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Home My WebLink About20071692.tiff RESOLUTION RE: APPROVE TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR HOME BASED INTENSIVE (OPTION B) SERVICES WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with two Notification of Financial Assistance Awards for Home Based Intensive (Option B) Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and various providers, listed below,commencing June 1,2007,and ending May 31, 2008, with further terms and conditions being as stated in said awards: 1. Reflections for Youth, Inc. 2. Nelson, Wolf, and Associates, P.C. WHEREAS, after review, the Board deems it advisable to approve said awards, copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, ex-officio Board of Social Services, that the two Notification of Financial Assistance Awards for Home Based Intensive (Option B) Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and various providers, listed above be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said awards. 2007-1692 SS0034 (l' ; SS Di-//- U 7 TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR HOME BASED INTENSIVE (OPTION B) SERVICES PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 18th day of June, A.D., 2007, nunc pro tunc June 1, 2007. BOARD OF COUNTY COMMISSIONERS V�D COUNTY, COLORADO ATTEST: l i�a; o vid E. Long, Chair Weld County Clerk to the Bo'• 1861 r GZ✓l. .q i;r` r afn H. ek , Profe BY: Deputy C to the Boar. \ � illi F Garcia APP D AS TO cb, 1b)/ Robert D. Masden ouhty Attorney 7-7-o7 Dougl s Radema her Date of signature: 2007-1692 SS0034 citisH43/44%), (eVii DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 OFax Number(970)353-5215 • COLORADO MEMORANDUM TO: David E. Long, Chair Date: June 14, 2007 Board of County Commissioners FR: Judy A. Griego, Director, Social Services. RE: Notification of Financial Assistance Award ith Various Contractors— Home Based Intensive (Option B) Services Enclosed for your approval are Notification of Financial Assistance Awards with Various Contractors for Home Based Intensive(Option B) Services. The Department and the Families, Youth, and Children (FYC)Commission are recommending approval of these Awards. These Awards were reviewed at the Board's work session of June 6,2007. The major provisions of these Awards are as follows: 1. The Award period is June 1, 2007 through May 31, 2008. 2. The source of funding is Core Services or Child Welfare Administration. 3. The Contractors will provide home based intensive(Option B)therapy services to families involved in the child welfare system. 4. The Contractors include: A. Reflections for Youth, Inc. $94.36 hourly rate home based services $80.00 hourly rate court testimony B. Nelson, Wolf&Associates $105.11 hourly rate home based services $65.00 hourly rate court testimony If you have any questions, please telephone me at extension 6510. J O n "C- M c m--i O - cm� w 2007-1692 Weld County Department of Social Services Notification of FinancialAssistance Award for Core Funds Type of Action Contract Award No. X Initial Award 07-CORE-68 Revision (FY-FYC-07005; 003-OPB-07) Contract Award Period Name and Address of Contractor Beginning 07/01/2007 and Reflections for Youth, Inc. Ending 05/31/2008 Option B-Home Based Intensive Services 1000 S. Lincoln Avenue#190-200 Loveland, CO 80537 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Program offers therapeutic services in the form Assistance Award is based upon your Request for of parenting skills,problem solving and conflict Proposal(RFP). The RFP specifies the scope of resolution,parent-child conflict management and services and conditions of award. Except where it is Solution Focused Family Therapy to increase in conflict with this NOFAA in which case the skills training and access to other community NOFAA governs,the RFP upon which this award is agencies. Workload of eight families based is an integral part of the action. concurrently.All services will be provided within Special conditions 20 hours,not to exceed a three-month period of 1) Reimbursement for the Unit of Services will be time per family. Bicultural services provided. based on an hourly rate per child or per family. 2) The monthly rate will be paid for only direct face to face contact with the child and/or family or as Cost Per Unit of Service specified in the unit of cost computation. Hourly Rate Per 3) Unit of service costs cannot exceed the hourly and Treatment Package $94.36 yearly cost per child and/or family. Treatment Package Low (Court Testimony) $80.00 4) Payments will only be remitted on cases open with, and referrals made by the Weld County Department of Social Services. Requests for payment must be an original submitted to the Weld County Department of Social Services by the end of the 25th calendar day following the end Enclosures: of the month of service.The provider must submit X Signed RFP: Exhibit A requests for payment on forms approved by Weld _Supplemental Narrative to RFP: Exhibit B County Department of Social Services. Requests for Recommendation(s) payments submitted 90 days from the date of service, X Conditions of Approval and thereafter,will not be paid. 5) The Contractor will notify the Department of any changes in staff at the time of the change. Approvals: Program Official: By A By ir David E. Long, Chair Jud . Grie ,Direct Board of Weld Count Commissi ers Wel County Department of Social Services Date: JUN 1 8 2007/ Date: EXHIBIT A SIGNED RFP 003-OPB-07 _ ORIGINAL INVITATION TO BID BID 001-07 DATE: February 28, 2007 BID NO: 001-07 RETURN BID TO: Monica Mika, Director of Administrative Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 Third floor, Centennial Building, Purchasing Department SUMMARY Request for Proposal for: Colorado Family Preservation Act—Core Services Program Deadline: Friday, March 30, 2007, 10:00 a.m. (MST) The Families, Youth and Children Commission, an advisory commission to Social Services, announces that competing applications will be accepted for approved providers pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act (C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2007,through May 31, 2008, at specific rates for different types of service, the County will authorize approved providers and rates for services only. This program announcement consists of the following documents, as follows: • Invitation to Bid • Main Request for Proposal (All program areas) • Addendum A—Program Improvement Plan Requirements (by program area) • Addendum B—Scope of Services (by program area) • Core Budget Form Delivery Date 30\07A- (After receipt of order) BID MUST BE SID IN INK Program Area: V\jMe.-ta bQh(5l.] (� \ Q _ TYPEDàLSLTURE VENDOR ()0,00I cy (Name) Handwritten Signature By Authorized Officer or Agent of Vendor ADDRESS \RD S. k_wci L J • i\co-loo TITLE U)rka WCANyA1,C�, / `N.1ellr4..0 Cp 8 S3+- DATE PHONE # ( ��) 1vy. \z4 The above bid is subject to Terms and Conditions as attached hereto and incorporated. ' Program Area Supervisor/Provider Meeting Verification/Comment Form Date of Meeting: 7-CI Program Area: hill t YL4 L ?ill Qom' 8 Comments (to be completed by Program Area Supervisor): - - �- L' • --k_ 7 / 1Y )-F /ry},cu r t /Lt h'ti A �r l t ([7( *It,t I LC E( L lj�(' �i % CC 7,); Y Li ' : : � C cry-..ec k 4L,t ytzt A/ rrCiftrtic - ftV ji;dIIiL/_Ct.) . 00—ktt_ Ca ->/sXri ) (1 r,i ) L € ) Signature of Program Area Supervisor Table of Contents Home-Based Intensive Services Option B Invitation to Bid no page number Verification/Comment Form no page number Abstract/Program Description 1 -2 Target/Eligibility Populations 2 -3 Projective Narrative/Supporting Documentation 3 Types of Service Provided 3-4 Measurable Outcomes 4-5 Service Objectives/P.I.P 5-6 Workload Standards 6-7 Staff Qualifications 7 Program Capacity per Month 7-8 Internal Tracking and Billing Process 8 Supporting Documentation 8 Evidenced-based Outcomes/Literature Citation 8-9 Confidentiality and Participant Protection/Human Subjects 9-11 Budget 11 Unit of Rate Computation 11 Program Budgets 12 Direct Service Costs 13 Admin Costs Non-Face-to-Face 14 Overhead Costs and Profits 15 Appendix 1 Resumes for key staff members 16-25 Appendix 2 Data Collection Instnunents/Protocols 26 Appendix 3 Sample Consent Form 27-31 Attachments following Evaluation Plan following Certificate of Insurance following • Reflections for Youth, Inc. "Discovering the Power of Positive Choice" Weld County Home-Based Intensive Family Intervention Program RFP-FYC-001-07 03-28-07 (Currently being offered and to continue services through 05-31-08) Abstract/Project Description Title of project: Home-Based Intensive Family Intervention Mission and Purpose Reflections for Youth will provide intensive home-based family interventions to children and adolescents in an effort to prevent out-of-home placement or to transition such youth back into the family system from placement. Youth transitioning back into the home after completion an out-of-home placement will transition with an Aftercare Plan/Agreement. The Aftercare Plan/Agreement includes an aftercare treatment plan to include family, social, emotional, spiritual,physical, legal (if applicable), educational (if not completed with high school diploma or GED), work/employment, financial, transportation, relapse prevention planning, substance abuse (if applicable), a home contract to be completed with family and an overall support contract. Design Families with children who are at risk for out-of-home placement and returning from placement to home will receive home-based services. All services will be home-based unless it is determined that a safety issue requires that services be provided outside the home. Families will be assessed through a thorough Psycho-Social and Risk Assessment to determine strengths and needs. Reflections will provide services for up to 10 client families at a time, including the youth transitioning from the residential program and in need of aftercare support. There may be the potential to serve more families as resources become available. Reflections will provide at least 20 hours of service over the course of three months. • Start-up: Reflections will gather information from the caseworker through a face-to- face meeting or phone contact to determine what are seen as important treatment issues within the family and for the youth(s) being served. Reflections clinical staff or the Weld County caseworker will complete the psychosocial assessment and determine strengths and needs, as well as the development and use of base-line measures on areas related to the out-of-home placement criteria, i.e., abuse/neglect/ domestic violence, substance abuse, mental illness, and danger to self and others in the community(Risk Assessment Measure). Interventions will be determined based on results of assessment and will include re-parenting/parenting skills/parent role modeling, problem solving, communication skills, and parent-child conflict management. Families will be assisted in attaining access to other community 1 agencies including mental health, drug and alcohol services, educational systems and recreational programs. At start-up, service will be from 2 to 3 hours per week. • Mid-Service: Assessment of progress, assessment of skill development, ability of family to implement and utilize skills and additional interventions as needed. At mid-service Reflections will be providing 2 to 3 hours of service per week. • End-Service: Determine family's ability to utilize skills in all areas addressed and attainment of appropriate community service support, i.e., mental health, drug and alcohol services, educational systems and recreational programs. Discuss treatment transitions as needed at this time. At end-service hours will be 1 to 2 hours per week. Reflections will use licensed therapists, masters level therapists with two years of experience and bachelor's level counselors with at least three years of experience as required by Staff manual volume VII Section 7.303.17 and section 7.3006,q. Each family will receive a case management plan within 30 days of initial contact with the family. The case management plan will be based on the results of the psycho-social and risk assessments and will take into consideration the family strengths. The plan will include at a minimum: goals, goal timelines and a measurement of success. Copies of this case management plan will be sent to the caseworker and the supervisor of the program area(C.O.R.E. or other area) Thereafter, a monthly report will be provided that describes presenting problems of the client family, specific services provided, extent of client's participation and commitment to the program, clients progress to date, any new areas of concern, and the anticipated date of discharge. Reflections will contact the case worker a minimum of two times a month to provide updates on any concerns and progress. Fifteen days after the final service to client, a discharge summary will be provided to social services that describes service outcomes and, if needed, recommendations for further support services. Target/Eligibility Populations: Reflections for Youth, Inc. agrees to work with a total of eight families at a time. Family constellations may include one child up to an undetermined number of children per family with at least one child at risk for out-of-home placement or returning to home from out-of-home placement. Based on our program description, it is our plan is to provide all services within 20 hours not to exceed a three-month period of time per family. Services will be provided in an intense nature in the first few weeks of service (2 —4 hours per week) and then in a less intense nature as service continues and the time of termination approaches. This is designed so that the family becomes more self-reliant as time progresses and less reliant on the Home-based specialist. Reflections will provide for a total of 32 families per calendar year. All families will be able to receive bicultural services but bilingual services will only be provide if Reflections can employ a Family Intervention Specialist that is able to speak a second 2 language. Reflections currently employs two interpreters to assist with family communication on an as needed basis. Generally this has included attending meetings, family therapy and other communication between the program and the family. All families will receive cultural/ethnically specific services. Services will be offered as often as possible on a 24-hour basis to client families living in all parts of Weld County, provided they are within one hour of the city of Loveland. RFY will provide services to south Weld County clients. Families will be able to have 24-hour support through access to the two-tiered emergency support system that Reflections for Youth, Inc. has in place for all of its' clients. PROGRAM NARRATIVE/SUPPORTING DOCUMENTATION I. Types of Services to be provided: Therapeutic Services will be provided in the form of parenting skills, problem solving and conflict resolution,parent-child conflict management and Solution Focused Family Therapy to decrease conflict in the home and increase communication and positive outcomes though skills training, education and access to other community agencies including mental health, drug and alcohol services, educational systems and recreational programs. Concrete services will be provided through specific programs that educate parents, and improve listening and communication skills between children and parents. Techniques utilized will involve hands-on parenting, limited Structural Family Therapy, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy,role plays and/or family exercises to enhance the understanding of these skills and dynamics. Collateral services will be provided though communication with caseworker and other community services to provide access or encouragement to utilize community services, i.e., mental health, drug and alcohol, educational, medical/dental/psychiatric, domestic violence/crisis intervention, etc. The Family Intervention Specialist employed by RFY will assist the family in access to these services and in"how to ask for help". Crisis Intervention: An on-call 24-hour service to all clients will be provided. Measurement of goals as described in the case management plan will be reported in monthly progress reports. Reports will highlight goal attainment and skill development along with decreases in concerned areas as originally identified. Based on needs as determined in assessments, all families may have access to any of the four outlined services: therapeutic, concrete, collateral and crisis intervention at any time during the duration of service. All service components can be offered as part of the 20-hours of face-to-face support for the family over the course of the contracted referral. Based on experience, in most cases all service components will be offered to varying degrees. The number of families to be served is no more than (8) eight at any given time and an average of 32 families over the course of a year. 3 Through the initial assessments Reflections will work to determine services already being made available to the family. With two contacts (minimum)per month with caseworkers, we will address newly identified concerns or problems that may require additional resources that are not within our purview of service or that may require a request for a program extension. Reflections will work to ensure that services provided and resources will not supplant available resources in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. This will be worked on with the support and knowledge of the referring caseworker and Weld County DSS. Reflections for Youth, Inc. currently works in collaboration with the Weld County Department of Social Services to provide residential treatment services, day treatment services and home based family intervention services. Our routine collaboration occurs with the caseworker asking for the services, Weld County core service caseworker, PRT team as needed and any other individuals involved in the child's family's life. If a client is receiving or will receive services from North Range Behavioral Health, we will make every effort to communicate with them regarding therapeutic needs and work to involve them in aftercare planning, including obtaining a release (example attached) and forwarding on a discharge summary including continuing recommendations for the client served. If needed, referral information for Greeley/Weld Housing Authorities and Employment Services of Weld County is provided. In addition we agree to provide court testimony services on an as needed basis. The cost of court testimony is $80.00/hr. II. Measurable Outcomes • Program will be considered successful as youth remain in the family home, hopefully permanently, but for a minimum of 12 months after the home-based family service has been provided. • Improvements in parental competency and skills, i.e., problem solving skills, communication, decrease in parental/child conflicts and other problematic behaviors as identified will be measured through a pre test during initial start-up and post test at the end-stage of services, as well as observation and self-report throughout the period of service. • For youth at risk for out-of-home placement and for those youth returning home from out of home placement, it will be the goal of our program at discharge to assure that all families have access to community services within Weld County in an effort to keep the child in the home permanently and for a minimum of 12 months after the 4 completion of our services. • Parental skill levels will be evaluated in a pre and post test and though clinical observation of hands-on parenting with the goal of preventing further instances of abuse or neglect. The program goal is to not have a substantiated abuse or neglect case hopefully permanently, but for a minimum of 12 months after participating in family preservation services. The risk assessment measure will indicate improvement in all areas of needs as indicated in the initial assessment. Reflections will evaluate measure and monitor our quantitative measures through observation, self-report of clients, monthly case management progress reports, collateral meetings, completion of any homework assignments given to family, crisis counseling interventions, and goal progress and attainment. III. Service Objectives • Solution focused interventions will be used with the goal of increasing overall parental skills, parental knowledge of child developmental areas, communication, logical and reasonable rules, consequences and expectations to improve and/or eliminate escalated conflicts with emotional discord between parents and children that may lead to child maltreatment,running away, low level criminal activity and other status offenses. • Household management that affects the safety and protection of the children in the home will be measured though the increased competency of the parent in parenting skills, communication, ability to provide adequate, consistent and logical discipline, regular