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Address Info: 1150 O Street, P.O. Box 758, Greeley, CO 80632 | Phone:
(970) 400-4225
| Fax: (970) 336-7233 | Email:
egesick@weld.gov
| Official: Esther Gesick -
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20051783.tiff
RESOLUTION RE: APPROVE MODIFICATIONS TO CORE SERVICES THREE-YEAR PLAN 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 Modifications to the Core Services Three-Year Plan 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 the Colorado Department of Human Services, Division of Child Welfare Services,commencing June 1, 2005, and ending May 31,2006,with further terms and conditions being as stated in said modified plan, and WHEREAS,after review,the Board deems it advisable to approve said modified plan,a copy of which is attached hereto and incorporated herein by reference. NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County,Colorado,ex-officio Board of Social Services,that the Modifications to Core Services Three- Year Plan 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 Colorado Department of Human Services, Division of Child Welfare Services be, and hereby are,approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said modified plan. The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 22nd day of June, A.D., 2005, nunc pro tunc June 1, 2005. BOARD OF COUNTY COMMISSIONERS E���`` MAI WELD OUNTY, COLORADO _ r 1861 _j William H. J e, Chair Cod lerk to the Board M. ile, ro- m Deputy Clerk o the Board Da E. Long_ AP AS TO Robert D. Masd n my Atfa ey GI n Vaad Date of signature: 7---r-03-- 2005-1783 SS0032 "Th (�(1 COI-0 to oC 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 WilDe COLORADO MEMORANDUM TO: William H. Jerke, Chair Date: June 17, 2005 Board of County Commissioners J ' / FR: Judy A. Griego, Director, Social Services JJt,L(>u a Lilt RE: Core Services Program Plan for FY2005-2007 Enclosed for Board approval is the Core Services Program Plan for FY2005-2007. The Core Services Program Plan was discussed and reviewed at the Board's Work Session of June 13, 2005. The Core Services Plan provides for a budget period beginning June 1, 2005 through May 31, 2006. The source of funding is Core Services funding,which includes 100%Federal/State and 80%FederaUState with 20% County match. The total budget under the Plan is $1,345,123. A. The budget of$986,676 will fund regular Core Services programs through: 1. Vendors participating in a Request for Proposal process and awarded funding through Notification of Financial Assistance Awards, approved by the Board. These programs included: Sexual Abuse Treatment,Day Treatment, Foster Parent Consultation, Life Skills, Mental Health, Intensive Family Therapy, and Option B Programs. In addition, Special Economic Assistance activities and Substance Abuse contracts were included in plan. 2. Department FTEs including staff conducting visitation, RTC Utilization Worker, and Foster Care Worker specializing in alternative RTC foster care programs. B. The budget of$358,447 will fund expansion Core Services Programs. The programs funded will include: Teamwork, Innovation, Growth, Hope and Training (TIGHT) Program and the Multi-Systemic Therapy(MST)Program. If you have any questions,please telephone me at extension 6510. • 2005-1783 CORE SERVICES PROGRAM THREE YEAR PLAN (Changes/Modifications) FY 2005-2007 FOR WELD COUNTY(IES) REQUEST FOR STATE APPROVAL OF PLAN If the three year Core Services Plan is ONLY being submitted for changes/modifications, this page does not have to be signed by required signatures. This Core Services Plan is hereby submitted for Weld [Indicate county name(s)and lead county if this is a multi-county plan],for the period June 1,2004, through May 31, 2007. The Plan includes the following: 4) Completed"Statement of Assurances"; $ Completed Statement of the eight (8) required Core services to be provided or purchased and a list of county optional services, County Designed Program Services, to be provided or purchased; 4) Completed program description of each proposed "County Designed Service"; $ Completed "Information on Fees"form; 4) Completed"Reunification Issues"form; $ Completed "Direct Service Delivery"form; 4) Completed"Purchase of Service Delivery"form; $ Completed"Projected Outcomes"form; $ Completed"Overhead Cost"form; $ Completed "Final Budget Page"form; $ Completed "State Board Summary"; and, $ Completed"100% Funding Summary"form. This Core Services Program Plan has been developed in accordance with State Department of Human Services rules and is hereby submitted to the Colorado Department of Human Services, Division of Child Welfare Services for approval. If the enclosed proposed Core Services Program Plan is approved, the plan will be administered in conformity with its provisions and the provisions of State Department rules. The person who will act as primary contact person for the Core Services Plan is, David Aldridge and can be reached at telephone number 970.352.1551 ext. 6290. If two or more counties propose