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Home My WebLink About20061587.tiff RESOLUTION RE: APPROVE THREE NOTIFICATION OF FINANCIALASSISTANCEAWARDS FOR SEX ABUSE TREATMENT PROGRAMS WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with three Notification of Financial Assistance Awards for Sex Abuse Treatment Programs between the County of Weld,State of Colorado,by and through the Board of County Commissioners of Weld County,on behalf of the Department of Social Services,and various providers, listed below,commencing June 1,2006,and ending May 31,2007, with further terms and conditions being as stated in said awards: 1. Ackerman and Associates, P.C. 2. Turning Point for Youth and Family Development 3. Adolescent and Individual Therapy WHEREAS,after review, the Board deems it advisable to approve said awards, copies of which are attached hereto and incorporated herein by reference. NOW,THEREFORE,BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, ex-officio Board of Social Services, that the three Notification of Financial Assistance Awards for Sex Abuse Treatment Programs between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services,and various providers listed above, be,and hereby are,approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said awards. 2006-1587 SS0033 nc ' SS Oh-io--off THREE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR SEX ABUSE TREATMENT PROGRAMS PAGE 2 The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 14th day of June, A.D., 2006 nunc pro tunc June 1, 2006. EL ♦ -OARD OF COUNTY COMMISSIONERS ELD COUNTY /• ORADO ATTEST: EL, 1227 4i.AGeile, Chair Weld County Clerk to the B O ssitk , �• oi a IAA_ 1 David . Long, Pro-Tern BY: Ka- De ty Cle to the Board Will m H. Jerke ��^ n APP E S TO FORM: ��J( �, 1\ Robert//`` D. Masde o y tt r e y '1� � A 1I l be Glenn Vaad Date of signature: 2006-1587 SS0033 DEPARTMENT OF SOCIAL SERVICES P.O. BOX GREELEY, CO. 806322 Website:www•co.weld.co.us Administration and Public Assistance(970)352-1551 Fax Number(970) 346-7691 COLORADO MEMORANDUM TO: M.J. Geile, Chair Date: May 31, 2006 Board of County Commissioners FR: Judy A. Griego, Director, Social Services RE: Notification of Financial Assistance Awards 'th ious ontractors— Sex Abuse Treatment Enclosed for your approval are Notification of Financial Assistance Awards with Various Contractors for Sex Abuse Treatment. 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 May 24, 2006. The major provisions of these Awards are as follows: 1. The Award period is June 1, 2006 through May 31, 2007. 2. The source of funding is Core Services or Child Welfare Administration. 3. The Contractors will provide therapy services for non-offending parent,victims and siblings of victims or for juvenile sexually abusive adolescents. 4. The Contractors include: A. Ackerman and Associates, $100.00 hourly treatment rate P.C. $50.00 per hour group therapy $100.00 per hour court testimony B. Turning Point for Youth and $31.79 hourly treatment rate Family Development $31.79 per hour court testimony C. Adolescent&Individual $50.00 hourly rate individual counseling Therapy $50.00 hourly rate family counseling $100.00 per hour court testimony $35.00 per episode treatment package $500.00 per episode after care evaluation $225.00 per episode polygraph(average rate) If you have any questions,please telephone me at extension 6510. 2006-1587 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 FY06-CORE-06007 Revision (RFP-FYC-06007; Bid 06SAT01) Contract Award Period Name and Address of Contractor Beginning 06/01/2006 and Ackerman and Associates P.C. Ending 05/31/2007 Sex Abuse Treatment 1750 25th Avenue, Suite 101 Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Time-limited, outcome-focused therapy services. Assistance Award is based upon your Request for for the non-offending parent, victims, and Proposal (RFP). The RFP specifies the scope of siblings of the victim. Individual services are in services and conditions of award. Except where it is office. Group services provided in office, foster in conflict with this NOFAA in which case the home, or WCDSS. The program maximum is 3 NOFAA governs, the RFP upon which this award is new families per month with a maximum ability based is an integral part of the action. to carry eight open cases a month. Services are culturally sensitive. Bilingual services are Special conditions available. 1) Reimbursement for the Unit of Services will be based on an hourly rate per child or per family. Cost Per Unit of Service 2) The hourly rate will be paid for only direct face-to- Hourly Rate Per Treatment Package $100.00 face contact with the child and/or family as evidenced Hourly Rate Per Group Therapy $ 50.00 by client-signed verification form, and as specified in Hourly Rate Per Court Testimony $100.00 the unit of cost computation. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. Enclosures: 4) Rates will only be remitted on cases open with, and X Signed RFP:Exhibit A referrals made by the Weld County Department of X Supplemental Narrative to RFP: Exhibit B Social Services. X Recommendation(s) 5) Requests for payment must be an original and Conditions of Approval submitted to the Weld County Department of Social Services by the end of the 25th calendar day following the end of the month of service. The provider must submit requests for payment on forms approved by Weld County Department of Social Services. 6) The Contractor will notify the Department of any change in staff at the time of the change. Approvals: Program Official: By 717 By M. J. Geile, Chair Ju . Grie , Direc r Board of Weld County issioners We County De artm nt of Social Services Date: JUN 142u Date: 6/ 3 I/OCo aoa6-/5'7 J C r,j1(TC I S INVITATION TO BID BID 001-06(06005-06011 and 006-00,A,B,& C)) DATE:March 1, 2006 BID NO: RFP-FYC-06001 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O. Box 758,Greeley, CO 80632 SUMMARY Request for Proposal(RFP-FYC-06007) for:Colorado Family Preservation Act—Sexual Abuse Treatment Program--Emergency Assistance Program Deadline: March 31,2006,Friday, 10:00 a.m. 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 1,2006, through May 31,2007, at specific rates for different types of service,the County will authorize approved providers and rates for services only. The Sexual Abuse Treatment Program must provide for therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction,sexual abuse perpetration,and to prevent further sexual abuse and victimization. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background,Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date ft\-p 1- )—/, 1-004 (After receipt of order) BID MUST BE SIGNED IN INK �n.P Ptelie 4-n- n n TYPED O PRINTED SIGNATURE VENDOR 61tAFm(In (aaa.C .ilainl.Q1 oQ �`'J Cis. (Name) Han2klwritten Signature By Authorized Officer or Agent of Vendor ADDRESS rAk Q chx\-hktNp. TITLE ��S\d � �ycc� Qel • Ci •$l�3� DATE i I\citrh I ic)C4, PHONE# "� l e- ,1"' ?.a The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 41 Bid 001-06(RFP-FYC-06007) Attached A SEXUAL ABUSE TREATMENT PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 2006-2007 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2006-2007 BID 001-06,RFP-FYC-06007 NAME OF AGENCY: i 1/� NYIC1Y\ Q\ila 1l�C Ict\ ADDRESS:� ` O ot� rh &-) 1•1L)Q • �61 t� l N D4&'3 , 6C• n PHONE:j"v S l a - r)'3 CONTACT PERSON: �� hC, VPt1CI6\ TITLE: Sexual �` t�,'Ln t DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The xual Abuse Treatment Program must provide for therapeutic intervention throw*one or more modalities to prevent further sexual abuse perpetration or victimization. 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1.2005 Start End May 31.2006 /� End TITLE OF PROJECT: Sec � .4 dk sc P An the Ehacari.L ..-A tr ea.Ctc. X CS'8 re - 7) Pro/-rn-- Oe p.._ 94. a.-.-,ri., O* .„_,.Th f./ o G Name and Signature of Person Preparing Docum ate Name Sign�ture Chief Administrative •Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. ✓ Project Description —7 Target/Eligibility Populations Types of Services Provided Measurable Outcomes ✓ Service Objectives S.en�� ✓ _✓Workload Standards fob ,. �ui„ : Laflle"S a Proof of Collaboration N RIM ' .W... , / Evidenced-based Outcomes / Staff Qualifications Unit of Service Rate Computation Billing Process on Fi it w'-t4' pret - / Program Capacity per Month ✓ Certificate of Insurance Date of Meeting(s)with Social Services Division Supervisor: Page 29 of 41 }aid No-001-06 RFP-FYC COMMISSION-006-00B Attached A O e. 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I m k § 2 1 2 ° V 8 a I.Z. § B ! a §nil ! § § § § ! ri . a § ■ 8 ! § k 4 4 Plain-12i T" ! / . . a , ! n! a ! ! ° e e ! Bid 001-06(RFP-FYC-06007) Attached A Program Category Sexual Abuse Treatment Program Bid Category Project Title Vendor /Q &k en?,/h AN r I.Sso°CA-�.ar / - C C . I. PROJECT DESCRIPTION Provide a one-page brief description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one-page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients to be served. Please describe if your clients are: 1. Victims under age 18. 2. Perpetrators under age 18. 3. Adult incest perpetrators. 4. Non-abusing spouse 5. Relatives(under 18)in the household of incest victims and/or incest perpetrators. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Subtotal of individuals who will provide 24-hour access to services. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program(weeks). J. Average hours per week in the program. K. Cultural/ethnically specific services L. Service to South Weld Clients III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Comprehensive,diagnostic and treatment planning with the family and other service providers. B. Therapeutic intervention with flexibility to bring in other services if needed. C. Therapeutic services through a variety of modalities including: individual,family,group, marital,data,etc. D. Therapy designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction,sexual abuse perpetration,and to prevent further sexual abuse. E. Specialized intake/investigation function for families with sexual abuse allegations. Provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g.mental health capitation services,ADAD and professional services otherwise funded. Page 31 of 41 Bid 001-06(RFP-FYC-06007) Attached A IV. MEASURABLE OUTCOMES Provide a two-page description of your expected measurable outcomes of the project. Please address the following measurable outcomes: A. Reduced rate of recidivism of sexual abuse perpetration within a stated time frame. B. Decrease in re-victimization. C. Prevent victim perpetration. D. A percentage of child abuse incest victims receiving services do not go into placement. E. Improvement in parental competency as measured by pre and post placement functional test. F. More rapid reunification of children with families. Describe your quantitative measures: Also,describe the methods you will use to measure,evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Provide a one-page description of your expected service objectives and quantitative measures. Please address,at a minimum,the following ways the project will: A. Improve Parental Competency-Capacity of parents to maintain sound relationships and appropriate physical and emotional boundaries with their children,and to empower non- abusing parents and victims. B. Improve Family Conflict Management-Mediation and counseling designed to resolve conflicts and disagreements within the family contributing to child maltreatment and sexual abuse. C. Improve Personal and Individual Competencies-Primarily in terms of self-esteem,victim awareness,awareness and management of one's own personal history of victimization,sex education,peer relationships enhancement,establishing appropriate physical and emotional boundaries,assertive in lieu of aggressive behaviors, and assuming responsibility for one's own behavior. D. Improve Ability to Access Resources- Services shall assist parent in learning to obtain help from other sources in the community and within local, state,and federal governments. E. -Address specific referral issue(s)—services shall be solution focused and address issues specified by the Department of Social Services. F. Improve outcomes in the Performance Improvement Plan(PIP) Describe the methods you will use to measure,evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Provide a one-page description of the project's work load standards and quantitative measures. Address, at a minimum,the following areas: A. Number of hours per day,week or month. Page 32 of 41 Bid 001-06(RFP-FYC-06007) Attached A B. Maximum caseload per worker in the intake function and in the Sexual Abuse Treatment. C. Modality of treatment D. Total number of hours per day/week/month. E. Total number of individuals providing these services. F. The maximum caseload per supervisor. G. The modality of treatment. H. Insurance. VII. PROOF OF COLLABORATION Provide the following evidence of/and description of collaboration processes your agency has established and can provide through your program. A. Letter from a housing referral contact your agency will utilize when the client has an identified housing need; B. Letter from a job services referral contact your agency will be utilizing when the client has an identified employment need; C. Describe the methods your agency will use to ensure collaboration including(I)releases of information; and(2)Placement Review Team. D. Provide a description of the routine collaborative communications with all providers and case participants that your agency will arrange. (i.e.,quarterly meetings at your office with all family members, substance abuse provider(s), individual and family therapist(s), Social Services caseworker,Guardian ad Litem,etc.) E. Provide a description of the collaborative efforts your agency will make in planning for a step-down program/continuum of care for the current clients after treatment with your facility. F. Letter from North Range Behavioral Health,addressing whether services for Medicaid clients will be contracted for through North Range Behavioral Health, or whether these services will be provided through your agency's application to provide services for Medicaid eligible clients. VIII. EVIDENCE-BASED OUTCOMES A. Provide bibliographic information on the research base being utilized for the therapy(ies)used by your agency's program. (For this year,anecdotal references will be accepted.) B. Provide a fictional sample of an assessment, including a detailed treatment proposal for a client,and a transition plan after services are completed. C. Provide a fictional sample of a request to renew services for a client. D. Provide a fictional sample of a monthly report. Nate 1 In tie K el Piano,.. lYp cc-?2404 rt,orsZi 4 . s-, V o' IX. STAFF QUALIFICATIONS A re Fries- /r/o r y t w r r -lei a trap Please provide a one-page description of staff qualifications and address,at a minimum,the following: A. Will your staff, including supervisors,who are providing direct services have the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17,and Section 7.000.6,Q,Colorado Social Services of Human Services. Describe. Page 33 of 41 Bid 001-06(RFP-FYC-06007) Attached A B. Total number of staff, including supervisors,as defined in Staff Manual Volume VII, Section 7.303.17, and Section 7.0006 Q,Colorado Department of Human Services. C. Will you staff have received mandated new caseworker training? D. Will your staff have knowledge in risk assessment? E. Is your agency approved by the Sexual Offender Management Board?Explain your compliance with any mandatory regulating agency. X. UNIT OF SERVICE RATE COMPUTATION The budget must be submitted in an hourly unit rate cost of direct delivery of services to an individual or family unit. The bidder must address the Unit of Service Rate Computation Calculation as follows on the attached budget pages. XL BILLING PROCESS A. Provide a description of their billing process. B1u�^� i�b' ' ( 14. B. Provide a fictional demonstration of a monthly billing. J`o, lac- 0.41 For torXII. LOWEST QUALIFIED BID /��* �`�^� y{ XIII. PROGRAM CAPACITY BY MONTH Provide a description of maximum and minimum client capacity per month necessary to support your agency's program. INSTRUCTIONS-UNIT OF RATE COMPUTATION The budget form is to be used to provide detailed explanation of the hourly or daily rate your organization will charge the Core Services Program for the services offered in this Request for Page 34 of 41 Project Description 2005-2006 Sexual Abuse Family Education and Treatment Program The SAFE-T Program Protect Description: Ackerman and Associates P.C. proposes to continue to provide in 2006-2007, the time limited, outcome focused therapy model for treatment of the non-offending parent, the victim and siblings of the victim in sexual abuse cases. The program is based in part on the Connections workbook by Jill S. Levenson and John W. Morin (2001) and upon the Handbook of Clinical Intervention in Child Sexual Abuse (1982) The program is proposed in four parts: (each of these parts may be used as part of an integrated program, may stand alone or be used in combination with other treatment regimens.) PART A. The development of the prescriptive safety education and treatment plan of the family unit. This will take place over no more than fifteen hours and should average ten hours. PART B. The implementation of the plan with the non-offending parent to increase safety and avoid repetition of sexual abuse in the family unit. This will take place for up to 20 sessions. Up to ten of these sessions would be for individual treatment. Up to the additional ten of these individual session times could be converted to ten sessions of group work. (Throughout the proposal, whenever we discuss group work, note that it will be billed as one hour of individual treatment for each two hours of group treatment). PART C. Short term treatment for the child who was abused and for the siblings) over a maximum of fifteen sessions to develop skills for future safety and to reestablish trust, including family issues that need to be addressed with the children. Each child who is in treatment, (whether the victim or the sibling), should have their own authorization for treatment. PART D. A protocol of therapy to taper down the frequency of support needed to provide maintenance of skills developed. This will take place over no more than ten sessions designed to be delivered on a twice a month basis over a maximum of five months. This provides an additional support program for those families in need of the service. Based on past experience Parts, B, and C have been used most by WCDSS and parts A and D have not been used much. Nevertheless, we submit them all here as an appropriate program for potential future use. Each part is presented on its own budget page 1 For any family who is not appropriate to continue in the treatment model due to severity that exceeds the capacity of the program they will be transferred back to WCDSS. Determination of progress in the program will occur at the following specific review points: Program Review point#1: A report of recommendations for treatment will be completed at the end of part A. It will specify: 1. The goals to be achieved in part B and part C, which can then occur over the next two or three months if authorized 2. What other types of treatment or intervention are appropriate and 3. If no other intervention is recommended. Program review point#2: A report of the summary of treatment as the completion of the treatment plan in part B or part C. The purpose of this report is to answer questions: 1. How much progress has been made to date in relation to treatment plan? 2. Is it probable the family will complete the treatment in part B or part C within the session limits specified and if not what other services might be needed. Program review point#2 will also be the time point that a determination will be made as to if there is a need for an extension of sessions in phase B and C and, if so, why this is needed. An extension, if needed, will be limited to twelve sessions. Such an extension can occur only though a second authorization. The criteria for making clinical judgments as to the family's progress will be based upon their completion of the prescriptive treatment plan and the adequacy of that treatment plan to protect the child and family from repeat offenses in relation to sexual abuse. Families not making progress will be discussed with the caseworker and as needed referred to other programs or back to WCDSS for further treatment. Please note: the end point of treatment is not necessarily intended to be the full and complete resolution of all psychodynamic issues precipitated by the sexual abuse event. Such issues will likely continue to emerge as the child enters different stages of development into adulthood. If further funds are needed for full and complete restoration of mental health (beyond that required for family safety) these funds should be obtained from legal action in relation to the perpetrator and or through victim's assistance and other funds. The purpose of this program is to recommend to WCDDS if the incident of the actual abuse has been resolved sufficiently to provide for the ongoing physical and mental health and safety of the non-offending parent, and the child victim and siblings residing with the non- offending parent at the time of discharge from the program. 2 The purpose of this highly structured system is to assist family members to achieve careful implementation of safety and child protection plans. Through role modeling, psychoeducational work with adults and /or child therapy, families will progress along a structured treatment course. Treatment will move from recognition of the factors that lead to the sexual abuse in their particular case to developing and effective plan to eliminate the resurfacing of these factors and repetition of these types of events in the future. Of the four phases of the program, Part A would be limited to 15 sessions delivered over no longer than three months. Part B and C would be limited to twenty sessions each delivered either separately or concurrently over four months. The step down phase of the program Part D would be limited to no more than 10 sessions over four to six months. Reviews for the need to continue in the program would occur in month one, month three and month five. Families will need the Sexual Abuse Family Education and Treatment program (the SAFE-Treatment Program) because the sexual abuse and its implications have either: 1. Imminently placed the children at risk of outplacement from the non offending parent (or parents) 2. Created a need to be reunified or 3. The family is facing imminent reunification failure or 4.the family has failed to implement the behaviors required of them. Our model does not treat the adult sexual offender .If that offender is the parent (usually the father or step father) and reunification is the agreed upon course of action desired by WCDSS, we would only assist the parties in developing a formal reunification plan after the offender has successfully completed treatment in another program. In those cases, we further reserve the right to refuse treatment to such individuals unless based upon our clinical judgment we agree that reunification is psychologically supportable within the treatment system we provide. Our model is expected to be especially useful where the non offending parent is herself a victim of sexual or physical abuse in her home of origin, or who has a highly disrupted home of origin from other causes. The program will provide continuity for the non offending parent and the children through each family having a coordinator within Ackerman and Associates. That coordinator will also coordinate the case and be the contact for the case worker and lead the clinical team within Ackerman and Associates in relation to the family. The coordinator will also track the goals of treatment and organize the aspects of treatment within our clinical team approach. Our clinical team meeting will discuss cases as necessary. 3 Purpose: The purpose of the time limited, outcome (safety) focused (as opposed to psychodynamically focused) therapy is to implement the changes needed to insure future safety from further sexual abuse. The model assumes a clinical team oriented family systems approach of education and treatment and seeks clearly defined behaviors and outcomes that will insure safety. The role of the non offending parent in the sexual abuse will be explored, looking for points where protection can be strengthened in the future. The life experiences of abuse or neglect of the non-offending parent in the home of origin will be a part of the psychoeducational work that will be necessary for many of the families. In order to develop a treatment plan for addressing the sexual abuse that has brought the family into social services, the first part of the model will be the development of the psychological scope of work that will need to be completed. What are the goals needed to insure future safety? This may be developed by WCDSS or the WCDSS may refer to the part A program to develop the treatment goals. These will be developed through a review of the case, psychological testing if indicated, and clinical assessment of the victim and of the victim's siblings. From there, clearly defined, achievable, structured behavioral changes that are needed to insure future safety of the child will be developed into a written plan. Once agreed on by the therapist and non-offending parent, this plan will become the treatment goals for the family in relation to the safety of the child. To be completed in parts B or C Time lines and work to be achieved by phase are listed below: Part A The development of the prescriptive treatment plan of the family unit over no more than fifteen sessions with a goal of the program for prescriptive assessment to average ten sessions. The prescriptive treatment plan typically involves background and family of origin interviews with the non-offending parent (up to five hours) three hours of case review with the non offending parent, three hours of assessment and interpretation and up to four hours of assessment of other family members. Part B. The implementation of the plan with the non-offending parent to assure the safety and avoidance of repetition of sexual abuse in the family unit.over more than 20 sessions. Ten hours of these 20 sessions can be through group work (at a cost equivalent of 10 individual hour long sessions) For the non offending parent a mentoring of psychoeducational process of identifying factors that contributed to the abuse and dealing with these factors will be explored. This will be particularly important if negligence or home of origin issues are present. We postulate that a large percentage of the non-offending parents will either have been themselves sexual abuse victims or have come from significantly dysfunctional backgrounds. Such a psychological profile is amenable to this mentoring approach as outlined in the Connections Workbook by Levenson and Morin. 