HomeMy WebLinkAbout20021829.tiff RESOLUTION
RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD AND AUTHORIZE
CHAIR TO SIGN - LUTHERAN FAMILY SERVICES OF COLORADO, INC.
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 a Notification of Financial Assistance
Award 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 Lutheran
Family Services of Colorado, Inc., commencing June 1, 2002, and ending May 31, 2003, with
further terms and conditions being as stated in said award, and
WHEREAS, after review, the Board deems it advisable to approve said award, a copy of
which is 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 Award for the above listed program 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 Lutheran Family Services of Colorado, Inc., be, and hereby
is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said award.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 10th day of July, A.D., 2002, nunc pro tunc June 1, 2002.
BOARD OF COUNTY COMMISSIONERS
WELD COUNT , COLORADO
Eil
ATTEST: faughti net)
GI Vaad, Chair
Weld County Clerk to 030'4 c '
te,f
QQ David E. Long, Pro-
BY: •
Deputy Clerk to the Bo
M. J. Geile
DAST
1(.1. is H Je ke
County Attorne 1 ly
Robert D. Masden
Date of signature:
0 0' SS /67 6 S1 20 SS0029
46411(t.14;44 DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
1 IWEBSITE:www.co.weld.co.us
and Public Assistance(970)352-1551
a MEMORANDUMAdministration
II
Child Support(970)352-6933
O: Glenn Vaad, Chair Date: July 8, 2002
COLORADOBoard of County Commissioners
FR: Judy A. Griego, Director, Social Services \\ ( (---NLOp
RE: Notification of Financial Assistance Award with Lutheran Family
Services of Colorado, Inc.
Enclosed for Board approval is a Notification of Financial Assistance Award (NOFAA)
with Lutheran Family Services of Colorado, Inc. The NOFAA was approved by the
Weld County Families, Youth, and Children(FYC) Commission for Board approval.
This NOFAA was discussed at the Board's Work Session of July 8, 2002.
The major provisions of the NOFAA are as follows:
1. The term of the NOFAA is June 1, 2002 through May 31, 2003.
2. The Department agrees to reimburse Lutheran Family Services up to $100,000 per
year at an hourly rate of$107.00 with a full home study at $850 per study and an
updated home study at $425 per study.
3. Lutheran Family Services will provide home studies with families under the Child
Welfare system and relinquishment counseling.
If you have any questions, please telephone me at extension 6510.
2002-1829
Weld County Department of Social Services
Notification of Financial Assistance Award
for Child Welfare Regular Administration& EPP Funds
Type of Action Contract Award No.
X Initial Award 02-CPS-21
Revision (RFP-06-000)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2002 and Lutheran Family Services
Ending 05/31/2003 3800 Automation Way, Suite 200
Fort Collins, CO 80525
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial •
Assistance Award is based upon your Request for
Each home study is "worth" 18 hours and will Proposal (RFP). The RFP specifies the scope of
be spread over a four-week period of time for a services and conditions of award. Except where it is
weight of 4.5 hours per week. Relinquishment in conflict with this NOFAA in which case the
counseling will be provided on an hourly basis. NOFAA governs, the RFP upon which this award is
Estimated time for relinquishment counseling is based is an integral part of the action.
three hours of direct service per person. Special conditions
Bilingual and South County services available. 1) Reimbursement for the Unit of Service will be based
Fee includes background checks and necessary on a rate per home study; home study update, and
interviews for a two-parent family. relinquishment counseling session.
Cost Per Unit of Service 2) Reimbursement requests must be an original with an
original signature from the provider and/or designee.
Hourly Rate Per $ 107.00 3) Reimbursements requests must include the date the
Full Home Study $850 home study, update, or relinquishment counseling was
Updated Home Study $425 completed.The request must reflect the referral
number assigned to each home study, the amount
Unit of Service Based on Approved Plan billed for each home study, and the month the service
was provided.
Total expenditure for program during term of 4) Payment will only be remitted on referrals made by
contract is limited to One Hundred Thousand the Weld County Department of Social Services.
Dollars ($100,000). 5) Requests for payment must be an original submitted to
the Weld County Department of Social Services by
Enclosures: the end of the 25th calendar day following the end of
X Signed RFP:Exhibit A the month of service. The provider must submit
Supplemental Narrative to RFP: Exhibit B requests for payment on forms approved by Weld
Recommendation(s) County Department of Social Services.
Conditions of Approval
Approvals:a/ Program Official:
rit
By ilit t By ,�_ �� Q --Glenn Vaad, Chair Judyrh,,irector1Board of Weld County Commissioners WeldDepartment of Social Services
Date: "7-IC OO Date: 71 ( 2--
Rcc2_/g-74
INVITATION TO BID
DATE:May 22, 2002 BID NO: 06-000
RETURN BID TO: Pat Persichino, Director of General Services
915 10th Street, P.O. Box 758, Greeley, CO 80632
SU1v1MARY
Request for Proposal (RFP-FYC 06-000) for: Adoption, Foster Care, and Expedited Permanency
Planning Home Studies, and Relinquishment Counseling
Deadline: May 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 pursuant to Colorado Statute and the Weld County Home
Rule Charter. The Families, Youth and Children Commission wishes to,approve services targeted to run
from July 1, 2002, through May 31, 2003, at specific rates for home studies,home study updates, and
relinquishment counseling services. The County will authorize approved vendors and rates for services only.
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 �„�j�(yjl
(After receipt of order) B MUST BE SI D IN INK
Sharon K. Thomas
TYPED TED SIGNATURE
VENDOR LUTHERAN FAMILY SERVICES OF COLORADO
(Name) written Signature By thorized
Officer or ent of Vend
ADDRESS 3800 Automation Way, #200 TITLE PRESIDENT CEO
Fort Collins, CO 80525
PHONE# (970) 266-1788 DATE 09 l'
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 36
RFP-FYC-06-000 Attached A
HOME STUDY, UPDATE, & RELINQUISHMENT COUNSELING BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER CASE SERVICE AND EPP
SERVICES FUNDING
2002-2003 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2002-2003
BID #RFP-FYC-06-000
NAME OF AGENCY: LUTHERAN FAMILY SERVICES OF COLORADO
ADDRESS: 3800 Automation Way, Suite 200, Fort Collins, CO 80525
PHONE: ( 970) 266-1788
CONTACT PERSON: Julie Box 111'LE: Program Supervisor
DESCRIPTION OF HOME STUDY PROGRAM CATEGORY: Adoption,Foster Care, and Expedited Permanency Planning
Home Studies in compliance with the uniform format utilized by the State of Colorado Department of Human Services since
October 1, 1999 (Attached A).
12-Month approximate Project Dates: _ I2-month contract with actual time lines of:
Start June 1,2002 Start
End May 31, 2003 End
1TILE OF PROJECT: Home Studies/Relinquishment Counseling
Sharon K. Thomas
Name and Signature of Person ' =.ari' • Document Date
James D. Barclay ��
Name and Signature Ch' • dmmiis Live O'leer Appl' ant Age y Date
PRO' .SAL RE,UIREMENTS
For new bids,please initial to indicate that the followin• equired sections are included in this Proposal for Bid.
Project Description
jaSTarget/Eligibility Populations
4ilTypes of services Provided
Measurable Outcomes
_gtService Objectives
Workload Standards
Staff Qualifications
Unit of Service Rate Computation
ogram Capacity per Month
W. Certificate of Insurance
Page 25 of 36
June 12, 2002
Core Services Proposal
Home Studies, Relinquishment Counseling
Lutheran Family Services of Colorado
I. PROJECT DESCRIPTION
Lutheran Family Services of Colorado(LFS) is a community-based agency with an experienced
staff that offers a wide range of services to children, families and adults. It is a non-profit agency,
which has provided human services to Colorado since 1948. Although the agency was
established as an affiliate of the Lutheran Church, it is an equal opportunity agency that provides
services to all individuals without consideration of religious beliefs, race, ethnicity, sex or
economic status.
