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Home My WebLink About20061591.tiff RESOLUTION RE: APPROVE THREE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR HOME STUDIES, UPDATES, AND RELINQUISHMENT COUNSELING SERVICES WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with three Notification of Financial Assistance Awards for Home Studies, Updates,and Relinquishment Counseling Services,between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services,and various providers, listed below,commencing June 1, 2006, and ending May 31, 2007,with further terms and conditions being as stated in said awards: 1. Transitions Psychology Group, LLC 2. Julie Box, LCSW 3. Ackerman and Associates, P.C. WHEREAS,after review,the Board deems it advisable to approve said awards, copies of which are attached hereto and incorporated herein by reference. NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, ex-officio Board of Social Services, that the three Notification of Financial Assistance Awards for Home Studies,Updates,and Relinquishment Counseling Services between the County of Weld,State of Colorado,by and through the Board of County Commissioners of Weld County,on behalf of the Department of Social Services,and various providers, listed above be,and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be,and hereby is,authorized to sign said awards. 2006-1591 e, 5S SS0033 THREE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR HOME STUDIES, UPDATES, AND RELINQUISHMENT COUNSELING SERVICES PAGE 2 The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 19th day of June, A.D., 2006, nunc pro tunc June 1, 2006. `` BOARD OF COUNTY COMMISSIONERS _�® 4WELD COUNTY, COLORADO ATTEST: iaid ;! , ..; '�', XCUSED �e1 ,;,:re" Oil. . eile, Chair Weld County Clerk to the,. .. David E. Long, Pro-Tem 4 - t De u y Glen k'o the Board `l Will H. Jerke AP AS Robert D. Masten y A4 o ney (LI 02 FL Glenn Vaad Date of signature: 'Mar 2006-1591 SS0033 DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website:www.comeld.co.us I Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 C. COLORADO MEMORANDUM TO: M.J. Geile, Chair Date: June 16,2006 Board of County Commissioners FR: Judy A. Griego, Director, Social Services jadt OtAID RE: Notification of Financial Assistance Awar s with a Contractor— Home Studies,Updates and Relinquishment Counseling Enclosed for your approval is a Notification of Financial Assistance Awards with a Contractor for Home Studies, Updates and Relinquishment Counseling. 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 Child Welfare Administration. 3. The Contractor, Ackerman and Associates, will provide home studies, updates and relinquishment counseling under the child welfare system. 4. The Contractor will provide: A. $120 hourly rate relinquishment counseling(2-hour maximum) B. $1,045 full home study C. $570 updated home study If you have any questions,please telephone me. 4 ce a DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970) 352-1551 lung O Fax Number(970) 346-7691 • COLORADO MEMORANDUM TO: M.J. Geile, Chair Date: June 1, 2006 Board of County Commissioners I ' FR: Judy A. Griego, Director, Social Servicesj/C&AJ) )RE: Notification of Financial Assistance Awarwitharious Contractors— Home Studies,Updates and Relinquishment Counseling Enclosed for your approval are Notification of Financial Assistance Awards with Various Contractors for Home Studies, Updates and Relinquishment Counseling. 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 Child Welfare Administration. 3. The Contractors will provide home studies, updates and relinquishment counseling under the child welfare system. 4. The Contractors include: A. Transitions Psychology $1,115.00 full home study Group, LLC $725.00 updated home study $111.50 hourly rate relinquishment counseling $150.00 hourly rate court testimony B. Julie Box $103.89 hourly rate relinquishment counseling $850.00 full home study with background check $750.00 full home study no background check $425.00 updated home study If you have any questions,please telephone me. 2006-1591 Weld County Department of Social Services Notification of Financial Assistance Award for Child Welfare Regular Administration Type of Action Contract Award No. X Initial Award 06-HS-0029 Revision (RFP-06-000;06HS07) Contract Award Period Name and Address of Contractor Beginning 06/01/2006 and Transitions Psychology Group,LLC Ending 05/31/2007 Home Study,Updates,and Relinquishment Counseling 804 11th Avenue Greeley,CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Capacity for three new referrals per month,two new Award is based upon your Request for Proposal(RFP). referrals per month for updates,and four referrals per The RFP specifies the scope of services and conditions of month for relinquishment counseling.Total monthly award. Except where it is in conflict with this NOFAA in capacity is 18 families,with a monthly average of 10 which case the NOFAA governs,the RFP upon which this families. Approximately 100 individuals would award is based is an integral part of the action. receive Bilingual-bicultural services, and an Special conditions estimated 105 individuals would receive services in 1) Reimbursement for the Unit of Service will be based on a South Weld County.The average stay in the program rate per home study;home study update,and is eight weeks for home studies,six weeks for relinquishment counseling session. updates and relinquishment counseling, with an 2) Reimbursement requests must be an original with an average of two hours participation per week. original signature from the provider and/or designee. Bilingual and South County Services. 3) Reimbursements requests must include the date the home Cost Per Unit of Service study,update,or relinquishment counseling was completed. Rate per Study The request must reflect the referral number assigned to Full Home Study $1,115.00 each home study,the amount billed for each home study, Updated Home Study $725.00 and the month the service was provided. Hourly Rate per 4) Payment will only be remitted on referrals made by Relinquishment Counseling $111.50 the Weld County Department of Social Services. Court Testimony $150.00 5) Requests for payment must be an original submitted to the • The threshold for hours for an incomplete home study Weld County Department of Social Services by the end of will be set at 3.5 hours. the 25th calendar day following the end of the month of • Turnaround time for receipt of the completed home service.The provider must submit requests for payment on study is 6 weeks from the date of receipt of the forms approved by Weld County Department of Social referral. Services. • Additional home studies will be billed at a maximum 6) The Contractor will notify the Department of any changes of$250 per person. in staff at the time of the change. Enclosures: X Signed RFP:Exhibit A Supplemental Narrative to RFP: Exhibit B Recommendation(s) onditions of Approval Approva Program Official: By By David E. Long, Chair P —Tem Judy Griego Directo Board of Weld County co#missio rs Weld o tyD partment of Social Services Date: • 06/19/2006 Date: 0/I O(0 or 6O6 -/59/ INVITATION TO BID OFF SYSTEM BID 001-06 (06005-06011 and 006-00, A, B , & C DATE:March 1, 2006 Bid No. RFP-FYC 006-00B 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 006-00B) for: Adoption, Foster Care, and Expedited Permanency Planning Home Studies, and Relinquishment Counseling Deadline: March 31, 2006, Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to Weld County Social Services, announces that competing applications will be accepted for approved providers pursuant to the Board of Weld County Commissioners' authority under Colorado Statute and the Weld County Home Rule Charter. 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 home studies, home study updates, and relinquishment counseling services. The County will authorize approved providers and rates for services only. The adoption, foster care, and child welfare home studies, updates, and relinquishment counseling program must provide services that are in compliance with the uniform format utilized by the State of Colorado Department of Human Services. 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 Tai Moe- N-(rf rnav-i, Mh TYPED OR PRINTED SIGNATURE VENDOR "Ira PSlf ibh15 fI,GhoIcj &YDupliAL (Name) J Handwritten Signature By Authorized Officer or Agent of Vender ADDRESS Go'-! UM'' >< V&• TITLE co-d Yethe2 (lr&elel, CO 80(a I DATE O3-3O-O(0 PHONE # jelTO) 33- II2_3 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 37 ORIGINAL Bid Nb. 001-06 RFP-FYC COMMISSION-006-00B Attached A HOME STUDY, UPDATE, & RELINQUISHMENT COUNSELING BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CHILD WELFARE ADMINISTRATION FUNDING 2006-2007 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2006-2007 Bid 001-06rRFP-FYC COMMISSION-006-00B NAME OF AGENCY: TraV)51'+I 0V) 5 1jLlnoI og j 6-vvi,tp, Lt C ADDRESS: (304 hint Awe. , &reeteN , CD 2)00-a ( PHONE: (afi) 33 0-( 12-77 CONTACT PERSON: Sum t Wipe-etar-�JY1J A fr1 MA- TITLE: CO -dire c-fr DESCRIPTION OF HOME STUDY PROGRAM CATEGORY: Adoption, Foster Care, and Expedited Permanency Planning Home Studies in compliance with the uniform format utilized by the State of Colorado Social Services of Human Services since October 1, 1999(Attached A). 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1, 2006 Start End May 31, 2007 End TITLE OF PROJECT: Ito me Shpt Tam; Moe -HZ{rfvinall , MA- 03-30-QUO Name and Signature of Person Preparing Document Date ire& t1,1.fre-1t21rt %i.ah , MA cg-30-01,0 Name and Signature Chief Administrative 0 leer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS Fo ew and renewal bids, please initial to indicate that the following required sections are included in this Proposal for Bid. Project Description Sample Home Study T et/Eligibility Populations 4 r General Indicates ultural/Eligibility Populations Types of services provided easurable Outcomes ervice Objectives Workload Standards taff Qualifications Unit of Service Rate Computation Billing Process Program Capacity per Month Certificate of Insurance Page 23 of 37 Home Study Program Bid Proposal RFP-FYC 006-OOB Transitions 1 • • •• • Home Study, Update and Relinquishment Counseling ea • • ♦ • Bid Proposal • • • � • • • Home Study Program • • • Transitions Psychology Group, LLC • •• 2006-2007 •�a • a • Transitions PSYCHOLOGY GROUP, LLC I. PROJECT DESCRIPTION Transitions Psychology Group, LLC is a private counseling agency consisting of a multidisciplinary team of human service professionals, including Licensed Psychologist and School Psychologists, Licensed Professional Counselors, Licensed Clinical Social Worker and other degreed paraprofessionals. Transitions provides superior counseling, assessment and consultation services to children and families in Northern Colorado. The purpose of the Home Study, Update and Relinquishment Counseling program is to provide quality home assessment and consultation services to expedite permanency placements of children in Weld County. A. Home Study The Home Study segment of the program strives to effectively and efficiently evaluate prospective foster and adoptive homes in order to provide for safe, nurturing environments for children as quickly as possible. Transitions Psychology Group, LLC (hereafter referred to as "Transitions") utilizes the SAFE (Structured Analysis Family Evaluation) process endorsed by the State of Colorado throughout the Home Study. A Home Study begins with a referral from a Weld County caseworker. A staff member from Transitions sends an email confirmation of receipt of the referral to the caseworker and mails a packet of information to the family which includes a cover letter, the Home Study Application, the Reference List, SAFE Questionnaire I, and finger prints cards for all adults residing in the home. The family is asked to complete all materials prior to the initial interview, called the Family Screening. The Family Screening is held in the family's home and includes all members of the household. The Transitions counselor collects all materials from the family, interviews the family, and reviews Questionnaire I with the parent(s). The Transitions counselor views the home, yard and neighborhood at this time. Background checks and references are processed after the Family Screening. A second Transitions counselor conducts the Parental Unit Interview as well as Individual Interviews with each parent, other adults, Home Study Program Bid Proposal RFP-FYC 006-OOB Transitions 2 and children in the home. The parent(s) complete SAFE Questionnaire II during the Parental Unit Interview. The content of SAFE Questionnaire II is reviewed in both the Parental and Individual Interviews. The SAFE Psychosocial Inventory is completed by the both Transitions counselors involved in the Home Study. Subsequently, both Transitions counselors meet with the Transitions supervisor for the Team Consultation. The team reviews the data obtained and makes the final recommendations. The second Transitions counselor contacts the family to share the results and recommendations.. The information collected is compiled into a written report that follows the State of Colorado format and the SAFE model. The written report is submitted to the referring caseworker, along with all of the original Questionnaires, Home Study Application, background check and reference materials. B. Update The Update program follows the SAFE format. The Update program begins with a review of the previous Home Study. A counselor from Transitions then interviews the Parental Unit to discuss any changes in the family since the previous Home Study; all members of the household are included in part of the interview in order to observe current family functioning. Following this interview, the counselor meets individually with the parent(s). The SAFE Psychosocial Inventory is completed to assess areas of strength and concern in the family. C. Relinquishment Counseling The Relinquishment Counseling program consists of two individual sessions with a parent referred by Weld County who is considering relinquishing a child. A minimum of six days will transpire between the two sessions and the sessions will address all of the components of the Weld County Department of Social Services Relinquishment Counseling Outline. II. SAMPLE HOME STUDY See attached copy. III. TARGET/ELIGIBILITY POPULATIONS The Home Study, Update and Relinquishment Counseling Program serves adults of Weld County, who are interested in foster parenting, becoming foster/adoptive parents, or becoming a next-of-kin placement for children. The program also serves those parents who are relinquishing children. Program Home Study Program Bid Proposal RFP-FYC 006-OOB Transitions 3 participants must be referred by the Weld County Department of Social Services. Transitions does not discriminate based on race, color, religion, national origin or sex, in accordance with State and Federal Laws, rules and regulations. The Transitions program can serve a total of 85 family units, including 60 families for Home Studies, 15 families for Home Study Updates and 10 families for relinquishment counseling. The 85 family units would consist of approximately 320 individuals. Of the 320 individuals, 160 would be children ages 0-18. Approximately 100 individuals could receive bilingual services and another 105 could receive services in South Weld County. Individuals in the Transitions program can typically access a counselor between 8 AM and 8 PM, Monday through Friday and weekends by appointment. Twenty-four hour services are not provided as part of the Home Study, Update and Relinquishment Counseling Program. The monthly maximum program capacity would be 18 families, with an average of 10 active families each month. The average stay in the program would be six weeks for Home Studies and four weeks for Updates and Relinquishment Counseling. The average hours per week in the program would be two per family. IV.TYPES OF SERVICES PROVIDED Transitions will provide Home Studies, Updates and Relinquishment Counseling as referred by the Weld County Department of Social Services. These services will not supplant existing services in the community, as these services are not funded by mental health capitation services, ADAD or other funding. A. Home Study 1. Background Checks and References After an authorized referral is received from a Weld County Social Services caseworker, Transitions e-mails the referring caseworker to confirm that the referral has been received. Transitions then delivers a packet of information to the prospective family. The family will be asked to complete an application, release of information, and SAFE Questionnaire I. All adults in the household will be supplied with fingerprint cards to complete the CBI checks (FBI checks will be performed on individuals who have resided in Colorado for less than two years). Transitions will collect and submit the fingerprint cards, incurring the costs for fingerprint processing for individuals referred by Weld County child protection caseworkers. Prospective foster/adoptive parents will be responsible for their own fingerprint processing cost. Additionally, Transitions will pay for and complete background checks with CoCourts or similar agency to identify Home Study Program Bid Proposal RFP-FYC 006-00B Transitions 4 criminal, civil, traffic and money offenses cited in the Colorado court system. Transitions will distribute reference forms to up to four references provided by applicants. The reference persons will be provided with a postage paid return envelope in which to return the reference form. Transitions staff will continue to contact the referred family by phone to address any questions posed by the family and expedite the completion of the paperwork. 2. Family Screening A counselor from Transitions meets with all the members of the prospective foster family in the family home. The counselor explains the Home Study process and collects all materials from the family including the application, SAFE Questionnaire I, finger print cards, and reference lists. The counselor reviews the application with the family, discusses their reponses on Questionnaire I, and assesses family interactions and functioning. The SAFE Psychosocial Inventory is completed by the counselor after the interview. 3. Parental Unit Interview A second counselor from Transitions meets with the prospective parent(s) to administer the SAFE Questionnaire II in person and review the answers with the parent(s). Some answers related to more sensitive topics will be reviewed in further detail in the Individual Interviews. During this interview the counselor evaluates the parent(s) ability to function as caretakers of children. This interview will occur at least one week after the Family Screening. When appropriate, corroborative information from agencies and individuals that have been involved with family members will be included in the Home Study to supplement information gathered from the family. After the interview, the second counselor rates the family on the SAFE Psychosocial Inventory. 4. Individual Interviews Following the Parental Unit Interview, in households with more than one parent, each parent will be interviewed individually. These interviews focus on evaluating each parent's general functioning, personal history, views on childrearing and motivation to become a foster parent. Questionnaire II is reviewed with each parent separately in order to assist this assessment. An age appropriate, developmentally sensitive interview will also be held with each child residing in the home. The purpose of these interviews will be to assess the probable impact of fostering on the child and explore any child issues that could adversely impact foster children. The location of the individual interviews will be either in the family home or in the Transitions office, at the counselor's discretion. The SAFE Psychosocial Inventory will be completed again following this interview to ensure that the strengths and concerns in all areas are being sufficiently addressed. Home Study Program Bid Proposal RFP-FYC 006-00B Transitions 5 5. Team Consultation After the interviews have been completed and the background and reference and collateral data has been compiled, both Transitions counselors involved in the Home Study meet with a Transitions supervisor to review the case. The supervisor will have at least three years experience performing home assessments and have completed the SAFE training and the SAFE supervisor's training. The team reviews all of the information collected in order to develops conclusion and delineate specific recommendations for the family. 6. Follow up Contact The parental unit is contacted to review the issues identified in the Team Consultation. The counselor will share some of their perceptions with the family and any recommendations made by the team. 7. Written Report Within six weeks of the receipt of the Home Study request from Weld County, the Transitions counselor will submit a written report to the referring caseworker. The report will follow the State of Colorado format. The original fingerprint cards, CBI or FBI reports, application, original written reference forms and copies of the Questionnaires will be included with the report. After submitting the report, the Transitions counselor will contact the referring caseworker to ensure that the report was received and compiled satisfactorily. B. Update 1. Review of the Initial Home Study A Transitions counselor will review the previous Home Study and/or updates. The counselor will then contact the referring Weld County caseworker in order to determine the focus of the Update. 2. Family Interview and Home Inspection The Transitions counselor will meet with all members of the household in the family home. The counselor will view the home and observe the interactions among family members. The SAFE Psychosocial Inventory will be review to ensure that all areas of assessment have been included in the update. 3. Parental Unit Interview Parent(s) will meet with a Transitions counselor to discuss any changes that have occurred since the last Home Study or Update. Family strengths will be re-evaluated and progress towards improving areas of need identified in the previous study will be determined. The SAFE Psychosocial Inventory will be completed by the counselor. Home Study Program Bid Proposal RFP-FYC 006-00B Transitions 6 4. Supervisory Consultation The Transitions counselor will meet with the Transitions supervisor to review the case and develop recommendations. 5. Written Report The Transitions counselor will submit a written report to the referring caseworker within four weeks of the date on which the Update request was received. The report will include specific conclusions and recommendations regarding the family's ability to provide a safe, nurturing environment for children. C. Relinquishment Counseling 1. Individual Parent Consultation After receiving a referral from a Weld County caseworker, a Transitions counselor will meet with the referred parent(s) to address questions from the Weld County Relinquishment Counseling Outline. 2. Follow-up Consultation and Review At least seven days after the first parent consultation session, the Transitions counselor will again meet with the referred parent(s) to review the previous session, check for understanding and address any further questions the parent may have. The counselor will also provide the parent with referrals and recommendations for other services as deemed appropriate. 3. Written Report The Transitions counselor will provide a written description of the services provided that addresses all of the questions in the Weld County Relinquishment Counseling Outline. It will be submitted to the referring Weld County caseworker within six weeks of the date on which the referral was received. V. MEASURABLE OUTCOMES A. More Expedient Placement of Children Transitions will track the date on which the referrals from the Weld County caseworker are received as well as the date the Transitions reports are submitted to the referring Weld County Caseworker. There will be no more than six weeks that transpire between the date of the receipt of the referral and the date the report is submitted to the county for Home Studies. Reports for Home Study Updates and Relinquishment Counseling will be submitted within four weeks of the receipt of the referral. If Transitions experiences delays, (e.g. applicants not completing the required paperwork, applicants not keeping appointments or applicant vacations), the referring caseworker will be notified and an adjusted time line will be determined. Submitting the majority of the reports within the Home Study Program Bid Proposal RFP-FYC 006-00B Transitions 7 four to six week time parameters will enable Weld County caseworkers to place children more quickly. To further facilitate caseworkers' decisions regarding placement, Transitions will perform an internal review of each Home Study and Update to ensure that it includes definitive conclusions and specific recommendations regarding the viability of referred families to become foster or adoptive homes. B. Quality Adoptive Home Studies Done in a Timely Manner Transitions' Home Studies, Updates and Relinquishment Counseling, including bilingual services, will be performed only by degreed human service professionals. All Transitions counselors possess at least a Master's Degree in a human service field; most providers are licensed by the State of Colorado as Licensed Professional Counselors (LPC), Licensed School Psychologists or Licensed Clinical Social Workers (LCSW). Transitions has two bilingual LPCs contracted to perform home studies. Proof of each counselor's education will be provided to Weld County. The Transitions counselors and the supervisor have also applied for inclusion on the State Vendor List. All Transitions counselors and supervisors will have completed the required SAFE training. Supervisors will have completed an additional training session for SAFE supervisors. Transitions uses a multidisciplinary team approach to staff each Home Study before the final report is completed and recommendations are made. This will be measured by at least three members of the Team Consultation, including the initial counselor, the primary counselor and the supervisor, signing off on the final report. Transitions will further ensure quality by performing an internal review of all Home Study, Update and Relinquishment Counseling reports. The reviewer will document that the review has been completed. Transitions will track received dates for Home Study, Update and Relinquishment Counseling requests as well as the submission dates of the corresponding reports. Home Studies will be submitted within six weeks from the received date; Updates and Relinquishment Counseling reports will be submitted within four weeks from the referral date. C. Number of Acceptable Home Studies Submitted The Transitions counselor submitting the written report will contact the referring Weld County caseworker within one week of the report's submission to ensure that the Home Study, Update or Relinquishment Counseling report was acceptable. Transitions staff will then document the contact in order to track the number of acceptable studies submitted. VI. SERVICE OBJECTIVES Home Study Program Bid Proposal RFP-FYC 006-00B Transitions 8 A. Provide Quality Home Studies, Updates and Relinquishment Counseling for Adoptive Parents, Foster Parents and Department of Social Services' Clients. 1. Transitions Home Studies, Updates and Relinquishment Counseling will be performed only by degreed human service professionals. Proof of each counselor's education will be submitted to Weld County. All of the services provided, including bilingual services, will be performed by Master's level counselors, with the exception of the tasks listed in the Background Check and Reference portion of the home study; these tasks may be performed by paraprofessional staff. 