4 Part C. For the child victim or sibling, the restoration of trust and safety assurance after the abuse incident itself would be a goal of child treatment. If appropriate and if the offending parent has successfully completed treatment and if the victim and the non-offending parent are appropriate for reunification, steps toward reunification may progress in selected cases. Part D. A step down protocol of therapy for no more than ten sessions designed to be delivered on no more than a twice a month basis for supportive transition from the support program, for those families in need of this service. Other Considerations: There is no risk of the program running costs up to levels beyond those budgeted for any one family because we set a treatment cap for social services funds at a maximum number of sessions:15 for part A, 20 for part B, 15 per child for part C. Our experience has been that sections A, B and C have been used and D is not used often. Limitations on service delivery allow only 12 additional hours to be provided in part D. If significant resolution cannot be achieved to assure the safety of the child within 45 hours of competent psychological treatment, other options should be considered to attain that safety. In our opinion, it will be very rare for a case to go on for a lengthy period and then fail, as the family will need to make progress sufficient at each review point to continue in the process. Target/Eligibility Populations Total number of clients to be served in this twelve month program has been calculated as follows. Three families per month times twelve months equals thirty six families per year. If we assume a nuclear family size of five, two adults and three children, then the total client pool to be served is 180 individuals. If we subtract from the five family members the one offending parent the total becomes 144 individuals. As a minimum, there will be up to 36 non-offending parents and 36 victim children to be served. We expect the need to be lower than this number and anticipate 18-24 families in treatment over a one year period. We calculated the budget based on one child in treatment in part C, thus each child in treatment in part C will need an individual referral. Distribution of clients. Total number of clients we will serve is approximately 36 index children or more as calculated above. Our experience suggests that for the family we would expect approximately 36 additional of these would be adult members of the family (the non offending parent) and approximately 72 additional siblings who would be minors. Families Served. We would anticipate serving 36 family units or less. We expect 18-24 families is a more likely use rate. 5 Sub total who will receive bicultural/bilingual services. We have a Hispanic member of the staff, Emily Montoya M.A., L.P.C. who speaks Spanish. One of the facilitator's (Joyce Shohet Ackerman) doctoral work was on Hispanic patients' mental health treatment patterns compared to Anglo patients in Weld County. She also has four years of direct cross cultural experience with an American Indian population. All of the other staff have cross cultural experience. We expect up to 20% of referrals can receive services in Spanish and 100%will receive services in a culturally appropriate manner. We anticipate that the majority of the work in this program will be conducted at our Greeley offices. Accessibility. On weekdays a provider is on call from Ackerman and Associates for the each day and is accessible through our office and through the connected 24 hour answering service and pager system. On weekends, the 24 hour access reaches the provider on call for that weekend all of whom are Ackerman and Associates' licensed mental health providers described in the staff section of this proposal. Maximum per month. The program maximum is three new families per month with a maximum ability to carry eight open cases a month. The monthly average capacity is two new families per month with the average load of five open cases a month. The average stay in the program is expected to be 40 sessions over a six month period. The maximum stay is 45 sessions over a twelve month period assuming one child in part C with parts A and B also being used. Use of part D would add 10 hours to this total. Group treatment (if there are sufficient referrals) would be provided at a rate of one hall of the rate for individual sessions so that each two hours of group session treatment would be at the same rate as one hour of individual treatment. There are a number of options WCDSS can use to decrease the cost of this program. For example, if treatment goals are completed by the department prior to referral then part A might be omitted. Part D costs have been less than projected over the several years of this project. Nevertheless, we have tried to make best estimates for the average length of stay in our budget calculations. Types of Services Provided The types of services have been described in detail above under project description and purpose sections. They are summarized here. We propose to provide a maximum of 55 sessions of outcome focused treatment over four program subtypes (A, B, C or D) for the victim of sexual abuse, his or her siblings and the non offending parent. Part A offers assessment of the non offending parent and the children in terms of treatment needed and if they would benefit from this program (15 sessions maximum). Part B is for treatment of the 6 non offending parent (20 sessions maximum) to improve safety of the child in the future, Part C is to treat the child victim (15 sessions maximum) of the abuse and the siblings to improve safety and to establish short term treatment goals for safety as well as to develop a long term treatment plan. Part D is a transition of up to 10 sessions for maintenance of achieved skill in those families requiring this service. Measurable Outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... Family cooperation with appointments and process of treatment in parts A, B C or D form components of the formative review. Did the family cooperate in treatment is a primary formative measure. This data could be extracted from the case file and reflected in monthly reports. Summative Outcomes A. To reduce the rate of recidivism of sexual perpetration. This program does not treat sexual perpetrators so at one level this question does not directly apply. However the goal of the program is to prevent 100% of revictimizations by treating the victim and the non- offending parent to alter the family environment and opportunities for revictimization. (Note that the bid application does not provide that Ackerman and Associates conduct such follow up. The goals set here fall outside the scope of the bid but can be assessed by WCDSS if they wish to do so). B. Decrease in revictimization should be substantial and persistent. The program is set up to empower the non-offending parent to identify situations where victimization is likely and to reduce these occurrences. We set a goal of 90% of families who complete treatment will not be victimized in the next two years. This number assumes that after treatment is completed that the non-offending parent does not reenter a marital relationship with the offending parent. We set a goal at 50% at two years post treatment would avoid revictimization if marital reunification occurs with the offending parent occurs in the next year. (Note that the bid application does not provide that Ackerman and Associates conduct such follow up. The goals set here fall outside the scope of the bid but can be assessed by WCDSS if they wish to do so). 7 C. Prevention of victim perpetration. For those victims who complete part C treatment, most will be children who are not sexually active. We expect that for a two year period following treatment victim perpetration will be rare and that 90% of children will not be perpetrators over a two year period following end of treatment. Comments on individual case risk will be made in final reports. The goals set here fall outside the scope of the bid but can be assessed by WCDSS if they wish to do so. D. We expect that 70%of non-offending parents will complete treatment. Such data as to treatment completion will be in the final case report. Of these we expect that 90%will be able to keep their children over the next two years if they do not reenter a marital relationship with the perpetrator. The goals set here for assessment at two years fall outside the scope of the bid but can be assessed by WCDSS if they wish to do so. E. Improvement in parental competency: Parameters measured in this area include acceptance of the sexual abuse and the need for restructuring the family environment as well as the client's ability to achieve that goal to prevent such abuse from occurring again. Clinical improvement in this area is the goal of the Part B treatment program and for each client will be reported at the end of treatment. F. While we do not expect more rapid reunification with biological family members (the offending parent), we do expect the acquisition of life skills in anger management and an increase in psychoeducational knowledge. These should lead to risk reduction for a return to an abusive environment. However, quantification of these goals fall outside the scope of the bid. Statistics on reunification can be obtained by WCDSS from a post hoc review they would conduct at some desired timepoint. Statistical tabulation of these outcomes could be assessed at WCDSS discretion by chart review at two years post treatment by WCDSS to determine if new charges had been reported or cases reopened. Individuals who leave the county would be lost to follow up in this mechanism. A more vigorous evaluation method would be preferable, but long term evaluation is not budgeted within this proposal Service objectives This proposal meets all the service objectives for the non-offending parent and the victim. The areas for improvement are documented in the quantitative measures that will be rated for the non-offending parent at the review points and at the completion of therapy as listed under the measurable objectives section. These areas include the required components of improving parental competency, 8 improving family conflict management, improving family conflict management improving personal and individual competencies and improving ability and access resources for the non offending parent. Work Load Standards A. The program has a capacity of 5 families per month with an average of 3 per month. The families will receive an average of 45 hours of service as described if parts A, B and C are utilized. B. We have 5 providers for this program. They are Emily Montoya M.A., Licensed Professional Counselor., Susan Plod* Bromley, Psy. D Licensed Psychologist, Laurence Kerrigan, Ph.D. Licensed Psychologist, Tom Pappas, MSW. Licensed Social Worker and Joyce Ackerman, Ed.D. Licensed Psychologist • Emily Montoya, M.A., L.P.C. received her masters in Agency Counseling from UNC. Prior to joining Ackerman and Associates, P.C., she had a wide range of work in mental health including treatment for alcoholic patients and support of minority college students. She speaks Spanish, but limits her Spanish therapy to bilingual families who have some capacity in English but prefer Spanish. Her undergraduate major was in Criminal Justice and Sociology Emily has been associated with Ackerman and Associates for eight years and has recently opened her own practice while continuing to work with us on WCDSS bids and in other projects. • Susan Plock Bromley, Psy .D. Susan s original training is as an M.S.W. prior to her Psy .D. degree and her psychologist licensure in the early 1980's. She has been a professor of Psychology at UNC and is now emeritus upon her retirement from the University. She has provided services through Ackerman and Associates over the past ten years, including services to the SafeT program • Laurence Kerrigan, Ph.D. Dr. Kerrigan has been a licensed psychologist for more than twenty years and has worked on the children's team of the local Mental Health Center prior to joining Ackerman and Associates in the mid 1980's, • Tom Pappas,M.S.W. is a licenced clinical social worker who has more than 20 years of experience in both agency and in private practice settings. He has worked in the Boston, Massachusetts area ,as well as ,in Montrose, Colorado prior to coming to Greeley to join Ackerman and Associates in 2004. 9 • Joyce Ackerman, Ed.D. Licensed Psychologist will function as the clinical supervisor of the program. She has more than 20 years of private practice experience and is listed in the National Register of Health Service Providers in Psychology. She has been a licensed psychologist in Colorado since 1984. C. Of the up to 36 projected families the caseload is projected seven families with each provider. D. The modality of treatment is individual or group therapy focused on the psychoeducational model outlined in the Connections workbook by levensoon and Morin. E. Hourshveeks. The total number of therapist hours is 60 per family over six months, or a total for the budget calculation of 3600 per year based on our projected average. Maximum capacity is the same as this level. The hourly fee is requested at $ 100 as documented in the rate calculation section. F. Staff. There are 5 individual providers supported by two office professionals in the practice as well as a contracted accountant. G. Supervisor. This contact would be supervised and clinically managed by Joyce Shohet Ackerman, Ed.D. who will monitor the project for compliance. The maximum caseload for the supervisor is five families per month. H. Insurance. Ackerman and Associates, P.C. carries one million, three million liability coverage for professional liability on the corporation and its associates and each associate also carries the same level of coverage individually. In addition, Ackerman and Associates, P.C. carries a general liability policy related to accident or injury on our premises through Farmer's Insurance. Collaboration letters Collaboration letters or phone contact have been sent to Employment services of Weld County., Greeley Weld housing services and the North Range Behavioral Health center. Our letters to each agency and their responses are either appended (or if their response was not received prior to our early submission of this bid on March 21 2006), the received responses will be forwarded to the program area supervisor. Evidentiary basis: The evidentiary basis of this proposal rests in the structured watk1 a kses psychoeducational treatment plan'published by Jill S. Levenson and John W. Morin ( 2001) Sage Publications Inc.Thousand Oaks California. 111 pages. The theoretical basis of the treatment plan was formulated by these authors from the 10 work of Sgro j,Handbook of Clinical Intervention in Child Sexual Abuse,1982 Lexington Books, Lexington, Mass. This work emphasized the understanding of the cycle of sexual abuse and the need for this cycle to be understood by the non-offending parent. Staff Qualifications A. All staff members exceed the minimum qualifications needed for this project in both education and experience as described above. B. Staff available for the project are listed above. None have mandated caseworker training because none are caseworkers within the definition of that that term in the Colorado Social Services system. All of the staff are trained in risk assessment as part of their licensure. Unit of service rate computation We have calculated the unit of service rate based in the instructions. We used 2005 data for our agency. Using overall figures for the agency for 2005 fiscal year we arrive at a figure of $100 per contact hour. Group rates are billed at one half this rate per hour. The profit margin for Ackerman and Associates for all programs for the 2005 fiscal year showed a net loss of approximately one half of one percent. The proposed cost is $100 per face to face contact hour. This is 17% lower than our psychologist fee for service rate of$120 per fifty minutes for a face to face therapy hour. Budget Justification Ackerman and Associates purchases services for accounting through an independent contractor and through Anderson and Whitney to track funds. No special issues are present related to project audit to out knowledge. Ackerman and Associates mediation program and all other social services programs were audited in a random audit(conducted by Anderson and Whitney) since its first year of operation with no deficiencies. Audits of the program are conducted on a yearly basis, as required by WCDSS, with no deficiencies noted. Given bid rule changes in 2004-2005, we attest that our billing is an accurate reflection of services rendered and that we will maintain needed records should a future audit be needed. 11 Ackerman and Associates, P.C. is a type S professional for profit corporation and not a 501.c.3. 2005 showed a net loss of one half of one percent on our total expenditures. 12 From: "LARRY POTTORFF" <larry.pottorff@northrange.org> To: <joyceackerman@comcast.net> Subject: Core Services Date: Mon, 20 Mar 2006 21:57:24 +0000 Dr. Ackerman, I have reviewed your proposals for services with Karen Thompson, Executive Director of Northeast Behavioral Health. North Range Behavioral Health contracts with NBH to provide medically necessary mental health services to Medicaid eligible residents of Weld County. The proposal to provide home studies for prospective adoptive cases is not a covered service under our Medicaid contract and presents no duplication of services. The proposal to provide psychoeducational services to sexually abused children and the non offending parent would not be a covered service under our contract as long as the diagnosis for treatment is not a covered diagnosis. For example, the DSM-IV code V61.2, Sexual Abuse of a Child, is not a covered diagnosis under our contract and would therefore not be a duplication of service. NRBH can provide psychoeducational services as an "alternative service" under the contract but only in the case where the service is being provided to an individual carrying a covered diagnosis. NRBH would be agreeable to working with you to ensure that services provided by your agency are not services that should be paid for with Medicaid funds. Sincerely, Larry Pottorff Deputy Director North Range Behavioral Health 970.347.2373 The information contained in this e-mail is confidential and private. Its dissemination is a violation of state and federal laws. If you are not the authorized recipient, you must not disclose, copy, distribute, or retain this message or any part of it. If you have received this e-mail in error, please immediately notify the sender via telephone or return e-mail. nimL.COMM' Fage I of 1 Dear Debbie The Weld County Department of Social Services as a component of the Core services bid process for 2006 is requiring each bidder on theraputic services to obtain a letter from NRBH. The bids state the letter will " address.. whether the services provided in the RFP(that each bidder submits)are services available through NRBH and paid for by Medicaid funds for Medicaid eligible clients." If that is the case(that the services would be covered under Medicaid.)the bidder in the RFP must specify that they will contract with NRBH to provide these services or apply to become a Medicaid provider themselves. Ackerman and Associates is submitting a proposal to provide psychoeducational services to children who have been sexually abused and to the non offending parent to educate these family members on safety issues with the intent of preventing future incidents of sexual abuse. The program is modeled upon the methods documented in the Connections Workbook by Jill S Levenson and John Morin, Sage publications 2001. It is our understanding that such services are not funded under Medicaid. We are submitting an additional proposal to provide home study assessments as required by Colorado law in adoptions. Similarily we understand that adoption home studies are not provided under Medicaid funds . As clinical issues arise in clients eligible for Medicaid which are comorbid with the sexual abuse and which become more than incidental to the the patient's activities of daily living, and for which Medicaid provides treatment, such as depression, we would be referring those clients for additional treatment. As well, as we identify mental health issues in adoption studies in Medicaid eligible patients incidental to the home study process we would refer such patients to treatment by NRBH. Such referrals would be the ethical obligation of any mental health provider. Such referrals are not a contract, in the sense of the bid language, where we would pay NHRB with Department of Social services funds as a subcontractor, as the identified mental health issues would be incidental needs not specifically covered by either of these bids. Could you provide by return email an acknowledgement of the receipt of this letter and any comments you wish us to include in the bids we submit. As well could you identify how to best contact NRBH when making any incidental referrals. For your convenience I have attached an electronic file of one of the bids available to any bidder(Sexual Abuse Treatment)The requirement for all theraputioc services contain the same language found in the section VII f of that file(page 32)requiring a letter from NRBH. Thank you for your assistance. Alan Ackerman Ph.D. for Ackerman and Associates P.C. http://mailcenter.comcast.net/wm/toolbar/notheme.html 3/17/2006 DEPARTMENT OF HUMAN SERVICES it 6 EMPLOYMENT SERVICES OF WE COUNTY 1551 NORTH 17LD TH AVENUE 0 114 LE BOX 1805 C3REELEY,0080832 (970)353-3800 FAX(970)358-3975 111k COLORADO March 20, 2006 To whom it may concern: This letter is being submitted to all agencies and providers requesting letters of collaboration from Employment Services of Weld County concerning the CORE services RFP from Weld County Department of Social Services. Prior to issuing any letters of collaboration,Employment Services of Weld County(ESWC) is requesting that bidders submit a letter to Linda Perez, Director, which addresses the bidders" intent and the parameters under which they will collaborate with ESWC to address the employment and training needs for the specific population group they are proposing to serve. In the letter submitted to ESWC, bidders' should outline their current process or services under CORE service funds and their intent to address the following processes for collaboration with ESWC: • Case management • A referral process • A follow-up process • Cross training of staff • Other collaborative areas • Development of a Memorandum of Understanding(MOU)concerning collaborative efforts by February 1, 2007. Letters should be addressed and sent to: Employment Services of Weld County PO Box 1805 Attn;Linda L Perez Greeley, CO 80632 From: joyceackermanecomcast.net JAdd to Address Bookt To: "Ted Long" <tiong@co.weld.co.us> Cc: Iperez@co.weld.co.us, Subject Re: FW: CORE Services Collaboration Letter Date: Monday, March 20, 2006 1:09:58 PM Mon, 20 Mar 2006 20:09:58 +0000 UView Sourcej Thank you for your email. We are submitting our bids tommorrow. Ackerman and Associates is proposing two work areas with Core services. One Is adoption home study and relinquishment counseling. the other is a program for families who have had sexual abuse, with the focus on the non offending parent. Both programs have a capacity of 24 families per year. Neither area is expected to be related directly to job services. However, here is our plan for referrals as they arise: Case management: We will be providing some case management for the isues related to sexual perpetartion that may require the non offending parent to seek employment. For such individuals we will make a referreal to Job services. It is not the role of the home study adoption process to provide case management to solve identified employment issues in families seeking to adopt. The role of the Bid by statute is defined as more investigatory than therapeutic. Therefore, we anticipate reporting adoption home study related employment issues in our report to the department program. Referral process: We will ask the client we refer to contact Job services by phone or in person and send an email to Job services attention Unda Perez that we had done so.. We will send that email within five business days of making the referral.. If you prefer another mechanism please let us know. Follow up. We will contact Job services by the same mechanism 10 business days after sending the initial e mail. Please let us know by email if the client has not contacted you and we will discuss the matter with the client at the next visit. We will provide written email of that follow up to Linada Perez within five business days. Cross training: As new staff come to Ackerman and Associates this protocol will be in the master list of tasks to provide training in for the secretary and the provider. Providers will be trained in the protocol when the bid is accepted. Other collaborative areas. We are not aware of other collaborative areas with Job service in relation to our bids at this time . If such areas arise we will include them in our memorandum of agreement discussions to be completed by Feb 2007. We request a meeting in July to initiate the collaboirative memorandum of agreement process, once the bids are accepted.. We will call in July to make an appointment with Unda Perez. Please let us know by email If these plans are acceptable for the bid process. For Ackerman and Accodates P.C. Alan Ackerman Ph.D. Treasurer 970-396-5945 re--T u ,✓.e. r 1-i n-e t k ^ano . o., Al O G (y to, '( be S-err to kyle ,t rla - Prootem•- &penmr w . Dear Tom: Thank you for your time on the phone today. Ackerman and Associates P.C. is a Mental He1th Provider group(www.ackermanandassociates.com). We are bidding on two programs with WCDSS core services. One is for adoption home studies. It is not usually the purpose of a home study to resolve housing issues in applicants seeking to adopt a child. However, if such issues arise,we would want to be able to refer them to the Housing Authority. We are also submitting a bid for psychoeducational treatment for the non offending spouse when there has been a sexual abuse of a child. The purpose of the bid is to reduce the risk of a future abuse incident. We could also want to be able to refer such non offending family members who may be seeking to live seperate from the alleged perpetrator to housing if they needed it. WE expect these to be unusual cases as usually the housing issue of seperation of the alleged perpetrator from the family has been accomplished before we receive the case. Please let us know how we can best work with the housing Authority in regard to such referrals . The program bid for 2006 is expected to begin on June 1,2006. We look forward to your reply. Alan Ackerman Ph.D. For Ackerman and Associates P.C. II RcP it us- re ce t(net kit- 3/Alo r: • l(e/41 hie Ses Ky I �� / flrot rn... S./enter • Developing a Safely Plan for Your Family 91 WORK SHEET#8:FAMILY SAFETY PLAN Family Safety Contract The Family agrees to the following rules designed for child safety during visitation and after reunification. Prevention 1. The offender will not be alone or unsupervised with children at any time;any contact with children will be within the eyesight of an adult chaperone who is fully aware of the offender's history and accepts the potential for future abuse to occur. 2. The following people are approved to supervise contact between the offender and children: 3. When the nonoffending parent leaves the room,offender will 4. Our child care plans for work: 5. Offender will never be responsible for babysitting or supervising children. L /fs r f e/res≤ tT w o74 fain2CaCeAL44 tie IY\on_i iii/ -. ( f.u.Q reporZ`S . fle �°roaerr . I tic id �nflsTS _© 1D � Rrw^ 3/m-t.tvLotiicS €04-ekiiNslAilitY-Aet,m{ bore_ _{,veek rotes 07.4Ark weei Jo) CONNECTIONS WORKBOOK 92 • 6. Discipline of the children will be done primarily by the nonof fending caretaker. 7. Offender will not discuss sex or dating with the children. 8. Physical affection between offender and children will be brief and will avoid bodily contact. 9 Physical hygiene assistance is always to be done by the nonoffending caretaker. This includes Bathing Dressing Diapering Toileting 10. There will be no tickling or wrestling between offender and children. 11. Offender will not have secrets with any child. 12. Offender will never enter the children's bedrooms alone. 13. Offender will never enter the bathroom while a child is in it nor will offender al- low a child to enter the bathroom while he is in it. 14. MI bedroom and bathroom doors will have locks. 15. If mutually agreed,children will be permitted to lock doors. 16. All family members will sleep in their own beds. 17 All family members bathe,shower,and toilet separately. 18. No family member shall enter a bathroom or bedroomwithout knocking and re- ceiving permission to enter. 19 All family members will be dressed at all times(pajamas or robes are OK if cov- ering adequately). 20 Alcohol and drug use is completely and strictly prohibited if substance use was in any way involved in previous sex offenses. 21. For offenders who have not used alcohol or drugs in previous offenses,rules for moderate use will be established. pictures,or videos) 22. No pornography or sexually oriented materials(magazines,p will in the home. - Intervention In does not ar to bethe following the sp specified rules,the nonoffending caretaker event that prevention measures break down and offendwill immediately Separate offender and children by 1.2. 3. Developing a Safely Plan for Your Family 93 In the event that child sexual abuse recurs,the nonoffending caretaker will immediately - Report the abuse to the local child protection agency • Cooperate with authorities conducting an investigation ▪ Secure a restraining order • Some other,more specific rules that apply to our family based on the abuser's past patterns,grooming behaviors,and known high-risk factors: n x AMkrg Sense of ft Ali 107 TABLE 10.1 Connections Safety Checklist V=The safety objective has been achieved,as demonstrated by your behaviors,statements,or situation. X=The safety objective has not been achieved;you do not demonstrate the behavior or the situation does not exist. N/A=The safety objective does not apply to your family. Description of Safety Objective Complete 1.Caretaker and offender both acknowledge that abuse occurred and that it was not the child's fault. 2.Caretaker acknowledges and describes her responsibility to manage risk factors in the home. 3.Caretaker acknowledges the offender's potential for future abuse, 4.Caretaker can name the five types of denial. 5.Caretaker can give original examples of the five types of denial. 6.Caretaker can spontaneously recognize denial in self,offended and others. 7.Caretaker can describe common feelings of sexually abused children. 