete written discharge summaries and correspondence within established time lines 11. Attend staff meetings/clinical supervision and other required meetings as assigned 12. Facilitate family counseling as appropriate 13. Other duties as assigned by the Program Manager and/or Director Job Specific Duties: • May conduct alcohol and drug individual and group counseling services independently • A CAC II may perform the complete range of duties associated with alcohol and drug abuse treatment, with the exception of clinical supervision. • Review of client charts. • Observation of clinical practice—minimum of once every six months • Direct clinical supervision at a minimum of two hours per month by a CAC III or other clinical professional who has demonstrated competency equivalent to a CAC III in alcohol and drug treatment or has passed the NAADAC NCAC II exam in the past 5 years • DOMESTIC VIOLENCE SUPERVISON AT A MINIMUM OF 4 HOURS PER MONTH Adjunct Staff Jose Vasquez, Nurse Prescriber Working with the project team on a part-time basis is Jose Vasquez, prescribing nurse practitioner, also bicultural and bilingual. Linda Baum, PhD, Psychologist Linda Baum is a Licensed Psychologist with sixteen years of testing and evaluation experience and secretarial staff yet to be determined. Alice McPherson, LPC Alice McPherson a Licensed Professional Counselor working at the Weld County Jail will participate on the team as an evaluator. She can draw on 20 years experience in mental health. Section I—Confidentiality and Participant Protection Identified foreseeable risks or adverse effects: The primary risk identified is the need to implement agreements with all the legal entities to ensure the participant's rights are protected within the legal processes and that the diversion agreement is upheld by the treatment providers and the District Attorney's office. Since these clients will be facing prosecution and there is a high likelihood that during the treatment process Page 40 of 70 participants could disclose information about the crime or other crimes that they may have committed which could be used against them in court. The diversion agreement will be developed to limit information disclosed from the treatment team. The information will be limited to the following: • Attendance and participation • Results of Drug/Alcohol screening tests • Status of the client's housing, employment, school, etc. • Risk assessment results • Concerns for community safety • Recommendations for disposition of the case • Current Illegal Activity Clearly,this agreement has risks should a major crime come to light and a court order be given; testimony beyond these elements could then be required. However, since we are focusing on individuals involved with only minor criminal issues, this will be unlikely and will happen rarely. The diversion agreement will contain a clause to this effect. Plans identified to provide guidance and assistance in the event there are adverse effects to participants. The MOUs with the District Attorney, Public Defender and Judicial System will outline the intent of the project and agreement regarding expectations. The basic Diversion Agreement will be approved by all of these key players prior to implementation. Description of the target population and reasons for inclusion/exclusion criteria. Description of how and who will recruit and select participants. The target population will be men and women with an active diagnosis of a substance abuse and/or mental health disorder who are incarcerated or at risk of incarceration for non- violent,minor crimes. The crimes will typically be things like trespassing, possession, public intoxication, vagrancy, panhandling, etc. This population has been chosen as the most likely to succeed and the least likely to present a risk to the community. As stated in the body of the proposal,jail counselors and jail personnel will provide an initial screening that will identify potential clients. The project staff will provide the full clinical and risk assessment. The assessment will include a review of criminal and clinical records, client interviews and accessing information from collaterals in the individual's life including family, employer, or probation/parole officers. Individuals will be excluded that do not have a diagnosable mental illness and/or substance abuse. Other exclusionary criteria will be unwillingness to participate in the project. People with major crimes or people who present as a significant risk to the community will be excluded from the program and individuals who are later identified as being a risk to the community will be discharge from the program for safety reasons. Is participation voluntary or required? Participation will be voluntary. Description of data collection procedures, including sources and settings Data pertinent to the clinical care will be collected from agencies and legal entities identified as being involved with the participant. The participant will be asked to sign appropriate release of information forms to access this information. This information will be primarily used to make assessment and provide clinical care. No identifying information will be used in reports about the program. The reported information will include data such as diagnosis, age, marital status,number and type of arrests, previous treatment, living situation, and Page 41 of 70 employment status. The clinical record will be maintained in the electronic medical record at NRBH. All of this data can be extracted through simple reporting processes. The clients will participate in random drug and alcohol screening and the results will be used to adjust the treatment plan and may lead to consequences up to and including discharge from the program. Annually throughout the project, a client satisfaction survey will be given and will ask clients to give feedback regarding their experience. The data from the client satisfaction survey will be reviewed by the Project Advisory Committee and may lead to modifications to the project. Satisfaction Surveys will also be given to the agencies and judicial entities involved to determine how the project is proceeding from the prospective of key players. How the project will ensure privacy and confidentiality of participants'records, data collected, interviews, and group discussions. The clinical and program records will be maintained within the electronic medical record at NRBH. The database will also be maintained through NRBH's Planning and Evaluation Director. Both NRBH and IGRTC have been treatment providers for 30+ years and are fully compliant with all state and federal confidentiality laws and rules. Information will be shared with the Advisory Group in reports. No identifying information will be provided as part of that report. Description of the process for obtaining and documenting consent from participants. At the point of assessment, release of information forms will be requested to the district attorney, public defender or attorney,past treatment providers, family and other parties identified by the client. A consent for provide the assessment will be obtained prior to the client interview. Once the assessment is complete and the client has been accepted, a diversion agreement will be developed outlining the rights and responsibilities of the participant and the consequences should they fail to follow-through. It will be signed by all involved parties. Discussion of why risks are reasonable. The key stakeholders agree that treatment is a preferable alternative to incarceration for the individuals identified for this project. The community benefits through addressing jail