this plan, the required signatures below are to be completed by each county, as appropri te. Please ach a dditional signature page as needed. W: 7/osr Signat r: , Dl-E dddUUU TOR, UN DEP MENT OF SOCIAL SERVICES DATE �l Si a , CHA 'LA M TL DATE V IVES COMMISSION � r � E A-1 _� /'��-. JUN 2 2 2005 Signature, CHAIR, BOARD OF COUNTY COMMISSIONERS DATE William H. Jerke / Imo! Eta � ATTEST: tede/A /// WELD COUNTY CLERK T THE BOA 1861 ?;Ge zp D PUTY CLERK TO THE BO %( J ,��j�, 2 aoe1S-/780 • CORE SERVICES STATEMENT OF ASSURANCES Weld County(ies)assures that, upon approval of the Core Services Program Plan the following will be adhered to in the implementation of the Plan: Core Services Assurances: • Operation will conform to the provisions of the Plan; • Operation will conform to State rules; • Core Services Program Services, provided or purchased,will be accessible to children and their families who meet the eligibility criteria; • Operation will not discriminate against any individual on the basis of race, sex, national origin, religion, age or handicap who applies for or receives services through the Core Services program; • Services will recognize and support cultural and religious background and customs of children and their families; • Out-of-state travel will not be paid for with Core Services funds; • Al forms used in the completion of the Core Services plan will be State prescribed or State approved forms; • Core FTE/Personal Services costs authorized for reimbursement by the State Department will be used only to provide Core Services authorized in the county(ies)' approved Core Services Plan; • The purchase of services will be in conformity with State purchase of service rules including contract form, content, and monitoring requirements; and • Information regarding services purchased or provided will be reported to the State Department for program,statistical and financial purposes. 3 CORE SERVICESTO BE PROVIDED/PURCHASED Place an "X" to indicate which of the following Core Services Program Services will be provided/purchased in accordance with State Department rules: X Home Based Intervention X Intensive Family Therapy X Sexual Abuse Treatment Services X Day Treatment X Life Skills X Special Economic Assistance X Mental Health Services X Substance Abuse Treatment Services List below"County Designed Service"that will be provided/purchased in accordance with State Department rules: Service Name: 1. North Colorado Medical Center--PsychCare,Youth Passages,Partial Hospitalization and Day Program,Day Treatment Alternative 2. Sherri Malloy,Foster Parent Consultation 3. Jubilee Retreat Center,Foster Parent Consultation 4. Transitions Psychology Group,Foster Parent Consultation 5. Additional Funding for Evidenced Based Services to Adolescents(See attached.) • TIGHT Proposal • MST Proposal 6. Foster Care Caseworker III 7. RTC Utilization Caseworker III Additional Funding for Evidenced Based Services to Adolescents If your county received additional funding from the additional $3.75 million dollars appropriated to fund evidenced based services to adolescents, and you would like to continue to receive the same funding for the same expansion or created of your evidenced based County Designed Program to adolescents, please indicate that on your Core Plan under County Designed. Your county must also document historical outcomes with regard to how these specific County Designed services demonstrate effectiveness in reducing the need for higher costs of residential services. Your county must follow the requirements set forth in Agency Letter CW-03-21-A, page 6 of the Request for Proposal, under the Needs Assessment, County Design Description and Projected Outcomes section. The County Designed Program may be renewed/re-approved at the sole discretion of the State Department, contingent upon funds being appropriated, budgeted and otherwise made available and other contract requirements, if applicable, being satisfied. If your county did not receive an award or you did not apply, you are welcome to apply by following the requirement set forth in Agency Letter CW-03-21-A. Please submit the Request For Proposal with the Core Services Plan, due April 29, 2005. 4 FAMILY STABILITY SERVICES TO BE PROVIDED/PURCHASED Due to budget reallocations for state fiscal year 2005-2006, funding is not available for the Family Stability Services (FSS) based on Senate Bill 01-012. If a county would like to provide Family Stability Services as outlined in Colorado Department of Human Services Staff Manual Volume 7, at 7.310,with Child Welfare Block,Temporary Assistance to Needy Families (TANF), or county only funds(FSS falls under the Child Welfare Block), please contact Melinda Cox at 303.866.5962 for details and plan requirements. A. "Respite Care": a service to provide temporary care to children who are not in an out-of-home placement through the county departments of social/human services and to their families who request a short break in parenting in order to stabilize family environment. Respite may