HomeMy WebLinkAbout20041630.tiff RESOLUTION
RE: APPROVE TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS WITH
VARIOUS PROVIDERS FOR SEX ABUSE TREATMENT 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 two Notification of Financial Assistance
Awards for Sex Abuse 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 the following providers, commencing June 1, 2004, and ending May 31, 2005,with
further terms and conditions being as stated in said awards:
1) Ackerman and Associates, P.C.
2) Adolescent and Individual Therapy, and
WHEREAS, after review, the Board deems it advisable to approve said awards, copies of
which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the two Notification of Financial
Assistance Awards for Sex Abuse 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 the above listed providers be, and hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said awards.
2004-1630
SS0031
A0 ' SSC)el- � O6,-023-0 y
TWO NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR SEX ABUSE TREATMENT
PAGE 2
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.
IEILa BOARD OF COUNTY COMMISSIONERS
ry • • /M WE ..:: COUNTY, COLORADO
oY.°. ,' & 1 LU
1861 lJ(,. V J
Robert D. Masden, Chair
� • !fj*�}�Clerk to the Board
®
i William H. erke, Pro-Tem
BY: �(
Deputy Clerk to the Board _},-_,......--
M. ile
A O A D AS TO e
•
David . Long
unty Attor
Glenn Vaad
Date of signature: 2 c2..er'
2004-1630
SS0031
a
DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY,CO. 80632
' Website:www.co.weld.co.us
11 Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
•
COLORADO
MEMORANDUM
TO: Robert D. Masden, Chair Date: June 14, 2004
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services
RE: Notification of Financial Assistance Awards for Sexual Abuse Treatment
with Various Providers
Enclosed for Board approval are Notification of Financial Assistance Awards (NOFAAs) for
Sexual Abuse Treatment between the Weld County Department of Social Services and various
providers. The NOFAAs are based upon the provider's Request for Proposal,which has been
reviewed and approved by the Families, Youth and Children(FYC) Commission. The NOFAAs
were reviewed at the Board's Work Session of 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 providers under Core Services funding according to
the NOFAA and their respective bid proposal for Sexual Abuse Treatment. These
services are for children,youth, and families receiving child welfare services. Generally
therapeutic intervention is designed to address issues and behaviors related to sexual
abuse victimization, sexual dysfunction, sexual abuse perpetration, and to prevent further
sexual abuse and victimization.
3. Providers will be reimbursed according to various rates as provided below:
Vendor Name Rate
A. Ackerman and Associates P.C. $80.00 per hour
B. Adolescent&Individual Therapy $50.00 per hour(individual/family)
$50.00 per hour(staffings with
family/client)
$35.00 per episode(Group Session)
2004-1630
$500.00 per episode and is dependent
upon services (evaluation)
$225.00 per episode and is dependent
on cost(polygraph)
$10.00 per client(one time fee at first
group session for supplies/notebook)
If you have any questions,please contact me at extension 6510.
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission(Core)Funds
Type of Action Contract Award No.
X Initial Award FY04-CORE-04007
Revision (RFP-FYC-04007)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2004 and Ackerman and Associates P.C.
Ending 05/31/2005 Sex Abuse Treatment
1750 25th Avenue, Suite 101
Greeley, CO 80634
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Time-limited, outcome focused therapy services Assistance Award is based upon your Request for
for the non-offending parent, victims, and Proposal(RFP). The RFP specifies the scope of
siblings of the victim. Individual services are in services and conditions of award. Except where it is
office. Group services provided in office, foster in conflict with this NOFAA in which case the
home, or WCDSS. The program maximum is 3 NOFAA governs, the RFP upon which this award is
new families per month with a maximum ability based is an integral part of the action.
to carry eight open cases a month. Services are
culturally sensitive. Bilingual services are Special conditions
available. 1) Reimbursement for the Unit of Services will be based
on an hourly rate per child or per family.
Cost Per Unit of Service 2) The hourly rate will be paid for only direct face-to-
Hourly Rate Per Individual Consultation $80.00 face contact with the child and/or family as evidenced
by client-signed verification form, and as specified in
Enclosures: the unit of cost computation.
X Signed RFP:Exhibit A 3) Unit of service costs cannot exceed the hourly and
X Supplemental Narrative to RFP: Exhibit B yearly cost per child and/or family.
Recommendation(s) 4) Rates will only be remitted on cases open with,and
X Conditions of Approval referrals made by the Weld County Department of
Social Services.
5) Requests for payment must be an original and
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
change in staff at the time of the change.
ABy � By
als:� Program Official:
VV�d
Robert D. Masden, Chair Judy . eg , Direct
Board of Weld Coun Commissioners Weld ounty epartment of Social Services
Date: JUN 16 2004 Date:________
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-04007
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-04007)for:Colorado Family Preservation Act--Sexual Abuse 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 competing applications will be accepted for approved vendors pursuant to the
Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-
5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement
Act(C.R.S. 26-5.3-101). The Families,Youth and Children Commission wishes to approve services targeted
to run from June 1, 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 Sexual Abuse Treatment Program must
provide for therapeutic intervention through one or more modalities to prevent further sexual abuse
perpetration or victimization. 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 '2 q -ey
(After receipt of order) BID MUST BE SIGNED IN INK .�
TYPt�CP. �n, b
OIt PRINTED SIGNATURE
VENDOR IVVJUIWCIAI ' 1 ts- t,k. N*ctQ
(Name) Hand en ignature By Authorized
C� Officer or Agent of Vendor
R
ADDRESS r)SQ o1 ] �'� J tk@ (O� TITLEj)8 1;
Ir eAs.(1 I �--CIC1 ( L1 DATE 3
PHONE# W1 s= 3'?),.;17
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
Off-System Bid B001-04 (RFP-FYC-04007)
Attached A
SEXUAL ABUSE TREATMENT PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
FAMILY PRESERVATION PROGRAM
2004-2005 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2004-2005
OFF-SYSTEM BID B001-04,RFP-FYC-04007
NAME OF AGENCY: trAWartNei (11 ,(
ADDRESS: �`�C1� 0_eih IN LA -- t3-1\e_ lot -(�\ l \p \&y i CY �Qt? 1U
PHONE: f f 07
CONTACT PERSON: C�G t\C\A-l- 4tIrf\CeA 11 TITLE: ,�% 1 (tick
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Sexual Abuse Treatment Program must
provide for therapeutic intervention through one or more modalities to prevent further sexual abuse perpetration or
victimization.
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: Mi t: �ITltlt(l ���� 1 S@Cs P6�� �tb�CCt inn
ettS in 0 ,�6\kt--Q.
1J 3-a -c
Name d ' atu of Person Preparing Document Date
(
TX I `I. !' Tan
Name and Satdte Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REQUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal
for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2003-
2004 to Program Fund year 2004-2005.
Indicate No Change from FY 2003-2004 to 2004-2005
Project Description _J.!
Target/Eligibility Populations J L
Types of services Provided J�
Measurable Outcomes r/
Service Objectives ✓
o� StandardsStaff Qualifications
Unit of Service Rate Computation (/
Program Capacity per Month
Certificate of Insurance
Page 26 of 32
Off-System Bid B001-04 (RFP-FYC-04007)
Attached A
Date of Meeting(s)with Social Services Division Supervisor:
Comments by SSD�pervisor:r2testilAk „ e S- `^V� //
/Lvlc.v�.aX but d-� A _ - 1. �a•�.� C.d-..vt
4:e 4"11.0
Ana
Nam d Sign of SSD Supervisor Date
•
Page 27 of 32
Off-System Bid B001-04 (RFP-FYC-04007)
Attached A
Program Category Sexual Abuse Treatment Program Bid Category
Project Tide /� r nn
Vendor Aokern\ c. S5c.ai P. e-•
I. PROJECT DESCRIPTION
Provide a one-page brief 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 to be served. Please describe if your clients are:
1. Victims under age 18.
2. Perpetrators under age 18.
3. Adult incest perpetrators.
4. Non-abusing spouse
5. Relatives(under 18) in the household of incest victims and/or incest perpetrators.
C. Total family units.
D. Sub-total of individuals who will receive biculturalbilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. Subtotal of individuals who will provide 24-hour access to services.
G. The monthly maximum program capacity.
H. The monthly average capacity.
I. Average stay in the program(weeks).
J. Average hours per week in the program.
M. TYPE OF SERVICES TO BE PROVIDED
Please 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. Comprehensive, diagnostic and treatment planning with the family and other service
providers.
B. Therapeutic intervention with flexibility to bring in other services if needed.
C. Therapeutic services through a variety of modalities including: individual, family, group,
marital,data, etc.
D. Therapy designed to address issues and behaviors related to sexual abuse victimization, sexual
dysfunction, sexual abuse perpetration, and to prevent further sexual abuse.
E. Specialized intake/investigation function for families with sexual abuse allegations.
Also,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.
Page 28 of 32
Off-System Bid B001-04 (RFP-FYC-04007)
Attached A
IV. MEASURABLE OUTCOMES
Please provide a two-page description of your expected measurable outcomes of the project. Please
address the following measurable outcomes:
A. Reduced rate of recidivism of sexual abuse perpetration within a stated rime frame.
B. Decrease in re-victimization.
C. Prevent victim perpetration.
D. A percentage of child abuse incest victims receiving services do not go into placement.
E. Improvement in parental competency as measured by pre and post placement functional test.
F. More rapid reunification of children with families.
Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate,
and monitor each quantitative measure.
V. SERVICE OBJECTIVES
Please provide a one-page description of your expected service objectives and quantitative measures.
Please address, at a minimum,the following ways the project will:
A. Improve Parental Competency-Capacity of parents to maintain sound relationships and
appropriate physical and emotional boundaries with their children, and to empower non-
abusing parents and victims.
B. Improve Family Conflict Management-Mediation and counseling designed to resolve
conflicts and disagreements within the family contributing to child maltreatment and sexual
abuse.
C. Improve Personal and Individual Competencies -Primarily in terms of self-esteem,victim
awareness, awareness and management of one's own personal history of victimization, sex
education,peer relationships enhancement, establishing appropriate physical and emotional
boundaries, assertive in lieu of aggressive behaviors, and assuming responsibility for one's
own behavior.
D. Improve Ability to Access Resources- Services shall assist parent in learning to obtain help
from other sources in the community and within local, state, and federal governments.
Describe the methods you will use to measure, evaluate, and monitor each service objective.
VI. WORKLOAD STANDARDS
Please provide a one-page description of the project's work load standards and quantitative measures.
Please address, at a minimum,the following areas:
A. Number of hours per day,week or month.
B. Number of individuals providing the services.
C. Maximum caseload per worker in the intake function and in the Sexual Abuse Treatment.
Page 29 of 32
I
PROGRAM BUDGETS
r/har a �A /�
PROGRAM �� ��%- P� Nome ha Lrh S4Is /iRofYconl y> hw.he ,Uta1Y`+ yam¢IMA1'oan( Tn�,sare. MANU.
mr t.�tot",-.w(b(-Avis
k TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT a6 ,3e alit_8 as VS S
G
3 TOTAL CLIENTS TO BE SERVED o /0 /000 /0o yg ,36 AO
TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) /9-00 / $oo 1__/o /a-o0 / G;0 G 00
COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) 5/.Co5/. Ge y r oo Go•oo fr oc y8,o0
TOTAL DIRECT SERVICE COSTS 6 I P-OD V boo jury°vev0° 2a� 97)66 Sr too
_,- 7j
ADMINISTRATION COSTS NON-DIRECT ALLOCABLE TO PROGRAM 9 200 10c0° 6 roc, ypo 9 c/00 of 2 g 3&00
-
i OVERHEAD COSTS ALLOCABLE TO PROGRAM 33 Soo 3-0 V06 ?Gay servo 3`r Goo Y2/a0 LEG oo
I TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) /offo0o /53 00.9 sClicgkt%Ggopo 00000 /attn0 ea
ANTICIPATED PROFITS CONTRIBUTED BY THIS PROGRAM a 0 D 0 0 o
TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) /o'-0 O I5-3ow 8g evoco fa-0000 1629,60o 4'too°
i
TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(C) l Aoo I foe /goo /6 7o 4 00
RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE TO BE CHARGED
TO WELD COUNTY SOCIAL SERVICES(J/K) $O,oo gS-oo d'0,00 /0.00 80. ae, 80,oo
`2 2 f // 1 Lq W
li EATIONSTATEI�IEN�
,...z...\......,.,--, -.‘,AD 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
id o e factual unit costs supporting the compensation paid or to be paid under this contr ct are accurate,complete and includes no duplicate costs and
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Project Description 2004 - 2005
Sexual Abuse Family Education and Treatment Program
The SAFE-T Program
Project Description: Ackerman and Associates P.C. proposes to continue to
provide, in 2004 -2005, the time limited, outcome focused therapy model for
treatment of the non-offending parent, the victim and siblings of the victim in
sexual abuse cases.
The program is proposed in four parts: (each of these parts may be used as part
of an integrated program, may stand alone or be used in combination with other
treatment regimens.)
A. The development of the prescriptive safety education and treatment plan of
the family unit. This will take place over no more than fifteen hours and should
average ten hours.
B. The implementation of the plan with the non-offending parent to increase
safety and avoid repetition of sexual abuse in the family unit. This will take place
over no more than 15 sessions. Up to ten of these sessions would be for
individual treatment. Up to an additional five of these individual session times
could be converted to ten hours of group work. (Throughout the proposal,
whenever we discuss group work, note that it will be billed as one hour of
individual treatment for each two hours of group treatment).
C. Short term treatment for the child who was abused and for the siblings over a
maximum of fifteen sessions to develop skills for future safety and to reestablish
trust, including family issues that need to be addressed with the children. Each
child in treatment, either the victim or the sibling, should have their own
authorization for treatment.
D. A protocol of therapy to taper down the frequency of support needed to
provide maintenance of skills developed. This will take place over no more than
ten sessions designed to be delivered on a twice a month basis over a maximum
of five months. This provides an additional support program for those families in
need of the service.
Based on past experience Parts A, B, and C have been used by WCDSS and D
has not been used much. Nevertheless, we submit it here as an appropriate
program for potential future use. Note that part D is presented as a separate
budget page.
For any family who is not appropriate to continue in the treatment model due to
severity that will be transferred. Determination of progress in the program will
occur at the following review points:
Program Review point#1: A report of recommendations for treatment will be
completed at the end of part A. It will specify 1. The goals to be achieved in part
B and part C, which can then proceed over the next two or three months if
authorized 2. What other types of treatment or intervention are appropriate and 3.
If no other intervention is recommended.
Program review point#2: A report of the summary of treatment as the completion
of the treatment plan in part B and part C. The purpose of this report is to answer
questions.
1. How much progress has been made to date in relation to treatment plan?
2. Is it probable the family will complete the treatment in part B or part C
within the session limits specified and if not what other services might be
needed.
This will also be the time point that a determination will be made as to if there is a
need for an extension of sessions in phase B and C and if so why this is needed.
An extension, if needed, will be limited to twelve sessions. Such an extension
can occur only though a second authorization.
The criteria for making judgments as to the family's progress will be based upon
their completion of the prescriptive treatment plan and the adequacy of that
treatment plan to protect the child and family from repeat offenses in relation to
sexual abuse. Families not making progress will be discussed with the
caseworker and as needed referred to other programs.
Please note: the end point of treatment is not necessarily intended to be the full
and complete resolution of all psychodynamic issues precipitated by the sexual
abuse event. Such issues will likely continue to emerge as the child enters
different stages of development into adulthood. If further funds are needed for full
and complete restoration of mental health (beyond that required for family safety)
these funds should be obtained from the perpetrator and or through victim's
assistance and other funds. The purpose of this program is to recommend to
WCDDS if the incident of the actual abuse has been resolved sufficiently to
provide for the ongoing physical and mental health and safety of the non-
offending parent, the child victim and siblings at the time of discharge from the
program.
