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Home My WebLink About20051651.tiff RESOLUTION RE: APPROVE FIVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR OPTION B-HOME BASED INTENSIVE PROGRAMS WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with five Notification of Financial Assistance Awards for Option B-Home Based Intensive 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 various providers, listed below,commencing June 1,2005,and ending May 31, 2006, with further terms and conditions being as stated in said awards: 1. Lutheran Family Services 2. Youth Emancipation and Services, Inc. 3. North Colorado Medical Center- Youth Passages 4. Ackerman and Associates, P.C. 5. Reflections for Youth, Inc. 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 five Notification of Financial Assistance Awards for Option B-Home Based Intensive 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 various providers listed above, be, and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said awards. 2005-1651 SS0032 SS C6 - /-OS- FIVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR OPTION B-HOME BASED INTENSIVE PROGRAMS PAGE 2 The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 6th day of June, A.D., 2005, nunc pro tunc, June 1, 2005. do BOARD OF COUNTY COMMISSIONERS 'e%' WELD COUNTY, COLORADO std . 86! r_: ,_ grie Vie, William✓� �'7/W ,,,y H. Jerk hair pre .on-ye lerk to the Board Deputy Clerk to e Board t) • D 'd . Long APP AS RM: Roberde� my ttor y �� Glenn Vaad Date of signature: /P ��.!- 2005-1651 SS0032 DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website: www.co.weld.co.us I Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 MEMORANDUM Ee TO: William H. Jerke, Chair Date: June 1, 2005 Board of County Commissioners g / COLORADO FR: Judy A. Griego,Director, Social Services j{A.d(3O( RE: Notification of Financial Assistance Awards for Option B-Home Based Intensive Programs with Various Providers Enclosed for Board approval are Notification of Financial Assistance Awards (NOFAAs) for Home Based Intensive Programs between the Weld County Department of Social Services and various providers. The NOFAAs are based upon the provider's Request for Proposal, which has been reviewed and approved by the Families, Youth and Children (FYC) Commission. The NOFAAs were reviewed at the Board's Work Session of May 31, 2005. The major provisions of the NOFAA are as follows: 1. The term period is from June 1, 2005 through May 31, 2006. 2. The Department agrees to reimburse providers under Core Services funding according to the NOFAA and their respective bid proposal for Home Based Intensive Programs. 3. Providers will be reimbursed according to various rates and services to child welfare families,youth, and children as provided below: No. Core Services Description of Program/Special Award Amount Contractor Conditions A. Lutheran Family Home Based Intensive is to strengthen $84.68 per hour Services and preserve families through counseling. $60 per hour court Capacity is to serve 19 families per year testimony through a 12 week program with 1 to 3 hours per week of therapy and related services B. Youth Emancipation& Home Based Intensive provides a $69.86 per hour Services, Inc. combination of family systems approach $65 per hour court with a community systems intervention testimony style. Crisis intervention is available 24- hours per day. Yearly capacity is 12. Average stay is 8 weeks with 2 to 3 hours per week of therapy. C. NCMC—Youth Home Based Intensive provides family $80.10 per hour Passages treatment interventions to re-parent, $155 per hour court problem solve,build communication skills, testimony and manage parent-child conflict. Clinic- based multi family systems group is held 2005-1651 each Saturday. Monthly capacity is 15; average stay in program is 7 to 10 weeks for 2 to 3 hours per week. D. Ackerman&Associates Home Based Intensive is a solution- $100 per hour focused service for up to 20 hours per $100 per hour court family. Capacity is 2 families per month testimony for 3 hours per week. E. Reflections for Youth Home Based Intensive is a solution- $82.09 per hour (Berthoud) focused therapy for a total of4,0 hours per $80 per hour court family and for 40 families per year. testimony If you have any questions,please contact me at extension 6510. 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 05-CORE-0001 Revision (RFP-FYC-05010) Contract Award Period Name and Address of Contractor Beginning 06/01/2005 and Lutheran Family Services Ending 05/31/2006 Option B,Home Based Intensive 3800 Automation Way, Suite 200 Fort Collins, CO 80525 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Designed to strengthen and preserve families Assistance Award is based upon your Request for who are at risk of having children placed in Proposal (RFP). The RFP specifies the scope of foster care or have been recently reunified services and conditions of award. Except where it is following out-of-home placement.Designed to in conflict with this NOFAA in which case the strengthen&preserve families by providing a NOFAA governs,the RFP upon which this award is safe, stable, and nurturing family environment, based is an integral part of the action. promote safety&well-being of children & families,maintain&build upon family Special conditions connections & supportive resources,reduce 1) Reimbursement for the Unit of Services will be based isolation, assist parents in parenting techniques, on an hourly rate per child or per family. improve individual&family functioning, 2) The hourly rate will be paid for only direct face to household management, &prevent,reduce, or face contact with the child and/or family, as eliminate at-risk behaviors for the child and evidenced by client-signed verification form, and as family. Capacity to serve 19 families per year, specified in the unit of cost computation. monthly average capacity 4,duration of service 3) Unit of service costs cannot exceed the hourly and to 12 weeks, 1-3 hours per week. Bilingual and yearly cost per child and/or family. South County Services. 4) Payment will only be remitted on cases open with,and referrals made by the Weld County Department of Cost per Unit of Service Social Services. Hourly Rate Cost Per Unit of Service 5) Requests for payment must be an original submitted to Hourly Rate Per $84.68 the Weld County Department of Social Services by the Individual Counseling end of the 25th calendar day following the end of the Family Counseling month of service.The provider must submit requests Treatment Package-Intensive for payment on forms approved by Weld County Treatment Package-Moderate Department of Social Services. Treatment Package-Low 6) The Contractor will notify the Department of any Early Intervention Program changes in staff at the time of the change. Reunification Community Based Service -Child Protection In-home Svcs for At Risk Delinquents Therapeutic Staffing Hourly Rate Per Court Testimony $60.00 Enclosures: X Signed RFP: Exhibit A Supplemental Narrative to RFP: Exhibit B Recommendation(s) Conditions of Approval Approvals: Program fficial: /\ A By By \, IIJN` William H. Jerke, Chair Judy . Grieg , irector Board of Weld Counw Commissioners Weld unty D artment of Social Services Date: JUN 0 6 2005 Date: (D/2/0C _9v0S — /62S/ SIGNED RFP: EXHIBIT A INVITATION TO BID • • • BID 002-05 (05005-05011 and 006-00) DATE February 16, 2005 BID NO: RFP-FYC-05010 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-05010) for:Colorado Family Preservation Act--Home Based Intensive Family Intervention Emergency Assistance Program Deadline: March 11, 2005,Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26- 5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2005, through May 31, 2006, at specific rates for different types of service. The County will authorize approved vendors and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased in intensity, and produce positive change which protects children,prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK C ,7ro- iRm6- 77 TYPED O TED SIGNATURE VENDOR Lutheran Family Services of CO (Name) andwri en Signat e By Au rized Officer or e Vender • ADDRESS 3800 Automation Way. Ste 200 TITLE ,GI/1E C Z≥ Fort Collins, CO 80525 DATE Li— .97—de, PHONE# (970) 266-1788 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 Bid 002-05 (RFP-FYC-05010) Attached A . HOME.BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2005-2006 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2005-2006 BID 002-05 (05010) NAME OF AGENCY: Lutheran Family Services of Colorado ADDRESS: 3800 Automation Way, Suite 200 Fort Collins, CO 80525 PHONE(970) 766-1788 CONTACT PERSON: Betsy Baier er TITLE: Program Di rector DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased intensity, and produce positive change which protects children,prevents or ends placement, and preserves families. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1,2005 Start End May 31, 2006 End TITLE OF PROJECT: Home-BasedParent Coach Program Julie E. Swanson 1 d Alk06L�� 3/10/05 Name and Signature of Person Pr wrigqng Document Date Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2004- 2005 to Program Fund year 2005-2006. Indicate No Change from FY 2004-2005 to 2005-2006 S Project Description Target/Eligibility Populations Types of services Provided Measurable Outcomes Service Objectives Workload Standards Staff Qualifications Unit of Service Rate Computation Program Capacity per Month Certificate of Insurance Page 26 of 32 Core Services Proposal - Life Skills Program FY 05-06 Lutheran Family Services of Colorado Home-Based Parenting Coach Program PROJECT DESCRIPTION Lutheran Family Services of Colorado(LFS) is a community-based agency with an experienced staff that offers a wide range of services to children,families and adults. It is a nonprofit agency that has provided human services in Colorado since 1948. Although the agency was established as an affiliate of the Lutheran Church, it is an equal opportunity agency that provides services to all individuals without consideration of religious beliefs, race, ethnicity, gender or economic status. Home-Based Parenting Coach Program Lutheran Family Services' Home-Based Parenting Coach Program is a component of a comprehensive array of family preservation services offered by LFS,the mission of which is to maintain families as safe, stable and nurturing units. The purpose of this program is to serve families who are either at risk of having children placed in foster care or who have recently been reunified following the children's out-of-home placement.This program is designed to strengthen and preserve families by providing a home-based service for a limited length of time using flexible, individualized service modalities as appropriate based on the family's strengths and needs. Skills taught and modeled in the home by Parenting Coaches are designed to do the following: create a safe, stable, and nurturing family environment; promote the safety and well-being of children and families; maintain and build upon family connections and supportive resources; reduce isolation; assist parents in developing appropriate parenting techniques; improve individual and family functioning; improve family interactions; improve household management skills; prevent, reduce,or eliminate behaviors that may place a child or family at risk; and prevent unnecessary out- of-home placements. Practitioners in the program will serve as Parenting Coaches and facilitators of change, encouraging and supporting the family in meeting jointly defined goals while working toward self-sufficiency. The Home-Based Parenting Coach Program combines all of the elements listed below and promotes the belief that in order for families to begin behavioral change,the coaches must strengthen those positive techniques the family already utilizes. Many problem behaviors stem from families having never learned to consistently apply their strengths across a broad spectrum of situations and settings such as home, work, school, etc. Elements included: • Short Term (approximately 12 weeks of service duration) • Intensive(a range of 1 to 3 hours of direct service weekly) • Home-Based(service is provided in the family's natural environment) • Individualized intervention focuses on the family's specific strengths and needs • Skill-Based (comprehensive skills are taught and modeled in a step-by-step method) • Competency-Based (length of intervention determined by the family's achieved level of competency in utilizing and generalizing the skills taught and modeled) • Strength-Oriented (intervention builds on behavioral strengths of family members) • Family and Coach as partners(emphasizes relationship between family and Coach; intervention based on family's expertise) • Asset Building (increasing the positive building blocks that young people need to grow up to be healthy, principled, caring adults) II. TARGET/ELIGIBILITY POPULATION Because referrals come to LFS from Weld County Department of Social Services(DSS)caseworkers,the decision that a child is at imminent risk of out-of-home placement has been made prior to the referral of the family to LFS for Parenting Coach services. However, if during the process of working with a family unit an LFS staff member feels • that a child is in imminent danger,we will immediately contact Weld County DSS to discuss the conditions that exist in the family to determine whether they meet the criteria as defined in C.R.S. 26-5.3-103(2). LFS is strongly committed to upholding the Core Services Program primary goals of preventing imminent placement of children and reunifying children in placement with their families. The Home-Based Parenting Coach Program is intended to serve families who are either currently at risk of having children placed within the custody of DSS or who have recently been reunified. LFS considers that the families who are the appropriate target population for this program are those in which family members are facing problems that have affected their well being,safety, psychosocial growth and development, and family stability. These are families that may benefit from basic life-skills training, asset building, and parent coaching. Families mandated or referred by the courts will be considered for inclusion in the program contingent upon their willingness to participate in and ability to profit from participation in such services. The primary caregivers must demonstrate a desire to maintain family relationships and must possess the mental stability to utilize home-based services. Clients will not be eligible for this program if they can be successfully treated with less intensive service programs. This program is intended to build assets, basic life-skills, and parenting skills in the family in order to maintain family stability and/or to increase the success of reunification, and is not intended to treat marital problems/instability or chronic mental health issues. A. Total number of clients served: 76 individuals in 19 families Based on last year's statistics,we estimate that there will be an average of four family members per family served, and that we will serve 19 families. B. Total individual clients and the children's ages: 76 We estimate we will serve 76 individual clients. Children's ages may range from birth to 18. C. Total family units: 19 This size caseload requires a half-time professional staff person. Additional staff is available to provide these services if we receive an increased number of referrals from DSS. We estimate that the average family unit will use an average of 1-3 hours per week of direct services and stay in the program for up to 12 weeks if needed. D. Sub-total of individuals who will receive bicultural/bilingual services: 12 (3 families) We have one bilingual master's level clinician on staff, and we have not experienced a significant increase or decrease in referrals of families who are monolingual and speak Spanish. However, in anticipation of this need within Weld County,we have budgeted approximately one quarter of our clients to receive bicultural/bilingual services. The development of treatment plans takes into consideration culturally appropriate issues,family values and family strengths, and the family is actively involved as part of the team in developing treatment goals and objectives. Spanish classes and materials are also available. E. Sub-total of individuals who will receive services in South Weld County: 16 (4 families) This number reflects an estimated one-quarter of the referrals being from South Weld County. F. The monthly maximum program capacity: 5 families or based on referrals received This number is based on the estimated number of family units per year(19). We will provide an average of 1 —3 hours of direct service per week for eight to twelve weeks to the families in the program. G. The monthly average capacity: 4 families H. Average stay in the program (weeks): 12 weeks I. Average hours per week in the program: 1.3 hours of direct service III. TYPES OF SERVICES TO BE PROVIDED The specific services provided to families participating in the Home-Based Parenting Coach Program are based on the results of assessments of the families' risk and strengths and parenting values. Assessments will also be conducted to determine the asset base of those children participating in Asset Building. Assessment of Parenting Values: The Adult-Adolescent Parenting Inventory(AAPI)is used to assess high-risk parenting attitudes and behaviors in all families both upon intake and at case closure. Responses to the AAPI provide an index of risk for practicing behaviors positively correlated with child abuse and neglect(i.e., inappropriate expectations of children, parental lack of empathy toward children's needs, belief in corporal punishment, reversal of 2 • parent-child role responsibilities, and oppression of children's power and independence). Low scores indicate agreement in the aforementioned parenting behaviors and a high risk for abuse and neglect. Assessment of Assets(children ages 12-18): When it is appropriate and needed within the context of the family, the Asset Checklist will be given to youth ages 12-18 upon both intake and case closure to measure the positive building blocks(developmental assets)that a youth currently has in his/her life. This checklist consists of 40 developmental assets clustered into eight categories: support, empowerment, boundaries and expectations, constructive use of time, commitment to learning, positive values, social competencies, and positive identity. Families will work as partners with the Parenting Coach in developing goals and objectives for their treatment plans. During the assessment phase, families will be asked for feedback on what they feel to be the areas of highest stress or greatest risk. The treatment plan will begin with skill building in the areas that are of greatest risk to the family and children. Furthermore, youth ages 12-18 may be involved in Asset building. Utilizing the Asset Checklist, youth will self-assess the Assets(positive building blocks)that they feel they possess in their lives(both upon intake and case closure). Youth will actively participate in developing goals and objectives that relate to specific Assets they desire to build into their lives. 1. Teach, model,and coach adaptive strategies The areas of focus will be determined by results of the AAPI in conjunction with the agenda of the family and the agenda of the DSS Caseworker. Variables that are deemed as areas of high risk will be viewed as priority, and skills will be taught accordingly. When we begin work with a family,we focus on skills where family strengths already exist in order to encourage family cooperation and motivation. 2. Model and influence parenting practices Through the use of home-based education, parents are introduced to appropriate, healthy, creative, and effective parenting techniques and values. The Parenting Coach will provide families with training in child development, limit setting, discipline, esteem-building, providing structure, nurturing, attachment,etc. We will assist families in implementing and integrating the information we teach through modeling,demonstrating and coaching. For example, if the assessment shows that the family resorts to corporal punishment when a child misbehaves, goals would be set to help them develop alternative disciplinary actions such as time out or loss of privileges,or we would teach other options through step-by-step skill building. At times parents may benefit from skills taught through specific curricula,which may include:the Nurturing Parenting Program, Parenting with Love and Logic, and the Terrific Infant Program. These curricula focus on reducing inappropriate parental response to children's behavior while increasing age-appropriate parental expectations of children. 3. Teach relational skills The skills taught will be determined by results of the AAPI in conjunction with the agenda of the family and the agenda of the DSS Caseworker. Variables that are deemed as areas of high risk will be viewed as priority, and skills will be taught accordingly. When we begin work with a family, we focus on skills where family strengths already exist in order to encourage family cooperation and motivation. 4. Teach household management, including prioritizing,finances, cleaning and leisure activities Individuals and families directly served will develop beneficial life-skills,thereby reducing factors associated with abuse, neglect, domestic violence, substance abuse, unemployment, poverty, etc. We will teach the family basic life-skills including: budgeting, bill paying, dealing with rental agreements, debt management,cleaning, household maintenance, personal hygiene,shopping, menu planning, meal preparation, utilizing formal and informal support systems, etc. If the family is struggling with financial difficulties, the family and Parenting Coach together would delineate the steps necessary to build strengths in this area. For example, if the family has not been able to pay bills on time, goals and objectives will be written for this area of concern and during each meeting between the family and coach, the progress toward those goals and objectives will be reviewed and monitored. 3 • 5. Actively help to establish community connections and resources The Parenting Coach will assist the family in accessing and utilizing community resources to deal with particular risk areas such as access to health care, housing, employment, extracurricular activities, support groups, etc. The family's effective use of community resources is an imperative goal within this program, as the inability to access resources is generally a core issue for families who have achieved a level of stress that would indicate a need for family preservation services. Furthermore, access to community resources reduces isolation and increases support for the family. IV MEASURABLE OUTCOMES Outcomes of treatment are documented in a family's case record. Additionally,the Home-Based Parenting Coach uses the Adult-Adolescent Parenting Inventory to assess the family's/child's pre-and post-service functioning. Interpretation of the scores for each of the five AAPI sub-scales provides useful information regarding the relative parenting strengths and weaknesses of each parent who takes the profile. A completed Parenting Profile portrays parenting patterns that serve as the basis for specific parenting intervention, particularly in the following five areas: 1. Parents' expectations of appropriate developmental capabilities. 2. Parents' level of empathy. 3. Parents' beliefs surrounding corporal punishment. 4. Parents' perceptions of appropriate family roles. 5. Parents'expectations regarding child(ren)'s independence. A. Improvement of household management competency:We estimate that 85%of families will improve in this area, as evidenced by the parent coach's pre-intervention and post-intervention and case documentation. B. Improvement of parental competency: measured by case documentation, and improvement on the Adult- Adolescent Parenting Inventory. The AAPI is used to assess high risk parenting attitudes and behaviors both upon intake and case closure. Responses to the inventory provide an index of risk for practicing behaviors positively correlated to child abuse and neglect(i.e., inappropriate expectations of children, parental lack of empathy toward children's needs, belief in corporal punishment, reversal of parent-child role responsibilities, and oppression of children's power and independence). Low scores indicate agreement in the aforementioned parenting behaviors and a high risk for abuse and neglect, and higher scores on the post-test indicate improvement. We estimate that 80%of families will improve in this area, i.e., will evidence higher scores from pre-to post-test on the AAPI. C. Parents can work independently with other resources in the community and within the local, state and federal governments: We estimate that 80%of families will improve in this area, as evidenced by the parent coach's pre-intervention and post-intervention case documentation. D. Families receiving Life Skills services will remain intact for six months after discharge: measured by Weld County DSS family tracking. E. Families will have improved competencies and/or reduced risk of need for placement: measured by the Adult-Adolescent Parenting Inventory. V. SERVICE OBJECTIVES Objective 1. When determined as a need,no less than 85% of individual/family households will show improved household management competencies as demonstrated by an improved financial situation, increased habitability of residence, equitable division of household responsibilities, etc. Objective 2. When determined as a need, no less than 80%of individual/family households will show improved parental competencies as demonstrated by increased understanding of child development concepts, increased use 4 • of positive parenting techniques, increased understanding of safety issues in caring for a child, appropriate health and hygiene practices, and encouragement of each child's independence and healthy self-concept. Objective 3. When determined as a need, no less than 80% of individual/family households will show improved ability to access resources as demonstrated by the number of encounters with community agencies, healthcare providers,schools, etc. Objective 4. At least 95%of the individual/family households will participate in setting the goals and objectives for their treatment plan that reflect positive personal and family values clarification and enhancement of the family's strengths and lessening of risk areas. Parents will be assessed utilizing the AAPI upon both intake and case closure. Clients involved in the above services will demonstrate improved parental competency as evidenced by improved scores on the AAPI from pre-to post-test. These scores will be documented in monthly reports and treatment plans. VI. WORKLOAD STANDARDS A. Number of hours per day,week,or month: 20 per week Each family is budgeted to receive 1-3 hours of direct service per week for an average of 12 weeks. We are budgeted to provide services to four families per week for a total of 20 hours of direct service per week. These numbers are based on the budgeted number of cases. We have the capacity to provide services to more families, if referred. B. Number of individuals providing the services: 1 The budget submitted shows one professional staff providing services in this program. As mentioned in an earlier section, we additionally have seven staff members who could provide services in this program if the number of referrals increases. C. Maximum caseload per worker: 4 families A full-time professional staff person can provide 20 hours per week of direct service, so the caseload will be four cases per clinician if they are providing five hours of direct service per case. If providing only three hours per family per week, a full-time professional staff could serve six-seven families. D. Modality of treatment: The modality of treatment is based on the Boy's Town Family Preservation Model,which includes the following elements: short term, intensive, home-based, individualized, skill-based,crisis-oriented, competency-based, strength-oriented, and family and Parenting Coach as partners in the treatment process. We utilize education, modeling, and demonstration to build on family strengths and to teach skills that will empower and stabilize families. Our treatment modality encourages flexibility and allows program staff to provide intensive services in the first part of implementing the treatment plan and to decrease sessions/weeks as the client achieves treatment goals and outcomes. This flexibility will increase the possibility that the client will be able to end services in the shortest possible time. E. Total number of hours per day/week/month: 20 per week Each family is budgeted to receive 5 hours of direct service per week for an average of 12 weeks. However a client can receive increased hours during the first 2-4 weeks in order to incorporate a step-down plan as the client nears the case closure timeframe. We are budgeted to provide services to 2 families per week for a total of 10 hours of direct service per week. These numbers are based on the budgeted number of cases. We can provide increased hours and services to more families, if referred and desired. 