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Home My WebLink About20021312 RESOLUTION RE: APPROVE FIVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR VARIOUS PROGRAMS AND AUTHORIZE CHAIR TO SIGN -ACKERMAN AND ASSOCIATES, P.C. 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 five Notification of Financial Assistance Awards 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 Ackerman and Associates, P.C., commencing June 1, 2002, and ending May 31, 2003, with further terms and conditions being as stated in said awards for the following programs: 1) Option B - Home Based Intensive 2) Intensive Family Therapy - Short Term IFT (GAP) and Mediated Family Conflict Resolution 3) Intensive Family Therapy - Family Group Decision Making 4) Sex Abuse Treatment 5) Foster Parent Consultation, and 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 Notification of Financial Assistance Awards for the above listed programs between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and Ackerman and Associates, P.C., be, and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said awards. SS 2002-1312 SS0029 FIVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS -ACKERMAN AND ASSOCIATES, P.C. PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 22nd day of May, A.D., 2002. BOARD OF COUNTY COMMISSIONERS / WELD COUNTY, COLORADO ATTEST: 5t �j�/� t aad, Char GI IJ G� . Weld County Clerk tot P:o. ., r 1861 (` 44, //� • ' David . g, Pro-Tem BY: Deputy Clerk to the / 1y ----�' M. J. Geile AP D AS TO F. "M: 1L-L5 )77_1 illiam H. Jerke C nt ttorn4 11\1\itY obert D. M'asden Date of signature: 2002-1312 SS0029 4 , DEPARTMENT OF SOCIAL SERVICES PO BOX A 1 GREELEY,CO 80632 WEBSITE:www.co.weld.co.us C Administration and Public Assistance(970)352-1551 111 O Child Support(970)352-6933 COLORADO MEMORANDUM TO: Glenn Vaad, Chair Date: May 22, 2002 Board of County Commissioners FR: Judy Griego, Directoret Weld County Departme of S i Servi s RE: PY 2002-2003 Notification of Financial Assistance Awards (NOFAA) under Core Services Funds-Ackerman& Associates, P.C. Enclosed for Board approval are the PY 2002-2003 Notifications of Financial Assistance Awards (NOFAA) for Families, Youth, and Children Commission (FYC) Core Services Funds, which are for the period of June 1, 2002,through May 31, 2003. The Families, Youth and Children Commission (FYC) reviewed proposals under a Request for Proposal process and are recommending approval of these bids. Ackerman and Associates. P.C. A. Option B, Home Based Intensive: A maximum of 60,family units, or 360 individuals for an average of three hours per week of in-home services for a 20- week period. The average length of stay will be 60 hours. Monthly average capacity is 5 families.Rate is$104/hour per unit of service. B. Intensive Family Therapy: 1. Mediated Family Conflict Resolution and Short-term Intensive Family Therapy-Goal Achievement Program (GAP):Maximum capacity is five families per month (60 per year). Maximum stay is 20 hours over a five- month period. The program has a capacity of providing Bicultural- bilingual services to 15,families per year. South County Service Delivery with provision of a site. Rate is$104.00/hour. Pagel of 2 2002-1312 MEMORANDUM TO GLENN VAAD, CHAIR WELD COUNTY BOARD OF COMMISSIONERS RE: CORE SERVICE NOFAA PY 2002-2003 2. Family Group Decision Making: A maximum of four families per month (48 per year) involving the nuclear family,professionals involved in the case, and individual members of the extended family. Services billable at $84/hr.Rate is a maximum of$2,100 per family group conference. C. Sex Abuse Treatment: Projected maximum total per year is estimated at 36 families, the average monthly capacity is two new families per month with the average caseload of five open cases per month, the maximum stay is 45 sessions over a 12-month period Group treatment is provided at an equivalent of five individual hour-long sessions. Bilingual-Bicultural services. Services available in SouthCounty with provision of a site. Rate is$104.00/hour. D. Foster Parent Consultation: Group training for a maximum of 12 participants with an average of four participants per group. Average stay is 12.5 hours. Telephone consultations for crisis management are available for a maximum of one-half hour per call. This program anticipates serving 60 family units. Rate is $90 an hour. Group rate per client is$45/hour. If you have any questions, please telephone me at extension 6510. of Page 2 of 2 Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission (Core) Funds Type of Action Contract Award No X Initial Award FY02-PAC-2001 Revision (RFP-FYC-(02010) Contract Award Period Name and Address of Contractor Beginning 06/01/2002 and Ackerman and Associates, P.C. Ending 05/31/2003 Option B—Home Based Intensive 1750 25h Avenue, Suite 101 Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Improve both individual and family functioning Assistance Award is based upon your Request for through in-home services. Service to a Proposal (RFP). The RFP specifies the scope of maximum of 60 families. The service offers a services and conditions of award. Except where it is range, on average, of three hours per week of in- in conflict with this NOFAA in which case the home services for a 20-week period. The NOFAA governs,the RFP upon which this award is average length of stay will be 60 hours. Monthly based is an integral part of the action. average capacity is 5. Special conditions 1) Reimbursement for the Unit of Services will be based Cost Per Unit of Service on an hourly rate per child or per family. Hourly Rate Per $ 104.00 2) The hourly rate will be paid for only direct face-to- Unit of Service Based on Approved Plan face contact with the child and/or family, as evidenced by client-signed verification form, and as specified in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly, and yearly cost per child and/or family. 4) Rates will only be remitted on cases open with, and referrals made by the Weld County Department of Enclosures: Social Services. X Signed RFP:Exhibit A 5) Requests for payment must be an original and X Supplemental Narrative to RFP: Exhibit B submitted to the Weld County Department of Social X Recommendation(s) Services by the end of the 25th calendar day following Conditions of Approval the end of the month of service. The provider must submit requests for payment on forms approved by Weld County Department of Social Services. BAyprovalSiii4 Program B Official: y Glenn Vaad, Chair Jude 4t. G 'e o, Directo Board of Weld County Commissioners We Cou Department of Social Services Date: Q57,2Q6W. ., Date: 5/0/GZ 4So©a- /3/a • EXHIBIT A SIGNED RFP • • INVITATION TO BID 4 'ICJvrma„ flout &icsea . DATE:February 27, 2002 e BID NO: RFP-FYC-02010 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-02010) for:Family Preservation Program--Home Based Intensive Family Intervention Program Family Issue's Cash Fund or Family Preservation Program Funds Deadline: March 22, 2002, Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Statewide Family Preservation Program(C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement(C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2002,through May 31, 2003, at specific rates for different types of service. The County will authorize approved vendors and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased in intensity, and produce positive change which protects children,prevents or ends placement, and preserves families. 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 44.1—vrf" 9./ AMA ..``t•, (After receipt of order) B MOST BE SIGNED IN INK \ _ ,t� l`i.��ei it cw$dD L/^1' Qp TYPED OR PRINTED SIGNATURE A VENDOR C bet/ .\ t l scca Pt- ioL \r46)O (Name) H dw .tten Signature By Authorized Of icer or Agent of Vender ADDRESS 1950 .S'CS A-tit TITLE / s Ca , DATE 3/.2/Pa" PHONE# ,3.S 23 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 31 RFP-FYC-02010 Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 2002-2003 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2002-2003 BID #RFP-FYC-02010 NAME OF AGENCY: .04744-12n1"..”-- r 4SS E CC S ec • ADDRESS: , ' rb Qs- ri Aate_ PHONE: Mc) .3 S 3 "33)n3 CONTACT PERSON: ' A Cie! . elf TITLE: Is- DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program iamily 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 1.2002 Start End May 31. 2003 i-149-re End TITLE OF PROJECT: rTa-re ;Ara rt/ a.C /a ",,. Named Signature of Person Preparing Document Date Name d Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2001-2002 to Program Fund year 2002-2003. Indicate No Change from FY 2001-2002 to 2002-2003 _ Project Description ,/ ✓ Target/Eligibility Populations/ Types of services Provided tee ✓ Measurable Outcomes V Service Objectives / Workload Standards ✓ Staff Qualifications Unit of Service Rate Computation Program Capacity per Month ✓ ✓ Certificate of Insurance Page 25 of 31 RFP-FYC-02010 / Attached A Date of Meeting(s)with Social Services Division Supervisor: b Oa Comments by SSD Supervisor: B 4 2 e eV-1 PL A rite i p a , butt cciPe; I- 4-D2 Name and Signature df SSD Supervisor Date Page 26 of 31 RFP-FYC-02010 Attached A Program Category Home Based Intensive Family Intervention Program Bid Category Project Title 11„„e ®mod 7 f ti.r,� Vendor P Gkrnw t I4SSo PROJECT DESCRIPTION Provide a brief one-page description of the project. H. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Sub-total of Individuals who will have access to 24 hour service. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Therapeutic Services- includes re-parenting, family therapy, support groups,problem solving, communication skills,parent-child conflict management, etc. B. Concrete Services-means concentrated assistance in the development and enhancement of parenting skills, stress reduction, problem solving, hands-on parenting,budget management, recreational activities, etc. C. Collateral Services-teaching families to work with other community agencies such as drug and alcohol,health care,job training, information and referral, advocacy, etc. D. Crisis Intervention Services - including in-home counseling and other interventions available on a 24-hour basis. Provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. Page 27 of 31 RFP-FYC-02010 Attached A IV. MEASURABLE OUTCOMES Provide a two-page description of your expected measurable outcomes of the project. Address the following measurable outcomes: A. Child remains in home at time case is closed. B. Improvements in parental competency, parent/child conflict management and household management competency as measured by pre and post placement functional tests. C. Children who are currently in their own home will remain in their own home 12 months after the completion of Home Based Intensive Family Intervention family preservation services. D. Children currently in long-term placement who are provided reunification Home Based Intensive Family Intervention services will return to their own home and not reenter out-of- home placement 12 months after completion of Home Based Intensive Family Intervention services. E. Families who receive either family preservation or reunification services will not have a substantiated abuse or neglect 12 months after completion of Home Based Intensive Family Intervention services. F. Cases which receive either family preservation or reunification services by Home Based Intensive Family Intervention will measure "LOW"on the risk assessment devise at service closure. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Provide a one page description of your expected service objectives and quantitative measures. Address, at a minimum, the following ways the project will: A. Improve Family Conflict Management- Mediation and counseling designed to resolve conflicts and disagreements between parents and their children contributing to child maltreatment,running away and other status offenses. B. Improve Parental Competency- capacity of parents to maintain sound relationships with their children and provide care, nutrition,hygiene, discipline, protection, instructions, and supervision. C. Improve Household Management Competency-capacity of parents to provide a safe household environment for their children through competent household cleaning and maintenance, budgeting and purchasing. D. Improve Ability to Access Resources- services shall assist parents in learning to obtain help from other sources in the community and within the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. Page 28 of 31 RFP-FYC-02010 Attached A VI. WORKLOAD STANDARDS Provide a one page description of the project's work load standards and quantitative measures. Address, at a minimum, the following areas: A. Number of hours per day, week or month. (Minimum intensity of 3 hours per week per family.) B. Number of individuals providing the services. C. Maximum caseload per worker. (Minimum family caseload of 8-10.) D. Modality of treatment. E. Total number of hours per day/week/month. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. H. Insurance. VII. STAFF QUALIFICATIONS Provide a one page description of staff qualifications and address, at a minimum, the following: A. Will your staff, including supervisors,who are providing direct services have the minimum qualifications in education and experience in Staff Manual Volume VII, Section 7.303.17, and Section 7.0006,Q, Colorado Department of Human Services? Describe. B. Total number of staff, including supervisors, available for the project. C. Will your staff have received mandated new caseworker training? D. Will your staff have knowledge in risk assessment? E. Will your staff have completed the required State Home Based Intensive Family Services training component? Page 29 of 31 RFP-FYC-02010 Attached A VIII. COMPUTATION OF DIRECT SERVICE RATE This form is to be used to provide detailed explanation of the hourly rate your organization will charge the Core Services Program for the services offered in this Request for Proposal. This rate may only be used to bill the Weld County Department of Social Services for direct, face-to-face services provided to clients referred for these services by the Department. Requests for payment based on units of service such as telephone calls, no shows, travel time, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise, billings must be for hours of direct service to the client, regardless of the number of staff involved in providing those services. Therefore, it is imperative that this rate be sufficient to cover all costs associated with this client, regardless of the number of staff involved in providing these services. (Explanations for these Lines are Provided on the` Following Page) (v Total Hours of Direct Service per Client & Hours [A] Total Clients to be Served (Pen-, lies) Zoe) Clients [B] Total Hours of Direct Service for Year 3 6 OO Hours [C] (Line [A] Multiplied by Line [B] // s1 2 Cost per Hour of Direct Services $ 4 . Yo Per Hour [D] Total Direct Service Costs $ ,.2 a- yi 69 p (E] (Line [C] Multiplied by Line [D] ) Administration Costs Allocable to Program $ 3 7 1 y Ito [F] IC: Ho/Rr II LJ 3� 0 Overhead Costs Allocable to Program $ [G] 31, a.oAA, Total Cost, Direct and Allocated, of Program$ [H) Line .[E] Plus Line [F] Plus Line [G] ) Anticipated Profits Contributed by this Program $ O [I] Total Costs and Profits to be Covered c1 by this Program(Line [H] Plus Line [I] ) $ 3 / yfyoo [J] Total Hours of Direct Service for Year 36, o o [K] (Must Equal Line [C] ) Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of Social Services $ i o y, 00 [L] Day Treatment Programs Only: Direct Service House Per Client Per Month (M) Monthly Direct Service Rate $ [N] Page 30 of 31 Project Description, 2002-2003 Option B Home Based Services Overview: Ackerman and Associates, P.C. proposes to continue to deliver an Option B Intensive Home Based program. We have had a very successful past five years of operation. To date we have treated more than a hundred cases in Weld County. The proposal presented here incorporates our accumulated experiences. Target families are either facing imminent out of home placement or the family has a member who has returned from foster placement. These services are designed to help maintain placement at home or to help reunification succeed. In addition, in specific cases, home based services can help prevent placement in residential treatment. Modifications have been made in this proposal to time limit the delivery of services to one sixty hour cycle with a mechanism to continue therapy in this model for an additional cycle only in very clearly defined circumstances. Entry into the program would involve construction of clearly defined and measurable goals for the family to achieve during the Option B program. Such goal construction would be completed and accepted by the client (as a signed"purpose of the program" for their family) by the end of ten hours of client contact. Review of these goals with the client will occur at 30 and 45 hours of treatment. Treatment will be continued after thirty hours only if progress is being made. Purpose: We propose to continue to provide home-based services in Weld County that: 1. are strongly based in the principles of bilingual/bicultural treatment, 2. are based upon a nationally recognized model for home-based family preservation, 3. continue to be promptly responsive to the needs of Social Services for feedback on the enrollment of families and the progress of families in the home-based treatment process, 4. continue to be effective at preventing placement of referred children, 5. place the needs of the child first and is consistent within that mandate while simultaneously being valued and appreciated by caseworkers, social services supervisors and the families that are being served. 6. conform to good management practices that are both cost effective and cost contained as set forth in the practice standard stated in the overview above and further in the project design below. Out target for prevention of placement for the past year was 85%which means of the projected up to 60 families in our program, no more than nine families should have to ultimately receive placement during the program period. Design: Implementation of our program in Weld County has been quite successful in the last five years. The proposal incorporates changes and adaptations to this model as we have implemented it since 1996. We have also incorporated a number of mechanisms for 1) cost containment and 2)to limit renewals of clients beyond sixty hours of service. We believe the program should be time limited and results oriented in the delivery of services. The goal for 2002-2003 for the program is to maintain service delivery standards as follows: 1. To have 70%or more of clients referred need no more than sixty total hours of service. Those who continue will do so only because this is the most cost effective alternative available. 2. A mid point review at 30 hours into the initial program will be conducted. The aim of this review is to identify families who have reached appropriate treatment goals who can either 1) stop or 2) who can step down to a more supportive or maintenance level of treatment. This "step-down" level will be delivered less often for the remainder of the program. Those who have entered a maintenance phase will have a review at 45 hours of treatment. Those who, at the 30 hour review, appear to have had a clinically insignificant level of progress on their case plan will be referred back to Social Services. 3. Of the remaining 30% or less who we anticipate will need more than 60 hours of treatment, two out of three will complete treatment for the episode they were referred for in 30 additional hours or less. Specifically, continuation would be in increments of 15 hours and a thorough review by the clinician and the caseworker would be documented. A decision would be made by this team at sixty and seventy five hours if further treatment is needed prior to proceeding into the next 15 hour segment. 4. All families who need more than 60 hours of treatment will either be: • Referred to a specific life skills program, • Referred to short term intervention programs such as GAP to finalize treatment, • Stepped down to a maintenance mode of treatment in a home based renewal either once every two weeks or once a month or • Referred back to Social Services for determination of future action if progress in our determination has been inadequate. 2 Other considerations: The strength of our staff in this project, in experience, in bilingual/bicultural service delivery and in the delivery of home-based services to over one hundred client families are considerations we think are important for the reviewers of this proposal. Dr. Sherri Malloy, Licensed Psychologist, was formerly director of the Children's team of the Boulder Mental Health Center and has several years in Home Based Option B Program delivery with us here in Weld County. Emily Jaramillo, MA, is a bilingual licensed professional counselor from the Greeley community with a master's degree in counseling. She also self-identifies as Hispanic. She has worked in the Family Recovery Center and in educational support for minority students at UNC as well in private practice, including work for Home Based clients sor several years. Dr Evelin Gomez, Ph.D., licensed professional counselor holds a masters and doctoral degree in counseling and is bilingual in Spanish, which is her first language. She also adds clinical supervisory expertise in drug and alcohol treatment issues to the Ackerman and Associates professional breadth of experience. Valerie Larson, M.S.W. is a licensed clinical social worker with experience in family issues, sexual abuse of children and intervention. She has worked in residential treatment prior to joining Ackerman and Associates and has been a home based provider over the last year. Cassie Yackley, MA, L.P.C. is completing he doctoral studies in psychology and has been a home based provider during the past year. She brings expertise in community oriented psychology to the home based project. Dr. Joyce Ackerman, Licensed Psychologist, is director of Ackerman and Associates and clinical supervisor of the program. Other staff are listed later in this proposal. Nicole Warnygora, MA, Licensed Professional Counselor and Doctoral Candidate in School Psychology,has extensive experience in work with children from extremely disturbed backgrounds and a year of hands-on experience with our home based program. She will return part time in 2002-2003 to this program. We seek to continue to be on the list of approved vendors for the provision of these services. 3 Target/Eligibility Populations A. Total number of clients to be served. Five families per month times twelve months equals sixty families per year. If we assume a family size of six,two adults and four children, then the total client pool to be served is 360 individuals. That number includes at least 60 individuals who face either imminent out of home placement or who need reunification services. B. Distribution of clients. Total number of clients we will serve is approximately 360 as calculated above. Our experience suggests we would expect approximately 120 of these to be adult members of the family and approximately 240 to be minors. The age of distribution of the index case children would tend toward the younger children based on our experience with home-based intensive therapy. We estimate that about one third of the index children would be older than ten with an average age of about 14 and about two thirds would be under ten. The older group would most likely be teenagers in conflict with their family. The younger group will consist of children of no particularly predictable age whose parents are in conflict usually in relation to instability in the marriage. C. Families Served. We would anticipate serving up to 60 family units. D. Sub total who will receive bicultural/bilinaual services. As stated above, Emily Jaramillo is a master's level counselor(who is also Hispanic of Mex;can American heritage)who can provide services in Spanish or English. She will serve one fourth of the projected caseload. Evelin Gomez Ph.D. who is also a licensed professional counselor who is bilingual in Spanish(and of Central American heritage) will be able to cover an additional one fourth of the population referred. This represents a maximum of 30 families. Thus, one half(or more if needed)of the projected total will be able to be conducted bilingually. All of the services provided (for a maximum of 60 families) would be done in a manner that is sensitive to the culture of origin of the family. E. We can provide service in South County and have done so as requested since our inception of these services in 1997. We anticipate that up to one third of the projected caseload (or 20 families)may reside in the South County Area. F. Accessibility. All providers of Ackerman and Associates are accessible through a 24 hour answering service, cell phone and pager system. On weekends, our 24 hour access reaches the provider on call who is always a licensed Mental Health Provider. These providers are Laurence Kerrigan, Ph.D., Susan Plock Bromley, Psy. D., Emily Jaramillo, M.A. L.P.C., Evelin Gomez, Ph.D. L.P.C., Sherri Malloy, Ph.D., Joyce Ackerman, Ed.D., Karen Bender, M.S., L.P.C., Valerie Larson, M.S.W., L.C.S.W., Nicole Wamygora, M.A., L.P.C. and Cassie Yackley, M.S., L.P.C. 4 G. Maximum per month. The program maximum is eight families accepted into the program per month. H. The monthly average capacity is five families per month. I. The average stay in the program is three hours per week over an average of a twenty week period(sixty hours). For some families the sixty hours of treatment may be delivered over a longer or shorter period with more services delivered early in the program and less per week toward the end of treatment. This is a design where services are more intense during a crisis and decrease gradually as clinically appropriate. The average length of stay will be sixty hours. Specific restrictions on the average stay in the program are described in the design section of this proposal. Types of Services Provided We will provide the following services to all families in the program. Specific details that further define these services are in the section of this bid called Service Objectives. Our model is summarized below: We are using the following strategies to help families attain desired outcomes: 1. An immediate initial response to the crisis is made because people who are in crisis are often motivated to change. This has proven to be an excellent opportunity for client/therapist bonding. 2. The therapist focuses on the family's presenting problem. This increases the client's motivation to work on that problem. Clients are perceived in this model as having the best information about themselves and their lives. Everyone has strengths, skills, and unique cultural experiences. Recognition of these experiences and respect for the family usually lead to positive working relationships. From this working relationship a scope of work to be achieved over sixty hours or less of treatment is formulated and signed off by the therapist and the client(s). This becomes the case management plan and will be completed before the completion of the tenth hour of therapy. 3. Services are provided in the client's natural environment as much as possible to increase accurate assessment,therapist credibility with the client, and the probability the client will incorporate the material they learn into daily family activities. Some services and group work will be available in the office setting. 4. The practice is available on a 24-hour basis to address client concerns. Such access increases the ability to monitor for potentially dangerous situations and provide immediate assistance in crisis situations. 5 5. Home Based Services uses skills-based intervention to empower the client to handle life situations without the help of others. This also lessens the need for ongoing long-term intervention. 6. Specific review of use of services will be conducted at 30 and 45 hours of treatment. The client will participate in these reviews as a requirement for continuation of services. A. Therapeutic Services: We will provide the following services and document the delivery of these services using an individualized treatment plan for each family. Progress on this treatment plan will be reported to the caseworker on a monthly basis. The family treatment plan will be developed during the first 30 days of contact and as early as clinically appropriate but no later than hour ten of treatment. The plan will address the concerns identified by the WCDSS caseworker who fills out the family referral form as well as those raised through a clinical assessment of the family by the therapist. The therapist working with the family will choose clinically appropriate intervention strategies. Inherent in these modalities is the need to show progress on the goals stated in the case treatment plan. In most families served by this program a selection of the following modalities will be utilized based on the individualized list of identified family needs: 1. Re-parenting including emotional support to address those issues related to the parents' family of origin, and parenting role models. 2. Family therapy to address structural and issue related difficulties the family is experiencing. 3. Support groups to address couples' communication,alcohol and drug issues and other issues as identified. 4. Problem solving and negotiation skills to enhance the client's interpersonal effectiveness in implementing change. 5. Communication skills to enhance general aspects of interpersonal effectiveness. 6. Parent-child conflict management skills to enhance the parent's ability to set effective limits for the child in a nurturing manner. Note that while the modalities outlined are general and may not apply to all families in all cases,the choice of clinical mode of treatment will be determined by the desire to produce evidence of change over the period of treatment in relation to the specific problem for which the family has come to the attention of Social Services System. There is obviously a balance between general improvement for the family unit and specific 6 improvement in current behaviors and likely patterns of behavior that are detrimental to child safety. This balance needs to be reflected in the case plan and therapy must focus on achieving child safety and family improvement sufficient to protect the child within the treatment time limits in this program. B. Other Services: In addition to the therapeutic interventions described above, client families must be able to apply those concepts and skills to their own specific needs and experiences. They must be able to put these ideals into practice in their own family in order to protect their children. Their ability to do so is what we term concrete skills acquisition. We use the term concrete skills acquisition to describe the incorporation of behavioral management practices into daily life of the family. This is distinct from the functional aspects of concrete services that are described later. Progress in this area and in other aspects of treatment will be documented in the family treatment chart. Behavioral Components of Concrete Services: Specific aspects of the family behavior where concrete skill acquisition can be documented and usually is necessary for family success to either prevent placement or retain a child who has been returned to home include: 1. Development/enhancement and maintenance of parenting skills including nurturing, limit setting and appropriate child management. 2. Stress reduction and anger management skills. 3. Communications, problem solving, and negotiation skills to enhance interpersonal effectiveness. 4. Practice in hands on parenting skills using a coaching model to provide feedback, reinforcement, and clarification as to appropriate child management skills. 5. Money management including budgeting and resource acquisition. 6. Other activities of daily living including recreational activities related to enhancing family development, spiritual support, community involvement and maintenance of physical and emotional well being. Functional Aspects of Concrete Services In addition to helping clients learn and use concrete behavioral skills as described above, many client families need what we term functional concrete skills. These are skills at meeting the physical needs of daily living. By providing a forum for the client to determine how to improve access to the basic needs of daily living,the therapist helps the 7 family to obtain and plan for basic support. When a family's basic needs for food, shelter, and safety are met, they are better able to focus on acquisition of skills and on emotional recovery. We will seek to help families identify resources so that they can meet basic needs from within the income available to them or through supplemental programs. C. Collateral Services: Collateral services involve connecting the family with the services they need in the community. Such services may include: • Drug and Alcohol Services. Referrals to alcohol and drug treatment programs including Island Grove and Family Recovery Center are available. • Health Care Referrals are also routinely available in our practice. Referrals to Sunrise Health Center and The Family Residency program are also available. •Job training referrals are available through the Job Services and through Vocational Rehabilitation. Case management is an important role for the providers of the home-based services in that our providers will help the family access services they need. D. Crisis Intervention: Twenty four hour access is assured for the families to reach the providers. We have secretarial and office staff support 9-5 Monday through Friday at Ackerman and Associates, P.C. We maintain a twenty four hour, 365 day a year access system through our answering service. All providers can be reached through pagers by the answering service. In-home services for crisis intervention are available through this on call system. We have a rotating call system within the providers of Ackerman and Associates. Measurable Outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following: 1. Did the family accept the referral from their caseworker? 