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Home My WebLink About20041633.tiff RESOLUTION RE: APPROVE FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS WITH VARIOUS PROVIDERS FOR FOSTER PARENT CONSULTATION 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 four Notification of Financial Assistance Awards for Foster Parent Consultation 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) Lutheran Family Services 2) Ackerman and Associates, P.C. 3) Lori Kochevar 4) Transitions Psychology Group, LLC, 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 four Notification of Financial Assistance Awards for Foster Parent Consultation 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. 2004-1633 SS0031 �'� : ss�- -u5) 06 -�z3 .oy FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR FOSTER PARENT CONSULTATION 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 tuns June 1, 2004. onserNiip , \* EL am% BOARD OF COUNTY COMMISSIONERS W D COUNTY, COLORADO ti.,47 ^^R1 1861 I; :�--_e i , , Robert D. Masden, Chair NO 40, `�'\�rClerk to the Board William H. rke, Pro-Tern BY: Deputy Clerk to the Board M. Bile RO DASTj e' : David . Long P�unty Attor. -y Glenn Vaad Date of signature: 2004-1633 SS0031 a DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, CO. 80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 O • COLORADO MEMORANDUM TO: Robert D. Masden, Chair Date: June 14, 2004 Board of County Commissioners J �} FR: Judy A. Griego, Director, Social Services-�,rLl t�.h,� 0 91A-13 / J RE: Notification of Financial Assistance AwardWfor County Designed Programs with Various Providers Enclosed for Board approval are Notification of Financial Assistance Awards (NOFAAs) for County Designed Programs between the Weld County Department of Social Services and various providers. The NOFAAs are based upon the provider's Request for Proposal, which has been reviewed and approved by the Families, Youth and Children (FYC) Commission. The NOFAAs were reviewed at the Board's Work Session of 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 County Designed Programs. These services are for children, youth, and families receiving child welfare services. Generally, County Designed Programs are innovative and/or otherwise unavailable services that meet the goals of the Core Services Program. 3. Providers will be reimbursed according to various rates as provided below: Vendor Name Rate A. North Colorado Medical Center—Youth Passages $21.00 per hour Adolescent Partial Hospitalization Lutheran Family Services $350.00 per hour(group rate) Foster Parent Consultation $90.00 per hour(individual rate) C.C. Ackerman and Associates P.C. $350.00 per hour(group rate) Foster Parent Consultation $90.00 per hour(individual rate) 2004-1633 D. Lori Kochevar $350 per hour(group rate) Foster Parent Consultation $90.00 per hour(individual rate) LE.) Transitions Psychology Group, LLC $350 per hour(group rate) Foster Parent Consultation $90.00 per hour(individual rate) 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-0008 Revision (PY 04-05 RFP-FYC-06-000) Contract Award Period Name and Address of Contractor Beginning 06/01/2004 and Lutheran Family Services Ending 05/31/2005 Foster Parent Consultation 3800 Automation Way, Suite 200 Fort Collins,CO 80525 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Program is designed to provide support,training, Assistance Award is based upon your Request for and consultation services to Weld County foster Proposal(RFP). The RFP specifies the scope of parents. Foster parent consultations will be services and conditions of award. Except where it is provided through group consultation services for in conflict with this NOFAA in which case the a maximum of five groups per month, 6-10 NOFAA governs, the RFP upon which this award is participants per group. Individual consultation based is an integral part of the action. services will only be provided when approved by the Resource Services Manager or Child Special conditions Welfare Admnistrator of Social Services. Bilingual-bicultural and South County services 1) Reimbursement for the Unit of Services will be based available. on a per group rate. 2) Payment will only be remitted on cases open with, Cost Per Unit of Service and refs rals made by the Weld County Department of Social Services. Group Rate per $ 350.00 3) Requests for payment must be an original submitted to Hourly Rate per Individual Consultation $ 90.00 the Weld County Department of Social Services by Based on Approved Plan the end of the 25th calendar day following the end of the month of service. The provider must submit Enclosures: responses for payment on forms approved by Weld X Signed RFP:Exhibit A County Department of Social Services. X Supplemental Narrative to RFP: Exhibit B 4) Requests for payment must include original client Recommendation(s) verification signatures(blue or red ink preferred)and X Conditions of Approval dates and hours of service. 5) The Contractor will notify the Department of any change in staff at the time of the change. Approvals: _ Program Official: By YuD..1 \�l UVUeil---- By Robert D.Masden, Chair Judy Gri ,Direc Board of Weld County Commissioners Weld ouunty epartm t of Social Services Date: i:21/1 1-p p y Date: yisioll )a6 y-/E,33 SIGNED RFP-EXHIBIT A REQUEST FOR QUALIFICATIONS OFF SYSTEM BID B001-04 (RFQ-006-00) DATE:February 11, 2004 RFQ NO: 006-00 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Qualification (006-00) for: Colorado Family Preservation Act—Foster Parent Consultation,Emergency Assistance Program Deadline:March 5, 2004,Friday, 10:00 a.m. The Families,Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act (C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2004,through May 31, 2005, at specific rates for different types of service, the county will authorize approved vendors and rates for services only. The Foster Parent Consultation Program must provide services that focus on providing psychological consultations and parenting support to foster parents which are designed to improve foster parent competency, family conflict management, and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A. Administrative Information PART D...Qualifier Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) RFQ MUST BE SIGNED IN INK %co 4ea17/ TYPED OR P' 1 ED SIGNATURE VENDOR Lutheran Family Services (Name) an 'tten Sign.. a By orized Office s A_a. . Vender ADDRESS 3800 Automation Way, #200 TITLE Trar,ek—e)--- Ft. Collins CO 80525 DATE //4Cf PHONE# 970.266. 1788 970.356.6080 The above RFQ is subject to Tunis and Conditions as attached hereto and incorporated. Page 1 of 28 Off-System Bid Number B001-04 (RFQ-FYC 006-00A) Attached A FOSTER PARENT CONSULTATION PROGRAM REQUEST FOR QUALIFICATION (BID) PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING COLORADO FAMILY PRESERVATION ACT 2004-2005 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2004-2005 OFF SYSTEM BID B001-04 RFQ 006-00 NAME OF AGENCY: Lutheran Family Services of Colorado ADDRESS: 3800 Automation Way #200 Ft, Collins CO 80525 PHONE: (970 ) 266. 1788 970.356.6080 CONTACT PERSON: Amy Hatcher TITLE: Program Manager DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation Program Category must provide services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household management competency,parental competency, family conflict management and effectively accessing community resources. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1, 2004 Start End May 31, 2005 End TITLE OF PROJECT: Foster Parent Education and Empowerment Program AMOUNT REQUESTED: Julie E. Swanson L 3/4/2004 Name and Signature of Person eparing Document Date Judy A. Griego, Director Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new proposals and renewal proposals,please initial to indicate that the following required sections are included in this Proposal for Qualification. 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 Target/Eligibility Populations Types of services Provided Measurable Outcomes Service Objectives Workload Standards Staff Qualifications Program Capacity per Month Certificate of Insurance Page 24 of 28 Core Services Proposal Foster Family Consultation FY 04-05 Foster Parent Education and Empowerment Lutheran Family Services of Colorado PROJECT DESCRIPTION Lutheran Family Services of Colorado(LFS) is a community-based agency with an experienced staff that offers a wide range of services to children,families and adults. It is a nonprofit agency that has provided human services in Colorado since 1948. Although the agency was established as an affiliate of the Lutheran Church, it is an equal opportunity agency that provides services to all individuals without consideration of religious beliefs, race,ethnicity, gender or economic status. The Foster Parent Education and Empowerment program is intended to provide support,training and consultation services to Weld County foster and foster-to-adopt parents. The purpose of this program is twofold: to prevent the imminent move of foster children from one foster home to another, and to provide support services to foster parents toward improving their overall skills. This program will be available only to Weld County foster parents and will be provided in Weld County. Services are intended to reduce the risk of abuse and/or disruption of placements of children by being proactive with foster parents, as well as offering support to foster parents who are feeling overwhelmed by the specific needs of the traumatized children placed in their homes. Education and training on issues common to children in the foster care system as well as behavioral management techniques will be provided. These issues may include, but are not limited to the following:grief and abandonment, attachment and bonding, self- image, sexual abuse,sexualized behaviors, appropriate boundary setting, empathetic response,substance abuse, resolution of birth family issues,etc. The Foster Parent Education and Empowerment program offers a continuum of services,which include the following three program components: • Ongoing Topic Specific Support Groups—All Weld County foster/foster adopt parents who are interested in receiving ongoing consultation and education around specific topics may self-refer to these groups. Depending on need,two separate groups will be provided on an ongoing, monthly/bi-monthly basis throughout the year,one for foster parents and one for foster adopt parents. The groups will be topic specific in that they are intended to address specific issues that typically impact a foster child or foster/foster adopt family (i.e., grief and loss, attachment and bonding, effects of foster child on biological children, legal risk, visitation, treatment planning,etc.). • Home-based Individual Foster Parent Assessment and Consultation —This time-limited, home-based assessment and consultation service will be provided to foster/foster adopt parents referred through Weld County who are either new and inexperienced or have indicated a need for a possible corrective action plan. The Foster Parent Consultant will conduct a needs and strengths-based assessment on the family. An assessment tool will also be utilized to determine parenting values and/or behaviors that indicate a risk of potential abuse/neglect toward a child. After the assessment is completed, the Consultant will assist the Weld County DSS caseworker in devising a development or corrective action plan. • Training Workshops—Trainings will be offered to all Weld County foster parents(some foster parents may be mandated to attend through Weld County DSS under a corrective action plan)on an as-needed basis. The flat fee for conducting such training will be agreed upon between the contractor and the Department on a per event basis. This program will submit specific training proposals that will be pre-approved by the Weld County program supervisor prior to offering the training to foster parents. The specific content of the training,time for the training and fee will be included in each pre-approved proposal. II. TARGET/ELIGIBILITY POPULATION Because referrals come to LFS from Weld County Department of Social Services(DSS)caseworkers,the decision that a child is at imminent risk of out-of-home placement has been made prior to the referral of the family to LFS for Parenting Coach services. However, if during the process of working with a family unit a LFS staff member feels that a child is in imminent danger, we will immediately contact Weld County DSS to discuss the conditions that exist in the family to determine whether they meet the criteria as defined in 26-5.3-103(2), C.R.S. LFS is strongly committed to upholding the Core Services Program primary goals of preventing imminent placement of children and reunifying children in placement with their families. Ongoing Topic Specific Support Groups—This program component accepts self-referrals from any Weld County foster or foster adopt family who may be experiencing stress or who may simply desire to improve their skills. Home-based Individual Foster Parent Assessment and Consultation—This service will be provided to foster/foster adopt parents referred through Weld County who are either new and inexperienced or have indicated a need for a possible corrective action plan. Training Workshops—Trainings will be offered to all Weld County foster parents(some foster parents may be mandated to attend through WCDSS under a corrective action plan). A. Total number of clients to be served: 154 Ongoing Topic Specific Support Groups—Two groups per month (one for foster parents and one for foster adopt parents)that will accommodate an average of eight participants. We currently have the capacity to serve 20 clients under this program component. We can add additional groups if the need exists. Home-based Individual Foster Parent Assessment and Consultation—We estimate that each family unit will be composed of four individuals, and that each family unit will receive eight hours of direct service over a period of four weeks. Therefore,we have the capacity to serve two family units per week for a total of 26 families(104 clients). Training Workshops— We estimate that we will provide two trainings throughout the year,on an as-needed basis, with an estimated 15 participants in each training session. Therefore,we could potentially serve 30 clients. B. Total family units: 51 Ongoing Topic Specific Support Groups—10 family units Home-based Individual Foster Parent Assessment and Consultation—26 family units Training Workshops— 15 family units C. Sub-total of individuals who will receive bicultural/bilingual services: 16 It is our assumption that there are few foster parents who are monolingual in Spanish as it is difficult to access Spanish speaking pre-service training and state rules have not been translated into Spanish. However, we do have the potential to serve monolingual foster parents under the home-based individual foster parent assessment and consultation component(15%of 104 clients). D. Sub-total of individuals who will receive services in South Weld County: 26 We are willing to provide services where they are needed. The decision to have groups in South Weld County vs. the Greeley area will be based on having a majority of group participants from South Weld County. This number assumes that both 15%of the individuals served under the home-based individual foster parent assessment and consultation service and one group will be in the South Weld County area. E. The monthly program capacity per group: 10 participants per group F. The monthly average capacity per group: 8 participants per group G. Average stay in the program: Ongoing Topic Specific Support Groups—Ongoing monthly basis for 12 months Home-based Individual Foster Parent Assessment and Consultation—4 weeks or 8 hours of direct service max. Training Workshops—8 hours H. Average groups per week: 2 per month Although we are budgeted to offer two groups per month, we can offer more groups if the Department wishes and if there is a demonstrated need for additional groups. 