2. Transitions Home Studies and Updates follow the SAFE model of analysis and evaluation. All counselors and supervisors are trained in and possess a thorough understanding of the SAFE model. 3. A multidisciplinary team approach will be utilized to staff each Home Study referral before the final report is completed and recommendations are made. This will be measured by at least three Team Consultation participants signing the final report: the initial counselor, primary counselor and the supervisor. Updates will be staffed between the primary counselor and the supervisor as documented by both signing the final report. 4. Transitions will perform an internal review of all reports to check for overall quality, writing skills, definitive conclusions and specific recommendations. The reviewer will document in the chart that the review has been completed. 5. The Transitions counselor submitting the Home Study will contact the referring Weld County caseworker to ensure that the Home Study, Update or Relinquishment Counseling report is acceptable. Transitions staff will then document the follow-up contact and track the number of acceptable studies submitted. VII. WORKLOAD STANDARDS A. Number of Hours Per Day, Week or Month Families in the Home Study program will participate for a minimum of one hour per week for a maximum of eight weeks. Update families will participate for a minimum of three hours during the four weeks of service. Weld County clients referred for Relinquishment Counseling will participate for a minimum of two hours during the four weeks of service. B. Number of Individuals Providing the Services Each Home Study will be performed by two individuals: one counselor who conducts the initial Family Screening and another counselor who completes the remaining interviews of the family members and produces the report. A licensed psychologist will also be involved in the Home Study in a supervisory capacity, to assist with the evaluation of the family • Home Study Program Bid Proposal RFP-FYC 006-OOB Transitions 9 and recommendations. However, the supervisor will typically not have direct contact with the referred family. Updates will be performed by one counselor, but will also have the Team Consultation component with a supervisor for evaluation and recommendation purposes. Relinquishment counseling will be performed by one Master's or doctoral level, licensed counselor or social worker. Transitions currently contracts with one PhD, Licensed Psychologist for supervisory services. Three doctoral level staff and five master's level staff are contracted to provide direct services. C. Maximum Caseload Per Worker Each counselor will not carry more than four open Home Studies or Updates at any time. Counselors will not carry more than two Relinquishment Counseling cases at a time. D. Modality of Service Home Studies and Updates will consist of individual, couple and family service modalities with the referred family. Most of the services will be delivered in the family home, with the possible exception of the Individual Interviews, which may be held in the Transitions office. Case management services, case reviews, data collection and consultation without the family members present are also included. E. Total Number of Hours per Day/Week/Month Transitions will provide approximately 2 hours of direct services per day, 10 hours per week and 43 hours per month. F. Total Number of Individuals Providing These Services Ten individuals provide services on the program. Transitions has two co- directors, both Licensed Professional Counselors, available to provide these services along with one Licensed Psychologist to provide supervision and case consultation. Three additional master's level licensed professional contractors and three doctoral level contractors are also available. A paraprofessional staff member provides indirect administrative support, including processing fingerprint cards, performing background checks and collecting reference information. G. The Maximum Caseload per Supervisor The Transitions supervisor will not exceed 24 open cases for Home Studies and Updates. H. Insurance Transitions co-directors and employees are insured through Healthcare Providers Service Organization Purchasing Group (HPSO). The limits of liability are $1,000,000 per occurrence and $6,000,000 aggregate. Contract staff members maintain their own policies, each with a minimum Home Study Program Bid Proposal RFP-FYC 006-00B Transitions 10 of $1 M/$3M liability. Current contracted staff members are insured through HPSO and the Philadelphia Indemnity Insurance Company. VIII. STAFF QUALIFICATIONS A. All Transitions staff, including supervisors, who are providing direct services have a minimum of a master's degree in a human service field. The supervisor has a Doctorate in psychology and is a Licensed Psychologist. All staff performing Home Studies, Updates and Relinquishment Counseling have at least a Master's degree in a human service field. Most current providers are licensed in State of Colorado as Professional Counselors, Clinical Social Workers, or School Psychologists. Transitions staff have training and expertise in family systems and experience working with social services, foster/adoptive parents and foster/adopted children. The supervisor has had five years of experience performing home assessments. All Transitions staff working on the program completed or will have completed the required SAFE training by the start of the new program year. As an agency, Transitions and its entire staff and contractors are registered on the State of Colorado Department of Human Services Vendor list. B. Transitions has ten staff members, including a supervisor, available for the project. IX. UNIT OF SERVICE RATE COMPUTATION Please see attached budget form. Flat rates are as follows: $1115 for full home study; $725 for update; incomplete home study, update and relinquishment counseling is calculated at the hourly rate of $111.50 for face- to-face contact. X. BILLING PROCESS A. Billing Process Transitions follows a structured billing process in order to maintain prompt billing for services. Transtions staff are required to submit all signed, completed Home Studies and Updates or verification forms for relinquishment counseling by the 1st workday of the month after the services are provided to the administrative assistant at Transitions. All documentation including original, signed written reports for relinquishment counseling are due by the 5th workday of the new month. The administrative assistant completes all invoices, Authorization Forms, and Core Service Forms by the 5th workday of the month. The forms are Home Study Program Bid Proposal RFP-FYC 006-00B Transitions 11 audited by a co-director for accuracy and signed. The billing, which includes all signed documentation (i.e., Transitions' invoice, Authorization Forms, Core Services Forms, Home Study reports, Update reports, Relinquishment Counseling reports, and a copy of the referral forms), is then hand delivered by the administrative assistant to Elaine Furister at the Department of Social Services. B. Fictional Monthly Billing Demonstration Please see Attached . Xl. LOWEST QUALIFIED BID Transitions strives to provide the highest quality of professional services to Weld County families while maintaining reasonable fees. XII. PROGRAM CAPACITY BY MONTH The Transitions program can serve a total of 85 family units, including 60 families for Home Studies, 15 families for Home Study Updates and 20 families for relinquishment counseling. As a minimum requirement to support the program, we would need to have 30 referrals for Home Studies, and 8 referrals for Updates for the program year. There is not minimum requirement for relinquishment counseling because the program can operate on Home Study and Update referrals alone. Referrals for relinquishment counseling are, of course, always welcome. 03/17/.2006 FRI 15:30 FAX UJ002/003 °acaoa Bid 001-06(RFP-FYC106007) Attached A Date of Meeting(s)with Social Services Division Supervisor_ ;omments by SSD Supervisor: '" k -9 e :-e ;au, a4 �Z'�iurLe 4_ 1 / c*p ' T/t may � a® lriryL A. (44L4 , any rte- . . . G Name and Signature of SSD Date • ORIGINAL 1 1 SAFE Child Specific Home Study Report 1 'his home study was completed by Transitions Psychology Group,LLC to consider the placement of a specific Ichild or specific children with the applicants for the purpose of either relative or foster care placement and/or I adoption. - - — —— -- ---- ' -- r Name of Family:Thyme —___-- — ----I (Address: 520 Alpine Dr. ___.____-_ i City: Greeley _-- 1 State:CO I Postal Code: 80634-0000 1 Home Phone:970-353-3333 ; Cell Phone:NA — __ APPLICATION INFORMATION The Applicant applied specifically to be considered for the placement of Justin Thyme. Select One for Foster Care on: 11/30/2005 Select One for Adoption on: Consolidated Home Study Application received on: APPLICANT INFORMATION 1 Karen Thyme(Krono9 Date of Birth: 1 10/10/1949 [-Birth lace: Duluth,MN t Gender: I Female — _ I Religion: I Christian _ Occupation: _ t Disabled&Part-time flower shop _ i Lan ua e(s):__- I En lg ish _Education: ; 2 yrs.College I_Height: -.._...._, 5,3,E — _ I Weight: X140 i Hair: I Brown 1 Eyes: __ i Brown — i I Date of health uestionnaire/re rt: 7NA DATES OF CONTACT Date Person Interviewed Location 11/15/2005 Phone Call to Karen to set up interview Office 11/17/2005 Family Screening Karen In-Home 1/5/2006 Phone call to Karen Office 1/13/2006 Parental Unit Interview In-Home 1/19/2006 Individual Interview(Karen) In-Home 1/19/2006 Individual Interview(Justin) In-Home 1/20/2006 Team Consultation Office -_ 1/20/2006 Final Interview(Karen) In-Home • Structured Analysis Family Evaluation(SAFE)Colorado Single Child Specific Home Study Report-Version 09-14-2005 Page 1 of 8 Copyright, 2005, Consortium for Children,AR Rights Reserved •CHILD OR YOUTH BEING CONSIDERED FOR PLACEMENT Name: Justin Thyme Age: 12 Date of Birth: 4/16/1993 Reason for Protective Custody: Justin was physically and emotionally abused when he was a young child. He then started acting out violently towards his younger siblings. Justin was hospitalized when lie was 10 years old for two weeks. After his release, he went to live with his grandmother, Karen Thyme. Justin lived with her until he was 11 years old. At that time, his behaviors were out of control. He was sent to a residential treatment facility. Justin had been living at this residential treatment facility until November of 2005 when he was returned to his grandmother's care. Social Services has custody of Justin at this point. Parental rights have not been terminated; however, his mother has had no contact with Justin for 1 year. Justin's grandmother is applying to be a kinship foster placement. Justin has been living with his grandmother since November 30,2005. He appears to have adjusted well.He continues to attend school at the residential treatment facility. Justin is involved with the youth group at church twice a week and Boy Scouts. Justin is a likeable young man. He enjoys outdoor activities and sports such as soccer and baseball.Justin has lived with his grandmother in the past and appears to be comfortable with her and their home. Justin presently has no contact with his biological mother. She has not had any contact with Justin for the past year. Justin has a history of acting out violently. He needs to live in a single child home.Justin's grandmother is very aware that he has tried to harm other children in the past. She does not allow her other grandchildren to stay at her house over night. In addition, she does not leave him alone with small children. Justin needs a high level of supervision.Due to the fact that Karen does not work, she is able to provide a high level of supervision. Justin is presently involved in a day treatment program. In addition, he attends therapy twice a week individually and once a week with his grandmother. Karen is very committed to the therapy process. Collateral information indicates that Karen follows through with suggestions. Karen hopes that she will be able to continue to utilize the same therapists that Justin is currently seeing. MOTIVATION Karen is Justin's grandmother. Justin has lived with her in the past. She is motivated to see him develop into a responsible young man. She is committed to raising him until he is an adult. HOME ENVIRONMENT Type of residence: House Square Footage: 1700 Bedrooms: 3 Bathrooms 2 Length of Time in current residence: 12 Years Karen lives in a 3-bedroom,2 bath ranch style home on a quiet residential street in Greeley.There is a garage and a fenced yard. The home was neat and tidy. Karen has a large dog and 2 birds. Justin has a spacious room with a twin bed. He has a TV in his room as well as a video game system. Karen has her own bedroom. FAMILY Applicant-Karen Thyme(Kronos) Karen presents her self as a friendly and outgoing individual. She enjoys exercising and walking. In the summer, she enjoys hiking and tent camping. Karen appears to be a caring and loving individual. Structured Analysis Family Evaluation(SAFE)Colorado Single Child Specific Home Study Report-Version 09-14-2005 Page 2 of 8 Copyright, 2005, Consortium for Children,All Rights Reserved Karen's father, Albert Grant, is deceased. He died from lung cancer.Karen's mother, Lilly, is also deceased. She passed away from a brain aneurism. Karen has four siblings,two of whom are living. Veronica Grant, died in a car accident when she was 30 years old. Garry Grant died from a heart attack. Cynthia Hughs, Karen oldest sister lives in CA. She speaks to her on the phone weekly. She sees her once a year during the holidays. Oliver Grant,Karen's youngest living brother, resides in Colorado Springs. She seems him during the holidays and speaks to him on the phone a few times a year. Karen has been married twice in the past. Her first marriage was to Bud Smith in April of 1969.This marriage ended due to Bud's alcoholism. Karen's second marriage was in October of 1974 to Herbert Thyme. This marriage ended because Herbert was physically abusive. Herbert died of an auto accident shortly after their divorce. Applicant's Sons and Daughters Name DOB Gender Interests Stan Smith 12/30/70 Male Stan works for as a financial planner. Stan is married and has two adolescent children. He lives in Denver,CO. He sees Karen and Justin on a regular basis. Veronica Jones 05/13/75 Female Veronica is married and has two children. She presently works a physician's assistant. Veronica's husband is a high school teacher.The family actively participates in church activities. Desiree Gray 09/23/78 Female Desiree is Justin's mother. She lives in New Mexico and has had with Justin for one year. Desiree has three other children. She has a conflictual no contact relationship with her mother. Michael Thyme 04/01/79 Male Michael is married and has two children. He lives in Greeley and sees his mother regularly. He works as a mechanic in a car dealership. Other children living or frequently in the home None Other adults residing or frequently in the home None Family Lifestyle: Karen works only part-time out of the home at a local flower shop. She is able to be home with Justin when he is not in school. In addition, she has accessed respite care providers when she had foster parent classes. Karen takes care of all of the cooking, bill paying, and home maintenance. Justin has some age-appropriate chores including taking out the garbage, cleaning the bathroom, feeding his dog, and cleaning his room. Justin has his own room and his own privacy. Karen and Justin attend church weekly. The family celebrates holidays with extended family members. Holidays are generally celebrated at Karen's house. Previous adoptions or foster care experience: Justin has been in RTC for the past two years. He reportedly has done well with that level of care.The professionals involved in his case feel that he is ready to move back into the community. FINANCES Combined annual gross earned income: $20,150, which includes disability and approximately $5,000 part-time income. Sources of additional income: none Structured Analysis Family Evaluation(SAFE)Colorado Single Child Specific Home Study Report-Version 09-14-2005 Page 3 of 8 Copyright,2005, Consortium for Children,All Rights Reserved CRIMINAL/CHILD ABUSE RECORD The required criminal record and Child Abuse Index checks were completed for Karen Thyme(Kronos). Criminal History Repository:None CANS:None Other findings: Dissolution of Marriage was confirmed.No other offenses were noted. EMERGENCY CARE PLAN At the present time,there is no one in the immediate family who would be able to take care of Justin in the event of an illness or injury to Karen. CONTACT WITH FAMILY OF ORIGIN AND SIGNIFICANT OTHERS Justin's mother has not had any contact with him for the past year. Karen is open to contact with Justin's biological mother,however,his mother has not made any contact with him. Justin has contact with his aunts,uncles,and cousins. REFERENCES All references were received. References indicated that Karen is prepared to take on the responsibility of her grandson. One of her references expresses concern over the level of supervision she would provide to Justin. However, it is important to note that Karen has followed through with seeking out treatment, counseling and resources for Justin in the past. The fact that she has demonstrated a willingness to seek out these resources,make it likely that she would continue to seek out appropriate resources in the future. FAMILY PREPARATION AND TRAINING ACTIVITIES Karen is presently involved in foster parent training. In addition, she has been involved in family therapy with Justin for the past year. Collateral information indicates that she is an active participant who is able to follow through with suggestions. LEGAL/FINACIAL RIGHTS AND RESPONSIBILITIES Karen Thyme(Kronos)has been provided with information concerning the different roles,responsibilities, legal and financial rights and benefits of relative/fictive kin caregivers, foster parents,Legal Guardians and adoptive parents. Also, should she file a petition to adopt, Karen Thyme (Kronos)understand that she will be accepting full legal and financial parental responsibility for Justin Thyme once an adoption is finalized. The agency's grievance review hearing procedures were explained to the Applicant. Structured Analysis Family Evaluation(SAFE)Colorado Single Child Specific Home Study Report-Version 09-14-2005 Page 4 of 8 Copyright,2005, Consortium for Children, All Rights Reserved PSYCHOSOCIAL INVENTORY RESULTS NOTE: Below is a list of the psychosocial factors found on the SAFE Psychosocial Inventory. Using the Psychosocial Inventory, each factor was considered and rated several times by the social worker during the course of this home study. The ratings below represent the final ratings. The ratings are defined as follows: I = an exceptional strength, 2 =a strength, 3 = an issue of concern, 4 = a major issue of concern and 5 = very serious problem. The OVERALL EVALUATION OF SECTION ratings reflect the degree to which all issues of concern identified in the section were either resolved,mitigated or the prognosis for change.HISTORY PHYSICAL/SOCIAL ENVIRONMENT 2 Childhood Family Adaptability 2 Cleanliness/Orderliness/Maintenance 2 Childhood Family Cohesion 2 Safety 2 Childhood History of Deprivation/Trauma 2 Furnishings 2 Childhood History of Victimization 2 Play Area/Equipment/Clothing 3 Adult History of Victimization/Trauma 2 Finances 2 History of Child Abuse/Neglect 2 Support System 2 History of Alcohol/Drug Use 2 Household Pets 2 History of Crime/Arrest/AllegationsNiolence 2 OVERALL EVALUATION OF SECTION 2 Psychiatric History 2 Occupational History GENERAL PARENTING 4 Marriage/Domestic Partner History 2 Child Development 2 OVERALL EVALUATION OF SECTION 2 Parenting Style 2 Disciplinary Methods PERSONAL CHARACTERISTICS 2 Child Supervision 2 Communication 2 Learning Experiences 2 Commitment and Responsibility 2 Parental Role 2 Problem Solving 2 Child Interactions 2 Interpersonal Relations 2 Communication with Child 2 Health and Physical Stamina 2 Basic Care 2 Self-esteem 2 Child's Play 2 Acceptance of Differences 2 OVERALL EVALUATION OF SECTION 2 Coping Skills 2 Impulse Control SPECIALIZED PARENTING 2 Mood 2 Expectations 2 Anger Management and Resolution 2 Effects of Abuse/Neglect 2 Judgment 2 Effects of Sexual Abuse 2 Adaptability 2 Effects of Separation and Loss 2 OVERALL EVALUATION OF SECTION 2 Structure 2 Therapeutic/Educational Resources SONS/DAUGHTERS/OTHERS RESIDING 2 Birth Sibling Relationships OR FREQUENTLY IN HOME 2 Child Background Information 2 Minor Sons and Daughters 2 Birth Parent Issues 2 Minors Residing or Frequently in the Home 2 OVERALL EVALUATION OF SECTION 2 Adult Sons and Daughters 2 Adults Residing or Frequently in the Home ADOPTION ISSUES 2 OVERALL EVALUATION OF SECTION 2 Infertility 2 Telling Child about Adoption EXTENDED FAMILY RELATIONSHIPS 2 Openness in Adoption 3 Extended Family Cohesion 2 Adoptive Parent Status 2 Extended Family Adaptability 2 OVERALL EVALUATION OF SECTION 2 Relationship with own Extended Family 2 Relationship with Spouse's/Partner's Family 3 OVERALL EVALUATION OF SECTION Structured Analysis Family Evaluation(SAFE)Colorado Single Child Specific Home Study Report-Version 09-14-2005 Page 5 of 8 Copyright,2005, Consortium for Children,All Rights Reserved •PSYCHOSOCIAL EVALUATION REPORT HISTORY Karen grew up in Minnesota.Her parents were married until their deaths. She described her childhood as happy and free of abuse. As an adult, Karen was involved in an abusive relationship with her ex-husband. He was physically abusive towards her and sexually abused her son. Karen did not know about the abuse until years after the relationship ended. Shortly after she learned about the abuse of her son, her ex-husband died. Karen is not presently involved in a relationship. PERSONAL CHARACTERISTICS Karen is an outgoing individual. She appears open and honest. She approached problem solving in a step-by-step manner. Karen is a disabled worker. She reportedly injured her lower back at work 10 years ago and received disability. She has some numbness in her legs. However, she enjoys working out and remaining active. In spite of this injury, it does not appear to get in Karen's way of enjoying life. Karen takes pain medication as needed to control her pain. SONS/DAUGHTERS/OTHERS RESIDING OR FREQUENTLY IN THE HOME Stan Smith-Stan works as a financial planner for a large agency.Brian is married and has two adolescent children. His wife is a homemaker. He and his family live in Denver,CO. He and his family see Karen and Justin on a regular basis. Veronica -Veronica is married and has two children. She presently works as a physician's assistant.Veronica's husband is a high school teacher. The family actively participates in church activities. Desiree-Desiree is Justin's mother. She lives in New Mexico and has had no contact with Justin for one years. She has three other children. She has a conflictual relationship with her mother. Michael Tyme - Michael is married and has two children. He lives in Greeley and sees his mother regularly. He works as a mechanic at a car dealership. Justin Tyme—Justin has been living with his grandmother since November 30, 2005. He appears to have adjusted well. He continues to attend school at the residential treatment facility. Justin is involved with the youth group at church twice a week and Boy Scouts. Justin is a likeable young man. He enjoys outdoor activities and sports such as soccer and baseball.Justin has lived with his grandmother in the past and appears to be comfortable with her and their home.Justin has a history of physical aggression towards other children. He needs a high level of supervision. In addition,he needs consistent therapy. EXTENDED FAMILY RELATIONSHIPS Desiree has not had any contact with Justin for the past year. She appears to have a conflictual relationship with Karen. Because parental rights have not been terminated, Desiree continues to have some legal rights in regards to Justin's care. This is a source of conflict. For example; Karen wanted to have Justin join the Boy Scouts. The caseworker called Desiree to notify her. Desiree apparently called a number of family members to have them interfere with Justin joining the Boy Scouts. While Desiree motives are unclear, it would appear to be in Justin's best interest to have Karen in charge of parental decision-making to enable her to make such decisions without the interference of Desiree. PHYSICAL/SOCIAL ENVIRONMENT The house is a 3-bedroom, 2 bath ranch style home in a quiet residential street in Greeley. There is a garage and a fenced yard. The home was neat and tidy. Justin has a spacious room with a twin bed. He has a TV in his room as well as a video game system. Karen has her own bedroom. Structured Analysis Family Evaluation(SAFE)Colorado Single Child Specific Home Study Report-Version 09-14-2005 Page 6 of 8 Copyright,2005, Consortium for Children,All Rights Reserved GENERAL PARENTING Karen has implemented a discipline system similar to the one that was used at Justin's RTC. This appears to work well for him. In addition, she uses taking away of privileges. This appears to be a positive mix. SPECIALIZED PARENTING Karen is presently enrolled in foster parent courses. In addition, she participates in weekly therapy with Justin to discuss any behavioral issues. ADOPTION ISSUES Karen is committed to raising her grandson until he is an adult. PSYCHOSOCIAL EVALUATION CONCLUSIONS Karen is an outgoing woman who appears capable of raising Justin. She is motivated to keep Justin connected with works only part-time outside of the home at a flower shop during school hours and this In addition, she o his family. - allows her to provide him with a high level of supervision.Karen is very aware of Justin's Issues. She is cognizant of his supervision needs. In addition she notified her neighbors of Justin's return to the house, another example of the fact that she is proactive in providing his care. Justin is involved with activities at his church, which is another example of Karen's commitment. Finally, Karen continues to transport Justin to two different therapists.. Justin is presently involved in day treatment program. It would seem crucial that this continue over the summer in order to keep Justin engaged in positive activities. Karen's relationship with Desiree appears to be conflictual. Desiree appears to interfere with Karen's decision making regarding Justin even though she has had no contact with him in one year. It would appear to be in Justin's best interest to have Karen be appointed as legally responsible for decision-making,thereby reducing the conflict in this relationship. PLACEMENT COMPATABILITY Justin appears to fit well into Karen's household. He appears to be comfortable in the home. In addition, she is able to provide the high level of supervision that he needs. RECOMMENDATION It is recommended that Karen Thyme(Kronos)be approved as relative caregivers for the placement of Justin Thyme. Caseworker Supervisor Title Title Date: -ad- Q( t Date OI a'a" p Additional Attachments Indicate "None"or list additional attachments. RECEIPT OF COPY OF HOME STUDY REPORT C) By signing below I acknowledge that I received a copy of this report. /'�5 Y Structured Analysis Family Evaluation(SAFE)Colorado Single Child Specific Home Study Report-Version 09-14-2005 Page 7 of 8 Copyright,2005, Consortium for Children,All Rights Reserved WELD COUNTY AUTHORIZATION FOR CONTRACTUAL SERVICES Date: _02/28/06 Provider: Transitions Psychology Group, LLC Billing Contact: Karel Longan Phone #: 970-336-1123 Address: 804 11EAvenue, Greeley, CO 80631 Description of Services: Home Study Program Service Month / Year 02/06 Charges: $_3785.00 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 SERVICES. s_crand tpa l 1 / 7/1166 Printed tkame of Signer ovidergnature 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 Transitions Psychology Group, LLC Invoice 804 11th Avenue Date Invoice# Greeley, CO 80631 Y 2/28/2006 441 Bill To WCDSS-Home Study PO Box A Greeley,CO 80632 Due Date 3/31/2006 Family Name REF# HH# Qty Item Rate Amount Barron,Ray 05-255 5555 1 HS-FuII06 1,200 00 1,200.00 Magnum.Thomas 05-256 5525 1 HS-Update06 785.00 I 785.00 Ball,Lucy 05-258 11115 1 HS-FuIl06 1,200.00 1,200.00 Howell.Maryann 05-Ill 54566 5 HS Hourly 120.00 I 600.00 EC /` ( Total $3,785.00 0 a) o o t- g a at v oM �, U6 a - 'a •U ' v Q, U c3 k rn C/) Cn S. x — 15 W U v' a. cis71, .. U = N O W .