over- crowding and rehabilitating these individuals to be productive, tax-paying citizens. The clients will benefit by receiving necessary treatment to recover from their illness and by gaining the opportunity to avoid prosecution. Appendix 1: The Statement of Assurance and letters of commitment/support. Page 42 of 70 D Kit OFFICE OF BOARD OF COMMISSIONERS PHONE: 970-336-7204 FAX: 970-352-0242 915 10TH STREET WI I p P.O. BOX 758 C. GREELEY, COLORADO 80632 COLORADO March 12, 2007 Dear Grant Application Reviewer: The Board of County Commissioners fully supports Weld County's application for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve the continuum of substance abuse and mental health services for Weld County. We have has worked directly with many of the agencies and departments involved in this grant, including Island Grove Regional Treatment Center, North Range Behavioral Health, and the county entities and departments involved, including the sheriff, probation, and district attorney. In lieu of incarceration, this project will further the partnerships between these organizations and will assist this community in its efforts to develop an effective continuum of care for people with substance abuse or mental health disorders. We plan to work closely with this project as it progresses and to participate in the interagency collaboration efforts to ensure its success. We are confident that these efforts will positively impact our community. Should you have any further questions, please contact any of us at 970-336-7204. Very truly yours, i Jli ciE David E. Long, Chair y2 Will' -I. erg, ro T m William F. Garcia: Robert D. Masden Douglas a macher cc: Don Warden 3d c037 ,7aY?-O735' q3 xi NINE NT Al: RIOT (970) 351-7300 of U OX Extension 5410 GRE 62 -0138 Far (970) 3564356 4( tlat ve 4 March 9, 2007 Dear Grant Application Reviewer, The 19th Judicial District fully supports Weld County's application for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve the continuum of substance abuse and mental health services for Weld County. This judicial district uses the services of many of the agencies and departments involved in this grant, including Island Grove Regional Treatment Center and North Range Behavioral Health and the county entities and departments involved, including the • sheriff, probation, and district attorney. This project will further the partnerships among these organizations and will assist this community in its efforts to develop an effective continuum of care for people with substance abuse or mental health disorders in lieu of incarceration. The court plans to work closely with this project as it progresses and cooperate with the interagency collaboration efforts to ensure its success. We are confident that these efforts will positively impact our community. Please let me know if you need any further information from our district. Sincerely, -� II Ie Rog Klein Chief Judge 114 island rove er% • regional treatment center 1 140 M Street 1260 H Street 145 First Street 212 West Mountain Avenue 1250 N.Wilson Avenue Greeley,CO 80631 Greeley,CO 80691 Fort Lupton,CO 80621 Fort Collins,CO 80521 Loveland,CO 80537 (970)356-6664 (970)351-6678 (303)857-6365 (970)493-1157 (970)669-1700 March 13, 2007 Dear Grant Application Reviewer: - Island Grove Regional Treatment Center fully supports Weld County's application, for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve the continuum of substance abuse and mental health services for Weld County. Island Grove Regional Treatment Center has worked directly with many of the agencies and departments involved in.this grant, including North Range Behavioral Health, and the county entities and departments involved, including the sheriff, probation, and district attorney. • This project will further the partnerships between these organizations and will assist this community in its efforts to develop an effective continuum of care for people • with substance abuse or mental health disorders in.lieu of incarceration. • We plan to work closely with this project as it progresses and to participate in the' interagency collaboration efforts to ensure its success. We are confident that these efforts will positively impact our community. Should you have any further questions, please contact me at 970-313-1186 or , kalexanderCcD,,islandg rovecenter.orq. Sincerely, - Kendall P. Alexander Executive Director • • "Solutions for Living" North. Colorado 7r Health Alliance A COMMUNITY PARTNERSHIP SERVING NORTHERN COLORADO March 9, 2007 Monfort Children's Clinic North Colorado Family Medicine North Colorado Medical Dear Grant Application Reviewer, Center—Banner Health North Range The North Colorado Health Alliance fully supports Weld County's Behavioral Health application for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve substance abuse and mental health services for Sunrise Community Weld County. Health Center Weld County Department The North Colorado Health Alliance works directly with many of the of Public Health agencies and departments involved in this grant, including Island Grove Regional Treatment Center, North Range Behavioral Health and the county entities and departments involved. Our Mission: This project will further the partnerships between these organizations, will Expanding Access assist this community in its efforts to develop an effective continuum of Improving Qualitycare for people with substance abuse or mental health disorders in lieu of incarceration. Eliminating Disparities We plan to work closely with this project as it progresses and to participate in the interagency collaboration efforts to ensure its success. We are confident that these efforts will positively impact our community. Island Grove Regional Treatment Center,Inc. Should you have any further questions, please contact me at North Colorado Medical 970.313.1140. Center Foundation NCMC,Inc. Sinc re , United Way of Weld County University of Northern Colorado- el, College of Health&Human Sciences Michael Bloom Chief Executive Officer Weld County Medical Society Weld County Board of Commissioners 1260 H Street Greeley,CO 80634 970-313.1133 a ^I North Range Behavioral Health March 19, 2007 Dear Grant Application Reviewer, Recognizing that untreated mental illness and addictions have heavily influenced the rapid growth of inmates in the Weld County Jail and its being much overcrowded, North Range Behavioral Health, Island Grove Regional Treatment Center and Weld County, with the full support of the District Attorney and the Chief Judge of the 19`h Judicial District, the Chief Probation Officer and a host of other community agencies, have come together to address this most serious problem. While Weld County is the official sponsor of the Targeted Capacity Grant application, the proposed project represents the combined efforts of a number of individuals and agencies in Weld County. Over the past number of years North Range Behavioral Health has worked in partnership with all of the agencies involved in this project. Our partnerships in the past have been limited to two-party agreements to coordinate services to those involved with both agencies. The current effort represents a much broader approach, however, by including many more agencies whose common goal is to provide the necessary array of services to reduce the number of days people with mental illness and addictions spend in the county jail. We fully understand that our efforts will only be successful if all agencies involved in the lives of individuals in the targeted population are working together. We must work together to assure community safety, to assure that there are no gaps in needed services, and that no services are overlapping or conflicting. I sincerely hope that the reviewers of this proposal recognize the need for this project, the commitment of the partners to make it successful, how it can have an enormous positive impact on the lives of individuals served, and the significant cost savings that will be another important outcome. Needless to say, we plan to work closely with this project as it progresses and to participate in the interagency collaboration efforts to ensure its success. We are confident that these efforts will positively impact our community. Sincerely, Wayne A. Maxwell, Ph.D. Executive Director Mission Statement: North Range Behavioral Health provides professional, culturally competent mental health services for Weld County. 