Lutheran Family Services has been providing home study and relinquishment counseling services
to Weld County Department of Social Services for about three years. Lutheran Family Services
uses the Foster Family Assessment System developed by ACTION for Child Protection. A
written, narrative home study will be provided to Weld County DSS. All of our staff is currently on
the state vendor list for adoptive home study providers.
Additionally, we have the experience and expertise to provide relinquishment counseling in a
timely fashion.
II. TARGET/ELIGIBILITY POPULATIONS:
The population to be served under this contract includes: families who wish to adopt children
from Weld County Department of Social Services; relinquishment counseling for parents who are
considering relinquishing children; applicants for foster care certification; kinship care families;
and, children identified as expedited permanency planning.
LFS has been providing home study services to Weld County for three years and has never
turned down a referral because we were 'full'. Occasionally there has been a delay in assigning
the study, due to the need to complete other studies first. We assign cases based on a
direct/indirect service ratio. The ratio is currently 50% direct, 50% indirect. Home studies are
given nine hours of direct service and nine hours indirect service. One change we plan to
implement is to ask staff to complete their portion of the home study in four weeks (instead of six)
so that we incorporate supervisory review into our time frame of six weeks. All of our clinicians
are cross-trained to provide a variety of clinical services including therapy, clinical case
management, relinquishment counseling or home studies. Therefore, we can assign a home
study to any staff person who has an 'opening' on their caseload. These numbers reflect the work
of one FTE:
A. Total Number of Clients to be served:
Each home study is 'worth' 18 hours and will be spread over a four-week period of time for a
weight of 4.5 hours per week. One FTE (40 hours) could complete 8.8 home studies every four
weeks (every month). One FTE could complete 106 home studies per year.
Relinquishment counseling will be provided on an hourly basis like our other core service hourly
services, ex: Home Based Therapy. One FTE can provide 936 hours of direct service per year.
We estimate the relinquishment counseling takes an average of three hours of direct service per
person. One FTE could counsel 312 individuals.
Lutheran Family Services Home Studies/Relinquishment Counseling
B. Total Individual clients and the children's ages.
The number of individuals and ages of children is completely dependent on the demographics of
the families referred for services. We do not limit our services to families with children of specific
ages.
C. Total family units.
One FTE could complete 106 home studies per year. We are willing to hire additional staff if the
Department demonstrates a sustained need for services.
D. Subtotal of individuals who will receive bicultural/bilingual services
LFS has the capacity to contract for bilingual services and currently has contracts with two bi-
lingual clinical social workers. If they were unavailable at the time the service is needed, we
would have to put the family/individual on a waiting list or refuse the referral. We have not
refused any bilingual referrals this year.
E. Subtotal of individuals who will receive services in South Weld County.
LFS does not limit our services to specific geographical areas so we will provide services in the
Southern part of Weld County as they are referred.
F. Subtotal of individuals who will have access to 24-hour service.
All of the families/individuals we work with have access to our emergency, after-hours service
Each clinician is responsible for giving their contact numbers to the families they are working with.
G. The monthly maximum program capacity.
LFS currently has 8.5 clinical staff in the foster care program, for a total of 663 hours of direct
service per month. If these clinicians only provided home studies that would equal 37 home
studies per month.
H. The monthly average capacity.
We expect that one full time clinician can manage the volume of home studies we have received
this year. At the present rate of referral, we would plan to complete 9 home studies per month.
Average stay in the program(weeks)
Our goal is to complete home studies within six weeks of implementation of the home study. We
are estimating that relinquishment counseling averages 3 weeks.
J. Average hours per week in the program.
Families who are having a home study completed will average 2 hours of direct service per week.
Individuals receiving relinquishment-counseling services will average 1 hour per week of direct
service.
Weld County 2
Home Studies/Relinquishment Counseling
RFP-FYC 06-000 •
Lutheran Family Services Home Studies/Relinquishment Counseling
III. TYPES OF SERVICES TO BE PROVIDED
Adoption, Foster Care and Expedited Permanency Planning Home Studies
Lutheran Family Services uses the Foster Family Assessment(FFA) System developed by
ACTION for Child Protection. This is the format that was taught in state sponsored training. That
format is the format used in the fictitious home study. A narrative home study is produced using
the FFA system. These home studies are 'adoptive quality' and meet the state prescribed format.
There is no difference between adoption, foster care or kinship care home studies. All of the staff
that will complete home studies has applied for inclusion on the state vendor list.
Home study updates will be completed using the FFA System and there will be a reduced fee
charged.
The following background checks will be completed unless otherwise indicated on the referral:
• Fingerprints sent to CBI on Weld County Department of Social Services fingerprint cards,
results will be returned directly by CBI to Weld County DSS. LFS will distribute, collect
and submit the fingerprint cards. The fee for the submission of these cards will be
covered by LFS. If the applicant has lived in the state for less then two years, an FBI
search will be requested. This additional fee will also be covered by LFS.
• Department of Motor Vehicles (results returned to LFS)
• Local county DSS search for open or past cases (results returned to LFS)
• Five reference questionnaires will be sent out with a SASE (results returned to LFS)
• Local police department (results returned to LFS)
• Central Registry (results returned to LFS)
All original background check information will be forwarded to Weld County DSS with the written
home study. A copy will be retained in the LFS files.
Since Lutheran Family Services is a child placement agency we have all of the forms and
processes in place necessary to complete these background checks. Additionally, we can
provide a safety inspection of the home, if requested, at no additional fee to the county.
Relinquishment Counseling Services
Relinquishment counseling services will be provided to all adult individuals referred for this
service by Weld County Department of Human Service as well as to their children age 12 and
older. Services will be provided individually and we will submit a written report and the
appropriate affidavits.
IV MEASURABLE OUTCOMES
The goal for each home study referral is to complete a comprehensive, written home study within
six weeks of initiation of the home study. The outcome will be measured through timely
submission of the home study to the referring caseworker. We will also track the number of home
studies referred that we did not accept and the number of home studies referred and
subsequently cancelled by the department.
Relinquishment counseling referrals will be tracked and measured in the same way as home
studies.
Weld County 3
Home Studies/Relinquishment Counseling
RFP-FYC 06-000
Lutheran Family Services Home Studies/Relinquishment Counseling
V. SERVICE OBJECTIVES
The Lutheran Family Services service objectives are the same as the measurable outcomes, that
is: the completion of quality home studies, updates and relinquishment counseling services. All
home studies will be completed using the state endorsed FFA System and will be reviewed by the
clinical supervisor prior to submission.
Relinquishment counseling services will be reviewed and approved by our adoption supervisor to
insure compliance with all necessary laws and mandates.
VI. WORKLOAD STANDARDS
Please see the previous section "Target/Eligibility Populations"for a detailed explanation of our
workload standards. In summary, cases are assigned based on a direct/indirect service ratio. Our
clinical staff carry a variety of cases including: regular foster care, therapeutic foster care, foster
parent consultation, parent education, clinical groups, home based therapy (family preservation)
as well as home studies and relinquishment counseling. Our supervision standard is one FTE
supervisor for every seven FTE professional staff members. The requested minimum standards
for insurance have been met and documentation provided.
VII. STAFF QUALIFICATIONS
Direct service providers assigned to this program are qualified by one of the following:
• a master's degree in social work or a master's degree in another human service field and at
least two years of pre-or post-master's experience in family and children's services; and/or
• a bachelor's degree in social work or a bachelor's degree in another human service field and
at least six years' post-degree experience in family and children's services.
All staff has expertise in family therapy as demonstrated by specialized training and/or
experience. All staff in this program will be required to secure a minimum of eight hours per year
of continuing education training. All staff will receive weekly supervision from a supervisor
experienced in family assessment and counseling. The clinical supervisor will be required to
secure a minimum of ten hours per year of continuing education training.