5 F. Total number of individuals providing these services: 1 We currently have part of one staff member's time budgeted to this program. Our structure has been established to allow us maximum clinical flexibility. We currently have seven additional staff that can offer services in this program, not including the program supervisors. G. The maximum caseload per supervisor: 1:7 H. Insurance Our proof of insurance, naming Weld County Department of Social Services as co-insured, is attached. VII. STAFF QUALIFICATIONS A. Minimum qualifications in education and experience Professional staff assigned to this program are qualified by one of the following: • A master's degree in social work or another human service field; and/or • A bachelor's degree in social work or another human service field and at least five years post-degree experience in family and children's services. B. Total number of staff, including supervisors, available for the project. We currently employ three Licensed Clinical Social Workers, one clinician with a Master's in Social Work,three clinicians with Masters in Human Development and Family Studies, and two employees with a Bachelor's Degree and over 10 years experience in Child Welfare. All nine of these staff members could be assigned cases in the Home-Based Parent Coach program if the number of referrals increases. Our Program Director has a Master's in Social Work. All staff has gained experience in child and family services. All staff in this program is required to secure 16 hours per year of continuing education training. All staff will receive weekly supervision from a supervisor experienced in child welfare work. The supervisors are also required to secure 16 hours per year of continuing education training. Clinical Supervisor—This position will provide additional supervision for the determination of the appropriate level of services after the initial assessment period and will provide ongoing supervision for any cases in level B, meeting with the visitation supervisor at least every other week, with immediate supervision available as needed. A licensed clinical social worker with experience in human services and child welfare is employed in this position. VIII. UNIT OF SERVICE RATE COMPUTATION The budget spreadsheets are attached to this proposal. 6 Bid 002-05 (RFP-FYC-05010) Attached A Date of Meeting(s)with Social Services Division Supervisor: 4 c S& y Comments by SSD Supervisor: \-191 fit az? ‘,L.--2 Inui Name and Signature of(/ uY44iJi3 , upervisor Date Page 27 of 32 ACORD OAT R . CERTIFICATE OF LIABILITY INSURANCE 08/24/2004 PRow0m THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh Advantage America ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 14-`? Spear St. 15th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. L ( Francisco, CA. 94105 4r5-983-5145 INSURERS AFFORDING COVERAGE Nava mum Lutheran Family Services of Colorado INSURER,. GUIDEON£ SPECIALTY MUTUAL INSURANCE GUIDEONE MUTUAL INSURANCE COMPANY INSURER B: 363 South Harlan, Suite 200 INSURER<: Denver, CO 80226 INSURER D. 1303-922-3433 x 109 INSURERE: COVERAGES THE POLICIES CF INSURANCE LIS I LU BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PODGY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CaADD1ON 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 C0N0MONS OF SUCH PCUCIES.AOGRE ATEUMRSSHOWNMAYHAVEBEEN REDUCED BY PAID CLAIMS. pp. wx POINTY EFFECTIVE P0HCYESPIRATIOR LT. cm TYPE OF MSURANCE POLICY MANNER Di IMMO TED TEIMMNDIYVI UMIR GENERAL LIABILITY EACH OCCURRENCE S 3, 000,000 . X L NL GENERAL LABILFP( PR�EMSES IE.mNGE TO EDe) S 3, 000,000 <NWSMADE OCCUR MED NAP TAMEN MbO S 1,000,000 A 1213-2363 07/01/04 07/01/05 PERSGML. DVI URY 1,000, 000 X COUNSELOR LIAB. GENERAL AGGREGATE , 1,000, 000 GENL AGGREGATE LWR APPLIES PER: (^ PRODUCTS-COMPIOP AGG S 5,000 POLICY JFCT 1 LCC ,VRgSdLELMB4nY COMBINED SINGLE LIMIT $ 1, 000, 000 X ANYAUTO IBvPENT ALL OWNED AUTOS BOOLYINJURY SCHEDULED AUTOS IPvprm) B REDAUFGS 1757-711 07/01/04 7/01/05 BODILY INJURY NONONNEDAUTOS (P.rvdLM) PROPERTY DAMAGE i (PTirWM GARAGE UAENJTY AUTO ONLY.EA ACCIDENT S ANYAUTO EA ACC S OTNERTXIM AUTOONLY: AGO S EBCESBVMBREW LWIL„Y EACH OCCURRENCE S 4, 000, 000 X OCCUR CLWMSSADE AGGREGATE S 4, 000, 000 9618-912 07/01/04 07/01/05 B DEDUCTIBLE S RETENTION N S BWNERSCCMPENSATIONAID STATTLL R roCYLM OEP EMPLOYERS LIABILITY EL EACH ACCIDENTmy Amp pmmamwwwwf Au,m S ormstromen gym EL DISEASE-EA EMPLOYEE S Ryas.A SN.LE SPECIAL PROVISIONS bk. EL DISEASE-POLICY LIMIT S OTHER 1213-263 07/01/04 07/01/05 $792, 400 A Property PROVISIONS CERTIFICATE HOLDER IS ADDITIONAL INSURED (CG 2026) AS RESPECTS GENERAL LIABILITY ONLY IN CONNECTION WITH CONTRACT SERVICES PROVIDED BY THE INSURED REPLACES CERTIFICATE ISSUED ON 6/23/04 CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED PQJCIES BE CANCELLED BEFORE THE EXPIRATION WELD COUNTY SOCIAL SERVICES DATE THEREOF,THE ISSUING INSURER VALE ENDEAVOR TO MAIL 30 DAYS WRITTEN ATTN: JUDY A. GREICO, DIRECTOR NOTICE TO THE CERTIFICATE MOLDER NAMED TO TEE LEFT.ELITFASURETU Do so SPLRLJ. P.O. BOX A WNil NARY.Ia.I Inall ry K ANy KIND UPON THE INSURER.ITS AGENTS OR GREELEY, CO 80632 • ACORD25(20011OB) _ IJACORD CORPORATION 1988 z z a y a a m a. c N (0 a ee y. 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Q O❑ d i@F� `,'e �'. , Z gW Q O W O IL G O U w 0 oT v WS O m, 47.• ;. = a re O F = H C O F'O w O 0 w to . Z O O '✓__ " . O z U a. o. in ui F rno cc e) 6 O LL i ' < < 0 U ❑ ' } & > Z > < K "'itr °'� O J O O W ^ . s`----DX' , < < r 74%"&snieeN" t. of tv WeisCte c unx,oenLutheran Family Services 1 2005 of Colorado An Services that heal,strengthen&provide hope April 27, 2005 Gloria Romansik Weld County Department of Social Services P.O. Box A Greeley, CO 80632 Dear Ms. Romansik: We are in receipt of the April 18, 2005 letter concerning the following bids that were submitted by Lutheran Family Services for FY 2005-06. 1. RFP 05010: Option B, Home Base Therapy (A mistake was made when submitted this bid as it was originally identified as RFP 05005. We have corrected it to read RFP 05010) 2. RFP 05005: Option B Lifeskills, Home Base Parent Coach (A mistake was made when submitted this bid as it was originally identified as RFP 05010. We have corrected it to read RFP 05005) 3. RFP 05005: Lifeskills, Visitation Lutheran Family Services hereby accepts the conditions set forth in our bid, which shall be applied to all 2005-06 contacts. In response to the condition that we define our capacity to do after-hours supervision, please be advised that Lutheran Family Services offers all three of the above contract services between the hours of 8:00 am and 8:00 pm, Monday through Friday. We look forward to working with you during the upcoming fiscal year. If you have any questions please eat 303.217.5831. ce y �a es .arclay •resident/CE• • 363 S. Harlan St., Suite 200 • Denver, CO 80226-3552 • (303) 922-3433 • Fax (303) 922-7335 • www.lfsco.org Em LSA rr"Way a DEPARTMENT OF SOCIAL SERVICES P.O.BOX A .‘ -li 44 GREELEY, CO. 80632 Websifee www.co.weld.eo.ns Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 April 18,2005 James Barclay President/CEO Lutheran Family Services 38©0 Automation Way,Suite 200 , FortCollins,CO 80525 Re: RFP 05005: (Corrected to 05010).Option B,Home Based Therapy RFP 05010 Option B,Home Based Parent Coach RFP 05005:Lifeskills,Visitation Dear Mr.Barclay: The purpose of this letter is to outline the results of the Bid process for PY 2005-2006 and to request written information or confirmation from you by Wednesday,April 27,2005. A. Results of the.Bid Process for PY 2005-2006 • The Families,Youth and Children(FYC)Commission recommended approval of Bids#05010,Option B-Home Based Therapy(Submitted under RFP 05005),and Option B-Home Based Parent Coach for inclusion on our vendor list. • The Families,Youth and Children(FYC)Commission recommended approval of Bid#€05005,Lifeskills for inclusion on our vendor list, attaching the following condition for all.Litfeslailsprogram Providers. Condition: All providers must define their capacity to do after-hours visitation. B. Required Response by FYC Bidders Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA).If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances, If you do not accept the condition, you must provide in writing reasons why.A meeting will be arranged to discuss your response.Your response to the above condition will be incorporated in the Bid and Notification of Financial Assistance Award. Page 2 Lutheran Family Services/Results of RFP Process for PY 2005-2006 The Weld County Department of Social Services is requesting your written response to the FYC Commission's condition.Please respond in writing to Gloria Itomansik,Weld County Department of Social Services,P.O.Box A,Greeley, CO, 80632,by Wednesday,April 27, 2005,close of business. If you have questions concerning:the above,please call Gloria Rctrnansilc, 970.352.1551 extension 6230; Sincerely> ego, cc: Juan Lopez,Chair,)YC Commission Gloria.Rtomansdc,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 FY 05-CORE-61 Revision (RFP-FYC-(05010) Contract Award Period Name and Address of Contractor Beginning 06/01/2005 and Youth Emancipation&Services,Inc. Ending 05/31/2006 Option B—Home Based Intensive 3400 16th Street,Bldg.3,Suite R Greeley,CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance In-home services to families using a combination of Award is based upon your Request for Proposal(RFP). The Family Systems approach with a Community Systems RFP specifies the scope of services and conditions of award. intervention style. Services include family therapy, Except where it is in conflict with this NOFAA in which case lifeskills instruction,conflict mediation,communication the NOFAA governs,the RFP upon which this award is based skill building,interventions such as mentoring, is an integral part of the action. community agency referrals,and other collateral Special conditions services such as classroom instruction.Crisis 1) Reimbursement for the Unit of Services will be based on an intervention available 24 hours/day,7 days a week.. hourly rate per child or per family. Maximum hours provided is 20 hours per referral. 2) The hourly rate will be paid for only direct face-to-face contact Yearly program capacity is 12 families concurrently, with the child and/or family,as evidenced by client-signed monthly average capacity is 12,average stay is 8 weeks; verification form,and as specified in the unit of cost Phase 1,3 hours per week;Phase 2,2 hours per week. computation. Ethnically and culturally diverse services-Spanish 3) Unit of service costs cannot exceed the hourly,and yearly cost speaking staff available.South county access. per child and/or family. 4) Rates will only be remitted on cases open with,and referrals Cost Per Unit of Service made by the Weld County Department of Social Services. Cost Per Unit of Service 5) Requests for payment must be an original and submitted to the Hourly Rate Per $69.86 Weld County Department of Social Services by the end of the Individual Counseling 25th calendar day following the end of the month of service. Family Counseling The provider must submit requests for payment on forms Treatment Package-Intensive approved by Weld County Department of Social Services. Treatment Package-Moderate 6) The Contractor will notify the Department of any change in Treatment Package-Low staff at the time of the change. Early Intervention Program Reunification Community Based Service -Child Protection In-home Svcs for At Risk Delinquents Therapeutic Staffing Hourly Rate Per Court Testimony $65.00 Enclosures: X Signed RFP:Exhibit A _ Supplemental Narrative to RFP:Exhibit B Recommendation(s) Conditions of Approval Approvals: Program Official: ByM By V� William H.Jerke,Chair Jud ' o,Dire or Board of Weld County Commissioners We County Department of Social Services Date:j(JtsJ 0 6 2005 Date: P / 1pS ,os — (GS ( SIGNED RFP: EXHIBIT A • INVITATION TO BID BID 002-05 (05005--05011 and 006-00) BATE: February 16, 2005 BID NO: RFP-FYC-05010 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-05010) for:Colorado Family Preservation Act--Home Based Intensive Family Intervention Emergency Assistance Program Deadline: March 11, 2005, Friday, 10:00 a.m. The Families,Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act (C.R.S. 26- 5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2005, through May 31, 2006, at specific rates for different types of service. The County will authorize approved vendors and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased in intensity, and produce positive change which protects children,prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date Se' /� ..1-19ar dGN ea/la (After receipt of order) B ST BE SIGNED IN INK 6,-66X/ hill, LPG � TYPED OR PRINTED SIGNATURE VENDOR _%4Z'7i£1114k. ty_el L /0t g121��%9 - WI/4e(Name) H dwritten Signature By Authorized Youth Emancipation&Services,Inc. Officer or Agent of Vender 3400 16th St., Bldg.3,Suite R Greeley,CO 80634 y&aamvs i/�GTO� ADDRESS TITLE C. DATE PHONE # � Z. S5,177 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 Ind 002-05 (RFP-FYC-05010) Attached A • HOW, BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2005-2006 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2005-2006 BID 002-05 (0501,0)' NAME OF AGENCY: jI , ,4WC/,°ATZIV/c JGzwc s, 'C, /n,^ ADDRESS: .31/202) /4771 Sintr, SAara._ -. 69€ Ggeate� Y PHONE(QV 353-,y Sts CONTACT PERSON: - is PA/testy/ TITLE: Eat-untie. 2j ,acJr-X.- DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased intensity, and produce positive change which protects children,prevents or ends placement,and preserves families. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1, 2005 Start End May 31,2006 / �� End "" /�/ TITLE OF PROJECT: 14/fi.M/SIIft i /L.9 L/UT}r�I eAtra — "Weft ..V44525— /OA--fit:- 5-42-Or N and Signature of Person Preparing Document Date in1//.0� 3 /D— — Name d Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2004- 2005 to Program Fund year 2005-2006. IIndicate No Change from FY 2004-2005 to 2005-2006 Project Description Target/Eligibility Populations Types of services Provided Measurable Outcomes Service Objectives Workload Standards taff Qualifications Unit of Service Rate Computation Program Capacity per Month Certificate of Insurance Page 26 of 32 'Bid 002-05 (RFP-FYC-05010) Attached A Date of Meeting(s)with Social Services Division Supervisor: S i 'C‘r" Comments by SSD Supervisor: f-// _ dam.. ll-r, Vl.,t- ' ' ) : Ltd .3 -3 (J— ame and Signature of SSD Supervisor Date Page 27 of 32 Youth Emancipation & Services, Inc. 3400 le Street, Suite 3-R Greeley, CO 80634 RFP-FYC-02010 Family Preservation Program—Home Based Intensive Family Intervention Program Proposal (Attachment A) Project Title: Intensive Family Intervention—March 2005 Vendor: Youth Emancipation & Services,Inc. (YES) Contact Person: James P. Nelson MA, LPC Executive Director 0 I. PROJECT DESCRIPTION What is YES,Inc.? Youth Emancipation& Services, Inc., (YES), is a private not-for-profit Colorado corporation. It is a cooperative venture of several youth service professionals who live and work in Weld County. This group of concerned professionals has come together to provide Weld County families with needed services, such as assessment,life skills education, individual, group and family therapy,emancipation preparation,family and community mediation services,and monitored apartment living. Our Mission The mission of YES is to be of service to families in Weld County who are at risk of broader involvement with the legal and social services systems.We seek to assist youth who have had a difficult adolescence to transition to adulthood in a responsible and sustainable manner. To accomplish our mission we will: 1. Network effectively with area professionals in the youth service field to identify needs which are under-served, and likely to respond favorably to a timely preventive intervention. 2. Develop quality programming designed to meet these targeted needs. 3. Partner with human service agencies, foundations and benefactors to generate community resources to provide services in the most effective way possible. 4. Provide top-quality stewardship of,and accountability for,community resources. 5. Provide ongoing evaluation of the effectiveness of services we provide in order to make improvements in what we do. 6. Provide timely reports to our referral sources to keep them informed of our effectiveness. 7. Remain responsive to the needs of the community,open to new ideas and opportunities to be of service,while consolidating gains and expanding family resources. The Founders of YES are Masters level therapists who have had many years of experience in family therapy, social science research,community needs assessment, individual therapy, group therapy,mediation,and supervision.We have worked extensively with at risk teens and their families, in both a residential treatment and non-residential settings. Intensive Family Intervention: In-Home Family Therapy The overall purpose of this project is to provide in-home services to families using a combination of Family Systems approach with a Community Systems intervention style.The effort on the part of the intervention team will be to assess the family's internal strengths and challenges as well as it's relationship to the community. The team will then match up the family's needs with appropriate interventions,helping the family members to make connections with those agencies and individuals in the community who can provide sustainable support. Each family will be assigned a Masters level licensed therapist(LPC, LSW, LCSW, or LMFT)who will act as Intervention Coordinator. The Intervention Coordinator may directly provide family therapy, life skills instruction,conflict mediation,communication skill building and other direct services,as needed.This person will also coordinate such interventions as mentoring,community agency referrals,and other collateral services, and/or classroom instruction. Family contact will take place in the family home,primarily during late afternoons,early evenings,and weekend hours when families are not at school or work. Crisis Intervention services will be available 24 hours a day,seven days a week.All areas of Weld County will be served, including the fast-growing South County area. 1 II. Target/Eligible Population A. Total number of clients served: Approximately 96 persons By serving 24 family units,half of which are composed of 2 parents and half of which are composed of 1 parent,and averaging 2.5 children per household,the total of clients impacted will be 96. B. Total individual clients and their children's ages: 24 Families(all ages) Clients may be of any age or gender(as families always are). Some will be adolescents between the ages of 15 and 18 years of age, and they will have siblings of various ages as well as parental figures living in the home with them. C. Total family units: 24 families The program is designed for families with youth who are struggling in their present home environment and are at risk of being removed. Families can be of any size or constitution. D. Bicultural/bilingual services: 12 families. Families of any cultural and/or ethnic origin will be served. YES staff are culturally aware and are an ethnically and culturally diverse group. Consideration of and respect for established cultural patterns is an ingrained value in this organization. Spanish speaking staff are available.* E. Clients receiving services in South Weld County: 6 families concurrently. This constitutes up to 25%of the total case load. This figure was arrived at by comparing population totals from North-Central Weld with totals for the South Weld cities. F. Access to 24 hour service:24 families All client families will have access to 24 hour crisis intervention services through a 24 hour crisis telephone line. Each family's Intervention Coordinator, or designated on-call therapist, will respond to calls within one(1)hour. G. Maximum Program Capacity: 12 families concurrently. Maximum caseload for an intervention team will be 6 families.We will have two teams in place if awarded a contract. This insures that appointments can be kept without double- booking, support groups and classes will be of optimal size. However, if the Department would like to expand the program,we would be open to discussions on this topic. H. Monthly Average Capacity: 12 families L Average stay in the program: 8 weeks(See Item.1, below) J. Average hours per week in the program: Phase 1. (1 month): 3 hours per week. (Total 12 hours) Phase 2.(1 month): 2 hours per week.(Total 8 hours) *Weld County is a culturally diverse population center in Northern Colorado.Therefore,services will be delivered in a culturally sensitive manner.YES currently employs staff members who are aware of the issues of acculturation,enculturation and assimilation which are relevant in the present social milieu.Every effort will be made to provide a staff/client match with these issues in mind.YES currently employs Spanish speaking, culturally competent staff to deliver program services. 2 III. Types of Services Provided A. Therapeutic Services Family Systems and Community Systems Assessment The YES intervention coordinator will meet with the family and caseworker to assess the strengths and needs of the family system as well as the families familiarity with and use of community supports. YES Staff and DSS Caseworker will design an intervention plan to meet the family's needs based upon the results.The coordinator will report to the caseworker on a timely basis to keep caseworker informed of family's progress(at least weekly). The YES staff member will coordinate with the family to access other needed community resources as well. Family Therapy: The Intervention Coordinator will be experienced in family therapy.However,the emphasis will be on modest and achievable improvement in family functioning. Due to the time constraints involved,there will only be enough time to focus on the sources of greatest disruption which prevent effective family functioning. Problem Solving, Mediating Family Conflict: The impact of a knowledgeable and diligent mediator with sophisticated counseling skills, working with families in their home environment cannot be underestimated.The ability to identify the opportunities to stimulate change,work with the key members of the system, and see that right action is taken at the right time, is very powerful in bringing about positive change. Parenting Skills: Many families suffer from cross-generational(multi-generational)child rearing practices that are violent and abusive,or which are completely ineffective in preparing children to be positive, competent and productive participants in society. YES staff members will assist parents in learning more productive methods and practices. Group Therapy/Support Groups: It will be valuable for those family members who can participate to have a sounding board in which to discuss and process issues related to the difficult challenges of raising a family. Groups will be facilitated by a licensed master's level therapist who has experience in group therapy with this challenging yet rewarding population. B. Concrete Services Life Skills Instruction: YES staff will deliver self-paced instruction in Life Skills. Curriculum includes: • Nutrition, menu planning, food shopping, and preparation, • Home Safety,Maintenance,cleaning and repair, • Employability assessment,job-specific prospecting,application and interviewing skills, follow-up techniques, • Home budgeting,money management,banking, • Transportation needs and affordability, • Finding and leasing an apartment,purchasing a home, • Clothing, shopping, maintenance and repair, • Time management and goal setting, 3 • Personal values,social skills,refusal skills,and sound decision-making, • Community values, living with neighbors,coping with others expectations, • Understanding and managing anger • Accessing Community Resources • Alternative dispute resolution,problem solving, Family Conflict Management: When internal conflict reduces the family's ability to work together to achieve common goals and interests,the YES team will teach dispute resolution skills to reduce stress and foster an atmosphere of cooperation rather than contention. The degree of conflict within the family will be measured using an assessment devise at the initiation of services,and at the termination of services. Parenting Skills: YES Team will teach child rearing and parenting skills,such as: • Effective boundary and limit setting, • Affection,nurturing,and positive reinforcement, • Importance of consistency and dependability, • Effective and safe discipline methods, • Monitoring and maintaining health, • Accessing behavioral assistance when needed. C. Collateral Services Accessing Community Support System: YES team will assess the family's connections with agencies in their community which they can access when needs arise. The team will then assist them in filling any gaps in the system through establishing personal contacts at agencies which provide health and medical services, legal assistance,etc. Education: Youth must have either completed high school, or be in the process of finishing.Youth must be eligible for enrollment in public school,attending a GED Program,or attending a Day Treatment Program which has an educational component.Youth who are in school or pursuing a GED will be assisted in finding part-time employment so as to save money for emancipation expenses. If the youth has already finished his/her education,the emphasis will be on securing full-time employment. Employment: Youth will be given a career assessment and skills evaluation,vocational interest measure, and get a full interpretation in order to determine what career area is most advantageous. Youth will be helped to write a resume,fill out applications for employment,taught how to interview appropriately, and otherwise assisted in finding employment with a future. Physical and Mental Health System: Families must find and develop a context for using local physical and mental healthcare providers. YES Team will assist family and emancipating youth to match providers with resources and location,develop resources for known chronic health concerns,and balancing treatment and prevention to avoid acute episodes. 4 D. Crisis Intervention Services Telephone Response: YES maintains 24 hour answering services with emergency paging. Intervention Coordinators(or a designated on-call therapist)will be available to contact the family or individual in the event of an emergency. Protocol calls for intervention over the phone as the first step. If phone intervention proves to be insufficient,the responding therapist will assess the level of severity of the incident and take appropriate action, including calling police, ambulance, etc., if danger is imminent. Personal Visit: If the situation would not pose a safety problem for the staff member,they may visit the home on an emergency basis. Otherwise, a safe neutral meeting place will be maintained in the event of the need for person-to-person contact outside the home, or the family may choose to come to the office. Intervention Coordinators and on-call personnel are trained in crisis intervention procedures and follow pre-determined written protocols. IV. Measurable Outcomes A. Children and adolescents will remain at home at the time the case is closed.This will be reflected in our monthly progress reports, and case termination report. B. Improvements in parental competency,reduction in parent/child conflict,and improvements in household management will be reflected in completion of Skills Units and in scores on pre-post referral competency assessments.These scores will be compared in the form of bar graphs which will be attached to the case termination report.This report will be delivered to the department no later than 30 days after the termination of YES involvement in the case. C. Children and adolescents who are in their own home at the beginning of referral will continue there at the termination of services. A quarterly contact summary will be prepared on each referral after termination of services for a period of one year.This information will be mailed to the department caseworker or supervisor in written form no later than 30 days after the close of the 4th quarter post-discharge. D. Children or youth who are currently in long-term placement, and who are in the process of reunification at the time of referral,will be living in their family home, and will not be in residential placement,DYC custody,or under adult judicial proceedings within 12 months of the termination of YES services. An annual contact summary will be prepared on each referral after termination,for a period of one year,and a report will be mailed to the department caseworker or supervisor. E. Families who receive services will not have a substantiated abuse or neglect case within 12 months of termination of services as indicated in the periodic report. F. Qualitative measures of improvement will be reported at the termination of services using the same or substantially similar evaluation instruments as used in the pre-service assessment. YES staff will prepare an annual report listing the number of referrals given,referrals accepted, and will chart the disposition of each case in as much detail as we can obtain. 