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Home My WebLink About20041628.tiff RESOLUTION RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR LITTLER CENTER, DAY TREATMENT, AND AUTHORIZE CHAIR TO SIGN - NORTH RANGE BEHAVIORAL HEALTH WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with a Notification of Financial Assistance Award for The Littler Center, Day Treatment, between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services,and North Range Behavioral Health,commencing June 1,2004,and ending May 31,2005, with further terms and conditions being as stated in said award, and WHEREAS, after review, the Board deems it advisable to approve said award, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County,Colorado,ex-officio Board of Social Services,that the Notification of Financial Assistance Award for the above listed program between the County of Weld,State of Colorado,by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and North Range Behavioral Health be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said award. The above and foregoing Resolution was,on motion duly made and seconded, adopted by the following vote on the 16th day of June, A.D., 2004, nunc pro tunc June 1, 2004. #\N IE BOARD OF COUNTY COMMISSIONERS WERCOUNTY, COLORADO Robert D. Masden, Chair 'sO 2u Clerk to the Board . e- William H. ke, Pro-Tem BY: /. r•< s Deputy Clerk to the Board 4' /&zc— M eile Q O D ORM: J( C Davi . Long ounty Attq ney �1 GI nn Vaad Date of signature: 4'- 9 T�j 2004-1628 SS0031 a jit ;"\\:, DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY,CO. 80632 • Website:www.co.weld.co.us IliaAdministration and Public Assistance(970)352-1551 Child Support(970)352-6933 C COLORADO MEMORANDUM TO: Robert D. Masden, Chair Date: June 14, 2004 Board of County Commissioners FR: Judy A. Griego, Director, Social Services 063 f .Cr , RE: Notification of Financial Assistance Award or Day Treatment with North Range Behavioral Health Enclosed for Board approval is a Notification of Financial Assistance Award (NOFAA) for Day Treatment between the Weld County Department of Social Services and North Range Behavioral Health. The NOFAA is based upon the provider's Request for Proposal, which has been reviewed and approved by the Families, Youth and Children (FYC) Commission. The NOFAA was reviewed at the Board's Work Session of June 14, 2004. The major provisions of the NOFAA are as follows: 1. The term period is from June 1, 2004 through May 31,2005. 2. The Department agrees to reimburse North Range Behavioral Health under Core Services funding according to the NOFAA and its respective bid proposal for Day Treatment. North Range Behavioral Health agrees to provide a comprehensive, highly structured service that provides education to children and therapy to children and their families. 3. North Range Behavioral Health will be reimbursed according to the rate of$88.69 per hour. If you have any questions,please contact me at extension 6510. 2004-1628 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 FY04-PAC-2004 Revision (RFP-FYC-04006) Contract Award Period Name and Address of Contractor Beginning 06/01/2004 and North Range Behavioral Health Ending 05/31/2005 The Littler Center-Day Treatment 1306 11th Avenue Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial A comprehensive,highly structured service Assistance Award is based upon your Request for alternative to the out-of-home placement or the Proposal (RFP). The RFP specifies the scope of more intensive placement,that provides mental services and conditions of award. Except where it is health care and education to its student clients. in conflict with this NOFAA in which case the Capacity to service 15-18 children and their NOFAA governs, the RFP upon which this award is families at any one time, 29.5 hours weekly, an based is an integral part of the action. average of 5.9 hours daily, for 36-52 weeks. Special conditions Cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based on an hourly rate per child or per family. Daily Rate Per $ 88.69 2) The hourly rate will be paid for only direct face-to- face contact with the child and/or family, as specified Based on Approved Plan in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly and Enclosures: yearly cost per child and/or family. X Signed RFP: Exhibit A 4) Payment will only be remitted on cases open with, X Supplemental Narrative to RFP: Exhibit B and referrals made by the Weld County Department X Recommendation(s) of Social Services. X Conditions of Approval 5) Requests for payment must be an original submitted to the Weld County Department of Social Services by the end of the 25th calendar day following the end of the month of service. The provider must submit requests for payment on forms approved by Weld County Department of Social Services. 6) The Contractor will notify the Department of any changes in staff at the time of the change. Approvals: h 1 Program Official: By \>,,..Q1 ll 4'4� -- By 1 /L . Robert D. Masden, Chair Ju A Crr go, DirQ„or Board of Weld County Commissioners County Department of Social Services Date: JUN 16 2004 Date:___ C Out L.11 ,, l2'2z//tea SIGNED RFP-EXHIBIT A • INVITATION TO BID OFF SYSTEM BID B001-04 (04005-04011 AND 006-00) DATE: February 11,2004 BID NO: RFP-FYC-04006 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal(RFP-FYC-04006) for:Colorado Family Preservation Act--Dav Treatment Program' Emergency Assistance Program Deadline: March 5, 2004,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, 2004, through May 31, 2005, at specific rates for different types of service, the county will authorize approved vendors and rates for services only. The Day Treatment Program Category must provide a comprehensive,highly structured program alternative to placement or more restrictive placement that provides therapy and education for children. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK Wayne A. Maxwell, Ph.D. TYPED OR PRINTED SIGNATURE VENDOR North Range Behavioral Health of (Name) Handwritteti Signature By Authorized Officer or Agent of Vendor ADDRESS 1306 11th Avenue TITLE Executive Director Greeley, Colorado 80631 DATE February 27, 2004 PHONE# 970-347-2120 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 31 Off-System Bid B001-04 (RFP-FYC-04006) Attached A DAY TREATMENT PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2004/2005 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2004-2005 OFF-SYSTEM BID B001-04 (04006) NAME OF AGENCY: NORTH RANGE BEHAVIORAL HEALTH ADDRESS: 1306 11th AVENUE GREELEY CO 80631 PHONE: ( 970) 347-2120 or 347-2127 CONTACT PERSON: Sandra K. Atwood, MSW, LCSW TITLE: Director Littler Center DESCRIPTION OF EMERGENCY ASSISTANCE PROGRAM CATEGORY: The Day Treatment Program Category must provide a comprehensive,highly structured program alternative to placement that provides therapy and education for children. 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1,2004 Start End May 31,2005 End TITLE OF PROJECT: KATHLEEN PAINTER LITTLER CENTER aireicese a e Sandra K. Atwood 02 f o�710`7 N e and Signature of Person Preparing Document NSW, LCSW Date (� ' (Af Wayne A. Maxwell c2/o2 7/(4 Name a d Signa e Chief Administrative Officer Applicant Agency Ph•D• Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Posposal for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2003- 2004 to Program Fund year 2004-2005. Indicate No Change from FY 2003-2004 Project Description X Target/Eligibility Populations X rt40 Types of services Provided X -lie Measurable Outcomes X roc) Service Objectives X !) Workload Standards X Staff Qualifications X t Unit of Service Rate Computation (cost of living increase) 1r• Qt Program Capacity per Month- - -_ X JL Certificate of Insurance X IT Provider Number for State Child Care Licensing X Page 25 of 31 ' Off-System Bid B001-04 (RFP-FYC-04006) Attached A Date of Meeting(s)with Social Services Division Supervisor: Comments by SSD Supervisor: 19lY- m 7_2271,4,71-1 t S ' 11.-1 9 P Cyttzyl '/ //F E9 S Kam' lc/ / ` ». ,C,-�j-702.4-.., rX),lv ca/r ce1r-,g,,e_Ar2l h _/ yes.--s,--9 c 7.