occur outside of the home and in the home settings for less than 24 hours. The family may choose appropriate respite care providers including, but not limited to, kin, friends and licensed providers depending on the needs of the family and available resources. B. "In-home Services": short-term, solution-focused services provided to children who are not in an out- of-home placement through the county departments and to their families, based on their unique needs in order to strengthen the home environment so that children do not need a higher level of intervention or out- of-home placement. C. "Reintegration Services": transition services to assist children and families to reintegrate following an out-of-home placement. Service elements would prepare children and their families for successful reunification. Counties that may receive funds in October 2005 for meeting performance outcomes in their Integrated Care Management Plans will need to submit all Family Stability Services information as outlined in the Core Services Plan, as appropriate. For questions on the Integrated Care Management Plan performance outcomes, please contact Norm Kirsch at 303.866,5936. 5 • CORE SERVICES COUNTY DESIGNED SERVICE Service Name: (1)Day Treatment Alternative(Purchased Services) (2) Foster Parent Consultation (Purchased Services) (3)Specialized Foster Home Recruitment, Certification, and Monitoring (Foster Care Caseworker III) (Direct Service Delivery) (4)Additional Funding for Evidenced Based Services to Adolescents (See attached:) • T.I.G.H.T. Proposal • MST Proposal Optional services approved as a part of the county's Core Services Plan are approved on an annual basis. For a County Designed Service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. Given that County Designed programs are not standardized across counties, it is important to provide detailed information as outlined below. This information can be use to justify continued funding of the program with the legislature. The information listed below is to be completed for each County Designed Service to be included in the County(ies)' Core Services Program Plan. 1. Describe the service and components of the service, define the goals of the program. 2. Indicate if a new Trails service detail is necessary for this County Designed Program or is the service detail already an option in Trials. 3. Define the eligible population to be served. 4. Define the time frame of the service. 5. Define the workload standard for the program: • number of cases per worker, • number of workers for the program, and • worker to supervisor ratio. 6. Define the staff qualifications for the service, e.g., minimum caseworker Ill or equivalent, see 7.303.17 for guidelines. • Define the performance indicators that will be achieved by the service, see 7.303.18. • Identify the service provider. • Define the rate of payment(e.g., $250.00 per month). North Colorado Medical Center-PsychCare-Youth Passages,Day Treatment Alternative(Purchased Services) 1. Adolescent Day Treatment Alternative is a program designed to address the multifaceted needs of adolescents experiencing significant emotional, behavioral,educational,interpersonal,familial problems,and adolescents suffering from a wide range of psychiatric disorders and chemical dependency.Program includes day treatment,and intensive outpatient services.Youth Passages utilizes a partial or day hospitalization model that provides specific therapeutic interventions that can be implemented with the family system or with the child's problem behavior while the child continues to reside at home.Day program is conducted in English while family sessions can be conducted in Spanish through a Bilingual therapist. Youth Passages does not prohibit south Weld County Residents from attending.Youth Passages employs a Bilingual therapist. 2. This service option is already in the Trails system. 3. 96 adolescents(10-18 years)per year,and/or(range of 5-18 years), 7 monthly average capacity. 4. 35 hours per week for day treatment and 20 average hours per week for intensive outpatient services,for 12-20 weeks. 5. Total number of staff is five full-time staff members dedicated solely to adolescent services with per diem therapists and staff available as needed,and one MD contracted to see patients a minimum of once per week available for project based on projected average daily census of 12.Two staff members to five children ages 5 years to 13 years(minimum is one staff member to eight children.)Two staff members to six children ages 16 years and over (minimum is one staff member to 10 children.) 6. Staff members include one teacher,two behavioral health therapists,one behavioral health team assistant,one behavioral health youth clinical coordinator.Personnel staffing at Youth Passages meets or exceeds the standards enumerated in Volume VII(7.303.) 