8.Caretaker can accurately describe her own child's feelings. 9.Caretaker can accurately describe the impact of sexual abuse on her child(ren) or can speculate about her partner's victim. W.Caretaker demonstrates empathy toward her child(ren)or her partner's victim(s). 11.Caretaker can name and describe at least five physical symptoms of child sexual abuse. 12.Caretaker can name and describe at least five behavioral symptoms of child sexual abuse. 13.Caretaker can name and describe at least five emotional symptoms of child sexual abuse. 14.Caretaker can,in retrospect,name at least five symptoms her child exhibited while being sexually abused. 15.Caretaker can identify signs to look for in the future,and can propose interventions if needed. 16.Caretaker demonstrates effective manag ent of child resulting from sexual abuse,including sexually reactive behavior ehavio problems 17.If applicable,caretaker can discuss her own childhood abuse and its impact on her reaction to her own child's abuse. 108 CONNECTIONS WORKBOOK 18.Caretaker can name at least six grooming behaviors offenders may use. 19.Caretaker can describe and give examples of grooming behaviors,offense patterns,and relapse prevention strategies. 20.Caretaker can describe her partner's offense pattern,grooming behaviors, high-risk situations,thoughts,feelings,and behaviors. 21.Caretaker can describe in detail her partner's relapse prevention plan and demonstrates behaviors that support her partner in his relapse prevention plan. 22.Caretaker can name at least five strategies for protecting children from sexual abuse. 23.Caretaker has developed and implemented prevention strategies with her own children. 24.Offender has successfully completed a sex offender rehabilitation program or is enrolled in and participating actively in a sex offender treatment program. 25.Offender demonstrates understanding of his offense patterns and has developed and implemented a realistic relapse prevention plan. ;X:r 26.Victim or other children express a desire to be reunited with caretaker or offender or both,and this is supported by child(ren)'s therapist. 27.Children have knowledge of offender's past sexually abusive behavior. 28.Children demonstrate knowledge of prevention education. 29.Caretaker can financially support herself and the children independently. 30.There is no evidence of current substance abuse by either adult. 31 There is no history of domestic violence. 32.Family safety plan includes prevention and intervention strategies. 33.All family members have agreed to and signed the safety plan. This checklist reflects my assessment of the safety indicators in the family. Connections Therapist Date I have reviewed my therapist's safety assessment checklist. 'r • Client Date 03/17/2006 14:39 9703€36134 FARMERS PAGE 02 Commercial Certificate of Insurance a FARMERS. Agency • Nina KIovdahl Name • 2705 W 10th St bane 0634 Address • 970-352-1234O8 D ate AD [rumps This certificate is issued sea matter of hdomadon only and confers no two upon tba certificate holder.This certificate does not amend.emend melte the St 07 Drat. 4 •_pmt_562 mange*Wed by the paitetetsh abeam below. Companke Providing Coverage: Insured • Alan tit Joyce Ackerman - company A Told Insurance Exchange Es Name • 1750 25th Ave Sta.101 Leroy B Fatmns Insurance Exchange Address • Otnolcy,CO 80634 C Mid-C Lruagt8ttce =ploy ennnY Company rimy D '1qhyh m certify dot the poncho d er lice Ibte below cave be booed to the Insured named am the poky wed.Natwt rg e afforded •tam or condition of,contract or other document with respect to which this certifies may be!scared or may pain stn hterran= afforded die policies detalhed herein is add so all the taros.eacholoos and conditions of such policies.Ltoda shown may hen hem reduced by Ica Type of Insurance Policy Number pwrcElletthert Dar pelPiart no Policy UMW A st General Liability 045%3807 07/012005 07/012006 GomelAfigrairdeS 1,000,000 Coumtwdai General Pfoducts•CompoOpS Liability AWMate S 1,000,000 VersionPersonal& MintCaurnacorai_7txldrml on l f /,000,000 Only cuarence $ 1,000,00D Owners&Contractors Prot. (Altllre Coinage S 150000 iviedicalExpense P $5,000 Automobile Liability 4 Combined Single All Owned CommercialUm t $Antos Scheduled Auto 804411efrY S an ma d Au _ Noe Gamed Auras ?ariia>otrt J $ N Gram Liability Properly Damage S Goad"Aggro $ Umbrella Liability Urn S Workers'Compensation Rotator' and Each Acddent $ Employers'Liability - Employee $ saga non of Opantfovp/y Disease Policy f eestdes/Restrlcttore/Spectel items: . Certificate It Cancellation • Weld County Social Services Should any of the above delulbed policies be cancelled bd'ore the mpletthan due Name • 315 N I 1 th Ave thereof,the issuing company vein endeavor m man 30 days written notice to the & • Greeley,CO 80631 certificate holder named to the left,but Rem to man such notice mall impose no Address • obligation or liability of any kind upon the company.its agents or repro elver. Nits Klovdabl Authorised ReNgenglke se-aaoz 444 Copy isttibniton:Sed'vdt:e Center Copy and Art's Copy H-01 • EXECUTIVE RISK SPECIALTY INSURANCE COMPANY 12/06/05 - A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY *** RENEWAL *** )TICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION"SEXUAL MISCONDUCT"IN THE POLICY). DECLARATIONS '0LICYNO: 008-1766682 ACCOUNT NO: CO-KERL175-0 0099745B TEM 1. (a)NAME AND ADDRESS OF INSURED: ITEM 1. (b)ADDITIONAL NAMED INSUREDS: LAURENCE P. KERRI GAN, PH.D. 1750 25TH AVE. SUITE #101 GREELEY, CO 80634 • • TYPE OF ORG: INDIVIDUAL :M 2. ADDITIONAL INSUREDS: :M 3. POLICY PERIOD: FROM: 12/01/05 TO: 12/01/06 • 12:01A.M.STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: :M 4. LIMITS OF LIABILITY: (a)$ 1, 000,000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS,REPEATED OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE ro)$ 5, 000 DEFENSE REIMBURSEMENT (c)$ 3 , 000, 000 AGGREGATE M S. PREMIUM SCHEDULE: ANNUAL PREMNM CLASSIFICATION NUMBER RATE 1ST PSYCHOLOGIST 7. 1,191. .!10 1 ,79J... 0Q DEFENSE LIMIT 00 SURPLUS LINES TAX 1 35 . 73 INSPECTION FEE 1 • 1 .19 M 6. RETROACTIVE DATE: 12/01/91 TOTAL PREMIUM: 1, 227 . 92 M 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM(if exercised):$ 2 , 149 . 00 NO DISCOUNT INCLUDED Nir 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY 2138 (7/95 ED. ) B22137 /,s - -� • PERSONAL.. DATA SHEET Identifying Information: Nhme : Laurence "Larry" P. Kerrigan , Ph. D. Address : 1706 19th Avenue Greeley , CO 80631 DOB : 9/20/32 Phone : t30a )353-3373 - business Degrees : BSC - Business Economics , from Creighton University , 1954 . MS - Economics , from St. Louis University, St. Louis, Mo. , 1963 . MA - Theology, from St. Mary' s University, Regis College Campus , Toronto , Ontario , Canada, 1967 . Ph . L. - Philosophy, St. Louis University, St . Louis , Mo. 1960 , ( Ecclesial Degree ) . Ph . D. - California School of Professional Psychology , Berkeley/Alameda Campus, 1974 , Clinical Psychology , Currently a licensed psychologist in the state of Colorado . Educational Background: 1950-54 Creighton University, Business economics , 1954-56 Marquette University, Milwaukee , WI . , Classical studies and ascetical theology, 1956-57 Springhill College , Grand Coteau LA. Campus , Classical studies , 1957-60 St . Louis University, Philosophy and Economics , 1963-67 St . Mary ' s University, Toronto Campus , Theology, 1971-74 California School of Professional Psychology , clinical psychology, Berkeley/Alameda Campus Positions Held : 1969-71 Member of Board of Directors , Campion College , Prairie du Chien, WI . 1968-71 Director , Department of Psychology, Campion College . 1971-74 Director of Student Counseling Center , Long Mountain College . 1975-80 Director of Short-term Children and Family Team, Weld Mental Health Center , Greeley, CO . 1975-`87 Clinical Psychologist, Child and Family Team , Weld Mental Health Center , Greeley , CO . • 1976,88 Co-founder of Weld County Child Protection Team, 1987-88 Member of Executive Board, Weld Mental Health Center , Greeley, CO . Honors Received : • 1968-69 and Teacher of the year, Campion College . 1970-71 1972-73 Class Representative to Campus Executive Committee , and California School of Professional Psychology 1973-74 Work and Experiential Background : 1959-60 Counselor at Dismas Halfway House for ex-convicts , St . Louis , Missouri , 1960-63 Teacher-counselor-coach, Marquette Prep High School , Milwaukee , WI . 1964-67 Counselor-therapist at Street Haven and Sancta Maria Halfway Houses for women and at the Don ( metro ) Jail in Toronto , Canada. 1967-68 Teacher and Campus Counselor at Creighton University, Omaha, NB. 1968-71 Teacher at Campion College , Prairie du Chien , WI . , Director of Psychology Department , Department chairman . 1970-71 Director. and Staff member of a total environment for Inter-city boys , late grade school age from Milwaukee , WI . 1971-73 Director of Student Counseling , Lone Mountain College , San Francisco , CA. Teacher at the Lone Mountain College , San Francisco , California. 1973-74 Psychologist Trainee at San Francisco Mental Health Center , Richmond District , Outpatient Care . 1974-75 Private Practice , So . Bay Human Services Center , San Diego , CA. Part-time instructor at/California School of Professional Psychology, San Diego , CA . •• 1975-80 Director , Short-Term Therapy Team , Children and Family Unit , Weld Mental Health Center , Greeley , CO .• 1980-87 Member of Children and Family Therapy Team , Weld Mental Health Center , Greeley , CO . 1987- present Full time private practice with Joyce Shohet Ackerman , Ed . D . , Licensed Psychologist , Greeley, CO . • Part time practice at Weld Mental Health Center , Greeley , CO . Publication : Kerrigan , Laurence P . - The Relationship Between Therapist and Client ' s Perceptions of One Therapy Session . Published Doctoral Dissertation , University of California School . of Professional Psychology . Copyright , 1974 . Wor_ka)ronli and S, ,eci.al_yrainiilg: Since 1974 , I have attended an average of about three workshops per year . Most of these workshops have presented specialized training in the following areas : Neuro-linguistic training , Autogenic and relaxation training , Visualization-Imagery- Hypnosis , Cognitive-Behavioral Therapy , Ericksonian approaches to hypnotherapy and psychotherapy, Family therapy, Strategic family therapy , Sexual abuse , dynamics and applied treatment , Paradoxical intention psychotherapy, and other related areas . In the last fifteen years , I have taught classes and conducted workshops in the following subjects : The Psychology of Dreams Emotional and Physical Health through Visualization and Imagery Western Psychotherapies and Eastern Ways of Liberation Cognitive and Behavioral Therapy Hypnosis in Pain and Habit Control The Psychology of Consciousness and Meditation Emily Montoya, M.A. Licensed Professional Counselor 1851 13th Avenue, Greeley,Colorado 80631 Home (970) 353-9361 *Cell (970) 545-0928*Office (970) 353-3373 Email: emilymontoya2003@yahoo.com EDUCATION • Master of Arts, Counseling University of Northern Colorado,Greeley,Colorado • Graduate Fellowship Study, Criminology Rutgers State University of New Jersey, Newark, New Jersey • Bachelor of Arts, Sociology/Criminology with emphasis in Psychology University of Northern Colorado,Greeley, Colorado PROFESSIONAL EXPERIENCE 2003-Present, Marriage Education Independent Consultant, Greeley, CO Deliver marriage education with the Prevention and Relationship Enhancement Program(PREP) to a Hispanic population nationwide that includes both faith and non-faith-based populations. Delivery of marriage education (PREP) and consultation services in high Hispanic populations (Los Angeles, CA, Orlando, Florida and Philadelphia,PA.) Provide consultation to national Hispanic serving organizations on strengthening Hispanic families and marriages. Deliver PREP curriculum as a master trainer candidate (New York Puerto Rican Institute). Provide marriage education program development and oversight to Saint Patrick Presbyterian Church,Greeley, CO. 1998-Present, Licensed Professional Counselor,self-employed,Ackerman &Associates, Greeley, CO. Provide intensive home-based family therapy to families involved in the Child-Welfare System with the Weld County Department of Social Services (WCDSS) and those families voluntarily seeking assistance from WCDSS. Provide foster parent training and consultation to foster families and children in Weld County placed in WCDSS foster care. Provide psychotherapy to children placed in the Weld County foster care system. Provide therapy to children and foster parent consultation to private foster care agencies (Lutheran Family Services). Provide therapy to clients under EAP, insurance, and private-pay sectors. Areas of expertise: Marriage and Family;families in transition, and Latino cultural issues. March 1996 —February 1999, Director, Ronald E. McNair Post-baccalaureate Achievement Program, University of Northern Colorado, Greeley, CO. Directed all efforts to ensure efficient administration of the McNair federal TRIO grant. The grant's targeted population was minority, low-income, first-generation college students. Received funding for the U.S. Department of Education McNair grant. Compiled, analyzed, and submitted annual performance reports to the U.S. Department of Education. Monitored McNair's near million-dollar budget over the program's four year funding. Supervised and trained staff members. Developed and directed all student scholar activities. Collaborated with campus departments in order to exceed program objectives. Directed the publishing of the"The McNair Scholars Journal." Identified, recruited, and selected program scholars. Ensured the completion of scholar's academic research projects. Provided academic advising and guidance to the scholars. Directed the academic year research seminar series,the residential Summer Research Internship, and other scholarly activities that prepared scholars for doctoral study. Coordinated research and scholarly actives between faculty mentors and McNair scholars. Lobbied in Washington, D.C. on continued funding for TRIO programs. Counseled scholars academically and personally. September 1995 -March 1996,Assistant Director, Ronald E. McNair Post-baccalaureate Achievement Program, University of Northern Colorado. Assisted in the implementation of the McNair Scholars Program. Facilitated the recruitment and selection of program scholars. Compiled and submitted federal reports. Informed and collaborated with campus offices and depar Intents. Implemented an academic workshop series based on student needs. Provided academic advisement and guidance to scholars. January 1995 — September 1995, Assistant Coordinator of Academic Advising, Student Support Services, University of Northern Colorado. Provided academic advisement and guidance to federal TRIO Student Support Service students. Maintained student record database. Assisted with the compilation of federal student outcome reports. Served as liaison to the athletic department and the financial aid office. Assisted in the supervision of peer advisors. Provided technological assistance within the program. August 1994 — December 1994,Assistant Coordinator of Technology, Student Support Services, University of Northern Colorado. Supervised, evaluated and trained technology lab students. Provided technical assistance and advisement to federal TRIO Student support Service participants in a learning environment. RELATED EXPERIENCE 1985 - 1988,Admissions Office Assistant, University of Northern Colorado. Assisted in the daily operation of the UNC Admissions Office. Received and reviewed applications and distributed accordingly. Filed, typed, and performed data-entry on all incoming, transfer, re-entry, and non-traditional students. Trained and supervised work-study employees on office procedures, FERPA, and the CCHE Index system. Provided general information to incoming students and parents. 1995, Co-Instructor, Student Support Services, University of Northern Colorado. CSPA 359: Paraprofessionals in Student Affairs, Academic Peer Advisors. Co-facilitated the instruction of training of peer advisors who advised Student Support Service participants at the Center for Human Enrichment. Coordinated curriculum and instruction for pre-service and on-going training for a staff of fifteen peer advisors. January 1996 -July 1996, Counselor Intern, North Colorado Medical Center, Greeley, CO. Facilitated psychotherapy counseling groups and individual counseling for chemically dependent and eating disordered patients. Performed case management from admission to discharge. Presented psychoeducational information to patients,family members, and staff.. Designed a portfolio brochure distributed to health care and managed care providers. September 1994-February 1995, Clinical Care Assistant, Weld Mental Health Center, Greeley, CO. Monitored and supervised the daily activities of chronically mentally ill patients in a learning/self- development environment. Facilitated group and individual counseling sessions. Coordinated patient recreation activities. Prepared written and oral reports. PRESENTATIONS Participant: Hispanic Healthy Marriage Research Meeting,Washington, D.C. Panelist: Marriage Forum, Colorado Springs, Successful Marriage Education Programs Presenter: Esperanza USA, The Prevention and Relationship Enhancement Program,Philadelphia, PA, Orlando, FL, Los Angeles, CA. Saint Patrick Presbyterian, The Prevention and Relationship Enhancement Program, Greeley, CO. Puerto Rican Family Institute, The Prevention and Relationship Enhancement Program, New York City, NY. Moderator: University of Northern Colorado, "Research and Policy Affecting the Education of the Mexican Child in the 21st Century." Panelist: Colorado State University "Minority Students in Graduate.School." Presenter: Ackerman & Associates, "Perspectives on Treating Cultural Diverse Populations." Instructor: Centennial Area Health Education Center, Greeley, CO, "Children of Divorce/Stepchildren: Feelings, Thoughts, Behaviors, and Interventions for Children and Adults of Divorce and Stepfamilies." Instructor: Centennial Area Health Education Center, Greeley, CO, "Children of Divorce: Helping Stepfamilies Succeed." Presenter: University of Northern Colorado: Cultural Sensitivity and Awareness Hispanic Women in Higher Education • Communicating Across Cultures Financing a Graduate Education How to Help Someone with an Eating Disorder, National Eating Disorders Week Presenter: North Colorado Medical Center Cultural Sensitivity and Awareness Communicating Across Cultures Conflict Resolution and Communication Skills Setting Limits and Boundaries Family Dynamics in Substance Abuse An Overview of Eating Disorders Presenter: Weld County Foster Parent Program The Terrific Twos! Prenatal Insults and Long-Term Effects Social, Emotional and Sexual Development: Infancy through Adulthood Cognitive and Physical Development: Infancy through Adulthood Parenting with Love and Logic An Overview of Eating Disorders Officer/Member Board Member, Strong Marriages Northern Colorado Board Member,The Redeemer Project Mentor, Escalante At-Risk Youth Program Weld County Mental Health/Substance Abuse Coalition Professional and Administrative Staff Council, UNC Co-chair, Student Advisory Committee, Cesar Chavez Cultural Center, UNC Undergraduate Research Council,UNC Cesar Chavez Cultural Center Advisory Council, UNC Relations with UNC Board of Trustees Committee, UNC Salary Equity Committee, UNC Exempt Staff Evaluation and Performance Committee,UNC Team UNC Fund Raising Committee Academic Excellence Week Task Force,UNC Continuing Education/Training Prevention & Relationship Enhancement Program (PREP) Love Without Hurt: Compassion Power The Relationship Enhancement Program Premarital Inventories: A User's Guide Imago: Couplehood as a Spiritual Path Remarriage Preparation Divided Selves: Children of Divorce Designing Stepfamilies Play Therapy and Therapeutic Care Reaching Children Through Play Therapy Advanced Play Therapy Internship Family Preservation Basic & Advanced Dialectical Behavioral Therapy Jurisprudence for Psychotherapists Grant Writing and Evaluation Diverse Learners Academy Fire Starters Training and Prevention Counseling At-Risk Students Parent/Child Hispanic Leadership Supervised Practicum in Family Preservation Cultural Diversity Conference Yours, Mine, and Ours: Stepfamily Finances Honors/Awards Featured in New York Times: Stepfamilies (2004) Featured in Redbook Magazine: Spiritual Marriage (Print Date: December 2005) Hispanic Leader of the Year,Cesar Chavez Cultural Center, University of Northern Colorado Keynote Speaker, Latina Youth Leadership Conference,University of Northern Colorado Distinguished Alumni, Department of Sociology, University of Northern Colorado Fellowship, Graduate Study, Rutgers State University of New Jersey, 1993 Scholarship, National Hispanic Scholarship Fund Scholarship, Candelaria Scholarship Branch BLA Producer Number Issue Date Renewal/Replacement No 32 A 0003107 12/07/2005 RENEWAL PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY FOR PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS PURCHASING GROUP POLICY NUMBER: 44-2010129 Item DECLARATIONS CERTIFICATE NUMBER 80M- 4003488 1. Named Insured EMILY L MONTOYA MA LPC 2.. MAILING ADDRESS SUITE 101 1750 25TH AVENUE GREELEY CO 80634 3. Policy Period 12:01 AM Standard Time At Location of Designated Premises From: 11/01/2005 To: 11/01/2006 4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges: COVERAGE PREMIUM $ A. Professional Liability X 293.00 B. General Liability $ 293.00 5. LIMITS OF LIABILITY each Incident $ 1 ,000,000 or each Occurrence $ 3,000,000 in the Aggregate 6. The Named Insured is: R Sole Proprietor (including Individual) Partnership Corporation Other: 7. Business or Occupation of the Named Insured: COUNSELING 8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following forms(s) or endorsement(s): PUT-2016 (10/94) 'PLE-2189 (9/97) PLE-2081 PON-2003 CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA 50398 Toll-free Number: 1-800-557-5092 PLP-2016 (10/94) (Elec.) HEALTHCARE PROVIDERS Print Date: 12/14/05 CNA SERVICE APURCHASINGG " GROUP CERTIFICATE OF INSURANCE OCCURRENCE POLICY FORM n1anaa Ain RA sn HP(; n2FiQ9d9fi1 Fi -from-12-01 AM SFendard Time nn•iNni/OF to: 12:01 AM Standard Time on 10 01 06 e-: 7 ., ,. : .y Tom Pap s Healthcare Providers Service Organization 1624 Kirkwood Dr 159 East County Line Road Fort Collins, CO 80525-2017 Hatboro, PA 19040-1218 Medical S dahv; Social Worker, Clinical Code:72990 .1-._./i.-.; 1 " American Casualty Co of Reading, PA CNA Plaza 28S Chicago, IL 60685 A. PROFESSIONAL LIABILITY - Professional Liability PL ( ) $ 1,000,000 each claim $ 6,000,000 aggregate Good Samaritan Liability included above Personaflnjury Liability --- d 3 included above —li____acemen la ilify — included above B. _COVERAGE EXTENSIONS: —License Protection ______- __. _ $-- 10,000 r .roceedi I $ 25,000 aggregate_ Defendant Expense Benefit it $ 10,000 aggregate_ —Assault Depositio_n epresentation $ ,5 r r per deposition $ 5,000 aggregate Ass --'-- $ 10,000 perinddentS 25,000 aggregate _Medical ?ayments — $ 2 000 r •erson $-1T ,-000 aggregate— _FirstAid --- - 1 -- _2,500 _..._.-.._ __aggregate__ _Damage to Property of Others $ 500 per incident $ 10,000 aggregate C. WORKPLACE LIABILITY Coverage part C.Workplace Liability does not apply If Coverage pad D.General Liability is made part of this policy. _Workplace Liability included in A. PL limit shown above _.-Fire& Water Le al Liabili_9 ty included in A PL Iimlt shown above sub act to 5150,000 sub-lt_ Personal Liability — — --- — *t<F t _ ;U00 000 aggregate D. GENERAL LIABILITY Coverage part D.General Liability does not apply ifCoverage part C.Workplace Liability is made pen of Ibis policy. General Liability (GL) none none _Hired Au1alskif C•wned-ro ----- none _. rte;, Fire &Water Legal Liability none none Personal-l Liability r _r_ none Total Premium: $ 300 . 0 0 QUESTIONS?CALL: 1-800-982-9491 G-121500 C G-121503 -C G-121501-C G-145184-A G-147292 -A G-144872 -A G-123846-005 Master Policy# 188711433 Keep ibis document in a safe place. It and proof of payment are evidence of your insurance coverage. /-4 ,A Chairman of the Board Secretary G-141241-A (07/2001) Coverage Change Date: Endorsement Change Date: TOM PAPPAS, LCSW 1624 Kirkwood Drive Ft. Collins, Colorado 80525 970-472-1315 EDUCATION 6/86 Masters Degree in Clinical Social Work, Simmons College School of Social Work,Boston,Massachusetts. 5/80 Bachelor of Arts Degree in Psychology and Secondary Education University of Lowell,Lowell,Massachusetts. EMPLOYMENT 10/04- Psychotherapist. Group practice with Ackerman and Associates, P.C. Individual,marital and family therapy. 3/94-10/04 Clinical Social Worker. Montrose Memorial Hospital Care Center Inpatient/Outpatient Services,Montrose, Colorado. Individual, family,marital and group therapy; discharge planning services. Co-therapist for geriatric partial-hospitalization program; supervisor for Masters Level student. 3/90-3/94 Senior Clinician. Justice Resource Center/The Butler Center, Westboro, Massachusetts. Individual, family and,group therapy specializing in sexual offender treatment to adjudicated adolescent males in secure treatment facility. 11/86-4/89 Clinical Social Worker. New Bedford Area For Human Services, Inc., Children Services Unit. Individual, family and group therapy in outpatient setting. Co-therapist for latency-age girls' sexual abuse groups. • 9/85-6/86 Social Work Intern. Beaverbrook Guidance Center,Waltham, Massachusetts. Individual, family and group therapy with children in outpatient setting. 9/84-5/85 Social Work Intern. Children's Hospital,Boston,Massachusetts. Individual, family and group therapy in pediatric out-patient setting. 12/81-5/84 Mental Health Counselor. Marlboro Hospital Mental Health Unit, Marlboro,Massachusetts. Individual, family and group therapy with adolescents and adults in inpatient psychiatric setting. 5/80-5/81 Mental Health Counselor. Littleton Girls House,Littleton, Massachusetts. Counseling to adjudicated adolescent females in secure treatment facility. TRAINING 2/01 Certificate in Level II EMDR Training. 5/91 Postgraduate Certificate in Advanced Psychotherapy With Children and Adolescents,Boston University, Boston,Massachusetts. REFERENCES AVAILBLE UPON REQUEST leE ACE American Insurance Company Psychologists' ❑ ACE Insurance Company of Illinois ❑ Atlantic Employers Insurance Company Professional Liability Claims Made Insurance Policy Declarations (This Policy is issued by the stock insurance company listed above. Herein called "Company".) F BRANCH I B/A I PRODUCER NUMBER DATE OF ISSUE PRIOR CERTIFICATE NUMBER 273865 03/21/2005 PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY PURCHASING GROUP POLICY NUMBER: 45-0002000 Item DECLARATIONS CERTIFICATE NUMBER: 58G22307137 1. Named Insured Ackerman and Associates PC 1750 25th Ave ADDRESS Greeley, CO 80634-4943 Number&Street,Town, County,State&Zip No.) 2. Policy Period: 12:01 A.M.Standard Time At From:05/01/2005 To: 05/01/2006 Location of Designated Premises 3. COVERAGE LIMITS OF LIABILITY PREMIUM Professional Liability $ 1,000 000 each incident $ 3,000,000 aggregate $ 1,437.00 4. BUSINESS OF THE NAMED INSURED: Psychology 5. The Named Insured is: ❑ Sole Proprietor(including independent contractor) O Partnership In Corporation ❑ Other: 6. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the Declarations: or b) the effective date of the earliest claims-made policy issued by the Company to which this. policy is a renewal;or c) the date specified in any endorsement hereto. 05/01/1992 7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s). PF-15215, PF-15217, CC-1K11 d , PF-15242, PF-15225, PF-15238, PF-15230, PF-15241 , PF-15742 , PF-15253 ,PF-17914 Notice of Claim should be sent to: All other notices should be sent to: Claims Vice President Underwriting Vice President ACE USA ACE USA 140 Broadway, 40th Floor 140 Broadway, 41n Floor New York, NY 10005 New York, NY 10005 REPRESENTATIVE: Agent or broker: Trust Risk Management Services, Inc. 181 W Madison St Ste 2900 • Office address: Chicago, IL 60602-4643 City, State,Zip: DF--15215 103/041 JOYCE SHOHET ACKERMAN, Ed.D. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 RESUME • PERSONAL DATA Date of Birth: August 3, 1950 Health: Excellent Married; two children CERTIFICATION- LICENSURE Licensed Clinical Psychologist,State of Colorado since 1984 Listed in National Register of Health Service Providers in Psychology since 1986 Staff Privileges, North Colorado Medical Center,Greeley, Colorado since 1985 PROFESSIONAL MEMBERSHIP American Psychological Association Colorado Psychological Association (elected board member 1986-1989) HONORS President's Award - Colorado Psychological Association, 1989 EDUCATION 1978 - 1981 Ed.D. in Counseling Psychology, University of Northern Colorado, December 1981 graduate 1972- 1974 M.S. in Education (E.D./L.D.) Lesley College,Cambridge, Massachusetts,August graduate 1968 - 1971 B.S. in Special Education and Elementary Education with a minor in psychology Boston University, Boston, MA, December 1971 graduate ' PROFESSIONAL EXPERIENCE 1981 - present Clinical Director in group practice in Greeley,CO. Among responsibilities are: Diagnosis,therapeutic intervention and referral for • adults, families,children and groups. Primary areas are: mediation, alternative conflict resolution,stress reduction. Also developing, organizing and presenting workshops and consultative programs to community,schools,organizations and agencies. 