HomeMy WebLinkAbout20021350.tiff RESOLUTION
RE: APPROVE TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR
VARIOUS PROGRAMS AND AUTHORIZE CHAIR TO SIGN - NORTH RANGE
BEHAVIORAL HEALTH
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 two 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 North
Range Behavioral Health, 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) The Littler Center-Day Treatment
2) 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 North Range Behavioral Health, be, and hereby are,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said awards.
CG SS
2002-1350
SS0029
TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS - NORTH RANGE
BEHAVIORAL HEALTH
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 29th day of May, A.D., 2002.
BOARD OF COUNTY COMMISSIONERS
J�/� WELD OUNTY, C LO O
ATTEST:gall
�/� :; b
*� n Vaad, Chair
Weld County Clerk to `8B.-; 0
Davi . L g, Pro-Tem
BY:
i !►!2: /_% , `���
Deputy Clerk to the Boor•�iw.,IV
M. J. eile
PR ED A F RM: ` ^' "O
Ili m H. Jerke
aG ty Attorn y a
Wil—
Robert D. Masden
Date of signature: ��
2002-1350
SS0029
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
I
WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
VI
De
Child Support(970)352.6933
COLORADO
MEMORANDUM
TO: Glenn Vaad, Chair Date: May 22, 2002
Board of County Commissioners
FR: Judy Griego, Director
Weld County Department f Soci6 Servic
RE: PY 2002-2003 Notification of Financial Assistance Awards (NOFAA) under Core
Services Funds-North Range Behavioral Health.
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.
A. Foster Parent Consultation: This program provides education and training for
foster parents and consultation services for foster parents. Monthly capacity is an
average of five foster families at any given time in the Greeley area and one-two
foster families in South Weld County. Each family will receive a minimum of one-
two hours per month. Spanish speaking staff will not be available for this
program until such time that additional staff members are added to the
Multicultural Services Program. The rate is $90 per hour for consultation and
$45 per hour for education and training.
B. Day Treatment:Littler Center, A capacity of 18 residential and 12- day treatment
students. 20 children at any given time annually, ages 5-12, 29.5 hours weekly,
5.9 hours per day,for 36-52 weeks. On-site plans (JEP); i.e., occupational
therapy, speech/language services,physical therapy. Rate is $1,728/month,
$15.03/hourly.
If you have any questions, please telephone me at extension 6510.
of
2002-1350
Page 1 of 1
Weld County Dcpartment 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-0024
Revision (RFP-FYC-06-000
Contract Award Period Name and Address of Contractor
Beginning 06/01/2002 and North Range Behavioral Health
Ending 05/31/2003 Foster Parent Consultation
1306 11th Avenue
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
Education,training, and consultation services for Proposal (RFP). The RFP specifies the scope of
foster parents. Average monthly capacity is 5 services and conditions of award. Except where it is
foster families at any given time in the Greeley in conflict with this NOFAA in which case the
area and 1-2 foster families in South Weld NOFAA governs,the RFP upon which this award is
County. Each family will receive 1-2 hours of based is an integral part of the action.
service per month. Spanish speaking staff not
available at this time, however,will be added at Special conditions
such time that additional staff is added to the
Multicultural Services Program. 1) Reimbursement for the Unit of Services will be based
on a monthly rate per child or per family.
Cost Per Unit of Service 2) The monthly rate will be paid for only direct face to
face contact with the child and/or family, as specified
Hourly Rate(Consultation) $ 90.00 in the unit of cost computation.
Hourly Rate (Education&Training) $ 45.00 3) Unit of service costs cannot exceed the hourly and
Based on Approved Plan yearly cost per child and/or family.
4) Payment will only be remitted on cases open with,
Enclosures: and referrals made by the Weld County Department
X Signed RFP:Exhibit A of Social Services.
X Supplemental Narrative to RFP: Exhibit B 5) Requests for payment must be an original submitted
X Recommendation(s) to the Weld County Department of Social Services by
_Conditions of Approval the end of the 25th calendar day following the end of
the month of service. The provider must submit
requests for payment on forms approved by Weld
County Department of Social Services.
Approvals: Program Official:
By at[ By
Glenn Vaad, Chair Judy Gri ,Director
Board of Weld County Commissioners Wel ounty epartment of Social Services
Date: n5/a9/..aoia, Date: 5)I UI ln—
07002-/350
•
EXHIBIT A
SIGNED RFP
ar
INVITATION TO BID
PY 02-03 006-00
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
(After receipt of order) BID MUST BE SIGNED IN INK
Wayne A. Maxwell, Ph.D.
TYPED OR PRINTED SIGNATURE
VENDOR North Range Behavioral Health 0)44,t,2 elattiateg
(Name) Handwritten'Signature By Authorized
Officer or Agent of Vender
ADDRESS 1306 11th Avenue TITLE Executive Director
Greeley, CO 80631 DATE 03/21/02
PHONE # 970-353-3686
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 29
606-00 Attached A
FOSTER PARENT CONSULT4TION PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
FAMIJS PRESERVATION PROGRAM ;
2002-t003 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2002-2003
BID#006-00
NAME OF AGENCY: North Range Behavioral Health
ADDRESS: 1306 11th Avenue Greeley, CO 80631
PHONE: (970 ) 353-3686
CONTACT PERSON: Paulette Tarnasky TITLE: Program Director
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation
Progr m ateg. must provide ervi ec that focus nn teach' life skills designed to facilitate implementation of
the case plan by improving household management competency.parental competency. family conflict
management and effectively accessing community resources,
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1. 2002 Start
End Min/31. 2003 End
TITLE OF PROJECT: Foster Parent Consultation Program
AMOUNT QUESTED: $18,900 ll aazzaC lad Laijitl Paulette Tarnasky 3/.2/42---
Name d Signature of Person Prep.. ng ocument LCSW Date
/,-2 t 4-0070 Wayne A. Maxwell, 03/21/02
Name anSignature Chief Administrative Officer Applicant Agency Ph.D. 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
Gem_ Project Description
udel Target/Eligibility Populations
tarotTypes of services Provided First Year
WA.% Measurable Outcomes of Request
kipbck Service Objectives
1 Workload Standards
(ai, Staff Qualifications
trM2A. Unit of Service Rate Computation
t4'AM Program Capacity per Month
taink Certificate of Insurance
Page 23 of 29
,O:f/19/02 TUE 10:20 FAX 353 5215 WELD SOCIAL SERVICES 4002
UP-M-02005 Attached A
Date o (c)with Social Services Division Supervisor:
3(1101-
Comments by SSD Supervisor
�r.9�es� fF P('et, of //Lis/F.fkkJ '_Goz raif • l a-1
d9,04:00 anya,
Afr&fer-anK7fre:S iifirD71,-64IP-5 9,i4-----yrratc.,...„0/44,,,e_of
ad-fa, •
°fez_ss 7z 7// 9 02 -Name and Si ture ofSupervisor Date
Page 27 of 32
FOSTER PARENT CONSULTATION PROGRAM
North Range Behavioral Health
2002 -2003 BID #006-00
March 21, 2002
PROJECT DESCRIPTION
North Range Behavioral Health has been serving children placed in foster homes
for over three decades. In addition to outpatient therapy (provided both in the
office and in the home), medication management and case management, our
services have also included extensive consultation, guidance, and education to
foster parents. Based on this experience and the professional training of our
staff, NRBH has developed and offers to Weld County Department of Social
Services (WCDSS) a foster parent consultation program designed to provide the
supportive services foster parents need to enable children placed in their homes
to receive the maximum possible benefits of that placement in the shortest
possible time. This program is offered with assurance that all services would be
provided in full accordance with the provisions of Request for Proposal 006-00.
The service program is designed to support the Department's permanency
planning efforts, to expedite reunification with the family, or at a minimum,
prevent the need for a more restrictive level of placement. These goals would be
accomplished by providing consultation designed as a supportive resource that
would enable individuals to be as effective as they can be in their role as foster
parents. Consultants will be available to answer foster parent questions, provide
training and guidance to enhance foster parent competency and family conflict
management, and to ensure that foster families are aware of and effectively
access available community resources. Close collaboration with the assigned
caseworker and others involved with the children will be incorporated into all
phases of the program on an ongoing basis. This will assure that the services
provided are consistent with the overall treatment plan of the foster parents.
Our proposed foster parent consultation service consists of two components:
• Education and training to enhance skills and confidence of foster parents in
addressing the numerous needs of foster children and meeting state training
requirements for foster parents. A significant component of education will be
ensuring that foster parents are aware of the variety of community resources
available and how to access them. One component of the educational
program will be the development of a flyer describing the foster parent
consultation program and the variety of consultation services available
through it. This flyer could be distributed to WCDSS caseworkers, foster
parents and other interested parties to enhance access to the services
available.
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FOSTER PARENT CONSULTATION PROGRAM, North Range Behavioral Health 2002-2003, BID#006-00
• Consultations with foster parents in connection with issues or concerns the
foster parents identify themselves. These issues typically include discipline in
the home, behavior management, how to assist the foster children to cope
with and overcome their emotional and behavioral problems, transition and
loss, implementation of the treatment plan, safety and risk.
Our foster parent consultants would use a wide variety of strategies to
accomplish goals identified in concert with foster parents and the designated
caseworker.
II. TARGET/ELIGIBILITY POPULATIONS
The monthly capacity for our identified consultants would average five foster
families at a given time in the Greeley area and one to two foster families in
southern Weld County. Our primary target is foster families that provide homes
for children 1-14 years of age. Each foster family would receive a minimum of
one to two hours of contact per month. We would expect that the frequency of
contacts would initially be higher, but taper down to a lower level as the
educational phase is completed.
During the past year NRBH developed and implemented a Multicultural Services
Program staffed by bicultural, bilingual mental health professional staff to better
meet the mental health needs of the Hispanic community in Weld County. The
number of request for services from and referrals to this program has been
overwhelming. At this time we have a waiting list and cannot commit to providing
Foster Parent Consultation services with our Multicultural Services Program staff
at this time. This means that foster parent consultation services for monolingual
Spanish speaking staff will not be available until such time that additional staff
members are added to the Multicultural Services Program.
Culturally sensitive and culturally competent services will, however, be available
through the proposed program at all times. NRBH annually provides mandatory
cultural competence training for all staff members, and has a very long history of
providing services to the Hispanic population of Weld County. Staff members
serving as consultants will have had the cultural competence training and
experience in dealing with Hispanic consumers.
An initial assessment will be made to help determine the needs of the foster
parents. Foster families will receive support as long as the need exists.
Coordination and collaboration with WCDSS would aid our consultants in
developing a realistic plan for consultation services.