5 V. Service Objectives A. Improve Family Conflict Management To keep children from being removed from the home: family conflict management skills will be addressed using the mentoring and in home family therapy treatment modes.If youth has a high rate of truancy from school,running from the home, disregard for family/home rules,or the family is chronically engaged in abusive quarrelling,conflict management will be a top priority.This will be reflected in the family treatment plan. If children have already been removed: reuniting the family with targeted support and assistance will be a top priority. Getting family members to participate in a planned process of constructive change in order to maximize strengths and remediate challenges will be the top priority.Outlining the concrete tasks and conditions which require each family members assistance will be emphasized.These will be written into the family's treatment plan. B. Improve Parental Competency To assist clients in adopting and passing along to their children, an improved and more effective life style, YES Team will teach child rearing and parenting skills, such as: • Effective boundary and limit setting, • Affection,nurturing,and positive approval, • Importance of consistency and dependability, • Effective and safe discipline methods, • Monitoring and maintaining health, • Accessing behavioral assistance when needed. YES Team members will use the Family Strengths Assessment to determine the degree of parental competency at referral, and will include in the family treatment plan steps to consolidate assets and develop areas of weakness. Post- intervention results will determine what gains have been made. C. Improve Household Management Competency Household management competence will be measured by YES Team observation and completion of a proprietary life skills assessment. Areas of concern will be addressed in the family intervention plan and re-evaluated at the conclusion of services. D. Improved Ability to Access Resources: YES team will assess the family's connections with agencies in their community which they can access when needs arise.The team will then assist them in filling any gaps in the system through establishing personal contacts at agencies which provide health and medical services, legal assistance,etc.The family will have a complete selection of resources and personal contacts at each community resource by the end of the intervention. 6 VI.Workload Standards A. Total number of staff(Intervention Coordinators): (Licensed Masters level staff),will be assigned based on a ratio of 3:1, (direct contact hours to non-direct hours). 12 families will constitute a full caseload. Under the present circumstances,the maximum number of families which can be accommodated is 12 per month(average of 12). However, if the sustainable caseload is larger than 24 families per year, we are willing and able to expand to accommodate more. Expansion to accommodate a larger caseload has been planned for in our Strategic Plan. B. Number of employees providing services is 7 employees for this project, (3 Intervention Coordinators and 3 Case Aides,and 1 Supervisor). We will begin with one team(I Coordinator, 1 Case Aid, and 1 Supervisor)and see how the referral base develops. C. Maximum caseload per worker is 12. D. Modality of treatment will vary with the family's needs and the treatment plan.However, generally,we are planning for a combination of Family Systems and Community Systems Therapy,delivered in the client family home and in other locations throughout the community. E. Total number of hours: Phase 1.(1 month): 3 hours per week(Total of 12 hours) Phase 2. (1 month): 2 hours per week(Total of 8 hours) (20 Hours per case). F. Total number of individuals providing these services:3-7 G. Maximum caseload for each Supervisor is 6 masters level therapists. H. (See Attached Affidavit of Insurance) 7 VII. Staff Qualifications A. YES personnel have extensive experience in Marriage and Family Therapy, Individual and Group Therapy,Emancipation Programming, Social Work,Case Management, Family and Community Mediation. B. Staff and qualifications: James Nelson, MA, LPC Kris Wolf, MSW James Rodman,MA, LMFT Cori Buggeln, BA CAC II Ana Chiodo, MD (Translator, Family Milieu Consultant) Daniel Korb, MD, Psychiatrist Staff are qualified according to Staff Manual Volume VII, Section 7.303.17,and Section 7.0006, Q. of the Colorado Department of Human Services Regulations. C. Mandated Caseworker training: We will complete this training at the earliest possible opportunity if awarded the opportunity to serve. D. Knowledge in Risk Assessment: The above named staff have had extensive experience in the assessment of risk in a family environment,as well as on a systems and individual level. E. State Home-Based Intensive Family Services Training: We will complete this training at the earliest possible opportunity if awarded the opportunity to serve. (I was not aware until now that this was required?) VIII. Unit of Services Rate Computation (See attachments) 8 1111111 I I , I ! 1 to tol rol al 1 co O8 co § R - _ IR } ° oi CO IA co S co _ Ci 01 CC § ��- o N. 8 /01 CO M ( 0 N coc - _-Nr en - _- , )`° } _ _ _ fa 0° 0 \ k _ _ § I Luck a 0 Lc.) 0 Lu 0 a — et § cn cn W < Zi § § o > _ » ± ) [ § g E cc 6 & M § CD + k ) 5 — co ° F- k u) \ CC 0 § - § ) 2 < § - 0 k § o CO 2 § - o 8 ° 2 g & _ & § U- LU% 2 - § u. W < 0 W CO@ in § \ g o 0 b § o 0 § I- 0 � 2 ce n m ir o D 0 CO (Kg 0 E te ® 9 w o ° § w ± 2 ± X W a Q � 2 § W u § } § o 0 g < § E E * 0 2 < Et o $ r S@ c o o $§ o • w < W n Z I- re day)W CO 0 Et WO k § § < § 2 0 c ( 0 CO _ D o » co" z m 0 § I- o o 0 r cc oo F D Lu D z < D 20 < 0 o ? ) § § $ § § S ? I [ o < < < I- < ® X < B < < u . 0 I- H I- CO e W e p I- H e ® D . E 2 R R 0 p < 0 2 < R R ± H 0 < = 0 0 W u c = _ - Y . . . . . Youth Emancipation & Services March 10, 2005 To Whom It May Concern, This is to certify that Youth Emancipation& Services, and Nelson, Wolf&Associates, it's principle employees,property, facilities and vehicles are insured according to the standards of Weld County Government for the purposes it has undertaken on behalf of the County, and that at the present time due to contracts currently in force, Weld County is a named Co-insured on all policies. A current declarations page is currently on file with the Business Office of the Department of Social Services. Sincerely,elk-amen P. Nelson Executive Director 3400 16th Street, Bldg 3R•Greeley,CO 80634•tele: 970.353.5577 •fax:970.356.7280•www.griffinyes.org•email:gh@griffinyes.org , itt Youth Emancipation & Services 4; Judy Griego, Director /7.9 / j Weld County Department of Social Services 48 P.O. Box A Greeley, CO 80632 April 27,2005 Re: RFP 05005: Lifeskills RFP 05010: Option B, Home Based Services RFP 05008: Intensive Mediation under Intensive Family Therapy Dear Ms. Griego, Thank you for opportunity to be of service to the Department again this year.We will be happy to abide by and fulfill the conditions of the contracts under the above named RFP's. As regards Condition#1. (Mediation);This is acceptable and will be observed as an ordinary ethical constraint. As regards Condition#2. (Workload Standards); As I am the only trained mediator in the office at the present time,and because of my other duties, I can only conduct one case each week. However,my personal assistant can help coordinate schedules and we now have access to an adequate meeting room. Therefore, I feel confident that we can conduct four(4)cases per month in a satisfactory manner. As regards the Condition(Lifeskills); After-hours visitation, my assumption is that most (if not all)these cases will occur after hours. We are therefore able to schedule visits and consultations Monday through Saturday at the convenience of the client up to 8:00 PM. We provide our therapists with cell phones and alternate taking emergency calls on a 24 hour/day, 7 day per week basis. 2 I will need additional information from John Kruse as to the back-up documentation. which you request in your letter of April 18, 2005. I will contact him this week and provide the information as soon as possible. 3400 16th Street,Bldg 3R•Greeley,CO 80634•tele:970.353.5577•fax:970.356.7280•www.griffnyes.org•email:gh@grifffnyes.org Again,Thank You and the Commission for the opportunity to be of service. We look forward to working with you again this year. Sincerely, un P.Nelson MA, LPC Executive Director DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY, CO. 80632 Website:www.co.weld.co.us ' Administration and Public Assistance(910)352-1551 Child Support(970)3524933 O • COLORADO April 18,2005 Jim Nelson,MA,LPC Youth Emancipation&Services,Inc./ Nelson,Wolf and Associates,P.C. 3400 16 Street,Bldg 7, Suite MM Greeley,CO 80634 Re: RFP 05005: Lifeskills RFP 05010: Option B,Home Based Services RFP 05008:Intensive Mediation under Intensive Family Therapy Dear Mr.Nelson: The purpose of this letter is to outline the results of the Bid process for PY 2005-2006 and to request written confirmation from you by Wednesday,April 27,2005. A. Results of the Bid Process for PY 2005-2006 • The Families,Youth and Children(FYC)Commission recommended approval of the bid,RFP 05010, Option B-Intensive Home Based Therapy for inclusion on our vendor list. • The Families,Youth and Children(FYC)Commission recommended approval of the bid,RFP 05008 Mediation under Intensive Family Therapy for inclusion on our vendor list with the following conditions. Condition#1 is applicable to all Intensive Mediation providers,while Condition#2 is specific to your program. Condition#1: If a consultation has occurred between a party to this action,and any party objects to the proposed mediator because of that consultation,the mediator shall remove himself/herself from performing the mediation. Condition#2:The provider will clarify"Workload Standards"as requested in the RFP. • The Families,Youth and Children(FYC)Commission recommended approval of the bid REP 05005, Lifeskills for inclusion on our vendor list with the following condition for all Lifeskills providers. Condition: All providers must define their capacity to do after-hours visitation. • Review of Service Rate Computations for All Submitted Bids: Back-up documentation for cost sheets was not provided for all submitted bids. Page 2 Youth Emancipation&Services,Inc./Nelson Wolf&Associates/Results of Bid Process 2005-2006 B. Required Response by FYC Bidders Concerning FYC Commission Conditions. 1. FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA).If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances.If you do not accept the condition,you must provide in writing reasons why.A meeting will be arranged to discuss your response.Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. 2. Unit of Service Rate Computations: You are requested to provide back-up documentation to John Kruse,Business Office Manager. You may contact him at extension 6530 if you have questions. The Weld County Department of Social Services is requesting your written response to the FYC Commission's conditions.Please respond in writing to Gloria Romansik,Weld County Department of Social Services,P.O.Box A,Greeley,CO, 80632,by Wednesday,April 27,2005,close of business. If you have questions concerning the above,please call Gloria Romansik at 352.1551,extension 6230. cerely, ^ A. ego, for cc: Juan Lopez,Chair,FYC Commission Gloria Romansik, Social Services Administra or 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 FY05-CORE-0010 Revision (FP-FYC-05010) Contract Award Period Name and Address of Contractor Beginning 06/01/2005 and North Colorado Medical Center-Youth Passages Ending 05/31/2006 Option B-Home Based Services 1801 16 Street Greeley, CO 80031 Computation of Awards Description Unit of Service The issuance of the Notification of Financial This program includes family treatment Assistance Award is based upon your Request for interventions that provide re-parenting,problem Proposal(RFP). The RFP specifies the scope of solving, communication skill building, and services and conditions of award. Except where it is parent-child conflict management. Services in conflict with this NOFAA in which case the available in the home and in the clinic-based NOFAA governs, the RFP upon which this award is Multi Family Systems Group held each based is an integral part of the action. Saturday. A full-time Bilingual therapist Special conditions available.Maximum monthly capacity is 15, 1) Reimbursement for the Unit of Services will be based average stay in program is 7-10 weeks, 2-3- on an hourly rate per child or per family. hours per week. South County services are 2) The hourly rate will be paid for only direct face-to- limited to 25% of total cases referred. face contact with the child and/or family or as Cost Per Unit of Service specified in the unit of cost computation. Hourly Rate Per $80.14 3) Unit of service costs cannot exceed the hourly and Individual Counseling yearly cost per child and/or family. Family Counseling 4) Payments will only be remitted on cases open with, Treatment Package-Intensive and referrals made by the Weld County Department Treatment Package-Moderate of Social Services. Treatment Package-Low 5) Requests for payment must be an original submitted Early Intervention Program to the Weld County Department of Social Services Reunification by the end of the 25th calendar day following the end Community Based Service of the month of service. The provider must submit -Child Protection requests for payment on forms approved by Weld In-home Svcs for At Risk Delinquents County Department of Social Services. Therapeutic Staffing 6) The Contractor will notify the Department of any Hourly Rate Per Court Testimony $155.00 changes in staff at the time of the change. Enclosures: X Signed RFP: Exhibit A Supplemental Narrative to RFP: Exhibit B _Recommendation(s) Conditions of Approval Approvals: Program fficial: /\ By 11--Ci l By , William H. Jerke, Chair Judy . Griego)Director( Board of Weld County Commissioners Weld ounty Department of Social Services Date: JUN 0 g 2005 Date: 2 of r)CO5 / C 5 ( SIGNED RFP: EXHIBIT A INVITATION TO BID BID 002-05 (05005--05011 and 006-00) DATE: February 16,2005 BID NO: RFP-FYC-05010 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal(RFP-FYC-05010) for:Colorado Family Preservation Act--Home Based Intensive Family Intervention Emergency Assistance Program Deadline: March 11, 2005,Friday, 10:00 a.m. The Families,Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26- 5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2005, through May 31, 2006, at specific rates for different types of service. The County will authorize approved vendors and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited, phased in intensity, and produce positive change which protects children,prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID ST BE SIGNED IN INK TYPED OR PRINTED SIGNATURE VENDOR North Colorado Medical Center C�A t C�\ 4 (Name) Handwritten Signature By Authorized Officer or Agent of Vender ADDRESS 1801 16th Street TITLE c O Greeley. CO 80631 DATE 3Tn/Gi PHONE# (970) 352 -4121 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 Bid 002-05 (RFP-FYC-05010) Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2005-2006 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2005-2006 BID 002-05 (05010) NAME OF AGENCY:North Colorado Medical Center ADDRESS: 1801 16t°Street,Greeley CO 80631 PHONE(970) 352-1056 CONTACT PERSON:Karen Nicholson TITLE: Outpatient Services Coordinator DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased intensity,and produce positive change which protects children,prevents or ends placement, and preserves families. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1. 2005 Start 6/1/05 End Mav 31,2006 End 5/31/06 TITLE OF PROJECT: David Rastatter U� 3/i OJOK Name and Signature of Person Preparing Document Date 3po(or Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REOUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2004- 2005 to Program Fund year 2005-2006. Indicate No Change from FY 2004-2005 to 2005-2006 x Project Description x Target/Eligibility Populations x Types of services Provided x Measurable Outcomes x Service Objectives x Workload Standards x Staff Qualifications x Unit of Service Rate Computation x Program Capacity per Month _x Certificate ofInsurance Page 26 of 32 Bid 002-05 (RFP-FYC-05010) Attached A Program Category Home Based Intensive Family Intervention Program Bid Category Project Title Youth Passages Vendor North Colorado Medical Center PROJECT DESCRIPTION Provide a brief one-page description of the project. H. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Sub-total of Individuals who will have access to 24-hour service. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. K. Cultural/ethnically specific services L. Service to South Weld clients III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Therapeutic Services - includes re-parenting, limited family therapy,problem solving, communication skills,parent-child conflict management, etc. Duration of service is limited to 20 hours face-to-face contact per referral. B. Concrete Services -means concentrated assistance in the development and enhancement of parenting skills, problem solving, hands-on parenting. C. Collateral Services-teaching families to work with other community agencies such as drug and alcohol,health care,job training, information and referral, advocacy, etc., use of community support groups. D. Crisis Intervention Services - including in-home counseling and other interventions available on a 24-hour basis. Provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g. mental health Page 28 of 32 I. PROJECT DESCRIPTION Youth Passages has been an FYC provider for ten years. Throughout that time we have provided high quality intensive treatment to youths experiencing significant emotional, behavioral, psychiatric, educational, interpersonal, familial and chemical dependency problems. Treatment modalities that we specialize in include: milieu, individual, group, experiential,behavioral and family therapy. Our family therapy program is one of the strengths of our service delivery system. Youth Passages staff has consistently demonstrated the ability to develop positive relationships and facilitate growth with an unmotivated clientele. We feel this skill base will be an asset in working with the type of families referred for Home Based Intensive Family Intervention Program (IFIP). The Youth Passages Home Based IFIP program will consist of 2 to 3 hours of direct service per week per family. The therapists assigned to these cases are master's level therapists, including one bilingual therapist, experienced in the treatment for families with chemical dependency, domestic violence and abuse, issues. The intervention model will be based on a brief therapy solution oriented model with an average length of treatment of 10 to 14 weeks. Youth Passages Home Based IFIP will serve children and adolescents under age 18 and their families. This program will serve new clients in our system as well as being utilized as a step down service for our partial hospitalization and intensive outpatient program clients. It should be noted that clients and their families can enter the Home Based Intensive Family Intervention Program directly without having been a Youth Passages partial hospitalization client. An individualized intervention plan will be developed for each family to specify appropriate and attainable goals. Input from referring agencies will be utilized in the formulation of these plans. Youth Passages staff will communicate progress toward treatment goals via biweekly phone reports to WCDSS caseworkers and a written discharge summary at the end of treatment. Families who successfully complete the Intensive Family Intervention Program are invited to participate in North Colorado PsychCare's Common Sense Parenting class. This class meets weekly for 6 weeks, for a minimal cost, at the PsychCare/Family Recovery Center building. 1 f 2 2 0 k/ Cis . �k To k A § / o \ - & a : 2. \ k \ \ \ � % ■ a ) § = _ ! / \ k a } \{ 7 ) a 7\ a7 ■ © e & ) / k \ �k \ ig k \ Q ) \ 8. i DO w \ k \ H } / \ ) #2 f 2 d \ & a / �\ z j § N » OO o « \ % .8$ : o 0 } Tr ® ° \ ( \ \ } g } § t & E q ) w@ k 2 7 t _im 7 ( § \ ) f / / ( \ a . § 2 k k 8 « « " \ ( 8 o. § § } } / \ ) » ) ( § $ } o 7 � \ \ | g a ) ) J k ( \ \ a.a § ( 7 k \) § \ ) } ) 7 f & Ito ow ) ( ) \ ) ) ) ) ^ nk ) } \ \ § _ « & 7 d k Q m » oo / j z W k G 0 w w s@ w III. TYPE OF SERVICES TO BE PROVIDED A. Youth Passages Home Based IFIP will include family treatment interventions which provide re-parenting, problem solving, communication skill building and parent-child conflict management.. B. Youth Passages Home Based IFIP will provide concentrated assistance in the development and enhancement of parenting skills, problem solving and "hands-on"parenting. C. Youth Passages Home Based IFIP will provide education and training which will enable families to improve their ability to access services from other community agencies such as drug and alcohol, health care,job training, information and referral, community support groups and client advocacy. D. Youth Passages Home Based IFIP will include in-home counseling for referred clients. PsychCare/FRC is staffed with licensed professionals 24 hours per, 365 days per year. These staff members will collect relevant case information and communicate it to the direct service provider as soon as possible. Quantitative Measures A. 100% of clients will receive family intervention services that include re- parenting, problem solving, communication skill building and parent-child conflict management. B. 100%of clients will receive treatment services that assist in the development and enhancement of parenting skills,problem solving and "hands-on" parenting. C. 100%of clients will receive collateral services which include teaching families to work with other community agencies. D. 100%of clients will receive in-home family intervention services and all clients will be able to call in to speak with a licensed professional 24 hours a day, 365 days a year. This professional will pass on the relevant information to the assigned therapist as soon as the therapist is available. North Colorado PsychCare/Family Recovery Center deals daily with patient funding issues which include mental health capitation, ADAD and private insurance. We will not utilize FYC funds when other payer sources are available. IV. MEASURABLE OUTCOMES A. 80% of children remain in the home at time the case is closed. 2 This will be tracked by gathering relevant information at discharge. B. 80%of clients will demonstrate improvements in parental competency, parent/child conflict management and household management competency as measured by pre and post placement functional tests. This will be measured via an approved parenting skills inventory administered at admission and discharge. C. 75%of children who are currently in their own homes will remain at least 12 months after the completion of Home Based Intensive Family Intervention services. D. 70%of children currently in long-term placement who are provided reunification Home Based Intensive Family Intervention services will return to their own home and not reenter out-of-home placement 12 months after completion of Home Based Intensive Family Intervention services. This will be measured via: 1)gathering relevant info at discharge; and 2) FYC follow-up family questionnaires administered 12 months after discharge. E. 75% of families who receive either family preservation or reunification services will not have a substantiated abuse or neglect case 12 months after completion of Home Based Intensive Family Intervention services. This will be measured via a follow-up phone call to the assigned WCDSS caseworker. F. 75% of cases which receive either family preservation or reunification services by Home Based Intensive Family Intervention will measure "LOW"on the risk assessment devise at service closure. This will be measured by an approved questionnaire at the time of discharge. V. SERVICE OBJECTIVES A. 80%of our clients will demonstrate improved family conflict management which will lead to decreased child maltreatment, running away and other offenses. 3 This will be measured via an approved parenting skills and family functioning inventory administered at admission and discharge. B. 80% of our clients will demonstrate improved parental competency as based on their capacity to provide a safe household environment for their children. This will be accomplished during the intervention by addressing safety issues and improving parental protection of their children. This will be measured via an approved parenting skills inventory administered at admission and discharge. C. 100%of our clients will have increased their knowledge of and ability to access other resources in the community and those offered by the local, state and federal governments. This will be measured via an approved parenting skills inventory administered at admission and discharge. VI. WORKLOAD STANDARDS A. The person providing this service for North Colorado PsychCare will be a full time therapist who will not work more than 12 hours per day,40 hours per week, or 173 (on average)per month. One full time Master's Level therapist will be available to assist in high census periods, as well as a bilingual therapist when needed. B. Youth Passages plans on treating no more than 15 families concurrently at its maximum capacity. Master's Level therapist(s), as specified in Section A,will handle this caseload. C. Maximum caseload per therapist - 15 D. The treatment modality is a systems based approach to family interventions. The treatment philosophy is brief in nature with solution oriented interventions. Anticipated duration of treatment is 10 to 14 weeks. E. Total Number of Hours of Service- 1-3 hours per day of home based family treatment(on days clients are seen) 2-3 hours per week of family treatment 6 - 12 hours per month of family treatment F. Total number of individuals providing these services- 4 1 full time therapist 1 part time therapist when the census is high 1 bilingual therapist as needed G. Maximum caseload per supervisor- 15 H. Insurance- See attached certificate of insurance VII. STAFF QUALIFICATIONS A. The Behavioral Health Therapist(s)providing services will have a minimum of a Master's Degree in psychology, counseling, social work or a related field and work experience treating children, adolescents and families. B. Two staff members will be available for the direct service phase of this project with one additional staff member providing supervision. Additional direct service staff is available on a per diem basis if census dictates. C. Youth Passages staff members will participate in mandated orientation and training as required by NCMC. Our providers are not employees of DSS and should not require the 12 days of training mandated for new caseworkers. We are open to discussing orientation and short term training for our therapists in order for them to become more familiar with DSS rules and regulations. D. The therapists providing services to this program will be fully trained to cover all aspects of the Behavioral Health Therapist II position at North Colorado Medical Center. This includes providing assessment coverage at the Emergency Department as well as providing care to involuntary patients on our locked psychiatric unit. A significant portion of the training for this position includes risk assessment, involuntary treatment and legal reporting requirements. E. Our staff members are not employees of the State of Colorado and should not be subject to state training requirements. As previously mentioned, our therapists possess a minimum of a Master's Degree in psychology, marriage and family therapy, counseling, social work or related field. They also possess direct service experience providing family therapy to at risk children and adolescents. We are open to discussing an orientation period for our therapists to become more familiar with the requirements and requests of DSS. 5 • • VERIFICATION OF COVERAGE ISSUE DATE: Jan. 14, 2005 Issuer:Banner Health This verification of coverage Is issued as a matter of information only,and does not extend or alter the coverage carried by Banner Health. 'COVERED PARTY COMPANIES PROVIDING COVERAGE COMPANY BANNER HEALTH LETTER A SAMARITAN INSURANCE FUNDING,LTD. 1441 N.12TH STREET COMPANY PHOENIX, AZ 85006 . LETTER B COMPANY LETTER C COMPANY LETTER D COVERAGES THIS IS TO CERTIFY THAT THE INSURANCE COVERAGE LISTED BELOW IS CARRIED BY 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 VERIFICATION OF COVERAGE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF THE POLICIES OF INSURANCE CARRIED BY BANNER HEALTH. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXP.DATE LIMITS A HOSPITAL PROFESSIONAL B SIFL2005 01/01/05 01/01/06 PL EACH LOSS $10,000,000 GENERAL LIABILITY GL EACH LOSS $10,000,000 GL AGGREGATE $10,000,000 HOSPITAL PROFESSIONAL HPL EACH LOSS $ LIABILITY HPL AGGREGATE $ HOSPITAL PROFESSIONAL HPL EACH LOSS $ LIABILITY HPL AGGREGATE $ MEDICAL PROFESSIONAL PER MEDICAL INCIDENT $ LIABILITY ANNUAL AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION STATUTORY LIMITS $ AND EMPLOYER'S LIABILITY $ EMPLOYER'S LIABILITY COMMENTS. BANNER HEALTH HAS ARRANGED TO HAVE COVERAGE EXTENDED TO NORTH COLORADO MEDICAL CENTER. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED OR MATERIALLY TO WHOM IT MAY CONCERN CHANGED BEFORE THE EXPIRATION DATE,BANNER HEALTH WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER,BUT FAILURE TO MAIL SUCH NOT1fCE SHALL IMPOSE NO LIABILITY OF ANY KIND UPON BANNER HEALTH,ITS INSi1RERS OR THEIR AGENTS OR REPRESENTATIVES, AUTHORIZED$E RESENTATIVE , 4 ✓ ASSIGNED N0.:26-62 a\aranoon@005 CeNficateaTaciljt,NCMC4.xls Page 1 ( / ) k ) an 0 Ul Ill o -Ili N N- co _ _ & _ ea 69 - 6,_ 69 49 j2 ( ° m _ _ / 61 _ _ _ COo ea< I- w ( N e to in 0 ( / CO en ® ® " 61; " is; w0 id; $ ) k a ( o E _ 0 \ — 0 § U = o ° o / / § } , 0 = 0- U. 0 � ( o W 0 lx D g - > IL + w H ( co / f $ \ w w 0 ) § f ) § 0- ) a e 0 ) cr w ) 0 0 0 m = e = o_ co§ w 0 < 0 E 6 \ w 0 -, 2 o 0 / 0 § 0 o I 0 ° u) ) Cl) E. 