HomeMy WebLinkAbout20051645.tiff RESOLUTION
RE: APPROVE THREE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR
FOSTER PARENT CONSULTATION 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 three Notification of Financial Assistance
Awards for Foster Parent Consultation 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. Transitions Psychology Group, LLC
2. Sherri Malloy, Ph. D.
3. Jubilee Retreat Center-Lori Kochevar, LLC
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 three Notification of Financial
Assistance Awards for Foster Parent Consultation 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.
2005-1645
SS0032
�►e : ss oio
THREE NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR FOSTER PARENT
CONSULTATION 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.
BOARD OF COUNTY COMMIS
Imo, ~I �� ���, WELD COUNTY, COLORADO STONERS
r — •••im William H. J e, Chair
V"iI. . ty Clerk to the Board •
�`_s_ . /J _,t M. J. ile, Pro- em
Deputy Clerk to the Board
vi E. ng
APP D •
Robe// D�. Masden
unty At rney
Glenn Vaad
Date of signature: Z. .a 42r
2005-1645
SS0032
416 a
DEPARTMENT OF SOCIAL SERVICES lill 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
II O MEMORANDUM
• TO: William H. Jerke, Chair Date: June 2,2005
COLORADOBoard of County Commissioners
FR: Judy A. Griego, Director, Social Services tt
C0
RE: Notification of Financial Assistance Awards for Foster
Parent Consultation Programs with Various Vendors
Enclosed for Board approval are Notification of Financial Assistance Awards (NOFAAs) for
Home Based Intensive Programs between the Weld County Depaituient 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 Foster Parent Consultation Programs.
3. Providers will be reimbursed according to 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. Transitions Psychology Consultation and foster parent support, $58.33 per episode
Group mandated corrective action consultation, $90 per group session
and mandated critical care home
consultation.
B. Sherry Malloy, PhD Consultation and foster parent support, $58.33 per episode
mandated corrective action consultation, $90 per group session
and mandated critical care home
consultation.
C. Jubilee Retreat Center— Consultation and foster parent support, $58.33 per episode
Lori Kochevar mandated corrective action consultation, $90 per group session
and mandated critical care home
consultation.
If you have any questions, please contact me at extension 6510.
2005-1645
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 05-CORE-0037
Revision (PY 05-06 RFP-FYC-006-00A)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2005 and Transitions Psychology Group, LLC
Ending 05/31/2006 Foster Parent Consultation
810 11 Avenue
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Program incorporates the elements of Assistance Award is based upon your Request for
assessment, foster parent consultation and Proposal (RFP). The RFP specifies the scope of
support groups,biological child support groups, services and conditions of award. Except where it is
individual psychological consultation, and in conflict with this NOFAA in which case the
mandated corrective action consultation with NOFAA governs,the RFP upon which this award is
foster parents. Services to Weld County foster based is an integral part of the action.
parents.Foster parent consultations will be
provided through groups,monthly capacity per Special conditions
group is 10 members or a total of 50 participants
monthly. Group participation is limited to one 1) Reimbursement for the Unit of Services will be based
group session per foster parent per month. on a per participant rate.
Individual consultation services will only be 2) Payment will only be remitted on currently certified
provided when approved by the Resource WCDSS foster parents, and referrals made by the
Services Manager or Child Welfare Weld County Department of Social Services.
Administrator of Social Services. Bilingual and 3) Requests for payment must be an original submitted to
South County services are available. the Weld County Department of Social Services by
the end of the 25th calendar day following the end of
Cost Per Unit of Service the month of service. The provider must submit
responses for payment on forms approved by Weld
Per individual foster parent County Department of Social Services.
Participant per episode 4) Requests for payment must include original foster
Treatment Package $58.33 parent verification signatures (blue or red ink
Other Services Per Hourly Rate $90.00 preferred) and dates and hours of service.
Enclosures: 5) The Contractor will notify the Department of any
X Signed RFP: Exhibit A change in staff at the time of the change.
Supplemental Narrative to RFP: Exhibit B
Recommendation(s)
Conditions of Approval
Approvals: Program Official:
By I1/GG1 .J By
William H. Jerke, Chair Judy . Griego, irector
Board of Weld County Commissioners Wel ounty artment of Social Services
Date: JUN 0 6 2005 Date:__(75—
�� 9005 - /!o `f S
SIGNED RFP:
EXHIBIT A
' INVITATION TO BID
OFF SYSTEM BID 002-05(05005-05011 and 006-00)
DATE:February 16, 2005 BID NO: 006-00A
RETURN BID TO: Pat Persichino, Director of General Services
915 10th Street, P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal(006-00A) for: Colorado Family Preservation Act—Foster Parent
Consultation. 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 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 Foster Parent Consultation Program must provide services
that focus on providing psychological consultations and parenting support to foster parents which are
designed to improve foster parent competency, family conflict management, and effectively accessing
community resources. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
enlist-1 S. Crs 4Cl
`` TYPED OR PRINTED SIGNATURE
n• s 1'4•Al�t���i,��t wrll l
VENDOR Trawil
(Name) andwritten Signature By Authorized
Officer or Agent of Vender
ADDRESS W4 t14"sAuwva. TITLE CA. C,0-oltvakrv-
ewDteisi CD 5063 ) DATE '3ft• ?sr
PHONE# (q-to) fl Cs— ?4
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 30
•
Bid Number 002-05(RFP-FYC 006-00A) Attached A
- • FOSTER PARENT CONSULTATION PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
COLORADO FAMILY PRESERVATION ACT
2005-2006 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2005-2006
BID 002-05 (006-00A)
NAME OF AGENCY: Tr-a+-s,A- ehs rsI Ae^i‘b &retie
ADDRESS: 804 lt4'^ Pews. Gant,law? , CO so 631
PHONE: ( 94-0)336-412:3
CONTACT PERSON: t?W,eO�r�5-G TITLE: �'^a'•na'r
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation
Program Category must provide services that focus on teaching life skills designed to facilitate implementation of
the case plan by improving household management competency,parental competency, family conflict
management and effectively accessing community resources.
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: t r&Yss'Y-tw$ 4o s ke-r pr ran4- C.rt,.1 -4t o r\
AMOUNT REQUESTED: S3$D/1reu.'o 149Osr /chett Av,--1
Jam We-H-1Y1WUtVt i Mk, L-Po 1'/101175
Name d Signature of Person Preparing Document Date
GvittposAS
N e and i tore Chief Administrative Officer A plicant 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
roject Description
Target/Eligibility Populations
Types of services Provided
Measurable Outcomes
Service Objectives
Workload Standards
Staff Qualifications
Unit of Service Rate Computation
rogram Capacity per Month
Certificate of Insurance
Assurance Statement
Page 24 of 30
03/07/2005 M0N 09:40 FAX Z7004/004
---Bid-Number-00245(RFP FYC 006-DOGS Attached-A
Date of Meeting(s)with Social Services Division Supervisor �� /dam/ �
Comments by SSD Supervisor: 6 ' .,L
• � `��"'" L
ite
t a a tionail�
ame and St_n : - of SSD S - .r Date
• Foster Parent Consultation 2005-6 Transitions 1
i; FOSTER PARENT CONSULTATION
•• • :• • , 2005-2006
•; •• : Transitions Psychology Group, LLC
• •rit , :
•
• 00
°ea
Transitions
PSYCHOLOGY GROUP, LLC
I. PROJECT DESCRIPTION
Transitions Psychology Group, LLC (Transitions) is a private counseling
agency consisting of a multidisciplinary team of human service professionals
providing superior counseling, assessment services, and supportive services
to children and families in Northern Colorado. The mission of the Foster
Parent Consultation Program is to enhance the overall quality and safety of
foster care for children in Weld County by supporting foster families. The
purpose of the Foster Parent Consultation Program is to provide
psychological consultations and parenting support in order to promote foster
family retention, increase foster parent competencies, improve family conflict
management, and improve access to appropriate community resources.
The design of the Foster Parent Consultation Program incorporates the
elements of assessment, consultation and foster parent group support,
biological child support groups, individual psychological consultation with
foster parents, social events and membership. All of the components are
intended to encourage foster family retention through the experience of
successful foster parenting. As facilitators, Transitions will promote the
activities and events of the program to all foster families in Weld County.
Transitions Foster Parent Consulting is based on the belief that foster families
possess inherent strengths and that these strengths can be shared in foster
parent networks in order to bolster parenting effectiveness and satisfaction in
fostering children. Access to information and resources is a vital part of
promoting behavioral change and increased effectiveness in parenting.
Transitions Foster Parent Consulting strives to empower foster parents
through reduction of isolation, viewing the foster parents as experts, mutual
sharing of information on community resources, encouraging positive parent-
child interactions, and promoting continual self-motivated development of
parenting competencies. Programs that provide social support have direct
and indirect influences on the family from the personal health and sense of
well-being of the foster parents to family functioning to parent-child interaction
on down to child behavior and development. Transitions Foster Parent
Consulting is geared towards creating a ripple effect of positive change within
and among families.
• • • Foster Parent Consultation 2005-6 Transitions 2
II. TARGET/ELIGIBILITY POPULATIONS
The Transitions Foster Parent Consulting serves foster families in Weld
County. Foster parents are directly served through consultation and foster
parent support groups, individual foster parent consultation, and mandated
training for foster parents under corrective action plans. Finally the foster
children are served indirectly through improved foster parent-child interaction,
and subsequently improved behavior and personal development. Transitions
does not discriminate based on race, color, religion, national origin or sex, in
accordance with State and Federal lawn, rules, and regulations.
Transitions Foster Parent Consulting is equipped to handle up to five groups
per month. Groups are open. The monthly capacity per group is 10
members per group or a total of 50 participants monthly. Transitions can
accept up to five new referrals a month for individual foster parent
consultation or mandated training, with a monthly maximum case load of ten
referrals. Accounting for participants from the groups, individual consulting
and mandated training, the program could have up to 110 participants. Of
course, many of these participants could attend more than one group or
consultation. We would expect to serve 150 individuals and approximately 50
families.
Transitions provides services in South County and would expect to serve
approximately 20 individuals in South County. Transitions provides culturally
sensitive services and takes pride in offering bilingual services. Approximately
20 participants could receive bilingual services.
III. TYPE OF SERVICES TO BE PROVIDED
A. Foster Parenting Rating Scales (Pre & Post)
Transitions will conduct an assessment with all families entering the
program. The assessment serves multiple purposes. First, the
assessment is used as an intake and screening tool for the Consultation
and Foster Parent Support Groups, which includes gathering information
on the foster parents' hopes and expectations for the support group. As a
part of the intake process, foster parents are informed about the objectives,
goals, and limitations of the support group. The assessment is also used
to assess various content areas for current strengths and needs of the
families including, but not limited to, parenting competencies, support
network, family conflict management, biological and foster children's
needs, motivation and commitment. The data gathered from the
• Foster Parent Consultation 2005-6 Transitions 3
assessment tool ties into the program's measurable outcomes by using
solution-focused scaling on all content areas. In addition, scaling will also
be conducted on the parents' goals for progress in the support group.
These goals and improvement in content areas will be tracked and
measured upon termination of each group.
B. Consultation and Foster Parent Group Support
Transitions will form up to four time-limited groups for foster parents.
Groups meet for two hours at Transitions' offices. Members will be
encouraged to attend the same group monthly but will be allowed to
attend more than one group per month, based on need and Department
approval or recommendation. Members will also be allowed to attend
other groups with advanced notice to Transitions, when they have
scheduling conflicts. Transitions intends to create cohesiveness in each
group, and at the same time, we want to maintain enough flexibility to
accommodate foster families' needs and busy schedules.
The support group offers a unique opportunity for foster families to create
a supportive network and to share useful information on community
resources and parenting successes. The groups are intended to remain
proactive and preventative in nature, and counselors will structure groups
so as not to become mere complaint sessions or simple social hours.
Transitions counselors are trained to be facilitate the group process, to
consult, and to respect and encourage the participation and contribution of
each member. Transitions will solicit ideas for group themes from the
participants based on their specific needs so the group will remain
relevant and helpful.
C. Individual Foster Parent Consultation
Transitions will make a request to the Social Services Foster Program for
individual psychological consultation with an individual foster parent(s)
when a situation of critical and urgent nature arises that cannot effectively
be dealt with in the support group format. The criteria for the request
would include the risk of imminent removal or danger to a foster child.
Transitions will utilize models of parent consultation only and will maintain
clear boundaries for the intervention so as not to confuse the consultation
with therapy. Appropriate referrals for counseling or other necessary
services will be made depending on professional assessment at the time
of the intervention. Consultations will be limited to six direct contact hours.
Transitions will also accept referrals from caseworkers for individual
consultation. The initial referral will consist of three hours, renewable for
an additional three hours with caseworker and supervisor's approval.
• • - Foster Parent Consultation 2005-6 Transitions 4
•
D. Mandated Training for Foster Parents
Transitions will receive referrals of mandated training of foster parents
under corrective action plans and follow-up services. The goals on the
action plan will be central to the intervention and will be incorporated on
the Foster Parenting Assessment. Progress towards goals will be tracked
and measured in this manner pre and post with a two month follow-up to
monitor maintenance of changes.
E. Assurances
Transitions assures that foster parent group consultation will not be
provided by a professional staff member who is providing therapeutic
services to foster children in the same home. Transitions works in
collaboration with case workers assigned to the children involved. All
assessments, clinical recommendations, and opinions derived in
consultation will be directly shared with the case worker. Transitions
strives to have all components of the system working in together and will
attend any necessary staffing meetings with case workers, foster parents,
and supervisors involved in the case. In accordance with 19-1-120 C.R.S.,
reports of child abuse and identifying information is held in strict
confidentiality.
IV. MEASURABLE OUTCOMES
Transitions will measure outcomes based on participant self-anchored scales
on solution-focused oriented goals, on participant self-report of progress in
content areas on 1-10 scales. The self-anchored scales allow the consultant
to formulate solutions in collaboration with the participant, from the
participant's view of the problem and tapping into the participant's resources.
People are more accepting of help and have a greater sense of
empowerment in this approach. This approach also fosters self-efficacy and
less dependence on the "system" for solutions. The self-anchored scales are
essentially a single-case AB research design.
The content areas include, but are not limited to, household management,
parental competency, support network, specific skills and competencies
related to caring for children in foster care, family stress levels, family
communication and interpersonal relations, sense of well-being, problem
solving and coping, family resources, and meeting the needs of biological
children in the home. Assessment of these content areas tie into the
solutions-focused oriented goals and progress on the individual goals
. Foster Parent Consultation 2005-6 Transitions 5
•
promote changes in the content areas. Individual goals are addressed in
consultation and parent support groups.
V. SERVICE OBJECTIVES
The Transitions Foster Parenting Consulting program service objectives have
direct links to assessment, measurable outcomes, and participant goals. The
pre-assessment begins to shape participants' expectations for the program
because content areas are directly covered. If foster parents' concerns fall
outside of the content areas or go beyond the content areas in severity, they
would be screened from the consultation group and the proper referrals would
be made. After the pre-assessment intake process, Transitions will have a
better idea of participant needs and common goals. These will become the
focus of the groups. We can then form the groups based on needs (i.e.,
identifying and dealing with sexual acting out behaviors, supporting foster
children through separation and loss or specific discipline problems).