2. Did we accept the family to our program? 3. Is the family making progress with the treatment plan for each component as outlined in the service objectives? 4. Has the family followed through with recommendations and referrals during the course of treatment? Summative Outcomes: 8 Over the duration of the sixty hour treatment, we determine the following information: Is the child still in the home? How well are the changes from treatment persisting? This measures if family behavior is different compared to their behavior before treatment. Specific sununative goals are listed below. A. The child receiving services does not go into placement and remains at home at the time the case is closed. This will be measured by recording the status of the child at the time the case is closed. B. Improvement in Parental competency and parent child conflict management will be measured by pre and post clinical assessment. A narrative which we term the monthly summary of pre and post treatment family conditions will be constructed based on a review of the treatment on a month to month basis and when the case is closed. This narrative will document the therapist's judgment of changes in parental competency compared to baseline. Failure to make progress will be discussed with the client at the 30 and 45 hour review sessions. C. Children will remain in the home twelve months after the case is closed. This criterion can be measured at the twelve month follow up contact by the caseworker. D. Children who were reunified will still be in the home twelve months after the case is closed. This criterion can be measured at the twelve month follow up contact by the caseworker. E. Treatment families will not have a substantiated abuse or neglect twelve months after the case is closed. This information can be obtained by checking with the referring caseworker at Social Services at the same time as points C and D above are assessed. F. Families will be rated "low" on the risk assessment device at closure of the case. The providers will rate the family at the time of case closure on: 1. adherence and success with the treatment plan, 2. pre/post changes as documented in the discharge summary, 3. clinical impression of future success. As well, other rating instruments in use by Social Services for monitoring home-based programs will be completed as requested. Service Objectives We have the following service objectives: A. Improvement of family conflict management. The program is specifically designed to resolve conflicts that either precipitated the likely imminent placement of the child or which prevent the reunification of the child with the family. The initial goal of services 9 is to assist the family in finding behavioral solutions to the existing conflict. Each provider is skilled in family systems work by experience and training. Other aspects of conflict management include parent child conflict resolution,problem solving skills development as well as application of negotiation and communication skills. B. Improved parental competency in this treatment model concentrates on the parents developing more age appropriate strategies. In dealing with conflict with their child especially with teenagers, the areas of discipline, protection, instruction and supervision seem most responsive to improvement. With younger children the treatment gives the parents the opportunity in their home to practice and to clarify the roles each parent expects of the other and what is expected of the child. This model of home-based care is able to improve parental performance based on the experience that this staff brings to this proposal. Some examples of these service objectives include delivery of services in the following skill areas (although not all families will need all skills improved or work on all topics):Improvement of parenting skills related to discipline and management of child behavior, Emotional skills set development such as anger management, identification of depression or anxiety related behavior, and techniques for dealing with frustration, Interpersonal skills development and Assertiveness skills. C. Improve household safety. One aspect of the treatment plan is associated with maintaining a safe household environment, and in some families adequately cleaned and maintained and stocked with food and supplies. Service objectives assisting in the acquisition of the following areas as appropriate to the needs of a family might include: D. The program will provide access to needed services as documented in the treatment plan for each family. Specific types of referrals may include the following drug and alcohol treatment, school issues,probation coordination, domestic violence resources, victim's assistance or other referrals. Workload Standards A. The program has a capacity of ten families per month with an average of five families per month. The families will receive an average of three hours per week for twenty weeks with a maximum length of service being five months and a maximum number of hours per family being sixty. All families will be treated within this framework regardless of the family composition. B. We have six licensed mental health providers for this program who will be home based specialists. They are Evelin Gomez, Emily Jaramillo Valerie Larson, Sherri Malloy,Nicole Warnygora and Cassie Yackley • Cassie Yackley, M.S. L.P.C. is a doctoral student in Psychology who has worked with us in Home based treatment over the last two years. She has family and community based experience as well in her doctoral internship and thesis research. 10 • Valerie Larson, MSW LCSW is a licensed social worker who has residential treatment experience especially with sexually abused children and who has worked with us on home based interventions over the past year. • Evelin Gomez Ph.D. L.P.C. recently completed her doctorate in psychology. Her work experience includes clinical supervision of drug and alcohol issue counseling at Island Grove Treatment Center and work with us on home based treatment and conflict resolution in divorce cases. She is fluent in Spanish. • Emily Jaramillo, M.A. L.P.C. received her masters in Agency Counseling from UNC. Prior to joining Ackerman and Associates, P.C., she has a wide range of work in mental health including treatment for alcoholic patients and support of minority college students. She is fluent in Spanish. Her undergraduate major was in Criminal Justice and Sociology. She has worked for two years in home based treatment delivery • Sherri Malloy, Ph.D. is a Licensed Psychologist specializing in children. She was director of the Children's Team at the Boulder Mental Health Center. She worked in home based delivery in Weld County during the past four years. • Nicole Warnygora, M.A., L.P.C. is a doctoral student in School Psychology at the University of Northern Colorado. She has extensive experience with severely disturbed children including day treatment program experience. She has been providing Option B services over the past three years. All of our staff are highly regarded by the caseworkers based on feedback we have received from supervisors. Three other psychologists and an additional licensed professional counselor complete the staff of Ackerman and Associates and serve as back up and support for the Home Based Specialists. The back up group is available on call to assist them as well as to consult on intervention strategies on an anonymous case presentation basis. The psychologists are Joyce Ackerman, Ed.D., Laurence Kerrigan, Ph.D., and Susan Bromley, Psy.D. Karen Bender, M.A., L.P.C. has extensive experience in treating adults for domestic violence and in the treatment of adults who have suffered sexual abuse. C. Of the up to 96 families the caseload is projected at 16 families with each provider. D. The modality of treatment is home-based care using our adaptation of the home builders model. As well, referral and group treatment and support will be offered as described above. E. Hours/weeks. The total number of therapist hours is 60 per family over six months, or a total for the budget calculation of 3600 per year based on our projected average of sixty families. Maximum capacity for 96 families is 5760 hours per year. The hourly fee is requested at $104 as documented in the rate calculation section. 11 F. Staff. There are six individual providers supported by two office professionals in the practice. There are also three psychologists and another licensed professional counselor who provide on call support and back up services. G. Supervisor. This contact would be supervised and clinically managed by Joyce Shohet Ackerman, Ed.D. who would monitor the project for compliance. The maximum caseload for the supervisor is eight families per month. H. Insurance. Ackerman and Associates, P.C. carries one million three million liability coverage for professional liability on the corporation and its associates and each associate also carries the same level of coverage individually. In addition, Ackerman and Associates, P.C. carries a general liability policy related to accident or injury on our premises through Farmer's Insurance. Each provider carries individual automobile insurance. Staff Qualifications A. All staff members who will be Home Based Specialists exceed the minimum qualifications needed for this project in both education and experience as described above. B. Staff available for the project consists of the six Home Based specialists and three licensed psychologists and a Licensed Professional Counselor. C. Current Mandated Training: Emily Jaramillo,Nicole Warnygora, and Sherri Malloy all trained under supervision in this model with an individual who was supervisor in Home Based Programs at that time. All of the above are trained at the master's degree or higher as mental health professionals. Valerie Larson, Evelin Gomez and Cassie Yackley trained with Jaramillo, Malloy or Warnygora prior to taking clients in this program. D. All of the Home Based specialists and all the psychologists have knowledge of risk assessment and are skilled in the application of that knowledge especially in relation to the assessment of risk or harm to self or others. E. Will staff have required state home based training? We have operated for the past five years without additional training beyond that described in paragraph C above. Unit of service rate computation We have calculated the unit of service rate based in the instructions. We used 2001 data for our agency. 12 Using overall figures for the agency we arrive at a figure of$104 per contact hour. Group rates are billed at one half this rate per hour. The profit for Ackerman and Associates for all programs was 1% of gross revenues in 2001. The volume of services for the home based program has been substantial and we anticipate it being maintained based on the success and popularity of the program with both families and caseworkers. As well the modifications put into place in the design section should increase its cost efficiency. The proposed cost is $104 per face to face contact hour. This is consistent with our operating fees for face to face therapy hour as allowed in other protocols we do with WCDSS and provides essentially the same provider fees consistent with the goals we set for all contractual relationships for our providers. Budget Justification A trained accountant who works as an independent subcontractor with Ackerman And Associates tracks contract funds. No special issues are present related to project audit to our knowledge. Ackerman and Associates programs were audited in a random audit (conducted by Anderson and Whitney) after its first year of operation with no deficiencies. Audit of this program conducted on a yearly basis over several years, by Anderson and Whitney, has detected no deficiencies. Ackerman and Associates, P.C. is a type S professional for profit corporation and not a 501.c.3. Specific standards of responsibility for the 2002-2003 year have been addressed in the body of the proposal. 13 ti JOYCE SHOHET ACKERMAN, Ed.D. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 RESUME PERSONAL DATA Date of Birth: August 3, 1950 Health: Excellent Married; two children CERTIFICATION - LICENSURE Licensed Clinical Psychologist,State of Colorado since 1984 Listed in National Register of Health Service Providers in Psychology since 1986 Staff Privileges, North Colorado Medical Center, Greeley, Colorado since 1985 PROFESSIONAL MEMBERSHIP American Psychological Association Colorado Psychological Association (elected board member 1986-1989) HONORS President's Award - Colorado Psychological Association, 1989 EDUCATION 1978 - 1981 Ed.D. in Counseling Psychology, University of Northern Colorado, December 1981 graduate 1972- 1974 M.S. in Education (E.D,/L.D.) Lesley College, Cambridge, Massachusetts, August graduate 1968 - 1971 B.S. in Special Education and Elementary Education with a minor in psychology Boston University, Boston, MA, December 1971 graduate PROFESSIONAL EXPERIENCE 1981 - present Clinical Director in group practice in Greeley,CO. Among responsibilities are: Diagnosis, therapeutic intervention and referral for adults, families,children and groups. Primary areas are: mediation, alternative conflict resolution, stress reduction. Also developing, organizing and presenting workshops and consultative programs to community, schools, organizations and agencies. 1986 - present Consulting psychologist on interdisciplinary team for in-patient rehabilitation program. Progressive Care Rehabilitation Center, Greeley, CO. Medical Director Dr.Judith Vaughan, Neurologist. Adults with traumatic injuries- primary problems are: psychological aspects of physical rehabilitation, grief counseling, and brief group counseling using cognitive-behavioral goal oriented therapy. 1989 - 1992 Consulting psychologist for Head Injury Treatment Team North Colorado Medical Center,Greeley CO Team coordinator - Dr.John McVicker, neurosurgeon. 1986- 1989 Consulting psychologist for Family Recovery Center(in-patient substance abuse/chemical dependency program), North Colorado Medical Center,Greeley CO Coordinator Ruth Wick, R.N. 1986 - 1989 Provider and Coordinator for Mental Health Services in Northern Colorado for Peak Health Care(HMO). Peak mental health services utilized a three-session model for initial services followed by referral. Activities included coordination of Psychological and Psychiatric Services for approximately the last two years of the Contract. Peak supervisor- Elaine Taylor 1983 - 1986 Psychologist subcontractor for a Vietnam Veteran's Counseling Program funded by the Veteran's Administration. Principal Contract Dr. Robert Stewart. 1980- 1987 Part time faculty member with responsibilities for classes, workshops and community programs in parenting skills. Family/Life Education Program, Aims Community College,Greeley CO August 1980- August 1981 -Clinical internship on Children's Team of Community Mental Health Center. Responsibilities included: consultation to schools and community programs; therapy for children and families; and assessment of diverse mental health programs. Assistant program evaluator - developed evaluation tools to determine cross-cultural perceptions of expectations and satisfaction with services. Supervisors - Dr.Joan Gillespie and Dr. Laurence P. Kerrigan. 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 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 Neu ropsychological assessment,1983. 2. Child Neuropsychology, Dr. Hynd. 3. Child Neuropsychological Methods 1988 Cognitive Rehabilitation Training Program, Dr.Sena, Ph.D., Colorado Springs CO 1988 - present Psychologist- Head Injury Treatment Team at North Colorado Medical Center, Greeley CO 1987 Halstead Reitan Neuropsychological Assessment Training. Ralph Reitan, Ph.D., Washington DC Summer 1986 Albert Einstein School of Medicine, Workshop on Adolescent Therapy, Cape Cod MA 1985 to present North Colorado Interdisciplinary Team of Child Custody Member and participant Fall 1985 Interdisciplinary Workshop on Child Custody, Keystone CO Summer 1984 Workshop in Clinical Use of Hypnosis, Boston MA Winter 1983 Workshop on In-patient Programs for Service Related Disorders, Cheyenne Veterans Administration Hospital. Fall 1983 Veteran's Administration Workshop on Post Traumatic Stress Syndrome, Denver Veteran's Center. Fall 1981-Winter 1984 Post-Doctoral Supervised Candidate for Licensure(psychology) under Gale R. Giebler, Ph.D. Licensed Psychologist and Susan Spilman, Ph.D., Licensed Psychologist 1980 - 1981 Intern- Weld County Sexual Abuse Team,Greeley CO Summer 1981 Independent Study of Child Sexual Abuse, University of Northern Colorado Spring 1981 Interdisciplinary Workshop on Assessment of Sexual Assault, Boulder Social Services Summer 1979 Biofeedback Training related to labor and delivery. Summer 1974 Participant in Institute on Obstacles to Learning. Joint Symposium between McLean psychiatric hospital, Harvard University and Lesley Graduate School, Cambridge MA Summer 1973 Kennedy Memorial Hospital, Boston MA. Participant,Summer Aphasia Institute. PUBLICATIONS Ackerman A., Ackerman,J.S., Kelley K. Hale K. Family Planning Attitudes of Traditional and Acculturated Navajo Indians. Key Issues in Population and Food Policy. University Press of America, pp. 178-171 (1979) Ackerman,J.S.,Client Expectations and Satisfaction with Community Mental Health Center Services: A Cross-Cultural Analysis Between Hispanics and Anglos. Published Doctor Dissertation, University of North Colorado. Copyright 1981. Branch B/A Producer# Issue Date Renewal/Replacement No. • 3a A 0002360 04/30/2001 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2032570 1. NAMED INSURED: ACKERMAN AND ASSOCIATES PC ADDRESS 1750 25TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) 2. POLICY PERIOD: From 05/01/2001 To 05/01/2002 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: LIMITS OF LIABILITY PREMIUM Professional Liability $1,000,000 $3,000,000 $1 ,575.00 each Incident Aggregate 4. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: Sole Proprietor (including Independent Contractors) ( ) Partnership (X ) Corporation OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the Declarations; or b) the effective date of the earliest claims-made policy issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/1992 7. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s): PLJ-2008 ( 10/94 ) POE-8004 ( 5/88) PLE-2167 ( 07/00) PLE-2081 P0N-2003 PLE-8036 ( 09/97 ) 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: 1-800-852-9987 INIMMINAMMENE INTERSTATE INSURANCE GROUP MMEMMIMMII PLP-2O12 (06/93) (Elec.) PLP-8003 (7/94) (Ed LASER) 11/08/00 CURRICULUM VITAE N. Karen Bender, MA. LPC, NCC 1104 Twin Peaks Circle Longmont, Colorado 80503 Phone: 303-678-8940 BUSINESS ADDRESS: Ackerman and Associates 1750 25th Ave., Suite 101 Greeley, CO 80634 Phone: 970-353-3373 MARRIED: Brice J. Bender, MD, April 26, 1974 CHILDREN: Sara C. Bender, Born 3/13/79 and Melissa K. Bender, born 9/8/80 EDUCATION: Bachelor of Arts, Chemistry University of Colorado at Denver. 1977 Master of Arts in Agency Counseling, Emphasis in Marriage and Family University of Northern Colorado, 1993 Externship: Mental Health Center of Boulder County, Longmont Branch, Community Support Services Team. Sept. '92 to June '93 Currently enrolled in Professional Psychology Doctoral Program, University of Northern Colorado WORK EXPERIENCE: July '00 to present: Facilitator, Women's group for the WINGS Foundation (Women Incested Needing Group Support). Oct. '99 to present: Private practice with Ackerman and Associates, Greeley. Individual adult clients, couples, and groups. Feb. '94 to June '00: Private practice, Longmont. Individual adult clients and couples. Fall '95: Counselor and presenter in multidisciplinary PMS program. Longmont Clinic. March '95 to May '96: Domestic Violence Counselor, Longmont Coalition for women in Crisis, Individual adult clients and women's groups: domestic violence curriculum, support, and parenting. June '93 to Sept. '93: Therapist, Mental Health Center of Boulder County, Longmont Branch, Women's Issues Group. Sept. '84 to Dec. '86: Cardiopulmonary Technologist, part-time, Longmont United Hospital, 1950 W. Mountain View Ave., Longmont, Colorado 80501. June '79 to April '82: Supervisor, Pulmonary Laboratory, Presbyterian/St. Luke's Medical Center, 601 E. 19th Ave., Denver, CO 80203 Jan. '76 to June '79: Supervisor Pulmonary Laboratory, St. Joseph Hospital, 1835 Franklin St., Denver, CO 80206 1975-1979: Clinical Instructor: Front Range Community College, 3645 W. 112t Ave., Westminster, CO 80030. VOLUNTEER EXPERIENCE: June '00: Facilitator, Women's Group for the WINGS Foundation (Women Incested Needing Group Support). May '99: Teaching Assistant: Child Abuse and Neglect (PPSY 508) Sept. '98 to Sept. '99: Doctoral Student Representative, Division of Professional Psychology, University of Northern Colorado. Sept. '94 to Mar. '95: Volunteer therapist: Longmont Coalition for Women in Crisis. Individuals and groups: domestic violence curriculum and parenting. Jan. '94 to July '95: Volunteer therapist: St. Vrain Valley Child Development Council, Inc., Head Start Program. Individuals, families, parent support groups that include parenting curriculum. June '93 to Aug. '93: Volunteer Co-therapist: Mental Health Center of Boulder County. Drug Treatment Team, Women's Group: History of Sexual and Drug Abuse. Co-therapist: Lisa Franseen. June '93 to July '93: Volunteer Co-therapist: Mental Health Center of Boulder County, Longmont Branch. Children's group: Attention Deficit Disorder. Co-therapists: John Fallon, MSW and John Garson, Ph.D. Nov. '91 to May '92: Volunteer individual counselor: University of Northern Colorado Counseling Center. Feb. '91 to Feb. '92: Master's Student Representative, Division of Professional Psychology, University of Northern Colorado. Sept. '91 to Oct. '91: Volunteer Counselor: A Woman's Place, Greeley, CO. Issues: depression, domestic violence, and anxiety. 1990-1991: Member Board of Directors for Longmont Coalition for Women in Crisis. PROFESSIONAL ORGANIZATIONS: Member, Eye Movement Desensitization Response Study Group. July, '00 to present. Co-chairman, Public Information and Education Committee, Child and Family Advocacy Program (now called Blue Sky Bridge), Niwot, CO, June '95 to August '97. Facilitator, Longmont Study Group, Colorado Society for the Study of Dissociation, May '95 to Aug. '97. Member: American Counseling Association, Colorado Counseling Association, Eating Disorders Professionals of Colorado, Colorado Society for the Study of Dissociation. Associate Member: American Psychological Association. PUBLICATIONS: N. Karen Estridge Bender Slonim, N. B., & Estridge, N. K. (1969). Ozone --- An underestimated environmental hazard. Journal of Environmental Health, 31, 577. Slonim, N. B., & Estridge. N. K. (1970). The acid-base surface --- A 3- dimensional visual model. Rocky Mountain Medical Journal, 67, 59. Slonim, N. B., & Estridge, N. K. (1970). Carbon dioxide --- Environmental health aspects. Journal of Environmental Health, 33, 171. Slonim, N. B., & Estridge, N. K. (1970). The acid-base surface: A three- dimensional visual model for analysis of acid-base information. Journal of Medical Education, 45, 828. Slonim, N. B., & Estridge, N. K. (1971). Carbon dioxide --- Environmental health aspects. In T. J. DeKornfeld (Ed.). Selected papers in inhalation therapy. Flushing, NY: Medical Examination Publishing Co., Inc. Slonim, N. B., & Bender, N. K. (1974). Responses to carbon dioxide containing atmospheres. In N. B. Slonim (Ed.). Environmental physiology. St. Louis: The C. V. Mosby Co. Slonim, N. B., & Bender, N. K. (1976). A tabular history: Cardiopulmonary technology as a profession. CVP, The Journal of Cardiovascular and Pulmonary Technology, 4, 31. Bender, N. K. (1977). Relevant respiratory physiology. The post-surgical patient. Spirometry. In V. Archuleta, O. B. Plummer, and K. D. Hopkins, A demonstration model for the project "Training nurses to improve patient education, Boulder, CO: Western Interstate Commission for Higher Education. Bender, N. K. (1988). Future trends in education, SVVEA Bridge, 3, 5. (St. Vrain Valley Education Association) O'Halloran, M. S., Bender, K., & Rogers, C. (2001). Facing our clients' trauma: Implications for counselors in training. Manuscript in preparation, University of Northern Colorado. O'Halloran, M. S., Bender, K., & Rogers, C. (2001). Secondary traumatic stress in counselors in training. In T. Baldo and B. Softas-Nall (Eds.). Manuscript in preparation. University of Northern Colorado. Bender, K., & D'Amato, R C. (2001). Goldenhar syndrome. In E. Fletcher-Janzen and C. R. Reynolds (Eds.), The diagnostic manual of childhood disorders: Clinical and special education applications. Manuscript in preparation, New York: John Wiley & Sons, Inc. PRESENTATIONS: J. Warrilow & Bender, K. (1995. May). Effects of domestic violence on children. Symptoms of sexual abuse. Seminar for parents. St. Vrain Child Development Council: Head Start, Longmont, CO. Bender, K. & Howell, H. (1995, Fall) Multidisciplinary Premenstrual Syndrome program, Longmont Clinic, Longmont, CO. O'Halloran, M. S., Rogers, C., & Bender, N. K. (1998, Oct.). Facing our clients' trauma: Implications for counselors in training. Round table discussion presented at the annual meeting of the Rocky Mountain Association for Counselor Education and Supervision, Breckenridge, CO. Bender, K., Lewis, J., Fako, R, Tiedemann, T., Forness, S., & Franklin, L. (2000, Jan.). Using sculpting as a form of supervision for group facilitators. Round table discussion presented at the annual meeting of the Association for Specialists in Group Work, Deerfield Beach, FL. Lewis, J., Fako, R, Tiedemann, T., Franklin, L., Forness, S., & Bender, K. (2000, Jan.). Microskills in group work. Round table discussion presented at the annual meeting of the Association for Specialists in Group Work, Deerfield Beach, FL. Bender, K., & Bromley, S. P. (2000, Feb.) Savvy with systems: How to be an assertive foster parent. Workshop for Weld County Department of Social Services Franklin, L., Bender, K, Marine, S., & Johnson, B. (April, 2000). Client resources, strengths, overall level of functioning, and the ability to change. Poster session. University of Northern Colorado Research Conference. Franklin, L., Bender, K., Marine, S., & Johnson, B. (April, 2000). Client resources, strengths, overall level of functioning, and the ability to change. Poster session. Rocky Mountain Psychological Association Convention, Tucson, Arizona Bender, K. (May, 2000). Secondary traumatic stress: Implications for counselors in training. Invited presenter: Child Abuse and Neglect Class, PPSY 508, University of Northern Colorado. Bender, K. (Oct., 2000). Sexual behavior: What's appropriate for your child, and what's not? Workshop for foster parents for Weld County Department of Social Services. POST-GRADUATE TRAINING (in addition to my Doctoral Program) 5/93: Treating Trauma Survivors, Laura Davis, Longmont, CO. 9/93: Treatment of Sexual Abuse. The Institute for Advanced Clinical Training. 4-day seminar, Anaheim, CA. 10/93: Sexuality and Survivors of Sexual Abuse, Wendy Maltz, Boulder. 1/94: Legal Aspects of Counseling, ACA presentation in Denver 4/94: False Memory Debate: Centennial Hospital, Denver 5/94: Eating Disorders Conference: Eating Disorder Professionals of Colorado, Denver 10/94: Treating Patients with PTSD: Donald Meichenbaum, Denver 10/94: Interviewing Child Abuse Victims: Susan Sgroi, Boulder County Child Sexual Abuse Task force, Boulder. 2/95: Therapeutic Approaches to Incest and Post-traumatic Stress Disorder: Christine Courtois, Boulder County Child Sexual Abuse Task Force, Boulder. 3/95: Advances in Treating Survivors of Sexual Abuse. The Institute for Advanced Clinical Training. 4-day seminar in San Francisco, CA. 5/95: Trauma and Development. Colorado Society for the Study of Dissociation, Denver. 9/95: Multidisciplinary Approach in the Treatment and community Monitoring of Adolescent Sex Offenders. Child and Family Advocacy Program, Boulder. 11/95: 3-day conference by Colorado Organization for Victim Assistance, Beaver Creek, CO. 1/96: Can You Lawsuit-proof Your Practice? Colorado Society for the Study of Dissociation, Denver. 2/96: Domestic Violence: Child Protection. Colorado Department of Human Services, Golden, 2-day seminar. 4/96: The Use and Misuse of Memory in Psychotherapy. Colorado Psychiatric Society, Denver. 5/96. Brief Therapy for Managed Care. Family Therapy Institute of Washington, DC, Boulder. 6/96: Therapeutic Conversations: Narrative and Cooperative Approaches to Therapy. 4-day seminar. Institute for Advanced Clinical Training, Denver. 9/96: Treatment of Sexual Abuse, Eliana Gil, Child and Family Advocacy Program, Boulder, 2-day seminar. 10/96: Today's Therapy: Treatment of Persons or of Symptoms? Colorado Society for Psychology and Psychoanalysis, Denver. 11/96: Issues in the Treatment of Trauma and Dissociation: Working with Children, Adolescents, Couples and Families. Colorado Society for the Study of Dissociation. Denver. 1/97: Advances in Treating Sexual Trauma: John Briere. Child and Family Advocacy Program, Boulder, CO. 2-day seminar. 4/97: The Science of Memory and its Clinical Applications in the Treatment of Trauma. Colorado Society for the Study of Dissociation, Denver. 1/98: Divorce-busting: solution-oriented Brief Therapy with Couples. Michele Weiner-Davis. Colorado Association for Marriage and Family Therapy, Denver. 1/98: Colorado Association of Marriage and Family Therapy: 2-day seminar. Variety of topics. 2/98: Treatment of Adolescent Sex Offenders, Child and Family Advocacy Program, Boulder. 2/98: Western Division, American Psychological Association Conf., Albuquerque, NM. 3-day conf. Variety of topics. 5/99: Transference or Secondary Traumatic Stress, Caring for the Care Giver, Christine Courtois, Colorado Society for the Study of Dissociation. 3/00: Level I Training: EMDR, Denver. 3-day seminar. Issue Date: 01/25/02 The Reci rocal PROFESSIONAL LIABILITY OCCURRENCE �� p INSURANCE POLICY FOR Alliance Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ACA Insurance Trust,Inc. scA us� 5999 Stevenson Avenue LVT Policy Number: cLloo734oz Administered by: Alexandria,VA 22304-3300 Toll Freeo1400-347-6647 x264 Or" ITEM DECLARATIONS RENEWAL CERTIFICATE NO. CL100734 INDIVIDUAL POLICY 1. NAMED INSURED: Norma Karen Bender 2.- ADDRESS: 1104 Twin Peaks Circle Longmont, CO 80503-2170 3. POLICY PERIOD: From: 02/04/02 To: 02/04/03 12:01 A.M.Standard Time at 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 S 296 . 00 B. GENERAL LIABILITY $ 0 . 00 TOTAL PREMIUM: S 296 . 00 5. LIMITS OF LIABILITY: $1, 000, 000 each Incident or each Occurrence $3 , 000, 000 in the Aggregate 6. THE NAMED INSURED IS: Sole Proprietor(incl.Individual) X Other Partnership(refer to Item 7 helow) Corporation 7. BUSINESS OF THE NAMED INSURED: Part-Time Self-Employed (Rating Category) Counselor/Human Development Professional 8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and agreements contained in the following form(s)or endorsement(s): CPL-00040199 CPL-0005.0199 CPL-0006.0199 NOTICE THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. CPI:005R 1201.00 FACULTY VITA February 1998 NAME: BROMLEY, Susan Plock SOCIAL SECURITY NUMBER: 483-50-9243 POSITION: Associate Professor of Psychology Department of Psychology College of Arts and Sciences University of Northern Colorado Greeley, CO 80639 HOME ADDRESS: 1621 13th Avenue Greeley, CO 80631 TELEPHONE: Office: (303) 351-2236 Home: (303)352-8750 EMAIL:sbromley@bentley.unco.edu EDUCATION: Year(s) Degree Institution Area of Study 1983 PsyD 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 1985-Pres University of Northern Colorado Assoc. Professor Psychology Teaching/Advising 1983-84 University of Northern Colorado Asst. Professor Psychology Contract Teaching WORK EXPERIENCE --Professional Non Academic: Years) 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 1 AREA OF SPECIALIZATION: Behavioral Medicine/Pain Management/Clinical Hypnosis RESEARCH AREAS/INTERESTS: Hypnosis/Pain Assessment and Management/Women's Issues/Teaching Methods PROFESSIONAL ACTIVITIES: Colorado Licensure: Psychology License#1086 PUBLICATIONS--Professional/Juried: 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. Journal of Alzheimer's Disease and Related Disorders and Research 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--furled: 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 caregiver of demented and lucid chronically ill". Poster presented at the Rocky Mountain Psychology Association Convention,Boise,Idaho. (April) 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 faciliate research understanding". Paper presentation as part of panel titled, 'Teaching techniques in the social sciences", Western Social Science Association Convention, Denver, Colorado. (April) 2 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 nondementia 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: Handelsman,M.M., Bromley, S.P. &Davis, S.F. (1995). "Clinical Psychologist, Counseling Psychologist, Clinical Social Workder,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) 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. Western Psychological Association/Rocky Mountain Psychological Association 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, "Psyc ological and Social Perspectives on Male Violence Against Women", Western Psychological Association/Rocky Iemtain Psychological Association Convention, Phoenix, Arizona (April). 