-t-,- i Zen 77/ %,/ ret-eJ 7,/7-711�- t - dy4/1 7 , Name and Signature of Su 'sor D t€ t • Page 26 of 31 COLORADO FAMILY PRESERVATION PROGRAM — DAY TREATMENT—North Range Behavioral Health 2004-2005 BID#RFP-FYC-04006 I. PROJECT DESCRIPTION In August 1995, Weld County School District Six (District 6), the University of Northern Colorado (UNC), and North Range Behavioral Health (NRBH) jointly opened the Carson Children's Center (CCC). In August 1999 the CCC became the Kathleen Painter Littler Center. Littler is a year around residential and day treatment program for children ages five through 12 years. It has capacity of 18 residential and 12 day treatment students. Day treatment is a comprehensive, highly structured alternative to the out-of-home placement or the more intensive placement of a child already in placement, that provides mental health care and education to its student clients. Treatment services for each client's family are an integral part of the program. The Littler Center provides highly integrated and coordinated educational and treatment services to its students. The affective needs of each child are responded to not only by the treatment staff, but by the educational and supportive services staff as well. Similarly, the students' education and emotional and behavioral needs are not solely the responsibility of the teaching staff but shared by all on-site personnel. Because all Littler students are staffed as special needs children, additional services called for in each child's individualized education plans (JEP) such as occupational therapy, speech/language services, and physical therapy are provided on-site. The Littler day begins with a welcoming group to greet the children and to help them make the transition from life at home to a day in school and in treatment. Information from each student's parents, guardians, or foster parents is obtained directly or via notebooks sent home with and brought back each day by the students to keep the staff and parents/guardians up-to-date and to encourage open communication. Each child's goals and progress toward them are updated daily before the children move to other aspects of the day. Educational and affective curricula are simultaneously in place as much as is feasible in the various daily activities. The students progress through a series of treatment and educational offerings each day. While some children are in the classroom for group or individual instruction, others are seen in individual therapy while others are in a treatment group. Each day treatment student is assigned a master level therapist who not only assists in developing individualized treatment plans, but also serves as an on-going consultant and treatment coordinator to all school staff. There are ongoing, scheduled psycho-educational groups that address new themes as well as themes from earlier sessions. These groups address social skills, conflict resolution, self-esteem, and positive relation building as well as how to handle feelings. The daily schedule is similar from day to day promoting the consistent milieu essential to the children's success. Recess, lunch, and other activities are similarly integrated. The day ends back in the room where the focus is to review the day with the children and prepare them for the transition back to their homes. Goals and successes of the day are the focus of this activity. Children may remain for a family therapy session. Family therapy typically is planned for the end of the day to allow for parents' work schedules. The schedule is sufficiently flexible to allow for such sessions during the school day as well. Individual and family therapy continues to occur during school breaks, depending on the availability of the clients. Participation in family therapy is a requirement in the day treatment program at the Littler Center to achieve optimum success. COLORADO FAMILY PRESERVATION PROGRAM — DAY TREATMENT— North Range Behavioral Health 2004-2005 BID#RFP-FYC-04006 Psychiatric services are integrated in the program. Each child receives a psychiatric evaluation including a determination of need for psychotropic medications. Follow-up psychiatric services are provided throughout each student's stay and, when appropriate, in the care that follows treatment at Littler. Students with special treatment needs have available to them the full array of services of NRBH in addition to those available at Littler. Students can be seen in groups designed to help them deal with sexual abuse and other trauma they have endured. II. TARGET/ELIGIBILITY POPULATIONS It is intended that the Littler Center serve up to 20 children ages five through 12 years and their families at any given time in the 6 to 18 month day treatment program. Of these, it is anticipated that up to ten could have the financial aspect of their care covered under the services proposed herein. Up to 18 children and their families will be served annually of whom 12 will possibly be eligible for FYC-funded services. It is anticipated that approximately 25% of all the students and/or their families will receive some level of bilingual/bicultural services on- site. Based on current utilization rates, it is estimated that up to 25% of the Littler students will be from southern Weld County. For the purposes of this grant, the monthly maximum program capacity is defined as 10 children with a monthly average program capacity of eight. The average length of stay in the program is estimated to be in the range of 36 to 52 weeks. Students spend a minimum of 29.5 hours weekly in the total program. In order for a child to be considered as a potential student of the Littler Center, she or he must be staffed into special education services in her or his home school district and must have demonstrated the capacity to return to her or his home school upon successful completion of the Littler program. In addition, the student must have a full scale IQ of 76 to benefit from the Littler Center program levels and expectations. Children referred to the project will have met, or be at high risk to meet, the out-of-home placement criteria detailed in the request for proposal. As mentioned above, each will also have met or be believed to qualify for special education services. III. TYPE OF SERVICES TO BE PROVIDED Site-based services to the students of the Littler Center and their families will be held each day District 6 schools are regularly in session plus through the summer. An academic year will consist of 46 total weeks with an average of not less than 29.5 hours of programming weekly, 5.9 average daily hours. The planning and implementation of the Littler Center has been a collaborative and cooperative effort from its inception. The Weld County Department of Social Services (WCDSS), involved early on in the planning process, agreed to utilize the services of this day treatment program for those of its clients demonstrating the need for it and for whom they believe they have financial responsibility. The Littler Center's admission coordinator works to ensure that FYC resources do not supplant other community resources and WCDSS caseworkers are involved prior to the 2 • COLORADO FAMILY PRESERVATION PROGRAM—DAY TREATMENT— North Range Behavioral Health 2004-2005 BID#RFP-FYC-04006 screening process for all WCDSS children. The collaborative role of Weld County School District 6 has been exemplary from the planning stage forward as it furnished the past site, recruited and hired professional and paraprofessional staff, and provided administrative guidance. Similarly, NRBH, with the strong support of its Board of Directors and management team, offered administrative assistance in planning and implementing the treatment program. Extensive effort has been invested into planning the milieu and overall program of the Littler Center so that educational, therapeutic, behavioral, and recreational components are closely integrated. By design, each of these four components contains aspects of the other three. Concerted efforts helped to achieve and now serve to maintain this high level of integration. The educational component is primarily the responsibility of the District 6 teaching staff plus other instructional staff as may be required. The therapeutic component is primarily the responsibility of the NRBH on-site staff. The behavioral component of the Littler Center is present across all activities of the program and is the responsibility of all on-site personnel. Each student has an individualized education plan and a mental health services/treatment plan that spell out educational, behavioral, and emotional concerns and detail how those concerns will be addressed in the daily activities of the student. Similarly, the recreational component of the Littler Center includes educational, therapeutic, and behavioral programming to meet each student's needs. All components of the program are typically carried out on-site. Exceptions to this occur primarily during times when a student is in a transitional stage in returning to her or his home school and when off-site services, such as involvement in a particular therapy group not offered on-site, are indicated. Beginning at intake and throughout the program, parents, guardians, and other caretakers are actively encouraged to engage in their children's education and treatment. Family therapy sessions are held at least weekly for each student. In all cases, parental or guardian involvement is mandatory. This stems from a core belief that not just the child, but also his or her family must actively involve themselves in the treatment/education process for it to be effective and for the positive results to be longstanding. The mental health services plan dictates the specific nature of the family work that is required for each child. The teachers at the Littler Center are certified special education teacher for significantly identifiable emotionally disturbed children. They are assisted by three full-time, specially trained paraprofessionals in carrying out each student's individualized educational plan. Due to age of the Littler students, there has been no need for vocational or independent living assessment or training to date. Each student receives an initial mental health assessment. The therapist, parents/guardians, caseworker, if