Program service objectives will address household management
competencies and parental competencies. Each group will be unique based
on participants' stated goals and needs, but the group facilitator has the
obligation to ensure to the best of his/her assessment that basic
competencies are not being overlooked, such as providing a safe
environment, care, nutrition, hygiene, discipline, protection and supervision.
Consultants and other group members will assist foster parents to access
resources in the community and within local, state, and federal governments.
VI. WORKLOAD STANDARDS
Transitions will have up to five groups per month. Transitions can accept up
to five new consultation referrals per month with a total of ten open cases at
any given time. There will be four professionals providing services on the
program with a maximum caseload of facilitating four groups a month and
having five open consultation cases. The program uses the following
modalities of treatment: support group, psychological consultation and
assessment. Transitions' professionals also perform case management, case
consultation and staff meetings associated with the program. Total number of
work hours per week would range from 20-25. Transitions has four
professionals available to provide services. Each individual carries
professional liability insurance of$1,000,000 per occurrence and $3,000,000
aggregate.
Foster Parent Consultation 2005-6 Transitions 6
VII. STAFF QUALIFICATIONS
All staff involved in the Foster Parent Consulting program have a minimum of
a master's degree in a counseling related field and are licensed professionals.
For case consultation with more complex cases our supervisor is a Licensed
Psychologist with a Ph.D. Currently we have three LPC staff available, one
Licensed School Psychologist and one Licensed Psychologist available for
the program.
VIII. UNIT OF SERVICE RATE COMPUTATION
Healthcare Providers Service
Organization Purchasing Group ®u�CJO
it Nn Plata, 1 1
lricago.IL 6U6S5 r•.nn,..r.„,k.,s..;,,a,,.,,,
C..erttft.cat.e of �Insuranrr
Producer Branch Prefix Policy Number Policy Period
018098 970 from: 12:01 AM Standard Time on: 07/04/04
HPG 270170686-8 to: 12:01 AM Standard Time on: 07/04/05
Named Insured and Address Program Administrator
GREGORY S CREED Healthcare Providers Service Organization
G4 ORYH ACE 159 East Count Line Road
GREELEY CO 80631-3246 Hatboro, PA 1940-1218
Medical Specialty: Code: Insurance Provided by
Clinical Counselor 72990
American Casualty Co. of Reading, PA
CNA Plaza 26S Chicago, IL 60685
COVERAGE PARTS LIMITS OF LIABILITY
A. PROFESSIONAL LIABILITY
Professional Liability $1,000,000.00 each claim $6,000,000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B. Coverage Extensions
License Protection $5,000.00 per proceeding
Defendant Expense Benefit $12,500.00 aggregate
$5,000.00 aggregate
Deposition Representation
$1,250.00 per deposition
Assault $2,500.00 aggregate
$5,000.00 per incident $12,500.00 aggregate
Medical Payments $1,000 .00
First Aid per person $50,000.00 aggregate
Damage to Property of Others $1,250.00 aggregate
$250.00 per incident $5,000.00 aggregate
C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this polio-.
Workplace Liability I Included in A. Professional Liability Limit shown above
Fire and Water Legal Liability Included above subject to
Personal $150,000 sub-limit
Liability
I $500,000.00 aaareaate
D. GENERAL LIABILITY Coverage part D. does not apply if Coverage
F P g part C. is made parr of this policy.
Workplace Liability None
Hired Auto & Non Owned Auto None
None
Fire & Water Legal Liability None None
Personal Liability I
None
Total Premium $125.00
Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491
G-144872-A G-144959-A G-121500C G-121E31C G-1238460-05 G-121503O
Healthcare Providers Service(1rganrzvron is a division of Affinity Insuruice Services.Inc:in NY and NH.AIS Affinity Insurance Agency,in MN and OK.AIS Af finny Insurance
Agency.Inc.;and in C.A.IS Affinity Instuance Agency,Inc dba Aon Direct Insurance Adnunistrators License#ii 79S165
Master Policy: 188711433
CA.Y.4,- '�Q� Keep this document in a safe plane. This and
1�aill f t/ " ' your cancelled check act as proof of coverage.
Chairman of the Board Secretary
a,c vv ,_ .. -
Healthcare Providers Service
A Organization Purchasing Group ®HPSO
t •
Nt1 Plaza.
hitago.IL 60685 C:erttf �"
u xte f �1xnsurarnce
Producer Branch Prefix Policy Number Policy Period
from: 12:01 AM Standard Time on: 07/04/04
018098 970 HPG 270170798-8 to: 12:01 AM Standard Time on: 07/04/05
Named Insured and Address Program Administrator
Healthcare Providers Service Organization
JAMI MOE HARTMAN 159 East County Line Road
804 11TH AVE Hatboro, PA 19040-1218
GREELEY CO 80631-3246
Medical Specialty: Code: Insurance Provided by
Clinical Counselor 72990 American Casualty Co. of Reading, PA
CNA Plaza 26S Chicago, IL 60685
COVERAGE PARTS LIMITS OF LIABILITY
A. PROFESSIONAL. LABILITY
Professional Liability $1,000,000.00 each claim $6,000.000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B. Coverage Extensions
License Protection $5,000.00 per proceeding $12,500.00 aggregate
Defendant Expense Benefit _ $5,000.00 aggregate
Deposition Representation $1,250.00 per deposition $2,500.00 aggregate
Assault $5,000.00 per incident $12.500.00 aggregate
Medical Payments $1,000.00 per person $50,000.00 aggregate
First Aid $1,250.00 aggregate
Damage to Property of Others $250.00 per incident $5-000.00 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 1 $500,000.00 aggregate
D. 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 I None
Total Premium $125.00
Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491
G-144872-A G-144959-A G-121500C G-121501C G-123846C-05 G-121503C
Healthcare Providers Service Organization is a division of Affinity Iuuramce Services,Inc:in NY and NH.AIS Affinity Insurance Agency,in MN and OK,AIS Affinity Insurance
Agency.Inc.:and in CA.AIS Affinity Insurance Agency,Inc.dba Ann Direct Insurance Administrators License 50795-165_
Master Policy: 188711433
A-YCL ,...,_44....
l �A Vv Keep this document in a safe place. This and
your cancelled check act as proof of coverage.
Chairman of the Board Secretary
925 XX 0000246-R 040426 RENHCP 2/04 R177HH 04117
•
• • *w• ♦ + 804 11'"Avenue
• • w • Greeley, CO 80631
• •*T * : Phone: (970) 336-1123
• •#s . 4 FAX: (970)351-0182
, Cell: (970)590-1424 RECEIVED APR 27 2005
•Li
Transitions
PSYCHOLOGY aCU,LLC
Weld County Dept. of
Social Services
Judy Griego, Director Clerical Unit
Weld County Department of Social Services APR 2 7 2005
PO Box A
Greeley, Colorado 80632
April 26, 2005
Re: RFP 04005: Lifeskills
RFP 006-00A: Foster Parent Consultation
RFP 006-00B: Home Study, Relinquishment Counseling
RFP 006-00: Mental Health Services
Dear Ms. Griego,
Transitions Psychology Group, LLC, is pleased to confirm our acceptance of the
bids for PY 2005-2006 with the attached conditions as follows:
• RFP 006-00A: Foster Parent Consultation. CONFIRMED.
• RFP 006-00B: Home Study, Relinquishment Counseling. CONFIRMED
with conditions:
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 form the date of receipt of the referral.
• RFP 04005: Lifeskills: CONFIRMED with the condition:
Condition: Transitions has the following capacity to provide after-hours
visitation: Monday-Friday evenings times from 5:00-8:OOPM with the
maximum of two simultaneous sessions in any given time slot.
Saturdays 8:00AM-12:00Noon with only one therapist available for
services.
• RFP 006-00: Mental Health Services: CONFIRMED with the condition:
Condition: Reports will be provided to the Department no later than 90
days from the beginning date of services. In the event the report is not
received within the required time frame, services will not be eligible for
payment.
We look forward to another successful year of serving Weld County residents
and Social Services agencies. Please feel free to call me on my cell phone, 590-
1424, or at the office, 336-1123, with any questions. Thank you.
Sincerely,
jor-orieil c 0—.
Gregory S. Creed, MA, LPC
Cc: Jami Moe-Hartman, Co-director, Transitions Psychology Group, LLC
111
•
•*�• ' • 804 11'"Avenue FAX
' •00 .;: • Greeley, CO 80631
• •• + • Phone(970)336-1123
• s ~ FAX(970)351-0182
D••0 1 •
Transitions
PSYCHOLOGY GROUP.LLC
TO: Elaine Furister, CPS/CAP
FAX 970-346-7698
FROM: Gregory S. Creed, MA, LPC
DATE: 4/26/05
RE: Confirmation Letter to Judy Griego
PAGES: 3
COMMENTS: Please accept this letter of confirmation for the 2005-2006 Bid
process. Thanks for going over the conditions with me, Elaine. You are always
such a big help. Please confirm that you have received this FAX by calling me at
590-1424. Then I can rest assured.
CONFIDENTIAL
The information contained in this facsimile message is privileged and confidential information
intended for the use of the individual or entity named above. If the reader of this message is not
the intended recipient or the employee or agent responsible to delver it 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 fax in error, please immediately notify us by
telephone and return the original message to us at the above address via the U.S. Postal Service.
Thank you.
04/26/2005 11:52 3510182 PAGE 01
•s�*.4 •` 80411th Avenue FAX
•• 4 Greeley, CO 80631
w;»• '+ Phone(970)336-1123
} e Sj e Y r FAX(970)351.0182
Transitions
nntotocy 4ou•,tie
TO: Elaine Furister, CPS/CAP
FAX 970-346-7698
FROM: Gregory S. Creed, MA, LPC
DATE: 4/26/05
RE: Confirmation Letter to Judy Griego
PAGES: 3
COMMENTS: Please accept this letter of confirmation for the 2005-2006 Bid
process. Thanks for going over the conditions with me, Elaine. You are always
such a big help. Please confirm that you have received this FAX by calling me at
590-1424. Then I can rest assured.
CONFIDENTIAL
The information contained in this facsimile message is privileged and confidential information
intended for the use of the individual or entity named above. If the reader of this message is not
the intended recipient or the employee or agent responsible to delver it 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 fax in error, please immediately notify us by
telephone and return the original message to us at the above address via Lhe U.S. Postal Service.
Thank you.
04/26/2005 11:52 3510182 PAGE 02
• s**�. 80411'"Avenue
•
lets I" Greeley, CO 80631
•el# • Phone: (970) 336-1123
•• , FAX: (970)351-0182
t:dr.
0 ••• ., Cell: (970)590-1424
Transitions
rom tU.Mr
Judy Griego, Director
Weld County Department of Social Services
PO Box A
Greeley, Colorado 80632
April 26, 2005
Re: RFP 04005: Lifeskills
RFP 006-00A Foster Parent Consultation
RFP 006-00B: Home Study, Relinquishment Counseling
RFP 006-00: Mental Health Services
Dear Ms. Griego,
Transitions Psychology Group, LLC, is pleased to confirm our acceptance of the
bids for PY 2005-2006 with the attached conditions as follows:
RFP 006-00A: Foster Parent Consultation. CONFIRMED.
• RFP 006-00B: Home Study, Relinquishment Counseling. CONFIRMED
with conditions:
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 form the date of receipt of the referral.
• RFP 04005: Lifeskills: CONFIRMED with the condition:
Condition: Transitions has the following capacity to provide after-hours
visitation: Monday-Friday evenings times from 5:00-8:00PM with the
maximum of two simultaneous sessions in any given time slot.
Saturdays a:0DAM-12:00Noon with only one therapist available for
Q4/26/2005 11:52 3510182 PAGE 03
services.
• RFP 006-00: Mental Health Services: CONFIRMED with the condition:
Condition: Reports will be provided to the Department no later than 90
• days from the beginning date of services. In the event the report is not
received within the required time frame, services will not be eligible for
payment
We look forward to another successful year of serving Weld County residents
and Social Services agencies. Please feel free to call me on my cell phone, 590-
1424, or at the office, 336-1123, with any questions. Thank you.
Sincerely,
Gregory S. Creed, MA, LPC
Cc: Jami Moe-Hartman, Co-director, Transitions Psychology Group, LLC
....;11%a DEPARTMENT OF SOCIAL SERVICES
�1 P.O. BOX A
1 GREELEY,CO. 80632
TWebsite:www.co.weld.co.us
' Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
April 18,2005
COLORADO
Greg Creed,Co-owner
Transitions Psychology Group,LLC
804 11 Avenue
Greeley,CO 80631
Re: RFP 04005: Lifeskills
RFP 006-00A:Foster Parent Consultation
RFP 006-00B:Home Study,Relinquishment Counseling
RFP 006-00 Mental Health Services
Dear Mr.Creed:
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 RPF 006-
OOA,Foster Parent Consultation for inclusion on our vendor list.
• The Families,Youth and Children(FYC)Commission recommended approval of Bid#006-
00,Home Studies and 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.
• 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
Lifeskills program providers.
Condition: All providers must define their capacity to do after-hours visitation.
Page 2
Transitions Psychology Group/Results of RFP Process for 2005-2006
• The Families,Youth and Children(FYC)Commission recommended approval Bid#006-00
Mental Health Services for inclusion on our vendor list, attaching the following condition for
all Mental Health Services providers.
Condition: It is a requirement that provider reports be received no later than 90 days from the
beginning date of services.In the event the report is not received within the required time
frame,services will not be eligible for payment.
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.
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.
Sincerely,
'eaDir 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 05-CORE-68
Revision (PY 05-06 RFP-FYC-006-00A)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2005 and Sherri Malloy, Ph. D.
Ending 05/31/2006 Foster Parent Consultation
1228 8th Street
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Individual and group foster parent consultation Assistance Award is based upon your Request for
provided for all referred Weld County foster Proposal (RFP). The RFP specifies the scope of
parents,to a maximum of four groups per services and conditions of award. Except where it is
month, 12 individuals each,and two individual in conflict with this NOFAA in which case the
consultations per week, averaging two adults per NOFAA governs, the RFP upon which this award is
household. Group participation is limited to one based is an integral part of the action.
group session per foster parent per month.
Individual consultation services will only be Special conditions
provided when approved by the Resource
Services Manager or Child Welfare 1) Reimbursement for the Unit of Services will be based
Administrator of Social Services. Culturally on a per participant rate.
sensitive with the expectation of 20-30 percent 2) Payment will only be remitted on currently certified
minority families; South County services are WCDSS foster parents, and referrals made by the
available. Weld County Department of Social Services.
3) Requests for payment must be an original submitted to
Cost Per Unit of Service the Weld County Department of Social Services by
the end of the 25th calendar day following the end of
Per individual foster parent the month of service.The provider must submit
Participant per episode responses for payment on forms approved by Weld
Treatment Package $58.33 County Department of Social Services.
Other Services per Hourly Rate $90.00 4) Requests for payment must include original foster
parent verification signatures (blue or red ink
Enclosures: preferred)and dates and hours of service.
X Signed RFP: Exhibit A 5) The Contractor will notify the Department of any
Supplemental Narrative to RFP: Exhibit B change in staff at the time of the change.