2 III. TYPES OF SERVICES TO BE PROVIDED As mentioned in Section I, a continuum of services or program components will be offered through the Foster Parent Education and Empowerment program. We will offer consultation, support,training, and education to Weld County foster parents under the following three program components/services:topic specific support groups, home-based individual foster parent assessment and consultation, and training workshops. The level of service required would be dependent upon the needs of the foster family and the approval of the Department. A. Ongoing Topic Specific Support Groups This program component or service is prepared to accept self-referrals from any Weld County foster family who may be experiencing stress or who may simply desire to improve their skills. The program is intended to provide group support for Weld County foster families around such issues as helping foster families understand the county system process and the implementation of court ordered treatment plans, options in discipline, issues with the biological children of the foster families,the transition process and the grief and loss issues foster children face,the importance of visitation with birth family or other extended family members, understanding the legal risks and the importance of the commitments made to these children, problem solving skills with solution oriented goals, etc. The groups will be topic specific in that they are intended to address specific issues that typically impact a foster child or foster/foster adopt family. The topics will be set by the group participants on an ongoing basis and will address, at a minimum,the above-described issues. The Consultant will also provide families with training in child development, limit setting, discipline, esteem building, providing structure, nurturing, attachment,etc. At times foster parents may benefit from skills taught through specific curricula,which may include:the Nurturing Parent Program, Parenting with Love and Logic, and the Terrific Infant Program. These curricula focus on reducing inappropriate parental response to children's behavior while increasing age-appropriate parental expectations of children. These groups will be offered on an ongoing basis throughout the year(12 months). Depending on need,two separate groups will be provided on an ongoing, monthly/bi-monthly basis throughout the year,one for foster parents and one for foster adopt parents. Each group will be composed of six to 10 participants. We estimate that we will serve 20 participants total. We could add additional groups if the need exists. We will provide services in the family's environment whenever possible and appropriate. LFS also can access meeting space in churches and at the Visitation House that we rent. The Adult-Adolescent Parenting Inventory(AAPI)will be utilized as a pre-and post-test measurement(at the beginning and end of the 12 months)to assess high-risk parenting attitudes and behaviors. Responses to the inventory provide an index of risk for practicing behaviors positively correlated to child abuse and neglect(i.e., inappropriate expectations of children,parental lack of empathy toward children's needs, belief in corporal punishment, reversal of parent-child role responsibilities, and oppression of children's power and independence). Low scores indicate agreement in the aforementioned parenting behaviors and a high risk for abuse and neglect. In addition to this quantitative measurement, foster parents will complete a feedback form at the end of each individual monthly session. The feedback form will ask them what they gained from the session, what could be improved,what other topics they may be interested in having covered, etc. B. Home-based Individual Foster Parent Assessment and Consultation This time-limited (four weeks or eight hours of direct service), home-based assessment and consultation service will be provided to foster/foster adopt parents referred through Weld County who are either new and inexperienced or have indicated a need for a possible corrective action plan. We have the potential to serve two family units per week for a total capacity of 26 family units. The intent of these home-based,family-specific meetings will be to assess the possibility of imminent risk of disruption of the placement, imminent risk of abuse occurring in the foster home and/or the risk of losing the foster home. The Foster Parent Consultant will conduct a needs and strengths-based assessment on the family utilizing the Family Risk Scales and the Adult Adolescent Parenting inventory, mentioned above. The Family Risk Scale(FRS)was designed as a standardized measure to assess a particular kind of risk— a child's need for out-of-home placement. The risk variables measured are those that contribute to,or precipitate, 3 the need for out-of-home placement(i.e., habitability of residence,financial problems,family social support, verbal discipline, knowledge of childcare,etc). The FRS consists of 26 individual rating scales, each with four to six levels that range from adequacy(1)to increasing degrees of inadequacy(5-6)on the variable being measured. The AAPI, mentioned above,will also be utilized to determine parenting values and/or behaviors that indicate a risk of potential abuse/neglect toward a child. After the assessment is completed,the Consultant will assist the Weld County DSS caseworker in devising a development or corrective action plan and will continue some specific consultation focusing on areas of risk in the family. C. Training Workshops Training will be offered to all Weld County foster parents when requested. The flat fee for conducting such training will be agreed upon between the contractor and the Department on a per event basis. This program will submit specific training proposals that will be pre-approved by the Weld County program supervisor prior to offering the training to foster parents. The specific content of the training,time for the training,and fee will be included in each pre-approved proposal. A pre-and post-test that specifically addresses the content of the training will be administered to foster parents at each individual training workshop as a means of outcome measurement. We currently own six curricula that could be offered,depending on the specific needs of the families involved, including: ABC Parent Training, Parents as Tender Healers(PATH), Love and Logic, Nurturing Parent Program, STEP Parenting and Foster Pride/Adopt Pride, and Understanding and Responding to Normalized Sexual Behavior in Children. Additionally,we have one staff member trained as a CPR/1sI Aid instructor. The ABC Parent Training, Nurturing Parent Program, STEP Parenting and the Foster Pride/Adopt Pride are curricula that provide more basic parent education training. The PATH training deals with more clinical issues faced by foster families,foster/adopt families,and kinship care families. We consider the Love and Logic Training to provide more intensive skill development then the four basic parent education programs. The County can refer any families and/or staff to these training groups. We estimate that we will provide two training sessions throughout the year. We further estimate that we will have 15 participants in each training session. Therefore,we could potentially serve 30 clients. D. Foster Parent Pre-Service and Ongoing Training State rule currently requires foster parents to have 27 hours of pre-service(core)training and 20 hours of ongoing training for regular foster parents and 32 hours of ongoing training for therapeutic foster parents. LFS currently provides all of the training to the LFS foster parents as required by state rule. See section"C"above. E. and F. Assurances LFS will not provide Foster Parent Group Consultation Services and therapeutic services to the children in those foster homes by using the same professional staff member. LFS will not use the legal system to oppose the Department's recommendations. LFS will provide all assessments,clinical recommendations, and other opinions derived through the course of performance of this contract directly to the caseworkers of the children in care in the foster homes. G. Child Abuse Reporting All LFS professional staff members providing services in this program are mandated reporters of suspected child abuse. Additionally, LFS will keep all reports of child abuse and any identifying information in those reports strictly confidential. IV. MEASURABLE OUTCOMES The Adult-Adolescent Parenting Inventory(AAPI) is a tool utilized to assess high-risk parenting attitudes and behaviors. Responses to the inventory provide an index of risk for practicing behaviors positively correlated to child abuse and neglect(i.e., inappropriate expectations of children, parental lack of empathy toward children's needs, belief in corporal punishment, reversal of parent-child role responsibilities, and oppression of children's power and 4 independence). Low scores indicate agreement in the aforementioned parenting behaviors and a high risk for abuse and neglect. The Family Risk Assessment Scales(FRS)was designed as a standardized measure to assess a particular kind of risk—a child's need for out-of-home placement. There are 26 specific variables measured which include: habitability of residence, suitability of living conditions, financial problems, adult relationships,family's social support, parent's physical health, parent's mental health, knowledge of child care, parent's substance abuse, parent's motivation, parental cooperation, attitude to placement, preparation for parenthood,supervision of children, parenting children ages 10 and above, physical punishment, verbal discipline, emotional care, physical needs of child,sexual abuse of a child,child's physical health,child's mental health,child's school adjustment, delinquent behavior, and home-related behavior. The 26 variables measured are those that contribute to, or precipitate,the need for out-of-home placement. Each of these 26 variables is measured on a scale that ranges from adequacy(1) to increasing degrees of inadequacy(5-6). Lower ratings on the FRS indicate an improvement in areas of risk. • Ongoing Topic Specific Support Groups—The Adult-Adolescent Parenting Inventory will be utilized as a pre-and post-test measurement(at the beginning, at six months and at the end of the 12 months)to assess parenting attitudes and behaviors. In addition to this quantitative measurement, foster parents will complete a feedback form at the end of each individual monthly session. The feedback form will ask them what they gained from the session, what could be improved, what other topics they may be interested in having covered, etc. • Home-based Individual Foster Parent Assessment and Consultation—The Foster Parent Consultant will conduct a needs and strengths-based assessment on the family utilizing the Family Risk Scales and the Adult Adolescent Parenting inventory, mentioned above. The Weld County DSS caseworker will also be asked to complete a shortened version of the FRS. After the assessment is completed,the Consultant will assist the Weld County DSS caseworker in devising a development or corrective action plan and will continue some specific consultation focusing on areas of risk in the family. • Training Workshops—A pre-and post-test that specifically addresses the content of the training will be administered to foster parents at each individual training workshop as a means of outcome measurement. The Adult Adolescent Parenting Inventory and the Family Risk Assessment Scales will be used as pre-and post- assessment instruments to assess the following measurable outcomes: A. Improvement of household management competency: measured by components of the Family Risk Assessment Scales. We estimate that 85%of families will improve in this area, i.e.,will evidence decreased scores from pre-to post-test on variables associated with household management. B. Improvement of parental competency: measured by components of the Family Risk Assessment Scales and the Adult Adolescent Parenting Inventory. We estimate that 80%of families will improve in this area, i.e., will evidence changed or improved scores from pre-to post-test. C. Foster parents can work independently with other resources in the community and within the local, state and federal governments: measured by components of the Family Risk Assessment Scales. We estimate that 80%of families will improve in this area, i.e.,will evidence decreased scores from pre-to post-test on variables associated with family support. D. Foster parents are able to demonstrate higher skill and competency levels in fulfilling their designated function for children in out-of-home placement, including helping children transitioning into their home, understanding the grief and loss issues the children arrive with and the importance of contact between the child and the child's birth family: measured by components of the Family Risk Assessment Scales and the Adult Adolescent Parenting Inventory. We estimate that 75%of families will improve in this area, i.e., will evidence changed or improved scores from pre-to post-test. 5 E. Foster parents are able to demonstrate the ability to meet the needs of their biological children in adjusting to and coping with the presence of foster children in the home: measured by components of the Family Risk Assessment Scales and the Adult Adolescent Parenting Inventory. We estimate that 75%of families will improve in this area, i.e., will evidence changed or improved scores from pre-to post-test. F. Foster parents will demonstrate an increased ability to discipline the children in their home in an appropriate manner as well as increasing their behavioral management skills: measured by components of the Family Risk Assessment Scales and the Adult Adolescent Parenting Inventory. We estimate that 80%of families will improve in this area, i.e.,will evidence changed or improved scores from pre-to post-test. V. SERVICE OBJECTIVES Objective 1. When determined as a need, no less than 85%of individual/foster family households will show improved household management competencies as demonstrated by an improved financial situation, increased habitability of residence,equitable division of household responsibilities, etc. Objective 2. When determined as a need, no less than 80%of individual/foster family households will show improved parental competencies as demonstrated by increased understanding of child development concepts, increased use of positive parenting techniques, increased understanding of safety issues in caring for a child, appropriate health and hygiene practices, and encouragement of each child's independence and healthy self- concept. Objective 3. When determined as a need, no less than 80%of individual/foster family households will show Improved ability to access resources as demonstrated by the number of encounters with community agencies, healthcare providers, schools, etc. As outlined in Section IV,the achievement of these objectives will be measured using the Family Risk Scales and the Adult-Adolescent Parenting Inventory, as well as case documentation. All families involved in the program are assessed utilizing the FRS upon intake and case closure, or at the end of service. The assessment is helpful in the development of treatment goals for each individual family. It is also a means of measuring progress. Clients served will demonstrate improved parental competency, improved household management, and an improved ability to access resources as indicated by decreased FRS scores. These scores will be documented in monthly progress reports. Parents will be assessed utilizing the AAPI upon both intake and case closure. Clients involved in the above services will demonstrate improved parental competency as evidenced by improved scores on the AAPI from pre-to post-test. These scores will be documented in monthly reports. VI. WORKLOAD STANDARDS A. Number of groups per month: 2 Ongoing Topic Specific Support Groups—This program component has budgeted two groups per month(one for foster parents and one for foster adopt parents). Each group will be approximately two hours in length. The groups will accommodate an average of eight participants(6-10participants). These groups will be open to new participants throughout the year. Groups will be run on an ongoing basis for a total of 12 months. We currently have the capacity to serve 20 clients under this program component. We can add additional groups if the need exists. Home-based Individual Foster Parent Assessment and Consultation—We currently have budgeted .20 FTE(8 hrs.) of professional staff time to this program component. On average,we estimate that each family unit will be composed of four individuals. We further estimate that each individual family unit will receive eight hours of direct service over a period of four weeks. Therefore,we have the capacity to serve two family units per week for a total of 26 families. 6 Training Workshops—This program component will occur on an as needed basis. We estimate that we will provide two training sessions throughout the year. We further estimate that we will have 15 participants in each training session. Therefore,we could potentially serve 30 clients. B. Number of anticipated requests for individual consultation per month: 2 C. Number of individuals providing services: 1 (.30 FTE) We currently have budgeted .30 FTE(12 hrs.)of professional staff time to this program. Our structure has been established to allow us maximum clinical flexibility. We currently have five staff members that could offer services in this program, not including the program supervisors. D. Maximum caseload per worker: 12 hours (direct and indirect time)per week • Ongoing Topic Specific Support Groups—2 groups per month (two hours of direct time per month for each group =four hours of direct time per month and eight hours total per month) =two hours per week • Home-based Individual Foster Parent Assessment and Consultation—2 families per month/week(We currently have budgeted .20 FTE(8 hrs.)of professional staff time to this program component. On average,we estimate that each family unit will be composed of four individuals. We estimate that each individual family unit will receive eight hours of direct service over a period of four weeks. Therefore, we have the capacity to serve two family units per week.) • Training Workshops—With having .30 FTE (12 hours per week)of professional staff time budgeted in this program,we have the capacity for one hour of training per week or 4 hours of training per month. E. Modality of treatment: The predominant modality of treatment in this program will be group education, support, and training. Our program philosophy is based on what is in the best interest of children and that traumatized children have the best chance of healing in a corrective family environment. Therefore,there is a strong family component to our programs. Education and training on issues common to children in the foster care system as well as behavioral management techniques will be provided. These issues may include, but are not limited to the following: grief and abandonment, attachment and bonding,self-image, sexual abuse, sexualized behaviors, appropriate boundary setting,empathetic response, substance abuse, resolution of birth family issues,etc. F. Total number of hours per day/week/month: 12 hours (direct and indirect time)per week G. Total number of individuals providing these services: 1 (.30 FTE) We currently have budgeted .30 FTE (12 hrs.)of professional staff time to this program. Our structure has been established to allow us maximum clinical flexibility. We currently have five staff members who could offer services in this program, not including the program supervisors. H. The maximum caseload per supervisor: 1: 7 I. Insurance Our proof of insurance, naming Weld County Department of Social Services as co-insured, is attached. VII. STAFF QUALIFICATIONS A. Minimum qualifications in education and experience Clinicians assigned to this program are qualified by one of the following: • A master's degree in social work or another human service field; and/or 7 • • A bachelor's degree in social work or another human service field and at least five years post-degree experience in family and children's services. B. Total number of staff, including supervisors, available for the project We currently employ two Licensed Clinical Social Workers, one clinician with a Master's in Social Work, three clinicians with Masters in Human Development and Family Studies, and two employee with a Bachelor's Degree and over 10 years experience in Child Welfare. All eight of these staff members could be assigned cases in the Home- Based Parent Coach program if the number of referrals increases. Our Program Director has a Master's in Social Work. All staff has gained experience in child and family services. All staff in this program is required to secure 16 hours per year of continuing education training. All staff will receive weekly supervision from a supervisor experienced in child welfare work. The supervisors are also required to secure 16 hours per year of continuing education training. Clinical Supervisor—This position will provide additional supervision for the determination of the appropriate level of services after the initial assessment period and will provide ongoing supervision for any cases in level B, meeting with the visitation supervisor at least every-other-week, with immediate supervision available as needed. A licensed therapist with experience in human services and child welfare will be required to fill this position. VIII. COMPUTATION OF DIRECT SERVICE RATE LFS understands that it will be reimbursed with the following rates: Group rate per six-ten(6-10) participants $350 Hourly rate per Individual Consultation $90 8 I2/20/2004 FRI 12:11 FAX Z001/001 Off-System Bid Number B001.04(RFQ-FYC 006-00A) Attached A )ate of Meeting(s)with Social Services Division Supervisor: ;omments by SSD Supervisor: 5 a. frg5.15- 4Stitifor krt2/ti.4.; . , , , ast- ler 5 40,1Lar - ' . Cifae"-S° AtC,--, aL, ' al q6r Name and Signature of SSD Sup sor Date Page 25 of 28 M.F-47-94-2D04 14:51 MIIIPSH =iDVaNT,REE RMEP I CP 415 993 557E: F32 ACORD CERTIFICATE OF LIABILITY INSURANCE I 03/04/2004 am.. THIS CERTIFICATE IS I ESDED AS A MATTER OF INFORMATION Marsh Advantage America ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 160 Spear St. 15th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR pALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sane Francisco, CA. 94105 415-903-5145 INSURERS AFFORDING COVERAGE NAcs Aswan Lutheran Family Services of Colorado IN;UR;RA GuideOne Specialty ...ER, GuideOne Mutual 363 South Harlan, Suite 200 ,N,D,cRC Denver, Co 80226 INSURER C 303-922-3433 x 109 MENDER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TC THE INSURED NAMED ABOVE FOR THE PODGY PERIOD INDICATED.NOTWITHSTANDING ANY REOIIREmENT.TERM OR CONDITION OF AMY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE AMY BE IEEUED OR MAY PERTAIN,THE INSURANCE AFFORDED CM THE POLICIES DESCRIBED HEREN IS EUSIECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OP SUCH POUJCIESS.AOGREGATE LIMITESHOWN MATHAVEBEENREDUCEDET PROCLAIMS. m ma AUET mama MEMO j POCTBTPWAT U anus OIIMML Amours EACH DeuNNReACE 1 X COMMERCIA GENERAL MEWS A• R°ET°�M� 1 000 00 MIMG R.