We currently have the following staff available to provide direct services in this program:
Patti Martini, LCSW Ann Flynn Crowe, LCSW
Carenine White, MA Shawna Boatman, MSW
Joe Madrid, LCSW Julie Box, MSW
Amy Hatcher, MSW Mary Klopfenstein, BSW
Sharon Thomas, LCSW
VIII. COMPUTATION OF DIRECT SERVICE RATE
Total Hours of Direct Service Per Client 9 Hours(A)
Total Clients to be Served 116 Clients (B)
Weld County 4
Home Studies/Relinquishment Counseling
RFP-FYC 06-000
Lutheran Family Services Home Studies/Relinquishment Counseling
Total Hours of Direct Service for Year 1040 Hours (C)
(Line[A] Multiplied by Line [B])
Cost Per hour of Direct Services 24 Per Hour(D)
(salary, benefits, travel)
Total Direct Service Costs $24.877 (E)
(Line[C] Multiplied by Line [D])
Administrative Cost Allocable to Program $49,532 (F)
Overhead Costs Allocable to Program $37,354 (G)
Total Cost, Direct and Allocated, of Program $111,763 (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 $111,763 (J)
Line [H] plus Line [I]
Total Hours of Direct Service for Year 1040 (K)
Rate Per Hour of Direct, face-to-face Service to be Charged to $107 (L)
Weld County Department of Social Services
This hourly rate is what we will charge for each hour of direct service of relinquishment counseling
provided.
Home studies are charged at a flat rate: for a full home study: $850
for an updated home study: $425
This fee includes the background check and all necessary interviews for a two-parent family. The
assessment of additional adults living in the home will necessitate an additional fee of$250 per
adult.
Additionally, about 20% of home studies referred have subsequently been cancelled through no
fault of LFS. We would like to propose a flat fee of$300 for any home study that was initiated and
where we provided a minimum of 3 hours of direct, face-to-face contact.
IX. PROGRAM CAPACITY BY MONTH
This program is a component of our Foster Care Services Program, which includes foster care,
and family preservation services. As outlined in this proposal, our capacity is based on the
number of staff we have and a direct/indirect service ratio. Clinical staff are trained to provide
services in any of the program components, so there is not a minimum client capacity necessary
to support this program.
We are willing to hire additional staff if we assess that the county is presenting a sustained need
for expansion of our capacity, so there is also not a maximum capacity per month.
Weld County 5
Home Studies/Relinquishment Counseling
RFP-FYC 06-000
RFP-FYC-06-000 Attached A
Date of Meeting(s)with Social Services Division Supervisor:
Comm7SSD Su soa
trn`-"C e--17
iffiN
‘6A7
Name and Signature o Supervisor Date
Page 26 of 36
ACORD CERTIFICATE OF F LIABILITY l_NSUR ONCE= � TQ sD D o;sWDQpyy'
PRODUCER Serial# A3498 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MARSH ADVANTAGE AMERICA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
160 SPEAR STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
SAN FRANCISCO, CA 94105 comv,wv
A GUIDEONE MUTUAL INSURANCE COMPANY
INSURED
COMPANY
LUTHERAN FAMILY SERVICES OF COLORADO - B
363 SOUTH HARLAN,SUITE 200 COMPANY
DENVER, CO 80226 C
COMPANY
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THIS IS TOCERTFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REOUIREAENT,TERM OR CONDITION CF ANY CONTRACT OR OTHER DOCUAENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICES,LIMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CJUMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR DATE(MMADDIYY)DATE RIM/DEWY) LIMITS
GENERAL LIABILITY 1213-263 711/01 7/1/02 GENERAL.AGGREGATE $ 3,000,000
A X COMMERCIAL GENERA-LIABILITY
PROMOTE-CCMPJOPAGG s 3,000,000
�0.NMSMAOE t OCCUR PERSOYKAADVINJURY S 1,000,000
OWNER'S A CCNTRAClOR'3 PROT EACH OCCURRENCE 3 1,000,000
X COUNSELORLIAB. FIRE°WAAGE (Any meIre) $ 1,000,000
- MED EXP (My me person) 3 5,000
AUTOMOBILE LIABAITY
ANY AUTO OERSNEDSNGLE LIMIT S
ALL OWNED AUTOS
SCHEDULED AUTOS (PSGPrem) 3
HIRED AUTOS
NON-OWNED AUTOS BODILY INJURY
(Per acdnmq
PROPERTY DAMAGE 3
rrvars LIABILITY
AUTOONLY-EA ACCIDENT S
ANY AUTO OTHER THAN AUTO ONLY' —
EACH ACCIDENT 3
AGGREGATE $
EXCESS LIABWTY EACH OCCURRENCM $
UMBRELLA FORM AGGREGATE S
OTHER THIN UMBRELLA FORM
3
WORKER'S COMPENSATOR AND weyisrr Im
EMPLOYERS LIABILITY TQYLMRS Ex
EL EACH ACODENT 3
Tlf PA@MEtM/ NaI EL Q`EASE-POLICY LIMIT 3 PMTMRSEXECUM E
OFFICERS ME EXC. EL DISEASE-EA EMPLOYEE 3
OTHER
OESCAMTIpR CF OPNRATKN540CATCNSNEWCLESISPEQK ITEMS
EVIDENCE ONLY
9ROULD ANY OF THE MOW DESCRIBED POLICIES BE CANCELLED BEFORE THE
WELD COUNTY DEPARTMENT OF SOCIAL SERVICES EXPMATTON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
PO BOX A 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
GREELEY,CO 80631 BUT FAILURE TO MALL SUCH NOTICE SHALL IMPOSE NO CBLIGATICN CR LIABILITY
OF ANY KIND UPOI THE COMPANY, ITS AGENTS CR REPRESENTATIVES
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Sample
Home
Study
FAMILY ASSESSMENT AND UPDATE
INITIAL ASSESSMENT: DATE: 6/10/02
RE-CERTIFICATION: DATE:
Family Name: Jay and Tracy King
Clinician Name: Sharon Kesling, MSW
Parent Force
1. History Element: Social History/Background Check, Character and Suitability (Adults) What is
the parents'childhood and adult history? Consider the individual's cultural context in your description.
When updating or re-certifying, describe new or significant information that indicates a change from
previous assessment.
Specific areas include: personal history of abuse, marriages, divorces,births,deaths; issues of grief
and loss, employment; education; physical/mental health; childbearing or infertility; arrests or legal
encounters; relationships (including other races/cultures); number and type of foster/adoptive
placements (CPS,Juvenile Justice, other);placement success or disruption; other information.
Parent#1: Jay Dean King was born on 3/11/64 in Idaho Falls, Idaho. His father was a teacher and
worked summers as a contractor for the Forest Service. His mother was a stay-at-home Mom. They had
six children, and Jay is the third to the oldest. His oldest brother lives in Boulder, and two siblings live in
Idaho and two in California. His parents are still living in Idaho,although the last two years they have
been on a mission in Australia for their church,the Latter Day Saints.
Jay remembers his childhood as being carefree. It involved school, some chores, and playing on the •
acreage behind their home. They had animals,tree houses, and he and his older brother were always
climbing trees. His mother was very active, very positive, and tended to"wait"on the children. Their
home was the gathering place for neighborhood kids, and it felt like a safe environment. He has few sad
or hurtful memories. The two incidents he related involved his father being chewed up by a bear when
Jay was around five years old and his puppy dying when he was around seven.
He recalls his father being busy with work and not able to relax and play. His mother was very attentive,
patient and a good listener. When Jay was in Jr. High, his mother returned to college and got her teaching
degree in Elementary Special Education. Jay was tender hearted and easily disciplined. He can
remember only one spanking because a raised voice was usually enough to stop him.