_Recommendation(s)
Conditions of Approval
Approvals: Program Official:
By \,N/1". By 4i4
William H. Jerke, Chair Judy . Grie Directo
Board of Weld County Commissioners Weld ounty epartmen of Social Services
Date: JUN 0 6 7005 Date: 05/
inns- /6y
SIGNED RFP:
EXHIBIT A
INVITATION TO BID
OFF SYSTEM BID 002-05(05005-05011 and 006-00)
•
DATE:February 16, 2005 BID NO: 006-00A
RETURN BID TO: Pat Persichino, Director of General Services
915 10th Street, P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal(006-00A) for: Colorado Family Preservation Act—Foster Parent
Consultation, 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 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 Foster Parent Consultation Program must provide services
that focus on providing psychological consultations and parenting support to foster parents which are
designed to improve foster parent competency, family conflict management, and effectively accessing
community resources. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
Sherri al/o , Ph/b.
TYPED OR PRINTED SIATURE
VENDOR Sh erri a II o jc Ph, D. S /AD
(Name) Handwritten Signature B Authorized
Officer or Agent of Vender
ADDRESS 1228 St'' SMeer TITLE Clinical Psycho/Ty/St-
Greeley)
3-E-0_5o 80631 DATE 3-g-O
PHONE # 037 0) 3 — 4'82 set C.*
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 30
Bid Number 002-05(RFP-FYC 006-00A) Attached A
• FOSTER PARENT CONSULTATION PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
COLORADO FAMILY PRESERVATION ACT
2005-2006 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2005-2006
/ BID 002-05 (006-00A)
NAME OF AGENCY: Sherri YY1g/icy ) Ph.D.
ADDRESS: [2.-2-8 8th Street' eree/ey1 CO 206-Si
PHONE: (970) 356- g482 ext 6#1=
CONTACT PERSON: .51.1e.rr-i 121 allo Ph.D. TITLE: Cljn jca / Psycho%%sl-
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation
Program Category must provide services that focus on teaching life skills designed to facilitate implementation of
the case plan by improving household management competency,parental competency, family conflict
management and effectively accessing community resources.
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1, 2005 Start
End Mav 31, 2006 End
TITLE OF PROJECT: Fosrer Parent Onsu/i-a7ion
AMOUNT REQUESTED: per R'Jency rate- (RFQ)
Sherri 7Ectiloy, PA.1 .
rna.eki A.D. 3-3-dS
Name and Signature of PersobRreparing Document Date
Sti erri 'ma f/aj, Ph.(3.
PAD. 3-8-05
Name and Signature Chief A inistrative 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
nit Project Description
gm Target/Eligibility Populations
a Types of services Provided
WA. Measurable Outcomes
MZ'Z Service Objectives
/?1,71.-Workload Standards
re.Staff Qualifications
fW2. Unit of Service Rate Computation
LIZ Program Capacity per Month
Certificate of Insurance a f hje
Assurance Statement —per David 4/Jridg e) 11115 IS Piot pa- t-
wos7" pa-up-kit co&4 st11 D2?ttaf R Fcp II
Page 24 of 30
Bid Number 00245(RFP-FYC 006-OOA) Attached A
Date of Meeting(s)with Social Services Division Supervisor:
Comments by SSD Supervisor:
414 Alei. Ote-d5; 64,":611- caltett
ame and ignatur of SSD ervisor Date
Page 25 of 30
I. PROJECT DESCRIPTION
Individual and group foster parent consultation will be provided for all referred Weld
County foster parents, up to a maximum of four groups per month and two individual
consultations per week. The consultation services are designed to improve knowledge
about and the ability to work effectively with placement issues, behavioral management
and discipline, family conflict resolution, transition and loss issues, visitation issues,
safety plans for suicidal or violent children, attachment issues, dealing with difficult
behaviors, recognizing the impact of trauma on children, responding to traumatized
children, and identifying common symptoms of mental illness in children. Foster parents
will receive information about helping their biological children adjust to foster children in
the home. Recent research on brain development will be used to guide the foster parents
in creating conditions in the home that will optimize brain development, and attachment.
Culturally sensitive services will be provided to all foster homes, and consultation will be
geared toward heightening the understanding for foster parents of the importance of
supporting foster children's cultural values,practices, and religious beliefs. Special
attention will be given to situations in which a foster child in the home has additional
needs, arising from a physical disability, developmental delay, drug exposure, fetal
alcohol syndrome/effects, or other medical conditions. Supplemental readings, additional
support, and suggestions will be offered to help deal with these unique situations.
All referred foster parents will be supported in building upon their strengths, and will be
guided by suggestions and recommendations to improve areas of weakness. My extensive
library of resources (books, articles, DVDs, CDs, and videos) will be readily available for
interested foster parents. The use of self care techniques such as stress management and
using respite care when necessary will be suggested to help foster parents function
effectively. Foster parents will also be given help when needed to understand and adhere
to all foster parent regulations, and to understand and operate in a professional manner
within their role as foster parents. Encouragement and support will be given when
difficulties arise, and guidance will be offered to enhance the foster parent's
communication, coordination, and cooperation with all those involved in the foster
child's case. Mandated training for foster parents will be available when needed.
Following group or individual consultation, foster parents will be able to demonstrate
higher skill and competency levels in the areas of initial concern. Foster parents will
show more willingness and ability to maintain challenging placements. They will have
increased knowledge about accessing community resources to help the children in their
care. They will feel recognized for their strengths, supported and guided in handling
challenges, and come away with ideas to improve areas of weakness. Consultation will
also result in an improvement over time of emotional and behavioral functioning for
foster children, who will benefit from the improved parenting competency of their foster
parents. Foster parents, caseworkers, and foster care coordinators will report that foster
parents have benefited from consultation in that they have received the support and
information they needed to successfully meet the needs of their foster and biological
children, and to effectively overcome the many challenges facing foster families each
day.
II. TARGET/ELIGIBILITY POPULATIONS
A. Total number of clients to be served:
1. up to four monthly groups, with a maximum of 12 people each: 48
2. up to two individual consultations per week, averaging
two adults per household: 208
Maximum of: 256
B. Total family units: Maximum of: 128
C. Sub-total of individuals who will receive bicultural/bilingual services:
Approximately 20 to 30 percent of foster parent families that I have worked with
in past years have been minority families. Over the last 18 years, I have worked
extensively with culturally diverse families, and I will provide culturally sensitive
services to people of various ethnic backgrounds. In college I minored in Spanish,
and I have retained some phrases and vocabulary that helps me connect with
Spanish speaking families.
D. Sub-total of individuals who will receive services in South Weld County:
Based on my experiences over these last several years, I would estimate that
approximately 15% of individuals will receive services in South Weld County.
E. The monthly program capacity per group: up to 12 group members
F. The monthly average capacity per group: 8 group members
G. Average stay in the program (weeks):
1. individual consultation: 2 weeks
2. group consultation: ongoing, up to 52 weeks (up to 12 groups per year)
H. Average groups per week in the program: one
III. TYPES OF SERVICES TO BE PROVIDED
A. Consultation and Foster Parent Group Support will provide services designed to
improve knowledge about and ability to work with the following topics:
1. Placement issues (e.g. making decisions about whether a potential placement is
feasible for the foster family's current resources; helping the new child/children
feel welcomed, and oriented to the foster family; support and problem solving to
avoid disruption when the placement is difficult).
2. Behavioral management (e.g. ways to structure the home,provide praise and
nurturing, ways to teach children self-care, various tasks and chores, and problem-
solving skills; reduction of sibling rivalry, conflict resolution, appropriate
expression of feelings).
3. Foster home issues involving biological children in the home (e.g. grief and loss
issues, resolving jealously issues, safety concerns when foster children are
violent, or acting out sexually).
4. Transition and loss issues (e.g. supporting foster parents through losing foster
children; teaching foster parents to help foster children appropriately express grief
and loss, and helping foster children transition back to biological family or to a
foster-adopt home).
5. Working with caseworkers around interpretation and implementation of treatment
plans (e.g. support foster parents in cooperating with all professionals involved in
the case; assist in open and clear communication between parties to facilitate
maximum progress toward the treatment plan).
6. Discipline in the home (e.g. use of logical consequences,praise and rewards,
removal of privileges, clearly stated house rules; reducing power struggles).
7. Foster parents will receive relevant articles and handouts, and will have access to
books, cassette tapes, CDs, videos, and DVDs from my extensive library of
resources dealing with issues that foster parents face.
8. Foster parents will receive support and information around legal risk and
commitment issues.
9. Visitation issues (e.g. dealing with difficult biological relatives; helping children
cope with anxiety around visits; helping children with grief and loss responses
after visits; dealing with children acting out around visits).
10. Solution oriented planning(e.g. maintaining a professional attitude, and
remembering one's role as foster parent when working toward solutions in
stressful or conflicted situations).
11. Understanding and supporting the foster child/family's cultural values, practices,
and religious beliefs.
12. Understanding the impact of child abuse, neglect, and witnessing domestic
violence on children; dealing with traumatized children, and children who have
symptoms of attachment disorder.
13. Safety plans for suicidal or violent children.
14. Children who have special needs (e.g. fetal alcohol syndrome and effects;
physical disabilities; developmentally delayed; medical conditions; drug exposed
children).
15. Creating conditions in the home for optimal brain development, and optimal
attachment.
16. Appropriate use of respite care, and accessing community resources for children.
17. Dealing with false allegations of child abuse.
18. Dealing with difficult behaviors (e.g. lying, stealing, food issues, property
destruction, wetting and soiling, self-inflicted injuries, sexualized behavior,
defiance).
19. Recognizing mental illness in children(e.g. depression, anxiety, post-traumatic
stress, attachment disorder,bipolar disorder,psychosis).
20. Understanding and adhering to foster parent regulations.
21. Recognizing and building upon the unique strengths and gifts that each foster
parent brings to foster care.
Number to be served: up to four ongoing groups, up to 12 members (48 maximum served
in group; up to 104 individual consultations per year).
B. Time limited, individual foster parent consultation will be provided only with
Department approval.
Number to be served: up to two consultations per week, averaging two foster parents per
household (208 maximum).
C. I will provide mandated training for foster parents in areas including, but not limited
to items under"IIA" under corrective action plans, when referred by the Department.
Number to be served: maximum of 12 households per year.
D. I will adhere to the following guidelines, in order to satisfy State training requirements
for foster parents:
1. One training credit per month will be recorded for each critical care foster parent
participating in the mandated monthly consultation group.
2. All additional foster parent training will be pre-approved by Agency staff(i.e.,
Foster Care Coordinators or Resource Services Manager).
3. All training will be offered to all Weld County foster parents, whether they are
involved in the Consultation Program or not. The flat fee for conducting such
training will be agreed upon between the provider and the Agency on a per event
basis. Contracted individual and group consultation rates will not be charged for
training. Post training testing will be part of the training component.
E. I will not provide foster parent group consultation if I am already providing
therapeutic services to foster children in the same home.
F. All assessments, opinions, and clinical recommendations derived by the contractor in
the performance of this contract will be shared directly with the assigned caseworker of
the children involved. If there is disagreement over the implementation of the treatment
plan with the caseworker, a meeting shall be held with the contractor, assigned
caseworker, foster parents, and the caseworker's supervisor. The objective will be to
determine a unified departmental response for court. The contractor will not use the legal
system to oppose the Department's recommendations.
G. I agree to comply with 19-1-120 C.R.S., which requires that reports of child abuse and
any identifying information in those reports are strictly confidential.
H. I will consult with the Foster Care Coordinators or Resource Services Manager, and
the caseworker to ensure that FYC resources will not supplant existing and available
community services.
IV. MEASURABLE OUTCOMES
A. Improvement of household management competency as measured by pre and post
assessment instruments: Per David Aldridge, Resource Services Manager, Weld County
Department of Social Services, this item is not relevant to the Foster Parent Consultation
RFQ.
B. Improvement of parental competency as measured by pre and post assessment
instruments: Per David Aldridge, Resource Services Manager, Weld County Department
of Social Services, this item is also not relevant to the Foster Parent Consultation RFQ.
C. Foster parents will be able to work independently with others in the community and
within the local, state, and federal governments:
The individual and group foster parent consultation that I provide will result in an
enhanced understanding of the distinct role of the foster parent, and an improved ability
to carry out this role in a professional manner. There will also be increased awareness of
the roles and functions of the Foster Care Coordinator, Resource Services Manager,
Caseworker, Department Supervisor, CASA workers, Guardian Ad Litem, Attorneys, and
service providers (e.g. mental health workers, occupational therapists, speech/language
therapists, and physical therapists, visit supervisors and case aides). Respect for and good
communication with other foster parents, and all of those involved in the foster child's
life will be strengthened by individual and group foster parent consultation.
When necessary, clarification about local, state, and federal guidelines for foster parents
will be given. Support and information will be provided to foster parents around issues of
cooperating and coordinating with all other parties involved in the foster child's case, and
in successfully accessing community resources. Foster parents will be given guidance
regarding ways to efficiently supply caseworkers, guardian ad litems, and Foster Care
Coordinators with information pertinent to the foster child in their care. In the event that a
foster parent is called to testify in court, support and information will be provided about
the process of testifying.
D. Following group or individual consultation, foster parents will demonstrate higher
skill and competency levels in fulfilling their designated function for children in out-of-
home placement, as measured by:
1. The ability to consistently nurture their foster children, even when faced with
challenging behaviors.
2. Creation of a written list of house rules and consequences, and the foster parent
will demonstrate the ability to provide effective, fair discipline for the foster child.
3. Knowledge of and sensitivity to cultural and religious values, practices, and
beliefs, so that the foster child and his or her family feels valued and respected.
4. Emotional and behavioral problems that the child evidenced when entering care
will subside over time, as reported by the foster parent, and as observed by the
other professionals involved in the child's case.
5. The foster parent will be able to identify common symptoms of mental illness in
children, and to consult with the child's caseworker about seeking appropriate
services for the child. Foster parents will be able to articulate the impact of trauma
and loss on foster children, and an understanding of attachment difficulties.
6. The foster parent will demonstrate an increasing ability to maintain a calm,
rational approach with difficult children, to avoid power struggles, to resolve
family conflict, and to use self-care (e.g. the foster parent will take a time out, use
stress management techniques, or will seek respite care) when needed.
7. The foster parent will demonstrate the ability to help a child express feelings
appropriately, and make a smooth transition when a transition is necessary, as
measured by the observations of the other professionals involved with the foster
child.
8. Foster parents will be able to recognize when a foster child is a danger to himself
or herself or to others and to make an appropriate safety plan.
9. Foster parents will request and use training materials on any special needs their
foster child has.
10. Foster children will appear clean, appropriately clothed, well fed, and well cared
for.
11. Professionals involved with the foster child will observe that the foster child
appears to be comfortable with the foster parent, safe, and over time develops
emotional closeness with the foster parent, looks happy, and seems to be thriving
in the care of the foster parent.
12. In cases where the placement of the child is in jeopardy, foster parents will report
an increased willingness to maintain a difficult placement.
E. Foster parents will be able to positively meet the needs of their biological children in
adjusting to and coping with the presence of foster children in the home, as measured by:
1. The foster parent will demonstrate the ability to help their biological children
understand (based on their developmental level), the role of foster care and the
need for confidentiality, and to have compassion and respect for the foster
children in their home.
2. The foster parent will educate their biological children about appropriate
boundaries, and will provide supervision to ensure that the biological children are
kept safe from aggressive or sexualized foster children.
