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Home My WebLink About20061609.tiff • Weld County Department of Social Services **C0RRECTED** Notification of Financial Assistance Award for Families,Youth and Children Commission(Core)Funds Type of Action Contract Award No. X Initial Award FY 06-CORE-61 Revision (RFP-FYC-06010;06OPB07) Contract Award Period Name and Address of Contractor Beginning 06/01/2006 and Nelson,Wolf,&Associates,DBA Youth Emancipation&Services,Inc. Ending 05/31/2007 Option B—Home Based Intensive 3400 16th Street,Bldg.3,Suite Q Greeley,CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance In-home services to families using a combination of Award is based upon your Request for Proposal(RFP). The Family Systems approach with a Community Systems RFP specifies the scope of services and conditions of award. intervention style.Services include family therapy, Except where it is in conflict with this NOFAA in which case lifeskills instruction,conflict mediation,communication the NOFAA governs,the RFP upon which this award is based skill building,interventions such as mentoring, is an integral part of the action. community agency referrals,and other collateral Special conditions services such as classroom instruction.Crisis 1) Reimbursement for the Unit of Services will be based on an intervention available 24 hours/day,7 days a week. hourly rate per child or per family. Maximum hours provided is 20 hours per referral. 2) The hourly rate will be paid for only direct face-to-face contact Yearly program capacity is 12 families concurrently, with the child and/or family,as evidenced by client-signed monthly average capacity is 12,average stay is 12 verification form,and as specified in the unit of cost weeks;Phase 1,3 hours per week; Phase 2,2 hours per computation. week. Ethnically and culturally diverse services-Spanish 3) Unit of service costs cannot exceed the hourly,and yearly cost speaking staff available. South county access. per child and/or family. Cost Per Unit of Service 4) Rates will only be remitted on cases open with,and referrals Cost Per Unit of Service made by the Weld County Department of Social Services. Hourly Rate Per $100.00 5) Requests for payment must be an original and submitted to the Individual Counseling Weld County Department of Social Services by the end of the Family Counseling 251h calendar day following the end of the month of service. Treatment Package-Intensive The provider must submit requests for payment on forms Treatment Package-Moderate approved by Weld County Department of Social Services. Treatment Package-Low 6) The Contractor will notify the Department of any change in Early Intervention Program staff at the time of the change. Reunification Community Based Service -Child Protection In-home Svcs for At Risk Delinquents Therapeutic Staffing Per Roundtrip over 20 miles from Greeley Treatment Package $20.00 Hourly Rate Per Court Testimony $65.00 Enclosures: X Signed RFP:Exhibit A _ Supplemental Narrative to RFP:Exhibit B X Recommendation(s) Conditions of Approval Approvals: Program Official: By By M.J.G le,Chair Judy .Griego, irector Board of Weld Cougty�CoD{otssioners Weld o tg f artm t o Social Services Date: JUN1 LLUUIIII0O Date: I 1 2006-1609 INVITATION TO BID OFF SYSTEM BID 001-06 (06005-06011 and 006-00,A,B,&C) DATE: March 1,2006 BID NO: RFP-FYC-06010 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-06010)for:Colorado Family Preservation Act--Home Based Intensive Family Intervention Emergency Assistance Program Deadline: March 31,2006,Friday, 10:00 am. 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 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 services.The County will authorize approved providers and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based service to families in crisis that are time limited,phased in intensity,and produces positive change,which protects children,prevents or ends placement, and preserves families. Services are provided primarily in the home of the client and include a variety of service elements of therapeutic,concrete,collateral, and crisis intervention 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 June 1 . 2006 (After receipt of order) BID MUST BE SIGNED IN INK ,Tamps P Nelson MA, LPC TYPED OR PRINTED SIGNATURE VENDOR N , „ , f P Ass ;yes P.c. GN C,I�(/l4✓lam (Name) written Signature By Authorized fficer or Agent of Vender ADDRESS 3400 16th Street, Suite 0 TITLE (___ (iL____ arppley, CO 80634 DATE �1)j /..O6 PHONE# Q20 X13 377 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 42 ' Bid 001-06(RFP-FYC-06010) Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2006-2007 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2006-2007 BID 001-06(06010) NAMEOF AGENCY: Nelson. Wolf & Assoriates, P P ADDRESS: 3400 16th Strpat S11i tP Q Crocicy, CO 80(34 PHONE(97e 353-5577 CONTACT PERSON: T p Nelsen TITLE: Cheif Executive DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased intensity, and produce positive change which protects children,prevents or ends placement,and preserves families. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1,2006 Start June 1 , 2006 End May 31,2007 End .May 31 , 2007 TITLE OF PROJECT: Home Based Intensive Family Therapy James P. N?1sgn March 30, 7006 Name and Signature of Person Preparing Document Date 7f/k72-61 21 jyL-- March 30, '110.6 N e and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REOUIREMENTS For both new and returning bidders,please initial to indicate that the following required sections are included in this Proposal for Bid. Project Description Target/Eligibility Populations / Types of services Provided !(4 Measurable Outcomes ,./N Service Objectives JPA Workload Standards Proof of Collaboration Evidenced-based Outcomes ii/ Staff Qualifications 77 Unit of Service Rate Computation J� Billing Process Program Capacity per Month Certificate of Insurance Page 30 of 42 Bid 002-05(RFP-FYC-06005) Attached A Date of Meeting(s)with Social Services Division Supervisor: .3- t Comments by SSD Supervisor: k \ { ' u (( I j i X4itLfL f' • It -Ltpct(. Any k (_F IftC� j � ; ti /=/S1 \--/K Rdtj L y '- il( f ( IL( /1 ! ( c 1 \_L A e �Li 11 �f i v '1 A 1 ( Iti sc 1- LA ILA it. ��-� /� L- • ( ( , . << 1 . .4z . (ClCf/C. .5 r1 Name and Signature of SSD Supervisor Date Page 31 of 41 Nelson, Wolf & Associates, P.C. 3400 16th Street, Suite 3-Q Greeley, CO 80634 RFP-FYC-06010 Family Preservation—Home Based Intensive Family Intervention Program Proposal (Attachment A) Project Title: Home Based Intensive Family Intervention Using the Multi-Systemic Therapy Model March 30,2006 Vendor: Nelson,Wolf& Associates,P.C. Contact Person: James P.Nelson MA,LPC (970)405-7014 0 I. PROJECT DESCRIPTION Nelson,Wolf&Associates,P.C. Nelson,Wolf&Associates is a private Colorado professional corporation first registered in 2004.It is a cooperative venture founded by James P.Nelson and Kristine M.Wolf for the purpose of providing services on an out-patient basis to the citizens of Weld County. We are associated with several youth service professionals who live and work in Weld County. This group of concerned professionals has come together to provide Weld County families with needed services, such as assessment, life skills education, individual,group and family therapy,emancipation preparation,family and community mediation services. Our Mission The mission of Nelson,Wolf& Assoc.(NWA)is to be of service to families in Weld County who are at risk of broader involvement with the legal and social services systems. We seek to assist families who have had a difficult time interfacing with their community in a successful and sustainable way.To accomplish our mission we will: 1. Network effectively with area professionals in the family service field to identify needs which are under-served,and likely to respond favorably to a timely preventive intervention. 2. Develop quality programming designed to meet these targeted needs. 3. Partner with other community family resources and human service agencies,to generate therapeutic community resources,and to provide services in the most effective way possible. 