Ill. TYPE OF SERVICES TO BE PROVIDED
All foster families referred and accepted to our foster care consultant component
will receive in-home or clinic-based consultation and education as appropriate. It
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FOSTER PARENT CONSULTATION PROGRAM, North Range Behavioral Health 2002-2003, BID#006-00
is anticipated that we would begin initial services in the home. All services
provided will be developed through collaboration with Department staff in
response to needs and requests of the foster parent. Each foster family served
will be provided consultation or strength-enhancement interventions, concrete
and crisis intervention services.
Consultation or strength-enhancement intervention services include education
and guidance in problem solving, lessons in communication skills, and training in
parent/child and parent/parent conflict management. The services provided by
our consultants are designed to capitalize on existing strengths within the foster
family, to empower foster parents and to focus on resolving conflicts and
disagreements within the home (specifically those that contribute to potential
child maltreatment, running away, and to the behaviors constituting status and
legal offenses).
Additional services include training for foster parents in areas of development of
and enhancement of parenting skills, stress management, problem solving,
anger and impulse control, and planning of family activities related to recreation.
Consultation and training will also focus on transition and loss issues, discipline
in the home, visitation issues, solution oriented planning, and issues involving
biological children in the home. Consultants will work with foster adopt parents
on legal risk commitment issues.
A fundamental component of the educational services is a focus on making foster
parents aware of the array of community resources available to them and
assisting them in utilizing those resources effectively. There will be group training
to assure foster parent access to training materials. Educational training services
will address mandated training for foster parents under corrective action plans.
Follow-up services based on consultation and training will be tailored to the
individual needs of specific foster parents.
Upon receiving a referral, our consultants will contact the referring WCDSS
worker to begin the planning process and gathering pertinent information.
Services to the foster family will begin at the first opportunity. Initially the
consultant will work with foster parents to assess strengths and weaknesses.
Based on the assessment, a plan will be developed taking into consideration the
foster parents' strengths. Our consultants will continually reassess interventions
and educational material offered to foster parents. As the foster parents
demonstrate greater effectiveness, plans are revisited and adjusted accordingly.
Training will be offered and made available to all foster parents wishing to attend,
whether or not they see us for direct consultative services. If we are working with
critical care foster parents, monthly mandated consultation sessions will be
provided.
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FOSTER PARENT CONSULTATION PROGRAM, North Range Behavioral Health 2002-2003, BID#006-00
Our consultants will work closely with the foster care coordinator or resource
services manager to insure foster parent training is appropriate and meets the
needs and expectations of the State and WCDSS. A flat fee will be established
for such training on a per event basis. A post training assessment/test will be
part of the training component.
A professional staff member who is providing consultation or strength-
enhancement intervention services to foster children in the same home will not
provide foster parent consultation. All assessments, clinical recommendations,
and other opinions derived by the contractor in the performance of this contract
will be shared directly with the assigned caseworker of the children involved. If
there is a disagreement over the implementation of the treatment plan with the
caseworker, a meeting shall be held with the contractor, assigned caseworker,
foster parents, and the caseworker's supervisor. The objective will be to
determine a unified departmental response for the court. The contractor will not
use the legal system to oppose the department's recommendations. NRBH
agrees to comply with 19-1-120 C.R.S., which requires that reports of child abuse
and any identifying information in those reports are strictly confidential.
The needs of each foster parent referred or requesting consultation services will
be assessed to determine if any of their needs can be met with existing
resources within NRBH. The nature of services needed will be discussed with
the assigned caseworker, to determine the appropriate funding source for those
services. Any needed services that fall within the scope of responsibility of
NRBH through its Medicaid contract will not be charged to the Foster Parent
Consultation program. The Foster Parent Consultation program is designed to
supplement, not supplant services already being provided.
IV. MEASURABLE OUTCOMES
The specific outcomes we expect to be realized through implementation of the
proposed program are as follows.
1. Improvement of household competency management.
2. Improvement of parental competency.
3. Ability to work independently with other community resources and local, state,
and federal governments.
4. Higher skills and competency levels in fulfilling designated functions for
children in out-of-home placements.
5. Ability to positively meet the needs of their biological children in adjusting to a
coping with the presence of foster children in the home.
The Foster Parent Survey (see following pages), specifically developed for use in
foster parent consultation programs, will be utilized to assess the outcomes
specified above. This self-report survey assesses competency, coping, problem
solving strategies, and empowerment levels as related to issues pertaining to
Page 4
FOSTER PARENT CONSULTATION PROGRAM, North Range Behavioral Health 2002-2003, BID#006-00
service agencies and systems, community and political resources. It also
addresses family issues and problems, as well as skills and abilities in managing
the household and accessing/utilizing resources. This survey will be administered
at admission, to assess strengths and areas of need for each foster care
provider, and to develop consultation goals that are uniquely matched with the
needs of each foster care provider. It will also be administered at the conclusion
of consultation services to assess the effects of the program on the variables
measured by the survey instrument.
All foster parents involved in the program will also be asked to complete a
satisfaction survey to asses the extent to which the program met their needs and
to provide suggestions as to how the program could be improved.
V. SERVICE OBJECTIVES
In working with foster parents, the goal of the program would be to improve
competency in areas of household management, parenting ability and ability to
access resources. Success in meeting these goals will be measured by the
foster parents, caseworker and consultants reporting that the objectives were
met. The foster parents would be asked to report on their subjective
improvements in these areas.
To improve household management competency, the objective is to enhance the
capacity of the foster parents to provide for and teach the children, and to provide
a safe household environment through competently managing the home. Areas
to review include cleaning, repairing and maintaining the home, budgeting, and
purchasing. The family, consultant, and caseworker will document the
improvements made in this area.
The goal of overall parental competency improvement will be assess by the level
of attainment of the objective of increasing the foster parents' abilities to develop
and maintain sound, caring, effective relationships with each other and with their
children. An additional FPC objective is to enhance the abilities of the parents to
provide the best possible for family care, nutrition, hygiene, discipline, protection,
education and supervision. Again, the foster parents and children, the consultant
and caseworker will be polled about their subjective opinions on the
improvements that they have made.
The third service goal of FPC services is to improve the foster parents' abilities,
individually and collectively, to find and use appropriate resources. Treatment
and case management services assist the family to learn more effective means
to obtain needed help from other sources in the community and from local, state
and federal governments. The families will report their progress, and their
caseworker and consultant will confirm their gains related to this goal and
objective.
Page 5
FOSTER PARENT CONSULTATION PROGRAM, North Range Behavioral Health 2002-2003, BID#006-00
VI. WORKLOAD STANDARDS
One primary NRBH consultant in the Greeley area will be assigned sufficient time
to work five foster families at a given time. An additional NRBH staff member
working the NRBH Fort Lupton office will be assigned to work with one to two
foster families at a given time. The actual caseload size is dependent on the
nature of the consultant's overall caseload and the number of requests for
consultation services. The consultant will provide an average minimum of two
hours of direct consultation services per family per month.
The identified consultants, while having specialty skills with foster parent issues,
carry a diverse caseload in which they provide comprehensive services offered
by NRBH. It is estimated that fifteen hours a month will be provided towards
direct service to foster parents (five families) and potentially two to four additional
hours could be offered on average for an educational and supportive group. The
predominant model will be psycho/educational with the foster parents in this
individual natural setting or in-group settings.
Identified consultants will have at least eight hours of continuing education
relevant to their job descriptions and they will continue to do so on an annual
basis. Any new staff members hired will receive training as soon as possible
after they have begun their employment with NRBH.
Direct supervision of the foster parent consultation project will be the
responsibility of Program Directors. The ratio of mental health workers to
administrative supervisors typically does not exceed ten to one. There will be
ongoing supervision specific to this project. In the beginning, such supervision
will take place on a weekly basis at a minimum. As the project gets underway
supervision will be modified to fit the needs of the consultants providing the
consultation services. In the event of very difficult or extraordinary situations in
the foster home, additional senior clinical supervision would always be available.
Paulette Tarnasky, LCSW would administer the supervision in the Greeley area,
and the supervision of south Weld County would be administered by Patricia
Orleans, LCSW. Both supervisors report directly to the Executive Director,
Wayne Maxwell, Ph.D. A clinical consultant, Maureen Huff, Ph.D., is available as
a resource.
The supervisors and consultants are insured. Liability and professional coverage
is provided by NRBH (see attachment).
Page 6
FOSTER PARENT CONSULTATION PROGRAM, North Range Behavioral Health 2002-2003, BID#006-00
VII. STAFF QUALIFICATIONS
Staff members assigned to work in the NRBH proposed foster parent
consultation program have qualifications that exceed those necessary to be a
Caseworker III within the state social service system. All consultants will have a
masters degree in a mental health field and either be licensed or eligible for
licensure as a mental health professional or clinical social worker. Consultants
elected to work on this project will be senior and experienced mental health
therapists. The consultants will have demonstrated strong abilities in working in
variety of community settings and in family and foster family home settings. They
also will have demonstrated strong ability in working effectively in collaborative
relationships with caseworkers.
Each consultant will be knowledgeable in family and individual dynamics and in
the treatment of a wide variety of family problems as demonstrated by
specialized training, workshops, and experience in working with families. Each
identified consultant working with foster parents will receive a monthly minimum
of two to four hours of clinical supervision from a licensed NRBH staff person.
Supervision will likely address clinical issues, strategies of intervention, dealing
with resistance and obstacles, and effective process. Clinical supervisors will
also be involved in regular training to keep current in the state of the art
counseling modalities and findings.
The foster parent consultant in Greeley would be Marian Schoenfelder, M.Ed.
Ms. Schoenfelder is one of the Center's most experienced and skilled therapists.
She has a strong interest in working with children and foster parents, and as a
foster parent herself for many years is uniquely qualified to serve as a consultant.
The foster parent consultant in south Weld County has not yet been identified,
but whoever is assigned will be a mental health professional trained at least to
the masters degree level and eligible for licensure. The consultant in the south
Weld County area will also have a strong interest in working with children and
foster parents.