1306 11(h Avcnuc/Grccicv.CO 80631 /(9711 347-2120/Fax(9711 353-39(16 . ' youe,ei POLICE DEPA RTMENT City of PUBLIC SAFETY BUILDING,919 7TH STREET,SUITE E,GREELEY,COLORADO 80631 •(970)350-9605 Greeley March 16, 2007 Dear Grant Application Reviewer: The Greeley Police Department fully supports Weld County's application for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve the continuum of substance abuse and mental health services for Weld County. In our city we have a large number of persons with mental illness, some of whom end up incarcerated because few other options are available. This is not only bad for the individual concerned; it also has an extremely negative impact on a criminal justice system that is already overtaxed. This grant opportunity represents a real chance to fix a broken system. Greeley Police Department has worked directly with many of the agencies and departments involved in this grant, including Island Grove Regional Treatment Center and North Range Behavioral Health and the county entities and departments involved, including the sheriff, probation, and district attorney. This project will further the partnerships between these organizations and will assist this community in its efforts to develop an effective continuum of care for people with substance abuse or mental health disorders in lieu of incarceration. Collaboration and cooperation are highly valued in our jurisdiction. We plan to work closely with this project as it progresses and to participate in the interagency collaboration efforts to ensure its success. We are confident that these efforts will positively impact our community. Please consider this letter as representing the strongest possible support for this grant application. We need and seek your valuable assistance. Should you have any further questions, please contact me at 970-350-9665. QSi�ncue�rely,9 / /�}v(*` `.• Jerry Garner Chief of Police SERVING OUR COMMUNITY • I T ' S A TRADITION �— We promise to preserve and improve lEie yeal y°P ilefor✓Yreefey IA ou9Fi timely, courteous any/Cost effective service. j • ay:rot �w DEPARTMENT OF PROBATION SERVICES T :O Nineteenth Judicial District: Serving Weld County 4.0 j Kevin Nelan, Chief Probation Officer 1.06 Adult 8 Juvenile Probation Weld County Alcohol Unit 934 Ninth Avenue 934 Ninth Avenue Greeley, CO 80631 Greeley, CO 80631 (970)392-4589 (970)392-4588 (970)351-8695[fax] (970)351-8695[fax] March 13, 2007 Dear Grant Application Reviewer, The 19th Judicial District Probation Department wholly supports Weld County's application for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve the continuum of substance abuse and mental health services for the County of Weld. Our Probation Department has worked directly with all of the agencies and departments involved in this grant, including Island Grove Regional Treatment Center, North Range Behavioral Health as well as county entities and departments involved, including the sheriff, and district attorney. This project will advance and further develop the partnerships between these organizations and will assist this community in its labors to grow an effective continuum of care for people with substance abuse or mental health disorders in instead of jailing them. Jail overcrowding is an issue throughout the country, which has been very difficult to address. The cost to the county, the safety issues it causes in the jails as well as the difficulty in addressing these defendants' behaviors in a locked setting demonstrates the need for a project of this type. The criminal justice system is overwhelmed in the sheer numbers of individuals being involved with it in some capacity. These efforts to divert people from becoming more entrenched in criminal behavior will benefit the Courts, the District Attorney's office, the Probation Department and our community as a whole. We plan to participate directly with this project as it progresses and to contribute in the interagency collaboration efforts to ensure its success. I believe that this program will assist defendant's with issues of this type to be released from a locked setting to address these issues, and it will also give them an opportunity to be productive citizens within our community. I am also confident that these efforts will positively influence our community as a whole. If you have, any questions please feel free to contact me at (970)392-4589 extension 4500. Sincerely, it kftu ire. Kevin A. Nelan Chief Probation Officer So Sheriff john a Cooke 1950 O Street Greeley, CO 90631 ty March 16 2007 Dear Grant Application Reviewer, I fully support Weld County's grant application targeting capacity expansion for Jail Diversion Programs by improving the continuum of substance abuse and mental health services for Weld County. I believe this grant will reduce the demand for detention space by making more efficient and effective use of community substance abuse and mental health resource placement alternatives. My staff and I have worked collaboratively with many agencies and departments in the development of this grant. Some of the participants include the Island Grove Regional Treatment Center, North Range Behavioral Health, the Chief District Court Judge, the District Attorney, the Public Defender's Office and members of the Board of Weld County Commissioners. This project will further these collaborative partnerships. My staff and I have been, and will continue to be, an integral part of this project to ensure its success. We are confident that these efforts will positively impact our community. Should you have any further questions, please contact me at (970) 356-4015. Si cerely, S riff John B. Cooke Weld County Sheriffs Office 1950"O"Street Greeley,CO 80631 Phone(970)356-4015 Fax(970)304-6467 5M ?its sunrise COMMUNITY HEALTH. INC. A aW Dental A s bra CNak Lovebird Colima y Hata Center Neon Mahn"Clint SmNe Cmmmay Health Caner Weld humeral Cline March 12, 2007 Dear Grant Application Reviewer, Sunrise Community Health, Inc. fully supports Weld County's application for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve the continuum of substance abuse and mental health services for Weld County. Sunrise Community Health has worked directly with many of the agencies and departments involved in this grant, including Island Grove Regional Treatment Center and North Range Behavioral Health and the county entities and departments involved, including the sheriff, probation, and district attorney. This project will further the partnerships between these organizations and will assist this community in its efforts to develop an effective continuum of care for people with substance abuse or mental health disorders in lieu of incarceration. We plan to work closely with this project as it progresses and to participate in the interagency collaboration efforts to ensure its success. We are confident that these efforts will positively impact our community. Should you have any further questions, please contact me at (970) 304-2377. Sincerely, i�I Ill / tWtn.