� o ..:,, c/] w ,O >, Q, © O1 o ›, ° ° U W el VVi E j DZ m v) ›.a1 g Q ^v �" W p XOM 00 V N L O 5 x oA � a � :9 - o W crs o © 30 - U � v x a Fs. E. o .� 2 z � O • a; Z o H >, c) O V 'as-. a O Z O M Tz >, oCh a c o 2E° ri N 'C:1 V N zawc � w ao C � aio °' 0 0 0 o x a a " o O �" Q -. p 'c• O O A co G e� L,' (S] Cd A. P� N "- ~ W Lr. 8 - •.• z a - O w Q � O 0 c4 z vac a, 4 A � z N C72. o 0. U o ,.Oo .o \C W ,tu V F 0 O O o C = b O, .••+ k 1 kr, N •- t) o U Q.) a U A 0 N O 0 p c aZ t% , V o a 73 U Q a4 3 O •> x w a? R, v : o x U = cf) V -o r -� ,4 � � o F y — c '� �, m p;' O ,r, c.-1 U ° 0./ R.• ir: �; �3 Z A a p., n v v) a.) •� a, .- -E �. z a) .t3 z - N . O cu H = x � c rl) aQ, 04' 03/28/2006 12:.47 FAX 970 346 7690 GREELEV/WELD HSG AUTH a 002/002 ii4OREELEWELD HOUSY/ING AUTHORITIES Irign315 N. 11 th Avenue, Bldg. B P.O. $ox130 16 Greeley, Colorado 80632-0130 (970) 346-7660 (970) 346-7690 Pax March 28, 2006 (800) 659-2656 TTY Relay Gregory S. Creed, MA,LPC Transitions Psychology Group, LLC 804 1lfti Avenue Greeley, CO 80631 Dear Mr. Creed: As a Housing Authority we would be glad to accept any appropriate referrals for clients needing our services from Transitions. 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, ()Ce. - - 17:4:7767-:7"1 Thomas Teixeira Executive Director ORIGINAL (lit DEPARTMENT OF HUMAN SERVICES EMPLOYMENT SERVICES OF WELD COUNTY 1551 NORTH 17TH AVENUE PO BOX 1805 AVENUE GREELEY, CO 80632 (970)353-3800 VilkFAX(970) 356-3975 COLORADO March 21, 2006 Transitions Psychology Group, LLC Employment Services of Weld County is providing you this letter outlining the areas of collaboration when a client you serve under CORE service funds is identified as having an employment need. The collaborative areas were developed from your responses concerning the parameters you felt were practical, based upon the services you intend to provide. Transitions Psychology Group, LLC currently collaborates extensively with Employment Services of Weld County (ESWC) in serving Temporary Assistance for Needy Families (TANF) participants. The Transitions Psychology Group, LLC is proposing a variety of services which include Mental Health services to provide both Psychological and Mental Health evaluations, and Life Skills services which include Therapeutic Visitation and Life Skills Coaching to work with parents to increase the parents' ability to provide appropriate care to their children. It is unknown if these services will have a direct relationship to employment, however, the following outlines the plan for referrals when, or if, they arise: Case management: The Transitions Psychology Group, LLC agrees to provide case management for families that may require the parent to seek employment. For these individuals, the Transitions Psychology Group, LLC agrees to make a referral to Employment Services of Weld County. Referral process: For individuals identified as having employment needs, the Transitions Psychology Group, LLC will refer the client to Employment Services of Weld County and will send an email to Employment Services, under the attention of Linda Perez, stating that the client was referred. The Transitions Psychology Group, LLC agrees to forward the email within five business days of making the referral. Follow up: The Transitions Psychology Group, LLC will email a follow-up concerning the referral made to Employment Services of Weld County 10 business days after sending the initial email. Employment Services of Weld County will email the Transitions Psychology Group, LLC if the client does not contact us, and the Transitions Psychology Group, LLC agrees to discuss the matter with the client at their next visit. The Transitions Psychology Group, LLC will provide a written email of that discussion to the attention of Linda Perez within five business days. Cross trainingi As new staff come to the Transitions Psychology Group, LLC they will be made aware of this collaborative arrangement and will be provided training concerning the employment and training services offered by Employment Services of Weld County. Other collaborative areas: At this time there are no additional collaborative efforts with Employment Services. As additional areas of collaboration arise, the '• ' '' ` " `" ` ' `"=ilics Transitions Psychology Group, LLC agrees to include them in the Memorandum of Understanding discussions to be completed by February 1, 2007. Employment Services will meet with representatives of the Transitions Psychology Group, LLC in July 2006 to initiate the collaborative Memorandum of Understanding process once bids for CORE services are completed and accepted. Sincerely, Linda L. Perez Director Employment Services of Weld County OR/GINA L • r Y North Range Behavioral Health March 29, 2006 Jami Moe-Hartman Transitions Psychology Group 804 11th Avenue Greeley, CO 80631 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 Transitions Psychology Group 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 Transitions Psychology Group 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 Transitions Psychology Group to determine which services are benefits of the Medicaid Mental Health program and to facilitate a process through which Transitions Psychology Group can be compensated with Medicaid funds when services provided are a benefit of Medicaid. Sincerely, Wayne A. Maxwell, Ph.D. Executive Director Mission: North Range Behavioral Health provides professional, ORIGINAL culturally competent mental hea/th services for Weld County. 1306 11th Vvenue/(1r)dec,CO 80631 /(970)34741130/Pas(970)333-3906 Healthcare Providers Service CNA Organization a Purchasing g Group y� VIHPSO CNA Plaza, (CertifiCatr of r'�lnsura��r lr..la..ls.....oti..,,.,�- Chicago,IL 60685 L OCCURRENCE POLICY FORM Producer Branch Prefix Policy Number Policy Period from: 12:01 AM Standard Time on: 07/04/05 018098 970 HPG 270170686-8 to: 12:01 AM Standard Time on: 07/04/06 Named Insured and Address Program Administrator Healthcare Providers Service Organization GREGORY S CREED 159 East County Line Road 804 11TH AVE Hatboro, PA 19040-1218 GREELEY CO 80631-3246 Medical Specialty: Code: Insurance Provided by Clinical Counselor/LPCC 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, IL 60685 COVERAGE PARTS LIMITS OF LIABILITY A. PROFESSIONAL LIABILITY • Professional Liability $1,000,000.00 each claim $6,000,000.00 aggregate Good Samaritan Liability Included above Personal Injury Liability Included above Malplacement Liability Included above B. Coverage Extensions License Protection $10 ,000.00 per proceeding $25,000.00 aggregate Defendant Expense Benefit $10,000.00 aggregate Deposition Representation $2,500.00 per deposition $5,000.00 aggregate Assault $10,000.00 per incident $25,000.00 aggregate Medical Payments $2,000.00 per person $100,000.00 aggregate First Aid $2,500.00 aggregate Damage to Property of Others $500.00 per incident $10,000.00 aggregate C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part I). is made part of this policy. Workplace Liability Included in A. Professional Liability Limit shown above Fire and Water Legal Liability Included above subject to $150,000 sub-limit Personal Liability 1 $1,000,000.00 aggregate D. GENERAL LIABILITY Coverage parr D. does riot apply if Coverage part C. is made part of this policy. Workplace Liability None I None Hired Auto & Non Owned Auto None Fire & Water Legal Liability None None Personal Liability 1 None Total Premium $330.00 Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 G-121500C G-121501C G-121503C G-145184-A G-147292-A G-144872-A G-123846C-05 Healthcare Providers Service Organization is a division of Affinity Insurance Services,Inc.,in NY and NH.AIS Affinity Insurance Agency,in MN and OK,AIS Affinity Insurance Agency.Inc.;and in CA.AIS Affinity Insurance Agency,Inc.dba Ann Direct Insurance Administrators License sJ795465. Master Policy: 188711433 Keep this document in a safe place. This and 6/Y1°4 \ 7/ n I (f'li 1�`�` your cancelled check act as proof of coverage. Chairman of the Boar Secretary t 604 XX 0000098—R 050321 RENHCP 1/05 R1C3HN 05080 ' Healthcare Providers Service CNA ► Organization Purchasing Group ®HPSO Chicago CNA aza I ,60685 i e.L t`+ `ca t o of J U s U L a.0 rC MrohhurlProrld. OCCURRENCE POLICY FORM Producer Branch Prefix ' Policy Number Policy Period from: 12:01 AM Standard Time on: 07/04/05 018098 970 _ HPG 270170798-8 to: 12:01 AM Standard Time on: 07/04/06 Named Insured and Address Program Administrator Healthcare Providers Service Organization JAMI MOE HARTMAN 159 East County Line Road 804 11TH AVE Hatboro, PA 19040-1218 GREELEY CO 80631-3246 Medical Specialty: Code: Insurance Provided by Clinical Counselor/LPCC 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, IL 60685 COVERAGE PARTS LIMITS OF LIABILITY A. PROFESSIONAL LIABILITY Professional Liability $1,000,000.00 each claim $6,000,000.00 aggregate Good Samaritan Liability Included above Personal Injury Liability Included above Malplacement Liability Included above B. Coverage Extensions License Protection $10,000.00 per proceeding $25,000.00 aggregate Defendant Expense Benefit $10,000.00 aggregate Deposition Representation $2,500.00 per deposition $5,000.00 aggregate Assault $10,000.00 per incident $25,000.00 aggregate Medical Payments $2,000.00 per person $100,000.00 aggregate First Aid $2,500.00 aggregate Damage to Property of Others $500.00 per incident $10,000.00 aggregate C. WORKPLACE LIABILITY Coverage part C. dues not apply if Coverage part D. is made part of this policy. Workplace Liability Included in A. Professional Liability Limit shown above Fire and Water Legal Liability Included above subject to $150,000 sub-limit Personal Liability I $1,000,000.00 aggregate D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy. Workplace Livbi R lity t None None Hired Auto & Non Owned Auto None Fire & Water Legal Liability None None Personal Liability I None Total Premium $330.00 Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 G-121500C G-121501C G-121503C G-145184—A G-147292—A G-144872—A G-123846C-05 Healthcare Providers Service Organization is a division of Affinity Insurance Services,Inc;in NY and NIL AIS Affinity Insurance Agency;in MN and OK,AIS Affinity insurance Agency,Inc.:and in CA,AIS Affinity Insurance Agency,Inc dba Aon Direct Insurance AdtniruitrAors License 50795465. Master Policy: 188711433 1)1(4Lt..... /1 „ ` _ Keep this document in a safe place. This and 1 JV�_,44......\. your cancelled check act as proof of coverage. 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U 0 h z,N N`.M1^q P .e r _ »�� M ��A'.1 w q er5 Y W fQ C 46 > 6 IN— 8 8 s ,,,,. i o a 2 7 ce a W a Lu Ea W N 6 6- {/ FYM" Bk 0. 0 ) an. 6 0 > K Y 1 .F/ "°S 0 F K 0 Hy� ! Rf 2 N W > y e a Abe N 0 0 0 QO 6 EE �„ F.Y'Abe ,,s, J - '�4 E Ni < w 0 � w Q o ] O 0 W z W 0 = P 3 0 z > w C R o ¢ 0 J J 2 O rmv' 6�ni J Q m 0 0 _ • • 804111°Avenue FAX v .0 Greeley, CO 80631 Phone(970)338-1123 • •' r, _ FAX(970851-0182 w+Y11/S 4 Transitions nwmomacrommtue TO: Gloria Romansik FAX# 346-7698 FROM: Jami Moe-Hartman, MA, LPC DATE: 05/19/06 RE: Bids PAGES: 3 COMMENTS: CONFIDENTIAL The information contained in this facsimile message is privileged and confidential information intended for the use of the individual or entity named above. If the reader of this message is not the Intended recipient or the employee or agent responsible to delver it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this fax in error, please immediately notify us by telephone and return the original message to us at the above address via the U.S. Postal Service. Thank you. TO 39t1d Z8T0TSE TT:ST 900Z/6T/S0 •• • ii 80411"'Avenue • s i 0 y r Greeley, CO 80631 Y •e• - ' ', Tel.(970)336-1123 r® �• T •+ ,,r FAX (970)351-0182 OS Transitions PrttliPACICY=KIP-MC May 18, 2006 Gloria Romansik, Social Services Administrator Weld County Department of Social Services PO Box A Greeley, CO 80632 RE: Bid # 06LS15 (RFP 05005) Lifeskills Bid # 06FPC09 (RFP 006-00A) Foster Parent Consultation Bid # 06HS07 (006-008) Home Study, Relinquishment Counseling Bid # 06MH07 (RFP 006-00) Mental Health Services Dear Ms. Romansik, I am writing in response to Judy Griego's letter concerning the Bid process for PY 2006-2007. Thank you for sending the results of the process; it was helpful to see our bid scores this year. A. Bid # 06MH07 (RFP 006-00) Mental Health Services Transitions agrees to work with the Weld County DSS Business Office to set the rate per episode for completed evaluations. Psychological Evaluation and Assessment Services for Children. Adolescents and Adults: These services will be provided by a licensed eligible psychologist with a PhD who is supervised by a licensed psychologist, or by a licensed psychologist. The billing rate is $282.38/face-to-face client hour. A typical psychological evaluation ranges form 4-6 hours of direct service time. Clients sign a verification form for this timo and Transitions bills it at the hourly rate; test materials, scoring, analysis, collateral contacts, case management and report writing time are not billed. The average rate for a completed evaluation will be $1270.71 Mental Health Evaluations: These services require a minimum of masters degree in the human services field, a minimum of five years' Z0 3Jtld Z8T0T9E TT:9T 900Z/6T/90 experience, and a mental health license (e.g. Licensed Professional Counselor, Licensed Clini al Social Worker, etc). The Mental Health evaluations are billed at a�flat rate of$212.50 per evaluation. This is based on an hourly rate of$106.25 for face-to-face client contact. B. Transitions Psychology Group, LLC accept the recommendations as written by the FYC Commission. The Terms and Conditions on the Bid and NOFAA act as a cover sheet to Transitions' written bids. Transitions adheres to all he Terms and Conditions. Transitions accepts all of the conditi ns and recommendations set forth in the Department of Social Services letter�dated May 15, 2006. Transitions will include this letter and the letter received from the Department as addendums to our bids. Transitions confirms that it will provi �e the services delineated in Bid #06LS15, #U Bid UFPC09, Bid #06HS07, and id #06MH07. If you have any questions about our esponses to the condition and recommendations on the bid, please let us know. We would be more than happy to discuss them with you. Thank yov for your consideration. Sincerely, 1O---C----vi pc- Jami Moe-Hartman, MA, LPC Co-Director Transitions Psychology Group, LLC I I E0 39Vd ZBTOTSE TI:ST 9003/61/90 • DEPARTMENT OF SOCIAL SERVICES A P.O. BOX GREELEY,CO. OX80632A Website:www.co.weld.co.us ' Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 111 C COLORADO May 15,2006 Jami Moe-Hartman, Co-owner Transitions Psychology Group, LLC 804 11 Avenue Greeley,CO 80631 Re: Bid#06LS15 (RFP 05005)Lifeskills Bid#06FPC09(RFP 006-00A)Foster Parent Consultation Bid#06HS07 (006-00B)Home Study, Relinquishment Counseling Bid#06MH07 (RFP 006-00)Mental Health Services Dear Ms. Moe-Hartman: The purpose of this letter is to outline the results of the Bid process for PY 2006-2007 and to request written confirmation from you by Monday, May 22, 2006. A. Results of the Bid Process for PY 2006-2007 • The Families, Youth and Children(FYC) Commission recommended approval of your Bid#06LS14 (RFP#06005), Lifeskills, for inclusion on our vendor list. Your bid scored a total of 98 points out of 100. • The Families, Youth and Children(FYC) Commission recommended approval of your Bid# 06FPC09 (RPF 006-00A), Foster Parent Consultation, for inclusion on our vendor list. Your bid scored a total of 100 points. • The Families, Youth and Children(FYC) Commission recommended approval of Bid #0611S07, (RFP 006-00B),Home Studies and Relinquishment Counseling, for inclusion on our vendor list. Your bid scored 87 points. • The Families, Youth and Children (FYC) Commission recommended approval Bid #06MH07 (RFP 006-00) Mental Health Services for inclusion on our vendor list. Your bid scored 98 points. The FYC Commission attached the following conditions and recommendations to your bid. Condition: The bidder will work with the Weld County DSS Business Office to set a rate per episode for completed evaluations. Recommendation: You must clarify the level of expertise or credentials of the staff person who is providing each service. Page 2 Transitions Psychology Group/Results of RFP Process for 2006-2007 B. Required Response by FYC Bidders Concerning FYC Commission Conditions and Recommendations: Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the condition,you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. 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 conditions and 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 at 352.1551, extension 6230. Sincerely, j) ot L Vl y A.yrnego, +1.1or ' cc: Juan Lopez, Chair, FYC Commission Gloria Romansik, Social Services Administrator Weld County Department of Social Services Notification of Financial Assistance Award for Child Welfare Regular Administration Type of Action Contract Award No. X Initial Award 06-CPS-31 Revision (RFP-006-00B; 06HS03) Contract Award Period Name and Address of Contractor Beginning 06/01/2006 and Julie Box,Private Practice. Ending 05/31/2007 Home Studies,Updates, Relinquishment Counseling 1702 68`"Avenue Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Home study format is based on 20 hours of Assistance Award is based upon your Request for work.Relinquishment counseling for a Proposal (RFP). The RFP specifies the scope of maximum of 4 hours per parent. Program services and conditions of award. Except where it is capacity is 67 home studies or updates per year in conflict with this NOFAA in which case the and 24 individuals receiving relinquishment NOFAA governs,the RFP upon which this award is counseling per year.The average stay is based is an integral part of the action. expected to be 6 weeks for a home study, and Special conditions two weeks for each parent in relinquishment 1) Reimbursement for the Unit of Service will be based counseling. Bilingual-bicultural services on a rate per home study; home study update, and available through subcontract. relinquishment counseling session. 2) Reimbursement requests must be an original with an Cost Per Unit of Service original signature from the provider and/or designee. Hourly Rate per Relinquishment Counseling $103.89 3) Reimbursements requests must include the date the Full Home Study with Background Check * $850.00 home study, update, or relinquishment counseling was Full Home Study(No Background Check)* $750.00 completed.The request must reflect the referral Updated Home Study $425.00 number assigned to each home study, the amount Home Study(3.5 Hour Minimum Direct Face- billed for each home study, and the month the service to-Face Contact)Cancellation by DSS $225.00 was provided. Additional Fee per Additional Adults in 4) Payment will only be remitted on referrals made by Household per Home Study * $250.00 the Weld County Depatturent of Social Services. 5) Requests for payment must be an original submitted to the Weld County Department of Social Services by the end of the 25th calendar day following the end Enclosures: of the month of service.The provider must submit X Signed RFP:Exhibit A requests for payment on forms approved by Weld Supplemental Narrative to RFP: Exhibit B County Department of Social Services. Recommendation(s) 6) The Contractor will notify the Department of any Conditions of Approval changes in staff at the time of the change. Appro a • Program Official: A By C J By _,_Davthd E. Long, Chair ro Tem Judy rie o Directo Board of Weld Cn„ntv-ac normesi ers Weld ty epartment of Social Services Date: June 19, 2006 Date: 6/ IIoc o?O ' -1.597 (O 4-LS C`J s t SIGNED RFP-EXHIBIT A INVITATION TO BID OFF SYSTEM BID 001-06 (06005-06011 and 006-00, A, B , & C DATE:March 1, 2006 Bid No. RFP-FYC 006-00B 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 006-00B) for: Adoption. Foster Care, and Expedited Permanency Planning Home Studies, and Relinquishment Counseling Deadline: March 31, 2006, Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to Weld County Social Services, announces that competing applications will be accepted for approved providers pursuant to the Board of Weld County Commissioners' authority under Colorado Statute and the Weld County Home Rule Charter. 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 home studies, home study updates, and relinquishment counseling services. The County will authorize approved providers and rates for services only. The adoption, foster care, and child welfare home studies, updates, and relinquishment counseling program must provide services that are in compliance with the uniform format utilized by the State of Colorado Department of Human Services. 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 Jtie � ax TYPED OR PRINTED SIGNATURE VENDOR C7 ?J (Name) Hatuiwnttcy Signature By Authorized Officer or Agent of Vender ADDRESS L"-1 D Z. Cc $"0L` . TITLE L CC Ai i za4 C, 1 rac-1z'Lf G-•rrelr1 , CO 20v.3 DATE d3. 72.0k. PHONE# q 3eZ . 1`111 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 39 '•Bid No. 001-06 RFP-FYC COMMISSION-006-00B Attached A ' HOME STUDY, UPDATE, & RELINQUISHMENT COUNSELING BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CHILD WELFARE ADMINISTRATION FUNDING 2006-2007 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2006-2007 Bid 001-06 RFP-FYC COMMISSION-006-00B NAME OF AGENCY: �u11C R> , [.--(5%\-1 ?r,vtie Ptae}z(e ADDRESS: 1-1 OZ 6-634±k �v-e,.) (—vrrLci,w C0 ?Die 34 PHONE:(4-0 30Z . )&47 1 CONTACT PERSON: -UT-hi— lid X TITLE: Pri v-l-e Iv ccc-}-i c 1 L_(- IV DESCRIPTION OF HOME STUDY PROGRAM CATEGORY: Adoption,Foster Care,and Expedited Permanency Planning Home Studies in compliance with the uniform format utilized by the State of Colorado Social Services of Human Services since October 1, 1999(Attached A). 12-Month approximate Project Dates: l2-month contract with actual time lines of: Start June I,2006 Start Twee o 1, 2001, End May 31,2007 End AA" 31, 2007 TITLE OF PROJECT: Ade ph 6-,-n Fo sle r CccvC—, AAA xi)t dcl-rci I e Uvv o k“wA' 17L in..v.i Yy E--cvtt S4�� ^�5 03 12_.0 C, Name an of Person Preparing Document` Date 1 (93 , vz •ob Nam and Sign ture Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For new and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. c_ Project Description Sample Home Study ,11,3 Target/Eligibility Populations General Indicates Cultural/Eligibility Populations Types of services provided Measurable Outcomes ,?, Service Objectives Workload Standards 1Staff Qualifications ) Unit of Service Rate Computation Billing Process Program Capacity per Month Certificate of Insurance Page "4 of 19 03/17/2006 FRI 15:22 FAX ®002/004 •� ',' 00 Seep' Bid 001-06(RFP-FYCuW07) Attached A Date of Meetings)with Social Services Division Supervisor: egars Connnents by SSD Supervisor: e7t / ±t4=z,zr cespats$60.2.4 at- Aral den seta)` s ✓e' , ' , 617_P 1 /(rne2 e� as•esseaa• • 0 7:4 iseadiev, #A410114.1 147r9C-24 Anagri rpt ja,41,4 ta204-1. IF Are)" -67,„ • Nara and Signature of ate Date Page 30 of 41 , June 2006 Off-System Bid 001-06 (06005-06011 and 006-00, A, B, &C) Bid No. RFP-FYC 006-006 Adoption, Foster Care, and Expedited Permanency Planning Home Studies and Relinquishment Counseling Julie Box, LCSW Private Practice I. PROJECT DESCRIPTION Julie Box(Bidder) is a Licensed Clinical Social Worker offering a wide range of services to children, families and adults. Bidder has been providing human services to the Northern Colorado area since 1986. During the past 20 years, Bidder has provided services as a counselor, a caseworker and a therapist in the field of child welfare. Bidder has provided services to all individuals without consideration of religious beliefs, race, ethnicity, sex or economic status. From 2001 through 2004, Bidder provided home studies and relinquishment counseling services to the Weld County Department of Social Services through this Bidder's previous employer, Lutheran Family Services, a non-profit agency. Bidder has been providing these same services for the Weld County Department of Social Services through contractual services as a Private Practitioner since June of 2004. Bidder uses the Structured Analysis Family Evaluation (SAFE) inventory completed by the Consortium for Children in October of 2005. A written, narrative home study will be provided to the Weld County Department of Social Services. Bidder is currently on the state vendor list for adoptive home study providers. Additionally, Bidder has the experience and expertise to provide relinquishment counseling in a timely fashion. II. SAMPLE HOME STUDY A sample home study is attached to this proposal. III. TARGET/ELIGIBILITY POPULATIONS: The population to be served under this contract includes: families who wish to adopt children from the Weld County Department of Social Services; relinquishment counseling for parents who are considering relinquishing children, applicants for foster care certification and children identified as expedited permanency planning. Bidder has been providing home study services to Weld County for the past five years and has never turned down a referral. At 20 hours per home study, Bidder would be able to complete 5 home studies per month. Home studies are given ten hours of direct service and ten hours indirect service. Bidder is cross-trained to provide a variety of clinical services including therapy, clinical case management, relinquishment counseling or home studies. The following numbers reflect a caseload of 5 home studies per month: A. Total Number of Clients to be served: Each home study is 'worth'20 hours and will be spread over a six-week period of time. Bidder estimates she could complete 67 home studies per year. Relinquishment counseling will be provided on an hourly basis. Bidder estimates the relinquishment counseling takes an average of four hours of direct service per person. Bidder estimates she could counsel 24 individuals per year. B. Total Individual clients and the children's ages. The number of individuals and ages of children is completely dependent on the demographics of the families referred for services. Bidder does not limit services to families with children of specific ages. C. Total family units. Bidder estimates she could complete 67 home studies per year. D. Subtotal of individuals who will receive bicultural/bilingual services Unfortunately, Bidder is not bilingual; however, Bidder would be able to contract with a qualified Spanish speaking clinician to complete home studies as referred. Bidder would not refuse any bicultural services. E. Subtotal of individuals who will receive services in South Weld County. Bidder does not limit her services to specific geographical areas so Bidder will provide services in the Southern part of Weld County as they are referred. F. Subtotal of individuals who will have access to 24-hour service. Bidder provides all applicants with her cell phone number. She is available 24-hours per day, 7 days per week G. The monthly maximum program capacity. Bidder estimates she could complete 5 home studies every month. H. The monthly average capacity. Bidder estimates she can manage the volume of home studies as Bidder has done so the past five years. At the present rate of referral, Bidder would plan to complete 3 home studies per month. I. Average stay in the program (weeks) Bidder's goal is to complete home studies within six weeks of implementation of the home study. Bidder is estimating that relinquishment counseling averages 2 weeks. J. Average hours per week in the program. Families who are having a home study completed will average 2-3 hours of direct service per week, for 4 weeks. Individuals receiving relinquishment-counseling services will average 2 hours per week of direct service. IV. TYPES OF SERVICES TO BE PROVIDED Adoption and Foster Care Home Studies Bidder uses the Structured Analysis Family Evaluation (SAFE) protocol developed by the Consortium for Children. This is the format that was taught in state sponsored training in Greeley, Colorado, on October 10 and 11, 2005. That format is the format used in the fictitious home study submitted with this bid. A narrative home study is produced using the SAFE protocol. These home studies are 'adoptive quality' and meet the state prescribed format. There is no difference between adoption, foster care or kinship care home studies. Bidder is currently on the state vendor list for adoptive home study providers. Home study updates will be completed using the SAFE protocol and there will be a reduced fee charged. Bidder will complete the following background checks unless otherwise indicated on the referral: 1 Fingerprints sent to CBI on Weld County Department of Social Services fingerprint cards, results will be returned directly by CBI to the Weld County DSS. Bidder will collect and submit the fingerprint cards after the Weld County Department of Social Services has distributed the cards. Bidder will cover the fee for the submission of these cards. If the applicant has lived in the state for less than two years, an FBI search will be requested. Bidder will cover this additional fee. 2 Department of Motor Vehicles (results retumed to Bidder). 