Page 7
006-00 EDUCATIONAL AND SUPPORT GROUP Attached A
III. 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 8 Hours [A]
Total Clients to be Served 15 Clients [B]
Total Hours of Direct Service for Year 120 Hours [C]
(Line [A] Multiplied by Line [B]
Cost per Hour of Direct Services $ 35 Per Hour [D]
Total Direct Service Costs $ 4,200 [E]
(Line [C] Multiplied by Line [D] )
Administration Costs Allocable to Program $ 600 [F]
Overhead Costs Allocable to Program $ 600 [G]
Total Cost, Direct and Allocated, of Program $ 5,400 [H]
Line [E] Plus Line [F] Plus Line [G] )
Anticipated Profits Contributed by this Program $ — [I]
Total Costs and Profits to be Covered
by this Program(Line [H] Plus Line [I] ) $ 5,400 [J]
Total Hours of Direct Service for Year 120 [K]
(Must Equal Line [C] )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 45 [L]
Day Treatment Programs Only:
Direct Service House Per Client Per Month n/a [M]
Monthly Direct Service Rate $ n/a [N]
Page 28 of 29
00640 DIRECT INDIVIDUAL SERVICE RATE TO FOSTER PARENTS Attached A
III. 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 10 Hours [A]
Total Clients to be Served 15 Clients [B]
Total Hours of Direct Service for Year 150 Hours (Cl
(Line (A] Multiplied by Line [B]
Cost per Hour of Direct Services $ 70 Per Hour [D]
Total Direct Service Costs $ 10,500 [E]
(Line [C] Multiplied by Line (DI )
Administration Costs Allocable to Program $ 1,500 [F]
Overhead Costs Allocable to Program $ 1,500 (G]
Total Cost, Direct and Allocated, of Program $ 13 500 [H]
Line (El Plus Line [F] Plus Line [G] )
Anticipated Profits Contributed by this Program $ - [I]
Total Costs and Profits to be Covered
by this Program(Line [H] Plus Line (I] ) $ 13,500 [J]
Total Hours of Direct Service for Year 150 [K]
(Must Equal Line (C] )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 90 [L]
Day Treatment Programs Only:
Direct Service House Per Client Per Month n/a [M]
Monthly Direct Service Rate $ n/a (N]
Page 28 of 29
1.11C11Lff : 1JJJ4 1VVtfnto
AcnxD4 CERTIFICATE OF LIABILITY INSURANCE �2/(zsio
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins . Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. O. BOX 578 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street
Greeley, CO 80632 I INSURERS AFFORDING COVERAGE
INSURED I INSURER A:Irwin Siegel Agency Inc__
North Range Behavioral Health INSURER B: Assurance
1306 11th Avenue --
Greeley, CO 80631 INSURER C:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN SRI - IPOLICYEFFECTIVE POLICY EXPIRATION
LTR I TYPE OF INSURANCE POLICY NUMBER i DATE IMM/DDNY) DATE(MMIDD/YY)' LIMITS
A GENERAL LIABILITY '5182327225 01/01/02 01/01/03 I EACH OCCURRENCE '$1, 000, 000
X 1 COMMERCIAL GENERAL LIABILITY 1 I,FIRE DAMAGE(Any one fPe $200, 000
I CLAIMS MADEI Xi OCCUR I I I MED EXP(Any one person) $15, 000
; ' _ PERSONAL AADV INJURY $1, 000, 000
i_G_ENE_RAL AGGREGATE $3 , 000, 000
I ENL AGGREGATE LIMIT APPL ES PER: ! I PRODUCTS-COMP/OPAGGI f3 , 000, 000
I ! POLICY 1 JF OT I— LOCI
A I AUTOMOBILE LIABILITY 15182327225 01/01/02 101/01/03 COMBINED SINGLE LIMIT
iIANYAUTO (Ea accident) $1, 000, 000
_ ! ALL OWNED AUTOS i 1
BODILY INJURY $
• SCHEDULED AUTOS I(Per person)
X HIRED AUTOS I BODILY INJURY
X NON-OWNED AUTOS 10 .(Peraceldent) f
- - -- -AUTO ONLY-EA ACCIDENT
--- PROPERTY DAMAGE
"' i, (Per accident)
GARAGE LIABILITY C')
I$
ANY AUTO
-'-
'OTHER THAN EA ACC ,f
1 1 .AUTO ONLY: AGG I f
A '. EXCESS LIABILITY_ '5182327225 01/01/02 Iii 01/01/03 I, EACH OCCURRENCE if
OCCUR J CLAIMS MADE; i AGGREGATE 1$
i
— I$
_ DEDUCTIBLE ' I$
XI RETENTION $ . 1 f
B WORKERS COMPENSATION AND 404331 10/01/01 107/01/02 1T52ftY UM TS ,OEM
EMPLOYERS LIABILITY _
EL.EACH ACCIDENT i$100, 000
_E_L.DISEASE-EA EMPLOYED$10 0, 0 0 0
E.L.DISEASE-POL ICY LIMIT1$500, 000
A OTHER Professional 5182327225 F01/01/02 : 01/01/03
Liability $3 , 000 , 000 Aggregate
$1, 000 , 000 Occurrence
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS AD DE D BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDMONALINSUREO;INSIIRER LETTER _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE E ffIRATION
Weld County Social Services DATETHEREOF,THE ISSUING INSURER WILL ENDEAVOR TOMAIL3_ ,. DAYSWRITTEN
315 N. 11th Avenue NOTICETOTHE CERRFICATE HOLDER NAMED TOTHE LEFT,BUTFAILURE TO DO SO SHALL
Greeley, CO 80631 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
F/odd -Pe lr..ison- -rnsc4Qne_e , -z.,y
ACORD2s-S(7/97)1 of 2 #5204952/M204922 CCN 0 ACORD CORPORATION 1988
FOSTER PARENT SURVEY
FORM
FOSTER PARENT SURVEY
Below are a number of statements that describe how caregivers of children in out-of-home
foster placement might feel about their situations. For each statement, please circle the
response number that best describes how the statement applies to you. The purpose of this
survey is to identify areas of need and provide you with the kind of information and
assistance that best fits with your unique needs. Please respond as honestly as possible and
keep in mind that there are no right or wrong answers.
1 =Not at all true 2 =Mostly not true 3 = Somewhat true 4 =Mostly true 5=Very true
1. I am familiar with community resources and services agencies in
my area. 1 2 3 4 5
2. I know the steps to take when I am concerned that my children are
receiving poor services. 1 2 3 4 5
3. I am able to make good decisions about what services my children need. 1 2 3 4 5
4. I am able to work with agencies and professionals to decide what
services my children need. 1 2 3 4 5
5. I make sure I stay in regular contact with professionals who are
providing services to my children. 1 2 3 4 5
6. I make sure that professionals understand my opinions about what
services my children need. 1 2 3 4 5
7. My opinion is just as important as professionals opinions in deciding
what services my children need. 1 2 3 4 5
8. I tell professionals what I think about the services being provided to
my children. 1 2 3 4 5
9. When necessary, I take the initiative in looking for services for my
children and family. 1 2 3 4 5
10. I have a good understanding of the service systems that my children
are involved in. 1 2 3 4 5
11. I understand how the service systems for my children are organized. 1 2 3 4 5
12. I understand the role of government agencies in providing services
for my children. 1 2 3 4 5
13. I know how to contact agency administrators and legislators. 1 2 3 4 5
14. I know the rights of children under governmental and educational laws. 1 2 3 4 5
15. I get in touch with my legislatures when important bills or issues
concerning children are pending. 1 2 3 4 5
1 =Not at all true 2 =Mostly not true 3 = Somewhat true 4=Mostly true 5 =Very true
16. I know what to do when problems arise with my children. 1 2 3 4 5
17. I am able to get information to help me better understand my children. 1 2 3 4 5
18. I believe I can solve problems with my children when they happen. 1 2 3 4 5
19. When I need help with problems in my family, I am able to ask for
help from others. 1 2 3 4 5
20. I make efforts to learn new ways to help my children grow and develop. 1 2 3 4 5
21. When dealing with my children, I focus on the good things as well as
the problems. 1 2 3 4 5
22. I have a good understanding of childhood disorders. 1 2 3 4 5
23. I feel competent in dealing with childhood disorders as they impact
our family life. 1 2 3 4 5
24. I feel I am a good parent. 1 2 3 4 5
WHEN WE FACE PROBLEMS OR DIFFICULTIES IN OUR FAMILY, WE RESPOND BY:
1. Facing problems"head-on"and trying to find solutions right away. 1 2 3 4 5
2. Accepting stressful events as a fact of life. 1 2 3 4 5
3. Accepting that difficulties occur unexpectedly. 1 2 3 4 5
4. Defining the family problem in a more positive way so that we
do not become discouraged. 1 2 3 4 5
5. Realizing that no matter what we do, we will not know or be
prepared for everything. 1 2 3 4 5
6. Seeking encouragement and support from friends. 1 2 3 4 5
7. Trying to learn more about problems and issues that we do not
understand. 1 2 3 4 5
8. Seeking information and advice from persons in other families who
have faced similar problems. 1 2 3 4 5
9. Seeking encouragement, support, and advice from relatives (parents,
grandparents, etc.). 1 2 3 4 5
10. Seeking assistance from community agencies and programs designed
to help families in our situation. 1 2 3 4 5
11. Seeking information and advice from the family doctor. 1 2 3 4 5
12. Seeking professional counseling and advice for family difficulties. 1 2 3 4 5
13. Seeking spiritual support, advice, and encouragement. 1 2 3 4 5
Foster Parent Survey — Breakdown
From the Family Empowerment Scale (FES)
• Questions #1-10 = Social Services Empowerment
• Questions #11-15 = Political Empowerment
• Questions #16-24 = Family Empowerment
From the Family Crisis Oriented Personal Evaluation Scale (F-Copes)
• Questions #1-13 = Problem solving strategies
EXHIBIT B
SUPPLEMENTAL NARRATIVE TO RFP
RECOMMENDATIONS
•
1 17 API? 17 -,
im
North Range
Behavioral Health Sally Wattle
President
Michele Vetting
Vice-President
April 15, 2002 Rebecca Roguea-C Way
Secretary
Bill Fisher
Treasurer
Ed Jord Pe Gloria Romansik Past Presiden
t
Weld County Department of Social Services
P.O. Box A
Greeley, CO 80632
SUBJECT: RFP 02-03 06-000 Foster Parent Consultation
RFP 02006 Day Treatment
Dear Ms. Romansik:
We are in receipt of your notification letter dated April 8, 2002 in reference to the results
of the RFP Bid process for 2002-2003.
North Range Behavioral Health agrees to report outcomes specific to each of the two
programs noted above as per your recommendation. Should you need anything further,
please contact me.
Sincerely,
Wayne Wayne A. Maxwell
Executive Director
1306 11th Avenue/Greeley,CO 811631/(970)463-3686/Fax(970)4.S4-8906
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
' WEBSITE:www.co.weJd.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352 6933
COLORADO
• April 8,2002
Wayne Maxwell,Executive Director
North Range Behavioral Health
1306 11 Avenue
Greeley, CO 80631 •
Re: REP 02-03 06-000 Foster Parent Consultation
RIP 02006 Day Treatment
Dear Mr. Maxwell:
The purpose of this letter is to outline the results of the RFP Bid process for PY 2002-
2003 and to request written 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
recommendation(s)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 06-000,Foster Parent Consultation:
Approved with the above recommendation:
2. RFP 02006,Day Treatment:
Approved with the above recommendation:
B. Required Response by RFP Bidden Concerning FYC Commission
Recommendations
The Weld County Department of Social Services is requesting your written
response to the FYC Commission's recommendations and conditions. 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:
Page 2
North Range Behavioral Health
Results of RFP Process for PY 2002-2003
FYC Commission Recommendations:
You are requested to review the recommendation(s)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 recommendation(s) in
your bid. If you do not accept the recommendation(s), please provide
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 though Elaine Furister, 352.1551, extension 6295, and
one will be arranged prior to April 17, 2002.