---�� Mitzi Moran Executive Director Sunrise Community Health, Inc. (it La H.10 DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 WEBSITE: www.co.weld.co.us ii ADMINISTRATION: (970) 304-6410 FAX: (970) 304-6412 PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420 FAX: (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415 COLORADO FAX: (970) 304-6411 March 16, 2007 Dear Grant Application Reviewer, The Weld County Department of Public Health fully supports Weld County's application for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve the existing continuum of community-based substance abuse and mental health services for individuals in Weld County who will be diverted from jail. The health department has a long history of successfully working directly with many of the agencies and departments participating in this grant application, including Island Grove Regional Treatment Center and North Range Behavioral Health, and our sister county offices and departments, including the Sheriffs Office, Probation, Social Services, and the Office of the District Attorney. An example of our department's existing collaborations include the work we do with the Department of Social Services in lending our health expertise to our community's youth risk assessment team. We have also worked closely with both the regional treatment center and the community mental health agencies on providing medical testing for infectious diseases in high-risk populations in our community. The project proposed in this application for funding will strengthen the partnerships between these critical agencies and also assist our community in further developing an effective, research-based, accessible, sustainable continuum of care for people with substance abuse and/or mental health disorders in lieu of incarceration. We plan to work very closely with our partners as this diversion project progresses and to fully participate in the interagency collaboration efforts to ensure the project's long term success. We are confident that these efforts will positively impact our community. Should you have any further questions, please contact me at 970-304-6410, extension 2104. Sincerely, Mark E. Wallace, MD, MPH Executive Director 53 (c:‘,0c ltiTy Weld County TitDistrict Attorneys Office Kenneth R. Buck-District Attorney Nineteenth Judicial District Philip M. Clark-Assistant District Attorney �3'Jh ilk a ' , A7'tO March 21, 2007 Dear Grant Application Reviewer: As the District Attorney for the 19th Judicial District, please accept this letter of support regarding Weld County's application for Targeted Capacity Expansion Grants for Jail Diversion Programs. The District Attorney's Office has long-standing relationships with area agencies involved in this grant including the Weld County Sheriff's Office, the Greeley Police Department, North Range Behavioral Heath, and Island Grove Regional Treatment Center. These agencies are aware of the problems created when people with mental illness or addictions end up in the criminal justice system. There is no disagreement among these agencies that some people would be better served by diversion programs rather than by jail time. The motto of this office is "Assuring public safety in the community while seeking justice in the courtroom." We are aware, however, that justice can be served through diversion programs as well. Diversion programs serve two primary purposes: they allow people to receive the help they need in order to get on track with their life and be a productive member of our community, and they allow us to keep our limited jail space reserved for the criminals who truly require incarceration. The District Attorney's Office will continue to work closely with these community agencies to find alternative ways to help people who would be best served through diversion programs. Each agency involved in the grant application is committed to the success of such diversion programs—we all understand that the success is essential to the wellness of our community. Thank you for your consideration, Sincerely, Kenneth R. Buck Weld County District Attorney Post Office Box 1167•915 Tenth Street•Greeley, CO 80632 • (970)356-4010• FAX(970) 352-8023 , la. 'i i OFFICE OF THE STATE PUBLIC DEFENDER ': COLORADO PUBLIC DOUGLAS K. WILSON DEFENDER STATE PUBLIC DEFENDER a 4 c^ THAT JUSTICE ESCAPE NONE ESTABLISHED 1970 #e*`f March 23, 2007 Re: Weld County Jail Diversion Project To Whom It May Concern: This letter of support is written with respect to the Weld County Commissioners" proposal for the Weld County Jail Diversion Project. I write as the Office Head for the Greeley Regional Office of the Colorado State Public Defender system. This office handles the majority of court appointments for indigent clients charged with criminal offenses in Weld County. A large percentage of our clients suffer from either or both mental health and substance addiction issues. Many of these clients spend unnecessarily long periods incarcerated due to the lack of workable alternatives. I strongly support the concept of a diversion program that would focus on treatment and supervision of individuals suffering from mental health and/or substance addiction issues. A diversion program that emphasizes treatment and supervision rather than incarceration will benefit these individuals, the judicial system and the community. Very T Yours, Kevin L. Strobel Office Head Greeley Regional Office GREELEY REGIONAL OFFICE • 822 7T" STREET, #250 • GREELEY, COLORADO 80631 PHONE: (970) 353-8224 • FAX: (970) 352-8293 AP OFFICE OF THE MAYOR sty ci Greeley 1000 10th Street, Greeley, Colorado 80631 (970) 350-9774 March 19, 2007 Dear Grant Application Reviewer: The City of Greeley fully supports Weld County's application for Targeted Capacity Expansion Grants for Jail Diversion Programs to improve the continuum of substance abuse and mental health services for Weld County. The City of Greeley has worked directly with many of the agencies and departments involved in this grant, including Island Grove Regional Treatment Center and North Range Behavioral Health and the County entities and departments involved, including the Sheriff, Probation, and District Attorney. This project will further the partnerships between these organizations will assist this community in its efforts to develop an effective continuum of care for people with substance abuse or mental health disorders in lieu of incarceration. We plan to work closely with this project as it progresses and to participate in the interagency collaboration efforts to ensure its success. We are confident that these efforts will positively impact our community. Should you have any further questions, please contact our office at 350-9774. Sincerely, �/ XwZ, t Thomas E. Selders Mayor CA)Ss L'ickAALLQ Don Feldhaus Ed Phillipsen Carrol Martin Mayor PPro-TTem, Ward III Council�/ MMemberWardII Council Member At Large / hALL. j Jo Branham Debbie Pilch Pim Shaddock Council Member Ward I Council Member Ward IV Council Member At Large SERVING OUR COMMUNITY • I T ' S A TRADITION 're,promise to preserve and improve die v•iiaf y ofllefor✓9 eeley IAAou96ctimely courteous anticosi effective service. 