The purpose of this highly structured system is to assist family members to
achieve careful implementation of safety and child protection plans. Through role
modeling, psychoeducational group and individual work with adults, through child
therapy in individual and on a group basis, families will progress along a
structured treatment course. Treatment will move from recognition of the factors
that lead to the sexual abuse in their particular case to developing and effective
plan to eliminate the resurfacing of these factors and repetition of these kind of
events in the future.
Of the four phases of the program, Part A would be limited to 15 sessions
delivered over no longer than three months. Part B and C would be limited to
fifteen sessions each delivered either separately or concurrently over four
months. The step down phase of the program Part D would be limited to no more
than 10 sessions over four to six months. Reviews for the need to continue in the
program would occur in month one, month three and month five.
Families will need the sexual abuse family education and treatment program (the
SAFE-Treatment Program) because the sexual abuse and its implications have
either 1. Immanently placed the children at risk of outplacement from the non
offending parent or parents, 2. Created a need to be reunified or 3. The family is
facing imminent reunification failure or 4. Have failed to implement the behaviors
required of them. Our model does not treat the adult offender. Where that
offender is the parent (usually the father or step father) and reunification is the
agreed upon course of action desired. We would only assist the parties in
developing a formal reunification plan after the offender has completed treatment
in another program and then only in those cases we accept based upon out
clinical judgment.
Our model is expected to work best with younger children and younger teens. It
is expected to be especially useful where the non offending parent is herself a
victim of sexual or physical abuse in her home of origin, or who has a highly
disrupted home of origin from other causes. The program will provide continuity
for the non offending parent and the children through each family having a
coordinator within Ackerman and Associates. That coordinator will also
coordinate the case and be the contact for the case worker and lead the clinical
team on the family. The coordinator will also track the goals of treatment and
organize the aspects of treatment within our clinical team approach. Clinical
teams will discuss each case as necessary.
Purpose: The purpose of the time limited, outcome (safety) focused (as opposed
to psychodvnamicallvfoused) therapy is to implement the changes needed to
insure future safety from further sexual abuse. The model uses a clinical team
oriented family systems approach of education and treatment and seeks to
clearly define behaviors and outcomes that will insure safely. The role of the non
offending parent in the sexual abuse wil be explored,looking fa:points where
protection can be strengthened-in the future. The life experiences of abuse or
neglect of the non-offending parent in the home of origin will be a part of the
7 sychoeducational work that will be necessary for many of the families.
In order to develop a treatment plan for addressing the sexual abuse that has
brought the family into social services, the first part of the model will be the
development of the psychological scope of work that will need to be completed.
What are the goals needed to insure future safety? This will be developed
through a review of the case, psychological testing if indicated, and assessment
of the victim and of the victim's siblings. From there, clearly defined, achievable,
structured behavioral changes that are needed to insure future safety of the child
will be developed into a written plan. Once signed by the therapist and non-
offending parent, the plan will become the treatment goals for the family in
relation to the safety of the child.
Time lines and work to be achieved by phase are listed below:
Part A is the development of the prescriptive treatment plan of the family unit
over no more than fifteen sessions with a goal of the program for prescriptive
assessment to average ten sessions. The prescriptive treatment plan typically
involves interviews with the non-offending parent (up to five hours) three hours of
case review, three hours of assessment and interpretation and up to four hours
of assessment of other family members.
Part B is the implementation of the plan with the non-offending parent to assure
the safety and avoidance of repetition of sexual abuse in the family unit over no
more than 15 sessions. It is anticipated that ten hours of these 15 sessions can
be through group work (at a cost equivalent of five individual hour long sessions)
For the non offending parent a mentoring of psychoeducational process of
identifying factors that contributed to the abuse and dealing with these factors will
be explored. This will be particularly important if negligence or home of origin
issues are present. We postulate that a large percentage of the non-offending
parents will either have been themselves sexual abuse victims or have come
from significantly dysfunctional backgrounds. Such a psychological history would
be amenable to this mentoring approach.
Part C is for the child victim or sibling. The restoration of trust and safety
assurance after the abuse incident itself would be a goal of child treatment. If
appropriate and if the offending parent has successfully completed treatment and
if the victim and the non-offending parent are appropriate for reunification, steps
toward reunification may progress in selected cases.
Part D is A step down protocol of therapy for no more than ten sessions designed
to be delivered on no more than a twice a month basis for supportive transition
from the support program, for those families in need of this service.
Other Considerations:
There is no risk of the program running costs up to levels beyond those budgeted
for any one family because we set a treatment cap for social services funds at a
maximum number of sessions, 15 for part A 15 for part b 15 per child for part C.
Our experience has been that sections A, B and C have been used and D is not
used often. Limitations on service delivery allow only 12 additional hours to be
provided in part D. If significant resolution cannot be achieved to assure the
safety of the child within 45 hours of competent psychological treatment, other
options should be considered to attain that safety. In our opinion it will be very
rare for a case to go on for a lengthy period and then fail, as the family will need
to make progress sufficient at each review point to continue in the process.
Target/Eligibility Populations
Total number of clients to be served in this twelve month program has been
calculated as follows. Three families per month times twelve months equals thirty
six families per year. If we assume a nuclear family size of five, two adults and
three children, then the total client pool to be served is 180 individuals. If we
subtract from the five family members the one offending parent the total becomes
144 individuals. As a minimum, there will be up to 36 non-offending parents and
36 victim children to be served. We expect the need to be lower than this number
and anticipate 18-24 families in treatment over a one year period. We calculated
the budget based on one child in treatment in part C, thus each child in treatment
in part C will need an individual referral.
Distribution of clients. Total number of clients we will serve is approximately 36
index children or more as calculated above. Our experience suggests that for the
family we would expect approximately 36 additional of these would be adult
members of the family (the non offending parent) and approximately 72
additional siblings who would be minors.
Families Served. We would anticipate serving 36 family units or less. We expect
18-24 families is a more likely use rate.
Sub total who will receive bicultural/bilingual services. We have a Hispanic
memberof the staff, Emily (Jaramillo) Montoya M.A., L.P.C. who speaks Spanish.
One of the facilitator's (Joyce Shohet Ackerman) doctoral work was on Hispanic
patient's mental health treatment patterns compared to Anglo patient's in Weld
County. She also has four years of direct cross cultural experience with an
American Indian population. All of the staff have cross cultural experience. We
expect up to 25% of referrals can receive services in Spanish and 100% will
receive services in a culturally appropriate manner. We will continue to provide
bilingual services for any family who needs them.
We can provide services in South Country if Social Services can provide a site
to do such work. However, we anticipate that the majority of the work in this
program will be conducted at our Greeley offices.
Accessibility. On weekdays all providers of Ackerman and Associates are
accessible through 24 hour answering service and pager system. On weekends,
the 24 hour access reaches the provider on call all of whom are Ackerman and
Associates' licensed mental health providers described in the staff section of this
proposal.
Maximum per month. The program maximum is three new families per month
with a maximum ability to carry eight open cases a month.
The monthly average capacity is two new families per month with the average
load of five open cases a month.
The average stay in the program is expected to be 40 sessions over a six month
period. The maximum stay is 45 sessions over a twelve month period assuming
one child in part c with parts A and b also being used. Use of part d would add 10
hours to this total. Group treatment would be provided at a rate of one half of the
rate for individual sessions so that each two hours of group session treatment
would be at the same rate as one hour of individual treatment. There are a
number of options WCDSS can use to decrease the cost of this program. For
example if assessment is complete prior to referral then part A might be omitted.
Part D costs have been less than projected over the several of this project.
Nevertheless, we have tried to make best estimates for the average length of
stay in our budget.
Types of Services Provided
The types of services have been described in detail above under project
description and purpose sections. They are summarized here.
We propose to provide a maximum of 55 sessions of outcome focused treatment
over four program referral subtypes (A,B,C or D) for the victim of sexual abuse,
his or her siblings and the non offending parent. Part A offers assessment of the
non offending parent and the children in terms of treatment needed and if they
would benefit from this program (15 session maximum). Part B is for treatment of
the non offending parent{15 sessions maximum) to improve safety of the child in
the future, Part C is to treat the child victim (15 sessions maximum) of the abuse
and the siblings to improve safety and to establish short term treatment goals for
safety as well as to develop a long term treatment plan. Part D is a transition of
up to 10 sessions for maintenance of achieved skill in those families requiring
this service.
Measurable Outcomes
Measurable outcomes are of two varieties. One type is termed formative
outcomes and the other type is called summative outcomes. Formative outcomes
measure how the program is proceeding while the freatmant 4 Irag Iaca
Summative outcomes are the results of the treatment.
In terms of formative measures we have the following...
Family cooperation with appointments and process of treatment in parts A, B C
or D form components of the formative review. Did the family cooperate in
treatment is a primary formative measure.
This data will be extracted from the case file.
Summative Outcomes
A. To reduce the rate of recidivism of sexual perpetration. This
program does not treat sexual perpetrators so at one level this
question does not directly apply. However the goal of the program is
to prevent 100% of revictimizations by treating the victim and the non-
offending parent to alter the family environment and opportunities for
revictimization.
B. Decrease in revictimization should be substantial and persistent. The
program is set up to empower the non-offending parent to identify
situations where victimization is likely and to reduce these
occurrences. We set a goal of 90% of families who complete treatment
will not be victimized in the next two years. This number assumes that
after treatment is completed that the non-offending parent does not
reenter a marital relationship with the offending parent. We set a goal
at 50% at two years post treatment would avoid revictimization if
marital reunification occurs with the offending parent occurs in the next
year.
C. Prevention of victim perpetration. For those victims who complete
part C treatment, most will be children who are not sexually active. We
expect that for a two year period following treatment victim perpetration
will be rare and that 90% of children will not be perpetrators over a two
year period following end of treatment. Comments on individual case
risk will be made in final reports.
D. We expect that 70% of non-offending parents will complete
treatment. Of these we expect that 90% will be able to keep their
children over the next two years if they do not reenter a marital
relationship with the perpetrator.
E. Improvement in parental competency: Parameters measured in this
area include acceptance of the sexual abuse and the need for
restructuring the family environment as well as the client's ability to
achieve that goal to prevent such abuse from occurring again. Clinical
improvement in this area is the goal of the Part B treatment program
and for each client will be reported at the end of treatment.
F. While we do not expect more rapid reunification with biological family
members (the offending parent), we do expect the acquisition of life
skills in anger management and an increase in psychoeducational
knowledge. These should lead to risk reduction for a return to an
abusive environment.
Quantitative measures of these outcomes could be assessed at WCDSS
discretion at chart review at two years post treatment by WCDSS to determine if
new charges had been reported or cases opened. Individuals who leave the
county would be lost to follow up in this mechanism. A more vigorous evaluation
method would be preferred but is not budgeted within this proposal
Service obiectives
This proposal meets all the service objectives for the non-offending parent and
the victim. The areas for improvement are documented in the quantitative
measures that will be rated for the non-offending parent at the review points and
at the completion of therapy as listed under the measurable objectives section.
These areas include the required components of improving parental competency,
improving family conflict management, improving family conflict management
improving personal and individual competencies and improving ability and
access resources for the non offending parent.
Work Load Standards
A. The program has a capacity of 5 families per month with an average of 3 per
month. The families will receive an average of 45 hours of service as described
if parts A, B and C are utilized.
B. We have 7 providers for this program. They are Emily (Jaramillo) Monytoa
M.A., L.P.C., Valerie Larson, M.S.W., L.C.S.W., Joyce Ackerman Ed..D.,
licensed psychologist. John Gray, M.A., L.P.C. and Bill Kelly M.A.
psychotherapist
• Emily (Jaramillo) Montoya, M.A. L.P.C. received her masters in Agency
Counseling from UNC. Prior to joining Ackerman and Associates, P.C., she
has a wide range of work in mental health including treatment for alcoholic
patients and support of minority college students. She is fluent in Spanish.
Her undergraduate major was in Criminal Justice and Sociology.
• Joyce Ackerman, Ed.D. Psychologist will function as the clinical supervisor of
the program. She has 20 years of private practice experience and is listed in
the National Register of Health Service Providers in Psychology
• Valerie Larson, M.S.W. is a licensed social worker who has experience in the
residential treatment of sexually abused children.
• John Gray MA LPC is an experienced caseworker who has worked with a
number of social services agencies in Colorado in family systems oriented
casework. He currently works part time for Ackerman and Associates.
• Bill Kelly holds an MA in counseling and a Ph.D. in education. He was
previously chair of the Department of Education of Regis College, a principlal
and an assistant principal in Public and religious schools
•
• Laurence P. Kerrigan Ph.D. is a Licensed psychologist who has provided
services in Greeley over the past twenty five years.
•
• Susan Bromley Psy D is a licensed psychologist who is also an MSW who
has provided psychological services for twenty years in Greeley.
All of our staff are highly regarded by the caseworkers based on feedback we
have received from supervisors. . Of the up to 36 families the caseload is
projected at twenty families with each provider.
D. The modality of treatment is individual or group therapy.
E. Hours/weeks. The total number of therapist hours is 60 per family over six
months, or a total for the budget calculation of $3600 per year based on our
projected average. Maximum capacity is the same as this level. The hourly fee
is requested at $80.00 as documented in the rate calculation section.
F. Staff. There are 7 individual providers supported by two office professionals
in the practice as well as a contracted accountant.
G. Supervisor. This contact would be supervised and clinically managed by
Joyce Shohet Ackerman, Ed.D. who will monitor the project for compliance. The
maximum caseload for the supervisor is five families per month.
H. Insurance. Ackerman and Associates, P.C. carries one million, three million
liability coverage for professional liability on the corporation and its associates
and each associate also carries the same level of coverage individually. In
addition, Ackerman and Associates, P.C. carries a general liability policy related
to accident or injury on our premises through Farmer's Insurance.
Staff Qualifications
A. All staff members exceed the minimum qualifications needed for this project
in both education and experience as described above.
B. Staff available for the project are listed above.
Unit of service rate computation
We have calculated the unit of service rate based in the instructions. We used
2003 data for our agency.
Using overall figures for the agency we arrive at a figure of 0.00 r contact
hour. Group rates are billed at one half this rate per hour. The ofit for
Ackerman and Associates for all core services programs was approximately 0%
for the 2003-2004 FY
The proposed cost is $80.00 per face to face contact hour.
Budget Justification
Ackerman and Associates purchases services for accounting through an
independent contractor. Budget worksheets are attached.
Ackerman and Associates, P.C. is a type S professional for profit corporation and
not a 501.c.3.
Specific standards of responsibility for the 2004 -2005 year have been
addressed in the body of the proposal.
Farmers Insurance Group Issue Date
03/01/2004
Farmers Insurance Group This certificate is issued as a matter of information only and confers no rights
PO Box 1054
01 orado Springs, CO 8090 1-1054 upon the certificate holder. This certitcate does not amend,extend or alter the
coverage afforded by the policies shown below.
NSURED Company
1 Truck Insurance Exchange
Man & Joyce Ackerman
750 25th Ave Ste.101
ireeley, CO 80634
'overages
This is to certify that the policies of insurance listed Below have been issued to the insured named above for the policy period
dicated. Notwithstanding any requirement,term or condition of any contract or other document with respect to which this certificate
ay be issued or may pertain,the insurance afforded by the policies described herein is subject to all the terms,exclusions and
mditions of such policies. Limits shown may have been reduced by paid claims.