Sincerely,
Judy A Griego,Director
Weld County Department of Social Services
of
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 FY02-PAC-2004
Revision (RFP-FYC-02006)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2002 and North Range Behavioral Health
Ending 05/31/2003 The Littler Center-Day Treatment
1306 11th Avenue
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
A comprehensive, highly structured service Proposal (RFP). The RFP specifies the scope of
alternative to the out-of-home placement or the services and conditions of award. Except where it is
more intensive placement. A capacity of 20 at in conflict with this NOFAA in which case the
any given time, 29.5 hours weekly, an average of NOFAA governs, the RFP upon which this award is
5.9 hours daily, for 36-52 weeks. based is an integral part of the action.
Cost Per Unit of Service Special conditions
Monthly Rate $ 1,728.00 1) Reimbursement for the Unit of Services will be based
Hourly Rate Per $ 15.03 on a monthly rate per child or per family.
Based on Approved Plan 2) The monthly rate will be paid for only direct face to
face contact with the child and/or family, as specified
Enclosures: in the unit of cost computation.
X Signed RFP:Exhibit A 3) Unit of service costs cannot exceed the hourly and
X Supplemental Narrative to RFP: Exhibit B yearly cost per child and/or family.
X Recommendation(s) 4) Payment will only be remitted on cases open with, and
referrals made by the Weld County Department of
_Conditions of Approval
Social Services.
5) Requests for payment must be an original submitted to
the Weld County Department of Social Services by the
end of the 25th calendar day following the end of the
month of service. The provider must submit requests
for payment on forms approved by Weld County
Department of Social Services.
Approvals:
s�jj:% � /1-4
/ Program Official:
By 44.4.L / By.
Glenn Vaad, Chair Judy . Gri , Direc r
Board of Weld County Commissioners Wel ouu ty Department of Social Services
Date: 05/29420001- Date: 10 I
/.
•
EXHIBIT A
SIGNED RFP
Y
INVITATION TO BID
DATE: February 27, 2002 BID NO: RI-P-FYC-02006
RETURN BID TO: Pat Persichino, Director of Generalfiervices
915 10th Street, P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (RFP-FYC-02006) for:Family Preservation Program--Day 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 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 Day Treatment Program Category must provide a
comprehensive, highly structured program alternative to placement or more restrictive placement that
provides therapy and education for children. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
Wayne A. Maxwell, Ph.D.
TYPED OR PRINTED SIGNATURE
VENDOR North Range Behavioral Health Wa t� 4�
(Name) Handwritten Signature By Authorized
Officer or Agent of Vendor
ADDRESS 1306 11th Avenue TITLE Executive Director
Greeley, CO 80631
DATE 03/21/02
PHONE # 97(l-154-1686
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
RFP-FYC-02006 Attached A
DAY TREATMENT PROGRAM BID PROPOSAL
FAMILY PRESERVATION PROGRAM
" 2002/2003 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2002-2003
BID#RFP-FYC-02006
NAME OF AGENCY: North Range Behavioral Health
ADDRESS: 1306 11th Avenue Greeley, CO 80631
PHONE: ( 970 ) 353-3686 or 352-2201
CONTACT PERSON: Sandra K. Atwood, NSW, LCSW TITLE: Program Director
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Day Treatment Program Category must
provide a comprehensive.highly structured program alternative to placement that provides therapy and education for
children.
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: Kathleen Painter Littler Center
9,„„,69 Jl. ` 4 `v�/ 56 Sandra K. Atwood, •3-�nd Signature of Person Prepa ng Document MSW, LCSW Date
/',O t Wayne A. Maxwell, 03/21/02
Name and Signature iefAdministrative Officer Applicant Agency Ph'D' Date
MANDATORY PROPOSAL REQUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in this
Posposal 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
t/& Project Description X
wig;_ Target/Eligibility Populations
WA Types of services Provided
Why Measurable Outcomes X
WAS, Service Objectives X
tt. Workload Standards 'X
a Staff Qualifications X
(/Am Unit of Service Rate Computation (cost of living increase)
(fin Program Capacity per Month X
r - Certificate of Insurance X
Page 26 of 32
� w
RFP-FYC-02006 Attached A
.9' .e'
• • .
Date of Meeting(s)with Social Services Division Supervisor: 3//.)-7O
c _)--
Comments by SSD Supervisor: / e �-�XvzciS ti !/ /I Gt ccz-icr 7,e
en / ✓ (i c n- -
Name and Signature of SSD Supervisor Date
Page 27 of 32
•
FAMILY PRESERVATION PROGRAM,North Range Behavioral Health 2002-2003, BID #RFP-FYC-02006
I. PROJECT DESCRIPTION
In August 1995, Weld County School District Six (District 6), the University of Northern Colorado
(UNC), and North Range Behavioral Health (NRBH)jointly opened the Carson Children's Center
(CCC). In August 1999 the CCC became the Kathleen Painter Littler Center. Littler is a year around
residential and day treatment program for children ages five through 12 years. It has capacity of 18
residential and 12 day treatment students.
Day treatment is a comprehensive, highly structured alternative to the out-of-home placement or the
more intensive placement of a child already in placement, that provides mental health care and
education to its student clients. Treatment services for each client's family are an integral part of the
program. The Littler Center provides highly integrated and coordinated educational and treatment
services to its students. The affective needs of each child are responded to not only by the treatment
staff, but by the educational and supportive services staff as well. Similarly, the students' education
and emotional and behavioral needs are not solely the responsibility of the teaching staff but shared
by all on-site personnel. Because all Littler students are staffed as special needs children, additional
services called for in each child's individualized education plans (JEP) such as occupational therapy,
speech/language services, and physical therapy are provided on-site.
The Littler day begins with a welcoming group to greet the children and to help them make the
transition from life at home to a day in school and in treatment. Information from each student's
parents, guardians, or foster parents is obtained directly or via notebooks sent home with and brought
back each day by the students to keep the staff and parents/guardians up-to-date and to encourage
open communication. Each child's goals and progress toward them are updated daily before the
children move to other aspects of the day. Educational and affective curricula are simultaneously in
place as much as is feasible in the various daily activities. The students progress through a series of
treatment and educational offerings each day. While some children are in the classroom for group or
individual instruction, others are seen in individual therapy while others are in a treatment group.
Each day treatment student is assigned a master level therapist who not only assists in developing
individualized treatment plans, but also serves as an on-going consultant and treatment coordinator
to all school staff. There are ongoing, scheduled psycho-educational groups that address new themes
as well as themes from earlier sessions. These groups address social skills, conflict resolution, self-
esteem, and positive relation building as well as how to handle feelings. The daily schedule is similar
from day to day promoting the consistent milieu essential to the children's success. Recess, lunch,
and other activities are similarly integrated. The day ends back in the room where welcomes
occurred. Now, the focus is to review the day with the children and prepare them for the transition
back to their homes. Goals and successes of the day are the foci of this activity. Children may remain
for a family therapy session. Family therapy typically is planned for the end of the day to allow for
parents' work schedules. The schedule is sufficiently flexible to allow for such sessions during the
school day as well. Individual and family therapy continues to occur during school breaks, depending
on the availability of the clients.
Psychiatric services are integrated in the program. Each child receives a psychiatric evaluation
including a determination of need for psychotropic medications. Follow-up psychiatric services are
provided throughout each student's stay and, when appropriate, in the care that follows treatment at
Littler.
1
FAMILY PRESERVATION PROGRAM, North Range Behavioral Health 2002-2003, BID #RFP-FYC-02006
Students with special treatment needs have available to them the full array of services of NRBH in
addition to those available at Littler. Students can be seen in groups designed to help them deal with
sexual abuse and other trauma they have endured.
II. TARGET/ELIGIBILITY POPULATIONS
It is intended that the Littler Center serve up to 20 children ages five through 12 years and their
families at any given time in the 6 to 18 month day treatment program. Of these, it is anticipated that
up to ten could have the financial aspect of their care covered under the services proposed herein.
Up to 18 children and their families will be served annually of whom 12 will possibly be eligible for
FYC-funded services. It is anticipated that approximately 25% of all the students and/or their families
will receive some level of bilingual/bicultural services on-site. Based on current utilization rates, it is
estimated that up to 25% of the Littler students will be from southern Weld County. For the purposes
of this grant, the monthly maximum program capacity is defined as 10 children with a monthly
average program capacity of eight. The average length of stay in the program is estimated to be in
the range of 36 to 52 weeks. Students spend a minimum of 29.5 hours weekly in the total program. In
order for a child to be considered as a potential student of the Littler Center, she or he must be
staffed into special education services in her or his home school district and must have demonstrated
the capacity to return to her or his home school upon successful completion of the Littler program. In
addition, the student must have a full scale IQ of 76 to benefit from the Littler Center program levels
and expectations.
Children referred to the project will have met, or be at high risk to meet, the out-of-home placement
criteria detailed in the request for proposal. As mentioned above, each will also have met or be
believed to qualify for special education services.
III. TYPE OF SERVICES TO BE PROVIDED
Site-based services to the students of the Littler Center and their families will be held each day
District 6 schools are regularly in session plus through the summer. An academic year will consist of
46 total weeks with an average of not less than 29.5 hours of programming weekly, 5.9 average daily
hours.
The planning and implementation of the Littler Center has been a collaborative and cooperative effort
from its inception. The Weld County Department of Social Services (WCDS S), involved early on in
the planning process, agreed to utilize the services of this day treatment program for those of its
clients demonstrating the need for it and for whom they believe they have financial responsibility. The
Littler Center's admission coordinator works to ensure that FYC resources do not supplant other
community resources and WCDSS caseworkers are involved prior to the screening process for all
WCDSS children. The collaborative role of Weld County School District 6 has been exemplary from
the planning stage forward as it furnished the past site, recruited and hired professional and
2
FAMILY PRESERVATION PROGRAM,North Range Behavioral Health 2002-2003, BID #RFP-FYC-02006
paraprofessional staff, and provided administrative guidance. Similarly, NRBH, with the strong
support of its Board of Directors and management team, offered administrative assistance in planning
and implementing the treatment program.
Extensive effort has been invested into planning the milieu and overall program of the Littler Center
so that educational, therapeutic, behavioral, and recreational components are closely integrated. By
design, each of these four components contains aspects of the other three. Concerted efforts helped
to achieve and now serve to maintain this high level of integration. The educational component is
primarily the responsibility of the District 6 teaching staff plus other instructional staff as may be
required. The therapeutic component is primarily the responsibility of the NRBH on-site staff The
behavioral component of the Littler Center is present across all activities of the program and is the
responsibility of all on-site personnel. Each student has an individualized education plan and a mental
health services/treatment plan that spell out educational, behavioral, and emotional concerns and
detail how those concerns will be addressed in the daily activities of the student. Similarly, the
recreational component of the Littler Center includes educational, therapeutic, and behavioral
programming to meet each student's needs. All components of the program are typically carried out
on-site. Exceptions to this occur primarily during times when a student is in a transitional stage in
returning to her or his home school and when off-site services, such as involvement in a particular
therapy group not offered on-site, are indicated.