3 Local county DSS search for open or past cases (results retumed to Bidder). 4 Four reference questionnaires will be sent out with a SAFE reference questionnaire (results returned to Bidder). 5 Local police department (results returned to Bidder). 6 Central Registry checks will be completed by the referring caseworker through the Trails system at the Weld County Department of Social Services. All original background check information will be forwarded to the Weld County DSS with the written home study. A copy will be retained in Bidder's files. Also included with the final home study will be the SAFE questionnaires one and two, completed by the applicants. Bidder has all of the forms and processes in place necessary to complete these background checks. Additionally, Bidder can provide a safety inspection of the home, if requested, at no additional fee to the county. Relinquishment Counseling Services Relinquishment counseling services will be provided to all adult individuals referred for this service by the Weld County Department of Social Services as well as to their children age 12 and older. Services will be provided individually and Bidder will submit a written report and the appropriate affidavits. V. MEASURABLE OUTCOMES The goal for each home study referral is to complete a comprehensive, written home study within six weeks of initiation of the home study. The outcome will be measured through timely submission of the home study to the referring caseworker. Bidder will also track the number of home studies referred that Bidder did not accept and the number of home studies referred and subsequently cancelled by the department. The SAFE protocol provides a psychosocial inventory used to measure the risk of the placement in an applicant foster family or adoption of a child in any given home. Bidder will use the psychosocial inventory to measure, evaluate and monitor outcomes of the home assessment. Relinquishment counseling referrals will be tracked and measured in the same way as home 1 studies. Bidder uses the state format to interview and assess consumers intent regarding relinquishment. VI. SERVICE OBJECTIVES The service objectives are the same as the measurable outcomes, that is: the completion of quality home studies, updates and relinquishment counseling services in a timely manner. All home studies will be completed using the state endorsed SAFE protocol. VII. WORKLOAD STANDARDS Please see the previous section "Target/Eligibility Populations°for a detailed explanation of Bidder's workload standards. In summary, Bidder intends to devote 20 hours per week to completing the home studies referred. Half of Bidder's time will be in Direct Service hours and half in Indirect Service hours. The requested minimum standards for insurance have been met and documentation provided. VIII. STAFF QUALIFICATIONS Bidder has a bachelor's degree in Psychology (BA), a Masters degree in Social Work (MSW) and is a Licensed Clinical Social Worker(LCSW) since January 21, 2003 (license number 992996). Please see the attached copy of Bidder's license. Bidder has her own private practice and is the only staff available. However, Bidder can provide a qualified professional that can translate during mediations as needed. As an LCSW, Bidder does not have a clinical supervisor. Bidder has not received mandated new caseworker training. Bidder has many years of training and experience in risk assessment. Bidder secures a minimum of 8 hours per year of continuing education training. Bidder agrees to notify the Department immediately of any change in staff at the time of change. IX. UNIT OF SERVICE RATE COMPUTATION Please refer to the attached budget for computation of direct service rate. This hourly rate is what Bidder will charge for each hour of direct service of relinquishment counseling provided. Full home study with background check: $850 Full home study without background check: $750 Updated home study: $425 Additional adults living in the home: $250 per adult. Cancellation fee, if cancelled by WCDSS, after 3.5 hours of direct, face-to-face contact: $225 Relinquishment counseling: $103.89 per hour This fee includes the background check and all necessary interviews for a two-parent family. X. BILLING PROCESS Bidder bills once the home study has been completed and the applicants have read the home study and signed. Bidder submits the bill with the completed home study with all attachments, e.g., SAFE questionnaires one and two, local background checks, the department of motor vehicle checks and four references. Bidder will submit bills using the Weld County CORE Services Program monthly request for reimbursement-PY 2006-2007, home studies, updates, and relinquishment counseling form. XI. LOWEST QUALIFIED BID Bidder provides quality home studies and relinquishment counseling in a timely manner accepting the lowest possible payment. Knowing that state and federal resources for these services are distinct, Bidder has not increased rates over the past five years. XII. PROGRAM CAPACITY BY MONTH As outlined in this proposal, Bidder's capacity is based on a direct/indirect service ratio. Bidder estimates that her monthly capacity is 5 home studies and 2 individuals needing relinquishment counseling per month. e SAFE Child Specific Home Study Report IThis home study was completed by Julie Box. LCSW to consider the placement of a specific child -or specific children with the applicants for the purpose of either relative or foster care placement. Legal Guardianship and/or I ado Lion. ' Name of Family: Jane and Bob Name Address: City: Greeley State: CO Postal Code: 80634-0(100 Home Phone: Cell Phone: APPLICATION INFORMATION The Applicants applied specifically to be considered for the placement of Sally Jones. Select One for Foster Care on: Approved for Adoption on: 2/28/2006 Home Study Application received on: 2/2/2006 APPLICANT INFORMATION _ Jane Name t Bob Name Date of Birth: 08/26/1963 E Date of Birth: 02/06/1962 Birthplace: CO Birthplace:_._._._.. CO.__.____.___------__.____._._____...-_---.__.-.._-..._._______ j Gender: ( F Gender: M Religion: Prodestant Religion: Prodestant Occupation. - Middle School Teacher Occupation_ <<Financial Controller Lanuage(s)_ lish Language(s): ` English Education: BA in English Education: ' MBA(business) Hei t: 5'8" Height: 6'3" i Weight: I I 7 Weight: L. 190 Hair: . Brown Hair: Brown Eves: 1 Blue Eyes: j Blue l Date of health questionnaire/report:_ _v Date of health questionnaire/report: I TB test results: J N/A TB test results: j N/A_ 1 MARITAL INFORMATION [ Date of Marriage: 08/11/1984 Marriage Verification: On File -1 Place of Marriage: Granada Hills, CA DATES OF CONTACT Date Individual/Couple Location 2/8/2006 Couple interview. Their home. 2 hrs. 2/14/2006 Individual with Mr. Name His home. 1.5 hrs. 2/27/2006 Individual with Mrs. Name and Son#2 Their home. 2.5 hrs. Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Specific Home Study Report -Version 09-14-2005 Page 1 of 18 Copyright,2006,Consortium for Chidren,All Rights Reserved CHILD OR YOUTH BEING CONSIDERED FOR PLACEMENT Mr. and Mrs. Name are interested in adopting Sally Jones, born July 21, 1994. Sally is an eleven-year-old, Caucasian girl currently in placement at the Littler Center in Greeley. Sally's therapist is Erika Jones. Mrs. Name reported that Sally's parental rights were terminated approximately three years ago. Sally's mother was fourteen- years-old when she had Sally. Mrs. Name stated that the Littler Center therapist told her that Sally wasn't physically or sexually abused, but the neglect was extreme. She has been diagnosed with Reactive Attachment Disorder (RAD). Mrs. Name stated that Sally takes Abilify, Concerta, and Risperdal. Mrs. Name stated that Sally could become very aggressive and hurt herself and others around her. Mrs. Name reported that Sally hadn't had any problems for a year and a half, but when she found out about the possible move to the Name's her therapist stated Sally might start acting out. When asked to describe Sally's strengths, Mrs.Name stated, "She's incredibly intelligent. She's very artistic. She's got this sense of loyalty about her. I think once she decides she can trust you she does attach. She's amazing with animals; she loves them,which is another conflict with her diagnosis. For all she's been through, she's very polite and considerate of other people. Since we've met her I've done a lot of research on RAD and some of the things she matches,but there are a lot of places where she doesn't fit the mold. She's so medicated we don't even know what's under all that. We've talked with her caseworker and her GAL who also want her off of her medication. Her therapist is a little hesitant to do that. The three of us who want her off the medication think it might be a good idea to get her off of the medications this summer. She will probably always stay on the Concerta, but the rest of it should be doable. The therapist said she's been taking this for so long her body doesn't know what it would feel like without it(medication)." Mr.Name added, "She's really good at art. She's always drawing pictures. The first night we had her she hardly said a word, but the difference between then and now is night and day „ Regarding Sally's developmental status, Mrs.Name stated, "as far as school, she's on target,but socially she's delayed. Although that has improved dramatically over the past four or five months." Mrs. Name added, "She was in a foster/adopt situation before and she essentially did everything she could to destroy the relationship and she succeeded. She's brought it up with both Bob and I and we've discussed it with her therapist, but we agree that for now she really doesn't want that(adoption)to happen." Mrs. Name reported that Sally has no contact with any of her birth family members. She stated, "They don't know where she is. It's my understanding that was the County's decision." MOTIVATION The Name's were asked to discuss their motivation in wanting to foster/adopt children. Mrs. Name replied, "Through teaching her I saw this child that had so much potential and yet it seems like she just needs a break. She's never had anything in her entire life that would be supportive and we have the ability to provide that support to her." Mr. Name added, "I think we saw a need here and,just spending some time with her I would echo what Jane said. We have two older sons, one will be leaving for college next year and we have the room and the ability to take this on if we can provide her with some stability. Jane's been a lot closer to her because she's been teaching her in school but we've had a good time here when she's here. The boys enjoy seeing her when they're here from school and we feel like we can make a difference." HOME ENVIRONMENT Type of residence: House Square Footage: 6,400 Bedrooms: 4 Bathrooms 5 Length of Time in current residence: 5 years Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-14-2005 Page 2 of 18 Copyright,2005,Consortium for Children,Al Rights Reserved The Name's are buying their home and have lived in the home for five years. Mr. Name reported their monthly payments are$2,200.00. The home is a two-story house with a living room, family room, kitchen, dining room. office,two bedrooms,three bathrooms, a sunroom and a laundry room on the main floor. The second floor has two bedrooms,two bathrooms,an office and a loft. The basement is unfinished. The home is situated on two acres of land. There is no fenced area and the Name's are not interested in fencing their property. Mr. and Mrs.Name sleep in the master bedroom. Their son has his own room and Sally would have her own room. There is no play equipment in the backyard. The Name's have a dog, Lexie,and three cats,Alfred, Miss Kitty and Wayne. The Name's also have a turtle named Herbie and two iguanas, Stumpy and Eddie. Mrs. Name reported that Sally had her own turtle, Squirt,who recently died. There is no pool or spa in the home, but the Name's have a hot tub. There is a cover with four clip fasteners. When asked if they have any guns in the home, Mrs.Name replied, "No." When asked about their neighborhood make-up and community resources, Mr. Name replied, "I think everyone in here is white. It's a mixture of younger and older folks. There are people with babies and there are retired people." The closest hospital is NCMC. The closest park with equipment is Peakview Park, approximately one and a half miles from the home. Mrs.Name stated that a recreation center is almost completed and it is approximately a half a mile from the home. University is the closest elementary school. Sally is in the sixth grade and currently attends Franklin Middle School where Mrs. Name teaches. Mrs. Name stated that they have completed the open enrollment form so that Sally may continue to attend Franklin once she is placed with the Name's. Mrs. Name reports that she works at Franklin Middle School teaching sixth grade language arts and reading. Mrs. Name has just started teaching this past August(2005). Mrs. Name works Monday through Friday, 7:00am through 4:00pm. She stated that she is paid 32,000.00 annually. Mrs.Name stated that she has no other income. Mr.Name reports that he works at Group Publishing as a controller. Mr. Name stated, "I oversee the financial/ accounting department." Mr.Name has been there since January of 2006. Mr. Name reported that he has worked for various companies as a controller for six and a half years. Mr. Name stated he works Monday through Friday, 7:30am to 6:30pm. Mr.Name reported that he is paid every two weeks and earns approximately$115,000.00 annually. Mr. Name reported that he has no other income. The Name's were asked if they have any plans to remodel or make any new additions to their home. Mrs.Name responded, "All we're going to do is put a door on the loft for a bedroom for Sally. There's already a closet and everything else is there as far as smoke detectors and all that. Right now she's downstairs, which is the guest bedroom and it's fairly small. When we built the house we had promised our boys that their rooms would always be there for them." Mr. and Mrs. Name were asked to describe any health problems they have. Mr. Name replied, "None." Mrs. Name added, "None." When asked about their financial self-sufficiency, Mr. Name reported, "It's self-sufficient. Until both kids are in college next year." Regarding any stresses related to demographics, Mr. Name stated, "None." The Name's were asked if they have ever filed for bankruptcy. Mr. Name responded, "No." When asked if they have any plans for anyone,other than a Sally,to move in or out of their home, Mr. Name said, "Son#2 will be moving out in August to go to school in Grove City College in Pennsylvania." Mrs. Name reported that she has never been accused of, investigated for or convicted of child maltreatment. Mr. Name reported that she has never been accused of, investigated for or convicted of child maltreatment. The interior and exterior of the home was inspected for health and safety hazards. The inspection was completed on 02.14.06. FAMILY Applicant#1 -Jane Name Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Specific Home Study Report -Version 09-14-2005 Page 3 of 18 Copyright,2005,Consortium for Ctten,Al Rights Reserved Jane Name was born on August 26, 1963, in Provo, Utah,to . She has two half sisters and three half brothers. Mrs. Name is the oldest. Mrs. Name reported that she was one-year-old when her parents divorced. She remained with her mother and had limited contact with her father. Mrs.Name stated, "I literally saw him six times before I was eighteen." Mrs.Name reported that her mother remarried when Mrs. Name was two-years-old. His name was . Mrs.Name stated that her mother and Mr. had two girls. The oldest is J, 37 years old, currently living in Bakersfield, California, and is married with four children. The second child, J, is 34 years old, currently living in Orem, Utah, and is married with no children. Mrs. Name stated that her mother and her stepfather live in Bakersfield. Mrs.Name stated her father married several more times. The first time, Mrs. Name estimates that she was three-years-old. Her father married a woman named . Ms. and Mrs. Name's father had three sons. The oldest, K, is in his late 30's,cuuerrtly living in Great Falls, Montana, and is divorced with two children. The second born son is K. Mrs. Name stated she has no idea how old he is. K currently lives in Great Falls and is divorced with no children. The youngest boy, S, is 30 years old, currently lives in Rio Rancho,New Mexico, and is single with no children. Mrs. Name was seventeen when her father divorced Janet. He married again when Mrs. Name was approximately 22 years old. Her name is L. Mrs. Name's father and L did not have any children together. They currently remain married as far as Mrs.Name knows. Mrs.Name's father currently lives in Great Falls. When asked about her relationship with her parents when she was a child, Mrs. Name said, "My mom was everything to me. We had a great relationship. My stepfather, for whatever reason, he was just never accepting of me and he just kind of ignored me. It wasn't bad; it was just like I wasn't there. Then my father, I really had no relationship and never did. His cerond wife, Janet,tried really hard to create a relationship with my father but he wasn't interested. I still maintain a relationship with Janet. She has come here to visit. I haven't had any contact with my father in probably six years." Mrs. Name was then asked about her current relationship with her parents. She stated, "With my mom it's good. She's been married to him for 40 years but he's never really been part of my life. So I have a relationship with my mom, she comes to visit. He doesn't come. I have contact with my mom at least every two weeks, sometimes every week. We talk on the phone. We don't go to her home. We usually go to California to Palm Dessert once a year and she meets us there. She comes here maybe twice a year. I think growing up;mom said she didn't know what his problem was. He also ignored his own daughters. We joke sometimes about who had it worse. Now it's just a given and we don't even talk about him." Regarding her relationship with her siblings,both when she was a child and now, Mrs.Name reported, "With the boys, no contact at all. The girls I consider my sisters. Geographically we're kind of far apart. The one in Utah I haven't seen probably in eight years. That's terrible. I have contact with her. Birthday cards, all the holidays. I have more contact with Juli. I see her when we go to California. We're closer in age." When asked what her parents did for a living when she was a child, Mrs. Name responded, "My mom's a registered nurse. Her husband was a highway patrol officer. Then my father was in the Air Force,probably until I was about fifteen. Then he became a private investigator and,as far as I know,he's still doing that." When asked where she grew up, Mrs. Name replied, "In Southern California. Wh.n I was about seven-days-old my parents moved to Clovis,New Mexico,and when my morn left him, she moved in with her parents who were in Arcadia, California. We moved a lot until I was eight. From the time she married Joe until I was eight we moved every couple of years, but all within fifteen miles of each place. When I was eight we moved to Granada Hills and I stayed there until Bob and I moved to Salt Lake." Regarding any issues, such as domestic violence, substance abuse,gambling or pornography, in her home of origin, Mrs. Name reported, "Nothing." When asked if she has ever been physically abused, Mrs. Name replied, "No." Mrs. Name was then asked if she has ever been sexually abused. She responded, "No." Mrs. Name reports that she has never been neglected. Mrs. Name was asked to discuss her general childhood memories. She stated, "I can remember some very impressive Barbie house set-ups,games and clothing. My great-grandfather had made all of this Barbie furniture. The whole living room floor would be Barbie houses. So that was a good one. My mother's parents were a huge Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-142005 Page 4 of 18 Copyright,2005,Consortirm for Ctidren,Al Rights Reserved part of my life. I would spend every summer with them and they lived in Holyoak, Massachusetts. That was so different than the concrete of Southern California. I don't remember being conscious of why I went to my grandparent's, but I wouldn't be surprised if that wasn't my stepfather saying, `school's out, she doesn't need to be around.' I don't even remember how young I was when I started doing that, but it was just the highlight of my childhood. It was just me. I got their full attention for three months." Regarding how she was disciplined as a child, Mrs.Name stated, 'Well, my mother would yell, but honestly I was always like the perfect child. My sisters were spanked. My stepfather would spank them so I saw that, but he didn't lay a hand on me. I remember my grandmother washed my mouth out with soap one time. It's probably that oldest child syndrome thing,but I just can't think of anything. I'm sure I was sent to my room or something." Regarding her education, Mrs. Name stated,"I went kindergarten through graduation in Southern California. I liked school. I was a great student. I enjoyed the academics. I was very quiet. I played tennis in high school. I was in student council for most of high school. I think that's about it. I graduated in '81. I went to college in Southern California and then some when we had moved to Northern California. I received my BA in English with a teaching credential from California State University, Sacramento, in May of'98. That's it other than what I have to do to keep my credential going." When asked for her dating history, Mrs. responded, "I had three dates prior to Bob. Nothing significant and I was sixteen for all three of them. I was sixteen when I met Bob in high school. We dated five years before we got married. We got married on August 11, 1984. He's funny. He's very stable and he's very moral." Mr. and Mrs. Name have two sons. The oldest Son#1 Name, was born on December 14, 1986. The second son, Son#2 Name, born on August 04, 1988. Mrs. Name stated, "Both of them are fertility drug boys. Son#2 was born six weeks premature. He was in the hospital for four days. We were in Salt Lake at the time and they had an incredible home care system. We were able to rent the equipment and take him home. A nurse came out every day and I took him to the hospital every day. We basically turned our living room onto an ICU unit. He had to have IV's in his head every four hours. I literally slept in the living room and he had very,very bad jaundice so he had to have the lights for that. My water had broken but at that point I was seven weeks early so they did an ammo and determined that his lungs weren't ready. So I lay on my side in the hospital. They did an ammo every week and they determined that, as soon as his lungs were ready,they would do a caesarian. But then he beat them to the next amino and determined that he was coming. So they ended up doing an c,nergency C-section. The amniotic fluid protects the baby, and I had a catheter and there was an area that lets all the air-born bacteria in and he got infections. They thought the bones of his skull had already fused together so we were worried he was going to have surgery. All of the antibiotics he was on were sulfa based and they can cause hearing loss, so we were worried about that too. We were constantly checking the skull fusion and his hearing. For the first thirteen months he was just really sick and miserable. As soon as he started feeling better,he became the happiest,goofiest little kid ever. Son#1 was just a perfect, mellow, happy child. If Son#2 had been born first, he'd be an only child! After Son#2,we actually tried one more time. That was maybe '92. We did one month of fertility drugs and it was just awful. I had cysts on my ovaries and had to have them surgically removed and then it was like,two's plenty. We literally did one cycle and that caused so many problems that,after all that cleared up, I was done. Son#2 was four. We liked having the boys close in age together." Regarding Mrs. Name's employment history, she reported, "I was sixteen and worked at Taco Bell. Then I went from there to Tinker Bell dry cleaners, Then when I graduated from high school, I went to work for Bob's father as a secretary while I was in college. Then I switched and went to work at a bank as a secretary while I was still going to college. Then we got married and moved to Salt Lake and I was a secretary again for a real estate company. Then as soon a Son#1 was born I was a stay-at-home mom. So from '86 until probably '97 I was just home with them. Then I started doing some freelance writing. I had gone back to school and a lady in our neighborhood owned an advertising company. From home I would write press releases and promotional materials,things like that, for her company. I worked for her whenever she would call and say she had a client. The boys were in school during the day and I could write during the day. One of her clients was an organization that was running a political campaign. She got too busy so,through her, I started managing the campaign. Then she had a falling out with the organization so they fired her, but they kept me. When the election was over they asked if I would continue to work with them. It was a recreation organization. I was writing press releases and articles for the recreation of the city we were in. I worked about 20 hours a week.. They were closely tied with the government and they asked me to go Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Specific Home Study Report -Version 09-142005 Page 5 of 18 Copyright,2005,Consortium for ChNdren,Al Rights Reserved 'work for them the other 20 hours a week. Marketing recreation activities. I worked with the city to get land donated and get community buy-in to have projects built. So when we decided to move to Northern Colorado, I got the exact same position with the city