schedules for meals, bedtime, school attendance, homework, free time, decrease in parental conflicts with child, and self report of overall satisfaction in parent/child relationship. • Through our communication with assigned case worker,parents will be informed of all services provided in Weld County(county, state and federal) and counseling/support will be provided on how to access these services. Progress will be measured though parents ability to follow-through and access these services while the Family Intervention Specialist is still available to offer support to the family at challenging times and as they access community-based services. • Specific referral issues will be addressed prior to and through-out the treatment process. It is Reflections intent to provide all the services (within our purview) needed as identified by the Weld County Department of Social Services in the categories of collateral, concrete, therapeutic and crisis intervention services. Services will be solution focused and address issues specified by the Department of Social Services. • We will evaluate,measure and monitor our service objectives throughout the 5 treatment process with on-going observation, self-report of clients, monthly case management progress reports, contact with assigned case worker, collateral meetings, completion of any homework assignments given to family, crisis counseling interventions, and goals progress and attainment. The Home-Based Intensive Family Intervention program at Reflections will work to improve outcomes in the Performance Improvement Plan in a few key ways. First, the program will work to reduce the need for any kind of out-of-home placement for all clients served. Second, the home-based program will work to provide additional skills and new cognitions of old problems and new family systems for the caregivers and families, with the overall goal of increasing the parent's ability to cope better with the child; less chance of asking the youth to be removed to be placed in an out- of-home care placement and away from his/her family of origin. It is understood that Home Based Intensive Service Providers are to focus on the permanency needs of children in out-of-home placement, by working to preserve an at risk placement, working to reunify a child or youth with their family, and/or in preserving the continued residence of a child/youth with their family. Other than imminent danger, it is further understood that the removal of a child is a decision made by the Placement Review Team and Case Manager of the Department of Social Services, and although in extreme cases recommendations may be made by the Family Intervention Specialist, the final decision for removal is the purview of Weld County DSS and must be in line with the child's permanency plan. Third, assessments and aftercare support are part of the overall services offered by the home-based program. RFY has developed an aftercare plan to be used as part of the discharge process and to be used during and after the successful; completion of Option B services. Case planning will continuously occur and crisis intervention and support will be part of the plan. Family Intervention Specialists employed will cooperate with an applicable youth's plan for independent living and to the extent possible, will contribute to the plan through daily living skills instruction on an as needed basis. Fourth, RFY will complete needs assessments for the families that are comprehensive enough to identify as many underlying problems as possible and address them as thoroughly as possible over the course of the 20 hours of face-to-face intervention and support. The assessment will also include the needs of the parents and not just of the youth in the family. Home-based services will have a goal of addressing the needs of the caretakers/parents experiencing the problem and to increase the likelihood that the youth will stay in the home. Finally, RFY will work to maintain the cultural and racial identities of all referred families. Family Intervention Specialists will provide ethnically and culturally appropriate services. IV. Workload Standards • Based on a workload of(8) eight families at a time, Reflections will provide a minimum of 24 hours per week or approximately 100 hours per month of home-based intensive family intervention. 6 • Reflections will provide a minimum of 6 licensed therapists, master's level counselors with two years experiences or bachelor's level counselors with three years of experience all working under the umbrella of Reflections for Youth, Inc. • Maximum caseload of any one Family Intervention Specialist will be (4) four families at any given time. • Reflections for Youth, Inc. will utilize solution focused interventions that targets family strengths and educational material that increases parental knowledge in crisis management, de-escalation, communication, child development, parenting skills and discipline. Success will be measured throughout the treatment process with on-going observation, self-report of clients, monthly case management progress reports and contact with assigned case worker, clinical meetings, completion of any homework assignments given to family, crisis counseling interventions, and the goal progress and attainment. • Reflections for Youth, Inc. employs two licensed therapists with job responsibilities to provide direct service and oversee the home-based intensive family intervention program, i.e.,the maximum caseload per supervisor will be three to four service providers. The coordinator and direct supervisor for the program is a licensed LMFT. • All insurance coverage for RFY is shown on the Certificate of Liability Insurance and exceeds the amount requested in the bid proposal. Insurance coverage includes general liability, automobile liability, comp and collision, worker's compensation and employer's liability and professional liability. Weld County has been named as a certificate holder. V. Staff Qualifications • All service providers and supervisors under the umbrella of Reflections for Youth, Inc. meet the requirements as listed in Staff manual volume VII Section 7.303.17 and section 7.3006, q. The supervisors for the program will also carry a caseload. All supervisors are licensed therapist, either with licensure as a LPC, LMFT and in two cases, LCSW. All other home-based intervention specialist will have either a master's degree with two years experience or a bachelor's degree with three years experience in the field. All staff involved directly in the Option B program have knowledge of risk assessment and in some cases very thorough and complete knowledge of risk assessment. All staff employed by RFY are required to have an annual full-day class on assessing risk and suicide prevention/intervention. At the time of this contract I am unaware of the State Home-Based Intensive Family Services training component. I would very much like to have the opportunity to send all of our intervention specialists to the training. Please advise. VI. Program Capacity per Month Program capacity is(8)eight families at any one time. With services being offered 7 within a three month period of time, it is the plan of Reflections for Youth, Inc. to meet the needs of approximately 32 families per calendar year. VII. Internal Tracking and Billing Process It is understood that Reflections for Youth, Inc. is responsible for all program costs, including start-up costs, facility,personnel, operating,travel, equipment, audit and capital items. Reflections for Youth, Inc. will submit original monthly billing forms to the appropriate Department staff person on or about the 10th of the month following the service month. It is further understood that all billings must be date-stamped by Social Services by the 25th day of the month following service to be eligible for reimbursement. It is understood that Reflections for Youth, Inc. will include all of the deliverables listed in order to verify services on our monthly billing. Although not anticipated, in the event that it becomes necessary, Reflections for Youth, Inc will work with families to prepare to pay for the services beyond the established time frame and out of the scope contracted with Social Services. VIII. Evidenced-Based Outcomes/Literature Citations Reflections for Youth, Inc. as an agency and the Family Intervention Specialists working under the umbrella of Reflections for Youth, Inc. uses evidenced-based therapies and interventions as part of providing quality services to the clients served. The best supported interventions for youth and families are Cognitive Behavioral Therapy, parent training and psycho-educational strategies. Cognitive-behavioral therapies are helpful because it(they) focus on the "here and now"rather than the past, they are brief and time limited. The sessions are structured, goal-oriented, skill-based and directive,the sessions are instructional in nature, relapse prevention is built into the treatment so high risk situations can be anticipated and planned for and the end goal is having the youth and family become their own"therapist" so to speak so down the road they can deal with life's challenges, rewards and up and down nature without necessarily needing to go back to treatment each time. Parent training programs have been developed and found effective to improve child-parent interactions, enhance parenting effectiveness and reduce coercive and"unsafe" interactions. Psychoeducation is a specialized form of education aimed at helping people learn about a broad range of emotional and behavioral difficulties, their effects and strategies to deal with them. Psychoeducation is not therapy and it is designed to stand alone or to complement psychotherapy. Psychoeducation is an important part of home-based services because knowledge is crucial. With appropriate knowledge and techniques,undesirable behaviors occur less often and are less severe in duration and intensity. Knowledge and awareness result in more control over that behavior. What follows is a bibliography highlighting some of the research as it relates to the interventions used in the course of providing home-based services. 1. Juvenile Justice Bulletin—April 2000—Brief Strategic Family Therapy. Comparing Structural Family Therapy with other types of therapy. www.nyrs.gov./html/oj jdp/j jbul 2000. 8 2. E. George, C. Iveson, H. Rather; Problem to solution; brief therapy with individuals and families. BT Press, 1990. 3. Berg, I.K. (1994) Family-Based Services: A Solution-Focused Approach. New York: Norton. 4. Parenting Teenagers: Systematic Training for Effective Parenting of Teens. Don Dinkmeyer, Sr., Gary D. McKay. Circle Press, MN: American Guidance Service, 1980. 5. Don Dinkmeyer and Lewis E. Losoncy, The Encouragement Book: Becoming a Positive Person. Englewood Cliffs,N.J..: Prentice Hall, 1980. 6. Evidenced-Based Therapy: Cognitive Behavioral Therapy. www.nacbt.org/evidenced-based-therapy.htm 7. Elizabeth C. Hair, Ph.D., Justin Jager, and Sarah B. Garrett (July, 2002). Helping Teens Develop healthy Social Skills and Relationships: What the Research Shows about Navigating Adolescence. NA\A, 8. Feldman, J. & Kazdin, A.E. (1995). Parent management training for oppositional and conduct problem children. The Clinical Psychologist, 48(4), 3 —5. 9. Sanders, M.R., & Dadds, M.R. (1993) Behavioral Family Interventions. Needham Heights, MA: Allyn & Bacon. 10. Webster-Stratton, C., & Herbert, M. (1994). Troubled Families-problem children: Working with parents: a collaborative process. Chichester, England: John Wiley. IX. Confidentiality and Participant Protection/Human Subjects 1. Protect Staff and Clients from Potential Risk—There do not appear to be any foreseeable risks or potential adverse effects as a result of the project itself or any data collection activity. RFY will follow procedures to minimize participants (youth and families in day treatment program) against potential risks, including risks to confidentiality. Risks to confidentiality will be minimized by having therapy take place in designated therapy rooms and offices and with the use of a sound machine as necessary. All records, including background and intake information, education information and treatment/clinical information will be stored in locked filing cabinets and/or in locked rooms with specific access being granted for specific individuals on a need to know basis. Although not anticipated, in the event of adverse effects, the Weld County Caseworker would be contacted and a special meeting would/could be held to discuss what has occurred and the most appropriate method of dealing with the situation. All treatment and methods used within the day treatment program have previously been described. 2. Fair Selection of Participants—Target populations for the proposed project have been previously described an include youth between the ages of 11 — 18 that are in need of a structured day treatment program involving special education and therapeutic components. Other populations include siblings of the referred youth(if applicable) and bio and/or foster families members of the youth being served. The other information in this section applies to research type studies and projects and is not applicable for the purposes of the day treatment program offered to Weld County DSS by Reflections for 9 Youth, Inc. 3. Absence of Coercion—If a referred youth and his/her family is accepted into the day treatment program at Reflections then participation is required for a successful discharge and return to a lower level of care (foster home, public school, family home, etc). Without participation it is highly unlikely that any progress would be shown. In addition, it is possible that youth would be court ordered into our day treatment program. I am unclear on part II of this section and I do not believe that it applies to the day treatment services offered. 4. Data Collection—Date will be collected from the referring caseworker prior to placement and throughout the placement on an as needed basis. Data may also be collected from probation officers, previous therapists or evaluators, other professionals with involvement in the case of the youth and family being referred,past school districts and other placements if applicable. Data for testing may be collected based on the needs/requirements of the IEP with classroom observation,test taking, assignments, instruments such as the Woodcock Johnson, PIAT, BASC, etc. Prior to intake, our Educational Director, Treatment Coordinator or Day Treatment Coordinator will conduct an intake interview and collect data in order to make a decision about the overall appropriateness of the referral and to ensure that RFY can meet the needs of the youth and family being referred. All data collection instruments can be accessed by contacting RFY directly but for page limit and voluminous reasons, have not been copied. The intake interview packet alone is 10-plus pages in length. 5. Privacy and Confidentiality—The privacy and confidentiality of youth and their families will be ensured by having limited number of professionals having access to records and by having records stored in a locked confidential place at all times. Access to the information collected and information gained prior to intake will be granted only on a need to know basis and in general will include the Special Education Teacher, Educational Director, Treatment Coordinator, Day Treatment Coordinator, Executive Director and assigned Therapist. Consent and releases are signed at intake by the family (youth if age of consent and applicable) and referring caseworker. A coding system is not used but access to the records is limited and at all times records are kept in a locked filing cabinet and/or in a locked room at the administration offices of Reflections for Youth, Inc. 6. Adequate Consent Procedures—Again, most of what is covered in this section has been previously answered or is not applicable to the day treatment program at Reflections for Youth, Inc. It applies more to research studies in general than it does to providing treatment to youth and families in a structured day treatment setting. A Day Treatment Handbook and Parent Packet will be given to all program participants outlining the key components of the program, contact numbers, rights and responsibilities, consequences and rewards, expectations,phase system information, therapy information and transition from the program at program completion. Participation is voluntary in the sense that a youth is not going to be physically restrained for attempting to physically leaving the program in the course of the day and if a youth refuses to attend the program once ]0 a accepted, a decision will be made about the continued involvement of that youth in the program. It is likely that for most youth being referred there would be "problems" if they chose to not participate and top leave the project. Problems would occur in the nature of a visit from a probation officer, referral to more restrictive placement or additional requirements through the court. Reflections will work to get consent from the caseworker making the referral,the youth participating in the program and a parent or guardian. Consent for youth under the age of 15 will be given by the parent or guardian. In the event that a youth at the age of consent has reading, processing or verbal problems, the program and requirements of the program will be described in a manner in which they are able to understand. Our program does require in nearly all cases, an IQ of at least 70 to be accepted into the program. Reflections for Youth, Inc. employs two contracted interpreters to assist youth and families that do not use English as their first language in these situations. Informed consent is obtained for participation in all aspects of the program and a separate informed consent is obtained to access services from our child and adolescent psychiatrist, including prescribing of medications if needed. The consent forms can be read out loud of required and questions are asked to ensure that all parties understand what they are signing. Copies of the entire intake packet, including consents are given to the caseworker and parent or guardian at the time of the intake or as soon as possible after the intake. Again for page limit and voluminous reasons, the entire intake packet, including consents are not provided in the proposal. Again, those forms can be accessed by contacting Reflections for Youth, Inc. directly. The intake packet for day treatment is approximately 25 pages in length. 7. Risk/Benefit Discussion—Risks for participation in the day treatment program are minimal. Every precaution is taken to ensure that the environment at Reflections for Youth, Inc. fosters trust, accountability and responsibility in a safe and healthy environment. Certainly there are risks in terms of other youth in the program, the possibility of bullying and intimidation, name calling and inappropriate behavior that is experienced through direct or indirect involvement. All of these risks occur in every treatment setting and in most cases, are more prevalent in public school environment and in the community overall. The benefits of the program far outweigh the potential risks and give referred youth the opportunity to make better decisions, gain a new level of trust, show increased responsibility and independence and make it possible for the youth and family to achieve a better life and lasting success. BUDGET X. Unit of Rate Computation The hourly unit or rate computation is $94.36 per hour for 20 hours of in-home face-to- face intervention contact. The program budgets including direct service costs, administrative costs non-face-to-face and overhead costs and profits is attached. 11 U) I— Ill CI Co CD C,D CO V O0 a �' ID N of Ol yoy (C+] �yO N CO S n N N M 6 " 6 co VI 69 sil 69 CO 69 C' 0 w O re 0 K W 0 U O 0 (3 U W + 0 X O LL z K 0 � W 2 7 y w W 0 > w 00 ti O ~ LL K re w � 0 a Z O W 0 U W Q O LL ~ W w O W 2a Q = OO W U U U W LL Q W 2 H d J LL Y > Ct co IT 0 0 W ° m w r 3 N N 0 W ~ a 0 W I 0 W y H W W 0 LL Q OF Z 0 O W 0 > K 0 a' LL CO LL W OK K mm p W p O 1,7) Z' m F¢ E LL a OM W > U- ti O O ¢ K Z W LL co ® O W O Q O m O H 0 m 0 Q Q O w N Co W > 0 y _. 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S. . §§ ,, ,, ,, ,z zzzzzz wowwwww0000000 zzzzzz 000000 ��.� 88;88888888888 N 8 .8 t!#t««r&&&kg■g ( g § 50,55=a . & ■, 000828 W ■ II cle I=E !!■||!! �/ !!!„1, k ow w a § • | k ■ ( ur LL a a.2 am et | | � | E m , , BB Em O \ �ti|t$| a. k 0 . . 0 |||||| 2 w° ) - - - ) _ , / | a 0 a \ ||||| \ - - g 5 I- §| §§ § § 888888888888888888 8 2 !;&&ag;lad;aao;o;d; a 8 ▪ x. Cu,. §( 888888888888888888 8 8 8 § ca 0< a#&#«a&a;=&a&»2a#a a . . in ) f( § 0. \§ COr 888888888888888888 8 8 8 B §| ;a;#;;a&g;aa&aggg- & ; & en o 8 ! 