Beginning at intake and throughout the program, parents, guardians, and other caretakers are
actively encouraged to engage in their children's education and treatment. Family therapy sessions
are held at least weekly for each student. In all cases, parental or guardian involvement is mandatory.
This stems from a core belief that not just the child, but also his or her family must actively involve
themselves in the treatment/education process for it to be effective and for the positive results to be
longstanding. The mental health services plan dictates the specific nature of the family work that is
required for each child.
The teachers at the Littler Center are certified special education teacher for significantly identifiable
emotionally disturbed children. They are assisted by three full-time, specially trained para-
professionals in carrying out each student's individualized educational plan. Due to age of the Littler
students, there has been no need for vocational or independent living assessment or training to date.
Each student receives an initial mental health assessment. The therapist, parents/guardians,
caseworker, if appropriate, and psychiatrist work to establish a behaviorally specific service plan that
details individual therapy, family therapy, psychiatric needs, and case management needs. The
service plan identifies the specific outcomes necessary for the child to be successful at a lower level
of care. It is the tool by which progress is measured. Typically each student weekly receives at least
one individual therapy session, five sessions of therapeutic or psycho-educational group activities,
and one session of family therapy.
This can vary based on the needs of the specific child and their family. More frequent services may
be provided during the initial stages of treatment or during a time of crisis. Fewer services maybe
provided during the latter stages of treatment when a child is transitioning back to their home school.
Those students with psychotropic medication needs are the responsibility of the Littler staff
3
FAMILY PRESERVATION PROGRAM, North Range Behavioral Health 2002-2003, BID #RFP-FYC-02006
psychiatrist, Wallace LaBaw, MD. There is simultaneous development or updating of the
individualized education plan when a child is staffed into the Littler Center.
The physical health needs of Littler students including, but not limited to nutrition, medical, and dental,
are primarily the responsibility of District 6 nursing staff. These are shared as appropriate by the staff
of the Littler Center.
Proactive planning for reintegrating a student into her or his home school begins during the initial
screening of the child for consideration of admission to Littler. The capacity to return to one's home
school, i.e., the school referring the child, or the school the child will be returning to, will depend upon
promotion to her or his next higher grade, must be established before a child will be accepted into the
Littler program as must be the referring school's willingness to have the student return there.
Similarly, the graduation requirements for students admitted to the Littler Center are formulated in a
preliminary manner during the screening and planning sessions held with each child and her or his
family, the staff of the referring school, and social services caseworkers when appropriate. The
requirements are largely expressed in terms of outcomes the child will achieve. The program is
constructed to emphasize the positive outcomes and gains each student will make. Whenever
possible, the strengths of the child will be used as the primary tools for progress.
Follow-up mental health care for students graduating from the Littler will be arranged by the Littler
Center's mental health staff with NRBH, other mental health centers, or a private practitioner of the
graduate's family's or guardian's choosing. The transition plan that guides the student's return to her
or his own school also provides for a stepped, systematic introduction to the new therapist or
reintroduction to a previous therapist to ensure continuity from day treatment to more traditional
outpatient services.
IV. MEASURABLE OUTCOMES
At the time of admission to the Littler Center, each student will be evaluated using, in part, the
Colorado Clinical Assessment Report (CCAR) developed by the Colorado Office of Mental Health
Services. Every six months thereafter and at discharge from the Littler Center the CCAR will again be
administered. The three-page form covers a wide range of variables and assessments. The Littler
Center Admission and Termination Evaluation Forms are to be used as evaluation tools as well.
These look specifically at the effects of the littler program. Copies of these forms are attached at the
end of this proposal. The therapist conducts a complete assessment 10 days after enrollment to
develop an all inclusive behavior/treatment plan to meet the student's needs. Discharge goals are
developed for all identified areas of need and the measurable short-term goals developed monthly to
measure and work toward the discharge goal.
It is anticipated that 90% of the children successfully completing the Littler program will reside in their
own homes, or remain in placement at a similar level of care as they were at the time of their referral,
for the first six months after their discharge. The criteria for success will be that each child returns to
4
FAMILY PRESERVATION PROGRAM, North Range Behavioral Health 2002-2003, BID #RFP-FYC-02006
or remains in her or his home or foster home and is able to safely and constructively do so for at least
the first six months they are no longer attending the Littler Center. This information will be gathered
by three and six month follow-ups with the child's family and their WCDSS caseworker, if appropriate.
Additionally, all successful graduates will enter, remain in, and make satisfactory progress in public
school after their discharge from the Littler Center. More specifically, each graduate of Littler will
maintain or enhance the progress she or he made academically, socially, behaviorally, and
emotionally during her or his time in the program. This will be monitored by three and six month follow
ups with the child's family, their WCDSS caseworker, if appropriate, and by the school community
facilitator (or the equivalent) from her or his home school. The criteria for success will be maintenance
of or improvement upon her or his levels of functioning in the four areas mentioned above as stated in
their individualized educational plan and their mental health services plan.
The families of 90% of the children successfully completing the Littler program will report a more
relaxed, nurturing, and competent relationship with their children than existed prior to enrollment.
Families will be surveyed at discharge, three months and at six months after discharge.
Ninety percent of the children completing the Littler program will report and demonstrate an improved
sense of self worth, self-confidence, and decreased high-risk behaviors. Appropriate improvements
will be revealed when pre-C.C.C. CCAR ratings are compared with similar ratings done at the time of
completed transition back to the home school.
V. SERVICE OBJECTIVES
The primary goal of the Littler Center is to successfully intervene in the lives of its students and their
families to minimize the future need for similar intensive services, to enhance each child's ability to be
educated and to benefit from that education in her or his home school, to enhance each child's ability
and capacity to respond appropriately and healthfully to her or his family, and to improve each child's
family's abilities to adequately and appropriately respond to and provide for the child's needs in a
competent, safe, nurturing, And growth enhancing manner.
In working with families to achieve the goal of improving their abilities to manage family conflict in a
safe, constructive manner, the Litter Center staff works toward the objective of resolving conflicts
between parents and children so that no maltreatment of the children occurs, no domestic violence
occurs, no children run away from home, and no children commit status or legal offenses. Success is
measured by family, caseworker, and therapist reports that the objective was met. Each family will
also be asked to report on its subjective improvements in this area.
To meet the Littler Center goal of improving overall parental competency, an objective of increasing
the parents' abilities to develop and maintain sound, caring, effective relationships with each other
and with their children is established. An additional objective is to enhance the abilities of the parents
to provide, with as much proficiency as possible, for their family's care, nutrition, hygiene, discipline,
protection, education, and supervision. All parents are encouraged to develop appropriate support
5
FAMILY PRESERVATION PROGRAM, North Range Behavioral Health 2002-2003, BID #RFP-FYC-02006
systems designed to last beyond their child's involvement with the Littler Center. Again, the parents
and children will be polled concerning their subjective opinions about the improvements they have
made, as will the therapist and caseworker.
The Littler Center works with each client family to achieve the goal of improving its household
management competency. The objective is to enhance the capacity of the parents to provide a safe
household environment for the children through competently managing the home to include cleaning,
repairing, and maintaining the home, as well as via effective budgeting and purchasing. The family,
therapist, and caseworker will document the improvements made in this area.
The Littler Center works to improve each family's ability to find and use appropriate resources.
Treatment and case management services assist each family to learn more effective means to obtain
needed help from other sources in the community and from local, state, and federal governments.
This is modeled in each of the families' relationships with the Littler staff. The families will report, and
their caseworker and therapist will confirm, all gains made in this area.
VI. WORKLOAD STANDARDS
The Littler Center will provide day treatment services to 20 children aged five through 12 years who
will meet the FYC funding criteria. A year round academic/treatment schedule is in place. It is
anticipated that up to 18 children will be enrolled in the course of a year. The average length of stay in
the program will range from 36 to 52 school weeks. Littler students will attend an average of at least
5.9 hours of programming daily on all days the school is in session. The total staff of the Littler Center
numbers mote than 17 individuals, comprising slightly more than the equivalent of 13 full-time
employees. This staffing level exceeds all Colorado licensing rules. Said rules specify a student to
total staff ratio of not more than eight to one which is far less than the four to one ratio employed at
Littler. If there is a time when only one staff member is present, a second staff member is on call and
immediately available to be summoned to an emergency. NRBH certificate of insurance coverage is
attached.
VII. STAFF QUALIFICATIONS
Licensing requirements mandate that day treatment programs have a treatment leader who is
responsible for the overall mental health services to each child. This person must hold a master's
degree in the behavioral sciences and have not less than three years of clinical experience.
Counselors in day treatment programs are mandated by the State of Colorado to have completed a
bachelor's degree in the behavioral sciences or to have at least four years of experience with
appropriate aged children, and must be at least 21 years of age. All of the staff meet or exceed these
requirements. John Ashby, MSW (soon to be LCSW) with eleven years experience, Matt Newton,
MSW, LCSW with twelve years of experience, Bonnie Derby, MSW, LCSW, with fifteen years of
experience and Sheryl Gonzalez, MS, four years experience.
6
•
FAMILY PRESERVATION PROGRAM, North Range Behavioral Health 2002-2003, BID #RFP-FYC-02006
Sandee Atwood, MSW, LCSW, is the Littler Center Program Director as well as Clinical Director.
Once a child is accepted into the Littler Center the intake coordinator, Cath Stilwell, MSW, establishes
a preliminary treatment plan and then the clinical director works with the primary therapist in the
development of the day treatment plan for each student. Ms. Atwood has fifteen years experience as
a Psychiatric Social Worker in the school system and twelve additional years as a clinical director for
an outpatient treatment center and day treatment center. Three of those years were as Clinical
Director of Devereux Cleo Wallace Treatment Center in Westminster, Colorado.
Wallace LaBaw, MD, staff psychiatrist for the Littler Center, is a board certified psychiatrist. He is able
to follow-up with children after they graduate from the Littler Center and enter more traditional
outpatient care through NRBH.
Mike Hoover, Ed.D is the administrative supervisor of the Littler Center's educational component.
Since 1992, he has been a Special Education Coordinator for District 6. Currently certified as a
School Psychologist and Special Education Administrator, he has worked in the field for more than 20
years.
The Littler Center's teachers are Gayle Schneider, MA, Gail Gerdes, BA and Cindy Takahashi, BA.
Ms. Schneider is a certified special education teacher for significantly identifiable emotionally
disturbed children and is also certified in the area of learning disabilities and mentally handicapped.
Ms. Gerdes has a BA in Special Education and is a licensed teacher in the State of Colorado. Ms.