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K § 2 d e U ,a w ■ i ; / ` o 6 ) w § ■ D 0 f 6 ( 0 0 0 $ 9 0 2 > 0 r z I- § § 2 0 z - _ j W ( § � � kw : ` § > > o / / / § ( K � � � \ § k K k 0 0 0 a o 0 0 o § m § ODw a0 e ° I- C 0 0 0 - Home Study Home Study Update ML Relinquishment 1:1 2005 Number of Statistic: Hours/Cast Cases Home Study 15 50 Home Study Update 8 15 ML Relinquishment 1:1 3 7 Total Cases 72 1872 Revenue Per Case Home Study 5 Interviews $ 900 $ 36,000 Home Study 6th interview $ 950 $ 2,850 Home Study 7th interview $ 1,000 $ 4,000 Home Study 8th interview $ 1,500 $ 4,500 Home Study 9th interview $ 2,000 Home Study Update $ 600 $ 9,000 ML Relinquishment 1:1 $ 80 $ 560 Gross Revenue $ 56,910 Deductions: No Shows $ 1,000 Net Revenue $ 55,910 Expenses: Salary- ML therapist $ 44,460 Salary Clinical Coordinator $ 543 Other(BA,Reimb,MR,etc) $ 262 Sub Total Salaries with benefits $ 45,265 Non-Salary expense: Mileage $ 3,000 Background Checks$60ea $ 9,000 Supplies $ 750 Sub Total Non-Salary $ 12,750 Total Expense $ 58,015 Contribution Margin $ (2,105) DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 O • COLORADO April 18,2005 Gene O'Hara North Colorado Medical Center 1801 16th Street Greeley,CO 80631 Re: RFP 05010: Option B,Home Based Services RFP 05006: Day Treatment RFP 006-00: Home Studies,Relinquishment Counseling Dear Mr. O'Hara: The purpose of this letter is to outline the results of the Bid process for PY 2005-2006 and to request written information or confirmation from you by Wednesday,April 27, 2005. A. Results of the Bid Process for PY 2005-2006 • The Families,Youth and Children(FYC)Commission recommended approval of the bids listed below for inclusion on our vendor list. 1. RFP 05010: Option B,Home Based Services 2. RFP 05006:Day Treatment • The Families,Youth and Children(FYC) Commission recommended approval of the bid, RFP 006-00B,Home Study,Updates,Relinquishment Counseling,for inclusion on our vendor list,attaching the following conditions for all Home Study providers. Condition#1: The threshold for hours for an incomplete home study will be set at 3.5 hours. Additional home studies will be billed at a maximum of$250 per person. Condition#2: It has been mutually decided that the turnaround time for receipt of the completed home study by the Department is set at six weeks from the date of receipt of the referral. B. Required Response by FYC Bidders Concerning FYC Commission Conditions: All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA).If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances.If you do not accept the condition,you must provide in writing reasons why.A meeting will be arranged to discuss your response.Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. Page 2 North Colorado Medical Center/Results of Bid Process for PY 2005-2006 The Weld County Department of Social Services is requesting your written response to the FYC Commission's condition.Please respond in writing to Gloria Romansik,Weld County Department of Social Services,P.O.Box A,Greeley, CO, 80632,by Wednesday,April 27, 2005,close of business. If you have questions concerning the above,please call Gloria Romansik at 352.1551,extension 6230. Sincerely, i J d A. t; 'ego,Di ctor cc: Juan Lopez,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 FY 05-PAC-2001 Revision (RFP-FYC-(05010) Contract Award Period Name and Address of Contractor Beginning 06/01/2005 and Ackerman and Associates,P.C. Ending 05/31/2006 Option B—Home Based Intensive 1750 25`h Avenue, Suite 101 Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Solution-focused services provided primarily in the Award is based upon your Request for Proposal(RFP). home. Maximum hours provided is 20 hours per The RFP specifies the scope of services and conditions referral. Services are focused on assessing needs, of award. Except where it is in conflict with this providing short-term intervention and assisting NOFAA in which case the NOFAA governs,the RFP Department with recommendations. Program upon which this award is based is an integral part of the average capacity is 2 families per month, action. maximum yearly capacity is 24.The average stay Special conditions in the program is 3 hours per week over an average 1) Reimbursement for the Unit of Services will be based on of a 3-month period. Bilingual/Bicultural and an hourly rate per child or per family. South County services are available. 2) The hourly rate will be paid for only direct face-to-face contact with the child and/or family,as evidenced by Cost Per Unit of Service client-signed verification form,and as specified in the Cost Per Unit of Service unit of cost computation. Hourly Rate Per $100.00 3) Unit of service costs cannot exceed the hourly,and Individual Counseling yearly cost per child and/or family. Family Counseling 4) Rates will only be remitted on cases open with,and Treatment Package-Intensive referrals made by the Weld County Department of Treatment Package-Moderate Social Services. Treatment Package-Low 5) Requests for payment must be an original and submitted Early Intervention Program to the Weld County Department of Social Services by Reunification the end of the 25th calendar day following the end of the Community Based Service month of service. The provider must submit requests for -Child Protection payment on forms approved by Weld County In-home Svcs for At Risk Delinquents Department of Social Services. Therapeutic Staffmg 6) The Contractor will notify the Department of any change Hourly Rate Per Court Testimony $100.00 in staff at the time of the change. Enclosures: X Signed RFP:Exhibit A Supplemental Narrative to RFP: Exhibit B Recommendation(s) _Conditions of Approval Approvals: Program Official: By e /k"/C Byel g() William H.Jerke,Chair Ju o D rectoBoard of Weld County Commissioners Wy Department of Social Services Date: JUN U 6 2n05 Date: CO/Z/O� cr9 S--- �( SIGNED REP: EXHIBIT A • INVITATION TO BID BID 002-05 (05005-05011 and 006-00) DATE: February 16, 2005 BID NO: RFP-FYC-05010 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal(RFP-FYC-05010) for:Colorado Family Preservation Act--Home Based Intensive Family Intervention Emergency Assistance Program Deadline: March 11, 2005, Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26- 5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2005, through May 31, 2006, at specific rates for different types of service. The County will authorize approved vendors and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited, phased in intensity, and produce positive change which protects children, prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date A\Our 4, I 9-OD ,S (After receipt of order) BID MUST BE SIGNED IN INK CO ce 4C)--erm4 C61 AD. nn TYPED OR PRINTED SIGNATURE VENDOR ltcierrrvnq, ,-, //SSdua, (C. (Name) wren Signature Officer or Agent of Vender ADDRESS I7 TO o`L Sl1 9 fre *1)0/ TITLE P.sy /O !ST a re e 7 Co 5'063 y DATE p).„ok_re,/, `Si--co S PHONE # 97b-?S3-33' 3 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 -Bid 002-05 (RFP-FYC-05010) Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2005-2006 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2005-2006 BID 002-05 (05010) NAME OF AGENCY: ` eAk r ASS occ - P G - ADDRESS: 17.tO irk in IAA.. Gr.e2(Q Co P063 '/ PHONE(VP ?S 3 33713 CONTACT PERSON: Q-O y C.2 A-c L-'--fr oa, U p TITLE: Ps)'cL1 O S DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased intensity, and produce positive change which protects children,prevents or ends placement, and preserves families. 12-Month approximate Project Dates: _ 12-month contract with actual rime lines of: Start June 1, 2005 Start End Mav 31, 22006p End TITLE TITLE OF PROJECT: ITC. .irnj..- 0, �-, /9 Wo'n 6 t s F-r f c -t ft(w, A LittAte,, , .U. 111a4 /0 9-0c75 • Name and Signature of Person Preparing Do um t Date Name and 'ign e ief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2004- 2005 to Program Fund year 2005-2006. Indicate No Change from FY 2004-2005 to 2005-2006 di Project Description Target/Eligibility Populations we Types of services Provided ^/ _✓ Measurable Outcomes Service Objectives 11/ Workload Standards ✓ Staff Qualifications M Unit of Service Rate Computation _ Program Capacity Month per Month —y( Certificate of lnsurance Page 26 of 32 . • Bid 002-05 (RFP-FYC-05010) Attached A Date of Meeting(s)with Social Services Division Supervisor: Comments by SSD Supervisor: 6-1 a L-t SIO - i _ 7 L Cu L x i ,, ) ,, & a . f , -r.L.J.M Q-kr .f -CF) 1 , it_ ,i - tJ ;_qk LIA4‘ty_ , -4( 1'f urn ci, )--- ' frf_l_ f4L-7-- _ c 4 ,hnspa : Ott, 4k 0'il k_.•2tP . OLJ )f tefti'+ , . e ` L.t_€ 1 t , (,C,�,k.�.°�,rw___�f_,�.) `" (Ai 8�t e_a r ,i.> e Ni--/ cke ItiteL . ��C �f ' rttek.--"Cpthita•JILT a-ILL-k-si al( 6-kJ 4.tio9-G k-C.L.c.L ,L dcsr-E-Lv e Ajf NJateeand Si/ature^of SSD Supervisor `� ..} antee ^ n n ,'Li L---LO e. - - t .y 16)(±L L Iti.-&k yaLLL-14.4 Cl, Ld 1L-k (LS e E LL- l-L LiLLcLL Y . P l,Ck_ -a L et aaiti_ ca u Le_LLILLL 'iL bud- 44 , L-p-LtiLL 1-o 6,-n-p-G-t-* 4kt kid � ,_ wail �� Page 27 of 32 Bid 002-05 (RFP-FYC-05010) Attached A Program Category 4 Home Based Intensive Famil Intervention Pro am Bid Cate o Project Title her- or- o pt Assoc(Assocco ter e- _ J SST !D t or a-"+"- Vendor /9c tnt- o,.L Ass c.14.-Co-c_ _C . PROJECT DESCRIPTION Provide a brief one-page description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Sub-total of Individuals who will have access to 24-hour service. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program(weeks). J. Average hours per week in the program. K. Cultural/ethnically specific services L. Service to South Weld clients III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Therapeutic Services -includes re-parenting, limited family therapy,problem solving, communication skills,parent-child conflict management, etc. Duration of service is limited to 20 hours face-to-face contact per referral. B. Concrete Services -means concentrated assistance in the development and enhancement of parenting skills,problem solving,hands-on parenting. C. Collateral Services - teaching families to work with other community agencies such as drug and alcohol, health care,job training, information and referral, advocacy, etc.,use of community support groups. D. Crisis Intervention Services -including in-home counseling and other interventions available on a 24-hour basis. Provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g. mental health Page 28 of 32 . Bid 002-05 (RFP-FYC-05010) Attached A capitation services, ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES Provide a two-page description of your expected measurable outcomes of the project. Address the following measurable outcomes: A. Child remains in home at time case is closed. B. Improvements in parental competency,parent/child conflict management and household management competency as measured by pre and post placement functional tests. C. Children who are currently in their own home will remain in their own home 12 months after the completion of Home Based Intensive Family Intervention family preservation services. D. Children currently in long-term placement who are provided reunification Home Based Intensive Family Intervention services will return to their own home and not reenter out-of- home placement 12 months after completion of Home Based Intensive Family Intervention services. E. Families who receive either family preservation or reunification services will not have a substantiated abuse or neglect 12 months after completion of Home Based Intensive Family Intervention services. F. Cases which receive either family preservation or reunification services by Home Based Intensive Family Intervention will measure "LOW" on the risk assessment devise at service closure. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Provide a one-page description of your expected service objectives and quantitative measures. Address, at a minimum, the following ways the project will: A. Improve Family Conflict Management -Intervention and counseling designed to resolve conflicts and disagreements between parents and their children contributing to child maltreatment, running away and other status offenses. B. Improve Household Management Competency- capacity of parents to provide a safe household environment for their children by addressing safety issues and protection of children. C. Improve Ability to Access Resources - services shall assist parents in learning to obtain help from other sources in the community and within the local, state, and federal governments. D. Address specific referral issue(s)—services shall be solution focused and address issues specified by the Department of Social Services. Describe the methods you will use to measure, evaluate, and monitor each service objective. Page 29 of 32 Bid 002-05 (RFP-FYC-05010) Attached A VI. WORKLOAD STANDARDS Provide a one-page description of the project's workload standards and quantitative measures. Address, at a minimum, the following areas: A. Number of hours per day, week or month. (Minimum intensity of 3 hours per week per family.) B. Number of individuals providing the services. C. Maximum caseload per worker. (Minimum family caseload of 8-10.) D. Modality of treatment. E. Total number of hours per day/week/month. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. H. Insurance. VII. STAFF QUALIFICATIONS Provide a one-page description of staff qualifications and address, at a minimum,the following: A. Will your staff, including supervisors, who are providing direct services have the minimum qualifications in education and experience in Staff Manual Volume VII, Section 7.303.17, and Section 7.0006,Q, Colorado Department of Human Services? Describe. B. Total number of staff, including supervisors, as defined in Staff Manual Volume VII, Section 7.303.17, and Section 7.0006, Q, Colorado Department of Human Services. C. Will your staff have received mandated new caseworker training? D. Will your staff have knowledge in risk assessment? E. Will your staff have completed the required State Home Based Intensive Family Services training component? VIII. Unit of Service Rate Computation The budget form is to be used to provide detailed explanation of the hourly or daily 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 by the Department. Requests for payment based on units of service such as telephone calls,no shows,travel rime, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise,bills must be for hours or days of direct services 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. The rate for court testimony includes preparation of and actual court testimony during the Kau of this contract. Please list your requested rate for court testimony separate from your direct hourly rate for client services. Page 30 of 32 'Bid 002-05(RFP-FYC-05010) Attached A There are two different ways to fill out the budget form. The budget can either be done manually or by computer. Regarding the manual budget, all areas that are required to be filled in are highlighted. The computerized budget is less work due to predefined calculations,but does require Microsoft Excel for Weld County's predefined budget. There are highlighted areas on the computerized budget that are required to be filled in as well. There are disks available that have this predefined budget on it. Firms can also design its own budget form on a spreadsheet, but at minimum, it must have all of the columns that are on the manual or computerized budget. Explanations on how to fill out the budget form are provided below and on the following pages. (A) This is an estimate of the total hours or days of direct, face-to-face services each client will receive from the time he or she enters the program until completing the program. On the manual budget,the only place to put this number is on the Program Budget worksheet. The computerized budget requires this number to be entered on the Direct Service Cost worksheet only. Once filled in there, this number is populated throughout the entire budget. (B) This is an estimate of the number of clients who will be served during the period from June 1, 2005, through May 31, 2005. On the manual budget, the only place to put this number is on the Program Budget worksheet. The computerized budget requires this number to be entered on the Direct Service Cost worksheet only. Once filled in there,this number is populated throughout the entire budget. (C) This is the total number of hours or days per client multiplied by the total number of clients to be served for(B). On the manual budget,this will have to be calculated manually on the Program Budget worksheet. The computerized budget will automatically calculate this then populated throughout the entire budget. (D) This is calculated by taking the total direct service costs(E) and dividing it by the total number of hours in( C ). On the manual budget,this will have to be calculated manually. The computerized budget will automatically do this calculation for you. (E) This number represents the salary and benefits that your organization pays its direct service providers plus any costs which are directly attributable to the face-to-face session with the client. On the manual budget, all areas that are highlighted on the Direct Service Costs worksheet must be filled out according the descriptions. The Grand Total Direct Service Costs must be then carried over to the Program Budget worksheet. The computerized budget, once all of the highlighted areas are filled in, it will automatically carry the total over to the Program Budget worksheet. (F) This represents the salary and benefits of direct service, supervisory, and clerical personnel which are not incurred in providing direct, face-to-face service to the client,but can be allocated to this program for time spent on the program for activities such as travel,phone conversations,no- shows, discussions with involved parties,meeting preparation, and report completion. On the manual budget, all areas that are highlighted on the Admin Costs Non-Face-to-Face worksheet must be filled out according to the descriptions. The Grand Total Direct Service Costs Not-Face-To-Face must be carried over to the Program Budget worksheet. The computerized budget, once all of the highlighted areas are filled in on the Admin Costs Non-Face-to Face worksheet, it will automatically carry the total over to the Program Budget worksheet. Page 31 of 32 •• 3ld 002-05 (RFP-FYC-05010) Attached A (G) This represents the agency overhead costs, such as rent,utilities, supplies, postage, travel reimbursement, telephone charges, equipment, depreciation, data processing, interest, and taxes which are not incurred in providing direct, face-to-face service to the client,but can be allocated to this program for time spent on the program for activities such as travel,phone conversations, no- shows, discussions with involved parties,meeting preparation, and report completion. On the manual budget, all highlighted areas on the Overhead Costs and Profits worksheet must be completed according to the descriptions. The Total Overhead Costs must be carried over to the Program Budget worksheet. The computerized budget, once all of the highlighted areas are filled, will automatically carry over to the Program Budget worksheet. (H) This represents the total of all direct face-to-face costs, admin direct non face-to-face costs, and overhead costs. On the manual budget, this will have to be manually calculated by adding these three total costs together. The computerized budget does it automatically. (I) This represents the total amount of profit your firms expects to realize as a result of operating this program. Any difference between lines (H) and(J)must be substantiated by an amount indicated on this line. The manual budget,this amount will be entered on the Overhead Costs and Profit worksheet and then have to be carried over to the Program Budget worksheet. The computerized budget, once it is filled in on the Overhead Costs worksheet, it will then automatically be carried over to the Program Budget worksheet. (J) This represents the total costs and profits added together. This is (H) and(I). On the manual budget, it will have to be calculated manually on the Program Budget worksheet. The computerized budget will automatically calculate it on the Program Budget worksheet. (K) This represents the total hours or days of direct service for the year. This is ( C) above. On the manual budget,you will have to carry this number down from(C ). On the computerized budget,it is automatically carried down. (L) This is the actual direct, face-to-face hourly or daily rate at which you will be requesting payment for the services provided under the conditions of this Request for Proposal. This amount cannot be more then what is charged to the general public or collected from insurance providers. On the manual budget,this amount must be calculated by taking the total costs and profits (J)and dividing it by the total hours or days of direct service for the year(C or K). The computerized budget automatically calculates this total. All providers who receive a NOFAA must also submit a certified computation of the organization's actual expenditures for the approved Core Service program by January 31, 2006, for a six-month period from June 1, 2005, to November 30, 2005. The actual expenditures must be submitted in the same format as the budget was prepared. The certification language must be the same as on the Computerized Actual Expenditures worksheet. The document must be signed by the Chief Executive Officer or the authorized officer of the bidder in order for it to be considered certified. The use of the actual program expenditures is to insure that the direct, face-to-face hours/daily rate is comparable to the budget computation. The actual numbers will be taken into consideration for the 2006-2007 Request for Proposal for that specific program. Page 32 of 32 Project Description, 2005-2006 Home Based IFT Services Overview: Ackerman and Associates, P.C. proposes to continue to deliver an Intensive Family Therapy Home Based program. We have had a very successful past eight years of operation in this program. The proposal presented here incorporates our accumulated experiences. Target families • are either facing imminent out of home placement or the family has a member who has returned from foster placement. These short term services are designed to help maintain placement at home or to help reunification succeed. In addition, in specific cases, home-based services can help prevent placement in residential treatment. Modifications originated over the past several years are maintained in this proposal to time limit the delivery of services to an initial twenty hour cycle. Entry into the program would involve creation of very clearly defined goals for the family to achieve during the program. Purpose: We propose to continue to provide home-based services in Weld County that: 1. are strongly based in the principles of appropriate mental health treatment, 2. reaffirm our intent to be promptly responsive to the needs of Social Services for feedback on the enrollment of families and the progress of families in the home-based treatment process, 3. Continue to be effective at preventing placement of referred children, reunifying children and are time and cost efficient. 4. place the needs of the child first while simultaneously being valued and appreciated by caseworkers, social services supervisors and the families that are being served. 5. conforms to good management practices that are both cost effective and cost contained as set forth in the project design below. 6. Meet the needs of bilingual and bicultural families. Our target for prevention of placement for this year is 60%, which means of the projected 24 families in our program, no more than nine families should have to ultimately receive permanent placement during the program period. Deakin: Implementation of our program in Weld County has been quite successful in the last eight years. This proposal incorporates changes made over the past several years for more intensive and rapid responses by families to meet the requirements set forth in their case plan. We believe the program should be time limited and results oriented in the delivery of services as specified in our bid request. The goal for 2005-2006 for the program is to maintain service delivery standards as follows: 1. To have @60% of clients referred need no more than twenty total hours of service. (We project 15 of 24 referred families will meet this standard) 2. All families who need more than 20 hours of treatment(9 families of twenty four projected referrals) will either be: • Referred to a specific life skills program, • Referred to short term intervention programs to finalize treatment, • Referred back to Social Services for determination of future action if progress during the first twenty hours in our determination has been inadequate. Other considerations: The strength of our company in this project, in experience, in bicultural/bilingual service delivery and in the delivery of home- based services to over one hundred client families since our programs inception in 1996 are considerations we think are important for the reviewers of this proposal. We seek to continue to be on the list of approved vendors for the provision of these services. Target/Eligibility Populations A. Total number of clients to be served. two families per month times twelve months equal 24 families per year. If we assume a family size of six, two adults and four children, the total client pool to be served is 138 individuals. That number includes at least 24 individuals who face either imminent out of home placement or who need reunification services. B. Distribution of clients. Total number of clients we will serve is approximately 138 as calculated above. Our experience suggests we would expect approximately 40 of these to be adult members of families and approximately 100 to be minors. The age of distribution of the index case children would tend toward the younger children based on our experience with home-based intensive therapy. We estimate that about one third of the index children would be older 2 than ten with an average age of about 14 and about two thirds would be under ten. The older group would most likely be teenagers in conflict with their family. The younger group will consist of children of no particularly predictable age whose parents are in conflict and have come to the attention of the social services system. Frequently, there is also instability in the marriage. C. Families Served. We would anticipate serving up to 24 family units. D. Subtotal who will receive biculturallbilingual services. As stated below, Emily (Jaramillo) Montoya is a master's level counselor (who is Hispanic of Mexican American heritage). She can provide services in Spanish or English for most families. Thus, most of the projected total will be able to be conducted bilingually without needing additional language services. All of the services provided (for a maximum of 24 families) would be done in a manner that is sensitive to the culture of origin of the family. Joyce Ackerman has specific doctoral level work on cross cultural aspects of mental health with the Mexican American cultural population. She also has 8 years experience supervising this program in Weld County E. Accessibility. All providers of Ackerman and Associates are accessible through a 24 hour answering service and their cell phone which is used by our answering service as a pager system. On weekends, our 24-hour access reaches the provider on call who is always a licensed Mental Health Provider. These providers are Laurence Kerrigan, Ph.D., Susan Plock Bromley, Psy. D., Emily Jaramillo Montoya, MA L.P.C.., Joyce Ackerman, Ed.D, and Tom Pappas L.PC. M.S.W. Access for clients who for any reason need services outside the home are available at our Greeley office. F. Maximum per month. The program maximum is two families accepted into the program per month. H. The monthly average capacity is two families per month. I. The average stay in the program is three hours or more per week over an average of a three-month period (to an initial 20 hours maximum). For some families the twenty hours of treatment may be delivered over a longer or shorter period with more services delivered early in the program and less per week toward the end of treatment. This is a design where services are more intense during a crisis and decrease gradually as clinically appropriate. Types of Services Provided We will provide the following solution focused services to all families in the program. Specific details that further define these services are in the section of this bid called Service Objectives. 3 Our model is summarized below: We are using the following strategies to help families attain desired outcomes: 1. An immediate initial response to the crisis is made because people who are in crisis are often motivated to change. 2. The therapist focuses on the family's presenting problem as defined clearly in the referral. Clear statement of the goals for behavioral change often increases the client's motivation to work on that problem. Solution focused therapy acknowledges that clients have the best information about themselves and their lives and can apply skills to solve these problems when properly treated. 3. Services are provided in the client's home environment as much as possible to increase accurate assessment, therapist credibility with the client, and the probability the client will incorporate the material they learn into daily family activities. 