22 r o )2 le N §i` 888888888888888888 8 8 8 LO |02 8 8 ; ;4242#;a&a&#&aa#«# a a § vi 8 .iii ! ! - - .6,0.r ei ‘co; • 0 ) |||| 0 to §§ _. wwwwo00000o0o00000 �a 8a &zzzzzzzzzzzzzz s0 8 o• go 0 a / ( | 0• 88I Ore a. - o▪ a. 0 § co 0 re r a ec o ) k § 2 § 22 1 al F Ili 202 . . | §, - . . . e \ \ phi k|1 - - - RESUME JANE E. WILLIAMS, LCSW 916 Parkview Drive Ft.Collins,CO 80525 970-206-0329 taillsouses Excellent at accessing services,assessing client needs,treatment planning,and developing relationships. Experience in parenting skills,calling on community resources,coordinating with other agencies, organizing and facilitating family participation,providing individual, family and group therapy. Strong understanding of childhood mental health issues. Specialization in play therapy, sandplay therapy,behavior management. Proactive,compassionate,energetic,independent,and resourceful. Work History 5/01-present Clinical Care Coordinator,Latimer Center for Mental Health Responsible for case management and discharge planning of all children in higher levels of care. Perform all assessments for clients requesting hospitalization,day treatment,or residential treatment, and those parents requesting residential placement under 11B 1116. Work closely with other agencies to assure that appropriate resources are available. Provide individual and family therapy to small caseload. 9%00-4/01 Therapist,Managed Adolescent Care and Hope High School Program Developed treatment plans, provided individual, family and group therapy. Provided interventions for de-escalations and crisis management. Provided case management and facilitated a parent support group meeting once-a-week. 1998-8/2000 Therapist, Pathways Schools at Hyattsville Re-entry Provided individual,family,group therapy and crisis intervention to adolescents. Developed and implemented treatment plans, provided clinical summaries, progress reports and behavioral plans. Managed program in absence of Coordinator, supervised student intern,assumed the role of instructor for certain exploratory subjects. Participated in Student Assistance Program (Substance Abuse)and Alternative Therapies. Recipient of Jim McGeogh Staff Award for the growth and development of Pathways' students. 1997-1998 Senior Clinician, Psychotherapeutic Rehabilitation Services Responsible for school-based therapeutic program providing individual and family therapy to elementary school-aged children. Provided therapeutic services to adults, children,and groups in a community mental health clinic. Supervised two clinicians. 1993-1997 Social Worker 11, P.C. Co.Health,Division of Mental Health Primary therapist for children(age 7-12),and their families. Performed evaluations, including diagnostic impressions,made referrals,developed and implemented treatment plans,handled crisis situations. Provided case management. Documented and maintained all records, prepared summary reports. Developed and implemented parenting skills classes,parent support groups,family night,etc. Monitored program,supervised staff and responded to other administrative functions in the absence of the coordinator. /989-1990 Contract Therapist and Volunteer Coordinator/Community Services Advocate, Family Crisis Center Co-led support groups for victims of domestic violence,provided intakes on an as-needed basis,performed case management,led two weekly educational and support groups. Responsible for recruitment,training and supervision of all volunteers, outreach and public speaking engagements to educate community about domestic violence. a flIM /989 B.A., Summa Cum Laude, Psychology,University of Maryland College Park 1993 M.S.W.,University of Maryland at Baltimore,Child and Family Specialization MUSES LCSW: State of Colorado 1(49 • John R.Kinnaird 419 Ord St. Laramie,Wyoming 82070 (307) 755-5285 CAREER OBJECTIVE To use my personal,academic and work experience to help individuals develop insight and solutions to their psycho-social problems. LICENSE Licensed Clinical Social Worker MLCSW-358,Approved April 2001 by the Mental Health Board of Wyoming. EDUCATION Masters of Social Work,August 1998. GPA 3.75/A=4.0. Arizona State University, Tempe, AZ. Second Degree Student,Health Sciences(Pre-Med.),June 1993-May 1994. GPA 3.9/A=4.0 University of Wyoming,Laramie, WY. B.A.,Psychology, December 1992. GPA 3.2 (cum.)3.5(psychology)/A=4.0 University of Wyoming,Laramie, WY. WORK EXPERIENCE March 1999-Present Counselor,Cathedral Home for Children,Laramie, WY. Provide individual,family and group therapy to adolescents and their parents. Weekly co-facilitation of the campus chemical dependency and sex offender groups. Developed currently used curriculum for adolescent chemical dependency program. Responsible for treatment planning,implementation and documentation for all residents. Insure that documentation for residents is to JCAHO standards. Provide supervision and in-service training for the treatment team staff. Communicate progress of residents to social workers,judges, lawyers and other involved parties. Attend admissions meeting once per week to help decide on future in-takes and to discuss discharge planning with a committee of directors,counselors and physicians. Provide supervision for Masters of Social Work Students. Aug. 1998—March 1999 Masters Level Therapist,Arizona Youth Associates,Phoenix,Al Assessed clients prior to placement in a residential setting for traumatized children.Developed and supervised therapeutic programs used by the Behavioral Health Technicians. Provided individual and family therapy for each child. Conducted therapeutic groups and social skills training. Educated staff and families on client diagnosis and therapeutic methods. Formulated each client's treatment and ensured that the plan was designed.to meet the individuals'needs. March 1998—Aug. 1998 M.S.W. Intern and Mental Health Technician, Remuda Life Program,Chandler,AZ. Worked with nurses,therapists, physicians,and dietitians in providing daily needs and long-term case planning for clients in an inpatient setting for eating disorders. Provided individual/group therapy. March 1997-March 1998 Program Director, Developmental Behavioral Consultants,Tempe, AZ. Supervision and training of Residential Managers of three therapeutic residential homes for emotionally and mentally handicapped children and adolescents. The major role of the Program Director was to oversee the total operations of these therapeutic settings. Development of programs and treatment plans. Sept. 1996—March 1997 M.S.W. Intern and Program Coordinator,Developmental Behavioral Consultants,Tempe,AZ. The development of the agency motivationaVbehavior management program for emotionally and mentally handicapped children and adolescents. Other duties included a problem analysis of staff turnover,individual counseling, development of treatment plans,and the production of new agency programs. Dec. 1994-Aug 1996 Residential Manager, Developmental Behavioral Consultants,Tempe,AZ. Supervised the implementation of treatment plans by staff in a residential setting of emotionally and for mentally handicapped children and adolescents. Educator,therapist and behavioral specialist for the six clients,their families,and all other persons involved in the clients' lives. INTERESTS Running,Golf,Fly Fishing,Health and Nutrition,Scientific Research. REFERENCES Available upon request. Jeffery Johnson, M.A., LPC 132 Yale Avenue Fort Collins,CO 80525 (970)472-9704 Objective: Position as a Director or Manager of a public or private agency responsible for providing quality services to the client population served. CLINICAL,CASE MANAGEMENT AND MANAGERIAL EXPERIENCE Three years experience providing consultation and technical assistance to management level staff on effectively implementing outcomes based system of data collection, summarization and decision making. Three years experience providing daily support,crisis intervention, family collateral sessions, and twice weekly individual therapy for adolescents attending non-public school and living in group home settings. Four years experience directing a residential treatment program including managerial and budgetary responsibilities for all aspects of the clinical, residential and educational aspects of the program. Five years experience as an agency clinical representative for adolescents involved in the court process or placed in juvenile detention centers, and for adolescents placed in a psychiatric hospital during the course of treatment. Six years experience conducting clinical interviews to assess appropriateness of prospective clients for placement within three separate treatment agencies. Eight years experience providing client assessment in the areas of residential placement, education and day treatment, individual and family therapy, goal planning development, discharge planning and any other support services important for the individuals served. Eight years experience of program implementation and hiring,training, and supervising counseling, clinical and management level staff responsible for the care and quality of life of children,adolescents and adults with special needs. Fourteen years experience as a liaison between various programs and families,mental health providers,county probation and child welfare agencies, vocational programs and school districts to ensure the best possible opportunity for client success. • EMPLOYMENT HISTORY April '00—present (continuing): Director of Operations,Monarch Youth Homes, Inc. Loveland,C) 80537. Supervisor: Scott Fardulis, CEO July '98—April '00: Mental Health Director,Monarch Youth Homes,Inc. California Deer Park, CA 94576. Supervisor: Bill Cremen, Director of Operations. June '95 —July '98: Mental Health Specialist/Day Treatment Mental Health Supervisor, La Cheim Residential Treatment Center and La Cheim School, Inc. Richmond,CA. Supervisor: Bob Garriot, Program Director and Charles Mason, School Director. June '93 —June '95: Associate Program Manager, Ohlson House, La Cheim Residential Treatment Center. Richmond, CA 94804 Supervisor: John Herkenhoff,Program Manager. July '89—March '93: Program Manager,Portland Metro Residential Services, Inc. Portland, OR 97206. Supervisor: Lisa Francolini Nov. '89—Feb. '93: Technical Assistance Consultant, Oregon Technical Assistance Corporation. Salem,OR 97305. Supervisor: Sue Stoner. Feb. '89—Sept. '89: Program Coordinator,EastCo. Diversified Services, Inc. Gresham,OR 97030. Supervisor: Tom Leeland. EDUCATION AND PROFESSIONAL CREDENTIALS University of San Francisco Master of Arts—Counseling Psychology,May 1996 University of Portland Bachelor of Arts—Psychology,May 1988 National Certified Counselor(NCC), April 1998 Licensed Professional Counselor(LPC),July 2000 American Counseling Association,Professional Member,June 1996—present Workshops, Trainings,Continuing Education Classes(not a complete list) CPR/First Aide Training Professional Assault Response Training(PART) IA • Crisis Prevention Institute Training(CPI) Medication Administration Training Medications and Medical Management HIV/AIDS Training System of Care Performance Outcomes Training Basic and Advanced Behavior Planning Child Abuse, Assessment,Reporting and Treatment Assessment and Treatment of Alcohol and Drug Problems Human Sexuality Child Sexual Abuse: Assessment and Treatment Child and Family Team Building Workshop(Wraparound Services) Anger Management/Violence Prevention Workshop Music Therapy Colorado Jurisprudence Workshop Foster Home Assessment Safe Environments in Foster Care and Residential Settings Sex Offender Treatment Reactive Attachment Disorder Assessment and Treatment Suicide Prevention References Robert Garriot,PhD. La Cheim Residential Treatment Services (415)485-5416 Bill Cremen, Monarch Youth Homes, Inc(California) (707) 291-2411 Scott Fardulis, Monarch Youth Homes, Inc. (Colorado) (970)613-4385 Mark Suprenand,Colorado Department of Human Services (303) 866-4565 • CAROL S. JOHNSON, MA 132 Yale Avenue Ft. Collins, CO 80525 (970) 472-9704 • License Marriage and Family Therapist#578 State of Colorado Marriage and Family Therapist#37606 State of California • Education University of San Francisco MA—Clinical Psychology;Dec 1994 San Francisco State University BA—Economics with a Minor in Business; May 1987 • Experience 2001 —present Grismore Trmt Cntr,Monarch Youth Homes, Loveland,CO Therapist Provide individual and family therapy to emotionally disturbed adolescents and their families. 2000-2001 V-II Logistics, Ft. Collins, CO Controller Responsible for records management; expedite A/R, A/P, payroll, journal posting, and general ledger maintenance. Produced year-end financial reports and reconciled bank statements. 1995-2000 Braun Place, Sunny Hills Children's Garden,Novato, CA Therapist Provide individual,family, group,and milieu therapy to emotionally disturbed adolescents. 1994-1995 Petaluma School District, Petaluma,CA School Counselor Provide counseling for K to 6th graders in individual and group settings. aL 1990-1994 Earl's/Johnny Love's, San Francisco, CA Controller Responsible for records management; disburse checks, expedite A/R,A/P,payroll,journal posting, and general ledger maintenance. Produced quarterly and year-end financial reports and reconciled bank statements with budget control and supervisory responsibilities. 1979-1990 San Rafael Health Foods Inc., San Rafael,CA Manager/Head Bookkeeper Involved in all aspects of fast-paced retail operations. Strong public contact position included vendor interface, ordering, shipping and receiving health products, and controlling inventory. References available upon request Mar 29 07 07: 34a Receiptionist 970-498-7613 p. 2 Jason M. Staires 4916 West ParkView Drive Fort Collins, Colorado 80526 (970)206-0395 E-Mail: horsetooth_99@yahoo.com Objective: To obtain emplo ment that utilizes my skills and experience in the field of human relations. To make a difference by influencing positive change in the community. De icated, resourseful and client centered. Skills and qualifi tions Extensive experi nce in the field of Psychology Excellent interp rsonal skills in dealing with clients, parents and other professionals Dedication to pe orming job duties with Strong verbal an written communication skills Proficient with mputers Education: Masters in Hum n Relations - Oklahoma University - 1998 Bachelor of Scie ce - Oklahoma State University - 1996 Currently in sup rvision to obtain liscensure Employment: 2000 to present North Range Behavioral Health, Greely, Colorado Mental Health erapist/Shift Leader Facilitate groups Perform intakes nd discharges Extensive case anagement Supervise work tudy employees Staffing with me ical director daily on needs of clients 1996 to1998 Th rapeutic Interpretations, Tulsa, Ok Head Counselor Developed and i plemented RTC program for Juvenille's with offense specific issues Facilitated a van ty of life skills, independent living, and offense specific groups case managem nt 1995 to 1996 Sa ctions, Tulsa, Ok Counselor Facilitated cogni ive behavioral modification groups Developed and oordinated physical activity groups Case managem nt , 03/29/2007 21:33 9706632941 PRAIRIE VIEW PAGE 01/02 Shanon Aurora Skeen St r-S 4 s t 3411r to), tarlcvft44 OQ Fort Collins,Co. 80526 (970)-206-0395 Education: OSU: Dept. of Arts and Sciences,B.A.Psychology/minor in Philosophy Oklahoma State University, Stillwater,Ok.(fall of'94-spring of'97)GPA 3.67 Tulsa Junior College Tulsa Ok.(fall of`92-spring of'94)UPS 3.5 _ Ia f to 00 -Ylno�narcA•'k, nt� H in'ts —op- .g even Y'≤! l j Work History: to vior l ealt Hop , C ' b—SPkose. s, Sept. ` -jabM itaid Cedar Sprirrt{gg�slBehavioral salt Hospital, olnra o 98 ar. '00). Lead mental health worker. Supervision of employees and residents on 2 sexual offender units and 2 conduct disorder units. Extensive documentation including charting and auditing skills. Cognitive group facilitation. Implementation of a social model program. YMCA, Colorado Springs, Co. (Aug'98-Dec. '98). Before and after school care for children ages 5-12, Recreational coordinator and tutoring. Youth Services of Tulsa, Tulsa, Ok. (Feb. '98- Aug. '98). Intake counselor and group facilitator for the Misdemeanant Alternative Program. Trained in assessment skills,extensive case-management, group facilitation. Worked in conjunction with the judicial system. Youth Services Youth Shelter,Tulsa,Ok. (Dec. '97-Feb. '98). Residential counselor. Intakes,leading groups, coordinating recreational activities, and contact reports. Street School, Tulsa,Ok. (June '97-Dec. '97). Tutor/Mentor for `special needs', State custody youth ages 12-17. Pepper's Restaurant, Tulsa, Ok. Aug `90-April '95 &June `97-Aug. '98) Mexico Joe's, Stillwater,Ok. (Aug`95-May '97) 6 years experience in a high-paced restaurant/club environment. Helped to build organizational and interpersonal Skills. Volunteer Work: Youth Services Payne County Youth Shelter, Stillwater, Ok. (June'96-Aug '96). Residential counselor(10 hours per week). , 03/29/2007 21:33 9706632941 PRAIRIE VIEW PAGE 02/02 et References (employers) Chris Valdez-Unit Coordinator 2135 Southgate Rd, Colorado Springs, Co. 80906 (719)-633-4114 ex. 1514 Larry Dalton-Program Coordinator 2105 Southgate Rd. Colorado Springs, Co. 80906 (719)-227-0213 ex. 1504 Pamela Rhodes-MAP Program Leader _. . 302 S. Cheyenne Rd. Tulsa, Ok. 74105 (918)-582.0061 (personal) John Jones-friend of family (8 yrs.) 706 Knapp Wolf Point,MT. 59201 (406)-653-1721 alC Reflections for Youth, Inc. P.O.Box 1860 Berthoud, CO 80513 970-344-1380 (p) INTENSIVE FAMILY THERAPY REPORT Client Name HH# Trails# Date Family Participants 1 Hr. Session Summary Date Family Participants 2 Hrs. Session Summary Date Family Participants 2 Hrs. Session Summary Date Family Participants 1 Hr. Session Summary TOTAL HOURS = 6 PROFESSIONAL DISCLOSURE STATEMENT Home Based Intensive Family Intervention Services Reflections for Youth, Inc. * Discovering the Power of Positive Choice * (Your name and personal information here) Philosophy and Approach to Services: Our philosophy for home based intensive family intervention services is holistic, meaning that we believe that people are made up of many parts - body, mind, emotions, will, intellect, and spirit. We believe that difficulties arise when our relationship with ourself and/or our relationships with others are out of balance, causing pain, which signals the need for help and healing. Our approach is from a systemic perspective. We believe that people work in relationship systems and each person in the relationship is important to the balance of the whole. When relationships become out of balance, it is a result of many different factors and patterns which can be examined as we work together. We place a strong emphasis on strengthening the structure of the parent/child hierarchy, developing healthy communication patterns and problem solving skills, setting natural/logical consequences, and building strong support systems. Professional Boundaries: We will not acknowledge the existence of our relationship outside of the work that we do together unless initiated by you, the client. The therapeutic relationship is a professional relationship and therefore will not be a social or business relationship at any time. Such a relationship, in our view, would be detrimental to our goals and purposes. Client Rights and Important Information: 1 . You are entitled to receive information from me about the techniques I use and the duration of services. a1- 2. You have the right, at any time, to decide not to receive services from me or to seek information from Weld County Department of Human Services and your case worker. 3. In a professional relationship, such as ours, sexual intimacy between service providers and clients is never appropriate. If sexual intimacy occurs, it should be immediately reported to Weld County Department of Human Services and/or the Weld County Police Department. 