1986 - present Consulting psychologist on interdisciplinary team for in-patient rehabilitation program. Progressive Care Rehabilitation Center,Greeley, CO. Medical Director Dr.Judith Vaughan,Neurologist. Adults with traumatic injuries- primary problems are: psychological aspects of physical rehabilitation,grief counseling,and brief group counseling using cognitive-behavioral goal oriented therapy. 1989-1992 Consulting psychologist for Head Injury Treatment Team North Colorado Medical Center,Greeley CO Team coordinator - Dr.John McVicker,neurosurgeon. 1986 - 1989 Consulting psychologist for Family Recovery Center(in-patient substance abuse/chemical dependency program), North Colorado Medical Center,Greeley CO Coordinator Ruth Wick,R.N. 1986 - 1989 Provider and Coordinator for Mental Health Services in Northern Colorado for Peak Health Care(HMO). Peak mental health services utilized a three-session model for initial services followed by referral. Activities included coordination of Psychological and Psychiatric Services for approximately the last two years of the Contract. Peak supervisor- Elaine Taylor 1983 - 1986 Psychologist subcontractor for a Vietnam Veteran's Counseling Program funded by the Veteran's Administration. Principal Contract Dr. Robert Stewart. 1980 - 1987 Part time faculty member with responsibilities for classes, workshops and community programs in parenting skills. Family/Life Education Program, Aims Community College,Greeley CO August 1980 - August 1981 -Clinical internship on Children's Team of Community Mental Health Center. Responsibilities included:consultation to schools and community programs; therapy for children and families; and assessment of diverse mental health programs. Assistant program evaluator - developed evaluation tools to determine cross-cultural perceptions of expectations and satisfaction with services. Supervisors - Dr.Joan Gillespie and Dr. Laurence P. Kerrigan. APA National Convention in Toronto,Canada"Psychology and National Health Reform: "National Health Insurance: Policy Considerations, Benefit Designs. and Economic Realities",and"Marketing: Psychology's Key to National Health Reform. 1993 Disaster Relief Training. Alan Keck through Colorado Psychological Association,Denver CO 1992- Fall Short Term Therapy, Bernard Bloom; University of Northern Colorado, Greeley CO 1990- Fall National Cognitive Rehabilitation Conference, Richmond VA 1990-summer Postgraduate training: • 1. Adult Neuropsychological Method based on Lezak Neuropsychological assessment,1983. 2. Child Neuropsychology,Dr.Hynd. 3. Child Neuropsychological Methods 1988 Cognitive Rehabilitation Training Program, Dr.Sena,Ph.D., Colorado Springs CO 1988- present Psychologist- Head Injury Treatment Team at North Colorado Medical Center,Greeley CO 1987 Halstead Reitan Neuropsychological Assessment Training. Ralph Reitan, Ph.D.,Washington DC Summer 1986 Albert Einstein School of Medicine, Workshop on Adolescent Therapy, Cape Cod MA 1985 to present North Colorado Interdisciplinary Team of Child Custody Member and participant Fall 1985 Interdisciplinary Workshop on Child Custody, Keystone CO Summer 1984 Workshop in Clinical Use of Hypnosis, Boston MA Winter 1983 Workshop on In-patient Programs for Service Related Disorders, Cheyenne Veterans Administration Hospital. Fall 1983 Veteran's Administration Workshop on Post Traumatic Stress Syndrome, Denver Veteran's Center. Fall 1981-Winter 1984 Post-Doctoral Supervised Candidate for Licensure(psychology) under Gale R.Giebler, Ph.D. Licensed Psychologist and Susan Spilman, Ph.D., Licensed Psychologist 1980 - 1981 Intern - Weld County Sexual Abuse Team,Greeley CO Weld Mental Health Center,Greeley CO adults,adolescents, families. Primary areas anxiety disorders,mood disorders and adjustment disorders. Typical problems included: trauma, physical abuse substance abuse,job stress. Orientation used - primarily cognitive-behavioral therapy. 1980 Group Facilitator- Regional and National Conferences in cross-cultural community needs. Flagstaff,AZ-Colorado Springs CO August 1975-July 1978 Chairperson of the Department of Education and Behavioral Science at an accredited, Indian controlled community college on the Navajo Reservation. Administration responsibilities included: Supervision and evaluation of faculty;budget preparation and management;curriculum development and integration of Navajo culture; personnel recruitment and selection;class scheduling and program development. Also faculty member with academic responsibilities for instruction in Psychology, Child Development and Counseling courses, advising and counseling students. Navajo Community College,Tsaile AZ September 1974-August 1975 Education Specialist and counselor at an Indian controlled primary and secondary school on the Navajo Reservation. Coordinated community resource program,which included: counseling,student assessment, prescriptive programming,staff development and curriculum. Also,adjunct faculty for the University of New Mexico and for Navajo Community College at the Rough Rock Demonstration school, Rough Rock, AZ September 1972-June 1974 Designed and coordinated Learning Center Program for Dedham Public Schools. A program and crisis intervention center for emotionally disturbed children. Responsibilities included: Diagnostic prescriptive programming,counseling,supervision and training of aides, tutors and volunteers,and consultation with regular classrooms teachers. Also organized group and individual meetings with parents. Adjunct faculty for Curry College assisting with in-service instruction for Dedham School System employees. Dedham Public Schools, Dedham MA WORKSHOPS AND SPECIAL TRAINING 1996 Biodyne training workshop adolescent treatment in short term therapy. Tom Kalous, Ph.D. 1995 Biodyne Training Workshops in short term therapy Julian Ang, Ph.D. 1994 Certification in family mediation, CDR Associates, Boulder CO 1993 Disaster Relief Training. Alan Keck,through Colorado Psychological Association, Denver CO 1993 August Hospital Practice for Psychologists Summer 1981 Independent Study of Child Sexual Abuse, University of Northern Colorado Spring 1981 Interdisciplinary Workshop on Assessment of Sexual Assault, Boulder Social Services Summer 1979 Biofeedback Training related to labor and delivery. Summer 1974 Participant in Institute on Obstacles to Learning. Joint Symposium between McLean psychiatric hospital,Harvard University and Lesley Graduate School,Cambridge MA Summer 1973 Kennedy Memorial Hospital, Boston MA. Participant,Summer Aphasia Institute. PUBLICATIONS Ackerman A., Ackerman,J.S.,Kelley K. Hale K. Family Planning Attitudes of Traditional and Acculturated Navajo Indians. Key Issues in Population and Food Policy. University Press of America, pp. 178-171 (1979) Ackerman,J.S.,Client Expectations and Satisfaction with Community Mental Health Center Services: A Cross-Cultural Analysis Between Hispanics and Anglos. Published Doctor Dissertation,University of North Colorado. Copyright 1981. El ACE American Insurance Company Psychologists' ❑ ACE Insurance Company of Illinois Professional Liability Claims Made Insurance ❑ Atlantic Employers Insurance Company Policy Declarations (This Policy is issued by the stock insurance company listed above.Herein called"Company".1 I BRANCH I WA PRODUCER NUMBER I DATE OF ISSUE PRIOR CERTIFICATE NUMBER 273865 03/31/2005 PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY NOTICE:THIS IS A CLAIMS-MADE POLICY,PLEASE READ THE POLICY CAREFULLY PURCHASING GROUP POLICY NUMBER: 45-0002000 Item DECLARATIONS CERTIFICATE NUMBER: 58G22320300 1 Named Insured Susan Bromley 1621 13th Ave ADDRESS Greeley,CO 80631-5415 Number&Street,Town,County,State&Zip No.) 2. Policy Period: 12:01 A.M.Standard Time At From:04/01/2005 To: 04/01/2006 Location of Designated Premises 3. COVERAGE LIMITS OF LIABILITY PREMIUM Professional Liability $ 1,000,000 each incident $ 3000,000 aggregate $ 1,298.00 4. BUSINESS OF THE NAMED INSURED: Psychology 5. The Named Insured Is: In Sole Proprietor(including independent contractor) ❑ Partnership O Corporation ❑ Other: 6. This policy shall only apply to incidents which happen on or after:a)the policy effective date shown on the Declarations: orb)the effective date of the earliest claims-made policy issued by the Company to which this policy is a renewal; or c)the date specified in any endorsement hereto. 04/05/1996 7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions,stipulations and agreements contained in the following form(s)or endorsement(s). PF-15238, PF-15230, PF-15241 ,PF-15742,PF-15253,PF-17914,PF-15225,PF-15215,PF-15217,CC-1 K11 d,PF-15242 Notice of Claim should be sent to: All other notices should be sent to: Claims Vice President Underwriting Vice President ACE USA ACE USA 140 Broadway,40th Floor 140 Broadway,41"Floor New York, NY 10005 New York, NY 10005 REPRESENTATIVE: Agent or broker: Trust Risk Management Services, Inc. 181 W Madison St Ste 2900 Office address: Chicago, IL 60602-4643 City, State, Zip: PF-15215!03/04) • VITA May 2004 NAME: BROMLEY, Susan Plock SOCIAL SECURITY NUMBER: 483-50-9243 POSITION: Licensed Psychologist Ackerman&Associates 1750 25th Ave. Ste 101' Greeley, CO 80634 HOME ADDRESS: 1621 13th Avenue Greeley, CO 80631 TELEPHONE: Office: (970) 353-3373 Home: (970) 352-8750 EMAIL: sbromley/n!earthlink.net EDUCATION: Year(s) Degree Institution Area of Studv 1983 Psy.D University of Denver Clinical Psychology School of Professional Psychology Denver.Colorado 1968 MSSA Case Western Reserve University Casework (MSW) School of Applied Social Sciences Cleveland,Ohio • 1965 BA Mt. Holyoke College Economics/Sociologv South Hadley. Massachusetts WORK EXPERIENCE --Professional Academic: Year(s) Institution/Organization Position Responsibilities 1996-03 University of Northern Colorado Assoc. Professor Psychology Teaching/Research 1985-96 University of Northern Colorado Asst.Professor Psychology Teaching/Research 1983-84 University of Northern Colorado Asst.Professor Psychology Teaching WORK EXPERIENCE --Professional Non-Academic: Year(s) Institution/Organization Position Responsibilities • 1996-present Ackerman and Associates Psychologist Clinical 1984-85 Kaiser Permanente Psychotherapist Clinical Lakewood, Colorado 1979-80 Bethesda Mental Health Center Psychology Intern Clinical/ • Denver, Colorado Administrative 1968-79 Denver General Hospital Clinical Social Worker/ Clinical/ Denver, Colorado Supervisor Administrative AREA OF SPECIALIZATION: Behavioral Medicine/Pain Management/Clinical Hypnosis/EMDR RESEARCH AREAS/INTERESTS: Hypnosis/Pain Assessment and Management/Women's Issues/Teaching Methods 1 • • PROFESSIONAL ACTIVITIES: Colorado Licensure: Psychology License#1086 PUBLICATIONS--Pro fessionalJuried: Musgrave-Marquart,D.,Bromley, S.P. &Dailey,M.B. (1997)."Personality, academic attribution,and substance abuse as predictors of academic achievement in college students". Journal of Social Behavior and Personality 12(2), 501-511. Karlin, N.J. and Bromley, S.P. (1996). Differences in caregivers of demented and lucid chronically ill family members. American Journal of Alzheimer's Disease 11(5)3945. Retzlaff, P. and Bromley, S. (1994). Counseling personality disorders. In Ronch,J.L.,VanOrnum, W. &Stillwell, N.C. (Eds)The counseling sourcebook: A practical reference on contemporary issues. New York: Crossroad Publishing group. pp. 466474. Bromley, S. and Hewitt,P. (1992). Fatal attraction: The sinister side of women's conflict about career and family. Journal of Popular Culture. 26(3),pp. 17-24. Retzlaff, P. and Bromley, S. (1991). "A Multi-Test Alcoholic Taxonomy: Canonical Coefficient Clusters". Journal of Clinical Psychology, 47(2),pp. 299-309. Bromley, S.P. (1985). "Treatment of Pain:Theory and Research" in Zahourek.R. (Ed.). Clinical Hypnosis and Therapeutic Suggestion. New York: Grune and Stratton. Reprinted in Zahourek,R. (Ed.)(1990). New York: Bruner/Mazel, Inc.,pp. 77-98. . PROFESSIONAL PRESENTATIONS --Juried: Touchton, M.A. &Bromley, S.P. (2000). Complementary/alternative medical use among undergraduates at the University of Northern Colorado. Poster session presented at the Rocky Mountain Psychological Association, Tucson, AZ. (April). Nickisson. J.W. and Bromley, S.P. (1999)"Hypnosis: Attitudes,knowledge and experience among psychology and nursing students". Paper presentation at the American Psychological Association Convention,Boston. (August) Bromley, S. (1998)Hypnosis,psychology and managed care. In S.Bromley(Chair) Complementary. nontraditional and indigenous healing practices. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Bromley, S. (1998). Complementary healing methods: A psychological and artistic exploration. In L. Wickerlgren (Chair). Interdisciplinary courses involving psychology: A sampler. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Campbell, J. S., Titus, J. and Bromley S. P. (1998). "Neuroanatomy teaching technique for introductory psychology students. Poster presented at the joint WPA/RMPA convention,Albuquerque. NM. (April) Bromley, S. (1997)(Chair)"Linking through honors programs: The cross-discipline course). Paper presentation as part of a symposium titled"Creating links between psychology and other disciplines," American Psychological Association Convention, Chicago. (August) Bromley. S. , Gilliam D., &Johnson. T. (1995). "Assessment of student created tests as an evaluation method". Poster presented at the American Psychological Association Convention,New York City. (August) Bromley, S. (1994). "Student created tests as an evaluation method". Poster presented at 16th Annual National Institute on the Teaching of Psychology. St. Petersburg,Florida. Karlin, N. and Bromley. S. (1992). " Similarities and differences for caregivers of demented and lucid chronically ill". Poster presented at the Rocky Mountain Psychology Association Convention,Boise. Idaho. (April) 2 • I Montoya, K.J. and Bromley, S. (Chair)(1992). "Changes in undergraduate counseling styles in an introductory counseling theories course". Paper presented at the Rocky Mountain Psychology Association Convention,Boise, Idaho(April) Bromley, S. (1992). "Connected learning methods to facilitate recearch understanding". Paper presentation as part of panel titled. `Teaching techniques in the social sciences", Western Social Science Association Convention,Denver, Colorado. (April) Bromley, S.,Ramirez, S.,and McCoy, J. (1991). "Impact of a health psychology course on student health beliefs". Poster presented at the Rocky Mountain Psychology Association Convention.Denver. Colorado. (April) Karlin, N. and Bromley, S. (1991). " Support,burden and affect among caregiver of dementia and non-dementia patients". Poster presented at the American Psychology Association,San Francisco, California. (August) Bosley. G. and Bromley, S. (1990). Post death ritual in a Colorado community. Paper presentation at the American Psychology Association, San Francisco, California. (August) Bromley, S. (1990). "Husbands at Childbirth: Who Does It Help?"Paper presentation at Far West Popular Culture Association, Las Vegas,Nevada(January). • Hewitt, P. and Bromley S. (1989). "Images of Work and Intimacy in'Turning Point'and'Fatal Attraction". Paper presentation National Convention of Popular Culture Association and American Culture Association, St. Louis, Missouri. (Session Chair) Retzlaff, P. and Bromley, S. (1989). "The Basic Personality Inventory: Alcoh Sub-Group Identification". Poster session at the Joint Convention of the Rock Mountain Psychological Association and Western Psychological Association, Reno,Nevada. Bromley, S. (1988). "Our Culture Affects Our Pain."Paper presentation,National Convention of Popular Culture Association and American Culture Association,New Orleans,LA. (March). Bromley, S. (1987). "Husband-Assisted Autohypnosis for Labor and Delivery: A Clinical Model". Paper presented at Rocky Mountain Psychological Association. Albuquerque,New Mexico(April). Bromley, S. and Loy,P. (1987). "Politics of PMS". Paper presentation Association of Women Psychologists, Denver, Colorado (March). PROFESSIONAL PRESENTATIONS--Invited: Bromley, S.P. &Canales, G. (2000). Issues in presenting information on historically underrepresented groups in the classroom. Symposium conducted at the Rocky Mountain Psychological Association, Tucson. (April). Strongin, D. &Bromley, S. (1999). Student and faculty reactions to the introduction of a graduate ethics course. In Miller, R. (Chair)Ethics in college teaching. Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins, CO(April) Bromley. S. (1999). Issues of'religion and spirituality with therapists and clients. In S. Bromley(Chair)Religion and spirituality in research.practice and the classroom. Symposium conducted at the Rocky Mountain Psychological Association. Ft. Collins, Co(April) Handelsman. M.M.,Bromley. S.P. &Davis, S.F. (1995). "Clinical Psychologist, Counseling Psychologist, Clinical Social Worker, or Psychology Professor: Which Degree is Right for Me?"Psi Cli invited panel presentation,Rocky Mountain Psychological Association, Boulder, CO(April). Bromley, S. (Co-Chair), Seibert.P. (Co-Chair),Knuckey,D.,Bohlin,M.,Zaweski, C.. Watson,D..Hannon,D., West, K. &Robins, J. (1994). "Training the Teaching Assistant"Invited Panel Presentation,Rocky Mountain Psychological Association, Las Vegas,Nevada (April) 3 Bromley, S. (1993). "Hypnosis in Dentistry."Presentation at Monthly Meeting of Weld County Dentistry Association, Greeley, Colorado(February). Bromley. S. (1993). "Learning about the author as a way to understand research." Presentation at"Teaching Take Out", CTUP Special Event. WPA/RMPA Convention,Phoenix,Arizona(April). Allen. M. and Bromley, S. (1993). Co-Chairs Two CTUP Special Event Sessions, "Teaching Take Out: Experiences in Collaborative Learning", Western Psychological Association/Rocky Mountain Psychological Association Convention, Phoenix, Arizona(April). Bromley, S. (1993). Chair, Invited Symposium, "Psychological and Social Perspectives on Male Violence Against Women", Western Psychological Association/Rocky Mountain Psychological Association Convention,Phoenix, Arizona (April). Bromley, S. (1992). "Enhancement of student research and writing skills in any course". CTUP Workshop presented at the Rocky Mountain Psychology Association Convention,Boise, Idaho. (April) Bromley, S. and Karlin, N. (1992). "General and health locus of control of adult caregivers". Poster session at the UNC Research Forum, Greeley, Colorado. Bromley, S. (1992). Panel member in Mental Health Symposia for Victim Compensation Convention as part of the Colorado Organization for Victim Assistance Conference. (Estes Park/October) Bolocofski,Bromley, Foster and Mean(1988). "Hypnosis:Research and Clinical Perspectives," symposium presentation, Colorado Psychological Association, Greeley(March). Bromley, S. (1986). "Pain: A Psychological Event". Presenter-20th Annual Emotional Crisis Workshop,University of Northern Colorado, Greeley, Colorado(July). LECTURES--Invited: Bromley, S. (1998)"Psychological methods of pain control" Invited lecture for the annual meeting of the Weld County Arthritis Society. Bromley, S. (1998). "Hypnosis for pain control of arthritis"Invited lecture for"Brown Bag" lunch series sponsored by the Greeley Medical Clinic. Bromley, S. (1998) "Headache Control-Psychological Methods". Invited lecture as part of a seminar titled"Coping with headache". Sponsored by the Greeley Medical Clinic. Bromley, S. &Ackerman J. (1998)."What to do to handle burnout"A workshop conducted for foster parents working with Weld County Social Services. Bromley, S. (1995). Keynote speaker for Golden Key Honor Society Induction Ceremony,University of Colorado, Boulder, Co. (November) Bromley, S. (1992). Keynote speaker for Sophomore Honor Society Induction Ceremony. Bromley. S. (1991) Featured speaker. UNC Academic Honors Convocation. (April) Bromley, S. (1991). Banquet speaker Emotional Crisis Workshop, Greeley. Colorado. (July) GRANTS: Bromley, S (1994)Honors Grant ($500)to attend research training at the Society for Clinical Hypnosis meeting, San Francisco(October) Bromley, S. (1994). Research and Publications award of$1500.00. "Assessment protocols to measure the efficacy of 4 • hypnotic treatment for injured workers. Karlin,N. and Bromley, S. (1990). Research and Publications award of$2.4440.00. "Control, support,burden and affect differences among dementia and non-dementia caregivers". BOOK/GRANT REVIEWS: Grant review for Boise State Department of Education(1995) Review of Santrock. J. (1991). The science of mind and behavior. W.C.Brown and Benchmark. Review of McKee, P. Sc.Thiem, J. (1993). Real life: Ten stories of aging.University of Colorado Press. PROFESSIONAL CONSULTATION/PRACTICE: Year(s) Institution/Organization Role 1996-presnt Ackerman and Associates Clinical Psychologist. 1988 Bonnet Good Samaritan Center Pain Management Consultant and Trainer 1984-85 Denver Metropolitan Dental Care Consultant in Pain Management 1984 Iowa Association of Registered Physical Therapists Hypnosis for Pain Management Consultant and Teacher. PROFESSIONAL ASSOCIATION PARTICIPATION: Membership 1986-2003 Rocky Mountain Psychological Association 1988-present American Psychological Association(Divisions 2, 30, 35) 1989-96 Greeley Area Mental Health Network 1987-88 Association of Women in Psychology 1980-89 Colorado Psychological Association 1988 CPA Program Committee Member for Spring Meeting--Greeley Coordinator SERVICE: EXTERNAL: NATIONAL SERVICE: 1994-2002 Rocky Mountain Coordinator-American Psychological Association,Division 2 -Teaching of Psychology 1992-94 Co-Chair,Rocky Mountain Region Council of Teachers of Undergraduate Psychology(CTUP). 1991-94 Mountain States Regional Academic Coordinator, Golden Key National Honor Society REGIONAL/STATE SERVICE: 2000 -Moderator for G. Stanley Hall Lecturer-Dweck,C. (2000).Motivation and the self Presented at the Rocky Mountain Psychological Association Convention,Tucson. (April) 1999 -Moderator for G. Stanley Hall Lecturer-Vine/, W. (1999):A larger canopy for psychology: Unifying themes and pragmatic empiricism. Presented at the Rocky Mountain Psychological Association Convention,Ft. Collins, CO(April) 1989-present Rocky Mountain Psychology Association 1998-present Ex-Officio Board Member As Division 2 Coordinator 1992-1998 Board Member 1995- 1998 Elected Chair. Groups Under-Represented in Psychology Committee 1992-94 Co-Chair, Groups Under Represented in Psychology Committee 1991 Coordinator of Student Volunteers,RMPA Convention, Denver,Colorado. 1995 Psychology Chair-CCHE Faculty to Faculty Conference(October) COMMUNITY SERVICE: 2003-present Board Member Weld County Area Agency on Aging 1999-present Member Weld Senior Wellness Program Evaluation Committee 1999-2000 Member, Weld County Area Agency on Aging, Grandparenting Committee 1998-present Member, Weld County Medical Society Committee on Alternative and Complementary Healing 1997-1998 UNC Loaned Executive-United Way of Weld County 5 1997 Mental Health Pro Bono Workshop,"Communication in the Workforce" 1991- 1996 Board Member, 19th Judicial District Victim Compensation Board 1995-96 Chair 1990-93 Board Member,Weld County Area Agency on Aging 1992-93 Chair 1991-92 Vice-Chair 1986-2001 Exam Supervisor American Institute for Property and Liability Underwriters/Insurance Institute of America 1987-present Clinical Psychologist-pro-bono work with individual clients and community training INTERNAL: DEPARTMENTAL: 1993-2003 Member,Department Executive Committee 2000-2003 Advisor Psi Chi National Honor Society 1995-1999 Co-Advisor Psi Chi National Honor Society 1996-present Guest lecturer for Psi Chi Grad Night on getting into clinical/counseling grad programs. 1989-91,93. 1995-1998 Department Representative,CCHE Faculty to Faculty Conference 1987-94 Department Representative to graduation ceremonies 1986-94 Library Representative 1983, 86 89, 90-93,97,98 Member,Faculty Search and Screen Committee 1990-92 Member, Psychology Department Undergraduate Committee(Chair 1992) 1987-88 Co-Coordinator Semester Conversion Committee COLLEGE: 1992,93.96.97 Member of faculty invited to teach in the Cluster Program 1990-93 Graduation Marshall, Arts&Sciences 1988-89 Member, Arts and Sciences Teacher Education Committee 1986-89 Chair,Interdisciplinary Committee to develop and revise Human Development Major in the College of Arts and Sciences and Psychology Department UNIVERSITY: 2002 -present Graduate Faculty 2002-present Field Experience Coordinator for students at Ackerman&Associates 1992-94 1996-99 Member-Research and Publications Board 1993-94 Chair-Elect 1988-99 Founding Co-Advisor. Golden Key Honor Society 1992-95 Member-UNC Women's Commission 1992-94 Co-Chair-Assessment Task Force 1989-90 Faculty Representative, Student Fee Allocation Committee 1986-89 Member, Faculty Senate 1988-89 Secretary 1987-88 Vice-Chair 1986-87 At-Large Member, Executive Committee 1986-89 Member, Academic Policies Committee 1986-87 Member. Elections Committee 1988 Representative, Western States Faculty Leadership Conference,Reno 1988 Senate Representative, Statewide Commission Advisory Committee 1988 Advisor, In-Touch Help Line 1985-86 Volunteer Therapist,UNC Counseling Center GRADUATE STUDENT COMMITTEES--Doctora/: 2003-present Committee Member, Stefanie Stecker(School Psychology) 2002-present Committee Member,Karen Bender(Professional Psychology) 6 1998-99 Committee Member, Situ-Shin Lu,Professional Psychology.'Using Metaphor in Child Counseling in Taiwan" 1997-00 Committee Member, Christine Rogers,Professional Psychology,"A Qualitative study of the experiences of pastor's wives." 1995-1997 Committee Member,Lisa Ing, Special Education 1994-2003 Committee Member,Marla Gallagher,Educational Psychology 1993 Committee Member,Hsiu-Lan Ma, Science Ed. -Oral Comprehensives 1993 Committee Member,Jerry Buford, School Psychology,"Treatment of depressive symptoms of early adolescents". 1993-1998 Committee Member,Pat Flanagan, CSPA,Orals,"A comparison of attitudes and practices of Teaching faculty regarding student academic dishonesty at a two year and four year institution". 1991 Committee Member,Mike Propriano, School Psychology 1990-94 Committee Member,Paul Jantz, School Psychology, 1989 Committee Member,Mike Peters, Vocational Rehabilitation,"The Effectiveness of Vocational Evaluation for Various Disabling Conditions 1987 Committee Member,Ane Marie Kajenckii,English,"The Concept of Free Association in Virginia Woolf's The Waves" 1986 Committee Member,Fuming Liao,Mechanical Kinesiology,"Development and Validation of a Method for Providing Immediate Feedback Information on Speed and Angle of Release in Shotputting" GRADUATE STUDENT COMMI11EES --Masters: 2001 Jeremy Ehmke, Chair 1999-00 Jennifer Lawrence, Committee Member 1998 -99 Vanessa Ewing, Committee Member 1997 Stephanie Blasi,Committee Member 1997 John Nickisson,Chair 1994 David Watson, Committee Member 1994 Tiernan McIlwaine, Committee Member 1994 Jerrod McCoy, Committee Member 1993 Sheldine Runyan, Committee Member 1993 Sue Cole, Committee Chair,"Influences on Occupational Goals of Selected Male and Female College Students". 1990 Jerry Benner, Committee Member 1990 Kurtis Armstrong, Committee Member."Attitudinal Consequences of Pre-Employment and Random Employee Drug Testing" 1989 Michelle Hozer, Commnittee Member 1989 Anne Schnittgrund, Committee Chair," Age and Electrothermal Biofeedback Training". 1988 Cherri Hockett, Committee Member, "The Effects of Turnover on Those Who Remain in an Organization" 1988 Tony Ambrosio, Committee Member, "The Belief in a Just-World and the AIDS Epidemic: Predictors of Attitudes Towards Individuals with AIDS" 1988 Steve Foster, Committee Chair. "Hypnotic Susceptibility As a Function of Locus of Control and Director Indirect Induct ional Deepening and Suggestion Style" 1988 Lisa Dillon, Committee Chair. "Cognitive-Behavioral Approach to the Treatment of Elderly Rheumatoid Arthritis Patients" 1987 Deanna Holmes, Committee Member 1987 Darlene Nold, Committee Member, "Reading and Writing Assessment Tests as Predictors of Success in the Basic Peace officer Academy at Aims Community College" 1987 Dan May. Committee Member 1986 Jeff Schiels, Committee Member, "The Reformulated Hypothesis: Is Its dominator of Learned Helplessness Literature Justifiable?" 