6 The provider is North Colorado Medical Center,PsychCare,Youth Passages,1801 16ih Street,Greeley,C),80631. The hourly rate is$24.10 for face-to- face contact.Court testimony will be billed at$155 per hour. Jubilee Retreat Center,Foster Parent Consultation(Purchased Services) 1. This program provides foster care consultative services in the areas of(l)consultation and foster parent support,(2)mandated corrective action consultation,and(3)mandated critical care consultation.By training foster care parents,the children are being maintained at a lower level of care so the children can RETURN home and avoid imminent risk of out of home placement. 2. This service option is already in the Trails System. 3. This program is open to all Weld County Certified Foster Parents. 4. Group consultations are accessed through the foster parent and limited to one group per foster parent per month.Individual consultations are through Department referral only.The duration of service for individual consultation is determined through the Department's foster care coordinators. 5. The program has a capacity to serve 80 foster parents.Consultants would spend up to 14 hours a month providing services.With an average of eight foster parents per group,the total number of client hours provided over one year would be 1708.Staff includes five experienced specialists that have a similar core value of clinical excellence,with a diverse area of specialties.All consultants exceed the minimum qualifications specified. 6. Clients refl..'I-d to this program will choose training goals and objectives according to their perceived needs.In the case where the foster parent is sent for disciplinary action or critical care,the consultant and the foster care coordinators will help design specific outcome measures appropriate to the Service objectives include(1)improvement of household management competency,improvement of parental competency,the ability of the family to access resources.The rate of this service is$58.33 per foster parent per group,and$90 per direct contact hour for individual foster parent consultation and mandated training for foster parents as stipulated by Weld county. Transitions Psychology Group,Foster Parent Consultation (Purchased Services) 1. This program provides foster care consultative services in the areas of(1)consultation and foster parent support,(2)mandated corrective action consultation,and(3)mandated critical care consultation.By training foster care parents,the children are being maintained at a lower level of care so the children can RETURN home and avoid imminent risk of out of home placement. 2. This service is open on the Trails system. 3. This program is open to all Weld County Certified Foster Parents. 4. Group consultations are accessed through the foster parent and limited to one group per foster parent per month.Individual consultations are through Department referral only. 5. The duration of service for individual consultation is six weeks for individual participants and/or as requested by the Department..The monthly capacity per group is 10 participants,for a total of 50 group participants per uunth.Transitions has the capacity to serve 110 clients,. 6. The program expects to provide four different consultation and/or support groups per month.Foster parents will be encouraged to attend the same group monthly,but will be allowed to attend no more than one group per month.Following the sixth session,the counselor and foster parent will again use the solution-focused scaling of content areas to measure progress.If goals have been met,the foster parent completes the group or defines new goals.If goals have not been met,the foster parent will have the option to continue in another series of group sessions with Weld county approval or be referred to other services.The maximum caseload per supervisor is 1:3. 7. All staff members have a minimum of a Master's degree in a counseling related field and are licensed professionals.Current staff members are Licensed Professional Counselors(LPC),but this provider would accept the related licenses of Licensed Clinical Social Workers,Licensed Marriage and Family Therapist,or Licensed School Psychologist.The Transitions supervisor is a Licensed Psychologist.The service provider is Transitions Psychology Group,810 11 Avenue,Greeley.The rate of this service is$58.33 per foster parent participant per group,and mandated training for foster parents as stipulated by Weld county,and$90 per hour for individual consultations. Sherri Malloy,Ph.D,Foster Parent Consultation(Purchased Services) 1. This program provides individual and group foster parent consultation for all referred Weld County foster parents.By training foster parents,the children are being maintained at a lower level of care so the children can RETURN home and avoid imminent risk of out of home placement. 2. This service is not open on the Trails system. 3. This program is open to all Weld County Certified Foster Parents. 