3. The foster parent will be able to articulate the need for and provide to their
biological children a time and space to express their frustrations about their foster
siblings, and to receive extra support and nurturing when needed.
V. SERVICE OBJECTIVES
A. Foster Parent Consultation will focus on providing information, support and
recommendations to improve household management competency. At the outset of the
consultation, the foster parent, caseworker, and/or foster care coordinator will assist in
identifying areas of strength to build on in household management, as well as areas to
work on. The foster parent will be given training materials and suggestions on household
management, directed to the areas needing support. Areas to be discussed include meal
planning, laundry, managing paperwork, budgeting, and household cleaning and
maintenance. Improvements will be measured by the foster parent's, caseworker's, and/or
foster care coordinator's observations of improved competency in the areas identified to
work on.
B. Foster Parent Consultation will also be geared toward improving parental
competency. At the beginning of the consultation period, the foster parent, caseworker, or
foster care coordinator will specify the particular objectives of the consultation. The
foster parent's strengths will be recognized, and areas of weakness will be improved by
offering training materials, support, suggestions, and recommendations designed to
improve the capability of the foster parent to have healthy relationships with biological
and foster children, to keep the children clean, well fed, and safe, and to provide the
children with nurturing, structure, supervision, conflict resolution, and appropriate
discipline. Suggestions and recommendations will be offered to the foster parent based on
research about parenting methods that promote optimal emotional health in the child,
optimal brain development, healthy and appropriate behavior, and self-esteem around
cultural and religious values that are important to the children. The foster parent's
understanding and acceptance of the training information will be monitored throughout
the consultation, and results will be measured by the foster parent's, caseworker's, and/or
foster care coordinator's reports of improvement in parental competency.
C. Another service objective will be to assist the foster parent in improving his or her
ability to access resources. Suggestions will be given to help the foster parent coordinate,
cooperate, and communicate successfully with all of the other professionals involved
with the foster child. Recommendations will be given when appropriate to help the foster
parent access community resources, such as Parks and Recreational programs, summer
programs, and Senior Partner services (all with caseworker approval). The foster parent's
ability to maintain professionalism during discussions about difficult or conflicted
situations, and to correctly articulate the foster parent's role will be monitored during the
duration of the consultation. Feedback from the foster care coordinator or caseworker
will also be important in monitoring and evaluating this service objective.
VI. WORKLOAD STANDARDS
A. Number of groups per month: maximum of 4
B. Number of anticipated requests for individual consultation
per month: maximum of 8
C. Number of individuals providing services: 1
D. Maximum caseload per worker: 4 groups and 8 individual
consultations per month
E. Modality of treatment: individual or group consultation
F. Total number of hours per day/week/month: maximum of
3 hours in any given day
8 hours total per week
32 hours per month
G. Total number of individuals providing these services: 1
H. The maximum caseload per supervisor: not applicable
I. I. Insurance: the provider has auto insurance and
malpractice insurance;general liability insurance is covered
as part of the provider's rent (please see attachments).
Workman's Compensation and Employer's Liability is not
applicable to this project, as there are no employees.
VII. STAFF QUALIFICATIONS
A. My qualifications meet the criteria for education and experience as defined by Staff
Manual Volume VII, Section 7.303.17, and Section 7.000.6,Q, Colorado Department of
Human Services.
Sherri Malloy, Ph.D.
Licensed Clinical Psychologist
Ph.D. 1993, Clinical Psychology. University of Colorado,Boulder.
M.A. 1989, Clinical Psychology. University of Colorado, Boulder.
B.A., 1987, Major: Psychology, Minor: Spanish. Arizona State University.
Teaching Certificate, 1977. Montessori Elementary Education Certificate.
Since 1986 I have enjoyed working with culturally diverse children and families. I have
provided inpatient and outpatient psychotherapy to children, adolescents, adults and
families. I also have many years of experience working in emergency psychiatric
services, family preservation home-based services, and as a consultant to foster and
adoptive families. I have extensive experience working as a clinical supervisor, and as a
consultant to various agencies.
My teaching experience includes graduate level instruction in play therapy practicum;
college level psychology courses, presenter of numerous seminars and workshops, and
seven years as a Montessori elementary teacher. For four years, I was a columnist for The
Boulder County Parent, answering questions about child development and parenting
concerns. I am currently teaching a seminar for local clinicians on attachment disorder.
Also, I subscribe to publications relevant to foster care consultation, and attend
conferences to stay abreast of the latest research on children in foster care.
If additional detail is needed, please refer to my vita, which is an attachment to this RFQ.
VIII. UNIT OF SERVICE RATE COMPUTATION
Fixed rate for foster parent consultation contracts:
$90.00 per hour for individual consultation
$350.00 per foster parent support group
VIII. PROGRAM CAPACITY BY MONTH
A. Maximum and minimum capacity per month necessary to support program:
1. minimum capacity: there is no minimum necessary to support
program
2. maximum: 4 monthly groups; 8 consultations per month
•
List of Attachments
A. Curriculum Vitae
B. Professional Liability Insurance Certificate
C. Automobile Insurance
D. General Liability Insurance Certificate (this is included in my rent)
Sherri Malloy, Ph.D.
•
Licensed Clinical Psychologist
1228 8th Street
Greeley, Colorado 80631
970.356.8482
Education
Ph.D. Double Major: Child Clinical Psychology;Clinical Psychology.
August 1993 University of Colorado, Boulder. Licensed as Psychologist 1-5-95
M.A. Department of Psychology, Clinical Program. University of
July 1989 Colorado, Boulder.
B.A. Major: Psychology; Minor: Spanish. Arizona State University.
May 1987 Summa Cum Laude.
Teaching Cert. Roston Montessori Teacher Training Institute.
August 1977 Orange, California. Montessori Elementary Education Certificate.
Clinical Experience
April 1998- Clinical Psychologist, Private Practice, Greeley, Colorado.
present Provide outpatient psychotherapy to children, adolescents, adults
& families. Family preservation home-based services. Assessment
&consultation. Consultation to foster and adoptive families.
August 1991- Child and Family Psychotherapist, Mental Health Center of Boulder
March 1997 County, Boulder, Colorado. Provided outpatient psychotherapy to
children and their families. Parent,teacher, and other agency
consultation. Consultation to foster and adoptive families.
September 1992- Psychology Intern; Denver General Hospital, Denver, Colorado.
August 1993 Outpatient assessment, consultation, and treatment
To children, adolescents, and adults; Inpatient treatment
to adolescents&their families. Consultation to multidisciplinary
hospital staff. Attended regular seminars and case conferences.
Completed an additional rotation in neuropsychology.
August 1990- Psychotherapist,University of Colorado, Farrand Residence Hall.
May 1992 Provided individual, conjoint, and group psychotherapy to Farrand
residents. Psychiatric consultation to faculty and staff. Presented
seminars and workshops to faculty, staff, and students.
1228 8th Street • Greeley, CO 80631
970.356.8482 • Fax: 970.356.9646
2 Malloy
August 1988- Emergency Psychiatric Services Clinician, Mental Health Center
August 1992 of Boulder County, Boulder, Colorado. Evaluation and
disposition planning for clients with psychiatric emergencies.
Composed a training manual for emergency psychiatric clinicians
January 1988- Psychotherapy Intern, Raimy Psychology Clinic,
May 1992 Department of Psychology,University of Colorado, Boulder.
Provided outpatient psychotherapy to adults, families, and
children. Parent and teacher consultation.
February 1986- Intake Clinician; Group Facilitator, Tri-City Behavioral Health
July 1987 Center, Mesa, Arizona. Conducted intakes for the adult team.
Facilitator for children's psychotherapy groups.
Administrative and Supervisory Experience
April 1998- Private consultation and supervision provided to colleagues and to
Present unlicensed practitioners who are working toward licensure.
Jan 1996- Team Leader, Mental Health Center of Boulder County, Boulder,
May 1998 Colorado. Clinical and administrative supervision of a team of
psychologists and psychotherapists. Budgeting. Supervision of
support staff. Coordinate outpatient services/consultation to joint-
agency programs, including Head Start, Specialized Foster Care,
Fost-Adopt, 1178, School-Based Services, Boulder Day Nursery, and
People's Clinic.
August 1990- Adult Team Coordinator, Raimy Psychology Clinic, Department
August 1991 of Psychology, University of Colorado,Boulder. Chaired the adult
team meetings and case conferences. Assisted clinic director with
administrative tasks.
August 1990- Peer Counselor Supervisor, Farrand Residence Hall, University of
May 1991 Colorado, Boulder. Developed and implemented a peer counseling
training program. Provided ongoing training and supervision to
peer counselors.
January 1989- Supervisor in Training, Raimy Psychology Clinic,
August 1991 Department of Psychology,University of Colorado, Boulder.
Received training and supervision in supervisory techniques.
Supervised the psychotherapy of first-year clinical psychology
graduate students.
June 1989- Adult Team Intake Coordinator, Raimy Psychology Clinic,
August 1990 Department of Psychology,University of Colorado, Boulder. Intake
and disposition of psychotherapy clients.
3 Malloy
September 1989- Clinical Supervisor, Emergency Psychiatric Services Team,
August 1992 Mental Health Center of Boulder County,Boulder, Colorado.
Trained and supervised Masters level student interns in
emergency clinical assessment techniques, legal and procedural
practices, and psychological report writing.
February 1988- Volunteer Trainer, Maslin House for Chronically Mentally Ill,
May 1989 Mental Health Center of Boulder County,Boulder, Colorado.
Recruited and trained volunteer college students to work with
the chronically mentally ill population at this facility.
Publications
December 1994- Columnist: The Boulder County Parent,a monthly publication of the
April 1998 Parenting Place, Boulder, Colorado. Circulation: 8,000. Topics
include child development and parenting concerns.
Teaching Experience
January 2001- Instructor, University of Northern Colorado, Greeley, CO
May 2001 Graduate Level Play Therapy Practicum
August 1989- Psychology Instructor, Front Range Community College,
May 1992 Boulder Campus, Colorado.
Fall 1988 Head Teaching Assistant, Department of Psychology, University of
Colorado, Boulder. Trained and supervised graduate level Teaching
Assistants.
August 1987- Teaching Assistant, Department of Psychology,University of
May 1989 Colorado, Boulder.
August 1977- Montessori Elementary Teacher, Roston Montessori School,
May 1983 Orange, California; and subsequently, Tempe Montessori School,
Tempe, Arizona. Taught preschool through second grade classes.
Responsibilities included academic program planning and
implementation, supervising teacher assistants, conducting parent-
teacher conferences, academic record-keeping, and giving
educational presentations to parents.
August 1976- Student Teacher,Roston Montessori Teacher Training Institute,
August 1977 Anaheim, California. Taught in a Montessori classroom under the
supervision of a certified Montessori teacher. Duties were the same
as in the entry above.
4 Malloy
Presentation Topics and Trainings Given
Legal and Emotional Aspects of Adoption
Reactive Attachment Disorder
Inclusiveness: The Child With Different Needs
Parents and Teachers Working Together in a Culturally Sensitive Way
Transitions for Children in Foster Care
Corrective Attachment Therapy
Eye Movement Desensitization and Reprocessing(EMDR)
Creation of Life Books for Foster and Adopted Children
Play Therapy
Engaging so-called"resistant"clients
Psychotherapy with adolescents and their families
Case Conferences
Parent-Toddler Attachment Patterns
Child Abuse
Child Psychopathology
Stress Management Workshop
Depression and Risk of Suicide in College Students
Research Projects
Adult Attachment Style and College Functioning(Doctoral Dissertation), 1992
Parent-Toddler Attachment Relationships(Masters Thesis), 1990
Post-Divorce Visitation Patterns and Parent-Toddler Attachment, 1988
Effects of Divorce on Children, 1987
Mental Health Center Client Satisfaction Study, 1986
5 Malloy
Professional Affiliations
1997- 1998 Member: Internal Review Board MHCBC
1996-1997 Member: Professional Advisory Board, Mental Health Center of
Boulder County
1991- 1992 Co-Chair: Multi-Ethnic Action Committee, Department of
Psychology, University of Colorado, Boulder.
1991- 1993 Member: American Psychological Association, Division 12,
Clinical Child Psychology.
1989- 1991 Member: Multi-Ethnic Action Committee, Department of
Psychology, University of Colorado, Boulder.
1988- 1989 Student Representative: Department of Clinical Psychology,
University of Colorado, Boulder.
1987- 1989 Member:Developmental Psychology Research Group,
Department of Psychology, University of Colorado, Boulder.
1987- present Member: (intermittent)American Psychological Association.
Honors and Awards
1988 Department of Clinical Psychology Scholarship; University of
Colorado, Boulder.
1987 Phi Beta Kappa
1987 Academic Scholarship, Arizona State University, Tempe, Arizona.
1986 Phi Kappa Phi Honor Society
1986 Golden Key National Honor Society
1979 West Valley College Track Team, West Valley, California;
State Champions.
1977 Fellowship Award; Roston Montessori School, Orange, California.
Updated 2-03
BRANCFj B/A PRODUCER NUMBER DATE OF ISSUE PRIOR CERTIFICATE NUMBER
23 A 0004087 03/08/2004 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- 2055185
1. Named Insured Sherri Malloy
24 Alles Dr
ADDRESS Greeley, CO 80631-6829
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 Liability $ 1,000,000 each incident I $ 3,000,000 aggregate $ 814.00
4. BUSINESS OF THE INSURED: PSYCHOLOGY
5. The Named Insured is: X Sole Proprietor (including independent contractors) _ Partnership _ Corporation
_ Other:
6. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the
Declarations: or b) the effective date of the earliest claims-made policy issued by the Company to which this
policy is a renewal; or e) the date specified in any endorsement hereto. 04/01/1998
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: Near North Insurance Brokerage
in Association with Trust Risk Management Services
Office address: 875 N Michigan Ave
City, State, Zip: Ste 1900
Chicago, IL 60611-1803
Toll-Free Number: 1-877-637-9700
PLP-2012(06/93) APA-
USAA 3/9/2005 11 : 09 AM PAGE 2/002 Fax Server
•
• PAGE 3
USAA CASUALTY INSURANCE COMPANY
ADDL INFO ON NEXT PAGE MAIL PSCFI M I
RENEWAL OF
in sack ad remnAcolor thte 07 08 rr POLICY NJP1891
• BR88 Fredericksburg Rod - San AUHortlo Texas 78288 �U Ja3Ja� T•n 00211 02 59C 7103 5
COLORADO AUTO POLICY POLICY PERIOD (12:11 AM. st edrd time)
RENEWAL DECLARATIONS EFFECTIVE APR 17 2005 TO OCT 17 2005
(ATTACH TO PREVIOUS POLICYI _ OPERATORS
Nomad Insured end Address 01 SHERRI R MALLOY-GONZALEZ
07 DAVID M GONZALEZ
SHERRI R MALLOY-GONZALEZ
24 ALLES DR
GREELEY CO 80631-6829
Denerlptlon of VshioNW YEN JSE■ wwusowOL
YEN YEAR TRADE NNE tt00EL BODY TYPE � ' = IDENTIFICATION NUMBER SYM TIT li,
07 99 TOYOTA SIENA LE/XLE WAG 4X2 4D 100 0 4T3ZF13C9XUU91812 10 B
08 04 NISSAN MAXIMA SE/SL SED 4D 8000 1N4BA41E54C831527 17 W 01 5
The VehlcleW described herein is principally raged at the above address un us otherwise stated. c-anAcsaa.Yn...S F.F.,SP.PI.nw.