appropriate, and psychiatrist work to establish a behaviorally specific service plan that details individual therapy, family therapy, psychiatric needs, and case management needs. The service plan identifies the specific outcomes necessary for the child to be successful at a lower level of care. It is the tool by which progress is measured. Typically each student weekly receives at least one individual therapy session, five sessions of therapeutic or psycho- educational group activities, and one session of family therapy. This can vary based on the 3 'COLORADO FAMILY PRESERVATION PROGRAM —DAY TREATMENT— North Range Behavioral Health 2004-2005 BID #RFP-FYC-04006 needs of the specific child and their family. More frequent services may be provided during the initial stages of treatment or during a time of crisis. Fewer services maybe provided during the lafter stages of treatment when a child is transitioning back to their home school. Those students with psychotropic medication needs are the responsibility of the Littler staff psychiatrist, Wallace LaBaw, MD. There is simultaneous development or updating of the individualized education plan when a child is staffed into the Littler Center. The physical health needs of Littler students including, but not limited to nutrition, medical, and dental, are primarily the responsibility of District 6 nursing staff. These are shared as appropriate by the staff of the Littler Center. Proactive planning for reintegrating a student into her or his home school begins during the initial screening of the child for consideration of admission to Littler. The capacity to return to one's home school, i.e., the school referring the child, or the school the child will be returning to, will depend upon promotion to her or his next higher grade, must be established before a child will be accepted into the Littler program as must be the referring school's willingness to have the student return there. Similarly, the graduation requirements for students admitted to the Littler Center are formulated in a preliminary manner during the screening and planning sessions held with each child and her or his family, the staff of the referring school, and social services caseworkers when appropriate. The requirements are largely expressed in terms of outcomes the child will achieve. The program is constructed to emphasize the positive outcomes and gains each student will make. Whenever possible, the strengths of the child will be used as the primary tools for progress. Follow-up mental health care for students graduating from the Littler will be arranged by the Littler Center's mental health staff with NRBH, other mental health centers, or a private practitioner of the graduate's family's or guardian's choosing. The transition plan that guides the student's return to her or his own school also provides for a stepped, systematic introduction to the new therapist or reintroduction to a previous therapist to ensure continuity from day treatment to more traditional outpatient services. IV. MEASURABLE OUTCOMES At the time of admission to the Littler Center, each student will be evaluated using, in part, the Colorado Clinical Assessment Report (CCAR) developed by the Colorado Office of Mental Health Services. Every six months thereafter and at discharge from the Littler Center the CCAR will again be administered. The three-page form covers a wide range of variables and assessments. The Littler Center Admission and Termination Evaluation Forms are to be used as evaluation tools as well. These look specifically at the effects of the littler program. Copies of these forms are attached at the end of this proposal. The therapist conducts a complete assessment 10 days after enrollment to develop an all inclusive behavior/treatment plan to meet the student's needs. Discharge goals are developed for all identified areas of need and the 4 COLORADO FAMILY PRESERVATION PROGRAM—DAY TREATMENT— North Range Behavioral Health 2004-2005 BID#RFP-FYC-04006 measurable short-term goals developed monthly to measure and work toward the discharge goal. It is anticipated that 90% of the children successfully completing the Littler program will reside in their own homes, or remain in placement at a similar level of care as they were at the time of their referral, for the first six months after their discharge. The criteria for success will be that each child returns to or remains in her or his home or foster home and is able to safely and constructively do so for at least the first six months they are no longer attending the Littler Center. This information will be gathered by three and six month follow-ups with the child's family and their WCDSS caseworker, if appropriate. Additionally, all successful graduates will enter, remain in, and make satisfactory progress in public school after their discharge from the Littler Center. More specifically, each graduate of Littler will maintain or enhance the progress she or he made academically, socially, behaviorally, and emotionally during her or his time in the program. This will be monitored by three and six month follow ups with the child's family, their WCDSS caseworker, if appropriate, and by the school community facilitator (or the equivalent) from her or his home school. The criteria for success will be maintenance of or improvement upon her or his levels of functioning in the four areas mentioned above as stated in their individualized educational plan and their mental health services plan. The families of 90% of the children successfully completing the Littler program will report a more relaxed, nurturing, and competent relationship with their children than existed prior to enrollment. Families will be surveyed at discharge, three months and at six months after discharge. Ninety percent of the children completing the Littler program will report and demonstrate an improved sense of self worth, self-confidence, and decreased high-risk behaviors. Appropriate improvements will be revealed when pre-C.C.C. CCAR ratings are compared with similar ratings done at the time of completed transition back to the home school. V. SERVICE OBJECTIVES The primary goal of the Littler Center is to successfully intervene in the lives of its students and their families to minimize the future need for similar intensive services, to enhance each child's ability to be educated and to benefit from that education in her or his home school, to enhance each child's ability and capacity to respond appropriately and healthfully to her or his family, and to improve each child's family's abilities to adequately and appropriately respond to and provide for the child's needs in a competent, safe, nurturing, and growth enhancing manner. In working with families to achieve the goal of improving their abilities to manage family conflict in a safe, constructive manner, the Litter Center staff works toward the objective of resolving conflicts between parents and children so that no maltreatment of the children occurs, no domestic violence occurs, no children run away from home, and no children commit status or legal offenses. Success is measured by family, caseworker, and therapist reports that the 5 • COLORADO FAMILY PRESERVATION PROGRAM— DAY TREATMENT—North Range Behavioral Health 2004-2005 BID#RFP-FYC-04006 objective was met. Each family will also be asked to report on its subjective improvements in this area. To meet the Littler Center goal of improving overall parental competency, an objective of increasing the parents' abilities to develop and maintain sound, caring, effective relationships with each other and with their children is established. An additional objective is to enhance the abilities of the parents to provide, with as much proficiency as possible, for their family's care, nutrition, hygiene, discipline, protection, education, and supervision. All parents are encouraged to develop appropriate support systems designed to last beyond their child's involvement with the Littler Center. Again, the parents and children will be polled concerning their subjective opinions about the improvements they have made, as will the therapist and caseworker. The Littler Center works with each client family to achieve the goal of improving its household management competency. The objective is to enhance the capacity of the parents to provide a safe household environment for the children through competently managing the home to include cleaning, repairing, and maintaining the home, as well as via effective budgeting and purchasing. The family, therapist, and caseworker will document the improvements made in this area. The Littler Center works to improve each family's ability to find and use appropriate resources. Treatment and case management services assist each family to learn more effective means to obtain needed help from other sources in the community and from local, state, and federal governments. This is modeled in each of the families' relationships with the Littler staff. The families will report, and their caseworker and therapist will confirm, all gains made in this area. VI. WORKLOAD STANDARDS The Littler Center will provide day treatment services to 20 children aged five