4. If you request in writing, any records can be released to any person or agency you designate (note that consent from all clients in the family unit is needed for a release of records). Also, you may authorize me, in writing, to consult with another professional beyond your treatment team about the services I am providing you. 5. Generally speaking, the information provided by and to a client receiving home based intensive family intervention services is confidential to the involved Multi Disciplinary Team assigned to your family. There are certain situations though in which I am required by law to reveal information about you without your permission. These situations are: (a) if you threaten bodily harm or death to yourself or another person; (b) if a court of law issues a legitimate court order (signed by a judge); and (c) if you reveal information relative to physical abuse, sexual abuse, or neglect of a child or elder person (in the past as well as the present). Supervisor Information: My direct supervisor is: Carol S. Johnson, LMFT Reflections for Youth, Inc. P.O.Box 1860 Berthoud, CO 80513 970-532-5990 (general office); 970-420-9278 (confidential cell) Appointment Issues: If you need to cancel or reschedule your appointment, please call me on my cell phone: 970-556- Non-Discrimination Policy Statement: Our policy is to provide service to all persons without regard to race, color, national origin, religion, gender, sexual orientation, age, disability, or economic status. No person shall be excluded from participation in, or be denied the benefits of any service, or be 4 subject to discrimination because of race, color, national origin, religion, gender, sexual orientation, age, disability, or economic status. Consent to Treatment: We affirm that prior to becoming a client of she gave us sufficient information to understand the nature of the services she will be providing and the nature of confidentiality. We consent to participate in evaluation and treatment and we understand that we may refuse services at any time. We are also aware that the therapist will consult with her supervisor and be in regular contact with our case worker at Weld County Department of Human Services. Our signatures below affirm our informed and voluntary consent to participate in home based intensive family intervention services. With the understanding of the above information and conditions, we agree to participate. Signature: Date: Signature: Date: Signature: Date: Signature: Date: Signature: Date: Signature: Date: Signature: Date: Signature: Date: Signature: Date: Signature: Date: RFY Signature: Date: AUTHORIZATION TO RELEASE INFORMATION FORM , hereby authorize (Print name) , to release (Therapist/Physician/Facility/Probation or Parole/Employer) the information designated below for This authorization is valid only to: Individual: Agency: Reflections for Youth, Inc. Address: P.O.Box 1860, Berthoud, CO 80513 970-344-1394(fax) For the purpose of: Designate which of the following is to be released: Medical Psychiatric/Mental Health Treatment Drug and/or Alcohol Employment Educational Criminal History Financial Social Other (Specify) I understand that some of this information is protected by federal law and that my signature authorizes release of all of the above noted information. I also understand that I may revoke this consent at anytime and that upon fulfillment of the above stated purposes(s),this consent will automatically expire without my express revocation. Date: Signature Printed Name AUTHORIZATION TO RELEASE INFORMATION FORM MINOR CHILD hereby authorize (Print name) to release (Therapist/Physician/School/Facility the information designated below for This authorization is valid only to: Individual: Agency: Reflections for Youth, Inc. Address: P.O.Box 1860, Berthoud, CO 80513 970-472-1736(fax) For the purpose of: Designate which of the following is,to be released: Summary of Social/Family History Summary of Psychiatric History Summary of Medical History Educational Records Psychological Testing Other(Specify) I understand that I may revoke this consent at anytime and that upon fulfillment of the above stated purposes(s),this consent will automatically expire without my express revocation. Date: Client or Guardian Signature Relationship to Client 3' • Reflections for Youth, Inc. "Discovering the Power of Positive Choice" Evaluation Plan Reflections for Youth, Inc. has been providing services for Weld County Department of Social Services since its inception, September 1, 2004. In addition to TRCCF (RTC) services beginning at that time, Home-based Option B and Day Treatment Services have been provided since June 1, 2005 and Life Skills services were added beginning June 1, 2006. Based on comments from Program Area Supervisors and through quarterly quality assurance reviews of our services that began during this current contract year, good, quality services have been provided and RFY has been receptive to feedback and making any necessary adjustments when needed. RFY has in the past and will continue to work with Weld County collaboratively toward the goal of providing quality services for the youth and families served and make every effort to assist Weld County and Colorado Department of Human Services to meet the requirements of the Performance Improvement Plan. The supervisors of all programs included in our bid; Day Treatment(Mary Barron, M.Ed), Home-Based Option B (Carol Johnson, LMFT)and Life Skills (Laura Leah Olsen), agree to meet on a quarterly basis to collect data, monitor and evaluate the process components as outlined. These include the following: * How closely did implementation match the plan as outlined in the proposal? * What types of deviation(if any) from the plan occurred? * What led to the deviations? * What effect did the deviations have on the planned intervention and evaluation? * Who provided the services, what the services actually were (modality, type, intensity, duration) whom were the services provided to (individual, family, characteristics); in what context(system, day treatment,home-based, community) and at what costs (personnel face-to-face and non-face-to-face, facilities,travel, etc.) The supervisors of all programs included in out bid; Day Treatment, Home-Based Option B and Life Skills, agree to meet on a quarterly basis to review the data collected and information gained from the services actually being provided and to address the outcomes components as outlined. These include the following: • What was the effect of the interventions used and overall involvement in the program for the youth and/or families receiving the services? • What program/contextual factors were associated with outcomes? • What individual and/or family factors were associated with outcomes? • Were the effects of the interventions and involvement in the program long lasting? • How did outcomes achieved align with the overall Performance Improvement Plan objectives? Clkrd#:52227 BREFLFOR ACGRDT. CERTIFICATE OF LIABILITY INSURANCE DATE oyz„o7OWYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE 720 South Colorado Boulevard ALTER DOES THE AFFORDED AMEND, BY THE POLICIES BELOW. Suite 600N Denver,CO 80245 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Tudor Insurance Company 37982 Reflections for Youth,Inc. INSURER a Pinnace'Assurance 10780 P.O.Box 1860 INSURER G: Great American Insurance Company 16691 Berthoud,CO 80513 INSURER a INSURER E COVERAGE THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TEE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICES ISSCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN(EDUCED BY PAID CLAIMS. MR MDR POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR IO'L TYPE Of INSURANCE POLICY NUMBER DATE IMMN INMONY OYYYI DATE /DYI A GENERAL LIABILITY PGL739800 09/20/05 09/20/07 EACH OCCURRENCE $1,000,000 DAMAGE TO X COMMERCIAL GENERAL LIABLITY PREIXRP RENTED S(Fee m, MM rrmnrsl $50,000 X I CLAIMS MADE in OCCUR MED EXP(Mry one person) $1,000 PERSONAL 6 ADV INJURY s1,000,000 GENERAL AGGREGATE s3,000,000 GENL AGGREGATE LIMIT APPLES PER: PRODUCTS-COMP/OP AGO $1,000,000 7 POLICY n sr; n inc Claims Made Policy C AUTOMOBILE LIABILITY CAP5154804 09/20/06 09/20/07 COMBINED SINGLE LINT $1,000,000 X ANY AUTO (Ea nccdentl ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODLY INJURY $ X NON-OWNED AUTOS (Par amdent) PROPERTY DAMAGE Per Bwlden0 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSMMBRELLAUABILITY EACH OCCURRENCE $ 7 OCCUR n CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ r $ B WORKERS COMPENSATION AND 4085090 10/01/05 10101/07 X I TORY I IYrrSI I PR EMPLOYERS'LIABILITY EL.EACH ACCIDENT *100,000 ANY PROPRETOR/PARTNEFUEXECUTIVP OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 II yyae.aeealbe under SPECDL PROVISIONS bdme E.L.DISEASE-POKY LIAR *500,000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The following are Additional Insureds as respects General Liability only to the extent coverage might apply according to the policy terms, conditions and exclusions. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION Weld County,Dept of Social DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MNL _10_ DAYSWETTER Services NOTICE 10 THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FALURE TO DO SO SHALL P.O.Box A 315 North 11th IMPOSE NO OBLIGATION OR LIABILITY OF.ANY KIND UPON THE INSURE!{ITS AGENTS OR Avenue REPRESENTATIVES Greeley,CO 80632 AUTH REPREBEENTTAATNE ACORD 25(2001108)1 of 3 #S52155E/M513076 BLROH e ACORD CORPORATION 1988 003 IMPORTANT If the certificate holder is an ADDmONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the Issuing Insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 254(2001108) 2 of 3 #S521558IM5130T6 DESCRIPTIONS (Continued from Page 1) Additional Insureds: Certificate Holder&State of Colorado The following cancellation conditions always apply: -10 days for non-payment of premium -If policy shown,10 days for Workers'Compensation for fraud; material misrepresentation;non-payment of premium;other reasons approved by the Commissioner of Insurance AMS 25.3(2001108) 3 of 3 0115215513/M513078 EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP Reflections for Youth, Inc. "Discovering the Power of Positive Choice" P.O. Box 1860 Berthoud, CO 80513 (970) 344-1380 (p) (970) 344-1394(f) May 18th, 2007 Tobi Vegter, Core Service Coordinator Weld County DSS P.O. Box A Greeley, CO 80632 Tobi: Here is my response to the letter I received via email on May 16, 2007 regarding Bid 003-OPB-07 Option B, Bid 002-DT-07 Day Treatment and Bid 06LS13 Lifeskills. As it relates to RFP 07006 Dav Treatment,and the caseworker training component, Reflections for Youth, Inc. requires that each employee, regardless of the level of position, is required to have 20 hours of ongoing training per year. In addition to approximately 16 hours of new hire training, Reflections offers the following trainings on a quarterly basis throughout the year: Risk Assessment and Suicide Prevention, 4 hours; Therapeutic Relationships, 2 hours; Policy and Procedure Review, 4 hours; Fire Safety and Emergency Protocols, 2 hours; Crisis Intervention, 4— 8 hours; CPR/V' Aide, 8 hours; Mediation and Conflict Resolution, 2 hours; Phase System/Behavior Modification, 4 hours; Group Dynamics and running educational/psychoeducational groups, 2 hours; and Professional Relationships, 2 hours. Reflections also offers Medication Certification training on an as needed basis, 8 — 12 hours for a staff member to become a QMAP (qualified medication administration person). All teaching, clinical and administrative staff are required to have a minimum of 18 hours per year of professional development/continuing education in their respective field. Examples are Dialectical Behavioral Therapy, Motivational Interviewing, Adolescent Counseling Skills, Risk Assessment and Mental Status Exams, etc. for clinical staff Working with ADHD/ADD youth, IEP writing, Literacy Models, etc. for teaching staff and Milieu Management, Providing a Safe Working Environment and Employee/Employer Relations for administration staff As it relates to RFP 07010 Option B, and eligible populations, Reflections for Youth, Inc. will work with any family with one or more children either at risk for out of home placement or returning to the family home from an out of home placement. If required, Reflections for Youth, Inc. can also offer option B services to youth that are in foster care and provide services to the foster family in an effort to maintain the placement and decrease the need for higher level placement. Reflections for Youth, Inc. agrees to work with eight(8) different families at a time, for a three month period of time with each family, and a total of 32 families per year. If additional time after the authorized 20 hours is needed in the three month period of time, then we will adjust the program to meet the need of the family. Services will be provided in a more intense nature in the first weeks of service(2-4 hours a week at the family's convenience as much as possible) and then in a less intense nature as service continues and the time of termination approaches. This is designed so that the family becomes more self-reliant as time progresses and less reliant on the Home-Based Specialist and services being offered. All families will be able to receive bicultural services. Reflections for Youth, Inc. currently employs two interpreters to assist with family communication on an as needed basis. This includes attending meetings, family therapy and other communication between Reflections for Youth, Inc.,Weld County and the family. All families will receive culturally/ethnically specific services,but straight bilingual services can only be provided if Reflections for Youth, Inc. is able to employ a specialist that is able to speak a second language. In terms of family units and based on one family unit being one hour of direct service, Reflections can provide 640 family units per year. As it relates to RFP 07010 Option B, and Evidenced-Based Practices section, I had a conversation with you(Tobi Vegter) and was told to respond that this section was considered sufficient. Reflections for Youth, Inc. has reviewed the FYC Commission recommendations and agrees to accept the recommendations as written. Please call (970) 344-1380 x.202 or (970) 217-4435 or email me at jeff@reflectionsforvouth.org if you have any additional questions or need further clarification. I look forward to continuing our relationship with the core services program at Weld County DSS. Sincerely, Jeffery J. Johnson, LPC Executive Director 0 (it itiiiiiNtist DEPARTMENT OF SOCIAL SERVICES P.O. BOX A I GREELEY, CO. 80632 WI D Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 OFax Number(970)353-5215 • COLORADO May 11,2007 Jeffery Johnson, Executive Director Reflections for Youth 1000 S Lincoln Avenue#190-200 Loveland,CO 80537 Re: Bid 003-OPB-07 Option B Bid 002-DT-07 Day Treatment Bid 06LS13 Lifeskills Dear Mr.Johnson: The purpose of this letter is to outline the results of the Core Bid process for PY 2007-2008 and to request written information or confirmation from you by Monday,May 21, 2007. The Families, Youth, and Children Commission appreciates your interest in providing services for families in Weld county. This year, strides were made in structuring an RFP that is clear and concise,and more user friendly, for both prospective bidders and evaluators. It is important to stress the value of following formatting guidelines and addressing the required sections concisely and appropriately. Results of the Bid Process for PY 2007-2008 A. The Families, Youth and Children(FYC) Commission recommended approval of your Bid#004- LS-07, (07005), Lifeskills, for inclusion on our vendor list. This bid was approved with no recommendations or conditions B. The Families, Youth and Children(FYC)Commission recommended approval of your Bid#002- DT-07, (RFP 07006)Day Treatment, for inclusion on our vendor list.The FYC Commission attached the following condition to this bid. Condition: Bidder must clarify and address the caseworker training component. C. The Families,Youth and Children(FYC)Commission recommended approval of your Bid#003- OPB-07, (07010)Option B, for inclusion on our vendor list.The FYC Commission attached the following conditions to this bid. Conditions: The bidder must submit information that was not addressed or submitted with the original bid submission, including: 1. Bidder must elaborate and expand upon eligible populations, Page 2 Reflections for Youth/Results of RFP Process for PY 2007-2008 2. Bidder must respond to the Evidenced-based Practices section. Required Response by FYC Bidders Concerning FYC Commission Conditions: Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the conditions,you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. The Weld County Department of Social Services is requesting your written response to the FYC Commission's conditions. Please respond in writing to Tobi Vegter, Core Services Coordinator, Weld County Department of Social Services,P.O.Box A, Greeley,CO, 80632,by Monday,May 21,2007, close of business. If you have questions concerning the above,please call Tobi Vegter, 970.352.1551 extension 6392. Sincerely, 4141.4l� dy . Griego, rector cc: Juan Lopez, Chair,FYC Commission Tobi Vegter,Core Services Coordinator Gloria Romansilc, Social Services Administrator Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission(Core)Funds Type of Action Contract Award No. X Initial Award FY 07-CORE-61 Revision (RFP-FYC-06010;06OPB07) Contract Award Period Name and Address of Contractor Beginning 06/01/2007 and Nelson,Wolf,&Associates,PC Ending 05/31/2008 Option B—Home Based Intensive 1019 39 Avenue,Suite C Greeley,CO 80634 Computation of Awards Unit of Service Description In-home services to families using a combination of Family Systems approach with a Community Systems intervention style. The issuance of the Notification of Financial Assistance Award is Services include family therapy,lifeskills instruction,conflict based upon your Request for Proposal(RFP). The RFP specifies mediation,communication skill building,interventions such as the scope of services and conditions of award. Except where it is mentoring,community agency referrals,and other collateral in conflict with this NOFAA in which case the NOFAA governs, services such as classroom instruction.Crisis intervention the RFP upon which this award is based is an integral part of the available 24 hours/day,7 days a week.Maximum program action. capacity is 24 families concurrently,monthly average capacity is 18,and average stay is 12 weeks;Phase 1,3 hours per week; Special Conditions Phase 2,2 hours per week.Ethnically and culturally diverse services-Spanish speaking staff available. South county access. 1) Reimbursement for the Unit of Services will be based on Cost Per Unit of Service an hourly rate per child or per family. Hourly Rate Per 2) The hourly rate will be paid for only direct face-to-face Treatment Package Intensive $105.11 contact with the child and/or family,as evidenced by Family Systems and Community Assessment client-signed verification form,and as specified in the Family Therapy unit of cost computation. Problem Solving,Mediating Family Conflict 3) Unit of service costs cannot exceed the hourly,and yearly Parenting Skills cost per child and/or family. Group Therapy/Support Groups 4) Rates will only be remitted on cases open with,and Lifeskills Instruction referrals made by the Weld County Department of Social Family Conflict Management Services. Community Support Assessment 5) Requests for payment must be an original and submitted Education,Career Assessment to the Weld County Department of Social Services by Resource Development for Physical/Mental Health Care the end of the 25th calendar day following the end of the 24-hour Telephone Response/Crisis Intervention month of service.The provider must submit requests for Court Testimony $65.00 payment on forms approved by Weld County Department Enclosures: of Social Services.Requests for payments submitted X Signed RFP:Exhibit A 90 days from the date of service,and thereafter, X Supplemental Narrative to RFP:Exhibit B will not be paid. X Recommendation(s) 6) The Contractor will notify the Department of any change _Conditions of Approval in staff at the time of the change. 7) Weld County Department of Social Services has established a limit of 20 hours of service per referral under this program area. By Program Official: Y L Y David E.Long,Chair Judy A riego, irector Board of n,C,puptyAmmissio s Weld unty D partment of ocial Services Date: d IJ N 1 �j U I Date: (0 HO . EXHIBIT A SIGNED. RFP 806-OPB-07 INVITATION TO BID BID 001-07 DATE: February 28, 2007 BID NO: 001-07 RETURN BID TO: Monica Mika,Director of Administrative Services 915 10th Street,P.O.Box 758.Greeley,CO 80632 Third floor,Centennial Building,Purchasing Department SUMMARY Request for Proposal for: Colorado Family Preservation Act—Core Services Program Deadline: Friday, March 30,2007, 10:00 a.m. (MST) The Families,Youth and Children Commission,an advisory commission to Social Services,announces that competing applications will be accepted for approved providers pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.R.S. 26-5.3-101).The Families,Youth and Children Commission wishes to approve services targeted to run from June 1,2007,through May 31,2008, at specific rates for different types of service,the County will authorize approved providers and rates for services only.This program announcement consists of the following documents, as follows: • Invitation to Bid • Main Request for Proposal(All program areas) • Addendum A—Program Improvement Plan Requirements(by program area) • Addendum B—Scope of Services(by program area) • Core Budget Form Delivery Date June 1 7007 (After receipt of order) BID MUST BE SIGNED IN INK Program Area:op ion B James P. Nelson MA, LPC TYPED OR PRINTED SIGNATURE VENDOR Nelson, Wolf & Assnriates, PC (Name) Ha written Signature By Authorized Officer or Agent of Vendor ADDRESS 1019 39th Ave , quite r tt1ZE CEO S,reeley, co 80634 DATE Marrh 79, 7007 PHONE# 970-353-5577 The above bid is subject to Terms and Conditions as attached hereto and incorporated. ABSTRACT Nelson,Wolf& Associates,P.C. Nelson, Wolf& Associates, PC is a private Colorado professional corporation first registered in 2004. It is a cooperative venture founded by James P.Nelson and Kristine M. Wolf for the purpose of providing services on an out-patient basis to the citizens of Weld County and eastern Larimer County. Our Mission The mission of Nelson, Wolf&Associates(NWA) is to be of service to families in Weld County who are at risk of broader involvement with the legal and social services systems. We seek to assist families who have had a difficult time interfacing with their community in a successful and sustainable way. To accomplish out mission we will: 1. Network effectively with area professionals in the family service field to identify needs which are under-served,and likely to respond favorably to a timely preventive, or remedial intervention. 