3 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". Presentor-20th Annual Emotional Crisis Workshop, University of Northern Colorado, Greeley, Colorado(July). LECTURES--Invited' 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 Acadmic 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 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/GR ANT 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 CONS!JLTATION/PRACTICF: Year(s) Institution/Organization $Qk 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 4 PROFESSIONAL ASSOCIATION PARTICIPATION: Membership 1986-present Rocky Mountain Psychological Association 1988-present American Psychological Association(Divisions 2, 30, 35) 1989-present 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-present 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: 1989-present Rocky Mountain Psychology Association 1992-present Board Member 1995-present 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: 1997-1998 UNC Loaned Executive-United Way of Weld County 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-Present 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: 1985-88, 1995-presnt Co-Advisor Psi Chi National Honor Society 1989-91,93, 95-present 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 Undergradu Committee(Chair 1992) 1987-88 Co-Coordinator Semester Conversion Committ 5 COLLEGE: 1992,93,96,97 Member of faculty invited to teach in the Cluster Program 1990-93 Graduation Marshall, Arts& Sciences 1988-89 Member, Arts and Sciences Teacher Education Committee 1986-89 Chair, Interdisciplinary Committee to develop and revise Human Development Major in the College of Arts and Sciences and Psychology Department UNIVERSITY: 1992-94 1996-Present Member-Research and Publications Board 1993-94 Chair-Elect 1988-present Founding Co-Advisor, Golden Key Honor Society 1992-95 Member-UNC Women's Commission 1992-94 Co-Chair-Assessment Task Force 1989-90 Faculty Representative, Student Fee Allocation Committee 1986-89 Member, Faculty Senate 1988-89 Secretary 1987-88 Vice-Chair 1986-87 At-Large Member,Executive Committee 1986-89 Member, Academic Policies Committee 1986-87 Member, Elections Committee 1988 Representative, Western States Faculty I stadership Conference, Reno, 1988 Senate Representative, Statewide Commission Advisory Committee 1988 Advisor, In-Touch Helpline 1985-86 Volunteer Therapist,UNC Counseling Center GRADUATE STUDENT COMMITTEES—Doctoral: 1997 Committee Member, Christine Rogers,Professional Psychology 1995 Committee Member,Lisa Ing, Special Education 1994-pres 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-pres Committee Member, Pat Flanagan, CSPA, Oral Comprehensives 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 COMMIT PEES--Masters: 1997 Stephanie Blasi, Committee Member 1997 John Nickisson, Chair 1994 David Watson, Committee Member 1994 Tiernan Mcllwaine, Committee Member 1994 Jerrod McCoy, Committee Member 1993 Sheldine Runyan, Committee Member 1993 Sue Cole, Committee Chair, "Influences on Occupatiphal 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" 6 1989 Michelle Hozer, Committee Member 1989 Anne Schnittgrund, Committee Chair, "Age and Electrothennal 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 Inductional Deepening and Suggestion Style" 1988 Lisa Dillon, Committee Chair, "Cognitive-Behavioral Approach to the Treatment of Elderly Rheumatoid Arthritis Subjects" 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: 1997 Thesis Co-Advisor Kelly Kinser 1997 Honors Connection Course development-Alternative Healing Methods 1996-pres 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 Researh 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 AffectAmong Strangers Under Mildly Stressful Conditions" 1992 UNC Research Day, Faculty Panel Coordinator 1992 UNC Research Day, Faculty Panel Coordinator(2 student pnels)"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 Honors Connection Course Development Courses Taught: (1-4 Scale with 1 as Highest)(*1-5 Scale with 5 as highest) DATE COURSE TITLE HRS ENR AVG.RATING W 198 8 PSY 101 IntroSeminat psychology 1 43 W 1987 PSY 101 IntroSeminar Psychology 1 16 1.12 W 1986 PSY 101 IntroSeminar Psychology 1 32 1.24 F 1997 PSY 120 Principles of Psychology 4 107 3.76 • • F 1996 PSY 120 Principles of Psychology 4 139 F 1993 PSY 120 Principles of Psychology 4 119 1.64 F 1991 PSY 120 Principles of Psychology 4 161 1.67 F 1983 PSY 120 General Psychology 3 42 ---- Sp 1984 PSY 121 Intro to Psychology I 4 40 ---- Sum 1988 PSY 230 Human Growth &Development 5 55 ---- Sp 1988 PSY 230 Human Growth &Development 5 60 1.58 W 1988 PSY 230 Human Growth &Development 5 90 1.38 F 1987 PSY 230 Human Growth &Development 5 45 1.54 W 1987 PSY 230 Human Growth &Development 5 75 1.54 Sp 1987 PSY 230 Human Growth &Development 5 90 -- Sum 1986 PSY 230 Human Growth &Development 5 47 -- F 1986 PSY 230 Human Growth &Development 5 80 1.36 W 1986 PSY 230 Human Growth &Development 5 80 1.42 W 1986 PSY 230 Human Growth &Development 5 52 1.27 F 1985 PSY 230 Human Growth &Development 5 56 1.53 F 1985 PSY 230 Human Growth &Development 5 85 1.56 Sp 1984, PSY 265 Social Psychology 3 26 W 1984 PSY 265 Social Psychology 3 23 ---- Sp 1997 PSY 323 Health Psychology 3 44 4.37 F 1995 PSY 323 Health Psychology 3 47 Sp 1994 PSY 323 Health Psychology 3 41 1.69 F 1992 PSY 323 Health Psychology 3 49 Sp 1992 PSY 423 Health Psychology 3 42 1.69 F 1990 PSY 423 Health Psychology 3 1.66 F 1988 PSY 423 Health Psychology 3 35 1,36 Sp 1986 PSY 330 Child&Adolescent Psych 3 27 1.4 Sp 1993 PSY 331 Maturity&Aging 3 40 Sp 1991 PSY 331 Maturity &Aging 3 46 1.62 F 1989 PSY 331 Maturity &Aging 3 23 1.45 F 1988 PSY 331 Maturity &Aging 3 27 1.40 Sp 1988 PSY 430 Maturity&Aging 3 44 1.58 Sp 1987 PSY 430 Maturity&Aging 3 34 -- Sp 1986 PSY 430 Maturity&Aging 3 36 1.52 Sp 1997 PSY 455 Abnormal Psychology 3 49 4.03 F 1995 PSY 455 Abnormal Psychology 3 32 Sp 1993 PSY 355 Abnormal Psychology 3 37 Sp 1992 PSY 355 Abnormal Psychology 3 42 1.26 Sp 1991 PSY 355 Abnormal Psychology 3 37 1.37 F 1990 PSY 355 Abnormal Psychology 3 1.46 Su 1990 PSY 355 Abnormal Psychology 3 31 Sp 1990 PSY 355 Abnormal Psychology 3 37 1.38 Sp 1990 PSY 355 Abnormal Psychology 3 42 1.53 Sp 1989 PSY 355 Abnormal Psychology 3 78 1.51 Sp 1986 PSY 358 Abnormal Psychology 3 41 1.54 W 1984 PSY 358 Abnormal Psychology 3 31 Su 1990 PSY 357 Theories of Personality 3 21 1.45 W 1988 PSY 357 Theories of Personality 3 40 1.57 F 1987 PSY 357 Theories of Personality 3 55 1.38 W 1987 PSY 357 Theories of Personality 3 37 1.33 F 1986 PSY 357 Theories of Personality 3 54 -- F 1983 PSY 357 Theories of Personality 3 51 F 1997 PSY 407 Intro to Counseling Theories 3 15 4.71 F 1996 PSY 407 Intro to Counseling Theories 3 19 i 'ii 8 F 1995 PSY 407 Intro to Counseling Theories 3 19 Sp 1994 PSY 407 Intro to Counseling Theories 3 F 1993 PSY 407 Intro to Counseling Theories 3 24 1.32 Sp 1993 PSY 407 Intro to Counseling Theories 3 22 F 1992 PSY 407 Intro to Counseling Theories 3 25 1.18 Sp 1992 PSY 407 Intro to Counseling Theories 3 22 1.21 F 1991 PSY 407 Intro to Counseling Theories 3 44 1.26 Sp 1991 PSY 407 Intro to Counseling Theories 3 33 1.21 F 1990 PSY 407 Intro to Counseling Theories 3 Sp 1990 PSY 407 Intro to Counseling Theories 3 16 1.12 F 1989 PSY 407 Intro to Counseling Theories 3 24 1.20 Sp 1989 PSY 407 Intro to Counseling Theories 3 18 1.31 F 1987 PSY 407 Intro to Counseling Theories 3 26 1.21 F 1986 PSY 407 Intro to Counseling Theories 3 41 1.57 Sum 1987 PSY 499 Psychology of Sex Roles 3 16 1.18 Sum 1989 PSY 508 Emotional Crisis Workshop 1-2 39 *** "Frontiers of Mental Health And Education" Sum 1988 PSY 508 Emotional Crisis Workshop 2-3 63 "Mind/Body Interactions" Sum 1987 PSY 508 Emotional Crisis Workshop 2-3 106 "Relationships" Sum 1991 PSY 595 Health Psychology 3 15 F 1992 PSY 620 Assessment&Interviewing 2 12 1.66 F 1990 PSY 620 Assessment&Interviewing 2 1.02 F 1988 PSY 620 Issues in Behavioral Medicine 3 5 2.08 F 1997 PSY 621 Practicum College Teaching 2 10 4.77 F 1996 PSY 621 Practicum College Teaching 2 10 F 1993 PSY 621 Practicum College Teaching 2 13 1.45 F 1992 PSY 621 Practicum College Teaching 2 13 W 1984 PPSY 670 Tests and Measurements 3 20 -- Sp 1997 HON 200 Honors Connections Seminar: Alternative Healing Methods 2 20 3,67 of 4 Sp 1989 HON 200 Honors Connection Seminar II: 2 9 *** "Love" Sum 1986 Elderhostel "Dream On" NC (25) Sum 1987 Elderhostel "Mind/Body Interactions" NC 19 *** Courses Developed' 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- MindBody 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 9 1994 - Marla Gallagher, Sociometric Processes 1994 - Marla Gallagher, Cluster Development in Intro Psychology Classes 1992 - Bruce Holoman,Hypnosis Research and Practice 1988 - Paul Jantz,Hypnosis for Pain With Children 1988 - Lori Kochevar, Women as Leaders 1988 - Jerri Israel, Alan Shaw, Issues in Health Psychology 1988- Steve Foster, Michele Hozer,Teaching Apprenticeship 1987- Tony Ambrosio, Hypnosis Models 1986- Candy Disch, Psychological Testing Undergraduate: 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 1991 - Alice McPherson, African American Women and Higher Education 1991 - Jody Horner, 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 practica 1998- Ackerman and Associates-Amy Munnel,Kristin Pietrzyk,Jennifer Kimberling 1997- Greeley Medical Clinic-Lori Darst,Barbara Glode, Ann Marie McCullen, Jeff Titus 1993 - Greg Schooley, Breavement Research 1993 - Di Smice, Women's Commission 1992 - Mary Jo Hamilton, Hypnosis Research 1992 - Carol Sexton, Psychology Testing 1992 - Lisa Schlott, Learning Styles 10 PROFESSIONAL DEVELOPMENT ACTIVITIES: Workshops. Clinics Symposia. Conferences (Excluding Conferences as a Presentor) 1998- Integrative Treatment: Marriage and Divorce 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 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: 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: 1993 - Commencement Banner Carrier, Arts and Sciences 1993, 91,89, 88-Mortar Board Favorite Professor 1992 - Sudent 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 Branch B/A Producer# Issue Date Renewal/Replacement No. • .32 A 0002360 03/08/2001 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2050203 1. NAMED INSURED: SUSAN PLOCK BROMLEY PSYD ADDRESS 1621 13TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) • -. POLICY PERIOD: From 04/01/2001 To 04/01/2002 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: LIMITS OF LIABILITY PREMIUM Professional Liability $1 ,000,000 $3,000,000 $802 . 00 each Incident Aggregate • 4. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: ( x ) Sole Proprietor (including Independent Contractors) ( ) Partnership ( ) Corporation ( ) OTHER: b. 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 of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s) PH- 2008 ( 10/94 ) POE-8004 ( 5/88 ) PLE-2167 ( 07/00 ) PLE-2081 P0N- 2003 PLE-8035 ( 09/97 ) 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: 1-800-852-9987 IN1ERSIATE j U RANCE CRUUP PLP-2O (06/93) (Elec.) EVELIN D. GOMEZ 1006 14th Avenue#C Greeley, CO 80631 (970) 356-8030 Evelinmartin11aol.com POSITION $5N2 Sb -be-8p(4 5 oQ 8- 15-7 ) Licensed Professional Counselor EDUCATION Doctor of Philosophy: Counselor Education and Supervision University of Northern Colorado, Greeley, CO Expected Graduation: August 2001 Master of Arts: Secondary Counseling Adams State College, Alamosa, CO Graduated: May 1996 Bachelor of Arts: Spanish Emphasis: Bilingual Education University of California Irvine, Irvine, CA Graduated: June 1994 Certification • Licensed Professional Counselor in Colorado • National Certified Counselor • Domestic Violence Certified Counselor • Colorado Alcoholldrug Addiction Counselor III (In Progress) • National Certified Addictions Counselor(In Progress) PROFESSIONAL EXPERIENCE Clinical Coordinator Island Grove Community Counseling Center, Greeley, CO (7/00-Present) • Involved in management and budget decisions in conjunction with other administrators. • Maintained consistent development of services provided to ethnically diverse population. • Provided clinical supervision to program managers and staff to ensure professional competence in providing counseling services. • Reviewed with Structure Therapy's program manager the cost of service and income ratios to determine feasibility of services. • Performed evaluations of staff for skill development. • Continued with responsibilities held as Lead Bilingual Counselor. Lead Bilingual Counselor Island Grove Community Counseling Center, Greeley, CO (11/99-7/00) • Provided direct services such as evaluations, therapy, and case management. • Responsible for the Spanish therapy program. • Monitored and supervised bilingual/bicultural staff. • Provided training and clinical supervision to staff regarding group process in the field of substance abuse and domestic violence. ♦ Attended program manager's meeting to keep current with policies and/or program changes. • Assisted with recruiting, screening and interviewing staff. • Ensured that bilingual staff develop appropriate credentials and stay current with their training plans. • Worked in cooperation with Probation, Social Services and other community agencies. Bilingual Counselor Island Grove Community Counseling Center, Greeley, CO (9/96-10/99) • Provided direct services, evaluation, therapy, and case management for domestic violence and substance abuse adult clients. ♦ Trained bilingual staff in the counseling process. • Worked in cooperation with Probation and other community agencies. • Translated general intake and evaluation information into Spanish. Clinical Supervision University of Northern Colorado, Greeley, CO • Supervised master's students in Individual Counseling Practicum. (Spring, 1998; Summer, 1998; and Summer, 1999) • Supervised doctoral students in Group Facilitation Practicum. (Fall, 1998) • Supervised master's and doctoral students in Family Practicum. (Fall, 1998) Teaching University of Northern Colorado, Greeley, CO • Co-taught Theories of Counseling, master's level. (Summer, 1997) ♦ Co-taught Psychology of Prejudice, master's level. (Summer, 1998) • Taught Theories of Personality. (Spring, 1999) Career Counselor Career Services, Adams State College, Alamosa, CO (8/95-5/96) • Counseled students with social and emotional concerns and provided group educational and vocational guidance services. ♦ Collected, organized, and analyzed information about individuals through tests to appraise their interests, abilities, and personality characteristics, for vocational and educational planning. • Compiled and studied occupational, educational, and economic information to aid students in making vocational and educational objectives. • Planned and conducted workshops for `undeclared' students. • Trained staff on administering interest exams and conducting workshops. Issue Date: 01/11/02 < N P The Reciprocal PROFESSIONAL LIABILITY OCCURRENCE Alliance INSURANCE POLICY FOR Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ACA Insurance Trust,Inc. 5999 Stevenson Avenue ACA INsykya Policy Number: CL13187602 Administered by: Alexandria,VA 223043300 TRUST Toll Free:1.8003476647 x284 +f' ITEM DECLARATIONS INDIVIDUAL POLICY 1. NAMED INSURED: Evelin D . Gomez 2. ADDRESS: 16593 East Alabama Place Aurora, CO 80017 3. POLICY PERIOD: From: 01/16/02 To: 01/16/03 12:01 A.M. Standard Time at 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 S 136 . 00 B. GENERAL LIABILITY S 0 . 00 TOTAL PREMIUM: S 136 . 00 5. LIMITS OF LIABILITY: $100 , 000 each Incident or each Occurrence $100 , 000 in the Aggregate 6. THE NAMED INSURED IS: Sole Proprietor(incl. Individual) Partnership to Item 7 below) Corporation X Other 7. BUSINESS OF THE NAMED INSURED: Employed (Rating Category) Counselor/Human Development Professional 8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and agreements contained in the following form(s)or endorsement(s): CPL•0004.0199 CPL-0005.0199 CPL•0006.0199 NOTICE THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. CPL-0005.019900 • EMILY L. JABAMILLO 'M A. 183 50th Avenue Place' Greeley,Colorado 80,634 Home Phone (970) 353,1388 EDUCATION 1996,Master of Arts,Agency Counseling • University of Northern Colorado, Greeley, Colorado 1993, Graduate Fellowship'$tudy, Criminology Rutgers State University, Newark, New Jersey 1988, Bachelor of Arts, Sociology/Criinjnal Justice with emphasis in Psychology University of Northern Colorado, Greeley, Colorado. PROFESSIONAL EXXPERIENCE 1998-Present Psychotherapist, Ackerman &Associates, Greeley CO ' Provide intensive home based family therapy to families.referred by the Depot fluent of Social Services. Provide mediation services to families, Co-facilitate family group decision making conferences for permanent,placenwntof;children. Provide short- term, solution-focused therapy. Provide therapy to individuals,-referred from Employee Assistance Programs. Facilitate foster parent training workshops. Provide foster parent consultation. Practice is supervised byShe_rri Malloy, Ph.D., Licensed Clinical Psychologist. 1996-1999 Director, McNair Scholars Program, University of Northerti Colorado;Greeley, CO Provided counseling, guidance, and,academic advising to students who were low- income, first-generation college students, and of a minority group. Identified critical personal, familial, cultural, academic, and,financial issues to aid in the development of individual success plans. Planned, developed,;and implemented scholarly activities nationally. Developed and directed academ*C,year research,seminars. Coordinated research activities for scholars preparing for doctoral tudy. Directed all efforts to ensure efficient administration of a federal grant. Monitored project budget; supervised and trained staff members. 1995-1996 Assistant Director,McNair Scholars Program,`University of Northern Colorado Provided counseling, guidance, and.acadernic'advising,to students who were low- income, first-generation, and of a minority group ,Identified'critical personal, familial, cultural, academic, and financial issues to aid;iii the,deyelopment of individual success plans. Coordinated the recruitment and selection of program scholars. 1996 Psychotherapist(Intern),North Colorado PsychCare/Fantily Recovery Center, Greeley, CO Facilitated psychotherapy counseling groups and individual counseling for patients and families, with focus on chemically dependent and eating disorders. Performed case management from admission to discharge. Presented psychoeducational information to patients, family members;and staff. Worked collaboratively with a counseling team. 1994-1995 Assistant Coordinator, Student Support Services, University of Northern Colorado, Greeley, CO Provided counseling and academic advisement to at-risk first-generation, low-income, minority students. Identified critical personal, familial, cultural, academic, and financial issues to aid in the development of individual success plans. 1994-1995 Psychotherapist, Weld Mental Health Acute Treatment Unit, Greeley, CO Provided individual and group counseling to chronically mentally ill in-patient clients. Assisted clients in learning self-care,and daily hygiene. Coordinated and implemented client life-skills and social-skills activities. CONTINUING EDUCATION/SEMINARS Jurisprudence Workshop for Psychotherapists Family.Preservation Basic and Advanced Training Supervised Practicum in Family Preservation Reaching Children through Play Therapy Play Therapy and Therapeutic Care Fire Starter Training Diverse Learners Academy Counseling At-Risk Students Cultural Diversity Conference Parent/Child Hispanic Youth Leadership Conference PRESENTER/FACILITATOR The Terrific Twos Prenatal Insults and Long Term Effects Social, Emotional&Sexual Development:Infancy through Adulthood Cognitive & Physical Development: Infancy through Adulthood Parenting with Love & Logic Eating Disorders Cultural Sensitivity and Awareness Communicating Across Cultures Conflict Resolution/Communication Skills Setting Limits& Boundaries HONORS/AWARDS Hispanic Leader of the Year, Cesar Chavez Center, University of Northern Colorado, 1999 Keynote Speaker, Latina Youth Leadership Conference, University,of Northern Colorado, 1998 Distinguished Alumni, Department of Sociology, University of Northern Colorado Fellowship, Graduate Study, Rutgers State,University of New Jersey Scholarship, National Hispanic Scholarship Fund Scholarship, Candelaria Scholarship .............................. .... .............. MEMORANDUM OF INSURANCE ! Date Issued 10/30/2001 Memorandum Holder This memorandum is issued as a matter of information only and confers no ACKERMAN & ASSOCIATES ATTN DONNA rights upon the holder . This SUITE 101 memorandum does not amend, extend 1750 25 AVENUE or alter the coverages afforded by the GREELEY CO 80634 Certificate listed below. Company Affording Coverage Producer Chicago Insurance Company Seabury & Smith Owner 1776 West Lakes Parkway Covered Person (Status) West Des Moines, Iowa 50398 EMILY L JARAMILLO-BANSBERG MA Employee This is to certify that the Certificate listed below has been issued to the insured named herein for the policy period indicated, notwithstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Certificate Type of Insurance Number Effective Date Expiration Date Limits each incident 1 ,000,000 Professional Liability or occurrence Occurrence 80M-4003488 11/01/2001 11/01/2002 3,000,000 in the aggregate each incident General Liability or occurrence Occurrence in the aggregate Should the above described Certificate be canceled Insured before the expiration date thereof, the issuing company will endeavor to mail written notice to the L JARAHILL0-BANSBERG MA named Memorandum Holder, but failure to mail such EMILY 50 AVENUE PLACE notice shall impose no obligation or liabilty of any 183 83E50Y CO 80634 kind upon the company, its agents or representatives. Authorized Representative: rev u„ e d ; • PERSONAL- DATA SHEET Identifying Information : Name : Laurence "Larry" P . Kerrigan , Ph. D . Address : 1706 19th Avenue Greeley , CO 80631 DOB: 9/20/32 Phone : ( 303 ) 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 . ) 976,08 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 : 1959-6.0 Counselor at Dismas Halfway House for ex-convicts , St . Louis , Missouri , 1960-63 Teacher-counselor-coach , Marquette Prep High School , Milwaukee , WI . 1964-67 Counselor-therapist at Street Haven and Sancta Maria Halfway Houses for women and at the Don ( metro ) Jail in Toronto , Canada. 1967-68 Teacher and Campus Counselor at Creighton University , Omaha, NB . 1968-71 Teacher at Campion College , Prairie du Chien , WI . , Director of Psychology Department , Department chairman . 1970-71 Director. and Staff member of a total environment for Inter-city boys , late grade school age from Milwaukee , WI . 1971-73 Director of Student Counseling , Lone Mountain College , San Francisco , CA . Teacher at the Lone Mountain College , San Francisco , California. 1973-74 Psychologist Trainee at San Francisco Mental Health Center, Richmond District , Outpatient Care . 1974-75 Private Practice , So . Bay Human Services Center, San Diego , CA . Part-time instructor at/California School of Professional Psychology , San Diego , CA . 1975-80 Director , Short-Term Therapy Team , Children and Family Unit , Weld Mental Health Center, Greeley , CD . • 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 , Bd . D . , Licensed Psychologist , Greeley , CO . Part; time practice at Weld Mental Health Center , Greeley , CU . Publication : Kerrigan , Laurence P . - The Relationship Between Therapist and Client ' s Perceptions of One Therapy Session . Published Doctoral Dissertation , University of California School of Professional Psychology . Copyright , 1974 . Wor_ksho2 _uliil_peci.al _jyaiining: • 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 , Ericlrsonian 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 S EXECUTIVE RISK SPECIALTY CO. 12/06/•01 - A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY *** RENEWAL *** NOTICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). DECLARATIONS POLICYNO: 008-1766682 ACCOUNT NO: CO-KERL175-0 00997458 ITEM I. (a)NAME AND ADDRESS OF INSURED: ITEM I. (b)ADDITIONAL NAMED INSUREDS: LAURENCE P . KERRIGAN, PH.D. 1750 25TH AVE . SUITE #101 GREELEY, CO 80631 TYPE OF ORG: INDIVIDUAL ITEM 2. ADDITIONAL INSUREDS: ITEM3. POLICY PERIOD: FROM: 12/01/01 TO: 12/01/02 12:01 A.M.STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: ITEM 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 ITEM 5. PREMIUM SCHEDULE: CLASSIFICATION NUMBER RATE ANNUAL PREMIUM 1ST PSYCHOLOGIST 1 1191 . 00 1, 191 . 00 DEFENSE LIMIT . 00 SURPLUS LINES TAX 1 35 . 73 INSPECTION FEE 1 2 . 38 ITEM 6. RETROACTIVE DATE: 12/01/91 TOTAL PREMIUM: 1 , 229 . 11 ITEM 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM(if exercised):S 2 , 150 . 68 NO DISCOUNT INCLUDED ITEM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY B22138 (7/95 ED. ) B22137 THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. AUT RIZED COMPANY REPRE NTATIVE APA22(10/95) Americ Professional Agency•95 Broadway,Amityville,NY 11701 Curriculum Vitae for Valerie Larson, MSW, LCSW 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 (970) 353-3373 Fax: (970) 353-3374 PROFESSIONAL LICENSE Licensed Clinical Social Worker, Colorado, License#992608 Registered as an Associate Level Treatment Provider for Adult Sex Offenders under the Colorado Sex Offender Management Board EDUCATION June, 1999 - Completed Post-Graduate Family Therapy Coursework,Family Therapy Training Center of Colorado, Denver, Colorado. June, 1998 - Masters in Social Work, University of Denver,Denver, Colorado. December, 1995 - Bachelors in Social Work, Northeastern State University, Tahlequah, Oklahoma. PROFESSIONAL EXPERIENCE September, 2001 —present Ackerman and Associates, Greeley, Colorado Therapist Team member of multi-specialty group practice. Provide individual and family therapy for children, adolescents and adults. Conduct family preservation services for families where children are at-risk to be placed out of home or in foster care setting. June, 1999—March, 2001 Shiloh Home, Littleton, Colorado Therapist Conducted individual, group, and family therapy for day treatment and residential youth ranging from age eight to eighteen. Addressed various treatment issues including sexual perpetration, delinquency, sexual victimization, abuse/neglect, substance abuse, anger management, grief/loss, attachment, and depression. June, 1997 - June, 1999 Progressive Therapy Systems, Denver, Colorado M.S.W. Student Intern (1997 — 1998) Therapist (1998 — 1999) Provided group, individual and family therapy. This included offense-specific treatment for adults and adolescents who had committed sexual offenses, conducting anger management groups for adults on probation/parole, and working with children in foster care. Conducted educational groups for parents and spouses of clients with sexual offending issues. Participated in conducting offense-specific evaluations for sexual offenders and in developing curriculum for treatment program for adolescent with sexual offending behaviors. January, 1996 —May, 1997 Associated Centers for Therapy, Tulsa, Oklahoma. Adult Case Manager Worked as a case manager for severely mentally ill adults. May, 1993 —January, 1996 Domestic Violence Intervention Services, Tulsa, Oklahoma Women's Advocate Provided crisis intervention and support for women in domestic violence shelter. Answered the crisis line, assisted with intakes, and participated in children's program. October, 1992 —March, 1993 Parent/Child Center of Tulsa, Tulsa, Oklahoma Volunteer Volunteered in the day care for families who attended the weekly medical clinic. Membership Affiliations 1998 — current American Association for Marriage and Family Therapists 1999—2000 Steering Committee for Colorado Continuum Network (Colorado Chapter of the National Adolescent Perpetrator Network) 1999—2000 Site Committee-Chair for the-National Conference for the NAPN 1 ' Conferences Specific to Working with Sexual Offending Behaviors February 12-15, 2000 National Conference for the National Adolescent Perpetrator Network (NAPN). October 14— 17, 1998 Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers (ATSA). September 11, 1998 Resistance and Denial in the Sex Offender, presented by Geral Blanchard, M.A. June 26, 1998 Standards and Guidelines for the Assessment,Evaluation, Treatment, and Monitoring of Adult Sex Offenders Presented by ATSA. April 17, 1998 Training for Colorado Chapter of ATSA. Regularly attended quarterly training of the Colorado Continuum Network(Colorado Chapter of NAPN). Other Mental Health Related Conferences November 16-17, 2000 Promoting Emotional Development and Healthy Relationships in Young Children by Deborah Crockett, PhD, Janet Dean,LCSW,and Mary Sue Moore,PhD. April 28, 2000 The Rosenberry Conference: Intimidating and Nightmarish Adolescents: A Multi-Systemic Family Therapy Approach by Mathew Selekman, MSW. November 2-5,2000 Annual Conference for the American Association for Marriage and Family Therapists. March 14-16, 1999 Colorado Child and Mental Health Conference. January 30-31, 1998 Annual Conference for the Colorado Association for Marriage and Family Therapy. November 14, 1998 Play Therapy and Children with ADD by Reo Leslie, LPC, RPT-S. March 15-17, 1998 Colorado Child and Mental Health Conference. Participated in Various In-Service Workshops while employed at Shiloh Home. Graduate Coursework University of Denver Advanced Standing Seminar Psychodynamic Interventions Psychodynamic Assessment Research Methods and Designs Cognitive Approaches to Social Work Practice Community Mental Health Policy Social Work with Groups Indirect Practice Research Assessment and Interventions with Adolescents Direct Practice Research Field Practicuum—Mental Health (21 quarter hours) Family Therapy Training Center of Colorado Theories and Foundation of Family Therapy Family Therapy Assessment and Treatment Family Therapy Survey Course Family Therapy—Use of Self Ethics and Values in Family Therapy MFT Treatment Process Couple's Therapy/ Sex Therapy Adapting Interpersonal Models T SPECIALTY"P �T o"r' HEALTHCARE LIABILITY INSURANCE POLICY DECLARATIONS Policy Number: 3880 20 70 TIG Insurance Company Administrative Office Irving, TX 75039 Insured's Name and Mailing Address: Administered by: Valerie Larson National Professional Group 2603 49th Ave.# 3 875 North Michigan Avenue Greeley, CO 80634 Chicago, Illinois 60611 1488-982-2638 Affiliation: AAMFT Professional Occupation: Part Time Self Employed Marriage; Family; Therapist(MFT) Coverage Term From: (Effective Date) 06/27/2001 To: (Expiration Date) 06/27/2002 at 12:01 a.m. Standard Time at the Insured's Mailing Address shown above. Retroactive,Date(if applicable): N/A Claims Made Coverage ® Occurrence Coverage COVERAGE A- PROFESSIONAL LIABILITY COVERAGE LIMITS OF LIABILITY PREMIUM Individual -Each Incident: $1,000,000 $138.00 Aggregate: $5,000,000 Association, Partnership, or Corporation - Each Incident: Aggregate: COVERAGE B- SUPPLEMENTAL LIABILITY COVERAGE Each Occurrence: $1,000,000 Incl. Aggregate: $5,000,000 NOTE:A SMALLER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF ABUSE(SEE THE SPECIAL PROVISION"ABUSE"IN THE POLICY). Risk Purchasing Group: National Professional Purchasing Group Association, Inc. Policy Forms and Endorsements: HC24032 (01-96), HC24176 (01.96), HC26777 (03-00),ZC18558D (04-99), ZC18558D (04-99) Premium: $138.00 Taxes: N/A Total: $138.00 Please report Claims to either your Agent or directly to the TIG Professional Liability bility Claims Department Company Telephone Number Facsimile Number(972)831-5907 5205 N.O'Connor Blvd.,Irving,TX 75039-3712 Countersigned: July 10, 2001 by' pjf DateAuthorized gnalure 03-2000 HC2A031B Sherri R Malloy, Ph.D. Licensed Clinical Psychologist Office: Home: Ackerman and Associates, P.C. 24 Alles Drive 1750 25th Avenue, Suite 101 Greeley, Colorado 80631 Greeley, CO 80634 (970) 351-7218 (970) 353-3373 Education Ph.D. Double Major: Child Clinical Psychology; Clinical Psychology. August 1993 University of Colorado, Boulder. Licensed as Psychologist 1-5-95 M.A. Department of Psychology, Clinical Program. University of July 1989 Colorado, Boulder. B.A. Major: Psychology; Minor: Spanish. Arizona State University. May 1987 Summa Cum Laude. Teaching Cert. Roston Montessori Teacher Training Institute. August 1977 Orange, California. Montessori Elementary Education Certificate. Clinical Experience April 1998- Clinical Psychologist, Ackerman & Associates, Greeley, Colorado. present Provide outpatient psychotherapy to children, adolescents, adults & families. Family preservation home-based services. Assessment & consultation. August 1991- Child and Family Psychotherapist, Mental Health Center of Boulder March 1997 County, Boulder, Colorado. Provided outpatient psychotherapy to children and their families. Parent, teacher, and other agency consultation. September 1992- Psychology Intern; Denver General Hospital, Denver, Colorado. August 1993 Outpatient assessment, consultation, and treatment To children, adolescents, and adults; Inpatient treatment to adolescents &their families. Consultation to multidisciplinary hospital staff. Attended regular seminars and case conferences. Completed an additional rotation in neuropsychology. August 1990- Psychotherapist, University of Colorado, Farrand Residence Hall. May 1992 Provided individual, conjoint, and group psychotherapy to Farrand residents. Psychiatric consultation to faculty and staff. Presented seminars and workshops to faculty, staff, and students. 