O Type of Insurance Policy Policy Policy Policy
Number Effective Expiration Limits
Date Date
General Liability 045763807 03/02/2004 07/01/2004 General Aggregate $1,000,000
Products Comp-Ops $1,000,000
Aggregate
Personal & $1,000,000
Advertising Injury $1,000,000
Each Occurrence $1,0000,000
Fire Damage $150,000
Building Coverage (Any one Fire)
g 045763807 03/02/2004 07/01/2004 $195,000
Personal Property' 045763807 03/02/2004 07/01/2004 $58,400
•
Medical Expense $5,000
•
Automobile Liability
Umbrella Liability
Worker's Compensation
iftcate Holder
3 County Bank Cancellation
5 rd Should any of the above described policies be cancelled before the expiration dale thereof.
3 Ave the issuing company will endeavor to mail 30 days written notice to the cenificate holder
❑S, CO 80621 named to the left, but failure to mail such notice shall impose no obligation or liability of any kind
upon the company,its agents or representatives.
Authorized Representative
1/20 04' - A EXECUTIVE RISK SPECIALTY CO.
/ PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY
THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY
*** RENEWAL ***
NOTICE:A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS
OF SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION"SEXUAL MISCONDUCT"IN THE POLICY).
DECLARATIONS POLICY NO: 008-1766682
ITEM 1. (a)NAME AND ADDRESS OF INSURED: - TEM1.ACCOU (b)N CO-KERL175-D 0099745B
- - ITEM 1. ADDITIONAL NAMED INSUREDS:
LAURENCE P. KERRIGAN,
PH.D.
1750 25TH AVE.
SUITE #101
GREELEY, CO 80634
'EM 2. - ADDITIONAL INSUREDS: TYPE OFORG: INDIVIDUAL
?M3- POLICY PERIOD: FROM: 12/01/03 TOc
12/01/04
12:01A.M.STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN:
:M 4. LIMITS OF LIABILITY: (a)$ EACH WRONGFUL ACT OR SERIES OF CONTINUOUS,REPEATED
1, 000, 000 OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE
(13)S 5, 000 - DEFENSE REIMBURSEMENT
(cj$—— —370'0'0, 000— AGGREGATE ---
5- PREMIUM SCHEDULE:
CLASSIFICATION NUMBER RATE ANNUAL PREMIUM
1ST PSYCHOLOGIST 1 1191 . 00 1; 191 .00
DEFENSE LIMIT . 00
SURPLUS LINES TAX 1 35 . 73
INSPECTION FEE 1 2 .38
6. RETROACTIVE DATE: 12/01/91
7. EXTENDED REPORTING PERIOD TOTAL PREMIUM: 1, 229. 11
ADDITIONAL PREMIUM(if exercised):$ 2, 150 . 68 NO DISCOUNT INCLUDED
POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY
3 8 (7/95 ED. ) B22137
PERSONAL.DATA SHEET
Identifying Information:
Name : Laurence "Larry" P. Kerrigan, Ph.D.
Address: i
DOB:
Phone :
ness
Degrees •
BSC - Business Economics, from Creighton University, 1954 .
MS - . Economics , from St. Louis University, St. Louis ,
Mo. , 1963 .
MA - Theology, from St. Mary's University, Re
Campus , Toronto, Ontario , Canada, 1967 . College
Ph. L. - Philosophy, St. Louis University, St . Louis, Mo. 1960 ,
(EccleiPh . D. - CaliforniaB Degree ) .
a School of Professional Psychology,
Berkeley/Alameda .Campus , 1974 , Clinical Psychology.
Currently a licensed psychologist in the state of Colorado.
Educational Background:
1950-54 Creighton University, Business economics ,
1954-56 Marquette University, Milwaukee, WI . , Classical studies
and ascetical theology,
1956-57 Springhill College , Grand Coteau LA. Campus, Classical
studies ,
1957-60 St. Louis University, Philosophy and Economics ,
} 1963-67 St. Mary' s University, Toronto Campus , Theology,
1971-74 California School of Professional Psychology,
clinical psychology, Berkeley/Alameda Campus
Positions Fleld:
•
1969-71 Member of Board of Directors, Campion College,
Prairie du Chien, WI .
1968-71 Director, Department of Psychology, Campion College .
1971-74 Director of Student Counseling Center, Long
Mountain College.
1975-80 Director of Short-term Children and Family Team,
Weld Mental Health Center, Greeley, CO .
1975-'87 Clinical Psychologist, Child and Family Team, Weld
Mental Health Center, Greeley, CO .
) 975,88 Co-founder of Weld County Child Protection Team,
1987-88 Member of Executive Board, Weld Mental Health Center,
Greeley, CO .
Honors Received :
1968-69
and Teacher of the year, Campion College .
1970-71
1972-73 Class Representative to Campus Executive Committee ,
and California School of Professional Psychology
1973-74
Work and Experiential Background :
1959-60 Counselor at Dismas Halfway House for ex-convicts ,
St. Louis, Missouri ,
1960-63 Teacher-counselor-coach, Marquette Prep High School ,
Milwaukee, WI .
1964-67 Counselor-therapist at Street Haven and Sancta Maria
Halfway Houses for women and at the Don ( metro ) Jail
in Toronto, Canada.
1967-68 Teacher and Campus Counselor at Creighton University,
Omaha, NB.
1968-71 Teacher at Campion College, Prairie du Chien, WI . ,
Director of Psychology Department , Department
chairman.
1970-71 Director and Staff member of a total environment
for Inter-city- boys , late grade school age from
Milwaukee , WI .
1971-73 Director of Student Counseling, Lone Mountain
College , San Francisco , CA.
Teacher at the Lone Mountain College , San Francisco ,
California.
1973-74 Psychologist Trainee at San Francisco Mental Health
Center, Richmond District, Outpatient Care .
1974-75 Private Practice, So. Bay Human Services Center,
San Diego, CA.
Part-time instructor at/California School of
Professional Psychology, San Diego , CA .
•
1975-80 Director , Short-Term Therapy Team, Children and
Family Unit , Weld Mental Health Center , Greeley ,
CO . .
1980-87 Member of Children and Family Therapy Team,
Weld Mental Health Center, Greeley , CO .
1987-
present Full time private practice with Joyce Shohet Ackerman ,
Ed . D. , Licensed Psychologist , Greeley , CO .
Part time practice at Weld Mental Health Center ,
Greeley , CO .
Publication :
Kerrigan , Laurence P. - The Relationship Between Therapist and
Client ' s Perceptions of One Therapy Session. Published
Doctoral. Dissertation , University of California School
of Professional Psychology. Copyright , 1974 .
Worksho_s and Special_'I_raining:
Since 1974 , I have attended an average of about three workshops
per year. Most of these workshops have presented specialized
training in the following areas : Neuro-linguistic training ,
Autogenic and relaxation training , Visualization-Imagery-
Hypnosis , Cognitive-Behavioral Therapy, Ericksonian approaches to
hypnotherapy and psychotherapy, Family therapy, Strategic family
therapy, Sexual abuse , dynamics and applied treatment ,
Paradoxical intention psychotherapy, and other related areas .
In the last fifteen years , I have taught classes and conducted
workshops in the following subjects :
The Psychology of Dreams
__ _Emotional- and-Ph-mint Health through Visualization and Imagery
Western Psychotherapies and Eastern Ways of Liberation
Cognitive and Behavioral Therapy
Hypnosis in Pain and Habit Control
The Psychology of Consciousness and Meditation
FACULTY VITA
February 1998
NAME: BROMLEY, Susan Plock
SOCIAL SECURITY NUMBER: 483-50-9243
POSITION: Associate Professor of Psychology
Department of Psychology
College of Arts and Sciences
University of Northern Colorado
Greeley, CO 80639
HOME ADDRESS:
TELEPHONE: O five:(303)351-2236
Home: (303)352-8750
EMAIL:sbromley@benttey.unco.edu
EDUCATION:
Year(s) DDegree Institution Area of Study
1983 PsyD University of Denver Clinical Psychology
School ofProfessional Psychology
Denver,Colorado
I968 MSSA Cac.Western Reserve University Casework
(MSW) School of Applied Social Sciences
Cleveland,Ohio
1965 BA Mt Holyoke College Economics/Sociology
South Hadley,Massachr,ceits
WORK EXPERIENCE—Professional Academic:
Yearts) Institution/Organizntibn Position Responsibilities
1985-Pis University of Northern Colorado Assoc.Professor Psychology Teaching/Advising
1983-84 University of Nor(bem Cplprado Asst.Professor Psychology Contract Teaching
WORK EXPERIENCE—Professional Non Academic:
Year(s) Institution/Organization % Position Responsibilities
1996-present Ackerman and Associates Psychologist Clinical
1984-85 Kaiser Permanence Psychotherapist Clinical
Lakewood, Colorado
1979-80 Bethesda Mental Health Center Psychology Intern Clinical/
Denver, Colorado A ve
1968-79 Denver General Hospital Clinical Social Worker/ Clinical/
Denver, Colorado Supervisor Administrative
1
AREA OF SPECIALIZATION:
Behavioral Medicine/Pain Management/Clinical Hypnosis
RESEARCH AREAS/INTERESTS:
Hypnosis/Pain Assessment and Management/Women's Issues/Teaching Methods
PROFESSIONAL ACTIVITIES:
Colorado Licensure: Psychology License#1086
PUBLICATIONS—Pro fessional/Juried:
Musgrave-Marquart,IX,Bromley, S.P.&Dalley,M.B. (1997)"Personality,academic attribution,and substance
abuse as predictors of academic achievement in college students".Journal of Social Behavior and Personality 12(2),
501-511.
Karlin,N.J.and Bromley, S.P. (19%).Differences in caregivers of demented and lucid chronically ill family
members. Journal of Alzheimer's Disease and Related Disors and Research
Retzlaff,P.and Bromley,S. (1994). Counseling personality disorders.In Ronch,J.L.,VanOmum,W.&Stillwell,
N.C. (Eds)The counseling sauceboat' A practical reference on contemporary issues. New York:Crossroad
Publishing group.pp.466-474.
Bromley, S.and Hewitt,P. (1992). Fatal attraction:The sinister side of women's conflict about career and family.
Journal of Popular Culture. 26(3),pp. 17-24.
Retzlaff,P.and Bromley, S. (1991). "A Multi-Test Alcoholic Taxonomy: Canonical Coefficient Clusters". Journal
of Clinical Psychology 47(21,pp. 299-309.
Bromley, S.P. (1985). "Treatment of Pain:Theory and Research"in Zahourek,R. (Ed). Clinical Hypnosis and
Therapeutic Suggestion. New York: Grune and Stratton. Reprinted in Zahourek,R(Ed.)(1990). New
York:Bnmer/Mazel,Inc.,pp.77-98..
PROFESSIONAL PRESENTATIONS--Juried:
Bromley, S. (1997)(Chair)"Linking through honors programs:The cross-discipline course).Paper Presentation as
- oft symposium titled"Creating links between psychology and other disciplines".,American Psychological
Association Convention,Chicago. (August)
Bromley, S. , Gilliam D.,&Johnson,T. (1995). "Assessment of student created tests as an evaluation method".
Poster presented at the American Psychological Association Convention,New York City. (August)
Bromley, S. (1994). "Student created tests as an evaluation method". Poster presented at 16th Annual National
Institute on the Teaching of Psychology,St.Petersburg,Florida.
Karlin,N. and Bromley. S. (1992)." Similarities and differences for caregiver of demented and lucid chronically
ill". Poster presented at the Rocky Mountain Psychology Association Convention,Boise,Idaho. (April)
Montoya, K.J. and Bromley, S. (Chair)(1992)."Changes in undergraduate counseling styles in an introductory
counseling theories course". Paper presented at the Rocky Mountain Psychology Association Convention,Boise,
Idaho(April)
Bromley, S. (1992). "Connected learning methods to faciliate research understanding". Paper presentation as part
of panel titled, `Teaching techniques in the social sciences", Western Social Science Association Convention,
Denver, Colorado. (April)
2
Bromley, S.,Ramirez, S.,and McCoy,J. (1991)."Impact of a health psychology course on student health beliefs".
Poster presented at the Rocky Mountain Psychology Association Convention,Denver,Colorado.(April)
Karlin,N.and Bromley, S.(1991)."Support,burden and affect among caregiver of dementia and nondementia
patients". Poster presented at the American Psychology Association,San Francisco,California.(August)
Bosley,G.and Bromley S. (1990).-Post death ritual in a Colorado community. Paper presentation at the American
Psychology Association, San Francisco,California.(August)
Bromley, S. (1990). "Husbands at Childbirth:Who Does It Help?"Paper presentation at Far West Popular Culture
Association,Las Vegas,Nevada(January).
Hewitt,P. and Bromley S. (1989). "Images of Work and Intimacy in'fuming Point'and'Fatal Attraction". Paper
presentation National Convention of Popular Culture Association and American Culture Association,St.Louis,
Missouri. (Session Chair)
Retzlag P.and Bromley,S.(1989). "The Basic Personality Inventory:A1coh Sub-Group Identification". Poster session
at the Joint Convention of the Rock Mountain Psychological Association and Western Psychological Association,Reno,
Nevada.
Bromley, S. (1988). "Our Culture Affects Our Pain."Paper presentation,National Convention of Popular Culture
Association and American Culture Association,New Orleans,LA.(March).
Bromley, S. (1987). "Husband-Assisted Autohypnosis for Labor and Delivery: A Clinical Model". Paper presented
at Rocky Mountain Psychological Association,Albuquerque,New Mexico(April).
Bromley, S. and Loy,P. (1987). "Politics of PMS". Paper presentation Association of Women Psychologists,
Denver, Colorado(March).
PROFESSIONAL PRESENTATIONS—Invited:
Handelsman, MM.,Bromley, S.P. &Davis,S.F. (1995)."Clinical Psychologist,Counseling Psychologist,Clinical
Social Workder,or Psychology Professor: Which Degree is Right for Me?"Psi Chi invited panel presentation,Rocky
Mountain Psychological Association,Boulder,CO(April).
-Bromley;-S:(Co-Chair),Seibert,-P.(Co-Char),Knuckey,D.,Bohlin,M.,Zaweski,C.,Watson,D.,Hammon,D.,
West,K. &Robins, J. (1994)."Training the Teaching Assistant"Invited Panel Presentation,Rocky Mountain
Psychological Association,Las Vegas,Nevada(April)
Bromley, S. (1993). "Hypnosis in Dentistry."Presentation at Monthly Meeting of Weld County Dentistry
Association, Greeley, Colorado(February).
Bromley, S. (1993). "Learning about the author as a way to understand research." Presentation at"Teaching Take
Out", CTUP Special Event. Western Psychological Association/Rocky Mountain Psychological Association
Convention,Phoenix, Arizona(April).
Allen,M. and Bromley, S. (1993). Co-Chairs Two CTUP Special Event Sessions, "Teaching Take Out:Experiences
in Collaborative Learning", Western Psychological Association/Rocky Mountain Psychological Association
Convention,Phoenix, Arizona(April).
Bromley, S. (1993). Chair, Invited Symposium, "Psychological and Social Perspectives on Male Violence Against
Women", Western Psychological Association/Rocky Mountain Psychological Association Convention,Phoenix,
Arizona(April).
.. _, 3
Bromley, S. (1992)."Enhancement of student research and writing skills in any course". CTUP Workshop
presented at the Rocky Mountain Psychology Association Convention,Boise,Idaho.(April)
Bromley, S.and Karlin,N. (1992). "General and health locus of control of adult caregivers". Poster session at the
UNC Research Forum,Greeley,Colorado.