-a—..I1 , , 0 X CwI,MASE X OCCUR MEDENPMmsmianp ,5, 000 A XCounselors 1213-263 7/1/03 7/1/04 PCRPDIML.AwIwMRT .1, 000, 000 GENERAL AOGREOA1S .3, 000, 000 EENt AGGREGATE LW?A^PLN:E PER PRODUCTS.ECMROPAa0 N 1,000,000 vOLICY ANA n set LOC AMTOMORIWMT COMBINEDSMELE LW? , 1, 000, 000 .WIAMTO 16dLU .-- ALL oveithufTOS P BCHEDVIEDAU108 I Nspacl T .I.W S B X Hada AUTOS BA1714-122 4/1/03 4/1/04 X NON.NTNEOMRDP O©ILrI A f RwMMN Heenan DAIMDE • (P,AtmIIA s anteof Stain MITOORLY.BAACCICOR I 1*MAUS° OMERTMAN °j"� I AUTODM.V• AGO I I �aSJI AL"I'"BLE'' EACH OCCMMENCE .4, 000, 000 AGGREGATE ,4, 000, 000 X DDCMR °"' MADE 9618-912 7/1/03 ' 7/1/04 B OEDUCHBLE 1 TI eeTeNTaN L 10, 000 MYMIMWT1WTou,v WC,TATU- OM C,Inme�'Win= TdMIMRB FR EINCHACCI°EXT I errr m mr eL=Oak-eA BAIPLDT,E I AncixwDw.vNxsk. EL.DIBFABE.POLICY LYM { 0,'- ACMnIVOeASTaIIL¢A1na menazasilIDIAMOD4 WENN to I!Mbw 0GL4PROINIe.I Certificate holder is additional, insured as respects general liability only re: contract services of insured as per form CG2026/1185. EFRTIFlCATE HOLDER CANCELLATION PINNED AM OS T%MOVE MIMI=POTS=PB Gout=;MOM M WRMTaN Weld County Social Services DATE TICIItaP,TOE MONO MUM HILL ENDEAVOR TO MAE 30 ran,,M„O1 PO Box A Dente some CENTMT.TI IMLa RAI=TO TC Im.RI.T'ALLAN To Iro so SHALL Greeley, CO 80632 NOM=,DIyJOATeNR LatilLrrfv,N,CYO wTYR MIRROR.ITN mama az ATTN Judy Greigo DIR RiEniuNTATtat AIRIeNyp OPR111MST I B :OROES(s.01/GB) TwuurrUIVA RDN1/1B I H SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B RECOMMENDATIONS X CONDITIONS Veb -‘4\e"1/4*--M •z' Lutheran Family Services of Colorado ca Services that heal,strengthen&provide hope April 12, 2004 Gloria Romansik Weld County Department of Social Services P.O. Box A Greeley, CO 80632 Dear Ms. Romansik: We are in receipt of the April 6, 2004 letter concerning the following bids that were submitted by Lutheran Family Services for FY 2004-05. 1. RFP 04010: Option B 2. RFP 04005: Home Based Parent Coach 3. RFP 04005: Visitation 4. RFT 006-00: Foster Parent Consultation Lutheran Family Services hereby accepts the condition applied to all 2004-05 contacts. In specific, LFS will notify the Department of any changes in staff at the time of the change. We look forwar. • working with you during the upcoming fiscal year. If you have any questions -a call me at 303-217-5830. ncer- , arclay President/C'• 363 S. Harlan St., Su. c 200 • Denver, CO 80226-3552 • (303) 922-3433 • Fax (303) 922-7335 • www.lfsco.org ILSA 0 XMw,-"XM rTh- DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY,CO.80632 Website:www.co.weld.co.us ' Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 O • COLORADO April 6,2004 James Barclay President/CEO Lutheran Family Services 3800 Automation Way, Suite 200 Fort Collins,CO 80525 Re: RFP 04010: Option B,Home Based RFP 04005: Lifeskills,Home Based Parent Coach RFP 04005: Lifeskills,Visitation RFP 006-00: Foster Parent Consultation Dear Mr.Barclay: 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 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 04010: Option B 2. RFP 04005: Home Based Parent Coach 3. RFP 04005:Visitation 4. RFP 006-00:Foster Parent Consultation 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 Bid and Notification of Financial Assistance Award(NOFAA).If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances.If you do not accept the condition,you must provide in writing reasons why. A meeting will be arranged to discuss your response.Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. Page 2 Lutheran Family Services/Results of RFP Process for PY 2004-2005 The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and/or 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, as follows: If you have questions concerning the above,please call Gloria Romansik,970.352.1551 extension 6230. Sincerely, J y A. ego, irect cc: Juan Lopez,Chair,FYC Commission Gloria Romansik, Social Services Administrator i 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-CPS-2 Revision (RFP-FYC-PY 04-05 06-000) Contract Award Period Name and Address of Contractor Beginning 06/01/2004 and Ackerman and Associates,P.C. Ending 05/31/2005 Foster Parent Consultation 1750 25th Avenue Suite 101 Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial This program provides foster parent consultative Assistance Award is based upon your Request for services in the areas of(1)consultation and Proposal (RFP). The RFP specifies the scope of foster parent support, (2)mandated corrective services and conditions of award. Except where it is action consultation,and(3)mandated critical in conflict with this NOFAA in which case the care consultation. Foster Parent Consultation NOFAA governs,the RFP upon which this award is will be provided through group consultation for based is an integral part of the action. a maximum five groups per month, 6-10 participants per group. Individual consultation Special conditions services will only be provided when approved by the Resource Services Manager or Child 1) Reimbursement for the Unit of Services will be based Welfare Administrator of Social Services. on a per group rate. Bilingual-Bicultural services. 2) Payment will only be remitted on foster parents,and referrals made by the Weld County Department of Cost Per Unit of Service Social Services Certified Foster Parents. 3) Requests for payment must be an original and Group Rate per 8-10 participants $350.00 submitted to the Weld County Department of Social Hourly Rate per Individual Consultation $90.00 Services by the end of the 25th calendar day following Based on Approved Plan the end of the month of service.The provider must submit requests for payment on forms approved by Enclosures: the Weld County Department of Social Services. X Signed RFP:Exhibit A 4) Requests for payment must include original client X Supplemental Narrative to RFP: Exhibit B verification signatures(blue or red ink preferred)and Recommendation(s) dates and hours of service. X Conditions of Approval 5) The Contractor will notify the Department of any change in staff at the time of the change. Approvals: Program Official: By b_U By Robert D. Masden, Chair Judy . Gri g ,Direc Board of Weld County Commissioners Wel $ounty epartm nt of Social Services Date: 1 ill/,-) i Date: 5 situ SIGNED RFP-EXHIBIT A REQUEST FOR QUALIFICATIONS OFF SYSTEM BID B001-04(RFQ-006-00) DATE:February 11,2004 RFQ NO: 006-00 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O.Box 758, Greeley, CO 80632 SUMMARY Request for Qualification(006-00)for: Colorado Family Preservation Act—Foster Parent Consultation.Emergency Assistance Program Deadline:March 5,2004,Friday, 10:00 a.m. The Families,Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.RS. 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 Foster Parent Consultation Program must provide services that focus on providing psychological consultations and parenting support to foster parents which are designed to improve foster parent competency, family conflict management,and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Qualifier Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date a a-1 —OM (After receipt of order) RFQ MUST BE SIGNED IN INK Oci \-111On ie1b TYPED OR PRINTED SIGNATURE VENDOR 11.9Nt1Qaf1 Q11O1 11/4Stel \ {G- \ b. (Name) ° Har�dwri{ten Signature By Authorized Officer or Agent of Vender ADDRESS \;U1 at" TITLEP�SI( (\\ - P ► C1 PMM DATE 3 "3—h 9 PHONE# � O _—The above RFQ is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 28 Off-System Bid Number B001-04(RFQ-FYC 006-00A) Attached A FOSTER PARENT CONSULTATION PROGRAM REQUEST FOR QUALIFICATION(BID) PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING COLORADO FAMILY PRESERVATION ACT 2004-2005 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2004-2005 OFF SYSTEM BID B001-04 RFQ 006-00 NAME OF AGENCY: U>v V(11CD Ct n OJ (11 C$&g 1 'C, ADDRESS: 1`l5Ca \bQ , U tI O_ text • PHONE: (tl`lO) g 3 —3-a b7�3 CONTACT PERSON: C\E 1 A pLtt_PPf \Q fl l otO. TITLE VIS 1( r \y DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation Program Category must provide services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household management competency,parental competency, family conflict management and effectively accessing community resources. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of; Start June 1. 2004 Start End May 31. 2005 End TITLE OF PROJECT: 1\01.1( �(Y�()1-1 AevAfOt vSU1\-C, Cc\r1?C °1• AMOUNWI REQUESTED: 'rc• Ca ate- by U\C� v cl ic\ VO mon, a -a -oy Name d Siriature of Person Preparing Document Date 3 csL c� � \ c - 3 -c�4 Name an Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new proposals and renewal proposals,please initial to indicate that the following required sections are included in this Proposal for Qualification. 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 Target/Eligibility Populations // Types of services Provided 1/ Measurable Outcomes Service Objectives r/ Workload Standards 1/ Staff Qjlifications Program Capacity per Month !l Certificate of Insurance Page 24 of 28 02/26/2004 14:37 9703533374 AOcERMAN5 PAGE 02/03 SOCIAL 8)%rl CBS 1@OU2 Y/!6/!004 15:iS Pa 870S535Y16 . 7 - ••I�j:ti' : A i;., ::!)_4., Y-';y, rii4O1.Viieffifinteill Bid Na; . .- ..x•- ..;. ,.•,.l,s , Attiori&i !Yq". r r.:. ..:.F 4,,. AieRonvi, v Agee.. 74- ,, ,,a if 41161"1 PMteleS4's/ ite of Meeting®with Social Sew Division Supervisor: _ ..._ _... /. w ._�._ir�._... ...._-..o _ ..�..-_. ._... •.._.... ... — by SSD ; #4: ...dorsi.10;ra„ . Pe's& .P2e- ckifis I twras--- *jet alla Astr-AnAt- sea-e44,-, seen-Yrsclassrahs . e lists tr /� Prior to SG1:AISSion ` 21/ Zit/7 kips= , Scn Supervisor • Page 24 of 34 • Off-System Bid Number B001-04(RFQ-FYC 006-00A) Attached A Program Category Foster Parent Consultation Project Title Aciv,-,.no•• Pos4er per-C$stteelo L Vendor ► ermrm. or—k fl--Sso-w .. f G, I. PROJECT DESCRIPTION Provide a brief one-page description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one-page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total family units. C. Sub-total of individuals who will receive bicultural/bilingual services. D. Sub-total of individuals who will receive services in South Weld County. E. The monthly program capacity per group. F. The monthly average capacity per group. G. Average stay in the program(weeks). H. Average groups per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Consultation and Foster Parent Group Support around placement issues,behavioral management, foster home issues involving biological children in the home, transition and loss issues,work with foster parents and caseworkers around interpretation and implementation of treatment plans,discipline in the home, group training for foster parents-access to training materials,work with foster adopt parents on legal risk and commitment issues,visitation issues, and solution oriented planning. B. Individual Foster Parent Consultation on a time-limited basis will be provided only with approval of the Department. C. Mandated training for foster parents under corrective action plans and follow-up services when referred by the Department. D. Training to satisfy State training requirements for foster parents may be offered though this program within the following guidelines; 1. One training credit per month will be recorded for each critical care foster parent participating in the mandated monthly consultation group. 2. All-additional--foster-parent-training-will-be pre approved by Agency staff;i.e.,Foster Care Coordinators or Resource Services Manager. All training will be offered to all Weld County foster parents,whether they are involved in the Consultation Program or not. The flat fee for conducting such training Page 26 of 28 • Off-System Bid Number B001-04(RFQ-FYC 006-00A) Attached A will be agreed upon between the provider and the Agency on a per event basis. Contracted individual and group consultation rates cannot be charged for training. It is expected that post training testing will be part of the training component. E. Assure the foster parent group consultation will not be provided by a professional staff member who is providing therapeutic services to foster children in the same home. F. Assure that all assessments, clinical recommendations, and other opinions derived by the contractor in the performance of this contract will be shared directly with the assigned caseworker of the children involved. If there is disagreement over the implementation of the treatment plan with the caseworker, a meeting shall be held with the contractor, assigned. - caseworker, foster parents, and the caseworker's supervisor. The objective will be to determine a unified departmental response for the court. The contractor will not use the legal system to oppose the department's recommendations. G. Agrees to comply with 19-1-120 C.R.S.,which requires that reports of child abuse and any identifying information in those reports are strictly confidential. Provide your quantitative measures as they directly relate to each service. At a minimum,include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g.mental health capitation services,ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES Provide a two-page description of your expected measurable outcomes of the project.Address the following measurable outcomes: A. Improvement of household management competency as measured by pre and post assessment instruments. B. Improvement of parental competency as measured by pre and post assessment instruments. C. Foster parents can independently work with other sources in the community and within the local, state, and federal governments. D. Foster parents have demonstrated higher skill and competency levels in fulfilling their designated function for children in out-of-home placement. E. Foster parents have positively met the needs of their biological children in adjusting to and coping with the presence of foster children in the home. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Provide a one-page description of your expected service objectives and quantitative measures. Address, at a minimum,the following ways the project will: A. Improve Household Management Competency-capacity of parents to provide safe household environment for their children through competent household cleaning and maintenance,budgeting and purchasing. Page 27 of 28 f Off-System Bid Number B001-04(RFQ-FYC 006-00A) Attached A B. Improve Parental Competency-capacity of parents to maintain sound relationships with their children and foster children and provide care, nutrition,hygiene,discipline,protection, instructions, and supervision. C. Improve Ability to Access Resources-services shall assist parents to work with other sources in the community and within the local,state, and federal governments. Describe the methods you will use to measure,evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Provide a one-page description of the project's workload standards and quantitative measures. Address, at a minimum,the following areas: A. Number of groups per month. B. Number of anticipated requests for individual consultation per month. C. Number of individuals providing services. D. Maximum caseload per worker. E. Modality of treatment F. Total number of hours per day/week/month. G. Total number of individuals providing these services. H. The maximum caseload per supervisor. I. Insurance. VII. STAFF QUALIFICATIONS Provide a one-page description of staff qualifications and address, at a minimum, the following: A. Will your staff,including supervisors,who are providing direct services have the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17, and Section 7.000.6,Q, Colorado Department of Human Services? Describe. B. Total number of staff, including supervisors, available for the project. VIII. Reimbursement Qualified applicants approved through this RFQ/Bid process will be reimbursed at the following rate: • Group rate per six-ten(6-10)participants $350; • Hourly Rate per Individual Consultation $90; Foster Parent Consultations will be provided through group consultation services for a maximum of five groups per month, 6-10 participants per groups. Individual consultations services will only be provided when approved by the Resource Services Manager or Child Welfare Administrator of Social Services. Page 28 of 28 /� /� �� " �- PROGRAM BUDGETS Aryie PROGRAM rIl�ar,orK ITSS uy,.�ar l G /i11 m ba a 1_,A 51,1k tatiorroniy, Azaxe HfatTii ,�K i»n( ca-sa,Ro . MANUAAtthdr'/f u/L ra-n., TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT ya b 36 r 8 ,2,r :is" ,S TOTAL CLIENTS TO BE SERVED /,O (o0 /00 /00 ill* 34. o`to TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) / -00 / 000 l'105/f oo 1,9-ca / G,'to G o o COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) c/.00 51. 00 q t.o e-O.ao fro, yr.oo TOTAL DIRECT SERVICE COSTS. 