4. The practice is available on a 24-hour basis to address client concerns. Such access increases the ability to monitor for potentially dangerous situations and provide immediate assistance in crisis situations. 5. Home Based Services uses skills-based intervention to empower the client to handle fife situations without the help of others. This also lessens the need for ongoing long-term intervention. A. Therapeutic Services: We will provide the following services and document the delivery of these services using an individualized treatment plan for each family. Progress on this treatment plan will be reported to the caseworker on a monthly basis. The family treatment plan based on the referral will be confirmed during the first week of contact. The plan will address the concerns identified by the WCDSS caseworker who fills out the family referral form as well as those raised through a clinical assessment of the family by the therapist. The therapist working with the family will choose clinically appropriate intervention strategies. Inherent in these modalities is the need to show rapid progress on the goals stated in the case treatment plan. Success or failure to do so will be communicated to WCDSS in the monthly reports. In most families served by this program a selection of the following modalities will be utilized based on the individualized list of identified family needs: 1. Re-parenting including emotional support to address those issues related to the parents'family of origin, and parenting role models. 2. Family therapy to address structural and issue related difficulties the family is experiencing. 4 3. Support groups to address couples' communication, alcohol and drug issues and other issues as identified. 4. Problem solving and negotiation skills to enhance the client's interpersonal effectiveness in implementing change. 5. Communication skills to enhance general aspects of interpersonal effectiveness. 6. Parent-child conflict management skills to enhance the parent's ability to set effective limits for the child in a nurturing manner. Note that while the modalities outlined are general and may not apply to all families in ail cases, the choice of clinical mode of treatment will be determined by the desire to produce evidence of change over the period of treatment in relation to the specific problem for which the family has come to the attention of Social Services System. There is obviously a balance between general improvement for the family unit and specific improvement in current behaviors and likely patterns of behavior that are detrimental to child safety. This balance needs to be reflected in the case plan and therapy must focus on achieving child safety and family improvement sufficient to protect the child within the treatment time limits in this program. B. Other Services: in addition to the therapeutic interventions described above, client families must be able to apply concepts and skills to their own specific needs. They must be able to put what they learn into practice in their own family in order to protect their children. Their ability to do so is what we term concrete skills acquisition. We use the term concrete skills acquisition to describe the incorporation of behavioral management practices into daily life of the family. This is distinct from the functional aspects of concrete services that are described later. Progress in this area and in other aspects of treatment will be documented in the family treatment chart. Behavioral Components of Concrete Services: Specific aspects of the family behavior where concrete skill acquisition can be documented and usually is necessary for family success to either prevent placement or retain a child who has been returned to home include: 1. Development/enhancement and maintenance of parenting skills including nurturing, limit setting and appropriate child management 2. Stress reduction and anger management skills. 5 3. Communications, problem solving, and negotiation skills to enhance interpersonal effectiveness. 4. Practice in hands on parenting skills using a coaching model to provide feedback, reinforcement, and clarification as to appropriate child management skills. 5. Money management including budgeting and resource acquisition. Only brief services in this area are possible under the current time limitations. Extensive needs in this area will be referred to a life skills program. 6. Other activities of daily living including recreational activities related to enhancing family development, spiritual support, community involvement and maintenance of physical and emotional well being. Only brief services in this area are possible under the current time limitations. Extensive needs in this area will be referred to a life skills program. Additional services may be needed and, if so, referral made to an appropriate resource for collateral services. C. Collateral Services: Collateral services involve connecting the family with the services they need in the community. Such services may include: • Drug and Alcohol Services. Referrals to alcohol and drug treatment programs including Island Grove and Family Recovery Center are available. • Health Care Referrals are also routinely available in our practice. Referrals to Sunrise Health Center, Monfort's Children's Clinic and The Family Residency Program are also available. •Job training referrals are available through the Job Services and through Vocational Ration. . D. Crisis Intervention: Twenty-four hour access is assured for the families to reach the providers. We have secretarial and office staff support 9-5 Monday through Friday at Ackerman and Associates, P.C. We maintain a twenty four hour, 365 day a year access system through our answering service. All providers can be reached through pagers by the answering service. In-home services for crisis intervention are available through this on call system. We have a rotating call system within the providers of Ackerman and Associates. Measurable Outcomes 6 Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following: 1. Did the family accept the referral from their caseworker? 2. Did we accept the family to our program? 3. Is the family making progress with the treatment plan for each component as outlined in the service objectives? 4. Has the family followed through with recommendations and referrals during the course of treatment? Summative Outcomes: Over the duration of the twenty-hour treatment, we determine the following information: Is the child still in the home? How well are the changes from treatment persisting? This measures if family behavior is different compared to their behavior before treatment. Specific summative goals are listed below. A. The child receiving services does not go into placement and remains at home at the time the case is closed. This will be measured by recording the status of the child at the time the case is closed. B. Improvement in Parental competency and parent child conflict management will be measured by clinical assessment A narrative in the monthly summary of treatment of the family will be provided. This is based on a review of the treatment on a month-to-month basis. This narrative will document the therapist's judgment of changes in parental competency. Success or failure to make progress will be discussed in monthly reports. C. Children will remain in the home twelve months after the case is close& This criterion can be measured at the twelve-month follow up contact by the caseworker. D. Children who were reunified will still be in the home twelve months after the case is closed. This criterion can be measured at the twelve-month follow up contact by the caseworker. E. Treatment families will not have a substantiated abuse or neglect twelve months after the case is closed. This information can be obtained by checking with the referring caseworker at Social Services at the sane time as points C and D above are assessed. 7 F. Families will be rated "low" on the risk assessment device at closure a the case. The providers will rate the family at the time of case closure on: 1. adherence and success with the treatment plan, 2. pre/post changes as documented in the discharge summary, 3. Clinical impression of future success. Service Objectives We have the following service objectives: A. Improvement of family conflict management The program is specifically designed to resolve conflicts. A solution focused treatment approach is used. Specifically, treatment will be focused on behaviors that either 1. Precipitated the likely imminent placement of the child or 2. Which prevent the reunification of the child with the family. The initial goal of services is to assist the family in finding behavioral solutions to the existing conflict. Each provider is skilled in family systems work and solution focused therapy. Other aspects of conflict management include parent child conflict resolution, problem solving skills development and application of negotiation and communication skills. B. Improved parental competency in this treatment model concentrates on the parents developing more age appropriate strategies. In dealing with conflict with their child, especially with teenagers, the areas of discipline, protection, instruction and supervision seem most responsive to improvement. With younger children the therapy gives the parents the opportunity in their own home to practice and to clarify the roles each parent expects of the other and what is expected of the child. This model of home-based care is able to improve parental performance based on the experience that this staff brings to this proposal. Some examples of these service objectives include delivery of services in the following skill areas (although not all families will need all skills improved or to work on all topics): improvement of parenting skills related to discipline and management of child behavior, emotional skills set development such as anger management, identification of depression or anxiety related behavior, and techniques for dealing with frustration, interpersonal skills development and assertiveness skills. C. Improve household safety. One aspect of the treatment plan is associated with maintaining a safe household environment. Some families may need help in behaviors related to having a home adequately cleaned, maintained and stocked with food and supplies. Given time constraints in this proposal extensive needs in this area will be referred back to WCDSS for management. D. The program will provide access to needed services as documented in the treatment plan for each family. Specific types of referrals may include the following drug and alcohol treatment, school issues, probation coordination, domestic violence resources, victim's assistance or other referrals. 8 Workload Standards A. The program has a capacity of two families per month with an average of five families per month. The families will receive an average of three hours per week for twenty weeks with a maximum length of service being five months and a maximum number of hours per family being sixty. All families will be treated within this framework regardless of the family composition. B. We have two licensed mental health providers for this program who will be home based specialists. They are Emily Jaramillo Montoya, and Joyce Ackerman • Emily Jaramillo Montoya, MA, L.P.C., received her masters in Agency Counseling. Prior to joining Ackerman and Associates, P.C., she had a wide range of work in mental health including treatment for alcoholic patients and support of minority college students. She is fluent in Spanish. Her undergraduate major was in Criminal Justice and Sociology. She has worked for three years in home-based treatment delivery • Joyce Ackerman Ed.D. Licensed Psychologist has supervised the Home Based program contract for Ackerman and Associates for the past eight years. Both of our staff members are highly regarded by the caseworkers based on feedback we have received from supervisors. Two other psychologists and a social worker complete the staff of Ackerman and Associates and serve as back up and support for the Home Based Specialists. The back up group is available on call to assist them as well as to consult on intervention strategies on an anonymous case presentation basis. The psychologists are Laurence Kerrigan, Ph.D., and Susan Bromley, Psy.D. The social worker is Tom Pappas, M.S.W.,LC,S.W. C. Of the up to 24 families the caseload is projected at 20 families with Montoya and 4 families with Ackerman D. The modality of treatment is home-based solution focused short-term therapy. As well, referral and support will be offered as described above. E Howie/weeks. The total number of therapist hours is 20 per family over three months, or a total for the budget calculation of 480 hours per year based on our projected average of 24 families. Maximum capacity for 24 families is 480 hours per year. The hourly fee is requested at$100 as documented in the rate calculation section_ 9 F. Staff. There are two individual providers supported by two office professionals in the practice. There are also two psychologists and an MSW social worker who provide on call support and back up services. G. Supervisor. This contact would be supervised and clinically managed by Joyce Shohet Ackerman, Ed.D., who monitors the project for compliance. The maximum caseload for the supervisor is two families per month. H. Insurance. Ackerman and Associates, P.C. carries one million three million liability coverage for professional liability on the corporation and its associates and each associate also carries the same level of coverage individually. In addition,Ackerman and Associates, P.C. carries a general liability policy related to accident or injury on our premises through Farmer's Insurance. Each provider carries individual automobile insurance. Staff Qualifications A. All staff members who will be Home Based Specialists exceed the minimum qualifications needed for this project in both education and experience as described above. B. Staff available for the project consists of the two Home Based specialists and two licensed psychologists and a licensed social worker. C. Current Mandated Training: AU of the above are trained at the master's degree or higher as mental health professionals. All also trained under the supervision of a home based specialist with our program before providing services to this program. D. All of the Home Based specialists and all the psychologists have knowledge of risk assessment and are skilled in the application of that knowledge especially in relation to the assessment of risk of harm to self or others. E. Will staff have required state home based trying? We have operated for the past 8 years without additional training beyond that described in paragraph C above. Unit of service rate computation We have calculated the unit of service rate based in the instructions. We used 2004 data for our agency modified per requirements for low bid as of this fiscal year review process. Costs have been adjusted back to our 2001 base year as cost reductions solicited by the county in 2002-2004 from actual use in 2002- 2004 were not sufficient to allow adequate cost recovery. 10 Using overall figures for the agency we arrive at a figure of$100 per contact hour. The profit for Ackerman and Associates for all programs was less than 1% of gross revenues and cost recovery under the bid at last years rate from WCDSS programs was insufficient to cover expenditures within our business plan. The proposed cost is $100 per face-to-face contact hour. This is lower that our operating fees for face-to-face therapy hour by doctoral level providers and equal to our usual provider fees for other providers. Budnet Justification A trained accountant who works as an independent subcontractor with Ackerman and Associates tracks contract funds. No special issues are present related to project audit to our knowledge. Ackerman and Associates programs were audited in a random audit(conducted by Anderson and Whitney) after its first year of operation with no deficiencies. Audit of this program conducted on a yearly basis over several years, by Anderson and Whitney, has detected no deficiencies. 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Address • GREELEY CO 80684-4944 07-0—4-362 04576-38-07 The named insured is an individual unless otherwise stated: Agent No. Policy Number DPartnership ❑Corporation O Joint Venture ❑Organization (Any other) Type of Business DOCTOR b S OFFICE 2. Policy Period from 07/01./04 (not prior to time applied for)to 07/01/05 1201 a.m. Standard Time If this policy replaces other coverage that ends at noon standard time of the same ay until the other coverage ends. This policy will continue for successive policy periods a follows: this pelie will net take effect insurance. we will renew this policy if you pay the required renewal premium for each uccessive policyp If we rules and forms Men in effectelect to continue this 3. Insured location same as mailing address unless otherwise stated; p "� subject to our premiums 4. We Provide insurance only for those coverages described below and for which a specific limit of insurance is shown. PROPERTY COVERAGES AND LIMITS OF INSURANCE COVEms PREN NO. 001 001 BUSINESS PERSONAL PROPERTY PROPERTY DEDUCTIBLE Sb3,100 GLASS DEDUCTIBLE $100 a00 S, ShRUBS, PLANTS INCLUDED PINE ARTS COVERAGE $2,500 $2,000 COVERAGE ADDITIONAL COVERAGES All Premises mom 7-09 0 CSM12P1 PAGE 1 OF 8 ..... a 41'00 Att�h to-yourapollcy wdfiahe same,number�shoWn of1•this;:endorsement . �e �.. 2nd, ,• • Agent Policy Number famed Insured• ' DR JOYCE SHORET ACI,ERMAN•PC ' - Address• 1750 25TH AVE SUITE 101 07-04-362 04576-38-07 • GREELEY CO 80631 • • of the Company designated in the Declarations Insured Location - (Same as above unless otherwise stated here) 1 000 0�0 each occurrenceEffective Date 07/31/96 Limit o1 Liability $ $ 1,000,000 Annual Aggregate ADDITIONAL INSURED.ENDORSEMENT (SPECIAL SENTINEL) in consideration of the premium we agree with you to the following: 1. The insurance provided by this policy for bodily inJury liability and property damage liability under Coverage • D—Business Liability insurance will also apply to the additional insured named below,but only with respect to an occurrence arising out of the ownership, maintenance or use of that part of the Insured location occupied by you. 2. This insurance does not apply to: (a) Any occurrence which takes place after you cease to occupy the insured location. (b) Any structural alterations, new construction or demolition operations performed by or for any additional insured named below. 3. The additional insured;will not be construed or deemed to be a subscriber to the Company issuing this policy. 4. The additional insured will not be or become liable for any premium payments due upon this policy. • 5. If this policy ie terminated for any reason we will give 30 (THIRTY) days notice in writing to the additional insured named below. • contrary. This endorsement is part of your policy. It supersedes and controls anything to the co y. It is otherwise subject to all other terms of the policy. ' STATE OF COLORADO Additional • C/O WELD COUNTY SOCIAL SERVICES DEPT Insured • A 7: JUDY GRIECO PO BOX A - `4 GREELEY CO 80632 Countersigned 1 Authorized Representative • • MINERS JOYCE SHOHET ACKERMAN, Ed.D. 1750 2561 Avenue,Suite 101 Greeley, Colorado 80634 RESUME PERSONAL DATA Date of Birth: August 3, 1950 Health: Excellent Married; two children CERTIFICATION - LICENSURE Licensed Clinical Psychologist,State of Colorado since 1984 Listed in National Register of Health Service Providers in Psychology since 1986 Staff Privileges, North Colorado Medical Center, Greeley, Colorado since 1985 PROFESSIONAL MEMBERSHIP American Psychological Association Colorado Psychological Association (elected board member 1986-1989) • HONORS President's Award - Colorado Psychological Association, 1989 EDUCATION 1978 - 1981 Ed.D. in Counseling Psychology, University of Northern Colorado, December 1981 graduate 1972- 1974 M.S. in Education (E.D./L.D.) Lesley College, Cambridge, Massachusetts,August graduate 1968 - 1971 B.S. in Special Education and Elementary Education with a minor in psychology Boston University, Boston, MA, December 1971 graduate PROFESSIONAL EXPERIENCE 1981 - present Clinical Director in group practice in Greeley, CO. Among responsibilities are: Diagnosis, therapeutic intervention and referral for adults, families, children and groups. Primary areas are: mediation, alternative conflict resolution,stress reduction. Also developing, organizing and presenting workshops and consultative programs to community,schools,organizations and agencies. 1986- present Consulting psychologist on interdisciplinary team for in-patient rehabilitation program. Progressive Care Rehabilitation Center,Greeley, CO. Medical Director Dr.Judith Vaughan,Neurologist. Adults with traumatic injuries- primary problems are: psychological aspects of physical rehabilitation,grief counseling,and brief group counseling using cognitive-behavioral goal oriented therapy. 1989 - 1992 Consulting psychologist for Head Injury Treatment Team North Colorado Medical Center,Greeley CO Team coordinator- Dr.John McVicker,neurosurgeon. 1986 - 1989 Consulting psychologist for Family Recovery Center(in-patient substance abuse/chemical dependency program), North Colorado Medical Center,Greeley CO Coordinator Ruth Wick,R.N. 1986 - 1989 Provider and Coordinator for Mental Health Services in Northern Colorado for Peak Health Care(HMO). Peak mental health services utilized a three-session model for initial services followed by referral. Activities included coordination of Psychological and Psychiatric Services for approximately the last two years of the Contract. Peak supervisor- Elaine Taylor 1983 - 1986 Psychologist subcontractor for a Vietnam Veteran's Counseling Program funded by the Veteran's Administration. Principal Contract Dr. Robert Stewart. 1980- 1987 Part time faculty member with responsibilities for classes, workshops and community programs in parenting skills. Family/Life Education Program, Aims Community College,Greeley CO August 1980- August 1981 -Clinical internship on Children's Team of Community Mental Health Center. Responsibilities included: consultation to schools and community programs;therapy for children and families;and assessment of diverse mental health programs. Assistant program evaluator - developed evaluation tools to determine cross-cultural perceptions of expectations and satisfaction with services. Supervisors - Dr.Joan Gillespie and Dr. Laurence P. Kerrigan. • APA National Convention in Toronto,Canada"Psychology and National Health Reform: "National Health Insurance: Policy Considerations. Benefit Designs. and Economic Realities",and"Marketing: Psychology's Key to National Health Reform. 1993 Disaster Relief Training. Alan Keck through Colorado Psychological Association,Denver CO 1992-Fall Short Term Therapy, Bernard Bloom; University of Northern Colorado, Greeley CO 1990- Fall National Cognitive Rehabilitation Conference, Richmond VA 1990-summer Postgraduate training: 1. Adult Neuropsychological Method based on Lezak Neuropsychological assessment,1983. 2. Child Neuropsychology, Dr.Hynd. 3. Child Neuropsychological Methods 1988 Cognitive Rehabilitation Training Program, Dr.Sena, Ph.D., Colorado Springs CO 1988- present Psychologist-Head Injury Treatment Team at North Colorado Medical Center,Greeley CO 1987 Halstead Reitan Neuropsychological Assessment Training. Ralph Reitan, Ph.D.,Washington DC Summer 1986 Albert Einstein School of Medicine, Workshop on Adolescent Therapy, Cape Cod MA 1985 to present North Colorado Interdisciplinary Team of Child Custody Member and participant Fall 1985 Interdisciplinary Workshop on Child Custody, Keystone CO Summer 1984 Workshop in Clinical Use of Hypnosis, Boston MA Winter 1983 Workshop on In-patient Programs for Service Related Disorders, Cheyenne Veterans Administration Hospital. Fall 1983 Veteran's Administration Workshop on Post Traumatic Stress Syndrome, Denver Veteran's Center. Fall 1981-Winter 1984 Post-Doctoral Supervised Candidate for Licensure (psychology) under Gale R. Giebler, Ph.D. Licensed Psychologist and Susan Spilman, Ph.D, Licensed Psychologist 1980 - 1981 Intern- Weld County Sexual Abuse Team,Greeley CO Weld Mental Health Center,Greeley CO adults,adolescents, families. Primary areas anxiety disorders, mood disorders and adjustment disorders. Typical problems included: trauma, physical abuse substance abuse,job stress. Orientation used - primarily cognitive-behavioral therapy. 1980 Group Facilitator-Regional and National Conferences in cross-cultural community needs. Flagstaff,AZ- Colorado Springs CO August 1975-July 1978 Chairperson of the Department of Education and Behavioral Science at an accredited,Indian controlled community college on the Navajo Reservation. Administration responsibilities included: Supervision and evaluation of faculty; budget preparation and management;curriculum development and integration of Navajo culture; personnel recruitment and selection;class scheduling and program development. Also faculty member with academic responsibilities for instruction in Psychology, Child Development and Counseling courses, advising and counseling students. Navajo Community College,Tsaile AZ September 1974-August 1975 Education Specialist and counselor at an Indian controlled primary and secondary school on the Navajo Reservation. Coordinated community resource program,which included: counseling,student assessment,prescriptive programming,staff development and curriculum. Also,adjunct faculty for the University of New Mexico and for Navajo Community College at the Rough Rock Demonstration school, Rough Rock, AZ September 1972-June 1974 Designed and coordinated Learning Center Program for Dedham Public Schools, A program and crisis intervention center for emotionally disturbed children. Responsibilities included: Diagnostic prescriptive programming,counseling,supervision and training of aides, tutors and volunteers,and consultation with regular classrooms teachers. Also organized group and individual meetings with parents. Adjunct faculty for Curry College assisting with in-service instruction for Dedham School System employees. Dedham Public Schools, Dedham MA WORKSHOPS AND SPECIAL TRAINING 1996 Biodyne training workshop adolescent treatment in short term therapy, Tom Kalous, Ph.D. 1995 Biodyne Training Workshops in short term therapy Julian Ang, Ph.D. 1994 Certification in family mediation,CDR Associates, Boulder CO 1993 Disaster Relief Training. Alan Keck, through Colorado Psychological Association, Denver CO 1993 August Hospital Practice for Psychologists • Summer 1981 Independent Study of Child Sexual Abuse, University of Northern Colorado Spring 1981 Interdisciplinary Workshop on Assessment of Sexual Assault, Boulder Social Services Summer 1979 Biofeedback Training related to labor and delivery. Summer 1974 Participant in Institute on Obstacles to Learning. Joint Symposium between McLean psychiatric hospital, Harvard University and Lesley Graduate School,Cambridge MA Summer 1973 Kennedy Memorial Hospital,Boston MA, Participant,Summer Aphasia Institute. PUBLICATIONS Ackerman A., Ackerman,J.S., Kelley K. Hale K. Family Planning Attitudes of Traditional and Acculturated Navajo Indians. Key Issues in Population and Food Policy. University Press of America, pp. 178-171 (1979) Ackerman,J.S.,Client Expectations and Satisfaction with Community Mental Health Center Services: A Cross-Cultural Analysis Between Hispanics and Anglos. Published Doctor Dissertation, University of North Colorado. Copyright 1981. BRANCH B/A PRODUCER NUMBER 23 DATE OF ISSUE PRIOR CERTIFICATE NUMBER A 0004087 05/04/2004 Renewal PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY PURCHASING GROUP POLICY NUMBER: 45-0002000 Item DECLARATIONS CERTIFICATE NUMBER: 455P- 2032570 1. Named Insured Ackerman and Associates PC 1750 25th Ave ADDRESS Greeley, CO 80634-4943 Number&Street,Town, County,State&Zip No.) 2. Policy Period: 12:01 A.M.Standard Time At From: To: Location of Designated Premises 05/01/2004 05/01/2005 3• COVERAGE LIMITS OF LIABILITY PREMIUM Professional Liability $ 1,000,000 each incident I $3,000,000 aggregate $ 1,529.00 4. BUSINESS OF THE INSURED: PSYCHOLOGY 5. The Named Insured is: _ Sole Proprietor (including independent contractors) Partnership X Corporation _ Other: 6. This policy shall only apply to incidents which happen on or after: a)the policy effective date shown on the Declarations: or b) the effective date of the earliest claims-made policy issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/1992 7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s). PLP-2012 (06/93), PLJ-2008(Rev. 10/94), , PLE-8035(09/97), PLE-2167(07/00), POE-8004(05/88) (Ed. `10/93), PLE-2081 Current, PON-2003(08/02) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or broker: Trust Risk Management Services, Inc. 875 N Michigan Ave Office address: Chicago, IL 60611-1803 City, State, Zip: Toll-Free Number: 1-877-637-9700 PLP•2012(06/93) APA- • VITA NAME: BROMLEY, Susan Plock May 2004 SOCIAL SECURITY NUMBER: 483-50-9243 POSITION: Licensed Psychologist Ackerman& Associates 1750 25th Ave. Ste 101 Greeley, CO 80634 HOME ADDRESS: 1621 13th Avenue Greeley, CO 80631 TELEPHONE: Office: (970) 353-3373 Home: (970)352-8750 EMAIL: sbromley0?earthlink.net EDUCATION: Year ----- Degree Institution Area of Shid� 1983 Psy.D University of Denver School of Professional Psychology Clinical Psychology Denver, Colorado 1968 MSSA Case Western Reserve University Casework (MSW) School of Applied Social Sciences Cleveland,Ohio 1965 BA Mt. Holyoke College South Hadley,Massachusetts Economics Sociology WORK EXPERIENCE--Professional Academic: Year InstitutioNOr �nization Position Responsibilities 1996-03 University of Northern Colorado Assoc. Professor Psychology Teaching/Research 1985-96 University of Northern Colorado 1983-84 University of Northern Colorado Asst. Professor Psychology Teaching Research Asst. Professor Psychology Teaching WORK EXPERIENCE--Professional Non Academic. Year(s) Institution/Orpanization Position Responsibilities 1996-present Ackerman and Associates Psychologist 1984-85 Kaiser Permanente Clinical Psychotherapist Clinical Lakewood, Colorado 1979-80 Bethesda Mental Health Center Psychology Intern Clinical/ Denver, Colorado 1968-79 Denver General Hospital Administrative P Clinical Social Worker/ Clinical/ Denver, Colorado Supervisor Administrative AREA OF SPECIALIZATION: Behavioral Medicine/Pain Management/Clinical Hypnosis/EMDR RESEARCH AREAS/INTERESTS: Hypnosis/Pain Assessment and Management/Women's Issues/Teaching Methods 1 PROFESSIONAL ACTIVITIES: Colorado Licensure: Psychology License#1086 PUBLICATIONS --Pro essionalJuried Musgrave-Marquart, D.,Bromley, S.P. &Dailey, M.B. (1997). "Personality,academic attribution, and substance abuse as predictors of academic achievement in college students". Journal of Social Behavior and Personality 12(2), 501-511. Karlin, N.J. and Bromley, S.P. (1996). Differences in caregivers of demented and lucid chronically ill family members. American Journal of Alzheimer's Disease, 11(5)3945. Retzlaff, P. and Bromley, S. (1994). Counseling personality disorders. In Ronch,J.L., VanOrnum, W. &Stillwell, N.C. (Eds)The counseling sourcebook: A practical reference on contemporary issues. New York: Crossroad Publishing group.pp. 466-474. Bromley, S. and Hewitt,P. (1992). Fatal attraction: The sinister side of women's conflict about career and family. Journal of Popular Culture. 