5io Appendix 2: Data Collection Instruments/Interview Protocols The data collection will take place primarily through the electronic health record at NRBH as outlined in the body of the application. The risk assessment is being developed with the help of the Colorado Mental Health Institute—Pueblo's Forensic Unit and has not yet been finalized. Interview Questions Current age Age of 1st Conviction Age of Pt Violent Conviction Number of Juvenile Convictions Prior release failures Elopements/Escapes Compliance with community supervision Violent episodes or cycles Stability of family upbringing Abuse /Neglect as child Mental disorders and treatment history Substance abuse history Frequency/Intensity/Duration of substance abuse Stability of relationships with significant others Community Supports Living environment upon release Violent lifestyle Criminal personality style Criminal attitude Impulsivity Cognitive distortions Page 57 of 70 Appendix 3: Sample Consent Forms WELD COUNTY DIVERSION PROJECT CLIENT INFORMATION SHEET TODAY'SLast Name Segal) First Name Middle Dual Mutlm/AKA DATE Check type: ❑Biete Social Admission O Mid-yeJar Update� ❑Annual Mental Status Gelder Omupanm Home Phone Os❑M 0 W OD❑Sep ❑Male OF w.le Shea Address City Lousy State Ap Mailing Address City County State Lip Spuse armhGuardtan Name Address Phone Came mer's Employer Address Phone Rrspmable Patty's Employer Address Phone In Case of Pmergmey,Notify Address Phone Relabmfiip Is he or she aware you are haze?❑ Yes OEM MEDICAL AND INSURANCE INFORMATION Name of Physician Address Phone Will Insurance Be Used Toward Payment of This Account? ❑Yes(Copy of Insurance Card) ❑No Primary Insurance ❑Medicare❑Medicaid ❑Orher Insurance Co. Address Phone ouo P a tnatwe Dale Behavioral Health Co. Address Phone Secondary Insurance❑Medicare riMedicaid ❑other Insurance Co. Address Phone Fr a I II Effective Date Behavioral Health Co. Address Phone FOR OFFICE USE ONLY TYPE(S)/FUNDING SOURCE(S) FEEIS)/INSURANCE Clinician fl Fl MENTAL HEALTH Clinician Name SUBSTANCE ABUSE Insurance Copay:$ DX nEwluation Only O Outpatient Deductible $ Admission Date ❑UA Screening ❑Breathalyzer #of Sessions Authorized: Consumer's P O Detox O Outpatient Office f�l ACT/IDDT Types) FAMILY FALY INCOME I❑I Acute Treatment Session Length Annual Income$ ❑Residential/Housing Auth.# Number of Family Members I-1 Other Proof of Income I CONSENT TO TREATMENT: I understand the fee policy and certify the above information I have provided is complete and accurate to the best of my knowledge. I hereby apply for evaluation offered to me and/or members of my household by North Range Behavioral Health and/or Island Grove Regional Treatment Center. I am aware that the practice of medicine(mental health and substance abuse treatment)is not an exact science,and I acknowledge that no guarantees have been made to me as a result of treatment through the Weld County Jail Diversion Project. I hereby agree to these conditions. Consumer or Guardian Signature/Date ower o Homey mania esponsl l Ity ate itness ignature ate CONSUMER HANDBOOK: I have received a copy of the Weld County Diversion Project Handbook. I have had the Consumer Rights,Confidentiality laws and exceptions,Disclosure of therapist's credentials,the Grievance Procedure,and the Health Information explained to me and I have had an opportunity to ask any questions I had about the handbook. Signature Date Witness Signature Date Page 58 of 70 Weld County Diversion Plan Client Name _ Client# Plan covers period from To Care Coordinator: Charges to be Deferred Penalties Possible I will reside at I agree to the following restrictions I agree to regular contact with at least times per ISSUES AND GOALS Issue# My Current Situation is: My Goal is: I will know I am successful when: Issue# My Current Situation is: My Goal is: I will know I am successful when: Issue# My Current Situation is: My Goal is: I will know I am successful when: Page 59 of 70 Interventions/Services: Modality/Service Provider Name(s) Frequency Duration Case Management Intervention: #1 Check types: ['Advocacy❑Monitoring/Follow-up❑Service Planning['Crisis Management DReferral❑Linkage With Whom(Person,Agency) Frequency Duration Case Management Intervention: #2 Check types: ['Advocacy DMonitoring/Follow-up❑Service Planning['Crisis Management['Referral❑Linkage With Whom(Person,Agency) Frequency Duration Case Management Intervention: #3 Check types: DAdvocacy❑Monitoring/Follow-up❑Service Planning❑Crisis Management❑Referral❑Linkage With Whom(Person,Agency) Frequency Duration Case Management Intervention: #4 Check types: DAdvocacy❑Monitoring/Follow-up['Service Planning['Crisis Management❑Referral❑Linkage With Whom(Person,Agency) Frequency Duration Page 60 of 70 - I have been offered the opportunity to participate in treatment through the Weld County Diversion Project and I understand that I am agreeing to treatment in lieu of prosecution or as an alternative to incarceration. I understand that if I fail to follow through with treatment I face the consequences listed above.I have been involved in the development of this Diversion Agreement Plan and I agree to follow it. — Further,I understand that certain information will be shared with the courts,District Attorney and/or other entities involved in the oversight of my legal case. I have signed a release of information to each applicable agency. This information includes, attendance and participation compliance, results of drug and alcohol screening,status of my housing,employment,school,etc.,risk assessment result,concerns I pose to community safety,CURRENT illegal activity that I am involved in,and the project team's recommendations. — Further,I understand that my failure to comply with this agreement will result in the following consequences: 1. 2. 3. 4. 5. 6. And/or prosecution of my case and/or return to incarceration. My signature indicates my agreement with everything in this plan. Client Signature Date Guardian Signature Date Our signatures indicate our agreement with everything in this plan Care Coordinator Signature Date District Attorney Signature Date Defendant's Attorney Signature Date Probation/Parole Officer's Signature Date Supervisor Signature Date Page61 of70 Appendix 4: Letter to the SSA(if applicable; see Section IV-4 of this document) Not applicable Appendix 5: A copy of the State or County Strategic Plan, a State or county needs assessment, or a letter from the State or county indicating that the proposed project addresses a State- or county-identified priority. See next page Page 62 of 70 �c OFFICE OF BOARD OF COMMISSIONERS PHONE: 970-336-7204 FAX: 970-352-0242 915 10TH STREET P.O. BOX 758 C. GREELEY, COLORADO 80632 COLORADO March 23, 2007 To: Grant Application Committee Members On behalf of Weld County it is my pleasure to recommend this application for funding. Not only does this grant address a primary countywide priority, but it also enables both law enforcement and mental health workers to come together to better serve one of the fastest growing segments of our county correctional facility. Consistent with national trends, the growth of the Weld County jail population is stretching our ability to provide jail facilities, and it is challenging our limited resources. The funding of this grant will enable resources to directly benefit those in need, while at the same time decrease recidivisms and utilization of the county jail in favor of a more appropriate placement. Most specifically, this grant has been developed around four keys, goals, or objectives, to ensure a successful outcome. The goals of the project are as follows: 1. Reduce the average jail days served by inmates identified as having substance abuse/mental health issues per year by 30% 2. Reduce recidivism of substance abuse/mental health inmates by 30% 3. Successfully engage 80% of enrolled clients in the project as measured by consistent attendance and/or successful termination 4. Provide comprehensive integrated dual disordered treatment to a minimum of 50 former inmates Should you have additional questions and or concerns, I am happy to visit with you regarding our support for this grant. I may be reached at the above address and telephone number. Sincerely, BOARD OF COUNTY COMMISSIONERS `l '� William H. Jerke, Chair Pro Tem (03 ASSURANCES - NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, (e) the Drug Abuse Office and Treatment Act of and the institutional, managerial and financial 1972 (P.L. 92-255), as amended, relating to capability (including funds sufficient to pay the non- nondiscrimination on the basis of drug abuse; (f) the Federal share of project costs) to ensure proper Comprehensive Alcohol Abuse and Alcoholism planning, management and completion of the project Prevention, Treatment and Rehabilitation Act of described in this application. 