through 12 years who will meet the FYC funding criteria. A year round academic/treatment schedule is in place. It is anticipated that up to 18 children will be enrolled in the course of a year. The average length of stay in the program will range from 36 to 52 school weeks. Littler students will attend an average of at least 5.9 hours of programming daily on all days the school is in session. The total staff of the Littler Center numbers more than 17 individuals, comprising slightly more than the equivalent of 13 full-time employees. This staffing level exceeds all Colorado licensing rules. Said rules specify a student to total staff ratio of not more than eight to one which is far less than the four to one ratio employed at Littler. If there is a time when only one staff member is present, a second staff member is on call and immediately available to be summoned to an emergency. NRBH certificate of insurance coverage is attached. VII. STAFF QUALIFICATIONS Licensing requirements mandate that day treatment programs have a treatment leader who is responsible for the overall mental health services to each child. This person must hold a master's degree in the behavioral sciences and have not less than three years of clinical 6 COLORADO FAMILY PRESERVATION PROGRAM—DAY TREATMENT— North Range Behavioral Health 2004-2005 BID#RFP-FYC-04006 experience. Counselors in day treatment programs are mandated by the State of Colorado to have completed a bachelor's degree in the behavioral sciences or to have at least four years of experience with appropriate aged children, and must be at least 21 years of age. All of the staff meet or exceed these requirements. John Ashby, LCSW, with thirteen years experience. Matt Newman, LPC, with sixteen years of experience, much of it in intensive treatment area. Trish Halsey, MA (soon to be LPC) with at least six years experience in group homes with behavior disordered clients and Lara Schifbauer, MSW (soon to be LCSW) with seven years inpatient experience. Sandee Atwood, MSW, LCSW, is the Littler Center Program Director as well as Clinical Director. Once a child is accepted into the Littler Center the intake coordinator, Shannon Harris, MA, establishes a preliminary treatment plan and then the clinical director works with the primary therapist in the development of the day treatment plan for each student. Ms. Atwood has fifteen years experience as a Psychiatric Social Worker in the school system and thirteen additional years as a clinical director for an outpatient treatment center and day treatment center. Three of those years were as Clinical Director of Devereux Cleo Wallace Treatment Center in Westminster, Colorado. Wallace LaBaw, MD, staff psychiatrist for the Littler Center, is a board certified psychiatrist. He is able to follow-up with children after they graduate from the Littler Center and enter more traditional outpatient care through NRBH. Mike Hoover, Ed.D. is the administrative supervisor of the Littler Center's educational component. Since 1992, he has been a Special Education Coordinator for District 6. Currently certified as a School Psychologist and Special Education Administrator, he has worked in the field for more than 20 years. The Littler Center's teachers are Gayle Schneider, MA, Linda Hanchulak, MA, Kathy Brittain, MA, and Meredith Kinsey, BA. Ms. Schneider is a certified special education teacher for significantly identifiable emotionally disturbed children and is also certified in the area of learning disabilities and mentally handicapped. Ms. Hanchulak is certified in all areas of special education and has an MA in counseling. Ms. Brittain is also certified in special education K-9 and an endorsement in early childhood special education. Her MA is in learning diabilities and resource. Meredith Kinsey has a BA in Psychology and presently is completing a masters program in severe affective disorders. She has a temporary teaching endorsement while completing her education. Karen Gookin, MS, CCC-SLP, is the speech/language pathologist and clinicial supervisor. Beth Gay is the School Psychologist and does assessments and conducts IEP team meetings. Ms. Gay has an Ed.S. degree in School Psychology and is a nationally certified school psychologist and is half time at the Littler Center. Heide Atrell, OTR, is a registered occupational therapist and provides both direct and consultative OT services every Thursday morning to the Littler Center. She is assisted by Amy Duer, BA, a speech/language pathologist graduate clinician and Jaclyn Mutz, BS, a speech/language graduate clinician. Added to the program this year is Judith Leigth, MA, who facilitates the Adaptive P.E. prlgram for a couple of hours every Tuesday and Thursday. Four full-time ' COLORADO FAMILY PRESERVATION PROGRAM —DAY TREATMENT— North Range Behavioral Health 2004-2005 BID #RFP-FYC-04006 paraprofessionals, Tammy Miller, Tammy Gonzales, Karen King and Patricia Erickson assist the teachers in carrying out each student's individualized educational plan. Peg Hoover, an RN and Nurse Practitioner, is the school nurse and health consultant to the program. She regularly checks in with the staff and students and is also available as needed. She is providing on-going health education classes for all students. VIII. PROGRAM CAPACITY BY MONTH The Littler Center is designed to function with a minimum clinical staff contingent of 4.4 FTE, serving an average of 15 - 18 children and their families at any given time. 8 PROGRAM BUDGETS COMPUTERIZED ACTUA North Range Behavioral Health Fiscal Year Ending 6/30/2003 • PROGRAM Day-Treatment Residential Resident-Day A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 92 178 92 B TOTAL CLIENTS SERVED 20 37 20 C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 1,840 6,586 1,840 D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $38.95 $49.49 $38.96 E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $71,671 $325,925 $71,680 F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $70,216 $829,447 $70,216 G OVERHEAD COSTS ALLOCABLE TO PROGRAM $7,824 $126,475 $7,824 H TOTAL DIRECT,ADMINISTRATION B OVERHEAD COSTS(E+F+G) $149,711 $1,281,847 $149,720 I PROFITS CONTRIBUTED BY THIS PROGRAM $13,487 $1 $13,487 J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $163,198 $1,281,848 $163,207 K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 1,840 6,586 1,840 L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE (J/K) $88.69 $194.63 $88.70 CERTIFICATION/^�S_TAATTEM ENT I //��--- L 121-1-- declare to the best of my knowledge and belief that the statements made on this document are true and complete and that the wage rates and Ether factual unit costs supporting the compensktion paid or to be paid under this contract are accurate,complete and includes no duplicate costs and and that I am the CEO or duly authorized agent of rho at u R#.ar_m BF IdAvitio.J44.. 1.1€,-L . DIRECT SERVICE COSTS North Range Behavioral Health m.1r1:n:Raeunrrr,u Fiscal Year Ending 6/30/2003 . Minimum Bu4g1 Average Total %OF THE SALARY %OF TIME SALARY %OF TORE SALARY 54 OF TORE SALARY %OF TIME SALARY %OF TAE SALARY DUB. 8 0 Salry1Bunv BtlrNal 100% SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND OESCRPTON orCad FTEt 51.0 FTE Bu.Au4011W ALLOCATED PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM DµTmal enl Reabn0M Reslnlduy A TOTAL CLIENT HOURS OR DAYS PER PROGRAM 02 1]S 92 B TOTAL CLENTS TO BE SERVED PER PROGRAM 20 37 20 C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 184003 8588.00 160000 000 000 0.00 DIRECT LABOR FACE-TO-FACE POSITION.TITLE OR JOB FUNCTION P5yµarn DR 100 692,339 $92,33817 NO 2.24% $2.06378 1174% 510,843.39 2.25% $2.07301 $0.00 5003 $0.00 Clinical COM AeivinS2 BCI5015 1181 124,804 $292,93183 YES 1]50% $49,79843 88.00% $193,335.05 17.00% $49.79843 $0.00 $003 SO 00 TMllryp Mmba 3.40 $44.478 $151,22303 YES 1250% 51890299 75.00% $113,417.94 12.50% 518.90299 5000 $003 50.00 $000 NO 5000 50.00 $0 00 50.00 $000 50.00 $000 NO 5000 00.00 50.00 50 DD $0.00 50.00 $0.00 NO $000 $0.30 $000 50.00 $0.00 50.00 $0.00 NO 5000 80 OD $0.00 50.00 $000 $D.DD $0.00 NO $000 $0.00 $0.00 50.00 $000 $D DD $0.00 NO $000 $000 $0.00 $0.00 $000 $0.00 $0.00 NO SO 00 $000 $000 $0 DO $000 $0.00 $0.00 NO $000 $000 $00D $0.00 $000 $0.00 50.00 NO SD 00 $0.00 $0 OD $0.00 $000 $0.00 50.00 NO $0.00 $0.00 $000 $0.00 $000 $0.00 50.00 NO $0.00 $0.00 $000 $0.00 $0.00 $0.00 TOTAL DIRECT LABOR PER PROGRAM $538,495.03 $7028520 $312,596.41 120,22443 5000 $000 50.00 OTHER DIRECT COSTS PER PROGRAM FACE-TO-FACE CYO BUCEaa $8,41029 YES 10% $84103 60% $5,128.23 10% 5041.03 50.00 5000 50.00 Medical end TMMpu&Suniw $f88]37 YES 4% $8034 93% $1,584.69 4% 500.34 $0.00 $000 $0.00 RenedwI $2.04185 YES 10% $204.12 80% 51833.32 10% $204.17 $0.00 $000 $0.00 NO $0.30 $0.00 $0.00 50.00 $000 $0.00 NO $0 5000 $0.00 00.00 50.00 $0.30 NO $000 50.00 50.00 50.00 5000 $0 CO TOTAL OTHER DIRECT COSTS PER PROGRAM 610.13931 $049 $90553 $120 $8320.24 $049 500033 $000 $0.00 $000 E GRAND TOTAL DIRECT SERVICE COSTS $546,834.34 $3895 $71,870.73 $4949 532592465 538.98 $21,829.92 5000 $0.00 $000 ADMIN COST NON-FACE-TO-FACE North Range Behavioral Health roMVLRixv'vr>u]v.G. Fiscal Year Ending 6/30/2003 - Willman Budget Avenge Total % TIME SALARY % TIME SALARY % TIME SALARY % TIME SALARY % TIME SALARY % TIME SALARY Dena a Of Salarylbne Salaries/ 100% SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPUR ON AND DESCRIPTION or Cart FIE* @1.0 FTE Benefits/Other ALLOCATED PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM Day-Treatmenl Residential Residenl-Day A TOTAL CLIENT HOURS OR DAYS PER PROGRAM 92 170 92 B TOTAL CLIENTS TO BE SERVED PER PROGRAM 20 37 20 C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 1640.00 6596 0 1840.00 0.00 000 000 DIRECT LABOR NOT FACE-TO-FACF Rvgen Director MWs 1.00 585.838 565,937.85 YES )50% 54.922.82 05.00% $55,792200 7.50% $4,922.82 00.00 $0.00 $0.00 Admissions Coordinator Masters 1.00 $43,742 $43,74183 YES 10.00% 54.374 18 80.03% $34,99348 10.00% 54,374 18 $00] 50.00 50.C0 Cook H 2.45 $21,975 $53,39.98 NO 18.00% $8.81439 40.006 $25,843.18 18.00% $8.01439 50.00 $0.00 SO CO Janitor H.5. 