His extended family is dedicated to their church,family, and to education. Jay went to college in Idaho
and earned a Bachelors degree in Mechanical Engineering in 1990. He met his wife, Tracy, at a church
function in September 1985 while at college. They got married on 5/1/86 in Idaho Falls. Jay finished
school and worked several jobs in Idaho and Utah prior to moving to Boulder, Colorado. His youngest
brother works at IBM and helped Jay find a job at ABC Widget Corporation in Longmont in May 1998.
He is still employed there as a Mechanical Engineer.
Jay and Tracy live in Mead, Colorado, a small community just north of Longmont. They have five
children, ages 13, 12, 10, 8,and 6.
Parent#2: Tracy Kaye(Gardner)King was born 2/19/67 in Salt Lake City, Utah. Her mother got
pregnant with Tracy out of wedlock, and her parents forced her to marry the father. Her mother divorced
him when Tracy was an infant because he was abusive. She remarried when Tracy was on year old, and
he adopted her. Tracy feels that he is her Dad, and she has had only one contact with her biological father
since that time. Tracy's parents had three other children,two girls and one boy. The second to youngest
girl was born with a heart defect and died at 17 months when Tracy was six years old. Since Tracy was
the oldest child, she took on the mother role and blamed herself when her sister died. She cried herself to
sleep every night for three years and developed ulcers. She was able to put some closure to this tragic
2
event when she was 9 years old through a spiritual experience. Tracy feels that this built a strong
personal faith and strength.
Tracy's family moved often. She grew up in cities in Hawaii, Mississippi, Idaho, and Utah, then when
Tracy was 10 years old they settled into a rural community. Her parents now live in Atlanta, Georgia.
Her father is retired from the Forest Service,and her mother is an Insurance Agent.
Tracy's fondest memories are of camping,going to Yellowstone,and visiting her grandparents in Hawaii.
Her saddest memories are when her sister died and during her teen-age years, she did not get along with
her mother. She did not feel loved by her mother. Her mother was easily upset and could be verbally
abusive. School was difficult for Tracy so she worked hard at it, and she had many friends.
Tracy went to beauty college after high school. This is when she saw her biological father. He carne into
the beauty school while she was cutting someone's hair and wanted to talk to her. It upset her a great
deal, and she told him that she did not want to be a part of his life. Tracy worked as a beautician for a
while then her mother had a brain tumor so she went to care for her mother. She and Jay were married
eight months after they met. Their first child was born exactly two years after they married.
Parent Force
2. Adult General Functioning Element: Character and Suitability How does the adult
function with respect to daily management and general adaptation? When updating or re-
certifying, describe new or significant information that indicates a change from the previous
assessment.
Specific areas include: previous emotional problems, mental illnesses, substance abuse issues, or
marital/relationship problems that may have an impact on a child(ren); problem solving capacity/
history, response/reaction to stress, ability to communicate, styles of communication, cognitive
functioning; ability to make judgments/decisions and capacity to/history of follow through; use of
defense mechanisms; levels of self-esteem; awareness of own capabilities and limitations; ability to
control emotions; adaptation to infertility (if appropriate); levels of impulse control; expression of
emotions/feelings/general temperament; attitudes towards people of similar/different races,
cultures, religions; attitudes toward and response to sexual contact between children; homophobia.
Parent#1: Jay describes himself as a lot like his father. He works more than he would like to and wishes
he had more time to spend with his family. He is also like his father in that he is a"teaser". He wishes he
were more patient and attentive like his mother. He believes his family sees him as a"realist"in that he is
always looking for details, obstacles, or practicalities. He seldom gets angry, and when he does his voice
is louder than normal. He is dependable as an employee and is fairly organized. He lives by a"to do"list
both at work and at home.
Although Jay wishes he had more time to spend with his family,he is a devoted father and husband.
Family and church are his priorities. He has no history of emotional problems or mental illness, and no
substance abuse issues or marital problems. He describes himself as a"communications geek"because
he is not confident in his abilities to listen well enough or verbally say exactly what he means. He does;
however, feel he is good at "sizing up the situation or a person"fairly quickly.
He is quite controlled in expressing his emotions and impulses and"tries to convince himself that things
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are fine." When he heard about his son's brain hemorrhage, he was getting on a plane headed out of the
country and received a message to call his wife. He got off the plane and called to discover that his son
was in intensive care. He initially cried then prayed on the plane back home. He and Tracy spent all of
their time at the hospital while extended family and friends stayed with their other children.
Jay is aware of his own capabilities and limitations. He has grown through the tough times, church
involvement, and his relationships with his wife and children.
Parent#2: Tracy describes herself as a problem-solver, "liking to come up with win-win situations".
She believes at times she is too driven and thinks it"bugs"her family and causes stress for herself. She
believes she is similar to her father and mother in that she is optimist and likes to move a lot like her Dad,
but she can also be like her Mom at times and be overly anxious and quick to get upset. This happens
more often if she is experiencing depression.
Tracy has experienced post-partum depression after her first child. She was on anti-depressant for a
while, but has not needed it for the last four years. She described her depression as feeling"guilty about
everything, crying,and not being able to sleep. Jay noticed the depression and is "her gauge". Her last
bout with depression was last winter when one of their sons had a brain hemorrhage. Because they were
not sure he was going to live, she believes she was in shock for a while. She had to give herself
permission to "not do some things". She received support through talking with Jay and her extended
family. In June, she took some classes through her church that helped her recover. This experience is
what motivated her to want to provide foster care.
Tracy has no substance abuse issues or marital problems. She is devoted to her family and loves being
with them. She home schools all of their children and has them involved in many activities. This utilizes
her skill in being"almost too organized". Tracy is expressive of her emotions and feelings most of the
time. She relates that she is also an empathetic listener. She is very sensitive to her limitations and
sometimes "almost apologetic", but she is aware of her strengths and capabilities.
Parent Force
3. Parenting -- Discipline Element: What are the disciplinary approaches used by the potential
foster or adoptive parent, including the typical context? When updating or re-certifying, describe new or
significant information that indicates a change from the previous assessment.
Specific areas include: view of the role of discipline (teaching, punishment, safety, etc.); parenting
practices in the family in terms of expectations, frustrations, supervision,and disciplinary approaches.
Specifically include discipline used with their own children, grandchildren, daycare, etc.; other
information.
Parent#1: Jay related that he disciplines"very carefully". Their family has developed family rules
together, and consequences depend on the child's age and the act. The most severe type of discipline is
a"swat"on the behind while over his knee. He does not do this to inflict pain, but to show the child they
have done something wrong. They always talk afterward. He stated that he rarely gives swats,and the
primary type of discipline is to send a child to a time out to sit and think then to talk afterward.
4
He does not want to come down too hard on his children because he does not want them to feel they have
to be perfect. He believes that his children are very disciplined, and wondered if maybe they are too
disciplined because"no one even tried to sneak a peek at the Christmas presents."
Jay stated that he understands that physical punishment cannot be used with foster children, and he agrees
he will not use it on his own children in front of a foster child. He related that during the pre-service
training when he learned this, he struggled with disciplining his children and foster children differently.
However,through the classes he began to understand why physical punishment would not be appropriate
or effective with a child who has been abused.
Parent#2: Since Tracy is home with the children all day, she disciplines more than Jay. She uses a token
system that she learned through her church. It is very specific about what chores are to be done and
expectations of behavior. The children can earn money or leisure time during the day. Teaching her
children about financial responsibility is a part of the system. Being of service to others can also earn a
child points. She also gives time outs or takes away privileges, such as playing with a certain game or
toy. She feels very confident in her ability to manage her children's behavior,and is patient with teaching
them skills for living. She is a natural asset-builder.
Parent Force
4. Parenting — General Element: What are the overall, typical, pervasive parenting practices used by
the applicant? Do not include discipline. When updating or recertifying, describe new or significant
information that indicates a change from the previous assessment
Specific areas include: knowledge of child development and expectations of children,
parenting/child rearing practices in the family in terms of sensitivity, concern,provision of basics;
comfort with parent role; ability to parent transracial/transcultural child(ren) or with special
needs and/or disabilities; school attendance of all children; parent's school involvement; bonding;
dress, hygiene, general appearance of children; parent's ability to meet children's emotional needs
(time alone with parent, etc.); checking with county departments for any reports of child
maltreatment and investigations; other information.