26(3),pp. 17-24. Retzlaff,P. and Bromley, S. (1991). "A Multi-Test Alcoholic Taxonomy: Canonical Coefficient Clusters". Journal of Clinical Psychol_ og 47(21 pp. 299-309. Bromley, S.P. (1985). "Treatment of Pain: Theory and Research" in Zahourek, R. (Ed.). Clinical Hypnosis and Thera utic Su estion. New York: Grune and Stratton. Reprinted in Zahourek, R. (Ed.)(1990). New York: Bruner/Mazel, Inc.,pp. 77-98. PROFESSIONAL PRESENTATIONS--turfed: Touchton, M.A. &Bromley, S.P. (2000). Complementary/alternative medical use among undergraduates at the University of Northern Colorado. Poster session presented at the Rocky Mountain Psychological Association, Tucson. AZ. (April). Nickisson, J.W. and Bromley, S.P. (1999)"Hypnosis: Attitudes,knowledge and experience among psychology and nursing students". Paper presentation at the American Psychological Association Convention, Boston. (August) Bromley. S. (1998)Hypnosis, psychology and managed care. In S.Bromley(Chair)Complementary, nontraditional and indigenous healing practices. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Bromley, S. (1998). Complementary healing methods: A psychological and artistic exploration. In L. Wickerlgren (Chair). Interdisciplinary courses involving psychology: A sampler. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Campbell. J. S., Titus, J. and Bromley S. P. (1998). "Neuroanatomy teaching technique for introductory psychology students. Poster presented at the joint WPA/RMPA convention,Albuquerque, NM. (April) Bromley, S. (1997)(Chair)"Linking through honors programs: The cross-discipline course). Paper presentation as part of a symposium titled"Creating links between psychology and other disciplines," American Psychological Association Convention, Chicago. (August) Bromley, S. , Gilliam D., & Johnson, T. (1995). "Assessment of student created tests as an evaluation method". Poster presented at the American Psychological Association Convention,New York City. (August) Bromley, S. (1994). "Student created tests as an evaluation method". Poster presented at 16th Annual National Institute on the Teaching of Psychology, St. Petersburg,Florida. Karlin, N. and Bromley. S. (1992). " Similarities and differences for caregivers of demented and lucid chronically ill". Poster presented at the Rocky Mountain Psychology Association Convention,Boise. Idaho. (April) Montoy romley, S. (Chair) 92). " anges n aduate ng les in an uctory counseling K.J.theo theories se". Paper presented at the Association Convention,Boise, Idaho(April) Bromley, S. (1992). "Connected learning methods to facilitate research understanding". Paper presentation as part of panel titled. 'Teaching techniques in the social sciences", Western Social Science Association Convention,Denver, Colorado. (April) Bromley, S., Ramirez. S.,and McCoy, J. (1991). "Impact of a health psychology course on student health beliefs". Poster presented at the Rocky Mountain Psychology Association Convention,Denver, Colorado. (April) Karlin, N. and Bromley, S. (1991). " Support,burden and affect among caregiver of dementia and non-dementia patients". Poster presented at the American Psychology Association, San Francisco, California. (August) Bosley, G. and Bromley, S. (1990). Post death ritual in a Colorado community. Paper presentation at the American Psychology Association, San Francisco, California. (August) Bromley, S. (1990). "Husbands at Childbirth: Who Does It Help?"Paper presentation at Far West Popular Culture Association,Las Vegas, Nevada (January). Hewitt.P. and Bromley S. (1989). "Images of Work and Intimacy in'Turning Point'and'Fatal Attraction"'. Paper presentation National Convention of Popular Culture Association and American Culture Association, St. Louis, Missouri. (Session Chair) Retzlaff, P. and Bromley, S. (1989). "The Basic Personality Inventory: Alcoh Sub-Group Identification". Poster session at the Joint Convention of the Rock Mountain Psychological Association and Western Psychological Association, Reno, Nevada. Bromley, S. (1988). "Our Culture Affects Our Pain."Paper presentation,National Convention of Popular Culture Association and American Culture Association, New Orleans,LA. (March). Bromley, S. (1987). "Husband-Assisted Autohypnosis for Labor and Delivery: A Clinical Model". Paper presented at Rocky Mountain Psychological Association, Albuquerque,New Mexico(April). Bromley, S. and Loy,P. (1987). "Politics of PMS". Paper presentation Association of Women Psychologists, Denver. Colorado (March). PROFESSIONAL PRESENTATIONS--Invited: Bromley, S.P. & Canales, G. (2000). Issues in presenting information on historically underrepresented groups in the classroom. Symposium conducted at the Rocky Mountain Psychological Association,Tucson. (April). Strongin, D. &Bromley, S. (1999). Student and faculty reactions to the introduction of a graduate ethics course. In Miller, R. (Chair)Ethics in college teaching. Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins, CO(April) Bromley, S. (1999). Issues of religion and spirituality with therapists and clients. In S. Bromley(Chair)Religion and spirituality in research, practice and the classroom. Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins, Co(April) Handelsman, M.M.,Bromley, S.P. &Davis, S.F. (1995). "Clinical Psychologist, Counseling Psychologist, Clinical Social Worker, or Psychology Professor: Which Degree is Right for Me?"Psi Chi invited panel presentation,Rocky Mountain Psychological Association, Boulder. CO(April). Bromley, S. (Co-Chair), Seibert, P. (Co-Chair), Knuckey,D.,Bohlin,M.,Zaweski, C., Watson,D..Hammon,D., West, K. &Robins,J. (1994). "Training the Teaching Assistant"Invited Panel Presentation,Rocky Mountain Psychological Association, Las Vegas. Nevada(April) 3 Bromley, S. (1993). "Hypnosis in Dentistry."Presentation at Monthly Meeting of Weld County Dentistry Association, Greeley, Colorado(February). Bromley, S. (1993). "Learning about the author as a way to understand research." Presentation at"Teaching Take Out". CTUP Special Event. WPA/RMPA Convention,Phoenix, Arizona(April). Allen,M. and Bromley, S. (1993). Co-Chairs Two CTUP Special Event Sessions, "Teaching Take Out: Experiences in Collaborative Learning", Western Psychological Association/Rocky Mountain Psychological Association Convention, Phoenix. Arizona(April). Bromley, S. (1993). Chair,Invited Symposium. "Psychological and Social Perspectives on Male Violence Against Women". Western Psychological Association/Rocky Mountain Psychological Association Convention,Phoenix, Arizona (April). Bromley, S. (1992). "Enhancement of student research and writing skills in any course". CTUP Workshop presented at the Rocky Mountain Psychology Association Convention,Boise, Idaho. (April) Bromley, S. and Karlin,N. (1992). "General and health locus of control of adult caregivers". Poster session at the UNC Research Forum, Greeley, Colorado. Bromley, S. (1992). Panel member in Mental Health Symposia for Victim Compensation Convention as part of the Colorado Organization for Victim Assistance Conference. (Estes Park/October) Bolocofski,Bromley, Foster and Mean(1988). "Hypnosis: Research and Clinical Perspectives,"symposium presentation. Colorado Psychological Association, Greeley(March). Bromley, S. (1986). "Pain: A Psychological Event". Presenter-20th Annual Emotional Crisis Workshop,University of Northern Colorado, Greeley, Colorado(July). LECTURES--Invited: Bromley. S. (1998)"Psychological methods of pain control" Invited lecture for the annual meeting of the Weld County Arthritis Society. Bromley, S. (1998). "Hypnosis for pain control of arthritis" Invited lecture for'Brown Bag" lunch series sponsored by the Greeley Medical Clinic. Bromley, S. (1998) "Headache Control -Psychological Methods". Invited lecture as part of a seminar titled"Coping with headache". Sponsored by the Greeley Medical Clinic. Bromley, S. &Ackerman J. (1998):"What to do to handle burnout" A workshop conducted for foster parents working with Weld County Social Services. Bromley, S. (1995). Keynote speaker for Golden Key Honor Society Induction Ceremony,University of Colorado, Boulder, Co. (November) Bromley, S. (1992). Keynote speaker for Sophomore Honor Society Induction Ceremony. Bromley, S. (1991)Featured speaker. UNC Academic Honors Convocation. (April) Bromley, S. (1991). Banquet speaker Emotional Crisis Workshop, Greeley. Colorado. (July) GRANTS: Bromley, S(1994)Honors Grant ($500)to attend research training at the Society for Clinical Hypnosis meeting, San Francisco(October) Bromley, S. (1994). Research and Publications award of$1500.00. "Assessment protocols to measure the efficacy of 4 hypnotic treatment for injured workers. Karlin,N. and Bromley, S. (1990). Research and Publications award of$2.4440.00. "Control, support,burden and affect differences among dementia and non-dementia caregivers". BOOK/GRANT REVIEWS: Grant review for Boise State Department of Education(1995) Review of Santrock, J. (1991). The science of mind and behavior. W.C. Brown and Benchmark. Review of McKee, P. &Thiem, J. (1993). Real life: Ten stories of aging. University of Colorado Press. PROFESSIONAL CONSULTATION/PRACTICE: Years Institution/Organization Role 1996-presnt Ackerman and Associates 1988 Bon Clinical Psychologist Bonne] Good Samaritan Center Pain Management Consultant and Trainer 1984-85 Denver Metropolitan Dental Care Consultant in Pain Management 1984 Iowa Association of Registered Physical Therapists Hypnosis for Pain Management Consultant and Teacher PROFESSIONAL ASSOCIATION PARTICIPATION: Membership 1986-2003 Rocky Mountain Psychological Association 1988-present American Psychological Association(Divisions 2, 30, 35) 1989-96 Greeley Area Mental Health Network 1987-88 Association of Women in Psychology 1980-89 Colorado Psychological Association 1988 CPA Program Committee Member for Spring Meeting--Greeley Coordinator SERVICE: EXTERNAL NATIONAL SERVICE: 1994-2002 Rocky Mountain Coordinator-American Psychological Association, Division 2-Teaching of Psychology 1992-94 Co-Chair, Rocky Mountain Region Council of Teachers of Undergraduate Psychology(CTUP). 1991-94 Mountain States Regional Academic Coordinator,Golden Key National Honor Society REGIONAL/STATE SERVICE: 2000 -Moderator for G. Stanley Hall Lecturer-Dweck. C. (2000). Motivation and the self Presented at the Rocky Mountain Psychological Association Convention,Tucson. (April) 1999-Moderator for G. Stanley Hall Lecturer-Viney. W. (1999). A larger canopy for psychology: Unifying themes and pragmatic empiricism. Presented at the Rocky Mountain Psychological Association Convention,Ft. Collins, CO(April) 1989-present Rocky Mountain Psychology Association 1998-present Ex-Officio Board Member As Division 2 Coordinator 1992-1998 Board Member 1995- 1998 Elected Chair, Groups Under-Represented in Psychology Committee 1992-94 Co-Chair, Groups Under Represented in Psychology Committee 1991 Coordinator of Student Volunteers,RMPA Convention.Denver, Colorado. 1995 Psychology Chair-CCHE Faculty to Faculty Conference(October) COMMUNITY SERVICE: 2003-present Board Member Weld County Area Agency on Aging 1999-present Member Weld Senior Wellness Program Evaluation Committee 1999-2000 Member, Weld County Area Agency on Aging, Grandparenting Committee 1998-present Member, Weld County Medical Society Committee on Alternative and Complementary Healing 1997-1998 UNC Loaned Executive-United Way of Weld County 1997 Mental Health Pro Bono Workshop,"Communication in the Workforce" 1991- 1996 Board Member, 19th Judicial District Victim Compensation Board 1995-96 Chair 1990-93 Board Member, Weld County Area Agency on Aging 1992-93 Chair 1991-92 Vice-Chair 1986-2001 Exam Supervisor-American Institute for Property and Liability Undenyriters/Insurance Institute of America 1987-present Clinical Psychologist-pro-bono work with individual clients and community training INTERNAL, DEPARTMENTAL: 1993-2003 Member,Department Executive Committee 2000-2003 Advisor Psi Chi National Honor Society 1995-1999 Co-Advisor Psi Chi National Honor Society 1996-present Guest lecturer for Psi Chi Grad Night on getting into clinical/counseling grad 1989-91,93, programs. 1995-1998 Department Representative, CCHE Faculty to Faculty Conference 1987-94 Department Representative to graduation ceremonies 1986-94 Library Representative 1983, 86 89, 90-93,97,98 Member,Faculty Search and Screen Committee 1990-92 Member,Psychology Department Undergraduate Committee(Chair 1992) 1987-88 Co-Coordinator Semester Conversion Committee COLLEGE: 1992,93.96.97 Member of faculty invited to teach in the Cluster Program 1990-93 Graduation Marshall, Arts&Sciences 1988-89 Member, Arts and Sciences Teacher Education Committee 1986-89 Chair, Interdisciplinary Committee to develop and revise Human Development Major in the College of Arts and Sciences and Psychology Department UNIVERSITY: 2002 -present Graduate Faculty 2002-present Field Experience Coordinator for students at Ackerman&Associates 1992-94 1996-99 Member-Research and Publications Board 1993-94 Chair-Elect 1988-99 Founding Co-Advisor. Golden Key Honor Society 1992-95 Member-UNC Women's Commission 1992-94 Co-Chair-Assessment Task Force 1989-90 Faculty Representative, Student Fee Allocation Committee 1986-89 Member, Faculty Senate 1988-89 Secretary 1987-88 Vice-Chair 1986-87 At-Large Member,Executive Committee 1986-89 Member, Academic Policies Committee 1986-87 Member,Elections Committee 1988 Representative,Western States Faculty Leadership Conference,Reno 1988 Senate Representative, Statewide Commission Advisory Committee 1988 Advisor, In-Touch Help Line 1985-86 Volunteer Therapist, UNC Counseling Center GRADUATE STUDENT COMMITTEES—Doctoral 2003-present Committee Member, Stefanie Stecker(School Psychology) 2002-present Committee Member,Karen Bender(Professional Psychology) 6 1998-99 Committee Member, Shu-Shin Lu,Professional Psychology. "Using Metaphor in Child Counseling in Taiwan" 1997-00 Committee Member, Christine Rogers,Professional Psychology,"A Qualitative study of the experiences of pastor's wives." 1995-1997 Committee Member, Lisa Ing, Special Education 1994-2003 Committee Member, Marla Gallagher,Educational Psychology 1993 Committee Member, Hsiu-Lan Ma, Science Ed. -Oral Comprehensives 1993 Committee Member. Jerry Buford, School Psychology,"Treatment of depressive symptoms of early adolescents". 1993-1998 Committee Member. Pat Flanagan. CSPA. Orals,"A comparison of attitudes and practices of Teaching faculty regarding student academic dishonesty at a two year and four year institution". 1991 Committee Member, Mike Propriano, School Psychology 1990-94 Committee Member, Paul Jantz, School Psychology, 1989 Committee Member, Mike Peters, Vocational Rehabilitation, "The Effectiveness of Vocational Evaluation for Various Disabling Conditions 1987 Committee Member, Ane Marie Kajenckii.English,"The Concept of Free Association in Virginia Woolf's The Waves" 1986 Committee Member, Fuming Liao,Mechanical Kinesiology,"Development and Validation of a Method for Providing Immediate Feedback Information on Speed and Angle of Release in Shotputting" GRADUATE STUDENT COMMI11 EES--Masters: 2001 Jeremy Ehmke, Chair 1999-00 Jennifer Lawrence, Committee Member 1998-99 Vanessa Ewing, Committee Member 1997 Stephanie Blasi, Committee Member 1997 John Nickisson, Chair 1994 David Watson, Committee Member 1994 Tiernan McIlwaine, Committee Member 1994 Jerrod McCoy, Committee Member 1993 Sheldine Runyan, Committee Member 1993 Sue Cole, Committee Chair."Influences on Occupational Goals of Selected Male and Female College Students". 1990 Jerry Benner, Committee Member 1990 Kurtis Armstrong, Committee Member,"Attitudinal Consequences of Pre-Employment and Random Employee Drug Testing" 1989 Michelle Hozer, Committee Member 1989 Anne Schnittgrund, Committee Chair,"Age and Electrothermal Biofeedback Training". 1988 Cherri Hackett, Committee Member, "The Effects of Turnover on Those Who Remain in an Organization" 1988 Tony Ambrosio, Committee Member, "The Belief in a Just-World and the AIDS Epidemic: Predictors of Attitudes Towards Individuals with AIDS" 1988 Steve Foster, Committee Chair. "Hypnotic Susceptibility As a Function of Locus of Control and Director Indirect Induct ional Deepening and Suggestion Style" 1988 Lisa Dillon, Committee Chair. "Cognitive-Behavioral Approach to the Treatment of Elderly Rheumatoid Arthritis Patients" 1987 Deanna Holmes, Committee Member 1987 Darlene Nold, Committee Member, "Reading and Writing Assessment Tests as Predictors of Success in the Basic Peace officer Academy at Aims Community College" 1987 Dan May, Committee Member 1986 Jeff Schiels, Committee Member. "The Reformulated Hypothesis: Is Its dominator of Learned Helplessness Literature Justifiable?" 1986 Linda Coulthard-Morris, Committee Member, "Biofeedback of Cortical Slow Wave Potentials, Hand Temperature and Muscle Tension in Normal and Attention Deficit Disorder with Hyperactivity Children" TEACHING: Honors Activities: 7 2000-2002 Thesis Co-coordinator, Stephanie Price,Allison Osag,Anna Grenier, Jennifer Donnelly 2000-2002 Thesis Co-advisor, Shanti Pepper,"Hindsight bias and prejudice against homosexuals" 2000-2002 Thesis Advisor, Angela Hanson, "Effects of aromatherapy on attention" 2000 Thesis Coordinator. Cindy Mitchell, Christin Hillyer,Angela Hanson 1999 Thesis Advisor,Melissa Touchton"Complementary/alternative medical use among undergraduates at the University of Northern Colorado". 1999 Thesis Advisor, Sarah Painton. "Early parent loss in terms of maintaining a connection with the deceased. 1999 UNC Research Day,Faculty Panel Coordinator, "Complementary Healing Methods" 1999 Thesis Coordinator-Kristin Pietryzick,Jennifer Kimberling,Cristine Dickey 1997 Thesis Co-Advisor Kelly Kinser. "An evaluation of the city of Greeley community outreach program". 1997 Honors Connection Course development-Alternative Healing Methods 1996-2002 Honors Co-Coordinator, Psychology Department 1989-94 Honors Coordinator.Psychology Department 1994 Thesis Co-Advisor, Diane Musgrave."The Relationships Among Personality Traits, Alcohol, Caffeine, and Nicotine Consumption, and Academic Performance in College Students" 1994 UNC Research Day.Faculty Panel Coordinator,"Hypnosis: Theory and Research" 1993 UNC Research Day.Faculty Panel Coordinator,"Non-traditional Theories of Therapy Serving Women and Minorities". 1993 Thesis Co-Advisor,Linda Norman, "Clozapine and Event Related Brain Potentials in Schizophrenics" 1992 Thesis Advisor,Deborah Knuckey, "The Effect of Touch on Affect Among Strangers Under Mildly Stressful Conditions" 1992 UNC Research Day,Faculty Panel Coordinator 1992 UNC Research Day, Faculty Panel Coordinator(2 student panels)"Sex Roles and Psychology,"The Power of Social Influence 1989 Thesis Advisor, Geri Bosley, "Post Death Ritual in a Small Colorado Community" 1988 Thesis Advisor,Pain Clasen, "The Use of Relaxation and Imagery Techniques in Pain Management" 1989&97 Honors Connection Course Development Courses Taught: (1-4 Scale with 1 as Highest)(*1-5 Scale with 5 as highest) AVG. DATE COURSE TITLE HRS ENR AVG.RATING 1986-1988 PSY 101 Intro Seminar Psychology 1 30 1.16 1983-1997 PSY 120 Principles of Psychology 4 113 2.35 1984 PSY 121 Intro to Psychology I 4 40 ---- 1985-1988 PSY 230 Human Growth &Development 5 68 1.46 1984 PSY 265 Social Psychology 3 25 ---- 1988-2000 PSY 323 Health Psychology 3 43 3,02 1986 PSY 330 Child&Adolescent Psych3 27 1.4 1986-1993 PSY 331 Maturity&Aging 3 36 1.51 1984-2000 PSY 455 Abnormal Psychology 3 32 3.01 1983-1998 PSY 350 Theories of Personality 3 40 2.05 1986-2000 PSY 407 Intro to Counseling Theories 3 23 2.52 1987 PSY 499 Psychology of Sex Roles 3 16 1.18 2000 PSY 508 Health Psychology and Healing 2 17 4.57 1989 PSY 508 Emotional Crisis Workshop 1-2 39 --- "Frontiers of Mental Health And Education" 1988 PSY 508 Emotional Crisis Workshop 2-3 63 "Mind/Body Interactions" 1987 PSY 508 Emotional Crisis Workshop 2-3 106 "Relationships" 1991 PSY 595 Health Psychology 3 15 1990-2000 PSY 620 Assessment&Interviewing 3 12 3.13 1988 PSY 620 Issues in Behavioral Medicine 3 5 2.08 1992-1997 PSY 621 Practicum College Teaching 2 12 3.11 1997 HON 200 Honors Connections Seminar: "Alternative Healing Methods" 2 20 3.67 of 4 1989 HON 200 Honors Connection Seminar II: 2 9 --- 8 "Love" 1986 Elderhostel "Dream On" NC (25) 1987 Elderhostel "Mind/Body Interactions" NC 19 Courses Developed: 2000 PSY/PPSY 508,Health Psychology and Healing 1997 HON 200, Alternative Healing Methods 1991 PSY 595,Issues in Health Psychology. Summer 1989 23rd Annual Emotional Crisis Workshop,Frontiers of Mental Health and Education, Summer 1988 PSY 620, Assessment in Behavioral Medicine, Fall(Revised Spring 1998) 1988 PSY 423, Health Psychology,Fall 1988 22nd Annual Emotional Crisis Workshop, Mind/Body Interactions. Summer 1987 21st Annual Emotional Crisis Workshop,Relationships, Summer 1987 Mind/Body Interactions-Elderhostel Program, Summer 1987 PSY 499, Psychology of Sex Roles-Summer 1986 Dream On-Elderhostel, Summer Directed Studies: Graduate: 1995 Cynthia Holley, Hypnosis 1994 Tara Johnson, Hypnosis Theory and Practice 1994 Marla Gallagher, Sociometric Processes 1994 Marla Gallagher, Cluster Development in Intro Psychology Classes 1992 Bruce Holoman,Hypnosis Research and Practice 1988 Paul Jantz,Hypnosis for Pain With Children 1988 Lori Kochevar, Women as Leaders 1988 Jerri Israel, Alan Shaw, Issues in Health Psychology 1988 Steve Foster,Michele Hazer,Teaching Apprenticeship 1987 Tony Ambrosio, Hypnosis Models 1986 Candy Disch,Psychological Testing Undergraduate: 2000_ Lynell Rice-Cross-cultural attitudes towards healing methods 2000_ Andrea Hagedorn-Attitudes towards counseling(in lieu of honors thesis) 2000_ Laura Bell -Psychology of childbirth 1999 Lynell Rice-Healing Methods 1999 Stefani Stecker- Student's perceptions of parent-child sex communication(in lieu of honors thesis 1998 Jennifer Altman-Exercise and Psychology 1996 Kindra Sanchez-Biracial Identity 1996 Jenna Weatherbee-Pain Coping Styles 1995 Allison Ellis-Psychological Theories in Business Management • 1995 Holli Elrick, Counseling and the Hearing-Impaired Child 1994 Lewis Garza, Etiology of Schizophrenia 1994 Suzanne Bodetko, Autogenic Training 1994 Rebecca Furstenberg, Impact of Alzheimer's Disease on Families 1994 Bonnie Sarton,Hypervigilence in Youth(Hon 351) 1993 Mary Jo Hamilton,Hypnosis Theory 1994 Greg Schooley, Forgiveness as a Therapy Tool 1993 Jason DeBueno, Youth Advocacy 1993 Kelley Ferguson-Women in Psychology 1993 David Rosenberg-Offender Programs 1992 Robin Trostel,Analysis of Learning Styles 1992 Robin Trostel,Health Locus of Control 1992 Roberta Inman, Family Violence and Lesbians(Hon 351) 1991 Mark Kahl, Back Pain 1991 Tracy Moulton. Treatment of Sexual Abuse • 1991 Alice McPherson, African American Women and Higher Education 1991 Jody Hurner,Hypnosis: Theory and Practice 1990 Jimmie Berg. Women's Learning Styles 1989 Elary Violett, Cognition and Pain Management 1989 Geri Bosley, Chris Snodgrass,Bev Foster. Elary Violett, Issues in Personality 1989 Penny Vaughn.Female Pioneers in Social Work 1989 Lori Peterson,Pain and the Elderly 1988 Peer Training for Hotline Service 1987 Tracy Boh, Issues in Child Abuse 1987 Julie Stoddard, Grief and Divorce 1987 Eric Bouch.Hypnosis Models 1987 Mike Lesser, Assessment in Sport Psychology 1986 Lynne Sheffield, Childhood and Loss 1986 Jennifer March, Adolescence Pracii 2000 Rebecca Kuhn-Aromatherapy research 2000 Ackerman and Associates -Berkely Holston 1999 Melissa Touchton-Applied statistics 1998 Andrea Lamb-Hypnosis and golf performance 1998 Rebecca Varoula-Women's Place 1998 Greeley Medical Clinic-Gay Lemons,Renae Smith 1998 Ackerman and Associates -Amy Munnel.Kristin Pietrzyk, Jennifer Kimberling, Greg Pedersen 1997 Greeley Medical Clinic -Lori Darst,Barbara Glode,Ann Marie McCullen,Jeff Titus 1993 Greg Schooley, Bereavement Research 1993 Di Smice, Women's Commission 1992 Mary Jo Hamilton,Hypnosis Research 1992 Carol Sexton,Psychology Testing 1992 Lisa Schlott,Learning Styles PROFESSIONAL DEVELOPMENT ACTIVITIES: Woth1999 shops, Clinics Symnnsia r (Excluding Conferences as a Presenter) Cognitive Behavioral Therapy Training Program, Institute for Behavioral Healthcare 1999 EMDR training and Level 1 certification 1998 Qualitative research lecture series-UNC 1998 Lewis M. Terman Western Regional Teacher's Conference sponsored by APA Division2 in conjunction with the WPA/RMPA joint convention. 1998 "Spirituality and health in counseling", CAHEC Workshop, Greeley 1998 "Divorce Busting: Solution oriented brief therapy with couples", Colorado Assoc. Marriage and Family 1997 Health Maintenance-Legal and Ethical Issues 1997 Body and Soul: Healing in the 90's 1996 Celebrating our Essence: Women's Health and Spirituality 1995 International Society for Clinical and Experimental Hypnosis-Research Workshop. San Francisco,CA (30 more hours toward certification) 1989 "Minding the Body, Mending the Mind", CAHEC Workshop,Ft. Collins 1988 "Demystifying Publishing", CAHEC Workshop,NCMC, Greeley 1985 "Attentional Deficit Disorders in Children", Meichenbaum,Denver 1980 International Society for Clinical and Experimental Hypnosis-30 certification hours,Denver Numerous other workshops on Parent Loss. Child Abuse, Grantsmanship, Short-Term Treatment, Supervision, Pain Management, Medical Terminology,Depression, Personality Disorders Courses Taken Credit: 1994 EPRE 603 - Analysis of Variance A edit: 1993 EPRE 602 -Elements of Statistics 1990 EPRE 700 -Advanced Research Methods Continuing Education Credit 10 • 1976 C.U. Medical School-Medical Ethics • 1972 C.U. School of Nursing-Hypnosis(10 weeks) 1969 University of Chicago -Kubler-Ross,Death and Dying HONORS AND AWARDS. 2000 "Wonderful Outstanding Woman" Award 1998 Distinguished Service Award-Rocky Mountain Psychological Association 1998 Arts and Sciences Teacher of the Year Award 1998 "Wonderful Outstanding Woman" Award-Highlighted in October newsletter-Women's Resource Center 1993 Commencement Banner Carrier, Arts and Sciences 2002,1993, 91,89, 88 -Mortar Board Favorite Professor 1992 Student Representative Council University Professor of the Year 1992 Student Representative Council University Advisor of the Year 1989 Arts and Sciences Achievement Award 1988 Honors Advisor of the Year 1984 Psi Chi, University of Northern Colorado Chapter 1982-83 Writing Associateship-Rocky Mountain Women's Institute • 11 BRANCH B/A PRODUCER NUMBER 23 ( DATE OF ISSUE A 0004087 PRIOR CERTIFICATE NUMBER 04/08/2004 Renewal PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY PURCHASING GROUP POLICY NUMBER: 45-0002000 Item DECLARATIONS CERTIFICATE NUMBER:45P- 2050203 1. Named Insured sDea^Bromley 1621 13th Ave ADDRESS Greeley,CO 80631.5415 Number&Street,Town,County,State&Zip No.) 2. Policy Period: 12:01 A.M.Standard Time At From: To: Location of Designated Premises 04/01/2004 04/01/2005 3. COVERAGE LIMITS OF LIABILITY PREMIUM Professional Liabil' $ 1,000,000 each incident $3,000,000 a.. a. , 4. BUSINESS OF THE INSURED: $ 1298.00 PSYCHOLOGY 5. The Named Insured is: X Sole Proprietor(Including independent contractors) _ Partnership Other. _ Corporation 6. This policy shall only apply to incidents which happen on or after a)the policy effective date shown on the Declarations: or b)the effective date of the earliest claims-made policy issued by the Company to which this policy is a renewal;or c)the date specified in any endorsement hereto. 04/05/1996 7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions,stipulations and agreements contained in the following form(s)or endorsement(s). PLP-201O.PLJ-2008(Rev.10/94),,PLE-8035(09/97),PLE-2167(07/00),POE-8004(05/88)(Ed.*10193),PLE-2081 Current, _2003(08/02) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE; Agent or broker: Trust Risk Management Services, Inc. 875 N Michigan Ave Office address: Chicago,IL 60611-1803 City, State,Zip: Toll-Free Number. 