4. Provide top-quality stewardship of,and accountability for,community resources. 5. Provide ongoing evaluation of the effectiveness of services we provide in order to make improvements in what we do(Program Improvement Planning). 6. Cooperate effectively and communicate in a timely way with our referral sources. 7. Remain responsive to the needs of the community,open to new ideas and opportunities to be of service,while consolidating gains and expanding family resources. 8. The Founders of NWA are Masters level therapists who have had many years of experience in family therapy, social science research,community needs assessment, individual therapy, group therapy,mediation,and supervision. We have worked extensively with at risk teens and their families, in residential treatment,out-patient,and in-home settings. Our Location Our consulting offices are located in Bittersweet Square at the corner of 16'h Street and 35'" Avenue in Greeley,Colorado. We can be reached at 970-353-5577.Our fax number is 970- 356-7280. We are in the office and available for therapy and in-office consultation Monday through Thursday from 10:00 am through 8:00 PM.We find these hours to be most convenient for our clients,and we use Fridays to catch up on our paper work. We and our associates are available to clients on a 24 hour on-call basis in order to provide consultation in emergencies. 1 Intensive Family Intervention: In-Home Family Therapy The overall purpose of this project is to provide in-home services to families using a combination of Family Systems approach with a Community Systems intervention style. Thus,we have been interested in,and have obtained training in the MST Model which has been developed by the Medical University of South Carolina in Charleston.Our associates have been practicing according to these principles since approximately December, 1999. Multisystemic Therapy is an intensive family and community-based treatment that addresses the multiple determinants of serious antisocial behavior in juveniles.The Multisystemic approach views individuals as occurring within a complex network of interconnected systems,encompassing peers,schools,and neighborhoods,as well as immediate and extended family. Intervention may be needed in one or any combination of these systems. The name"Multisystemic Therapy' is a proprietary label. It is,as such, intellectual property and cannot be used to identify what we do. We are not licensed by the owners of this label. Both Kris Wolf and James Nelson,the principles of Nelson, Wolf and Associates,P.C. have worked in the past for a MST license-holder, and have had training and supervision(and have provided)training and supervision to others in this mode of therapy while employed by the license holder.However,we do not currently have any relationship to MST Services of MT. Pleasant, SC. In this project,our effort on the part of the intervention team will be to assess the family's internal strengths and challenges as well as its relationships to the community resources. The team will then formulate a working hypothesis based upon direct and measurable evidence, establish goals, identify interventions,and periodically re-evaluate the effectiveness of the interventions.The focus of therapists efforts will be on helping the family members to make connections with those agencies and individuals in their community who can provide sustainable support after the successful termination of our services. Each family will be assigned a Masters level therapist licensed to practice by the State of Colorado(LPC, LSW,LCSW,or LMFT)who will act as Team Supervisor. The Team Supervisor will coordinate the efforts of the team in a small group meeting format.The Supervisor may directly provide family therapy, life skills instruction,conflict mediation, parenting education,communication skill building and other direct services, as needed. However,the Supervisor's primary responsibility will be to keep the In-Home family therapists on tract during the course of their cases.The supervisor will also assist the assigned therapists in the measurement of effectiveness of the selected interventions. Family contact will take place in the family home,primarily during late afternoons,early evenings,and weekend hours when families are not at school or work.Crisis Intervention services will be available 24 hours a day, seven days a week. All areas of Weld County will be served, including the fast-growing South County area.In past years we have effectively provided services for families in the Peckham, Lochbuie,Fredrick,Firestone,and Ft. Lupton areas,as well as in Greeley,Eaton and Windsor. 2 II. TARGET/ELIGIBLE POPULATION A. Total number of clients served: Approximately 96 persons By serving 24 family units,half of which are composed of 2 parents and half of which are composed of 1 parent,and averaging 2.5 children per household,the estimated total of clients impacted will be 96. B. Total individual clients and their children's ages:24 Families(all ages) Clients may be of any age or gender(as families always are). Some will be adolescents between the ages of 15 and 18 years of age, and they will have siblings of various ages as well as parental figures living in the home with them. C. Total family units: 24 families The program is designed for families with youth who are struggling in their present home environment and are at risk of being removed. Families can be of any size or constitution. D. Bicultural/bilingual services: 12 families. Families of any cultural and/or ethnic origin will be served.NWA staff are culturally aware and are an ethnically and culturally diverse group. Consideration of and respect for established cultural patterns is an ingrained value in this organization. Spanish speaking staff are available.* E. Clients receiving services in South Weld County: 6 families concurrently. This constitutes up to 25%of the total case load. This figure was arrived at by comparing population totals from North-Central Weld with totals for the South Weld cities. F. Access to 24 hour service:24 families All client families will have access to 24 hour crisis intervention services through a 24 hour crisis telephone line. Each family's Intervention Coordinator,or designated on-call therapist, will respond to calls within one(1)hour. G. Maximum Program Capacity: 12 families concurrently. Maximum caseload for an intervention team will be 6 families. We will have two teams in place if awarded a contract.This insures that appointments can be kept without double- booking, support groups and classes will be of optimal size. However, if the Department would like to expand the program,we would be open to discussions on this topic. H. Monthly Average Capacity: 12 families I. Average stay in the program: 12 weeks(See Item J.,below) J. Average hours per week in the program: Phase 1.(1st month): 3 hours per week. (Total 12 hours) Phase 2.(2nd month onward): 2 hours per week. (Total 16 hours) *Weld County is a culturally diverse population center in Northern Colorado.Therefore,services will be delivered in a culturally sensitive manner.NWA currently employs staff members who are aware of the issues of acculturation,enculturation and assimilation which are relevant in the present social milieu.Every effort will be made to provide a staf 7client match with these issues in mind.NWA currently employs Spanish speaking, culturally competent staff to deliver program services. 