Parent#1: Jay has knowledge of child development through life experience of growing up in a large
family and currently raising five children. He has high expectations of his children and is willing to
examine those expectations for reasonableness. Respect of others and honesty are two very important
qualities that is the basis to his family interactions. He is very sensitive to his children and concerned
about them. He provides well for their basic needs as can be noted by their home and their children's
general appearance. He wishes he had more time to spend with his children and will most likely feel the
same way about a foster child in their home. Jay would be open to children who are
transracial/transcultural or with children with mild special needs or disabilities.
Weld Co. Department of Social Services is currently checking on any contacts with their department, and
Jay is not listed on the Colorado Central Registry of Child Abuse. He has no criminal history checked
5
through Weld Co. Sheriff's Office and the Colorado Bureau of Investigation. Nothing appeared on his
driving record. Colorado Department of Human Services checked for previous certification and he has no
record.
•
Parent#2: Tracy has extensive knowledge of child development through raising five children ages 0—
13. She has read books and researched topics related to child development. She also has high
expectations of her children and works with them daily to reach those expectations. She is the organizer
of the family and is very busy scheduling school,home, and recreational activities. She enjoys organizing
and it comes natural to her to always be on the go. She and Jay discuss the children each day and take
turns being the primary care taker after Jay gets off work. Her strong belief in family, service to others,
and becoming a productive adult focus her daily efforts. She enjoys being with her family, although she
states that it can be tiring at times. She loves children, is very empathetic about their needs, and is able to
provide a structured environment. Teaching,modeling respect, and honesty are the basic values of all her
interactions with children.
Weld Co. Department of Social Services is currently checking on any contacts with their department,and
Tracy is not listed on the Colorado Central Registry of Child Abuse. She has no criminal history checked
through Weld Co. Sheriff's Office and the Colorado Bureau of Investigation. Nothing appears on his
driving record. Colorado Department of Human Services checked for previous certification and she has
no record.
Child Force
Child 1: Name Bradley Age 13 (enter"0" if no child
exists.)
5. Child Functioning Element: Social History/Background (Child) How does the child
function on a daily basis? When re-licensing, describe significant information that indicates a
change from the previous assessment.
Specific areas include: Parents' Own Children in Placement, Other Children in the Home
Age Appropriate, general temperament, expressions of emotions/feelings, typical behaviors,
presence and level of peer relationships, school performance, known mental health disorders
including substance abuse (organic/inorganic); issues of independence/dependence; issues related to
racial/cultural,identity; other information.
Bradley is the oldest boy in the King home. He stated he is excited about having"more little people"in
their home. He has babysat for his parents and other families at times. He feels that he can be a support
and an example for a foster child. For older children,he would like to help them with school and sports.
With younger children, he would play with them and help them develop their imagination.
He reports that he gets along with his brothers and sisters"better than other families..." He has more in
common with Eli because he is more his age and they enjoy similar interests,except sports. Bradley likes
sports. He argues some with Crystal and hypothesizes that it is because he is the oldest son and she is the
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oldest daughter so they vie for"power". They deal with arguments by walking away or their Mom
"settles it with a compromise or separates." He stated that"Billy gets along well with anyone"and they
joke around a lot together. He described Mariah as "in a phase of arguing"and he either ignores or tells
Mom she's "following him and whining".
Bradley has one good friend in the neighborhood, and 11 friends at church. He believes people usually
like him because he is accepting of others. He plays with friends approximately three times a week. For
fun,he likes to work on the computer,play video games, enjoys country music, and just hangs out. He is
involved in the 6-12 grade Home Schoolers Club that does an activity once a month, sometimes
entertainment and sometimes service to others. His hobbies are guitar and music of which he likes the
guitar the best. He is involved in Boy Scouts and collects GI Joes.
He enjoys being home schooled. He started home schooling in the middle of 2°"grade then he tried
public school again in 7th grade. He did not like public school, especially in the 7th grade where it seemed
like a"whole different etiquette"than he is used to. He described the"shunning of students if they are
not liked by the popular people"as hard to understand other than"it seemed like they were all looking for
social acceptance". His favorite subject is science,and his least favorite is math because it is time-
consuming.
He related that both parents discipline him. He knows when his mother is mad at him because she gives
him a"glare", and Dad talks to him about being disappointed and that he wants him to do a better job. He
added that he has to do something wrong purposefully to make them mad at him. He described the house
rules as the"Golden Rule".
Child Force
Child 2: Name Donnie Age 12 (enter"0" if no child
exists.)
5. Child Functioning Element: Social History/Background (Child) How does the child
function on a daily basis? When re-licensing, describe significant information that indicates a
change from the previous assessment.
Specific areas include: Parents' Own Children in Placement, Other Children in the Home
Age Appropriate, general temperament, expressions of emotions/feelings, typical behaviors,
presence and level of peer relationships, school performance, known mental health disorders
including substance abuse (organic/inorganic); issues of independence/dependence; issues related to
racial/cultural identity; other information.
More reserved than Bradley, Donnie related that he is willing to share him room,books,toys, and include
a foster child in games and activities. He is willing to help them learn how to brush their teeth or just be
there for them. If he didn't know what to say or how to react to something a foster child said or did,he
would ask his Mom or Dad.
He says his family spends a lot of time together. He and Bradley sometime get into"little arguments"
about rules of the games they are playing,but overall, he gets along with all his brothers and sisters. At
7
times things get"bumpy"with his youngest sister because "she'll ruin something he is doing".
He has no friends in the neighborhood, but has friends at church. He has a scheduled play day with
friends one day a week. For fun, he likes to read fantasy books and play Game boy. He has been in Boy
Scouts since he was eight years old and likes it. With the Home Schoolers group, he participates in the
teen activities.
His favorite subject is typing, and his least favorite is spelling. He is home schooled with the rest of his
siblings. If they argue,they take"time outs". Billy's hemorrhage is the worst time he can remember, and
he said"not many things go bad." He sees both parents as disciplinarians, and he can get into trouble for
not doing his chores. He will lose"spare time"as a consequence. He stated that his parents do not
usually get mad and it has to be a big thing. His mother gives him"a look"and his Dad"doesn't show
he's mad". The rules of the house are: "You can't beat up each other and can't eat unless it is snack time
or with permission. He likes being the second to the oldest and looks forward to being the oldest for one
year when Bradley leaves.
Child Force
Child 3: Name Crystal Age 10 (enter "0" if no child exists.)
5. Child Functioning Element: Social History/Background (Child) How does the child
function on a daily basis? When re-licensing, describe significant information that indicates a
change from the previous assessment.
Specific areas include: Parents' Own Children in Placement, Other Children in the Home
Age Appropriate, general temperament, expressions of emotions/feelings, typical behaviors,
presence and level of peer relationships, school performance, known mental health disorders
including substance abuse (organic/inorganic); issues of independence/dependence; issues related to
racial/cultural identity; other information.
Crystal stated she felt nervous at first about having a foster child in the home,but is now looking forward
to it. She would like to share her teddy bear and blanket. She appeared to have a good understanding of
how foster children might feel and why biological parents might mistreat their children. She would like
to spend a lot of time with the foster child and play games with them. Each Monday they have "Family
Home Evening"which includes a family council to work out problems. They also talk, read, and do fun
things together. The first Sunday of the month, one of the children gets to go with their Dad on a"Daddy
Date".
Crystal also explained that she and Bradley are the oldest son and daughter in the family and both want to
be in charge,but they are working on it. She plays a lot with Donnie. Billy and Bradley joke around and
sometimes get annoying. She shares a room with Mariah, and they both have to pick up after each other.