6/9-00 7/ ra° 7(If23ttcn 7a-cw 97)60 �'8D0 ADMINISTRATION COSTS NON-DIRECT ALLOCABLE TO PROGRAM 9 90o /08.00 6000 taw 99 00 q210 3600 OVERHEAD COSTS ALLOCABLE TO PROGRAM 33 too -CO Y06 g.Gocn sDnoO 3`r Goo '!A/?O (f% 00 TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) 109-000 15-3 cop I0(`t, G goo° O-a oo0 19-9,Loo zt000 ANTICIPATED PROFITS CONTRIBUTED BY THIS PROGRAM O 0 a 0 0 o TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) log-o00 /S,3009 I LY000 0¢000° 16-9,Loo VOzzo TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(C) 0-00 / y? MO gap ',ace) /6 PLO G o° RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE TO BE CHARGED TO WELD COUNTY SOCIAL SERVICES(J/K) SD.°o gy- aa et,00 /00•00 86. ro goy o0 0Fun I Lolfte : ATION STATEMENT, etic),aki,,,...,� i:,Clll 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 d o he factual unit costs supporting the compensation paid or to be paid under this contrkct are accurate,complete and includes no duplicate costs and d that I am the CEO or duly authorized agent of f}(1L.P, rhos CJ,MI 1kDconihle� 6Y`. D Petit aoy-tc„,: cony = let‘b , ( t nt t� sncit'Wotn6 .1Y1. 0 2. $d./tom upt,..r.cops _ ieSjy.oO &,c Lem._ irr71 Aol%,rs) 3 re,L 7.44m&V4.f( Co.u-elv� . "4-0,00 (two L.Jrs._ AP/ diadoTs) 4. 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M , 4. . a gg 2282224€282222 222224 - id.: -t _4 Q 111 aa$!$aaaaaaaaa_8 a a 1 aaa aaaaasagga a a a 1 O I-@ 0 e L 888888888888888888 8 8 8 ', L, aaaaaaaaaaaaaaaaaa a a a I 8 18 o 8 8i ti gel xR 4 x` 888888888888888888 8 8 8 aaaaaaaaaaaaaaaaaa a a a x of 811 R i—\ C ril 888888888888888888 8 8 8 If 8 aaaaaaaaaaaaaaaaaa a a a 8 5 N. Rh!a 888888888888.88.8888. 8 8 8 aaaaaaaaaaaaaaaaaa a a a 4E€ 8 ≤ 10 el r 18 & 4° F a 888888888888888888 8 8 8 t e a aa ` h aaaaaaaaaaaaaaa a a a tg y Er. S 4l o In U V xS `4l U ail888888888888888888 8 8 `� a a a M a a a a a a a a a a a a a a a a a (^y-( ia V e(6 L. O Qu`C � J 6 40 S W yayaF O- O 2299°4222294224299 3 n 8 O128 .+ 8 8 8 N a N Project Description 2004 - 2005 ACKERMAN AND ASSOCIATES' FOSTER PARENT SERVICES I. Overview: Ackerman and Associates, P.C. has provided Foster Parent Consultation Services to Weld County over the past seven years. We propose to continue to provide foster parent consultative services in the following areas: 1. Consultation and Foster Parent Support concerning: a. placement issues, b. behavioral management, c. foster home issues involving the biological children in the home, d. transition and loss issues, e. assistance in the interpretation and implementation of treatment plans in coordination with foster parents and caseworkers in accord with the requirements of the contract. f. discipline in the home g. training for foster parents and access to training materials, including group and individual training for continuing education credits. Also, in selected cases, "Internet Searches" to help identify resources, such as support groups for foster parents with children with specific conditions, provision of in home seminars to deliver workshop services in an effective manner to foster homes, h. work with all foster parents on legal risk and commitment issues, visitation issues and solution oriented planning. i. facilitation of the networking of foster parents particularly in terms of identified subgroups such as group homes issues, issues in common to kinship homes, issues for on kinship homes etc. We will provide such services to those foster parents in groups of six or more or on an individual basis as requested by the department who voluntarily participate in such services for the benefit of themselves, their children and foster children. 2. Mandated Corrective Action Consultation in the above areas to those foster parents who are under corrective action orders and to provide them follow up services as needed. The services listen in No. 1 above will be provided. 3. Mandated Critical Care Consultation services for groups or individuals of critical care foster parents. The services listed in No. 1 above will be provided We will provide these programs primarily through group services in the home of the foster parent or in our offices for the fees specified by the WCDSS. Group training based on family and foster child needs that arise from specific situations (intensive care homes, group homes, teen foster kids, family interaction issues etc) will be provided for a minimum of six participants with an average of six participants per group. Group educational training seminars of a more general nature for continuing education credit will be offered only when such services are not available otherwise. The focus of service will be targeted or tailored group consultation or when requested by the WCDSS individual services in support of foster parents Target/Eligibility Populations A. Total number of clients to be served in this twelve-month program has been calculated as follows. There are approximately seventy-five foster family homes under WCDSS sponsorship. Our past work has reached about 40-50% of these homes with one or more contacts per year. We have the capacity to serve more than this number if demand for the services is there, especially in seminars and training. We project our maximum capacity for last year as seventy-five families and expected up to 60 families to be served. B. Distribution of clients. On a program by program basis we expect to serve 20 families for pre-approved group training, about five families for corrective action, and about 30 families for critical foster care group consultation. C. Families Served. We anticipate serving up to 60 family units with at least one contact and approximately 40 of these families with more than one contact, based on our use patterns and the level of trust built with foster families over the past seven years. D. Sub total who will receive bicultural/bilingual services. We anticipate we can serve 100% of families who need these services in a bilingual manner. All of the staff have extensive cross cultural experience. We have a Hispanic member of the staff, Emily (Jaramillo) Montoya, M.A., L.P.C. who is fluent in Spanish. Joyce Ackerman, Ed. D. has spent several years working in American Indian reservation populations and formally studied Hispanic mental health issues in Greeley in her doctoral work. She has practiced in Greeley since 1981. Larry Kerrigan, Ph. D. has more than twenty five years experience as a therapist in Greeley working with the Hispanic population through the Weld Mental Health Center. Susan Bromley, M.S.W., Psy. D. is both a trained social worker and a practicing psychologist with extensive experience training students in cross cultural sensitivity. Valerie Larson MSW has experience in family issues and especially in treatment of sexually abused children. Emily Jaramillo Montoya M.A., L.P.C. has an undergraduate background in criminal justice, and extensive experience in home based treatment issues. John Gray MA LPC has extensive family systems focused experience in a variety of Social Service settings. Bill Kelly holds an MA in counseling and has extensive experience in educational issues with children and families. E. Accessibility. On weekdays, all providers of Ackerman and Associates are accessible through our office secretary and through cell phones and pagers. After hours we maintain a 24-hour answering service and page system. On weekends, the 24-hour access reaches the provider on call who is always a licensed Mental Health provider. F. Maximum per month. The program maximum is estimated below by program area Service utilization guidelines Group training for referred group members up to 20 hours/month Individual Consultation 5 hours a month Mandated Training for Corrective Action 5 hours a month Monthly patterns are difficult to estimate. The yearly maximum for the contract is set at 120 two hour groups , at $300 per group for a maximum of$36,000 and 120 hours of individual consultation time at $90 per hour for a maximum of$10,800. The contract billable maximum for any combination of services is $46,800 per contract year. H. The monthly average capacity is 30 hours per month. I The average stay in the program is expected to be between 10 and 15 hours (average 12.5 hours) over the year period for 60 families. Types of Services Provided 1. Mandated Critical Care Consultation services for identified critical care foster parents. 2. Consultation and Foster Parent Support concerning: a. placement issues, b. behavioral management, c. foster home issues involving the biological children in the home, d. transition and loss issues, e. assistance in the interpretation and implementation of treatment plans in coordination with foster parents and caseworkers in accord with the requirements of the contract. f. discipline in the home g. training for foster parents and access to training materials, including group and individual training for continuing education credits, h. work with foster parents on legal risk and commitment issues, visitation issues and solution oriented planning. Emphasis in this area includes: How to structure your home to avoid triggering an investigation by preventing accidents. What to look for in a baby sitter, being a foster parent in a regulatory world and similar topics. 3. Mandated Corrective Consultation in the above areas to those foster parents who are under corrective action orders. We will provide them follow up services as needed. A partial list of the types of workshops and seminars we have provided over the last few years follows: Separation and Loss, Understanding Prescription Medications, Discipline, Assertiveness with Systems, Drug Abuse, Eating Disorders, Child Development, Sexual Abuse and Sexual Behavior-What's Normal With Teens, recovery From Prenatal Trauma-What to Expect, Anger Management, Stress Reduction, Parenting Round Tables, Parenting with Love and Logic. We have provided all proposed services, Corrective Consultation Services, and critical care services for five years for Weld County Department of Social Services. For the mandated programs we have developed response standards to 1) insure that we deliver services promptly and 2) report to social services if there is any difficulty in compliance with the corrective actions required. The mandated consultation programs are analogous to home based delivery of services in respect to keeping in close contact with the caseworker or in this case the foster parent supervisor. The consultants will not serve as advocates for the parents or for social services in cases of dispute. Our role with the foster parent is to provide consultation not to conduct assessments to discover the failures of the foster parent or to seek to alter the treatment plan for the foster child. Neither will the consultants serve as a conduit primarily for collecting information for the caseworker about the foster parent in a dispute. As trust is essential to the process, we have worked in and intended to continue to work in an environment of trust with all parties. Hopefully, any dispute can be discussed to find common ground in a meeting with the foster parents, the caseworker, the foster parents supervisor, the case workers supervisor and the consultant should such instances arise. As contractors, we will not initiate action with the courts on a consultation case. If under subpoena for any reason such that we are required to appear before a court, we will inform the court of this contractual restriction. We will also be obligated to obey the requirements of the court should such a situation arise. We also assure WCDSS as we have in the past that no individual working with Ackerman and Associates and providing therapy to a foster child in a foster home will concurrently provide consultation to that home, thus avoiding any appearance of conflict of interest. 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 preceding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... How did the foster family come into the foster parent support program? Did the family attend the groups or workshops they signed up for'? Did the foster parent complete the evaluation forms at the workshop? How many hours of total contact did the foster parent have and how many credits were earned? Summative outcomes A. Was there improvement in household management competency as measured by pre and post assessment? We will use a therapist rating of improvement for this area for each participant in either group or individual programs.. B. Was there improvement in parenting competency as measured by pre and post assessment? For individual consultation, an individual consultation plan will be developed in the first hour and completed and reviewed in the final hour of consultation goals were met. No plans to measure progress in the group setting (beyond charted notes) are included but can be developed if required by WCDSS. C. Were Foster parents enabled to better work with other sources in the community and the local state and federal government? Knowledge of resources can be determined from a listing of resources by the participants at the outset and the conclusion of the consultation on a pre post test basis if this data is desired. We will collect this data if so requested by WCDSS. Consultant notes will be routinely used to document change to this area as the need arises. D. Did foster parents demonstrate higher skills and competency levels in fulfilling their roles for children in out of home placements? Individualized treatment will be based on change from the initial to the final session as documented in a summary of the consultant's notes. Progress in group sessions will be reflected in charted notes. E. Did foster parents meet the needs of their biological children in adiusting to and coping with foster children in their home? Consultant's notes will document work with issues related to the biological children. Specific group services are planned for this area in 2004 -2005. Service obiectives We have the following service objectives: A. Improvement of Household Management Competency By using a checklist for individual consultation, we will ascertain if the parents are requesting assistance in relation to issues related to maintaining a safe household environment. The check list will include the foster parents assessment is assistance is needed in the following areas- household cleaning, household maintenance, budgeting or purchasing. We expect this to be a minor area of work except in families where corrective action may be needed. B. Improvement of parental competency We expect this to be a major area of work with regard to the foster parent's support program. Particular service goals for each foster parent family will be documented in their chart. A summary of the foster parent's participation will be made for all months of participation. C. The ability if the family to access resources By using a checklist for families in consultation concerning resources related to specific areas of need, the referrals to local and governmental resources will be documented. In addition, for some for some families an Internet Search will be run to identify further resources to assist them with specific questions if these concerns have not already been answered. This Internet option will likely be of use for families with foster children who have unusual medical or psychological needs. The methods used to document the service objectives will be a comparison of the goals of the individual plan for the family with the progress report completed each month for all families in individual treatment. For those in group treatment, a pre workshop/post workshop form will be used. Examples of these types of evaluation tool are appended to this proposal. Workload Standards A. The program has a capacity of 30 hours per month. The total per year will not exceed 360 hours. We anticipate an average of 20 group and ten hours of individual service per month. At each meeting, one therapist is present. This represents 360 hours of therapist/client time per year. B. There are seven providers—three licensed psychologists, two professional counselors, a licensed clinical social worker and a Psychotherapist with a masters in counseling who will provide these services. All have specific training in helping to assist individuals in behavioral changes. All have experience in psychoeducational instruction. C. The maximum caseload The monthly total average will be 30 hours. D. The modality of treatment is consultation for primarily group settings with some individual consultation in person. E. Hours/month The total number of therapist hours is a maximum of 30 per month and a maximum of 360 per year. F. Staff There are seven individual providers supported by two administrative professionals and an independent contractor accountant. Their resumes are attached to this document to qualify for provider status for these services. G. Supervisor Joyce Shohet Ackerman, Ed. D., who would monitor the project for compliance, would supervise this contact. Providers are individually licensed and do not require clinical supervision except for on therapist who is being supervised by a licensed psychologist in the practice. The maximum caseload per supervisor is 60 families per year. Caseload monitoring would be through tracking of time per foster parent. H. Insurance All providers carry one million/three million liability policy Ackerman and Associates carries an additional one million/three million liability policy on the group and a general liability policy that meets the required criteria for this application. Staff Qualifications A. and B. Staff Qualifications Seven staff are available for the project. They exceed the minimum qualifications specified as documented below. The staff are: Joyce Shohet Ackerman, Ed. D., Licensed Psychologist; Susan Bromley, Psy. D., Licensed Psychologist (and Social Worker); Emily Jaramillo Montoya, M.A., L.P.C., Laurence P. Kerrigan, Ph. D., Licensed Psychologist; Valerie Larson, M.S.W., L.C.S.W. John Gray, M.A., L.P.C. and Bill Kelly M.A. C. Training The staff has extensive training in family therapy and short-term therapy as documented by their extensive work experience. One set of resumes is attached to the original bid. D. Continuing education As a part of their work in the private sector all providers in this group maintain continuing education programs more than the minimum eight hours required. They participate in workshops and other activities. This proposal's continuing education requirements coincide with the requirements of other contractual arrangements and are being met on an ongoing basis by members of the group. E. Supervision All providers are independently licensed and required to have clinical supervision. All the staff have advanced skills in family therapy. The contract supervisor will monitor the specifications made in this proposal. G. Supervisor continuing education The supervisor of the project is involved in ongoing training to keep current with her profession through advanced workshops and seminars. Unit of service rate computation We agree to accept the fixed prices offered by WCDSS for this program. • • 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 - upon the certificate holder. This certificate does not amend,extend or alter the Colorado Springs, CO 8 090 1-1 05 4 coverage afforded by the policies shown below. [NS URED Company 1 Truck Insurance Exchange Alan & Joyce Ackerman 1750 25th Ave Ste.101 3reeley, 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 ndicated. Notwithstanding any requirement,term or condition of any contract or other document with respect to which this certificate lay be issued or may pertain,the insurance afforded by the policies described herein is subject to all the terms,exclusions and onditions 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 (Any one Fire) Building Coverage 045763807 03/02/2004 07/01/2004 $195,000 Personal Property' 045763807 03/02/2004 07/01/2004 $58,400 Medical Expense $5,000 Automobile Liability Umbrella Liability Worker's Compensation rtificate Holder Cancellation Id County Bank Should any of the above described policies be cancelled before the expiration date thereof. .35 23rd Ave the issuing company will endeavor to mail 30 days written notice to the certificate holder 'ans, CO 80621 named to the lefi, but failure to mail such notice shall impose no obligation or liability of any kind upon the company,its agents or representatives. Authorized Representative EXECUTIVE RISK SPECIALTY CO. 1/20/04 - A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY *** RENEWAL *** NOTICE:A LOWER LIMIT.OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION"SEXUAL MISCONDUCT"IN THE POLICY). POLICY NO: DECLARATIONS 008-1766682 ACCOUNT NO: CO-KERL175-0 0099745B ITEM 1. (a)NAME AND ADDRESS OF INSURED: ITEM I. (b)ADDITIONAL NAMED INSUREDS: LAURENCE P. KERRIGAN, PH.D. 1750 25TH AVE. SUITE #101 GREELEY, CO 80634 TR TYPE OFORG: INDIVIDUAL 2. ADDITIONAL INSUREDS. ("BM 3. POLICY PERIOD: : , FROM:- 12/01/03 TO: 12/01/04 12:0.1 A.M.STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: 'EM 4. LIMITS OF LIABILITY: (a)$ - EACH WRONGFUL ACT OR SERIES OF CONTINUOUS,REPEATED 1, 000, 000 OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE (b)$ 5, 000 DEFENSE REIMBURSEMENT c -0, 000 AGGREGATE ----- 3M 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 A 6. RETROACTIVE DATE: 12/01/91 TOTAL PREMIUM: 1, 229. 