3 III. TYPE OF SERVICES TO BE PROVIDED A. Therapeutic Services Family Systems and Community Systems Assessment: The NWA Team Supervisor will meet with the family and caseworker to assess the strengths and needs of the family system as well as the families familiarity with and use of community supports.NWA Staff and DSS Caseworker will design an intervention plan to meet the family's needs based upon the results.The NWA Therapist will report to the caseworker on a timely basis to keep caseworker informed of family's progress(at least weekly). The NWA staff member will coordinate with the family to access other needed community resources as well. Family Therapy: The therapist will be experienced in family therapy. However,the emphasis will be on modest and achievable improvement in family functioning.Due to the time constraints involved,there will only be enough time to focus on the sources of greatest disruption which prevent effective family functioning. Interventions will target overarching and intermediary goals. Problem Solving, Mediating Family Conflict: The impact of a knowledgeable and diligent mediator with sophisticated counseling skills, working with families in their home environment cannot be underestimated. The ability to identify the opportunities to stimulate change,work with the key members of the system,and see that right action is taken at the right time, is very powerful in bringing about positive change. Parenting Skills: Many families suffer from the continuation of maladaptive cross-generational(multi- generational)child rearing practices that are violent and abusive, or which are completely ineffective in preparing children to be positive, competent and productive participants in society.NWA staff members will assist parents in learning more productive methods and practices. Group Therapy/Support Groups: It will be valuable for those family members who can participate to have a sounding board in which to discuss and process issues related to the difficult challenges of raising a family. Groups will be facilitated by a licensed master's level therapist who has experience in group therapy with this challenging yet rewarding population. B. Concrete Services Life Skills Instruction: NWA staff will deliver self-paced instruction in Life Skills. Curriculum includes: • Nutrition, menu planning,food shopping,and preparation, • Home Safety,Maintenance,cleaning and repair, • Employability assessment,job-specific prospecting,application and interviewing skills,follow-up techniques, • Home budgeting, money management,banking, • Transportation needs and affordability, 4 • Finding and leasing an apartment,purchasing a home, • Clothing, shopping,maintenance and repair, • Time management and goal setting, • Personal values,social skills,refusal skills,and sound decision-making, • Community values, living with neighbors,coping with others expectations, • Understanding and managing anger • Accessing Community Resources • Alternative dispute resolution, problem solving, Family Conflict Management: When internal conflict reduces the family's ability to work together to achieve common goals and interests,the NWA team will teach dispute resolution skills to reduce stress and foster an atmosphere of cooperation rather than contention.The degree of conflict within the family will be measured using an assessment devise at the initiation of services,and at the termination of services. Parenting Skills: NWA Team members may teach child rearing and parenting skills, such as: • Effective boundary and limit setting, • consequenting negative behavior without violence • Affection,nurturing,and positive reinforcement, • Importance of consistency and dependability, • Effective and safe discipline methods, • Monitoring and maintaining health, • Accessing behavioral assistance when needed. C. Collateral Services Accessing Community Support System: NWA team will assess the family's connections with agencies in their community which they can access when needs arise.The team will then assist them in filling any gaps in the system through establishing personal contacts at agencies which provide health and medical services, legal assistance,etc. Education: Youth must have either completed high school,or be in the process of finishing. Youth must be eligible for enrollment in public school,attending a GED Program,or attending a Day Treatment Program which has an educational component.Youth who are in school or pursuing a GED will be assisted in finding part-time employment so as to save money for emancipation expenses. If the youth has already finished his/her education,the emphasis will be on securing full-time employment. Employment: Family members may be given a career assessment and skills evaluation,vocational interest measure,and get a full interpretation in order to determine what career area is most advantageous.Youth will be helped to write a resume,fill out applications for employment, taught how to interview appropriately,and otherwise assisted in fording employment with a future. 5 Physical and Mental Health System, Drug/Alcohol Abuse Treatment: Families must find and develop a context for using local physical and mental healthcare providers.NWA Team will assist family members in developing resources for treatment of acute and chronic health concerns,and provide education in balancing treatment and prevention to reduce the frequency of episodes. D. Crisis Intervention Services Telephone Response: NWA maintains 24 hour answering services with emergency paging.Intervention Coordinators(or a designated on-call therapist)will be available to contact the family or individual in the event of an emergency. Protocol calls for intervention over the phone as the first step. If phone intervention proves to be insufficient,the responding therapist will assess the level of severity of the incident and take appropriate action, including calling police, ambulance,etc., if danger is imminent. Personal Visits (Emergency Basis): If the situation would not pose a safety problem for the staff member,they may visit the home on an emergency basis.Otherwise, a safe neutral meeting place will be maintained in the event of the need for person-to-person contact outside the home,or the family may choose to come to the office.Intervention Coordinators and on-call personnel are trained in crisis intervention procedures and follow pre-determined written protocols. IV. MEASURABLE OUTCOMES A. Children and adolescents will remain at home at the time the case is closed. This will be reflected in our monthly progress reports,and case termination report. B. Improvements in parental competency,reduction in parent/child conflict,and improvements in household management will be reflected in completion of Skills Units and in scores on pre-post referral competency assessments.These scores will be compared in the form of bar graphs which will be attached to the case termination report.This report will be delivered to the department no later than 30 days after the termination of NWA involvement in the case. C. Children and adolescents who are in their own home at the beginning of referral will continue there at the termination of services. A quarterly contact summary will be prepared on each referral after termination of services for a period of one year.This information will be mailed to the department caseworker or supervisor in written form no later than 30 days after the close of the 4th quarter post-discharge. D. Children or youth who are currently in long-term placement,and who are in the process of reunification at the time of referral,will be living in their family home,and will not be in residential placement, DYC custody,or under adult judicial proceedings within 12 months of the termination of NWA services. An annual contact summary will be prepared on each referral after termination,for a period of one year,and a report will be mailed to the department caseworker or supervisor. E. Families who receive services will not have a substantiated abuse or neglect case within 12 months of termination of services as indicated in the periodic report. F. Qualitative measures of improvement will be reported at the termination of services using the same or substantially similar evaluation instruments as used in the pre-service assessment. NWA staff will prepare an annual report listing the number of referrals offered,referrals accepted,and will chart the disposition of each case in as much detail as we can obtain. 