She has friends in the neighborhood, and a good friend at ballet. She is a little afraid of teen-agers unless
they are her cousins or her parents know them. She loves younger children. For fun, she reads,plays
with friends, art,piano, and listens to country and instrumental music. She goes to ballet two times a
week. She is looking forward to the next level,Pointe. She loves art and will do"anything I can get my
hands on: sewing,painting,gluing, etc"
Her favorite subject is reading, and her least favorite is cursive. She likes being home-schooled. She
8
feels like her brothers and sisters care about each other. At times they will do "secret service,"which is
doing something nice for each other with out the other person knowing. They pray together as a family at
night. When Dad comes home,they see who can jump the highest onto him.
Crystal feels that her Mom and Dad are the boss in different areas. Her parents will get mad at them if
they act like a smart alec, and they will tell them to go to their room until they are ready to say they are
sorry. The rules of the house are don't take things from others,take turns with Nintendo (1/2 hr.
maximum), and be careful on the trampoline and swings.
Child Force
Child 4: Name Billy Age 8 (enter"0" if no child exists.)
5. Child Functioning Element: Social History/Background (Child) How does the child
function on a daily basis? When re-licensing, describe significant information that indicates a
change from the previous assessment.
Specific areas include: Parents' Own Children in Placement, Other Children in the Home
Age Appropriate, general temperament, expressions of emotions/feelings, typical behaviors,
presence and level of peer relationships, school performance, known mental health disorders
including substance abuse (organic/inorganic); issues of independence/dependence; issues related to
racial/cultural identity; other information.
Billy stated he is excited about having another child in their family and he wants another child. He
would give them teddy bears,which they have already gotten, and he wishes they were his. He thinks this
would help them feel safe. He will talk to his Mom if things are not going well, but he thinks they are a
good family and will be able to work things out.
He talked about Family Home Evening on Monday nights as fun, as well as,going on trips,taking
pictures, and seeing friends. He joked about liking to jump on the trampoline with his Dad when Mom is
gone. He gets along well with Bradley, unless he goes into "DUB's"room, and sometimes he likes to go
in just to bug him. He says he gets along really well with Donnie. He likes to ease his sisters, but he "is
working on not doing that".
He has two friends in the neighborhood and a lot of friends at church. For fun,he likes to eat, play
Crame boy and legos with Donnie. He has a collection of polished rocks and Pokeman. His favorite
subject is math, and his least favorite is writing in his journal a page a day.
When he is mad or gets into trouble,he goes to his room and plays in his Treasure Chest. He is tender
hearted, and feels that his Mom's firm voice is "yelling". When he gets into fights with his siblings,he
says that "Mom yells and sends them outside and makes them yell"I love you".
He believes that Mom&Dad are both the boss. The rules of the house are: "bedtime at 8:30,can read
until 9:00 pm.; wake up at 7:00 am,get dressed,go downstairs,eat,have fun, quiet time."
9
Child Force
Child 5: Name Mariah Age 6 (enter"0" if no child exists.)
5. Child Functioning Element: Social History/Background (Child) How does the child
function on a daily basis? When re-licensing, describe significant information that indicates a
change from the previous assessment.
Specific areas include: Parents' Own Children in Placement, Other Children in the Home
Age Appropriate, general temperament, expressions of emotions/feelings, typical behaviors,
presence and level of peer relationships, school performance, known mental health disorders
including substance abuse (organic/inorganic); issues of independence/dependence; issues related to
racial/cultural identity; other information.
Mariah stated she was not sure at first about having a foster child in their home, but now she feels
good about it and is excited. She will share her toys and would like to speak Spanish with them. She
like board games. She described her relationship with Bradley as "good", Donnie as "kind of good",
Crystal"good", and Billy"as funny and his teasing is not a problem"for her.
She has one friend in the neighborhood and more friends at church. For fun, she likes to play dress
up, babies, and make castles in the sandbox with Billy. She takes gymnastics and piano lessons. She
is just starting to read.
She describes herself as "funny". She gets mad at herself when she sometimes does stuff wrong. She
gets mad at Bradley sometimes and pushes him then calls for Mom. Mom talks to both of them then
Mom tells her what she did wrong and what she did right. She doesn't feel like she gets picked on.
Her mother will get mad at her is she breaks something on purpose.
The family rules are: "No eating in the family room without a snack rug and don't go into Bradley's
room unless he says it is ok".
Family Force
6. Family Functioning Element: Current Status of the Family, Family System,
Lifestyle How does the family function, communicate and interact? Consider the family's cultural
context as you describe family functioning. When updating or re-certifying, describe new or significant
information that indicates a change from the previous assessment.
Specific areas include: family structure and flexibility; clarity of roles and boundaries (including
roles children), who is in charge, how family decisions are reached, the level and type of
communication used, the presence and use of affection,marital issues, unresolved infertility issues of
couple (if appropriate), presence/absence of family violence, open/closed to trans-racial/trans-
10
culturaUreligious experiences;general feelings/climate within the family; other information.
It is clear for the King's children that their parents are the authority in the home. The roles,
boundaries, and expectations are clear. Tracy related that when she has an important decision to
make she first prays about it then talks to Jay. If it affects the family, they then discuss it with the
children. An example: when they go on vacation she and Jay come up with several options then
discuss it with the children. Jay described a similar process to problem solving. This seems to be an
effective system for them and their family.
There is much communication among all members of the family. It is based on mutual respect and
listening to the other person. The children are prompted when they interrupt another person. Tracy
related that she shows affection toward each child in different ways because each likes to receive love
in different ways. Jay stated that he shows affection toward children by hugs, kisses, and teasing.
Teasing typically works while using it in an affectionate way, but it sometimes backfires when he
uses it when a child is angry or frustrated.
Jay and Tracy's marriage is very stable. They were married in a temple, which in their religion,
signifies a higher level than a church. They made an eternal covenant between themselves and their
Heavenly Father. Tracy describes Jay as "kind, funny, supportive, and spiritual". Jay describes
Tracy as "devoted to kids, fun loving, and determined". If there were anything they would change
about each other, Tracy said "I wish he was more spontaneous. I wish I was more easygoing and not
so demanding of perfection in myself or Jay". Jay related "I would like Tracy to give me more
attention/affection, and for me to care less about it."
There are no unresolved infertility issues and no family violence. They are open to trans-
racial/transcultural children. They would expect a child placed in their home to participate in their
church and church activities since it is such an important part of their family life.
Jay expressed that "Billy's hemorrhage strengthened our whole family. Life can change within
minutes and we want 'No Regrets'. We keep that slogan as our family motto and treat each other
better."
Family Force
7. Family Support Network Element: Child Safety and Well-Being, Availability of
Support System. What is the quality of supportive relationships (formal and informal) outside the
home? Consider the family's cultural context as you describe their support network. When updating or
re-certifying, describe new or significant information that indicates a change from the previous
assessment.
Specific areas include: nature of extended family support; support of unrelated persons (friends,
confidantes); involvement/support of organizations, clubs, churches, agencies; involvement/support
of neighbors,business and social associates; other information.
The Kings have a large extended family in other states. Tracy talks with her mother one time a week.
She recently found out that her grandmother provided foster care at one time, and her mother can still
remember the things she heard from the foster child placed with them. They are supportive of Jay and
11
Tracy providing foster care but want them to be cautious. One of the family members in Jay's family has
adopted. Jay feels that his family is very supportive of the idea of foster care.
Jay's brother lives nearby and he and his family have been supportive, especially when Billy was in the
hospital. They helped take care of the four other children. Tracy's parents also came to Mead to help.
Jay's family did not come out during that time, and that continues to bother Tracy. She doesn't
understand why they did not respond more in their time of crisis. Typically they are a very supportive
family. Jay stated his family made him sad during that time, and stated "the things that I am most
thankful for(family)are also most frustrating."