900 524.0E $24,004.80 YES 1575% 53,780 78 88.50% 018.44332 15.75% $3,780.75 5003 $0.00 $000 Nurse LPN 200 537.181 $74,35139 YES 13.CO% $9680.90 74.00% $55,027.41 13.00% $9,884.98 0003 50.00 50.00 Clinical Care Aatitlarce HS. 300 $22,155 $88,484.33 YES $000 100DO% 588.46433 $0.03 $000 50.00 50.00 Commel*Y Sankt Bachelors 100 $32800 $32,00001 YES $000 15300% 03260.04 0000 5003 50.00 50.00 Secrets-mil supped H.5. 1.00 025,041 025,040.89 YES 50.00 100.00% 025.040 09 50.00 50 D3 $0.00 $0.00 Ter[Ms BMW's 340 528.983 098,13384 YES $0 D3 100.00% 598,133.84 50.03 00.00 50.00 50.00 Clinical Care Overnights HS. 365 $21,628 583,258.58 YES $000 100.00% 503,258.59 $003 $000 $0.00 $9.00 Oeo&S W MmiruWaiVe 100 5292,38 $292,353.00 YES 9.88% 528.67703 8.24% 5234.566.00 9.88% 020,67)00 $0.00 $0.00 00.00 5000 NO 50.00 $000 $000 5000 $0.00 SO CD 5000 NO 50.00 $0.00 $0.00 5000 1000 50.00 50.00 NO $08 508 $0.00 $0.00 1000 $000 TOTAL DIRECT LABOR PER PROGRAM NOT FACE-TO-FACE 5859,441 89 S50.236 14 504800 $728,20182 $60,236 14 5000 $000 $08 OTHER DIRECT COSTS PFR PROGRAM NOT FACE-TO-FACE GroaiIKdtlen Spplis 575,259.92 YES 7% 5`8,49645 85% $44,287.32 7% 55,488 45 50.00 508 $08 Mslle&TrM.&Sl,DevSoPmse and Training 58.781.94 YES 10% $69176 80% 05,390.42 10% 569176 50.00 $08 50.00 RemrixmM,LIMN,Inwedlrm $10,50563 YES 10% $1.008.98 81% 0855174 10% 01.038 90 $000 $08 50.00 Purchased Services 510,28!.53 YES 10% 51,028.25 80% 58.228 02 10% 01.028.25 $0.8 5000 5000 Operating Supplies $14.803.11 YES 10% $1.39533 81% 511,41248 10% $1395.3 $0.00 $0.00 50.00 Veneta accent* $3,712.13 YES 10% $37121 80% $295970 10% 37121 $0.8 $000 508 TOTAL OTHER DIRECT COSTS NOT FACE-TO-FACE PER PROGRAM $121,28.16 $5.42 $9,97999 $15.37 $101,245 37 55.42 $9979.89 $000 $000 $0.00 F GRAM TOTAL DIRECT SERVICE COSTS NOT FACE-TO-FACE $98,447.05 538.18 $70,21803 $12594 $828,446.99 53.10 570.21603 5000 $000 5000 OVERHEAD COSTS AND PROFITS IY,MPIrlvRl2u9ACTUAL North Range Behavioral Health _ Fiscal Year Ending 6/30/2003 - TOTAL ALLOCATED ALLOCATED ALLOCATED ALLOCATED I ALLOCATED I ALLOCATED ' OVERHEAD 100% ALLOCATED OVERHEAD COSTS ALLOCATED OVERHEAD COSTS ALLOCATED OVERHEAD COSTS ALLOCATED )VERHEAO COSTS %ALLOCATED OVERHEAD COSTS %ALLOCATED)VFYYLAO COSTS DESCRIPTION COSTS ALLOCATED TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM PROGRAM Day-Tleamenl Re¢penlial ReslenlOay A TOTAL CLIENT HOURS OR DAYS PER PROGRAM 92 $17800 592.00 B TOTAL CLIENTS TO BE SERVED PER PROGRAM 20 537..00 $20.00 C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 184.00 659600 1840.00 000 000 000 OVERHEAD Males 619.64799 YES 50% $982.35 90.00% $17,662.82 500% $982.38 50.00 50.00 50.03 TS6clniE N10 Papa $5.934.89 YES 5.00% $293.23 WCO% 55.34122 5.C0% $200.73 5000 50.00 $0.00 Omlpacyegmnd 625.672 22 YES 5.00% 51.29361 90.00% 123.285.03 $00% 51.293.61 $0.00 50.00 $0.03 Maumee General 510,364.49 YES 10.00% $1.038.45 60.00% 58.291.59 10.00% 51038.45 5000 $0.00 $0.00 Dep01Nkn 6 Amortization 372.817,62 YES 500% $3,840 88 90.00% 45,535.86 500% 53.640.88 5000 50.00 50.00 Irv10rd Cmirtutuv 55.984.00 YES 7.50% 552380 5500% 55.933.40 7..50% 5533.80 5000 50.CO $0.00 Other Mblmmus $502.68 YES 10036 550.26 BO.W% 5402.8 10.00% $50.28 5003 50.00 $0.00 NO E0.00 $0.00 $0.00 5000 SO DO 50.00 NO $0.00 50.00 50.00 5000 50.00 $O.W NO 50.00 5000 5..00 SO CO $0.00 $0.00 NO SO OD $0.00 $0.00 $000 SOLO $U.00 NO 50.00 5000 SO DO 5000 5000 50.00 NO 50.00 5000 $0.00 50 CO SO OD 50.00 NO $0.00 $0.00 $0.00 $0.D3 $0.00 50 OD NO $0.00 $000 SO 00 50.00 SO DO 50.00 NO 50.00 6000 50.00 $000 5000 $0.00 NO $0.00 SO 00 $0.00 $003 $0.00 $0.00 NO 50.00 $000 SO CG 5000 SO00 $000 0 TOTAL OVERHEAD COSTS $142,12229 57.824.12 5120.47505 57.824.12 $003 $0.00 $0.00 I TOTAL ANTICIPATED PROFITS 26.975.40 IYES 50% $13,457 CO 0% 5140 50% $13,48100 5000 5000 5000 TOTAL OVERHEAD AND ANTICIPATED PROFITS 5169.0 69 $21.311.12 $128476.45 621,311 12 5000 5000 50.00 PROGRAM BUDGETS COMPUTERIZED ACTUAL North Range Behavioral Health Budget for Fiscal Year Ending 6/30/2004 PROGRAM Day-Treatment Residential Resident-Day A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 92 178 92 B TOTAL CLIENTS SERVED 21 38 21 C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 1,932 6,764 1,932 D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $38.90 $50.51 $38.90 E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $75,151 $341,679 $75,160 F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $72,283 $859,190 $72,283 G OVERHEAD COSTS ALLOCABLE TO PROGRAM $8,215 $132,799 $8,215 H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $155,649 $1,333,668 $155,659 I PROFITS CONTRIBUTED BY THIS PROGRAM $16,560 $1 $16,560 J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $172,209 $1,333,669 $172,219 K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 1,932 6,764 1,932 L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE (J 1 K) $89.14 $197.17 $89.14 DIRECT SERVICE COSTS North Range Behavioral Health COMPUTERIZED ACTUAL Budget for Fiscal Year Ending 6/30/2004 , Minimum Budget Average Thiel %OF TIME SALARY 18 Of TIME SALARY %OF TalE SALARY % THE SALARY % THE SALARY % TIME SALARY Agree II Of Salary/Bone Salaries/ 100% SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT ON AND SPENT OH AND DESCRIPTION Or Cell PTE, ®18PTE een•SIsspMr ALLOCATED PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM DSYTeeMvu Readen9H ReabnlLp A TOTAL CLIENT HOURS OR DAYS PER PROGRAM 02 175 02 B TOTAL CLIENTS TO BE SERVED PER PROGRAM 21 78 21 C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 1832.00 6764.00 1832.00 0.00 000 5.00 DRECT LABOR FACE-TOFACE POSITION TITLE OR JOB FUNCTION %1pa*H OR 1.00 $02.336 $82,339.17 NO 224% $2.06328 1174% $10,643.30 2.25% 52.07301 $0.00 $003 $000 CIHcel Care Nwle,8 2 8.56ebe 11.81 526.044 $307575.53 YES 1700% 552200.35 88.00% $20300183 17.00% $52.288.35 50.00 $000 $000 Therapist Masters 3.40 540.702 $158,755.12 YES 1250% $10.84814 75.00% $115065.84 12.50% $16,846.14 $0.00 $0.00 $0.00 $0.00 NO $0.00 $0.00 $0OD $0.00 $0.00 $000 $0.D3 NO 50.00 $0.00 5000 $0.00 $0.00 $000 5000 NO $0.00 $0.00 $0.00 $000 $000 $0.00 $000 NO $000 $0.00 $0.00 $000 $0.00 $0.00 $000 NO $000 $0.00 $0.00 $000 50.00 $OW $0.00 NO $000 $0.00 $0.00 $0.00 $000 $0.00 $0.00 NO $000 $0.00 $0.00 $0.00 $000 $0.00 $0.00 NO $0.00 $0.00 $000 $0.00 $0O $0.00 5000 NO $0.00 5000 $000 $0.00 $000 $0.00 5000 NO $0.00 5000 $000 $0.00 $000 $0.00 $000 NO $0.00 50 D0 $000 $0.00 $000 $0.00 TOTAL DRECT LABOR PER PROGRAM ,$558.70282 574.200 27 $332.834 OH $74208.50 $0.03 $0.00 50.00 OTHER DRECT COSTS PER PROGRAM FACE-TO-FACE Cleat Supplies 56,7]3.50 YES 10% $67308 80% $5.384.84 10% $67308 $003 $0.00 $0.00 MJW MM Therapeutic Supplies* $1,771.74 YES 4% $6336 83% 51,64502 4% $63.36 5000 50 DO 50.00 Rsfebal $2.14373 YES 10% $21437 80% $1.714.99 10% $214.37 5000 SO 00 $030 NO $000 $0.00 5000 $0.00 $0.00 50.00 NO $000 $0.0 50.00 $0.00 $0.00 5000 I NO $000 50.00 5000 $0.00 $000 $000 TOTAL OTHER DRECT COSTS PER PROGRAM $10646.25 $040 $95081 5128 $8.744.65 $0.46 $85081 $0.00 $00D $000 E GRAND TOTAL DRECT SERVCE COSTS $558,348.1D $3880 $75,151 08 $5051 $34187671 $3690 $75.16032 $000 $000 $000 ADMIN COST NON-FACE-TO-FACE cnMnOSR¢EDArn:u North Range Behavioral Health Budget for Fiscal Year Ending 6/30/2004 - Minimum Budget Average Total %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY %OF TIME SALARY Degree •01 Sslery/Bone SaladW 100% SPENT ON AND SPENT ON AND SPENT ON AM SPENT ON AND SPENT ON AND SPENT ON AND DESCRIPTION or Cad Fits @ 1.0 FTE Benefits/Other ALLOCATED PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM Day-Treatment Residential ResidenlOay A TOTAL CLIENT HOURS OR DAYS PER PROGRAM 92 178 92 B TOTAL CLIENTS TO BE SERVED PER PROGRAM 21 30 21 C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 193200 678403 1932.00 000 000 0.00 PRECT LABOR NOT FARE-TO-FACE ROOM W61M Masters 1.00 060.920 588,91853 YES 750% $5,168.96 85.00% 058,581 60 7.50% 55,16800 $003 $000 5000 Admissions Coordinator Maters 100 $45,929 545,92092 YES 10.00% £4,59259 80.00% 136.743.14 10.00% $4,592.89 0000 0000 00.00 Cook H.5. 