Bromley,S.(1992). Panel member in Mental Health Symposia for Victim Compensation Convention as part of the
Colorado Organization for Victim Assistance Conference. (Estes Park/October)
Bolocofski,Bromley,Foster and Mean(1988). "Hypnosis:Research and Clinical Perspectives,"symposium
presentation, Colorado Psychological Association,Greeley(March).
Bromley, S.(1986). "Pain: A Psychological Event". Presentor-20th Annual Emotional Crisis Workshop,
University of Northern Colorado,Greeley, Colorado(July).
I.ECTI JRES—Invited.
Bromley,S. (1995).Keynote speaker for Golden Key Honor Society Induction Ceremony,University of Colorado,
Boulder,Co. (November)
Bromley, S. (1992). Keynote speaker for Sophomore Honor Society Induction Ceremony.
Bromley,S. (1991)Featured speaker. UNC Acadmic Honors Convocation.(April)
Bromley, S. (1991)..Banquet speaker Emotional Crisis Workshop,Greeley,Colorado. (July)
GRANTS:
Bromley, S( 1994)Honors Grant($500)to attend research training at the Society for Clinical Hypnosis meeting,
San Francisco(October)
Bromley, S. (1994). Research and Publications award of$1500.00. "Assessment protocols to measure the efficacy
of hypnotic treatment for injured workers.
Karlin,N.and Bromley, S. (1990). Research and Publications award of$2,4440.00."Control,support,burden and
affect-differences among-dementia-and-non-dementia caregivers".
ROOK/GRANT REVIEWS.
Grant review for Boise State Department of Education(1995)
Review of Santrack,J. (1991). The science of mind and behavior. W.C.Brown and Benchmark.
Review of McKee,P. &Thiem,J. (1993).Real life:Ten stories of aging.University of Colorado Press.
PROFESSIONAL CONSULTATION/PRA CE:
Year(sI Institution/Organization Role
1996-presnt Ackerman and Associates Clinical Psychologist
1988 Bonnel Good Samaritan Center Pain Management Consultant and Trainer
1984-85 Denver Metropolitan Dental Care Consultant in Pain Management
1984 Iowa Association of Registered Physical Therapists Hypnosis for Pain Management Consultant
And Teacher
4
PROFESSIONAL ASSOCIATION PARTICIPATION:
Membership
1986-present Rocky Mountain Psychological Association
I988-present American Psychological Association(Divisions 2,30,35)
1989-present Greeley Area Mental Health Network
1987-88 -- - Association of Women in Psychology
1980-89 Colorado Psychological Association
1988 CPA Program Committee Member for Spring Meeting—Greeley Coordinator
SERVICE:
EXTERNAL.
NATIONAL SERVICE:
1994-present Rocky Mountain Coordinator-American Psychological Association,Division 2-Teaching
of Psychology
1992-94 Co-Chair,Rocky Mountain Region Council of Teachers of Undergraduate Psychology(CTUP).
1991-94 Mountain States Regional Academic Coordinator,Golden Key National Honor Society
REGIONAL/STATE SERVICE:
1989-present Rocky Mountain Psychology Association
1992-present Board Member
1995-present Elected Chair,Groups Under-Represented in Psychology Committee
1992-94 Co-Chair,Groups Under-Represented in Psychology Committee
1991 Coordinator of Student Volunteers,RMPA Convention,Denver,Colorado.
1995 Psychology Chair-CCHE Faculty to Faculty Conference(October)
COMMUNITY SERVICE:
1997-1998 UNC Loaned Executive-United Way of Weld County
1991- 19% Board Member, 19th Judicial District Victim Compensation Board
1995-96 Chair
1990-93 Board Member,Weld County Area Agency on Aging
1992-93 Chair
1991-92-- - . Vice-Chair
1986-Present Exam Supervisor-American Institute for Property and Liability Underwriters/Insurance Institute
of America
1987-present Clinical Psychologist-pro-bono work with individual clients and community training
INTERNAL:
DEPARTMENTAL:
1985-88,
1995-preset Co-Advisor Psi Chi National Honor Society
1989-91,93,
95-present Department Representative,CCHE Faculty to Faculty Conference
1987-94 Department Representative to graduation ceremonies
1986-94 Library Representative
1983,86 89,
90-93,97,98 Member,Faculty Search and Screen Committee
1990-92 Member,Psychology Department Undergraduate Committee(Chair 1992)
1987-88 Co-Coordinator Semester Conversion Committee
5
•
BRANCH B/A I PRODUCER NUMBER DATE OP ISSUE -PRIOR CERTIFICATE NUMBER
23 A 0004087 - 04/07/2003 Renewal
PSYCHOLOGISTS PROFESSIONAL LIABILITY
CLAIMS-MADE INSURANCE POLICY
NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY
PURCHASING GROUP POLICY NUMBER: 45-0002000
Item DECLARATIONS CERTIFICATE NUMBER:45P- 2050203
1.
Named Insured SUSAN PLOCK BROMLEY
ADDRESS I
Number&Street,Town,County,State&Zip No.) I
2. Policy Period: 12:01 A.M.Standard Time At From: To:
Location of Designated Premises 04/01/2003 04/01/2004
3. COVERAGE LIMITS OF LIABILITY PREMIUM
Professional Liability $ 1,000,000 each incident I $3,000,000 aggregate $ 859.00
4. BUSINESS OF THE INSURED: PSYCHOLOGY
5. The Named Insured is: X Sole Proprietor(including Independent contractors) _ Partnership _ Corporation
Other:
6. This policy shall only apply to incidents which happen on or after a)the policy effective date shown on the
:r Declarations: or b)the effective date of the earliest claims-made policy issued by the Company to which this
policy is a renewal;or c)the date specified in any endorsement hereto. 04/05/1996
P
7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions,stipulations
and agreements contained in the following form(s)or endorsement(s).
PLP-2012(06/93),PLJ-2008(Rev.10/94),,PLE-8035(09/97),PLE-8036(09/97),PLE-2167(07/00),POE-8004(05/88)(Ed.
•10/93),PLE-2081 Current,PON-2003(08/02)
CHICAGO INSURANCE COMPANY
55 E. MONROE STREET,CHICAGO, ILLINOIS 60603
Near North Insurance Brokerage
REPRESENTATIVE: Agent or broker. In Association with Trust Risk Management Services
Office address: 875 N Michigan Ave
Ste 1900
City,State,Zip: Chicago,IL 60611-1803
Toll-Free Number. 1.877-637-9700
PLP-2012(06/93) APA-
JOYCE SHOHET ACKERMAN, Ed.D.
1750 25th Avenue,Suite 101
Greeley, Colorado 80634
RESUME
PERSONAL DATA
CERTIFICATION-LICENSURE
Licensed Clinical Psychologist,State of Colorado since 1984
Listed in National Register of Health Service Providers in Psychology since 1986
Staff Privileges, North Colorado Medical Center,Greeley,Colorado since 1985
PROFESSIONAL MEMBERSHIP
American Psychological Association
Colorado Psychological Association(elected board member 19864989)
HONORS
President's Award -Colorado Psychological Association, 1989
EDUCATION
1978 - 1981 Ed.D. in Counseling Psychology, University of Northern
Colorado, December 1981 graduate
1972-1974 M.S. in Education(E.D./L.D.) Lesley College,Cambridge,
Massachusetts,August graduate
1968 - 1971 B.S. in Special Education and Elementary Education with a
minor in psychology Boston University, Boston, MA,
December 1971 graduate
PROFESSIONAL EXPERIENCE
1981 —present Clinical Director in group practice in Greeley,CO. Among
responsibilities are: Diagnosis, therapeutic intervention and referral for
adults,families,children and groups. Primary areas are: mediation,
alternative conflict resolution,stress reduction. Also developing,
organizing and presenting workshops and consultative programs to
community,schools,organizations and agencies.
1986- present Consulting psychologist on interdisciplinary team for in-patient
rehabilitation program. Progressive Care Rehabilitation Center,Greeley,
CO. Medical Director Dr.Judith Vaughan,Neurologist. Adults with
traumatic injuries- primary problems are: psychological aspects of
physical rehabilitation,grief counseling,and brief group counseling
using cognitive-behavioral goal oriented therapy.
1989- 1992 Consulting psychologist for Head Injury Treatment Team North
Colorado Medical Center,Greeley CO Team coordinator-Dr.John
McVicker,neurosurgeon.
1986-1989 Consulting psychologist for Family Recovery Center(in-patient
substance abuse/chemical dependency program),
North Colorado Medical Center,Greeley CO Coordinator
Ruth Wick,R.N.
1986- 1989 Provider and Coordinator for Mental Health Services in Northern
Colorado for Peak Health Care(HMO). Peak mental health services
utilized a three-session model for initial services followed by referral.
Activities included coordination of Psychological and Psychiatric
Services for approximately the last twoyears of the Contract.
---Peak-supervisor-Elaine Taylor
1983- 1986 Psychologist subcontractor fora Vietnam Veteran's Counseling Program
funded by the Veteran's Administration. Principal Contract Dr. Robert
Stewart.
1980- 1987 Part time faculty member with responsibilities for classes,workshops
and community programs in parenting skills. Family/Life Education
Program,Aims Community College,Greeley CO
August 1980- August 1981 -Clinical internship on Children's Team of Community Mental
Health Center. Responsibilities included:consultation to schools and
community programs; therapy for children and families; and assessment
of diverse mental health programs. Assistant program evaluator-
developed evaluation tools to determine cross-cultural perceptions of
expectations and satisfaction with services. Supervisors - Dr. Joan
Gillespie and Dr. Laurence P.Kerrigan.
•
APA National Convention in Toronto,Canada"Psychology and National Health
Reform:"National Health Insurance: Policy Considerations,Benefit Designs.
and Economic Realities",and"Marketing: Psychology's Key to National
Health Reform.
1993 Disaster Relief Training. Alan Keck through Colorado Psychological
Association,Denver CO
1992-Fall Short Term Therapy,Bernard Bloom; University of Northern Colorado,
Greeley CO
1990- Fall National Cognitive Rehabilitation Conference, Richmond VA
1990-summer Postgraduate training:
1. Adult Neuropsychological Method based on Lezak
Neuropsychological assessment,1983.
2. Child Neuropsychology,Dr.Hynd.
3. Child Neuropsychological Methods
1988 Cognitive Rehabilitation Training Program,Dr.Sena, Ph.D.,
Colorado Springs CO
1988- present Psychologist-Head Injury Treatment Team at North Colorado Medical
Center,Greeley CO
1987 Halstead Reitan Neuropsychological Assessment Training. Ralph
Reitan,Ph.D.,Washington DC
Summer 1986 Albert Einstein School of Medicine, Workshop on Adolescent Therapy,
Cape Cod MA
1985 to present North Colorado Interdisciplinary Team of Child Custody Member and
-participant
Fall Fall 1985 Interdisciplinary Workshop on Child Custody,Keystone CO
Summer 1984 Workshop in Clinical Use of Hypnosis, Boston MA
Winter 1983 Workshop on In-patient Programs for Service Related Disorders,
Cheyenne Veterans Administration Hospital.
Fall 1983 Veteran's Administration Workshop on Post Traumatic Stress Syndrome,
Denver Veteran's Center.
Fall 1981-Winter 1984 Post-Doctoral Supervised Candidate for Licensure(psychology) under
Gale R.Giebler, Ph.D. Licensed Psychologist and Susan Spilman, Ph.D
Licensed Psychologist
1980 -1981 Intern- Weld County Sexual Abuse Team,Greeley CO
Weld Mental Health Center,Greeley CO adults,adolescents, families.
Primary areas anxiety disorders,mood disorders and adjustment
disorders. Typical problems included: trauma,physical abuse substance
abuse,job stress. Orientation used - primarily cognitive-behavioral
therapy.
1980 Group Facilitator-Regional and National Conferences in cross-cultural
community needs. Flagstaff,AZ-Colorado Springs CO
August 1975-July 1978 Chairperson of the Department of Education and Behavioral Science at
an accredited,Indian controlled community college on the Navajo
Reservation. Administration responsibilities included: Supervision and
evaluation of faculty;budget preparation and management;curriculum
development and integration of Navajo culture;personnel recruitment
and selection;class scheduling and program development. Also faculty
member with academic responsibilities for instruction in Psychology,
Child Development and Counseling courses,advising and counseling
students. Navajo Community College,Tsaile AZ
September 1974- August 1975 Education Specialist and counselor at an Indian controlled
primary and secondary school on the Navajo Reservation. Coordinated
community resource program, which included: counseling,student
assessment,prescriptive programming,staff development and
curriculum. Also,adjunct faculty for the University of New Mexico and
for Navajo Community College at the Rough Rock Demonstration
school,Rough Rock, AZ
September 1972-June 1974 Designed and coordinated Learning Center Program for
Dedham Public Schools. A program and crisis intervention center for
emotionally disturbed children. Responsibilities included: Diagnostic
prescriptive programming,counseling,supervision and training of aides,
tutors and volunteers,and consultation with regular classrooms
teachers. Also organized group and individual meetings with parents.
Adjunct faculty for Curry College assisting with in-service instruction for
Dedham School System employees. Dedham Public Schools, Dedham
MA
WORKSHOPS AND SPECIAL TRAINING
1996 Biodyne training workshop adolescent treatment in short term therapy,
Tom Kalous, Ph.D.
1995 Biodyne Training Workshops in short term therapy Julian Ang, Ph.D.
1994 Certification in family mediation,CDR Associates, Boulder CO
1993 Disaster Relief Training. Alan Keck,through Colorado Psychological
Association, Denver CO
1993 August Hospital Practice for Psychologists
Summer 1981 Independent Study of Child Sexual Abuse, University of Northern
Colorado
Spring 1981 Interdisciplinary Workshop on Assessment of Sexual Assault,Boulder
Social Services
Summer 1979 Biofeedback Training related to labor and delivery.
Summer 1974 Participant in Institute on Obstacles to Learning. Joint Symposium
between McLean psychiatric hospital,Harvard University and Lesley
Graduate School,Cambridge MA
Summer 1973 Kennedy Memorial Hospital,Boston MA. Participant,Summer Aphasia
Institute.
PUBLICATIONS
Ackerman A.,Ackerman,J.S.,Kelley K.Hale K. Family Planning Attitudes of Traditional and
Acculturated Navajo Indians. Key Issues in Population and Food Policy. University Press of
America, pp. 178-171 (1979)
Ackerman,J.S.,Client Expectations and Satisfaction with Community Mental Health Center
Services: A Cross-Cultural Analysis Between Hispanics and Anglos. Published Doctor
Dissertation, University of North Colorado. Copyright 1981.
[BRANCH B/A PRODUCER NUMBER DATE OF ISSUE - PRIOR CERTIFICATE NUMBER
23 I A 0004087 04/01/2003 Renewal
PSYCHOLOGISTS PROFESSIONAL LIABILITY
CLAIMS-MADE INSURANCE POLICY
NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY
PURCHASING GROUP POLICY NUMBER: 45-0002000
Item DECLARATIONS CERTIFICATE NUMBER:45P-2032570
1 Adcermen and Associates PC
Named Insured 1750251hAve
ADDRESS Greeley,CO 80634-4943
Number&Street,Town,County,State&Zip No.)
2. Policy Period: 12:01 A.M.Standard Time At From:- To:
Location of Designated Premises 05/01/2003 05/01/2004
3. COVERAGE LIMITS OF LIABILITY PREMIUM
Professional Liability $ 1,000,000 each incident $3,000,000 aggregate $ 1,667.00
4. BUSINESS OF THE INSURED: PSYCHOLOGY
5. The Named Insured is: _ Sole Proprietor(including independent contractors) _ Partnership X Corporation
_ Other
A 6. This policy shall only apply to incidents which happen on or after a)the policy effective date shown on the
Declarations: orb)the effective date of the earliest claims-made policy issued by the Company to which this
% policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/1992
7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions,stipulations
and agreements contained in the following form(s) or endorsement(s).