1986 Linda Coulthard-Morris, Committee Member, "Biofeedback of Cortical Slow Wave Potentials, Hand Temperature and Muscle Tension in Normal and Attention Deficit Disorder with Hyperactivity Children" TEACHING: Honors Activities: 7 2000-2002 Thesis Co-coordinator, Stephanie Price,Allison Osag,Anna Grenier. Jennifer Donnelly 2000-2002 Thesis Co-advisor, Shanti Pepper."Hindsight bias and prejudice against homosexuals" 2000-2002 Thesis Advisor, Angela Hanson."Effects of aromatherapy on attention" 2000 Thesis Coordinator. Cindy Mitchell, Christin Hillyer,Angela Hanson 1999 Thesis Advisor,Melissa Touchton"Complementary/alternative medical use among undergraduates at the University of Northern Colorado". 1999 Thesis Advisor, Sarah Painton. "Early parent loss in terms of maintaining a connection with the deceased. 1999 UNC Research Day,Faculty Panel Coordinator," Complementary Healing Methods" 1999 Thesis Coordinator-Kristin Pietryzick,Jennifer Kimberling,Cristine Dickey 1997 Thesis Co-Advisor Kelly Kinser. "An evaluation of the city of Greeley community outreach program". 1997 Honors Connection Course development-Alternative Healing Methods 1996-2002 Honors Co-Coordinator,Psychology Department 1989-94 Honors Coordinator,Psychology Department 1994 Thesis Co-Advisor,Diane Musgrave,"The Relationships Among Personality Traits,Alcohol,Caffeine,and Nicotine Consumption. and Academic Performance in College Students" 1994 UNC Research Day.Faculty Panel Coordinator,"Hypnosis: Theory and Research" 1993 UNC Research Day,Faculty Panel Coordinator,"Non-traditional Theories of Therapy Serving Women and Minorities". 1993 Thesis Co-Advisor,Linda Norman, "Clozapine and Event Related Brain Potentials in Schizophrenics" 1992 Thesis Advisor,Deborah Knuckey, "The Effect of Touch on Affect Among Strangers Under Mildly Stressful Conditions" 1992 UNC Research Day,Faculty Panel Coordinator 1992 UNC Research Day,Faculty Panel Coordinator(2 student panels)"Sex Roles and Psychology,"The Power of Social Influence 1989 Thesis Advisor, Geri Bosley, "Post Death Ritual in a Small Colorado Community" 1988 Thesis Advisor,Pam Clasen, "The Use of Relaxation and Imagery Techniques in Pain Management" 1989&97 Honors Connection Course Development Courses Taught: (1-4 Scale with 1 as Highest)(*1-5 Scale with 5 as highest) • AVG. DATE COURSE TITLE HRS ENR AVG.RATING 1986-1988 PSY 101 Intro Seminar Psychology 1 30 1.16 1983-1997 PSY 120 Principles of Psychology 4 113 2.35 1984 PSY 121 Intro to Psychology I 4 40 ---- 1985-1988 PSY 230 Human Growth &Development 5 68 1.46 1984 PSY 265 Social Psychology 3 25 ---- 1988-2000 PSY 323 Health Psychology 3 43 3.02 1986 PSY 330 Child&Adolescent Psych3 27 1.4 1986-1993 PSY 331 Maturity&Aging 3 36 1.51 1984-2000 PSY 455 Abnormal Psychology 3 32 3.01 1983-1998 PSY 350 Theories of Personality 3 40 2.05 1986-2000 PSY 407 Intro to Counseling Theories 3 23 2.52 1987 PSY 499 Psychology of Sex Roles 3 16 1.18 2000 PSY 508 Health Psychology and Healing 2 17 4.57 1989 PSY 508 Emotional Crisis Workshop 1-2 39 --- "Frontiers of Mental Health And Education" 1988 PSY 508 Emotional Crisis Workshop 2-3 63 "Mind/Body Interactions" 1987 PSY 508 Emotional Crisis Workshop 2-3 106 "Relationships" 1991 PSY 595 Health Psychology 3 15 1990-2000 PSY 620 Assessment&Interviewing 3 12 3.13 1988 PSY 620 Issues in Behavioral Medicine 3 5 2.08 1992-1997 PSY 621 Practicurn College Teaching 2 12 3.11 1997 HON 200 Honors Connections Seminar: "Alternative Healing Methods" 2 20 3.67 of 4 1989 HON 200 Honors Connection Seminar II: 2 9 --- 8 • "Love" 1986 Elderhostel "Dream On" NC (25) 1987 Elderhostel "Mind/Body Interactions" NC 19 Courses Developed: 2000 PSY/PPSY 508,Health Psychology and Healing 1997 HON 200, Alternative Healing Methods 1991 PSY 595,Issues in Health Psychology, Summer 1989 23rd Annual Emotional Crisis Workshop,Frontiers of Mental Health and Education, Summer 1988 PSY 620, Assessment in Behavioral Medicine.Fall(Revised Spring 1998) 1988 PSY 423, Health Psychology.Fall 1988 22nd Annual Emotional Crisis Workshop,Mind/Body Interactions. Summer 1987 21st Annual Emotional Crisis Workshop,Relationships, Summer 1987 Mind/Body Interactions-Elderhostel Program, Summer 1987 PSY 499, Psychology of Sex Roles-Summer 1986 Dream On-Elderhostel. Summer Directed Studies: Graduate: 1995 Cynthia Holley,Hypnosis 1994 Tara Johnson,Hypnosis Theory and Practice 1994 Marla Gallagher, Sociometric Processes 1994 Marla Gallagher, Cluster Development in Intro Psychology Classes 1992 Bruce Holoman, Hypnosis Research and Practice 1988 Paul Jantz,Hypnosis for Pain With Children 1988 Lori Kochevar, Women as Leaders 1988 Jerri Israel, Alan Shaw, Issues in Health Psychology 1988 Steve Foster,Michele Hozer, Teaching Apprenticeship 1987 Tony Ambrosio, Hypnosis Models 1986 Candy Disch, Psychological Testing Undergraduate: 2000_ Lynell Rice-Cross-cultural attitudes towards healing methods 2000_ Andrea Hagedorn-Attitudes towards counseling(in lieu of honors thesis) 2000_ Laura Bell -Psychology of childbirth 1999 Lynell Rice-Healing Methods 1999 Stefani Stecker-Student's perceptions of parent-child sex communication(in lieu of honors thesis 1998 Jennifer Altman-Exercise and Psychology 1996 Kindra Sanchez-Biracial Identity 1996 Jenna Weatherbee-Pain Coping Styles 1995 Allison Ellis-Psychological Theories in Business Management • 1995 Holli Elrick,Counseling and the Hearing-Impaired Child 1994 Lewis Garza, Etiology of Schizophrenia 1994 Suzanne Bodetko, Autogenic Training 1994 Rebecca Furstenberg. Impact of Alzheimer's Disease on Families 1994 Bonnie Sarton, Hypervigilence in Youth(Hon 351) 1993 Mary Jo Hamilton.Hypnosis Theory 1994 Greg Schooley, Forgiveness as a Therapy Tool 1993 Jason DeBueno, Youth Advocacy 1993 Kelley Ferguson-Women in Psychology 1993 David Rosenberg-Offender Programs 1992 Robin Trostel, Analysis of Learning Styles 1992 Robin Trostel, Health Locus of Control 1992 Roberta Inman, Family Violence and Lesbians(Hon 351) 1991 Mark Kahl,Back Pain 1991 Tracy Moulton, Treatment of Sexual Abuse 9 • 1991 Alice McPherson, African American Women and Higher Education 1991 Jody Humer,Hypnosis: Theory and Practice 1990 Jimmie Berg, Women's Learning Styles 1989 Elary Violett,Cognition and Pain Management 1989 Geri Bosley, Chris Snodgrass,Bev Foster.Elary Violett, Issues in Personality 1989 Penny Vaughn,Female Pioneers in Social Work 1989 Lori Peterson,Pain and the Elderly 1988 Peer Training for Hotline Service 1987 Tracy Boh,Issues in Child Abuse 1987 Julie Stoddard,Grief and Divorce 1987 Eric Bouch,Hypnosis Models 1987 Mike Lesser,Assessment in Sport Psychology 1986 Lynne Sheffield, Childhood and Loss 1986 Jennifer March, Adolescence Practia 2000 Rebecca Kuhn-Aromatherapy research 2000 Ackerman and Associates-Berkely Holston 1999 Melissa Touchton-Applied statistics 1998 Andrea Lamb-Hypnosis and golf performance 1998 Rebecca Varoula -Women's Place 1998 Greeley Medical Clinic-Gay Lemons,Renae Smith 1998 Ackerman and Associates -Amy Munnel,Kristin Pietrzyk,Jennifer Kimberling,Greg Pedersen 1997 Greeley Medical Clinic-Lori Darst,Barbara Glode, Ann Marie McCullen,Jeff Titus 1993 Greg Schooley,Bereavement Research 1993 Di Sluice, Women's Commission 1992 Mary Jo Hamilton.Hypnosis Research 1992 Carol Sexton,Psychology Testing 1992 Lisa Schlott,Learning Styles PROFESSIONAL DEVELOPMENT ACTIVITIES: Workshops. Clinics, Symposia, Conferences: (Excluding Conferences as a Presenter) 1999 Cognitive Behavioral Therapy Training Program,Institute for Behavioral Healthcare 1999 EMDR training and Level 1 certification 1998 Qualitative research lecture series-UNC 1998 Lewis M. Terman Western Regional Teacher's Conference sponsored by APA Division2 in conjunction with the WPA/RMPA joint convention. 1998 "Spirituality and health in counseling", CABEC Workshop, Greeley 1998 "Divorce Busting: Solution oriented brief therapy with couples", Colorado Assoc. Marriage and Family 1997 Health Maintenance-Legal and Ethical Issues 1997 Body and Soul: Healing in the 90's 1996 Celebrating our Essence: Women's Health and Spirituality 1995 International Society for Clinical and Experimental Hypnosis-Research Workshop, San Francisco, CA (30 more hours toward certification) 1989 "Minding the Body,Mending the Mind", CAHEC Workshop,Ft. Collins • 1988 "Demystifying Publishing",CAHEC Workshop,NCMC, Greeley 198.5 "Attentional Deficit Disorders in Children",Meichenbaum,Denver 1980 International Society for Clinical and Experimental Hypnosis-30 certification hours,Denver Numerous other workshops on Parent Loss, Child Abuse, Grantsmanship, Short-Term Treatment, Supervision, Pain Management.Medical Terminology,Depression.Personality Disorders Courses Taken Credit: 1994 EPRE 603 - Analysis of Variance Audit: 1993 EPRE 602 -Elements of Statistics 1990 EPRE 700-Advanced Research Methods Continuing Education Credit: 10 • s w 1976 C.U. Medical School-Medical Ethics 1972 C.U. School of Nursing-Hypnosis(10 weeks) • 1969 University of Chicago-Kubler-Ross,Death and Dying HONORS AND AWARDS: 2000 "Wonderful Outstanding Woman" Award 1998 Distinguished Service Award-Rocky Mountain Psychological Association 1998 Arts and Sciences Teacher of the Year Award 1998 "Wonderful Outstanding Woman" Award-Highlighted in October newsletter-Women's Resource Center 1993 Commencement Banner Carrier, Arts and Sciences 2002,1993, 91.89, 88 -Mortar Board Favorite Professor 1992 Student Representative Council University Professor of the Year 1992 Student Representative Council University Advisor of the Year 1989 Arts and Sciences Achievement Award 1988 Honors Advisor of the Year 1984 Psi Chi,University of Northern Colorado Chapter 1982-83 Writing Associateship-Rocky Mountain Women's Institute 11 • Page 1 of 1 March 24, 2006 RECEIVED MAR 30 af Alan Ackerman Ackerman and Associates P.C. Dear Mr. Ackerman: As a Housing Authority we would be glad to accept any appropriate referrals for clients needing our services from Ackerman and Associates. If you are awarded a contract to work with Weld County clients we will be agreeable to enter into a Memorandum of Understanding concerning the services provided by each agency. If you have any questions please contact me at(970)353-7437 ext 103 Sincerely, Thomas Teixeira Executive Director https://webmailcluster.perfora.net/xml/download/attachmentjjsessionid=41 E573CB2F68C90... 3/30/06 RECEIVED MR 3 U 1006 North Range Behavioral Health To: Applicants for CORE Services Funding From: Wayne Maxwell tics/µ-- Executive Director Re: Letter to Support CORE Services Applications Date: March 26, 2006 After the Weld County Department of Social Services issued its RFP through which mental health service providers could apply for CORE Services funding, we began to receive requests from applicants for letters from North Range Behavioral Health. We were aware that applicants need a letter from us, but we were unsure of what the Department of Social Services was specifically requesting. To obtain a clarification we met yesterday with Judy Griego and Dave Aldridge to determine the DSS expectations. I believe the letter we have written in response to your request will meet your need and fulfill the DSS expectation. If you have any questions, please give me a call. 1306 11th Avenue/Greeley,CO 80631/(970)M7-2120/Fax(970)353-3906 North Range Behavioral Health March 29, 2006 Joyce Ackerman 1750 25th Avenue#101 Greeley, CO 80634 Re: Letter to Accompany Proposal to Weld County Department of Social Services To Whom it May Concern: This letter is written to support the application of Joyce Ackerman to provide CORE Services through the Weld County Department of Social Services. North Range Behavioral Health is pleased to commit to a collaborative relationship with Joyce Ackerman to develop a system of care for children and families served to ensure that duplications in services are minimized, that gaps in needed services are eliminated and that services are billed to the appropriate payer source. For services involving Medicaid eligible clients North Range Behavioral Health will work with Joyce Ackerman to determine which services are benefits of the Medicaid Mental Health program and to facilitate a process through which Joyce Ackerman can be compensated with Medicaid funds when services provided are a benefit of Medicaid. �Si�nccerely, V� a��4m,j(��7 ' Wayne A. Maxwell,Ph.D. Executive Director Mission: North Range Behavioral Health provides professional, culturally competent mental health services for Weld County. 1306 11th Avenue/Greeley,CO 80631/(970)347-2120/Fax(970)353-3906 EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP Page 1 of 2 Elaine Furister From: Gloria L. Romansik Sent: Thursday, May 18, 2006 4:02 PM To: Andrea Shay; David Aldridge; Elaine Furister Subject: FW: May 15 letter response RFP 2006-2007 Fyi I'm assuming Andrea and Dave will be talking to the Ackermans. From: joyceackerman@comcast.net [mailto:joyceackerman@comcast.net] Sent: Thursday, May 18, 2006 2:24 PM To: Gloria L. Romansik Subject: May 15 letter response RFP 2006-2007 Gloria Romansik Per May 15 letter re RFP 06SAT01 Sex abuse treatment approval Ackerman and Associates accepts the recommendations of the FYC commission. Specifically regarding Outcomes reporting: Ackerman and Associates will report outcome as acceptable or unacceptable. The report will be based on the completion of the safety plan by the client as specified in the proposal. Compliance Item: We are cooperating with employment services and believe we have forwarded the appropriate letter sent by them to us over email. We will search for our copy we delivered to you and provide a second copy. Due to our time constraints noted in the original proposal, the letter was separated from the proposal itself. Court testimony: The current hourly rate for court testimony is 120 dollars per hour for new cases. We agree to the carry over rate in cases that are carried over. Per FYC determination on RFP 06-HS-02 Home Studies,Updates and Relinquishment Counseling The FYC commission did not recommend approval of this bid. We wish to file an appeal of this recommendation. In order to proceed with that appeal, we request full access to all notes, minutes, discussions and score sheets associated with the deliberations the FYC commission made in relation to this bid. We assume that these should be available to us as part of the public record. We look forward to hearing from you in regard to the appeal process. Please contact Alan Ackerman Ph.D. at this email address in regard to either of these matters. You can reach him at 970-396-5945. 5/23/2006 Page 2 of 2 Sincerely Joyce Ackerman Ed.D. Ackerman and Associates P.C. 5/23/2006 DEPARTMENT OF SOCIAL SERVICES P.O. A BOX GREELEY,CO. OX Website:www.co.wdd.co.us ' Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 C. COLORADO May 15, 2006 Joyce Ackerman Ed. D. Ackerman&Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, CO 80631 Re: RFP 06SAT01-Sex Abuse Treatment RFP 06-HS-02-Home Studies,Updates, Relinquishment Counseling Dear Ms. Ackerman: The purpose of this letter is to outline the results of the Bid process for PY 2006-2007 and to request written information or confirmation from you by Monday,May 22,2006. A. Results of the Bid Process for PY 2006-2007 • Through the 2006-2007 bid evaluation process,the Families, Youth and Children (FYC) Commission recommended approval of Bid#06SAT01 (RFP 05007) Sex Abuse Treatment.The score given to this bid was 86 points. The FYC Commission attached the following recommendation and compliance item to your bid. Recommendation: You must explain how you will provide outcome measurements to Weld County Department of Social Services. Compliance Item: The bidder must provide the required letter under the Collaboration Section from Employment Services. Hourly Rate for Court Testimony: The bidder did not provide a rate for court testimony. For bidders carrying over services to 2006,the Department will use last year's court testimony hourly rate. The rate for court testimony will be billed at is $100 per hour. • The Families, Youth,and Children(FYC) Commission did not recommend approval of your bid for Home Studies,Updates, and Relinquishment Counseling. The score given was 46 points. Page 2 Ackerman&Associates,P.C./Results of Bid Process for PY 2006-2007 B. Required Response by FYC Bidders Concerning FYC Commission Recommendations: You are requested to review the FYC Commission recommendations and to: 1. accept the recommendation(s) as written by the FYC Commission; or 2. request alternatives to the FYC Commission's recommendation(s); or 3. not accept the recommendation(s) of the FYC Commission. Please provide in writing how you will incorporate the recommendation(s)into your bid. If you do not accept the recommendation,please provide written reasons why. All approved recommendations under the NOFAA will be monitored and evaluated by the FYC Commission. The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations. Please respond in writing to Gloria Romansik, Weld County Department of Social Services,P.O. Box A,Greeley, CO, 80632,by Monday,May 22,2006, close of business. If you have questions concerning the above,please call Gloria Romansik, 970.352.1551, extension 6230. Sincerely, et J . ego, Ii -ctor cc: Juan Lopez, Chair, FYC Commission Gloria Romansik, 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 FY06-CORE-0027 Revision (RFP-FYC-06007;06SAT02) Contract Award Period Name and Address of Contractor Beginning 06/01/2006 and Adolescent&Individual Therapy Ending 05/31/2007 Sex Abuse Treatment P. O.Box 321 Fort Lupton,CO 80621 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance This program serves sexually abusive adolescents from Award is based upon your Request for Proposal(RFP). The the ages of 12 though 20.The mission of A.I.D. is RFP specifies the scope of services and conditions of award. designed to protect the safety of the community.A.I.D. Except where it is in conflict with this NOFAA in which services those who have been adjudicated,have case the NOFAA governs,the RFP upon which this award is admitted to sexual abuse,or are sexually reactive.The based is an integral part of the action. program provides for a maximum of 5 clients, 1 hour weekly group sessions, 1 group session with mandated Special conditions attendance of parent-guardian. Currently Bilingual I) Reimbursement for the Unit of Services will be based on an services are not available. South County services are hourly rate per child or per family. provided if an adequate number of clients are referred. 2) The hourly rate will be paid for only direct face-to-face Family reunification services upon request. contact with the child and/or family,as evidenced by client- Cost Per Unit of Service signed verification form,and as specified in the unit of cost Hourly Rate Per computation. Individual Counseling $ 50.00 3) Unit of service costs cannot exceed the hourly and yearly Family Counseling $50.00 cost per child and/or family. Court Testimony $100.00 4) Payment will only be remitted on cases open with, and Rate per episode referrals made by the Weld County Department of Social Treatment Package $35_00 Services. After care(Evaluation) $500.00* 5) Requests for payment must be an original submitted to the Polygraph(Average Rate) $225.00** Weld County Department of Social Services by the end of *Cost of evaluation is dependent upon services the 25th calendar day following the end of the month of provided. service. The provider must submit requests for payment on **Variable Rate is dependent on cost of polygraph. forms approved by Weld County Department of Social Other Services Services. Notebook(One time at first group session)$10.00 6) The Contractor will notify the Department of any changes in Unit of Service Based on Approved Plan staff at the time of the change. Enclosures: X Signed RFP:Exhibit A Supplemental Narrative to RFP: Exhibit B Recommendation(s) _Conditions of Approval Approvals: Program Official: By By M.J.Geil ,Chair Judy riego, hector Board of ht 4 GoilntzSnmissioners Weld ty Department o Social Services Date: IV 1 'f L��'+ Date: Spy°cp doe '-/5,7 , ' ,'>6,,s4TC° 2 . .. :Bid 001-06 (RFP-FYC-06007) Attached A SEXUAL ABUSE TREATMENT PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 2006-2007 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2006-2007 /� BID 001-06,RFP-FYC-06007 / NAME OF AGENCY: Acio IeSC Cflt �'YIuDlOt D (Act I ov'e 10Pmew r ADDRESS: 1 . O • BOi - aI ( Foci kupicky, C.t 8W ait PHONE: (Sig) S C/ (0 • ci st 6 CONTACT PERSON: (%eb4c(Cc ©utt c TITLE:EK'PC-01O-flbRJ eke (O(.t`E4/Z DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Sexual Abuse Treatment Program must provide for therapeutic intervention through one or more modalities to prevent further sexual abuse perpetration or victimization. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June I, 2005 Start End May 31, 2006 End TITLE OF PROJECT: 5e N u I C' b us--e TRPc trn ew t- laeb .cca_ J c. �Cll _k • ( 3 - aso6 Name and Signature of Person Preparing Document Date 2e6er«. T T . u-.4 c_I 3 as o>o Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids, please initial to indicate that the following required sections are included in this Proposal for Bid. tc9 Project Description ir Target/Eligibility Populations Types of Services Provided Measurable Outcomes /,, Service Objectives Workload Standards Proof of Collaboration Evidenced-based Outcomes taff Qualifications nit of Service Rate Computation illing Process gram Capacity per Month Certificate of Insurance Page 29 of 41 - 4.... ' Rid 001-06 (RFP-FYC-06007) Attached A Date of Meeting(s)with Social Services Division Supervisor: Comments by SSD Supervisor: -4." Pitinueo.... Liti_ 0- aeon" -rat AWCILits‘i.„.. A,1/411 L rises- Z.,. Ch-uett. -_eit.x. ..d-irL_ 3 0 0.6 Name a Signature of D Supervisor Date Page 30 of 41 INVITATION TO BID BID 001-06 (06005-06011 and 006-00, A, B, & C)) DATE:March 1, 2006 BID NO: RFP-FYC-06007 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-06007) for:Colorado Family Preservation Act--Sexual Abuse Treatment Program--Emergency Assistance Program Deadline: March 31, 2006, Friday, 10:00 a.m. 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, 2006, through May 31, 2007, at specific rates for different types of service, the County will authorize approved providers and rates for services only. The Sexual Abuse Treatment Program must provide for therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetration, and to prevent further sexual abuse and victimization. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK Rebeccc. �. QuIGlc MP. O2(t.1t TYPED OR PRINTED SIGNATURE VENDOR CIdoIPSCPN1- S_Liu D: orDuct cPc kfc (Name) 'JDeu e I opal + CAT0) Handwritten Signature By Authorized Officer or Agent of Vendor ADDRESS ?b. ?o )( 3 a I TITLE P d(-PC Ct_f i& 1 2oc4ee/o«.N N2 PT I.ii9$ORIi C Xn al DATE PHONE# 303- 5q (, `Is c'6 - The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 41 1 - RFP-FYC-060007 Sexual Abuse Treatment Program Bid Category Sexual Abuse Treatment Program Adolescent & Individual Development I Project Description: Adolescent & Individual Development (AID) serves sexually abusive adolescents from the age of 12 through 20 . The mission of AID is designed to protect the safety of the community. This includes protecting the safety of the victim or potential victim(s) at all costs . This is an outpatient Offense Specific Treatment Program which offers group therapy along with individual and family services . AID has been given approval by the State of Colorado to work with adolescent sex offenders under the standards and guidelines which were put into place July, 2002 . This treatment program will follow those guidelines and standards in every area . AID recognizes the importance of the family when working with the adolescent . The agency will provide family reunification under the state' s guidelines and standards of July, 2002 to help prevent any future victimization. The program is designed to work in a team effort in order that the adolescent may receive the skills and concepts necessary to help him/her to refrain from using sexually abusive behaviors . The team consists of the Probation Officer if one is appointed, Social Services Caseworker, counselor, and the parent (s) or guardian (s) of the client, plus anyone else who is considered supportive to the adolescent and who wants to be involved. AID will comply with the State of Colorado standards and guidelines of the sexually abusive adolescent and will be flexible in the program materials to ensure each adolescent is receiving the best services possible . AID will work with each adolescent as an individual and will address the individual' s specific issues . AID will remain flexible to adjust to the new rules and regulations and will review program materials as new studies indicate necessary change . II Target/Eligibility Populations: AID serves those adolescents referred by Weld County Department of Social Services who are 12 to 20 years of age and have been adjudicated, have admitted to sexual abuse, or are sexually reactive . Eligibility for the AID program will be addressed through recommendations provided within the Offense Specific Evaluation which includes police reports, victim statements, interview with the client and his/her parent (s) or 1 guardian (s) . The total number of clients expected from Weld County Department of Social Services will be five . The program will provide weekly group sessions which meet for 60 minutes . The last group session of the month the parent (s) or guardian (s) will be mandated to attend with the client . There will be group sessions for male and female . There will be no mixture of males and females in a group. The client can expect the program to last a minimum of 12 months . At this time, AID does not provide services for bilingual individuals . However, it does provide services for all races and creeds without discrimination. Family reunification will be provided for those family' s requesting the service . At that time, it will be necessary for the victim, the victim' s counselor, the parent (s) , the perpetrator, and the perpetrator' s counselor to all agree that reunification is in the best interest of the victim. If anyone of the required participants of the reunification do not believe the reunification is in the victim' s best interest, the subject will be dismissed until all parties agree . The reunification process will be completed under the guidelines of the Standards and Guidelines by the Colorado Sex Offender Management Board Section 8 . 00 Family Reunification, July 2002 . Victim counseling will be provided for individuals whose perpetrator is not participating in Offense Specific Treatment with AID. AID will be culturally and/or ethnically sensitive by interviewing the client and his/her family. The values and beliefs of the family will be respected as the law allows . When a parent/guardian has values/beliefs which may hinder community or family safety, it will be necessary to explain the reasons of concern. When the parent/guardian' s language is not that of the treatment team, an interpreter will be found in order to give the parent/guardian the best possible services . AID does not have an office in the South Weld County area at this time . This is due to the limited number of clients available in that area . If and when there are the required number of clients to make up a group, this option may be revisited. III Type of Services To Be Provided: The services which will be provided are Offense Specific Evaluations, Treatment, Reunification, Family sessions, and Individual sessions . 2 A. Upon referral, each client must have been adjudicated for or admitted to a sexual offense . The adolescent will be required to participate in an Offense Specific Evaluation which will contain the following components : Clinical Interview Millon Adolescent clinical Inventory Jesness Inventory - Adolescent Multiphasic Sexual Inventory (MSI) State-Trait Anger Expression Inventory Adolescent Anger Rating Scale (AARS) Shipley Institute of Living Scale SASSI - Alcohol & Drug Beck Depression Inventory Wilson Sex Fantasy Questionnaire Adolescent Sex History Adolescent Parent (s) statements Review of Collateral Information Police Reports Victim' s Statements It is important to note not all the above psychological tests are for all age groups . Therefore, only the age appropriate exams will be given to the adolescent . Additionally, it will be necessary for the adolescent to have a sixth grade reading level to complete the testing. The above battery of psychological exams will comply with upcoming standards and guidelines for adolescents the SOMB is recommending . The adolescent' s evaluation will give recommendations for the type of treatment in which he/she will be involved. The client will be required to participate in polygraphs to determine his/her treatment progress . The polygraphs will be a disclosure, offense specific, and/or a maintenance . The polygraphs have been found to be very useful in the breakdown of secrets . Adolescents may be polygraphed at the age of 12 as long as the client knows right from wrong. However, it will be necessary for the client to pass a polygraph with "no significant response" for it to be acceptable . If "significant response" or "inconclusive" are found, it will be necessary for the client to be reexamined when the Multidisciplinary Team determines another polygraph is necessary. The adolescent will have a treatment team which may include the Probation Officer if one is assigned, a caseworker from Weld County Department of Social Services, the family/legal guardian, and the counselor from AID plus any other interested party who is considered to be supportive to the client . This team of people 3 will be known as the Multidisciplinary Team as outlined in the SOMB' s State Standards and Guidelines of 5 . 