1-877-637-9700 F'LP-2012(06/93) APA- TOM PAPPAS, LCSW 2595 Iris Court Montrose,Colorado 970-240-8468 TomPappasLCSW@Montrose.net EDUCATION 6/86 Masters Degree in Clinical Social Work, Simmons College School of Social Work,Boston,Massachusetts. 5/80 Bachelor of Arts Degree in Psychology and Secondary Education University of Lowell,Lowell,Massachusetts. EMPLOYMENT 3/94- Clinical Social Worker. Montrose Memorial Hospital Care Center Inpatient/Outpatient Services,Montrose, Colorado. Individual, family, marital and group therapy; discharge planning services. Co-therapist for geriatric partial-hospitalization program; supervisor for Masters Level student. 3/90-3/94 Senior Clinician. Justice Resource Center/The Butler Center, Westboro,Massachusetts. Individual, family and group therapy specializing in sexual offender treatment to adjudicated adolescent males in secure treatment facility. 11/86-4/89 Clinical Social Worker. New Bedford Area For Human Services, Inc., Children Services Unit. Individual, family and group therapy in outpatient setting. Co-therapist for latency-age girls' sexual abuse groups. 9/85-6/86 Social Work Intern. Beaverbrook Guidance Center, Waltham, Massachusetts. Individual, family and group therapy with children in outpatient setting. 9/84-5/85 Social Work Intern. Children's Hospital,Boston, Massachusetts. Individual, family and group therapy in pediatric out-patient setting. 12/81-5/84 Mental Health.Counselor. Marlboro Hospital Mental Health Unit, Marlboro,Massachusetts. Individual, family and group therapy with adolescents and adults in inpatient psychiatric setting • 5/80-5/81 Mental Health Counselor. Littleton Girls House,Littleton, Massachusetts. Counseling to adjudicated adolescent females in secure treatment facility. TRAINING 2/01 Certificate in Level II EMDR Training. 5/91 Postgraduate Certificate in Advanced Psychotherapy With Children and Adolescents,Boston University,Boston, Massachusetts. REFERENCES AVAILBLE UPON REQUEST CNA Healthcare Providers Service Organization Purchasing Group ®HPSO CNA Plaza, pp ��yy of r�I y� �tM�yy�rA n.... n„w,n eme,om,:.;..- (,lticago,IL60685 Certificate of 4ttsurak�.Ce PnNhOxr Branch Prefix Policy Number _` Policy Period from: 12:01 AM Standard Time on: 10/01/04 018098 970 HPG 269949616-8 to: 12:01 AM Standard Time on: 10/01/05 Named Insured and Address Program Administrator Healthcare Providers Service Organization TOM PAPPAS 159 East County Line Road 2595 IRIS CT Hatboro, PA 19040-1218 MONTROSE CO 81401-7485 Medical Specialty: Code: , Insurance Pr oYPed by , Social Worker 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, IL 60685 AGE PARTS LIMITSOP LIABILTT Y A. PROFESSIONAL LIABILITY Professional Liability $1,000,000.00 each claimg6,000,000.00 aggregate_ Good Samaritan Liability Included above r Personal Injury Liability Included above Malplacement Liability Included above B. Coverage Extensions License Protection $10,000.00 per roceedinq $25,000.00 aggregate Defendant Expense Benefit " ` $10,000.00 aggregate Deposition Representation _ $2,500.00 per deposition $5,000.00 aggregate Assault $10,000.00 per incident $25,000.00 aggregate Medical Payments $2,000.00 per person $100,000.00 aggregate First Aid $2,500.00 aggregate Damage to Property of Others $500.00 per incident $10,000.00 aggregate C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy. Workplace Liability Included in A. Professional Liability Limit shown above Fire and Water Legal Liability Included above subject to $150,000 sub-limit Personal Liability I $1,000,000.00 agqreqate U. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy. Workplace Liability None None Hired Auto & Non Owned Auto None Fire & Water Legal Liability None None Personal Liability „ '� 1 None Total Premium $250.00 P and endorsements attached at inception QUESTIONS? CALL: :1i$O& X9.1. . . J7a G-144872-A G-145184-A G-1215000 G-121501C G-123846C-05 G-121503C G-147292-A Healthcare Providers Service Organist=is a division of Affinity Insurance Services,Inc.;in NY and NH,MS Affinity Insurance Agency.in MN and OK MS Affinity lnemenee Agency,Inc.;and in CA,MS Affinity Insurance Agency,Inc.dba Aon Direct Insurance Administrators License#0795465. Master Policy: 188711433 (� 1 ` Keep this document in a safe place. This and CA-y-4 j 1rVty�i'V f/l your cancelled check act as proof of coverage. Chairman of the Board Secretary 601 XX 0000041-N 040913 NENACP 8/01 N733HN 04257 • EMILY L. JARAMILLO, M.A. 183 50th Avenue Place Greeley,Colorado 80634 Home Phone(970)353-1388 EDUCATION 1996,Master of Arts,Agency Counseling University of Northern Colorado,Greeley, Colorado 1993,Graduate Fellowship Study,Criminology Rutgers State University, Newark, New Jersey 1988,Bachelor of Arts, Sociology/Criminal justice with emphasis in Psychology University of Northern Colorado, Greeley,Colorado PROFESSIONAL EXPERIENCE 1998-Present Psychotherapist,Ackerman&Associates, Greeley, CO Provide intensive home based family therapy to families referred by the Department of Social Services. Provide mediation services to families. Co-facilitate family group decision making conferences for permanent placement of children. Provide short- term, solution-focused therapy. Provide therapy to individuals referred from Employee Assistance Programs. Facilitate foster parent training workshops. Provide foster parent consultation. Practice is supervised by Sherri Malloy, Ph.D., Licensed Clinical Psychologist. 1996-1999 Director,McNair Scholars Program, University of Northern Colorado, Greeley, CO Provided counseling, guidance,and academic advising to students who were low- income,first-generation college students,and of a minority group. Identified critical personal, familial, cultural,academic,and financial issues to aid in the development of individual success plans. Planned, developed, and implemented scholarly activities nationally. Developed and directed academic year research seminars. Coordinated research activities for scholars preparing for doctoral study. Directed all efforts to ensure efficient administration of a federal grant. Monitored project budget, supervised and trained staff members. 1995-1996 Assistant Director,McNair Scholars Program, University of Northern Colorado Provided counseling, guidance, and academic advising to students who were low- income,first-generation,and of a minority group. Identified critical personal, familial, cultural, academic,and financial issues to aid in the development of individual success plans. Coordinated the recruitment and selection of program scholars. • 1996 Psychotherapist(Intern), North Colorado PsychCare/Family Recovery Center, Greeley, CO Facilitated psychotherapy counseling groups and individual counseling for patients and families,with focus on chemically dependent and eating disorders. Performed case management from admission to discharge. Presented psychoeducational information to patients, family members,and staff. Worked collaboratively with a counseling team. 1994-1995 Assistant Coordinator, Student Support Services, University of Northern Colorado, Greeley, CO Provided counseling and academic advisement to at-risk first-generation, low-income, minority students. Identified critical personal, familial,cultural,academic,and financial issues to aid in the development of individual success plans. 1994-1995 Psychotherapist, Weld Mental Health Acute Treatment Unit, Greeley, CO Provided individual and group counseling to chronically mentally ill in-patient clients. Assisted clients in learning self-care and daily hygiene. Coordinated and implemented client life-skills and social-skills activities. CONTINUING EDUCATION/SEMINARS Jurisprudence Workshop for Psychotherapists Family Preservation Basic and Advanced Training Supervised Practicum in Family Preservation Reaching Children through Play Therapy Play Therapy and Therapeutic Care Fire Starter Training Diverse Learners Academy Counseling At-Risk Students Cultural Diversity Conference Parent/Child Hispanic Youth Leadership Conference PRESENTER/FACILITATOR The Terrific Twos Prenatal Insults and Long Term Effects Social, Emotional&Sexual Development: Infancy through Adulthood Cognitive&Physical Development Infancy through Adulthood Parenting with Love&Logic Eating Disorders Cultural Sensitivity,and Awareness Communicating Across Cultures Conflict Resolution/Communication Skills Setting Limits&Boundaries HONORS/AWARDS Hispanic Leader of the Year, Cesar Chavez Center, University of Northern Colorado, 1999 Keynote Speaker, Latina Youth Leadership Conference,University of Northern Colorado, 1998 Distinguished Alumni, Department of Sociology, University of Northern Colorado Fellowship, Graduate Study, Rutgers State University of New Jersey Scholarship,National Hispanic Scholarship Fund Scholarship, Candelaria Scholarship ' B�th B/A Producer Nor 32 A IDate R�newa 0003107 URAplacement nL 11/05/2004 RENEWAL PROFESSIONAL LLiBILITY OCCURRENCE INSURANCE POLICY FOR PROFESSIONAL COUNSELORS HUMAN DEVELOPMENTAND PURCHASING GROUP POLICY PRACTITIONERS 10 Item DECLARATIONS CERTIFICATE NUMBER 80M- 4003488 1. Named Insured EMILY L MONTOYA MA LPC 2. MAILING ADDRESS 1851 13 AVENUE GREELEY CO 80631 3. Policy Period 12:01 AM Standard Time At Location of Designated Premises 4. The insurance afforded is only From: 11/01/2004 To: 11/01/2005 by specific premium charge or hargrsspect to such of the following types of insurance as indicated OVERA E A. Professional Liability X PRF_ MII1M B. General Liability S 293.00 5. S 293.00 LIMITS OF LIABILITY each Incident $ 1,000,000 or each Occurrence $ 3,000,000 in the Aggregate 6. The Named Insured is: • Other: Sole Proprietor (including Individual) Partnership Corporation 7. Business or Occupation of the Named Insured: COUNSELING 3• This policy is made and phisiic s accepted subject to the printed conditions of this policy together with the ions, stipulations and agreements contained in the following forms(s) or endorsement(s): PLJ-2016 (10/94) PLE-2189 (9/97) PLE-2081 PON-2003 CHICAGO INSURANCE COMPANY 55 E. MONROE STREET,•CIIICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA 50398 Toll-free Number: 1-800-557-5092 P-2016 (10/94) (Elec.) PERSONAL.. DATA SHEET Identif in Information: Name : Laurence Address : 1706 19th Avenue P. Kerrigan, Ph. D Greeley, CO 80631 DOB: 9/20/32 Phone : �� 111353-3373-3373 - business Dees : BSC - Business Economics MS - Economics , from Creighton University, 1954 . from St .. Louis University, St . Louis , 1963 . MA - Theology, from St. Mary' s University, Regis College Campus , Toronto, Ontario , Canada , 1967 . Ph . L . - Philosophy,P St . Louis University, St , Louis , Mo . 1960 , Ph . D. - (E°clesial Degree ) . California School of Professional Psychology, Berkeley/Alameda Campus , 1974 , Clinical Psychology, Currently a licensed psychologist in the state of Colorado . Educational Bacic round: 1950-54 Creighton University, Business economics , 1954-56 Marquette University, Milwaukee , WI . , Classical studies and ascetics' theology, 1956-57 Springhill College , Grand Coteau LA. Campus , Classical studies , 1957-60 St . Louis University, Philosophy and Economics , 1963-67 St. Mary ' s University, Toronto Campus , Theology, 1971-74 California School of Professional Psychology, clinical psychology, Berkeley/Alameda Campus Positions held : 1969-71 Member of Board of Directors , Campion College , Prairie du Chien, WI , 1968-71 Director, Department of Psychology, Campion College . 1971-74 Director of Student Counseling Center, Long Mountain College , 1975-80 Director of Short-term Children and Family Team, Weld Mental Health Center, Greeley, CO . 1975-'87 Clinical Psychologist, Child and Family Team, Weld Mental Health Center, Greeley, CO . ) 978.-88 Co-founder of Weld County Child Protection Team, 1987-88 Member of Executive Board, Weld Mental Health Center, Greeley, CO . Honors Received : 1968-69 and Teacher of the 1970-71 year, Campion College . 1972-73 Class Representative to Campus Executive Committee , and California 1973-74 School of Professional Psychology Work and Ex eriential Back round ' 1959-60 Counselor at Dismas Halfway House for ex-convicts , St. Louis , Missouri , 1960-63 Teacher-counselor-coach , Marquette Prep High School , Milwaukee , WI , 1964-67 Counselor-therapist at Street Haven and Sancta Maria Halfway Houses for women and at the Don ( metro ) Jail in Toronto , Canada. 1967-68 Teacher and Campus Counselor at Creighton University, Omaha, NB. 1968-71 Teacher at Campion College , Prairie du Chien, WI . , Director of Psychology Department , Department chairman , 1970- 71 Director and Staff member of a total environment for Inter-city boys , late grade school age from Milwaukee, WI , 1971-73 Director of Student Counseling , Lone Mountain College , San Francisco , CA. Teacher at the Lone Mountain College , San Francisco , California. 1973-74 Psychologist Trainee at San Francisco Mental Health Center, Richmond District , Outpatient Care . 1974-75 Private Practice, So . Bay Human Services Center, San Diego , CA. Part-time instructor at/California School of Professional Psychology, San Diego , CA. a 1,975-80 Director , Short-Term Therapy Team , Children and • Family Unit , Weld Mental Health Center, Greeley , CO . 1980-87 Member of Children and Family Therapy Team, Weld Mental Health Center, Greeley, CO . 1987- present Full time private practice with Joyce Shohet Ackerman , Ed . D . , Licensed Psychologist , Greeley, CO . Part time practice at Weld Mental Health Center , Greeley , CO . Publication :• Kerrigan , Laurence P. The Relationship Between Therapist and Client ' s Perceptions of One Therapy Session . Published Doctoral Dissertation , University of California School of Professional Psychology, Copyright , 1974 . Worksho_l_ail0 S ,ecial_Tra.ining: Since 1974 , I have attended an average o per year . Host of these workshops have p about three a rese ilizedps training in the following areas : Neuro-linguistic d Autogenic and relaxation training , Visua.lization-Imagery- 11ypnosi.s , Cognitive-Behavioral Therapy, Ericksonian approaches to hypnotherapy and psychotherapy, Family therapy, Strategic therapy , Sexual abuse , dynamics and applied treatment , Paradoxical family intention psychotherapy, and other related areas . In the last fifteen years , I have taught classes and conducted workshops in the following subjects : The Psychology of Dreams Emotional and Physical Health through Visualization and Imagery • Western Psychotherapies and Eastern Ways of Liberation Cognitive and Behavioral Therapy Hypnosis in Pain and Habit Control • The Psychology of Consciousness and Meditation ^11/18/04 - A EXECUTIVE RISK SPECIALTY CO. PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY NOTICE: LOWER LIMIT OF LIABILITY *** RENEWAL *** A•OF SEXUAL A MISCONDUCT(SEE THE SPECIAL APPLIES PR TO JUDGEMENTS OR SETTLEMENTS WHEN THERE POLICY NO: ION"SEXUAL MISCONDUCT"IN THE POLICY). ARE ALLEGATIONS ITEM 1. (a)NE0�AND ADDRESS DECLARATIONS ADDRESS OF INSURED: ACCOUNT NO: CO-KERL175-0 0 0 9 9 7 4 SB ITEM I. (b)ADDITIONAL NAMED INSUREDS: LAURENCE P. KERRIGAN, PH.D. 1750 25TH AVE. SUITE #101 GREELEY, CO 80634 EM 2. ADDITIONAL INSU REDS: TYPE OF ORG: INDIVIDUAL M 3. POLIC Y PERIOD: FROM: 12/01/04 TO: 12:0IA.M.STANDARD TIME AT THE ADDRESS OF THE INSURED 12/01/05 AS STATED HEREIN: 4 4. LIMITS OF LIABILITY: (a)$ EACH WRONGFUL ACT OR SERIES OF CONTINUOUS,REPEATED 1, 000, 000 OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE (b)$ DEFENSE REIMBURSEMENT 5: (c)$ 3, 000, 000 AGGREGATE PREMIUM SCHEDULE: CLASSIFICATION NUMBER iLMiMM . EGMERE 1ST PSYCHOLOGIST 1191 . 00 1, 191 . 00 DEFENSE LIMIT SURPLUS LINES TAX 00 INSPECTION FEE 35 .73 1. 19 RETROACTIVE DATE 12/01/91 EXTENDED REPORTING PERIOD TOTAL PREMIUM: NMI ADDITIONAL PREMIUM(if exercised)$ - - POLL )$ 2' 148 . 60 NO DISCOUNT INCLUDED 3 CY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY (7/95 ED. ) B22137 NOT A BILL.PREMIUM HAS BEEN PAID. AUT RIZED COMPANY REPRE NTATIVE Ackerman and Associates P.C. Dept. of 1750 25th Avenue,.Suite 101 Weld County Greeley, Colorado. 80634 SClericae Units 970-353-3373 APR 2 7 2005 Gloria Romansik Weld County Department of Social Services P.O. Box A Greeley, Colorado 80631 April 27, 2005 Dear Ms. Romansik: Thank you for your queries concerning the PY 2005-2006 bids containing the comments of the FYC commission. We understand that RFP 05007 Sex Abuse Treatment and 05010 Option B Intensive Home Based Therapy are recommended for inclusion on the vendor list. As to our Life Skills Program, 05005 : The following defines our capacity to do after hours visitation. Ackerman and Associates maintains a twenty four hour a day 365 day a year on call system to handle emergencies. Our hours to see clients in the office begin at Nine AM and frequently end at Nine PM depending on the provider. As to home based visitation after hours,we would expect the following scenario. A call would come into the answering service and the provider on call would be contacted. That provider would evaluate if emergency contact was needed or if police response would be more appropriate. Then we would schedule the family to be seen at our offices on an emergency basis only if the conditions did not permit contact in regular hours and police intervention was not needed. We do not anticipate providing emergency visits in the client's home after hours. Scheduled after hours contact within the time window described(after five PM and before nine PM)would be at the discretion of the provider. Concerning Intensive Mediation,we agree to the condition related to consultative conflicts.. It is our understanding that any consultative conflicts specific to the case pending will lead to the withdrawal of the mediator with the perceived conflict as requested by any party. 1 Page 2 Ackerman and Associates FYC Queries 2005-2006 Contact was made with John Kruse as requested concerning the unit of service rate consultations and all issues were resolved. John will be communicating his comments directly to Elaine. Basically, Ackerman and Associates has a 60% direct payment to providers and a 40%overhead rate. All social services programs submitted are justifiable within this framework as shown by the submitted budget worksheets. Please contact me to resolve any questions. We look forward to continued work with WCDSS. Sincerely, Joyce%) hut ckke man Ed. Ackerman and Associates P.C. 2 DEPARTMENT OF SOCIAL SERVICES Kit P.O.BOX A GREELEY, CO. 80632 Website:www.co.weld.co.us I Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 O • COLORADO April 18,2005 Joyce Ackerman Ed. D. Ackerman&Associates,P.C. 1750 25th Avenue, Suite 101 Greeley, CO 80631 Re: RFP 05007-Sex Abuse Treatment RFP 05008-Mediation and Facilitation under the Intensive Family Therapy Program Area RFP 05010-Option B,Home Based Therapy RFP 05005-Lifeskills Dear Ms.Ackerman: The purpose of this letter is to outline the results of the Bid process for PY 2005-2006 and to request written information or confirmation from you by Wednesday,April 27,2005. A. Results of the Bid Process for PY 2005-2006 • Through the 2005-2006 bid evaluation process,the Families,Youth and Children (FYC)Commission recommended approval of the bids listed below for inclusion on our vendor list. 1. RFP 05007-Sex Abuse Treatment 2. RFP 05010-Option B-Intensive Home Based Therapy • Through the 2005-2006 bid evaluation process,the Families,Youth and Children (FYC)Commission recommended approval of the bid listed below for inclusion on our vendor list,attaching the following condition for all Lifeskills program providers. 1. RFP 05005-Lifeskills Condition: All providers must define their capacity to do after-hours visitation. • Through the 2005-2006 bid evaluation process,the Families,Youth and Children (FYC)Commission recommended approval of the bid listed below for inclusion on our vendor list,attaching the following condition for all Intensive Mediation program providers. Page 2 Ackerman&Associates,P.C./Results of Bid Process for PY 2005-2006 1. RFP 05008-Intensive Mediation under the Intensive Family Therapy Program Area Condition: If a consultation has occurred between a party to this action,and any party objects to the proposed mediator because of that consultation,the mediator shall remove himself/herself from performing the mediation. • Review of Unit of Service Rate Computations for All Submitted Bids: The Unit of Rate Computations on the submitted bids did not include a non face- to-face cost sheet. Further,the overhead does not calculate correctly on the Cover Cost Sheet. B. Required Response by FYC Bidders Concerning FYC Commission Conditions: 1. FYC Commission Conditions: All conditions will be incorporated as part of your RFP Bid and Notification of Financial Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the condition,you must provide in writing reasons why. A meeting will be arranged to discuss your response.Your response to the above conditions will be incorporated in the RFP Bid and Notification of Financial Assistance Award. 2. Unit of Service Rate Computations: You are requested to contact John Kruse,Business Office Manager, extension 6530, to clarify the submitted Unit of Service Rate Computations. The Weld County Department of Social Services is requesting your written response to the FYC Commission's conditions. Please respond in writing to Gloria Romansik,Weld County Department of Social Services,P.O. Box A,Greeley,CO, 80632,by Wednesday,April 27, 2005,close of business. If you have questions concerning the above,please call Gloria Romansik, 970.352.1551, extension 6230. Sincerely, a_ y . 'ego,Di for cc: Juan Lopez,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 FY 05-CORE-60 Revision (RFP-FYC-(05010) Contract Award Period Name and Address of Contractor Beginning 06/01/2005 and Reflections for Youth,Inc. Ending 05/31/2006 Option B—Home Based Intensive 204 West County Road 10.5 Berthoud CO 80573 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Solution-focused therapy to decrease conflict in the Award is based upon your Request for Proposal(RFP). home and increase communication and positive The RFP specifies the scope of services and conditions of outcomes through skills training,education and award. Except where it is in conflict with this NOFAA in access to other community agencies including mental which case the NOFAA governs,the RFP upon which this health, drug and alcohol services,educational award is based is an integral part of the action. systems and recreational systems. Capacity for 10 Special conditions families concurrently, for a total of 30 hours of 1) Reimbursement for the Unit of Services will be based on an services per week, for a total capacity of 40 families hourly rate per child or per family. per year.Bilingual and South County services 2) The hourly rate will be paid for only direct face-to-face available. contact with the child and/or family,as evidenced by client- signed verification form, and as specified in the unit of cost Cost Per Unit of Service computation. Cost Per Unit of Service 3) Unit of service costs cannot exceed the hourly,and yearly Hourly Rate Per $82.09 cost per child and/or family. Individual Counseling 4) Rates will only be remitted on cases open with,and Family Counseling referrals made by the Weld County Department of Social Treatment Package-Intensive Services. Treatment Package-Moderate 5) Requests for payment must be an original and submitted to Treatment Package-Low the Weld County Department of Social Services by the end Early Intervention Program of the 25th calendar day following the end of the month of Reunification service.The provider must submit requests for payment on Community Based Service forms approved by Weld County Department of Social -Child Protection Services. In-home Svcs for At Risk Delinquents 6) The Contractor will notify the Department of any change in Therapeutic Staffing staff at the time of the change. Hourly Rate Per Court Testimony $80.00 Enclosures: X Signed RFP: Exhibit A Supplemental Narrative to RFP: Exhibit B Recommendation(s) Conditions of Approval Approvals: /_ Program Official: By %-1 By William H.Jerke, Chair Jud .Griego Director Board of Weld County Commissioners We ouny epartmenttf Social Services Date: JUN 0 6 2005 Date: tpf l Z, VS c- oDS /6S SIGNED RFP: EXHIBIT A INVITATION TO BID • - - BID 002-05 (05005--05011 and 006-00) DATE: February 16, 2005 BID NO: RFP-FYC-05010 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-05010) for:Colorado Family Preservation Act--Home Based Intensive Family Intervention Emergency Assistance Program Deadline: March 11, 2005, Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26- 5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.R.S. 26-5.3-101). The Families,Youth and Children Commission wishes to approve services targeted to run from June 1, 2005, through May 31, 2006, at specific rates for different types of service. The County will authorize approved vendors and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased in intensity, and produce positive change which protects children, prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date ,Lt (After receipt of order) BID MUSc IG IN INK D P J J D 1 SIGNAT URE VENDOR 1LENK(, fc( \ IIn,f1L, LP[, (Name) Handy i _ a e Authorized J • Officer o gent of Vender ADDRESS ?t \'t I`` F416.74-6,,e"i PQ TITLE (Q1 lUCI C0 ALAI DATE • I- •� PHONE# �� 153a • 5--qq The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 . Bid 002-05 (RFP-FYC-05010) Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2005-2006 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2005-2006 n \ BID 002-05 (05010) 1 1 NAME OF AGENCY: 1-e c l-QCi 5 Q0t \)c " n \r11i • I' - ADDRESS: Pr 0. NI- 1deO Of xU Wey GOUu)y lure' 3e�( u4O PHONE 915 S3 . SrA 1 ) 1 1,1_ Q 0513 CONTACT PERSON: J.I.. { J t jth( TITLE: I))\/kiuLl 17 i n t irok, DESCRIPTION OF FAMILY PRES RVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased intensity,and produce positive change which protects children,prevents or ends placement, and preserves families. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1, 2005 Start End May 31,2006 End TITLE OF PROJECT: 'It-11005K- 0jM r; SAP() `rA+-.A IUt Ib) ie)tA b►i11Q .--4' ,b.C Name ignature of Person Prep 'ng Docume Date t WAAL-UAW Act- J. Ayr Name and Signa r C hief Administrative bfficer Applicantgency A 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 2004- 2005 to Program Fund year 2005-2006. Indicate No Change from FY 2004-2005 to 2005-2006 6 Project Description c1 Target/Eligibility Populations 4C Types of services Provided IC Measurable Outcomes cr Service Objectives lir Workload Standards Staff Qualifications la Unit of Service Rate Computation ''Program Capacity per Month if—Certificate of Insurance Page 26 of 32 Bid 002-05 (RFP-FYC-05010) Attached A Date of'Meeting(s)with Social Services Division Supervisor: .J , -c Comments by SSD S ervisor: i - 'e / BZLL±.L (Lt.`L`t C-a--C(r ' 7Li I-1 ,1_, i i "� P jA_ {-� i jd ( h k.lA__i t:t. 1L.� 'C )fz {iit l4 t_-1 ±- / < < e �v , a. ( 0 11,1t, ) 3-,, -G' Name and Signature of SS Supervisor Date Page 27 of 32 Reflections for Youth, Inc. "Discovering the Power of Positive Choice" 1. Project Description Title of project: Intensive Home-Based Family Intervention Mission and Purpose Reflections for Youth will provide intensive home-based family interventions to children to prevent out-of- home placement or to transition such youth back into the family system from placement. Design Families with children who are at risk for out-of-home placement and returning from placement to home will receive home-based services. All services will be home-based unless it is determined that a safety issue requires that services be provided outside the home. Families will be assessed through a thorough Psycho-Social and Risk Assessment to determine strengths and needs. Reflections will provide services for eight to ten families at a time with the potential to serve more families as resources become available. Reflections will provide at least 20 hours of service with at least three hours of service per week per family. • Start-up: Reflections will gather information from the caseworker through a face-to- face meeting or phone contact to determine what are seen as important treatment issues within the family. Reflections will complete the psychosocial assessment and determine strengths and needs, as well as the development and use of base-line measures on areas related to the out-of-home placement criteria, i.e., abuse/neglect/ domestic violence, substance abuse, mental illness, and danger to self and others in the community (Risk Assessment Measure). Interventions will be determined based on results of assessment and will include re-parenting/parenting skills/parent role modeling, problem solving, communication skills, and parent-child conflict management. Families will be assisted in attaining access to other community agencies including mental health, drug and alcohol services, educational systems and recreational programs. At start-up, service will be from 3 to 5 hours per week. • Mid-Service: assessment of progress, assessment of skill development, ability of family to implement and utilize skills and additional interventions as needed. At mid-service Reflections will be providing 3 to 4 hours of service per week. • End-Service: Determine family's ability to utilize skills in all areas addressed and attainment of appropriate community service support, i.e., mental health, drug and alcohol services, educational systems and recreational programs. At end-service hours will be 3 hours per week. Reflections will use licensed therapists, masters level therapists with two years of experience and bachelor's level counselors with at least three years of experience as required by Staff manual volume VII Section 7.303.17 and section 7.3006,q. Each family will receive a case management plan within 30 days of initial contact with the family. The case management plan will be based on the results of the psycho-social and risk assessments and will take into consideration the family strengths. The plan will include at a minimum: goals, goal timelines and a measurement of success. Copies of this case management plan will be sent to the caseworker, program area supervisor, Andrea Lee, and the Core Service Specialist, Elaine Furister. Thereafter, a monthly report will be provided that describes presenting problems of the client family, specific services provided, extent of client's participation and commitment to the program,clients progress to date, any new areas of concern, and the anticipated date of discharge. Reflections will contact the case worker on a weekly basis to provide updates on any concerns and progress. Thirty days after the final service to client, a discharge summary will be provided to social services that describes service outcomes and,if needed, recommendations for further support services. II. Target/Eligibility Populations: Reflections for Youth, Inc. agrees to work with a total of 8 to 10 families at a time. Family constellations may include one child up to an undetermined number of children per family with at least one child at risk for out-of-home placement or returning to home from out-of-home placement. Based on our program description, it is our plan is to provide all services within 20 hours not to exceed a three-month period of time per family. It is hoped we would be able to serve approximately 40 families per calendar year. Reflections will provide bi-cultural and bi-lingual services to approximately one to two family units at a time with a total of 8 to 10 bi-lingual families per year(20 to 25 percent). Provided the language barrier is not an issue all client families will receive cultural/ethnically specific services on an as-required basis. Services will be offered as often as possible on a 24-hour basis to client families living in all parts of Weld County including South Weld County. III. Types of Services to be provided: Solution focused therapy to decrease conflict in the home and increase communication and positive outcomes though skills training, education and access to other community agencies including mental health, drug and alcohol services, educational systems and recreational programs. 