1970 (P.L. 91-616), as amended, relating to 2. Will give the awarding agency, the Comptroller General nondiscrimination on the basis of alcohol abuse or of the United States, and if appropriate, the State, alcoholism; (g) §§523 and 527 of the Public Health through any authorized representative, access to and Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 the right to examine all records, books, papers, or ee-3), as amended, relating to confidentiality of documents related to the award; and will establish a alcohol and drug abuse patient records; (h)Title VIII proper accounting system in accordance with of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et generally accepted accounting standard or agency seq.), as amended, relating to non-discrimination in directives. the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or statute(s) under which application for Federal presents the appearance of personal or organizational assistance f ayf is being i made; and (j) the requirements whhma conflict of interest, or personal gain. of any other pplicatiomination statute(s) which may apply to the application. 4. Will initiate and complete the work within the 7. Will comply, or has already complied, with the applicable time frame after receipt of approval of therequirements of Title II and III of the Uniform awarding agency. Relocation Assistance and Real Property 5. Will comply with the Intergovernmental Personnel Act Acquisition Policies Act of 1970 (P.L. 91-646) which of 1970 (42 U.S.C. §§4728-4763) relating to provide for fair and equitable treatment of persons prescribed standards for merit systems for programs displaced or whose property is acquired as a result funded under one of the nineteen statutes or of Federal or federally assisted programs. These regulations specified in Appendix A of OPM's requirements apply to all interests in real property Standard for a Merit System of Personnel acquired for project purposes regardless of Federal Administration (5 C.F.R. 900, Subpart F). participation in purchases. 6. Will comply with all Federal statutes relating to 8. Will comply with the provisions of the Hatch Act nondiscrimination. These include but are not limited (5U.S.C. §§1501-1508 and 7324-7328) which limit to: (a) Title VI of the Civil Rights Act of 1964 (P.L.88- the political activities of employees whose principal 352) which prohibits discrimination on the basis of employment activities are funded in whole or in part race, color or national origin; (b) Title IX of the with Federal funds. Education Amendments of 1972, as amended 9. Will comply, as applicable, with the provisions of the (20U.S.C. §§1681-1683, and 1685- 1686), which Davis-Bacon Act (40 U.S.C. §§276a to 276a-7), the prohibits discrimination on the basis of sex; (c)Section Copeland Act (40 U.S.C. §276c and 18 U.S.C. 504 of the Rehabilitation Act of 1973, as amended (29 §874), and the Contract Work Hours and Safety U.S.C. §§794), which prohibits discrimination on the Standards Act (40 U.S.C. basis of handicaps; (d) the Age Discrimination Act of y§as 1975, as amended (42U.S.C. §§6101-6107), which labor standards for federally assisted 7- 333), regarding construction subagreements. prohibits discrimination on the basis of age; Page 64 of 70 10. Will comply, if applicable, with flood insurance 13. Will assist the awarding agency in assuring purchase requirements of Section 102(a) of the Flood compliance with Section 106 of the National Disaster Protection Act of 1973 (P.L. 93-234) which Historic Preservation Act of 1966, as amended (16 requires recipients in a special flood hazard area to U.S.C. §470), EO 11593 (identification and participate in the program and to purchase flood protection of historic properties), and the insurance if the total cost of insurable construction Archaeological and Historic Preservation Act of and acquisition is $10,000 or more. 1974 (16 U.S.C. §§469a-1 et seq.). 11. Will comply with environmental standards which may 14. Will comply with P.L. 93-348 regarding the be prescribed pursuant to the following: (a) institution protection of human subjects involved in research, of environmental quality control measures under the development, and related activities supported by National Environmental Policy Act of 1969 (P.L. 91- this award of assistance. 190) and Executive Order (EO) 11514; (b) notification 15. Will comply with the Laboratory Animal Welfare of violating facilities pursuant to EO 11738; (c) Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. protection of wetland pursuant to EO 11990; (d) §§2131 et seq.) pertaining to the care, handling, evaluation of flood hazards in floodplains in and treatment of warm blooded animals held for accordance with EO 11988; (e) assurance of project research, teaching, or other activities supported by consistency with the approved State management this award of assistance. program developed under the Costal Zone 16. Will comply with the Lead-Based Paint Poisoning Management Act of 1972 (16 U.S.C. §§1451 et seq.); Prevention Act (42 U.S.C. §§4801 et seq.) which (f) conformity of Federal actions to State (Clear Air) prohibits the use of lead based paint in Implementation Plans under Section 176(c) of the construction or rehabilitation of residence Clear Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground structures. sources of drinking water under the Safe Drinking 17. Will cause to be performed the required financial Water Act of 1974, as amended, (P.L. 93-523); and and compliance audits in accordance with the (h) protection of endangered species under the Single Audit Act of 1984. Endangered Species Act of 1973, as amended, (P.L. 18. Will comply with all applicable requirements of all 93-205). other Federal laws, executive orders, regulations 12. Will comply with the Wild and Scenic Rivers Act of and policies governing this program. 