100 . The purpose of this staffing will be for ongoing treatment planning including, but not limited to, assessment of the client' s progress in treatment as well as his/her daily living. B. The client may require services AID can not provide and he/she will be referred to an appropriate provider . This includes, but is not limited to, medication intervention, psychiatric evaluations, and polygraphs . The client' s family may require additional services such as parenting skills, domestic violence treatment, or drug and alcohol intervention. These also will be referred to the appropriate source . C. The adolescent' s treatment plan will include individual, family, and group sessions . It is necessary for the family to be involved in the client' s life in order for them to understand sexually abusive behavior and to support his/her son/daughter. This will be especially relevant to those requesting reunification. The adolescent is more than just an individual who is sexually abusive . Therefore it is important to deal with the whole person and not simply the sexual behavior AID will provide counseling for anger management, teenage domestic violence, as well as general psychological issues . These services will only be provided if other agencies do not have these type of counseling services . If the client has Medicaid, he/she will be referred to the mental health facility which has this contract . D. The type of therapy which has proven most effective with the adolescent offender has been a cognitive based therapy in a group format . Issues which will be addressed in the group are thoughts, feelings, and behaviors, thinking errors, basic sexual education, the sexual offense cycle, stress management, empathy, and relapse prevention. The adolescent will be required to do daily journals and homework assigned by the group counselor. There will be projects assigned to determine what the client has learned and is applying to his/her life so as not to sexually re-offend. If it is discovered a client has been victimized, he/she will be recommended to participate in victim' s counseling after participating in the Offense Specific Treatment Program for not less than a period of six months . The reason for the delay is to make sure the adolescent does not blame his/her perpetration on the victimization. E. Investigation for families with sexual abuse 4 v . allegations will be reported and referred to those individuals who have the expertise in this field. IV. Measurable Outcomes: A. Adolescent & Individual Development' s program for Offense Specific Treatment has a time line of not less than 12 months . During this time frame recidivism may be reduced through the program materials . The adolescent will learn how his/her thoughts, feelings, and behaviors are 100% the individual' s responsibility. He/she will be presented with anger management skills, empathy, and how his/her behavior impacted the victim, family and the community. The client will learn coping skills, stress management, the sexual offense cycle, victim clarification, and the entire program will be based on Relapse Prevention. B. The client will demonstrate a decrease in re- victimization by the use of the polygraph. Each client will be required to participate in and pass a disclosure polygraph. The purpose for this polygraph is to make sure the adolescent is taking responsibility for all his sexually abusive behaviors . He/she will be expected to take a maintenance polygraph near the end of the program. This polygraph will help determine if the adolescent is using the skills and concepts provided and to note if he/she is able to follow the rules and regulations which may keep him/her from re-victimization. Additionally, each client will be required to demonstrate the skills and concepts they have been given through written assignments . The skills and concepts will not only indicate what the adolescent has put to use in his/her life but, will also demonstrate the level of empathy he/she has gained. These skills and concepts will be displayed before termination from the program by the requirements to write out his/her Sexual Offense Cycle, an Accountability/Awareness Project, and a Relapse Prevention Plan. C. Victim perpetration may be prevented because the client will learn through their own counseling how to deal with the emotional turmoil and pain appropriately without becoming sexually abusive to others . D. The child abuse incest victim will remain in the home unless it is determined there is a safety issue . The perpetrator will be removed immediately to a place where he/she will not have access to the victim if the perpetrator is in the home or to other potential victim(s) . 5 E . The parent (s) will be educated during the course of the adolescents treatment . This will be done through family sessions and mandated parent groups . Additionally, probation has an educational program which the client who is on probation is mandated to attend. The parent will be involved in the treatment process including the evaluation, polygraphs, and other relevant areas . The parent will demonstrate competency by their understanding of the material and by allowing the adolescent to take the responsibility of the sexual assault without trying to rescue him/her . If there is question of the parent (s) competency, an outside agency may be recommended to go into the home to work with the parent (s) . This has been found to be useful in the past . F. Reunification will depend solely on the progress of the offender in treatment . It will be necessary the adolescent take full responsibility for the sexual assault without blaming the victim. Reunification can be expected to take a minimum of six months with weekly sessions . The family will be mandated to participate in every step of reunification. The family will be mandated to learn and demonstrate how to determine the at risk behavior of the sexually abusive adolescent . What steps will be taken to either lower the risk or immediately report the behaviors to the appropriate source to protect the victim or potential victim (s) . Reunification will take place only when the victim, his/her counselor, the parent (s) of the victim and the parent (s) of the adolescent offender, and the treatment provider of the adolescent offender, all agree and all parties want the reunification . Reunification is necessary because the adolescent may return home at some point . However, it will be important for the victim to feel safe at all costs and know how to report any inappropriate behavior immediately to remain safe . Again, it is necessary the victim never feel re-victimized by any part of the process . Each month the Weld County Department of Social Services and/or Caseworker will be provided with monthly progress notes of each client . These progress notes and outcomes will be specific to the Offense Specific Treatment the client is receiving. Additionally, when necessary, a staffing will be arranged when ever the Caseworker and/or counselor deem it necessary. V. Service Objectives : A. Parental competency will be explored by observation of how they maintain sound relationships as well as appropriate physical and emotional boundaries with each of their children. This will be done through family sessions, individuals, and the 6 J parent group. If additional services are required, the recommendation will be made to have in home services by counselors who are experienced in this field as well as recommendations of parenting classes . B. Family conflict will be addressed through individual and family sessions . If there are issues which require more specialized treatment, recommendations will be made to the referral source . C. Adolescent & Individual Development' s program addresses self-esteem, victim awareness, awareness and management of one' s own personal history of victimization, sex education, peer relationships enhancement, establishing appropriate physical and emotional boundaries, assertive versus aggressive behaviors, and assuming full responsibility for one' s own behavior . The entire program addresses these items within the group, individual, and family sessions . D. Resources are given whenever it is necessary to the parent and/or client . These resources are given immediately when issues arise which are determined best handled outside of Adolescent & Individual Development' s scope of expertise . Due to Medicaid issues, should something arise which requires outside assistance, the parent (s) /guardian (s) will be directed to WCDSS . E . The Multidisciplinary Team will be involved in the referral process . An example of this will be the client who requires mental health counseling for depression or other mental health issues . This client will be referred to North Range Behavioral Health if the individual is a Medicaid participant . Other referrals, if self pay or insurance, may also be made to a mental health therapist . A client who requires psychotropic or antidepressants will be referred to North Range, if Medicaid, to a psychiatrist, other medical provider who is licensed to prescribe the necessary medications . The client is continually monitored through asking and observing if depression or other mental health issues are taking place . The parent/guardian is additionally asked for their observations . At times, a client may not be amenable to Outpatient Treatment . Reasons for non- amenability may include, but are not limited to, re-offending while in the community or not adhering to the Treatment Contract . If this is the case, after a comprehensive review of all factors including but not limited to the client being pulled from the group and put into Individual Treatment or participating in treatment more times per week, a referral will be made back to the Probation Officer or the WCDSS Caseworker to decide if a more structured environment is required. Inpatient Treatment is a 7 last resort . However, at times a necessary solution . This is monitored through the various members of the Multidisciplinary Team. When a client does not appear to be amenable to treatment, there will be a meeting with all agencies and individuals involved to make a decision as to the best solution to help the client succeed. F. Several attempts were made to locate the web address on the instruction sheet . However, it appeared no one knew how to access this web site . Therefore the answer to the statement of Improve outcomes in the Performance Improvement Plan will be answered to the best of my ability without having the access to the web site . When a client comes into this agency the outcome is to see the client successfully complete treatment and be a productive member of society. The clients parents, if they are involved, are given instruction on approaches to supporting their son/daughter and not accepting their sexually inappropriate behavior. If needed the parent will be directed to take parenting classes . Parents are recommended in the evaluation to attend the educational classes such as are given by Weld County Probation. These classes have helped parents to understand the adolescent sex offender. The parent is also recommended to participate in the Informed Supervision Class . This class directs the parent in helping to keep the client safer while in the community. This agency wants to have family together and working as a loving, supportive unit . All attempts will be made to make this a reality in the adolescent and his/her family whether that family is the biological, adoptive, or foster . Therefore agencies such as probation, social services, any mental health providers involved, churches, schools, physicians, and anyone else who is a support in the adolescents life will be contacted and brought into the Multidisciplinary Team. This collaboration of the various agencies and individuals will hopefully be enough of a support to help the client succeed. VI Workload Standards : A. The client will be expected to participate in group treatment every week for one hour at the minimum. Individual sessions will be 50 minutes on an as needed basis . Family sessions will be 60 to 90 minutes on an as needed basis . B . The number of counselors providing services will be at minimum two counselors . C . Maximum caseload per counselor will be eight clients in group treatment . This caseload will be meet the guidelines and standards of the SOMB. 8 D. The modality of treatment will be groups, individuals, and family sessions . E . The number of hours for group will be at the minimum of one hour per week throughout the treatment process . Individual and family hours will be on an as needed basis . F. There will be a minimum of two counselors providing the services . As the program expands, more counselors will be made available . A copy of the insurance policy for Adolescent & Individual Development is attached. VII : Proof Of Collaboration: A. The clients of this agency either reside with parent (s) , grandparent (s) , or are placed by social services . This is not an agency which places clients . Housing is not an issue with the agency. B. The clients range in age from 12 to 19 years . If a client becomes employed, they do so at the discretion of the Probation Officer, the WCDSS Caseworker, and this agency due to their sexual offenses . C. The client and his/her parent/guardian sign Releases of Confidentiality specific to that client . These releases include but are not limited too law enforcement, the department of probation, social services, the parents/guardians, the court system, the GAL, or representing attorney, school, previous placements or treatment, the D.A. ' s office, the polygrapher, and other supportive individuals in the clients life . If it is determined that placement is necessary, the WCDSS Caseworker is responsible for this placement . This is due to the client' s being under the age of 18 . D. Collaborative Communications are scheduled on an as needed basis with the client . This staffing is done with as many of the Multidisciplinary Team members as can be gathered. Therefore, the meetings may be monthly depending, as stated above, on the client and his/her needs . E . Once a client has met the requirements of the Standards and Guidelines, they are successfully terminated from treatment . Many times, the client, because of their age, do not require additional services from this agency. However, every client is told he/she may return to group if they want support . The client 9 is encouraged to return to group or to call the agency to talk with a therapist at no charge to them. Clients who had been placed in a Residential Treatment Center often come to the agency for further Relapse Prevention Treatment . When a client enters this type of treatment, a minimum of six months, weekly treatment is completed by the client . The client will be expected to complete a Final Project to the satisfaction of the Multidisciplinary Team and the other group members . F. Medicaid nor private insurance will pay for Offense Specific Treatment . The only connection North Range Behavioral Health would have with this agency is if the Medicaid client requires mental health treatment or medications . VIII : Evidence-Based Outcomes : A. Research for Adolescent Sex Offenders is a relatively new area . Traditional Psychotherapy is not sufficient for sex offense specific treatment (Standards and Guidelines for the Evaluation, Assessment, Treatment, and Supervision of Juveniles Who Have committed Sexual Offenses, July 2002 pp 37) . It has been found the best treatment is Cognitive Behavioral Therapy in a group setting (Barbaree, Marshal, & Hudson, 1993 The Juvenile Sex Offender pg 269-277 and pg 264-269 . ) This agency will follow the Colorado Sex Offender Management Board Standards and Guidelines for The Evaluation, Assessment, Treatment, and Supervision of Juveniles Who Have Committed Sexual Offenses . The Board has proven that this therapy the most successful in working with working with Adolescent Sex Offenders . AID has been identified that clients who have successfully completed our program have not re-offended. B. A sample of an Evaluation, Intake, and Treatment Contract have been included with this proposal . Each document is of the same format the Colorado Sex Offender Management Board approved for this agency. A transition plan is not made by this agency because it is an Outpatient Agency and the clients which are terminated successfully are not required to attend more sessions . The reasoning for this is because these are children. If a child, during the course of treatment, re-offends or does not complete treatment an assessment is made to determine the proper placement or structure for the client . An assessment has been included in this proposal . C. A fictional sample of a request to renew services for a client has been included with this proposal . D. A fictional sample of a monthly report has been included 10 with this proposal . IX: Staff Qualifications : AID staff members will possess at minimum a Master' s level education in a counseling related field including but not limited to psychology, rehabilitation, or sociology. They will be licensed with the State of Colorado or be eligible to become licensed. The agency has been granted by the SOME full operating status to work with Offense Specific adolescents in both Evaluations and Treatment . I have worked with sexually abusive youth for approximately eleven years . I have and will continue to attend workshops, conferences, and other types of training to be able to provide the most up to date treatment for the adolescent . This will include not only Offense Specific treatment, but other relevant issues of the adolescent as well . This agency will operate under the Standards and Guidelines for The Evaluation, Assessment, Treatment, and Supervision of Juveniles Who Have Committed Sexual Offenses which have been adopted by the Colorado Sex Offender Management Board, July 2002 . The Website of these standards and guidelines is as follows : http : //dcj . state . co. us/odvsom. B. The total number of staff which AID will contract for will be limited to the guidelines and standards of the SOMB' s Adolescent procedures . The staff will be supervised by myself until the individual contracting therapist is given full operating status from the SOME in treating and evaluating the adolescent . C. Co-therapist (s) which are contracted with the agency will also be mandated to attend trainings as required by the Sex Offender Management Board. D. The co-therapist (s) will have absolute knowledge in risk assessment . E . Adolescent & Individual Development is currently an approved agency for Adolescent Sex Offenders . The standards and guidelines for the adolescent were completed July, 2002 . All program materials and group, family, and individual treatment are currently following the SOMB as indicated in the adolescent standards and guidelines . X. Unit Of Service Rate Computation: Unit of Service : This program serves sexually abusive adolescents from the 11 ages of 12 though 20 . The mission of AID is designed to protect the safety of the community. AID services those who have been adjudicated, have admitted to sexual abuse, or are sexually reactive . The program provides for a maximum of five clients, one hour weekly group sessions, one group session with mandated attendance of parent-guardian . Currently Bilingual services are not available . South County services will be provided if an adequate number of clients are referred. Family reunification services will be provided upon request . Cost Per Unit of Service : Hourly Rate Per Individual/Family $50 . 00 Staffings with Family/Client $50 . 00 Rate per episode Group Session $35 . 00* Evaluation $500 . 00** Polygraph (Average Rate) $225 . 00*** * The group session will also include the parent (s) /guardian (s) SOMB' s mandated Informed Supervision of the sexually abusive adolescent . The fee for Informed Supervision is a one time fee of $35 . 00 for two people . If the same individuals want to attend further sessions, the sessions will be free to them. **Cost of evaluation is dependent upon services provided. ***Variable Rate is dependent on cost of polygraph . Supplies Notebook (One time at first of group session) $10 . 00 Unit of Service Based on Approved Plan The purpose of the billing breakdown is to insure that County and AID are fairly treated in the billing process . The billing system has been the same for the past three years . This was addressed with Niven Williams at the meeting on March 1, 2006 . He agreed with the billing of this agency. A fictional demonstration has been attached. XI : Billing Process : See Attachments . XII. Lowest Qualified Bid: The above costs have not been increased for this agency in 12 the past three years . It is believed that clients and/or their parent (s) /guardian (s) have incurred expenses with the sexual offense which may hurt the family financially. Therefore this agency is of the mind to keep costs as a minimum. XIII . Program Capacity By Month: Weld County Department of Social Services is only one referral source . The department is not expected to keep this agency in operation . The agency can operate on a minimum of 16 clients a month . The maximum may be any number as long as the group size remains within the Standards and Guidelines of the Colorado Sex Offender Management Board. 13 BRANCH B/A PRODUCER NUMBER CLIENT NUMBER DATE OF ISSUE RENEWAL OR REPLACEMENT NO. 23 A OOO1614 * 25O 2936O7 O4/13/O5 8OM-1193737 PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY FOR PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ALLIED HEALTH PURCHASING GROUP ASSOCIATION POLICY NUMBER: 44-2010129 Item DECLARATIONS CERTIFICATE NUMBER 80M- 1193737 Named Insured ADOLESCENT & INDIVIDUAL DEV. 2. MAILING ADDRESS PO BOX 321 FT. LUPTON, CO 8O621-O321 3. Policy Period 12:01 A.M. Standard Time At From: 04/03/2005 To: 04/03/2006 Location Of Designated Premises 4 The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges: COVERAGE PREMIUM A. Professional Liability [x I $330.00 B. General Liability [ I C. Endorsements [ I Total: $330.00 - 5. LIMITS OF LIABILITY $ 1,000,000 each Incident $ 3,000,000 in the Aggregate or Occurrence 6. The Named Insured Is: Sole Proprietor (including Individual) Partnership Corporation Other: Organization Affiliation: MENTAL HEALTH INSURANCE PROGRAM 7. Business or Occupation of the Named Insured: COUNSELOR s, This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained In the following formis) or endorsement(s): PLE-2081, PLJ-2016(10/94), PON-2003, PLE-2189(09/97) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 6O6O3 REPRESENTATIVE: MARSH Affinity Group Services a service of SEABURY& SMITH - 1440 RENAISSANCE DRIVE PARK RIDGE, IL 60068 1-800-503-9230 PLP-2O16 (Rev. 10/94) (Elec.) INSURED COPY PLP-2O31 (10/94) Bid 001-06 (RFP-FYC-06007) Attached A WELD COUNTY AUTHORIZATION FOR CONTRACTUAL SERVICES Date: 4, • a 7- v G Provider: O & .@end" s th oQrcc ie illing Contact: W e 055 A,2 'tJ-e.c.o n - -- nQiw-el etne Phone #: Q7v - 3 S a• /551 co e) Address: 0. 1?.. jeuvia as f - dttettir ec ko6 0/ r 17 <Description of Services: 9l p.t dQyi��u(Cecc 5 d�ycekL <eie - Service Month / Year QQWn y a 006, Charges: $ 000. OO I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF SOCIAL SERVIC I�F 6ecn 3 Oki ck �===-T _-� / • 91Y- Printed Name of Signer Provider Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: Approvals: / / Core Caseworker Date Director Date AMOUNT PAYABLE: $ ANY CHANGES LISTED BELOW: Client/ID/HH# Billed Amt Denied Paid Reason Page 38 of41 o •Ts V 0 t ^[' u o.CD 4 !�v CN V 0, _J v eC C. v n :p ^ (— " H Lt •° V ca v v .. a F- o o m =_ O t" Os 4'_ ca U O x �D x tA 1' "¢ F IN at II esi i �'- u �, O 0 0 0 c u L .5. N y• �d O ng V �. y 7 C .y. t— > u o v cu `d " u 0 oQ . = >, o U U ooia U 0 o aci w - - H ry p N di Ez g c� . oow o O S N 00 y N g �"" O cv • p rn p L U- 0. 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Adolescent & Individual Development Mailing: PO Box 321 Fort Lupton, CO 80621 Cell 303-596-4586 Fax 303-857-9720 June 27, 2006 Weld County Department of Social Services Attn : Andrea Shay, Core Services PRT/Caseworker FPP CORE Services P.O. Box A, 315 B N 11th Avenue Greeley, Colorado 80632 FAX: 970-346-7698 RE : John Smith DOB: August 31 10, 1989 Dear Ms . Shay: Here are the group sessions for the month of June, 2006. 6/06/06 35 . 00 6/13/06 35 . 00 6/20/06 35 . 00 6/27/06 35 . 00 70- Total $140 . 00 Si Rebecca J. Quick M.A. CRC Licensed professional Counselor 1 Adolescent & Individual Development Mailing: PO Box 321 Fort Lupton, CO 80621 Cell 303-596-4586 Fax 303-857-9720 June 27, 2006 Weld County Department of Social Services Attn: Andrea Shay, Core Services PRT/Caseworker FPP CORE Services P.O. Box A, 315 B N 112" Avenue Greeley, Colorado 80632 FAX: 970-346-7698 RE : John Doe DOB : September 10, 1991 Dear Ms . Shay: Here are the group sessions for the month of June, 2006 . 6/06/06 35 . 00 6/08/06 35 . 00 6/13/06 50 . 00 Individual 6/20/06 35 . 00 6/22/06 50 . 00 Individual 6/28/06 35 .00 \� Total $240 . 00 Since Rebecca J. Quick M.A. CRC Licensed professional Counselor Vetiettj ADOLESCENT & INDIVIDUAL DEVELOPMENT Mailing: PO Box 321 Fort Lupton, CO 80621 Fax: 303-857-9720 Cell Phone: 303-596-4586 February, 2006 Report Name : John Doe D.O.B. December 15, 2005 Address : 1234 Same Street Began Treatment : September, 2005 :Greeley, Colorado 80631 Phone : 970-352-1234 Monthly Subjects : Thoughts, Feelings, and Behaviors Attended: 2/7_yes 2/14_yes_ 2/21_yes_ 2/28_yes_ 0/00 Journals : 2/7_no 2/14 yes 2/21 no 2/28 no 0/00 Participation: Week 1 : Poor Fair Good Week 2 : Poor Fair Good Week 3 : Poor Fair Good Week 4 : Poor Fair Good Week 5 : Poor Fair Good Account : Current Owes Account paid by Senate Bill 94 Comments for each week: 2/7 John spoke when he was directly challenged. 2/14 John spoke when directly challenged. 2/21 John plays around too much and it' s necessary to redirect him. He was told he would be moved to the older group beginning March 7, 2006 . 