11 47. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM(if exercised):$ 2, 150 . 68 NO DI SCOUNT INCLUDED 18- POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY 138 (7/95 ED. ) B22137 PERSONAL. DATA SHEET L. 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. s College Ph . L. - Philosophy, St. Louis University, St . Louis , Mo. 1960 , (Ecclesial Degree ) . Ph. D. - California 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 Held: 1969-71 Member of Board of Directors, Campion College, Prairie du Chien, WI . 1968-71 Director, Department of Psychology, Campion college . 1971-74 Director of Student Counseling Center, Long Mountain College. 1975-80 Director of Short-term Children and Family Team, Weld Mental Health Center, Greeley, CO . 1975-'87 Clinical Psychologist, Child and Family Team, Weld Mental Health Center, Greeley, CO . 1976-88 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-rit_y- 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. 11975-80 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 . h!orkslro_hs And Spec i.al_[nijjakpg: 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 Pirystcal -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: Office:(303)351-2236 Home: (303)352-8750 EMAIL:stromley®benttey.unco.edu EDUCATION: Yearts) ThXfia Institution Area of Study 1983 PsyD University of Denver Clinical Psychology School of Professional Psychology Denver,Colorado 1968 MSSA Car Western Reserve University Casework (MSW) School of Applied Social Sciences Cleveland,Ohio 1965 BA Mt.Holyoke College Economics/Sociology South Hadley,Massachus WORK EXPERIENCE—Professional Academic: Yearts) Institution/Organizattbn &Sig= Responsibilities 1985-Pres University of Northern Colorado Assoc.Professor Psychology Teaching/Advising 1983-84 University of Northern Colorado 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 Permanente Psychotherapist Clinical Lakewood, Colorado 1979-80 Bethesda Mental Health Center Psychology Intern Clinical/ Denver,Colorado Administrative 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—Prafessionalauried: Musgrave-Marquart,D.,Bromley, S.P. &Dailey,M.B. (1997)"Personality,academic attribution,and substance ab ose as predictors of academic achievement in college students".Journal of Social Behavior and Personality 12(2), 501-511. Karlin,N.J.and Bromley, S.P. (1996).Differences in caregivers of demented and lucid chronically ill family members. Journal of Alzheimer's pisease and Related Disorders and Research Retzlaff,P.and Bromley, S. (1994). Counseling personality disorders.In Ronch,J.L.,VanOmum,W.&Stillwell, N.C. (FM)The counselor. sourcehook: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. 26( Journal of Popular Culture. 31.pp. 17-24. Retzlaff,P.and Bromley, S. (1991). "A Multi-Test Alcoholic Taxonomy: Canonical Coefficient Clusters". Journal of Clinical Psvchology 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: Grupe and Stratton. Reprinted in Zahourek,R(Ed.)(1990). New York: Bruner/Mazel,Inc.,pp. 77-98.. PROFESSIONAL PRESENTATIONS—Juried: Bromley, S. (1997)(Chair)"Linking through honors programs:The cross-discipline course).Paper presentation as - part of.a-symposium titled"Creating links between psychology and other disciplines".,American Psychological Association Convention,Chicago. (August) Bromley, S. , Gilliam D.,&Johnson,T. (1995). "Assessment of student created tests as an evaluation method". Poster presented at the American Psychological Association Convention,New York City.(August) Bromley, S. (1994). "Student created tests as an evaluation method". Poster presented at 16th Annual National Institute on the Teaching of Psychology, St.Petersburg,Florida. Karlin,N. and Bromley. S. (1992)."Similarities and differences for 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 tided, `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'Turning Point'and'Fatal Attraction"'. Paper presentation National Convention of Popular Culture Association and American Culture Association, St.Louis, Missouri. (Session Chair) Re zlag P.and Bromley,S.(1989). 'The Basic Personality Inventory:Alcoh Sub-Group Identification". Poster session at the Joint Convention of the Rock Mountain Psychological Association and Western Psychological Association,Reno, Nevada. Bromley, S. (1988). "Our Culture Affects Our Pain."Paper presentation,National Convention of Popular Culture Association and American Culture Association,New Orleans,LA.(March). Bromley, S. (1987). "Husband-Assisted Autohypnosis for Labor and Delivery: A Clinical Model". Paper presented at Rocky Mountain Psychological Association,Albuquerque,New Mexico(April). Bromley, S. and Loy,P. (1987). "Politics of PMS". Paper presentation Association of Women Psychologists, Denver,Colorado(March). PROFESSIONAL PRESENTATIONS—Invited: Handelsman,M.M.,Bromley, S.P. &Davis, S.F.(1995). "Clinical Psychologist, Counseling Psychologist,Clinical Social Workder,or Psychology Professor: Which Degree is Right for Me?"Psi CM invited panel presentation,Rocky Mountain Psychological Association,Boulder,CO(April). -Bromley,S.(Co-Chair), Seibert,P.(Co-Chair),Knuckey,D.,Bohlin,M.,Zaweski,C.,Watson,D.,Hammon,D., West,K.&Robins,J. (1994). "Training the Teaching Assistant"Invited Panel Presentation,Rocky Mountain Psychological Association,Las Vegas,Nevada(April) 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 Peispcuives 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). J.RCTI IRES—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". BOOK/GRANT REVIEWS. Grant review for Boise State Department of Education(1995) Review of Santrock,J. (1991). The science of mind and behavior. W.C.Brown and Benchmark. Review of McKee,P. &Thiem, J. (1993).Real life:Ten stories of a ling.University of Colorado Press. PROFESSIONAL CONSULTATION/PRACTICE: Year(s) Institution/Organization $41@ 1996-presnt Ackerman and Associates Clinical Psychologist 1988 Bonnet 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 1988-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-presnt 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 PRODUCER NUMBER DATE OF ISSUE _-PRIOR CERTIFICATE NUMBER 23 A 0004087 04/07/2003 Renewal PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY NOTICE: THIS IS A CLAIMSMADE 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 Number&Street,Town,County,State&Zip No.) 2- Policy Period: 12:01 A.M.Standard lime 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 contmctas) _ Partnership _ Corporation Otter: 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. 04/05/1996 7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions,stipulations and agreements contained in the following form(s)or endorsement(s). PLP-2012(06/93),PLJ-2008 Rev.10194),10/94)„PLE-8035(09/97),PLE-8036(09/97),PLE-2167(07/00),POE-8004(05/88)(Ed. 90/93),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 Office address: Ste 9 Ave City,State,Zip: Chicago, IL 60611-1803 Toll-Free Number. 1-877-637-9700 P19-2012(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 1986-1989) HONORS President's Award -Colorado Psychological Association, 1989 EDUCATION 1978 -1981 Ed.D. in Counseling Psychology, University of Northern Colorado, December 1981 graduate 1972-1974 M.S. in Education(E.D./L.D.) Lesley College,Cambridge, Massachusetts,August graduate 1968 - 1971 B.S. in Special Education and Elementary Education with a minor in psychology Boston University, Boston, MA, December 1971 graduate • PROFESSIONAL EXPERIENCE 1981 - present Clinical Director in group practice in Greeley,CO. Among responsibilities are: Diagnosis,therapeutic intervention and referral for adults, families,children and groups. Primary areas are: mediation, alternative conflict resolution,stress reduction. Also developing, organizing and presenting workshops and consultative programs to community,schools,organizations and agencies. 1986- present Consulting psychologist on interdisciplinary team for in-patient rehabilitation program. Progressive Care Rehabilitation Center,Greeley, CO. Medical Director Dr,Judith Vaughan,Neurologist. Adults with traumatic injuries- primary problems are: psychological aspects of physical rehabilitation,grief counseling,and brief group counseling using cognitive-behavioral goal oriented therapy. 1989- 1992 Consulting psychologist for Head Injury Treatment Team North Colorado Medical Center,Greeley CO Team coordinator - Dr.John McVicker,neurosurgeon. 1986-1989 Consulting psychologist for Family Recovery Center(in-patient substance abuse/chemical dependency program), North Colorado Medical Center,Greeley CO Coordinator Ruth Wick,R.N. 1986- 1989 Provider and Coordinator for Mental Health Services in Northern Colorado for Peak Health Care(HMO). Peak mental health services utilized a three-session model for initial services followed by referral. Activities included coordination of Psychological and Psychiatric Services for approximately the last two years of the Contract. Peak-supervisor-Elaine Taylor 1983- 1986 Psychologist subcontractor for a Vietnam Veteran's Counseling Program funded by the Veteran's Administration. Principal Contract Dr. Robert Stewart. 1980- 1987 Part time faculty member with responsibilities for classes,workshops and community programs in parenting skills. Family/Life Education Program, Aims Community College,Greeley CO August 1980- August 1981 -Clinical internship on Children's Team of Community Mental Health Center. Responsibilities included: consultation to schools and community programs; therapy for children and families;and assessment of diverse mental health programs. Assistant program evaluator- developed evaluation tools to determine cross-cultural perceptions of expectations and satisfaction with services. Supervisors - Dr.Joan Gillespie and Dr. Laurence P. Kerrigan. APA National Convention in Toronto,Canada"Psychology and National Health Reform: "National Health Insurance: Policy Considerations,Benefit Designs. and Economic Realities",and"Marketing: Psychology's Key to National Health Reform. 1993 Disaster Relief Training. Alan Keck through Colorado Psychological Association,Denver CO 1992- Fall Short Term Therapy,Bernard Bloom;University of Northern Colorado, Greeley CO 1990- Fall National Cognitive Rehabilitation Conference, Richmond VA 1990- summer Postgraduate training: 1. Adult Neuropsychological Method based on Lezak Neuropsychological assessment, 1983. 2. Child Neuropsychology,Dr.Hynd. 3. Child Neuropsychological Methods 1988 Cognitive Rehabilitation Training Program,Dr.Sena,Ph.D., Colorado Springs CO 1988- present Psychologist-Head Injury Treatment Team at North Colorado Medical Center,Greeley CO 1987 Halstead Reitan Neuropsychological Assessment Training. Ralph Reitan,Ph.D.,Washington DC Summer 1986 Albert Einstein School of Medicine, Workshop on Adolescent Therapy, Cape Cod MA 1985 to present North Colorado Interdisciplinary Team of Child Custody Member and —participant Fall 1985 Interdisciplinary Workshop on Child Custody, Keystone CO Summer 1984 Workshop in Clinical Use of Hypnosis, Boston MA Winter 1983 Workshop on In-patient Programs for Service Related Disorders, Cheyenne Veterans Administration Hospital. Fall 1983 Veteran's Administration Workshop on Post Traumatic Stress Syndrome, Denver Veteran's Center. Fall 1981-Winter 1984 Post-Doctoral Supervised Candidate for Licensure(psychology) under Gale R.Giebler, Ph.D. Licensed Psychologist and Susan Spilman, Ph.D., Licensed Psychologist 1980- 1981 Intern-Weld County Sexual Abuse Team,Greeley CO Weld Mental Health Center,Greeley CO adults,adolescents, families. Primary areas anxiety disorders,mood disorders and adjustment disorders. Typical problems included: trauma, physical abuse substance abuse,job stress. Orientation used- primarily cognitive-behavioral therapy. 1980 Group Facilitator-Regional and National Conferences in cross-cultural community needs. Flagstaff, AZ-Colorado Springs CO August 1975-July 1978 Chairperson of the Department of Education and Behavioral Science at an accredited,Indian controlled community college on the Navajo Reservation. Administration responsibilities included: Supervision and evaluation of faculty;budget preparation and management;curriculum development and integration of Navajo culture;personnel recruitment and selection;class scheduling and program development. Also faculty member with academic responsibilities for instruction in Psychology, Child Development and Counseling courses,advising and counseling students. Navajo Community College,Tsaile AZ September 1974-August 1975 Education Specialist and counselor at an Indian controlled primary and secondary school on the Navajo Reservation. Coordinated community resource program,which included: counseling,student assessment, prescriptive programming,staff development and curriculum. Also,adjunct faculty for the University of New Mexico and for Navajo Community College at the Rough Rock Demonstration school,Rough Rock, AZ September 1972-June 1974 Designed and coordinated Learning Center Program for Dedham Public Schools. A program and crisis intervention center for emotionally disturbed children. Responsibilities included: Diagnostic prescriptive programming,counseling,supervision and training of aides, tutors and volunteers,and consultation with regular classrooms teachers. Also organized group and individual meetings with parents. Adjunct faculty for Curry College assisting with in-service instruction for Dedham School System employees. Dedham Public Schools,Dedha m 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 A 0004087 04/01/2003 ' Renewal PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POUCY CAREFULLY PURCHASING GROUP POUCY NUMBER: 45-0002000 Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2032570 1. Named Insured Ackerman and Associates PC 175025th Ave ADDRESS Greeley,CO 806344943 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 IJABIUTY PREMIUM Professional Liability $ 1,000,000 each incident I $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. .6. This policy shall only apply to incidents which happen on or after a)the policy effective date shown on the . Declarations: or b) the effective date of the earliest claims-made policy issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/1992 7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions, stipulations and agreements contained in the following forms) 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- 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 Ae 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 been issued by the company indicated above to the insured named herein and that, subject to their provisions end 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 Type of Work Covered: PROFESSIONAL SOCIAL WORKER Location of Operations: N/A (IF 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 POLICY AND HE OR SHE SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Comments: This Certificate Issued to: Name: VALERIE LARSON 2500 HAVEN COURT Address : EVANS, CO 80620 Au orized Representative WILLIAM P.KELLY EDUCATION 1997-MA-PROFESSIONAL COUNSELLING,`UNIVERSITY OF NORTHERN COLORADO 1977-PhD.