VEH 07 GREELEY CO 80631-6829
VEH 08 GREELEY CO 80631-6829
This policy DrovI s p�,Y those,Qow 5 wi sre ■ %remlum Is wn low. limits shown
Pig De dtwhi b p000licproviswd d mev nnoot oombms ~ inns,'o t i. enter of
w cip which a pysm s ate unless specifically ass torts • in this policy.
COVERAGES VEH VEH 7 08 VEH VEH
LIMITS OF LIABILITY
07 6-MONTH 08 6-MONTH
rACV" MEANS ACTUAL CASH VALLLE) D-DED PREMIUM D$OED PREMIUM DICED I PREMIUM DCDED PREMIUM
AMOUNT $ AMOUNT a AMOUNT a AMOUNT e
PAR ' A — LIABILITY
BODILY INJURY EA PER i 100,000
EA ACC 300,000 66.59 39.78
PROPERTY DAMAGE EA ACC 50,000 65.54 39. 99
PART C - UNINSURED MOTORISTS
BODILY INJURY EA PER $ 100,000
EA ACC $ 300,000 15.14 15.14
PART D - PHYSICAL DAMAGE COVERAGE
COMPREHENSIVE LOSS ACV LESS D 250 56.06) 250 82.70
COLLISION LOSS ACV LESS D 500 104.26) 500 118.01
TOWING AND LABOR 6.00 6.00
ACCRUED LONGEVITY CREDIT
40% OP #01, 40% OP #07.
VEai1UL' TOTAL YKE;M1UM 313.59 -301.6z
6 MONTH PREMIUM $ 615.21
ADDITIONAL MESSAGE(S) - SEE FOLLOWING 'AGE(S)
LOSS PAYEE
VEH 07 COLLEGE CREDIT UNION OF GREELEY, GREELEY CO
VEH 08 COLLEGE CREDIT UNION, GREELEY CO
ENDORSEMENTS: ADDED 04-17-05 - NONE
REMAIN IN EFWhJCT(REFER TO PREVIOUS POLICY)- A400CW(01) A10000(05) 510000(01)
INFORMATION FORMS(NOT PART OF POLICY)— 39923(01)
IA 0000000 0000000
a pW WITNESS
D00po) ha a ued55s a:y ho be ed ( I Ina bow) III I L. I 1111111
fa ITPESS EREDF, we him amused this pa Icy sign by our President s a San Antonin, exae,
on this date FEBRUARY 0 5aLs_ distaal
Steven Alan Bennett Henry wcelllo Jr.
5000 C Sscrstrr Pruidsnt
621 05XD106901 01 000 CRW024
• AMERICAN FAMILY MUTUAL INSURANCE COMPANY
• MADISON, WISCONSIN 53783-0001
• BUSINESSOWNERS POLICY
POLICY NUMBER DECLARATIONS
05XD106901
NAMED JACK J GARDNER
INSURED DBA GREELEY CONSELING
MAILING 1228 8TH ST
ADDRESS GREELEY, CO 80631-3216
POLICY PERIOD FROM 11-01-2004 TO 11-01-2005
12:01 A.M. Standard Time at your mailing address shown above.
FORM OF BUSINESS INDIVIDUAL
In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in
this policy.
SECTION I PROPERTY
ALL PROPERTY COVERAGES ARE SUBJECT TO THE FOLLOWING:
COVERED CAUSES OF LOSS SPECIAL - RISK OF DIRECT PHYSICAL LOSS
COVERAGE PROVIDED INSURANCE AT THE FOLLOWING DESCRIBED PREMISES ONLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE
IS SHOWN UNLESS COVERAGE IS PROVIDED BY AN ENDORSEMENT.
DESCRIPTION OF PREMISES
PREMISES NO. 0001 BUILDING NO. 001
LOCATION 1228 8TH ST
GREELEY, CO 80631-3216
OCCUPANCY PSYCHOLOGIST OFFICE
CONSTRUCTION FRAME
YEAR BUILT 1902
COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 261
POLICY PROPERTY DEDUCTIBLE $250
OTHER PROPERTY DEDUCTIBLE(S)
OPTIONAL COVERAGE/GLASS DEDUCTIBLE $500
COVERAGE LIMIT OF INSURANCE PREMIUM
BUILDING $131,018 $367.00
❑ REPLACEMENT COST
ADDITIONAL COVERAGE LIMIT OF INSURANCE PREMIUM
❑ BUSINESS INCOME ACTUAL LOSS SUSTAINED INCLUDED
❑
OPTIONAL COVERAGES LIMIT OF INSURANCE PREMIUM
-n
AGENT 020-311 PHONE PAGE 0001
BRENT W FRIESTH 303-449-9595 BRANCH CRW024 RENW
2595 CANYON BLVD STE 250 ENTRY DATE 08-05-2004
BOULDER, CO 80302-6744
RP AF Al Al 04 .ue„ntn _. . .. ._...
627 05XD106901 01 000 CRWO24
AMERICAN FAMILY MUTUAL INSURANCE COMPANY
MADISON, WISCONSIN 53783-0001
BUSINESSOWNERS POLICY
• POLICY NUMBER DECLARATIONS
05XD106901
MONEY AND SECURITIES $15.00
INSIDE THE PREMISES $10,000 INCLUDED
OUTSIDE THE PREMISES $5,000 INCLUDED
Property forms and endorsements applying to this premises and made part of this policy at time of issue:
Any endorsement followed by a state abbreviation will only apply to coverages within this state.
BP 84 11 07 98
MORTGAGEHOLDER LOAN NO. 9011629 & 9011630 PREMISE NO. BUILDING NO.
BANK OF CHOICE 0001 001
3635 23RD AVE
EVANS, CO 80620-1725
TOTAL ADVANCE PROPERTY PREMIUM $382.00
Property forms and endorsements applying to all premises and made part of this policy at time of issue:
Any endorsement followed by a state abbreviation will only apply to coverages within this state.
BP 05 76 11 02 BP 83 01 07 98 BP 83 02 05 00 BP 85 11 05 00
SECTION II LIABILITY AND MEDICAL EXPENSES
Except for Damage To Premises Rented To You, each paid claim for the following coverages reduces the amount of insurance we
provide during the applicable annual period. Please refer to Section II Liability in the BUSINESSOWNERS COVERAGE FORM and any
attached endorsements.
COVERAGE LIMIT OF INSURANCE
LIABILITY AND MEDICAL EXPENSES $1,000,000
MEDICAL EXPENSES -ANY ONE PERSON $5,000
DAMAGE TO PREMISES RENTED TO YOU $50,000
LOCATION PREMIUM BASIS ADVANCE PREMIUM
La PREMISES NO. 0001 BUILDING NO. 001
2000 SQUARE FOOTAGE $48.00
U,
m
❑ TOTAL ADVANCE BUSINESS LIABILITY PREMIUM $48.00
o Liability forms and endorsements applying to all premises and made part of this policy at time of issue:
❑ Any endorsement followed by a state abbreviation will only apply to coverages within this state.
❑ BP 04 17 07 02 BP 04 39 07 02 BP 04 54 07 02 BP 04 93 07 02
• BP 05 77 11 02 BP 10 05 07 02 BP 84 24 07 02 BP 8505 07 98C0
❑ BP 85 10 07 98 BP 85 12 10 01 IL 75 26 10 01
m
❑
k AGENT 020-311 PHONE PAGE 0002
Q BRENT W FRIESTH 303-449-9595 BRANCH CRW024 RENW
2595 CANYON BLVD STE 250 ENTRY DATE 08-05-2004
BOULDER, CO 80302-6744
BP AF 01 01 99 INSURED stack No.15141
Sherri Malloy, Ph.D.
Licensed Clinical Psychologist
4-22-05
Weld Count
Judy A. Griego SClen e v o s of
Department of Social Services ~� u�'°
P.O. Box A APR 2 2005
Greeley, Colorado 80632 % I
Dear Ms. Griego,
Thank you for the notification that my bid(RFP 006-00A, Foster Parent Consultation),
was recommended for approval for inclusion on your vendor list, by the FYC
Commission. I am delighted to hear of this news, and the purpose of this letter is to
confirm that I received the notification and to let you know that I am interested in
becoming a vendor for Foster Parent Consultation. Thank you!
Sincerely,
117 OP7 , Ph-D.
Sherri Malloy, Ph.D.
Licensed Clinical Psychologist
1228 8th Street • Greeley, CO 80631
970.356.8482 • Fax: 970.356.9646
Kit Le. 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
Ne
April 18, 2005
COLORADO
Sherri Malloy,Ph. D.
1228 8 Street
Greeley, CO 80631
Re: RFP 006-00A: Foster Parent Consultation
Dear Ms. Malloy:
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.
The Families, Youth and Children(FYC) Commission recommended approval of the bid,RFP
006-00A, Foster Parent Consultation, for inclusion on our vendor list.
If you have questions concerning the above,please call Gloria Romansik, 970.352.1551,
extension 6230.
Sincerely,
y . riego, irect
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 FY05-CORE-0007
Revision (PY 04-05 RFP-FYC-006-00A)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2005 and Jubilee Retreat Center-Lori Kochevar, LLC
Ending 05/31/2006 Foster Parent Consultation
810 12 Street
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Assistance Award is based upon your Request for
This program provides foster parent consultative Proposal(RFP). The RFP specifies the scope of
services in the areas of(1)consultation and foster services and conditions of award. Except where it
parent support, (2)mandated corrective action is in conflict with this NOFAA in which case the
consultation, and(3)mandated critical care NOFAA governs,the RFP upon which this award is
consultation. Foster parent consultations will be based is an integral part of the action.
provided through group consultation services. Group
participation is limited to one group session per foster Special conditions
parent per month. Individual consultation services
will only be provided when approved by the Resource 1) Reimbursement for the Unit of Services will be
Services Manager or Child Welfare Administrator of based on a per group rate.
Social Services.Bilingual-Bicultural services are 2) Rates will only be remitted on cases open with,and
available to all families. South County services are referrals made by the Weld County Department of
available. Social Services.
3) Requests for payment must be an original and
submitted to the Weld County Department of Social
Cost Per Unit of Service
Services by the end of the 25th calendar day
Per individual foster parent following the end of the month of service. The
participant per episode
provider must submit requests for payment on
Treatment Package $58.33 forms approved by Weld County Department of
Other Services Per Hourly Rate $90.00 Social Services.
4) Requests for payment must include original client
verification signatures(blue or red ink preferred)
Enclosures:
X Signed RFP: Exhibit A and dates and hours of service.
Supplemental Narrative to RFP: Exhibit B 5) The Contractor will notify the Department of any
change in staff at the time of the change.
Recommendation(s)
Conditions of Approval
Approvals: // Program Official:
By �\�//�ir,i/ By
William H. Jerke, Chair Judy ego, irector
Board of Weld County Commissioners Weld ty D aitinent of Social Services
Date: JUN 0 6 2005 Date: 2 bS
oOs- /6ys
SIGNED RFP:
EXHIBIT A
' Bid Number 002-05(RFP-FYC 006-OOA) Attached A
FOSTER PARENT CONSULTATION PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
COLORADO FAMILY PRESERVATION ACT
2005-2006 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2005-2006
BID 002-05 (006-OOA)
NAME OF AGENCY: 921J1.62. Catvt.--7 7 ,[,21c,
O !.
ADDRESS: r/ h, co\ 4^L
0
PHONE: U 3S -n7 3
CONTACT PERSON: / pi1 4029.0ai TITLE: aI,N7(!/L
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation
Program Category must provide services that focus on teaching life skills designed to facilitate implementation of
the case plan by improving household management competency,parental competency, family conflict
management and effectively accessing community resources.
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: . 10512, VA0-.44k Oernate ton Q/10
AMOUNT REQUESTED: a,3S0 pp„ GI'acp 9Q ,)Dn Lialiv- �.,a 15,2.
0 3i 11 ICS--
Nam and Signature of Person Preparing Document Date
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
O— Project Description b(k
Target/Eligibility Populations ter"
a-- Types of services Provided d(�
Ali- Measurable Outcomes /K„
46 Service Service Objectives
N- Workload Standards Jar
� Staff Qualifications ,,G o art SOynp gfrill
AC. Unit of Service Rate Computation J� Gravy
0
Program Capacity per Month
Certificate of Insurance �d p,j � y�—
E Assurance Statement i- rt
Page 24 of 30
INVITATION TO BID
BID 002-05(05005-05011 and 006-00)
DATE:February 16, 2005 BID NO: 006-00C
RETURN BID TO: Pat Persichino,Director of General Services
915 10th Street, P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (006-00C) for: Colorado Family Preservation Act—Foster Parent Core
Training, 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 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 Foster Parent Core Training Program must provide
services that focus on providing psychological consultations and parenting support to foster parents which are
designed to improve foster parent competency, family conflict management, and effectively accessing
community resources. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work
Delivery Date
(After receipt of order) BID MUST BE SIGNED IN INK
lor•i $cllet14.r M5 L
TYPED OR PRINTED SIGNATURE
VENDOR C-2144 joi crrncgtaa ins Lit L.c.
ame Han tt Signature By Authorized
Officer or Agent of Vender
ADDRESS gi o I al-inS4ILQJ TITLE
CD 2%3/ DATE
PHONE# 970 Sia. -%3Z3
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 34
ediA
vi CBid No.002-05 Attached A
Date of Meetings)with Social Services Division Supervisor.
Comments by SSD Supervisor: / t / `�
al`s yp
ag,S ; ' -
tc4-__ab- I�F��D
11 ,rinee.. dt /10ea y_ CLs�-r
tttttl4 0r.tvr u.vK�
71A,140
s •
Name and Signature . SS a ' • • r Date
•
•
Page 24 of 35
Staff Qualifications
A. All the providers exceed the minimum qualifications needed for both
education and experience. All providers have their Master's Degree in Counseling
or Registered Nursing Degree. In addition, the therapists have between 8-20 years
a piece providing services for families. See Resumes in Appendix B.
B. Staff available for this project consists of five experienced specialists that have
a similar core value of clinical excellence. We believe in providing strength-
based, services that empower the families we serve. Another strength of our staff
is our diverse areas of specialties.
• Lori Kochevar a licensed professional counselor has extensive experience and
training in providing services and supervision using the family preservation
model. She has been working in the field for over twenty years and has been in
child welfare for the last ten of those. She has specialized training in
substance abuse, attachment and bonding, trauma, grief, and domestic violence.
In the last fifteen years Lori has developed and facilitated multiple training's
that emphasize experiential learning opportunities. Many of these training's
were developed specifically for foster parents, while others were created for
families, school personnel, and service providers across the state.
• Heidi Friese has a master's degree that includes specialization in public child
welfare, as part of government efforts to improve the foster care system, and
trauma counseling. She has over ten years of experience in child welfare, as
well as over fifteen years experience working with children. As a caseworker
in Milwaukee County's child welfare system, Heidi worked in the foster care
(carrying foster child and birth parent cases), family reunification (intensive
service provision to foster children and birth parents to reunify birth families),
and adoption units. In recent years, she has been the Child Placement
Supervisor for the Institute for Attachment and Child Development, specializes
in the treatment of foster children with attachment issues using Love and
Logic. Heidi has also provided outpatient and intensive therapy, as well as in-
home therapy, including Wraparound.