2. Develop quality programming designed to meet targeted needs. 3. Partner with other community family resources and human service agencies to generate therapeutic community resources,and provide services in the most effective way possible. 4. Provide top-quality stewardship of, and accountability for,community resources. 5. Provide ongoing evaluation of the effectiveness of services we provide in order to make improvements in what we do (Program Improvement Planning). 6. Cooperate effectively and communicate in a timely way with our referral sources. 7. Remain responsive to the needs of the community,open to new ideas and opportunities to be of service, while consolidating gains and expanding family resources. The Founders of NWA are licensed master's level therapists who have had many years of experience in family therapy, social science research,community needs assessment, individual therapy, group therapy, mediation, and supervision. We have worked extensively with at risk teens and their families in residential treatment,out-patient,and in-home settings. Intensive Family Intervention: In-Home Family Therapy The overall purpose of this project is to provide in-home services to families using a combination of Family Systems approach with a Community Systems intervention style. Thus,we have been interested in, and have obtained training in the Multisystemic Therapy(MST)* model, which has been developed by the Medical University of South Carolina in Charleston. Our associates have been practicing according to these principles since approximately December, 1999. *Disclaimer Multisystemic Therapy is an intensive family and community-based treatment modality that addresses the multiple determinants of serious antisocial behavior in juveniles. The Multisystemic approach views individuals as occurring within a complex network of interconnected systems, encompassing peers,schools,and neighborhoods,as well as immediate and extended family. Intervention may be needed in one or any combination of these systems. The name 'Multisystemic Therapy'is a proprietary label. It is,as such, intellectual property and cannot be used to identify what we do. We are not licensed by the owners of this label. However, both Julie Nelson and James Nelson,principles of Nelson, Wolf&Associates, P.C., have worked in the past for an MST license-holder,and have had training and supervision(and have provided)training and supervision to others in this mode of therapy while employed by the license holder. However,we do not currently have any relationship to MST Services of MT.Pleasant,SC. -2 - • TABLE OF CONTENTS ABSTRACT -2 - TARGET/ELIGIBLE POPULATIONS -4 - PROJECT NARRATIVE -3 Purpose - 5 Types of Services Provided - 5 - Therapeutic Services - 5 - Family Therapy: - 5 - Problem Solving, Mediating Family Conflict: - 6- Parenting Skills: - 6 Group Therapy/Support Groups: -6- Concrete Services -6 Life Skills Instruction: - 6 - Family Conflict Management: -6 - Collateral Services - Accessing Community Support system: - 7 - Education: - Employment: - Physical and Mental Health System, Drug/Alcohol Abuse Treatment: - 7 - Crisis Intervention Services - 7 - Telephone Response: - Personal Visits (Emergency Basis): - 7 - Measurable Outcomes - 8 - Service Objectives - 8 A. Improve Family Conflict Management - 8 - B. Improve Household Management Competency: - 9 - C. Improved Ability to Access Resources: - 9 - D. Address Specific Referral Issues: - 9 - E. Improved Outcomes in the Performance Improvement Plan• - 9 - Woridoad Standards - 10 - A. Total number of hours on a per/case basis: - 10 - B. Total number of staff - 10 - C Maximum caseload: - 10 - per full-time (1.0 FTE)therapist is 12 families. - 10 - D. Modality of treatment: - 10 - In-home family therapy using Multisystemic Therapy model. Following are generally the steps which will be followed in working a referral: - 10 - E. Total Number of hours per day/week/month: - 11 - F. Maximum caseload for each Supervisor is 6 masters level therapists. - 11 - G. (See Attached Affidavit of Insurance) - 11 - Staff Qualifications - 11 - Program Capacity by Month - 11 - Billing Process - 11 - BUDGET & Appendices - 12 - - 3 - TARGET/ELIGIBLE POPULATIONS A. Total number of clients served: Approximately 96 persons By serving 24 family units, half of which are composed of 2 parents and half of which are composed of 1 parent, and averaging 2.5 children per household,the estimated total of clients impacted will be 96. B. Total individual clients and their children's ages: 48 Families (all ages) Clients may be of any age or gender(as families always are). Some will be adolescents between the ages of 15 and 18 years of age, and they will have siblings of various ages as well as parental figures living in the home with them. C. Total family units: 48 families The program is designed for families with youth who are struggling in their present home environment and are at risk of being removed. Families can be of any size or constitution. D. Bicultural/bilingual services: 24 families Families of any cultural and/or ethnic origin will be served. NWA staff is culturally aware and are an ethnically and culturally diverse group. Consideration of and respect for established cultural patterns is an ingrained value in this organization. Spanish speaking staff is available.* E. Clients receiving services in South Weld County: 6 families concurrently This constitutes up to 30%of the total case load. This figure was arrived at by comparing population totals from North-Central Weld with totals for the South Weld cities. F. Access to 24 hour service: 24 families All client families will have access to 24 hour crisis intervention services through a 24 hour crisis telephone line. Each family's Intervention Coordinator, or designated on-call therapist, will respond to calls within one (1)hour. G. Maximum Program Capacity: 24 families concurrently Maximum case load for an intervention team will be 6 families. We will have two teams in place if awarded a contract. This insures that appointments can be kept without double-booking. Support groups and classes will be of optimal size. However, if the Department would like to expand the program, we would be open to discussions on this topic. H. Monthly Average Capacity: 18 families This will vary depending on the intensity of the interventions underway at any given moment, as the number of visits and average hours per visit are more numerous in the early stage of intervention. I. Average stay in the program: 12 weeks (See item J below) J. Average hours per week in the program: Phase 1. (1st month): 3 hours per week. (Total 12 hours) Phase 2. (2nd month onward): 2 hours per week. (Total 16 hours) •Weld County is a culturally diverse population center in Northern Colorado. Therefore,services will be delivered in a culturally sensitive manner. NWA currently employs staff members who are aware of the issues of acculturation,enculturation and assimilation which are relevant in the present social milieu. Every effort will be made to provide a staf 'client match with these issues in mind. NWA currently employs Spanish speaking,culturally competent staff to deliver program services. -4 - PROJECT NARRATIVE Purpose The purpose of this project is to produce an immediate and long-lasting increase in the stability and adequate functioning of referred families. This will be accomplished in order to alleviate the need for out-of-home placements. In this project, our effort will be to assess the family's internal strengths and challenges as well as its relationships to community resources. The team will then formulate a working hypothesis based upon direct and measurable evidence, establish goals, identify interventions, and periodically re-evaluate the effectiveness of the interventions. The focus of therapist's efforts will be on helping the family members to make connections with those agencies and individuals in their community who can provide sustainable support after the successful termination of our services. Types of Services Provided Each family will be assigned a masters level therapist, licensed to practice by the State of Colorado(LPC, LSW, LCSW,or LMFT)who will act as Team Supervisor. The Team Supervisor will coordinate the efforts of the team. Supervision will occur in a small group meeting format. The Supervisor may also directly provide family therapy, life skills instruction, conflict mediation,parenting education, communication skill building and other direct services, as needed. However,the supervisor's primary responsibility will be to keep the in-home family therapist on track during the course of their cases. The supervisor will also assist the assigned therapists in the measurement of effectiveness of the selected interventions. Family contact will take place in the family home,primarily during late afternoons, early evenings, and weekend hours when families are not at school or work. Crisis Intervention services will be available 24 hours a day, seven days a week. All areas of Weld County will be served, including the fast-growing South County area. In past years we have effectively provided services for families in the Peckham, Lochbuie, Frederick, Firestone, and Ft. Lupton areas, as well as in Greeley, Eaton, and Windsor. Therapeutic Services Family Systems and Community Systems Assessment: The NWA Team Supervisor will meet with the family and caseworker to assess the strengths and needs of the family system as well as the family's familiarity with and use of community supports. NWA Staff and DSS Caseworker will design an intervention plan to meet the family's needs based upon the results. The NWA Therapist will report to the caseworker on a timely basis to keep the caseworker informed of family's progress (at least weekly). The NWA staff member will coordinate with the family to access other needed community resources as well. Family Therapy: The therapist will be experienced in family therapy. However,the emphasis will be on modest and achievable improvement in family functioning. Due to the time constraints involved, there will only be enough time to focus on the sources of greatest disruption which prevent effective family functioning. Interventions will target overarching and intermediary goals. - 5 - Problem Solving, Mediating Family Conflict: The impact of a knowledgeable and diligent mediator with sophisticated counseling skills, working with families in their home environment cannot be underestimated. The ability to identify the opportunities to stimulate change,work with the key members of the system, and see that right action is taken at the right time, is very powerful in bringing about positive change. Parenting Skills: Many families suffer from the continuation of maladaptive cross-generational (multi- generational)child rearing practices that are violent and abusive,or which are completely ineffective in preparing children to be positive, competent and productive participants in society. NWA staff members will assist parents in learning more productive methods and practices. Group Therapy/Support Groups: It will be valuable for those family members who can participate to have a sounding board in which to discuss and process issues related to the difficult challenges of raising a family. Groups will be facilitated by a licensed master's level therapist who has experience in group therapy with this challenging yet rewarding population. Concrete Services Life Skills Instruction: NWA staff will deliver self-paced instruction in Life Skills. Curriculum includes: • Nutrition, menu planning, food shopping, and preparation, • Home Safety, maintenance, cleaning and repair, • Employability assessment,job-specific prospecting, application and interviewing skills, follow-up techniques, • Home budgeting,money management,banking, • Transportation needs and affordability, • Finding and leasing an apartment,purchasing a home, • Clothing, shopping, maintenance and repair, • Time management and goal setting, • Personal values, social skills, refusal skills, and sound decision-making, • Community values, living with neighbors, coping with others expectations, • Understanding and managing anger • Accessing Community Resources • Alternative dispute resolution, problem solving, Family Conflict Management: NWA Team members may teach child rearing and parenting skills, such as(but not limited to): • Effective boundary and limit setting, • Redirecting negative behavior, • Affection,nurturing, and positive reinforcement, • Importance of consistency and dependability, • Effective and safe discipline methods, • Monitoring and maintaining health, - 6 - • Accessing behavioral assistance when needed. Collateral Services Accessing Community Support system: NWA team will assess the family's connections with agencies in their community which they can access when needs arise. The team will then assist them in filling any gaps in the system through establishing personal contacts at agencies which provide health and medical services, legal assistance, etc. Education: Children must have either completed high school, or be in the process of working toward this goal in some developmentally appropriate way. Youth must be eligible for enrollment in public school, attending a GED program, or attending a day treatment program which has an educational component. Youth who are in school or pursuing a GED will be assisted in finding constructive after-school activities in their community or part-time employment, so as to assist in saving money for future expenses. If the youth has already finished his/her education,the emphasis will be on securing hill-time employment. Employment: Family members may be given a career assessment and skills evaluation, vocational interest measure, and get a full interpretation in order to determine what career area is most advantageous. They will be helped to write a resume, fill out applications for employment, taught how to interview appropriately,and otherwise assisted in finding employment with a future. Physical and Mental Health System, Drug/Alcohol Abuse Treatment: Families must find and develop a context for using local physical and mental health care providers. NWA Team will assist family members in developing resources for treatment of acute and chronic physical and/or mental health concerns, and provide education in balancing treatment and prevention to reduce the frequency of episodes. Crisis Intervention Services Telephone Response: NWA maintains a 24 hour answering service with emergency paging. A designated on-call therapist will be available to respond to the family or individual in the event of an emergency. Protocol calls for intervention over the phone as the first step. If phone intervention proves to be insufficient,the responding therapist will assess the level of severity of the incident and take appropriate action, including calling the police, ambulance, etc., if danger is imminent. Personal Visits (Emergency Basis): If the situation would not pose a safety hazard for the staff member, they may visit the home on an emergency basis. Otherwise, a safe neutral meeting place will be maintained in the event of the need for person-to-person contact outside the home,or the family may choose to come to the office. On-call personnel are trained in crisis intervention procedures and follow pre-determined written protocols. - 7 - Measurable Outcomes A. Children and adolescents will remain residing in the home at the time the case is closed. This will be reflected in our monthly progress reports, and case termination report. B. Improvements in parental competency,reduction in parent/child conflict,and improvements in household management will be reflected in the monthly progress reports delivered to the caseworker at the end of each billing period. We will administer a proprietary Life Skills Assessment which will be used to help determine treatment goals. The monthly report will assess whether or not the family is successfully completing their treatment goals. A termination report will be delivered to the department no later than 30 days after the termination of NWA involvement in the case. C. Children and adolescents who are in their own home at the beginning of referral will continue there at the termination of services. A quarterly contact summary will be prepared on each referral after termination of services for a period of twelve (12)months. This information will be mailed to the department caseworker or supervisor in written form no later than 30 days after the close of the 4th quarter post-discharge. D. Children or youth who are currently in long-term placement, and who are in the process of reunification at the time of referral,will be living in their family home, and will not be in residential placement, DYC custody,or under adult judicial proceedings within 12 months of the termination of NWA services. An annual contact summary will be prepared on each referral after termination, for a period of one year, and a report will be mailed or hand delivered to the Department's designee. E. Families who receive services will not have a substantiated abuse or neglect case within 12 months of termination of services as indicated in the periodic report. F. In order to establish goals at the outset, we will administer the North Carolina Family Assessment Scale. Quantitative measures will be reported at the termination of service period (evaluation of completion of treatment goals, and post administration of NCFAS). NWA staff will prepare an annual report listing the number of referrals offered, referrals accepted, and will chart the disposition of each case in as much detail as we can obtain. Service Objectives A. Improve Family Conflict Management To keep children from being removed from the home: Family conflict management skills will be addressed using the mentoring and in home family therapy treatment modes. If youth has a high rate of truancy from school, running from the home, disregard for family/home rules, or the family is chronically engaged in abusive quarrelling,conflict management will be a top priority. This will be reflected in the family treatment plan. - 8 - If children have already been removed: Reuniting the family with targeted support and assistance will be a top priority. Getting family members to participate in a planned process of constructive change in order to maximize strengths and remediate challenges will be the top priority. Outlining the concrete tasks and conditions which require each family member's assistance will be emphasized. These will be written into the family's treatment plan. B. Improve Household Management Competency: Household management competence will be measured by NWA Therapist observation as part of the treatment planning process. Completion of a proprietary life skills assessment will highlight strengths and opportunities for improvement. Areas of concern will be addressed in the family intervention plan and re-evaluated monthly and at the conclusion of services. C. Improved Ability to Access Resources: NWA team will assess the family's connections with agencies in their community which they can access when needs arise. The team will then assist them in filling any gaps in the system through establishing personal contacts at agencies which provide health and medical services, legal assistance, etc. The family will have a complete selection of resources and personal contacts at each community resource by the end of the intervention. D. Address Specific Referral Issues: NWA Treatment Plan will routinely include the issues which triggered the referral. This will be the starting point for the assessment process and the analysis of fit will provide the basis for formulation of intervention planning and goals selection. Regular weekly phone or email communication between the DSS Caseworker and the NWA Therapist will assure that issues of specific concern to the referring authority are included in the service plan. E. Improved Outcomes in the Performance Improvement Plan: We understand the vital importance of helping the Department demonstrate program improvement. In this project our services are specifically designed to address the following: Outcome S2, . . .Children are safely maintained in their homes whenever possible and appropriate. We see this program contributing directly to the accomplishment of this outcome by setting goals with the caseworker and family which result in a stable home environment. By appearing when scheduled at the Core Review Team meetings prepared to illustrate what is being accomplished in the home to promote placement stability, we reinforce the Departments PIP. To date, we have never recommended that a child of any age be removed from their home unless they were in immanent danger according to 265.3-103(2)of the Colorado Revised Statutes. Item 3,. . . Services to families to protect children in home and prevent removal. Nelson, Wolf&Associates will cooperate fully in the administration of the CAC. We are prepared to use the results to help determine the needs of the families referred to us. We will be happy to participate fully in any Team Decision Making opportunities, and have participated in the Department's Placement Review Team (PRT) in the past. Outcome P1, Children have permanency and stability in their living situation. - 9 - Item 5, Foster Care Re-entries: This program will not only reduce the number of out-of-home placements but will be available when children return home from an out-of-home placement as a measure to promote continued stability. This program seeks to strengthen children's and family's ties to the community in such a way as to reinforce permanency and stability in the home, thus reducing re-entries. Workload Standards A. Total number of hours on a per/case basis: Phase 1. (1st month): 3 hours per week(Total of 12 hours) Phase 2. (2"d month): 2 hours per week(Total of 8 hours) Phase 3. (Optional): 1 hour per week as a step-down level. (4 hours) (Total of 20-24 contact hours per case) B. Total number of staff 1 Licensed Masters-level staff as Supervisor(.25 FTE). (Direct contact hours to non-direct hours, 3:1) 2 Part-time (.50 FTE), Masters-level therapists working 8 cases each. (16 families concurrently will constitute a fiilltime caseload.) 