6 V. SERVICE OBJECTIVES A. Improve Family Conflict Management To keep children from being removed from the home: Family conflict management skills will be addressed using the mentoring and in home family therapy treatment modes. If youth has a high rate of truancy from school,running from the home,disregard for family/home rules,or the family is chronically engaged in abusive quarrelling,conflict management will be a top priority.This will be reflected in the family treatment plan. If children have already been removed: Reuniting the family with targeted support and assistance will be a top priority. Getting family members to participate in a planned process of constructive change in order to maximize strengths and remediate challenges will be the top priority.Outlining the concrete tasks and conditions which require each family members assistance will be emphasized. These will be written into the family's treatment plan. B. Improve Household Management Competency Household management competence will be measured by NWA Therapist observation as part of the treatment planning process.Completion of a proprietary life skills assessment will highlight strengths and opportunities for improvement. Areas of concern will be addressed in the family intervention plan and re-evaluated monthly and at the conclusion of services. C. Improved Ability to Access Resources: NWA team will assess the family's connections with agencies in their community which they can access when needs arise. The team will then assist them in filling any gaps in the system through establishing personal contacts at agencies which provide health and medical services, legal assistance,etc.The family will have a complete selection of resources and personal contacts at each community resource by the end of the intervention. D. Address Specific Referral Issues: NWA Treatment Plan will routinely include the issues which triggered the referral.These will be the starting point for the assessment process and the analysis of fit will provide the basis for formulation of intervention planning and goals selection. Regular weekly communication between the DSS Caseworker and the NWA Therapist will assure that issues of specific concern to the referring authority are included in the service plan. E. Improved Outcomes in the Performance Improvement Plan: We understand the vital importance of helping the Department demonstrate program improvement. In this program our services are specifically designed to address the following: Outcome S2, Children are safely maintained in their homes whenever possible and appropriate. We see this program contributing directly to the accomplishment of this outcome. Item 3, Services to families to protect children in home and prevent removal. Nelson,Wolf&Associates will cooperate fully in the administration of the CAC. We are prepared to use the results to help determine the needs of the families referred to us. We will be happy to participate fully in any Team Decision Making opportunities,and have participated in the Department's Placement Review Team(PRT)for the past several months. Outcome P1, Children have permanency and stability in their living situation. Item 5, Foster Care Re-entries: This program will not only reduce the number of out-of-home placements but will be available when children return home from an out-of-home placement. 7 This program seeks to strengthen children's and family's ties to the community in such a way as to reinforce permanency and stability in the home. VI.WORKLOAD STANDARDS A. Total number of hours on a per/case basis: Phase 1. (1st month): 3 hours per week(Total of 12 hours) Phase 2.(2"d& 3rd months): 2 hours per week(Total of 8 hours/month) Phase 3.(Optional): 1 hour per week as a step-down level.(4 hours) (Total of 28-32 Hours per case). B. Total number of staff: 1 Licensed Masters-level staff as Supervisor. (direct contact hours to non-direct hours,3:1). 3 Part-time(.50 FTE), Masters-level therapists working 4 cases each. (12 families concurrently will constitute a full caseload.) 1 part-time(.50 FTE)case aid will be assigned to each 12 families. NOTE: Under the present circumstances, the maximum number of families which can be accommodated is 12 per month(average). However, if the sustainable caseload is larger, we are willing and able to expand to accommodate more. Expansion to accommodate a larger caseload has been planned for in our Strategic Plan. C. Maximum caseload per full-time(1.0 FTE)therapist is 12 families. D. Modality of treatment will be in-home family therapy using the Multisystemic Therapy model. Following are generally the steps which will be followed in working a referral: 1. Team Supervisor will accept case from referring caseworker and receive any available assessments or observations as to the needs of the family and the reasons for referral. 2. Therapist will be assigned and briefed. 3. Therapist will meet with the family and verify intake information and complete assessments. This includes an analysis of strengths and challenges,analysis of fit,chart of community interfaces,and work out a contact schedule. 4. Therapist will make contact with the caseworker and share information and impressions of the family and their needs. 5. Therapist, in cooperation with the family, and with the results of the assessments and DSS caseworkers impressions in mind,will develop a series of over-arching goals, intermediary objectives,and establish benchmarks and measurements with which to evaluate progress weekly. 6. As the therapist meets with the family and with the team supervisor, progress and challenges will be communicated with all involved parties. 7. Supervision will occur weekly. These meetings will offer an opportunity for focusing on creative use of resources and means and methods for accomplishment of goals. 8. Monthly reports will be received by the family's caseworker,and staffings will be scheduled according to the caseworkers preferences. E. Total Number of hours per day/week/month: Plan is for 2 visits per week @ 1.5 hours per visit, for a total of 3 hours per week for a period of one month. (12 hours total) 8 In the second and third months,visits will be reduced to two hours,once per week,for a total of 8 hours each month.(16 hours in months 2 and 3,plus 12 hours in month one=28 elapsed hours.) If subsequent contact is deemed desirable,there will be one meeting per week,one hour in length,each week for a month. (4 more hours) At this point,the total hours invested in the case would be 32. F. Maximum caseload for each Supervisor is 6 masters level therapists. G. (See Attached Affidavit of Insurance) VII.PROOF OF COLABORATION A. (see attached letter from housing contact) B. (see attached letter from job services contact) C. As mentioned earlier,our agency has sent a representative to participate in the Placement Review Team meeting which has occurred at 9:00 AM Monday morning each week. We are always available to provide information on our client's progress at these meetings and to collaborate with the DSS staff to ensure that highest quality services are delivered in a timely fashion. Please see attached samples of the releases of information we use. D. At Nelson,Wolf&Associates,we routinely hold collaborative meetings(aka, "staffings")in our conference rooms at 3400 16'h Avenue,or at Department of Social Services, South Weld Offices,Department of Probation,or wherever it is most convenient and accessible. Attached is the invitation/checklist which proceeds all but emergency staffings. E. As the client family approaches the end of the allotted time period,the NWA staff and supervisor,in collaboration with the DSS Caseworker and other partners will determine the need for,and the duration of Phase 3 (step-down)consultations.This will likely occur during the third monthly staffing. VIII.EVIDENCE BASED OUTCOMES A. (See attached Bibliography) B. (See attachments) C. (See attachments) D. (See attachments) 9 • IX. STAFF QUALIFICATIONS A. NWA personnel have extensive experience in Marriage and Family Therapy,Individual and Group Therapy,Emancipation Programming, Social Work,Case Management,Family and Community Mediation. B. Staff and qualifications: James Nelson, MA, LPC(Director) Kris Wolf MSW(Therapist) James Rodman, MA, LMFT(Therapist) Julie Nelson, MA, LPC(Contract Therapist) Francis Garcia, MA (Contract Therapist) Cori Buggeln, MA, CAC II(Drug/Alcohol Program Coordinator) Ana Chiodo, MD (Translator, Spanish Speaking Therapist) Daniel Korb, MD, (Psychiatrist) Staff are qualified according to Staff Manual Volume VII, Section 7.303.17,and Section 7.0006,Q. of the Colorado Department of Human Services Regulations. (Resume or Curriculum Vita available upon request.) X. UNIT OF SERVICE RATE COMPUTATION (See attachments) XI. BILLING PROCESS A.Description of Billing Process: Therapists carry their Client Signature Sheets to the client's home.At the completion of their visit,they ask the head of household to sign the signature sheet.After the last visit of the month,they turn their sheets in to the bookkeeper. The bookkeeper then accumulates the signature sheets,totals the number of hours to be billed for,verifies the rates and fills out the billing forms.