2 Concrete services will be provided through specific programs that educate parents, and improve listening and communication skills between children and parents. Techniques utilized will involve role plays and/or family exercises to enhance the understanding of these skills. Collateral services will be provided though communication with caseworker and other community services to provide access or encouragement to utilize community services, i.e., mental health, drug and alcohol, educational, medical/dental/psychiatric, domestic violence/crisis intervention, etc. Crisis Intervention: An on-call 24-hour service to all clients will be provided. When possible, intervention specialists will be available for on-site interventions. Measurement of goals as described in the case management plan will be reported in monthly progress reports. Reports will highlight goal attainment and skill development along with decreases in concerned areas as originally identified. Based on needs as determined in assessments, all families may have access to any of the four outlined services: therapeutic, concrete, collateral and crisis intervention at any time during the duration of service. Through our initial assessments we will determine services already being made available to the family. With weekly contact with caseworkers, we will address newly identified concerns or problems that may require additional resources that are not within our purview of service. In addition we agree to provide court testimony services on an as-needed basis. IV. Measurable Outcomes • Program will be considered successful as youth remain in the family home after 20 hours of home-based family service. • Improvements in parental competency and skills, i.e., problem solving skills, communication, decrease in parental/child conflicts and other problematic behaviors as identified will be measured through a pre test during initial start-up and post test at the end-stage of services, as well as observation and self-report throughout the period of service. • For youth at risk for out-of-home placement and for those youth returning home from out of home placement, it will be the goal of our program at discharge to assure that all families have access to community services within Weld County in an effort to keep the child in the home 12 months after the completion of our services. • Parental skill levels will be evaluated in a pre and post test and though clinical observation of hands-on parenting with the goal of preventing further instances of 3 abuse or neglect. The risk assessment measure will indicate improvement in all areas of needs as indicated in the initial assessment. • We will evaluate, measure and monitor our quantitative measures through observation, self-report of clients, monthly case management progress reports, clinical meetings, completion of any homework assignments given to family, crisis counseling interventions, and goal progress and attainment. V. Service Objectives • Solution focused interventions that increase parental skills and parental knowledge of child developmental areas, communication, logical and reasonable rules and expectations will improve and/or eliminate escalated conflicts with emotional discord between parents and children. • Household management that effects the safety and protection of the children in the home will be measured though the increased competency of the parent in parenting skills, communication, ability to provide adequate, consistent and logical discipline, regular schedules for meals, bedtime, school attendance, homework, free time, decrease in parental conflicts with child, and self report of overall satisfaction in parent/child relationship. • Through our communication with assigned case worker, parents will be informed of all services provided in Weld County(county, state and federal) and counseling will be provided on how to access these services. Progress will be measured though parents ability to follow-through and access these services. • Specific referral issues will be addressed prior to and through-out the treatment process. It is Reflections intent to provide all the services needed as identified by the Department of Social Services in the categories of collateral, concrete, therapeutic and crisis intervention services. • We will evaluate, measure and monitor our service objectives throughout the treatment process with on-going observation, self-report of clients, monthly case management progress reports, contact with assigned case worker, clinical meetings, completion of any homework assignments given to family, crisis counseling interventions, and goals progress and attainment. VI. Workload Standards • Based on a workload of 10 families at a time,Reflections will provide a minimum of thirty hours per week of home-based intensive family intervention. • Reflections will provide a minimum of 6 to 8 licensed therapists, master's level 4 counselors with two years experiences or bachelor's level counselors with three years of experience all working under the umbrella of Reflections for Youth, Inc. • Reflections for Youth, Inc. will provide for a minimum of 8 to 10 families at any one time. • Reflections for Youth, Inc. will utilize solution focused interventions that targets family strengths and educational material that increases parental knowledge in crisis management, de-escalation, communication, child development, parenting skills and discipline. Success will be measured throughout the treatment process with on-going observation, self-report of clients, monthly case management progress reports and contact with assigned case worker, clinical meetings, completion of any homework assignments given to family, crisis counseling interventions, and the goal progress and attainment. • Reflections for Youth, Inc. employs four licensed therapists to provide direct service and oversee the home-based intensive family intervention program, i.e., the maximum caseload per supervisor will be from two to three service providers. • All insurance coverage for RFY is shown on the enclosed Certificate of Liability Insurance and exceeds the amount requested in the bid proposal. Insurance coverage includes general liability, automobile liability, comp and collision,worker's compensation and employer's liability and professional liability. Weld County has been named as a certificate holder. VII. Staff Qualifications • All service providers and supervisors under the umbrella of Reflections for Youth, Inc. meet the requirements as listed in Staff manual volume VII Section 7.303.17 and section 7.3006, q. The supervisors for the program will also carry a caseload. All supervisors are licensed therapist, either with licensure as a LPC, LMFT and in two cases, LCSW. All other home-based intervention specialist will have either a master's degree with two years experience or a bachelor's degree with three years experience in the field. • Staff will receive training in all areas as required, i.e., mandated caseworker training, risk assessment and state home-based intensive family services training. Program Capacity is 10 families at any one time. 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NS Certificate Holder Is Included as an Additional Insured under the General I t,iebility with respect..to the;;ability created by the negligent acts, I or omissions of the named insured heroin.Aft policy terms,conditions and exclusions *pp}y. I (B,ne Attached Desctiplions) � L;At4Cf:LLATgN ------- , �FRTIFiCAT HOLDER _,_ w -•�yMOULO ANY OF T AMUY[:Lti$CI4$EC FJLC1!$tit cAtCEr.lep 84FORk 7r.f[JtctuATWN Weill County',Dept of Social !DATE 71414 0f nit ISSLNIG'Ilp}RER AIM...er.SsAvo,4 To mAL !i. DAYS WAITILN ServiCati NOTICE TV TrtE GEflTMICATF HOLOER.AIAtr it:liti t:i '.SUT SALORE 7000 SO*QUA P 0. 3GX A, 315 No 1.1 ih Avenue .INrOiE M7 0luwn0ut cm Ltpgttl'?n►AM W+iJ L"ON ill IN3Jtisll,f74 AGrtAT. RESE+ITATIvt$— � _ '— 'I Greeley. CO 80632 ... 7-."tL6 kt PRESEh'fATY! K� _ -- r. Aec___Cor�aortwVIOLA'98E ac�tnRGis�zoo.,t.si :�ot :i rc52a32121fNL 2517E _ LGB NI It tIjIe.' fl -Ar• NJ. :40_oaJJr_'ij. Ii? IMPORTANT If the certificate holder is aH AD TtONAL INSURED.the poucylies)must be endorsee_ A statement on this r_ertilcats does not confer rights to the certfi.tate holder in lieu of such eidnrsement(s). It SUBROGAT ON IS WAILED, ,ucject to the terms and conditions()Nile po;icy ce^a;n policies may reQuire an endorsement. A stiternent or this certificate does not center rights to the certificate 1 hctdur h lieu of such e^dnrsement s). DISCLAIMER The Certificate of Insurance on the re'+orse side of th•s form does no; corcatiture a contract between re issuang ms,;rer(s; aothonzed representative or proo.icor, and the certifcate holder, nor ones it arrirmat vely or neQat'vely amend. extend or alter ;he coverage aforcec by the policies listed thereon, ACORN 255(2GDt/ee) 2 of 3 AS243212/M225178 M Jb ll .:?U FV 'I'li N), 30 6 a02 . DESCRIPTIONS (Continued from Page 1) •The following cancellation conditions always apply: -10 days for non-payment of premium • If policy shown, 10 days for Wolkors' Compensation for fraud: material misrepresentation; non-payment of premium; other reasons approved by the Commissioner of Insurance I I 1 � � I ton 25.312001'08) 3 of 3 1/5243212JM2Z5176 SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B RECOMMENDATIONS • FAX TRANSMISSION REFLECTIONS FOR YOUTH, Inc. 'Discovering The Power of PoslIfve Choices P,O.Box 1860 Berthoud, CO 80513 (970) 532-5990 (p) (970) 472-1736 (f) DATE: lfi 1�. I,eJ TO: 6k0(1.0 V'A°1 u� 4 3 A 11 FROM: )0.11 * 1 RE • : p v Fes. kccus`Utok )0-ra c LAtko -6.) tlico COMMENTS: / -41\i‘,‹ Total Pages CONFIDENTIAL This facsimile is intended only for the use of the individual or entity to which It Is addressed and may contain information that is prfvieged.confidential,and exempt from disclosure under applicable law. If the reader of this facsimile is not the intended recipient nor the employee or agent responsible for delivering the facsimile to the intended recipient.you are hereby notified that any dissemination,distribution,or copying of this communication is strictly prohibited. If you have received this communication in error.please notify us immediately by telephone and return the original message to us at the above address via the U.S.Postal Service. Thank you. TO 39t/d NOSNHOP 9ELTZL40L6 44:ZZ S00Z/93/40 Reflections for Youth, Inc. "Discovering the Power of Positive Choice" Gloria Romansik Weld County Department of Social Services P.O. Box A Greeley, CO 80632 Re: Bids #05010 and #05006 April 26, 2005 Dear Gloria, We accept the recommendation of approval by the FYC Commission of our Bid #05010 as written. We accept the recommendation of approval by the FYC Commission of our Bid #05006 and have included the following pages as clarification. Pages 8-10 clarify our outcome measurements and page 2 clarifies our ability to offer Bilingual services. Sincerely, Jeff Ty J. Johnson, MA, LPC Executive Director P.O. box 1860, Berthoud, CO 80513 (970)532-5990(p)/(970)472-1736(I) Z0 3Dtid NOSNHOf 9ELSZLP0L6 bb :ZZ 900Z/93/b0 for a date that least upsets the transition back to public school. Students can lose valuable clock hours/credits if expected to return to public school in the middle of a semester or academic quarter. 4. A key area that will be addressed throughout the course of placement but certainly during a transition meeting is student progress. For special education students this will be a discussion of the LE.P. goals and objectives and outcomes. Teachers will be able to give the receiving school information regarding the progress students made towards achieving their I.E.P. goals and their present level of functioning. Teachers and clinicians will also report on effective behavioral and academic interventions and modifications used within the classroom and throughout the day treatment day. 5. Students who have consistently attended school, retained acceptable or above- average grades, actively participated in the therapeutic program offered,and have followed the rules and expectations of the program are considered"being successful". IV. Measurable Outcomes Students attending Reflections for Youth's day treatment program will receive clinical and educational services by licensed staff. Educational services include small structured classrooms(1:5 or 1:6 ratios) with a certified special education teacher, a full-time paraprofessional and no more than 12 students in a classroom. RFY schools provide a safe environment for youth to grow and experience functional and healthy relationships with adults and other students. Basic expectations,tracked daily and evaluated weekly, include the relationship virtues of trust, responsibility, acceptance and accountability. RFY staff members teach social skills as well as academic skills and are role models of positive and appropriate behavior for the youth served. Students are asked to begin to take personal responsibility for passing core and elective classes with support from RFY's educational and therapeutic staff. This is measured and evaluated by each student's level of organization,responsibility for assignments and homework completion- RFY,Inc. teachers work with students to achieve T.E.P. goals if applicable or individualized learning goals if a student does not have an I.E.P. Each semester teachers switch elective class offerings to give students different options to gain elective credit. RFY students earn clock hours for each class while in the day treatment program. Upon leaving the program, a comprehensive educational and therapeutic discharge summary is written including total clock hours earned. The receiving school/district will convert the earned clock hours into credits depending upon their credit system. RFY assures a continuity care for each of the youth served in its day treatment program by providing educational experiences which remediate,maintain and improve academic, intellectual and social functioning. Students receive highly individualized instruction and attention, supportive mental healthhherapeutic intervention and complete. comprehensive transition and aftercare plans. All transition and aftercare plans include input from all current and future professionals involved with the youth. These students are more successful upon transition back to their homes and public school systems and it is the goal of Reflections for Youth,Inc to serve each of its youth in this manner. The 8 £0 39Cd NOSNHOP 9ELLZL40L6 VP:ZZ 9002/9Z/b0 success of RFY, Inc. will be monitored,measured and evaluated through compliance with the written Day Treatment Policy and Procedures and through classroom observations and educational and therapeutic staff supervision. To date, it has been our experience that all but one of our previous and current day treatment students has returned to his or her family or to a foster home if family was not available. With the one exception all were residing in their own home immediately after discharge. It is our goal that this trend continue with the goal of all youth served returning to their home as soon as possible after discharge, hopefully immediately, and in no longer than six months barring any safety(D& N) issues. The majority of students who discharge from RFY day treatment program have entered public school or an alternative,non-day treatment school managed by their home district. Decisions have been made for some students attending day treatment that earning their GED is a better option. When deemed appropriate by the professionals involved with the youth(age, credit situation,etc_)RFY staff will schedule the student for a GED locator test. Based on the results of the test,the student will continue to take classes in his/her areas of need (reading, math, etc.)and be given daily preparation time for the GED as well. In addition to preparation time the student will be evaluated by suitable community-based programs to assist in the areas of career exploration and job training/placement. If the GED is not completed while at RFY, the student, guardian and placement worker will be notified of formal GED preparation class offerings within his/her community to further prepare for taking and passing the GED. It is also our goal that unless another approved plan is put into place prior to discharge from day treatment,all youth served will enter public school upon completion of the day treatment program. Quantitative measurements of success include satisfactory progress on individual academic, behavioral and/or I.E.P. goals, progress and attainment of individual and family therapeutic goals and satisfactory compliance with rules and expectations of the program, including expectations for the home environment while in the program. We will measure and evaluate improvement in attendance,classroom participation, grades, behavioral interactions with teachers, clinical staff and peers, and consistency of positive family interactions and outcomes(communication,conflict resolution,limit setting and follow through). This is accomplished through monthly treatment plan and update reports including assessment and measurement of progress in the areas of social, emotional, family,recreational and educational (drug and alcohol if applicable); daily goals and percentages;reports from therapist regarding therapy progress in terms of positive decision making, conflict resolution and communication; and parental feedback and compliance and completion of treatment plan and goals related to the home environment. Students are evaluated and monitored weekly in improving their grades and consistently have access to teachers and can expect that appropriate accommodations will be made to aide in their overall success. RFY uses a wide range of assessment materials in evaluating student progress and performance. Teachers are trained in administering individual achievement tests and behavior rating scales and they are consistently used to measure and evaluate where a student is,what is needed and how to provide what is needed. When a student enters RFY he/she will be given formal assessments in the areas of reading and written language by the Title I reading specialist and informal assessments 9 40 35Vd NOSNHOP 9ELIZL40L6 44 :ZZ 900Z/9Z/t'0 • by the classroom teacher. Each student's needs will be assessed using past school records, I.E.P. goals and objectives, discharge summaries and educational history. Goals will be set to measure and evaluate that the student's true needs are being met. Reflections for Youth holds annual and triennial reviews for special education students as indicated by the I.E.P. and teachers report on annual goals at each grading period. In addition a monthly education summary, including the measurement and evaluation of behavioral,emotional and/or academic goals(depending upon assessed need)is completed by the Special Education Teacher. V. Service Objectives Reflections for Youth,Inc. will work diligently to assure that all youth attending its day treatment program will have a successful transition upon completion of the program. It is currently our experience that nearly all of our day treatment youth are living with their families at the time of placement. The exception has been for youth in which the parental rights are terminated or a family or even appropriate family member is not available to reunify with. In those cases the youth is with a foster family at the time of placement and remains with that fancily after completion of the day treatment program. As previously stated, our average length of placement in day treatment has been for one semester or approximately 16 weeks(4 months). Our longest stay in day treatment has been seven (7)months and was based on some extenuating circumstances that neither RFY nor the placement worker had control of. The vast majority of students that have discharged from RFY's day treatment program have returned to public school or a non-day treatment school that the home school district manages. To date,over 90%of the day treatment youth have returned to public school, Decisions have also been made for some students attending day treatment that after completion of the program,the GED is a better and more realistic option when compared to public school settings. All youth in the day treatment program at RFY participate in staffings, family therapy and case plan meetings in which resources and available services are discussed. Comprehensive educational and therapeutic discharge plans are written and an aftercare plan is put together prior to the referred youth completing treatment. The aftercare plan is very community resource based and discusses in detail services that are available and may be helpful. Access to those services is discussed during regular staffings and case planning meetings with the family, youth, caseworker and program present. VI. Workload Standards Reflections for Youth,Inc. has the capacity to serve six(6)youth and their families in day treatment at any one time. Program capacity per month is six(6)youth and their families. This number may increase depending upon length of stay of the youth served. This number will increase once RFY incorporates a centralized school into its services and expands the number of youth it can serve in a non-residential setting. This is 10 S0 39Vd NOSNHOP 9CLTZLb0LG b4 :ZZ S00Z/9Z/b0 students nearing discharge in locating appropriate community-based programs, such as the county workforce centers and Americorp, where career exploration and job training and placement are addressed, Day treatment students are required to participate in individual,group and family therapy unless contraindicated by the placement worker and/or school district referring the youth. The clinical services of the day treatment program are the overall responsibility of the Clinical Director in coordination with the Executive Director and therapist providing the services. This includes the development, implementation and coordination of the treatment program. Testing and psychiatric medication evaluations and appointments are conducted as needed. These evaluations aid in case planning and assure that the appropriate treatment is utilized for the youth's maximum growth and benefit. Reflections for Youth,Inc. therapists are all licensed and have specific training in at least one of the following: EMDR, Sand Play Therapy, Dialectic Behavioral Therapy (DBT)and/or Reactive Attachment Disorder. Reflections' treatment team evaluates each youth's treatment plan twice monthly. Monthly treatment progress reports are submitted to the appropriate agencies representing the youth and monthly(or as needed) staffings are scheduled to discuss the youth's progress in detail. A discharge plan and aftercare services are designed by the Clinical Director, assigned therapist, guardian and placement worker. IL Target/Eligibility Populations Reflections for Youth's day treatment program is open to any youth requiring a well- structured and secure program,consistent supervision,therapeutic/mental health services, and extra support educationally,both academic and behavioral. An I.E.P. is preferred but not required. Typically such youth will demonstrate behavioral and emotional difficulties and have a history that may involve one or more of the following: family conflict and discord, physical abuse, sexual abuse, running away and/or truancy issues,oppositional defiant behavior, self-defeating behaviors, delinquent acts and certain adjudications and leaming/emotional disorders/disabilities. RFY,Inc. employs a contracted child psychiatrist and accepts youth currently taking or in need of psychotropic medications. Each of RFY's three on-grounds schools can accept up to four day treatment youth. Ages range from 12-18 and RFY is licensed to take 18-21 year olds if necessary. Total family units would be six at any one time(based on our bid proposal)and family constellations may include one child up to an undetermined amount of children per family. Arrangements will be made to provide therapy sessions to all appropriate family members of split families if in the best interest in of the youth in day treatment and recommended by the placement worker or school district referring the youth. The needs for biculturaUbilingual services will be assessed by individual/family need and RFY will make every effort to employ a teacher and/or paraprofessional and a therapist that can speak a second language. At this time we do not currently employ any bilingual staff members in the day treatment setting. As stated, we do have an interpreter available and we a re working to employ a bilingual staff member that can assist in each of our three settings Currently RFY employs two staff that are used for the purposes of interpreting during sessions in which all family members can not speak English. All Reflections for Youth, Inc. on-grounds schools are located in southern Larimer County but within a few 2 90 39Cd NOSNHOf 9ELUZLb0L6 bb:ZZ 5003/9340 d• DEPARTMENT OF SOCIAL SERVICES iiistalik t\ P.O.BOX.A GREELEY, CO. 80b32 website:www.co.weldcous - Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 Il COLOR AD O April 18,2005 Jeffery Johnson,Executive Director Reflections for Youth P OBox 1860 204 W County Road 10.5 Berthoud, CO 80513 Re: RFP 05006:Day Treatment RIP 05010: Option B,Intensive Home Bacrd Therapy Dear Mr.Johnson: The purpose of this letter is to outline the results of the Bid process for PY 2005-2006 and to request written information or confirmation from you by Wednesday,April 27, 2005. A. Results of the Bid Process for PY 2005-2006 • The Families,Youth and Children(FYC) Commission recommended approval of your Bid#05010,Option B-Intensive Home Based Therapy for inclusion on our vendor list. • The Families,Youth and Children(FYC)Commission recommended approval of your Bid#05006,Day Treatment,our vendor list, attaching the following recommendations: 1. You are requested to clarify outcome measurements. 2. You are requested to clarify your ability to offer Bilingual services. B. Required Response by FYC Bidden Concerning FYC Commission Recommendations: You are requested to review the FYC Commission recommendations and to: 1. accept the recommendation(s) as written by the FYC Commission;or 2. request alternatives to the FYC Commission's recommendation(s); or 3. not accept the recommendation(s)of the FYC Commission. Page 2 Youth/Results of RFP Process for PY 2005-2006 Reflections for 0 on s into your bid. ( ) Please provide in writing how you will incorporate the recommendation(s) ecommendati written reasons why. All. If you re comm do.not accept the recommendation,please provide endations under the NOFAA will be monitored and evaluated by the approved recomm FYC Commission. response to the FYC Services is requesting your written Department of Social Senn •� to Gloria Romansik,Weld County The Weld County ommend . 8to Wednesday,April 2'7, Commission's recommendations.P.O.Please ox A5 Greeley,in writing S Department of Social Services; O Greeley,CO, 2005,close of business. 9�0.352.k551 uestions concerning the above,please call Gloria Romansik, If you have q extension 6230. Sincerely, J A, .ego ect cc: Juan Lopez,Chair,FYC Commission Gloria Romansik,Social Services Administrator Hello