of Greeley; as a marketing coordinator. I did that from May of'99 to July of '05. Actually in May of'05 I got my job teaching at my current position at Franklin and worked for the city until August." Mrs. Name was asked about issues of grief and loss. She replied, "I'm heart broken every time a pet dies. I still haven't figured out how to deal with that very well. My grandparents that I spent summers with have both passed on. Those are really the only deaths I've experienced. Prayer is probably my first source of comfort. I do like to walk and I like to read uplifting books and I guess I look at death as it's not really the end so you just have to remember all the good times." Mrs. Name reports that her physical health is"good." She stated, "It's excellent." When asked about her mental health status, Mrs. Name said, "Excellent." Mrs. Name stated that she has never been in counseling and has never been diagnosed with any mental health disorders. When asked if she has ever been arrested, Mrs. Name responded, "No." When asked about legal encounters, Mrs. Name stated, "I've had two traffic tickets. Both of them were before I was married so we're talking early '80's. No DUI's." Mrs. Name reported that she has never fostered children before. When asked about any history of substance abuse, Mrs. Name reported none. Mrs. Name was asked about her problem-solving abilities. She responded, "I think they're excellent. It depends on the situation. I think I'm very organized and logical. I try not to be emotional about whatever the problem is and I try to be more intellectual I guess." Regarding how she handles stress, Mrs. Name said, "I eat. Chocolate works really well. I do exercise every day and I think that helps a lot. And I pray." When asked about her judgment ability, Mrs.Name stated, "I wouldn't say it's excellent but it's a step down from there. I tend to not be a good judge of people. I'm kind of naive. Situations I'm good at,but sometimes I don't read people too well." When asked about her decision-making ability, Mrs. Name replied, "It's very good. Bob and I talk and talk and talk. We spent three years deciding on the sunroom furniture. We're going on five months deciding on a new washer and dryer." Mrs. Name was asked about her history of following through on her decisions. She responded, "That's excellent." When asked about her self-esteem, Mrs.Name stated, "It's very good. I think the thing I'm most proud of is being a mother. I know I did a great job with those boys and no matter what happens I always have that to fall back on. I think Bob and I have one of the best marriages that I know of and I really do know I've made a difference with my teaching." Mrs. Name was asked to describe any special interests, hobbies, expertise or talents she possesses. She responded, "I think I'm very creative and that shows up in sewing and graphic design,which I still do quite a lot of for personal projects. I still like playing tennis. I also like to work in my yard." Regarding her strengths, Mrs. Name said, "My parenting. I'm reliable; if I say I'll do it, I do it. I think I'm a good friend and part of that is being a good listener. I'm the peace keeper." When asked about weaknesses, Mrs. Name replied, "I'm probably too sensitive,that people judgment thing. I probably need to be more cautious. I'm a terrible housekeeper. It's just low on the priority list." Mrs. Name was asked about her ability to control her emotions. She replied, "I think I'm really reserved; real even. I don't get too excited or too down." Regarding her ability to express her emotions, Mrs. Name stated, "That's probably reserved as well. You probably wouldn't know it if I was upset with you. I'm more inclined to just let it go. And I actually do let it go. I try to look at everything in the big picture." When asked about impulse control, Mrs. Name said, "Not impulsive at all. I don't even like to shop, so that's no problem." When asked about her attitude toward and her response to sexual contact between children, Mrs. Name replied, "I'm horrified. I think I would know the difference between abuse and curiosity. Exploration needs education and I've always talked really open with my boys about body parts and the function of body parts. With abuse I would Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-142005 Page 6 of 18 Copyright,20D5,Consortium for Children,Al Rights Reserved separate the children completely and call for help. If for some reason we had multiple foster children and something was going on, remove them, call for therapy and follow the lead of folks who know how to deal with it." Mrs. Name was asked for her opinion on the role of discipline. She responded, "Discipline means 'to teach in the way you should go.' So you're leading by example and you're setting parameters. What most people think of as discipline is punishment actually. If you're talking about punishment I've always believed in natural consequences. If something gets broken,allowance money gets taken until it gets paid for." When asked what she expects of herself as a parent, Mrs.Name replied, "To mold independent adults through modeling, nurturing, supporting, punishing and exposing to real life functions;how to use a bank account,how to make a doctor's appointment." Mrs.Name was then asked what she would expect of a child in her home. She replied, "Well, immediately I wouldn't expect much of anything. I think over time I would expect the child to acquire the family values we have as far as respecting others,working hard and doing well in school." Regarding what she has found frustrating being a parent, Mrs. Name said, "Lying just sets me off. You can do just about anything, but don't lie to me about it." When asked about her views on supervision, Mrs. Name responded, "I think that's very age specific. Even now with our seventeen year old I like to know where he is and how he's doing. I think that's just common courtesy. At younger ages I would expect closer supervision. It's a maturity issue. The more trust they earn,the less supervision." Mrs. Name was asked how she disciplines her children. She rel,unded, 'We tried very, very hard to make the consequences equal for whatever they did. If they didn't pick up their toys, I would take the toys and they would have to earn them back. If they were fighting,they had `couch time.' They had to sit on the couch until they worked it out. When they were really little,two or three,they maybe got a swat on the behind. It always made me feel kind of queasy. There's a stage where you really can't talk to them and they're doing something that's really going to hurt them and you need to get their attention." Mrs.Name was asked how she intends to discipline any children placed in her home. She ressµ ndtd, "The consequences would fit whatever the situation is. Restricting privileges seems to work well with this age group. Basically loss of privileges. I really like to think in specific terms of consequences.." Mrs. Name was asked about her knowledge of child development. She responded, "I started my college career planning to major in child development so I think I have a pretty good grasp. Then with all my training through district six I think I have a strong foundation of understanding child development." Mrs. Name stated that she doesn't have any concerns about providing sensitivity, concern or the basics for any children in her home. Regarding her ability to provide for children of differing races, cultures or religions, Mrs. Name said, "I wouldn't anticipate any problem with that." When asked about her ability to care for children with special needs or disabilities, Mrs. Name replied, "I don't think I would want to work with any severe disabilities;physical or mental. I think that would be really difficult for me." Mrs. Name was asked about her views on attending school activities. She responded, "At every single activity, sporting event, I was there and I will be there. Parent organizations,volunteering. I think for one it shows the student there's value in what they're doing. If they're spending that much of their time doing what they need to do, you should be there to support that. I also know how much the schools need it." When asked about the importance of hygiene and general appearance, Mrs. Name said, "I think good hygiene is exticiuely important. I think society places too much importance on appearance. I tend to not be too trendy. I would tend to discourage a child from following a fad just because others are doing it." Applicant#2 -Bob Name Bob Name was born on February 06, 1962, in,to C Name. He has one brother and one sister. The oldest is Mr. Name. The second born, S, is 41 years old,currently lives in Valencia, California,and is married with three children. The youngest sibling is Name. J is 38 years old,currently living in Manassas, Virginia, and is married with two children. Mr. Name reports that his parents remain married and currently live in Granada Hills, California. Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Specific Home Study Report -Version 09-142005 Page 7 of 18 Copyright,2005,Consortium for Children,Al Rights Reserved 1 . When asked about his relationship with his parents when he was a child, Mr.Name said, "We were very close. A very close family." Mr. Name was then asked about his current relationship with his parents. He stated, "Still close. Asa matter of fact it's my mom's birthday today and I told Jane she couldn't let me go to bed tonight without giving her a ring. I talk to them once a week, ordinarily by phone. I see them probably about four times a year." Regarding his relationship with his siblings, both when he was a child and now, Mr.Name reported, "We were close growing up and we're still close. I see my brother once a year on average and I see my sister probably twice a year on average. My brother and I email probably once a week and not much with my sister. We're probably on the phone every other month." When asked what his parents did fora living when he was a child, Mr. Name responded, "My mom was a stay-at- home mom. My father worked for an architectural company. He's retired now." When asked where he grew up, Mr. Name replied, "In Granada Hills from about six-months-old." Regarding any issues, such as domestic violence, substance abuse,gambling or pornography, in his home of origin, Mr. Name reported, "Nothing." When asked if he has ever been physically abused,Mr. Name replied, "No." Mr. Name was then asked if he has ever been sexually abused. He responded, "No." Mr. Name reports that he has never been neglected. Mr. Name was asked to discuss his general childhood memories. He stated, "The biggest memory that I have was my parents bought a vacant lot and they built a house. My dad had some carpentry skills and my grandfather was a carpenter and my uncle did carpentry and electrical work so we all built the house. That took several years and I would help out as a gopher;getting tools and digging ditches. That was when I was about twelve years old. Vacations were primarily trips to Minnesota. A lot of my mom's family lived there so a lot of our time was taken driving 1,200 miles. We had the opportunity to see the country. Thad an intact family and what I consider a pretty normal life; a married couple with three children. We celebrated birthdays and holidays. It was a fairly stable existence." Regarding how he was disciplined as a child, Mr. Name stated, "A lot of lecturing and some privileges restricted or taken away. When I was real young I think there might have been spankings,but nothing I remember." Regarding his education, Mr. Name stated, "I went to school,kindergarten through graduation, in the same area, Granada Hills. I liked school. Math was actually my favorite. I think the class I disliked the most was foreign languages. I was in basketball and golf in high school. I graduated in 1980. I have a four-year deg e from UCLA in economics. That was in '84. Then I got a graduate degree,an MBA at Berkley in California in `91." When asked for his dating history,Mr. Name responded, "Jane and I were high school sweethearts. I did date others in high school, but nothing after high school. She was a year younger and we started dating her senior year in high school and it was steady dating until we got married,which was about three years later. We married in 1984." Mr. Name reported this is his only marriage and Son#1 and Son#2 are his only children. Regarding Mr. Name's employment history,he reported, "I had part-time jobs in high school and through college. My first full-time job was working for an accounting fine. I was there about five years. After that [worked for Intel Corporation, as a financial manager, for about eight years. Then I worked at Agilent,another technology company and I was also a financial consultant there. I was there for six years. After that is my current position, at Group Publishing as a financial manager." Mr. Name was asked about issues of grief and loss. He replied, "I haven't had much. Curiously enough I've only been to one funeral even though I've lost all my grandparents. I wasn't able to make their funerals for one reason or another. The thing that I can relate to you is that since we have moved around a lot,you tend to lose friendships and relationships and that's always been hard." Mr. Name reports that his physical health is"good." He reported that he has no chronic illnesses and takes no medication on a regular basis. When asked about his mental health status,Mr. Name said, "It's fine." When asked Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Spectra Home Study Report -Version 09-14-2005 Page 8 of 18 Copyright,2005,Consortium kit Chicken,Al Rights Reserved • if he has ever been arrested, Mr.Name responded, "No." When asked about legal encounters, Mr. Name stated, "I did get one speeding ticket in California. No Dill's." Mr. Name reported that he has never fostered children before. When asked about any history of substance abuse,Mr. Name reported none. Mr. Name was asked about his problem-solving abilities. He responded, "I think I'm above average because that's what I've had to do largely for my work. Solve financial problems for companies. I diagnose the issue and formulate a solution and then resource the solution. You can identify things but if you can't put people behind it, it's difficult to solve the problem." Regarding how he handles stress, Mr.Name said, "I usually just take quiet time. If you've had a stressful day, you just want to get home and unwind. Home is kind of our refuge." When asked about his judgment ability, Mr. Name stated, "I think it's solid." When asked about his decision-making ability,Mr.Name replied, "I think it's good. It's reasoned. Again that's largely what I've had to do in my work. We reflected on taking Sally since we met her. We discussed this, asking ourselves if this is something that we want to tackle given that our other children are older, but we bonded with her and it's something we feel we'd like to do. We'd like to help her out." Mr. Name was asked about his history of following through on his decisions. He responded, "Yes, I follow through. Once a decision's made,there's a commitment behind it." When asked about his self-esteem, Mr. Name stated, "I have good self-esteem. It comes from my up-bringing." Mr.Name was asked to describe any special interests, hobbies,expertise or talents he possesses. He responded, "Golf, snow skiing and gardening." Regarding his strengths, Mr. Name said, "How about reliable,well reasoned and committed, and I'm faithful." When asked about weaknesses, Mr.Name replied, "Impatient and not very artistic. I'm defiantely weak on the creative side." Mr. Name was asked about his ability to control his emotions. He replied, "I'm pretty even keeled and that's because you have to be in a professional environment and the only time I get upset at home is when my kids don't keep their commitments either to get their school work done or be home on time for their curfew." Regarding his ability to express his emotions, Mr. Name stated, "I'm fairly direct in that I'll speak my mind. To coin a phrase, I don't beat around the bush much." When asked about impulse control, Mr. Name said, "I'm not impulsive. We first met Sally around the first week of October (2005) and we hosted her on activities for four or five weekends after that. Then we really liked her and we started talking about Jane taking a bigger role in mentoring or,we decided if she needed a home,we would provide that." When asked about his attitude toward and his response to sexual contact between children, Mr. Name replied, "My attitude is I don't condone it. It's inappropriate. I would be direct and talk to her about the issue and ask that she change the behavior." Mr. Name was asked for his opinion on the role of discipline. He responded, "The purpose of discipline is to keep children on track to honoring their school commitments and protecting themselves physically." When asked what he expects of himself as a parent, Mr.Name replied, "Honesty and fairness." Mr. Name was then asked what he would expect of a child in his home. He replied, "Honesty is number one. My biological children know that I am fairly strict, but I'm fair and I expect a straight story from them." Regarding what he has found frustrating being a parent, Mr. Name said, "I think I've been frustrated by the lack of standards in school and the lack of work ethic in their peers." When asked about his views on supervision,Mr.Name iesponded, "Parents supervise because, as the legal guardian,they have to provide supervision so the children stay out of trouble." Mr. Name was asked how he disciplines his children. He responded, "We have given lectures and testi_icted privileges. We did spank some when they were real young, not after age six or seven. It's diminishing returns after that point." Mr. Name stated that he and his wife learned the states regulations on corporal punishment at their training this past weekend. Mr. Name was asked how he intends to discipline any children placed in his home. He responded, "Consistent With Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Specific Home Study Report -Version 09-14-2005 Page 9 of 18 Copyright,2005,Comm for Chidren,Al Rights Reserved how I have disciplined my older children, so restricting privileges and discussions around what they did wrong and why." Mr. Name was asked about his knowledge of child development. He responded, "Limited. I have a general sense for their abilities at each age level, but as far as an expert, Jane has a lot more background, as a teacher,than I do." Mr. Name stated that he doesn't have any concerns about providing sensitivity,concern or the basics for any children in his home. Regarding his ability to provide for children of differing races,cultures or religions, Mr. Name said, "No concern." When asked about his ability to care for children with special needs or disabilities, Mr. Name replied, "I'll say in general no concern,but there's a wide spectrum of disabilities there. A child with severe disabilities may go beyond how we could care for them because we both work full-time and we would need someone who could care for them full-time and we don't have that right now." Mr. Name was asked about his views on attending school activities. He responded, "I'm a strong advocate of parent involvement. As evidenced by my own children. We were heavily involved in their school activities. It's important because it keeps you in tune with how the child is progressing in school and, in their activities it shows love and commitment to honor them and their accomplishments." When asked about the importance of hygiene and general appearance, Mr.Name said, "Very important. The best thing you can do for a child is to teach them how to take care of themselves and hygiene is number one on the list." Applicants' Sons and Daughters Mr. and Mrs. Name have two sons. The oldest,Son#1 Name,was born on December 14, 1986. He is currently attending college in Houston,Texas. Their second born son,Son#2 Name,was born on August 04, 1988. Son#2 currently lives with his parents in Greeley. When asked who lives in his home, Son#2 stated, "My mom and dad." When asked if his parents talked to him about fostering children, Son#2 replied, "Yeah. I think it's fine." Son#2 was asked what he has to offer a child placed in his home. He responded, "I can be a good brother. I don't know. I'm not going to see too much of her because I'm going to college. But while she's here, I'll hang out with her." Regarding what he would expect from a child placed in his home, Son#2 said, "I expect her to behave and, I don't know,just be a good foster sister. She's pretty quiet." Son#2 as asked what support he will need from his parents if a child is placed in his home. He responded, "I don't really think my relationship with them should change at all because of this." When asked what he thinks of parents who hurt their children, Son#2 replied, "i think it's wrong and they shouldn't be doing that. I think they should probably have to go through counseling. Especially if it's too out of control." When asked to put himself in a foster child's place and describe how he thinks he might feel, Son#2 said, "I would probably be happy and scared to have a whole new family. It would be a whole new world." Son#2 was asked what he and his family do together. He responded, "We'll watch a movie once in a while. We'll go camping in the summers. We'll go out to dinner sometimes." When asked how he gets along with his family members, Son#2 stated, "With mom really well. I can tell her whatever I want. I feel like I can joke with her more than my dad. With my dad, pretty well. We argue a lot,well, not a lot, but he's shorter tempered than my mom. He's the one I usually fight with." When asked how he gets along with kids his own age, Son#2 said, "Fine. I don't think I have any problems interacting." Son#2 was then asked how he gets along with older kids. He replied, "Fine, I work with them down at the rec center. I think when you get to a certain age everyone can hang out with everyone." When asked how he gets along with younger kids, Son#2 responded, "Pretty good. it's a little harder with Sally because I don't know what she's thinking. Kids i baby-sit, like my cousins,we get along fine." Son#2 was asked what he likes to do for fun. He reported, "I like to go skiing. i like to play video games once in a Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-14-2005 Page 10 of 18 Copyright,2005,Consa um for Chidren.Al Rights Reserved I • while. Watch TV. I like to play sports and hang out with my friends and stuff." Son#2 reported that he is a senior at Greeley West High School. When asked if he likes school, Son#2 replied, "Yeah, but I'm kind of in the mode of being tired of high school and I want to move on. Some of the kids seem really immature and I'm ready to move on. The whole high school experience you should make the most of. I plan on going to Grove City College in Pennsylvania. I'm thinking maybe a communications major." When asked what activities or clubs he is involved in, Son#2 replied,"I'm the president of the French Club at my school. I played football. I'm in the International Baccalaureate Program at school. They're accelerated programs. I'm in Interact, a public services club. I'm in the Link Crew. We help underclassmen transition into the high school setting." Son#2 as asked if he has any hobbies. He responded,"Skiing's a hobby and that's probably my biggest one. I like to read about the civil war. I get into going back east and seeing the battlefields. I like video games and I like to golf during the summer." When asked how often he has contact with his friends, Son#2 stated, "Probably,with my girlfriend, every day,with my other friends, at least once on weekends." Son#2 was asked to list two or three things he likes about himself. He replied, "I'm pretty smart. I'm pretty funny at times. I'm dedicated to what I get myself into." When asked to list two or three things he doesn't like about himself, Son#2 said, "With some people I have a short temper, like my dad can get me mad in 30 seconds. I'm kind of unorganized at school. I don't keep a planner like some people do. I kind of just wing it. I think as far as, like, staying active outside of sports, I get tired and I don't run or workout." Son#2 as asked how he behaves when he is mad. He replied, "I just shout or get quiet. If it's someone I don't know very well, I'll get quiet. If it's my dad we'll shout at each other. But we don't get violent or anything." When asked how he behaves when he is sad, Son#2 stated, "I'm usually just quiet. I might tell someone about it, but I usually just keep it to myself" Son#2 was then asked how he behaves when he is happy. He responded, "I'm usually loud, like good loud. Pretty talkative, smile a lot." Regarding what happens when things aren't going well at home, Son#2 said, "Usually I'll just probably go to my room,try to avoid my parents because they're the only one's I get mad at these days. My brother's in college." Son#2 was asked if he is responsible for any chores at home. He reported, "Um,these days,this is kinda bad,but I'll do the dishes every once in a while,but mainly my parents do it. I have to clean up my dogs poop. I'll do some yard work in the summer but right now I don't have too much to do. I have to clean my bathroom and my bedroom once a month to get my gas money." When asked how family members show they care about each other, Son#2 replied, "Through hugs and just, like, talking,being interested in what I'm saying. Me and my dad go skiing a lot. My mom and I talk and she asks me about my thy and stuff." When asked who gives orders in the home, Son#2 responded, "My dad usually and my mom if she needs to, but it's usually my dad." When asked what happens when orders aren't followed, Son#2 said, "These days it's probably just gas money. I haven't gotten into trouble for a while. They probably won't let me go out with my friends that night, or get sent to my room for the night. These days I don't get too out of hand." Son#2 was asked which of his parents he is most like. He responded, "I'm more like my mom in most days. My dad and I have the exact same temper, which is why we fight a lot,but I think I'm more like my mom. We have the same sense of humor. We both like to talk to people I guess. [think it's mainly just our outlook on life. We both have the same sense of humor." Regarding what makes his mother angry with him, Son#2 reported, "If I don't do what she tells me. If I stretch the truth. Those would really do it. She usually knows I'm joking so I don't get in trouble if I talk back to her cause she knows I don't mean it." When asked how he knows his mother is mad at him, Son#2 said, "She either gets quiet or gets really direct with me and gives me an order. Her tone kind of changes and she calls me by my full name too." Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Specific Home Study Report -Version 0&142005 Page 11 of 18 Copyright,2006.Consortium to Children,Al Rights Reserved Son#2 was then asked what makes his father angry with him. He stated, "Probably the same thing. Like if I talk back to him at all he doesn't really take it. He gives me a of of orders and if I don't follow them he gets mad. If I raise my tone with him he gets really mad,but the main one is talking back." When asked how he can tell when his father is angry with him, Son#2 replied, "He gets really loud and yells. He'll grab my arm if he's really mad. He used to grab my ear too. I never worry about my safety. He's not a violent person. He wouldn't be as mad at her (Sally) probably because she's a girl." Son#2 was asked to list the rules in his house. He replied, "No swearing,no lying,obviously. No beating. My dad doesn't like me to watch too much TV or play video games too much. He likes you to eat what he puts on your plate. Obviously, no drinking or drugs, nothing illegal. My curfew is 12:00am on weekends. On weeknights they expect me to use common sense. Just clean up after yourself in general. You have to bring your laundry down to the laundry room and if you don't get it down in time you have to do it yourself. They don't like me to have people over too late." When asked if there is anything he would like to add, Son#2 stated, "As far as disciplining, my mom and dad are like opposites, but either one gets the job done." Other Children or Youth living or frequently in the home Sally visits often. Other adults residing or frequently in the home None Family Lifestyle When asked to describe their family routine, Mrs. Name responded, "It's pretty structured. We get up at the same time every day,go to work at the same time every day and go to church the same day every week." The Name's were asked about the clarity of roles and boundaries. Mrs. Name replied, "Definitely clear." Regarding how family decisions are reached, Mrs. Name stated, "Well, Bob and I communicate very well and talk it through. There's an occasional family meeting." Mr. Name added, "Collaboration." When asked how affection is displayed in the home, Mrs. Name said, "Hugs,teasing, kisses,gifts,verbal encouragement." The Name's were asked to discuss any marital issues. Mrs.Name responded, "Kids. In any given situation one of us will be more strict than the other one. Even that's rare,but that's probably the biggest one." Mr. Name stated that he would agree with his wife's assessment. Regarding infertility issues, Mrs. Name reported, "Both of our boys are fertility drug babies. We tried one more time with invetro and then decided two was a lovely number." When asked if there is any violence in the home, Mrs. Name responded, "No." When asked to describe their basic household rules and expectations, Mrs.Name replied, "We definitely expect respect." Mr.Name stated, "Respectful,no profanity, typal the house as far as cleaning up after yourself." The Name's were asked who does what in terms of chores, cooking, bill paying,home maintenance and transportation, Mr. Name responded, "It's shared jointly." Regarding how they deal with privacy and nudity in the home, Mr.Name said, "Nudity would be confined to the bathroom. We sleep with the bedroom door shut." The Name's were asked to discuss what kind of social, recreational and religious activities they engage in. Mrs. Name reported, "We go to church every week. We have friendship groups through church. Bob and Son#2 love to ski and golf. Bob and I play tennis and we're getting Sally into the tennis thing. Probably our biggest hobby is working in our yard." When asked if they celebrate any holidays. Mr. Name replied, "Yeah, Christmas, Valentines Day, Easter, all the biggies. We don't really have family in the area, so travel is involved, but we do pretty well." Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Specific Home Study Report -Version 09-14-2005 Page 12 of 18 Copyright,2006,Consortium for Chi dyes,All Rights Reserved When asked what childcare arrangements would be made for Sally, Mrs.Name replied, "Well, we understand that respite care is available to us and even daycare if we need it. It would be infrequent I think, only if we were truly in a bind." Previous adoption and/or foster care experience None FINANCES Combined annual gross earned income: $147,000.00 Sources of additional income:None CRIMINAL/CHILD ABUSE RECORD The required criminal record and Child Abuse Index checks were completed for Jane Name and Bob Name. Criminal History Repository: Colorado Criminal CBI, ICON/Co Courts, and FBI (if applicable) Clearance Findings: All of the results of the CBI, FBI and Co Courts background checks are sent directly to the Weld County Department of Social Services. This clinician has not seen the results of these background checks. Other findings: Mrs. Name Greeley Police Department: No arrests or citations. Weld County Sheriff's Department: No arrests or citations. Department of Motor Vehicles: No record. License is current. Expiration date: 08.26.2014. CPS: Completed by the We'd County Department of Social Services. Mr. Name Greeley Police Department: No arrests or citations. Weld County Sheriff's Department: No arrests or citations. Department of Motor Vehicles: No record. License is current. Expiration date: 02.06.2014. CPS: Completed by the We'd County Department of Social Services. EMERGENCY CARE PLAN Mr. and Mrs. Name were asked if they have a formal,written emergency care plan in the event of incapacitating illness or death of one or both of them. Mrs. Name responded, "No." Mr. and Mrs. Name were asked whom they have designated as the children's caretaker. Mr.Name stated, 'We haven't talked about it at all." CONTACT WITH FAMILY OF ORIGIN AND SIGNIFICANT OTHERS When asked about the nature of any extended family support, Mrs.Name replied, "Not in the area,but everyone knows and is supportive." Regarding the nature of any support of unrelated persons, Mrs.Name responded, "Lots of that. Through church and through my work and through parents of our children's friends." Mrs. Name was asked to discuss her viewpoint of birth parents that maltreat their children. She replied, "When I see it on the news it makes me very angry. Then I think of Sally's situation, she(birth mother)was only fourteen when she had Sally. She was just a child herself so I don't feel any anger toward her." When asked for her point of view on birth parents that voluntarily place their children into the system, Mrs. Name responded, "I think that's terrific." When asked for her viewpoint on foster children, Mrs.Name stated, "I'm amazed at how resilient they Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-142005 Page 13 of 18 Copyright,2005,Consortium for Chldren,Al Rights Reserved • are. Absolutely they have special needs and I think every one of them is unique in their needs. Love isn't the answer for all of them. I think you have to have the training and a plan for each kid." Mr. Name was asked to discuss his viewpoint of birth parents that maltreat their children. He replied, "Well it makes me very sad that you have a human life that you don't feel a personal stake in and you don't want to do everything possible to help that individual. I fully advocate trying to uplift kids out of bad situations and if the birth parents can't get out of a bad situation, I think I'd advocate for the child to be in a better situation." When asked for his point of view on birth parents that voluntarily place their children into the system, Mr. Name responded, "I'm supportive because that usually means they don't have the capability or the desire to take care of them and that's actually a better situation." When asked for his viewpoint on foster children, Mr. Name stated, "I tend to, with the limited knowledge I have, believe they do need extra attention and love. I have a lot of respect for foster parents because it is a big responsibility. Especially those who have done it for a long time." Regarding the type of relationship they are willing to have with the birth parents, Mrs. Name stated, "There is no contact with any birth family member,nothing at all." The Name's were asked how they intend to discuss the child's adoption with the child. Mrs. Name replied,"Based on the previous situation that she was in and how she reacted to that(adoption)and fought that, I'm going to be very deliberate with that. You don't want to do something that would jeopardize her progress." Mr.Name added, "Our feeling is we can care for her and love her just as well as foster parents and if that's what she needs,that's what we'll do." REFERENCES R and S O: 491'Ave.,Greeley, CO, 80634. Posted:02.03.06. Received: 02.07.06. Recommended. B and D S: 21' St. Ct., Greeley, CO, 80634. Posted: 02.03.06. Received: 02.10.06. Recommended. B and R U: 52' Ave.,Greeley, CO, 80634. Posted: 02.03.06. Received: 02.11.06. Recommended. T and F R: 20th, #38, Greeley, CO, 80634. Posted: 02.03.06. Not yet received. FAMILY PREPARATION AND TRAINING ACTIVITIES The Name's were asked how prepared they believe they are to foster/adopt Sally. Mrs.Name responded, "We're ready. We've been seeing her since September." When asked if they have participated in any agency family preparation activities, Mrs. Name said, 'We start Friday." LEGAL/FINANCIAL RIGHTS AND RESPONSIBILITIES Jane Name and Bob Name have been provided with information concerning the different roles, responsibilities, legal and financial rights and benefits of relative/fictive kin caregivers, foster parents, legal guardians and adoptive parents. Also, should they file a petition to adopt; Jane Name and Bob Name understand that they will be accepting full legal and financial parental responsibility for Sally Jones once an adoption is finalized. The agency's grievance review hearing procedures were not explained to the Applicants. Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-14-2005 Page 14 of 18 Copyright,2005,Consortium for Children,Al Rights Reserved PSYCHOSOCIAL INVENTORY RESULTS NOTE: Below is a list of the psychosocial factors found on the SAFE Psychosocial Inventory. Using the Psychosocial Inventory. each factor was considered and rated several times by the social worker during the course of this home study. The ratings below represent the final ratings. The ratings are defined as follows: 1=an exceptional strength. 2=a strength. 3 = an issue of concern. 4 = a major issue of concern and 5 = vent' serious problem. The OVERALL EVALUATION OF SECTION ratings reflect the degree to which all issues of concern identified in the section were either resolved.mitigated or the prognosis for change. #1 #2 HISTORY #1 #2 EXTENDED FAMILY RELATIONSHIPS 2 2 Childhood Fancily Adaptability 3 2 Extended Family Cohesion 3 2 Childhood Family Cohesion 2 2 Extended Family Adaptability 2 2 Childhood History of Deprivation/Trauma 2 2 Relationship with own Extended Family 2 2 Childhood History of Victimization 2 2 Relationship with Spouse's/Partner's Family 2 2 Adult History of Victimization/Trauma 2 2 OVERALL EVALUATION OF SECTION 2 2 History of Child Abuse/Neglect 2 2 History of Alcohol/Drug Use PHYSICAL/SOCIAL ENVIRONMENT 2 2 History of Crime/Arrest/Allegations/Violence 2 Cleanliness/Orderliness/Maintenance 2 2 Psychiatric History 2 Safety 2 2 Occupational History 2 Furnishings 2 2 Marriage/Domestic Partner History 2 Play Area/Equipment/Clothing 2 2 OVERALL EVALUATION OF SECTION 2 Finances 2 Support System #1 #2 PERSONAL CHARACTERISTICS 2 Household Pets 2 2 Conununication 2 OVERALL EVALUATION OF SECTION 2 2 Conucutcnent and Responsibility 2 2 Problem Solving #1 #2 GENERAL PARENTING 2 2 Interpersonal Relations 2 2 Child Development 2 2 Health and Physical Stamina 2 2 Parenting Style 2 2 Self-esteem 3 3 Disciplinary Methods 2 2 Acceptance of Differences 2 2 Child Supervision 2 2 Coping Skills 2 2 Learning Experiences 2 2 Impulse Control 2 2 Parental Role 2 2 Mood 2 2 Child Interactions 2 2 Anger Management and Resolution 2 2 Communication with Child 2 2 Judgment 2 2 Basic Care 2 2 Adaptability 2 2 Child's Play 2 2 OVERALL EVALUATION OF SECTION 2 2 OVERALL EVALUATION OF SECTION MARITAL/DOMESTIC PARTNER #1 #2 SPECIALIZED PARENTING RELATIONSHIP 2 2 Expectations 2 Conflict Resolution 2 2 Effects of Abuse/Neglect 2 Emotional Support 2 2 Effects of Sexual Abuse 2 Attitude toward Spouse/Partner 2 2 Effects of Separation and Loss 2 Communication between Couple 2 2 Structure 2 Balance of Power 2 2 Therapeutic/Educational Resources 2 Stability of the Marriage or Partnership 2 2 Birth Sibling Relationships 2 Sexual Compatibility 2 2 Child Background Information 2 OVERALL EVALUATION OF SECTION 2 2 Birth Parent Issues 2 2 OVERALL EVALUATION OF SECTION SONS/DAUGHTERS/OTHERS RESIDING OR FREQUENTLY IN HOME #1 #2 ADOPTION ISSUES 2 Minor Sons and Daughters 2 2 Infertility 2 Minors Residing or Frequently in the Home 2 2 Telling Child about Adoption 2 Adult Sons and Daughters 2 2 Openness in Adoption 2 Adults Residing or Frequently in the Home 2 2 Adoptive Parent Status 2 OVERALL EVALUATION OF SECTION 2 2 OVERALL EVALUATION OF SECTION Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-14-2005 Page 15 of 18 Copyright,2005,Consortium for ChtNen,AR Rights Reserved PSYCHOSOCIAL EVALUATION REPORT HISTORY Mrs. Name reported that her parents divorced when she was one-year-old and she only had contact with him approximately six times by the age of eighteen. Mrs. Name also described her stepfather as disengaged and distant. PERSONAL CHARACTERISTICS Both Mr. and Mrs. Name display superior communication skills. They are both articulate and display good comprehension. Mr. and Mrs. Name present as dependable,with a healthy sense of personal responsibility and cooperation. The Name's appear to be able to maintain several close and enduring relationships through family members, church as well as employment friendships. Both of the Name's display a healthy sense of humor and empathy. Mr. and Mrs. Name present as physically and mentally healthy. MARITAL/DOMESTIC PARTNER RELATIONSHIP Mr. and Mrs. Name present as a stable, committed couple. They present with similar values, expectations, goals and beliefs in their ability to resolve conflict. Mr. and Mrs. Name display sensitivity and responsiveness to one another's emotional needs and appear to be able to extend emotional comfort to each other. The Name's displayed affection and respect to one another and their communication patterns appeared mutually satisfying,honest and direct. Mr. and Mrs. Name report that the balance of power in the relationship is shared through consensus rather than applied by force. Both Mr. and Mrs. Name reported that their is no violence in their home. SONS/DAUGHTERS/OTHERS RESIDING OR FREQUENTLY IN THE HOME Mr. and Mrs. Name display a great deal of love,affection and respect toward their children. They verbalized age- appropriate expectations and presented as flexible in their interactions with their son, Son#2. Son#2 presents as a secure,well-adjusted and adaptable young man. He was pleasant and cooperative during his individual interview. This clinician did not meet the oldest son, Son#1 on,as he is attending college in Houston,Texas. EXTENDED FAMILY RELATIONSHIPS Mr. Name describes healthy emotional connections between family members. Mrs.Name reports that her relationship with her father as well as with her stepfather is distant and disengaged. Both Mr. and Mrs. Name report close friendships with church members as well as with co-workers. Mrs.Name states that all of her friends and family she has contact with have been very supportive. Three of the four references sent out were received with positive recommendations. The fourth reference was not received. PHYSICAL/SOCIAL ENVIRONMENT Mr. and Mrs.Name have a warm,welcoming home. The home is a two-story house built on a large lot in a gated community. Although Mrs. Name stated that one of her weaknesses is keeping up with the house cleaning,this clinician saw no evidence of that. The home was clean and orderly during all interviews. This clinician noted no safety concerns on the property. The home is adequately famished and Mr. and Mrs. Name intend to enclose a large room for Sally. Mr. and Mrs. Name's financial status appears to be quite stable. Their income appears to be reliable and sufficient to meet family needs. The household pets appear to be loved and well treated by family members. GENERAL PARENTING Mr. and Mrs. Name present with a good knowledge base regarding child development. They appear to have realistic expectations of children throughout each developmental stage. Both Mr. and Mrs. Name appear to be able to effectively incorporate warmth and control into their parenting style. Although Mr. and Mrs. Name reported that they used"swats"on their children when their children were young,they both stated that they understand that the Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-14-2005 Page 16 of 18 Copyrgrt,2005.Consortium for Chidren,Al Rights Reserved state of Colorado does not allow any form of corporal punishment as a disciplinary method with foster children. Mr. and Mrs. Name verbalize a healthy understanding of the purpose of supervision. Mr. and Mrs. Name reported an established relationship and active involvement with their children's schools. Mr. and Mrs.Name present with realistic confidence in their parenting abilities and appear positive and enthusiastic about parenting. SPECIALIZED PARENTING Mrs. Name appears to have a thorough and realistic understanding of Sally's needs. The Name's have had quite a bit of contact with Sally since September of 2005. Sally has spent the night at the Name's and they have reported positive interactions. The Name's appear to have an adequate understanding of how a child's normal emotional and physical development may be gravely impacted by the abuse or neglect they experienced. Mr. and Mrs.Name reported that they are more than willing to make sure that Sally's emotional and developmental needs are met. They are aware of the on-going need for therapeutic services for Sally. ADOPTION ISSUES Mrs.Name verbalized her understanding that Sally sabotaged her previous adoptive home and that Mrs. Name is willing to offer Sally the time she needs to adjust before exploring the possibility of adoption. Mrs. Name stated that, if Sally does not wish to ever be adopted,that is fine with Mrs. Name. PSYCHOSOCIAL EVALUATION CONCLUSIONS Both Mr. and Mrs.Name present as a healthy, stable,committed couple that is committed to helping Sally in the best way possible. PLACEMENT COMPATABILITY Sally has spent a great deal of time with the Name family since September of 2005. This clinician is not aware of any concerns about the Name's interactions with Sally. The relationship appears to be healthy and mutually satisfying at this time. RECOMMENDATION It is recommended that Jane Name and Bob Name be approved as foster and adoptive parents for the placement of Sally Jones. r \� J lie Box NA L NA Date: O'J.28.06 Date Waiver Required? Select One Type: Select One Directors Approval: Select One DCFS Administrator Approval: Select one Additional Attachments Questionnaires one and two for both Mr. and Mrs. Rendall. Three positive references. Local background checks. Department of Motor Vehicle background checks. REVIEW OF HOME STUDY REPORT Structured Analysis Family Evaluation(SAFE) Colorado Couple Child Specific Home Study Report -Version 09-142005 Page 17 of 18 Copyright,2005,Consortium for CMdren,Al Rights Reserved By signing below I acknowledge that I have read a copy of this report. Jane Name Bob Name Date: Date Structured Analysis Family Evaluation(SAFE) Colorado Couple Chid Specific Home Study Report -Version 09-14-2005 Page 18 of 18 Copyright,2005,Consortium for Children,MI Rights Reserved § la \ � // j c f,e -- i § / � 0 © / \ \ ) ( » 2 gm \ / / \ ) \ K J2 — a or a § ® k c \ \ § ) as e= / c a / § oo _ a3 .b • , & a '§ fXQ k co ...a ) -a K - 2 \ # \ 5 � § $ 1:3E ( ) $ � 2 \ § 2 f I our f f \ ) § 2 ` , / $ f \ O& & I = j _ m ....SL j § \ \ § » 3 8ON 2 �~ a tat $ / o ■ k / 4 44 z m 2 o No § / 0 / ; co J d § co} } 2 § § § k ( @ o _ _ \ m t k / / \ u k2 » c J / m0 / hi ,! 0to k \ � a ; / $ § $ 2 No 3 * b ) c w _* / / � 2 u En r,4 k a Q 0 (% & / q } K ) / // gel r/ ® a \ k \ \ \ \ } \ $ /\ ) / ) } / j� 9 • STATE OF COLORADO Department of Regulatory Agencies Division of Registrations ACTIVE PRINTED ON SECURE PAPER LICENSED CLINICAL SOCIAL WORKER 992006 I 07/01/2005 I 06/30/2007 Number Issue Date ! Expires Julienne Elise Box FT COLLINS,CO 80525 United States q.46011eALe c .ae - ...�.. AMERICAN HOME ASSURANCE CO. -HIS IS A CLAIMS MADE POLICY PLEASE READ CAREFULLY 12/05/05 SOCIAL WORKER PROFESSIONAL. LIABILITY POI. ifY NOTICE: A LOWER UMIT OF UABILITY APPLIES TO JUDGMENTSORRSETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION"SEXUAL MISCONDUCT"IN THE POLICY). DECL ARATIONS POUCY NO: SWL-1919252 ACCOUNT NO: CO—BOXJI70-0 0426974S ITEM 1.(a)NAME AND ADDRESS OF INSURED: . ITEM 1.(b)ADDITIONAL NAMED INSUREDS: JULIENNE E. BOX 1702 68TH AVENUE GREELEY. CO 80634 TYPE OF ORG: INDIVIDUAL ITEM 2. ADDITIONAL INSUREDS: STATE OF COLORADO/THE WELD CNTY. DEPT. OF S.S. P.O. HOX A GREELEY, CO 80631 ITEM 3. POUCY PERIOD: FROM: 02/20/06 TO: 02/20/07 12:01 A.M.STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: ITEM 4. LIMITS OF LIABILITY: (a)$ 190009000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS,REPEATE[ OR INTERRELATED WRONGFUL ACTS OR OCCURRFNCE (b)$ 1,000,000 AGGREGATE (c)$ 5.000 DEFENSE REIMBURSEMENT ITEM 5. PREMIUM SCHEDULE: CLASSIFICATION NUMBER RATE ANNUAL PREMIUM PROFESSIONALS 1 133.00 133.00 DEFENSE LIMIT .00 ADDITIONAL INSUREDSI 1 27.00 27.00 ITEM 6. RETROACTIVE DATE: 02/20/04 TOTAL PREMIUM: 160.00 ITEM 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM(If exercised):$ 160.no ITEM 8. POLICY FORMS AND ENDORSEMENTS =ORM 065x5 HT/98Ti1►658IgSY:(7/96) 52134 10/91 66053 § ] e 88888888888888 8 888888 8 8 | 8 ggg#g;.gsggegg g gggggg g s o e§ 8 gl'i ! | co 88888888888888 ■ ■88888 8 8 % a S.■Se.gSSSgggg S SgggSS ! g Qi 8 g ! %| 88888888888888 8 $88888 8 $ |§ i.#gg.,■g,ggg. § !!lggg \ § z : ! i8 A g | 3 ` i - | , 2 888888888$$$$$ ■ 8888■■ $ • |� tg;2■2.gg��a.■ | §!l�� | 2 | ) k ' � . 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C |e §| ■||||||| .,■..,,, /` e ! !° vn-n_ §,2222222222 f lar a2$ W |§§| - - k | | | | r | | | 1 | ■ | § | 2 | E § ■ | : .ik2 a | 9 O * 444IIII • • | ggl8 § § e ♦ 1 3 Julie Na WSW and Jacque Box,MA 1702 68th Ave ?: yeeley, CO 80634 Phone 970.339.9036 Fax 970.339.9036 Facsimile Transmittal Cover Sheet CONFIDENTIAL INFORMATION Date: May 18, 2006 To: Gloria Romansik Company: Weld County Department of Social Services Phone: 970.352.1551 Fax: 970.346.7698 From: Julie Box Fax number: 970.339.9036 Phone number: 970.339.9036 or 970.302.1471 Number of Pages,including Cover Sheet: 2 Comments: Gloria, here's my response to the recommendations for RFP 06008 (Mediation) and RFP 006-00C(Foster Parent Training). I will mail the original to you tomorrow. Re: Response to FYC Commission's recommendation re: RFP 06008 and RFP 006- 00C. If you have any questions, please feel free to call at 970.302.1471. Thank • 'u, Jul' :ox,LCSW NOTE:This message is intended for the use of the individual or entity to which it is addressed,and may contain information that is PRIVILEGED ANT)CONFIDENTIAL. If you are not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient,you are hereby notified that any dissemination,distribution,or copying of this communication is strictly prohibited. If you have received this communication in error,please notify the above sender immediately by telephone and return the original message to us at the above address via the U.S.Postal Service. Thank you. 1 05.18.06 Julie Box, LCSW Private Practice 1702 68th Avenue Greeley, CO 80634 970.302.1471 Re: Response to recommendations from the FYC Commission on Bid# 061FT02 (RFP 06008)Mediation and Facilitation under IFT and Bid #06FPT02 (RFP 006-00C)Foster Parent Training. Dear Ms. Romansik, I am writing in response to the recommendations made by the FYC Commission for the bids on mediation and foster parent training. I agree to all recommendations and will incorporate the recommendations into my bids as described below. Mediation: Recommendation #1: Bidder agrees to becoming certified in mediation within the next six months. Bidder will provide the Department a copy of certification once achieved. Recommendation#2: Bidder agrees to get written permission from the necessary parties in order to do telephone mediation. Bidder will keep records of individuals spoken to, dates of verbal approval for telephone mediation and provide such to the Department. Hourly rate for court testimony: Bidder agrees to use the approved rate of$100.00 per hour to bill for court testimony. Foster Parent Training: Recommendation: Bidder agrees to coordinate her schedule according to foster parent work times for their convenience. Bidder will submit a formal training outline, including dates and times of trainings and place of trainings, to the Department by June 30, 2006. Thank you for the continued opportunity to work with Weld County. If you have any questions or need further clarification, please feel free to contact me at any time at the above number. in rely, ulie ox, LCS • • . jes DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY,CO. 80632 Website:www.co.wdd.co.us ' Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 WI C. COLORADO May 15, 2006 Julie Box,Private Practice 1702 68 Avenue Greeley, CO 80634 Re: Bid#061FT02(RFP 06008)Mediation&Facilitation under IFT Bid#06FPT02 (RFP 006-00C)Foster Parent Training Bid#06FPC03 (RFP 006-00A)Foster Parent Consultation Bid#06HS07 (006-00B)Home Studies and Relinquishment Counseling Dear Ms. Box: 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 • The Families, Youth and Children(FYC)Commission recommended approval of your Bid# 061FT02, Mediation and Facilitation under the Intensive Family Therapy program area, for inclusion on our vendor list. This bid scored 93 points. The FYC Commission attached the following recommendations to your bid. Recommendation#1: The FYC Commission recommended that you pursue becoming certified in mediation. Recommendation#2: The bidder must get written permission in order to do telephone mediation. Hourly Rate for Court Testimony: You did not provide a rate for court testimony. For new bidders the Department will use your approved rate for services, $100.00 per hour,to bill for court testimony. • The Families, Youth and Children(FYC)Commission recommended approval of your Bid# 06FPT02, (RFP 006-00C)Foster Parent Training for inclusion on our vendor list. This bid scored 90 points. The FYC Commission attached the following recommendations to your bid. Recommendation: The FYC Commission recommended that you coordinate your schedule according to foster parent work times for their convenience.The FYC Commission recommended a detailed formal training outline be submitted. • The Families, Youth and Children(FYC)Commission recommended approval of your Bid# 06FPC03, (RFP 006-00A)Foster Parent Consultation for inclusion on our vendor list. This bid scored 93 points. Page 2 Julie Box,Private Practice/Results of Bid Process for PY 2006-2007 • The Families,Youth and Children(FYC)Commission recommended approval of your Bid# 06HS07, (RFP 006-00B)Home Studies, Updates,and Relinquishment Counseling, for inclusion on our vendor list. This bid scored 92 points. B. Required Response by FYC Bidders Concerning FYC Commission Recommendations: Recommendations: You are requested to review the FYC Commission recommendations and to: 1. accept the recommendation(s) as written by the FYC Commission; or 2. request alternatives to the FYC Commission's recommendation(s); or 3. not accept the recommendation(s)of the FYC Commission. Please provide in writing how you will incorporate the recommendation(s)into your bid. If you do not accept the recommendation, please provide written reasons why. All approved recommendations under the NOFAA will be monitored and evaluated by the FYC Commission. 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. You may fax your response to us at 970.346.7698. If you have questions concerning the above,please call Gloria Romansik, 970.352.1551, extension 6230. Sincerely, J y A. 