They are very involved in their church family and receive support from members of the church. The
Home Schoolers Association and their neighbors are also a support system for them. Jay's employer was
very supportive when Billy was in the hospital, and they are aware of their desire to foster.
Family Force
8. Demographic Element: Finances, Home Safety Inspection, Employment,
Community Makeup What are the demographics of the family?Consider the family's cultural
context as you describe demographics. When updating or re-certifying, describe new or significant
information that indicates a change from the previous assessment.
Specific areas include: economic resources; employment; home (additions/remodeling with square
footage); neighborhood and community (include raciaUcultural/refigious integration); health
problems; financial self-sufficiency; stresses related to demographics and how handled (e.g.,
medical, bankruptcy, family moves, household members leaving); other information.
The Kings are financially comfortable,although they are frugal and agree to live on a budget. Their home
is fairly new with two-stories and a finished basement. Square footage is approximately 2500. The
bedrooms are upstairs and the rooms for home schooling are downstairs. They live in a small subdivision
on the outskirts of Mead. Jay describes their home and neighborhood as "fairly quiet with not much
traffic; our home is not." They have a big back yard with two trampolines. Trampoline rules are on file.
The Kings are a Caucasian family that lives in a relatively Caucasian neighborhood in a small, farming
town that is developing as a bedroom community to Longmont and Boulder. It is one of those small
towns where the local police do not allow speeding.
Each family member has had a recent health evaluation with excellent results. Billy will be going back to
Children's Hospital in February for a check-up and more tests. He has had three surgeries since his
hemorrhage. The first one was to save his life and stop the bleeding. The next two were to repair the
capillary that swelled and broke. This was caused by a defect at birth. They are checking to make sure
other capillaries where the arteries and veins connect are not affected. If they are, other surgeries will be
needed. Billy does have a large scar on his head from the surgeries. He does not seem to be self
conscious about it. The hemorrhage happened a year ago and was probably the mostly stressful event the
Kings have experienced. Both parents have worked with Billy in re-learning some things. They have
provided him with speech therapy and occupational therapy,ie. learning to ride his bike again.
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Birth Family Force
9. Viewpoint of Birth Parents Element: How do the parents view child maltreatment, parents
who maltreat their child(ren),parents who place their children in foster care, and parents whose children
are placed by a court in foster care? When updating or re-certifying, describe new or significant
information that is a change from the previous assessment and examine the attitude toward the birth
family and understanding/support of positive relationships and/or memories of birth family.
Specific areas include: training completed or needed concerning the parent's viewpoint
of birth parents when updating or re-certifying, contact with birth parents and learning
gained from the experience; general learning regarding birth parents; other information.
Parent#1: Jay completed all but one session of the pre-service training, Parents as Tender Healers. He
was unable to attend due to a commitment with work. He is scheduled to make up that session this
month.
Jay and Tracy drove from Mead to Ft. Collins for 8 evenings and one Saturday to complete the training.
They stated that while it was tiring, it was very helpful in understanding the dynamics of abusive families
and symptoms of children who have been mistreated. While Jay may have been naive at the beginning of
the licensing process , he "realized that love may not be enough or a child may not be willing to accept
it." He believes fostering will be quite a challenge for them and is open to learning new things. Jay
believes that he is perceptive enough to know what a child needs
Parent#2: Tracy completed all sessions of training. She stated that the pre-service training was very
valuable in understanding the reasons a parent might abuse their children. She also talked with her
children so they will understand better. Tracy believes love is very important,as well as,a lot of contact
with the child. She related that the training was helpful for her individually and as a part of a married
couple and family. She hurts for the children who are abused, and admits she may be overly empathetic
with the child. She believes that having a Clinician come into their home and work with them as a family
once a week is a"good thing".
Birth Family Force
10. Viewpoint of Foster Children Element: How does the parent view children placed in
foster care?Any differences in view based on type/age/race/culture/religion of the child? When updating
or re-certifying describe new or significant information that indicates a change from the previous
assessment.
Specific areas include: feelings toward and treatment of foster children (general, and specific to
their foster children, if updating or re-certifying); training completed or needed concerning
parent's viewpoint of foster children; when updating or re-certifying, consider presentation of
children to community(sensitivity,advocacy); other information.
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12/18/01
Parent#1: Jay loves and enjoys children. He is a Scout Master. He will treat any child like his own,
attempting to keep in mind that a foster child needs time to adjust to a different way of family life. The
pre-service training included extensive information about abused children. Initially, he was quite shocked
that a parent could hurt a child in so many different ways, but has integrated that information into his
understanding of children. He stated"Children often misbehave when they don't understand, other times
to get attention, and other times because they are frustrated because they are not getting their way."
Parent#2: Tracy believes that children misbehave because of"lack of understanding,tiredness, age,
desire to be independent, and sometimes a child just needs a quiet space to gain control. Other times they
need to be held. Other times they need time out." Tracy also was quite surprised at the extent of the
physical and emotional damage a parent could do to a child. From her frame of reference of a loving
mother who loves to be with her children, she struggled to understand how a parent could abuse a child.
The pre-service training assisted her in understanding both the parent and the behaviors that a child may
display due to mal-treatment.
Foster Family Force
11. Preparation Element: How prepared is the family for adoption/fostering?How able is the family
to provide children with relevant racial, cultural, and religious experiences? Include issues related to
visitation with birth relatives and reunification as appropriate. When updating or re-certifying, describe
new or significant information that indicates a change from the previous assessment.
Specific areas include: family's own children's current view of fostering, including jealousy
issues; parents' specific capabilities as related to foster parenting; training completed or needed
concerning impact of fostering/adoption; when re-licensing consider effects of foster parenting
on extended family; attachment to foster children, and feelings about foster children who may
have left the home; other information.
The King children are as prepared as they can be to add a foster child to their family. Jay and Tracy have
talked with them extensively. This reporter has also spent time talking with them about their feelings and
expectations of foster care. They appear genuinely excited about adding another child to their family and
sharing what they have. They are accustomed to sharing their parents with their siblings. Crystal may
have some difficulty if she is replaced as the oldest girl, but she has the strength and desire to work
through any problems. Tracy stated Crystal has the most"heart"for providing foster care.
Jay and Tracy are willing to provide relevant racial and cultural experiences needed by a child. They also
desire to include a child in their family culture.
Foster/Adoptive Family Force
12. Motivational Commitment Element: Motivation for a Child What is the nature and level
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of motivation and commitment demonstrated by the family? Include infertility issues as appropriate.
When updating or re-certfying, describe new or significant information that indicates a change from the
previous assessment
Specific areas include: basis/reasons for motivation/commitment(e.g., status, financial. emotional,
adoption, own needs, service to community. etc.); other information.
Tracy and Jay initially desired to foster because they felt like they have a lot of love to share and love
children. The medical experience with Billy last year has lead them to want to give a home and
protection to a child in need. They are very motivated which was demonstrated by their follow-through
on attendance at training and completion of paper work. They were very open to the home study process
and wanted to make sure their children were prepared. They wanted the process to be a positive,not
negative, experience for them. When the home study interviews were completed, Billy excitedly asked
"when do we get a kid?"
Intervention Force
13. Family Response Element: Relationship with County Department of Human
Services, Agency How capable are the potential parents to use agency involvement and to seek help
on their own? Include willingness of family to seek cross-cultural models and experiences. When re-
certifying, describe new or significant information that indicates a change from the previous assessment.
Specific areas include: communication with agency staff; relationship with agency staff(includes
willingness to receive consultation/advice); relationship with other professionals; ability to share
information; ability to keep information confidential; ability to keep schedules and appointments;
willingness to be involved with birth family (as appropriate); resourcefulness in pursuit of
services; willingness to provide transportation; participation in foster/adoptive parent
activities (e.g., newsletter, foster parent association/support groups, parties/picnics, assist with
trainings, provide/use respite care); other information. When updating or re-certifying also consider
preparation of foster children for removal from home (includes gathering belongings, handling good
byes). Indicate summary of training attended since last certification. Also identify any
rule/contract violations and corrective/action plan if appropriate.