(Fictional examples are attached). B. (See attachments) XII.LOWEST QUALIFIED BID XIII.PROGRAM CAPACITY BY MONTH Nelson,Wolf&Associates,P.C. is prepared to deliver the services as bid in this proposal today. If the Department would like us to serve more than 24 client households during fiscal year 2006-07,we would be happy to discuss a mutually acceptable time table for increasing our staff and training new therapists. 10 Attachments Attachment VI . G. Insurance NELSON, WOLF & ASSOCIATES, PC (Private Counseling Affidavit of Insurance Following are the amounts and types of insurance coverage carried by Nelson, Wolf&Associates, P.C. , on its facilities, key employees and officers: Professional Liability Insurance: $1,000,000 each claim - $6,000,000 aggregate Workplace Liability $1,000,000 each claim- $6,000,000 aggregate Fire&Water legal Liability $150,000 sub-limit Personal Liability $1,000,000 aggregate Healthcare Providers Service Organization 159 E. County line RD. Hatboro,PA 19040 Workers Compensation and Employers Liability: Each Accident$100,000 Occupational Disease, each employee$100,000 Policy Limit$500,000 Pinnacol Denver, CO Automobile Insurance: Bodily Injury Liability- $100,000 each person, $300,000 each occurrence. Property Damage Liability - $100,000 American Family Insurance Madison, WI 53783 Eff4Otisl6tstSRt:Vlinde 7-A39/C6eeley, CO 80634' (970) 353-5577 p.tdfih t%t y Lb. Proof of Collaboration HOUSING AUTHORITIES Num P.O. Box 130 Eh Greeley, Colorado 80632-0130 (970) 353-7437 (97O) 353-7463 Fax March 30, 2006 (800) 659-2656 TTY Relay Nelson, Wolf and Associates Greeley, CO To Whom It May Concern: As a Housing Authority we would be glad to accept any appropriate referrals for clients needing our services from Nelson, Wolf 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 Co-op IV 06-04 Housing Authority of the City of Greeley • Weld County Housing Authority in 903 6th Street • Greeley, Colorado —0.-- Attachment VII . B. Proof of Collaboration CDEPARTMENT OF HUMAN SERVICES i 6N EMPLOYMENT SERVICES OF WELD COUNTY 47: 1551 NORTH 17TH AVENUE PO BOX 1805 GREELELEY,CO 80632 (970)353-3800 FAX(970)356-3975 C. COLORADO March 20, 2006 To whom it may concern: This letter is being submitted to all agencies and providers requesting letters of collaboration from Employment Services of Weld County concerning the CORE services RFP from Weld County Department of Social Services. Prior to issuing any letters of collaboration, Employment Services of Weld County (ESWC) is requesting that bidders submit a letter to Linda Perez, Director,which addresses the bidders"intent and the parameters under which they will collaborate with ESWC to address the employment and training needs for the specific population group they are proposing to serve. In the letter submitted to ESWC,bidders' should outline their current process or services under CORE service funds and their intent to address the following processes for collaboration with ESWC: • Case management • A referral process • A follow-up process • Cross training of staff • Other collaborative areas • Development of a Memorandum of Understanding(MOU) concerning collaborative efforts by February 1, 2007. Letters should be addressed and sent to: Employment Services of Weld County PO Box 1805 Attn; Linda L Perez Greeley, CO 80632 Attachment VII. B. (Collaboration) NELSON, WOLF & ASSOCIATES, PC (Private Counseling Employment Services of Weld County PO Box 1805 Greeley CO 80632 Atten: Linda L. Perez March 30,2006 Ms Perez, We would like to refer some of our clients who we believe are either chronically unemployed or under-employed to you for services.They will need the same services that you provide to the general public.However,it would be helpful if their job counselor could participate with us in the management of how the clients experience at job services interfaces with the rest of their lives. To further clarify, I have attached a copy of our agency description and an executive summary description of our program. It is currently being funded by Weld County Department of Social Services. However,we are preparing bids for next fiscal year,and are anticipating making some changes in the coming year which will make our program more useful to the department and its clients. One of those changes would be to have our staff learn more about Job Services and how we can help our clients to benefit from your services in a more focused manner. In order to work out the details,we would welcome the opportunity to meet with you in the near future and discuss items of mutual interest, such as: • Through what path would you like us to refer clients? • Will your staff be allowed to meet with us and discuss our mutual client's cases? • Would your case managers be available to participate in staffings along with Clients, Social Services Caseworkers,GAL,Therapists,etc.? We would be willing to engage with you pursuant to a Memorandum of Understanding as soon as you are available.I can be reached at 970-353-5577 during normal business hours. Sincerely, COPY James P.Nelson Chief Executive (attachment) 3400 16th Street* Suite 3-R* Greeley, CO 80634* (970) 353-5577 Attachment VII . C. Release of Information NELSON, WOLF & ASSOCIATES, P.C. RE: Date: RELEASE OF INFORMATION I hereby give permission to To release the following information either written or oral to authorized representative of Nelson, Wolf& Associates. This information is necessary in order to determine treatment needs and to coordinate treatment. This release of information remains in effect until , or DISCHARGE FROM TREATMENT WITHIN NELSON,WOLF&ASSOCIATES. The undersigned acknowledges that he/she/they understand that this release remains in effect until the above date or event,unless specifically revoked by written consent.* Signature of Client Date Other Person Authorized to Give Consent Date Witness Date Please return to: Nelson,Wolf&Associates,P.C. 340016'Street, Suite Q Greeley,CO. 80634 *To revoke consent, please send written notice of revocation to Nelson Wolf& Associates at the above address.Please include date and time revocation is to take effect. NELSON, WOLF & ASSOCIATES, P.C. RE: Date: Authorization For Communication I understand that information I share while involved in treatment with NELSON,WOLF&ASSOCIATES, P.C.will be shared with the treatment team to facilitate the provision of services. The treatment team may include teachers, clinical and counseling staff, as well as administrative staff serving in a supervisory or case management capacity to the client. (All violations of probation and/or any criminal behavior or conditions involving safety to the client and/or others must be disclosed to the appropriate authorities.) In addition, I hereby give NELSON,WOLF&ASSOCIATES,P.C.permission to exchange legal,medical and treatment information with the following agencies(check all those that apply): County Department of Social Services Representative District Courts County Juvenile/Adult Probation District Schools ,Guardian ad Litem ,Attorney Juvenile Detention Centers Police Department of jurisdiction Fire Department Family members-please list and describe relationship: I understand that this release is in effect until , or Until DISCHARGE FROM TREATMENT WITHIN THE AGENCY.