'ego, ector cc: Juan Lopez,Chair,FYC Commission Gloria Romansik, Social Services Administrator Weld County Department of Social Services Notification of Financial Assistance Award for Child Welfare Regular Administration Type of Action Contract Award No. X Initial Award 06/0711S/0030 Revision (RFP-006-00C) Contract Award Period Name and Address of Contractor Beginning 06/01/2006 and Ackerman and Associates,P.C. Ending 05/31/2007 Home Studies,Updates,Relinquishment Counseling 1750 25th Avenue, Suite 101 Greeley,CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Home study format is based on 20 hours of Assistance Award is based upon your Request for work, 11 hours of direct professional services as Proposal (RFP). The RFP specifies the scope of well as required background checks.Updates are services and conditions of award. Except where it is based on a format of six hours.Relinquishment in conflict with this NOFAA in which case the counseling is a maximum of two hours per NOFAA governs,the RFP upon which this award is parent,billed in one hour increments. Program based is an integral part of the action. capacity is 24 home studies or updates, and a Special conditions total of 48 hours of relinquishment counseling 1) Reimbursement for the Unit of Service will be based per year.The average stay is expected to be two on a rate per home study; home study update,and months for a home study, and two weeks for relinquishment counseling session. each parent in relinquishment counseling,with 2) Reimbursement requests must be an original with an up to two one-hour sessions of individual original signature from the provider and/or designee. counseling per parent.Bilingual-bicultural 3) Reimbursements requests must include the date the services are available through current staff. home study,update, or relinquishment counseling was completed. The request must reflect the referral Cost Per Unit of Service number assigned to each home study,the amount Hourly Rate per billed for each home study,and the month the service Relinquishment Counseling $120.00 was provided. (2-hour maximum) 4) Payment will only be remitted on referrals made by Rate per Study the Weld County Department of Social Services. Full Home Study $1,045.00 5) Requests for payment must be an original submitted Updated Home Study $570.00 to the Weld County Department of Social Services by the end of the 25th calendar day following the end Unit of Service Based on Approved Plan of the month of service. The provider must submit requests for payment on forms approved by Weld Enclosures: County Department of Social Services. X Signed RFP:Exhibit A 6) The Contractor will notify the Department of any Supplemental Narrative to RFP: Exhibit B changes in staff at the time of the change. _ Recommendation(s) _ Conditions of Approval Approv Program Official: i By By David E. Long, Chair P —Tem Judy 'eg irector Board of Weld County Commis oners Weld ty D artment o ocial Services Date: 06/19/2006 Date:__40 15-9/ c,, HS SZ INVITATION TO BID BID 001-06(06005-06011 and 006-00 A,B,&C) DATE:March 1, 2006 BID NO: 006-00C RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY '^ /rye ,S rk- DiA- Request for Proposal(006-000 for: T . . tignmeematmereatvre lbww-A G,f 4 ZZ, hfo 8 Stt/C.s ror. Deadline: March 31, 2006, Friday, 10:00 a.m. IV.ft tnr\ r 4 L ,a— Cok t ie-i 17. The Families,Youth and Children Commission, an advisory commission to the Weld County Social Services, announces that 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 Foster Parent Core Training Program must provide services that focus on providing Core Certification Training, satisfying all training requirements of State of Colorado Volume VII,and those required by Weld County Social Services. (See Appendices A, B, and C.) 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 MOW-`OW- t, 6200 (After receipt of order) BID MUST BE SIGNED f(�� IN INK n P I'lC�l..rN n Amery a TYP+1,4 Oft PRINTED SIGNATURE PROVIDER f\�'\LtiNMcin, Othdl ��QMe(C1N-c,_s ��aa.- e , (Name) wrl'tten Signature By Authorized O cer or Agent of Provider ADDRESS 1‘15 ® 2≥ p' o TITLE Mt1N1‘%‘;\ ` ( ‘N .��(13 DATE ' ►l1 ti f •h PHONE# l 3 2 'f . The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 38 I 4 Bid Number 002-05(RFP-FYC 006-OOC) Attached A FOSTER PARENT CORE TRAINING PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING COLORADO FAMILY PRESERVATION ACT 2006-2007 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2006-2007 BID 001-06 ( 0 0 8 NAME OF AGEN Y: \ i! ADDRESS 1� l tPn'se - gt> \o PHONE: ( fl1> `3 ""Ca 7'3 `7`3 CONTACT PERSON:(. (\Qs 4E Nmar'. t.6-Z- TITLE: fpcia.. Ct NA DESCRIPTION I ' FAMILY P' SERVATION PROGRAM CATE •.'Y. Th F. Pas ..re . + : Cat: _1► must .ro • ore C-rti .n T . . to Fo "•• are Certt ation : • ants •'' 1. Co . • . : . i'.. ..• - .h,: Weld .dsR;. oster Carte' . . '..• A. .lic• The ; • _s m, •t satis all traa's - .ui endi es B and and ose re•uired b Well . . %. .-a • eais--s of • tat - ices. };o o-.. ST 6, - 1 , o th a c.r. .'mate Pro'e-. a ates: _ month contract with actual time lines of: Start June 1, 2006 Start End May 31, 2007 L( /J End TITLE OF PROJECT: 4YjerfrtOv er.t /ASS O C t 6 ZL h6Vtt St h/Ot Wire- , O41e-rrr g"" �i,,.cl�. ,__ > ?/l /04 Name and Signature of Person Preparing �ocu\nent Date Name d Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REOUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid.Proj✓ eempte-T t Description T ✓ Target/Eligibility Populations V Types of services Provided V Measurable Outcomes ✓ Service Objectives Workload Standards V✓ Staff Qualifications I/ Unit of Service Rate Computation - 1#6 73.4 ,f�rviC haws' Billing F1a.c,es o/Isac^.irlon (rte a o r �1 �Ser dr . _Lew t-at Qt...Efi.,d Did Eve t e..a L93 5 — sqPE fern-a It Program Capacity per Month _V Certificate of Insurance D./�rn; 1049.2., e- F4/C Forw/p/!oi yew-i6eti4; . dr Date of Meeting(s)with Social Services Division Supervisor: 3/2/0 C Page 25 of 38 afloat: Bid 001-Of(RFNETC-06007)~ Attached A Date of Meeting(s)with Social Services Division Supervisor Comments by SSD Supervisor. t c_ • fifiew 771 ovate eiste r .0 s�a�jd�,► kerelor .2r airt.lG _Jf+c+r la co t �� -sue f r r elera . k 0.ter 1. �2. c tf • t #4441.0frs., As/ ..fiewsii est a ...trexesietese pap. aPdeder3/7/a Name and Signature of SSD S Date Page 30 0141 Project Description 2006- 2007 ACKERMAN AND ASSOCIATES' HOME STUDY AND ADOPTION RELINQUISHMENT SERVICES Overview: Ackerman and Associates, P.C. proposes to again conduct: 1. A home study program for new or existing cases where a family study is needed to certify an adoption placement is in the best interest of the specified potential adoptee and the adoptive family. A new home study is referred to in the proposal simply as a home study. A home study that is for an existing case, where an appropriate home study has been completed previously and where new information is required is termed a home study update. 2. The home study program would be required of new foster parent homes. 3. Relinquishment counseling is designed to assure that each parent relinquishing the child is fully aware of, in agreement with and capable of making a decision related to relinquishment. We propose to provide up to two hours of relinquishment counseling as specified by Colorado and Weld County. Such services will be referred individually for each parent relinquishing their rights and giving their child permanently to another family in an adoption process. We will provide these programs primarily through services in the home of the family intending to adopt, the new foster parent home or in our offices. Services will consist of: 1. A home study format of twenty hours of work based on eleven of direct professional services as well as required background checks. Work performed will meet the state criteria for an appropriate home study as illustrated by the fictional case study appended to this bid. 2. A home study format hours based on six hours of direct professional services to update an appropriate home study. The update will meet the state criteria for an appropriate home study. 3. Two hours of relinquishment counseling services for each parent billed in one hour increments. The billing format is designed to recognize that the parents may be estranged or one unavailable for the process. A maximum of two hours per referral is set in this process. The relinquishment counseling report will document the criteria set forth in the WCDSS outline and the Colorado relinquishment guidelines for relinquishment for each parent. 1 SAFE Multi Purpose Home Study Report This home study was completed by Joyce Ackerman,Ed.D solely for use in foster care placement and/or adoption by and for United States licensed/authorized agencies unless othenvise specified. Name of Family: Rodriquez-Smith Address: x. -x City: Greeley. State: Co I Postal Code: 00000 -0000 IHome Phone: i-c-xxx Cell Phone: xxxxx APPLICATION DISPOSITION Forward for consideration by Agency Approval Team on: Home Study Application received on: 2/10/2000 The Applicants have applied to accept placement of a child between the ages of 1 to 10 The Applicants are not open to placement of a sibling group. The Applicants are primarily interested in becoming an Adoptive Family. APPLICANT INFORMATION Fred Smith Mary Rodriquez Date of Birth: 07/29/1966 Date of Birth: 08/28/1967 Birthplace: Denver Birthplace: Greeley Gender: Male Gender: Female Religion: Methodist Religion: Catholic Occupation: Mechanic Occupation: Nurse's Aide Language(s): English Language(s): Spanish and English Education: 12th grade Education: 12th grade Height: 5'10" Height: 5'3" Weight: 175 Weight: 153 Hair: black Hair: black Eyes: brown Eyes: brown Date of health questionnaire/report: j 2/3/2000 Date of health questionnaire/report: 12/3/2000 MARITAL INFORMATION Date of Marriage: 06/05/1989 Marriage Verification: On File Place of Marriage: Greeley DATES OF CONTACT Date Individual/Couple Lnnation 2/15/2000 couple Home 2/15/2000 Individual Home 2/15/2000 Individual Home 2/25/2000 Couple Home 2/25/2000 Individual Home 2/25/2000 Individual Home 3/05/2000 Couple Office Structured Analysis Family Evaluation(SAFE)®Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 1 of 9 Copyright,2005,Consortium for Children,All Rights Reserved Indicate both Applicants' stated reasons for wanting to become a foster parent,an adoptive parent, a foster adoptive parent or resource family.Both parents believe that they are fortunate to have a good home with a healthy child. They have large extended family support and very much want to add to their family. They have good jobs, adequate income and a strong desire to parent. HOME ENVIRONMENT Type of residence: House,Apt, Condo, Etc. Square Footage: 1500 Bedrooms: 4 Bathrooms 3 Length of Time in current residence: 7 years Describe general characteristics of the Applicants'home and neighborhood. Indicate the type of residence (house, apartment,condo,etc.)and square footage. Describe the floor plan including the number of bedrooms and bathrooms.Describe the yard space and indicate if there is a pool,pond/fountain,etc. Describe the sleeping arrangements and also indicate whether or not there are guns or pets in the home. The bi-level home is in an older, residential neighborhood.There are 3 bedrooms on the main floor and an additional bedroom downstairs.There is a bathroom in the master bedroom,one other bathroom upstairs and one downstairs.The home is about 1500 square feet. A small fenced in yard has a swing set. The family has a 3 year old dog.The home appears well kept and organized.No guns are in the home and the home was been inspected for health and safety on March 10,2000.There is a park and an elementary school nearby. Describe how the applicant presents him/her self. Also indicate any special interests,hobbies,expertise or talents the applicant possessesIdentify parents, siblings,their location and circumstances plus type and frequency of contact.Indicate name(s)and length of time of previous marriages and/or domestic partnerships. Include how relationships were terminated,e.g.,death,divorce,annulment,breakup. Identify any children born of these unions and describe their current situation. Describe how the applicant presents him/her self. Also indicate any special interests,hobbies,expertise or talents the applicant possesses. Identify parents, siblings,their location and circumstances plus type and frequency of contact. Indicate name(s)and length of time of previous marriages and/or domestic partnerships. Include how relationships were terminated, e.g., death, divorce,annulment,breakup. Identify any children born of these unions and describe their current situation. FAMILY: Fred Smith Fred indicated that he is very happy to be involved in adopting a child. He presents as a devoted husband and father. He has been married once previously and reported that he experienced some depression at the end of that marriage about 18 years ago.He stated that he believed he was too immature at the time of his first marriage and was inattentive to his wife. She asked for a divorce after the second year of the marriage.There was one child in that marriage, Debbi,who is now 17 years old. Fred sees Debbi two weekends a month and he and his x-wife have a cordial relationship. .Fred enjoys working on old cars during his spare time,however,he states that his primary goal,at this time,is to be involved in raising his children. Fred indicated that he has a good relationship with his parents,although they were initially upset that Fred and Mary choose to baptize Felize in the Catholic church. He states that this has not been a current issue and that his parents are now very appropriate with Felize his parents reside in Denver and .he sees his parents a few times a month. Felize has one brother,Tom who is divorced. Tom lives outside of Denver and Fred sees him approximately once a month. Structured Analysis Family Evaluation(SAFE)O Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 2 of 9 Copyright,2005,Consortium for Children,All Rights Reserved Mary Rodriquez Mary Rodriquez Mary is very anxious to adopt a child. She grew up in a home with seven siblings and has always wanted a large family. In the last several years,she has had two miscarriages. She believes that by adopting a child, she and Fred can provide a healthy,happy environment for at least one or more additional children. Mary reports that she enjoys making crafts during her free time. She often makes handmade gifts for friends. Mary reported that she had one very serious relationship when she was in high school. She was engaged for a while but broke off that relationship after her senior year of high school. This is her first marriage. Mary is very close to her parents. Her father used to have a serious drinking problem,but he has been sober for nine years. Her mother enjoys being a grandparent to 12 grandchildren and is very excited that Mary and Fred are adopting another child. Mary's 6 siblings all live in Weld County and they see each other on a regular basis,at least once a week. Applicants' Sons and Daughters Indicate "None"or provide name(s), DOB and gender. Describe their personality,interests, school or occupational situation, general health and living situation. Felize, (DOB 5-12-99)is the only child of this couple.He is a bright,talkative 2""grade student. He is very excited about becoming a big brother.He has his own bedroom and is proud of his car collection. Other children living or frequently in the home Indicate"None"or provide name(s), DOB,gender. Provide description of their personality, interests, school report information if any,general health. Indicate nature of relationship to Applicants,and living situation. None Other adults residing or frequently in the home Indicate name of any adult who is living in the home or who is in the home on a regular basis. Describe the amount and type of contact they would have with a child. None Indicate each individual's occupation,general health and the nature of their relationship to the Applicant. None Describe current and proposed child care arrangements and work and non-work day routines and rituals. What are the basic household rules and expectations? Who does what in terms of chores, cooking,bill paying, home maintenance,transportation, etc.?Describe how the family deals with privacy and nudity in the home. What kind of recreational, social and religious activities does the family engage in? Does the family celebrate holidays;which ones and how are they spent? Family Lifestyle Fred drops off Felize at school each day and Mary picks him up after school. Felize is expected to complete daily chores. The rules appear to be uniformly enforced in the observations that were made. Fred does home maintenance (inside and outside). Mary does most of the cooking and pays the family bills. Nudity is not acceptable in the home. Structured Analysis Family Evaluation(SAFE)O Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 3 of 9 Copyright,2005,Consortium for Children,All Rights Reserved The family attends Catholic Church once a week . Much of the family free time is spent with Mary's siblings and their children. Christmas and Easter are reported to be especially significant events. Previous adoptions or foster care experience Indicate "None"or discuss the circumstances and the adjustment of the child or children to the family. None FINANCES Combined annual gross earned income: $56,000 from wages Sources of additional income: Explain,if any None CRIMINAL/CHILD ABUSE RECORD Indicate the name(s)of any other individuals who were screened. The required criminal record and Child Abuse Index checks were completed for Fred Smith and Mary Rodriquez. These reports were sent directly to WCDSS from CBI State automated system, CBI,ICON/Co Courts,and FBI(if applicable) Clearance Findings: Indicate the findings for each individual screened. State findings were reported directly to WCDSS.NO problems in background information were noted by the WCDSS caseworker. Other findings: Indicate who was screened for each of the following and the findings for each person: DMV (optional),local law enforcement(optional)and CPS service records. Check of these records DMV and local law enforcement revealed no relevant data on either applicant other than an orrasional parking ticket for overtime meters.. EMERGENCY CARE PLAN /In case of an incapacitating illness or death of the Applicants,indicate whom the designated caretaker(s)will be and the nature of their relationship to the Applicants. Mary's sister,Betty,has two small children and has agreed to be the emergency person to care for Mary and Fred's children in case of death or incapacitating illness. Indicate if these arrangements have been discussed with the designated caretaker(s),how willing they are to assume this responsibility and whether arrangements have been formalized in a will or mist. Betty,who is Felize's godmother,is also listed in Mary and Fred's will as a caretaker in case of their mutual demise. CONTACT WITH FAMILY OF ORIGIN AND SIGNIFICANT OTHERS Describe the type of relationship and contact the Applicants are willing to have with the birth parents and other significant connections such as siblings,grandparents,foster parents,etc. Describe any written post-adoption contact agreement(s). Mary and Fred would be willing to provide pictures to the birth parents. At this time,they are somewhat hesitant about having any other contact with the birth parents, but they are willing to consider it in the future REFERENCES References received: Yes Structured Analysis Family Evaluation(SAFE)O Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 4 of 9 Copyright,2005,Consortium for Children,All Rights Reserved FAMILY.TRAINING .Identify and describe agency family training. Include Applicants'statements regarding their participation and benefits derived from these activities. Both of these applicants have completed all of the required training LEGAL/FINANCIAL RIGHTS AND RESPONSIBILITIES Fred Smith and Mary Rodriquez have been provided with information concerning the different roles, responsibilities, legal and financial rights and benefits of relative/child specific kin caregivers,foster parents, legal guardians and adoptive parents. Also, should they file a petition to adopt, Fred Smith and Mary Rodriquez understand that they will be accepting fill legal and financial parental responsibility once an adoption is finalized. The agency's grievance procedures were explained to the Applicants. Structured Analysis Family Evaluation(SAFE)®Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 5 of 9 Copyright,2005,Consortium for Children,All Rights Reserved PSYCHOSOCIAL INVENTORY RESULTS NOTE: Below is a list of the psychosocial factors found on the SAFE Psychosocial Inventors. Using the Psychosocial Inventory. each factor was considered and rated several times by the social worker during the course of this home stud)'. The ratings below represent the final ratings. The ratings are defined as follows: 1 =an exceptional strength. 2=a strength, 3 = an issue of concern. 4=a major issue of concern and 5 =yen' serious problem. The OVERALL EVALUATION OF SECTION ratings reflect the degree to which all issues of concern identified in the section were either resolved, mitigated or the prognosis for change. #1 #2 FUSSY #1 #2 =TIMEDFAMiLYRELATIONSHIPS 3 2 Childhood Family Adaptability 2 2 Extended Family Cohesion 2 2 Childhood Family Cohesion 2 1 Extended Family Adaptability 2 2 Childhood History of Depris ation/Trauma 2 1 Relationship with own Extended Family 2 2 Childhood Hilton of Victimization 2 2 Relationship with Spouse's/Partner's Family 2 2 Adult History of Victimization/Trauma 2 1 OVERALL EVALUATION OF SECTION 2 2 History of Child Abuse/Neglect 2 2 History'of Alcohol/Drug Use 2 2 History of Crime/Arrest/Allegations/Violence 2 Cleanliness/Orderliness/Maintenance 2 2 Psychiatric History 2 Safety 2 2 Occupational History 2 Furnishings 3 2 Marriage/Domestic Partner History 2 Play Area/Equipment/Clothing 2 2 OVERALL EVALUATION OF SECTION 2 Finances 2 Support System #1 #2 � , 2 Household Pets 2 2 Communication 2 OVERALL EVALUATION OF SECTION 2 2 Commitment and Responsibility 2 2 Problem Solving 2 2 Interpersonal Relations 2 2 Child Development 2 2 Health and Physical Stamina 2 2 Parenting Style 2 2 Self-esteem 2 2 Disciplinary Methods 2 2 Acceptance of Differences 2 2 Child Supervision 2 2 Coping Skills 2 2 Learning Experiences 2 2 Impulse Control 2 2 Parental Role 2 2 Mood 2 2 Child Interactions 2 2 Anger Management and Resolution 2 2 Communication with Child 2 2 Judgment 2 2 Basic Care 2 2 Adaptability 2 2 Child's Play 2 2 OVERALL EVALUATION OF SECTION 2 2 OVERALL EVALUATION OF SECTION ' x fw2 s r #1 #2 S F z do - ` � 2 2 Expectations 2 Conflict Resolution 2 2 Effects of Abuse/Neglect 2 Emotional Support 2 2 Effects of Sexual Abuse 2 Attitude toward Spouse/Partner 2 2 Effects of Separation and Loss 2 Communication between Couple 2 2 Structure 2 Balance of Power 2 2 Therapeutic/Educational Resources 2 Stability of the Marriage or Partnership 2 2 Birth Sibling Relationships 2 Sexual Compatibility 2 2 Child Background Information 2 OVERALL EVALUATION OF SECTION 2 2 Birth Parent Issues 2 2 OVERALL EVALUATION OF SECTION 2 Minor Sons and Daughters 2 3 Infertility 2 Minors Residing or Frequently in the Home 2 2 Telling Child about Adoption 2 Adult Sons and Daughters 3 3 Openness in Adoption 2 Adults Residing or Frequently in the Home 2 2 Adoptive Parent Status 2 OVERALL EVALUATION OF SECTION 2 2 OVERALL EVALUATION OF SECTION Structured Analysis Family Evaluation(SAFE)C Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 6 of 9 Copyright,2005,Consortium for Children,All Rights Reserved PSYCHOSOCIAL EVALUATION REPORT HISTORY Describe the basis for ratings of 1 (exceptional strengths). Briefly summarize ratings of 2(strengths). Fully narrate ratings of 3,4 &5 (concerns)to include how the concern was addressed, severity, mitigating factors and degree of resolution. Fred and his family initially had a dispute about what religion to raise Felize in. This has seen been discussed by all family members and is not considered an issue at this time. Felize is being raised in his mother's religion PERSONAL CHARACTERISTICS Describe the basis for ratings of I (exceptional strengths). Briefly summarize ratings of 2(strengths). Fully narrate ratings of 3,4&5 (concerns)to include how the concern was addressed,severity,mitigating factors and the prognosis for change. Summary of strengths include a couple who communicates well and appears to have a dedication to detailed communication. MARITAL/DOMESTIC PARTNER RELATIONSHIP Describe the basis for ratings of 1 (exceptional strengths). Briefly summarize ratings of 2 (strengths). Fully narrate ratings of 3,4&5(concerns)to include how the concern was addressed, severity, mitigating factors and the prognosis for change. Fred was divorced after a brief marriage when he was younger. He continues to have contact with his 17 year old daughter from that marriage SONS/DAUGHTERS/OTHERS RESIDING OR FREQUENTLY IN THE HOME For each person identified in this section,provide full narration that relates to each of the Desk Guide examples for the rating given. Felize is a 7 year old child who is adjusting well to school and home. He looks forward to being a big brother EXTENDED FAMILY RELATIONSHIPS Describe the basis for ratings of 1 (exceptional strengths). Briefly summarize ratings of 2(strengths). Fully narrate ratings of 3,4&5(concerns)to include how the concern was addressed,severity,mitigating factors and the prognosis for change. The family all live in Weld county area and see each other regularly. Numerous cousins constitute an ongoing extended family for an adoptee. PHYSICAL/SOCIAL ENVIRONMENT Describe the hasis for ratings of 1 (exceptional strengths). Briefly sununarize ratings of 2(strengths). Fully narrate ratings of 3,4&5(concerns)to include how the concern was addressed,severity, mitigating factors and the prognosis for change.Housing and physical environment are appropriate. GENERAL PARENTING Describe the basis for ratings of 1 (exceptional strengths). Briefly summarize ratings of 2(strengths). Fully narrate ratings of 3, 4&5 (concerns)to include how the concern was addressed,severity, mitigating factors and the prognosis for change. General parenting skills are appropriate as noted in the rating scales. SPECIALIZED PARENTING Describe the basis for ratings of 1 (exceptional strengths). Briefly summarize ratings of 2(strengths). Fully narrate ratings of 3,4 &5 (concerns)to include how the concern was addressed,severity, mitigating factors and the prognosis for change.No specialized parenting issues have occured.. Structured Analysis Family Evaluation(SAFE)0 Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 7 of 9 Copyright,2005,Consortium for Children,Al Rights Reserved ADOPTION ISSUES Describe the basis for ratings of 1 (exceptional strengths). Briefly summarize ratings of 2 (strengths). Fully narrate ratings of 3, 4 &5 (concerns)to include how the concern was addressed, severity, mitigating factors and the prognosis for change. The couple wishes to adopt because they have had difficulty conceiving a pregnancy over the past five years including two miscarriages. They are also concerned that the biological parent will want to have access that they do not believe is appropriate. In the evaluator's opinion their anxiety was not excessive. PSYCHOSOCIAL EVALUATION CONCLUSIONS Provide your conclusions regarding the Applicants'committment,ability and readiness to parent. Highlight the strengths in any section given a rating of 1 and describe the effect any section rated as 3,4 or 5 will have on parenting.This couple is qualified to provide a consistent,stable,home for one or two adopted children. They are very committed to the process and are ready to parent. They have extended family members who are also excited about the adoption and will be willing to provide assistance,as needed CHILDREN THE FAMILY CAN BEST SERVE Indicate the age range,gender and number of children the Applicants are ready to accept. The family is able to accept any child ages one to ten. They would be willing to accept two children They appear well qualified to provide a safe home environment for children and would be willing to assist the children with obtaining any special assistance(e.g. counseling)that is needed.. Discuss the Applicants'ability to meet a child's special needs or considerations and level of competency to manage the characteristics,behaviors, conditions and issues of the children being considered for placement with them. They have no specific experience with special needs children,but are generally able to manage a non special needs adoption and depending on circumstances may be able to handle mild special needs of the adoptee.. Specify any child's special needs,considerations,characteristics,behaviors,conditions or issues that the Applicants are uniquely qualified to address. Also indicate what they are unable and/or unwilling to consider. No specific special needs skills of these applicants are apparent. RECOMMENDATION It is recommended that Fred Smith and Mary Rodriquez be approved for Adoption. xxxxxxxCaseworker xxxxxxxxSupervisor xxxxxxTitle xxxxxTitle Date: 7/ 10/2000 Date 7/12/2000 Additional Attachments Indicate"None"or list additional attachments. None Structured Analysis Family Evaluation(SAFE)45 Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 8 of 9 Copyright,2005,Consortium for Children,Aft Rights Reserved REVIEW OF COPY OF HOME STUDY REPORT By signing below I acknowledge that I have read a copy of this report. Fred Smith Mary Rodriquez Date: 7/2/2000 Date 7/2/2000 To cheek for form updates prrss the rtd key and click this link Structured Analysis Family Evaluation(SAFE)®Colorado Couple Multipurpose Home Study Report -Version 02-17-2006 Page 9 of 9 Copyright,2005,Consortium for Children,All Rights Reserved A primary strength of this proposal is the experience of the psychologist Joyce Ackerman, EdD. who is a certified as a vendor of these services and trained in the SAFE model. Our purpose is to: 1. assure that a placement is in the best interest of the adoptee and the family intending to adopt. 