4. Group consultations are accessed through the foster parent and limited to one group per foster parent per month.Individual consultations are through Department referral only. 5. The duration of service for individual consultation is two weeks for individual participants and/or as requested by the Department. The monthly capacity per group is 12 participants,up to 12 groups per year. 6. The program expects to provide four monthly groups,with a maximum of 12 people each,and up to two individual consultations per week,averaging two adults per household.Approximately 20-30 percent of foster parent families will be minority families.Approximately 15 percent of individuals who receive services will be South Weld County residents. 7. Dr.Malloy's qualifications meet the standards and 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.The service provider's address is Sherri Malloy,Ph.D.,1228 8th Street,Greeley,Colorado, 80631.The rate of this service is$58.33 per foster parent participant per group,and mandated training for foster parents as stipulated by Weld county, and$90 per hour for individual consultations. Jubilee Retreat Center,Foster Parent Training(Purchased Services) 1. This program provides Foster Parent Certification training,using a comprehensive experiential training curriculum that directly improves the foster parent's ability to provide quality care for children in foster care.T his training satisfies all training requirements of State of Colorado,Volume VII and those require by Weld County Department of Social Services. By training foster parents,the children are being maintained at a lower level of care so the children can RETURN home and avoid imminent risk of out-of-home placement. 2. This service is not open on the Trails system. 3. This program is open to all Weld County Certified Foster Parents. 4. Jubilee Retreat Center will provide eight trainings per year,an average of 12 participants per training,an estimated 216 hours of training per year. 5. The duration of service for individual consultation is two weeks for individual participants and/or as requested by the Department. The monthly capacity per group is 12 participants,up to 12 groups per year. 6. The program expects to provide services to 48 foster families,96 foster parents.On average, most foster parents provide services for approximately four foster children per year. Each foster child is in placement approximately six months.The average stay in the program is four weeks,average hours in the program is 6.75. Services available to South County and Bilingual foster parents.All providers of this training exceed the minimum qualifications needed for both education and experience. The monthly fee for training is set at$3,660,a cost of$12.33 per foster parent per hour of training. 7 • Foster Care Caseworker Ill-I FTE(Direct Service Delivery) 1. This FTE will do specialized recruiturerit,certification,and monitoring of foster care homes that will work with the most difficult youth or children;i.e., sex offenders,severe mental health issues,etc. 2. A new trails service detail will not be necessary because this service is direct service delivery. 3. This program services children and youth aged 0-17 who receive an intense level of treatment.These children and youths'behaviors and needs are severe enough to require that only one such child reside in each identified home. 4. The time frame of this service is 12 months. 5. There is one FTE under this program.The number of cases per worker is 20.The ratio of workers to supervisor is 8:1. 6. The minimum qualification for this position is Caseworker III.Performance indicators are that the RTC piac irrnt numbers will be reduced and youth and children will be able to step down from RTC placements sooner.The service will be provided through an FTE position,direct service delivery.The rate of payment is that of 1 FTE. RTC Utilization Caseworker III-1 FTE(Direct Service Delivery) 1. The RTC Utilization Caseworkers will would work with Leslie Cobb and caseworkers that have children placed in RTCs to ensure that quality of RTC treatment plans and transition plans are in place with youth and children. 2. A new trails service detail will not be necessary because this service is direct service delivery. 3. The eligible population is any youth or child in an RTC placement. 4. The time frame of this service is 12 months. 5. The number of cases for this program is potentially any child in an RTC,but priority would be given to any cases where issues have been identified. There will be 1 FTE under this program.The worker to supervisor ratio is 8:1(if the intake YIC supervisor supervises this position.) 6. The staff qualification for this service is Caseworker III.This service will shorten RTC placements and improve after care.The service is direct delivery. The rate of payment is that of 1 FTE. Additional Funding for Evidenced Based Services to Adolescents(See attached.) 