2/28 Neither of John' s parents attended group. This is unacceptable as John is only 15 and requires their support . John worked with another client and client' s mother in an interaction activity. Sincerely, Rebecca J. Quick M.A. CRC Licensed Professional Counselor Full Operating Level Adolescent Offense Specific Evaluator and Treatment Provider cjj;Iw-I9 ADOLESCENT & INDIVIDUAL DEVELOPMENT Mailing: PO Box 321 Fort Lupton, CO 80621 Fax: 303-857-9720 Cell Phone: 303-596-4586 January 20, 2006 Weld County Department of Social Services Attn : Andrea Shay FPP CORE Processing P.O. Box A Greeley, Colorado 80631 RE : John Doe DOB: November 25, 1989 Dear Andrea : Mr. Doe continues to require Offense Specific Treatment . His funding from WCDSS is scheduled to end 4/6/2006 . It will be necessary for Mr. Doe to be approved funding for at least six more months . Hopefully he will complete treatment by then if he will do the necessary requirements . At this time he has not passed a Maintenance Polygraph or a Sexual History. Mr . Doe has group treatment once a week. Sincerely, Rebecca J. Quick M.A. CRC Licensed Professional Counselor Full Operating Level Adolescent Offense Specific Evaluator and Treatment Provider 11 PROCEDURES: Clinical Interview SASSI Wilson Sex Fantasy Questionnaire Beck Depression Inventory Juvenile Sex Offender Assessment Protocol (J-SOAP) Adolescent & Individual Development Adolescent Questionnaire Review of Collateral Information Police Report Victims' Statements Parent/Guardian Interview CLINICAL INTERVIEW: Mr. John Doe and his mother came in on January 3, 2006 to sign the initial paper work. Mr. Doe was asked if he understood the reason he was coming to the agency. He stated he did not know. His mother reported Mr . Doe was somewhat confused as to what was happening. Mr. Doe appeared to become agitated when he was asked if he had committed a sexual offense . He said he had not . His mother related it was necessary to explain "sexual offense" to him. Mr. Doe was asked if he had touched someone in the vaginal, genital, buttocks, or breast area . He replied he had touched a female' s buttocks while at school . Mr . Doe' s mother was trying to answer some of the questions asked of Mr. Doe . It was necessary to ask her to let Mr . Doe answer the questions because it was his offense . She replied that she did not believe anyone wanted to listen to her . She was assured that she would be interviewed also and could give her comments at that time . She stated Mr. Doe was confused at times and it was necessary to explain what was taking place . Mr. Doe was interviewed on January 5, 2006 . He was asked to explain in detail the sexual offense for which he had been charged and pled guilty. He answered, "Sexual assault and I'm being charged for that because I touched a girl' s butt and I called her hot . " He claimed he had touched a 13-year-old female' s buttocks over her clothing at least twice . Mr. Doe reported the girl had told him to "knock it off. " He said "she said it happened" various times . Mr . Doe reported the victim had said it happened in the class room but "I had no classes with her. " Mr. Doe believed he had touched the victim' s buttocks while they were in line in the cafeteria at school . Mr. Doe stated he did not know the victim except to say "Hi" to her. He related they were not friends . Mr . Doe revealed he was trying to gain her attention to "ask her if she wanted to go out . " Mr. Doe denied he masturbated to the thoughts of touching the victim either then or later . He denied he had been sexually aroused at the time he touched the victim' s buttocks . He said he did not 3 believe the victim would tell . Mr . Doe stated "I was just messing around. Take it as a joke or something . " He reported all his friends were touching her too "she just caught me . " Mr . Doe stated six girls had accused him of sexually touching them but he had only been charged with sexually assaulting one of the girls . Mr. Doe denied he had threatened the victim if she told anyone . He said "it was weeks" before the victim told anyone . Mr. Doe was asked if he had the chance to speak to the victim at this time what he would say. He answered, "I wouldn' t speak to her. I don' t know why I wouldn' t speak to her. " Mr. Doe claimed he was not angry at the victim. He related he had been arrested at the school . He noted he thought "what did I do. They took me out of class and arrested me . They called my mom first and said they weren' t going to arrest me . " Mr. Doe believed he had been arrested because "I kept denying it and was arrested. " Mr . Doe remarked the sexual offense took place when he was in the 8th grade . He thought it was in November 2004 . Mr . Doe said when he was charged and went to court he thought "this is gay. Why do we have to go to court?" He believed when his mother found out about the sexual assault she thought "she knows it' s not how I am. She says this isn' t you. " He said when his father learned of the sexual assault he thought "the same as mom thought . He said the same thing that this isn' t me . " Mr. Doe claimed he had told his mother about all the details of the offense . He said he had not told his father because he had guilt and shame . Mr. Doe related his mother had told his father about the sexual assault . He said if he had spoken to his father he believed his father would have been "mad. " Mr. Doe did not believe his father knew all the details of the sexual assault . He thought his mother told his father because "my mom needs extra support . They always use to fight and argue . Now they talk. I'm happy about that . " When asked his thoughts about participating in Offense Specific Treatment, Mr . Doe replied "whatever I got to do to get done . Whatever I have to do to get this done and over with . " PARENTAL INTERVIEW: Mr. Doe' s mother was interviewed on January 5, 2006 . She had been asked to fill out a questionnaire before she came to the interview. When she was asked for the answers to the questions, she replied this evaluator would not like her responses . Mr. Doe' s mother was asked what she thought when she learned of the sexual assault . She answered "absolutely thrown way out of proportion. It went to an extreme . " She stated she was "not sure" if the sexual assault happened. Mr. Doe' s mother denied she had tried to justify Mr. Doe' s behavior. When asked 4 1 if she believed Mr . Doe received a fair trial she had "no answer" for the question. She stated she did not give any consequences because "everyone else decided that for me . " When asked her thoughts of Offense Specific Treatment Mr. Doe' s mother answered "if it fits the crime . " She stated she was willing to participate in treatment with her son. Mr. Doe' s mother was asked about her relationship with Mr. Doe' s father . She answered she received no support from him. She stated there had been domestic violence in the past . She reported it had been physical abuse as well as alcohol and illicit drugs . Mr . Doe' s mother stated Mr . Doe' s father had been incarcerated for the violence to her. She stated she had given Mr. Doe' s father 10 years of her life . Mr. Doe' s mother commented she blamed herself because Mr. Doe' s father "every day put the belt to Lee' s butt . " She stated Mr . Doe' s father does not appear to be violent at this time . She said at this time, she and Mr. Doe' s father have "fine communication. " She said she and he would now talk about the problems . She said Mr. Doe' s father wanted her to come back to him. She related she would not "want to get back together with him" due to the past domestic violence . Mr. Doe' s mother believed she and Mr. Doe' s father were now friends . Mr. Doe' s mother was asked if she believe Mr. Doe' s father was a gang member. She answered she did not believe he was in the gangs . Mr . Doe' s mother stated Mr . Doe "wanted to be like his father . To fit into a certain crowd. " She believed Mr . Doe was not the gang member he claimed to be . She explained that Mr. Doe "doesn' t go anywhere, had no friends . He likes the badness of it . " Mr . Doe' s mother stated when Mr . Doe was very young, he would hit his head against the wall and have seizures . She stated when she asked the family physician about Mr . Doe' s behavior, and the physician told her to make him stop that behavior immediately. She said she was not sure if Mr. Doe was having seizures or beating his head against the wall until he had a seizure. She said she spanked him one time when he was doing this behavior . Mr . Doe' s mother related Mr . Doe stopped the behavior and did not do it again after the spanking. Mr . Doe' s mother stated after that Mr . Doe would become instantly angry. She disclosed that Mr. Doe, while in the Head Start Program, was "biting himself" . Mr. Doe' s mother stated she "noticed other problems . " She stated since that time, he has had difficulty in school . She explained he can read but cannot explain what he read. Mr. Doe' s mother said when Mr. Doe was in the 8t° grade, he was placed in a classroom environment where he was learning . She explained since he had been placed in Greeley West he was once again failing every subject . Mr. Doe' s mother said the school refuses to give him an IEP. She explained because Mr. Doe can read that the school 5 does not believe anything is wrong. She reiterated what she had mentioned from the first meeting on January 3, 2006 that Mr. Doe does not understand what he reads . She said he becomes very confused. She stated she would, in the past, help him with his homework but he could not understand the material . She said Mr. Doe had failed every grade and been pushed to the next grade . Mr . Doe' s mother remarked she had held Mr. Doe back in the 8tn grade and he had told her "thank you . " Mr. Doe' s mother denied she knew of any other family members who may have sexually assaulted. Mr. Doe' s mother believed strengths in the family included she had rules and boundaries which she would enforce . She related she works 12 hours three days a week and it is hard to enforce the rules at times . She believed the family was "well bonded. However, the last year things have changed" due to the sexual assault . She stated she does not trust Mr. Doe . She disclosed that Mr . Doe has "broken into my room and stole money. " She explained he broke the door to her bedroom. Mr. Doe' s mother said she does not leave her purse where he may take money or other items . She said the weakness in the family was her having to work 12 hours a day three days a week. Mr. Doe' s mother described the safety in the family included putting locks on her television channels . She noted her younger son goes hunting with a friend and she makes him take his guns apart after he comes home . She stated she keeps the firing mechanism in a safe in her room. Mr. Doe' s mother stated she did not have anyone outside of herself and her two sons who were a support for her . She stated she has no one whom she can depend on. Mr . Doe' s mother stated the over all family environment was "pretty carefree and easy. Lee will ask if anyone wants anything if he goes to the kitchen. " Mr . Doe' s mother was told Mr . Doe believed he was her "personal slave . " She replied "Lee does nothing. He is lazy. He does not do chores . " Mr. Doe' s mother stated problems are solved by "talking a lot . " She admitted voices would become "elevated" and then they would talk. She reported her, Mr . Doe, and his brother would apologize to each other after the arguments . Mr. Doe' s mother was told it was going to be recommended that Mr. Doe participate in a Fire Setter' s Evaluation. She agreed that was a good idea. She disclosed that she had recently found a burn on the ceiling of her laundry room. INSTANT OFFENSE: Greeley Police Officer Scott Smith investigated an alleged sexual harassment at Brentwood Middle School on November 4, 2004 . Officer Smith stated he spoke to the school counselor who told him "some girls had left a note accusing" Mr . 6 Doe of sexually harassing them. The note stated Mr. Doe was "grabbing them on them on the butt, grabbing their breasts, and making inappropriate comments towards them. " Victim one, a 12-year-old female, stated Mr. Doe said "while they were standing in the lunch line, " Mr. Doe continually "grabs her on the butt . " The victim stated she attempted to move away from him, even using her elbows to try and stop him. She stated she "even used her elbows to try and stop him. " She stated he continued to "grab her on the butt . " The victim reported Mr. Doe, when she was walking from one class to another class had stated to her "oh I'm hard. " The victim stated that Mr. Doe had grabbed her around the waist and started doing a humping motion on her buttocks . She related Mr. Doe had also made a motion like he was trying to masturbate . She stated she told him to stop. Victim two, a 12-year-old female, reported to Officer Smith that Mr. Doe had touched her buttocks while standing in the lunch line . She stated she had told him to stop on numerous occasions . She reported Mr. Doe will say "I' ll give you a nickel to lick my pickle . " She reported Mr. Doe' s behavior and comments make her very uncomfortable . Victim three, a 12-year-old female, reported to Officer Smith that Mr. Doe will continually hit her buttocks . She stated she had told Mr. Doe to stop on numerous occasions . She reported Mr. Doe made a comment to "suck his cock. " She noted she is very uncomfortable with Mr. Doe' s behavior and wanted it to stop. Victim four, a 12-year-old female, reported to Officer Smith that Mr . Doe walked up behind her and started doing a humping motion on her head. She noted she tried to move away but Mr . Doe continued the behavior . She stated he had also told her he would "give her a nickel if she would tickle his pickle . " She related Mr . Doe had grabbed her by the waist and began doing the humping motion to her she stated she told him to stop and is tired of the problems he has had with Mr. Doe . She stated it had been very hard for her and on several occasions she had started crying. She reported she is scared when Mr . Doe is around and is "very uncomfortable . " Victim five, a 13-year-old female, reported to Officer Smith that Mr . Doe had pinched her on the buttocks . She stated she told him to "knock it off and pushed him away. She related Mr . Doe then grabbed her breast and twisted it . She reported Mr . 7 Doe then threw her and knocked her to the ground calling her a stupid "hoe . " She remarked she had told Mr. Doe on several occasions if he did not leave her alone she would report his behaviors to the teachers . The victim said Mr . Doe said he did not "are . That she can go ahead and tell whoever she wants but nobody is going to do anything to him. " Victim six, a 13-year-old female, reported Mr. Doe had also hit her buttocks and tried to lift her shirt to look underneath. The victim reported she had observed Mr. Doe hit several of her friends on the buttocks and say inappropriate things to them. She stated Mr. Doe also makes her feel uncomfortable and she had told him to stop his behavior. Officer Smith interviewed Mr. Doe on November 4, 2004 . Mr. Doe denied he had touched the girls sexually. He said the only comments he had made was they "look hot" or are "good looking . " Mr. Doe thought the victims were making this up because they were mad at him because he told some kid to leave his little brother alone . BRIEF SOCIAL HISTORY: Mr. Doe stated he had been born and raised in the Greeley area . He said he resided with his mother and brother. Mr . Doe described his relationship with his mother as "we' re not as open and trustworthy to each other . We use to be really, really close . But, now as I get older, now I can' t talk to her. I don' t feel a connection. We don' t talk as much. " Mr. Doe believed his mother loved him because "she shows it by putting a roof over my head and feeding me . " He claimed he loved his mother "but, I really don' t like her . Why is, she treats me like I'm her personal slave and never tells my brother to do anything. " Mr . Doe related he had to do all the chores in the home while his brother played video games . He said his mother "never tells my brother to do anything. " Mr . Doe described his relationship with his father as "me and my dad were homies . He' s a friend, Like very close . " Mr . Doe reiterated his father had told him "he doesn' t need to know" about the sexual assaults . He claimed his father told him to "get it done and over with. I' ve tried telling him. He just doesn' t want to hear it . He' s been in trouble with the law before and been in jail . " Mr . Doe believed his father loved him "because whenever I see him we do everything together. " Mr. Doe stated he loved his father because "he' s the best person and best thing in my life . " Mr. Doe stated he had gone to Texas this past summer to visit his father . He said his father had come to Greeley in September 2005 to visit him and take care of some court business . He stated his parents were never married and "right now I would like them to be married. " 8 Mr. Doe stated he had a biological brother who was 12 years of age and a half brother who was three years old. He commented he and his 12-year-old brother do not get along well . He said "sometimes things get out of hand. " Mr . Doe claimed him and his brother would get into physical altercations and would "hit and punch" each other. He claimed it was only sibling rivalry. He remarked his mother would have to tell them to stop. Mr. Doe reported he had one five year old half-sister and one eight year old stepsister. He believed they got "along pretty good. " Mr . Doe noted his three-year-old brother and two sisters reside in Texas . Mr. Doe stated he currently attended Greeley West High School and was in the 9te grade . Mr . Doe related the only subject he had passed this last semester was physical education. He stated he did not like school because he "cannot understand the questions . " He stated he had received ISS in the 8th grade for disrespecting the teachers . He denied he had ever been expelled from school . Mr. Doe stated he had failed the 8t" grade because "I hung out with gang bangers . " He claimed he was a "South Side Criminal" and had been "jumped into" the gang the end of August 2005 . Mr . Doe stated he had been bullied during his elementary school years by older children. He stated the "older kids took my stuff and threw it in the trash. " Mr. Doe remarked "I hate school and don' t want nothing to do with it . " Mr. Doe mentioned he had been twice employed by the Greeley Tribune as a paper carrier . He said he quit the first time because he did not want to do it anymore . Mr . Doe revealed the second time he had been employed by the paper, he had broken a window on a screen door when he threw the paper. Mr. Doe stated he had his first drink of alcohol at the age of 15 . He stated his mother gave him beer on Thanksgiving. Mr. Doe revealed he liked beer and had been drunk once in September 2005 . Mr. Doe related him and friends had "ditched school" and had become intoxicated together. Mr. Doe noted when his mother found out, she "grounded me . " Mr. Doe denied he had been drinking alcohol when he sexually assaulted the victims . He stated he first tried Marijuana at the age of 14 . Mr . Doe related this was his drug of choice because "it helps relax me and release my thoughts when I'm stressed and want to clear my mind. " Mr. Doe disclosed he had racing thoughts and cannot keep one subject in his head. He admitted he was currently in mental health counseling. Mr. Doe stated he was in counseling for his anger and depression. He said sometimes the counseling helps when they address his issues with his mother and father . Mr . Doe remarked he believed counseling "helped me lower my anger. " 9 Mr. Doe believed his mother was depressed also. He noted he is currently taking Zoloft and Trazodone . Mr . Doe denied he was or had ever been suicidal, attempted suicide, or was hospitalized for attempted suicide . He denied he was homicidal . Mr. Doe had been asked if he was suicidal on January 3, 2005 during the initial meeting. He denied he was and his mother agreed with this denial . Mr. Doe described his over all health as "it' s great . " He admitted he smokes cigarettes . He disclosed a friend will steal their mother' s packs of cigarettes . Mr. Doe admitted he will also take his mother' s cigarettes . He revealed he was in track and involved in cross-country running. Mr. Doe stated he does not do that any more . He disclosed when he was four or five years of age he would hit his head on a cement wall or a hard surface until he went into a seizure. He believed he had been examined by a physician for the seizures but could not remember . Mr. Doe denied he currently experienced seizures . When asked how he felt about himself, Mr. Doe answered "I'm a confused little kid. I don' t think I know what I'm doing. " Mr. Doe denied he had a criminal history other than the current sexual assault charge. He denied he had ever engaged in any criminal activity such as shoplifting and gotten away with this behavior . Mr . Doe claimed he had been involved in one physical altercation in which he gave the peer a broken jaw and broke his cheek bone. Mr. Doe said he was a "pyro" and had started "a bunch" of fires . He disclosed the police had been involved on one occasion. Mr. Doe denied he had been charged but said he watched videos of fires . Mr . Doe denied he had been sexually aroused while starting and watching these fires . He claimed he had not started a fire since watching the videos . Mr. Doe reiterated he was a South Side Criminals gang member. He noted "that' s where I belong. " Mr. Doe believed his dad was a gang member because he "dresses like one. " He commented "I'm a calm gang banger . I don' t beat up anyone . " Mr . Doe admitted running away from his home . He said he was gone for six days and stayed with friends . Mr . Doe admitted he had been put on an ankle monitor and was under the supervision of Senate Bill 94 . He said he now spends his time at home. Mr. Doe stated he cannot see his friends or call on the phone . He said the ankle monitor had been removed but he is required to call his caseworker at Senate Bill 94 regarding his whereabouts in the community. Mr. Doe commented before he was on the ankle monitor, he would ride his BMX and go running. He mentioned he would "hang with all kinds of people" and him and his friends would "hangout at the mall . " 10 Mr . Doe described his support system as "my family. " He believed these people were trustworthy for him because they kept his issues to themselves . Mr. Doe denied having a Spiritual Life and was not committed to any one religion or faith. SEXUAL DEVELOPMENT AND BEHAVIOR: Mr. Doe was asked to describe his sexual growth and development . He believed he was 11 or 12 years of age when he first experienced a nocturnal emission. Mr . Doe stated he first began to masturbate at the age of 11 . He denied he had ever engaged in sexual intercourse, had a homosexual experience, engaged in a rape, or had sexual encounters with small children . He denied he had ever engaged in voyeurism, frotturism, sadomasochistic sex practices, or tried to lose consciousness while having an orgasm. Mr. Doe admitted he had engaged in exhibitionism when he was playing "Truth or Dare" and he showed his penis to everyone in the game . He stated he told the others he would not do that again. Mr. Doe admitted he had engaged in cross-dressing when his male friends said they were going to dress in women' s clothing for Halloween and attend school that way the next day. He said he tried on the women' s clothing the night before and decided to not go as a woman to school the next day. Mr. Doe denied he had ever been sexually abused or raped. He denied he had ever observed any sexual activity between any of his family members . Mr. Doe denied he had ever engaged in incestuous relationships . He could not think of a sexual fantasy. Mr. Doe reported the last time he engaged in sexual activity was "before Christmas break. " He said he would be engaged in sexual activity at least "monthly. " Mr. Doe stated he had four different female partners, with which he had oral sex. He said this took place at his home with his "girlfriends . " Mr. Doe said he was first exposed to pornography at the age of 12 . He said he would watch "late night tv. " Mr. Doe said it was HBO. Mr . Doe related he learned about sex in sexual education he had this school year . He stated "nobody in my family talks about that stuff. " Mr. Doe did not believe he understood anything about sexual issues . He denied there was pornography in his home . He believed he was 13 or 14 years of age when he first viewed an "X" rated movie . He explained when he saw the movie he thought "It' s stupid. It' s wrong using your body as a toy. " Mr . Doe admitted masturbating to the images he saw. He claimed he saw this movie at his home. Mr. Doe denied he had ever patronized a porno shop, used or viewed magazines depicting naked children, had ever been treated for any venereal diseases, or had a checkup for AIDS . He denied he had ever engaged in sexual activities with animals, used the computer to engage in sexual activities, made obscene phone calls, or engaged 11 in phone sex. Wilson Sex Fantasy Questionnaire: The Wilson Sex Fantasy Questionnaire is a forty (40) question, six (6) point A Liekert scale questionnaire which asks whether a person has ever participated in a certain type of sexual fantasy ranging from "Never" to "Regularly. " The results of the Wilson Sex Fantasy Questionnaire can be helpful to potential treatment providers in determining which areas to focus in reducing deviant fantasies . Mr. Doe stated he seldomly fantasized about having intercourse with a loved partner, receiving oral sex, taking someone' s clothes off, having his clothes taken off, being whipped or spanked, or making love elsewhere other than the bedroom, being masturbated to orgasm by a partner, looking at obscene pictures or films, or kissing passionately. PSYCHOLOGICAL FINDINGS : OFFENSE SPECIFIC TESTING Mr. Doe was asked to participate in Psychometric Testing to aid in diagnoses and treatment planning. However, Mr . Doe stated he could read the questions but could not understand what the questions were asking. An attempt was made at explaining two of the questions he read out loud to this evaluator. However, he stated he still did not understand what they were asking. He stated his mother believed he should have been given an IEP at school, but this had not happened. Mr. Doe reiterated the questions he had read in the psychological battery were confusing and he had problems with this at school . Mr. Doe noted he would, at times, have friends answer the questions at school for him. He said he has had this problem throughout his school life . Mr. Doe filled out the SASSI and the Beck Depression Inventory. The results are suggestive of the following: Mr. Doe' s Beck Depression Inventory revealed he had severe depression. He stated he had several times taken drugs to improve his thinking and feeling, to help him feel better about a problem, taken drugs to be more aware of his senses, sight, hearing, touch, etc . , and taken drugs to help forget school, work, or family pressures . He reported he had once or twice became very stoned or wiped out on drugs, spent his spare time buying, taking, or talking about drugs, used alcohol and drugs at the same time, and gone to school after drinking or using drugs . J-SOAP: This testing is a checklist which purpose is to aid in 12 the systemic review of risk factors . These risk factors have been identified in the professional literature as associated with sexual and criminal offending. This checklist will not allow one to predict the probability someone will re-offend based solely on the score derived from the instrument, rather to be used by trained professionals to assist in identifying risk factors in order to establish other levels of risk management . Mr. Doe' s score on the J-SOAP was moderately high to high risk to re-offend. He scored high in the Impulsive-Antisocial Behavior Scale . He has resided with one biological parent, he stated he had a history with problems of expressed anger, and Mr . Doe admitted to having school behavior and had been given in school suspensions . His mother said Mr. Doe' s anger would become so out of control she was afraid of him at times when he was very young. Mr. Doe admitted to starting fires, physical altercations, and his mother reported he was stealing money and other items from her . Mr . Doe was arrested on the current sexual offense and he admitted to having multiple types of offenses such as the current sexual offense, possession of illicit drugs, running away, possession of alcohol, and not following the home rules and boundaries . He admitted using illicit drugs and alcohol . His mother reported Mr. Doe' s biological father had substance abuse issues . Mr . Doe scored high in the Intervention Scale as he accepted some responsibility for his sexual offenses, he indicated a small degree of internal motivation for change . He did not appear to understand the risk factors in his life and therefore does not apply risk management strategies . Mr. Doe did not have any evidence of empathy, remorse, or guilt for his sexual assaults . He displayed cognitive distortions . Mr. Doe' s score was moderate in the Community Stability Scale. He and his mother stated Mr. Doe had expressed anger. He had been received ISS for his anger in school . Mr. Doe' s mother related he would not follow her rules or boundaries at home . Mr . Doe admitted to the use of pornography. His mother reported he had purchased scantily clad posters of females and hung them around his bedroom. She stated she had taken them down . Mr. Doe stated he did not like school at all . He admitted to being disrespectful to a teacher and being given ISS and then suspended from school . Mr. Doe noted his support system included peers who were involved in the gangs . SUMMARY: Mr . Doe does not appear to understand the seriousness of his sexual assaults . He admitted to touching victim four' s buttocks . However, he did not admit to any other sexual harassment . Mr . Doe' s mother stated she had put up rules and boundaries but Mr. Doe was not following them. She was 13 concerned because she had to work 12 hours a day, three days a week to support her family. Mr. Doe used thinking errors of justifying his sexual harassment by saying his friends were also sexually touching the victim. He stated he was trying to gain the victim' s attention to ask her is she wanted to date him. Mr. Doe does not appear to have the social skills he requires in this area to be appropriate with peers . Mr. Doe minimized his sexual acting out by stated there had been six victims and he had only been charged for sexually assaulting one of the victims . He indicated no remorse or guilt when he said he would not say anything to the victim if he saw her today. Mr . Doe and his mother stated he had trouble understanding questions in the school . He may also have issues with learning appropriate social skills . Mr . Doe and his mother stated he had hit his head and put himself into seizures when he was four or five years of age. Mr. Doe does not appear to have a positive male role model . His mother revealed domestic violence when she was with Mr. Doe' s father. She stated Mr. Doe experienced the domestic violence as Mr. Doe would be spanked with a belt by his father daily. Mr . Doe believed his father was a gang member. However, his mother reported she did not believe this was true . Mr . Doe stated he had joined the gang because "that' s where I belong. " His mother reported Mr. Doe appeared to "like the badness of it . " Mr. Doe admitted to setting numerous fires . His mother reported recently finding a burn mark on the ceiling of the laundry room. Mr. Doe and his mother related the relationship between them is becoming worse . While Mr . Doe' s mother was talking to him before she was interviewed, she made the comment of one more thing and he could not remain with her . Mr . Doe stated he believed he was a confused "little kid. " He has had school problems with his work and has not been given an IEP at the school . There does not appear to be any indication that Mr. Doe' s mental abilities have been investigated. Mr. Doe admitted to drinking alcohol and using illicit drugs . He is currently on medications to help his depression. Mr. Doe appeared to be engaging in inappropriate behaviors while his mother worked. He said he had four sexual encounters with four different females at his home and he has viewed and used pornography in his home . His mother appeared to be trying to put up boundaries for Mr . Doe and she stated he does what he wanted to anyway. She stated Mr. Doe was stealing money and other items from her. Mr. Doe' s mother related she does not dare leave her purse where Mr . Doe has access to her purse . She reported Mr. Doe had broken her door which she had locked to take items from her room. In light of the above information the following recommendations are being made . RECOMMENDATIONS: 14 1 . Mr . Doe may not be an appropriate candidate for Out Patient treatment . He has problems understanding questions . It is recommended Mr. Doe have a neurological evaluation to investigate his cognitive abilities . Once the results of that evaluation are completed, Adolescent Offense Specific Treatment as an option should be revisited. Mr. Doe displayed Antisocial Behaviors . It is necessary to see if these behaviors are from Traumatic Head Trauma or from a mental health illness . It is recommended Mr. Doe be highly supervised and/or monitored 24 hours a day, seven days a week. His sexually offenses took place in the public school setting. It is recommended he be placed where he is not around those he can intimidate or have power and control over. It is necessary an investigation with Weld County Department of Social Services be completed to see if Mr. Doe is able to remain in his home and his family members are safe . He admitted to engaging in inappropriate sexual behaviors and physical altercations with his brother while his mother was working. Mr . Doe' s mother is recommended to participate in Informed Supervision and in the Educational Class Weld County Department of Probation has to educate her regarding sexual assaults by adolescents . 