PLP-2012(06/93), PU-2008(Rev. 10/94),,PLE-8035(09/97), PLE-8036(09/97), PLE-2167(07/00), POE-8004(05/88)(Ed.
*10/93),PLE-2081 Current, PON-2003(08/02)
- CHICAGO INSURANCE COMPANY
55 E. MONROE STREET, CHICAGO, ILLINOIS 60603
Near North Insurance Brokerage
REPRESENTATIVE: Agent or broker: in Association with Trust Risk Management Services
875 N Michigan Ave
Office address:
Ste 1900
City, State, Zip: Chicago, IL 60611-1803
Toll-Free Number: 1-877-637-9700
PLP-2012(06/93) APA-
Valerie Larson
PROFESSIONAL LICENSE'
License Clinical Social Work,Colorado,License#992608
EDUCATION
Completed Post-Graduate Family Therapy Coursework,Family Therapy Training Center
of Colorado,Denver, Colorado,June, 1999
Masters in Social Work,University of Denver,Denver,Colorado,June, 1998
Bachelors in Social Work,Northeastern State University, Tahlequah Oklahoma,
December, 1995
PROFESSIONAL EXPERIENCE
Shiloh Home Littleton,Colorado
Therapist June, 1999—March, 2001
• Conducted individual,group,and family therapy for day treatment and residential
r6 youth ranging from age eight to eighteen. Addressed various treatment issues
including sexual perpetration, delinquency, sexual victimization,abuse/neglect,
substance abuse, anger management,grief/loss,attachment,and depression.
• Completed appropriate documentation and case management duties. These
included completing monthly progress reports, performing psychosocial
assessments, and attending court hearings and staffings.
• Conducted trainings for on-line milieu staff and provided clinical advisement for
multi-disciplinary teams.
Progressive Therapy Systems Denver, Colorado
M.S.W. Student Internship June, 1997-June, 1998
Therapist June, 1998-June, 1999
• Provided offense-specific treatment for adults and adolescents who had
committed sexual offenses. This treatment included group, individual, and family
therapy. Conducted educational groups for parents and spouses of the offenders.
• Provided individual and family therapy for children in foster care. Addressed
issues including enuresis, abandonment, anger management, and abuse/neglect.
• Facilitated anger management groups for men and women on parole for criminal
behaviors.
• Conducted intake assessments and developed appropriate treatment plans.
Account Number: CO LARV 2500 Date: 5/20/03 Initials: KEN
CERTIFICATE OF INSURANCE
AMERICAN HOME ASSURANCE CO.
C/O: American Professional Agency, Inc.
95 Broadway, Amityville, NY 11701
This is to certify that the insurance policies specified below have bean issued by the company indicated
above to the insured named herein and that, subject to their provisions and conditions, such policies afford
the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s)
as stated.
THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR
ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE.
Name and Address of Insured: Additional Named Insureds:
VALERIE LARSON
I
Type of Work Covered: PROFESSIONAL SOCIAL WORKER
Location of Operations : N/A
(Ile different than address listed above)
)
Claim History:
Policy Effective Expiration Limits of
Coverages Number Date Date Liability
PROFESSIONAL/ 1,000,000
LIABILITY SWL-0000000 6/01/03 6/01/04 3,000,000
'NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS
?OLICY AND HE OR SHE SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING
NR RECEIVING NOTICE OF CANCELLATION.
:amment s:
'his Certificate Issued to:
`le: VALERIE LARSON
2500 HAVEN COURT
ddress:
EVANS, CO 80620
Au orized Representative
f
WILLIAM 1'.KELLY
EDUCATION
1997-MA-PROFESSIONAL COUNSELLING,UNIVERSITY OF NORTHERN COLORADO
1977-Ph.D.-EDUCATIONAL ADMINISTRATION,UNIVERSITY OF COLORADO
1964-MA-SECONDARY EDUCATION,ST.LOUIS UNIVERSITY
1954-BS-MATHEMATICS,CREIGHTON UNIVERSITY
SCHOOL EXPERIENCE
UNIVERSITY-
• 2002-2003- Adjunct Professor,Regis University,Denver,CO
1999-Professor Emeritus,Regis University,Denver,CO
1983-1999-Chair,Professor of Education,Regis University,Denver,CO
1978-1983-Assistant Professor,Elementary and Secondary Education,University of Minnesota-Morris
1970-1973-Assistant Professor,Education Department,Regis University,Denver,CO
SECONDARY
2001-2002-Teacher,Mathematics and Speech,Holy Family High School,Broomfield,CO
1974-77—Principal,Greeley West high school,Greeley,CO.
1973-1974-Associate Principal,Longmont high school,I nnginnnt CO.
1966-67,68-70 Teacher/Administrator/Coach In Denver Catholic High Schools-
1960-1963 Teacher/m ach Marquette University High School,Milwaukee,WI.
COUNSELING EXPERIENCE
1999-Green Villa Residential Treatment Center-A Combination Half-Way House and Drug Treatment
Center for Convicted Felons with Drug Abuse Problems-Paid Intern,Greenville,Texas
1998-99- Hunt County Mental Health/Mental Retardation-General Counseling for Children,Adolescents,
Adults, Families,and Various Groups-Internship-Greenville,Texas
1995-96 Jefferson Center for Mental Health(South Office)General Counseling for Children,
Adolescents, Adults,Families,and Various Groups-Intern
INDUSTRY EXPERIENCE
1967-1968- Performance Standards Administrator,CIMA,International Trade Association, Milwaukee,
WI
1963-1966-Sales Representative,Denver Area Territory,Hoffmann-LaRoche Pharmaceutical Co.,
Nutley,N.J.
LICENSES HELD(Current)
Elementary School(K-8)Teaching License,State of Colorado
Secondary(7-12)Mathematics and Science Teaching License,State of Colorado
HOBBIES
Playing Piano,Racquetball,Bicycling,Hiking,Reading Swimming
REFERENCES
Dr.Daniel Clayton,Associate Professor of History and former Associate Academic Den,Regis
University,3333 Regis Blvd.,Denver CO,80221 303.458.4914
Mr.James Neuman,MSW-LSW,Private Psychotherapist,Supervisor of My Practice, 10110 W.26 Ave.,
Paramount Bldg.,Wheat Ridge CO 303-233-9371
Dr. Allan Service,Provost,Regis University,3333 W.Regis Blvd,Denver,CO 80221,303458-1843
CNA Healthcare Providers Service
Organization Purchasing Group ®HPSO
CNA Plaza, a.e.,..r...w..su.�o.wi..a-
Chtcago,IL 60685 Certificate ofd .terra
Producer Branch Prefix Policy Number Policy Period
from: 12:01 AM Standard Time on: 07/04/03
018098 970 HPG 273003448-8 to: 12:01 AM Standard Time—Q11: 07/04/.-04,
Named Insured and Address Program Administrator _
Healthcare Providers Service Organization
WILLIAM P KELLY 159E Co un1ty Lie1 nRoad
11429 W BURGUNDY AVE Hatboro, 8
LITTLETON CO 80127-5870 --""—
Ivfedical Specialty: Code: Insurance Provided by
Clinical Counselor 72990 American Casualty Co. of Reading, PA
CNA Plaza 265 Chicago, IL 60685
COVERAGE PARTS LIMITS OF LIABILITY
A. PROFESSIONAL LIABILITY
Professional Liability , $1,000,000.00 each claim x$$,000 .000.00 aggregate
Good Samaritan Liability Included above
Personal Injury Liability Included above
Malplacement Liability Included above
B. Coverage Extensions
License Protection 5 000.00 er roceedi 00
Defendant Ex ense Benefit 5 000.00 a re ate
Deposition Representation $1,250.00 per deposition $2,500.00 a re ate
Assault 5 000.00 er incide t 1 00.00 a r ate
Medical Pa ents $1 000.00 er erson 50 000.00 a re ate
•
First Aid $1,250.00 aggregate
Dama a to Pro ert of Others 250.00 er 'no' t 0 00
C. WORKPLACE LIABILITY Coverage part C. does not a ply if Coverage part D. is made part of this policy.
Work lace Liabilit Included in A. Professional Liabilit Limit shown above
Fire and._Water Legal Liability Included above subject to $150,000 sub-limit
Personal Liabilit 500 000.00 a e ate
I
D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy.
Workplace Liabilit None None .
Hired Auto & Non Owned Auto None
Fire & Water Legal Liability None None
Personal Liabilit None
Total Premium $250 .00
Policy forms and endorsements attached at inception fUESTIONS? CALL: 1-800-982-9491
G-144872-A G-144959-A G-121500C G-121501C G-123846C-05 G-121503C
G-121489-ACA
Healthcare Providers'Service Organization is a division of Affinity Insurance Services,Inc.;in NY and NH,AlS Affinity Insurance Agency,in MN and OK,AIS Affinity Insurance
Agency,Inc.;and in CA,AIS Affinity Insurance Agency,Inc.dba Aon Direct Insurance Adminniralors License#0795465.
Master Policy: 188711433
Keep this document in a safe place. This and
(1)-Y4- / tJ *9- your cancelled check act as proof of coverage.
EMILY.'L, JARAMILLO :M A
�t h
t p
I PUC'A`I'ION
�_� • 1996,Mastcrof Arts/ Counktzn
•
University of Northern Colorado,Creeleyt Co• lorado
- If
1• 993, Gthduate Feilowslisp S tly Cdr it�ni)to y
) Rutgers State University,hfeiyark,1tJew Jersey
4.FI S
19�s, Bachelgr• of lrts, SocioIb Grin ftgi)gst*e wimanphasts in Psychology '
,77
• niversity of Nort1tern CQ1oxado,Greeley,Colorado
FItOF SSIONAL EXflkIENCS
v
•
998 1'rgsehl Psychotherapis>,tic pin4n f tissoc}ates Creel CD
Provide Intensive honte based�yytherapy to families referred by-the Department
of Social Services :Provide> ed≥ t}ori;servtees td famines, Co facilitate family="group
decistgn making conferences fgr permanei�taplacement ofchildren °Provide short
term,solution focused therapy° ?revile therapy=to Individuals referred from`
Employee'Asststan• ce Programs Padlitafe foster parenttrammg v orksftops Provide •
foster parent consultation 1's3' ce is supervised by Sherri Ma11oy,-Pn D; Licensed
Clinical Psychologist
1994 1999 13itectttr,McNair Scholars Pr atrk 1lnlverstty df IJort{Iern o(arpclo;CvieeIey, CO
Provided counseling giudan e; and cadeirue'advismg to*tudents"wlto were low
• mcome, first generation colfege hTdedts�and of a mmnonty group ldgntified critical •
eersonal, familial, cultural acaderit an issues to aid m thedevelbpmentof�.
ind•ividual success plans Planned, s evefope▪d,.arid implemented) cholarly activities
nationally Developed and directed academic year research seminars Coordinated
"research activthes'f`or scholars re aria for doctoral stud
p p y Directed all efforts to
ensure efficient adnunistratiosi pf a fF deral grant. Monitored protect budget,
si pervised and trained.staffrnem rs .;
•
?99S i'995 Asnstant Director,.IvlcNait-Scholars Program L₹niuers:t of Northern Colorado
- Provided•counseling guidance and a dernic advising-to students who were low
income,first generation;and of a xninonty group Identified critical personal, familial,
cultural academic;;and-firiapcialtss es<fo aid in'tlie development of ind vidual
success plans Coordinated;therccruitment andselection of program scholars.= .
1996 Psychotherapist(Intern), North Colorado PsychCare/Family RecooeryCenter,Greeley, CO
Facilitated psychotherapy counseling groups and individual counseling for patients
and families,with focus on chemically dependent and eating disorders. Performed
case management from admission to discharge. Presented psychoeducational
information to patients,family members,and staff. Worked collaboratively with a
counseling team.
1994-1995 Assistant Coordinator,Student Support Services, University of Northern Colorado,
Greeley, CO
Provided counseling and academic advisement to at-risk first-generation,low-income,
minority students. Identified critical personal,familial,cultural,academic,and
financial issues to aid in the development of individual success plan's.
1994-1995 Psychotherapist,Weld Mental Health Acute Treatment Unit, Greeley, CO
Provided individual and group counseling to chronically mentally ill in-patient
clients: Assisted clients in learning self-care and daily hygiene. Coordinated and
implemented client life-skills and social-skills activities.
CONTINUING EDUCATION/SEMINARS
Jurisprudence Workshop for Psychotherapists Family Preservation Basic and Advanced Training
Supervised Practicum in Family Preservation Reaching Children through Play Therapy
Play Therapy and Therapeutic Care Fire Starter Training
Diverse Learners Academy Counseling At-Risk Students
Cultural Diversity Conference
Parent/Child Hispanic Youth Leadership Conference
PRESENTER/FACILITATOR
The Terrific Twos
Prenatal Insults and Long Term Effects
Social, Emotional&Sexual Development Infancy through Adulthood
Cognitive Sr Physical Development Infancy through Adulthood
Parenting with Love&Logic
Eating Disorders
Cultural Sensitivity and Awareness
Communicating Across Cultures
Conflict Resolution/Communication Skills
Setting Limits& Boundaries
HONORS/AWARDS
Hispanic Leader of the Year, Cesar Chavez Center, University of Northern Colorado, 1999
Keynote Speaker, Latina Youth Leadership Conference, University of Northern Colorado,1998
Distinguished Alumni, Department of Sociology, University of Northern Colorado
Fellowship,Graduate Study, Rutgers State University of New Jersey
Scholarship, National Hispanic Scholarship Fund
Scholarship,Candelana Scholarship
•
- tO :'N.OI U - ; Date Issued
G. .. . . .... 10/14/2003
Memorandum Holder This memorandum is issued as a matter
of information only and confers no
ACKERMAN & ASSOCIATES rights upon the holder. This
SUITE 101 memorandum does not amend, extend
1750 25 AVENUE ur alter the coverages afforded by the
GREELEY CO 80634 Certificate listed below.
Producer Company Affording Coverage
Chicago Insurance Company
Seabury & Smith Owner
—1776-West Lakes-Parkway Covered Person(Sfatus)
West Des Moines, Iowa 50398 EMILY L JARAMILLO—BANSBERG MA LPC x
Employee
This is to certify that the Certificate listed below has been issued to the insured named herein for the policy
period indicated, notwithstanding any requirement, term or condition of any.cpntract or other document with
respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate
described herein._is ubjert to all the.xerms,_exclusion& anri conditinnc of cnrh Certincat&.emits-Showrr---
may have been reduced by paid claims.
Certificate
Type of Insurance Number Effective Date Expiration Date Limits
each incident
1,000,000
Professional Liability or occurrence
Occurrence 80M-4003488 11/01/2003 11/01/2004 3,000,000
in the aggregate
each incident
General Liability or occurrence
Occurrence in the aggregate
Should the above described Certificate be canceled Insured
3efore the expiration date thereof, the issuing
:ompany will endeavor to mail written notice to the L JARAMILLO-BANSBERG MA LPC
lamed Memorandum Holder, but failure to mail such EMILYM3 50 AVENUE PLACE
lot ice shall impose no obligation or liabi1ty of anyCO 80634
Ina upon the company, its agents or representatives. GREELEY
Authorized Representative:
_ J • —
John M.Gray
Education Master of Arts: Professional Psychology,
emphasis: Agency Counseling,
University of Northern Colorado,Greeley,Colorado
Graduation: August 1995
Nationally Certified Counselor,NBCC February 1996
Licensed Professional Counselor
Master of Arts: Sociology,Emphasis: Social Psychology
University of Northern Colorado, Greeley,Colorado
Graduation: December 1992
Bachelor of Arts: Sociology/Philosophy
Minot State University,Minot,North Dakota
Graduation: May 1989
Counseling Case Manager II: Larimer Department of
Human Services,Fort Collins,CO
. Adolescent Response Team member
Conduct emergency intakes/investigations involving
} parent/child conflicts,child abuse, sexual assault, and children
out of control of their parents.