1. TIGHT Proposal (See attached proposals for program description) 2. MST Proposal(See attached proposals for program description) 8 • INFORMATION ON CORE SERVICE FEES Please check all that apply: ✓ Fees will not be assessed for Core Services Program Services. If above line is checked, STOP. Remainder of information does not need to be completed. The following fees apply for the programs checked above. Fees will be assessed for the following services: Check those that apply: Home Based Intervention Intensive Family Therapy Sexual Abuse Treatment Day Treatment Life Skills Special Economic Assistance Mental Health Services Substance Abuse Treatment Services County Designed Service(List Services Below) Fee assessment formula is the same for all services. State the formula here (attach additional sheets as needed). Fee assessment formula varies with service. 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E q - _ § % § % / a) en �a t p 2 = ) § / o co Co 0 \\\ } q wz = 53 & la3 if) , a Ill en■ in ) f 47:171°°0 ® § \ m § 553 § J E \ ® \ Ill LL CO E \ ) _ � � � ) IX w q * r \ o <wc ° X22 E CO 5,- < III % CO 8� o \ t \@ § 0 _ » JG ) / { § 2.CO as ° \ ) \ 3 \ < Gz@ )b 70 a \ � \ ) = m \ \ CV / ) ) CV CO LO _ I , < �Lid ra2 45 Z / / I § ca o § oZ 0 , _ 5 7° ---c a) _ e2 < = 0 > ) 7x 0 { - ° � ® � ® ) § _N 2 N a e 15 0 co se § f \ te \ 0 \ \ \ N \ � Ea)t ( /) § 3 }} co 6969 \\ kk k ® � a i =2 i ILI ■ § = f \ % \ t < >re § 2 } § » 3 � 0 , § Iii CC O 2 OCEL - ) W C0 § \ k \ ° « \ K w q * ` < 0 ) 69 ) 0 / E Cin > E w « ■ 2 i- W5 ) \ / 0 z0Q2 ° ` 2 o , \ ) } ( ( o ° ® 2 ® 2 co a) ° / \ \ 2 a < 0LL@ o k -cu 0 I / � ) a as ^ F- \ = CoLo en IX k k \ \ ) \ >, I iii ± \ =7 T j : 6 az) z •co >,) \ ) CO = co — = tee EL § \{ f / f 7f } ; ) ) /® _ ) ) � \ _ / ) tit z2I ® ) 2 ) z77 ! ) ) ) $ ( § ! t0) \ a $ m « \g ° < , 2 C ± § % E52 # / i ) tel ; \ tl ; a2 ) / • ) 22 # 34 ) 4 ) / A / ] ) ) / § / a / @e / ) ' • PROJECTED CORE SERVICES OUTCOMES FOR PERFORMANCE INDICATORS FOR FY 2005-2006 FOR FY 2006-2007 Service Over 85%' 85%-25%` Under 25°/03 Total Clients Served 26 37 54 117 Home Base 8 6 25 39 Intensive Family Therapy 26 153 76 255 Life Skills 7 1 2 10 Day Treatment 36 19 11 66 Sexual Abuse Treatment 204 0 0 204 Mental Health Treatment 0 764 0 764 Substance Abuse Treatment 72 0 0 72 Special Economic Assistance 192 36 84 312 County Design (List) '-Client meets 86% or more of the treatment goals 2-Client meets between 85%-25% of the treatment goals 3-Client meets 24% or less of the treatment goals 28 • CORE SERVICES PROGRAM OVERHEAD COST 1. DIRECT SERVICE A. Total Salary/Fringe/Travel/Operating Costs of Line Service Workers and their Immediate Supervisors $298,478.00 B. Formula Percentage Allowed for Overhead Costs 15% C. Provided Service Overhead Costs(A X B) $44,771.70 2. PURCHASED SERVICE A. Purchased Service Dollar Amount $598,886.00 B. Formula Percentage Allowed for Overhead Costs 3.9% $0-50,000 =5% $50,001 -100,000 =4.9% For each $50,000(in total expenditure) increase the overhead decreases by.1 %. C. Allowed Amount for Overhead Costs (A X B) $23,955.44 D. Base Overhead Cost Allowed $500.00 E. Purchased Service Overhead Costs(C+ D) $23,856.55_ 3. TOTAL OVERHEAD COSTS (1C +2E) $66,628.25 DISTRIBUTION OF OVERHEAD COSTS AMONG SERVICES* SERVICE Provided Service Purchased Total Overhead Overhead Costs Service Overhead Costs Costs 1. Home Based Intervention $1,195.05 $1,195.05 2. Intensive Family Therapy $597.52 $597.52 3. Sexual Abuse Treatment $796.70 $796.70 4. Day Treatment $796.70 $796.70 5. Life Skills $15,293.29 $15,293.29 6. County Designed Service $2,788.44 $2,788.44 7. Expansion-TIGHT/MST $44,771.70 $2,388.86 $2,388.85 COLUMN TOTALS $44,771.70 $23,856.56 $68,628.25 Formula to determine overhead cost by service: Step 1: total provided service cost(by service)x 15% = provided service overhead cost Step 2: total purchased service cost (by service)x% listed in 2B = Y $500 divided by the number of purchased service =Z, then Y+Z =overhead cost Step 3: Provided service overhead cost plus purchased service overhead cost equals total overhead cost. 29 GENERIC COST SUMMARY SHEET 1. Account Code 2. Total number of children to be served by provided services 3. Total number of children to be served by purchased services 4. Average number of children (total 2 +3=12)to be served monthly 5. Total number of families to be served 6. Average number of families to be served monthly 7. Employee FTE number(should be the total staff listed on Direct Service Delivery Page) 8. Provided cost Overhead cost(From Overhead cost summary sheet) Total provided cost 9. Monthly provided cost per child [this is determined by dividing the total provided cost by the number of children to be served from provided services and then dividing that total by the number of months the service will be provided.] 10. Purchased cost Overhead cost(From Overhead cost summary sheet) Total purchased cost 11. Monthly purchased cost per child [this is determined by dividing the total purchased cost by the number of children to be served from purchased services and then dividing that total by the number of months the service will be provided.] 12. TOTAL COST REQUESTED[Total provided cost Total purchased cost] 13. Total 80/20 service cost requested 14. Total 100%service cost requested 30 To • co ( 0 to im � I— u. ] CO \ \ \ \ k \ Q \ \ } \ ) E . 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