2 Malloy August 1988- Emergency Psychiatric Services Clinician, Mental Health Center August 1992 of Boulder County, Boulder, Colorado. Evaluation and disposition planning for clients with psychiatric emergencies. Composed a training manual for emergency psychiatric clinicians January 1988- Psychotherapy Intern, Raimy Psychology Clinic, May 1992 Department of Psychology, University of Colorado, Boulder. Provided outpatient psychotherapy to adults, families, and children. Parent and teacher consultation. February 1986- Intake Clinician; Group Facilitator, Tri-City Behavioral Health July 1987 Center, Mesa, Arizona. Conducted intakes for the adult team. Facilitator for children's psychotherapy groups. Administrative and Supervisory Experience Jan 1996- Team Leader, Mental Health Center of Boulder County, Boulder, May 1998 Colorado. Clinical and administrative supervision of a team of psychologists and psychotherapists. Budgeting. Supervision of support staff. Coordinate outpatient services/consultation to joint- agency programs, including Head Start, Specialized Foster Care, Fost-Adopt, 1178, School-Based Services, Boulder Day Nursery, and People's Clinic. August 1990- Adult Team Coordinator, Raimy Psychology Clinic, Department August 1991 of Psychology, University of Colorado, Boulder. Chaired the adult team meetings and case conferences. Assisted clinic director with administrative tasks. August 1990- Peer Counselor Supervisor, Farrand Residence Hall, University of May 1991 Colorado, Boulder. Developed and implemented a peer counseling training program. Provided ongoing training and supervision to peer counselors. January 1989- Supervisor in Training, Raimy Psychology Clinic, August 1991 Department of Psychology, University of Colorado, Boulder. Received training and supervision in supervisory techniques. Supervised the psychotherapy of first-year clinical psychology graduate students. June 1989- Adult Team Intake Coordinator, Raimy Psychology Clinic, August 1990 Department of Psychology, University of Colorado, Boulder. Intake and disposition of psychotherapy clients. September 1989- Clinical Supervisor, Emergency Psychiatric Services Team, August 1992 Mental Health Center of Boulder County, Boulder, Colorado. Trained and supervised Masters level student interns in emergency clinical assessment techniques, legal and procedural practices, and psychological report writing. 3 Malloy February 1988- Volunteer Trainer, Maslin House for Chronically Mentally Ill, May 1989 Mental Health Center of Boulder County, Boulder, Colorado. Recruited and trained volunteer college students to work with the chronically mentally ill population at this facility. Publications December 1994- Columnist: The Boulder County Parent, a monthly publication of the April 1998 Parenting Place, Boulder, Colorado. Circulation: 8,000. Topics include child development and parenting concerns. Teaching Experience January 2001- Instructor, University of Northern Colorado, Greeley, CO May 2001 Graduate Level Play Therapy Practicum August 1989- Psychology Instructor, Front Range Community College, May 1992 Boulder Campus, Colorado. Fall 1988 Head Teaching Assistant, Department of Psychology,University of Colorado, Boulder. Trained and supervised graduate level Teaching Assistants. August 1987- Teaching Assistant, Department of Psychology, University of May 1989 Colorado, Boulder. August 1977- Montessori Elementary Teacher, Roston Montessori School, May 1983 Orange, California; and subsequently, Tempe Montessori School, Tempe, Arizona. Taught preschool through second grade classes. Responsibilities included academic program planning and implementation, supervising teacher assistants, conducting parent- teacher conferences, academic record-keeping, and giving educational presentations to parents. August 1976- Student Teacher, Roston Montessori Teacher Training Institute, August 1977 Anaheim, California. Taught in a Montessori classroom under the supervision of a certified Montessori teacher. Duties were the same as in the entry above. 4 Malloy Presentation Topics and Trainings Given Play Therapy Engaging so-called"resistant"clients Psychotherapy with adolescents and their families Case Conferences Parent-Toddler Attachment Patterns Child Abuse Child Psychopathology Stress Management Workshop Depression and Risk of Suicide in College Students Research Projects Adult Attachment Style and College Functioning(Doctoral Dissertation), 1992 Parent-Toddler Attachment Relationships(Masters Thesis), 1990 Post-Divorce Visitation Patterns and Parent-Toddler Attachment, 1988 Effects of Divorce on Children, 1987 Mental Health Center Client Satisfaction Study, 1986 Clinical Assessment Trained in the use of the following assessment tools: WISC-III MMPI Draw-a-Person Kinetic Family Drawing Thematic Apperception Test Rorschach Inkblot Test Sacks Sentence Completion Test Strong-Campbell Interest Inventory Professional Affiliations 1997- 1998 Member: Internal Review Board MHCBC 1996-1997 Member: Professional Advisory Board, Mental Health Center of Boulder County 1991- 1992 Co-Chair:Multi-Ethnic Action Committee,Department of Psychology, University of Colorado, Boulder. 1991- 1993 Member: American Psychological Association,Division 12, Clinical Child Psychology. 1989- 1991 Member: Multi-Ethnic Action Committee,Department of Psychology, University of Colorado, Boulder. . 1988- 1989 Student Representative: Department of Clinical Psychology, ` University of Colorado, Boulder. 1987- 1989 Member: Developmental Psychology Research Group, Department of Psychology,University of Colorado,Boulder. 1987- present Member: (Intermittent)American Psychological Association. Honors and Awards li ' , 1988 Department of Clinical Psychology Scholarship; University of Colorado,Boulder. 1987 Phi Beta Kappa 49 ,ate,?° 1P e,� `'r"n �: 1987 Academic Scholarship,Arizona State University,Tempe,Arizona. , 1986 Phi Kappa Phi Honor Society 5 `.-etyW 1986 Golden Key National Honor Society:; k1 t r' 1979 West Valley College Track Team, West Valley,California; State Champions. ` �� •to- aFV �+9 M::x Y 1977 Fellowship Award; Roston Montessori School,Oranges California. wYh Additional Training Regular participation in bi-monthly;seminars, case conferences and supervision held at the Mental Health Cepter of Boulder'Couuty. Readings and professional conferences iii thg,field of dlmtcal'psychology. conferences 1r Mj� a Other Experience 1996-1999 Vice President(elected), Suburban Ditch Company,Greeley,' Colorado. t _ t f',M 1983- 1985 Small Business Owner/Operator: Graphicolor, Phoenix,Arizona. Photography and advertising design.;Cgtrimercial and portrait photography,advertising design,,s lege;�sll�lsed salgspeople, performed administrative tasks'«1,r;t 1982- 1985 Dance Aerobics Instructor,International Fitness Center,Mesa, Arizona. Choreographed dance routines,taught classesregularly, made public presentations on behalf of the fitness club,-and participated in an ongoing certification/training program in exercise physiology and dance choreography.,;`' �^ Y^ 6 Malloy 4Fr, w ft4 w r�. Addendum " "° Graduate Coursework: Child Development/Psych ath Developmenmtal Psychology Developmental Psychopathology Child Psychotherapy Clinical Practicum(six semesters) Theory and Issues in Developmental Psychology Personality/Psychotherapy Advanced Psychopathology Advanced Personality Theory Clinical Study of the Individual Adult Psychotherapy •.. Family Research and Therapy ° ` '��{y�� 4 F v\f f ♦ iJl' 3�:.;�' r4.r'1ti'fr "R\4Rf'. Research Methodo . Gennerallogy/Statistics Statistics,(two semesters) Research Practicum(four semesters), , • Research Problems in Clinical Psychology k ,,�' Assessment Projective Testing Objective Testing Courses for Distributed Minor M's *� ? t Multicultural Ps cholop) Community Mental Health Marriage and Family Counseling Behavioral Neuroscience: Clinical and Pathological Perspective ns -',iw xxr n $k$1 t v v S r e't 7 e1 k �≥'P ' " s y'P'°'#t t:+ t rY Mr qM'• w ti Illr l i YAK a ..- Y trt Y p Y A.,dfe xAwii, � Brapch B/A Producer# Issue Date Renewal/Replacement No. 32 A 0002360 03/09/2001 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. item DECLARATIONS CERTIFICATE NUMBER: 45P- 2055185 1. NAMED INSURED: SHERRI MALLOY PHD ADDRESS 24 ALLES DRIVE (Number & Street; Town, GREELEY CO 80631 County, State & Zip No.) • 2. POLICY PERIOD: From 04/01/2001 To 04/01/2002 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: LIMITS OF LIABILITY PREMIUM Professional Liability $1,000,000 $3,000,000 $718.00 each Incident Aggregate • a. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: (X ) Sole Proprietor (including Independent Contractors) ( ) Partnership ( ) 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 I endorsement hereto. 04/01/1998 7. 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 form(s) or endorsement(s): PLJ-2008 ( 10/94) POE-8004 ( 5/88 ) PLE-2167 ( 07/00 ) PLE-2081 • P0N-2003 PLE-8035 ( 09/97 ) 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: 1-800-852-9987 i immew INTERSTATE INSURANCE GROUP PLP•2012 (06/93) (Elec.) -_P dQC3 JS: ,Eo. LASER) k' Cassie Yackley, M.S., L.P.C., N.C.C. 1750 25'1 Avenue, Suite 101, Greeley, Colorado 80639 EDUCATION Doctor of Psychology(ABD): Counseling Psychology (APA Approved) University of Northern Colorado—Greeley, Colorado—Expected Graduation: August 2002 Grade Point Average: 4.0/4.0 Master of Science: Counseling Emphasis: School Counseling (CACREP Accredited) Oregon State University—Corvallis, Oregon—December 1993 Grade Point Average: 3.9/4.0 Bachelor of Arts: Psychology Minor: Communication Western Washington University—Bellingham, Washington—August 1991 Grade Point Average in Major: 3.7/4.0 PROFESSIONAL EXPERIENCE COUNSELING/CLINICAL Licensed Professional Counselor August 2000—Present Ackerman and Associates, P.C. Greeley, Colorado • Provide individual and family psychotherapy in the office and through home-based services. • Consult with foster parents on child problems and parenting issues. • Facilitate family group conferences and assist with special advocate cases. Psychology Intern August 1999—August 2000 Riverbend Community Mental Health Concord,New Hampshire Children's Intervention Program • Provided individual and family psychotherapy to a primarily SED population of children and adolescents • Conducted psychoeducational and clinically-oriented evaluations • Participated on multidisciplinary and multi-agency treatment teams to provide comprehensive mental health services to youth and families Merrimack Valley High School Wellness Center • Provided individual psychotherapy for adolescents at a school-based clinic • Served on school administrative team formed to discuss student concerns and provide referrals for appropriate services • Monitored wellness center/school-based clinic operations during director's absence Career Counselor—Graduate Assistant August 1996—June 1998 University of Northern Colorado Career Services Greeley,Colorado • Provided individual career counseling to students at all levels of career development • Taught seminars and courses aimed at career planning and guidance • Interpreted interest inventories and personality measures to assist in career planning School Counselor September 1994—June 1996 Millicoma Middle School Coos Bay, Oregon • Counseled student body of 640 individually and in groups • Coordinated Millicoma's state school assessment program • Consulted with school staff regarding educational planning and behavioral interventions Adolescent&Family Treatment Specialist January 1995—August 1995 Belloni Counseling Services Coos Bay,Oregon • Provided psychotherapy for youth and their family members in a group home setting • Collaborated with community agencies to provide client services School Counselor January 1994—June 1994 Newport Middle School Newport,Oregon • Offered individual and group counseling services for student body of 450 • Served on student assistance teams formed to develop individualized education and behavior plans for students Counseling Intern September 1992—December 1993 Oregon State University Corvallis, Oregon Child Protective Services • Provided individual psychotherapy for children and adolescents who had been neglected and/or abused by their parents • Conducted psychotherapeutic groups for preadolescent girls who bad been sexually abused Adams Elementary School • Counseled elementary school children individually and in groups • Provided psychoeducational instruction in the classroom setting Assistant Crisis Worker May 1990—June 1991 Northwest Youth Services Bellingham, Washington • Planned and implemented daily activities for residents of youth group home • Conducted psychoeducational and activity-based groups for youth residents TEACHING AND SUPERVISION University of Northern Colorado—Greeley, Colorado Instructor September 1998—May 1999 Introduction to Psychology(PSY 120) Teaching Assistant May 1998—August 1998 Introduction to Qualitative Research (SRM 680) Instructor August 1996—June 1998 Career Theories and Employment Trends (CSPA 173) 2 Supervisor—Teaching Assistant January 1998—May 1998 Practicum in Individual Counseling(PPSY 612) Teaching Assistant June 1998 Child Abuse and Neglect (PPSY 508) RESEARCH University of Northern Colorado—Greeley, Colorado Dissertation Research April 1999—Present Youth Perceptions of Violence:A Collaborative Inquiry Graduate Research Assistant May 1998—September 1998 Transitions in Qualitative Research: Preparing for a New Century of Research Graduate Research Assistant May 1997—September 1997 Eating Disorders: The Insider's Perspective Research Apprenticeship(PPSY 733) January 1997 —May 1997 Hiring Preferences of PsyD Versus Ph.D. Candidates Qualitative Research Colloquium Participant September 1998—April 1999 University of Northern Colorado PRESENTATIONS Invited Presenter— Treating Adolescent Victims of Sexual Abuse May 1999 Child Abuse and Neglect(PPSY 513) Greeley, Colorado Panel Member— Writing the Qualitative Dissertation May 1999 Rocky Mountain Psychological Association Fort Collins, Colorado Poster Session—Directives and Direction in Counseling Practice October 2, 1998 Rocky Mt. Assoc. for Counselor Ed. and Supervision Breckenridge, Colorado Facilitator— What is Research? September 18, 1998 Transitions in Qualitative Research Greeley, Colorado Poster Session—Eating Disorders: The Insider's Perspective April 17, 1998 Western Psychological Association Albuquerque,New Mexico Poster Session—On the Front Line: Experiences of Direct Service Staff Member April 17, 1998 Western Psychological Association Albuquerque,New Mexico Panel Member—Qualitative Research Methodology April 8, 1998 UNC Annual Symposium for Graduate Research and Scholarship Invited Presenter— Trauma in the School Setting June 1997 School Trauma Intervention(PPSY 513) Greeley, Colorado 3 PROFESSIONAL MEMBERSHIPS AND ACTIVITIES Nationally Certified Counselor(NCC)—April 15, 2000 American Psychological Association—September 1997—Present APA Division of Peace Psychology—September 1997—Present APA Division of Counseling Psychology—September 1997—Present APA Division of Clinical Child Psychology—April 2000—Present 4 Issue Date: 09/21/01 �� The Reciprocal PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY FOR �� Alliance Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ACA Insurance Trust,Inc. 5990 Stevensaa Avenue AGtn Policy Number: CL12494601 Administered by: AMmandrla,VA223043300 TR Tel Fret 1.800347.647 x284 'a l ITEM DECLARATIONS INDIVIDUAL POLICY 1. NAMED INSURED: Cathleen Yackley 2. ADDRESS: 2911 12th Road Greeley, CO 80634 3. POLICY PERIOD: From: 09/05/01 To: 09/05/02 12:01 A.M.Standard Time at 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 8 387 . 00 B. GENERAL LIABILITY $ 0 . 00 TOTAL PREMIUM: $ 387 . 00 5. LIMITS OF LIABILITY: $1, 000, 000 each Incident or each Occurrence $3, 000, 000 in the Aggregate 6. THE NAMED INSURED IS: Sole Proprietor(incl.Individual) X Par (r efer Partnership Corporation to Item 7 below) 7. BUSINESS OF THE NAMED INSURED: Self-Employed (Rating Category) Counselor/Human Development Professional 8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and agreements contained in the following form(s)or endorsement(s): CPL•0004.0199 CPL•0005.0199 CPL•0006•0199 NOTICE THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. CPL•0005.0199.00 ,wa 'Attach to youcpolicy,with the same numbersho'wn on•this'endorsement a ;E-4,03" 2nd Edition ! Named insured• DR JOYCE SHOUT ACRERMAN PC Agent Policy Number / Address• 1750 25TH AVE SUITE 101 07-04-362 04576-38-07 GREELEY CO 80631 of the Company designated in the Declarations Insured Location • (Same as above urdess otherwise stated here) Effective Date 07/31/96 Limit of Liability.$ 1 ,000,000 each occurrence $ 1,000,000 Annual Aggregate ADDITIONAL INSURED ENDORSEMENT (SPECIAL SENTINEL) In consideration of the premium we agree with you to the following: 1 The insurance provided by this policy for bodily Injury liability and property damage liability under Coverage D—Business Liability insurance will also apply to the additional insured named below, but only with respect to an occurrence arising out of the ownership, maintenance or use of that part of the insured location occupied by you. 2 This insurance does not apply to: (a) Any occurrence which takes place after you cease to occupy the Insured location. (b) Any structural alterations, new construction or demolition operations performed by or for any additional insured named below. 3. The additional insured will not be construed or deemed to be a subscriber to the Company issuing this policy. 4. The additional insured will not be or become liable for any premium payments due upon this policy. 5 If this policy is terminated for any reason we will give 30 (THIRTY) days notice in writing to the additional insured named below. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all other terms of the policy. III• STATE OF COLORADO Additional C/0 WELD COUNTY SOCIAL SERVICES DEPT Insured • ATTN: JUDY GRIEGO PO BOX A GREELEY CO 80632 Countersigned Authorized Representative • MINER, �1111YP0I11� I ��WPUP q K 95 1501 ttri 9, 4 10] 2ND EDITION 695 1501 /DECLARATIONS TRUCK INSURANCE EXCHANGE El FARMERS INSURANCE EXCHANGE FIRE INSURANCE EXCHANGE , SPECIAL O IANMGi SENTINEL MEMBERS of FARMERS INSURANCE GROUP OF COMPANIESitxwxxuEN PACKAGE HOME OFFICE: 4680 WILSHIRE BLVD., LOS ANGELES,CALIFORNIA 90010 -4'- iL., SUPER 1. Named . DR JOYCE SHOHET ACKERMAN PC Prod. Count Insured Premalic/keel No. Mailing . 1750 25TH AVE SUITE 101 Address . 07-04-362 04576-38-07 GREELEY CO 80631 Agent Policy Number Type of The named insured is an individual unless otherwise stated: ❑ Partnershi X Corp. Business OFFICE C Joint Venture Li Organization (Other than Partnership or Joint Venture) 2. Policy Period from 0 7/0 1/00 (not prior to time applied for) to 07/01/01 12:01 a.m. Standard Time. If this policy replaces other coverages that end at noon standard lime on the same day this policy begins, this policy will not lake effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to continue this insurance, we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums, rules and forms then in effect. 3 Insured location same as mailing address unless otherwise stated: 1750 25TH AVE SUITE 101 GREELEY CO 80631 4 Mortgage Holders Loan # Loan # 5 Premium$ 507. 00 C "X" if Mortgage Holder Pays 6 Policy Forms and Endorsements attached at inception: 25-2880 E4103-ED2 565310-ED2 S0700-ED3 E6036-ED1 E4168-ED1 E4004-ED1 -E4216-ED1 E3026-ED1 . We provide insurance only for those coverages Indicated by a specific limit or by an I X COVERAGES LIMITS OF INSURANCE DEDUCTIBLE A-Building $ $250 applies unless other SECTION 1 B-Business Personal Property $ 52,000 O lion Indicated le an® 1)ds,00❑s5oo Es C-Loss of Income (Not exceeding 12 consecutive months) ACTUAL LOSS SUSTAINED NONE Properly OPTIONAL COVERAGES and Swimming Pool/Fences and Walkways $ Above oeeuc-3 Loss of X Building Glass(Blanket) REPLACEMENT COST able applies 3 100 _ Income X Outdoor Sign Coverage $ 1 00 unless other S `a Valuable Papers (In addition to$1000 included.) $ cationmcI- 3 I . 'calee Earthquake Damage See Coverages x A,B, & C of the applicable ins. limit. SECTION II 0-Business Liability- Including Products and Completed LIMITS OF LIABILITY Operations. (Annual aggregate applies for all occurrences (Annual Aggregate) during the policy period.) $ 1 , 000, 000 Liability E-Fire Legal Liability$75,000 included unless other option indicated by an X and O$100,000❑$150,000 each occurrence(Subject to the annual aggreagate shown for Coy. D) Medicals F-Medical Payments to Others (Subject to the annual aggregate $5,000 each person shown for Coverage D.) Limit of Liability (Annual Aggregate) O Professional Liability(see attached endorsement) $ E l • V COVERED DEDUCTIBLE i SECTION III Agreement I-Employee Dishonesty $5, 000 NONE Agreement II-Broad Form Money and Securities-Inside $1 , 000 $250 I Agreement III-Broad Font Money and Securities-Outside $ 1 , 000 $250 Crime Agreement IV-Medical Payments $500 each person NONE i Agreement V-Forgery or Alterations // ^$2,500 NONE TO 3)0B 212 2ND EDITION Countersigned, l `R--C 6V- I 0 /i>_Q j Authorized Represents ive EXHIBIT B SUPPLEMENTAL NARRATIVE TO RFP RECOMMENDATIONS Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 2taj APR 17 FP) �; Q9 Greeley, Colorado 80634 (970)353-3373 fax(970)353-3374 April 15, 2002 Weld County Department of Social Services Attn: Gloria Romansik P.O. Box A Greeley, CO 80632 Dear Gloria, We received your letter of April 8,2002 approving our RFP's RFP PY 02-03 006-00 Foster Parent Consultation RFP 02008 #1 Family Group Decision Making-Intensive Family Therapy RFP 02008#2 Goal Achievement Program-Conflict Resolution-Intensive Family Therapy RFP 02010 Option B RFP 02007 Sex Abuse Treatment Providers will report outcomes specific to our programs as has been our standard practice. Thank you very much. Sincer ly, Joyce ohet Ackerman, Ed.D. ' Licensed Psychologist 1.14(7411.1" DEPARTMENT OF SOCIAL SERVICES PO BOX A GREELEY,CO 80632 ' WEBSITE:www.co.weld.ao.us Administration and Public Assistance(970)352-1551 Child Support(970)352-6933• April 8, 2002 Ms. Joyce Ackerman, Ed. D. Ackerman and Associates,P.C. 1750 25 Avenue Suite 101 . Greeley CO 80631 Re: RFP PY 02-03 006-00 Foster Parent Consultation RFP 02008#1 Family Group Decision Making-Intensive Family Therapy RFP 02008#2 Goal Achievement Program-Conflict Resolution-Intensive Family Therapy RFP 02010 Option B RFP 02007 Sex Abuse Treatment Dear Ms. Ackerman: The purpose of this letter is to outline the results of the RFP Bid process for PY 2002- 2003 and to request written information or confirmation from you by Wednesday,April 17,2002. A. Results of the RFP Bid Process for PY 2002-2003 Through the 2002-2003 Core Services bid evaluation process,the Families,Youth and Children(FYC) Commission approved the RFP(s)listed above for inclusion on our vendor list. The FYC Commission attached the following recommendations and/or conditions regarding your RFP bid(s). The FYC Commission approved the following recommendation for all programs on the vendor list for 2002-2003. The recommendation reads as follows: Recommendation:Providers will report outcomes specific to their programs. 1. RFP PY 02-03 00-060,Foster Parent Consultation: Approved with the above recommendation. 2. RFP 02008 #1,Family Group Decision Making, Intensive Family Therapy: Approved with the above recommendation. Page 2 Ackerman and Associates,P.C. Results of RFP Bid Process for PY 2002-2003 3. RFP 02008, Combined Mediated Family Conflict Resolution and Goal Achievement Program(G.A.P.),Intensive Family Therapy: Approved with the above recommendation. 4. RFP 02010, Option B Approved with the above recommendation. 5. RFP 02007, Sex Abuse Treatment Approved with the above recommendation. B. Required Response by FYC Bidders Concerning FYC Commission Recommendations and Conditions 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 Wednesday,April 17, 2002,close of business, as follows: FYC Commission Recommendations• You are requested to review the FYC Commission recommendations and to: a. accept the recommendation(s) as written by the FYC Commission; or b. request alternatives to the FYC Commission's recommendation(s); or c. 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. If you wish to arrange a meeting to discuss the above conditions and/or recommendations,please do so through Elaine Furister, 352.1551, extension 6295, and one will be arranged prior to April 17,2002. Sincerely, • Judy A. Griego,Director cc: Dick Palmisano, Chair,FYC Commission Gloria Romansik, Social Services Administrator Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission (Core)Funds Type of Action Contract Award No. X Initial Award FY02PAC-17000 Revision (RFP-FYC-02008) Contract Award Period Name and Address of Contractor Beginning 06/01/2002 and Ackerman and Associates P.C. Ending 05/31/2003 Intensive Family Therapy-Short Term IFT(GAP) and Mediated Family Conflict Resolution 1750 25th Avenue Suite 101 Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Improve both individual and family functioning Award is based upon your Request for Proposal (RFP). through in-home and in-office services. The The RFP specifies the scope of services and conditions program has a capacity of 14 families per month. of award. Except where it is in conflict with this Maximum capacity is 5 families per month, for a NOFAA in which case the NOFAA governs, the RFP total of 60 families per year. Maximum stay is 20 upon which this award is based is an integral part of the hours face-to-face meetings per month over a five- action. month period. The techniques of Mediated Family Conflict Resolution may be brought into this Special conditions program. This restructures the Mediated Family 1) Reimbursement for the Unit of Services will be based on Conflict Resolution from being a free-standing an hourly rate per child or per family. program and incorporates it within the Goal 2) The hourly rate will be paid for only direct face to face Achievement Program(GAP)without eliminating contact with the child and/or family, as evidenced by the service for families. Bicultural-bilingual service client-signed verification form, and as specified in the capacity is 15 families per year. South County unit of cost computation. service delivery with provision of a site. 3) Unit of service costs cannot exceed the monthly and yearly cost per child and/or family. Cost Per Unit of Service 4) Payment will only be remitted on cases with, and Hourly Rate Per $104.00 referrals made by the Weld County Depat huent of Social Unit of Service Based on Approved Plan Services. 5) Requests for payment must be an original submitted to the Weld County Depai tinent of Social Services by the Enclosures: end of the 25`h calendar day following the end of the X Signed RFP:Exhibit A month of service.The provider must submit requests for X Supplemental Narrative to RFP: Exhibit B payment on forms approved by Weld County X Recommendation(s) Department of Social Services. Conditions of Approval Approval Progra Official Co By By Glenn Vaad, C Judy . Gri , Directs Board of Weld County Commissioners Wel aunty e artment of Social Services Date: (154Rop,2.. Date: 6 Z o?oc2-/3/.2. V. • EXHIBIT A SIGNED RFP • • INVITATION TO BID CAP DATE:February 27, 2002 BID NO: RFP-FYC-02008 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-02008) for:Family Preservation Program--Intensive Family Therapy Program Family Issue's Cash Fund or Family Preservation Program Funds Deadline: March 22, 2002, Friday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5- 101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement (C.R.S. 26-5.3-101). The Placement Alternatives Commission wishes to approve services targeted to run from June 1, 2002, through May 31, 2003, at specific rates for different types of service, the County will authorize approved vendors and rates for services only. The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists, typically with all family members, to improve family communication, function, and relationships. 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 rc.A 1 i 900 i � BE SIGNED (After receipt of order) BI ST IN INK �ov`ct l�ah�< (\1)SPmanC G 0�0 n n/� ic. t.S t• TYPED OR PRINTED SIGNATURE VENDOR 4(p� rn' 4 I�SSOG - t3 , (Name) Han w itten Signature By Authorized Officer or Agent of Vender ADDRESS )rO AC E-1, 4✓e TITLE ias/C tare Grep1 fd yOG3Y DATE Pwck ; 9-6aL PHONE# 35-3 - 3D3 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 31 RI'P-FYC-02008 Attached A INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 2002-2003 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2002-2003 //�� BID#RFP-FYC-02008 NAME OF AGENCY: A``k i nom.,. c'-rt AssASSOC-te-Gas. ec. ADDRESS: I )-S' ``,t.$_.7- /citeGre Co �GLs `�' PHONE: ( 1 s-33 - -.3323 /CONTACT PERSON: T7 ce 4r t,rr-. E tO,9- TITLE: 1 p Sy 4 6.94-jr DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists.typically with all family members, to improve family communication. functioning. and relationships. 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1.2002 Start End May 31. 2003 End TITLE OF PROJECT: Goc-P 4CA-u2Abenrere fir°trom 0 + C i -‘_, (4 l 6rt KeI - Name d Si.tnature of Person Preparing Document Date c am, .. ,,, `\--IC.a 3/ Name an ignature 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. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2001-2002 to Program Fund Year 2002-2003. Indicate No Change from FY 2001-2002 to 2002-2003 ✓ Project Description ✓ _i/Target/Eligibility Populations / 1,7 Types of services Provided I/ Measurable Outcomes ./ ✓ Service Objectives Workload Standards V V Staff Qualifications ,/ ✓ Unit of Service Rate Computation ✓ Program Capacity per Month 1 / Certificate of Insurance Page 25 of 31 RFP-FYC-02008 Attached A Date of Meetings)with S `�ces Division Supervisor: .� - n-02 / i 4 i Comments by SSD Su sot: 5 - krn t-tn,t ,l> tott c� ILLS' Lrc �-t f P LL) £7J p,_ x*, J , WJ 3 -t -o,7 Name and Signature ofupervisor Date Page 26 of 31 RFP-FYC-02008 Attached A Program Category In iv Famil Ther P o am Bid ate o Project Title Coo--. f} enr- Vendor 4/.44 rrne"1"- pv.A /9-5-see PROJECT DESCRIPTION Please provide a one page brief description of the project. II. TARGET/ELIGIBILITY POPULATIONS Please provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Sub-total of individuals who will have access to 24 hour services. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Please provide a two page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Comprehensive, diagnostic and treatment planning with the family and other service providers. B. Therapeutic intervention with flexibility to bring in other services, if needed. C. Co-facilitated therapeutic services provided by one or more qualified family therapists. D. Therapy that is designed to resolve conflicts and disagreement within the family, contributing to child maltreatment, running away, and to the behavior constituting status offenses. Also, provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that PAC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES Please provide a two page description of your expected measurable outcomes of the project. Please address the measurable outcomes for each area as described below: Page 27 of 31 RFP-FYC-02008 Attached A A. Children receiving services do not go into placement. B. Families remain intact. C. Reunification of children with families. D. Improvements in parental competency,parent/child conflict management as determined or measured by pre and post placement functional tests. E. More cost efficient services through the Intensive Family Therapy Program than the placement of the child. F. Therapeutic outcomes include fundamental changes in the family functioning and dynamics. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Please provide a one page description of your expected service objectives and quantitative measures. Please address, at a minimum, the following ways the project will: A. Improve Family Conflict Management- Mediation and counseling designed to resolve conflicts and disagreement within the family contributing to child maltreatment, running away and other offenses. B. Improve Parental Competency - capacity of parents to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision. C. Improve Ability to Access Resources - services shall assist parents to work with other sources in the community and within the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Please provide a one page description of the project's work load standards and quantitative measures. Please address, at a minimum, the following areas: A. Number of hours per day, week or month. B. Number of individuals providing the services. C. Maximum caseload per worker. (Generally 12 families per worker. Eight to 10 families per worker if the worker provides case management services to the families on the caseload.) D. Modality of treatment E. Total number of hours per day/week/month (Minimum average of two hours of service per family per week. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. (Minimum of 6 workers per supervisor.) H. Insurance. Page 28 of 31 RFP-FYC-02008 Attached A VII. STAFF QUALIFICATIONS Please provide a one page description of staff qualifications and address, at a minimum, the following: A. Will your staff, including supervisors, who are providing direct services have the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17, and Section 7.000.6,Q, Colorado Department of Human Services. Describe. B. Total number of staff, including supervisors, available for the project. C. Will staff have expertise in family therapy as demonstrated by specialized training, workshops and experience. D. Will staff have a minimum of eight hours per year of continuing education; i.e. courses, workshops, and/or review of literature to be documented by county. E. Will staff have a minimum of one hour per week of clinical supervision provided by someone with advanced skills in Intensive Family Therapy. F. Will the clinical supervisor(s)be involved in regular training to keep current in state-of-the-art counseling modalities and findings. Page 29 of 31 RFP-FYC-02008 Attached A VIII. COMPUTATION OF DIRECT SERVICE RATE This form is to be used to provide detailed explanation of the hourly rate your organization will charge the Core Services Program for the services offered in this Request for Proposal. This rate may only be used to bill the Weld County Department of Social Services for direct, face-to-face services provided to clients referred for these services by the Department. Requests for payment based on units of service such as telephone calls, no shows, travel time, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise, billings must be for hours of direct service to the client, regardless of the number of staff involved in providing those services. Therefore, it is imperative that this rate be sufficient to cover all costs associated with this client, regardless of the number of staff involved in providing these services. (Explanations for these Lines are Provided on the Following Page) Total Hours of Direct Service per Client Hours [A] Total Clients to be Served CF"-a_4,„) le Q Clients [B] Total Hours of Direct Service for Year I go o Hours [C] (Line [A] Multiplied by Line [B] Cost per Hour of Direct Services $ (0,9_ . 1(0 Per Hour [D] Total Direct Service Costs $ 9 gee [E] (Line [C] Multiplied by Line [D] ) {� Administration Costs Allocable to Program $ / .p- V V6n [F] Overhead Costs Allocable to Program $ 3 7 t' 'O [G] Total Cost, Direct and Allocated, of Program$ /9- / too [H] Line [E] Plus Line [F] Plus Line [G] ) Anticipated Profits Contributed by this Program $ V [I] Total Costs and Profits to be Covered �! by this Program(Line [H] Plus Line [I] ) $ !� / -©4 [J] Total Hours of Direct Service for Year /" V [K] (Must Equal Line [C] ) Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of / 0 I • 0O CJ Social Services $ [L] Day Treatment Programs Only: Direct Service House Per Client Per Month [M] Monthly Direct Service Rate $ [N] Page 30 of 31 • Project Description The Goal Achievement Program (GAP) Implementing behavioral goals through intensive short term solution focused therapy to avoid out of home placement. Overview: Ackerman and Associates P.C. originally proposed in 1996 to provide a time limited, solution focused therapy model to WCDSS. We called this the Goal Achievement Program or GAP. In 2002 we combined this program with a mediated conflict resolution program we had done for WCDSS since 1994. We propose to continue this revised combined GAP program in 2002-2003. The purpose of this highly structured time limited system is to enable families to implement their own care plans so they can avoid out of home placement. Families needing the GAP program are either immanently at risk of outplacement , need to be reunified and meet the PAC criteria or face imminent reunification failure and have failed or are failing to implement the program required of them. The model provides up to 20 hours of solution focused therapy over no more than a five month period, for these families at imminent risk of outplacement or needing reunification to achieve the required behavioral change. The twenty hours can be in directed solution focused therapy, mediation, conflict resolution or other modalities. It is focused therapy intended to help the client overcome whatever barriers are preventing them form meeting the requirements for their family. These requirements have emerged from either abuse, neglect and the consequences of the client's past behavior. Over the past year this limited 20 hour model has proven to be cost effective compared to longer term models such as home based treatment. As well, use of mediated services, in appropriate cases within this model has shortened the time needed for resolution to less than the 20 hours in a majority of those cases. Purpose: The purpose of the time limited, solution focused therapy is to implement the short term changes needed to either prevent placement or reunify the family. Clearly defined, achievable, structured behavioral changes are responsive to short term therapy because they have a very dear focus and do not necessarily require resolution of underlying personality factors to succeed. Although such long term change may well improve the health of the individual and the family, achievement of long term change is not necessarily a prerequisite to reunification or prevention of placement. As long as functionality of the family can be restored and the child is protected within the umbrella of the child protection statutes, the goals of the GAP program can be achieved. The GAP program creates a therapeutic environment for the family to establish a process of change, The GAP program is the place where the implementation of those goals is achieved for families that cannot do this on their own without psychological assistance. 1 Caseworkers can refer such families to the GAP program. When the court has ordered a care plan for a family, there is obviously a perception of diminished control on the part of the parents. The court has told the family what to do. This does not mean that the family has accepted what it must do. Nor does it mean that the family has the psychological skills to achieve the goals the court or WCDSS has set. Even when the family sincerely embraces the requirements, they may, at least psychologically, only have a vague or general sense how to do it. Such families are also appropriate for a GAP referral. Design:The time limited, solution focused therapy consists of up to 20 hours of therapy in a period of no more than five months. The structure of how the therapy is arranged varies to meet the specific deficiencies that need to be addressed and the goals that need to be met. Target/Eligibility Populations A. Total number of clients to be served in this twelve month program has been calculated as follows. Five families per month times twelve months equals sixty families per year. if we assume a family size of five, two adults and three children, then the total client pool to be served is 300 individuals. That number includes at least 60 individuals who face either imminent outplacement or need reunification. B. Distribution of clients. Total number of clients we will serve is approximately 300 as calculated above. We would expect approximately 120 of these would be adult members of the family and approximately 180 would be minors. We estimate that they would be distributed across the age range from 1 to 17. The older children would most likely be teenagers in conflict with their family most often conceming issues related to their maturation into adults. The younger group will consist of children of no particularly predictable age whose parents are in conflict usually in relation to instability in the marriage, neglect or abuse. Neglect or abuse may be present in either group. C. Families Served. We anticipate serving sixty family units. This estimate is increased over last year based on extensive use of this program. D. Sub total who will receive biculturaVbilingual services. We have two Hispanic members of the staff, Emily Jaramillo M.A. L.P.C. and Evelin Gomez Ph.D. L.P.C. , who are fluent in Spanish. We anticipate we can serve fifty percent or more of the total referred in a bilingual manner. All of the staff have extensive cross cultural experience. Joyce Ackerman Ed.D. spent several years working with American Indian reservation populations. Larry Kerrigan Ph.D. has more than twenty years experience as a therapist in Greeley and Susan Bromley Psy..D. is both a social worker and a psychologist with extensive experience training students in cross cultural sensitivity. E. We can provide services in South County if Social Services can provide a site to do such work. F. Accessibility. On weekdays, all providers of Ackerman and Associates are accessible through or office secretary and after hours through a 24 hour answering service and pager system. On weekends, this 24 hour access reaches the provider on call who is always a licensed Mental Health provider. We also provide Saturday sessions. 2 G. Maximum per month. The program maximum is five families per month. H. The monthly average capacity is four families per month. I. The average stay (and maximum stay) in the program is twenty hours over a five month period. Scheduling would be flexible and would attempt to maximize effective treatment in terms of achieving the best avoidance of placement or the most efficient return from placement. Types of Services Provided We propose to continue to provide up to twenty hours of short term solution focused treatment. We would use a flexible scheduling model which allows the therapist clinical judgment in scheduling and therapeutic technique in meeting the needs of the family and maximizing the cost effectiveness of the treatment. In terms of the criteria for the PAC process: A. Comprehensiveness: Solution focused therapy does not attempt to provide a comprehensive assessment or diagnosis of the family in a traditional psychotherapeutic model. It focuses the family on rapidly achievable solutions to the problems related to either their Family Service Plan or their court ordered care plan. We would require that the referred families have their Service Plans and their court ordered plans as applicable shared with the program at the time of referral. B. Access to other services: The purpose of short term therapy is to explicitly solve problems and lower barriers to achievement of the care plan. If the solution to a concern involves the referral to other services the caseworker will be notified at or before the conclusion of treatment and that service can be arranged for the family if they have not done so themselves. C. Co-Facillitation: Since there will be ten providers of short term focused therapy in the same group, each provider will have the opportunity to consult with other providers in Ackerman and Associates of similar services. We will use a consultation mechanism which preserves client anonymity. The therapy sessions will be conducted by a single provider. D. Conflict Resolution: Alternate conflict resolution such as mediation is included within the modalities of this proposal. One mediator has been sufficient in most cases to set rules and establish a good behavioral response in the majority of families treated in the last year. Measurable outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... 3 • 1. Did the family follow through with the referral from their caseworker? 2. Did the family attend the sessions that were scheduled? 3. Did the family need all 20 possible hours allowed? 4. Did the family complete the evaluation portion of the program? We expect a 95%follow through for contacting us. This data will be based on a comparison of referral documents received compared to the record of appointments of the family. We expect 95% to attend a first session. 90%to attend a second or further session. We expect that 90% will complete five or more sessions. Summative outcomes A. The child receiving services does not go into placement. The length of time between the referral to the end of treatment will be recorded in the providers report. We expect 85% of the index children referred to avoid placement. B. Families remain intact. Physically intact means the child remained or returned to the parents residence as specified in the treatment plans. We expect 70% of the families referred to remain physically intact and an additional 10%to remain psychologically intact (placed with a relative) as a result of this model. In our experience psychological intactness is usually accompanied by less formal care relationships than foster care such as living with other relatives who were previously not willing to assist. C. Reunification of children with their families. Short term therapy should be very amenable for the reunification of families because the family will have a Family Service Plan and perhaps also a court ordered plan to follow. The nature of the therapy would keep these goals focused before the family. We would expect reunification therapy to be more intense in terms of being done over a shorter time frame. We would measure the length of time between initiation of short term therapy and the reunification in these cases. We expect that 70% of the families will be reunified by this process. D. Improvement in parental competency and parent child conflict management are expected to occur in all families who complete treatment. The persistence of these changes can be measured at the evaluation session by self report. Parental competency questions will be linked to the treatment plans. E. Cost effectiveness. The cost of this program is projected at$2080 per family for 20 sessions. The program is expected to be extremely cost effective. Further, if any clients can use this program as an alternative to either inpatient or day treatment programs by using an intensive outpatient approach over a period of a week or two, cost effectiveness increases very substantially as a lower cost program is replacing a higher priced program to achieve a similar outcome. F. Does this program produce fundamental change in family dynamics? The process of solution focused therapy has the family define the behavioral goals for itself early in the process. At the last session these goals will be listed and the family report will summarize changes made in treatment. While the program is not focused on fundamental change it does provide a model for successful problem solving and learned problem solving skills and enhancement of interpersonal and negotiation skills that are important as tools for producing fundamental change in the family. 4 Service objectives We have the following service objectives: A. Improvement of family conflict management. The goals of the GAP program are centered on improving family conflict management and preventing conflicts which have placed the child imminently at risk. The treatment goals of short term therapy are the goals we have defined in this proposal as those needed to be fulfilled to avoid placement. Conflict with accepting and implementing these goals is requisite for placement in GAP. Therefore, improvement in conflict management is a central focus of this work. B. Improved parental competency in PAC sponsored programs centers on each parent developing more age appropriate and family system appropriate strategies. These include dealing with conflicts with their child, especially with teenagers. The areas of discipline, protection, instruction and supervision often need examination and practice to attain sustainable solutions. With younger children, the therapy gives the parents the opportunity to implement and better define the roles each parent expects of the other. Those parental behavioral goals specified in the WCDSS Family Care Plan or the court ordered plan will be the ones worked on. Thus, we help achieve goals that increase parental competency. C. The ability of the family to access resources is a strength of the short term therapy model. Short term therapy has one of its origins in programs designed to assist employees. That origin is called the employee assistance plan or EAP model. EAP specializes in directing people to the specific resources they needed in a very focused approach. The services recommended are determined by the problems presented. Determination of additional services needed is a standard portion of short term therapy. Usually in the first session, goals are clarified and in the subsequent sessions resources are specified that are needed to help reach those goals. We have extensive experience in providing this type of EAP therapy having done contractual short term therapy over the past ten years. The methods used to document the service objectives will be a review of progress compared to goals as reflected in the charted notes for the family. This progress will be summarized as an exit report to WCDSS. For the project, we will report on the type of goals and how well they were achieved using this short term treatment model, the numbers of children who were reunited or avoided placement Workload Standards A. The program has a capacity of five families per month. We anticipate an average of four. This is approximately four hours of face to face meetings per month per therapist. At each meeting, one therapist is present. This represents 1200 hours of therapist time per year. At our rate of$104 per hour the cost maximum is $124,800. B and C. There are ten providers who will provide these services. All have specific training in short term solution focused care treatment. All have work experience as providers who have used this model in treatment. Their resumes are attached. They are four psychologists: Joyce Ackerman, Ed.D., Susan Bromley, Psy.D., Laurence Kerrigan, Ph.D and Sherri Malloy, Ph.D. Five Licensed Professional Counselors, Karen Bender, MA, Evelin Gomez, Ph.D., Emily Jaramillo, M.A., Nicole Warnygora, M.A., and Cassie Yackley, M.S., and one Social Worker, Valerie Larson, MSW, LCSW. 5 D. The modality of treatment is a short term solution focused treatment. This can include directed therapy, mediation, alternative dispute resolution or other techniques. E. Hours/month The total number of therapist hours is 100 per month or 1200 per year. F. Staff There are 10 individual providers supported by two staff in the practice G. Supervisor This contract 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. H Insurance All providers carry one million three million liability, 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 is on file with the county and is provided through Farmers Insurance. Staff Qualifications A. and B. Staff Qualifications Ten staff are available for the project. They exceed the minimum qualifications specified as documented below. The staff are: Joyce Shohet Ackerman Ed.D., Licensed Psychologist; Karen Bender, M.A., L.P.C.; Susan Bromley, Psy. D., Licensed Psychologist; Evelin Gomez, Ph.D., L.P.C.; Valerie Larson, M.S.W.; Emily Jaramillo, M.A., L.P.C.; Laurence P. Kerrigan, Ph.D., Licensed Psychologist; Sherri Malloy, Ph.D., Licensed Psychologist; Nicole Warnygora, M.S., LPC; Cassie Yackley, M.A., L.P.C. C. Training The staff has extensive training in family therapy and short term therapy as documented by their extensive work experience. Resumes are available. D. 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. E. Supervision All providers are independently licensed and not required to have clinical supervision. All the staff have advanced skills in intensive family therapy. The contract supervisor will monitor the specifications made in this proposal. F. 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 for major managed care companies as short term solution focused therapy providers in Weld County. Unit of service rate computation We are requesting the rate of$104.00 per hour for the GAP program. It provides $62.40. for the therapist and overhead and expenses of$41.60 per therapist hour. This is the proportion of therapist fees to overhead that we have set for all programs of Ackerman and 6 • Associates. The overall profit margin was 1% for 2001. Budget Justification These rates are reasonable and customary for providers of the licensed doctoral level and breadth of training assembled in this proposal. Our fees, we believe are justified by the documented success rates we have demonstrated in the application of short term solution focused therapy techniques to prevention of placement. No special issues are present related to project audit to our knowledge and a random project audit for WCDSS have shown no discrepancies. A yearly audit review is budgeted. Ackerman and Associates P.C. is a type S professional corporation and not a 501.c.3. 7 Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission (Core) Funds Type of Action Contract Award No. X Initial Award FY02-CORE 19000 Revision (RFP-FYC-02008) Contract Award Period Name and Address of Contractor Beginning 06/01/2002 and Ackerman and Associates P.C. Ending 05/31/2003 Intensive Family Therapy Family Group Decision Making 1750 25th Avenue, Suite 101 Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal (RFP) The Family Group Decision Making model and the Addendum RFP information. The RFP specifies involves extensive planning with the nuclear the scope of services and conditions of award. Except family of the index child, coordination with all where it is in conflict with this NOFAA in which case the professionals involved in the case, and the NOFAA governs,the RFP upon which this award is consultation with individual members of the based is an integral part of the action. extended family followed by a mediation style meeting with the professionals and extended Special conditions family. The program has a capacity of 4 families 1) Reimbursement for the Unit of Services will be based on per month, (48 per year). a designated per family group conference. 2) The designated rate will be paid for only direct face to Cost Per Unit of Service face contact with the child and/or family, as evidenced by client-signed verification form, as specified in the Hourly Rate $84.00 unit of cost computation. Rate Per Family Group $ 2,100.00 3) Unit of service costs cannot exceed the designated rate Based on Average Capacity. and yearly cost per child and/or family. 4) Payment will only be remitted on cases open with, and Enclosures: referrals made by the Weld County Department of Social Services. X Signed RFP:Exhibit A 5) Requests for payment must be an original submitted to X Supplemental Narrative to RFP: Exhibit B the Weld County Department of Social Services by the X Recommendation(s) end of 25th calendar day following the end of the month Conditions of Approval of service. The provider must submit requests for payment on forms approved by Weld County Department of Social Services. Approvals: / Program fficial: By l By Judy . rieg�irectorq Glenn Vaad, Chair Weld unty Department of Social Services Board of Weld County Commissioners Date: 6f to 1UZ Date: &-5/ '7aaJ- t% J3/2 r • EXHIBIT A SIGNED RFP f INVITATION TO BID F--6 /) DATE:February 27, 2002 BID NO: RFP-FYC-02008 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-02008) for:Family Preservation Program--Intensive Family Therapy Program Family Issue's Cash Fund or Family Preservation Program Funds Deadline: March 22, 2002, Friday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5- 101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement (C.R.S. 26-5.3-101). The Placement Alternatives Commission wishes to approve services targeted to run from June 1, 2002, through May 31, 2003, at specific rates for different types of service, the County will authorize approved vendors and rates for services only. The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists, typically with all family members, to improve family communication, function, and relationships. 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...Statemeenit of Work Delivery Date I1/`ur (i a %.,A aA,nv„ t (After receipt of order) BI MUST BE SIGNED IN INK k.4U may TYPED OR PRINTED SIGNATURE VENDOR 1444 i rrpy4 tn� 4sgt)(Ad(z-- PG. (Name) Han wthten Signature By Authorized �Q Officer or Agent of Vender ADDRESS 17S o "cd I ' TITLE 1"SY c Gz( rze)Q-5 Cal trp. Lo DATE htar0Q • 1 pOt:2- PHONE # 3s3 3393 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 31 w RFP-FYC-02008 Attached A INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 2002-2003 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2002-2003 BID /t#RFP-FYC-02008 1n k NAME OF AGENCY: A r I Af d ss e c—e/ /p-C ADDRESS: ! 9 So g-s r Ir ve Coree.I> G 8'O62 PHONE: ( VD) 3 C 3 - 3 3` 3 plj CONTACT PERSON: 1/4152/ce Ac ern.,h L�-8 TITLE: /..cyd--0 tof,st DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists.typically with all family members,to improve family communication, functioning. and relationships. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1.2002 Start End May 31. 2003 End /- TITLE OF PROJECT: / 44- i //"' G rat-, G, S to,- 1n 4-k iy- Name nd Signature of Person Preparing Document Date � �. . ��, � `�`St . 3)Z/n2 Name nd Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2001-2002 to Program Fund Year 2002-2003. Indicate No Change from FY 2001-2002 to 2002-2003 / Project Description ✓ • Target/Eligibility Populations ✓ ✓ Types of services Provided ;/ Measurable Outcomes 1% ✓ Service Objectives ✓ ✓ Workload Standards ✓ / Staff Qualifications / Unit of Service Rate Computation ✓ ✓ Program Capacity per Month ✓ Certificate of Insurance Page 25 of 31 RFP-FYC-02008 Attached A Date of Meeting(s)with Social Services Division Supervisor: 3-t-D Comments b SSD Supervisor: t{CA-- C,0 J Pl - Ltitt P Ci t-0 Irkk' lit_. I �re,Jf� t �e a_t'a 4L r?V fi Ltz 2e. I t' , v v k {i &O r?r Al -L 046,1 ( till t it i 1.Q P ;_-r ti 1 ...{ Li A !Lid P,_ i s, a (LY/, Lit 3-�-ca .� � yea _, Name and Signature of SSD Supervisor Date Page 26 of 31 RFP-FYC-02008 Attached A Program Category Intensive Family Therapy rogram Bid Category Project Title ran-1y ran-1y a ro Ike u„c t cn Ihtan,. Vendor 14c fee rnr c'n-tt fi ssoco,. tea- PG, PROJECT DESCRIPTION Please provide a one page brief description of the project. II. TARGET/ELIGIBILITY POPULATIONS Please provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Sub-total of individuals who will have access to 24 hour services. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Please provide a two page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Comprehensive, diagnostic and treatment planning with the family and other service providers. B. Therapeutic intervention with flexibility to bring in other services, if needed. C. Co-facilitated therapeutic services provided by one or more qualified family therapists. D. Therapy that is designed to resolve conflicts and disagreement within the family, contributing to child maltreatment, running away, and to the behavior constituting status offenses. Also, provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that PAC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES Please provide a two page description of your expected measurable outcomes of the project. Please address the measurable outcomes for each area as described below: Page 27 of 31 RFP-FYC-02008 Attached A A. Children receiving services do not go into placement. B. Families remain intact. C. Reunification of children with families. D. Improvements in parental competency, parent/child conflict management as determined or measured by pre and post placement functional tests. E. More cost efficient services through the Intensive Family Therapy Program than the placement of the child. F. Therapeutic outcomes include fundamental changes in the family functioning and dynamics. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Please provide a one page description of your expected service objectives and quantitative measures. Please address, at a minimum, the following ways the project will: A. Improve Family Conflict Management - Mediation and counseling designed to resolve conflicts and disagreement within the family contributing to child maltreatment,running away and other offenses. B. Improve Parental Competency- capacity of parents to maintain sound relationships with their children and provide care,nutrition, hygiene, discipline, protection, instructions, and supervision. C. Improve Ability to Access Resources - services shall assist parents to work with other sources in the community and within the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Please provide a one page description of the project's work load standards and quantitative measures. Please address, at a minimum, the following areas: A. Number of hours per day, week or month. B. Number of individuals providing the services. C. Maximum caseload per worker. (Generally 12 families per worker. Eight to 10 families per worker if the worker provides case management services to the families on the caseload.) D. Modality of treatment E. Total number of hours per day/week/month (Minimum average of two hours of service per family per week. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. (Minimum of 6 workers per supervisor.) H. Insurance. Page 28 of 31 RFP-FYC-02008 Attached A VII. STAFF QUALIFICATIONS Please provide a one page description of staff qualifications and address, at a minimum, the following: A. Will your staff, including supervisors, who are providing direct services have the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17, and Section 7.000.6,Q, Colorado Department of Human Services. Describe. B. Total number of staff, including supervisors, available for the project. C. Will staff have expertise in family therapy as demonstrated by specialized training, workshops and experience. D. Will staff have a minimum of eight hours per year of continuing education; i.e. courses, workshops, and/or review of literature to be documented by county. E. Will staff have a minimum of one hour per week of clinical supervision provided by someone with advanced skills in Intensive Family Therapy. F. Will the clinical supervisor(s)be involved in regular training to keep current in state-of-the-art counseling modalities and findings. Page 29 of 31 • RFP-FYC-02008 Attached A VIII. COMPUTATION OF DIRECT SERVICE RATE This form is to be used to provide detailed explanation of the hourly rate your organization will charge the Core Services Program for the services offered in this Request for Proposal. This rate may only be used to bill the Weld County Department of Social Services for direct, face-to-face services provided to clients referred for these services by the Department. Requests for payment based on units of service such as telephone calls, no shows, travel time, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise, billings must be for hours of direct service to the client, regardless of the number of staff involved in providing those services. Therefore, it is imperative that this rate be sufficient to cover all costs associated with this client, regardless of the number of staff involved in providing these services. (Explanations for these Lines are Provided on the Following Page) Total Hours of Direct Service per Client Hours [A] Total Clients to be Served (f ) (Po Clients [B] Total Hours of Direct Service for Year 15-0 O Hours [C] (Line [A] Multiplied by Line [B] Cost per Hour of Direct Services $ V S'00 Per Hour [D] Total Direct Service Costs $ 7 1 OO O [E] (Line [C] Multiplied by Line [D] ) Administration Costs Allocable to Program $ .ty�'D,O 0C� [F] Overhead Costs Allocable to Program $ / 3 ©0 [0] Total Cost, Direct and Allocated, of Program$ 1 9_ (v O tK [H] Line [E] Plus Line [F] Plus Line [G] ) Anticipated Profits Contributed by this Program $ 0 [I] Total Costs and Profits to be Covered by this Program(Line [H] Plus Line [I] ) $ (9.-6 0 Total Hours of Direct Service for Year 1 So O [K] (Must Equal Line [C] ) Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of Social Services $ - O0 [L] Day Treatment Programs Only: Direct Service House Per Client Per Month [M1 Monthly Direct Service Rate $ [N] Page 30 of 31 Project Description 2002-2003 Family Group Decision Making Overview: Ackerman and Associates, P.C. began its program of Family Group Decision Making in February 1, 1998 for families undergoing expedited permanency planning. For other families that met PAC eligibility criteria, we began offering these services on June 1, 1998. This is an application to continue these services in 2002-2003. We will continue to use formats and procedures developed for the contract that began on February 1, 1998. The Family Group Decision Making model involves extensive planning with the nuclear family of the index child. Following this, coordination among all professionals involved in the case occurs. A structured meeting follows consultation with individual members of the extended families. The meeting format has been adapted from the Scandinavian model for a family group meeting format and from other formats. The results of the meeting with the professionals and the extended family unit nearly always produce a plan for placement of the child. This plan then can be considered by Social Services and the courts for its acceptability in each specific case. Early use of the family group decision model assists in contingency planning and allows a plan to be in place if the parental rights need to be terminated due to treatment failure. One goal for the 2002-2003 year is to use Family Group Decision Making process at an early stage to assist in contingency planning. FGDM can help to make clearer to the extended family and the parents who may ultimately face parental termination, the consequences of the failure to complete the case plan. Criteria for participation in the Family Group Decision Making process will uniformly be: 1. That the immediate family has been court ordered to participate in this process. 