1968 (16 U.S.C. §§1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. SIGNATURE OF A H IZED CERTIFYING OFFICIAL TITLE coei Chair, Board of Weld County Commissioners APPLICANT ORGANIZATION DATE SUBMITTED Weld County, Colorado 03/21/2007 Page 46.oc 7O OMB Approval No.0920-0428 CERTIFICATIONS 1. CERTIFICATION REGARDING DEBARMENT 2. CERTIFICATION REGARDING DRUG-FREE AND SUSPENSION WORKPLACE REQUIREMENTS The undersigned (authorized official signing for the The undersigned(authorized official signing for the applicant organization) certifies to the best of his or her applicant organization) certifies that the applicant knowledge and belief, that the applicant, defined as the will, or will continue to, provide a drug-free work- primary participant in accordance with 45 CFR Part 76, place in accordance with 45 CFR Part 76 by: and its principals: (a) Publishing a statement notifying employees (a) are not presently debarred, suspended, proposed that the unlawful manufacture, distribution, for debarment, declared ineligible, or voluntarily dispensing, possession or use of a controlled excluded from covered transactions by any substance is prohibited in the grantee's work- Federal Department or agency; place and specifying the actions that will be taken against employees for violation of such (b) have not within a 3-year period preceding this prohibition; proposal been convicted of or had a civil (b) Establishing an ongoing drug-free awareness judgment rendered against them for commission program to inform employees about-- of fraud or a criminal offense in connection with (1) The dangers of drug abuse in the obtaining, attempting to obtain, or performing a workplace; public (Federal, State, or local) transaction or (2) The grantee's policy of maintaining a drug- contract under a public transaction; violation of free workplace; Federal or State antitrust statutes or commission (3) Any available drug counseling, rehabil- of embezzlement, theft, forgery, bribery, itation,and employee assistance programs; falsification or destruction of records, making and false statements, or receiving stolen property; (4) The penalties that may be imposed upon employees for drug abuse violations (c) are not presently indicted or otherwise criminally or occurring in the workplace; civilly charged by a governmental entity (Federal, (c) Making it a requirement that each employee to State, or local) with commission of any of the be engaged in the performance of the grant be offenses enumerated in paragraph (b) of this given a copy of the statement required by certification; and paragraph(a) above; (d) Notifying the employee in the statement (d) have not within a 3-year period preceding this required by paragraph (a), above, that, as a application/proposal had one or more public condition of employment under the grant, the transactions (Federal, State, or local) terminated employee will-- for cause or default. (1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her Should the applicant not be able to provide this conviction for a violation of a criminal certification, an explanation as to why should be placed drug statute occurring in the workplace no after the assurances page in the application package. later than five calendar days after such The applicant agrees by submitting this proposal that it conviction; will include, without modification, the clause titled (e) Notifying the agency in writing within ten "Certification Regarding Debarment, Suspension, In calendar days after receiving notice under eligibility, and Voluntary Exclusion--Lower Tier paragraph (d)(2) from an employee or Covered Transactions" in all lower tier covered otherwise receiving actual notice of such transactions (i.e.,transactions with sub- grantees and/or conviction. Employers of convicted employees contractors) and in all solicitations for lower tier must provide notice, including position title, to covered transactions in accordance with 45 CFR Part every grant officer or other designee on whose 76 grant activity the convicted employee was working, unless the Federal agency has designated a central Page 66 of 70 point for the receipt of such notices. Notice shall signed, to any person for influencing or attempting include the identification number(s) of each to influence an officer or employee of any agency, a affected grant; Member of Congress, an officer or employee of (0 Taking one of the following actions, within 30 Congress, or an employee of a Member of Congress calendar days of receiving notice under in connection with the awarding of any Federal paragraph (d) (2), with respect to any employee contract, the making of any Federal grant, the who is so convicted-- making of any Federal loan, the entering into of any (1) Taking appropriate personnel action against cooperative agreement, and the extension, such an employee, up to and including continuation, renewal, amendment, or modification termination, consistent with the of any Federal contract, grant, loan, or cooperative requirements of the Rehabilitation Act of agreement. 1973, as amended; or (2) Requiring such employee to participate (2) If any funds other than Federally appropriated funds satisfactorily in a drug abuse assistance or have been paid or will be paid to any person for rehabilitation program approved for such influencing or attempting to influence an officer or purposes by a Federal, State, or local health, employee of any agency, a Member of Congress, an law enforcement, or other appropriate officer or employee of Congress, or an employee of agency; a Member of Congress in connection with this (g) Making a good faith effort to continue to Federal contract, grant, loan, or cooperative maintain a drug-free workplace through imple- agreement, the undersigned shall complete and mentation of paragraphs (a), (b), (c), (d), (e), submit Standard Form-LLL, "Disclosure of and(f). Lobbying Activities," in accordance with its instructions. (If needed, Standard Form-LLL, For purposes of paragraph (e) regarding agency "Disclosure of Lobbying Activities," its instructions, notification of criminal drug convictions, the DHFIS has and continuation sheet are included at the end of this designated the following central point for receipt of such application form.) notices: (3) The undersigned shall require that the language of Office of Grants and Acquisition Management this certification be included in the award documents Office of Grants Management for all subawards at all tiers (including subcontracts, Office of the Assistant Secretary for Management and subgrants, and contracts under grants, loans and Budget cooperative agreements) and that all subrecipients Department of Health and Human Services shall certify and disclose accordingly. 200 Independence Avenue, S.W., Room 517-D Washington, D.C. 20201 This certification is a material representation of fact 3. CERTIFICATION REGARDING LOBBYING upon which reliance was placed when this transaction was made or entered into. Submission of this Title 31, United States Code, Section 1352, entitled certification is a prerequisite for making or entering into "Limitation on use of appropriated funds to influence this transaction imposed by Section 1352, U.S. Code. certain Federal contracting and financial transactions," Any person who fails to file the required certification generally prohibits recipients of Federal grants and shall be subject to a civil penalty of not less than cooperative agreements from using Federal $10,000 and not more than $100,000 for each such (appropriated) funds for lobbying the Executive or failure. Legislative Branches of the Federal Government in connection with a SPECIFIC grant or cooperative 4. CERTIFICATION REGARDING PROGRAM agreement. Section 1352 also requires that each person FRAUD CIVIL REMEDIES ACT(PFCRA) who requests or receives a Federal grant or cooperative The undersigned (authorized official signing for the agreement must disclose lobbying undertaken with applicant organization) certifies that the statements non-Federal (non-appropriated) funds. These herein are true, complete, and accurate to the best of requirements apply to grants and cooperative his or her knowledge, and that he or she is aware agreements EXCEEDING $100,000 in total costs (45 that any false, fictitious, or fraudulent statements or CFR Part 93). claims may subject him or her to criminal, civil, or The undersigned (authorized official signing for the administrative penalties. The undersigned agrees applicant organization) certifies, to the best of his or that the applicant organization will comply with the her knowledge and belief,that: Public Health