2.45 623.074 $50,53108 NO 10.0X4 59045.11 48.00% 527.13534 18.00% $9,045.11 00.00 $000 50.00 Jaeger H.S. 1.00 125.200 $25,200.09 YES 1575% 03,95980 09.50% $17,265.48 1575% $3059 MO $000 00.00 $0.03 Nurse 1FN 200 $39.040 0776,07943 YES 13.00% $10,1:0.33 74.00% $57,77878 13.00% 010.1:0.33 5000 $000 $003 Gina Can Assistance H.S 3.00 023.263 $89,707.54 YES 00.00 100.00% $69,787.54 $0.00 0000 0003 0000 Community Service GRIMM 1.00 534.239 $34,23949 YES $000 103.0% $34,23949 $0.00 00.00 50.00 $0.00 SarMuly support H.8 100 $26,293 $26,292.72 YES 0000 103.[0% $26,292 72 $0.00 $003 6000 $0.00 Team Leaden BSMaa 340 $%1.306 0103.040 32 YES 0000 100.00% 0103.040.32 $0.00 $000 $0.00 5003 Clinical Care Overnights HS. 3.85 $22,707 087.42149 YES 50.00 100.00% $87,421.49 50.00 00.00 00.00 $0.00 General atl Administrative 1.00 5292,351 $20236109 YES 9.80% 028,877 10 80.24% 5234,598 84 988% $20,077.10 $0.00 00.00 $0.00 $0.00 NO $000 00 CO $0.00 $000 s000 $000 $0.00 NO $0.00 0000 $0.00 $0.00 $0.00 $000 $0.00 No $000 so.00 5000 5000 0000 5000 TOTAL DIRECT LABOR PER PROGRAM NOT FACE.TOFACE $587,797.54 081,604.20 0752,882.74 $61,804.20 $003 $0.00 $000 OTHER DIRECT COSTS PER PROGRAM NOT FACE-TOFACF GroaW40lMn SUMS $79,022.92 YES 7% $5,760.77 85% 067,50137 7% 55.760.77 $0.00 $000 $003 1Mlaea,Tra.L,9et1.Development and Training $7,121.04 YES 10% $720.35 00% 05,088.35 10% 0720.35 $0.00 $000 $0.00 Recruitment.License.1Mp00008 $11,09.01 YES 10% $105724 81% 5697933 10% $1,05724 $003 50.00 50.00 PMCNa045eva. 510,706.06 YES 10% 01,07987 80% 08.637.33 10% $1,079.97 $0.00 $0.00 $0.03 Opaalrg 9ngpas $15,333.27 YES 10% 5148506 01% 012403.08 10% 51,48509 $0.00 $000 $003 Voodoo expense $3,06774 YES 10% 538977 80% $3,110.19 10% $389.77 $0.00 50.00 50.00 TOTAL OTHER DIRECT COSTS NOT FACE-TO-FACE PER PROGRAM 5127,265.42 $542 $10,478.89 $15.72 0100307.54 $5.42 $1047089 $0.00 $000 $0.00 F GRAND TOTAL DIRECT SERVICE COSTS NOT FACE-TO-FACE $1015,05200 $37.41 $72,283.09 $12702 $899,190.30 $3741 572,283 06 50.00 50.00 $0.00 OVERHEAD COSTS AND PROFITS COMPUTERIZED ACTUALNorth Range Behavioral Health , Budget for Fiscal Year Ending 6/30/2004 TOTAL ALLOCATED ALLOCATED ALLOCATED ALLOCATED i ALLOCATED I ALLOCATED OVERHEAD 100% ALLOCATED OVERHEAD COSTS ALLOCATED OVERHEAD COSTS ALLOCATED OVERHEAD COSTS ALLOCATED )VERHEAD COSTS %ALLOCATED OVERHEAD COSTS %ALLOCATED DVERHEAD COSTS DESCRIPTION COSTS ALLOCATED TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM PROGRAM Day-Treatment Residential Resident-Day A TOTAL CLIENT HOURS OR DAYS PER PROGRAM 592.00 $178.00 B TOTAL CLIENTS TO BE SERVED PER PROGRAM $2100 538.00 92100 C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 193200 6764.00 1932.00 0.00 0.00 000 OVERHEAD Utilities 020.630 07 YES SDM $103150 00.00% $10,067.07 SOT% 9103150 50.00 5050 $0.00 Telephone and pagers 06,231.42 YES 5.92% 031157 80.0096 $5,60828 500% $31157 $0.00 $0.00 $0.00 Oavpan,expense' 027.10563 YES 5.00% $1.356.29 90.000 $24,449.25 500% $1,358.29 $0.00 $000 $0.00 Insurance General 110.88271 YES ID 00% $108627 00.00% $1,709.17 1092% 51,068.27 50.00 $000 $000 Oeprmalm 6 Amortization $76,458.50 YES 5.00% 53,822.93 00.00% 4041,81265 500% 93.821.93 50.00 SO 00 $0.00 In-KMd CmMddens $7,303.20 YES ]50% $540.88 0500% 58,233.22 7.E0F 554909 $0.00 $000 0000 dMrµeglWCOus $62)71 YES 1000% $52.77 80.00% 1422.17 10.00% $52.77 50.00 5000 50.00 NO $0.00 $0.00 $0.00 51.00 90.00 50.00 NO $0.00 $0.00 90.00 $0.CO 90.00 9000 NO $0 CC $0.00 $0.00 $0.00 $000 90.00 NO $0.00 $000 50.00 50.00 $0m 50.00 NO £0.00 $0.00 $0.CO 90.00 5000 $0.00 NO $000 $000 50.00 5000 $0.00 9OC NO $0.00 woo $0.00 50.00 50.00 $0.00 NO $0.03 $0.00 $0.00 90.00 5000 50.00 NO $0.00 $0.00 $0.00 0000 $0.00 5000 NO $0.00 $000 9000 90.00 5..00 $000 NO 50.00 $0.00 90.00 90.00 WOO $0.00 G TOTAL OVERHEAD COSTS 9149,229.45 $8,21532 $132,798.81 $8]1532 50.00 50.00 90.00 I TOTAL ANTICIPATED PROFITS 33,121.00 IYES 50% $16,58000 0% $0.83 50% 518,580.17 50.00 $0.00 $0.00 TOTAL OVERHEAD AND ANTICIPATED PROFITS $102,35045 $24,775 33 5132,709.63 92077540 90.00 $000 50.00 .14t;i!Pcua L tK I Irit M I C ur LIAbILI I T IN,UKANUC I 12/31/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood&Peterson Ins. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 578 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 4687 W. 18th Street Greeley, CO 80632 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Philadelphia Insurance Companies North Range Behavioral Health INSURER B: Pinnacol Assurance 1306 11th Avenue INSURER C: Greeley,CO 80631 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH , POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POUCY EXPIRATION UMRS LTR NSRCDATE IMMIDDITYI DATE IMMIDD/YYI A GENERAL UABIUTY BINDER229629 01/01/04 01/01/05 EACH OCCURRENCE 51,000,000 X COMMERCIAL GENERAL LIABILRY PREMISESETO a PRE SO RENTED uvenrol $200,000 CLAIMS MADE n OCCUR MED EXP(Any one person) $15,000 X Professional $1,000,000 Oce. PERSONAL&ADVINJURY $1,000,000 Liability 53,000,000 Agg. GENERAL AGGREGATE $3,000,000 GENT-AGGREGATE LIMIT APPLIES�' PER PRODUCTS-COMP/OP AGG s3,000,000 -1 POLICY I�78-, I IT 7 LOC A AUTOMOBILE LIABILITY BINDER229629 01/01/04 01/01/05 COMBINED SINGLE LIMIT X ANY AUTO (Es accident) $1,000,000 ALL OWNED AUTOS , BODILY INJURY $ SCHEDULED AUTOS Al v. e � (Per Person) X HIRED AUTOS ' BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Drive Other Car PROPERTY DAMAGE (Per acoidenn $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY BINDER229629 01/01/04 01/01/05 EACH OCCURRENCE $1,000,000 71 OCCUR n CLAIMS MADE AGGREGATE :1,000,000 $ • DEDUCTIBLE $ X RETENTION $10000 s B WORKERS COMPENSATION AND 4044331 07/01/03 07/01/04 X I TORr II IMRS I I FR EMPLOYERS'LIABILITY E.L.EACH ACCIDENT 5100,000 ANY PROPRIETOWPARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 B yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY UMIT 6500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Weld County Social Services DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAI __,9_ DAYS WRITTEN 315 N. 11th Avenue ( NOTC THE CERTIFICATE HOLDER DT E LEFT,B FAILURE TO DO SO SHALL Greeley, CO 80631 ` IMPOSE NO LIGATION OR UABIU OF ANY KIN UPON TH URER,ITS AG REPRESENTA ES. �'// D PR E ACORD 25(2001/08) 1 of 2 #S268713/M268680 a ACORD CORPORATION 1988 • Off-System Bid B001-04 (RFP-FYC-04006) Attached A Program Category Day Treatment Program Bid Category Project Title KATHLEEN PAINTER LITTLER CENTER Vendor North Range Behavioral Health Please list your provider number as given to you from the State Child Care Licensing 06220 PROJECT DESCRIPTION Provide a brief one-page description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. The monthly maximum program capacity. G. The monthly average capacity. H. Average stay in the program(weeks). I. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Site based services (The Bidder must state that a minimum of site based services of 5 hours per day, ages eight through twenty-one (21) and two and one-fourth hours minimum per day for children ages three to seven)will be provided. B. Community collaboration efforts. The Bidder must describe its community collaborative efforts with: 1. The Department of Social Services. 2. The Department of Mental Health. 3. The Department of Education. 4. Others(Please Describe). C. Program components. The Bidder must describe the program components of: 1. Educational 2. Therapeutic 3. Behavioral - 4. Recreational D. Parental/Caretaker involvement in all program components as indicated in the case plan and as required. Page 27 of 31 Off-System Bid B001-04 (RFP-FYC-04006) Attached A E. Assessment and plan to meet the needs of child and family including: 1. Education through a certified teacher. 2. Vocational/Independent living for age appropriate children. 3. Individual and family therapy which includes all family members. 4. Physical health needs, i.e.,nutrition, medical, dental, sex education,HIV, contraception, etc. 5. Mental health needs such as psychotropic medications, etc. F. Proactive planning for transition to public school setting or independent living: 1. Reintegration into public school. 2. Follow-up for individual and family therapy. 3. Completion of Day Treatment. 4. Identifies progress/outcomes. 5. Reinforces gains. Provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component.Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g.mental health capitation services,ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES • Provide a two-page description of your expected measurable outcomes of the project. Please address the following measurable outcomes: A. The children completing the Day Treatment Program will be residing in their own homes six months after discharge from the program. B. The children will enter public school upon graduation from Day Treatment. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Provide a one-page description of your expected service objectives and quantitative measures. Address, at a minimum, the following ways the project will: A. The number of children placed within six months of Day Treatment graduation/discharge. B. The number of children that were enrolled in public school from graduation/discharge from the Day Treatment Program. C. Improve ability to access resources - services shall assist parents to work with other sources in the community and within the local, state, ant federal governments Describe the methods you will use to measure, evaluate, and monitor each service objective. Page 28 of 31 . Off-System Bid B001-04 (RFP-FYC-04006) Attached A VI. WORKLOAD STANDARDS Provide a one-page description of the project's workload standards and quantitative measures. Address, at a minimum, the following areas: A. Total number of children and families served. B. Duration/length of time in program. C. Total number of hours per day/week/month. D. Total number of individuals providing these services. E. Insurance. VII. STAFF QUALIFICATIONS Please provide a one-page description of staff qualifications and address, at a minimum,the following: A. Will your staff, including supervisors,who are providing direct services have the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17, and Section 7.000.6, Q, Colorado Department of Human Services? Describe. B. Total number of staff, including supervisors, available for the project. C. Total number of counselor and/or treatment leader(s)to the number of children ages 5 years to 13 years. (Minimum expectation is 1 staff member to 8 children.) D. Total number of counselor and/or treatment leader(s)to the number of children ages 16 years and over. (Minimum expectation is 1 staff member to 10 children.) VIII. Unit of Service Rate Computation The budget form is to be used to provide detailed explanation of the hourly or daily rate your organization will charge the Core Services Program for the services offered in this Request for Proposal. This rate may only be used to bill the Weld County Department of Social Services for direct, face-to-face services provided to clients referred by the Department. Requests for payment based on units of service such as telephone calls,no shows, travel time, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise,bills must be for hours or days of direct services to the client, regardless of the number of staff involved in providing those services. Therefore, it is imperative that this rate be sufficient to cover all costs associated with this client,regardless of the number of staff involved in providing these services. There are two different ways to fill out the budget form. The budget can either be done manually or by computer. Regarding the manual budget, all areas that are required to be filled in are highlighted. The computerized budget is less work due to predefined calculations,but does require Microsoft Excel for Weld County's predefined budget. There are highlighted areas on the computerized budget that are required to be filled in as well. There are disks available that have this predefined budget on it. Finns-can also design its ownbudget form on a spreadshcct,but at minimunr, it must have all of the columns that are on the manual or computerized budget. Explanations on how to fill out the budget form are provided below and on the following pages. (A) This is an estimate of the total hours or days of direct, face-to-face services each client will receive from the time he or she enters the program until completing the program. On the Page 29 of 31 . Off-System Bid B001-04 (RFP-FYC-04006) Attached A manual budget, the only place to put this number is on the Program Budget worksheet. The computerized budget requires this number to be entered on the Direct Service Cost worksheet only. Once filled in there, this number is populated throughout the entire budget. (B) This is an estimate of the number of clients who will be served during the period from June 1, 2004, through May 31, 2005. On the manual budget, the only place to put this number is on the Program Budget worksheet. The computerized budget requires this number to be entered on the Direct Service Cost worksheet only. Once filled in there, this number is populated throughout the entire budget. (C) This is the total number of hours or days per client multiplied by the total number of clients to be served for(B). On the manual budget,this will have to be calculated manually on the Program Budget worksheet. The computerized budget will automatically calculate this then populated throughout the entire budget. (D) This is calculated by taking the total direct service costs (E) and dividing it by the total number of hours in( C ). On the manual budget, this will have to be calculated manually. The computerized budget will automatically do this calculation for you. (E)This number represents the salary and benefits that your organization pays its direct service providers plus any costs which are directly attributable to the face-to-face session with the client. On the manual budget, all areas that are highlighted on the Direct Service Costs worksheet must be filled out according the descriptions. The Grand Total Direct Service Costs must be then carried over to the Program Budget worksheet. The computerized budget, once all of the highlighted areas are filled in, it will automatically carry the total over to the Program Budget worksheet. (F) This represents the salary and benefits of direct service, supervisory, and clerical personnel which are not incurred in providing direct, face-to-face service to the client,but can be allocated to this program for time spent on the program for activities such as travel,phone conversations,no- shows, discussions with involved parties, meeting preparation, and report completion. On the manual budget, all areas that are highlighted on the Admin Costs Non-Face-to-Face worksheet must be filled out according to the descriptions. The Grand Total Direct Service Costs Not-Face- To-Face must be carried over to the Program Budget worksheet. The computerized budget,once all of the highlighted areas are filled in on the Admin Costs Non-Face-to Face worksheet, it will automatically carry the total over to the Program Budget worksheet. (G)This represents the agency overhead costs, such as rent,utilities, supplies,postage, travel reimbursement,telephone charges, equipment, depreciation, data processing, interest, and taxes which are not incurred in providing direct, face-to-face service to the client,but can be allocated to this program for time spent on the program for activities such as travel,phone conversations, no-shows, discussions with involved parties,meeting preparation, and report completion. On the manual budgetll highlighted areas-on the Overhead Costs and Profits-worksheet must-be - completed according to the descriptions. The Total Overhead Costs must be carried over to the Program Budget worksheet. The computerized budget, once all of the highlighted areas are filled, will automatically carry over to the Program Budget worksheet. (H) This represents the total of all direct face-to-face costs, admin direct non face-to-face costs, and Page 30 of 31 Off-System Bid B001-04 (RFP-FYC-04006) Attached A overhead costs. On the manual budget, this will have to be manually calculated by adding these three total costs together. The computerized budget does it automatically. (I) This represents the total amount of profit your firms expects to realize as a result of operating this program. Any difference between lines (H) and(J) must be substantiated by an amount indicated on this line. The manual budget, this amount will be entered on the Overhead Costs and Profit worksheet and then have to be carried over to the Program Budget worksheet. The computerized budget, once it is filled in on the Overhead Costs worksheet, it will then automatically be carried over to the Program Budget worksheet. (J) This represents the total costs and profits added together. This is(H) and(I). On the manual budget, it will have to be calculated manually on the Program Budget worksheet. The computerized budget will automatically calculate it on the Program Budget worksheet. (K)This represents the total hours or days of direct service for the year. This is ( C) above. On the manual budget, you will have to carry this number down from( C ). On the computerized budget, it is automatically carried down. (L)This is the actual direct, face-to-face hourly or daily rate at which you will be requesting payment for the services provided under the conditions of this Request for Proposal. This amount cannot be more then what is charged to the general public or collected from insurance providers. On the manual budget,this amount must be calculated by taking the total costs and profits (J) and dividing it by the total hours or days of direct service for the year(C or K). The computerized budget automatically calculates this total. All providers who receive a NOFAA must also submit a certified computation of the organization's actual expenditures for the approved Core Service program by January 31, 2005, for a seven-month period from June 1, 2004 to December 31, 2004. The actual expenditures must be submitted in the same format as the budget was prepared. The certification language must be the same as on the Computerized Actual Expenditures worksheet. The document must be signed by the Chief Executive Officer or the authorized officer of the bidder in order for it to be considered certified. The use of the actual program expenditures is to insure that the direct, face-to-face hours/daily rate is comparable to the budget computation. The actual numbers will be taken into consideration for the 2005-2006 Request for Proposal