1 Part-time (.25 FTE) case aid will be assigned to each 12 families. NOTE: Under the present circumstances, the maximum number of families which can be accommodated is 12 per month (average). However, if the sustainable caseload is larger, we are willing to expand to accommodate more. Expansion to accommodate a larger caseload has been planned for in our Strategic Plan. C. Maximum caseload: per full-time (1.0 FTE)therapist is 12 families. D. Modality of treatment: In-home family therapy using Multisystemic Therapy model. Following are generally the steps which will be followed in working a referral: 1. Team Supervisor will accept case from referring caseworker and receive any available assessments or observations as to the needs of the family and the reasons for referral. 2. Therapist will be assigned and briefed. 3. Therapist will meet with the family and verify intake information and complete assessments. This includes an analysis of strengths and challenges, analysis of fit, chart of community interfaces, and work out a contact schedule. 4. Therapist will make contact with the caseworker and share information impressions of the family and their needs. 5. Therapist, in cooperation with the family,and with the results of the assessments and DSS caseworker's impressions in mind, will develop a series of over-arching goals, intermediary objectives, and establish benchmarks and measurements with which to evaluate progress weekly. 6. As the therapist meets with the family and with the team supervisor,progress and challenges will be communicated with all involved parties. - 10 - 7. Supervision will occur weekly. These meetings will offer an opportunity for focusing on creative use of resources and means and methods for accomplishment of goals. 8. Monthly progress reports will be received by the family's caseworker, and staffings will be scheduled according to the caseworker's preferences. E. Total Number of hours per day/week/month: Plan is for 2 visits per week @ 1.5 hours per visit, for a total of 3 hours per week for a period of one month. (12 hours total) In the second and third months,visits will be reduced to two hours, once per week, for a total of 8 hours each month. (16 hours in months 2 and 3, plus 12 hours in month one=28 elapsed hours). If subsequent contact is deemed desirable, there will be one meeting per week,one hour in length,each week for a month. (4 more hours) At this point,the total hours invested in the case would be 32. F. Maximum caseload for each Supervisor is 6 masters level therapists. G. (See Attached Affidavit of Insurance) Staff Qualifications A. NWA personnel have extensive experience in Marriage and Family Therapy,Individual and Group Therapy, Emancipation Programming, Social Work, Case Management, Family and Community Mediation. B. Staff qualifications(resumes attached): James Nelson, MA, LPC (Supervisor) Kris Wolf MSW(Therapist) Julie Nelson, MA, LPC (Therapist) C. Staff are qualified according to Staff Manual Volume VII, Section 7.303.17, and Section 7.0006, Q of the Colorado Department of Human Services Regulations. D. Our staff have extensive training and experience in risk assessment. E. Staff will attend the required trainings prior to June 1, 2007 if such trainings are offered prior to that date. Program Capacity by Month Nelson, Wolf& Associates, P.C. is prepared to deliver the services as bid in this proposal today. If the Department would like us to serve more than 24 client households during fiscal year 2007- 2008, we would be happy to discuss a mutually acceptable time table for increasing our staff and training new therapists. Billing Process Therapists carry their Client Signature Sheets to the client's home. At the completion of their visit,head of household signs the signature sheet. After the last visit of the month,they turn their sheets in to the agency's billing agent, Mountain View Billing Service, Inc. The billing agent then accumulates the signature sheets,totals the number of hours to be billed for, verifies - 11 - Attachment VI . G. Insurance NELSON, WOLF & ASSOCIATES, PC Private Counseling Affidavit of Insurance Following are the amounts and types of insurance coverage carried by Nelson, Wolf&Associates,P.C. , on its facilities,key employees and officers: Professional Liability Insurance: $1,000,000 each claim- $6,000,000 aggregate Workplace Liability $1,000,000 each claim- $6,000,000 aggregate Fire&Water legal Liability $150,000 sub-limit Personal Liability $1,000,000 aggregate Healthcare Providers Service Organization 159 E. County line RD. Hatboro,PA 19040 Workers Compensation and Employers Liability: Each Accident$100,000 Occupational Disease,each employee$100,000 Policy Limit$500,000 Pinnacol Denver,CO Automobile Insurance: Bodily Injury Liability-$100,000 each person, $300,000 each occurrence. Property Damage Liability- $100,000 American Family Insurance Madison, WI 53783 1 Eff4Otid6'DSte&MVlie de 3a9/o5eeley, CO 80634* (970)353-5577 the rates and dates of service limits,then fills out the billing forms and mails them to the Department. BUDGET (see attached) CONFIDENTIALITY AND PARTICIPANT PROTECTION 1. Protection from potential risks: Risks to confidentiality are minimized due to the in-home setting employed in our program. All therapists and supervisors have been trained in protection of client rights and confidentiality standards at the time of licensure and periodically thereafter. All documents and computer records are kept under double locked storage when not in use. All possible precautions are routinely taken to protect client identity, including failure to confirm or deny any particular clients participation in the program. No other risks are apparent in this program. 2. Fair Selection of Participants: It is our policy to accept into the program any client family that is referred by the Department. All members of the immediate family in residence will be considered to be participants. Extended family members will be included if they play a significant role in the family constellation. 3. Absence of Coercion: In certain cases,participation may be court ordered. However, from our perspective, the family's participation is always voluntary. If they are court-ordered and choose not to participate with us, we may simply refer the family back to the department for disposition at the discretion of the Core Services Team. 4. Data Collection: Our therapists will collect demographic and identifying data as well as perform certain assessments which require the direct input from the family members. In all cases, data collection will be kept to a minimum, and directed exclusively toward focusing the treatment on goals which will likely yield most promising result. (See Appendix 2 for samples.) S. Privacy and Confidentiality: The therapists will collect all data pertaining to their client family. They will obtain signed consent forms when information can more reasonably be obtained from independent third parties, and will gather the resulting information themselves. Access to data and personal information is closely guarded at all times. 6. Adequate Consent Procedures: Participants receive information on the MST Model, why it works and what is required of them to successfully participate. In addition, all therapist have and obtain a signature on a disclosure statement that is required by law of all therapists in the state database. We also obtain signatures of clients on a basic"consent to treat" form which gives further information about the program. - 12 - If the client cannot read, we read it to them. If they are not fluent in English, we arrange for translation. 7. Risk/Benefit Discussion: We conduct a thorough discussion of risks of self disclosure,possible discomfort involved I changing old family or personal habits,etc. in order to obtain the client families willing participation. This is important in forming a therapeutic alliance with the family. - 13 - 2 €0 WWH I— Ill m § � a , ■ | ) ) ) ] ] § k B tu o ( w f 6 § - et a. / w \ m } / w rit E- Fr ( | W02w - ) 7 \ / ( } , i ; S 6 § mr2606 !§ § ; § & & § , ® 2 ! 0O § ( | § § § § } ! ! k )\ | \ /2 ` k ` e 2 § � k / §§ § \ § § ( | § § P »2 8 N ! | ' |2`||||||||| 8 -•`;-| 8 8 !7 || .. ala . a 0 !t 8 . !VI 8 888888 8 a | QggG2Gg \II |!( 22222222222222 8 888888 8 a C, 4 % ; 888888■g 8 888888 |§ ||||;|,.,.g... , #2...2 8 § ( I ■■ ■ . a f|| ` I || . . .! ■ ` ` §0 | ;;;;;;2;2;;2;; «;_9;2 !1| §§2242|||||||| 8 | - . f\ ■ }!! !! in li a 88E ( ! | I § i c § | | § | | § t 1 / 1 | i ii ill | iJ i / � 222 O 20 0SSg 1:[ 8 W X 6 88888888888888 8 8888888 8 2aasaaasaaaaaa a 22aaaaa a 0 0 195 tas 8 n:a T 88888.8888.88888 8 8888888 8 assaaaaaaaaaaa a 2222222 2 111 W a 88888888888888 8 8888888 8 22222222222222 2 2222222 a 4 14 o 0 IT 61€ 8 4 !II z o 88888888888888 8 8888888 8 a psaaaafaassaaa § 2222222 §. c 0 - o z FF ( w R Q ,Z8 L B g 8 :If !8 '02222222222222 222222 4 88888888888888 8 8 8 )1 gaaasaasaaaaaa § a LI ga i5d 6 a `F K 81K8 1 I Y a I i i Y a 8 P I § < 8 5 : e Y s E § s G ° 6 g1 i 8 i s 8g .4 ,4 .4w I- 0 z � `: s 20 G 0 C LL I 888888888888888888 8 8 8 L 22 2222222222222222 2 A A 8 ii ' §I F 888888888888888888 8 8 8 RAAAAAAAAAAAAAAAAA a A A 8 R it xR a 888888888888888888 8 2 8 AAARAAAAAAAAAAAAAA A A 2 8 R le 888888888888888888 8 8 8 AAAAAAAAAAAAAAAAAA A A 2 8 n R € z R r xg 888888888888888888 8 8 8 p fal 288882888282888222 A A 2 4 8 R Ile 888888888888888888 8 8 8 Bg x 8 8 8 §2CF 22AAAAAAAAA22A n = i 5 3 ER go 2y2yitiii2242242222 I I III I C ! g 0 g I i 1 1 III 4 ' 0 000 Program Area Supervisor/Provider Meeting Verification/Comment Form Date of Meeting: .2- 1/-C 1 Program Area: r 11 i ,C'kZ ,LL. _ Lp tr a-,) L— Comments (to be completed by Program Area Supervisor): �) tit A-1Lr ,L,IC( (""LR✓ ff ( (, �' ( A/ i_civLi i tL CL( 6iC �� , K. Li : L( . . cii_Lf rei- _'ti iii Jy, tb--L L ( ti- i� 4- ( i C.- -h by il Cdr f( It- [cI f it kJ l�_Li Ii iii_- a Ali til i ri J, . ,,Li' `-t_tJCr Cdtc. - 4t tk )� J�C tA �,� 4 ,1Ct Jj �i�[tk Sf ply � � G��l fftzte? it ; t hv £' / t�1 it r 4r l C,x 4th (r,( � C it (Li t a[,E ,i. - ) , _ t 't 4C�' LA_t `-k [.(L( Lc( /\../ Lk_c A� • 1 . e tee �, P. I �, Cl�� L C,)Itn( ( XI4 ,(Ct,(1 i \‘1G --Ii. €_‘± 1 4 .L <'c Olt 'cc_�,tic ' Lh' tt ( L SigF.�ur9q of Program Area Supervis - � NCCi( �_ 1 L - C�( CLrt-y) /k C_ LcCiLtik �i (CC \r--t � ( L ✓_ e ( � ( LIL�- Lt)ct LL A_k ` �� fa_ E y k_ . I I, t. L) Attachment VIII. A. Bibliography References Henggeler, S. W.,Scboenwald, S. K., Borduin,C. M-, Rowland, M. D., &Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents.New York:Guilford Press. Henggeler,S.W.,Mehon,G.B.,Brandin,M.J.,Scherer,D.G.,&Hanky,J.IL(1997).Muitisystemic therapy with violent and chronic juvenile offenders and their families:The role of treatment fidelity in successful dissemination.Journal of Consulting and Clinical Psychology,65,821-833. Henggeler, S. W., Rowland, M. D., Pickrel, S. G., Miller, S. L., Cunningham, P. B., Santos, A. B., Schoenwald,S.K.,Randall,J.,&Edwards,J.E.(1997).Investigating family-based alternatives to lusti- mtion-based mental health services for youth:Lessons learned from the pilot study of a randomized field triaL Journal of Clinical Child Psychology,26,226-233. Heuggeler,S.W.,Pickrel,S.G.,Brondino,M.J.,&Crouch,J.L.(1996).Eliminating(almost)treatment dropout of substance abusing or dependent delinquents through home-based nwltisystemic therapy.Ameri- can Journal of Psychiatry,153,427-428. Schoenwald,S.IC(1998).Muttisystemic Therapy Consultation Guidelines. Charleston,SC: MST Insti- tute. Schoenwald,S.K.,Henggeler,S.W.,Rowland, M.D.,&Hoagwood,K.(1998).Getting Outcomes with MST:Implications for Dissemination. Symposium presented at the Eleventh Annual Research Confer- ence,A System of Care for Children's Mutual Health: Expanding the Research Base,Tampa,FL: Re- search and Training Center for Children's Mental Health,The Louis de la Parte Florida Mental Health Institute,University of South Florida. Appendix 1: Resumes Resume Of James P. Nelson,MA, LPC 3400 16t Street,Suite 3-R Greeley,CO 80634 (970)353-5577 E-mail: JPNelson1452@Qwest.net Counseling and Mediation Experience Psychotherapy Associates of Greeley,(Private Practice): • Individual and family therapy,families with delinquent adolescents, • Relationship enhancement groups,Career counseling, • Hypnotherapy for phobias and habit cessation, • Mediation in a variety of settings. Skilled in therapy, mediation, and custody evaluations. Licensed Professional Counselor in the State of Colorado University of Northern Colorado Counseling Center,(Therapist): • Individual therapy • Marriage and couples counseling, • Emergency assessment,intake interviewing,and crisis intervention, • Diagnosis,treatment planning,and interdisciplinary staffmg. Skilled in diagnosis, treatment planning, and cognitive behavioral therapy. UNC Alternative Dispute Resolution Center,(Assistant to Director): • Assisted Director in budgeting,grant writing,and community education, • Team-taught classes in negotiation,mediation,and arbitration, • Assisted University Ombudsman in mediating cases involving university students and personnel. Skilled in establishing and maintain positive management/labor relations in a professional setting, and in ADR implementation. UNC Career Counseling Services,(Paid Intern): • Co-developed the Technical Assistance Center for Service Learning, • Co-wrote grant to bring AmeriCorp Volunteer Program to UNC, • Established and managed the UNC Community Service Learning Center, Experienced in implementation of Community Service Programming. Administrative and Agency Management Experience Youth Emancipation&Services,Inc,Executive Director • Founder and CEO supervising all aspects of agency management • Licensed Clinical Supervision • Provide daily organizational leadership Providing individualized therapeutic and residential services to a growing list of governmental entities and private clients. Alternative Homes for Youth,Vice President: • Supervised agency Program Directors, • Participated on Policy Committee, • Coordinated Initiatives in Strategic Planning and Continuous Quality Assurance, Experienced and skilled in organizational development and leadership. 1 of 2 Resume of James P. Nelson, MA,LPC—(970)353-5577 Alternative Homes for Youth,Program Director: • Managed the Greeley Youth Shelter,RTC,and Day Treatment Program, • Started the DYC Tracking Program,hired and trained the first staff, • Recruited,hired,trained and supervised a staff of 30 employees,including licensed clinical staff, • Promoted for excellence in program management. Skilled in clinical supervision,program management, and compliance with State RTC rules. Education University of Northern Colorado,1994: Master of Arts,Counseling,Secondary and Post-Secondary School Administration. Ph 7 Mediation Group, 1993: Training in Alternative Dispute Resolution,Conflict Management,Negotiation,and Mediation. Franklin Institute, 1986: Training in Series 6,7 and 22 Securities Dealer Licenses,Life Insurance Brokerage. Continuing Education,Various 1976 to 1991: Attended various courses and seminars in Business Management,Counseling,Conflict Resolution. University of Northern Colorado,1975: Bachelor of Arts in Psychology,Bachelor of Arts in Cultural Anthropology,Minor in Business. Licenses and Affiliations Colorado Professional Counselor,License#1626 National Board for Certified Counselors,Certificate#37597 Strength Based Services International,Empowering youth through emphasis on,and development of their strengths,rather than on problems and weaknesses. 2 of 2 Resume of James P.Nelson,MA,LPC—(970)353-5577 Julie E. Nelson, MA, LPC Psychotherapist Nelson, Wolf and Associates Youth Emancipation and Services 1452 43R° Avenue Greeley, Colorado 80634 (970) 353-5577 Cell (970) 405-1758 VITAE EDUCATIONAL AND PROFESSIONAL CREDENTIALS Master of Arts. Professional Psychology: Agency Counseling, Summa Cum Laude. University of Northern Colorado, August, 1996. Bachelors of Science. Business. Cum Laude. Colorado State University, August, 1979. Licensed Professional Counselor(LPC) with the State of Colorado, Department of Regulatory Agencies, Division of Registrations, #1512, September, 1996 to present. Sex Offender Management Board (SOMB) Full Operating Treatment Provider: Juveniles. Court Recognized Expert Witness for Sexual Offenders EMPLOYMENT HISTORY Psychotherapist-Individual and Group Therapy Services, Greeley, Colorado (February, 2004- Present). Provide individual and group therapy services to adults, adolescents, males, females, and families. Provide psychometric testing and generate mental health evaluation in the areas of domestic violence, sexual violence, victim's issues and general mental health. Conduct intakes for new clients. Psychotherapist-Youth Emancipation and Services, Greeley, Colorado (June, 2005-Present). Provide in home family therapy to at risk youth and their families. Generate monthly reports for social service and probation agencies regarding progress. Communicate closely with caseworkers and probation officers regarding youth and family progress. Provide training for employees. Conduct intakes for new clients. Psychotherapist-Alternative Homes for Youth, Greeley, Colorado (June, 1997 to January, 2004). Provided individual, group and family therapy for youth in out of home placement. Generated monthly reports for social service and probation agencies regarding progress. Coordinated staffing's for juveniles monthly. Conducted intakes with new clients. Developed juvenile sex offender program. Page 18 Psychotherapist-Centennial Mental Health, Sterling, Colorado (August, 1996 to June, 1997). Provided general mental health therapy for individuals and couples. Provided therapy for clients with employee assistance plans for various companies. Conducted intakes for new clients. Counselor:Externship-Ft. Collins Mental Heath, Ft. Collins, Colorado (August, 1995 to June, 1996). Provided individual and couples mental heath therapy, including chronically mentally ill clients. Counseled sexual abuse victims. Completed appropriate paperwork, as needed. Page 19 Resume Kristine Wolf Nelson, Wolf and Associates 1452 43rd Avenue (970)353-5577 Work Experience 9/02—Present Agency: Youth Emancipation&Services,inc. 3400 16'"St.Greeley,CO 80634 Position held:Program Director,Griffin House Residential Treatment Center. Nature of activities: Manages clinical practice,treatment and personnel of a home for emancipating young men ages 16 to 19 years. Duties: Supervises intake,treatment planning,administration of treatment,counsels and mentors youth and staff. Supervisor:James P.Nelson,MA,LPC—Executive Director 11/00—9/02 Agency: Alternative Homes For Youth 1110 Al Street Greeley,CO (970)353-6010 Position held: Therapist since 11/00, Assistant Director since 4/1/01 Nature of activities:the same as those listed under Case Manager duties,intern Therapist duties;training new counselors,teaching life skills classes,addressing treatment goals with the youth weekly,budgeting,training policies and procedures,parenting issues, setting youth up with community service. Supervisor:James Rodman,LMFT 5/00—11/00 Agency:Alternative Homes For Youth Position held:Case Manager Nature of Activities:Assist therapists in conducting staffings for clients,facilitating staff meetings,follow up with caseworkers,Guardian Ad Lidems,and Probation Officers regarding incidents with clients;transporting clients to and from court appointments, school,medical and dental appointments;conduct social skills and independent