Takahashi has completed her requirements in Special Education Affective Needs . Leigh Ann
Luberstedt is the Speech/Language Clinician. She has completed her masters degree in speech
language pathology. Beth Gay is the School Psychologist and does assessments and conducts IEP
team meetings. Ms. Gay has an Ed.S. degree in School Psychology and is a nationally certified
school psychologist. Karen O'Connell is a registered occupational therapist and provides both direct
and consultative OT services to the Littler Center. Three full-time paraprofessionals, Cindy Jones,
Freddie Ancheta, and Jennifer Crawford, assist the teachers in carrying out each student's
individualized educational plan.
Ann Teague, an RN and Nurse Practitioner, is the school nurse and health consultant to the C.C.C.
She regularly checks in with the staff and students of the C.C.C. and is also available as needed.
VIII. PROGRAM CAPACITY BY MONTH
The Littler Center is designed to function with a minimum clinical staff contingent of 4.O FTE, serving
an average of 15 - 18 children and their families at any given time.
7
RFP-FYC-02006 Attached A
VIII. COMPUTATION OF DIRECT SERVICE RATE
This forrlis to be used to provide detailed explanati€n of the hourly rate your
organization will charge the Core Services Program for the services offered in this
dquest for Proposal . This rate may only be ysed to bill the Weld County Department 4
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 944 Hours [A]
Total Clients to be Served 12 Clients [B]
Total Hours of Direct Service for Year 11,328 Hours [C]
(Line [A] Multiplied by Line [B]
Cost per Hour of Direct Services $ 12.65 Per Hour [D]
Total Direct Service Costs $ 143,325 [E]
(Line [C] Multiplied by Line [D] )
Administration Costs Allocable to Program $ 5,000 [F]
Overhead Costs Allocable to Program $ 22,006 [G]
Total Cost, Direct and Allocated, of Program$ 170,331 [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] ) $ 170,331 [j]
Total Hours of Direct Service for Year 11,328 [K]
(Must Equal Line [C] )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 15.03 [L]
Day Treatment Programs Only:
Direct Service House Per Client Per Month 115 [N]
Monthly Direct Service Rate $ 1,728 [N]
Page 31 of 32
Client# : 15394 NORRA
ACORLL CERTIFICATE OF LIABILITY INSURANCE DATE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins . Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. 0 . BOX 578 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street
Greeley, CO 80632 INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
North Range Behavioral Health
Irwin Siegel Agency Inc .
INSURER B:Pinnacol Assurance
1306 11th Avenue
INSURER C:
Greeley, CO 80631
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSN. TYPE OF INSURANCE POLICY NUMBER TPOLICY EFFECTIVETPOLICY EXPIRATION!
LTfl I DATE(MM/DO/YY) DATE(MM/DD/YY) LIMITS
A GENERAL LIABILITY •5182327225 01/01/02 I01/01/03 EACH OCCURRENCE $l 000, 000
X COMMERCIAL GENERAL LIABILITY
_ ! i FIRE DAMAGE(Any one flre)E2OO OOO ___
CLAIMS MADE! . OCCUR MED EXP(Any one person) $15, 000
II I r-_ - rt -,
PERSONAL BADV INJURY 4 51,_000, 000
I GENERAL AGGREGATE ;$3 , 000, 000
GENT_AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOPAGG!$3 , 000_y000_
POLICY JEOT LOC -.-_ --__
A AUTOMOBILE LIABILITY S182327225 : 01/01/02 01/01/03 IICOMBINED SINGLE LIMIT
X ' ANY AUTO I(Ea accident)
i $1, 000 , 000
- ALL OWNED AUTOS BODILY INJURY I,$
SCHEDULED AUTOS •
,"' per person)14 X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS l ? (Per accitlent)
y Iyy
PROPERTY DAMAGE $
(Per accident)
:w
GARAGE LIABILITY c'ST
AUTO ONLY EA ACCIDENT:$
ANY AUTO •
EA ACC
•OTHER THAN
' AUTO ONLY: AGG '$
A EXCESS LIABILITY :S182327225 01/01/02 : 01/01/03 EACH OCCURRENCE $
OCCUR CLAIMS MADE. AGGREGATE i $
DEDUCTIBLE ,$
X. RETENTION $ I $
B WORKERS COMPENSATION AND 404331 10/01/01 07/01/02 RYLIMITS.._ ..O14
EMPLOYERS'LIABILITY _TO
E.L.EACH ACCIDENT .$100, 000 __
E.L.DISEASE EAEMPLOYEE $100 , 000
CY IT , 000
A Professional S182327225 01/01/02 01/01/03 E$3I, 000 , O00 Aggregate
OTHER $3 , 000 , 000 Aggregate
Liability $1 , 000 , 000 Occurrence
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDRIONALINSURED;INSURER LETTER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE D?PIRATION
Weld County Social Services DATETHEREOF,THE ISSUING INSURER WILL ENDEAVOR TOMAIL30 DAYSWRITTEN
315 N. 11th Avenue NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUT FAILURE TO DO SO SHALL
Greeley, CO 80631 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Rood -?th_1son -Th.sa4an.C., , -L -
ACORD 25-S(7/97)1 of 2 #9204952/M204922 CCN 0 ACORD CORPORATION 1988
Littler Center
Forms
•
KATHLEEN P. LITTLER CENTER ADMISSION EVALUATION FORM(8/99)
Client Name Client Id#
Diagnosis: Primary Secondary
Date of Birth School Grade City
Admit Date Center Admit Littler
Medicaid Yes No(Check One) Sex Ethnicity
Who has custody of child at time of admit to Littler?
Where was child living immediately prior to admission to Littler?
Outpatient Therapist(if any)
Address/Phone
Special Behaviors or Circumstances/Reasons for referral
PAST PRESENT
Yes No Yes No
Suicidal
Violence toward others
Runaway Behavior _
Self Mutilating Behavior
Social Isolation
Past Legal Charges
Current Legal Charges
On Probation
Victim Physical Abuse
Victim Sexual Abuse
Alcohol Use
Use of Inhalants
Other Drug Use
Learning Disabilities
Special Education
Others(specify)
•
GAF SCORE AT ADMISSION
OVERALL PROBLEM SEVERITY SCORE
LEVEL OF FUNTIONING SCORES AT ADMISSION(Rate all six areas.)
High Moder. Aver. Moder. Very
Func. High Low Low
1 2 3 4 5 6 7 8 9
Societal Functioning
Interpersonal Functioning
Daily Living Personal Care
Physical Functioning
Cognitive Intellectual
Overall Level of Functioning
KATHLEEN P. LITTLER CENTER TERMINATION EVALUATION FORM(8/99)
Client Name Client Id#
Littler Discharge Date:
Discharge Diagnosis: Primary Secondary
If psychotropic meds were used,please list below:
2.
3.
Who has custody of child at time of discharge from Littler?
Where will the child be living immediately after discharge from Littler?
Who will follow youth after discharge?
Special Behaviors or Circumstances
PRESENT
Yes No
Suicidal
Violence toward others _
Runaway Behavior _
Self Mutilating Behavior
Social Isolation
Legal Charges Pending
On Probation
Victim Physical Abuse _
Victim Sexual Abuse _
Alcohol Use
Use of Inhalants _
Other Drug Use
Learning Disabilities
Special Education
Others(specify)
GAF SCORE AT DISCHARGE
OVERALL PROBLEM SEVERITY SCORE
LEVEL OF FUNTIONING SCORES AT ADMISSION(Rate all six areas.)
High Moder. Aver. Moder. Very
Func. High Low Low
1 2 3 4 5 6 7 8 9
Societal Functioning
Interpersonal Functioning
Daily Living Personal Care
Physical Functioning
Cognitive Intellectual
Overall Level of Functioning
l COLORADO CLIENT ASSESSMENT RECORD 1
NAME: Fr GAF SCORE
EIHNICIRACE 74 171
I 11 (AGENCY u I I I PROGRAM 4a (1)American Indian/Alaskan Native
I I I I I I I I I (CLIENT ID el4 (2)Asian/Pacific Islander
(3)Black
REFERRING AGY (4)Hispanic
CLIENT ID lam (5)W�(Non-Hispanic)
(6)Mull-Racial
I 1 1 1 1 I I I I (MEDICAID ID 2442 HISPANIC ORIGIN x
US
ADMISSION DATE ssro (1)Not of Hispanic Origin
MONTH DAY YEAR (2)
(3)Puerto Rican
ACTION TYPE (Manual Input Only) 412 (4)Cuban
- (5)Other Hispanic
01=Admission 11=Conecfbn to Admission MARITAL STATUS x I
02--Activate 12=Correctlan to Activation
03=Update 13--Consclbn to Update (1)Never Marled (4)Widowed
04=Inactivate 14=Correction to inactivation (2)Married (5)Divorced
05=Diedtage 15-Canection to Discharge (3)Married Separated(Legal or Marital Discord)
06=Evalu tion Only PLACE OF RESIDENCE n I
I MEDS ONLY CLIENT a (1)Correctional Facly/Jag
(2)(1)Yes (2)No (3)Nuising
ELM ADMISSION STATUS w (4)Residential Facility-Menial Heath
(5)Residential Friday-Non-Mental Heath
(1)New
(2)Readmission From Ills Fiscal Year (7)Boarding �Homeless-O She
(3)Readmission From Prior Fiscal Year (7)H St
(8)Homeless-On the Street
PERMANENT HAPDICAPIIMPAIRMENT 4545 (9)Other Independent Living Arragernerd
(Cods ALL 6 Bones Using t Yes 2 No) CURRENT LIVING ARRANGEMENT is
(1)Mental Retardation
(2)Deafness or Severe Hewing Loss (1)Lives Wmh Both Parents
(2)lives With One Parent
(3)Bfaldness or Severe Visual impairment (3)Lives Wth Spouse and or Other Relative(s)
(4)Speech Impairment (4)Lives Alone
(5)Nan-Anliatay or Assisted Ambulation (5)Lives With Unrelated Persat(s)
CURRENT EMPLOYMENT STATUS is I
LEGAL STATUS w
(1)Employed-Full Tkne
(1)Voluntary
(2)Court-Directed Vokrriaiy (3)Employed-Part Tine
(3)Forensic Involuntary (3)Homemaker-Not Otherwise Employed
(4)72-Hoar Evaluation and Treatment(MH-HOLD) (4)NotSh a Employment
(5)Short-Term Certified (5)Not in toyedr Face
(6)Long-Tam Certified (6)Unemployed For Less Than 3 Months
(7)Voluntary Hospitalization of Minors (7)AimeUnemd
Forces o (Active For c Months a More
(8)CNdau'Code C.R.S.19-1-101
(8) Maifary Dilly)
(9)Emergllnvol.Akatwismlucug Commitment ANNUAL FAMILY HOUSEHOLD INCOME m
—1—al
.emu REFERRAL SOURCE 5142 1 I I ' I I I
PRIMARY DIAGNOSIS SECONDARYDIAGNOSIS 6167 NUMBER OF PERSONS SUPPORTED BY e I