. Track,triage,and monitor clients
treatment.
. Facilitate and recommend treatment.
options.
Establish and maintain good working
relationships between and among various
agencies, such as: schools,courts,police,
and mental health agencies.
Psychotherapist: Private Practice
Fort Collins, CO
. Family Therapy
. Couples
. Individual
.. EMDR Level II
Supervisor:CORE services
Center for Mental Health
Fort Collins,CO December 2002-August
2002
. Supervise CORE therapy team
Facilitate supervision and thereaputic sessions
• Attend and contribute to the goals of Management Team
. Conduct Individual and Family therapy
Supervisor. Multi-Systemic Therapy Team February 2002-August 2002
. Supervise MST team
. Monitor compliance to MST model
. Receive supervision from MST
consultant
Psychotherapist Private Practice
Montrose, CO November 2000-December
2002
. Family Therapy
. Couples
. Individual/Group Therapy
. EMDR Level II for Trauma,Depression,
Addictions,Anxiety
Program Coordinator: Multi-Systemic Therapy Program Center
for Mental Health,Montrose,CO June 1999-June 2000
. Supervise Therapy Team. Ensure compliance with MST principles
and methods
. Conduct supervision sessions individually
and in groups
. Report to home office in South Carolina
. Report to in-house administration results
and status of program
. Responsible for hiring and terminations of
personnel in program
Mental Health Therapist Outpatient
Therapist Center for Mental Health,
Montrose,CO 1997-1999
Mental Health Therapist: Family
Preservation Team
Weld Mental Health,Greeley,Colorado
1995-1996
. Conduct family therapy in various settings
. Conduct individual/group therapy
Coordinate Mental Health groups
. Report progress oral and written
. Facilitate cooperative working
environment between
systems involving families
Mental Health Therapist: Acute Treatment
Unit Weld Mental Health,Greeley,Colorado
1994-1995
. Conduct individual/group therapy
. Supervise clinical staff
. Facilitate professional growth among staff
. Maintain clinical integrity of Alt
. Conduct emergency room evaluations
Report progress of clients and performance
of staff oral and written
Mental Health Therapist: Heath Junior High
Greeley,Colorado 1995-1996
. Facilitate anger management groups for
the retention of at-risk youth
. Coordinate needs of school with needs of
at-risk youth
in facilitation of groups
Extern: Psych-care, Greeley,Colorado 1995
. Co-facilitate group therapy sessions in a
clinical setting
. Coordinate direction of group in
conjunction with psychiatrist,director,
and all members of therapy team
Clinical Care Assistant: Acute Treatment
Unit, Weld Mental Health, Greeley,
Colorado 1993-1994
. Assist MHT in leading groups
Operate emergency mental health hotline
. Participate in in-house professional growth
training
Teaching Instructor: Mesa State College
Experience Montrose,CO 1997-2002
Taught Classes in:
. Social Psychology
• Social Problems
. Marriage and Family
. Introduction to Sociology
Teacher/Director, G&B Academy, Seoul,
Korea 1996
. develop curriculum for new ESL program
. train and advise ESL teachers
. coordinate programs for
parents/teachers/children
University of Northern Colorado, Greeley,
Colorado
Instructor 1990-1993
Courses taught:
. Sociology of Minorities
. Introduction to Sociology
Aims Community College,
Greeley/Loveland, Colorado
Instructor 1990-1993
Courses Taught
. Sociology of Minorities
. Introduction to Sociology
. Sociology of Education
Minot High School,
Minot,North Dakota
Coach—wrestling
1985-87
Presentations "The use of the Looking Glass Self in
Therapy," presented
At the Conference for Applied Sociology.
October 1998
"Bill McCartney and the Promise Keepers:
Exploring Connections Among Sport,
Masculinity, and Christianity."Presented at
American Alliance of Health,
Physical Education,Recreation,and Dance.
National convention. 1995
"Social Attachment and Deviant Behavior."
Presented at Western Social Science.Conference. Regional
Conference. 1994
"Mountain Biking as Counter-Culture."
Presented at North American Society for the
Sociology of Sport. International
Conference. 1992
of/18/04 FRI 10:25 FAX 515 243 5180 SEAMY & SMITH 002
Y•10 $L4 E X 4�'"S...� F .'�'f.✓Y"'• � raC-.Y'"s12�� r'xc .z� .a
e ,� er g :Y• q g��( is • sa . ."`�
�y�t stn /' d� S. t; Date Issued
l�2"C` �'T"ti T 7".Cb .�w�^^' ^h �3Sxt tS. i� .v, ar
fg•" w-„ "`21s'a 414k ' eE s'a '5 01/15/2004
Insured This memorandum is issued as a matter
-maxN of information only and confers no
GRAY rights upon the holder. This
230 N WHITCON$ memorandum does not amend, extend
FORT COLLINS CO 80524 or alter the coverages afforded by the
Certificate listed below.
Producer Company Affording Coverage
• Chicago Insurance Company
Seabury & Smith
1776 West Lakes Parkway Covered Person (Status) °z�18t
West Des Moines, Iowa 50398
Employee
JOHN N GRAY
This is to certify that the Certificate listed below has been issued to the insured named herein for the policy
period indicated, notwithstanding any requirement, term or condition of any contact or other document with
-spy to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate
leseribed herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown
nay have been reduced by paid claims.
Certificate '
Pype of Insurance Number Effective Date_ Expiration Date Limits
rofessional Liability each incident $1,000,000
or occurrence
Occurrence 80R-4005346 12/01/2003 12/01/2004 in the aggregate $3,000,000
ieneral Liability each incident
or occurrence
Occurrence
in the aggregate
Memorandum Holder
iorized Representative:
ter- _ e •
SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B
_ RECOMMENDATIONS
X CONDITIONS
B4/13/2004 12:'2'1 y ftlib.34.1/4 AUKLKMAN5 rlut int/ut
Ackerman and Associates, P.C.
1750 25th Avenue, Suite 1O1
Greeley, Colorado 80634
(970)353-3373
fax(97O)353-3374
April 12, 2004
Gloria Romansik
Weld County Department of Social Services
P.O. Box A
Greeley, Colorado 80632
Dear Gloria;
This is in response to your letter of April 7 concerning the results of the bid process for fiscal
year 2004-2005.
We accept the inclusion of all of our bids on the vendor list with the following conditions as
recommended by the Family and Youth Commission.
1. On RFP 006-00, the caseworker will select the contractor for the home study or
relinquishment counseling service.
2. We will notify the department if we have any changes in staff at the time of the change.
3. We will plan to have the following bids included on the vendor list with no additional
recommendations: REP 04007 (Sex Abuse Treatment), RFP 04008 (Mediation and
Facilitation under Intensive Family Therapy), REP 04010 (Option B/Home-Based), RFP
04005 (Lifeskills), and RFP 006-00 (Foster Parent Consultation).
Thank you very much.
Respectfiill ,
Joyce Shohet c erman, Ed.D.
Licensed Psychologist
President, Ackerman and Associates, P.C.
•
a � P
cft:
DEPARTMENT OF SOCIAL SERVICES
P.O.BOX A
GREELEY,CO.80632
Website:www.co.weld.eo.as
Administration and Public Assistance(910)352-1551
Child Support(910)352-6933
•
•
COLORADO April 7, 2004
Joyce Ackerman Ed.D.
Ackerman&Associates,P.C.
1750 25th Avenue, Suite 101
Greeley,CO 80631
Re: RFP 04007-Sex Abuse Treatment
RFP 04008-Mediation and Facilitation under the Intensive Family Therapy Progtam Area
RFP 04010-Option B,Home Based Therapy
RFP 04005-Lifeskills
RFP 006-00-Foster Parent Consultation
RFP 006-00 Home Study,Relinquishment Counseling
RFP 006-00 Mental Health Services
Dear Ms.Ackerman:
The purpose of this letter is to outline the results of the Bid process for PY 2004-2005 and to request
written information or confirmation from you by Wednesday,April 14,2004.
A. Results of the Bid Process for PY 2004-2005
1. The Families,Youth and Children(FYC)Commission recommended approval of the bids
listed below for inclusion on our vendor list with no recommendations.
1. RFP 04007-Sex Abuse Treatment
2. RFP 04008-Mediation and Facilitation under Intensive Family Therapy
3. RFP 04010-Option B,Home Based
4. RFP 04005-Lifeskills
5. RFP 006-00-Foster Parent Consultation
2. The Families,Youth and Children(FYC)Commission recommended approval of the bid,
RFP 006-00,Home Studies and Relinquishment Counseling, for inclusion on our vendor list,
attaching the condition listed below.
Condition:The caseworker will select the contractor for the home study,or relinquishment
counseling service.
3. The Families,Youth and Children(FYC)Commission did not recommend approval of Bid
Number 006-00,Mental Health Services.
Page 2
Ackerman&Associates,P.C./Results of Bid Process for PY 2004-2005
B. The Families,Youth,and Children Commission recommended the following condition be
applied to all 2004-2005 approved providers.
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 Conditions:
All conditions will be incorporated as part of your RFP Bid and Notification of Financial
Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as
a vendor unless the FYC Commission and the Weld County Department of Social Services accept
your mitigating circumstances. If you do not accept the condition,you must provide in writing
reasons why.A meeting will be arranged to discuss your response.Your response to the above
conditions will be incorporated in the RFP Bid and Notification of Financial Assistance Award.
The Weld County Department of Social Services is requesting your written response to the FYC
Commission's conditions Please respond in writing to Gloria Romansik,Weld County Department of
Social Services,P.O.Box A, Greeley,CO, 80632,by Wednesday,April 14,2004/close of business.
If you have questions concerning the above,please call Gloria Romansik, 970.352.1551,extension 6230.
Sincerely,
J A. 'ego, ecto
cc: Juan Lopez,Chair,FYC Commission
Gloria Romansik,Social Services Administrator
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission(Core)Funds
Type of Action Contract Award No.
X Initial Award FY04-CORE-0027
Revision (RFP-FYC-04007)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2004 and Adolescent&Individual Therapy
Ending 05/31/2005 Sex Abuse Treatment
P.O.Box 321
Fort Lupton,CO 80621
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial Assistance
This program serves sexually abusive adolescents from Award is based upon your Request for Proposal(RFP). The
the ages of 12 though 20.The mission of A.I.D. is RFP specifies the scope of services and conditions of award.
designed to protect the safety of the community.A.I.D. Except where it is in conflict with this NOFAA in which
services those who have been adjudicated,have case the NOFAA governs,the RFP upon which this award is
admitted to sexual abuse, or are sexually reactive.The based is an integral part of the action.
program provides for a maximum of 5 clients, 1 hour
weekly group sessions, 1 group session with mandated Special conditions
attendance of parent-guardian. Currently Bilingual 1) Reimbursement for the Unit of Services will be based on an
services are not available. South County services are hourly rate per child or per family.
provided if an adequate number of clients are referred. 2) The hourly rate will be paid for only direct face-to-face
Family reunification services upon request. contact with the child and/or family,as evidenced by client-
Cost Per Unit of Service signed verification form,and as specified in the unit of cost
Hourly Rate Per computation.
Individual/Family $50.00 3) Unit of service costs cannot exceed the hourly and yearly
Staffings with family/client $50.00 cost per child and/or family.
Rate per episode 4) Payment will only be remitted on cases open with,and
Group Session $35.00 referrals made by the Weld County Department of Social
Evaluation $500.00* Services.
Polygraph(Average Rate) $225.00** 5) Requests for payment must be an original submitted to the
*Cost of evaluation is dependent upon services Weld County Department of Social Services by the end of
provided, the 25th calendar day following the end of the month of
**Variable Rate is dependent on cost of polygraph. service.The provider must submit requests for payment on
Supplies forms approved by Weld County Department of Social
Notebook(One time at first group session)$10.00 Services.
Unit of Service Based on Approved Plan 6) The Contractor will notify the Department of any changes in
Enclosures: staff at the time of the change.
X Signed RFP: Exhibit A
X Supplemental Narrative to RFP: Exhibit B
Recommendation(s)
X Conditions of Approval
Approvals: Program Official:
By C By
Robert D. Masden, Chair Jud . Grie ,Direct r
Board of Weld County Commissioners We Coun epartme t of Social Services
Date: JUN 1 6 2004 Date: 5/7 Sl�)uj
,22Tz2`�_/ESC%
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-04007
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-04007) for:Colorado Family Preservation Act--Sexual Abuse 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 competing applications will be accepted for approved vendors pursuant to the
Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-
5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement
Act(C.R.S. 26-5.3-101). The Families,Youth and Children Commission wishes to approve services targeted
to run from June 1, 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 Sexual Abuse Treatment Program must
provide for therapeutic intervention through one or more modalities to prevent further sexual abuse
perpetration or victimization. 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
7Sekecr'c, a. [ u ,ckfltc, csc A.Pe
TYPED OR PRINTED SIGNATURE
VENDOR A do le s c e,c-4- .! Tn..)J i v o) vs 1 t n �J S Agt
(Name) j)r v E ko e it r A f Hand tten i ature By Authorized
Officer or Agent of Vendor
ADDRESS P C' " L3c I 36 f TITLE evf_cil stir AQr i(cP = ,
.-A- a- Ce-FP t Cl it Sr 4- 2s _ DATE a _ a 3 -CV
PHONE# 3C3 Sri1.—_ ci5 "!p - _
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 32
• ' Off:System Bid B001-04 (RFP-FYC-04007)
Attached A
SEXUAL ABUSE TREATMENT PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
FAMILY PRESERVATION PROGRAM
2004-2005 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2004-2005
OFF-SYSTEM BID B001-04,` RFP-FYC-04007
NAME OF AGENCY: tq c &-C.Q tS Clot le 5 C'ECAI-C C_XU of )€.O42,6-1. p I/V0 iv f
ADDRESS: boy Al-), I L UO-01v . 1 go 6 I
PHONE: (.) 7- 5CI(, - g5 c / e n1
1 CONTACT PERSON: LrnuPCC'a (7 c AiC. , TITLE: ril KO. A2c
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Sexual Abuse Treatment Program must
provide for therapeutic intervention through one or more modalities to prevent further sexual abuse perpetration or
victimization.
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1,2004 Start
End Mav 31,2005 End
TITLE OF PROJECT: C -0 iU ODp Q-, i 7-1 C T/ZPct # lq l.E' R,' I-
ct
` p k C(2s' APG (. - /-, en/
ame
and Signa o Person Preparing Document Date
L mac/ C15 kfc_ 3 <1-/-67
N and Sign hire ief Administrative Officer Applicant Agency Date
Rebtcce i . ®a ' 1<
MANDATORY PROPOSAL REQUIREMENTS
For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal
for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2003-
2004 to Program Fund year 2004-2005.