• Bill George has a master's degree in counseling from the University of
Northern Colorado. He has over twenty years of experience in the field and is
certified in many areas of practice. He has specialized training in individual
and group services as a member of a psychiatric crisis team, drug and alcohol
counselor, medical social worker, and vocational rehabilitation specialist. He
is a Certified Alcohol and Drug Counselor in the State of Colorado, level III
15
and an Expert Witness. Most recently he became certified as a Disability
Management Specialist and has provided evaluations, vocational testing and
assessments for the Department of Veteran Affairs. He is currently taking
additional training on therapeutic attachment and bonding issues.
• Ellenor Dominguez has a master's degree in counseling and is bilingual in
Spanish. She has eight years of experience with Weld County Social Services,
and is well respected by her colleagues. Last year, she received the prestigious
title of caseworker of the year. She received her Master's degree from the
University of Northern Colorado. Over the last ten years Ellenor, has worked
as a caseworker HI, Case aid, Supervisor, and lead Counselor at a Women's
Place, and Migrant Outreach Coordinator. She has extensive experience with
mono-lingual families in the community and community resources. She is
currently taking additional training on therapeutic attachment and bonding
issues.
• Lisa Downs is a licensed professional counselor and a registered play therapist.
She received her Master's degree from the University of Northern Colorado.
She has experience working with children and families in both the mental
health and school setting. Her expertises are working with families that have
been affected by drug or alcohol addiction, play therapy, and women's issues.
Along with being skilled trainers, due to our extensive background as caseworkers
and therapists we are knowledgeable of the systems (i.e... biological families,
social services, mental health services, legal services, etc...) that foster parents
need to interface with as advocates for the children that are placed with them.
16
Appendix A
Jubilee Center for Families
♦♦♦
810 12th Street♦Greeley CO 80631
Phone(970) 352-8873♦Fax(970) 352-8879
December 20, 2005
Dear Management Team at Social Services,
As requested,the 2005 evaluations of the foster parent support groups are attached.
These groups have been very successful. At this time, all of our groups are full and we have
several request to join a support group as openings come up.
After reviewing the feedback from both the foster parent coordinators and the foster
parents, we have implemented several changes. At the beginning of each group we will review
and answer any questions regarding the foster parent newsletter sent out by the coordinators.
Many of the foster parents have requested group more frequently and or longer time periods. We
have increased the structure(timing each couple)and will provide written handouts that foster
parents can review between sessions to increase learning opportunities. In addition, as topics of
concern for the department arise,we would be happy to process these issues with the foster
parents in our groups.
In reviewing the evaluations of the groups, most foster parents indicate that the support
and insight gained from informational topics and other group members is very valuable. As the
facilitators,we have noted that as foster parents learn to work smoothly with the system and
have specific concrete therapeutic parenting support that they are better able to meet the
complex needs of the foster children. It is delightful to watch them mature in their ability to
provide theraputic responses to very dysfunctional behavior. Over the last year,we have noticed
an increased sophistication and pure desire to help children heal in many of the foster parents we
have been blessed to work with.
Thank you for this opportunity to work with the foster families you support.
Sincerely,
42,4 rtichttak„
Lori Kochevar M.S.
Licensed Professional Counselor
Jubilee Center for Families - Facilitator, Lori Kochevar Ft Lupton FP Group
1 -Strongly Disagree 5-Strongly Agree Scores
The groups meet my expectations 4.88 out of 5.00
The group facilitator presents information in an organized, understandable way 4.88 out of 5.00
The information gained in group is valuable to me 4.88 out of 5.00
I believe that groups help me better meet the needs for the children I serve 4.88 out of 5.00
I would recommend joining a foster parent support group to others 4.88 out of 5.00
The group is helpful and relative to my needs 4.88 out of 5.00
• Other group member's opinions and insight are valuable to me 4.63 out of 5.00
During groups the most beneficial parts are
Listening to other couples with their concerns, problems, successes etc. Meeting with people that know what you
have gone thru or are going thru
Information shared, suggestions and knowing there are other people with the same concern
Support of other parents going through the same things as us
Sharing, caring and lots of support
Sharing different problems about things that go on in our home that you can't share with normal friends
Learning about good doctor to take the kid to
Learning the needs of other foster parents and foster children
During group the thing's I would like to change most are
Nothing at this time
Unknown as of today
Let's wait and see
Nothing really maybe have them more frequently
Nothing, our group is so open with each other it is like therapy for us
None
During these groups this year I learned or relearned
Court process, documentation, need of therapy, things to watch with your children
The rules and regulations
What's going on with Weld County
That there is lots and lots of support
How we can handle different situations that you might not have known before
I learned how to understand my kids and held them better
Updates of policies and new information, foster care needs
Things that might increase my leamina next year are
Unknown as of today
Meet twice a month
Maybe talk sometimes about other training topics
Go over different topics like attachment disorder and other problems that children have
The more people we have in a group I think the more we can learn
More specialized training on foster children
F
•
Jubilee Center for Families - Facilitator, Lori Kochevar Attachment 2 FP Group
1 -Strongly Disagree 5- Strongly Agree Scores
The groups meet my expectations 4.88 out of 5.00
The group facilitator presents information in an organized, understandable way 4.88 out of 5.00
The information gained in group is valuable to me 4.88 out of 5.00
I believe that groups help me better meet the needs for the children I serve 4.63 out of 5.00
I would recommend joining a foster parent support group to others 5.00 out of 5.00
The group is helpful and relative to my needs 4.88 out of 5.00
Other group members opinions and insight are valuable to me 4.88 out of 5.00
During groups the most beneficial parts are
Sharing information, getting ideas, having someone to talk to
Being able to talk to another about what is going on
Hearing actual problems from all participants and the give and take to try to come up with solutions
Discussing relevant items or situations as they arise. Having the positive support of other foster parents. Being able to
share openly with those in the same situation.
Discussion, venting in safe"ok" place, hearing experience of others, training around what we are going through
Being able to talk to about things and other know what you're going through
Talking and helping other parents out
During group the thing's I would like to change most are
Nothing
Just one 5 minute break in the middle of class. Mental break time
Meet more than once a month
More often-not enough time in one meeting/month to get to it all
Nothing really
During these groups this year I learned or relearned
Reinforced Love and Logic techniques, learned about attachment disorder and how to help affected kids
How to understand what is going on with the kids in our house
I don't have much background in formal study in adolescent psychology so much of what is presented is new to me and
very valuable
Love and logic, documentation, being"a team"member
Foster care system, dealing with drug-affected babies, attachment disorder and how to deal with it, how to keep bio and
other foster kids safe in system
Share the different sort of needs the children need
Things that might increase my learning next year are
Just continued discussion and sharing
Have this every two weeks
Good mix of written, video and oral presentation
Meeting more frequently
More love and logic pieces/information
4
Jubilee Center for Families - Facilitator, Lori Kochevar South County FP Group
1 -Strongly Disagree 5-Strongly Agree Scores
The groups meet my expectations 4.00 out of 5.00
The group facilitator presents information in an organized, understandable way 4.40 out of 5.00
The information gained in group is valuable to me 4.40 out of 5.00
I believe that groups help me better meet the needs for the children I serve 4.60 out of 5.00
I would recommend joining a foster parent support group to others 4.80 out of 5.00
The group is helpful and relative to my needs 4.80 out of 5.00
Other group member's opinions and insight are valuable to me 5.00 out of 5.00
During groups the most beneficial parts are
All the recent and up to date information brought to us by Lori and other foster parents. Also hearing the same things
over time help to concrete it in my mind and to understand better
Finding out how others deal with same kind of problems
Talking with other families and seeing how they meet their needs
Listening to other foster parents. Clarification on the information given at round the tables and such
Listening to everybody's problems and hearing solutions on how they solve the problem
During group the thing's I would like to change most are
I like it the way it is
Hours(more)
I feel like specific questions on situations I have are not answered by the facilitator
Nothing
During these groups this year I learned or relearned
Talking about issues or problems with others who are in this system greatly reduces stress, helps me vent and learn new
approaches
Coping techniques
Both
How to better understand some of the children's problems and to hear other foster parents solutions, what they did to fix it
Things that might increase my learning next year are
Available resources, setting and enforcing limits, effects of trauma on development, re-directing misbehavior
Attending more groups
Everything is good, I learn every time we have a group meeting
5 .
•
Jubilee Center for Families - Facilitator, Lori Kochvar Foster Adoption Group
1 -Strongly Disagree 5-Strongly Agree Scores
The groups meet my expectations 4.25 out of 5.00
The group facilitator presents information in an organized, understandable way 4.63 out of 5.00
The information gained in group is valuable to me 4.50 out of 5.00
I believe that groups help me better meet the needs for the children I serve 4.63 out of 5.00
I would recommend joining a foster parent support group to others 4.75 out of 5.00
The group is helpful and relative to my needs 4.50 out of 5.00
Other group member's opinions and insight are valuable to me 4.63 out of 5.00
During groups the most beneficial parts are
Open communication with other adults/parents in similar situations where it is bound by confidentiality. Sharing of
opinions helps me gauge if I am on the right track or not
Hearing that I'm not crazy and other are going through the same stuff or have gone through it
Talking about each foster parents situation
Support and better understanding of foster children's needs
The caring between individuals, the professionalism and resource that Lori presents
Sharing and listening to each member's experience related to their foster situation
The opportunity to share common experiences, and receive support
Sharing difficult and exciting events in our foster son's adjustment, listening to other's experiences
During group the thing's I would like to change most are
Running out of time, forcing ourselves to cut our discussions at the end
Having enough time(Not longer, there just isn't enough time in a day)
Talk more on the social service system and how to better serve out fost-adopt situation
Sometimes it is hard to get around to all the needs of each member. Sometimes need more chance/time to share
Expand on topics such as child bonding with foster parents or other foster parent related material(Videos, etc)
Nothing really. Start at 7 pm?
Changing meeting time to 7pm
During these groups this earl Iearned or relearned
Age appropriate behaviors and misbehaviors, basics of attachment disorders, disciplining philosophies
Without this support I would have gone crazy with all the court dates
Relating to others needs and how we are so much alike
Much about traumatized children
So much about being foster parents. The caring needed for special needs kids
How involved the foster care system is
Most of our experiences are not unique-merely how we interpret them
How to reduce stress in my life
Things that might increase my learning next year are
A baseline of experience, discussion of any changes within the DDS system, Discussion of"Youth in Crisis"
emancipation/bonding program
more foster parent meetings
Don't know
Take home to read literature
More Love and Logic discussion
2
• Jubilee Center for Families - Facilitator, Lori Kochevar Attachment Group
1 -Strongly Disagree 5-Strongly Agree Scores
The groups meet my expectations 4.63 out of 5.00
The group facilitator presents information in an organized, understandable 4.50 out of 5.00
The information gained in group is valuable to me 4.63 out of 5.00
I believe that groups help me better meet the needs for the children I 4.63 out of 5.00
I would recommend joining a foster parent support group to others 4.75 out of 5.00
The group is helpful and relative to my needs 4.63 out of 5.00
Other group member's opinions and insight are valuable to me 4.68 out of 5.00
During groups the most beneficial parts are
Hearing other peoples problems and solutions
Being able to discuss things with each other
Sharing information and stories, support from people who"get it"
Sharing similar experiences
Sharing of experiences, resources and frustrations. Learning different ways of handling issues and behavior
Seeing that others have the same challenges as you do and seeing how they handle issues. Seeing what works
for others
Validation that my instincts are working properly by connecting with others experiences
Parents stories of reality in their home
During group the thing's I would like to change most are
The chairs
Set aside a portion of every or every other group to discuss a specified topic
More structure/topics
I don't see a need to change anything other than including another 2-3 people
Group size could be a tad large but everything else is good
The chairs-some are really comfortable while others are really uncomfortable for the time you are in them
Getting started late
During these groups this year I learned or relearned
How much what we do effects the children
About the different needs of children in different situations
Typical behaviors of traumatized kids, parenting techniques
Changing rules with DSS
How trauma is multifaceted and the long lasting if not permanent effect it has on children psychologically and
physiologically
Hang in there. Your children need you
To trust my instincts
The value of collective thought-getting other ideas from many perspectives
Things that might increase my learning next year are
See question 2"Set aside a portion of every or every other group to discuss a specified topic"
Take home material on references for me to look at and read and to have available
Maybe some new families with some new issues
More reference material-videos ect
A wider range of reference sources
7
Jubilee Center for Families - Facilitator, Lori Kochevar Love & Logic FP Group
1 -Strongly Disagree 5--Strongly Agree Scores
The groups meet my expectations 4.75 out of 5.00
The group facilitator presents information in an organized, understandable way 4.75 out of 5.00
The information gained in group is valuable to me 4.75 out of 5.00
I believe that groups help me better meet the needs for the children I serve 5.00 out of 5.00
I would recommend joining a foster parent support group to others 4.88 out of 5.00
The group is helpful and relative to my needs 4.88 out of 5.00
Other group member's opinions and insight are valuable to me 4.75 out of 5.00
During groups the most beneficial parts are
Getting ideas from other foster parents and what has and hasn't worked for them, I tell people about itSIN:113 a tFf lywto
Support and information
Getting information from other group members and talking about things that happen in our home and learning how to
deal with it
Discussing problems that range from behavior uses with children to getting support for them and the rest of the family
as well. Getting input from other foster parents on things they have dealt with that are similar to the problems we are
dealing with. Getting names of conselors and other groups or associations that can help foster children and/or families.
How to better deal with foster children and their problems in a constructive manner
Sharing ideas with other group members on how to help the children
Everyone having and giving input on topics of interest. I learn new things from foster parents at every group meeting
Information, support, experiences
Listening to all the other foster parents and how they get through their harder times, and different ways to get support
During group the thing's I would like to change most are
Possibly going a little longer since we all like to check in and sometimes we run out of time
I am ok with the way the groups are, they're helpful
Nothing
The thing I would like to change most are the time of the group meetings. I'd like an earlier time to meet
Nothing
Nothing
During these groups this year I learned or relearned
Some of the love and logic ways to deal with kids in certain situations
I leam how to use empathy in working with the boys, and the ability to redirect mis-behavior
What to look for with attachment issues and ways to deal with them also where to get help for them. Better ways to
communicate with children at their level, to help them understand boundaries
Each child has different wants and needs and how to deal with them
About trauma that can start before birth
So many things!
Different ways to control my home and to deal with my kids
Things that might increase my learning next year are
Switching groups so you meet new foster parents and get new ideas. Maybe stay with a group for a year and then that
way you might get new insight from other families
Just to reinterate love and logic and support groups to help with medical and emotional problems
To keep the group small and informal. I really have enjoyed being in your group.
More info
Appendix B
LORI KOCHEVAR, M.S., L.P.C.
2118 19th Avenue
Greeley, CO 80631
(970) 353-6568
EDUCATION:
University of Southern Mississippi, M.S.
Counseling Psychology,
Cumulative GPA 3.8 _ •
University of Northern Colorado, B.A.