2. At least one child of this extended family (the index child) will be placed or is already placed in foster care. The program has been very successful and highly regarded by participants, WCDSS and the 19th Judicial District, based upon its operation over the last four years and the completion of approximately eighty conferences. The purpose of the Family Group Decision Making model is to engage the family (in its broadest configuration of the extended family), and to have them determine their recommendations for the placement of the child. The plan presented by the family is intended to meet the full requirements of the child protection statues. Evaluation and acceptance of the plan is the province of the Department of Social Services and the Courts. 1 Purpose: The purpose of the Family Group Decision Making conference is for the family members themselves to reach agreement on 1) the permanent placement of the child and 2) what is needed to resolve the problems that have caused this placement. The model was first developed in New Zealand as an alternative to having the courts decide child placement. Our model incorporates some adaptations that originated in Scandinavia that includes professionals in the meeting, offers a somewhat more structured approach to participant interactions and provides some psychological distance from Social Services for the participants. We have also increased physical security in the meeting process itself. Many of these adjustments have come through professional contacts with other FGDM programs. Joyce Shohet Ackerman Ed.D. was past vice president of the American Family Group Conference Association and was one of its founding members. The main idea of the Family Group Decision Making process is that the extended family unit must take responsibility for solving its own problems. The interest of the state is the protection of the child. The family likely has substantial strengths that can be utilized through this model to assist in protecting the child by creating either a better context to complete the case plan or by providing an option for permanent placement of the child. The Family Group Decision Making model may be viewed to limit what some may perceive as government sponsored intrusion into the family. We believe we are successful as the providers for both the expedited permanency planning contract and the non expedited Family Group Decision Making contract based on 1) our extensive training and success in mediation (particularly in relation to conflict resolution within families) 2) our training and experience in using the Family Group Decision Making model 3) our training in related models 4) extensive professional training in psychology and counseling and 5) our growing network of other FGDM programs we have professional interaction with. The model recognizes the need to involve parents and extended family members in the process of protecting and recommending permanent plans for their children. Details of how this process works are provided below. Design: The Family Group Decision Making process consists of 25 hours of billable services at a rate of$84.00 per hour, a five percent rate increase over the rate maintained over the past two years. This produces a case rate maximum for each of $2100.00. In previous contracts, we had a provision for increasing the fee for very large groups, but this was so rarely used that we dropped this from our bid. The rate increase covers increased costs associated with running the meeting and an annual audit. Typically the Family Group Decision Making is based upon the following patterns of work: 2 1. Once the referral is made to Ackerman and Associates, we contact the caseworker and identify the family history in terms of both mental health and medical needs. 2. An initial meeting takes place with the "nuclear" family, usually either or both the biological mother or father. At this meeting the Family Group Decision Making model is explained and the family helps to identify the extended family members who will be contracted. 3. Family members are contacted. Also, professionals involved in the case such as the guardian ad litem, attorneys, caseworker, medical and psychological providers are contacted. Ideally, all who are contacted will attend the FGDM meeting. Those who cannot will be represented based on their report to the FGDM presented by the team of conference facilitators. 4. The Family Group Decision Making conference takes place as follows: a. The first hour will be to establish the process and set the ground rules for how the process will occur. Two trained facilitators will be present at this stage. One will have the role to guide the process and reports for family members who could not be present. The other will represent the professionals who have gathered the information who are not present. The professionals will only be able to attend this part of the Family Group Decision Making. It is the responsibility of the facilitators to then assist the family in finding the outcome likely to be acceptable in terms of adequate detail and specificity to likely insure the protection of the child. The number at this conference is the total number of individuals represented in person or by proxy through the facilitators. A typical conference will have less than 25 represented. The average conference in out experience has nine adult family members and five professional who are present. The two facilitators are not counted in this total. b. After the initial period of time and a period of time that allows the facilitators to assess that there is a functional group process for this task, the facilitators will leave the room but are available in the next room. This second part of the meeting is the private Family Group Decision Making conference. Only family members attend it and no record is kept of its discussions. The reasoning for this is it is an undeniable truth that the family process will operate differently with outsiders present that it will in private. If the family needs mediation 3 assistance or clarification of the previously discussed viewpoints the facilitator can be called back in. In our experience, this process varies in length with different families. Where there is little connection with different kinship units of the extended family, in some cases the facilitators are needed throughout the process. c. When the family reaches a group decision, the plan is presented. The facilitators respond to seek clarification and to insure sufficient detail in the plan. d. On those aspects that are not clear, the family has the opportunity to rework the plan and present once more. e. At the end of the complete process a written document containing the plan is prepared for the court and signed by those present. f. The plan is a recommendation to the court from the extended family. The plan can be accepted, modified, or rejected by the court. g. WCDSS will need to follow the case for implementation compliance for the period of time ordered by the court. h. RESULTS: Over the last four years we have completed approximately 80 family group conferences. All but one or two have produced a written plan for WCDSS and the courts to consider. The average conference meeting lasts four to five hours. The preparations for the meeting have included in almost all cases discovery of additional relatives willing to adopt one or all of the • children needing placement because of the anticipated loss of parental rights in the foreseeable future. 85-90% of the cases have major components of their plan adopted by social services and the courts as best we can determine. A majority have their plans adopted in full with minor changes only. A paper presented at a national conference on FGDM last year by Dr. Joyce Ackerman identified components of perceived success in relation to the structure of the Family Group conference based on this model. Family members have been included across the US and in Mexico and in several cases international considerations for the child placement were involved in the conferences. Use of telephone conference calling has limited costs. Use of secure facilities such as the jail conference room has allowed participation of incarcerated parents in the process and permitted parents who would have otherwise bee unable to do so the ability to participate 4 in the decision making about foster placement or family adoption of their own children. Target/Eligibility Populations A. Total number of clients to be served in this twelve month program has been calculated as follows. Four families per month times twelve months equals forty-eight families per year. If we assume a nuclear family size of five, two adults and three children, then the total client pool to be served is 240 individuals. If we add to the five extended family members for each parent this adds ten to the conference and 480 to the yearly total which is now 720. Is we assume there are at least five professionals associated with a case the adds an additional 240 per year for a total of 960 people. This projects a typical family group conference as consisting of 20 people plus the two facilitators. Our average family group size last year was 14. This would be a projection of about 650-700 individuals at conferences if the four families per month were attained. Depending on the ages of the children, they may or may not be present. The above calculation assumes we are dealing with a "single nuclear family pattern". The assumption has often proved invalid. Most families have been divorced and are blended families, some divorced more than once. Some will involve teens or adults who had children with different partners outside of the legal relationships of marriage and involve complexities as to who should be attending. Some will involves grandparents or often other more distant relatives who desire custody. B. Distribution of clients. Total number of clients we will serve is approximately 60 index children or more as calculated above. Our experience suggests that for the nuclear family we would expect approximately 120 of these would be adult members of the family and approximately 150 would be minors. The age distribution of the children would tend toward the very young children in expedited permanency planning and to older children in PAC referrals. A family group conference in a case of alleged criminal abuse that has not been adjudicated or of ongoing spouse abuse or incestual sexual abuse that has not been admitted to needs to be considered on a case-by-case basis. It is not the purpose of the Family Group Decision Making process to determine guilt or innocence of any party in an alleged criminal 5 act. If all parties in the family can understand this, the Family group Decision Making conference can occur (and several of this type have taken place). It is the purpose of the process to protect the child. No matter what has occurred in the family as to the allegations and the outcome of any criminal adjudication, the production of the family's recommendations as to the protection of the child is the primary purpose of the family Group Decision Making process. We have learned that our initial guarded impression of a case's potential for success in a family conflict resolution situation, based on the written record, has often proved to be pessimistic. It appears that where intensive family interaction is concerned as in Family Group Decision Making conferences, that an analysis of the written record alone often undervalues surprising problem solving strengths of even very dysfunctional families. C. Families Served. We would anticipate serving sixty family units. All the family Group Decision Making Conferences will involve extended family members who might be considered a separate family unit. For simplicity, we count the referred family and its entire extended family unit as one family unit. D. Sub total who will receive bicultural/bilingual services. We have two Hispanic members of the staff (Emily Jaramillo, M.A., L.P.C. and Evelin Gomez, Ph.D., L.P.C.) who are fluent in Spanish. One of the facilitator's (Joyce Shohet Ackerman) doctoral work was on Hispanic patient's mental health treatment patterns compared to Anglo patients in Weld County. She also has four years of direct cross cultural experience with an American Indian population. We anticipate we can serve up to 100 percent of the total referred in a bicultural manner. We have been able to and will continue to provide bilingual services for any family who needs them. As to the final document for the court, it can be formulated in Spanish. However, an English translation of the document must also be prepared at that time if the family has bilingual members present. The reason for this is to avoid future disputes over translation. E. We can provide services in South Country if Social Services can provide a site to do such work. Family Group conferences are always run in an evening to avoid disruption of family work schedules for the large number of relatives who need to attend. 6 The may assist South Country families in scheduling without interference with work schedules. F. Accessibility. On weekdays all providers of Ackerman and Associates are accessible through 24 hour answering service and pager system. On weekends, the 24 hour access reaches the provider on call all of whom are Ackerman and Associates' providers. G. Maximum per month. The program maximum is five families per month. H. The monthly average capacity is four families per month. I. The average stay in the program is a maximum of eight to ten weeks. This is from the time of referral to the completion of the Family Group Decision Outcome: The Safety Plan for the index child. Types of Services Provided We will provide services described in the sections above called the Family Group Decision Making model. The basic assumptions that underlie this model are: 1. The people who get most deeply impassioned about a particular case of child abuse are the parents and the relatives of the abused child. 2. The people who have the most investment in protecting this child are the parents and relatives. 3. The people who understand the family structure and hcw decisions get made are the members of the family. 4. Families hold information that social workers and other professionals cannot access. 5. Harnessing forces related to kinship cannot be done by exerting legal authority. 6. There are status structures within families that social workers and other professionals may never know about or fully understand. 7. there are myths, stories, legends and secrets within families that social workers may never know about. 8. Families make decisions behind closed doors regardless of what professionals do or do not do. In terms of the criteria for the PAC process: A. Comprehensiveness Family Group Decision Making does not attempt to proved a comprehensive assessment or diagnosis of the family in a traditional psychotherapeutic model. It does allow the 7 family assisted by the facilitators to develop an offer to the court produced by the family that addresses the placement needs of the child. Like mediation from which it is derived, Family Group Decision Making brings "ownership" of the treatment plan because of the process through which it was developed. Further, it brings obligation to carry through with the plans that have been formulated through a process with participation by all family members. B. Access to other services: The therapeutic interventions that the family specifies in the safety plan that they produce go back to the caseworker and to the Court. The family has flexibility to include on the agreement the services it perceives it needs to implement successfully the actions they specify. The caseworker can then match up these services with the goals stated. C. Team based Treatment: All Family Group Decision Making conferences are co-facilitated at the formal meeting and all have a team of two therapists working with the family. This requires the team to have a detailed level of communication and is designed to jeep the process operating on the projected expedited time line we have set forth. All providers are professionally trained mental health providers in their own categories of Psychology, Professional Counselor or therapist. Currently 10 providers, including four psychologists, five licensed professional counselors and one licensed social worker staff Ackerman and Associates. All the providers have extensive experience in family therapy as well as specialty skills that they bring to a conference. One hundred percent of the 60 families projected for 2002-2003 will be treated within a team model. D. Conflict Resolution: The Family Group Decision Making Model is designed specifically to resolve the needs of a child for protection within his or her extended family. In this model, the emphasis is on the word resolution. The extended family will sit together in what may likely be a unique experience. The purpose of the project if for the family to focus its combined effort to resolve a specific problem. The index child would not have come into the Social Services system is there was not underlying conflict or disorganization on the part of the nuclear family. Decisions about how to keep the child out of that conflict will be developed by the extended family members. This is an excellent model for reduction of conflict and provision of resolution in a systematic way. Many people state strong support for family values as a slogan. As a society we have few mechanisms that really allow families as units to use their own 8 value system to solve their own problems. This is indeed one such opportunity for families to do so. Measurable Outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... 1. Did the nuclear family accept the Family group decision Making format and assist in setting up the conference? 2. Was contact successfully made with all specified parties and did those who could not attend provide sufficient information to the conference. 3. Did the family produce a plan to prevent placement or achieve reunification or set up a relative placement that was acceptable to social services and to the court? This data will be extracted from the case file. Summative Outcomes After the Family Group Decision Making meeting, the caseworker follows the family for assurance that the courts recommendations are being implemented. On a quarterly basis after the completion of the family Group Decision Making conference, the status of the family can be measured by social services at that time point. The following four areas should be assessed at about six months after the Family Group Decision Making meeting by the caseworker. A. Did the child receiving services not go into placement? B. Did the families remain intact? C. Was there reunification of children with their families? Did this take place within the nuclear family or within the extended family? D. Has there been an improvement in parental competency and parent child conflict management? Additional questions related to A-D above might include. Was a termination hearing avoided or modified through the use of the FGDM process? Did the index child find a placement in the extended family? Is this the case for siblings of the index child as well? Was a family proposed plan adopted in while or in part by the court? Has the proposed plan been effective over time? 9 • E. Cost effectiveness is very high. The FGDM process also offers the possibility to collect data from the case worker in the form of an estimate of what the length of time this family would have been in placement of there had been no Family Group Decision Making. Based on this estimate and using the rate per month for foster placement costs compared to the cost of our program the projected savings from avoiding foster placement could be estimated. For most of these families where there is a placement within the extended family, the cast majority in our experience to date, the cost of foster care will end for the county. Most families that reach this stage will be kept out of many months (or years) of placement if an acceptable plan can be formulated that will decrease resistance to extended family placement. F. Does the program produce fundamental change in family dynamics? Let's define fundamental changes as those changes that persist for two months after the conference. It would be possible to measure the caseworker's perception of the family in relation to this question. At six months after the conference is completed we expect to see basic change in family dynamics but these will be hard to quantify. Certainly, there are substantial changes in the operating structure of the extended family in relation to the index children of the cases conducted to date. Please do note that we have not budgeted for ongoing evaluation of this project and suggested evaluations would need to be conducted separately from this proposed work. Service objectives We have the following service objectives: A. Improvement of family conflict management Family group Decision Making is specifically designed to resolve conflicts that either precipitated the likely imminent placement of the child or which prevent the reunification of the child with the family. The model teaches the family how to use its own strengths to resolve problems. The Family Group Decision Making process provides a demonstration to the family that even very serious long standing difficulties can be worked out through the modification of the conflict resolution process. B. Improved parental competency In this treatment model Family Group Decision Making should assist the parents in the nuclear family in identifying sources of support and guidance in their own extended family. The help that may be provided by strengthening such a link could include modeling appropriate child rearing strategies in the areas of discipline 10 protection, instruction and supervision. The Family Group Decision Making conference can clarify how other members of the family have handled childrearing practices and age appropriate expectations different members of the family had for their own children. Some of the parents need the FGDM process because they are having their parental rights terminated and a relative of the index child may be appropriate to assume these parental responsibilities. In these cases it is not a question of improving the competency of the biological parent. Rather the family is selecting (subject to acceptance by WCDSS and the courts) a more competent relative (or external placement) to assume the permanent nurturing roles the biological parent has failed to provide. C. The ability of the family to access resources is enhanced by the Family Group Decision Making process. The need for a specific service should become apparent as the family develops the strategy to resolve the immediate conflict. When that need is written down as a component of the offer for resolution, it can be followed up by the courts and the caseworker. The strength of the Family Group Decision Making process is the identification by the family of the resources they need to gain access to. Families that need further assistance in implementing the goals that are set can be referred to the GAP program or other resources to assist in implementation such as life skills programs. The methods used to ascertain if the service objectives have been met would be through a report by the caseworker at sic months after the completion of the Family Group Decision Making conference. Workload Standards A. The program has a capacity of five families per month. This is approximately one hundred twenty five hours of therapist time per month. There are several therapists available for this program. Note that there is a need to continue to allow an exemption for the program in terms of the Face-to-Face rule usually within the PAC programs. While there are approximately 10 hours of face-to-face work there are at least fifteen hours of direct data gathering and planning of the Family Group Decision Making structure that should be counted as direct service and not as indirect time in this model. The Family Group Decision Making model relies upon telephone contact and written or faxed follow up. There are a large number of participants (at least fifteen in the meeting on average). The need for telephone data gathering is also crucial for individuals of the extended family who live large distances away from Weld County. Telephone contacts have included California, Utah, Washington, New Mexico, Arizona, Nebraska, Kansas, Wyoming, South Dakota, Florida, and other states. Extensive contact around Colorado including the western slope and 11 southern Colorado has occurred by phone. Work has also occurred by phone with Mexico. These costs are built into our administrative portions of the bid. Occasionally a conference call is used to include members of the family from long distances in the formal meeting. This is cost efficient as it reduces travel costs but we request that this item be passed through as a reimbursement expense. We document the call through specific phone bills related to the conference meeting. B and C. there are ten providers who staff Ackerman and Associates. Joyce Ackerman, Ed.D., who supervises the contract is certified as a mediator. This group will have conducted about 80 Family Group Decision Making conferences before June 1, 2002. D. The modality of treatment is the Family group Decision Making model described under the design section. A disclosure for all participants in this process and other support documents are available upon request if the reviewers wish to inspect them. E. Hours/month The total number of therapist treatment hours is 25 per family. This totals to 100 hours per month for four families pre month. A total of 1200 hours per year is projected. F. Staff There are 10 individual providers supported by two office professionals in the practice. G. Supervisor The contract would be supervised by Joyce Shohet Ackerman, Ed.D. who would monitor the project for compliance. Staff Qualifications A. and B. Staff Qualifications Ten staff are available for the project. They exceed the minimum qualifications specified as documented below. The staff are: Joyce Shohet Ackerman, Ed.D., Licensed Psychologist and mediator; Emily Jaramillo, M.A., L.P.C., Karen Bender, M.A., L.P.C., Nicole Warnygora, M.A., L.P.C., Sherri Malloy Ph.D., Licensed Clinical Psychologist; Susan Bromley, Psy. D., Licensed Psychologist, Cassie Yackley M.S., L.P.C., Valerie Larson M.S.W, L.C.S.W., and Evelin Gomez, Ph.D., L.P.C. and Laurence Kerrigan Ph.D.. We anticipate the key staff in this program to be Ackerman, Jaramillo, Malloy, and Gomez with utilization of other providers either in specialized roles of in Family information gathering. C. Training The staff has extensive training in family therapy and mediation as documented by their extensive work experience. Collectively, the ten providers have held licenses in their field for a total of more than 50 years. Resumes are available if desired. 12 Specific training has been taken by Ackerman in the Family Group Decision Making model. In addition, we are the current contracted providers of Family Group Decision Making conferences for expedited permanency planning. We also have an additional two years of experience in non- expedited cases through last years contract. Dr. Ackerman has recently been active in professional discussions on Family Group Decision Making staff on behalf of the American Family Group Conference Association as an officer of AFGCA. The is mentioned as documentation we are providing leadership in this field. D. 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. These continuing education requirements arise from other contractual arrangements. E. Supervision All providers are independently licensed and not required to have clinical supervision. All the staff have advanced skills in intensive family therapy. The supervisor, Joyce Shohet Ackerman, Ed.D. will monitor the specifications made in this proposal. F. Supervisor and continuing education. The supervisor of the project is involved in ongoing training to keep current with her profession through advanced workshops and seminars and as a member of the Colorado Counsel of Mediators and the American Psychological Association and through presentation at an International meeting on FGDM in June 2000 as well as professional activities in FGDM already described. Unit of service rate computation We have chosen to offer a rate of $84 per hour of total time per therapist, nearly the same rate as for 2001-2002. As in prior proposals and with the consent of the county we have capped the amount we can bill for any conference. Our proposal for that cap for 2002-2003 is $2100 regardless of the size of conference of the length of work beyond 25 hours required. This is the nearly same rate as the last two years. (which was at $80 per hour) Conferences which are canceled or are very small and do not need to justify the full capped fee will be billed for time expended at $84 per hour for hours used when less that 25 hours are used The rate of compensation is $48.00 per therapist per hour and $36 indirect cost per hour for an hourly rate of $84. Our usual rate for services is $104 per hour. Note that the County through special action of the County Commissioners has removed the restriction for all contact being face to face for this unique program. The costs are calculated as based on actual time of 13 • interaction with family members either face to face or by telephone. This is necessary because of large distances by which the extended family is often separated and by the nature of this process itself. The costs of avoiding continued long term foster placement, which are offset when appropriate within extended family placements are made make this a highly cost effective program. Budget Justification Each Family Group Decision Making conference uses up to twenty-five hours (per family unit) of therapist time. We use the figure of 40 conferences per year to generate the total hours of the project, which equal 1000 hours. 1000 hours times $84 equals $84,000 as the maximum budget for the project. Our actual capacity is 60 conferences but need does not seem this high at the present in Weld County. A more probable figure based on our past two years of experience would be 20 meetings at $42,000 per year. The 60 conference figure within the proposal is included in the event that the county and the courts move toward a more usual use of this model (compared to national trends) as being used more frequently in social services cases and being used as early in the process as it appears that a contingency plan must be in place in case the parents fail treatment. Our per hour rates are below those reasonable and customary for providers of the level and training assembled in this proposal. We are voluntarily selling a cap of twenty-five hours of billable time for each unit. 14 Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission (Core) Funds Type of Action Contract Award No. X Initial Award FY02-CORE-01007 Revision (RFP-FYC-02007) Contract Award Period Name and Address of Contractor Beginning 06/01/2002 and Ackerman and Associates P.C. Ending 05/31/2003 Sex Abuse Treatment 1750 25th Avenue, Suite 101 Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance This program proposes to provide a time-limited, Award is based upon your Request for Proposal(RFP). outcome focused therapy model for treatment of The RFP specifies the scope of services and conditions the non-offending parent,the victim and siblings of of award. Except where it is in conflict with this the victim in sexual abuse cases. The program is NOFAA in which case the NOFAA governs, the RFP proposed in four parts: (each of these parts may be upon which this award is based is an integral part of the used as part of an integrated program, may stand action. alone, or be used in combination with other treatment regimens.)The projected maximum total Special conditions per year is estimated at 36 families, 5 families per month. The average monthly capacity is 2 1) Reimbursement for the Unit of Services will be based on families. The maximum stay is 45 sessions over a an hourly rate per child or per family. 12—month period. Group treatment is provided at 2) The hourly rate will be paid for only direct face-to-face one-half the hourly rate. Bilingual-bicultural contact with the child and/or family as evidenced by services. Services available in South Weld County client-signed verification form, and as specified in the with the provision of a site. unit of cost computation. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. Cost Per Unit of Service 4) Rates will only be remitted on cases open with, and Hourly Rate Per $104.00 referrals made by the Weld County Department of Social Group rate per family $45.00 Services. 