Tracy stated they are very open to a Clinician coming to their home weekly. Her one concern is
scheduling with that person since they are so busy with activities. She is currently trying to decide on an
evening to devote to working with the Clinician. Tracy is quite open with her communication style and
will make her desires and requests known to a Clinician. She will ask for help or state her concerns. She
is very observant of child's behavior and will be able to report to a Clinician and complete the necessary
paperwork. She is very organized and feels she will excel in this area. Tracy is very good at finding
resources for her own children and will do the same for a foster child. She is interested the foster parent
support group,training, and enrichment activities through the Asset Building Project. Tracy will provide
most of the transportation because Jay works from 7:30 am—5:30 pm Monday—Friday.
Jay will be at work during the day, but he is open to working with the Clinician during one evening. The
whole family is open to meeting and discussing whatever needs to be dealt with in an open and
compassionate fashion. They are open to working with birth parents if they are given clear guidelines
and expectations and are willing to work toward reunification. They also might consider adoption if the
right child came into their home and became available.
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Intervention Force
14. Resource Element: Availability of Support Systems What are the resources, external to
the family, which support the placement(s)?Includes ongoing training services and support
groups. When updating or re-cert,ing, describe new or significant information that indicates a
change from the previous assessment.
Specific areas include:the availability of support to the family 24 hours a day, including
agency/staff resources; other information.
A Lutheran Family Services Clinician will be available by pager or cell phone 24 hours a day. In
addition,weekly or bi-monthly consultation will be provided to the foster family by an experienced,
licensed Clinician. They will have access to a food bank, the monthly agency newsletter,monthly
agency-sponsored training and a monthly foster parent support group. Financial reimbursement will be
provided based on the level of need of the child.
Another Lutheran foster family who live in Longmont referred the Kings. That family will also be
available for reference or possibly respite.
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PARENT FORCE CHILD FORCE FAMILY FORCE BIRTH FAMILY FOSTER FAMILY INTERVENTION
FORCE FORCE FORCE
History 3 Child Funct. 4 Family Funct 4 Viewpoint Parent 3.5 Preparation 3 Family 4
Adult general 3 Family Support 4 . Viewpoint Child 4 Motivation 4 Resource 4
Parenting Dcp 3 Demograpic 3.5 Parenting Gen 4
Conclusion
1. Add the ratings entered above in the 14 elements 51
(If no child in home, score "0" on"Child Functioning " in the Child Force)
2. Based on the rating in #1,identity the presence of positive parenting/effective family
functioning or the likelihood of disruption:
a.Very positive family field/No apparent risk (48 to 56) X
The presence of positive parenting and effective family functioning are apparent.There appear to be no conditions of
risk which exist;the parents capability to care for children is adequate.Based on appropriate matching,a child will
likely be/is enhanced by this placement.Indications are that a placement will be/is secure,productive and stable.
b. Generally positive family field/Minimal risk (37 to 47)
Generally,there is evidence of positive parenting and effective family functioning. There are indications that there is a
balance between the capacity,conditions,and needs of the family and the needs of the child There are minimal risks
present;the family is aware of and willing to address the areas of risk.Consideration should be given to continued
matching of the skills and abilities of the family with the needs of the child in order to insure that the child will
continue to be enhanced by the placement.
c. Somewhat positive family field/Low risk (22 to 36.5)
Although there is evidence of positive parenting and effective family functioning,there is an indication that the child
may not benefit/be benefiting from this placement and the placement may be problematic.There may be an imbalance
between the capacity,conditions,and needs of the family and the needs of the child.Consideration should be given to
the most pronounced risks and how manageable or adjustable they are.Documentation in the case record as to these
risks needs to be clear.When updating or recertifying,a support/action plan should be entered into with the foster
family in order to manage the most pronounced risk elements,if they are considered serious enough to address.
d. Negative family field/Moderate risk (11 to 21.5)
Enough negative influences have been identified within the field so that there is a threat that the child will sutfer/is
suffering directly from this placement and the placement may disrupt.There is an imbalance between the capacity,
conditions,and needs of the home and the needs of the child Analysis of the most concerning risks needs to occur.
Clear documentation of these risks is imperative. If a placement exists when updating or recertifying,it is
recommended that consideration be given to removing the children from the home and that the family not be approved
for any future placements.
e. Very negative family field/Significant to High Risk...(0 to 10.5)
It is probable that the child will suffers suffering directly from this placement and the placement will disrupt
Continued or future placements of a child could result in some form of maltreatment to the child The agency needs to
inform the family of the areas of risk influences.All risk influences need to be documented in the case record.It is
recommended that if a placement exists,the child should be removed from the home.The home should not be approved
for any future placements.If ANY children reside in this family,consideration should be given to making a referral for
a CPS assessment
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3. Is there concern for maltreatment or likelihood of maltreatment in this home?
Yes No a
If yes,identify decisions and actions concerning responsibility to refer for a Child Protection
assessment:
4. Is there a concern for disruption/likelihood for disruption in the potential foster/adoptive home?
Yes No
If this foster/adoptive applicant family is currently providing foster care, does the family require
agency support to strengthen skills/abilities to remain a foster family?
Yes No
If the foster/adoptive applicant family is not providing foster care, are there decisions and
actions that can be taken to prevent future disruptions and strengthen the family?
Yes No
If the answer to any of the above questions is "Yes," complete the Action/Support Plan designed
to remedy the disruptive condition(s) or to strengthen the family's skills/abilities.
Evaluation and Decision:
Based upon all materials, interviews, and use of this system,the conclusion of the assessment X
or re-assessment is as follows:
A. Provide a general summary of the strengths and weaknesses of the family, indicating any
categories within the field which raise concerns regarding the ability of the family to parent
children who may be or are now placed in the home.Address the significance of any support plan
that has been offered with regard to certification or re-certification of the family.
Jay and Tracy have been married for 16 years and have parented 13 of those years. Their own experience
raising five children is definitely a strength. They have developed skills in advocating for their children's
best interest and an understanding of what developmental stages are typical. They have also learned to
manage a home with many children,yet have set structure so that each child gets individual attention.
They also seek out time to be together as a couple.
They are committed to bringing a child into their home and offering what they have to give to the child.
They are very nurturing and respectful of each other and their children. They have a strong faith and
believe they are lead to open their home in this fashion.
They are an"emotionally healthy"family and, other than Billy's hemorrhage, have not experienced too
much trauma in their lives. The extent of trauma that a foster child may have experienced in his or her
life may be a bit overwhelming to them. Their children are basically well behaved, and a child that has
chronic behavior problems may wear them out or frustrate them to the point of wondering if they are,
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making a difference. Their children are excited and open at this point, but they will go through some
negative feelings at some point, which may be difficult for the children and for Jay and Tracy. The
family is committed to working through these problems; however, if a child hurts one of the children or
Tracy,this would jeopardize the child's placement. They are protective of their children, not only in a
physical way but emotionally.
B. Indicate your judgement as to the type ofchild(ren) that should be considered for this family.
When updating or re-certifying, consider: with which type of child does the family excel? With which
type of child does the family provide adequate care? Which type of child likely does not benefit from
placement in this family?Describe children in terms of age, race, sex and general functioning.
A child ages 0—5 of either gender should be considered for this family. They will also consider a sibling
group with a young child and an older child up to 12. Jay is concerned about older children's attitude and
their impact on his children. Tracy would prefer to home school a foster child, but she is willing to work
with the public schools if necessary. She is aware that the legal custodian would be the person to make a
decision regarding academic placement. A child who is oppositional defiant, severely unattached, or
assaultive would not do well in this home.
Clinician Supervisor
Date Date
Foster or Adoptive Parent Foster or Adoptive Parent
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