Pre-Professional Psychology,
Cumulative GPA 3.5
PROFESSIONAL
EXPERIENCE:
•
5/95 - PRIVATE PRACTICE THERAPIST, STRETCHING
OUR STRENGTHS
Serve others through a creative process that stretches participants
strengths and provides an environment for authentic healing. Facilitate
opportunity for individuals, families, and groups to participate in body
-centered spiritually based psychotherapy. Interpersonal dynamic
facilitation for community development team building, stress
reduction, anger management, parenting, and personal effectiveness
are available.
5/95 - 9/96 DIRECTOR,-VALLEY COMMUNITY FUND
Serve and manage Board of Directors to strengthen the internal
structure of the agency to increase fundraising capabilities.
Responsibilities include: access state, government, and businesses
to participate in payroll deduction, grant writing, marketing, coorcination
of special events and community trainings, and dlsbusement of funds.
5/92 - 5/95 FAMILY PRESERVATION SPECIALIST, SAN LUIS VALLEY
MENTAL HEALTH CENTER
Provide intensive home-based treatment for families that are at risk of
having youth removed from the home. Intervention emphasizing
strength-based approaches, inducing psychotherapy, skill building
(parenting, communication, anger control, problem-solving, etc.),
educational support, and assistance in obtaining support for concrete
needs. Management duties: public relations, supervise students,
hire staff, and provide training for staff and community.
3/92 - 5/95 WILDERNESS THERAPIST, SAN LUIS VALLEY MENTAL
HEALTH CENTER
Provide intensive tent-based treatment for youth ages 8-17. Facilitate
opportunities for young people to learn skills in leadership, team work,
decision making dealing with stress, facing fears, and building
responsibility. Use outdoor challenge course experience such as
ratting, backpacking, mountaineering, and rods climbing to provide skills
based learning opportunities.
5/89 - 5/91 CONSULTANT, GRADUATE ASSISTANT, UNIVERSITY
AFFLILIATED PROGRAM, UNIVERISTY OF SOUTHERN-
MISSISSIPPI
Participating in an interdisciplinary team that provides assistance for
community-based child care centers who serve children with
disabilities and their families. Responsibilities include: Grant writing,
development and presentation of awareness training, assessment of
learning environment and handicapping conditions. Provide
consultation for teachers and parents using a coaching model, skills-
based training, and evaluation of improvement
1/89 - 5/89 TEACHING ASSISTANT, UNIVERSITY OF NORTHERN
COLORADO
Teach skills for report writing and use of computer programs, PC Write
and Labstat Teach weekly labs and grade lab reports.
4/86 - 9/89 RECREATION SUPERVISION, BOYS AND GIRLS
CLUB OF GREELEY
` Providing guidance and support for at-risk youth, fundraising, program
planning, facilitate teenage drug and pregnancy prevention program,
family and community involvement, organization and supervision of
field trips, and participation in local and national staff development
!raining-
INVOLVEMENT:
FOUNDER, BOARD MEMBER, BOYS AND GIRLS CLUB OF
ALAMOSA
Spearhead community organization to obtain Boys and Girls Club.
Organize fundraising, board development, marketing, and regional and
natonal netwodcing.
MEMBER, SAN LUIS VALLEY COALITION FOR YOUTH
SERVICES .
Member of steering committee and chairperson of the multicultural task
force.
•
CONFERENCES:
SPIRITUAL
2000 Hakomi Training
11/05/99 Mariane Williamson - Enchanted Love
10/22-24/99 Shapeshif ing: Shamanic Trartormation
1999 Women Who Run With the Wolves -Jungian
10/5-17/99 Phoenix Rising: Yoga Therapy Levels 1 and 2
09/24-26/99 Energy Medicine - Donna Eden
08/19/99 James Redfield -The Celestine Prophecy -
08/14/99 Ruth and Naomi - Women's Partnerships
04/24/99 Substanability and Spirituality -
04/23/99 Time, Money and the Meaning of Life
03/19/99 Gandhi's Search for Meaning
10/23/98 Spirituality and Religion
06/06/98 Tying it all Together - Biblical Overview
03/28/99 Transformation-Job of the Old Testament
03/06/98 Matthew Fox- Spirituality of Compassion
11/6-9/97 Common Boundaries: Joy of Creation
07/10-13/97 Body and Soul Conference
04/26/97 Day of Prayer
04/19/97 Contemplative Living
1997 Catholic Biblical School
11/6-10/96 Common Boundaries: intentional Living
1993-1995 Creative Process
COMMUNITY DEVELOPMENT
1/7-8/00 Foster Parent Core Training
10/30/99 Matrix Leadership
10/21-22/96 f Working as Partners with Managed Care
04/02-05/95 Leadership for Executive Directors
03/29/95 - Fundsaving Workshop
Fall 1995 Leading Edge/Business
02/09-13/95 Challenge by Choice: Ropes Course
05/20-22/94 Organizational Conflict Management: CSAP
05/06/94 CPR and First Aid Certification
02/01-/4/94 Multicultural Conference
11/30/93 Exploring Mul6aiturahsm Within
10/13/93 Conflict ediation Training
08/11-14/92 Multiafhrral Training: CSAP
05/12-26/89 Women as Leaders
FAMILIES
06/4-6/99 Passionate Marriage
10/15-19/98 Marriage and Family Conference
05/16-17/98 Relationship Enhancement
t
12/08-9/97 Family Group Decision Making
10/06/97 Family Group Decision Making
05/2-3/97 Marriage and Family
9/15-16/94 Family Preservation - Supervision
07/20/94 Jim Fay Parenting
07/13/94 Family Sculpting .
4/26-27/93 Family Sculpting
Spring 1993 Redirecting Chidren's Behavior
02/06/93 Meaningful Family Comunication
07/070-8/92 Active Parenting
03/16-19/92 Famiy Preservation Training
•09/20-21/90 Parents and Professionals United
CHILDREN AND ADOLESCENTS
09/10/99 Testifying in Child Abuse Caes
07/12/99 Restarting- Prevention and Intervention
01/29/99 Play Therapy
12/11/98 Attachment Disorders
10/18/97 Art Therapy for Children
04/04/97 Attachment Disorder
10/11-13/96 International Play Therapy Conference
07/8-9/94 Play Therapy
09/26/93 Traumatic Stress Reactins in Children
03/11-14/93 Child Adolescent Conference
Spring 1993 . - Play Therapy Class
02/16-17/91 Strategic Therapy for Adolescence
10/11-13/90 C.H.A.D.D. Conference on ADHD
05/30-6/1/90 Early Intervention
12/05/89 Play Assessment
TRAUMA AND GRIEF REACTIONS
12/03/99 Jurisprudence Workshop
06/25/99 Molecule of Emotions
04/09/99 Depression and Anxiety
05/19/97 Cultural Grief
09/14-16/95 Annual Hospice Conference
04/14/94 Empowering Resistive Client II
06/09/93 Empowering Resistive Clients
09/17-19/92 Annual Mental Health Conference
• SUBSTANCE ABUSE AND DOMESTIC VIOLENCE
10/14/98 Working with Aggression in group Therapy
09/23/97 Domestic Violence
09/17/97 Substsance Abuse
05/16-17/94 FPS - Motivational Interviewing- Jill Kenney
05/3-14/94 Teen Baseline TOF - Drug Prevention
10/5-9/93 Baseline TOF - Drug Prevention
04/23-24/92 Domestic Violence Conference
San Luis Valley
•
0 Comprehensive Community
•
Mental Health Center
CLINIC OFFICE
ADMIN AND CUNIC OFFICE 1015 FOURTH STREET CLINIC OFFICE
522 ALAMOSA AVENUE ALAMOSA.CO 81101 402 FOURTH STREET
ALAMOSA.CO 81101 TDD 719-589-3671 MONTE VISTA.CO 81 144
719-589-3673 719-589-3671 719-852-5186
FAX 719-589-1521 FAX 719-589-9136 FAX 719-852-3043
August 6, 1996
26041 Woodland Ave.
Esparto, CA 95627
Dear Colleagues:
I have worked very closely with Lori in the Family Preservation program. Lori has
been a wonderful asset to this program and to all her colleagues at Mental Health.
More importantly, her dedicated and skillful service to our dients has greatly benefitted
many SLV families.
Lori's skills are numerous. She is well organized and very conscientious. She has
excellent speaking and writing skills. Her forte is her ability to work with all kinds of
people, and work through difficult interpersonal situations. Lori has consistently
impressed me with her resilience and problem solving skills in dealing with some of the
most chaotic and resistive families. In working with these families, Lori has also come to
know the needs of SLV families and has become an expert in resources that are
available throughout the Valley. She has worked in every county in the Valley.
Despite carrying a full caseload of challenging cases, Lori took time off" for herself
by making solid contributions to other programs. I was amazed to see Lori doing good
work for such things as the Mental Health Center's Wilderness Program, the Boys and
Girls Club of Alamosa, the Multicultural Awareness Committee and the Drug and
Alcohol Baseline program. She attended trainings in all of these programs and then
consistently returned to share her expertise and take responsible roles in each, and
handling the mix of responsibilities effectively.
Lori has a strong philosophical commitment to the empowerment of the oppressed.
Lori will direct people toward healthy, fun relationships. Lori will earn the confidence of
the people with whom she works: staff, clients, and community leaders. I highly
recommend her.
Sincerely,
Offering Comprehensive Mental Health Core For The Entire Son Luis Volley
Lisa R. Downs
4925 WCR 83
Roggen, CO 80653
Home(303) 514-6129
Work(970) 867-3770
SUMMARY OF OUALIFICATIONS
Insightful, creative, dedicated counselor who quickly establishes rapport with children and
adults of all ages. Able to facilitate change and outcomes by consistently communicating
respect and holding a belief that children, adults and families have the ability to heal.
Special skills include but are not limited to:
*Trained child/play therapist *Child and Adult Trauma *Children's Groups
*Supervision skilled *Crisis Management *Severe Mental Illness
EDUCATION
May 1996-December 2000
M.A. Community Counseling
University of Northern Colorado, Greeley, CO
August 1986-December 1990
B.A. Psychology, Minor in Music
University of North Dakota, Grand Forks,ND
August 1985-May 1986
General Education, Music & Sports Scholarships •
Tabor College, Hillsboro, KS
Numerous professional courses and workshops attended to specialize in: child
development, divorce, play therapy, social skills training and crisis counseling.
CERTIFICATION/LICENSURE
L.P.C.-#3374
N.C.C. National Certified Counselor-#67252
A.C.A. American Counseling Association Member-#06115160
R.P.T. Registered Play Therapist Certification -T-862
PROFESSIONAL EXPERIENCE
CROSSROADS COUNSELING CENTER,Ft Morgan,CO March 2003 to present
Self Employed Mental Health Therapist
Providing individual,group and child therapy.
CENTENNIAL MENTAL HEALTH CENTER, Ft Morgan, CO Dec. 2000-March 2003
Mental Health Professional II
• Provided counseling to court ordered and self-referred clients including: performing the initial
assessment,administering the mental status exam,creating treatment plans,providing individual and
group therapy,testifying in court on dependency and neglect cases and case management.
• Provided on-call crisis management which included evaluations for 72 hour holds.
• Counseled adults,children and couples with a wide range of emotional issues. This included
providing therapy to individuals with persistent mental illness and developmental delays.
CENTENNIAL MENTAL HEALTH CENTER,Ft. Morgan CO Jan. 1999-Dec.2000
Therapist Intern: Outpatient Team
• Co-facilitated therapeutic groups,conducted individual and group intakes,consulted with co-workers
to assess client progress,diagnosed clients and planned treatment strategies and group supervision
with co-workers.
• Counseled clients who were diagnosed with various mental health issues,differing forms of abuse,
family issues,gender issues,and dependence and neglect cases.
UNIVERSITY OF NORTHERN COLORADO, Greeley, CO Aug. 1998-Dec. 1998
Practicum: Master's Program
• Scheduled and treated individual clients.
• Observed peers through a one-way mirror.
• Conceptualized and treated individuals from different theoretical orientations.
HIGH PLAINS EDUCATIONAL COOPERATIVE, Ulysses, KS Aug. 1990-May 1993
School Psychologist Para-Professional: Undergraduate Experience
• Consulted with teachers regarding behavioral strategies for those with special needs,observed
children with developmental delays,provided counseling to parents,and conducted achievement
testing and behavioral assessments for brief therapeutic interventions.
Heidi S. Friese, LCSW
Experience
Kinder Kounseling
September 2003 to present
Therapist, Owner
Providing therapy to children, adolescents, adults, couples, and families.
•
Specializing in work with adoption, trauma, and Attachment Disorder.
Institute for Attachment and Child Development
August 2002 to present
Therapist, Training Coordinator
Child Placement Supervisor, Clinical Services Manager
Providing outpatient and intensive therapy to children and families.
Coordinate workshops, conferences, and Therapist Training Program
both on site as well as throughout the country.
Recruitment, initial licensure, training, and maintenance of licensure
for agency therapeutic foster homes.
Responding to initial and ongoing queries from potential clients and referral sources,
assessment of potential clients, as well as coordination of intake process.
Executive administrative responsibility when Clinical and Executive Directors absent.
Specializing in work with Attachment Disorder.
Child and Family Therapeutic Systems
November 1997 to August 2002
Child and Family Therapist
Provide outpatient and in-home therapy to individuals, couples, families, and groups.
Specializing in work with children, teenagers, trauma, and attachment problems.
Children's Service Society of Wisconsin
April 2000 to October 2000
Second team member
Provide in-home therapy for children, teenagers, and their families.
Client referrals primarily received form public child welfare system.
Milwaukee County Department of Human Services, Youth Services Division
March 1995 to April 2000
Human Service Worker, Child Welfare
Experienced in Adoption, Foster Care, and Family Reunification.
Assess and supervise family situations to protect the best interest of children.
References available upon request
Heidi S. Friese, LCSW
(nee Wilmanns)
901 Granite Court, Longmont, Colorado 80501
home 303-684-6847; cell 303-921-2173
Objective
To obtain a position as a therapist,
utilizing my skills and knowledge to promote personal growth of others.
Professional Qualifications
Clinical Social Worker license granted by the State of Colorado,
Department of Regulatory Agencies, on May 30, 2003.
Clinical Social Worker license granted by the State of Wisconsin,
Department of Regulation and Licensing, on February 27, 2003.
Advanced Practice Social Worker certification granted by the State of Wisconsin,
Department of Regulation and Licensing, on December 17, 1999.
Masters of Social Work conferred on August 9, 1997,
by the University of Wisconsin—Milwaukee.
Completed the Trauma Counseling Program, Child Welfare Training Program,
Marriage and Family Therapy curriculum, field experience in public child welfare.
Initiation into Upsilon Chapter of Alpha Delta Mu National Social Work Honor Society
on December 8, 1996.
Bachelor of Arts in Psychology conferred in May of 1991
by the University of Wisconsin—Milwaukee.
Maintain a Strengths Perspective Approach with colleagues and clients.
Communicate eloquently with professionals and clients, including those resistant to
intervention. Proficient in handling the complexities of case management, including
multifaceted ongoing assessments, problem resolution, crisis intervention,
court appearances, knowledge of state statutes, case documentation,
visitation scheduling, and referrals and coordination of services.