(a yraraa) THIS INCOME(Include Client)
I f I • 1-1 1 11 1 1 1 1 I (1)1 (client on y) (6)6
I PRESENTING PROBLEM HAS EXISTED es (2)2 (7)7
(1)1 Year or Lager (2)Less Than 1 Year (4)4 (9)8
(4)4 (9)9aMore
PREVIOUS MENTAL HEALTH SERVICES mu (5)5
(Cods W.Pow Bones Using 1 Yes 2 No) HIGHEST EDUCATION LEVEL-IN YEARS sun I I
Inpatient Care
(Less Than First Grade Code as 03)
Other 24-Hour Care
Partial Care DUE TO MENTAL HEALTH REASONS. se I
Care CLIENT IS CURRENTLY RECEIVING:
Outpatient (1)SSI (3)Both
I I COUNTY OF RESIDENCE OW (2)SSDI (4)Nether
DATE OF BIRTH se-n FIRST S LETTERS OF CLIENTS LAST NAMEnat I I I
ISW ta ;;u�:;f�:m ZIP CODE 5244 a•t00
MONTH DAY YEAR -1 . 111
ISSEX n Triage Denver Health a Medical Center Only tot I
(1)Male (2)Female
White—Billing Yellow—Chart SHADED BOXES ARE NOT PROCESSED ON UPDATE
ca....5955 R 11/97
COLORADO CLIENT ASSESSMENT RECORD 2
a
Client I.D. Name Admit Date
HISTORY 102-toe Check ALL that Apply CURRENT P-SEV Check ALL Problems that Apply
—Vic1:Sexual Abuse Hid: Unstable
Suicide Attempt _Hist: stable Employ's I I AGGRESSIVENESS 191-197
WI:Physical Abuse Hid:Family Mead-Ill
V- ict:Neglect _Hid:Family Sub-Abuse _wing OW _Defiant Threatening
Aggressive Hostile Intimidating
SPECIAL PROBLEMS/ISSUES 105-11s iis Check AU.that Apply — — _
prinsoctAL 196203Learning Disability CNS Disorder _Language Issues
Loss/Grief Wetting/SoilingCultural/Belief Issues _Disrespect Disregards Rules —Uses/Cons Others
_-Eating Disorder _Fire Set/Destroy Property _Disobedient —Dishonest
PROBLEM SEVERITY 1 I,.EGAL 204-210
_ _ _
Legal Problems Probations/Parole Offenses:Property
RATE the CURRENT P-SEV(PROBLEM SEVERITYI Charges Pending _Offenses:Substances _Offenses:Persons
for each area in the boxes provided,using the following scale:
None Slight Moderate Severe Extreme 1 VIOLENCE I DANGER TO OTHERS 211-217
1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 kx_Violent Fntctdal Ideation
_Assaukive Homicidal Threat/Attempt
CURRENT P-SEV Check ALL Problems that Apply —Phys/Sexual Abuser _Danger's Men 1$: ^l 0 r
1 EMOTIONAL WITHDRAWAL 117-123
n FAMILY ISSUES 216225
Underactive Passive Doesn't Verbalize Feelings
—Distant _Subdued _Blunted Affect No Family/No Contact Family Legal Domestic Violence
DEPRESSION 124-130 of Home Placement _Parenting _Unstable Home/Fam
_Separaliat/CudadY
—Depressed _Lonely —Hopeless n FAMILY PROBLEMS WITH 2zs-zit
Worthless Sad _Dejected
Parent Partner_Pa _
_ Relative ANXIETY 131-139 —Siding Child
_Anxious _Nervous Panic INTERPERSONAL PROBLEMS 232-236
Tense Flashbacks Phobic
_-Fearful _Nightmares/Terrors _w/Friend _Establishing Relationships
Social Skills Maintaining Relationships
HYPER AFFECT 140-145 — —
_Ov
eractive _Pressured Speech _Elevated Mood ROLE PERFORMANCE(Work/Schooli 237-243
Mood Swings Accelerated Speech Mania
Absenteeism Performance Behavior
ATTENTION PROBLEMS 147-153 _SuspencioNProbatbn —Termination —-Limited Employability
_Agitated Distractible Attention Span SUBSTANCE ABUSE 244-x9
Restless Impulsive Concentration
— _ _
SUICIDE/DANGER TO SELF 154-1 W — bleProblem w Alcohol —Depend°"tlPddwied In Recovery
Pron w Drugs _Interferes with Responsibilities
_Suicide Ideation _Self-Injury/Mutilation MEDICALIPHYSICAL 250-254
_Suicide Plan _Reckless Self-Endangerment
Suicide Attempt Danger to Self tZRB g7 216 _Acute Illness _Medical Care Needed Physical Handicap
Chronic Illness Injury au ByAbuse/Assll -Permanent Disability
THOUGHT PROCESSES 1st-iss
Bizarre _Suspicious Repeated Thought 1 SECURITY/MANAGEMENT ISSUES 257-265
_-Delusions Paranoid —Obsessiva _Seclusme Out Walkaway/Escape _Behavior Manageml
Hallucinations —
_Close Supervision Security Suicide Watch
— Medication Compliance —Inadequate Adult Supervision
COGNITIVE PROBLEMS 166175 — —
Confused Loose Associations Lacks Self Awareness OVERALL DEGREE OF PROBLEM SEVERITY 2sa_
—Disoriented —Disorganized —Impaired Judgement Check ONE Response
SELF-CARE/BASIC NEEDS 176iss None Slight Moderate Severe Extreme
_Hygiene Doesn VAanage Money Doesn't Provide Food 1 2 3 4 5 6 7 8 9
Self Care Problems Doesn't Use Resources Doesn't Provide Housing
—Gravely Disabled {OR52T,1.g! UPDATE.ACTIVATE.INACTIVATE&DISCHARGE ONLY
CHANGE IN OVERALL PROBLEM SEVERITY 257
RESISTIVENESS in-1se Check ONE Response
Resistive Evasive Wary Much Much
— _
_Ueboperative _Guarded Denies Problems Better Better No Change Worse Worse
1 2 3 4 5 6 7 a 9
White—Billing Yellow—Chart c.....,a2<n a t/o7
I COLORADO CLIENT ASSESSMENT RECORD 3
1
Client I.D. Name Admit Date
STRENGTHS/RESOURCES LEVEL-OF-FUNCTIONING (LOF)
Check ALL QURRENT STRENGTHS/RESOURCES Individual has: Check ONE Response for Each LOF Area
ECONOMIC RESOURCES x9-274 SOCIETAL/ROLE FUNCTIONING 301
_Medicaldeaedcare _Emplo snnd _Transportation Very High Moder High Average Moder Low Very Low
_Other Medical Maur _Housing Function Function Function Function Function
Other Public Assts _FMnrwial
1 2 3 4 5 6 7 6 9
gDUCATION/SKILL RESOURCES 276279
INTERPERSONAL FUNCTIONING 305
_Language Sias Interpersonal Skills _Intelligence Very High Moder High Average
_Education _Job Skills Function Function Function Function Function
PERSON RESOURCES x0-287
Parent(s) Partner _Professional Caregiver
_ _
1 2 3 4 5 6 7 8 9
Siblings) Children) _Other Supportive Relationship DAILY LIVING/PERSONAL CARE FUNCTIONING 3041
_Relative(s) _Friend(s) Very High Moder High Average Moder Low Very Low
PERSONAL STRENGTHS x9.301 Function Function Function Function Function
_Likeableness Emotional Stability Adaptability 1 2 3 4 5 6 7 8 9
_
Appearance _Heals' Thought Clarity PHYSICAL FUNCTIONING 307
Confidence Hopefulness Resourcefulness
_ _ _
_Judgement Responsibility_ Tolerance Very High Moder High Average Moder Low Very Low
_EmpaUry Function Function Function Function Function
Insight
1 2 3 4 5 6 7 8 9
COGNITIVE f INTELLECTUAL FUNCTIONING 309
Very High Moder High Average Moder Low Very Low
Function Function Function Function Function
1 2 3 4 5 6 7 6 9
CURRENT OVERALL STRENGTHS/RESOURCES 302 OVERALL LEVEL OF FUNCTIONING Check ONE Response 309
Check ONE Response Very High Moder High Average Moder Low Very Low
Very High High Moderate Some Very Low Function Function Function Function Function
1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9
UPDATE.ACTIVATE.INACTIVATE A DISCHARGE ONLY UPDATE.ACTIVATE.INACTIVATE&DISCHARGE ONLY
CHANGE IN OVERALL STRENGTHS/RESOURCES 330 CHANGE IN LEVEL OF FUNCTIONING Check ONE Response 310
Check ONE Response Much Much
Much Much Better Better No Change Worse Worse
Better Better No Change Worse Worse
1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9
IIIIIIIIII STAFF ID 311419 STAFF SIGNATURE
IlDISCIPLINE' 1=none 2=mh worker 3=nursing 4-social work 5=psychology 6=psychiatry 7=other 320
fl DEGREE' 1=none 2�ssoelate 3=bachelors 4=masters 5=Ph0/PsyD/EdD 6=MD 7=other 321
COMPLETE THIS BOX ONLY FOR COMPLETE THIS BOX ONLY AT DISCHARGE
UPDATE,ACTIVATE AND INACTIVATE STATUS
DATE FORM COMPLETED
MONTH DAY YEAR 330-337
I LAST CONTACT DATE
MONTH DAY YEAR 331445
1 EFFECTIVE DATE 322429 1 I DISCHARGE DATE
MONTH DAY YEAR
MONTH DAY YEAR 346-353
TYPE OF TERMINATION* 354
SPECIAL STUDIES I DUxharged/Transferred 5-From Inactive
2.TX Completed/No Referral EmPatient/Client Died
857465 3-TX Conpleted/Follow-up 7.PatienUCttent Terminated
4.Evaluation Only
357479 I TERMINATION REFERRAL' 355ass
NOTE:Use 61 'Self if no Referral
White—Billing Yellow—Chart Form#270 R 5/97
INTEGRATED ASSESSMENTS FOR GOAL DEVELOPMENT
Client Name: Client# DOB:
Admission Date: Clinician:
AGGRESSIVENESS/SELF OR OTHERS (Homicidal/Suicidal/Self-destructive)
ASSESSMENT:
History Clinical Assessment
Intake Assessment Other
Psych. Assessment To Be Assessed
Findings/Assessment Results:
STRENGTH: Not A Treatment Issue At This Time
Focus Of Treatment (Refer To Goal Sheet)
Defer Presently: Provide Clinical Rationale
FUNCTIONAL
COMMUNICATION/PROCESSING ISSUES
ASSESSMENT:
History Psych. Assessment
Intake Assessment Clinical Assessment
Speech/Language Assessment To Be Assessed
Other
Findings/Assessment Results:
STRENGTH: Not A Treatment Issue At This Time
Focus Of Treatment(Refer To Goal Sheet)
Defer Presently: Provide Clinical Rationale:
DAILY LIVNG SKILLS:
ASSESSMENT:
History Psych Assessment
Observation Other
Clinical Assessment To Be Assessed
Findings/Assessment Results:
STRENGTH:Not A Treatment Issue At This Time
Focus of Treatment: (Refer to Goal Sheet)
Defer Presently: Clinical Rationale:
EDUCATION
ASSESSMENT:
Academic Testing Other
History To Be Assessed
Observation
Findings/Assessment Results:
2
e
_ STRENGTH:Not a Treatment Issue At This Time
Focus of Treatment: (Refer to Goal Sheet)
Defer Presently: Clinical Rationale:
PHYSICAL/NEUROLOGICAL
ASSESSMENTS:
History _OT/PT Assessment
Clinical Assessment Other
Psych Assessment To Be Assessed
Findings/Assessment Results:
STRENGTH:Not A Treatment Issue At This Time
Focus of Treatment(Refer to Goal Sheet)
Defer Priestly: Clinical Rationale
SOCIAL SKILLS:
ASSESSMENT:
History _ Other
Clinical Assessment Intake Assessment
Psych Assessment To Be Assessed
Findings/Assessment Results:
3