5) Requests for payment must be an original and submitted Unit of Service Based on Approved Plan to the Weld County Department of Social Services by Enclosures: the end of the 25th calendar day following the end of the X Signed RFP:Exhibit A month of service.The provider must submit requests for X Supplemental Narrative to RFP: Exhibit B payment on forms approved by Weld County X Recommendation(s) Department of Social Services. Conditions of Approval Approvals: Program Official: By A�� By Glenn Vaad, Chair Judy Gri Directo Board of Weld County Commissioners Wel un D artment of Social Services Date: 05/ 7/9pv� Date: l0 L— • EXHIBIT A SIGNED RFP • INVITATION TO BID RFP„FYC 02007 S 1 Fe DATE:February 27,2002 • BID NO: RFP-FYC-02007 • • 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-02007) for:Family Preservation Program--Sexual Abuse Treatment Program Family Issue's Cash Fund or Family Preservation Program Funds Deadline: March 22, 2002,Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Statewide Family Preservation Program (C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement(C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1,2002, through May 31, 2003, at specific rates for different types of service,the County will authorize approved vendors and rates for services only. The Sexual Abuse Treatment Program must provide for therapeutic intervention through one or more modalities to prevent further sexual abuse perpetration or victimization. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work /l Delivery Date �Rrc.(� 9eo SaM\ fsNaiA_ • - � (After receipt of order) B MUST BE SIGNED IN INK (-+1 . 6-\Qi R ktt me n TYPED OR PRINTED SIGNATURE VENDOR 4Lkprrno), <ni R.,Sain-(� (Name) H Whitten Signature By Authorized Officer or Agent of Vendor ADDRESS 175 0 gr-rk 14 use TITLE /5/4-0 1 .S r Gree1e Co DATE /he-.41- 9-cun- PHONE# 3C3 ' 33(23 - The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 31 RFP-FYC-02007 Attached A SEtUAL ABUSE TREATMENT PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING • FAMILY PRESERVATION PROGRAM 2002-2003 BID PROPOSAL'APPLICATION • PROGRAM FUNDS YEAR 2002-2003 A I BID#RFP-FYC-02007 NAME OF AGENCY: CkPcm.,, cy-,k t7SSactia&-- 1C ADDRESS: I ) SD :)- S t-z 61 vz- J` /0 / &T.ay/¢_„_ C, (roc ) i PHONE:( TA)) 3 S 3 -3 37 3 �Iry CONTACT PERSON: ce 4 tin-- L a I PILE: P-5Y C DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Sexual Abuse Treatment Program must provide for therapeutic intervention through one or more modalities to prevent further sexual abuse perpetration or victlmi7arion 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1.2002 Start End May 31. 2003 End /1 \ TITLE OF PROJECT: S t r fl-4 t /�rp�' Xw P r!bc�. -- le... _ FA, X,-) AMOUNT REQUESTED: P# ? Os 72-('x,O0 f/ Name an Si ature of Person Preparing Document Date Name and igna'ture Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2001-2002 to Program Fund year 2002-2003. Indicate No Change from FY 2001-2002 to 2002-2003 ✓ Project Description V ✓ Target/Eligibility Populations I ' Le Types of services Provided ✓ Measurable Outcomes / --1,_ Service Objectives ,/ J Workload Standards _t Staff Qualifications / I Unit of Service Rate Computation Program Capacity per Month ✓ / Certificate of Insurance 1. Page 25 of 31 RFP-FYC-02007 Attached A • S Date of Meeting(s)with Social Services Division Supervisor: Comments by SSD Supervisor: /at.4 -72 �Gt.« <v c ✓ v�� fil g-c-7Z -cz 7 Lca. c. .--e- c C"--79- — c�-�-, </7 U G% c�VL�.-�c Yom'— 1)--7 ��-r- / ct� ., 7-..,. ,„:1 1� c7 it\ �,�...C7w- c-z!r -7 G C-71---14d--- 711ezc Crt7cC. 1 �lY� <r /s (03— Name and Signature of SSD Supervisor Date Page 26 of 31 RFP-FYC-02007 �.Attached A Program Category Sexual Abuse Treatment Program Bid Cate ory Project Title S F 7-r ^< /r rn • Vendor • 4i kst m nt /}ss o cw PROJECT DESCRIPTION Provide a one page brief description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients to be served. Please describe if your clients are: 1. Victims under age 18. 2. Perpetrators under age 18. 3. Adult incest perpetrators. 4. Non-abusing spouse 5. Relatives(under 18)in the household of incest victims and/or incest perpetrators. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Subtotal of individuals who will provide 24-hour access to services. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Please provide a two page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Comprehensive, diagnostic and treatment planning with the family and other service providers. B. Therapeutic intervention with flexibility to bring in other services if needed. C. Therapeutic services through a variety of modalities including: individual, family, group, marital, data, etc. D. Therapy designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetration, and to prevent further sexual abuse. E. Specialized intake/investigation function for families with sexual abuse allegations. Also,provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. Page 27 of 31 RFP-FY.C-02007 d Attached A W. MEASURABLE OUTCOMES • • Please provide a two page description of your expected measurable outcomes of the project. Please address the following measurable outcomes: A. Reduced rate of recidivism of sexual abuse perpetration within a stated time frame. B. Decrease in re-victimization. C. Prevent victim perpetration. D. A percentage of child abuse incest victims receiving services do not go into placement. E. Improvement in parental competency as measured by pre and post placement functional test. F. More rapid reunification of children with families. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Please provide a one page description of your expected service objectives and quantitative measures. Please address, at a minimum,the following ways the project will: A. Improve Parental Competency- Capacity of parents to maintain sound relationships and appropriate physical and emotional boundaries with their children, and to empower non- abusing parents and victims. B. Improve Family Conflict Management-Mediation and counseling designed to resolve conflicts and disagreements within the family contributing to child maltreatment and sexual abuse. C. Improve Personal and Individual Competencies-Primarily in terms of self-esteem, victim awareness, awareness and management of one's own personal history of victimization, sex education,peer relationships enhancement, establishing appropriate physical and emotional boundaries, assertive in lieu of aggressive behaviors, and assuming responsibility for one's own behavior. D. Improve Ability to Access Resources - Services shall assist parent in learning to obtain help from other sources in the community and within local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Please provide a one page description of the project's work load standards and quantitative measures. Please address, at a minimum, the following areas: A. Number of hours per day,week or month. B. Number of individuals providing the services. Page 28 of 31 RFP-FYC-02007 Attached A art S. C. Maximum caseload per worker in the intake function and in the Sexual Abuse Treatment. D. Modality of treatment • ' E. Total number of hours per day/week/month. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. H. The modality of treatment. I. Insurance. VII. STAFF QUALIFICATIONS Please provide a one-page description of staff qualifications and address, at a minimum, the following: A. Will your staff, including supervisors,who are providing direct services have the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17, and Section 7.000.6,Q, Colorado Department of Human Services. Describe. B. Total number of staff, including supervisors, available for the project. C. Is your agency approved by the Sexual Offender Management Board?Explain your compliance with any mandatory regulating agency. Page 29 of 31 RFP-FYC-02007 Attached A VIII. COMPUTATION OF DIRECT.SERVICE RATE .• This form is to be used to provide detailed explanation of the hourly rate your organization will charge the Core Services Program for tke services offered in this Request for Proposal. This rate may only be used, to bill the Weld County Department of Social Services for direct, face-to-face services provided to clients referred for these services by the Department. Requests for payment based on units of service such as telephone calls, no shows, travel time, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise, billings must be for hours of direct service to the client, regardless of the number of staff involved in providing those services. Therefore, it is imperative that this rate be sufficient to cover all costs associated with this client, regardless of the number of staff involved in providing these services. (Explanations for these Lines are Provided on the Following Page) Total Hours of Direct Service per Client 5J Hours [A] fr‘@,,Q LA c"L) Se t ° („3LTotal Clients to be Served � Pte`(2-2.<) c� p3G Clients (B] Propost— Total Hours of Direct Service for Year / D O Hours [C] (Line [A] Multiplied by Line [B] Cost per Hour of Direct Services $ i' 2 . y0 Per Hour [D] Total Direct Service Costs $ 1 2 3 .s (E) (Line [C] Multiplied by Line [D] ) Administration Costs Allocable to Program $ 'O S %2 [F] Overhead Costs Allocable to Program $ 0 2 7 G [G] Total Cost, Direct and Allocated, of Program$ 2 OS - A0 [H] Line [E] Plus Line [F) Plus Line [G) ) Anticipated Profits Contributed by this Program $ O [I) Total Costs and Profits to be Covered by this Program(Line [H] Plus Line [I] ) $ P-0 5_� c/ 9- O [J] Total Hours of Direct Service for Year i 9? O [K] (Must Equal Line [C] ) Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of Social Services $ 1 O �/ .co [L] Day Treatment Programs Only: Direct Service House Per Client Per Month [M] Monthly Direct Service Rate $ [N] Page 30 of 31 Project Description 2002-2003 Sexual Abuse Family Education and Treatment Program The SAFE-T Program Project Description: Ackerman and Associates P.C. proposes to continue to provide, in 2002-2003, the time limited, outcome focused therapy model for treatment of the non-offending parent, the victim and siblings of the victim in sexual abuse cases. The program is proposed in four parts: (each of these parts may be used as part of an integrated program, may stand alone or be used in combination with other treatment regimens.) A. The development of the prescriptive safety education and treatment plan of the family unit. This will take place over no more than fifteen hours and should average ten hours. B. The implementation of the plan with the non-offending parent to increase safety and avoid repetition of sexual abuse in the family unit. This will take place over no more than 15 sessions. Up to ten of these sessions would be for individual treatment. Up to an additional five of these individual session times could be converted to ten hours of group work. (Throughout the proposal, whenever we discuss group work, note that it will be billed as one hour of individual treatment for each two hours of group treatment). C. Short term treatment for the child who was abused and for the siblings over a maximum of fifteen sessions to develop skills for future safety and to reestablish trust, including family issues that need to be addressed with the children. Each child in treatment, whether the victim or the sibling, should have their own authorization for treatment. D. A protocol of therapy to taper down the frequency of support needed to provide maintenance of skills developed. This will take place over no more than ten sessions designed to be delivered on a twice a month basis over a maximum of five months. This provides an additional support program for those families in need of the service. Based on past experience Parts A, B, and C have been used by WCDSS and D has not been used much. Nevertheless, we submit it here as an appropriate program for potential future use. Note that part D is presented as a separate budget page. For any family who is not appropriate to continue in the treatment model due to severity that will be transferred. Determination of progress in the program will occur at the following review points: 1 Program Review point #1: A report of recommendations for treatment will be completed at the end of part A. It will specify 1. The goals to be achieved in part B and part C, which can then proceed over the next two or three months if authorized 2. What other types of treatment or intervention are appropriate and 3. If no other intervention is recommended. Program review point #2: A report of the summary of treatment as the completion of the treatment plan in part B and part C. The purpose of this report is to answer questions. 1. How much progress has been made to date in relation to treatment plan? 2. Is it probable the family will complete the treatment in part B or part C within the session limits specified and if not what other services might be needed. This will also be the time point that a determination will be made as to if there is a need for an extension of sessions in phase B and C and if so why this is needed. An extension, if needed, will be limited to twelve sessions. Such an extension can occur only though a second authorization. The criteria for making judgments as to the family's progress will be based upon their completion of the prescriptive treatment plan and the adequacy of that treatment plan to protect the child and family from repeat offenses in relation to sexual abuse. Families not making progress will be discussed with the caseworker and as needed referred to other programs. Please note: the end point of treatment is not necessarily intended to be the full and complete resolution of all psychodynamic issues precipitated by the sexual abuse event. Such issues will likely continue to emerge as the child enters different stages of development into adulthood. If further funds are needed for full and complete restoration of mental health (beyond that required for family safety) these funds should be obtained from the perpetrator and or through victim's assistance and other funds. The purpose of this program is to recommend to WCDDS if the incident of the actual abuse has been resolved sufficiently to provide for the ongoing physical and mental health and safety of the non- offending parent, the child victim and siblings at the time of discharge from the program. The purpose of this highly structured system is to assist family members to achieve careful implementation of safety and child protection plans. Through role modeling, psychoeducational group and individual work with adults, through child therapy in individual and on a group basis, families will progress along a structured treatment course. Treatment will move from recognition of the factors that lead to the sexual abuse in their particular case to developing and effective 2 plan to eliminate the resurfacing of these factors and repetition of these kind of events in the future. Specific treatment materials used in other programs of this nature are being added to the treatment plan for 2002-2003 at the request of WCDSS supervisor. Of the four phases of the program, Part A would be limited to 15 sessions delivered over no longer than three months. Part B and C would be limited to fifteen sessions each delivered either separately or concurrently over four months. The step down phase of the program Part D would be limited to no more than 10 sessions over four to six months. Reviews for the need to continue in the program would occur in month one, month three and month five. Families will need the sexual abuse family education and treatment program (the SAFE-Treatment Program) because the sexual abuse and its implications have either 1. Immanently placed the children at risk of outplacement from the non offending parent or parents, 2. Created a need to be reunified or 3. The family is facing imminent reunification failure or 4. Have failed to implement the behaviors required of them. Our model does not treat the adult offender. Where that offender is the parent (usually the father or step father) and reunification is the agreed upon course of action desired. We would only assist the parties in developing a formal reunification plan after the offender has completed treatment in another program and then only in those case we accept based upon out clinical judgment. Our model is expected to work best with younger children and younger teens. It is expected to be especially useful where the non offending parent is herself a victim of sexual or physical abuse in her home of origin, or who has a highly disrupted home of origin from other causes. The program will provide continuity for the non offending parent and the children through each family having a coordinator within Ackerman and Associates. That coordinator will also coordinate the case and be the contact for the case worker and lead the clinical team on the family. The coordinator will also track the goals of treatment and organize the aspects if treatment within our clinical team approach. Clinical teams will discuss each case as necessary. Purpose: The purpose of the time limited, outcome (safety) focused (as opposed to psychodynamically focused) therapy is to implement the changes needed to insure future safety from further sexual abuse. The model assumes a clinical team oriented family systems approach of education and treatment and seeks clearly defined behaviors and outcomes that will insure safety. The role of the non offending parent in the sexual abuse will be explored, looking for points where protection can be strengthened in the future. The life experiences of abuse or neglect of the non-offending parent in the home of origin will be a part of the psychoeducational work that will be necessary by many of the families. 3 In order to develop a treatment plan for addressing the sexual abuse that has brought the family into social services, the first part of the model will be the development of the psychological scope of work that will need to be completed. What are the goals needed to insure future safety? This will be developed through a review of the case, psychological testing if indicated, and assessment of the victim and of the victim's siblings. From there, clearly defined, achievable, structured behavioral changes that are needed to insure future safety of the child will be developed into a written plan. Once signed by the therapist and non- offending parent, this plan will become the treatment goals for the family in relation to the safety of the child. Time lines and work to be achieved by phase are listed below: Part A. the development of the prescriptive treatment plan of the family unit over no more than fifteen sessions with a goal of the program for prescriptive assessment to average ten sessions. The prescriptive treatment plan typically involves interviews with the non-offending parent (up to five hours) three hours of case review, three hours of assessment and interpretation and up to four hours of assessment of other family members. Part B. The implementation of the plan with the non-offending parent to assure the safety and avoidance of repetition of sexual abuse in the family unit over no more than 15 sessions. It is anticipated that ten hours of these 15 sessions can be through group work (at a cost equivalent of five individual hour long sessions) For the non offending parent a mentoring of psychoeducational process of identifying factors that contributed to the abuse and dealing with these factors will be explored. This will be particularly important if negligence or home of origin issues are present. We postulate that a large percentage of the non-offending parents will either have been themselves sexual abuse victims or have come from significantly dysfunctional backgrounds. Such a psychological history would be amenable to this mentoring approach. Part C. For the child victim or sibling, the restoration of trust and safety assurance after the abuse incident itself would be a goal of child treatment. If appropriate and if the offending parent has successfully completed treatment and if the victim and the non-offending parent are appropriate for reunification, steps toward reunification may progress in selected cases. Part D. A step down protocol of therapy for no more than ten sessions designed to be delivered on no more than a twice a month basis for supportive transition from the support program, for those families in need of this service. Other Considerations: There is no risk of the program running costs up to levels beyond those budgeted for any one family because we set a treatment cap for social services funds at a 4 maximum number of sessions, 15 for part A 15 for part b 15 per child for part C. Our experience has been that sections A, B and C have been used and D is not used often. Limitations on service delivery allow only 12 additional hours to be provided in part D. If significant resolution cannot be achieved to assure the safety of the child within 45 hours of competent psychological treatment, other options should be considered to attain that safety. In our opinion it will be very rare for a case to go on for a lengthy period and then fail, as the family will need to make progress sufficient at each review point to continue in the process. Target/Eligibility Populations Total number of clients to be served in this twelve month program has been calculated as follows. Three families per month times twelve months equals thirty six families per year. If we assume a nuclear family size of five, two adults and three children, then the total client pool to be served is 180 individuals. If we subtract from the five family members the one offending parent the total becomes 144 individuals. As a minimum, there will be up to 36 non-offending parents and 36 victim children to be served. We expect the need to be lower than this number and anticipate 18-24 families in treatment over a one year period. We calculated the budget based on one child in treatment in part C, thus each child in treatment in part C will need an individual referral. Distribution of clients. Total number of clients we will serve is approximately 36 index children or more as calculated above. Our experience suggests that for the family we would expect approximately 36 additional of these would be adult members of the family (the non offending parent) and approximately 72 additional siblings who would be minors. Families Served. We would anticipate serving 36 family units or less. We expect 18-24 families is a more likely use rate. Sub total who will receive bicultural/bilingual services. We have two Hispanic members of the staff, Evelin Gomez Ph.D., L.P.C. and Emily Jaramillo M.A., L.P.C. who both speak Spanish. One of the facilitator's (Joyce Shohet Ackerman) doctoral work was on Hispanic patient's mental health treatment patterns compared to Anglo patient's in Weld County. She also has four years of direct cross cultural experience with an American Indian population. All of the staff have cross cultural experience. We expect 50% of referrals can receive services in Spanish and 100% will receive services in a culturally appropriate manner. We have been able to and will continue to provide bilingual services for any family who needs them. We can provide services in South Country if Social Services can provide a site to do such work. However, we anticipate that the majority of the work in this program will be conducted at our Greeley offices. 5 Accessibility. On weekdays all providers of Ackerman and Associates are accessible through 24 hour answering service and pager system. On weekends, the 24 hour access reaches the provider on call all of whom are Ackerman and Associates' licensed mental health providers described in the staff section of this proposal. Maximum per month. The program maximum is three new families per month with a maximum ability to carry eight open cases a month. The monthly average capacity is two new families per month with the average load of five open cases a month. The average stay in the program is expected to be 40 sessions over a six month period. The maximum stay is 45 sessions over a twelve month period assuming one child in part c with parts A and b also being used. Use of part d would add 10 hours to this total. Group treatment would be provided at a rate of one half of the rate for individual sessions so that each two hours of group session treatment would be at the same rate as one hour of individual treatment. There are a number of options WCDSS can use to decrease the cost of this program. For example if assessment is complete prior to referral then part A might be omitted. Part D costs have been less than projected over the several of this project. Nevertheless, we have tried to make best estimates for the average length of stay in our budget. Types of Services Provided The types of services have been described in detail above under project description and purpose sections. They are summarized here. We propose to provide a maximum of 55 sessions of outcome focused treatment over four program subtypes (A,B,C or D) for the victim of sexual abuse, his or her siblings and the non offending parent. Part A offers assessment of the non offending parent and the children in terms of treatment needed and if they would benefit from this program (15 session maximum). Part B is for treatment of the non offending parent (15 sessions maximum) to improve safety of the child in the future, Part C is to treat the child victim (15 sessions maximum) of the abuse and the siblings to improve safety and to establish short term treatment goals for safety as well as to develop a long term treatment plan. Part D is a transition of up to 10 sessions for maintenance of achieved skill in those families requiring this service. Measurable Outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes 6 measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... Family cooperation with appointments and process of treatment in parts A, B C or D form components of the formative review. Did the family cooperate in treatment is a primary formative measure. This data will be extracted from the case file. Summative Outcomes A. To reduce the rate of recidivism of sexual perpetration. This program does not treat sexual perpetrators so at one level this question does not directly apply. However the goal of the program is to prevent 100% of revictimizations by treating the victim and the non- offending parent to alter the family environment and opportunities for revictimization. B. Decrease in revictimization should be substantial and persistent. The program is set up to empower the non-offending parent to identify situations where victimization is likely and to reduce these occurrences. We set a goal of 90% of families who complete treatment will not be victimized in the next two years. This number assumes that after treatment is completed that the non-offending parent does not reenter a marital relationship with the offending parent. We set a goal at 50% at two years post treatment would avoid revictimization if marital reunification occurs with the offending parent occurs in the next year. C. Prevention of victim perpetration. For those victims who complete part C treatment, most will be children who are not sexually active. We expect that for a two year period following treatment victim perpetration will be rare and that 90% of children will not be perpetrators over a two year period following end of treatment. Comments on individual case risk will be made in final reports. D. We expect that 70% of non-offending parents will complete treatment. Of these we expect that 90% will be able to keep their children over the next two years if they do not reenter a marital relationship with the perpetrator. E. Improvement in parental competency: Parameters measured in this area include acceptance of the sexual abuse and the need for restructuring the family environment as well as the client's ability to 7 achieve that goal to prevent such abuse from occurring again. Clinical improvement in this area is the goal of the Part B treatment program and for each client will be reported at the end of treatment. F. While we do not expect more rapid reunification with biological family members (the offending parent), we do expect the acquisition of life skills in anger management and an increase in psychoeducational knowledge. These should lead to risk reduction for a return to an abusive environment. Quantitative measures of these outcomes could be assessed at WCDSS discretion at chart review at two years post treatment by WCDSS to determine if new charges had been reported or cases opened. Individuals who leave the county would be lost to follow up in this mechanism. A more vigorous evaluation method would be preferred but is not budgeted within this proposal Service objectives This proposal meets all the service objectives for the non-offending parent and the victim. The areas for improvement are documented in the quantitative measures that will be rated for the non-offending parent at the review points and at the completion of therapy as listed under the measurable objectives section. These areas include the required components of improving parental competency, improving family conflict management, improving family conflict management improving personal and individual competencies and improving ability and access resources for the non offending parent. Work Load Standards A. The program has a capacity of 5 families per month with an average of 3 per month. The families will receive an average of 45 hours of service as described if parts A, B and C are utilized. B. We have 8 providers for this program. They are Karen Bender, M.A., L.P.C., Nicole Warnygora, M.A., L.P.C., Cassie Yackley MA, LPC, Emily Jaramillo M.A., L.P.C., Sherri Malloy, Ph.D. , Evelin Gomez, Ph.D., L.P.C. Valerie Larson, M.S.W., L.C.S.W. and Joyce Ackerman Ed.D. • Emily Jaramillo, M.A. L.P.C. received her masters in Agency Counseling from UNC. Prior to joining Ackerman and Associates, P.C., she has a wide range of work in mental health including treatment for alcoholic patients and support of minority college students. She is fluent in Spanish. Her undergraduate major was in Criminal Justice and Sociology. 8 • Sherri Malloy, Ph.D. is a Licensed Psychologist specializing in children. She was a supervisor on the Children's Team at the Boulder Mental Health Center. She worked in service delivery in Weld County during the past four years. Her specialty area involves work with young children. • Evelin Gomez, Ph.D. L.P.C. holds a doctorate in psychology and is fluent in Spanish. She has worked with adult perpetrators and in alcohol dependency issues. • Karen Bender M.A. LPC is completing doctoral studies in Psychology and specializes in treatment of adults who have been victims of domestic violence and in the treatment of adults who have suffered sexual abuse. • Joyce Ackerman Ed.D. Psychologist will function as the clinical supervisor of the program. She has 20 years of private practice experience and is listed in the National Register of Health Service Providers in Psychology • Valerie Larson MSW is a licensed social worker who has experience in the residential treatment of sexually abused children. • Nicole Warnygora, M.A., L.P.C. is a doctoral student in School Psychology at the University of Northern Colorado. She will be available on a part time basis for this program • Cassie Yackley MA, LPC is finalizing her doctoral work in psychology and has specialized in family systems approaches to treatment. She has particular skills in community oriented delivery of services. All of our staff are highly regarded by the caseworkers based on feedback we have received from supervisors. The 2 psychologists who complete the staff of Ackerman and Associates serve as back up and support. They are available on call to assist them as well as to consult on intervention strategies on an anonymous case presentation basis. The psychologists are . Laurence Kerrigan, Ph.D., and Susan Bromley, Psy.D. C. Of the up to 36 families the caseload is projected at twenty families with each provider. D. The modality of treatment is individual or group therapy. E. Hours/weeks. The total number of therapist hours is 60 per family over six months, or a total for the budget calculation of 3600 per year based on our projected average. Maximum capacity is the same as this level. The hourly fee is requested at $104.00 as documented in the rate calculation section. 9 F. Staff. There are 10 individual providers supported by two office professionals in the practice as well as a contracted accountant. G. Supervisor. This contact would be supervised and clinically managed by Joyce Shohet Ackerman, Ed.D. who will monitor the project for compliance. The maximum caseload for the supervisor is five families per month. H. Insurance. Ackerman and Associates, P.C. carries one million, three million liability coverage for professional liability on the corporation and its associates and each associate also carries the same level of coverage individually. In addition, Ackerman and Associates, P.C. carries a general liability policy related to accident or injury on our premises through Farmer's Insurance. Staff Qualifications A. All staff members exceed the minimum qualifications needed for this project in both education and experience as described above. B. Staff available for the project are listed above. Unit of service rate computation We have calculated the unit of service rate based in the instructions. We used 2001 data for our agency. Using overall figures for the agency we arrive at a figure of$104 per contact hour. Group rates are billed at one half this rate per hour. The profit for Ackerman and Associates for all programs was approximately 1% for the 2001- 2002 FY The proposed cost is $104 per face to face contact hour. This is consistent with our operating fees for face to face therapy hour as allowed in other protocols we do with WCDSS and provides essentially the same provider fees of$62.40 per contact hour consistent with the goals we set for all contractual relationships for providers. Budget Justification Ackerman and Associates purchases services for accounting through an independent contractor and through Anderson and Whitney to track funds. No special issues are present related to project audit to out knowledge. Ackerman and Associates mediation program was audited in a random audit (conducted by Anderson and Whitney) after its first year of operation with no deficiencies. Audits of the program are conducted on a yearly basis, as required by WCDSS, with no deficiencies noted. 