for that specific program. Page 31 of 31 Contract Number 04- 5310213(2/79) COLORADO STATE DEPARTMENT OF SOCIAL SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES 1. WELD COUNTY DATE: 2. Name of Provider "� - 3. Address 4. City, State, Zip THE DESCRIBED SERVICE IS AUTHORIZED FOR THE CLIENT INDICATED: 5. Name of Client Household# Cat Cat Grp. 6. Description Sv.Code 7.APPROVAL • • Caseworker Date Co.Dirc.Au.or Supervisor 8.TO BE COMPLETED BY PROVIDER DATE OF SERVICE CHARGES$ I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE COUNTY DEPARTMENT OF SOCIAL SERVICES INDICATED. Provider Signature Date Prepare in Triplicate,Original and One copy to Provider,One Copy for Pending File. Completed Provider's Forms-Original to County Finance Office-Copy to Case Record. WELD COUNTY CORE SERVICES PROGRAM MONTHLY REQUEST FOR REIMBURSEMENT-PY 2004-2005 Remit to:Elaine Furister,CPS/CAP,Core Service Specialist of Program Month of Service Weld County Department of Social Services -- Notice to Providers:1St all clients currently enrolled in your program. P.O.Box A,315 B N 11 Avenue,Greeley,CO 80632 Enter 0 if no services were provided during billing month Telephone:970.352.1551,extension 6295 FAX:970.346.7698 Client Name& HH# Referral Approved Approved Actual Maximum Rate per Monthly Social Services Payments Services Trails ID # Entry Date Exit Date Hrs/Service Hours Unit Total Only-Comments Denied/Delayed Payable Period Sessions/ Service Period • • Social Service Codes:CE-Computation Error;NR-No Referral;EED-Exceeds End Date;EMH-Exceeds Maximum Hours;EMS-Exceeds Maximum Sessions;NP-Not Payable; PD-Payment Delayed;SPD;Submitted Past Deadline;NDC-No Face to Face Contact;NV-No Client Verification;ICMP-Initial Case Management Plan Needed;PR-Progress Report Needed • WELD COUNTY CORE SERVICES PROGRAM PROJECT REPORT-PY 2004-2005 Remit to:Elaine Punster, CPS/CAP,Core Service Specialist Weld County Department of Social Services Program Month of Service P. O.Box A,315 B N 11 Avenue,Greeley, CO 80632 Telephone:970.352.1551,Ext.6295 FAX:970.346.7698 #Households Referred #of Households Enrolled #of Households Served #of Households Monthly Expenditure Expenditures to Date. During Month During Month During Month Discharged During Month Termination Reason Codes:SEP-Successfully Ended Program;M-Moved;UL-Unable to Locate;RCCF-Entered a Residential Facility;FCR-Foster Care Review;OT-Explain, TM-Transferred to Another Program More Restrictive;FC-Entered Foster Care;NT-Terminated;Unable to Work with Client;RH-Returning to Relative Child's Name Direct Date Service Termination Client Caseworker Provider Initial Case Monthly Funding Total Cost Social Service Ended Reasons Survey Survey Survey Management Progress Source of Program Services Date Plan(Date) Report to Date Use Funding Source:EPP-Expedited Permanency Planning;M-Medicaid;CI-Client Insurance;O-Other ` CORE SERVICES PROGRAM YEAR 2004-2005-CLIENT VERIFICATION FORM Notice to Provider:All clients served during the service month must complete this verification form at the time of service.No request for payment of services will be honored for billed services unless accompanied by the appropriate signed client verification form.Payment for services will not exceed maximum hours or sessions as stated in provider's RFP. Section I: (To be completed by the provider) Primary Client billed: Trails ID Total Hours Billed Household Number: Referral Number. Contact Person: SECTION II(To be completed by client) Client signatures must be signed at the time of service.Your signature verifies that services were provided by the service provider for direct face-to-face contact only,for the hours indicated. Date Hours Number of Hours Client/Participant Signature(Please have all those attending sign.In the case of a child who is not able to sign, Please state hours of Service please have someone sign for the child;i.e.,Sally Smith by Gregg Jones,Foster Parent of services;i.e., Provided 1:00-2:30 • Notice to Provider:Attach all client verification forms to the monthly billing when submitting your request for Payment for Contractual Services.All Requests for payment must be received by the 25ih day of the month following service in complete form. Send original signed billing and verifications to:Elaine Punster,CPS/CAP,Core Service Specialist,Weld County Department of Social Services P.O.Box A,315 B N 11 Avenue,Greeley,CO,80632 Telephone:970.352.1551,extension 6295;FAX:970.346.7698 • SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B X RECOMMENDATIONS X CONDITIONS RECEWED BY APR 1 4 2004 WELD Gt)uiNTY DEPT North Range OF Snr=i' ,c rr)mrrq Behavioral Health April 13, 2004 Gloria Romansik Department of Social Services P.O. Box A Greeley, CO 80632 Dear Gloria: We were pleased to receive the letter from Judy Griego informing us that the FYC Commission recommended approval of our bid to provide Day Treatment Services and hereby respond to the conditions and recommendations cited in the letter. In terms of the request for an explanation of how our program addresses Bilinguallcultural sensitivity we offer the following. All new staff members, as a part of their orientation to North Range Behavioral Health,receive training from Becky Marrujo, the Director of the NRBH Multicultural Services Program, on cultural and linguistic factors that must be considered in providing services to consumers from the variety of different cultural groups we serve. To provide linguistically appropriate services to children and their families in Spanish as needed, the North Range Behavioral Health Day Treatment Program at the Littler Center employs a Spanish speaking therapist who is currently assigned to those families needing bilingual services. Additional resources available to the Day Treatment program include the staff of the North Range Multicultural Services Program, all of whom are fluent in Spanish and knowledgeable the cultural issues that must be considered when services plans are developed and treatment provided. As a component of treatment services provided in the Day Treatment Program, all children in the classroom are invited to share their own individual traditions and cultures. This is especially apparent when each classroom presents several units devoted to introducing art, food, traditions, and languages of a variety of cultures and asking the children to write about what they learned, or to present projects devoted to a specific culture. 1306 11 W Avenue/Greeley,(O 80631 /(970)347-2120/Fax(970)353-3906 Gloria Romansik Page 2 Mentors from the community are also occasionally used in meeting specific cultural needs identified during assessment and treatment. North Range Behavioral Health agrees to notify the Weld County Department of Social Services any change in staff at the Day Treatment Program at the time of change. Please accept this letter as an amendment to our original bid and incorporate our acceptance of the FYC recommendations in any Notification of Financial Assistance Award that may be issued to North Range Behavioral Health. Sincerely, Wayne A. Maxwell, Ph.D. Executive Director CCI 4417:46 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 April 7, 2004 COLORADO Wayne Maxwell,Executive Director North Range Behavioral Health 1306 11 Avenue Greeley,CO 80631 Re: RFP 04006: Day Treatment Dear Mr. Maxwell: The purpose of this letter is to outline the results of the Bid process for PY 2004-2065 and to request written confirmation from you by Wednesday,April 14,2004. A. Results of the Bid Process for PY 2004-2005 The Families,Youth and Children(FYC)Commission recommended approval of the bid,RFP 04006,Day Treatment, for inclusion on our vendor list with the following recommendation. Recommendation: The provider will explain in writing how their program addresses Bilingual/cultural sensitivity. B. The Families,Youth,and Children Commission recommended the following condition be applied to all 2004-2005 contracts. The condition is: the provider will notify the Department of any change in staff at the time of the change. C. Required Response by FYC Bidders Concerning FYC Commission Recommendations and Conditions You are requested to review the FYC Commission recommendations and to: a. accept the recommendation(s)as written by the FYC Commission; or b. request alternatives to the FYC Commission's recommendation(s); or c. not accept the recommendation(s) of the FYC Commission. Please provide in writing how you will incorporate the recommendation(s)into your bid. If you do not accept the recommendation,please provide written reasons why. All approved recommendations under the NOFAA will be monitored and evaluated by the FYC Commission. • Page 2 North Range Behavioral Health/Results of Bid Process for PY 2004-2005 All conditions will be incoporated 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 recommendations and conditions.Please respond in writing to Gloria Romansik,Weld County Department of Social Services,P.O. Box A,Greeley, CO, 80632,by Wednesday,April 14, 2004,close of business. If you have questions concerning the above,please call Gloria Romansik at 352.1551, extension 6230. Sincerely, • J A. o, ' 1 tor cc: Juan Lopez, Chair,FYC Commission Gloria Romansik, Social Hello