STRENGTH: Not a Treatment Issue At This Time
Focus of Treatment(Refer to Goal Sheet)
Defer Presently: Clinical Rationale
MENTAL STATUS
THOUGHT PERCEPTION OR JUDGEMENT ISSUES
ASSESSMENT:
_ History Other
Psych Assessment _ Intake Assessment
Clinical Assessment To Be Assessed
Findings/Assessment Results:
STRENGTH:Not a Treatment Issue At This Time
Focus of Treatment(Refer to Goal Sheet)
Defer Presently: Clinical Rationale
MOOD/AltECT
ASSESSMENT:
History Other
Psych Assessment Intake Assessment
Clinical Assessment To Be Assessed
4
•
Findings/Assessment Results:
_STRENGTH:Not a Treatment Issue
Focus of Treatment(Refer to Goal Sheet)
Defer Presently: Clinical Rationale:
SEXUAL REACTIVE OR PERPITRATION ISSUES:
ASSESSMENT:
History/Physical M.D. Assessment
Medical Illness Other
Psych Assessment To Be Assessed
Intake Assessment
Findings/Assessment Results:
STRENGTH:Not a Treatment Issue:
Focus of Treatment(Refer to Goal Sheet)
Defer Presently: Clinical Rationale:
5
•
TRAUMA RELATED ISSUES: (Abuse/neglect/attachment issues)
ASSESSMENT:
I iistory _ Clinical Assessment
Intake Assessment _ Other
Psych. Assessment
Finding/Assessment Results:
STRENGTH: Not A Treatment Issue At This Time
Focus Of Treatment(Refer To Goal Sheet)
Defer Presently: Provide Clinical Rationale
OTHER CHALLENGING BEHAVIORS:
ASSESSMENTS:
History _ Clinical Assessment
Intake Assessment Other
Legal Involvement To Be Assessed
Psych Assessment
Findings/Assessment Results:
6
_STRENGTHS: Not a Treatment Issue
Focus of Treatment(Refer to Goal Sheet)
Defer Presently : Clinical Rationale
HEALTH ISSUES:
ASSESSMENTS:
History Clinical Assessment
Intake Assessment _ Other
Psyche Assessment To Be Assessed
Findings/Assessment Results:
STRENGTH:Not a Treatment Issue
Focus of treatment(Refer to Goal sheet)
Defer Presently Clinical Rationale:
SUBSTANCE ABUSE ISSUES:
ASSESSMENT:
History Clinical Assessment
Intake Assessment _ Other
Psych. Assessment To Be Assessed
Findings/Assessment Results:
7
Strength: Not a Treatment Issue At This Time
Focus of Treatment(Refer To Goal Sheet)
Defer Presently: Provide Clinical Rationale
FAMILY/GUARDIAN TREATMENT ISSUES:
ASSESSMENTS:
History Pscyh Assessment
Intake Assessment Other
Clinical Assessment To Be Assessed
Findings/Assessment Results:
•
STRENGTH: Not a Treatment Issue At This Time
Focus of Treatment: (Refer to Goal Sheet)
Defer Presently: Clinical Rationale:
CASEMANAGEMENT RESPONSIBILITIES:
Describe out-side sources involved in Client's treatment and on-going responsibilities of Littler Staff in
regards to these resources. Include understanding of responsibility of out-side source discharge planning as
well.
8
SUMMARY OF STRENGTHS FOR THIS CLIENT TO BE USED IN
TREATMENT:
JUS L WICATION FOR TREATMENT:
Decomposition of Psychiatric Illness
Medication Management/Stabilization
Continued Treatment Failures at other Placements or Less Restrictive Levels of Care
Crisis Stabilization Escalation of Behavior Problems Safety Issues
Other: (please State) _
JUSTIFICATION FOR LEVEL OF CARE:
9
DISCHARGE CRITERIA:
_ Absence of suicidal/self destructive behavior
Management/Self Management of Aggressive Behavior
Medication Stabilization
_ Stabilization of Psychiatric Illness
Management/Self Management of Feelings Causing Affective or Behavioral Issues
Determination of an appropriate Discharge Placement
Other(please specify)
Other(please specify)
DISCHARGE PLAN/FOLLOW-UP NEEDS:
Return to Parent/Guardian Intensive Family Treatment
_ FosterCare Placement _ Medication Management
_ Group Home Medical Treatment
_ Return to Public School _ OT/PT Services
_ Long Term Treatment Placement _ Perpetration Treatment(Group or
Individual)
Special Education Program _ Individual Therapy
Mentor/Community Referral(specify)
Other(specify)
Other(specify)
10
Supplemental Narrative to RFP:
Exhibit B
Recommendation(s)
RFP: 01006-Day Treatment
North Range Behavioral Health
� V �
cl
cC",1 r ; ;'3 ;f 12: co
North Range
Behavioral Health Ed Jordan
President
Judy Richter,R.N.,PhD
Vice-President
Michele Vetting
Secretary
May 18, 2001 fly Wye
Treasurer
Alvin Derrera
Past President
Frank Aaron, Social Services Administrator
Weld County Department of Social Services
PO Box A
Greeley, Co. 80632
Dear Frank:
Thank you and Judy for the letter of May 1, in which Judy reported the results of
the RFP Bid process for PY 2001-02. We see no difficulty with the additional
recommendations. We will incorporate the recommendations by providing
additional communication to Department staff, and by assuring that the treatment
plans for day treatment clients will focus on the primary goals of evaluating youth
for out-of-home placement and returning the youth to their home and to public
school when appropriate.
Please contact me if there is a need for any further information.
Sincerely,
Dale F. Peterson, LCSW, MHA
Executive Director
1306 119i i,Avenue/Greeley,CO 80631/(970)353-3686/Fax(970)353-3906
3 NOT DESTROY4&tt '\
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
1 WEBSITE:www.co.weld.co.us
Ili e Administration and Public Assistance(970)352-1551 .
Child Supped(970)352-6933
COLORADO May 11, 2001
Mr. Dale Peterson, Director
North Range Behavioral Health, Inc.
1306 11 Avenue
Greeley, CO 80361
Dear Mr. Peterson: -
Re: RFP 01006, The Littler Center,Day Treatment
•
Dear Mr. Peterson:
The purpose of this letter is to outline the results of the RFP Bid process for PY 2001-
2002 and to request written information or confirmation from you by Wednesday, May
23, 2001.
A. Results of the RFP Bid Process for PY 2001-2002
Through the 2001-2002 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).
RFP 01006, Day Treatment:
Recommendations:
1. North Range Behavioral Health will make more of an effort to maintain
communication with Department staff.
2. North Range Behavioral Health will focus on the primary goals of
evaluating youth for out-of-home placement and returning the youth to
their home and to public school when appropriate.
B. Required Response by RFP Bidden Concerning FYC Commission
Recommendations.
The Weld County Department of Social Services is requesting your written
response to the FYC Commission's recommendation. Please respond in writing
to Frank Aaron, Social Services Administrator,P.O. Box A, Greeley, CO, 80632,
by Wednesday, May 23,2001, close of business.
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. If you do not accept the recommendation,please provide 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 Wednesday,May 23, 2001.
Sincerely,
tVi.GP}1
J y e ,Dipector
ldbunty epartment of Social Services
cc: Dick Palmisano, Chair, FYC Commission
Frank Aaron, Social Services Administrator
JO:of
EXHIBIT B
SUPPLEMENTAL NARRATIVE TO RFP
RECOMMENDATIONS
211 .`77 I7 I
5 n
North Range
Behavioral Health Waldo
>uclicic\eti;iig
Viec-Yresidnit
April 15, 2002
Sa remy
lira Fia,cr
Trcvww
T:Lbrduii
Gloria Romansik
Weld County Department of Social Services
P.O. Box A
Greeley, CO 80632
SUBJECT: RFP 02-03 06-000 Foster Parent Consultation
RFP 02006 Day Treatment
Dear Ms. Romansik:
We are in receipt of your notification letter dated April 8, 2002 in reference to the results
of the RFP Bid process for 2002-2003.
North Range Behavioral Health agrees to report outcomes specific to each of the two
programs noted above as per your recommendation. Should you need anything further,
please contact me.
Sincerely,
Wayne A. Maxwell
Executive Director
1306 11th Avenue/Greeley,CO 80(131 /(970)&S3-3(86/Fns(970)353-390(i
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
' WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
1111
COLORADO
April 8,2002
Wayne Maxwell,Executive Director
North Range Behavioral Health
1306 11 Avenue
Greeley, CO 80631 •
Re: RFP 02-03 06-000 Foster Parent Consultation
RFP 02006 Day Treatment
Dear Mr. Maxwell:
The purpose of this letter is to outline the results of the RFP Bid process for PY 2002-
2003 and to request written 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
recommendation(s)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 06-000,Foster Parent Consultation:
Approved with the above recommendation:
2. RFP 02006,Day Treatment:
Approved with the above recommendation:
B. Required Response by RFP Bidders Concerning FYC Commission
Recommendations
The Weld County Department of Social Services is requesting your written
response to the FYC Commission's recommendations and conditions. 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:
1 1
Page 2
North Range Behavioral Health
Results of RFP Process for PY 2002-2003
FYC Commission Recommendations:
You are requested to review the recommendation(s) 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 recommendation(s) in
your bid. If you do not accept the recommendation(s), please provide
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 though Elaine Furister, 352.1551, extension 6295, and
one will be arranged prior to April 17, 2002.
Sincerely,
Judy A. Griego,Director
Weld County Department of Social Services
of
cc: Dick Palmisano, Chair,FYC Commission
Gloria Romansik, Social Services Administrator
Hello