Indicate No Change from FY 2003-2004 to 2004-2005
Project Description t^ n t C A'°n-y'
Target/Eligibility Populations /C? JUG cP iy
Types of services Provided < A;c C "
Measurable Outcomes (--- ace J'- k'
- Service Objectives id C,,,
- Workload Stan—dards Lie CL-1-I
Staff Qualifications tiC of�ry
Unit of Service Rate Computation C d C-4
- Program Capacity per Month ?Go C
L. Certificate of Insurance
Page 26 of 32
Off System Bid 8001-04 (RFP-FYC-04007)
Attached A
Date of Meeting(s)with Social Services Division Supervisor:
Comments/bySSD Supervisor:
IAA-' (J
ok
Q- 41 e nit,: t si:(71 c11111#11ta'
03/4 Wa
N and Signature of SSD Supervisor Date
Page 27 of 32
RFP-FYC-04007
Sexual Abuse Treatment Program
Adolescent & Individual Development
I Project Description:
Adolescent & Individual Development (A. I . D. ) Serves sexually
abusive adolescents from the age of 12 through 20 . The mission
of AID is designed to protect the safety of the community. This
includes protecting the safety of the victim or potential
victim(s) at all costs . This is an outpatient Offense Specific
Treatment Program which offers group therapy along with
individual and family services . A. I . D. has applied to the State
of Colorado to work with adolescent sex offenders under the new
standards and guidelines which were put into place July, 2002 .
This treatment program will follow those guidelines and standards
in every area .
AID recognizes the importance of the family when working
with the adolescent . The agency will provide family
reunification under the state' s guidelines and standards of
July, 2002 to help prevent any future victimization . The program
is designed to work in a team effort in order that the adolescent
may receive the skills and concepts necessary to help him/her to
refrain from using sexually abusive behaviors . The team consists
of the Probation Officer if one is appointed, Social Services
Caseworker, counselor, and the parent (s) or guardian (s) of the
client, plus anyone else who is considered supportive to the
adolescent and who wants to be involved.
AID will comply with the State of Colorado standards and
guidelines of the sexually abusive adolescent and will be
flexible in the program materials to ensure each adolescent is
receiving the best services possible . AID will work with each
adolescent as an individual and will address the individual' s
specific issues . AID will remain flexible to adjust to the new
rules and regulations and will review program materials as new
studies indicate necessary change.
II Target/Eligibility Populations:
AID serves those adolescents referred by Weld County
Department of Social Services who are 12 to 20 years of age and
have been adjudicated, have admitted to sexual abuse, or are
sexually reactive . Eligibility for the AID program will be
addressed through recommendations provided within the Offense
Specific Evaluation which includes police reports, victim
statements, interview with the client and his/her parent (s) or
1
guardian (s) . The total number of clients expected from Weld
County Department of Social Services will be five . The program
will provide weekly group sessions which meet once a week for 60
minutes and one group a month in which the parent (s) or
guardian (s) will be mandated to attend. There will be group
sessions for male and female . There will be no mixture of males
and females in a group . The client can expect the program to
last a minimum of 12 months .
AID does not provide services for bilingual individuals at
this time . However, it does provide services for all races and
creeds without discrimination . Services for South County will
not be specifically provided for unless there is an adequate
number of clients referred. At that time, services will be again
reviewed.
Family reunification will be provided for those family' s
requesting the service . At that time, it will be necessary for
the victim, the victim' s counselor, the parent (s) , the
perpetrator, and the perpetrator' s counselor to all agree that
reunification is in the best interest of the victim. If anyone
of the required participants of the reunification do not believe
the reunification is in the victim' s best interest, the subject
will be dismissed until all parties agree . The reunification may
be expected to last a minimum of six months with weekly meetings
of 60 minutes . Victim counseling will be provided for
individuals whose perpetrator is not participating in Offense
Specific Treatment with AID.
III Type of Services To Be Provided:
The services which will be provided are Offense Specific
Evaluations, Treatment, Reunification, Family sessions, and
Individual sessions .
A. Upon referral, each client must have been adjudicated
for or admitted to a sexual offense. The adolescent will be
required to participate in an Offense Specific Evaluation which
will contain the following components :
Clinical Interview
Millon Adolescent clinical Inventory
Jesness Inventory - Adolescent
Multiphasic Sexual Inventory (MSI)
State-Trait Anger Expression Inventory
Shipley Institute of Living Scale
SASSI - Alcohol & Drug
Beck Depression Inventory
2
Wilson Sex Fantasy Questionnaire
Adolescent Sex History
Adolescent Parent (s) statements
Review of Collateral Information
Police Reports
Victim' s Statements
It is important to note not all the above psychological
tests are for all age groups . Therefore, only the age
appropriate exams will be given to the adolescent . Additionally,
it will be necessary for the adolescent to have a sixth grade
reading level . The above battery of psychological exams will
comply with upcoming standards and guidelines for adolescents the
SOMB is recommending.
The adolescent' s evaluation will give recommendations for
the type of treatment in which he/she will be involved. The
client will be required to participate in polygraphs to determine
his/her treatment progress . The polygraphs will be a disclosure,
offense specific, and/or a maintenance . The polygraphs have been
found to be very useful in the breakdown of secrets . Adolescents
may be polygraphed at the age of 12 as long as the client knows
right from wrong . However, it will be necessary for the client
to pass a polygraph with "no significant response" for it to be
acceptable . If "significant response" or "inconclusive" are
found, it will be necessary for the client to be reexamined after
a 90 day period.
The adolescent will have a treatment team which may include
the Probation Officer if one is assigned, a caseworker from Weld
County Department of Social Services, the family/legal guardian,
and the counselor from AID plus any other interested party who is
considered to be supportive to the client . The purpose of this
staffing will be for ongoing treatment planning including, but
not limited to, assessment of the client' s progress in treatment
as well as his/her daily living .
B. The client may require services AID can not provide and
he/she will be referred to an appropriate provider. This
includes, but is not limited to, medication intervention,
psychiatric evaluations, and polygraphs . The client' s family may
require additional services such as parenting skills, domestic
violence treatment, or drug and alcohol intervention. These also
will be referred to the appropriate source .
C. The adolescent' s treatment plan will include
individual, family, and group sessions . It is necessary the
family be involved if they are involved the client' s life in
3
order for them to understand sexually abusive behavior and to
support his/her son/daughter . This will be especially relevant
to those requesting reunification . The adolescent is more than
just an individual who is sexually abusive . Therefore it is
important to deal with the whole person and not simply the sexual
behavior
AID will provide counseling for anger management, teenage
domestic violence, as well as general psychological issues .
These services will only be provided if other agencies do not
have these type of counseling services . If the client has
Medicaid, he/she will be referred to the mental health facility
which has this contract .
D. The type of therapy which has proven most effective
with the adolescent offender has been a cognitive based therapy
in a group format . Issues which will be addressed in the group
are thoughts, feelings, and behaviors, thinking errors, basic
sexual education, the sexual offense cycle, stress management,
empathy, and relapse prevention . The adolescent will be required
to do daily journals and homework assigned by the group
counselor. There will be projects assigned to determine what the
client has learned and is applying to his/her life so as not to
sexually re-offend. If it is discovered a client has been
victimized, he/she will be recommended to participate in victim' s
counseling after participating in the Offense Specific Treatment
Program for not less than a period of six months . The reason for
the delay is to make sure the adolescent does not blame his/her
perpetration on the victimization.
E. Investigation for families with sexual abuse
allegations will be reported and referred to those individuals
who have the expertise in this field.
IV. Measurable Outcomes :
A. Adolescent & Individual Development' s program for
Offense Specific Treatment has a time line of not less than 12
months . During this time frame recidivism may be reduced through
the program materials . The adolescent will learn how his
thoughts, feelings, and behaviors are 100% the individual' s
responsibility. He/she will be presented with anger management
skills, empathy, and how his/her behavior impacted the victim,
family and the community. The client will learn coping skills,
stress management, the sexual offense cycle, victim
clarification, and the entire program will be based on Relapse
Prevention.
4
B . The client will demonstrate a decrease in re-
victimization by the use of the polygraph . Each client will be
required to participate in and pass a disclosure polygraph. The
purpose for this polygraph is to make sure the adolescent is
taking responsibility for all his sexually abusive behaviors .
He/she will be expected to take a maintenance polygraph near the
end of the program. This polygraph will help determine if the
adolescent is using the skills and concepts provided and to note
if he/she is able to follow the rules and regulations which may
keep him/her from re-victimization . Additionally, each client
will be required to demonstrate the skills and concepts they have
been given through written assignments . The skills and concepts
will not only indicate what the adolescent has put to use in
his/her life but, will also demonstrate the level of empathy
he/she has gained. These skills and concepts will be displayed
before termination from the program by the requirements to write
out his/her sexual offense cycle, an apology letter, and a
Relapse Prevention Plan .
C . Victim perpetration may be prevented because the client
will learn through their own counseling how to deal with the
emotional turmoil and pain appropriately without becoming
sexually abusive to others .
D. The child abuse incest victim will remain in the home
unless it is determined there is a safety issue . The perpetrator
will be removed immediately to a place where he/she will not have
access to other potential victim (s) .
E. The parent (s) will be educated during the course of the
adolescents treatment . This will be done through family sessions
and mandated parent groups . Additionally, probation has an
educational program which the client who is on probation is
mandated to attend. The parent will be involved in the treatment
process including the evaluation, polygraphs, and other relevant
areas . The parent will demonstrate competency by their
understanding of the material and allowing the adolescent to take
the responsibility of the sexual assault without trying to
rescuing him/her . If there is question of the parent (s)
competency, an outside agency may be recommended to go into the
home to work with the parent (s) . This has been found to be
useful in the past .
F. Reunification will depend solely on the progress of the
offender in treatment . It will be necessary the adolescent take
full responsibility for the sexual assault without blaming the
victim. Reunification can be expected to take a minimum of six
months with weekly sessions . The family will be mandated to
5
participate in every step of reunification. The family will be
mandated to learn and demonstrate how to determine the at risk
behavior the sexually abusive adolescent . What steps will be
taken to either lower the risk or immediately report the
behaviors to the appropriate source to protect the victim or
potential victim(s) . Reunification will take place only when the
victim, his/her counselor, the parent (s) of the victim and the
parent (s) of the adolescent offender, and the treatment provider
of the adolescent offender all agree on all parties want the
reunification . Reunification is necessary because the adolescent
may return home at some point . However, it will be important for
the victim to feel safe at all costs and know how to report any
inappropriate behavior immediately to remain safe . Again, it is
necessary the victim never feel re-victimized by any part of the
process .
Each month the Weld County Department of Social Services
and/or Caseworker will be provided with monthly progress notes
and/or of each client . These progress notes and outcomes will be
specific to the Offense Specific Treatment the client is
receiving . Additionally, when necessary, a staffing will be
arranged when ever the Caseworker and/or counselor deem it
necessary.
V. Service Objectives:
A. Parental competency will be explored by observation of
how they maintain sound relationships as well as appropriate
physical and emotional boundaries with each of their children.
This will be done through family sessions, individuals, and the
parent group. If additional services are required, the
recommendation will be made to have in home services by
counselors who are experienced in this field as well as
recommendations of parenting classes .
B. Family conflict will be addressed through individual and
family sessions . If there are issues which require more
specialized treatment, recommendations will be made to the
referral source .
C. Adolescent & Individual Development' s program addresses
self-esteem, victim awareness, awareness and management of one' s
own personal history of victimization, sex education, peer
relationships enhancement, establishing appropriate physical and
emotional boundaries, assertive versus aggressive behaviors, and
assuming full responsibility for one' s own behavior. The entire
program addresses these items within the group, individual, and
family sessions .
6
D. Resources are given whenever it is necessary to the
parent and/or client . These resources are given immediately when
issues arise which are determined are best handled outside of
Adolescent & Individual Development' s scope of expertise .
VI Workload Standards:
A. The client will be expected to participate in group
treatment every week for one hour at the minimum. Individual
sessions will be 50 minutes on an as needed basis . Family
sessions will be 60 to 90 minutes on an as needed basis .
B. The number of counselors providing services will be at
minimum two counselors .
C. Maximum caseload per counselor will be eight clients in
group treatment . This caseload will be meet the guidelines and
standards of the SOMB.
D. The modality of treatment will be groups, individuals,
and family sessions .
E. The number of hours for group will be at the minimum of
one per week during throughout the treatment process . Individual
and family hours will be on an as needed basis .
F. There will be a minimum of two counselors providing the
services . As the program expands, more counselors will be made
available .
A copy of the insurance Adolescent & Individual Development
requires is attached.
VII . Staff Qualifications:
AID staff members will possess at minimum a Master' s level
education in a counseling related field including but not limited
to psychology, rehabilitation, or sociology. They will be
licensed with the State of Colorado or be eligible to become
licensed. The agency has applied to the SOMB for full operating
status to work with Offense Specific adolescents . This will
include evaluations and treatment at the minimum. At this time,
I have full operating status with the SOMB to work with adults .
However will not work with the adult population after May, 2003 .
I will strictly work with the adolescent . The SOMB has been made
aware of this request . I have worked with sexually abusive youth
for approximately seven years . I have and will continue to
7
attend workshops, conferences, and other types of training to be
able to provide the most up to date treatment for the adolescent .
This will include not only Offense Specific treatment, but other
relevant issues of the adolescent as well .
B . The total number of staff which AID will contract for
will be limited to the guidelines and standards of the SOMB' s
Adolescent procedures . The staff will be supervised by myself
until the individual counselor is given full operating status
from the SOMB in treating and evaluating the adolescent .
C . Adolescent & Individual Development is an approved
agency for adult sex offenders at this time . The standards and
guidelines for the adolescent were completed July, 2002 .
Application has been made to the SOMB. All program materials and
group, family, and individual treatment are currently following
what the SOMB has indicated in the adolescent standards and
guidelines .
8
Computation Of Awards :
Unit of Service :
This program serves sexually abusive adolescents from the
ages of 12 though 20 . The mission of A. I . D. is designed to
protect the safety of the community. A. I . D. services those who
have been adjudicated, have admitted to sexual abuse, or are
sexually reactive . The program provides for a maximum of five
clients, one hour weekly group sessions, one group session with
mandated attendance of parent-guardian . Currently Bilingual
services are not available . South County services are provided
if an adequate number of clients are referred. Family
reunification services upon request .
Cost Per Unit of Service :
Hourly Rate Per
Individual/Family $50 . 00
Staffings with Family/Client $50 . 00
Rate per episode
Group Session $35 . 00
Evaluation $500 . 00*
Polygraph (Average Rate) $225 . 00**
*Cost of evaluation is dependent upon services
provided.
** Variable Rate is dependent on cost of polygraph.
Supplies
Notebook (One time at first of group session) $10 . 00
Unit of Service Based on Approved Plan
The purpose of the above break downs is so Weld County
Department of Social Services is not billed more than the other
clients . Therefore an itemized bill will follow the client Core
Services Program Verification Form each month. Please see the
enclosed copy of the Revision for June, 2003 to May, 2004
CPS K-Pc,
9
• '• 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.
Initial Award FY03-CORE-0027
X Revision (RFP-FYC-03007)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2003 and Adolescent&Individual Therapy
Ending 05/31/2004 Sex Abuse Treatment
Revision Effective:06/01/2003 P.O.Box 321
Fort Lupton,CO 80620
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial Assistance
This program serves sexually abusive adolescents from Award is based upon your Request for Proposal(RFP). The
the ages of 12 though 20.The mission of A.I.D. is RFP specifies the scope of services and conditions of award.
designed to protect the safety of the community. A.I.D. Except where it is in conflict with this NOFAA in which
services those who have been adjudicated,have case the NOFAA governs,the RFP upon which this award is
admitted to sexual abuse,or are sexually reactive.The based is an integral part of the action.
program provides for a maximum of 5 clients, 1 hour
weekly group sessions, 1 group session with mandated Special conditions
attendance of parent-guardian.Currently Bilingual 1) Reimbursement for the Unit of Services will be based on an
services are not available. South County services are hourly rate per child or per family.
provided if an adequate number of clients are referred. 2) The hourly rate will be paid for only direct face-to-face
Family reunification services upon request. contact with the child and/or family,as evidenced by client-
Cost Per Unit of Service signed verification form, and as specified in the unit of cost
Hourly Rate Per computation.