-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 r 1999-Professor Emeritus,Regis University,Denver,CO 1983-1999-Chair,P,ofwsor 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,Longmont,CO. 1966-67,68-70 Teacher/Administrator/Cog h hi Denver Catholic High Schools- 1960-1963 Teacher/Oath 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 ClaAon,Associate Professor of History and former Associate Academic Dean $egis University, 3333 Regis Blvd.,Denver OO,80221 303-458-4914 Mr.James Neuman,MSW-LSW,Private Psychotherapist,Supervisor of My Practice,1O11O W.26 Ave., Paramount Bldg.,Wheat Ridge CO 303-233-9371 Dr. Allan Service,Provost,Regis University, 3333 W.Regis Blvd,Denver,CO 80221,303-458-1843 CNA Healthcare Providers Service Organization Purchasing Group • • LIHPSO CNA Plaza, nnaer.re hewn knit.or«+.ta. Chicago,IL 60685 a "" Certificate tt o neural-Ere Producer Branch Prefix Policy Number Policy Period from: 12:01 AM Standard Time on: 07/04/03 018098 970 FIPG 273003448-8 to: 12:01 AM Standard Time on:07/04J94_ Named Insured and Address Program Administrator _ Healthcare Providers Service Organization WILLIAM P KELLY 159 Eas 159bEast Coty4L County ie1R ne Road 11429 W BURGUNDY AVE LITTLETON CO 80127-5870 Medical Specialty: Code: Insurance Provided by Clinical Counselor 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, 'IL 60685 COVERAGE PARTS LIMITS OF LIABILITY • • A. PROFESSIONAL LIABILITY Professional Liability 51 ,000 ,000.00 each claim $6,000.000.00 aggregate Good Samaritan Liability Included above Personal Injury Liability Included above Malplacement Liability Included above B. Coverage Extensions License Protection $5,000.00 per proceeding $12,500.00 aggregate Defendant Expense Benefit $5,000.00 aggregate Deposition Representation $1,250.00 per de osition $2,500.00 a re ate Assault $5,000.00 per incident $12,500.00 aggregate Medical Payments $1,000.00 per person $50,000.00 aggregate First Aid $1,250.00 aggregate Damage to Proaerty of Others $250.00 per incident $5,000.00 aggregate C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy. Workplace Liability _ Included in A. Professional Liability Limit shown above _ Fire and Water Legal Liability_ Included above subject to $150,000 sub-limit Personal Liability I $500,000.00 aggregate D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy. Workplace Liability None None Hired Auto & Non Owned Auto None Fire & Water Legal Liability None None Personal Liability I None Total Premium $250.00 Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 G-144872-A G-144959-A G-121500C G-121501C G-123846C-05 G-121503C G-121489-ACA Healthcare Providers'Seivice Organization is i division of Affinity Insurance Services,Inc.;in NY and NH.MS Affinity Insurance Agency in FIN and OK.MS Affinity Insurance Agency,Inc.;and ut CA.MS Affinity Insurance Agency,Inc.dba Aon Direct Insurance Administrators License#0795765. Master Policy: 188711433 Keep this document in a safe place. This and your cancelled check act as proof of coverage. EMILY L.:,JARAMILLO,MA. 1 EDUCATION . 1:995,Master of Arts;. +encyOounselih nrversity of Northern Colorado,Greeley,Colorado . :. ,1993, Graduate Fellowship Study,C,t*iti inology ;e ` r Rutgers State University, Newark,Necw Jersey ' -...).-;,3%,$:-.;:.74,(3 %:::,.:.,. ..1,..7:19. ! i t I cS P 1988, Bachelor of Arts, ySoczolo-.s renal justwe with emphasis in Psychology University of Northern „:-'..c.-ado.Greeley,Colorado i1 � 5 4 R O '�SSTO1�lAl EXliTENCE 7_fi � t. :'1`998 Present Psychotherapist,Ackerman F ls`sociate5,YGreeley, CO Provide intensive home based`,family therap to families referred by the Department ,: of Social,Services Provide me tionservices to families. Co facilitate family group ." decision'making conferences for permalr ent+placement of children Provide short term, solution focused therap`y'' Provide therapy'to individuals referred from: r ','4:'.4S,-,..---istance Vrograms ,acato foster=tparent'training wo kshops 'Provide foster parent consultation, Practice j5 st pervised'by Sherri Malloy, Ph 11, Licensed " Clvucal P syChologrst 199.¢ 1999 Director,McNasr Scholars P.rograrrt, Untnersity of Northern Colorado, Greeley, COa Provided counseling,guidance,and academic advising to.students'.who were low income, first-generation college students, 4P, of a minority group. tdentified critical . personal, familial,cultural,academic/and ".-till[ . .",-'sses.to aid in;the development of individual success;plans Planned, developed,and implemented scholarly activities ' ' nationall Develo and di acted academic ear researchi seminars. Coordinated research actrvtties for scholarsprepaid0r.for doctoral.study.."Directed all efforts to ensure efficient administration of a federalMonitored project budget,'._ supervised and trained staff'nwth m. .'` 19951996 Assistant`Director,McNair Scholars grogram,'Unizver-sity of I?rorthern Colorado Provided counseling; guiirct'dance,and acodemrc advising to students who.were'low- income, first generation,and.of a minority group. Identified critical personal, familial, cultural, academic, and financial tssues_to aid in tine development of,individual success plans. Coordinated tine recruitment and-selection of program scholars. 1996 Psychotherapist(Intern), North Colorado PsychCare/Family Recovery Center, Greeley, CO Facilitated psychotherapy counseling groups and individual counseling for patients and families,with focus on chemically dependent and eating disorders. Performed case management from admission to discharge. Presented psychoeducational information to patients,family members,and staff. Worked collaboratively with a counseling team. 1994-1995 Assistant Coordinator, Student Support Services, University of Northern Colorado, Greeley, CO Provided counseling and academic advisement to at-risk first-generation,low-income, minority students. Identified critical personal,familial,cultural, academic,and financial issues to aid in the development of individual success plans. 1994-1995 Psychotherapist,Weld Mental Health Acute Treatment Unit, Greeley, CO Provided individual and group counseling to chronically mentally ill in-patient clients. Assisted clients in learning self-care and dilly hygiene Coordinated and implemented client life-skills and social-skills activities. CONTINUING EDUCATION/SEMMIARS Jurisprudence Workshop for Psychotherapists Family Preservation Basic and Advanced Training Supervised:Practicum in Family Preservation Reaching Children through Play Therapy Play Therapy and Therapeutic Care Fire Starter Training Diverse Learners Academy Counseling At-Risk Students Cultural Diversity Conference Parent/Child Hispanic.Youth leadership Conference PRESENTER/FACILITATOR The Terrific Twos Prenatal Insults and Long Term Effects Social,Emotional&Sexual Development Infancy through Adulthood Cognitive&Physical Development Infancy through Adulthood Parenting with Love&Logic Eating Disorders Cultural Sensitivity and Awareness Communicating Across Cultures Conflict Resolution/Communication Skills Setting Limits&Boundaries HONORS/AWARDS Hispanic Leader of the Year, Cesar Chavez Center, University of Northern Colorado, 1999 Keynote Speaker, Latina Youth Leadership Conference, University of Northern Colorado, 1998 Distinguished Alumni, Department of Sociology, University of Northern Colorado Fellowship,Graduate Study, Rutgers State University of New Jersey Scholarship,National Hispanic Scholarship Fund 3£iny�t- Scholarship,Candelaria olarship • - 'i,�ORANDIN4 (' OTet Date Issued 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 or alter the coverages afforded by the GREELEY CO 80634 Certificate listed below. Producer Company Affording Coverage Chicago Insurance Company Seabury & Smith owner eLmkes Parkway Covered Peison (Status) 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.contract or other document with respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate describers herein itsuhje t rcuo al the terms,exclusinne and conditions of snrh-Ceertificate fie-limits shown--- 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 8014-4003488 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 before the expiration date thereof, the issuing company will endeavor to mail written notice to the named Memorandum Holder, but failure to mail such EMILY L JARAM I L 10-BANS B ERG MA LPC notice shall impose no obligation or liabilty of any 183 50 AVENUE PLACE kind upon the company, its agents or representatives. GREELEY CO 80634 Authorized Representative: SA," e A 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 ATU . 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 01/18/04 FRI 10:25 FAX 515 243 5180 SEABURY & SMITH &b00P • ' ,.a � �,C '&`7..`.i"y'""'' , 1G'at rs A , PreV;, Date Issued �. r 01/15/2004 Insured This memorandum is issued as a matter JOHN K of information only and confers no GRAY rights upon the holder. This 230 N WHITCOK$ 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) (liner West Des Moines, Iowa 50398 JOHN K GRAY 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 contract or other document with respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Certificate Type of Insurance Number Effective Date Expiration Date Limits 'rofessional Liability each incident $1,000,000 or occurrence Occurrence 80h-4005346 12/01/2003 12/01/2004 in the aggregate $3,000,000 several Liability each incident or occurrence Occurrence in the aggregate Memorandum Holder thorized Representative: SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B _ RECOMMENDATIONS X CONDITIONS U4/13/2004 12:21 'i/03b333I4 fALKtKMHMJ rHUt JL/UZ Ackerman and Associates, P.C. 1750 25th Avenue, Suite 1O1 Greeley, Colorado 80634 (970)353-3373 Lax(970)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: RFP 04007 (Sex Abuse Treatment), RFP 04008 (Mediation and Facilitation under Intensive Family Therapy), RFP 04010 (Option B/Home-Based), RFP 04005 (Lifeskills), and RFP 006-00(Foster Parent Consultation). Thank you very much. Respectful) , Joyce Shohet c erman, Ed.D. Licensed Psychologist President, Ackerman and Associates, P.C. r , it°i\t(i :H4. 1 1 14 \ DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY,CO.80632 Webske:www.co.weid.co.us Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 O • 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 Program 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, recto 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-0007 Revision (PY 04-05 RFP-FYC-006-00) Contract Award Period Name and Address of Contractor Beginning 06/01/2004 and Lori Kochevar. Ending 05/31/2005 Foster Parent Consultation 23830 WCR 48 LaSalle,CO 80645 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Award is based upon your Request for This program provides foster parent consultative Proposal(RFP). The RFP specifies the scope of services in the areas of(1)consultation and foster services and conditions of award. Except where it parent support, (2)mandated corrective action is in conflict with this NOFAA in which case the consultation,and(3)mandated critical care NOFAA governs,the RFP upon which this award is consultation. Foster parent consultations will be based is an integral part of the action. provided through group consultation services for a maximum of five groups per month, 6-10 participants Special conditions per group. Individual consultation services will only be provided when approved by the Resource Services 1) Reimbursement for the Unit of Services will be Manager or Child Welfare Administrator of Social based on a per group rate. Services. Bilingual-Bicultural services are available 2) Rates will only be remitted on cases open with, and to all families. South County services are available. referrals made by the Weld County Department of Social Services. Cost Per Unit of Service 3) Requests for payment must be an original and submitted to the Weld County Department of Social Group Rate per 8-10 participants $350.00 Services by the end of the 25th calendar day Hourly Rate per Individual Consultation $ 90.00 following the end of the month of service.The provider must submit requests for payment on Based on Approved Plan forms approved by Weld County Department of Social Services. Enclosures: X Signed RFP:Exhibit A 4) Requests for payment must include original client X Supplemental Narrative to RFP: Exhibit B verification signatures(blue or red ink preferred) and dates and hours of service. Recommendation(s) 5) The Contractor will notify the Department of any X Conditions of Approval change in staff at the time of the change. Approvals: Program Official: By URI By Robert D. Masden, Chair Jud A. Gri , Direc r Board of Wel Copnty Commissioners Wel noun epartment of Social Services Date: )], `{ Date: 5 /o any-i.ess.:4 I- - SIGNED RFP-EXHIBIT A REQUEST FOR-QUALIFICATIONS OFF SYSTEM BID B001-04 (RFQ-006-00) DATE:February 11,2004 RFQ NO: 006-00 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Reque$t for Qualification(006-00) for: Colorado Family Preservation Act—Foster Parent Consultation,Emergency Assistance Program • Deadline: March 5, 2004,Friday, 10:00 a.m. The Families,Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.R.S. 26-5.3-101). The Families,Youth and Children Commission wishes to approve services targeted to run from June 1,2004,through May 31, 2005, at specific rates for different types of service, the county will authorize approved vendors and rates for services only. The Foster Parent Consultation Program must provide services that focus on providing psychological consultations and parenting support to foster parents which are designed to improve foster parent competency, family conflict management,and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Qualifier Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) RFQ MUST BE SIGNED IN INK TYPED OR PRINTED SIGNATURE S9e9 aid" ( VENDOR Wi i Ktortercr MS VC. LLC MS \P LLC (Name) Hand 'tte Signature By Authorized Officer or Agent- of^^Vender ADDRESS gi° f a f'1•51-1/2-#t TITLE Go 1mpt Qrz c Cl) 51 06 t DATE 3/3 /D% PHONE# G70 3cif, 9573 The above RFQ is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 28 Off-System Bid Number B001-04(RFQ-FYC 006-00A) Attached A FOSTER PARENT CONSULTATION PROGRAM REQUEST FOR QUALIFICATION (BID) PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING COLORADO FAMILY PRESERVATION ACT 2004-2005 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2004-2005 OFF SYSTEM BID B001-04 RFQ 006-00� } 1 n_- _ NAME OF AGENCY: " ' ,tyl ms LSt 1_ j)g4' LL, a,. . (2et�iA ll i ADDRESS: 3 I O 1 ;..4-1, PHONE: (9)v) 3 , 23 7 3 CONTACT PERSON: )4i, <Oc llLU t_-2 TITLE: ( rye DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation Program Category must provide services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household management competency,parental competency, family conflict management and effectively accessing community resources. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of; Start June 1, 2004 Start End May 31, 20105 n - l End J _ TITLE OF PROJECT: 16sb Qt'Z2 09-nza ?,T( ' AMOUNT REQUESTED: ` 7) flay, 94,24.,0 4 9j ij / to-- dodzieov, `,A9,,,tyJ rr5 \_W- LLB 3l 3 /of and Signature of Person Preparing Document Date - Name and Signature Chief Administrative Officer Applicant Agency Datt MANDATORY PROPOSAL REOUIREMENTS For both new proposals and renewal proposals,please initial to indicate that the following required sections are included in this Proposal for Qualification. 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 >kr Project Description /c- X/4-Target/Eligibility Populations fit Types of services Provided p(/� yMeasurable Outcomes �Q r—Service Objectives A/C 4-Workload Standards /./C &-Staff Qualifications - Program Capacity per Month C-h ` 1) (nst a AQ ' Certificate ofinsurance ,IC C $ 1A914°1-413- Page 24 of 28 02.20.20U4 FRI 12 off FAX j UUI 0,2 Off-System Bid B001-04(RFP-FYC-04005) Attached A 4021. kn-t wrrn__ % , 4-01k, Qslen- �d Knv/�.,r • -- kite of Meeting(s)with Social Services Division Supervisor. bmments by SSD Supervisor: woe iced 4024 S anal � C f r c y 1 S [�4 d eena+f f1 .141-de" Vitt !�*si -c4-e 47.4.4 CaglName and Signature of SS ' or Date Page 28 of 33 Foster Parent Consultation Program Purpose: The purpose of the Foster Parent Consultation Program is to provide on- going support and consultation to foster parents so that they are better able to provide positive healing relationships for the children they serve. Design: This program is designed on a strength based family preservation model of service. This model is proactive as well as promptly responsive to the foster parents in order to decrease placement disruption for foster children. This program provides a variety of support group tailored to meet the individual needs • of the foster parent. In addition, when requested by the department, prompt individual consultation by phone or appointment will be available to work with foster parents in accordance to their needs. In our experience, during a crisis the need for intense consultation decreases after the initial solution orientated planning sessions. This program can provide training opportunities to help foster parents meet the state requirements for on-going professional development. The information discussed during consultation services is always confidential for voluntary participants. Why Services are Important- Foster Parents have the difficult role of providing a loving relationship and a structured home environment to children whom have most often been severely abused and or neglected. These children often have a distorted sense of self. Children in the Foster Care system often act out their feelings of unworthiness by displaying behavior that is destructive to self and others. Foster parents need to be able to access consultation services quickly to assist them in better understanding what the child/children are going through and how to respond to their behavior. As caretakers they also need awareness and skills to address their own issues in order to not repeat maladaptive interactions behavior with the foster children. Consultation - Consultation will consist of short-term, solution orientated planning that facilitate empowerment of the foster parents. Services will be able to be accessed through a call to the specific provider and will be provided in an expedient manner. It is common for caregivers to feel anxious, overwhelmed, depressed and or resentment when working with children that are experiencing all of these same feelings. Receiving a response from an objective consultant in a timely manner can help the foster parents to regain their composure and confidence to act instead of react to the challenging behavior exhibited by many foster children. 1 Target / Eligibility Population A. Total number of clients to be served in the twelve month program has been calculated as follows. We would be able to provide up to ten support groups a month. We estimate that there would be an average of eight participants at each support group. Henceforth, at ten support group a month , x twenty hours , x eight participants, x 11 months this part of the program would provide 1600 hours of service a year. We anticipate that on the individual component of this program that we would spend two hours a week providing services for foster parents. Henceforth, 2 hours a week x 52 weeks provides 108 client hours a year. We anticipate that the average foster parent using our services would attend 11 hours of support group a year, which would mean that we would serve 80 individual foster parents a year. We anticipate that individual crisis consultation would be available to 40 families for 6 hours of individual service a week. Total number of client hours provides over one year would be 1912 hours. B. Distribution of clients. On average most foster parents provide services for approximately four foster children a year. Each foster child is in placement an average of 6 months. By providing support and consultation services for 40 foster families these services improve that quality of care for approximately 320 children in the placement system. C. Families Served. We anticipate serving 40 foster families, 80 foster parents. D. Sub total who will receive bicultural/bilingual services. All services provided will be in a manner which is sensitive to the culture of origin of the family. All of the therapist have extensive training in cultural competency issues. In addition, Lori Kochevar was the chair of the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. Anna Lane, a bilingual provider, would be available for any Spanish speaking families and written program materials will also be available in Spanish. 