2 . It is recommended after the neurological evaluation to investigate Mr. Doe' s cognitive abilities that if the evaluation indicates Mr. Doe can participates in regular Polygraph Examinations, that he does so. 3 . It is important for Mr. Doe to recognize the damage he did to his victim. It is recommended he is required to pay for any mental health treatment in which his victims choose to participate in regarding this sexual offense. 4 . It is recommended Mr . Doe not have any contact with pornographic materials or violent films . This includes any storage materials through the use of computers or in written format such as CD' s or tapes . 5 . It is recommended Mr. Doe not have contact with individuals who are more than two years younger than him. This includes individuals inside the home as well as outside the home until such time he can demonstrate he is no longer at risk to other individuals . He should not be allowed to frequent places where children usually congregate such as restaurants with playgrounds, matinee theaters, parks, swimming pools, schools, or arcades . 6. It is recommended Mr. Doe register as an Adolescent Sex Offender . 15 7 . It is recommended Mr . Doe have a Fire Setters Evaluation. 8 . It is recommended Mr. Doe have a Drug and Alcohol Evaluation. However, the above evaluations should be done after Mr. Doe' s cognitive abilities have been made known. It is necessary he understand what he is being asked of the evaluator . Sincerely, Rebecca J. Quick, M.A. , CRC Licensed Professional Counselor 16 54-1 Adolescent & Individual Development Mailing: PO Box 321 Fort Lupton, CO 80621 Cell 303-596-4586 Fax 303-857-9720 CONFIDENTIALITY RELEASE FOR RESEARCH PURPOSES I understand that all information in the notebook along with any accompanying forms furnished by Adolescent & Individual Development involving my treatment and Final Project, will be entirely based upon my personal documentation and accounting of any Sexual Offense I have admitted to or have been charged and convicted of. I further understand that my Final Project, if completed, as well as any other information I furnish throughout the course of my treatment may be used in research and further development of this program, possibly evolving into a published research project at a later date . Any such publication will be solely for the purpose of further study and refinement of treatment practices practiced by professional providers . In the event of future publication, all client names and identifying information will be changed or omitted in order to maintain the utmost confidentiality for all concerned. Further, in the event of future publication, all Client reporting in the notebook and/or Final Project will be protected in such a manner to eliminate as nearly as possible, any correlation between any particular client and event, names, or circumstances the publication may contain. I, agree to allow publication utilizing the above stated guidelines regarding my confidentiality. Client Signature Date Parent/Guardian Signature Date Therapist Signature Date Adolescent & Individual Development 303-857-9720 Fax 303-596-4586 Cell Mailing Address P.O. Box 321 Fort Lupton, Colorado 80621 POLYGRAPH AGREEMENT 1 . As a client with this agency, you may be required to participate in a polygraph examination. The type of Polygraph taken will depend upon a referral from the Multidisciplinary Team (MDT) who shall determine and document the type of polygraph testing used, frequency of testing, and the use of the results in treatment, behavioral monitoring, and supervision. At the time of testing, the polygraph examiner will make the final determination of suitability for polygraph examinations and when clear indicators exist, will not conduct the polygraph when the results would be invalid. Polygraphs are to be considered to those clients who are at least 12 years of age, depending upon minimum functional age- equivalency, and older. 2 . You acknowledge that no secrets may be kept while in this treatment program or from the polygraph examiner. 3 . Depending on the results of the polygraph, the Multidisciplinary Team will determine if and when another polygraph examination will be required. It is recommended that a client not have more than three separate examinations per year. 4 . If the client has failed the examination or there was no clear opinion as to the client' s truthfulness, any consequences will be determined by the MDT. 5 . If you have any questions regarding the polygraph procedures, these questions should be asked of the polygraph examiner and/or your therapist (s) prior to the examination. Signature of Client Date Signature of Therapist/Witness Date ADOLESCENT & INDIVIDUAL DEVELOPMENT Juvenile Offense Specific Treatment Contract I , hereby enter into agreement with Adolescent & Individual Development to allow their staff to provide me with treatment services designed to increase non-deviant sexual behavior and arousal patterns . The primary goal of treatment is to prevent recidivism. I understand and agree to the following conditions regarding my treatment : Treatment can generally be expected to last a minimum of twelve (12) to eighteen (18) months . Treatment will include : 1) Cognitive Restructuring: 2) Sex education: 3) Sexual Offense Cycle : 4) Behavioral Monitoring Techniques : 5) Relapse Prevention: and 6) Final Project . I understand that I will be asked to discuss these tasks and assignments in group treatment . 1 . I agree to be completely honest and assume full responsibility for my offenses and my behavior. 2 . I agree to sign an acknowledgment of non- confidentiality and waiver, and to sign any releases of information required to obtain information about my behavior. Refusal to waive confidentiality will result in me being referred back to my probation or parole officer. 3 . I understand my victim may be contacted by Adolescent & Individual Development staff for the purpose of victim input . This is also done to aid in those cases where family re-unification may take place . 4a . I will attend all treatment sessions, attend on time, and notify the appropriate staff member as soon as possible about any situation that affects my attendance or promptness . I understand the only acceptable excuse for absence or lateness is a verifiable medical emergency. I understand I will be allowed up to three (3) non-medical excuses per year. 4b. Parents are required to attend parents group with the offender, which is held once a month. 4c . Parents are required to attend all team staff meetings . 1 5 . I am responsible to pay group fees at the time of group. 6 . I will actively participate in treatment to the satisfaction of staff and other group members . 7 . Neither parents nor offender will disclose information regarding another client to anyone outside this program. 8 . I understand treatment may include periods of individual/family therapy in addition to weekly group therapy. 9 . I understand my offense had an impact on my family and any other significant relationships . In order to assist these individuals and myself in the recovery process, I agree they, or any future significant partners will participate in treatment on an as needed basis as determined by treatment staff. This may include individual, couple, and family treatment . 10 . I understand that ongoing assessment of progress through psychological and physiological evaluation will be part of my treatment . I understand the costs of these assessments are at my expense and the cost will be discussed each time I am requested to participate . It will be important I budget money each month for these ongoing assessments . 11 . I will comply with all conditions of probation or parole and these conditions become part of this contract. 12 . I will not attend any session while under the influence of alcohol or drugs . 13 . I will not become verbally threatening or assaultive toward any staff member or client whether inside or outside of the agency. 14 . I agree not to be in any adjunctive treatment of any kind without approval of Adolescent & Individual Development . 15 . I agree not to initiate or maintain contact with peers two (2) years younger than myself. 16. I agree not to initiate or maintain contact with my victim(s) of any kind without prior approval from Adolescent & Individual Development . 2 17 . I agree not to have any change of residence or job, if employed, without prior approval of Adolescent & Individual Development and my Probation/Parole Officer. 18 . I agree not to leave the state of Colorado without prior approval of Adolescent & Individual Development and my Probation/Parole Officer. 19 . I agree not to use pornography or view any sexually explicit or violent material . I also agree not to keep or store these types of materials in any format . 20 . I agree not to become involved with any person who has minor children living with them until I have prior approval of Adolescent & Individual Development, or until I have successfully completed treatment . 21 . I also agree to the following special conditions : 22 . I agree to be tested for sexually transmitted diseases and HIV, and agree for the results of such testing to be released to my victim(s) by the appropriate person. 23 . I agree to allow Adolescent & Individual Development to audio/visually record my treatment, both individually and in group for the purposes of professional education and furthering the treatment process . I understand any such materials will only be viewed in a professional context . I understand my Probation/Parole Officer or the referring source may be notified immediately of any violation of this contract. I also understand local and state police departments may be contacted if necessary to maintain victim or community safety. I also understand and agree any violation of this contract may be grounds for termination from the program at the discretion of the staff. I agree the staff may terminate my treatment for any other problem behavior not outlined above. My questions regarding this treatment contract have been 3 answered to my satisfaction with the person in charge of my treatment . By signing this I give my voluntary consent to participate in all the above . Signed: Client Signature Date Witnessed: Therapist Signature Date Parent/Guardian Signature Date 4 ADOLESCENT & INDIVIDUAL DEVELOPMENT Out-Patient TREATMENT PLAN Problem Statement: I have been referred for and completed my assessments for Adolescent & Individual Development Offense Specific Program. Treatment is designed to increase non-deviant sexual behavior and arousal patterns . Treatment is to prevent recidivism. As a result of my behavior, I will learn to improve my skills in the areas listed below: I , hereby enter into agreement with Adolescent & Individual Development to provide me with treatment services under the following guidelines . I understand these guidelines are in compliance with Colorado Standards and Guidelines addressed in sections 3 . 150 and 3 . 151 . I understand this Treatment Plan will be updated as the Multidisciplinary Team deems necessary. 1) . I will take full responsibility for my sexual offenses by completing each of the following: Date Completed: I am able to identify my abusive behaviors to my self, others, property, and/or physical, sexual, and psychological . These areas will be demonstrated by my ability to identify the four types of violence, and accurately place my abusive behaviors within each type . Additionally, others such as but not limited to my parents, probation/parole officer, and other members of my MDT will be able to recognize though my actions my progress . I am able to identify my thinking errors such as but not limited to excuses, blaming, justifying, lying, minimizing, vagueness, anger, victim stance, and puzzlement, and therefore take responsibility for my sexual offending and abusive behaviors, past and present, without minimization or externalization of responsibility or blame . I am able to identify and explain in detail, through verbal and a written project the 12 parts of my sexual abuse cycle . This cycle will include my triggers, thoughts, feelings, and behaviors, my seemingly unimportant decisions, my high risk behavior, how I targeted my victim (s) , my sexual fantasies, how I planned my sexual offense (s) , how I groomed my victim(s) , what sexually deviant behavior I used, how I 1 maintained secrecy, my remorse or fear of my sexual offense (s) , and the evasion tactics I used. I am able to write out in detail my Relapse Prevention Plan. This plan will include definitions of my non- offensive and non-abusive sexual fantasies; reduction and disruption of deviant sexual thoughts and arousal, when indicated. I am able to identify my stressors in my daily life and am able to use the skills, such as Time-Out, to lessen the stressors . Additionally, others such as but not limited to my parents, probation/parole officer, and other members of my MDT will be able to recognize though my actions my progress . I am able to surround myself with positive influences from individuals such as, including but not limited to, friends, peers, and family. I will be able to demonstrate anger management, conflict resolution, and problem solving skills . I will be able to demonstrate these skills through verbal and written material such as my daily journals . Additionally, others such as but not limited to my parents, probation/parole officer, and other members of my MDT will be able to recognize though my actions my progress . I will be able to demonstrate accurate information about human sexuality and positive sexual identity through verbal and written material in my required homework and journals . 2 . I will take responsibility for myself in the following areas : I will take care of my physical health and safety needs . If deemed necessary, this may include pharmacological treatments and management of concurrent psychiatric disorders including but not limited to experiences such as my victimization, trauma, maltreatment, loss, abandonment issues . If age and circumstance appropriate, I will take responsibility by finding employment so as to pay for my Offense Specific Treatment . By doing this, I will take responsibility for the financial consequences to my sexual offending. 2 I will participate in approved positive activities with my peers, family, and friends, (age appropriate) . These activities will be indications that I have learned to relax and enjoy play and recreation with positive role models . If my Offense Specific Evaluation indicated alcohol/drug abuse, I may be required to participate in treatment specifically for this abuse . 3 . Victim Impact : I will take responsibility in the following areas : I will be able to demonstrate through verbal and written documents such as the required Accountability/Awareness Project how my victim (s) , family, community, and myself were impacted and how all were harmed. This will also demonstrate my empathy. Additionally, others such as but not limited to my parents, probation/parole officer, and other members of my MDT will be able to recognize though my actions my progress . 1 . By signing this treatment plan, I am agreeing I have read and understand every rule of my Sex Offender Contract . 2 . I agree to learn to better control my sexually violent behavior by understanding the following: * Cognitive Restructuring * Family Dynamics * Sex Education * Sexual Offense Cycle * Behavioral Monitoring Techniques * Relapse Prevention * Final Project 3 . I agree to learn about the types of violence and how my sexual behavior effects others . I have agreed to attend: * Offense Specific Group Treatment * Parents Group * Individual/Family Therapy per recommendation 4 . I agree to better understand my deviant arousal and learn behavior skills to stop my deviant arousal . I will participate in a Penile Plethysmograph (age appropriate) 3 5 . I understand that my sexual offense (s) involved keeping secrets and deception. I agree to participate in Polygraph Examinations . 6. I agree to a Psychiatric Evaluation if determined necessary. I understand and agree with the above Treatment Plan. My inability to follow the Treatment Plan and Client Contract could result in a negative termination from Adolescent & Individual Development Offense Specific Treatment Program. Client Signature Date Parent/Guardian Signature Date Therapist Signature Date 4 _ • • ADOLESCENT & INDIVIDUAL DEVELOPMENT Mailing: PO Box 321 Fort Lupton, CO 80621 Fax: 303-857-9720 Cell Phone: 303-596-4586 January 13, 2006 Weld County Department of Social Services Attn: WCDSS Caseworker P.O. Box A Greeley, Colorado 80631 RE : Name : John Doe DOB: June 2, 1989 SSN: 000-00-0000 Assessed by: Rebecca J. Quick, M.A. , CRC, LPC Referral Date : December 12, 2005 Dear Caseworker: Mr. John Doe was referred to this agency to determine placement for him. I met with Mr. Doe and his parents on January 12, 2006 . I also contacted his Weld County Department of Social Services (WCDSS) Caseworker, Jason Nava on January 13, 2006 . Additional information was gathered from the discharge report given by Individual & Group Therapy Services (IGTS) as well as the discharge report from this agency. Mr . Doe began Offense Specific Treatment with this agency November 12, 2002 . He was negatively terminated from treatment October 4 , 2004 because he would not take responsibility for his sexual offending. Additionally, he could not pass a Disclosure Polygraph. Mr. Doe had taken four of these type of polygraph and each time would disclose more victims . Mr . Doe displayed many thinking errors throughout his treatment such as excusing his behavior, blaming others for his actions, and victims' stance because he was in Offense Specific Treatment . Mr . Doe, while in this agency' s Offense Specific Program, never appeared to learn empathy. Mr . Doe had been placed in a special Offense Specific Group with this agency in which he was highly confronted regarding his thinking and violent behavior. Mr . Doe did not comply with the requirements of this group. He continued to have - the thinking errors and irresponsibility. Mr. Doe, at the time of his termination, was believed at high risk to the community. Mr. Doe began Offense Specific Treatment at IGTS on October 18, 2004 . He, again, was negatively terminated on November 15, 2005 . In the termination letter from IGTS, it was noted that Mr. Doe was not completing the work as required and was watching pornographic movies . He was not following the treatment facility' s contract by disclosing continued significant physical contact with younger children . Again, Mr. Doe was considered a high risk to the community and it was recommended he is placed at the Department of Youth Corrections . Mr. Doe, during his interview with me on January 12, 2006, could not remember the Sex Offense Cycle . This cycle is one of the high priorities of treatment . If the client does not understand his thoughts, feelings, and behaviors within the cycle, he may re-offend again. Mr. Doe made excuses in which he stated IGTS had not taught him the same cycle as this agency. He used the thinking error of Puzzlement when he was asked to explain his Sexual Assault Cycle . Mr. Doe asked which cycle was he to address . When he could not remember the cycle, Mr . Doe asked if he could see the Offense Cycle . He was given a copy of the cycle and again asked which cycle he was to talk about . His mother told him to talk about either one as both were similar. Mr. Doe said he remembered Triggers but could not give his . He then avoided this subject and stated he did not learn much at that agency. Mr . Doe' s parents were very supportive of Mr. Doe . They stated they wanted Mr. Doe to do what was asked of him and move on with his life . Mr. Doe' s parents stated they knew Mr. Doe would probably be placed at the Department of Youth Corrections . Mr . Doe was asked about the pornography he had been viewing. Mr. Doe admitted he had been into pornography from the time he was 14 years of age to 16 . It appears Mr. Doe may be addicted to this material . Mr. Doe displayed a flat affect during the interview. Mr . Doe stated he was very scared to go to prison because he was claustrophobic when he was in small areas . However, his affect did not display this emotion. Mr. Nava, Mr. Doe' s WCDSS Caseworker, was contacted on January 13, 2006 . He agreed Mr. Doe' s affect was flat . Mr. Nava was advised when I spoke to Mr. Doe that Mr . Doe could not give any of the skills he had learned in group treatment . I related to Mr . Nava that I did not believe Mr. Doe would do well in a residential treatment program. I related that I believed it was necessary Mr . Doe be placed at the Department of Youth Corrections in their Offense Specific Treatment . Additionally, Mr. Doe' s parents reported they could • not pay the costs of a residential treatment facility. Mr. Nava reported that Mr. Doe was continually around younger children some who were his cousins and talking to girls on the Internet . Mr. Doe continues to put himself in high risk situations . RECOMMENDATIONS : 1 . Mr. Doe has had three years of Outpatient Offense Specific Treatment . He could not describe any of the skills or concepts which had been taught . Mr. Doe continues to put himself in high risk situations while he is in the community. It is recommended Mr . Doe is placed in the Department of Youth Corrections and attend their Offense Specific Treatment Program. When Mr . Doe is Paroled back into the community, it is recommended he be placed in a Relapse Prevention Program. 2 . It is recommended Mr. Doe not be allowed to have his name removed from the Sex Offender Registry early. Sincerely, Rebecca J. Quick M.A. CRC Licensed Professional Counselor Full Operating Level Adolescent Offense Specific Evaluator and Treatment Provider PC: Weld County Department of Probation ATTN: Probation Officer 934 9`h Street Greeley, Colorado 80631 •.,. • 1st a DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY, CO. 80632 Website:www.co.weld,co.us ' - Administration and Public Assistancert(970)352-1551 Child Suppo (970)352-6933 e COLORADO May ls, 2006 Rebecca Quick, Executive Director Adolescent &Individual Therapy P O Box 321 Fort Lupton, CO 80621 Re: Bid#06SAT03 Dear Ms. Quick: The purpose of this letter is to outline the results of the Core Bid process for PY 2006-2007 and to request written confirmation from you by Monday, 22,2006. Results of the Bid Process for PY 2006-2007 The Families, Youth and Children(FYC) Commission recommended approval of your Bid# 06SATo3 (RFP 06007) Sex Abuse Treatment, for inclusion on our vendor list. Your bid scored 90 points out of 100. You are asked to address the compliance item below. Compliance Item: You are required to provide the required letters under the Collaboration Section from Weld County/Greeley Housing Authority, employment training partners, and other partners as identified in the bidder's assessment of needs. You must identify the process you will utilize to facilitate Medicaid eligible clients receiving mental health services at North Range Behavioral Health. You may fax your response to us at 970.346.7698. Hourly Rate for Court Testimony: You did not provide a rate for court testimony. For bidders carrying over services to 2006, the Department will use last year's court testimony hourly rate. Court testimony will be billed at$100 per hour. If you have questions, please call Gloria Romansik, Administrator, at 352.1551, extension 6230. Sincerely, a, J y orl , cc: Juan Lopez, FYC Commission Gloria Romansik, Social Services Administrator • r ADOLESCENT & INDIVIDUAL DEVELOPMENT Mailing: PO Box 321 Fort Lupton, CO 80621 Fax: 303-857-9720 Cell Phone: 303-596-4586 May 18, 2006 Weld County Department of Social Services Attn: Judy A. Griego, Director P.O. Box A Greeley, Colorado 80631 RE: Response to Bid #06SATO3 Compliance Item and Hourly Rate for Court Testimony Dear Ms Griego: Offense Specific Treatment and Evaluations does not include collaborations in finding housing, employment, or other needs outside of treatment for the clients . When a need is brought to the attention of this agency, I or the co-therapist will work with the WCDSS Caseworker, Probation Officer, or other referring sources to make them aware of the need. Additionally, Medicaid nor insurance companies do not pay for Offense Specific Treatment, Evaluations, or any other treatment tools related to this treatment . Therefore a letter is not required from North Range Behavioral Health for Offense Specific Treatment . However, if a client is required to have mental health treatment outside of the Offense Specific Treatment, this client will be referred to North Range Behavioral Health for their therapists to give the necessary interventions . I hope this helps to answer the Compliance Item. The hourly rate for the court testimony remained the same at $100. 00 per hour. S ' Rebecca . Quick M.A. CRC Licensed Professional Counselor Full Operating Level Adolescent Offense Specific Evaluator and Treatment Provider ZOOS IVd 95:ZT 900Z/9T/90 Adolescent & Individual Development Mailing: PO Box 321 Fort Lupton, CO 80621 Cell 303-596-4586 Fax 303-857-9720 FACSIMILE TRANSMISSION COVER SHEET Date: 5• • acn5 Time : o+ '• SO /e� m • TO: ! u pp Q 4:Jlf�C l.t ) From: / Cl&QCC Q c CA.) c Number of Pages : a (including cover sheet) Comments : el . -& (1.0AJJ,IL‘ If you did not receive the total number of pages indicated above or have questions about this transmission, please call the agency at 970-681-9719 or fax to 303-857-9720. NOTICE : This facsimile transmission and any accompanying documents contain information belonging to the reader which may be confidential and legally privileged. This information is intended only for the use of the individual or entity to which this facsimile transmission was sent as indicated above. If you are not the intended recipient, any disclosure, copying, distribution, or act taken in reliance on the contents of the information contained in this facsimile transmission is strictly prohibited . If you have received this transmission in error, please immediately notify us by telephone and return the original message to us at the address above via the U.S . Postal Service. Thank You ToofPJ Xd3 94:ZT 900Z/9T/SO Hello