living skills groups for emancipating youth;keep youth account current;assist line staff with groups and individual one on one sessions when necessary;assist with termination reports and intakes when necessary. Populations served: adolescents,ethnic minorities,families,caseworkers,GAL's,and Probation Officers. Supervisor:Birch Hilton,M.A.,L.P.C. 8/99—5/00 Agency:Alternative Homes For Youth Position held:Intern Therapist Nature of Activities:Conduct family and individual sessions;facilitate staffmgs,case manage and liaison between outside agencies and client needs;diagnosing according to the DSM IV criteria;develop treatment plans according to DSM IV diagnosis; assist youth in transitioning back with biological or foster families;conduct anger management groups,self-esteem issues,conflict resolution,identifying social and personal values,grief and loss issues;administrate a phototherapy class to assist youth in identifying feelings,attitudes,and various self perspectives;attend community youth net meetings;conduct research on direct service assessment. Supervisor:Shari Simmons,LCSW 1/99—5/99 Agency: North Range Behavioral Health 13086611'"Ave Greeley (970)353-3686 Position held: Intern Therapist Nature of Activities: Facilitated individual and family therapy sessions,diagnosed according to DSM IV criteria,developed treatment plans,was co-facilitator for a grandparent care-taker support group. Populations served:children,adolescents,ethnic minorities,adults,families in crisis. Supervisors:Pat Orleans,LCSW 11/96— 11/00 Agency: Alternative Homes For Youth Position held: Lead Counselor Nature of Activities:Facilitate educational groups while ensuring the safety of all youth and facility maintenance;utilize listening and mediation skills with clients and support decisions in conflict resolution;develop plans with youth when transitioning back with parents or to foster care placements;assist therapists with suicide evaluations of youth in crisis,assist in the planning and implementation of individual therapy plans and document the progress of clients daily;attend staffings to assist in identification and development of treatment issues and plans with probation officers,caseworkers, therapists,and parents,work with youth in developing life skills,anger management, and evaluating personal values. Populations served: Adolescents,ethnic minorities,homeless and troubled youth,sex offenders. Supervisor:Jim Nelson,MA,LPC 6/96—9/96 Agency:C.A.R.E. 814 9th St.Greeley (970)356-6751 Position Held:Teen Advocate Nature of Activities:Teaching clients to utilize community and family resources,fostered personal growth in parenting skills improvement,supported short and long term goal planning,helped clients to prepare for job interviewing processes,mentored positive behavior. Populations served: Children,adolescents,young adults,ethnic minorities,single parent teens. Supervisor:Jill Andre,BA 12/94—5/95 Agency: Psychotherapeutic Services 1024 9m Ave. Greeley (970)356-8160 Position Held: Research Assistant Nature of Activities:Gathered information of available services for chronic pain patients, conducted interviews regarding the nature and extent of chronic pain experienced, developed a questionnaire asking clients about pain tolerance and willingness to pursue a non-traditional model of treatment,assessed the hypnotic talent of the client through testing and then presented the results to supervisor. Populations served:Physically disabled,ethnic minorities,older adults Supervisor: Sharon K.Benson,MA,LPC Education 5/93 A.A. in Paraprofessional Counseling,Aims Community College,Greeley,CO 5/95 B.A.in Sociology—Family Studies,University of Northern CO,Greeley,CO 5/00 MSW—Generalist Perspective,Colorado State University,Ft.Collins,CO Currently working on licensure for LSW and LCSW Appendix 2: Data Collection Instruments NCFAS North Carolina Family Assessment Scale • Version 2.0 Household#: Date Initial Assessment Completed / / waiter. Date Case Or Assessment Completed / / Family Name: Intrnducdon Each of the following scales is used to determine how a family is functioning. They also may be important to the level of imminent risk of out-of-home placement for this family in the context of family strengths and problems. For each scale,rate its influence as a strength or problem for the family along a 6-point continuum,using the following schema: +2=Clear Strength,+1 =Mild Strength,0=Baseline/Adequate, -1 =Mild Problem,-2=Moderate Problem,and -3=Serious Problem. To rate each scale,circle the appropriate number. "1" represents the rating given at intake, and"C"represents the rating at service or case closure. The "overall"ratings(the ones in the shaded areas)should indicate your overall, composite rating in each of the five domains. The subscales represent areas of interest relating to the domain under which they appear(e.g., Housing Stability appears under domain A. Environment). The reliability and validity study of the NCFAS revealed that it is essential to rate each of the subscales before rating the overall domain scale. Use the definitions in the Definitions Manual to the NCFAS (Version 2.0 or higher)to make your ratings. Complete each of the ratings within 60 days of evening the case on CWEST(IA)and again within 1-2 weeks of service or case closure(C). Many questions and issues of concern to practitioners are addressed in the User's Guide to the NCFAS(Version 2.0). Please also see the User's Guide for a discussion of the development and use of the Scale. The psychometric properties(reliability and validity)of the scale are also discussed in the User's Guide. 1 NCFAS:North Carolina Family Assessment Scale, Version 2.0, Kirk,R.S.,and Reed Aslwtafl, IC, 06/98 This instrument is derived from previous versions based on the Family Assessment Form,developed at the Children's Bureau of Southern California,Michigan's Family Assessment of Needs Form,and four assessment instruments developed in North Carolina by Haven House(Raleigh),Home Remedies(Morganton),Methodist Home for Children(Raleigh),and the stale Division of Mental Health,Developmental Disabilities and Substance Abuse Services. Special acknowledgments are due to Sandy Sladen and Judith Nelson at the Children's Bureau of Southern California and to researchers Jacquelyn McCroskey and William Mean at U.of Southern California. Special thanks also are due to numerous local IFPS providers in North Carona for participating in the ongoing development and field testing of the NCFAS Domain specifications for the original NCFAS was based on the work of Meean and McCroskey. Domains and subscales for Version 2.0 are based upon reliability and validity testing completed in the Fall of 1997. (•)Re:asterisked items,theoretical and empirical support exists in the literature for the Parental Capabilities domain and the associated subscales,and several other subscaks that either were not supported or examined independently in the 1997 reliability and validity study of the NCFAS. These items will be tested during future studies. See User's Guide to the NCFAS,Version 2.0,for additional information on scale consnnction and psychometrics. CAC-5 Clear S. Mild S. Bast A. MIM P. Moderate P. Serious P. 1.Overall envuonmalt (IA) +2 +1 0 1 -2 -3 (C) +2 +1 0 -1 -2 -3 Paw S. Mid S. Baseline A. Mid P. Moderate P. Serious P. 2.Housing stability (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 3.Safety in the community (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 1 -2 -3 4.Habitability of housing (IA) +2 +I 0 -1 -2 -3 I (C) +2 +1 0 -1 -2 -3 5.Income/employment (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 6.Financial management (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 T.Food and nutrition (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 8.Paatlld hygiene (IA) +2 +1 0 4 -2 -3 (C) +2 +1 0 -1 -2 -3 9.Tlaquttatbun (1A) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 10.Learning environment (IA) +2 +1 0 1 -2 -3 (C) +2 +1 0 -1 -2 -3 2 NCFAS:North Cerolim Family Assessment Scale, Version 2.0, Kirk,R.S.,and Reed Ashcroft, K, 06/98 This instrument is derived from previous versions based on the Family Assessment Form,developed at the Children's Btn ktu of Sachem California,Middgan's Family Assessment of Needs Form,and four assessment instruments developed in North Caolina by Haven House(Raleigh),Home Remedies(Morganton),Methodist Home for Children(Raleigh),and the state Division of Mental Health,Developmental Disabilities and Substance Abuse Services. Special acknowledgments are due to Sandy Staten and Judith Nelson at the Children's Bureau of Southern California and to researchers Jacquelyn McCroskey and William Meeaan at U.of Southern California Special thanks also are dire to numerous Focal IFFS providers in North Carolina for participating in the ongoing development and field testing of the NCFAS. Domain specifications for the original NCFAS were based on the work of Maas and McCroskey. Domains and subsales for Version 2.0 are based upon reliability and validity testing completed in the Fall of 1997. (•)Re:asterisked items,theoretical and empirical support exists in the literature for the mental Capabilities domain and the associated subscales,and several other str*scales that either were not supported or examined independently in die 1997 reliability and validity study of the NCFAS. These items will be tested during fusee studies. See User's abide to the NCFAS,Version 2.0,for additional infommtion on scale construction and psychometrics. CAC-5 B.Parental Capabilities* Note:TMs section refers to biological parent(s),if preset,or current caregiver(s) [1. w' ClS. Mid S. Basdine A. Mid P. Moderate P. Serious P. Overal►parental (IA) +2 +1 0 -1 -2 -3 capabilities (C) +2 +1 0 -1 -2 -3 Cleat'S. Mod S. Bodo A. Mid P. Moderate P. Serious P. 2.Supervision of ddld(rell) (IA) +2 +1 0 -1 -2 -3 (C) +2 +a 0 -1 -2 -3 3.Dlsdpinary practices +2 +1 0 4 -2 -3 (C) +2 +1 0 4 -2 -3 4.Provision of developmental/ e ridim nt opportunities (IA) +2 +1 0 -1 -2 -3 (C) +2 +'i 0 -1 -2 -3 5.Parent(s)/caregiver(s') ' mental health (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 6.Parelt(s)/cacegiver(s') physical health (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 . -2 -3 7.Parent(s')/caegiw'(s) use of drugs/alcohol (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -t -2 -3 3 NCFAS:North Carolina Family Assessment Scale, Version 2.0, Kirk,R.S.,and Reed Ashanti*, K, 06/911 This isutnanent is derived from previous versions based on the Family Assessment Foms,developed at the Children's Bueanu of Southern California,Michigm s Family Assessment of Needs Form,and four assessment iretrurvs is developed in North Carolina by Haven House(Raleigh),Home Remedies(Morganton),Methodist Home for Children(Raleigh),and the slab Division of Mental Health,Developmental Disabilities and Substance Abuse Services Special acknowledgments am due to Sandy Slides and Judith Nelson at the Children's Bureau of Southern California and to researchers Jacquelyn MCCreakey and William Mee an at U.of Southern California Special thanks also am 4ue to numerous local[FPS providers in North Carolina for participating in the ongoing development and field testing of the NCFAS. Domain specifications for the original NCFAS were based on the work of Mean and McCroekey. Doman and subunit!for Version 2.0 are based upon reliability and validity testing completed in the Fall of 1997. (11)Re asterisked items,tleomhcal and empirical support exists in to litetdme for the Parental Capabilities domain and the associated subscalcs,and several other subacales that either were not suppwud or examined independently in he 1997 reliability and validity study of fit NCFAS. These items will he tested during fUture studies. See User's Guide to the NCFAS,Version 2.0,for additional information on scale construction and psychometrics, CAC-5 • C.Fatly I actions Note:This section refers to family members living in the same or differed households Clear S. Mild S. Baseline A. Mid P. Moderate P. Swims P. 1.Overall family (IA) +2 +1 0 -1 -2 -3 interactions (C) +2 +1 0 -1 -2 -3 Clear S. Mild S. Bataan A. Mid P. Moderate P. Seams P. 2.Bonding with child(ren) (IA) +2 +1 0 -I -2 -3 (C) +2 +1 0 -1 -2 -3 3.Expectadons of the ddld(ren) (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 4.Mutual support within the family (IA) +2 +I 0 4 -2 -3 (C) +2 +1 0 4 -2 -3 5.Relationship between (IA) +2 +1 0 4 -2 -3 NA (C) +2 +1 0 -1 -2 -3 NA 4 NCFAS:North Carolina Family Assessment Scale, Version 2.0, Kirk,R.S.,and Reed Ashcroft, K, 06/98 This instrument is derived from previous versions based on the Family Assessment Ferri,developed at the Children's Bureau of Southern California,Michigan's Family Assessment of Needs Form,and four assessment irabanam developed in North Carolina by Haven House(Raleigh),Home Remedies(Morganton),Methodist Home for Children(Raleigh),and the sate Division of Mental Health,Developmental Disabilities and Substance Abuse Services. Special acknowledgments are due to Sandy Sladen and Judith Nelson at the Children's Bureau of Southern California and to researchers Jacquelyn McCloskey and William Moran at U.of Southern California Special thanks also are dire to raunerass local IFPS providers in North Carolina for participating in the ongoing development and field testing of the NCFAS. Domain specifications for the original NCFAS were based on the work of Mean and McCloskey. Domes and subnnlet for Version 2.0 are based rpm reliability and validity testing completed in the Fall of 1997. (t)Re:asterisked items,theoretical and empirical support exists in the literature for the earenul Capabilities domain and the associated subscdes,and several other suhecales that either were not apposed or examined independently in the 1997 reliability and validity study of the NCFAS. These items will be tested during future studies. See User's Guide to the NCFAS,Version 2.0,for additional information on scale construction and psychometrics. CAC-S • • D.Fah Iy Safety Note:This section refers to family members living in the same or different households. am S. Mild S. Baadlne A. Mild P. Moderate P. Serious P. 1.Overall family (IA) +2 +1 0 -1 -2 -3 safety (C) +2 +1 0 -1 -2 -3 Clear r S. MW S. Baseborn A. Mid P. Moderate P. Serious P. 2.Absence/presence of physical abuse of child(ren)* (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 3.Absence/presence of sexual abuse of c hIId(ren) ((A) +2 +1 0 1 -2 -3 (C) +2 +1 0 -1 -2 -3 4.Absence/presence of emotional abuse of chld(ren) (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 5.Absence/presence of neglect of child(ren)* (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 6.Absence/presence of domestic ! violence between parent/caregivers (IA) +2 +1 0 -1 -2 -3 NA (C) +2 +1 0 -1 -2 -3 NA 5 NCFAS:North Carolina Family Assessment Scale, Version 2.0, Kirk,It S.,and Reed Ashcraft, K, 06/98 This instrument is derived from previous versions based on the Family Assessment Fonn,developed at die Children's Bueau of Southern California,Michigan's Family Assessment of Needs Fenn,and four assessment amine-nerds developed in North Carolina by Haven House(Raleigh),Home Remedies(Morganton),Methodist Home for Children(Raleigh),and the state Division of Mental Health,Developmental Disabilities and Substance Abuse Services Special acknowledgments are due to Sandy Sladen and Judith Nelson at the Children's Bureau of Southern California and to researchers Jacquelyn McCroakey and William Meean at U.of Southern California. Special thanks also are due to nwnerous local IFPS providers in North Carolina for anticipating in the ongoing development and field testing of the NCFAS. Domain specifications for the original NCFAS were based on the work of Menton and McCroekey. Domains and subscalee for Version 2.0 are based apt reliability and validity testing completed in the Fall of 1997. (*)Re:asterisked items,theoretical and empirical support exists in the literati=for the Parental Capabilities domain and the associated sbscales,and several other subscales that either were not supported or examined independently in the 1997 reliability and validity study of de NCFAS. These items will be tested during future studies. See User's Guide to the NCFAS,Version 2.0,for additional information on scale construction and psychometrics. CAC-5 B.Chad Wen-Bing Note:This section pertains to the immhtes risk ddld(mn). Clear S. Mid S. Baseline A. Mad P. Moderate P. Soiree P. 1.Overall child (IA) +2 +1 0 -1 -2 -3 well-being (C) +2 +1 0 4 -2 -3 Char S. midis. Bodine A. Mid P. Moderate P. Serious P. 2.Child(ren's)mental health (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 4 -2 -3 3.Chtid(ren's)behavior (IA) +2 +1 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 4.School petrol name (1A) +2 +1 0 -1 -2 -3 NA (C) +2 +1 0 1 -2 -3 NA 5.Relationship with perent(s)/cant≥ (s) +2 +1 0 4 -2 -3 I (C) +2 +1 0 -1 -2 -3 6.Relationship with sibling(s) (lA) +2 +1 0 -1 -2 -3 NA (C) +2 +1 0 -1 -2 -3 NA 7.Relationss hip with peers (IA) +2 +1 0 -1 -2 -3 NA (C) +2 +1 0 -1 -2 -3 NA 8.Cooperation/motivation to maintain the family (IA) +2 +1 0 -1 -2 -3 (C) +2 +I 0 4 -2 -3 6 NCFAS:North Carolina Family Assessment Scale, Version 2.0, Kirk,It S.,end Reed Ashcraft, K, 06/98 This instrument is derived from previous versions based on the Family Assessment Form,developed at the Children's Rican of Southern California,Michigan's Family Assessment of Needs Form,and four assessment instruments developed in North Carolina by Haven Hose(Raleigh),Home Remedies(Morganton),Methodist Home for Children(Raleigh),and the awe Division of Mental Health,Developmental Disabilities and Substance Abuse Services. Special acloowledgments are due to Sandy Sladen and Judith Nelson at the Children's Bureau ofSouthem California and to researchers Jacquelyn McCroskey and William Mann at U.of Southern California Special thanks also are dye to numerous local IFPS providers in North Carolina for participating in the ongoing development and fiel4 taring of the NCFAS. Domain specifications for the original NCFAS were based on the work of Mesh and McCroskey. Dennis and stales or Version 2.0 me based upon reliability and validity testing completed in the Fall of 1997. (s)Re:asterisked item,theoretical and empirical prhppoit exists in the literature for the Federal Capabilities domain and the associated subsala,and several other subscales that either were not arypaled or examined independently in the 1997 reliability and validity study of the NCFAS. These items will be tested dung figure studies. See User's Guide to the NCFAS,Version 2.0,for additional in formation on scale constriction and psychometrics CAC-5 Attachment VIII. B. Assessment ANALYSIS OF"FIT" Family Name: Smith Therapist: Aorthor Kellogg Die StIrS WWI WOKS 3•!! SNP No 5m fR w3 Pain DMA we WS 017. Mot CIA131 11560000 K - PH aft ,may iSSISSEIS Attachment VIII . B. Evidence Based Outcomes IN-HOME FAMILY THERAPY CASE SUMMARY Month of: June 2005 Family Name: Smith Therapist: Aurthur Kellogg MA. LPC I. Overarching/Primary Goals: 1.Ralph will avoid any further problems with the legal system,as evidenced by lack of police reports,self and family hepu t. 2.Ralph will increase his successful experiences,as evidenced by reports from the TIGHT program,reports from Mom,and self report. 3.Improve conflict resolution skills,as evidenced by decreased fighting,family,and self report. II. Previous Intermediary Goals: Met Partially Not 1. Help Ralph understand more about his vulnerability to drugs. x 2. Ralph and his sister will help with chores around the house more. x 3. It's Mom will work on setting clearer boundaries and expectations with her children. x III. Barriers to Intermediary Goals: 1. Mom has an untreated anxiety disorder that makes it difficult for her to stay focused on the task at hand. 2. The children are used to doing as they please,as Mom has not set clear boundaries. 3. Ralph goes to Drug/Alcohol Group but does not participate. IV. Advances in Treatment: 1. Family meets weekly and openly discusses goals and how to meet them. Most of the sessions focused on how mom can get better at newgnizing when to set boundaries vs being lenient. V. Assessment of"fit"between Identified Problems and Broader Systemic Context: 1. Family members are struggling with how to have an organized household with less stress and better communication on how family members can help each other. 2. Ralph continues to come and go as he pleases,and has come home intoxicated several times. Mom has not followed the plan to take Ralph to Detox and has not ignited this to his substance abuse counselor. 3. Mom recognizes her need to become more assertive with her children regarding her expectations. VI. New Intermediary Goals: 1. Get Mom into see a psychiatrist for her anxiety. 2. Get Mom financial assistance to help pay for Rx. Therapist Signature Date Attachment VIII 13 Aagessmpntc Appendix 4-A W �t INDEX OF FAMILY RELATIONS (IFR) Name: Today's Date: This questionnaire is designed to measure the way you feel about your family as a whole.It is not a test,so there are no right or wrong answers.Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2 = Very rarely 3 = A little of the time 4 = Some of the time 5 = A good part of the time 6 = Most of the time 7 = All of the time 1._The members of my family really care about each other. 2. I think my family is terrific. 3._My family gets on my nerves. 4. I really enjoy my family. 5._I can really depend on my family. 6._I really do not care to be around my family. 7._I wish I was not part of this family. 8.^I get along well with my family. 9._Members of my family argue too much. 10._There is no sense of closeness in my family. 11. I feel like a stranger in my family. 12._My family does not understand me. 13._There is too much hatred in my family. 14. Members of my family are really good to one another. 15._My family is well respected by those who know us. 16._There seems to be a lot of friction in my family. 17._There is a lot of love in my family. 18._Member of my family get along well together. 19._Life in my family is generally unpleasant. 20._My family is a great joy to me. 21._I feel proud of my family. 22._Other families seem to get along better than ours. 23._My family is a real source of comfort to me. 24._I feel left out of my family. 25._My family is an unhappy one. Copyright(c)1992,Walter W.Hudson Illegal to Photocopy or Otherwise R..p.• uce 1,2,4,5,8,14,15,17,18,20,21,23. INDEX OF SISTER RELATIONS (ISR) Name: Today's date: This questionnaire is designed to measure the way you feel about your sister. It is not a test so there are no right or wrong answers. Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2=Very rarely 3=A little of the time 4= Some of the time 5=A good part of the time 6= Most of the time 7=All of the time 1. I get along very well with my sister. 2. _My sister acts like she doesn't care about me. 3. _My sister really treats me badly. 4. My sister really seems to respect me. 5. I can really trust my sister. 6. _My sister seems to dislike me. 7. My sister really understands me. 8. My sister seems to like me very much. 9. My sister and I get along well together. 10. _I hate my sister. 11. My sister seems to like having me around. 12. _I really like my sister. 13. I really feel that I am disliked by my sister. 14. I wish I had a different sister. 15. My sister is very nice to me. 16. My sister seems to respect me. 17. My sister thinks I am important to her. 18. _My sister is a real source of pleasure to me. 19. _My sister doesn't seem to even notice me. 20. I wish my sister was dead. 21. _My sister regards my ideas and opinions very highly. 22. _My sister is a real"jerk". 23. _I can't stand to be around my sister. 24. My sister seems to look down on me. 25. _I enjoy being with my sister. Copyright© 1992,Walter W. Hudson 1, 4, 5, 7, 8, 9, 11, 12, 15, 16, 17, 18, 21, 25 INDEX OF BROTHER RELATIONS (IBR) Name: Today's Date: This questionnaire is designed to measure the way you feel about your brother. It is not a test so there are no right or wrong answers. Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2=Very rarely 3=A little of the time 4=Some of the time 5=A good part of the time 6= Most of the time 7=All of the time 1. I get along very well with my brother. 2. _My brother acts like he doesn't care about me. 3. _My brother treats me badly. 4. _My brother really seems to respect me. 5. I can really trust my brother. 6. _My brother seems to dislike me. 7. My brother really understands me. 8. _My brother seems to like me very much. 9. My brother and I get along well together. 10. _I hate my brother. 11. My brother seems to like having me around. 12. _I really like my brother. 13. I really feel that I am disliked by my brother. 14. _I wish I had a different brother. 15. _My brother is very nice to me. 16. My brother seems to respect me. 17. _My brother thinks I am important to him. 18. My brother is a real source of pleasure to me. 19. My brother doesn't seem to even notice me. 20. _I wish my brother was dead. 21. My brother regards my ideas and opinions very highly. 22. _My brother is a real"jerk". 23. _I can't stand to be around my brother. 24. My brother seems to look down on me. 25. _I enjoy being with my brother. Copyright© 1992,Walter W. Hudson 1,4, 5, 7, 8, 9, 11, 12, 15, 16, 17, 18, 21, 25 CHILD'S ATTITUDE TOWARD MOTHER (CAM) Name: Today's date: This questionnaire is designed to measure the degree of contentment you have in your relationship with your mother. It is not a test so there are no right or wrong answers. Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2=Very rarely 3=A little of the time 4=Some of the time 5=A good part of the time 6= Most of the time 7=All of the time 1. My mother gets on my nerves. 2. _I get along well with my mother. 3. _I feel that I can really trust my mother. 4. _I dislike my mother. 5. _My mother's behavior embarrasses me. 6. _My mother is too demanding. 7. _I wish I had a different mother. 8. _I really enjoy my mother. 9. _My mother puts too many limits on me. 10. _My mother interferes with my activities. 11. _I resent my mother. 12. _I think my mother is terrific. 13. _I hate my mother. 14. _My mother is very patient with me. 15. _I.really like my mother 16. _I like being with my mother 17. _I feel like I do not love my mother 18. _My mother is very irritating. 19. _I feel very angry toward my mother. 20. I feel violent toward my mother. 21. _I feel proud of my mother. 22. I wish my mother was more like others I know. 23. My mother does not understand me. 24. _I can really depend on my mother. 25. I feel ashamed of my mother. Copyright O 1992,Walter W. Hudson 2, 3, 8, 12, 14, 15, 16, 21, 24 CHILD'S ATTITUDE TOWARD FATHER (CAF) Name: Today's date: This questionnaire is designed to measure the degree of contentment you have in your relationship with your father. It is not a test so there are no right or wrong answers. Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2 =Very rarely 3=A little of the time 4= Some of the time 5=A good part of the time 6= Most of the time 7=All of the time 1. _My father gets on my nerves. 2. _I get along well with my father. 3. I feel that I can really trust my father. 4. _I dislike my father. 5. _My father's behavior embarrasses me. 6. _My father is too demanding. 7. I wish I had a different father. 8. _I really enjoy my father. 9. _My father puts too many limits on me. 10. My father interferes with my activities. 11. I resent my father. 12. _I think my father is terrific. 13. I hate my father. 14. _My father is very patient with me. 15. _I really like my father. 16. I like being with my father. 17. I feel like I do not love my father. 18. My father is very irritating. 19. I feel very angry toward my father. 20. _I feel violent toward my father. 21. _I feel proud of my father. 22. _I wish my father was more like others I know. 23. My father does not understand me. 24. _I can really depend on my father. 25. I feel ashamed of my father. Copyright© 1992,Walter W. Hudson 2, 3, 8, 12, 14, 15, 16, 21, 24 Appendix 3: Sample Consent Forms . Attachment VII. D. Collaborative Communications NELSON, WOLF & ASSOCIATES, P.C. Staffing Notice This letter is to inform you of the scheduled staffing for This staffing will be on at 340016"'Street,Building #3,Suite Q. (Bittersweet Square Professional Offices, southeast corner of 16th street and 35th Avenue) The meeting is being held in order to provide an opportunity for collaboration and to recognize progress being made in our consultation together. If you have questions or concerns,please call me at(970)353-5577. Please call as soon as possible if you cannot attend the scheduled staffing at the above date and time so that I can make arrangements to reschedule the staffing so that all interested parties can attend. Thank You, J.P.Nelson Supervisor Cc to: Client Family Caseworker GAL Attorney Probation Officer Therapist • Attachment VII . C. Release of Information NELSON, WOLF & ASSOCIATES, P.C. RE: Date: RELEASE OF INFORMATION I hereby give permission to To release the following information either written or oral to authorized representative of Nelson, Wolf& Associates. This information is necessary in order to determine treatment needs and to coordinate treatment. This release of information remains in effect until , or DISCHARGE FROM TREATMENT WITHIN NELSON,WOLF&ASSOCIATES. The undersigned acknowledges that he/she/they understand that this release remains in effect until the above date or event,unless specifically revoked by written consent.' Signature of Client Date Other Person Authorized to Give Consent Date Witness Date Please return to: Nelson,Wolf&Associates,P.C. 340016's Street, Suite Q Greeley,CO. 80634 'To revoke consent, please send written notice of revocation to Nelson Wolf& Associates at the above address.Please include date and time revocation is to take effect. NELSON, WOLF & ASSOCIATES, P.C. RE: Date: Authorization For Communication I understand that information I share while involved in treatment with NELSON,WOLF&ASSOCIATES, P.C. will be shared with the treatment team to facilitate the provision of services. The treatment team may include teachers, clinical and counseling staff, as well as administrative staff serving in a supervisory or case management capacity to the client. (All violations of probation and/or any criminal behavior or conditions involving safety to the client and/or others must be disclosed to the appropriate authorities.) In addition,I hereby give NELSON,WOLF&ASSOCIATES,P.C.permission to exchange legal,medical and treatment information with the following agencies(check all those that apply): County Department of Social Services Representative District Courts County Juvenile/Adult Probation District Schools ,Guardian ad Litem ,Attorney Juvenile Detention Centers Police Department of jurisdiction Fire Department Family members-please list and describe relationship: I understand that this release is in effect until or Until DISCHARGE FROM TREATMENT WITHIN THE AGENCY.* Signature of Client Date Guardian or Person Authorized to Give Consent Date *To revoke consent,send written notice to: NWA 3400 16th Street,Suite 3Q Greeley,CO 80634 EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP • Elaine Furister From: jim nelson [yeservices@gwest.netj Sent: Thursday, May 31, 2007 2:18 PM To: Elaine Furister Subject: Option B Conditions Attachments: Evidencebasedoutcomes_monthly.doc; OPTION_B_Pre-Post.doc Evklencebasedoutc OPTION_B_Pre-Pos omes_monthly.,.. t.doc(64 KB) Dear Elaine, Here are a couple of documents that will illustrate how we determine areas of concentration with Option B families, and how we measure and report monthly progress. If other information is needed, please contact me and I will forward it to you. Thanks, Jim Nelson Nelson Wolf & Associates 970-405-0559 (cell) 1 Elaine Furister From: Jim Nelson [jpnelson1452@qwest.net] Sent: Tuesday, May 22, 2007 8:04 AM To: Elaine Furister Subject: RE: Core Bid-Award Letter Hi Elaine, We were at an educational conference in Durango this past week and did not receive the email until we returned. We would like to continue to do business with Weld and will accept the conditions set forth in the award letter regarding Option B Intensive In Home Family Services. Due to our attendance at the conference last week, we have not had the time to prepare the detailed response about Measurable Objectives and Service Objectives, but I will deliver those later today. The billing function will be accomplished by Mountain View Billing in the same manner as delineated in the Terms, and billing will appear on the same forms and on the same schedule as appears in the Bid specifications. We don't intend to mention MST much but, but if we do, we will use the same disclaimer we did in our bid. We will contract under Nelson, Wolf & Associates. If there are any other points, please let me know. Thanks, Jim Nelson MA, LPC Nelson, Wolf & Associates Original Message From: Elaine Furister [mailto:furistef@co.weld.co.us] Sent: Wednesday, May 16, 2007 1:51 PM To: JPNELSON1452@gwest.net Subject: Core Bid-Award Letter Dear Jim, In response to your bid submission through the Core Services Bid Process, I am attaching a copy of the Award letter, which has been signed by Judy Griego, Director. The original signed copy of this letter has been mailed to you. If you have further questions, please direct them to Tobi Vegter, Core Services Coordinator, 970.352.1551, ext.6392. Elaine Furister CPS/CAP Core Services/Rate Negotiator Clerk V 970.352.1551 ext. 6295 1 Attachment VIII. B. Evidence Based Outcomes IN-HOME FAMILY THERAPY CASE SUMMARY Month o£ Ante 2405 Family Name:_Singh Therapist:Aurthur Kelbgn MA.Lit I. Overarching/Primary Goals: I.Ralph will avoid any further problems with the legal system,as evidenced by lack of police reports,self,and family regal. 2.Ralph will Increase his successful experiences,as evidenced by reports torn the TIGHT program,reports Ran Man,and self report. and self report. 3.Improve cationresolatiao skills,as evidenced by decreased fighting,family, II. Previous Intermediary Gals: Met Partially Not I. Help Ralph undersized more about his vulnerability to dugs. x 2. Ralph and his sister will help with Sat ramd the house more. x 3. les Man will work a setting clearer boundaries and expectations with ha children. x Ill. Barriers to Intermediary Gads: 1.Mom has an untreated anxiety disorder that makes itdifficult for hertostay focused on the tat at hand. 2. The children re used to doing as they please,as Mom has not set clear boundaries. 3. Ralph goes to Drup/Alwhd Group but does not participate. IV.Advances in Trestmat I. Family meets weekly and openly discusses goals and how to meet them. Most of the sessions focused a how mom cm get better at recognizing when to set boundaries vs being lenient. V. Assessment oPanty m e hers enare Identified with how to haw an orga izd household with less stress and roblems and Breeder Systemic Context 1. Fannym®basaresbowfam R eaanmiva toa how a d go a me Alas can help each other. 2. Ralph continua a cane undo take Ralph 1phto rid has caneb re intoxicated e severaltime. Mom hen not followed the plan to take Ralph to Detox Ind has not reported this to his substance abuse counselor. 3. Man recognizes her need to become more assertive with ha children regarding ha erpata4as. VI.New Intermediary Goals: 1. Get Mom in to sou a psychiatrist for her anxiety. 2. Get Man financial assistance to help pay for Rs. Therapist Signature Date NELSON, WOLF &ASSOCIATES INC. ASSESSMENT OF INDEPENDENT LIVING SKILLS (Verbal Interview Format) Referral County: Caseworker: Date of Assessment: Clinician: Client Family Name: Head of Household: Significant Other (Relationship): Children/Gender/Age: EMPLOYMENT: 1. Who in the household is currently employed, and for how long with current employer? A.) B.) C.) Score: 2. Inventory of marketable job skills: Please list(up to four skills): Score: 3. Where can you find out about job openings or work availability? Score: 4. What do you do after turning in a job application? Score: _ 5. How will you make a good impression on a potential employer during an interview? Score: 6. Why is it important to maintain steady employment? Page 1 of 7 NELSON, WOLF &ASSOCIATES INC. TRANSPORTATION: 7. Does the family have dependable means of transportation? 8. What are the families current methods of getting from one place to another? Hitch-hiking Carpooling Walking Driving own car Taking the bus Riding a bike Taking a Taxi Ask friend for a ride Score: EDUCATIONAL PLANNING 9. What is current level of education(all adults)? (appropriate to expectations of future advancement?) Score: 10. What plans do you have for your education? Score: _ 11. Is there a career you are interested in other than your current one? Score: 12. What level of education must you obtain for your career goals? Score: 13. How do your strengths/likes fit into your career choice? Score: 14. What is the difference between gross pay and net pay? Score: 15. What is a W-4 form? Score: 16. What do you believe are three good work habits? Score: 17. How do you appropriately triuiinate employment? Score: Housing: Page 2 of 7 NELSON, WOLF & ASSOCIATES INC. 18. How do you find a suitable place to live? Score: 19. What are you looking for specifically in finding a place to live? Score: 20. What qualities make a good tenant (landlords point of view)? Score: 21. What is a lease? What purpose does it serve? Score: 22. What is the difference between a security deposit and a damage deposit? Score: 23. What are your options for breaking a lease? Score: 24. What steps would you take for getting your damage deposit back in full? Food& Nutrition: 25. What meals do you typically prepare for your family: Score: 26. Menu: breakfast, lunch, dinner: 27. Can an adult in the household put together a grocery list based on menu for breakfast, lunch, diner? (score 0 for fast food and commercial frozen meals) Score: 27. Are all children within optimal weight height to weigh ratios for their chronological ages? Yes No: (List names) Score: Page 3 of 7 • NELSON, WOLF &ASSOCIATES INC. Financial Resources & Credit (All working age adults): 28. Who in the household has a: a. Social Security Card? b. Certified Birth Certificate or Passport? c. State ID or Colorado Driver's License? d. Savings or Checking Account? 29. Does anyone in the household owe fines, restitution, court fees, etc? Yes No $ 30. Which answer best describes a useful budget? (Choose the best answer): A. A plan for monthly expenses B. A method for deciding how to spend your money C. Keeping your checkbook balanced D. A method to save money E. A & B F. A, B & D Score:_ 31. Why is it important to have a budget? A. It's not important if you don't spend more than you earn. B. It's important to not spend more than you earn. C. It's important to be able to earn more. D. It helps you spend more. Score: 32. True or False? (circle one) It is important to file an income tax return every year and keep a copy in a safe place? Score: 33. In which order would you perform the following steps to open a checking account? (Number the steps) Bring two forms of Identification. Have at least $100.00 to deposit. Go to the Bank of your choice. Call around to find out which Bank has the lowest costs. Pick out your check design. Choose the best checking plan for your needs. Leave the Bank. Score: Page 4 of 7 DEPARTMENT OF SOCIAL SERVICES P.O. BOX A ' GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 OFax Number(970)353-5215 • COLORADO May 11, 2007 Jim Nelson,MA, LPC Nelson,Wolf&Associates, Inc. 1019 39`"Avenue, Suite C Greeley, CO 80634 Re: Bid#006-OPB-07 (RFP 07010)Option B,Home Based Intensive Services Dear Mr.Nelson: The purpose of this letter is to outline the results of the Bid process for PY 2007-2008 and to request written confirmation from you by Monday, May 21, 2007. The Families,Youth,and Children Commission appreciates your interest in providing services for families in Weld county.This year, strides were made in structuring an RFP that is clear and concise, and more user friendly, for both prospective bidders and evaluators. It is important to stress the value of following formatting guidelines and addressing the required sections concisely and appropriately. A. Results of the Bid Process for PY 2007-2008 • The Families,Youth and Children(FYC)Commission recommended approval of your Bid#006-OPB- 07 (RFP 07010), Option B-Intensive Home Based Therapy, for inclusion on our vendor list. The FYC Commission attached the following conditions to the bid. Conditions: The Bidder must submit information that was not addressed or submitted with the original bid submission, including the following: 1. Clarify the bidder name,Nelson,Wolf&Associates,or Youth Emancipation& Services,Inc. 2. All documentation including reports/correspondence shall include a disclaimer after each mention of MST services; 3. Although the bidder provided that Mountain View is providing bookkeeping services,the bidder must provide their process for submitting their billing, 4. Provide more detail under the Measurable Outcomes section,including quantitative measurements, 5. Provide more detail under the Service Objectives section. B. Required Response by Bidders Concerning FYC Commission Conditions: Page 2 Youth Emancipation& Services,Inc./Nelson Wolf&Associates/Results of Bid Process 2007-2008 • All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award (NOFAA). If you do not accept the condition(s), you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accepts your mitigating circumstances. If you do not accept the conditions, you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. The Weld County Department of Social Services is requesting your written response to the FYC Commission's conditions. Please respond in writing to Tobi Vegter,Core Services Coordinator,Weld County Department of Social Services,P.O. Box A, Greeley,CO, 80632, by May 21, 2007,close of business. If you have questions concerning the above, please call Tobi Vegter at 352.1551, extension 6392. Sincerely, ta iv. ego, for cc: Juan Lopez, Chair,FYC Commission Tobi Vegter,Core Service Coordinator Gloria Romansik, Social Services Administrator Hello