2 E. Consultation services will be available in South Weld County. Currently We are running two support groups in South Weld County. Services will be available where the foster parents live. F. The monthly maximum program capacity- If needed, we could expand the number of hours we are available for individual consultation to 8 hours a week, which would make available 32 hours of individual consultation and 20 hours of support groups a month. G. The monthly average capacity- The monthly average capacity of this program is 16 hours of consultation services and 9 support groups. H. Average stay in the program - The average stay in this program would be 10 months. I. Average hours per week in the program would be one support group a month. From experience, most foster families in crisis choose to use more hours when they are initially dealing with an issue and then cut back after the first few solution orientated planning sessions have occurred. Services Provided A. Consultation and Foster Parent Support will be provided around these and other key issues that will assist foster parents: initial placement adjustment, transition, separation and loss, effective discipline for children raised with inconsistent parenting, behavioral management, child development, the effects of visitation, legal risk and commitment issues, importance of documentation , work with foster parents and caseworkers around interpretation and implementation of treatment plans, solution oriented planning, and balancing your own/couples/ biological children's /birth families/ systems/foster children's needs. Both consumer elicited and mandated consultation for critical care foster parents and corrective action plans will be provided. B. Mandated training's for foster parents under corrective action plans will be provided as directed by the Department of Social Services C. Training's - Training needs will be identified through an evaluation of foster parents needs as well as in response to needs identified by the department. Before training's are offered they will be approved and or requested by the department. The budget for training will be determined on a per event basis. All foster parents 3 in Weld County will be invited to participate in each event. Evaluations of training's provided will be conducted. D. Therapeutic services for foster children will not be provided in a home where consultation services are in place. E. Team building staffing -At the foster parents request and if the caseworker is willing, a team building meeting with the foster parent and the caseworker will be held to address ongoing concerns and to develop a solution oriented plan. This will be coordinated with the administration at DSS. This will help develop a unified plan and address any miscommunication or differences in opinion before court. This will increase the probability that the systems involved are able to work together for the best interest of the foster children in their collective care. All assessments and recommendations will be shared directly with the children's caseworker. F. Agree to comply with 19-1-120 CRS., which requires that reports of child abuse and any identifying information in those reports are strictly confidential. All federal laws will be followed including the confidential reporting of suspected child abuse. In this program consultation funds will not be used to fund therapy or drug and alcohol services for foster parents. If deemed appropriate a referral to a mental health provider, or ADAD professional will be made. Program Components: 1. Consultation - Both foster parent elicited and mandated consultation for critical care foster parents and corrective action plans will be provided. Short term, problem solving services will facilitate personal empowerment of the consumer. It is imperative that foster parents have access to a variety of resources to support their own psychological well being and to prevent burnout. 2. Support groups - We will organize and facilitate in depth exploration of issues that effect certain sub-groups of foster parents i.e.., critical care, foster adopt, etc... Foster parents will be encouraged to support each other. This creates a natural ongoing support system. Underlying focus will include collaborative team work with all parties working toward serving the best interest of the child in placement, i.e. DSS, GAL, Therapist, etc. 4 3. Resource and Referrals - This program will facilitate the development of internal and external resources to enhance the foster parents ability to meet the demanding requirements of their role. Foster parents will be able to access written information on specific diagnostic, behavioral, and developmental issues specific to the foster children's special needs. See appendix A for a partial listing of topics available. In addition, it is important to link foster parents to appropriate community resources and with each other. We will facilitate knowledge of and encourage use of available community resources , and make appropriate referrals. See Appendix A for listing of current community resources available to foster parents. 4. Team building staffing - When requested by the foster parent and agreed upon by the caseworker the consultant will facilitate a group meeting with the foster parent and the case worker. This staffing will be coordinated with the administration at DSS. The focus of the team building will always be on the foster child's needs. We will address ongoing concerns and develop a solution oriented plan. This will increase the probability that we are able to work together for the best interest of the foster children in the systems care. Measurable Outcomes When clients are self-referred to this program they will choose training's, goals, and objectives according to their perceived needs. In the case where the foster parent is sent for disciplinary action or critical care, the consultant and the foster care coordinators will help design specific outcome measures appropriate to the situation. It is important to understand that as in any consultation process that these skills, concepts, and techniques need to be understood and practiced before foster parents will be able to consistently apply them with the children they serve. A. After involvement in this program component foster parents will be able to identify an improvement in their ability to deal competently with household management issues, as measured by a pre and post assessment inventory - Volume 7 Compliance Checklist. • Increase knowledge of and understanding of Volume 7 requirements for foster parents. • Increase understanding of importance of documentation and timelines concerning medical, dental and, medication monitoring • Increase awareness of state and federal requirements in Volume 7 regarding higher standards of care required by foster homes. 5 • Increase awareness of and adherence to household cleaning, safety, and maintenance requirements outlined in Volume 7. • Increase awareness of resources available to assist with budgeting and purchasing resources for foster children. B. After involvement in this program component foster parents will be able to identify an improvement in their parental competency as measured by a pre and post assessment of skills needed to implement non-power based parenting effectively. • Increase adherence to and understanding of state and federal requirements regarding discipline policies. • Increase understanding of characteristics of children raised with inconsistent parenting. • Increase ability to use and identify alternative discipline strategies. • Increase ability to acknowledge and listen to the child's concerns with empathy. • Increase recognition of communication barriers. • Increase ability to set effective limits using choices and enforceable statements. • Increase ability to use empathy and consequences effectively. • Increase ability to facilitate problem solving skills in foster children. • Increase understanding of the importance of positive relationship message when delivering negative content message. • Increase ability to redirect mis-behavior. • Increase understanding of foster children's need to learn about cause and effect thinking in an emotionally neutral non blaming environment. C. Foster parents will increase their ability to access resources independently so that they are able to improve their ability to meet the specialized needs of each individual foster child they serve. This will be measured by self report on evaluations completed by foster parents after consultation and tracking the number of referrals made by this program. • This program will facilitate empowerment for foster parents by providing clear user friendly information about the resources available in the community and within the local, state, and federal government. D. Foster parents will obtain higher skills and competency levels in fulfilling their role in providing a healing relationship for children in out of home placement. This will be measured and monitored through the development of individualized consultation service objectives which will be evaluated at the exit interview by the foster parent and the consultant. • Increase ability to accept the child as s/he is 6 • Increase ability to deal with child's behavior in the context of a healing relationship. • Increase ability to support what the foster child is going through. • Increase understanding of dynamics of child abuse and neglect. • Increase understanding of developmentally appropriate expectations and the effects of trauma on development. • Increase understanding of the factors influencing the child's reaction to parent separation and loss. • Increase understanding of cultural competency issues that effect foster parenting. • Increase understanding of roles and dyr jnics of children that grow up in homes where parents have substance abuse issues. • Increase ability to anticipate special emotional needs. • Increase attunement to attachment and bonding issues. • Increase understanding of the need for foster children to have empowering corrective experiences. • Increase understanding of regressive behavior and the need for reparative bonding within the relationship. • Increase understanding of the need for consistency and structure to establish trust. • Increase understanding of the effects severe boundary violations have on children and how to facilitate the development of health boundaries in children. E. Foster parents will positively meet their own and the needs of their biological children's in adjusting to and dealing with the presence of foster children in the home. This will be measured and monitored through the development of individualized consultation service objectives which will be evaluated at the exit interview by the foster parent and the consultant. • Increase ability to set and maintain outside interests and relationships. • Increase ability to communicate effectively with the multiple systems involved in foster children lives. • Increase ability to set and teach children how to set effective physical and emotional boundaries. • Increase awareness of symptoms of burnout. • Increase understanding of the importance of knowing when to access support. • Increase awareness of grief and loss issues for foster families when foster child reunifies with family of origin. • Increase awareness of inappropriate coping strategies (i.e , substance use, denial, eating, fault-fmding, passivity,revenge, withdrawal or excessive worry, etc...). 7 • Increase ability to use appropriate coping strategies (i.e , diversions, balance, conflict resolution, flexibility, networking, affirmations, assertiveness, contact, enforceable limits, linking, organization, problem solving, re-labeling, providing choices, time management, relaxation, self-care, exercise, commitment, prayer, worship, surrender, etc...). Service Objectives We have the following service objectives: A. Improvement of household management competencies. It is imperative that foster parents are aware of and uphold regulations outlined in Volume 7 regarding the need to maintain a safe household environment, that is adequately cleaned and maintained. In addition, foster parents need to be able to budget their resources so that they are able to provide for the children they serve. Specific aspects on this service objective may include the following; consultation and referrals. This component will be measured through the foster parents ability to reach specific individualized consultation goals, a pre and post assessment tool and program evaluations. B. Improved parental competencies. Foster parents need to have the capacity to maintain a solid relationship with each other, with their own biological children and with the foster children they serve. In addition, foster parents need to provide developmentally appropriate care, nutrition, hygiene, discipline,protection, guidance and supervision. This service objective will be met through support groups and consultation. This component will be measured through the foster parents ability to reach specific individualized consultation goals, a pre and post assessment tool and program evaluations. C. Improve ability to access resources. Foster parents shall be empowered to access resources in the community, as well as resources available thorough the local, state and federal government. This program will encourage networking with other foster parents. This service objective will be provided through support groups, linking, consultation, and referrals. This component will be measured through foster parent evaluations, ability to reach specific individualized consultation goals, and record of number of referrals made. 8 Workload Standards A. The program has the capacity to serve 80 foster parents. Consultants would spend up to forty four hours a month providing services. With an average of eight foster parents per group, total number of client hours provides over one year would be 1912 hours. B. Staff- There are three Family Preservation Specialists. Lori Kochevar M.S., L.C.., LLC will serve as a provider and the program supervisor for Sherri Malloy Ph.D.. and Anna Lane L.P.C. All providers have extensive experience in Family Services as documented in the attached resumes. C. The caseload will be between 2-10 families per therapist. The caseload of each therapist will depend on matching the specific needs of the referred family with the therapist area of specialty. D. The modality of treatment is support groups and individual crisis consultation. Referral and linking services will be provided. E. Hours - Total number of clinical time devoted to this program equals two hours a day, eleven hours a week, and forty four hours a month. F. Staff- The providers are supported by part time bookkeeping and clerical services. G. Supervisor- This contract would be supervised part time by Lori Kochevar M.S. L.P.C. who would monitor the project for program compliance and clinical excellence. H. Insurance - - Lori Kochevar M.S., L.P.C., LLC carries one million three million liability on the company and each one of the independent contractors connected to this bid. In addition, Lori Kochevar M.S., L.P.C., LLC carries a general liability policy related to accident or injury on the premises. The State of Colorado is named as an additional insured on this policy. Each individual provider also carries a one million three million liability insurance. Both general and group liability coverage's are attached. All therapist providing services are self employed and choose to be exempt from workman's compensation and Employer's liability insurance. 9 Staff Qualifications A. All the providers exceed the minimum qualifications needed for both education and experience. All providers have their Master's Degree or Doctorate in Counseling. In addition, the therapists have between 6-12 years a piece providing services for families. See Resumes in Appendix C. B. Staff available for this project consists of three experienced consultants that have a similar core value of clinical excellence. We believe in providing strength- based, family-focused services that empower the families we serve. Another strength of our staff is our diverse areas of specialties. • Lori Kochevar a licensed professional counselor has extensive experience and training in providing services and supervision using the family preservation model. She has specialized training in substance abuse, trauma, grief, and domestic violence. In the last ten years Lori has developed and facilitated multiple training's that emphasize experiential learning opportunities. Many of these training's were developed specifically for Foster Parents, while others were created for familles, school personnel, and service providers across the state. • Sherri Malloy is a licensed clinical psychologist with clinical expertise in attachment and adoption issues. She has extensive experience in identifying developmental and relational issues for children dealing with trauma, and attachment disorders. She is trained in EMDR. • Anna Lane is licensed professional counselor who is bilingual in Spanish. She received her Master's degree from the University of Northern Colorado. Over the last fourteen years, Anna has worked as a play therapist, CASA advocate, a victim advocate with the Boulder County's Sheriffs Department, and a mental health specialist. She has experience child and family therapy and in the treatment of children who have experienced trauma. Along with being skilled consultants, due to our extensive background as therapists we are knowledgeable of the systems (i.e.. biological families, social services, mental health services, legal services, etc..)that foster parents need to interface with as advocates for the children that are placed with them. 10 Appendix A Lori Kochevar M.S. L.P.C. LLC ♦♦♦ Stretching our Strengths•810 12th Street•Greeley CO 80631 Phone(970) 352-8873• Fax(970)352-8879 Additional Resource • Consultation Program -Call Dee or Barb for Info 352-1551 Ex 6293 or 9292 • Clothing Allowance - $200 per child per calendar year, see forms • Foster Parent Library- Extensive collection of books and Videos, located at DSS • Weld-Foster Parent Association- See brochure. Call Linda King 506-9754 • Food Bank- Medicaid side & Weld Foster Parent Association, 100 pounds a month. • Round Table Lunches- Monthly at DSS with Dee and Barb • State Foster Parent Association - Call Beverly Holtz at (303) 463-7989 • Training's- Look in Newsletters • Rocky Mountain Children 's Law Center- (303) 871-6410 • Court Appointed Special Advocates- Contact Marsha at 353-3400 • Guardian ad Litem (GAL)- Appointed for your child by the court • Monthly Newsletter- Sent by Barb and Dee • Child Find- See brochure and contact Brenda at 330-3842 • Children's Hospital Evaluation - (303) 861-6410 • North Range Behavioral Health - 346-1166 • Medicaid 1800 511- 5010 (Access) 1-800221-3943 (Regular services) • Sunrise Clinic - 353-9403 • North Colorado Family Medicine - Scheduling 346-2818 356-2424 • Monforts Clinic- 352-8898 • Dentistry for the Handicapped Orthodontics and other dentistry 1-800-466-8129 • Smile High Dentistry (303)825-2295 • HCP- orthodontics (303) 678-6064 • Statewide list Drs. & ODS- take Medicaid(303) 866-4562 • Donated Dental Services 298-1910 • Child Car Safety check- Greeley Fire Department-Mike Medhearst 350-9500 • Recreation Center- 350-9400 Voucher in summer&scholarships. • Larimer- Foster Parent Association- (970) 669-3047 • Probation Department- 356-4000 ext 3870 • Boys and Girls Club- 353-5109 National Youth Sports Program- summer camp ages 10-16 351-1996 Individualized Consultation Plan for 1. Foster parents will be able to identify an improvement in their parental competency as measured by a pre and post assessment of skills needed to implement non-power based parenting effectively. • Increase adherence to and understanding of state and federal requirements regarding discipline policies. • Increase understanding of characteristics of children raised with inconsistent parenting. • Increase ability to use and identify alternative discipline strategies. • Increase ability to acknowledge and listen to the child's concerns with empathy. • Increase recognition of communication barriers. • Increase ability to set effective limits using choices and enforceable statements • Increase ability to use empathy and consequences effectively. • Increase ability to facilitate problem solving skills in foster children. • Increase understanding of the importance of positive relationship message when delivering negative content message. • Increase ability to redirect mis-behavior. • Increased understanding of foster children's need to learn about cause and effect thinking in an emotionally neutral non blaming environment. 