* Signature of Client Date Guardian or Person Authorized to Give Consent Date *To revoke consent,send written notice to: NWA 3400 16'"Street,Suite 3Q Greeley, CO 80634 Attachment VII. D. Collaborative Communications NELSON, WOLF & ASSOCIATES, P.C. • Staffing Notice This letter is to inform you of the scheduled staffing for This staffing will be on at 3400 16th Street,Building #3, Suite Q. (Bittersweet Square Professional Offices, southeast corner of 16th street and 35th Avenue) The meeting is being held in order to provide an opportunity for collaboration and to recognize progress being made in our consultation together. If you have questions or concerns,please call me at(970)353-5577. Please call as soon as possible if you cannot attend the scheduled staffing at the above date and time so that I can make arrangements to reschedule the staffing so that all interested parties can attend. Thank You, J.P.Nelson Supervisor Cc to: Client Family Caseworker GAL Attorney Probation Officer Therapist Attachment VIII . A. Bibliography References Henggeler, S.W., Schoenwald, S. IC, Borduin, C. M., Rowland, M. D., &Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents.New York:Guilford Ness. Henggeler,S.W.,Melton,G.B.,Brandin,M.J.,Scherer,D.G.,&Hanley,J.H.(1997).Multisystemic therapy with violent and chronic juvenile offenders and their families:The role of treatment fidelity in successful dissemination.Journal of Consulting and Clinical Psychology,65,821-833. Henggeler, S. W., Rowland, M. D., Pickrel, S. G., Miller, S. L., Cunningham, P. B., Santos, A. B., Schoenwald,S.K.,Randall,J., &Edwards,J.E.(1997).Investigating family-based alternatives to insti- tution-based mental health services for youth:I rssons learned from the pilot study of a randomized field trial.Journal of Clinical Child Psychology,26,226-233. Henggeler,S.W.,Pickrd,S.G.,Brondino,M.J.,&Crouch,J.L.(1996).Eliminating(almost)treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy.Ameri- can Journal of Psychiatry, 153,427-428. Schoenwald,S.K.(1998).Multisystemic Therapy Consultation Guidelines. Charleston,SC: MST Insti- tute. Schoenwald, S.K.,Henggeler, S.W.,Rowland, M.D., &Hoagwood, IC.(1998). Getting Outcomes with MST: Implications for Dissemination. Symposium presented at the Eleventh Annual Research Confer- ence,A System of Care for Children's Mutual Health: Expanding the Research Base,Tampa,FL: Re- search and Training Center for Children's Mental Health,The Louis de la Parte Florida Mental Health Institute,University of South Florida. Attachment VIII . B. Evidence Based Outcomes IN-HOME FAMILY THERAPY CASE SUMMARY Month of June 2005 Family Name: Smith Therapist: Aurthur Kellogg MA. LPC I. Overarching/Primary Goals: 1.Ralph will avoid any further problems with the legal system,as evidenced by lack of police reports,self;and family report. 2.Ralph will increase his successful experiences,as evidenced by reports from the TIGHT program,reports from Mom,and self report. 3.Improve conflict resolution skills,as evidenced by decreased fighting,family,and self report. 11. Previous Intermediary Goals: Met Partially Not 1. Help Ralph understand more about his vulnerability to drugs. x 2. Ralph and his sister will help with chores around the house more. x 3. R's Mom will work on setting clearer boundaries and expectations with her children. x III. Barriers to Intermediary Goals: 1. Mom has an untreated anxiety disorder that makes it difficult for her to stay focused on the task at hand. 2. The children are used to doing as they please,as Mom has not set clear boundaries. 3. Ralph goes to Drug/Alcohol Group but does not participate. IV. Advances in Treatment: 1. Family meets weekly and openly discusses goals and how to meet them. Most of the sessions focused on how mom can get better at recognizing when to set boundaries vs being lenient. V. Assessment of"fit"between Identified Problems and Broader Systemic Context: 1. Family members are struggling with how to have an organized household with less stress and better communication on how family members can help each other. 2. Ralph continues to come and go as he pleases,and has come home intoxicated several times. Mom has not followed the plan to take Ralph to Detox and has not reported this to his substance abuse counselor. 3. Mom recognizes her need to become more assertive with her children regarding her expectations. VI. New Intermediary Goals: 1. Get Mom in to see a psychiatrist for her anxiety. 2. Get Mom financial assistance to help pay for Rx. Therapist Signature Date Attachment VIII. B. Assessment ANALYSIS OF"FIT" Family Name: Smith Therapist: Aurthur Kellogg DAD S iflopt Wags 'en S1S Op WIER WNW Awn &DAM% Was 50.060 9. a� cam tritt Angara. SINN tan an Sa- sy Attachment VTIT B Aggpqgrnpnr- Appendx 4-A W I7 INDEX OF FAMILY RELATIONS (IFR) Name: Today's Date: This questionnaire is designed to measure the way you feel about your family as a whole.It is not a test,so there are no right or wrong answers.Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2 = Very rarely 3 = A little of the time 4 = Some of the time 5 = A good part of the time 6 = Most of the time 7 = All of the time 1. The members of my family really care about each other. 2._I think my family is terrific. 3._My family gets on my nerves. 4._I really enjoy my family. 5._I can really depend on my family. 6. I really do not care to be around my family. 7. I wish I was not part of this family. 8._I get along well with my family. 9._Members of my family argue too much. 10._There is no sense of closeness in my family. 11. I feel like a stranger in my family. 12. My family does not understand me. 13._There is too much hatred in my family. 14._Members of my family are really good to one another. 15.__My family is well respected by those who know us. 16._There seems to be a lot of friction in my family. 17._There is a lot of love in my family. 18. Member of my family get along well together. 19._Life in my family is generally unpleasant. 20._My family is a great joy to me. 21._I feel proud of my family. 22._Other families seem to get along better than ours. 23._My family is a real source of comfort to me. 24._I feel left out of my family. 25._My family is an unhappy one. Copyright(c)1992,Walter W.Hudson Illegal to Photocopy or Otherwise Reproduce 1,2,4,5,8,14,15,17,18,20,21,23. INDEX OF SISTER RELATIONS (ISR) Name: Today's date: This questionnaire is designed to measure the way you feel about your sister. It is not a test so there are no right or wrong answers. Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2 =Very rarely 3= A little of the time 4 = Some of the time 5=A good part of the time 6= Most of the time 7 =All of the time 1. I get along very well with my sister. 2. My sister acts like she doesn't care about me. 3. My sister really treats me badly. 4. My sister really seems to respect me. 5. _I can really trust my sister. 6. My sister seems to dislike me. 7. My sister really understands me. 8. _My sister seems to like me very much. 9. My sister and I get along well together. 10. I hate my sister. 11. My sister seems to like having me around. 12. I really like my sister. 13. I really feel that I am disliked by my sister. 14. _I wish I had a different sister. 15. My sister is very nice to me. 16. _My sister seems to respect me. 17. My sister thinks I am important to her. 18. My sister is a real source of pleasure to me. 19. My sister doesn't seem to even notice me. 20. _I wish my sister was dead. 21. My sister regards my ideas and opinions very highly. 22. _My sister is a real"jerk". 23. I can't stand to be around my sister. 24. _My sister seems to look down on me. 25. I enjoy being with my sister. Copyright© 1992, Walter W. Hudson 1,4, 5, 7, 8, 9, 11, 12, 15, 16, 17, 18, 21, 25 INDEX OF BROTHER RELATIONS (IBR) Name: Today's Date: This questionnaire is designed to measure the way you feel about your brother. It is not a test so there are no right or wrong answers. Answer each item as carefully and as accurately as you cart by placing a number beside each one as follows. 