Individual/Family $ 50.00 3) Unit of service costs cannot exceed the hourly and yearly
Staffmgs with family/client $ 50.00 cost per child and/or family.
Rate per episode 4) Payment will only be remitted on cases open with,and
Group Session $35_00 referrals made by the Weld County Department of Social
Evaluation $500.00* Services.
Polygraph(Average Rate) $225.00** 5) Requests for payment must be an original submitted to the
*Cost of evaluation is dependent upon services Weld County Department of Social Services by the end of
provided. the 25th calendar day following the end of the month of
**Variable Rate is dependent on cost of polygraph. service.The provider must submit requests for payment on
Supplies forms approved by Weld County Department of Social
Notebook(One time at first group session)$10_00 Services.
Unit of Service Based on Approved Plan
Enclosures:
X Signed RFP: Exhibit A
Supplemental Narrative to RFP: Exhibit B
Recommendation(s)
Conditions of Approval
Ap rovals: CJ "W Pro Official:
By By U U- &WO
David E. Long, Chair Jud .Gri g m,Dmrec r
Board rocie1 CRunty Commissi ners Wel ount '0ep t of Social Services
Date: '—' V 2003 Date: J 0/11103
d/G3 1,4Pycf
BRANCH B/A PRODUCER NUMBER CLIENT NUMBER DATE OF ISSUE RENEWAL OR REPLACEMENT NO.
23 A 0001614 * 130 293607 04/03/03 80M-1193737
PROFESSIONAL LIABILITY OCCURRENCE
INSURANCE POLICY FOR
PROFESSIONAL COUNSELORS
AND
HUMAN DEVELOPMENT PRACTITIONERS
ALLIED HEALTH PURCHASING GROUP ASSOCIATION POLICY NUMBER: 44-2010129
Item DECLARATIONS CERTIFICATE NUMBER 80M- 1 193737
1.
Named Insured ADOLESCENT & INDIVIDUAL DEV.
2. MAILING ADDRESS PO BOX 321
FT. LUPTON, CO 80621-0321
3. Policy Period 12:01 A.M. Standard Time At From: 04/03/2003 To: 04/03/2004
Location Of Designated Premises
4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge
or charges:
COVERAGE PREMIUM
A. Professional Liability [XI $301.00
B. General Liability [ I
C. Endorsements [ I
Total: $301.00
5. LIMITS OF LIABILITY
$ 1,000,000 each Incident $ 3,000,000 in the Aggregate
or Occurrence
6. The Named Insured Is: Sole Proprietor (including Individual) Partnership Corporation
r Other: Organization Affiliation: MENTAL HEALTH INSURANCE PROGRAM
7. Business or Occupation of the Named Insured:
COUNSELOR
8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and
agreements contained in the following form(s)or endorsement(s):
PLE-2081, PLJ-2016(10/94), PON-2003, PLE-2189(09/97)
CHICAGO INSURANCE COMPANY
55 E. MONROE STREET, CHICAGO, ILLINOIS 60603
REPRESENTATIVE:
MARSH Affinity Group Services
a service of SEABURY &SMITH
1440 RENAISSANCE DRIVE
PARK RIDGE, IL 60068
1-800-503-9230
PLP-2016 (Rev. 10/94) (Elec.) INSURED COPY
PLP-2031 (10/94)
PROg_lVI BUDGETS
PROGRAM IT t i e s p,d- 4 �C✓ ll U I ou ' V ILl�(7(J TY Q n_ MANUAL BUDGET
A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT \ /o 7 4
B TOTAL CLIENTS TO BE SERVED 5
C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) (4-. 5
D COST PER HOURS OR DAYS OF DIRECT SERVICES ( E/C ) q S 98
E TOTAL DIRECT SERVICE COSTS 96,66).30 -
F ADMINISTRATION COSTS NON-DIRECT ALLOCABLE TO PROGRAM aggz ',O _
G OVERHEAD COSTS ALLOCABLE TO PROGRAM /amp.pe
H TOTAL DIRECT,ADMINISTRATION &OVERHEAD COSTS(E+ F +G) 023 9 `11 0 D
I ANTICIPATED PROFITS CONTRIBUTED BY THIS PROGRAM
J TOTAL COSTS AND PROFITS FROM THIS PROGRAM (H + I) o�3CItK(_od _
K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(C ) (1A5
L RATE PER HOURS OR DAYS OF DIRECT, FACE-TO-FACE SERVICE TO BE CHARGED
TO WELD COUNTY SOCIAL SERVICES (J/K) 5566
CERTIFICATION STAT MENT
I rdtL-e C LcA--T (4i LUCK 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 other factual unit costs supporting the compen do id or to be aid teVer this contract are accurate, complete and includes no duplicate costs and
and that I am the CEO or duly authorized agent of �J CU�> t t.lek (1gr,1/•-lftL/_QD 3 a'JJl p! x�v ti r
r urti9 CIA 69
o e Lid ace s 02, c -0
MANUAL BUDGET
DIRECT SERVICE COSTS
MANUAL BUDGET
Minimum Budget Average Total %OF SALARY %OF SALARY %OF SALARY X OF SALARY
Degree MOf Salary Salaried 100% ALLOCATION AND ALLOCATION AND ALLOCATION AND ALLOCATION AND
DESCRIPTION or Cert FTEs 1.0 FTE Benefits ALLOCATED TO PROGRAM OTHER COSTS TO PROGRAM OTHER COSTS TO PROGRAM OTHER COSTS TO PROGRAM OTHER COSTS
PROGRAM_•-
DIRECT LABOR FACE TOFACE POSITION,TITLE OR JOB FUNCTION .. a ,_ _ -,z 4y, s. ;a;
u-: 9' It°i ai #+... e5'-TL OR s.: ON s :K x '"'`...,-+ .,,, .."k !„ _"; ----n, -eeJ _ _ 5 .� �. __ .' -,r..1''
".' ,` .. i a� i a+" c .sF x L- 5 ':'v m;- ₹+ ^`x,c t - '.._9 ._. :_ r a
"' *T +, :i 4 ,n r" - -, 'a 7 r bi, . r = '� • . a� ._. ' I a. W Y' _
-; t .q.. '. �, �rvt � ,': .S' -„ A4-11
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:.:.,.,. : - " - Sty f ar_ . _ a 3 yr = „E
+v f - f. "'W -}. . h '1, r y b .. aid Ai S 'z_ k , di,.w}.. ;WM ...o.�
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.•,. ,. .a . L'' ._.... _ ,.............
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TOTAL DIRECT LABOR PER PROGRAM
OTHER DIRECT COSTS PER PROGRAM FACE-TO-FACE • ..
va.yg:, ^". '+F9, %' s�5 ,yxq;'a'- ` ''A .ek 1-�t".o L� '3 Y eu `�= S: "(.�3—tat n'{.
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TOTAL DIRECT COSTS PER PROGRAM 'x5'x '- I -s z.i, '"`= iiia`"=
E GRAND TOTAL DIRECT SERVICE COSTS S •"-"ip.Ss.. . _: ��" -�- ' `" ` -:• '
MANUAL BUDGET
ADMIN COSTS NON-DIRECT
MANUAL BUDGET
Minimum Budget Average Total %OF SALARY '/.OF SALARY %OF SALARY %OF SALARY
Degree #Of Salary Salaried 100% ALLOCATION AND ALLOCATION AND ALLOCATION AND ALLOCATION AND
DESCRIPTION or Gel FTEs 1.0 FTE Benefits ALLOCATED TO PROGRAM OTHER COSTS TO PROGRAM OTHER COSTS TO PROGRAM OTHER COSTS TO PROGRAM OTHER COSTS
PROGRAM . -, ` :1,:.; 4:,'N.2O:-.I .,w.. - -
DIRECT LABOR NOT FACE TO-FACE z __ : �.,Lier't,
6 ." A, - w.. :•,4„w4,,•,-S14.211:,a s .r .e t t:_x i v ^(�w ffi",,r ''''.,.;,,,NW +L� - ' a.rs- u '
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G Ta�'.'Ps_ --r.,:.-4:::7‘,7,.-- ,. r 4-,...-pc a r- s 7.4 TOTAL DIRECT LABOR PER PROGRAM NOT FACE-TO-FACE """'-• " " �� - :;."
OTHER DIRECT COSTS PER PROGRAM NOT FACE TO-FACE
—... ,,x S i" n§ `;n _,,. �Yd L �L
,cm
F (TOTAL DIRECT COSTS PER PROGRAM ...x_ - ..4-..m::,.- 4,,,,,,..,,„,,i_ `L -'- ' "
GRAND TOTAL DIRECT SERVICE COSTS NOT FACE-TO-FACE -- " Y "'
MANUAL BUDGET
OVERHEAD COSTS AND PROFITS
MANUAL BUDGET
TOTAL ALLOCATED ALLOCATED ALLOCATED ALLOCATED
OVERHEAD 100% % OVERHEAD COSTS % OVERHEAD COSTS % OVERHEAD COSTS % OVERHEAD COSTS
DESCRIPTION COSTS ALLOCATED TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM
PROGRAM :,-- .� .
OVERHEAD i ,n iv- `" ,.. w 4^v*� - a `- .5:. rc +. t
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�_.-P .:. = .. ..................................
::�.' s^ . -. '�+£ -;.. .a R�.. ,: ,.'" ,� +. - Fps. ril ,.,� .. ^2_ '§ --'� °.%1 .
,. , r,, - `� 3.=- o f _'` § . .:r: a. K,' =f - '.a. '. .�- xr�L . ,r _
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_ t itAW._ _ - .
:a '"t-77441G TOTAL OVERHEAD COSTS .. .. _, T . �TT.,. - _- ��_ � _��-= �- -�N�
I TOTAL ANTICIPATED PROFlTS F"" :`. :: x _ 4 _ p :r- a. �- -
TOTAL OVERHEAD AND ANTICIPATED PROFITS _ -
MANUALBUDGET
SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B
RECOMMENDATIONS
x CONDITIONS
ADOLESCENT & INDIVIDUAL DEVELOPMENT
9-
Mailing: PO Box 321 Fort Lupton, CO 80621 1
Pager: 970-681-9719 Fax: 303-857-9720
Cell Phone: 303-596-4586 f�
April 17, 2004
Judy A Griego, Director
Weld County Department of Social Services
P .O. Box A
Greeley, Colorado 80631
RE: RFP 04007
Dear Ms . Griego:
I called Ms . Furister on April 12, 2004 . She told me to let
you know I have two contract males who work with me in the
Offense Specific Treatment . It is necessary to have male/female
co-therapists in accordance to the Colorado State Standards and
Guidelines in working with adolescent offenders . Each of these
men are in the Psychology Masters Program at the University of
Northern Colorado. Their names are Jodie Smith and Jason Allen .
I accept the conditions of notifying the Department of any
change in staff. Mr . Smith has worked with me for approximately
a year. Mr. Allen has worked with me for approximately nine
months .
Please let me know if you have any questions about either or
both of the men.
incere ,
Rebecca J. Qui k . .
Licensed Professional Counselor
0
re. tiDEPARTMENT OF SOCIAL SERVICES
P.O.BOX A
GREELEY,CO.80632
Website:www.co.weld.co.us
Administration and Public Assurance(970)352-1551
Child Support(970)352-6933
O
Apri16,2004
COLRebeccaORADOck,Executive
Adolescent&Individual Therapy
P O Box 321
Fort Lupton,CO 80621
Re: RFP 04007
Dear Ms.Quick:
The purpose of this letter is to outline the results of the Bid process for PY 2004-2005 and to•request written
confirmation from you by Wednesday,April 14,2004. i
A. Results of the Bid Process for PY 2004-2005
The Families,Youth and Children(FYC)Commission recommended approval of the bid,RFP 04007,Sex
Abuse Treatment,for inclusion on our vendor list with no recommendations.
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.
All conditions will be incorporated as part of your RFP Bid and Notification of Financial Assistance Award
(NOFAA).If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC
Commission and the Weld County Department of Social Services accept your mitigating circumstances.If
you do not accept the condition,you must provide in writing reasons why.A meeting will be arranged to
discuss your response.Your response to the above conditions will be incorporated in the RFP Bid and
Notification of Financial Assistance Award.
The Weld County Department of Social Services is requesting your written response to the FYC Commission's
conditions Please respond in writing to Gloria Romansik,Weld County Department of Social Services,P.O.Box A,
Greeley,CO,80632,by Wednesday,April 14,2004,close of business.
If you have questions,please call Gloria Romansik,Administrator,at 352.1551,extension 6295.
4ty Sincerely,
'ego, irecto
cc: Juan Lopez,FYC Commission
Gloria Romansik,Social Services Administrator
SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B
RECOMMENDATIONS
x CONDITIONS
ADOLESCENT & INDIVIDUAL DEVELOPMENT ')
Mailing: PO Box 321 Fort Lupton, CO 80621 ?�
4
Pager: 970-681-9719 Fax: 303-857-9720
Cell Phone: 303-596-4586 y�
April 17, 2004
Judy A Griego, Director
Weld County Department of Social Services
P.O. Box A
Greeley, Colorado 80631
RE : RFP 04007
Dear Ms . Griego:
I called Ms . Furister on April 12, 2004 . She told me to let
you know I have two contract males who work with me in the
Offense Specific Treatment . It is necessary to have male/female
co-therapists in accordance to the Colorado State Standards and
Guidelines in working with adolescent offenders . Each of these
men are in the Psychology Masters Program at the University of
Northern Colorado. Their names are Jodie Smith and Jason Allen.
I accept the conditions of notifying the Department of any
change in staff . Mr . Smith has worked with me for approximately
a year. Mr . Allen has worked with me for approximately nine
months .
Please let me know if you have any questions about either or
both of the men .
�ncere ,
Ccr
Rebecca J. Qui k . .
Licensed Professional Counselor
a
DEPARTMENT OF SOCIAL SERVICES
P.O.BOX A
GREELEY, CO.80632
'D Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
III
O
COLORADO April 6,2004
Rebecca Quick,Executive Director
Adolescent&Individual Therapy
P O Box 321
Fort Lupton,CO 80621
Re: RFP 04007
Dear Ms.Quick:
The purpose of this letter is to outline the results of the Bid process for PY 2004-2005 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 04007,Sex
Abuse Treatment, for inclusion on our vendor list with no recommendations.
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.
All conditions will be incorporated as part of your RFP Bid and Notification of Financial Assistance Award
(NOFAA).If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC
Commission and the Weld County Department of Social Services accept your mitigating circumstances.If
you do not accept the condition,you must provide in writing reasons why.A meeting will be arranged to
discuss your response.Your response to the above conditions will be incorporated in the RFP Bid and
Notification of Financial Assistance Award.
The Weld County Department of Social Services is requesting your written response to the FYC Commission's
conditions Please respond in writing to Gloria Romansik,Weld County Department of Social Services,P.O.Box A,
Greeley,CO, 80632,by Wednesday,April 14,2004,close of business.
If you have questions,please call Gloria Romansik,Administrator,at 352.1551,extension 6295.
Sincerely,
A 'ego, irecto
y 4cc: Juan Lopez,FYC Commission
Gloria Romansik,Social Services Administrator
Hello