10 Ackerman and Associates, P.C. is a type S professional for profit corporation and not a 501.c.3. Specific standards of responsibility for the 2002-2003 year have been addressed in the body of the proposal. 11 Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission (Core) Funds Type of Action Contract Award No. X Initial Award FY02-CPS-2 Revision (RFP-FYC-PY 02-03 06-000) Contract Award Period Name and Address of Contractor Beginning 06/01/2002 and Ackerman and Associates, P.C. Ending 05/31/2003 Foster Parent Consultation 1750 25th Avenue Suite 101 Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Award is based upon your Request for This program provides foster parent consultative Proposal (RFP). The RFP specifies the scope of services in the areas of(1) consultation and services and conditions of award. Except where it is foster parent support, (2) mandated corrective in conflict with this NOFAA in which case the action consultation, and(3) mandated critical NOFAA governs, the RFP upon which this award is care consultation. The programs will be based is an integral part of the action. provided through individual services in the home of the foster parent or in the office. Group Special conditions training will be provided for a maximum of 12 participants with an average of four participants 1) Reimbursement for the Unit of Services will be based per group. Average stay is 12.5 hours. on an hourly rate per child or per family. Telephone consultations for crisis management 2) The hourly rate will be paid for only direct face to will be available for a maximum of one-half face contact with the foster parent and/or family, and hour per call. This program anticipates serving as specified in the unit of cost computation. 60 family units. Bilingual-Bicultural services. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. Cost Per Unit of Service 4) Payment will only be remitted on foster parents, and referrals made by the Weld County Department of Hourly Rate Per $24.44 Social Services Certified Foster Parents. Group Rate per credit hour $45.00 5) Requests for payment must be an original and Unit of Service Based on Approved Plan submitted to the Weld County Department of Social Enclosures: Services by the end of the 25th calendar day following X Signed RFP:Exhibit A the end of the month of service. The provider must X Supplemental Narrative to RFP: Exhibit B submit requests for payment on forms approved by _X Recommendation(s) the Weld County Department of Social Services. Conditions of Approval BApproval-�G� ,/ PBrogram facial: /�_ Glenn Vaad, (/// Judy A iego, i c/ltoorr` Board of Weld County Commissioners Weld my Department of Social Services Date: o5/a2/7z3 3 Date: OOP L cQOY_>>2-/_il� EXHIBIT A SIGNED RFP INVITATION TO BID PY 02-03 006-00 f H'Ster p+e•-ts DATE:February 27, 2002 BID NO: PY02.03 006-00 RETURN BID TO: Pat Persichino,Director of General Services• 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (006-00) for: Family Preservation Program—Foster Parent Consultation Family Issue's Cash Fund or Family Preservation Program Funds Deadline: March 22, 2002, Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Statewide Family Preservation Program (C.R.S. 26-5.5- 101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement (C.R.S. 26-5.3-101). The Families,Youth and Children Commission wishes to approve services targeted to run from June 1, 2002, through May 31, 2003, at specific rates for different types of service, the county will authorize approved vendors and rates for services only. The Foster Parent Consultation Program must provide services that focus on providing psychological consultations and parenting support to foster parents which are designed to improve foster parent competency, family conflict management, and effectively accessing community resources. 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 MD e a 11:14 (After receipt of order) B]I M JST BE SIGNED IN INK oe httiw-t"ctnkct TYPED OR PRINTED SIGNATURE VENDOR i1+< / czr m«- riSSoc . �� Nm�e (Name) H dwri�.tten Signature By Authorized Of icer or Agent off Vender ADDRESS I '2 Co 'CST /1tf #10 I TITLE /'S,C G^e Grp , 70 DATE 2/V/ / ?HONE # 970 <e (,r 3 33)3 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 29 006-00 Attached A FOSTER PARENT CONSULTATION PRQGRAM BID PROPOSAL AND e• *EQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM . • 2002-2003 BID PROPOSAL APPLICATION • PROGRAM FUNDS YEAR 2002-2003 • BID#006-00 NAME OF AGENCY: A-cite r'"ne` A sseSC / C- ADDRESS: l 7 s°a Sr-i... A.4-e G r Co rots `/ PHONE: f M1 ) 3S 3 3 3 )3 CONTACT PERSON: Yo>/Ce l4cAiLrrrn_ (C. �J TITLE: CsYe -.---t DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation Program Category must provide services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household management competency. parental competency. family conflict management and effectively accessing comrnunity_resources 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1. 2002 Start End May 31. 2003 End TITLE OF PROJECT: AMOUNT REQUESTED: Name Sknature of Person Preparing Document Date N\.�, ft -., ��\ LkC1c�Pmah , c4� . 3/3D-/Oa. Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2001-2002 to Program Fund year 2002-2003. Indicate No Change from FY 2001-2002 to 2002-2003 • Project Description / ✓ Target/Eligibility Populations / ✓ Types of services Provided ' ✓ Measurable Outcomes / Service Objectives V i/ Workload Standards v ✓ Staff Qualifications / ✓ Unit of Service Rate Computation ✓ --iL Program Capacity per Month 7 Certificate of Insurance :/ Page 23 of 29 • 006-00 .7 Wel zi Attached A Date ofileeting(s)with Social Services Division Supervisor: Comments by SSD Supervisor. _• el—hi, r/ dese • eieneeer.e:J 71#14-t71#14-tye Lit,. et L2e )/ ostcrAifi a..1 at:IMAM A•+-st kis tori .l,r., /n.tuvAncted, d re-1/ fV Se-eve Cis 7' w /I 4td, sue,g, p -f2 yd fI /2 s• •f c vsfCr) ch 7rs OP.!. vette /ke pia orosn94 ,'it (,Nrvl tm•e* Rev144J 11 .1. l/aid,tot 4R flit err-My ye?R. ]7.4,E n012 1,4) 602.74.0.4/ Le,ki A crechnvEx t vp/✓�/e teen aece 4c V1J.t/ l au- y ft-as pw Since- I a leRnts' ✓� reknit/it/ RdrNAoat Miry/ t fetRuit ` u O4 r/Re...• ,LM a/�Ro&e'o., 's l.eeer/io-t f-1 erq a 44 s Zee?, A- Mkt ,s t r•1 ` l` Zen, S0� 1 ,as fe pq ae.,16 ll..eeavr .z5 �ov.,�-y - s/� Rid i Name and Signature SS upervisor Date • Page 24 of 29 006-00 Program Category __•Foster Parent Consultation Attached A ' Project Title � tr-r,flea— Ssrrl- Vendor /9-SS o-a.' z Re_ I. ' PROJECT DESCRIPTION Provide a brief one-page description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. The monthly maximum program capacity. G. The monthly average capacity. H. Average stay in the program (weeks). I• Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Consultation and Foster Parent Support around placement issues, behavioral management, foster home issues involving biological children in the home, transition and loss issues,work with foster parents and caseworkers around interpretation and implementation of treatment plans, discipline in the home, group training for foster parents-access to training materials, work with foster adopt pat.nts on legal risk and commitment issues, visitation issues, and solution oriented planning. B. Mandated training for foster parents under corrective action plans and follow-up services as needed. C. Training to satisfy State training requirements for foster parents may be offered though this program within the following guidelines; 1. One training credit per month will be recorded for each critical care foster parent participating in the mandated monthly consultation session, 2. All additional foster parent training will be pre approved by Agency staff; i.e., Foster Care Coordinators or Resource Services Manager. All training will be offered to all Weld County foster parents, whether they are involved in the Consultation Program or not. The flat fee for conducting such training will be agreed upon between the provider and the Agency on a per event basis. Page 25 of 29 006-00 Attached A B. Improve Parental Competency- capacity of parents to maintain sound relationjkips with their children and foster children and provide care, nutrition,hygiene, discipline,protection, instructions, qnd supervision. C. Improve Ability to Access Resources - services shall assist parents'to work with other sources in the community and within the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Provide a one-page description of the project's workload standards and quantitative measures. Address, at a minimum, the following areas: A. Number of hours per day, week or month. B. Number of individuals providing the services. C. Maximum caseload per worker. D. Modality of treatment E. Total number of hours per day/week/month. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. H. Insurance. VII. STAFF QUALIFICATIONS Provide a one-page description of staff qualifications and address, at a minimum, the following: A. Will your staff, including supervisors, who are providing direct services have the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17, and Section 7.000.6,Q, Colorado Department of Human Services? Describe. B. Total number of staff, including supervisors, available for the project. Page 27 of 29 Project Description 2002-2003 ACKERMAN AND ASSOCIATES' FOSTER PARENT SERVICES I. Overview: Ackerman and Associates, P.C. has provided Foster Parent Consultation Services to Weld County over the past five years. We propose to continue to provide foster parent consultative services in the following areas: 1. Consultation and Foster Parent Support concerning: a. placement issues, b. behavioral management, c. foster home issues involving the biological children in the home, d. transition and loss issues, e. assistance in the interpretation and implementation of treatment plans in coordination with foster parents and caseworkers in accord with the requirements of the contract. f. discipline in the home, and including a 24 hour telephone access line for foster parent questions —the Cool Line, g. training for foster parents and access to training materials, including group and individual training for continuing education credits. Also, in selected cases, "Internet Searches" to help identify resources, such as support groups for foster parents with children with specific conditions, provision of in home seminars to deliver workshop services in an effective manner to foster homes, h. work with all foster parents on legal risk and commitment issues, visitation issues and solution oriented planning. i. facilitation of the networking of foster parents particularly in terms of identified subgroups such as group homes issues, issues in common to kinship homes, issues for on kinship homes etc. We will provide such services to those foster parents who voluntarily participate in such services for the benefit of themselves, their children and foster children. 2. Mandated Corrective Action Consultation in the above areas to those foster parents who are under corrective action orders and to provide them follow up services as needed. The services listen in No. 1 above will be provided. 3. Mandated Critical Care Consultation services for identified critical care foster parents. The services listed in No. 1 above will he provided We will provide these programs primarily through group services in the home of the foster parent or in our offices. Group training based on family 1 and foster child needs that arise from specific situations (intensive care homes, group homes, teen foster kids, family interaction issues etc) will be provided for a maximum of twelve participants with an average of four participants per group. Group educational training seminars of a more general nature for continuing education credit will be offered only when such services are not available otherwise. Telephone consultations for crisis management will be available for a maximum of one half hour per call. Yearly maximums per foster parent are set in the proposal to prevent excessive demand for services by any single family unless approved by the clinical director of this program. The focus of service will be targeted or tailored individual and group consultation and psychological support of foster parents Target/Eligibility Populations A. Total number of clients to be served in this twelve-month program has been calculated as follows. There are approximately seventy-five foster family homes under WCDSS sponsorship. Our past work has reached about 40-50% of these homes with one or more contacts per year. We have the capacity to serve more than this number if demand for the services is there, especially in seminars and training. We projected our maximum capacity for last year as seventy-five families and expected 60 families to be served. B. Distribution of clients. On a program by program basis we expect to serve 20 families for pre-approved group training at a site agreeable to WCDSS, about five families for corrective action, and about 30 families for critical foster care group consultation in their homes. Many families will access more than one service. We will set an upper limit on services received by any one family to six hours per month over the year unless approved in writing by the DSS supervisors of the foster parents. C. Families Served. We anticipate serving 60 family units with at least one contact and approximately 40 families with more than one contact, based on our use patterns and the level of trust built with foster families over the past four years. D. Sub total who will receive bicultural/bilinqual services. We anticipate we can serve 100% of families who need these services in a bilingual manner. All of the staff have extensive cross cultural experience. We have 2 Hispanic members of the staff, Emily Jaramillo, M.A., L.P.C. and Evelin Gomez, Ph.D., LPC who are fluent in Spanish. Joyce Ackerman, Ed. D. has spent several years working in American Indian reservation populations and formally studied Hispanic mental health issues in Greeley in her doctoral work. She has practiced in Greeley since 2 1981. Larry Kerrigan, Ph. D. has more than twenty five years experience as a therapist in Greeley working with the Hispanic population through the Weld Mental Health Center. Susan Bromley, M.S.W., Psy. D. is both a trained social worker and a practicing psychologist with extensive experience training students in cross cultural sensitivity. Sherri Malloy, Ph. D., who has bicultural experience at the Boulder Mental health Center also has been doing foster parent support work for the past several years. Nicole Warnygora, M.A., L.P.C., and Cassie Yackley M.S., L.P.C., each have clinical experience with bicultural families and have worked in our foster parent program in the last year. Valerie Larson MSW has experience in family issues and especially in treatment of sexually abused children. Evelin Gomez, Ph.D. L.P.C. has experience in drug and alcohol related issues and in working with sexual abuse and domestic violence perpetrators. Emily Jaramillo M.A., L.P.C. has an undergraduate background in criminal justice, and extensive experience in home based treatment issues. E. We understand there are about a dozen foster families in South County at the present time. Home based consultation in South County will be the normal mode of service delivery and has been available at the level needed for this contract to cover 100% of these homes. If for some reason home based consultation is not appropriate and service delivery at our offices in Greeley is not practical, we can provide services in South County if Social Services can provide a site to do such work. F. Accessibility. On weekdays, all providers of Ackerman and Associates are accessible through our office secretary and through cell phones and pagers. After hours we maintain a 24-hour answering service and page system. On weekends, the 24-hour access reaches the provider on call who is always a licensed Mental Health provider. G. Maximum per month. The program maximum is estimated below by program area Service utilization guidelines Group training or workshops for continuing education 10 hours/ month Individual Consultation in homes 25 hours a month Mandated Training for Corrective Action 5 hours a month Mandated Training Critical Care (individual or group) 30 hours a month Cool line 10 hours per month A maximum of 80 hours of service per month can be distributed across areas of need except for the cool line maximum of ten hours per month. 3 Cool line maximum per contact is one half-hour of billing. No individual can produce more than 10 cool line contracts (5 hours) per year. For individual foster parents in remote areas of the county (more than a fifty mile trip each way to Greeley) cool line services may be expanded above this limit by the program supervisor. No more than 75 hours total per year can be billed to the services provided over the Cool Line. This represents eight cells per family per year as a projected maximum for cool line expenditures. The project monthly maximum for the cool line is 15 hours and we expect to operate at about six hours per month. Monthly patterns are difficult to estimate. The yearly maximum for the contract is set at 960 hours at $90 per hour. In fact, many services in- group are billed at the group rate of$45 per credit hour so three hundred billable hours for group actually represent 600 hours of training. The contract billable maximum for any combination of services is $86,400.00 per contract year. H. The monthly average capacity is 80 hours per month. I The average stay in the program is expected to be between 10 and 15 hours (average 12.5 hours) over the year period for 60 families. The maximum stay is 30 hours over a one-year period except in the mandated corrective and critical care programs, which are not limited. Group treatment would be used at a rate of one half of the proposed rate of this bid so each hours of group treatment would be equivalent to one half hour of individual treatment. Types of Services Provided 1. Mandated Critical Care Consultation services for identified critical care foste- parents. 2. Consultation and Foster Parent Support concerning: a. placement issues, b. behavioral management, c. foster home issues involving the biological children in the home, d. transition and loss issues, e. assistance in the interpretation and implementation of treatment plans in coordination with foster parents and caseworkers in accord with the requirements of the contract. f. discipline in the home, and including a 24 hour telephone access line for foster parent questions —the Cool Line 4 g. training for foster parents and access to training materials, including group and individual training for continuing education credits, h. work with foster parents on legal risk and commitment issues, visitation issues and solution oriented planning. Emphasis in this area includes: How to structure your home to avoid triggering an investigation by preventing accidents. What to look for in a baby sitter, being a foster parent in a regulatory world and similar topics. 3. Mandated Corrective Consultation in the above areas to those foster parents who are under corrective action orders. We will provide them follow up services as needed. A partial list of the types of workshops and seminars we have provided over the last few years follows: Separation and Loss, Understanding Prescription Medications, Discipline, Assertiveness with Systems, Drug Abuse, Eating Disorders, Child Development, Sexual Abuse and Sexual Behavior-What's Normal With Teens, recovery From Prenatal Trauma-What to Expect, Anger Management, Stress Reduction, Parenting Round Tables, Parenting with Love and Logic. We have provided all proposed services, Corrective Consultation Services, and critical care services for five years for Weld County Department of Social Services. For the mandated programs we have developed response standards to 1) insure that we deliver services promptly and 2) report to social services if there is any difficulty in compliance with the corrective actions required. The mandated consultation programs are analogous to home based delivery of services in respect to keeping in close contact with the caseworker or in this case the foster parent supervisor. The consultants will not serve as advocates for the parents or for social services in cases of dispute. Our role with the foster parent is to provide consultation not to conduct assessments to discover the failures of the foster parent or to seek to alter the treatment plan for the foster child. Neither will the consultants serve as a conduit primarily for collecting information for the caseworker about the foster parent in a dispute. As trust is essential to the process, we have worked in and intended to continue to work in an environment of trust with all parties. Hopefully, any dispute can be discussed to find common ground in a meeting with the foster parents, the caseworker, the foster parents supervisor, the case' workers supervisor and the consultant should such instances arise. As contractors, we will not initiate action with the courts on a consultation case. If 5 under subpoena for any reason such that we are required to appear before a court, we will inform the court of this contractual restriction. We will also be obligated to obey the requirements of the court should such a situation arise. We also assure WCDSS as we have in the past that no individual working with Ackerman and Associates and providing therapy to a foster child in a foster home will concurrently provide consultation in that home, thus avoiding any appearance of conflict of interest. We will provide quantitative measures for group courses similar to the format used in Continuing medical Education for medical providers. We will provide a workshop evaluation form for each workshop. We will establish a work plan for individual consultation and show completion of that work plan through documented chart notes. Foster parents will be referred to other resources in the community for provision of services if they need such resources. We will develop a checklist for services that may be of use to foster parents outside of WCDSS funds and include the completed worksheet in each file. A copy will be given to the foster parent and so documented in the chart. A disclosure stating foster parent agreement to participate in these programs will be signed by every foster parent prior to treatment (with the exception of the cool line). Measurable Outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is preceding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... How did the foster family come into the foster parent support program? (voluntary or mandatory)? ' Did the family attend the groups or workshops they signed up for? Did the foster parent complete the evaluation forms? Did the foster parent need the Cool Line?, individual consultation? How many hours of total contact did the foster parent have and how many credits were earned? 6 Summative outcomes A. Was there improvement in household management competency as measured by pre and post assessment? We will use a pre and post clinical assessment based in a therapist rating of improvement for this area. B. Was there improvement in parenting competency as measured by pre and post assessment? For individual consultation, an individual consultation plan will be developed in the first hour and completed and reviewed in the final hour of consultation goals were met. No plans to measure in the group setting (beyond charted notes) are included but a suitable format that meets the needs of WCDSS will be added to the information collected if requested. C. Were Foster parents enabled to better work with other sources in the community and the local state and federal government? Knowledge of resources can be determined from a listing of resources by the participants at the outset and the conclusion of the consultation on a pre post test basis if this data is desired. We will collect this data if so requested by WCDSS. Consultant notes will be routinely used to document changes to any area. D. Did foster parents demonstrate higher skills and competency levels in fulfilling their roles for children in out of home placements? Individualized treatment will be based on change from the initial to the final session as documented in a summary of the consultant's notes. E. Did foster parents meet the needs of their biological children in adjusting to and coping with foster children in their home? Consultant's notes will document work with issues related to the biological children. Service objectives We have the following service objectives: A. Improvement of Household Management Competency By using a checklist for individual consultation, we will ascertain if the parents are requesting assistance in relation to issues related to maintaining a safe household environment. The check list will include the foster parents assessment is assistance is needed in the following areas - household 7 cleaning, household maintenance, budgeting or purchasing. We expect this to be a minor area of work except in families where corrective action may be needed. B. Improvement of parental competency We expect this to be a major area of work with regard to the foster parent's support program. Particular service goals for each foster parent family will be documented in their chart. A summary of the foster parents participation will be made for all months of participation. C. The ability if the family to access resources By using a checklist for families in consultation concerning resources related to specific areas of need, the referrals to local and governmental resources will be documented. In addition, for some for some families an Internet Search will be run to identify further resources to assist them with specific questions if these concerns have not already been answered. This Internet option will likely be of use for families with foster children who have unusual medical or psychological needs. The methods used to document the service objectives will be a comparison of the goals of the individual plan for the family with the progress report completed each month for all families in individual treatment. For those in group treatment, a pre workshop/post workshop form will be used. Examples of these types of evaluation tool are appended to this proposal. Workload Standards A. The program has a capacity of 160 hours per month. The total per year will not exceed 960 hours. We anticipate an average of 60- 80 per month. At each meeting, one therapist is present. This represents 960 hours of therapist/client time per year:tic our rate of $90 per hour, the cost maximum is 86,400 per year. The monthly average is 1.33 hours per family per month if we assume a use of 960 hours of the program by all 60 families over the year. We have structured the bid to include the cool line as the only service that is not face to face. We have set its maximum use per an individual at ten hours total and set its maximum level at 96 hours for the year (a maximum of 10% of the services) or a total of $8640 maximum that can be billed for Cool Line services. This allows one or two cool line calls per year per family as the average. Needs of families in very rural areas for more cool line use, if this becomes a concern, will be discussed with WCDSS. S. There are ten providers —four licensed psychologists, five professional counselors and a licensed clinical social worker who will provide these services. All have specific training in helping to assist individuals in behavioral changes. All have experience in psychoeducational instruction. 8 C. The maximum caseload The monthly total average will be 80 hours. D. The modality of treatment is consultation for primarily group settings with some individual consultation in person or by phone. E. Hours/month The total number of therapist hours is a maximum of 160 per month and a maximum of 960 per year. We expect to operate at about sixty hours to eighty hours per month. F. Staff There are ten individual providers supported by two administrative professionals and an independent contractor accountant. G. Supervisor Joyce Shohet Ackerman, Ed. D., who would monitor the project for compliance, would supervise this contact. Providers are individually licensed and do not require clinical supervision except for on therapist who is being supervised by a licensed psychologist in the practice. The maximum caseload per supervisor is 60 families per year. Caseload monitoring would be through tracking of time per foster parent. H. 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 that meets the required criteria for this application. Staff Qualifications A. and B. Staff Qualifications Ten staff are available for the project. They exceed the minimum qualifications specified as documented below. The staff are: Joyce Shohet Ackerman, Ed. D., Licensed Psychologist; Susan Bromley, Psy. D., Licensed Psychologist (and Social Worker); Emily Jaramillo M.A., L.P.C., Laurence P. Kerrigan, Ph. D., Licensed Psychologist; Sherri Malloy, Ph.D., Licensed Psychologist; Karen Bender, M.A., L.P.C., Nicole Warnygora, M.A., L.P.C., Cassie Yackley, M.S., L.P.C., Evelin Gomez, Ph.D., L.P.C. and Valerie Larson, M.S.W., L.C.S.W. C. Training The staff has extensive training in family therapy and short-term therapy as documented by their extensive work experience. One set of resumes is attached to the original bid. D. 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 9 requirements of other contractual arrangements and are being met on an ongoing basis by members of the group. E. Supervision All providers are independently licensed and required to have clinical supervision. All the staff have advanced skills in family therapy. The contract supervisor will monitor the specifications made in this proposal. F. 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 for major managed care companies as short-term, solution- focused therapy providers in Weld County. By contract, we have provided more than 1000 short term therapy sessions per year for four of the last seven years. Dr. Ackerman manages all short term solution focused therapy contracts for Ackerman and Associates, P.C. Unit of service rate computation We have a usual rate for therapy services of $104 per hour. Since these are consultation services, we are requesting a billing rate per hour of individual time of $90 per hour for individual or couples consultation. Group services will be billed at one half this rate per person as in these circumstances individual credits are being given for continuing education. The overall profit margin for Ackerman and Associates, P.C. for 2001 was 1% of gross revenues. Budget Justification/Standards of responsibility for 2002-2003 bids These rates are reasonable for providers of the licensed level and breadth of training assembled in this proposal and lower than our usual rate based on mental health treatment service rates. Funds are tracked through a computer data base system that allows us to track payments by client and by source of payment. All payment through the contract will be tracked in this manner. An independent contractor trained as an accountant does our tracking. No special issues are presently related to project audit to out knowledge and a random project audit for WCDSS have shown no discrepancies. Audits will be conducted on a yearly basis. Ackerman and Associates, P.C. is a type S professional corporation and not a 501.c.3. 10 006-00 Attached A III. COMPUTATiiDN OF DIRECT SERVICE RATE of This form is to be used to provide detailed explanation of the hourly rate your organization will charge the Core Services Program for the services offered in this Request for Proposal. This rate may only be used to bill the Weld County • Department of Social Services for direct/ face-to-face services provided to • clients referred for these services by the Department. Requests for payment based on units of service such as telephone calls, no shows, travel time, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise, billings must be for hours of direct service to the client, regardless of the number of staff involved in providing those services. Therefore, it is imperative that this rate be sufficient to cover all costs associated with this client, regardless of the number of staff involved in providing these services. (Explanations for these Lines are Provided on the Following Page) Total Hours of Direct Service per Client /6 Hours (Al Total Clients to be Served ( P0.-4.24.0 p�'0 Clients [B] Total Hours of Direct Service for Year ( (o O Hours [C] (Line [A] Multiplied by Line [B]Cost per Hour of Direct Services $ J /u Per Hour [D] Total Direct Service Costs $ / 87 4/0 (E) (Line [C] Multiplied by Line [D] ) G L Administration Costs Allocable to Program $ a j O [F] Overhead Costs Allocable to Program $ S,y [G] Total Cost, Direct and Allocated, of Program $ F‘ 4(v D [H] Line [E] Plus Line [F] Plus Line [G] ) Anticipated Profits Contributed by this Program $ 0 [I] Total Costs and Profits to be Covered by this Program(Line [H] Plus Line [I] ) $ ffq` Y o O [J] Total Hours of Direct Service for Year / 60 [K] (Must Equal Line [C] ) Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of q Social Services $ 70,00 [L] Day Treatment Programs Only: Direct Service House Per Client Per Month [M] • Monthly Direct Service Rate $ [N] Page 28 of 29 Hello