1 = None of the time 2=Very rarely 3 = A little of the time 4 = Some of the time 5 =A good part of the time 6= Most of the time 7=All of the time 1. _I get along very well with my brother. 2. _My brother acts like he doesn't care about me. 3. My brother treats me badly. 4. My brother really seems to respect me. 5. _I can really trust my brother. 6. _My brother seems to dislike me. 7. My brother really understands me. 8. _My brother seems to like me very much. 9. _My brother and I get along well together. 10. _I hate my brother. 11. My brother seems to like having me around. 12. I really like my brother. 13. _I really feel that I am disliked by my brother. 14. I wish I had a different brother. 15. _My brother is very nice to me. 16. My brother seems to respect me. 17. My brother thinks I am important to him. 18. _My brother is a real source of pleasure to me. 19. My brother doesn't seem to even notice me. 20. I wish my brother was dead. 21. _My brother regards my ideas and opinions very highly. 22. _My brother is a real"jerk". 23. _I can't stand to be around my brother. 24. My brother seems to look down on me. 25. I enjoy being with my brother. Copyright© 1992, Walter W. Hudson 1, 4, 5, 7, 8, 9, 11, 12, 15, 16, 17, 18, 21, 25 CHILD'S ATTITUDE TOWARD MOTHER (CAM) Name: Today's date: This questionnaire is designed to measure the degree of contentment you have in your relationship with your mother. It is not a test so there are no right or wrong answers. Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2 =Very rarely 3=A little of the time 4= Some of the time 5=A good part of the time 6 = Most of the time 7=All of the time 1. _My mother gets on my nerves. 2. I get along well with my mother. 3. I feel that I can really trust my mother. 4. _I dislike my mother. 5. My mother's behavior embarrasses me. 6. My mother is too demanding. 7. _I wish I had a different mother. 8. _I really enjoy my mother. 9. _My mother puts too many limits on me. 10. _My mother interferes with my activities. 11. I resent my mother. 12. I think my mother is terrific. 13. I hate my mother. 14. _My mother is very patient with me. 15. _I really like my mother 16. _I like being with my mother 17. I feel like I do not love my mother 18. My mother is very irritating. 19. I feel very angry toward my mother. 20. I feel violent toward my mother. 21. I feel proud of my mother. 22. I wish my mother was more like others I know. 23. _My mother does not understand me. 24. I can really depend on my mother. 25. I feel ashamed of my mother. Copyright© 1992, Walter W. Hudson 2, 3, 8, 12, 14, 15, 16, 21, 24 CHILD'S ATTITUDE TOWARD FATHER (CAF) Name: Today's date: This questionnaire is designed to measure the degree of contentment you have in your relationship with your father. It is not a test so there are no right or wrong answers. Answer each item as carefully and as accurately as you can by placing a number beside each one as follows. 1 = None of the time 2 =Very rarely 3 =A little of the time 4=Some of the time 5=A good part of the time 6= Most of the time 7=All of the time 1. _My father gets on my nerves. 2. I get along well with my father. 3. _I feel that I can really trust my father. 4. _I dislike my father. 5. My father's behavior embarrasses me. 6. My father is too demanding. 7. _I wish I had a different father. 8. _I really enjoy my father. 9. _My father puts too many limits on me. 10. _My father interferes with my activities. 11. I resent my father. 12. _I think my father is terrific. 13. I hate my father. 14. _My father is very patient with me. 15. _I really like my father. 16. _I like being with my father. 17. _I feel like I do not love my father. 18. My father is very irritating. 19. I feel very angry toward my father. 20. __ I feel violent toward my father. 21. _I feel proud of my father. 22. _I wish my father was more like others I know. 23. My father does not understand me. 24. _I can really depend on my father. 25. _I feel ashamed of my father. Copyright© 1992, Walter W. Hudson 2, 3, 8, 12, 14, 15, 16, 21, 24 Attachment VIII . C. Fictional Renewal Reqwuest NELSON, WOLF & ASSOCIATES, PC (Private Counseling Ches Bond Weld DSS Greeley, CO 80632 Nov. 30, 2005 Dear Mr. Bond, We are requesting a renewal of services for your clients,the Smiths. We are requesting renewal due to the following factors: 1. Ralph has three more Drug/Alcohol Abuse classes to go before completion and Mom would like some step-down services to help prevent a relapse. 2. Mom is transitioning to a new job with a new work schedule starting in January and the transition may trigger stress behavior due to schedule changes and new supervision requirements for Ralph. Therefore,we would like to do Phase 3 work for a total of 4 additional hours with this family during the month of January 2006. The case is due to terminate December 31, 2005. Please advise if this will be acceptable as soon as possible. Thanks, Aurthur Kellogg, MA,LPC IN-Home Therapist CC: Andrea Lee, Supervisor 3400 16th Street* Suite 3-R* Greeley, CO 80634* (970) 353-5577 Attachment VIII . D. Fictional Monthly Report IN-HOME FAMILY THERAPY MONTHLY REPORT Month of: December, 2005 Family Name: Smith Therapist: Aurthur Kellogg MA, LPC I. Overarching/Primary Goals: 1. Ralph will avoid any further problems with the legal system,as evidenced by lack of police contacts,self and family reports. 2. Ralph will increase his successful experiences,as evidenced by reports from Mom and self report. 3. Improve conflict resolution skills,as evidenced by decreased fighting,as reported by family and self report. II. Previous Intermediary Goals: Met Partially Not 1. Mom and Ralph will work on addressing each other without sarcasm and fighting. x 2. Ralph will start the WIA program as soon as possible upon discharge from DYC. x 3. Ralph will continue to attend AA and will investigate the younger group that meets in Loveland. x III.Barriers to Intermediary Goals: 1. Now that Ralph has returned home and is no longer on probation,he is not very invested in following through with the agreed upon decisions made while he was incarcerated. 2. Mom has difficulties expressing her feelings of concern for Sam and feels more comfortable lecturing him. 3. Ralph is having a difficult time getting invested in starting the WIA program,as he lacked some of the documentation needed to get started. 4. Ralph is not necessarily invested in stopping his drug use. IV. Advances in Treatment 1. Ralph and Mom continue to participate in all therapy sessions. 2. Ralph is planning to participate in the WIA program when he is discharged from DYC. 3. Ralph is still somewhat invested in exploring what he needs to do in order to complete his high school diploma. V. Assessment of"fit"between Identified Problems and Broader Systemic Context: 1. Mom has difficulty avoiding worrying about Ralph's choices when he is discharged. Who bears consequences when Ralph makes poor choices? 2. Mom wants to have control over Ralph's decisions. How can Mom help Ralph learn to make better choices? VI. New Intermediary Goals: I. Ralph and Mom will work with on disengaging with this therapist. 2. Ralph will follow through with his responsibility of having a job,getting his education,or a combination of the two. Therapist Signature/Date ` I I I I I I I I I I | | I § a 2 g OF- E ; _co { \ } ' Q . 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E lig , \ } g � | | | It § § § WELD COUNTY AUTHORIZATION FOR CON FRACTUAL SERVICES Date: Jan. 10, 2008 Provider: Nelson, Wolf& Associates Billing Contact: Linnie Wolf Phone #: 970-353-5577 Address: 3400 16th Street, Suite Q, Greeley, CO 80634 Description of Services: In Home Family Therapy Service Month / Year December 2007 Charges: $ 1231.44 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. James P. Nelson / Printed Name of Signer Provider Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: Approvals: / / Core Caseworker Date Director Date AMOUNT PAYABLE: $ ANY CHANGES LISTED BELOW: Client/ID/HH# Billed Amt Denied Paid Reason \ ( \Z - f \ ( ) / t CI en } \ § \ ; \) ) k AE « \ ct >4 .8 -412 ‘0 a ( ) g � ± fl° h19 Ii .