Strong background in childcare, complete with lapsed state certification.
Consistently maintain a professional demeanor.
Member of the National Association of Social Workers.
References
Beverly Baker White, M.A., LPC
Clinical Supervisor and colleague through the
Institute for Attachment and Child Development
8094 South Trinchera Peak
Littleton, Colorado 80127
303-9-4-3012
Forrest Lien, LCSW
Clinical Director and colleague at the
Institute for Attachment and Child Development
5911 South Middlefield Road, #102
Littleton, Colorado 80123
303-904-0038
Jennifer Lant, MSW
Coworker with the Milwaukee County
Department of Human Services, Child Welfare Division
10267 Glassboro Court
Las Vegas, Nevada 89123
702-205-9538
Lawrence Gross, MSW
Coworker with the Milwaukee County
Department of Human Services, Child Welfare Division
18685 Centennial Street
Hesperia, California 92345
760-617-7831
Paul Krepel, CICSW, MFT
Clinical Supervisor and Owner of
Child and Family Therapeutic Systems
4848 South 76 Street
Milwaukee, Wisconsin 53220
414-325-7741
William(Bill)E.George
4909 30th St
Greeley, CO 80634
Home Ph. (970) 339-9328
Cell Ph. (970)371-2220
E-mail bgeorgel6@comcast net
objective
To work as a health care professional where I can utilize my skills in counseling, case
management and health care coordination.
Relevant Skills
Clinical Knowledge&Practice:
• Unique ability to communicate with people in stressful situations, establish trust and
facilitate positive change.
• Have counseled adults in both outpatient and inpatient settings. Over six years of
experience in group and individual therapy. Experience in mental health and substance
abuse assessments with adults and adolescents. Identification of appropriate diagnoses
using ICD-9 and DSM IV-TR.
• Over ten years of case management experience coordinating patient focused outcomes.
Excellent problem resolution skills through face to face intervention or telephone. The
ability to gather and synthesize sensitive information from people with varied
backgrounds.
• Experience in home visits to clients for vocational/medial disability evaluations.
• Expertise in medical and psychiatric utilization review. A unique blend of clinical
background including mental health, substance abuse,vocational rehabilitation
counseling or consultation and disability management
Administrative&Organizational Strengths:
• In a director-level position, made policy decisions, delegated work, handled problems,
oversaw budget and represented interests for a non-profit organization.
• Proven skills in classifying and organizing information, allowing for quick access to
needed facts and resources.
• Implemented new treatment curriculum for a non-profit agency.
• Possess broad computer background in database administration, Microsoft Word and
Internet
Background in Employee Relations&Training:
• Completed graduate-level training in counseling/interpersonal communications.
• For more than five years, have provided employee relations counseling and support to
team members.
• Skilled in creating a confidential environment, sharing company-policy information,
coaching employees on options, and operating within established guidelines.
• Provided ongoing training and support to team members regarding procedures, policies,
and computer tools.
• Have completed extensive course work addressing personality and learning styles, and
the development of effective training methods and curricula.
Skills in Management&Supervision:
• Supervised seven highly-skilled case management professionals, providing guidance,
monitoring work quality and deadlines, and overseeing reporting and administrative
activities.
• Supervised three counselors and provided clinical supervision of two hundred clients for
an outpatient alcohol/drug treatment program.
• Have consistently received positive feedback for managerial and administrative work
•
performed. Comment from previous supervisor. "He is not afraid to face a challenge,
and works as a team player. He had a good grasp on the business end, and follows up
every step of the way."
• Excellent oral/written communication abilities, especially for status reports, business
correspondence, etc. Comments from a provider-He was kind, direct,thorough and
respectful.'
Benefits Knowledge:
• Knowledge of COBRA, HIPAA, Workers'Compensation, labor acts, and discrimination
policies.
• Extensive background in benefits claims handling, including serving as a liaison between
the plan participant, the insurance provider, and other related parties.
• Highly accomplished at managing enormous amounts of data: Was responsible for
knowing the details for more than 30 different benefit insurance plans, as well as
monitoring eligibility status for thousands of plan participants.
• Accomplished negotiator. Coordinated treatment with various providers, insurance
companies. Arranged costs and pricing with a range of service providers, including home
health care, skilled nursing facilities, rehabilitation centers, and hospitals.
Work History:
2003-Present Vocationai/Medical Genex-Denver, CO
Case Manager
2001 -2002 Medical Case Manager Sedgwick CMS-Denver, CO
2000-2001 Clinical Director Mile High Council on Alcoholism and Drug Abuse-
1994-2001 On-call Therapist Longmont United Hospital-Longmont, CO
1994-2000 Health Management Zenith Administrators-Westminster, CO
Coordinator
1987-1993 Supervisor Intracorp-Denver, CO
(Also held positions as Psychiatric Case Coordinator and Rehabilitation
Specialist at Intracorp)
1983- 1987 Therapist Island Grove Regional Treatment Center-
Greeley, CO
•
1980- 1983 Psychiatric Team Assistant North Colorado Medical Center-Greeley, CO
Education:
University of Northern Colorado, MA, Psychology, Counseling &Guidance with emphasis in
Agency Counseling, 1984
University of Northern Colorado, BA, Psychology, 1980
Certifications:
Certified Case Manager, Certified Disability Management Specialist
Alcohol and Drug Counselor,Level III
•
PROFESSIONAL AND PERSONAL REFERENCES
William E. George
4909 30th St.
Greeley, Colorado 80634
Home(970)339-9328
Work(970)339-3427
Professional References:
Ellen Goren,Vocational Rehabilitation Counselor
16739 E. Arkansas Dr.
Aurora,CO 80017
(303) 369-8884
Mary Anderson,Previous Supervisor
19053 E. Low Dr.
Aurora,CO 80015
(303)287-3748
Joan Lee, Previous Supervisor
915 W. 44th
Loveland,CO 80538
(970)635-9679
Cathleen Cundell, Previous Supervisor
Longmont United Hospital-ATS
1331 Linden St
Longmont, Colorado 80501
(303) 651-5388
DiAnn Kalvels,Previous Supervisor
1090 Birch St.
Broomfield, CO 80020
(303)469-9917
Anne Hazelton,MD,MSPH
11453 E. Orchard Place
Englewood, CO 80111
(303) 587-7879
Personal References:
Jackie Moore-Davis
4464 Pioneer Dr.
Greeley, Colorado 80634
(970) 381-3559
ELLENOR DOMINGUEZ
720 26 Avenue,Greeley,Colorado 80634(970) 392-2653
OBJECTIVE Seeking a challenging and rewarding position performing Home
Studies and utilizing my bi-lingual educational background to
assist clients in the bonding process with the children.
OVERVIEW OF
CAPABILITIES Offering a Masters degree and more than nine years of experience
on positions requiring the following abilities:
Interpersonal Relationships Crisis Intervention
Individual and Group Counseling Report Preparation
Advocacy Assessment
Understand and work closely with community referral agencies
Establish and maintain productive rapport with people of all
Backgrounds and socioeconomic levels
Communicate clearly and concisely, speak fluent Spanish
Possess sound judgment and excellent decision-making skills
Work efficiently and under pressure;good coping skills
EDUCATION UNIVERSITY OF NORTHERN COLORADO, Greeley, CO
Master of Arts Degree in Rehabilitation Counseling(1995)
Bachelor of Arts Degree in Psychology(1990)
EMPLOYMENT SOCIAL SERVICES,Greeley, CO 1/98-1/05
Caseworker III
Create client treatment plans and monitor client progress
Visit clients monthly to ensure safety and well being of children
• Work closely with attorneys and the legal community
Document client progress and distribute reports to appropriate
Individuals '
Utilize the TRAILS computer system to document case
information accurately
SOCIAL SERVICES,Greeley, CO 1/98-7/99
Case Service Aide
Supervise child/parent visitations to ensure appropriate and safe
Environment for children
Document and report findings to case workers;testify in court
Regarding home visit observations
Work closely with foster parents to coordinate visits and
transportation
•
El.i.FNOR DOMINGUEZ Page 2
EMPLOYMENT(cont.)
A WOMAN'S PLACE,Greeley, CO 10/95-1-98
Lead Connselor/Supervisor
Evaluate, provide individual and crisis counseling, and serve as
advocate for women and children victims of domestic violence
Establish and maintain effective working relationships with
community referral agencies resulting in a more effective
assistance program
Successfully initiated new counseling program for Spanish
speaking sector
Facilitate Spanish-speaking support groups
Oversee daily operations, scheduling, and safe-house coverage
Developed record-keeping forms used for reporting to Social
Services
CATHALIC CHARITIES, Greeley, CO 5/93-10/95
Migrant Outreach Coordinator
Visited homes and labor camps throughout Weld County,
providing supportive services
COLORADO EASTER SEALS,Denver,CO 4/94-11-94
Migrant Coordinator -
Participated in highly successful pilot program developed to work
with migrant workers with disabilities
Assessed needs, provided referrals to community agencies and
served as advocate for migrant farm workers with disabilities
Served as agency representative throughout Colorado
Print Date: 01/18/0 5
HEALTHCARE PROVIDERS
• £ SERVICE ORGANIZATION
PURCHASING GROUP
CERTIFICATE OF INSURANCE
, - w---? x,..1.4 .a. '-f r?—i 1-4 :
{
018098 970 HPG 0273177648 fro :12:01 AM Standard Time on:02/26/05
to:m 12:01 AM Standard lime on: le 2. 06
Lori Kochevar MS LPC LW Healthcare Providers Service Organization
810 12th Street 159 East County Line Road
Greeley, CO 80631-4022 Hatboro, PA 19040-1218
Medical Specialty: Code:? ;...., `- ':- �• `
Clinical Counselor Firm American Casualty Co. of Reading, PA
CNA Plaza 26S Chicago, IL 60685
A. PROFESSIONAL LIABILITY
Professional Liability (PL) $ 1,000,000 each claim $ 6,000,000 aggregate
Good Samaritan Liability included above k ` L----tilt lt
Personal Injury liability included above = -- rs,.3� = ,
Malplacement Liability included above
B. COVERAGE EXTENSIONS:
License rotection r in , a ate
Defendant Expense Benefit $ 10,000 aggregate
Deposition epresentation $ 10,0 ag regate
Assault $ 10,000 per incident $ 25,000 aggregate
Medical Pa ents 2 000 r rson 100 000 a ate
First Aid 2 500 a ate
Damage to Property of Others $ 2,500 per incident $ 10,000 aggregate
C. WORKPLACE LIABILITY Coverage part C.Workplace Liability does not apply if Coverage peril).General Liability is made part of this polio/.
Workplace Liability none
Fire &Water Legal Liability none
Personal Liability none
D. GENERAL LIABIUTY Coverage pad D.General Liability does not apply if coverage ,an C.Workplace Liability Is made pad Sift polio/.
' General Liability(GL) $1,000,000 each occurrence $1,000,000 aggregate
Hired Auto&Non Owned Auto included in UL limit above
Fire&Water Legal Liability included in GL limit above subject to $250,000 sub-limit
Personal Liability none
Total Premium: $ 673 .00 QUESTIONS?CALL: 1-888-288-3534
G-121500-C G-121501-C G-145184-A G-147292-A
G-144872-A G-123846-005 G-121504-C G-123827-B G-14123 9-A
Master Policy#188711433
Keep this document in a safe place. It and proof of payment are evidence of your insurance coverage.
()4 , / t,A 7k --t.
Chairman of the Board Secretary
-. — — •/.l n—...
® HEALTHCARE PROVIDERS
GENERAL LIABILITY COVERAGE PART ENDORSEMENT
Additional Insured General Liability
In consideration of the premium paid,and subject to the General Liability limit of liability shown on the
certificate of insurance,It is agreed that the GENERAL LIABILITY COVERAGE PART is amended as
follows:
The person or entity named below(the"additional insured")is an insured under this Coverage Part but
only as respects its liability arising out of named insured's operations, or premises owned by or rented
by the named insured and solely to the extent that:
1. a general liability claim is made against the named insured and the additional insured;and
2, in any ensuing litigation arising out of such claim,the named insured and the additional insured
remain as co-defendants.
In no event S there any coverage provided under this policy for an occurrence that is the direct liability
of the additional insured.
Additional Insured: State of Colorado
dJo Weld County Social Svs.
PO Box A
Creeley,CO 80634
This endorsement is a part of your policy and takes effect on the effective date of your policy, unless
another effective date is shown below. All other provisions of the policy remain unchanged.
Must Be Completed Complete Only When This Endorsement Is Not Prepared with the
Policy
Pr ENOT.NO. POLICY NO. ISSUED TO IS Not to be Effective with the Policy
I ENDORSEMENT EFFECTIVE DATE
j
01 j 0273177648 Lori Kochevar MS LPC LLC 2/28/2005
G-123827-B(07/2001)
Page 1 of t
TOTAL P.03
Appendix C
SUPPLEMENTAL NARRATIVE TO RFP:
EXHIBIT B
CONDITIONS
Lori Kochevar,MS LPC
810 12th Street
Greeley Co 80631 Weld County Dep
Soda.. Service . of
Clerical Unit
Weld County DSS
PO Box A APR 2 5 2005
Greeley Co 80631
Re: RFP 04005; Lifeskills
Re: RFP 006-00c: Foster Parent Consultation
Re: RFP 006-00a: Foster Parent Training
Re: RFP 006-00: Home Study
Dear Ms. Griego,
This letter serves as written confirmation that I received the results of the Bid
process for the 2005-2006. I am in agreement with the Commission's conditions with the
following clarifications.
The following is the response requested by the conditions for the RFP 05005,
Lifeskills.
Condition 1: Definition of our capacity to do after-hour visits.
We will have the capacity to see clients after 4 and on Saturdays as deemed appropriate
by caseworker and or client request. Appropriateness will be measured by safety
concerns for the children.
The following is the response requested by the conditions for the RFP 006-00 Home
Studies.
Condition 1: The threshold for hours for an incomplete home study will be set at
3.5 hours at our hourly rate of$85. Additional adults in the home were a home study is
being completed will be billed at $250.
Thank you for this opportunity to again serve the families of Weld County. Please let me
know if you are in need of any further clarification.
Sincerely,
Lori Kochevar M.S. LPC
41(
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
Lori Kochevar MS LPC
The Jubilee Center for Families
810 12th Street
Greeley,CO 80631
Re: RFP 05005:Lifesldlls
RFP 006-00C:Foster Parent Consultation
RFP 006-00A:Foster Parent Training
RFP 006-00:Home Study,Relinquishment Counseling
Dear Ms.Kochevar:
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 bids
below for inclusion on our vendor list.
1. 006-00A Foster Parent Training
2. 006-00C Foster Parent Consultation
• The Families,Youth and Children(FYC)Commission recommended approval of the bid,
RFP 05005 Lifeskills,for inclusion on our vendor list,attaching the following condition for
all Lifeskills providers.
Condition: All providers must define their capacity to do after-hours visitation.
• The Families,Youth and Children(FYC)Commission recommended approval of the bid,
RFP 006-00 Home Studies,Updates,and 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.
Page 2
Lori Kochevar,LLC,Results of Bid Process 2005t2006
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.
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.
Sincerely, ot,
J A. go, or
cc: Juan Lopez,Chair,FYC Commission
Gloria Romansik, Social Services Administrator
Hello