Service terms and conditions of award if a grant is awarded as a result of this application. (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the under- Page 67 of 70 5. CERTIFICATION REGARDING Failure to comply with the provisions of the law ENVIRONMENTAL TOBACCO SMOKE may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the Public Law 103-227, also known as the Pro-Children imposition of an administrative compliance order on Act of 1994 (Act), requires that smoking not be the responsible entity. permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used By signing the certification, the undersigned routinely or regularly for the provision of health, day certifies that the applicant organization will comply care, early childhood development services, with the requirements of the Act and will not allow education or library services to children under the age smoking within any portion of any indoor facility of 18, if the services are funded by Federal programs used for the provision of services for children as either directly or through State or local governments, defined by the Act. by Federal grant, contract, loan, or loan guarantee. The law also applies to children's services that are The applicant organization agrees that it will require provided in indoor facilities that are constructed, that the language of this certification be included in operated, or maintained with such Federal funds. The any subawards which contain provisions for law does not apply to children's services provided in children's services and that all subrecipients shall private residence, portions of facilities used for certify accordingly. inpatient drug or alcohol treatment, service providers The Public Health Services strongly encourages all whose sole source of applicable Federal funds is grant recipients to provide a smoke-free workplace Medicare or Medicaid, or facilities where WIC and promote the non-use of tobacco products. This coupons are redeemed. is consistent with the PHS mission to protect and advance the physical an mental health of the American people. SIGNAT E OF AUTHORIZED CERTIFYING OFFICIAL TITLE CMS( C \ Chair, Board of County Commissioners David E. Long APPLICANT ORGANIZATION DATE SUBMITTED Weld County, Colorado 03/21/2007 Page 66 of 70 DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB 0348-0046 Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action 3. Report Type: a. contract a. bid/offer/application b. grant b. initial award c. cooperative agreement c. post-award For Material Change Only: d. loan e. loan guarantee Year f. loan insurance date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee,Enter Name and Address of Prime: ❑ Prime ❑ Subawardee Tier ,if known: Congressional District,if known: Congressional District,if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,if applicable: 8. Federal Action Number,if known: 9. Award Amount,if known: 10.a.Name and Address of Lobbying Entity b. Individuals Performing Services(including address if different (if individual,last name,first name,Ml): from No. 10a.)(last name,first name,MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying Signature: activities is a material representation of fact upon which reliance was placed by the tier above when this transaction Print Name: David E. Long was made or entered into. This disclosure is required — pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for Title: Chair, Board of County C issioners public inspection. My person who fails to file the required disclosure shall be subject to a civil penalty of not less than Telephone No.: (970)356-4000 $10,000 and not more than$100,000 for each such failure. 4i94 wJAP9d, z�r,tf '�ed�r��U$tk�D� �, Page j9 of 70 OMB Approval No.0920-0428 CHECKLIST Public Burden Statement: Public reporting burden of this collection of Clearance Officer, 1600 Clifton Road, MS D-24,Atlanta, GA 30333,ATTN: information is estimated to average 4 - 50 hours per response, PRA(0920-0428). Do not send the completed form to this address. including the time for reviewing instructions, searching existing data NOTE TO APPLICANT: This form must be completed and submitted with sources, gathering and maintaining the data needed, and completing the original of your application. Be sure to complete both sides of this form. and reviewing the collection of information. An agency may not Check the appropriate boxes and provide the information requested. This conduct or sponsor, and a person is not required to respond to a form should be attached as the last page of the signed original of the collection of information unless it displays a currently valid OMB control application.This page is reserved for PHS staff use only. number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Noncompeting Competing Type of Application: ® NEW 0 Continuation 0 Continuation ❑ Supplemental PART A:The following checklist is provided to assure that proper signatures,assurances,and certifications have been submitted. NOT Included Applicable 1. Proper Signature and Date for Item 18 on SF 424(FACE PAGE) 2. Proper Signature and Date on PHS-5161-1 "Certifications" page. 3. Proper Signature and Date on appropriate"Assurances"page, i.e., SF-4246 (Non-Construction Programs)or SF-424D (Construction Programs) 4. If your organization currently has on file with DHHS the following assurances, please identify which have been filed by indicating the date of such filing on the line provided. (All four have been consolidated into a single form, HHS Form 690) ❑ Civil Rights Assurance(45 CFR 80) ❑Assurance Concerning the Handicapped(45 CFR 84) ❑Assurance Concerning Sex Discrimination(45 CFR 86) ❑Assurance Concerning Age Discrimination(45 CFR 90& 45 CFR 91) 5. Human Subjects Certification,when applicable(45 CFR 46) O PART B:This part is provided to assure that pertinent information has been addressed and included in the application. YES NOT Applicable 1. Has a Public Health System Impact Statement for the proposed program/project been completed and distributed as required? O 2. Has the appropriate box been checked for item#16 on the SF-424(FACE PAGE) regarding intergovernmental review under E.O. 12372?(45 CFR Part 100) 3. Has the entire proposed project period been identified in item#13 of the FACE PAGE? 4. Have biographical sketch(es)with job description(s)been attached,when required 0 O 5. Has the"Budget Information"page, SF-424A(Non-Construction Programs)or SF-424C (Construction Programs), been completed and included? 6. Has the 12 month detailed budget been provided? 0 O 7. Has the budget for the entire proposed project period with sufficient detail been provided? 0 O 8. For a Supplemental application, does the detailed budget address only the additional funds requested? O 9. For Competing Continuation and Supplemental applications, has a progress report been included? O PART C: In the spaces provided below,please provide the requested information. Business Official to be notified if an award is to be made. Program Director/Project Director/Principal Investigator designated to direct the proposed project or program. Name Donald Warden Name Jacki Kennedy Title Director of Administration and Finance Twe Adult Services Director Organization Weld County Government Organization North Range Behavioral Health Address 915 10th Street Address 1310 11th Ave. E-mail Address dwarden@co.weld.co.us E-mail Address jacki.kennedy@northrange.org Telephone Number 970-356-4000 Telephone Number 970-347-2495 Fax Number 970-352-0242 Fax Number 970-392-1354 APPLICANT ORGANIZATION'S 12-DIGIT OHMS EIN(If already assigned) SOCIAL SECURITY NUMBER HIGHEST DEGREE EARNED 522-86-3443 MA Page 70 of 70 Hello