% < t , . wo . — ■ i2 - - - , . ° » ! ) m - m" ] (( Fee= � . § f \$ ( o = g § ( 0 — x2 § ) « i ¢ E \ aAF- au ■ a . F § 26 � # ; ] § p � $ ' > -IC 0 , s � \ ch , } I » - § / Zoo #y so 2 ^ ) {_ tn 7 I J3 ] ) u 0 ) § ® \ , § 03 % ` \O a ■ v0 o 2 / 0 § 0 ef. K � U F ° H �n ) ) [ § ! ) } 0 § , k \ ) kE ei 9 ® # % () § ) § \ § } } ; k -0 >. - B � 0 \ / { \ /t . 6 k ( \ ) � H , y • ! ) — h. j )al rn \ 0a so, on § { 41 t � ) t § e 4) § \ ) 0 w .E a.2 \ y ) S e ; % & / @ r � II { � —tri .2 0 SI tI) td SI ti CA \k \ � § eel ; « 5 § { / ® \ rt > aIn 7 4) en 4:4 J / § en ) ) bon \ - % % $ e § ± - 'M % % ) AA * f » § j \ a. 2 r ! 44 ° � O § \ k / \ G3ny oa if f ) II f % ) ) & — — & \� \{ ` � ` ) °` % i. 7to � ( / \ ] /\ ] /e { V k ) \ { ) � \ § § 2 #/ 12 \ •® % ® ) 0 II) a2 \ mkt _ \ f / § a � a O O Q !a. ( s 0 ca O4 \ k i 7 % x § • .5 ) { t / \ \ 2 / % \ � § \_ \ 8 z .8 ; \ \ ~ ! { ) ® Io 2 \ > ° 6 \ \ / ry / kk } ) / B ) 0 I EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP l-RUM : FRX N0. :9703567280 May. 22 2006 04:18PM P1 Nelson, Wolf fi PRIVATE_ COLIN.5LL_INC Indivi<ual&family • nr.¢ mg for ' our NUT x Fax Transmittal Cover Page Phone:(970)353-5577 Fax: (970)356-7280 3400 161t1 Street, Bldg. 3R Greeley, CO 80634 Date: 5".2'O To: 610041—R Fax II: 970 _..3�1n - 7(Q9o_ Number of Pages: 4. .__ From:- ..A(de-O'7 11 �� Comments:-5.429 .._. - 1 _ Confidentiality Notice: The information contained in this facsimile message is privileged and confidential, and is intended only for the use of the individual(s) named above and others who have been specifically authorized to receive it. If you are not 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, or if any problems occur with transmission, please notify us immediately by telephone at the above number, and return the original message to us at the above address via the U.S. Postal Service. Thank you for your cooperation. M.1M FAX NO. :9703567280 May. 22 2006 04:18PM P2 '°el'e€dlt Vi/flit 3400 16'4 Street Suite 3-It,Q Greeley, CO 80634 Ph: 970,353.5577 Fax: 970.356.7280 Weld County Department of Social Services PO Box A Greeley, CO 80632 Attention: Gloria Romansik Re: RFP 06010 option B, Home Based Intensive Services Dear Ms. Romansik: This letter is in reference to the above referenced matter in which you requested additional information. in response to the recommendations for#I and#2 in the letter provided to us dated May 15th 2006, we are willing to comply in proving timely and accurate billing statements. We are also willing to provide proof of our status in providing services to the Medicaid eligible population. • In response to the compliance item you requested,we previously provided a letter from. the Housing Authority stating they would accept any appropriate referrals from Nelson, Wolf and Associates(see attached). Additionally, we have contacted Employment Services for verification letters, however; they would only give a verbal agreement of collaboration even though we asked for written verification(see attached). In response to the Hourly rate for Court Testimony: We accept the hourly rate of$65 per hour. If you have any questions concerning the above, please call Jim Nelson @ 970.353.5577 Sincerely, gX/1)././8e, James P. Nelson, Executive Director Ft'!OM : FAX NO. :9703567260 May. 22 2006 04:19PM P3 Proof of Collaboration tiz , ES, L�• 1`noLISIIYO AUTHORITIES NinP.O. Box 130 Greeley, Colorado 80632-0130 v M (970) 353-7437 March 30,2006 (970) 353-7463 Fax (800) 659-2656 TTY Relay • Nelson, Wolf and Associates Greeley, CO To Whoxi It May Concern: As a Housing Authority we would be glad to accept any appropriate referrals for clients needing our services from Nelson,Wolf 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 r.<,: . Executive Director c;=o COPY Co-op Itr 0604 Housing Authority of the City of Greeley • Weld County Housing Authority a 903 6th Street r Greeley, Colorado ..a.aC 3400 lir street-sung.S-R ca►aeary. _ __ . pr . FAX NO. :9703567280 May. 22 2006 04:19PM P4 • tiR Yiv<•N A. Attachment VII_ B. (Collaboration) x.k; y, ti 9 NELSON, WOLF & ASSOCIA: ,;40.::, activate Counseling Employment Services of Weld County PO Box 1805 Greeley CO 80632 Atten:Linda L.Perez • March 30,2006 Ms Perez,, We would like to refer some of our clients who we believe are either cli pnicaHY intemployed or under-anployed to you for services.They will need the same services thatyOu.prov with us in ide gilt public.However,it would be helpful if their job counselor conld:perticipate management of how the clients experience at job services interfaces with the rest of their lives. To further clarify,I have attached a copy of our agency description and an executive summey description of our program.l3 is currently being funded by Weld County Department of Social Services.However,we are preparing bids for next fiscil year,and are antlapating raking some changes in the coining year which will make our program mote useful to the department and its clients. One of those changes would be to have our staff learn more about Job Services and how we can help our clients to benefit horn your services in a more focused manna'.In order to work oat the details,we would welcome the opportunity to meet with you in the near future and discuss items of mutual interest,such as: • Through what path would you like us to rear clients? • Will your staff be allowed to meet with us and discuss our mutual client's cases? • Would your case managers be available to participate in starlings along with Clients, Social Services Caseworkers,GAL,Therapists,etc.? We would be willing to engage with you pursuant to s Memorandum of Understanding as soon as you arc available.I can be reached at 970-353-5577 during normal business hours. Sincerely, COPY James P.Nelson Chief Executive (attachment) 340016°1 Street*Sulte 3-R'Greeley,CO 80634*(970)353-5577 • a DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY, CO. 80632 %Valita Administration and Public Assiisistance � Child Support(970)352-1551 C (970)352-6933 O COLORADO May 15, 2006 Jim Nelson,MA, LPC Youth Emancipation&Services,Inc./ Nelson, Wolf and Associates,P.C. 3400 16 Street,Bldg 7, Suite Q Greeley,CO 80634 Re: RFP 05005: Lifeskills Bid#06OPB05 (RFP 06010)Option B,Home Based Intensive Services Dear Mr. Nelson: The purpose of this letter is to outline the results of the Bid process for PY 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#06OPB05 (RFP 06010), Option B-Intensive Home Based Therapy, for inclusion on our vendor list. This bid scored a total of 94 points. The FYC Commission attached the following recommendations and compliance item to your bid. Recommendations: Recommendation#1: You are requested to work towards providing accurate, clear, and timely billing statements. If bills are not received in an accurate and correct format, they may be returned to you unpaid. Recommendation#2: As a Medicaid provider,you are requested to provide proof of your status for providing services to the Medicaid eligible population. Comoh�ance Item• You must provide the required letters under the Collaboration Section from Weld County/Greeley Housing Authority, employment/training partners,and other partners as identified in the bidder's assessment of needs. You must identify the process you will utilize to facilitate Medicaid eligible clients receiving mental health services at North Range Behavioral Health. Hourly Rate for Court Testimony: You did not provide a rate for court testimony. For bidders carrying over services to 2006, the Department will use last year's court testimony hourly rate. The rate for court testimony will be billed at is $65 per hour. Page 2 Youth Emancipation&Services, Inc./Nelson Wolf&Associates/Results of Bid Process 2006-2007 • The Families,Youth and Children(FYC)Commission did not recommend approval of your Bid 06LS18(RFP 06005),Lifeskills, for inclusion on our vendor list.This bid scored 81 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 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 at 352.1551, extension 6230. Sincerely, J A. Gri o,Dire r cc: Juan Lopez,Chair, FYC Commission Gloria Romansik, Social Services Administrator Hello