2. recommend for or against the placement with clear explanation for those recommendations. 3. recommend activities and work needed to improve or enhance the adoptive process and outcomes for the adoptive child. 4. assure that relinquishment is fully understood within the context of the Weld County and Colorado process. Target/Eligibility Populations A. Total number of clients to be served in a twelve-month program has been calculated as follows. Up to two home studies, either as complete home studies or updates, per month for a maximum of 24 per year is the anticipated capacity of our program. B. Distribution of clients. We anticipate that about 1/3 of the studies will be for new foster parents. About one third will be for kinship placements and the remaining third for adoption outside the kinship system. This assumes a maximum of approximately 48 hours of counseling services for relinquishment across 24 cases of relinquishment. C. Families Served. We anticipate serving 24 family units for home study and 24 mothers and 24 fathers for relinquishment counseling. D. Sub total who will receive bicultural/bilingual services. We anticipate we can serve up to 25% of families who need these services in a bilingual manner. All of the staff have extensive cross cultural experience. We have a Hispanic member of the staff, Emily Jaramillo, M.A., L.P.C. who is fluent in Spanish. Joyce Ackerman, Ed.D. has spent several years working in American Indian reservation populations and with Hispanic mental health in Greeley. She has practiced in Greeley since 1981. E. Accessibility. On weekdays, all providers of Ackerman and Associates are accessible through our office secretary and through cell phones. After hours ,we maintain a 24 hour answering service and page system. On 2 weekends, the 24 hour access reaches the provider on call who is always a licensed Mental Health provider. F. Maximum per month. The program maximum is estimated at two home studies and four hours of relinquishment counseling per month G. The monthly average capacity is one home study and two hours of relinquishment counseling per month. H. The average stay in the program is expected to be two months for a home study and two weeks for each parent in relinquishment counseling. Types of Services Provided Home study: The home study will consist of the following procedures (11 hours) 1. Each parent will complete a detailed questionnaire designed to assist the interview process and return it prior to the first appointment. 2. Each parent will complete the required activities for a background check. 3. An initial meeting in the home with both parents desiring to adopt or to be certified as foster parents. (2 hours) 4. One or two additional interviews and observation of family in the home setting, including age appropriate interviews with children, as needed. (4 hours) 5. Data review as needed (2 hours) 6. Home study report and recommendations. (2 hours) 7. Meeting with parents in office. (1 hour) A sample home study report is attached. Home study update: (6 hours) 1. Each parent will complete a detailed questionnaire designed to assist the interview process and return it prior to the next appointment. 2. Review of previous report. (1hour) 3. A meeting at with each parent desiring to adopt or to be certified as foster parents. (2 hours). 3 4. Additional interviews and observation of family members in the home setting. (2 hours) 5. Home study report. (1 hour) Relinquishment counseling: 1. Relinquishment counseling will consist of focused discussion based on the required WCDSS outline for provision of relinquishment services and the State of Colorado guidelines for relinquishment counseling 2. We also assure WCDSS, as we have in the past, that no individual working with Ackerman and Associates and providing therapy or having any other relationship with clients being served will provide relinquishment counseling, thus avoiding any conflict of interest. 3. Up to two hours per referral (per parent)will be provided under relinquishment counseling services. Measurable Outcomes are specified as : 1. acceptability of Home Study reports to WCDSS. Our goal is for 100% of our home study reports are acceptable to WCDSS Foster parent and adoptive services. Home study reports will be based on the SAFE model. 2. Timeliness of reports: Our goal is that 90% of reports will be completed within one month of referral for those whose background checks are processed within this period and that 100% of reports (i.e. the remaining ten percent)will be completed within eight weeks of referral. By adhering to these standards, we would expect that the department could expedite permanent placement of children assuming that failure to provide high quality home studies in a timely manner has been the factor which has limited the rate of placement. Service Objectives One aspect of all home studies will be to assess parental competency We expect that all reports will comment on strengths and weakness of the potential adoptive home. Very serious weaknesses that rise to a clinical potential for injury to the adoptive child may disqualify a family as prospective adopters in the judgment of WCDSS. However it is expected that the majority of reports will suggests strategies for improvement where areas of deficiency are noted where these deficiencies in themselves do not negate the potential of the home to serve an adoptive role for the specified child. Some of the areas may include: Improvement of parental competency 4 The ability if the family to access resources Application of parental competencies in daily activities. After a full assessment of the family and home recommendations are made in each of these areas. The attached study report indicates how we have applied the state mandated format to a fictional example of a case study. The new SAFE model will be utilized for all new home studies. Workload Standards The program has a capacity of 24 home studies and relinquishment counseling for thirty mothers and thirty fathers. There is one provider—Joyce Ackerman Ed. D. for home studies and relinquishment counseling. One additional provider is available for home studies only— Susan Bromley, Psy. D. and one additional provider is available for relinquishment counseling only- Emily Montoya, L.P.C. The maximum caseload a maximum of two home studies and 4 hours of relinquishment counseling is projected per month. The modality of treatment is face to face assessment and background checks by written format. A questionnaire and other formats will be developed to standardize the content of the home study. Hours/month a maximum of two home studies and 4 hours of relinquishment counseling is projected per month. Staff There are 3 individual providers supported by one administrative professional in practice as well as contracted staff for billing and accounting. Supervisor This contact would be supervised by Joyce Shohet Ackerman, Ed. D., who would monitor the project for compliance. Providers are individually licensed and do not require clinical supervision. The maximum caseload per supervisor is 24 families per yew. Insurance All providers carry one million/three million liability policy Ackerman and Associates carries an additional one million/three million liability policy on the group and a general liability policy, which meets the required criteria for this application. Co-listing of the state of Colorado on Ackerman and Associates insurance for professional liability is required by the procedures of the State vendor list. 5 Evidence standards: The Colorado Home study program is based upon the SAFE format, a validated instrument adopted by the Colorado program and required for certifying vendors in the home study process. Collaboration: Appended are letters related to collaboration from NRBH, Weld County Job Services and Weld County Housing services. Our letters to these agencies and their responses are either appended or did not arrive to us by the time of submission. If the later is the case they will be provided to the program managers when we receive them. Staff Qualifications Staff Qualifications Three staff are available for the project. They exceed the minimum qualifications specified as documented below. The staff members are: Joyce Shohet Ackerman, Ed. D., Licensed Psychologist; Emily Jaramillo M.A., L.P.C., and Susan Bromley Psy. D., M.S.W. All are listed as vendors for home studies by the state of Colorado. Training The staff has extensive training in family therapy and short term therapy as documented by their extensive work experience. All listed providers are vendors on the state list for home study providers. Dr. Ackerman and Dr. Bromley have completed the SAFE training. Continuing education As a part of their work in the private sector, all providers in this group maintain continuing education programs more than the minimum eight hours required. They participate in workshops and other activities. This proposal's continuing education requirements coincide with the requirements of other contractual arrangements and are being met on an ongoing basis by members of the group. Supervision All of the providers are independently licensed and not required to have clinical supervision. All the staff have advanced skills in family therapy and in individual and family assessment. The contract supervisor will monitor the specifications made in this proposal. They are not caseworkers and so they do not have training associated with that role as mandated for caseworkers in Colorado. Supervisor continuing education The supervisor of the project is involved in ongoing training to keep current with her profession through advanced workshops and seminars. Ackerman and Associates, P.C., of which the supervisor is the president, has more than ten years contracting experience with WCDSS. Dr. Ackerman has done extensive evaluation work in child custody, Special Advocate and Child and Family Investigator cases. Dr. Ackerman manages all contracts for Ackerman and Associates, P.C. 6 • Unit of service rate computation For home study professional time outlined above we are requesting a rate of $1045 for a full home study and $570 for a home study update. For relinquishment counseling, we will bill up to two hours ($120 per hour). Direct and indirect costs and how these relate to overall expenses of the corporation are shown on the required bid sheet. Standards of responsibility for 2006 bids Ackerman and Associates, P.C. is a type S professional corporation and not a 501.c.3. In 2005, Ackerman and Associates had a net loss of one half of one percent on its revenue compared to expenses, generating no profit. 7 , , 1 , 1 1 , , , 1 , 1 1 ` k a a a i © i 8 I t , a ■ § 2 # P a ■ , # % S # ; # # tli _ C a | $ # ° ! 2 2 8 8 8 § $ ° ■ } k ■ # ■ tti _ in § ! * ( a $ a k © \ k a $ k § 0 E 111 W 13. « § Er z § ! { ) w § • § ill 0 u. o 0 S » § / ) / } $ co § k \a k \ ( § ) ( \ w 05 © > 0 0) ° \ § / 2 k ur§ 0 nu_ § a) a « § < fa— ® II ^ a 2 A § I s E § § m 0 co 0 Ce CO § § re ?a. 0 It § ( 0 § al k ( CC 0 k 5 k r w9 . . . '§ § I- § 0 / \ re 0 § ( I— § § § • ® © maeaa $ a # a ■ a ■ m q m ■ maaa ° ® Ba 2 � aaaaaaaaaaaa r a2aaaa k 2 O� bk k . 0 § s§ ` ` � 88 # $ K 8 �� r \ } CO §\ ` � � � � � � § � W § � � � � � � � � � � CO � § § # # s # mm # $ aamm a ° 8 v 7 � � ■aaaaaaaaaaa 7-r J , � 21 }2 & w - � ■ � f��a � k * # § k■ I?4 ` $ � � 3 � / k � i I k | § L. ( 8 § � § 7 § P I. a.� � � $ § � k � � . m � � . � k � � 0 k � � \ k I § � } lO � k � K \ g0 0 5 � . 1 § § � 15 01 � � a t � � 0 � k k . a ! § o . • 8 et� k / oat k E � k � ' P a@ 8 ■ ■ # # aam e % § 2a m aaaaaaa R §a , k k § ® # a § U. _ ir,._ � f # # � ,.§ la - 0 § §$ - E � % � � b � � g § W $ � ■ & � « z # a # 8 # W | � § g � g § ID Ift atS § !E § « �t� ei - a �2E § I g§ 2 I� A g ! k I ) ; I 7 7 § § I I a. § § § �ILI §` § � � § $ � � � � o •| � . § § ) § § | � � § « A 8 § § f. 1 � § k ik 8 �ff k k � � g 2 � Z. $ � � § § a ; k ■ a ■ • - & ■ f b 2 § � $ j � � � | � � � O � ! f e e L e i k $ ! P # mVmgm # m @ @ ! § § � � E �$§��§§ $§ � 1 \ { g 2§ � $ � � - 4 §e � k2 ! ) ) § § § § §) § � CO §§ � � §� � g � o § � # * # � mmm # @ #_ ° 1 � � § �§ Si m , k� �� § � / k2 � � §. _ _ � #■- ; _ & 2 $\ O k k� k § � d| kk § § k §§ § § � & 82 m § §| 0 a §) - - - � � � � $ � � � � � � � ) cq 4 $_ # @@8888a 8 B v e § ` KR�f#kK§ § $ a k A k23;&■;a2 ■ 2 k ) k � i \ I k � ! § 1 � / ) $ § 8 � .0- B k ` 0 � k $ $ K 2 � � \ > . a k 2 § � a r co ( � E � k � � � i � w ) � � § , � . ■ f � a § k § 2 • w &- $ � ) � § ! � lfk § � � ) ! ) ! . . ' E k e e 2Ilik ! } ! � ! 2 § k 2 � From: "LARRY POTTORFF" <larry.pottorff@northrange.org> TO: <joyceackermati@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 Hearth 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. Nnrz� dQ tkr 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 fend 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 Ackennan and Associates P.C. http://mailcenter.corncast.nrt/wm/toolbar/notheme.html 3/17/2006 DEPARTMENT OF HUMAN SERVICES tirstte, EMPLOYMENT SERVICES OF WELD COUNTY 1551 NORTH 17TH AVENUE PO BOX 1835 GREELEY,CO 80832 (970)353-3800 FAX(970)356-3975 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 Attu;Linda L Perez Greeley, CO 80632 From:joyceackerman@comcast.net jAdd to Address Book To: "Ted Long" <tlong@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 View Source" Mar 2006 20:09:58 +0000 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 Linda 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 Linda Perez. Please let us know by email if these plans are acceptable for the bid process. For Ackerman and Accociates P.C. Alan Ackerman Ph.D. Treasurer 970-396-5945 Reel i pact rQCt,v 4 .2/2.//oe 6 J were s4 , err l��y will last Ponw01#4. Zb �c ^v s /e/vrsh' . One l9Mn� Dear Tom: Thank you for your time on the phone today. Ackerman and Associates P.C. is a Mental Helth Provider group(www,ackermanandaccociates.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. Rally APT ✓ 420ti 6y 3/P-l/oG ^ L/Xs G,ert Su6n.cCt4 . Roily w; p For lu wK AAA tv /nor Soinv ""or _o A��,�.� . Commercial Certificate of Insurance t_ •`• FARMERS.Agency • Nila Klovdahl Nana; • 2705 W 10th St tpry lane Date (MM/DEVYY) L/01/t005 & Greeley CO 80634 Address ' 070-352-1234 This certificate b bored as a matte'of information oo ,and confers no rya upon the cerd&ate 07 Dist62 holder.'rhuinedi atedoesmtamend.etteodoralterthe 04 �eseaWarded Agent cam- b! pellets an Ir sitieiloeloMv. Companies Providing Cavetagc insured • Alan&Joyce Ackerman us A Truckfinennoe Exchange Norse • 1750 25th Ave Ste.101 imipamr B Fanners Insurance Exchange & • Ore soy,CO 80634 _ • AddressC NM-Century Ike Company cowl, D tan CCIVItrarla to certify drat the polo,of hwarenoe inter be ow have been issued to the butted nomad above kr the polky Period Skated Nnbldtdirg mnryalretant,tam or condition dany centred or odor document with repect to which this terror m 'be hawed or Siren the Saran= �the ponds described hereinb sutrato as Menem sedustons and eendidoce d w ine pal cb p .Llmla Mown�bee�beet reduc by C.oLir.' Type of Insurance Policy Number PeDittis Leal( Polley Limits A sr Gelerallie6gity 0457/3807 07/01/2005 07/01/2006 Cenerel Asgrepte s 1,000w000 C000rradel GanProdncomp/ors Alamos, s 1,000,000 Liabinty Onarmco VeneerPerrone'& Cenmcorat-lmdderW Ong i s 1.000,000 Only oaar®ee $ a arvrret&ConteacronPret Fire N~ ui s 150,000 Mdial Expense OW aieperm) s 5,000 Mrmrlb6Na Liability Limit Combined All Owned Cotenants' L ° 8 Al trah Scheduled Anita 13=1 s biked As Neu Owned Ants kdatot s Garage Lbbiley +g'Dm. $ emir Allintem $ Umbrella vsbidy 1 lint S Workers 7 am Sub Accident $ Employers'Lbbillty Mete Implant $ Description of operatto,a/VehI p aySpech!items: DimePatki Limn $ Certificate Holder Canteibtion • Weld County Social Services &odd my oldie above derailkri polices be N 1e • 315N11thAve �6 ywNmdemorm aysmkheeapbadtndek Address • Orealey,CO 8063I ca days none AM to e cerUMate olds maned to the let but erawee to retie such,notice YteB Impose no °won or Why of any kiwi upon the toorpeny,is apt tie meprse Nils Klovdeh, MAINS Aapramtathe se-anti +a "Cg1O lti it Service Center Copy and Agent's Copy 14411 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 'OLICY NO: 008-1766682 ACCOUNT NO: CO-KERL175-0 0099745B TEM 1. (a)NAME AND ADDRESS OF INSURED: ITEM 1. (b)ADDITIONAL NAMED INSUREDS: LAURENCE P. KERRIGAN, PH.D. 1750 25TH AVE. SUITE #101 GREELEY, CO 80634 • TYPE OF ORG: INDIVIDUAL EM 2. ADDITIONAL INSUREDS: EM 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: EM 4. LIMITS OF LIABILITY: (a)$ 1 , 000, 000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS,REPEATED OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE (b)$ 5, 000 DEFENSE REIMBURSEMENT (c)$ 3 , 000, 000 AGGREGATE EM 5. PREMIUM SCHEDULE: ANNUAL PREMIUM CLASSIFICATION NUMBER RATE • 1ST PSYCHOLOGIST 1 13.91. .. 0 1 ,191. 00 . DEFENSE LIMIT . 00 SURPLUS LINES TAX 1 35 .73 INSPECTION FEE 1 1 . 19 EM 6. RETROACTIVE DATE: 12/01/91 TOTAL PREMIUM: 1,227 . 92 EM 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM(if exercised):$ 2, 149 . 00 NO DISCOUNT INCLUDED EM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY 22138 (7/95 ED. ) B22137 TI-rrs TS WIT A Rli.r. PRFMTTIM HAS BEEN PAID. AU BRED COMPANY REPRE ATIVE PERSONAL.. DATA SHEET Identifying Information: Name : Laurence "Larry" P. Kerrigan , Ph. D. Address : 1706 19th Avenue Greeley , CO 80631 DOB: 9/20/32 Phone : 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 . • ) 975-88 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 . • • 1,975-80 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 , 1971 . Wor_kshgLti_unil Speci._al_;fi_ailtilll;: 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, Ericksoni.art 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 • department's 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 departments. 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 215' 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 Though 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 r Branch B/A 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 3. Policy Period 12:01 AM Standard Time At From: 11/01/2005 To: 11/01/2006 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 $ 293.00 B. General Liability • $ 293.00 5. LIMITS OF LIABILITY $ 1,000,000 each Incident or each Occurrence $ 3,000,000 in the Aggregate 6. The Named Insured is: X Sole Proprietor (including Individual) Partnership Corporation Other: 7. Business or Occupation of the Named Insured: COUNSELING B. 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): PLJ-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.) rant Date: 12/1 4/U 5 HEALTHCARE PROVIDERS CNA SERVICE ORGANIZATION PURCHASING GROUP CERTIFICATE OF INSURANCE OCCURRENCE POLICY FORM J .•.r. �� c:c�' �' k..: 65Sr-:S.i:,:.:,...:..sv¢..c.4... 1 o:ic_x.].xc<..3-51E.1 ..�_...accros'Fwx c. 'cra Tc.` . -.]' `: ..-.. ..:...x x..� f11 REAR 97f1 HPC; (12 F 9 9 4 4F1 1 F from.12-01 AM Stanriarri Time nn• 1(1/(11/(1A ;�� to: 12:01 AM Standard Time on: 10 01 06 •i •c•• ` �3.r 3�-a-cr,r. ..-s a.�mJcx:aeGo".K'5'cfv:cµa-sx"` ta•:.1 xx '_₹_t._ ..Tf.{- "'.er�ra•:.;mexae. szca-•-•x' .e."`:a"':f3 4,..£-s-•�caz•::cvx_s,:=.,.a e..o •*�aa._ a�]r�;R G 3•k...-----.•.�a o::a±':•� L�:L tyro ssa_.�''"^: x. Torn Pa p s Healthcare Providers Service Organization 16 2 4 Kirkwood Dr 159 East County Line Road Fort. Collins, CO 80525-2017 Hatboro, PA 19040-1218 i Medical Specialty. r.raatr. -•r- ati'-_:fie:. .s x:r.:.. "*1..`--n` Social Worker, Clinical Code: ��r.,,.rY=� }.�.�_ :� .� s 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, IL 60685 ?.', -_-•]-.- :r:'-4 3.- r: •-6 fj6-w:-r_.oiE:.f.l—p;rf: t-sE r •-,c Li F 'f1j.... C• i2:r.-�iTi. :__.. �:.S�::yL2_:fl.:i_'3'._m l `'Li_, .�1:E ]F.,.,,sit-..-�+'�.,:,,.,..:w�•�ri•4:�?�a£p•',':tia',�L• :'_':�„"�.f�Ck�e�m�o:. �•s,'' :�, ,�r-�»Me-^Y,3"�°a o cx-�o�,-*_��.�.J. 3 T. �,�''„ ��• w.,a.'4' :•moo .•,. •.:a.,.,.-, ,• . —— .•��:• s.-. A. PROFESSIONAL LIABILITY Professional Liability (PL) $ 1,000,000 each claim $ 6,000,000 aggregate Good Ssmaraan Liability----" ---- -included above : Hi - -. -: ''_x f j f ' e ersona nary a included above — _ 1 1] 3 _ i ifplace_ment Liability -i Y included above -- 3 _ B. COVERAGE EXTENSIONS: _License fs otes fen 10,000 _ ___ _.__$-__.._ er roceedin $_._.�ty00 _____._ a re ate - 99 9 Defendant Expense Benefit €D E. $-10,000 aggregate onbeposition Representat T — _~_ $ 5 per 'epos 1.on $ S,5i� aggregate _ __ Assault _ 10,000 per incident $ 25,000 aggregate Medical Payments — -____ - $ --- -f3---_ r erson 100,0-60 aggregate— _______Aid _____. -- _—_ _ --- - t. '6' $ 2,5 ...._._..__...__...-____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 part D.General Liability Is made part of this policy. . Workplace Liability included in A. PL limit shown above - Fire&Water Legal Liability. _ included in A. PL kilt shownabove sub ect to$150,000 sub-limit Personal Liability 4 ' -- rte; 1 •r = .„ . _ — -- :x r - „-.,:,' 4, •:,.,• �: $1,000,000 aggregate D. GENERAL LIABILITY Coverage part D.General Liability does not apply if Coverage part C.Workplace Usbiity is made part of this policy. -- General Liability(GL) none -- none Oe J--- Hired Auto&Nonwnd ---Auto- -- none __ 3 r f.^_,^j_-.{_ -.Y. Fire &Water Legal Liability none -- none Personal Liability 3:t =.; : . w - ; t " z -� ..�3 ..none_..__.. . illy, Total Premium:$ 300. 00 - QUESTIONS?CALL: 1-800-982-9491 - gs:]•r3i' •;-` ., :-F ?] ;: _ x.t ,_—n-a sc'9iv:.. __.per F. - ^:J*=;'"w - .. - -a_.3• - :: ii:,:;;•. i;.. •ecic;:. -,:;_ .i�•�_- 'ei: �4:aa_r-,F s�� ..a,e;1 ...s> cxc x: '• .. a .:• E8]mar 5 '� yp� . :.: ...-: ;;... ,..-.... x�.-�.:^.•r.... _• .X C_.'[ -C.:C, -`']Y[YS Y-^ y�Y.CC.y.,,T,•]Y�Y F?],_ _._.zJT'_ u.c^..J ? c.'zCa F2 .... 'J?•:. � 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 Ihis document in a sale place. It and proof of payment are evidence or your insurance coverage(3—) '"---E-t. /L-C-a.t__- 4( ( 44.Aitiii\ 7A-iig--\- Chairman of the Board Secretary G-141241-A (07/2001) Coverage Change Date: Endorsement Change Date: TOM PAPPAS, LC SW W 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. 11/864/89 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 in 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".) I BRANCH B/A PRODUCER NUMBER I DATE OF ISSUE PRIOR CERTIFICATE NUMBER 273865 1 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: 58622307137 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: 1201 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: O Sole Proprietor (including independent contractor) O Partnership C Corporation O 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 dale 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-1 K11 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, 401°Floor 140 Broadway, 41`t 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(03/041 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 Crenter,Greeley CO Coordinator Ruth Wick,R.N. 1986 - 1989 Provider and Coordinato 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 Licetvsure(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 Communi y 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' 0 ACE Insurance Company of Illinois 0 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".) 1 BRANCH I B/A 1 PRODUCER NUMBER I DATE OF ISSUE PRIOR CERTIFICATE NUMBER 1 273865 03/31/2005 PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY NOTICE:THIS IS A CLAIMSMADE POUCY,PLEASE READ THE POUCY 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 $ 3,000,000 aggregate $ 1,298.00 4. BUSINESS OF THE NAMED INSURED: Psychology 5. The Named Insured is: ® Sole Proprietor(including independent contractor) 0 Partnership 0 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. 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 I)6 sent to: All other notices should be sent to: Claims Vice President Underwriting Vice President ACE USA ACE USA 140 Broadway, 40^ 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(03/041 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(grnarthlink.net EDUCATION: Year Degree Institution Area of Study 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/Sociology 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--ProfessionalJuried: 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)39-45. 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. 466-474. 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 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 research 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 Chi 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., Hammon,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. &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 Bonnel 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-Viney. 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 Conunittee 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 Conunittee 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 Conunittee 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 COMMIT f1 ES--Doctoral: 2003-present Committee Member, Stefanie Sleeker(School Psychology) 2002-present Committee Member, Karen Bender(Professional Psychology) 6 1998-99 Committee Member, Shu-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 COMMITTEES --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, Committee 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: (14 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 Psych 3 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 "MindBody 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 Practicum 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, Man 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 Hurner,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 Smice, 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", CAHEC 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 1985 "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 • 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 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/attachmentjsessionid=41 E573CB2F68C90... 3/30/06 RECEIVED MR 3 0 2.006 North Range Behavioral Health To: Applicants for CORE Services Funding From: Wayne Maxwell ca/ — 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 finding, 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)347-2120/Fax(970)353-3906 a.. ,may✓+ oY • 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. fSi/nccerely, 4y}2 / a 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 Hello