2. Foster parents will increase their ability to access resources independently so that they are able to improve their ability to meet the specialized needs of each individual foster child they serve. • Increase understanding of the importance of knowing when to access support. • Increase awareness of resources available. • Increase ability to access resources available in the community and within the local, state, and federal government. 3. Foster parents will obtain higher skills and competency levels in fulfilling their role in providing a healing relationship for children in out of home placement. • Increase ability to accept the child as s/he is. • Increase ability to deal with child's behavior in the context of a healing relationship. • Increase ability to support what the foster child is going through. • Increase understanding of dynamics of child abuse and neglect. • Increase understanding of developmentally appropriate expectations and the effects of trauma on development. • Increase understanding of the factors influencing the child's reaction to parent separation and loss. 11 • Increase understanding of cultural competency issues that effect foster parenting. • Increase understanding of roles and dynamics of children that grow up in homes were parents have substance abuse issues. • Increase ability to anticipate special emotional needs • Increase attunement to attachment and bonding issues • Increase understanding of the need for foster children to have empowering corrective experiences. • Increase understanding of regressive behavior and the need for reparative bonding within the relationship. • Increase understanding of the need for consistency and structure to establish trust. • Increase understanding of the effects severe boundary violations have on children and how to facilitate the development of health boundaries in children. 4. Foster parents will positively meet their own and the needs of their biological children's in adjusting to and dealing with the presence of foster children in the home. • Increase ability to set and maintain outside interests and relationships. • Increase ability to communicate effectively with the multiple systems involved in foster children lives. • Increase ability to set and teach children how to set effective physical and emotional boundaries. • Increase awareness of symptoms of burnout. • Increase understanding of the importance of knowing when to access support • Increase awareness of inappropriate coping strategies (i.e , substance use, denial, eating, fault-finding,passivity, revenge, withdrawal or excessive worry.) • Increase ability to use appropriate coping strategies (i.e , diversions, balance, conflict resolution, flexibility, networking, affirmations, assertiveness, contact, enforceable limits, linking, organization,problem solving, re-labeling, providing choices, time management, relaxation, self-care, exercise, commitment,prayer, worship, surrender, etc...) 5. The areas checked above would assist me in serving the needs of foster children and the areas circled are were improvement has occurred. 12 Household Management Issues 1. Foster parents will identify an improvement in their ability to deal competently with household management issues. • Increase knowledge of and understanding of Volume 7 requirements for foster parents. • Increase understanding of importance of documentation and timelines concerning medical, dental and, medication monitoring. • Increase awareness of state and federal requirements in Volume 7 regarding higher standards of care required by foster homes. • Increase awareness of and adherence to household cleaning, safety, and maintenance requirements outlined in Volume 7. • Increase awareness of resources available to assist with budgeting and purchasing resources for foster children. 13 III RISK FACTOR CHECKLIST - INTAKE ASSESSMENT , ACCEPTABLE Lam'{ MODEM HIGH L Severity ofAbuse/Accessof •Not Applicable •Minor injury/noninpuy. •Mild/Multiple marks/bruise on •Severe injury. Perextrator .•Parent is protective&supportive torso,arms,and legs. •Old and new injuries. of child. •Parent has history of ongoing or •Ongoing history of harsh •Parental discipline maybe use of excessive discipline. physical discipline. arbitrary and occasionally uses •Parent makes direct threats on a •Marks or bruises to child under 2 scare tactics. daily basis to child's sense of years. •Alleged perpetrator of sexual security. •Parent makes direct and dramatic abuse has no unsupervised access •Perpetrator has some access. threats to curd's emotional to the child and is not in the home. security. •Perpetrator in home. Z•Severity of Neglect •Not Applicable •Child has unkempt appearance. •!indisposed trash •Substantial safety and health •Howe disorderly but not a hazard. •Parent reveals frequent inability to hazards in home. •Meals irregular but adequate. are for or protect child. •Leaves child unsupervised for •Child does not receive routine •Meals go unprovided and child is excessive periods of time and/or medical/dental care but no ill ch onially hungry. environment poses a threat_ effects on the child. •Unattended medical/dental •Neglect results or could result in •Parent is periodically urattuned to problems causing child severe injury or illness. child's needs. discomfort. •Parent consistently withholds •Some periods of unsupervised affection and rejects child. are and child has no access to or •Non-organic failure to thrive. knowledge of resources. ••Significant developmental delays •Parent avoids interaction with due to neglect. child to meet emotional needs. 3. Aping •thild partakes in appropriate •12 years of age and over,displays •6.12 years. •Infancy to 5 years old or older Conditions of Child activities outside of home no handicapping conditions. •Requires some level of adult child who is severely disabled or •bvisibkloathers. •Isableto obtain help. assistance to are for and protect handicapped. •Child shows no symptoms of self,based upon age and •Unable to are for or protect self developmental lags. conditions. without extensive adult assistance and supervision. •Child not visible to others outside of household. 44�.rr Previous'�R�e,poib of •No prior reports of abuse to •One unsubstantiated prior report. •More than one prior report. •Previous substantiated reports of nrusrarusraess agency. •One previously substantiated severeabuse/negllect. abuse/neglect or several •Children in the past have been unsubstantiated reports from placed due to abuse/neglect. various sources. •Termination of parental rights on • one or more children. 1 Appendix B ® HEALTHCARE PROVIDERS GENERAL LIABILITY COVERAGE PART ENDORSEMENT Additional Insured General Liability In consideration of the premium paid, and subject to the General Liability limit of liability shown on the certificate of insurance, it is agreed that the GENERAL LIABILITY COVERAGE PART is amended as follows: The person or entity named below(the"additional insured") is an insured under this Coverage Part but only as respects its liability arising out of named insured's operations, or premises owned by or rented by the named insured and solely to the extent that: 1. a general liability claim is made against the named insured and the additional insured; and 2. in any ensuing litigation arising out of such claim,the named insured and the additional insured remain as co-defendants. In no event is there any coverage provided under this policy for an occurrence that is the direct liability of the additional insured. Additional Insured: State of Colorado do Weld County Social Svs. PO Box A Greeley, CO 80634 This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. All other provisions of the policy remain unchanged. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ENDT. NO. POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE 01 0273177648 Lori Kochevar MS LPC LLC 2/26/2004 G-123827-B(07/2001) Page 1 of 1 • Print Date: 02/1 6/04 HECARE PROVIDERS ® SERVICE ORGANIZATION PURCHASING GROUP CERTIFICATE OF INSURANCE ' oaf ..:..n4rr H-of Y!VNtrrnber��'a �`a:4..f u'Pdncy:rGriodrs � �.. .bavi: ..y�sui4$.: 018098 41 970}� HPG 0273177648) from:12:01 AM Standard Time on:02/26/04 to: 12:01 AM Standard lime on:0 2 05 Named Ins uredand ress3 ., s ;.... . `Frog np : Lori Kochevar MS LPC LLC Healthcare Providers Service Organization 810 12th Street 159 East County Line Road Greeley, CO 80631-4022 Hatboro, PA 19040-1218 Medical Syeaiatty: Code: FlnsUfaficdPPoVided tekt4fl;.I'S . Clinical Counselor.Firm... .. 72990 American Casualty Co of Reading; PA CNA Plaza 26S Chicago, IL 60685 Ct?VEMGIMARTS ,A7 "' . A'z .fMITS'OF4JABItfi ` " mss- =g A. PROFESSIONAL LIABILITY Professional Liability(PL) $ 1,000,000 each claim $ 6,000,000 aggregate Good Samaritan Liability included above -= F, Personal Injury Liability included above _ Malplacement Liability included above ; . _. r B. COVERAGE EXTENSIONS: License Protection $ 10,000 per proceeding $ 25,000 aggregate Defendant Expense Benefit - ' $ 10,000 aggregate Deposition Representation W $ 10,000 ate a99m9 Assault $ 10,000 per incident $ 25,000 aggregate Medical Payments $ 2,000 per person $ 100,000 aggregate - First Aides . - _ $ 2,500 aggregate Damage to Property of Others $ 2,500 per incident $ 10,000 aggregate C. WORKPLACE LIABILITY Coverage port C.Workplace Liability does not apply if Coverage pan D.General Liability is made partridge pogo/. Workplace Liability none Fire&Water Legal Liability none Personal Liability �. -37,.:_ none D. GENERAL LIABILITY Cesarean pen D.General Liability does not apply i Coverage pan C.Workplace Liability is made part of this pricy. General Liability(GL) $1-000,000 each occurrence $1,000,000- aggregate - - - - Hired Auto& Non Owned Auto included in GL limit above - ,.. Fire &Water Legal Liability included in a limit above subject to $250,000 sub-limit Personal Liability t-. none Total Premium: $ 433.00 QUESTIONS?CALL: 1-888-2883534 G-121500-C G-121501—C G-144872—A G-144959—As G-123846—005 G-121504-C G-123827-B G-141239—A i Master Policy#188711433 Keep this document in a safe place. Rand proof dpayment are evidence of your irmrce coverage. Chairman of the Board Secretary LORI KOCHEVAR, M.S., L.P.C. 2118 19th Avenue Greeley, CO 80631 (970) 353-6568 EDUCATION: University of Southern Mississippi, M.S. • Counseling Psychology, Cumulative GPA 3.8 University of Northern Colorado, B.A. Pre-Professional Psychology, Cumulative GPA 3.5 PROFESSIONAL EXPERIENCE: 5/95 - PRIVATE PRACTICE THERAPIST, STRETCHING OUR STRENGTHS Serve others through a creative prrc s that stretches participants strengths and provides an environment for authentic healing. Facilitate opportunity for individuals, families, and groups to participate in body centered spiritually based psychotherapy. Interpersonal dynamic facilitation for community development, team budding, stress reduction, anger management, parenting, and personal effectiveness are available. 5/'95 - 9/96 DIRECTOR, VALLEY COMMUNITY FUND Serve and manage Board of Directors to strengthen the internal structure of the agency to increase fundraising capabilities. Responsibilities include: access state, government, and businassas to participate in payroll deduction, grant writing, marketing, coorcination of special events and community trainings, and disbursement of funds. 5/92 - 5/95 FAMILY PRESERVATION SPECIALIST, SAN LUIS VALLEY MENTAL HEALTH CENTER Provide intensive home-based treatment for families that are at risk of having youth removed from the home. Intervention emphasizing strength-based approaches, including psychotherapy, skill building (parenting, communication, anger control, problem-solving, etc. , educational support, and assistance in obtaining support for concrete needs. Management duties: public relations, supervise students, hire staff, and provide training for staff and community. 3/92 - 5/95 WILDERNESS THERAPIST, SAN LUIS VALLEY MENTAL HEALTH CENTER Provide intensive tent-based treatment for youth ages 8-17. Facilitate opportunities for young people to learn skills in leadership, team work, decision making, dealing with stress, facing fears, and building responsibility. Use outdoor challenge course experience such as rafting, backpacking, mountaineering, and rock climbing to provide skills based learning opportunities. 5/89 - 5/91 CONSULTANT, GRADUATE ASSISTANT, UNIVERSITY AFFLILIATED PROGRAM, UNIVERISTY OF SOUTHERN- MISSISSIPPI Participating in an interdisciplinary team that provides assistance for community-based child care centers who serve children with disabilities and their families. Responsibilities include: Grant writing, development and presentation of awareness training, assessment of learning environment and handicapping conditions. Provide consultation for teachers and parents using a coaching model, skills- based training, and evaluation of improvement. 1/89 - 5/89 TEACHING ASSISTANT, UNIVERSITY OF NORTHERN COLORADO Teach skills for report writing and use of computer programs, PC Write and Labstat. Teach weekly labs and grade lab reports. • 4/86 - 9/89 RECREATION SUPERVISION, BOYS AND GIRLS CLUB OF GREELEY Providing guidance and support for at-risk youth, fundraising, program planning, facilitate teenage drug and pregnancy prevention program, family and community involvement, organization and supervision of field trips, and participation in local and national staff development training. INVOLVEMENT: FOUNDER, BOARD MEMBER, BOYS AND GIRLS CLUB OF ALAMOSA Spearhead community organization to obtain Boys and Girls Club. Organize fundraising, board development, marketing, and regional and national networking. MEMBER, SAN LUIS VALLEY COALITION FOR YOUTH SERVICES . Member of steering committee and chairperson of the multicultural task force. CONFERENCES: SPIRITUAL 2000 Hakomi Training 11/05/99 Mariane Williamson - Enchanted Love 10/22-24/99 Shapeshifting: Shamanic Trantormation 1999 Women Who Run With the Wolves - Jungian 10/5-17/99 Phoenix Rising: Yoga Therapy Levels 1 and 2 09/24-26/99 Energy Medicine - Donna Eden 08/19/99 James Redfield -The Celestine Prophecy 08/14/99 Ruth and Naomi - Women's Partnerships _ _ 04/24/99 Substanability and Spirituality 04/23/99 Time, Money and the Meaning of Life 03/19/99 Gandhi's Search for Meaning 10/23/98 Spirituality and Religion 06/06/98 Tying it all Together- Biblical Overview 03/28/99 Transformation- Job of the Old Testament 03/06/98 Matthew Fox - Spirituality of Compassion 11/6-9/97 Common Boundaries: Joy of Creation 07/10-13/97 Body and Soul Conference 04/26/97 Day of Prayer 04/19/97 Contemplative Living 1997 Catholic Biblical School 11/6-10/96 Common Boundaries: Intentional Living 1993-1995 Creative Process COMMUNITY DEVELOPMENT 1/7-8/00 Foster Parent Core Training 10/30/99 Matrix Leadership 10/21-22/96 Working as Partners with Managed Care 04/02-05/95 Leadership for Executive Directors 03/29/95 - Fundsaving Workshop Fall 1995 Leading Edge/Business 02/09-13/95 Challenge by Choice: Ropes Course 05/20-22/94 Organizational Conflict Management: CSAP 05/06/94 CPR and First Aid Certification 02/01-/4/94 Mural Conference 11/30/93 Exploring Multiculturalism Within 10/13/93 Conflict Mediation Training 08/11-14/92 Multicultural Training: CSAP 05/12-26/89 Women as Leaders FAMILIES 06/4-6/99 Passionate Marriage 10/15-19/98 Marriage and Family Conference 05/16-17/98 Relationship Enhancement 12/08-9/97 Family Group Decision Making 10/06/97 Family Group Decision Making 05/2-3/97 Marriage and Family 9/15-16/94 Family Preservation - Supervision 07/20/94 Jim Fay Parenting 07/13/94 Family Sculpting 4/26-27/93 Family Sculpting Spring 1993 Redirecting Chidren's Behavior 02/06/93 Meaningful Family Comunication 07/070-8/92 Active Parenting 03/16-19/92 Family Preservation Training 09/20-21/90 Parents and Professionals United CHILDREN AND ADOLESCENTS 09/10/99 Testifying in Child Abuse Caes 07/12/99 Firestarting - Prevention and Intervention 01/29/99 Play Therapy 12/11/98 Attachment Disorders 10/18/97 Art Therapy for Children 04/04/97 Attachment Disorder 10/11-13/96 International Play Therapy Conference 07/8-9/94 Play Therapy 09/26/93 Traumatic Stress Reactins in Children 03/11-14/93 Child Adolescent Conference Spring 1993 Play Therapy Class 02/16-17/91 Strategic Therapy for Adolescence 10/11-13/90 C.H.A.D.D. Conference on ADHD 05/30-6/1/90 Early Intervention 12/05/89 Play Assessment TRAUMA AND GRIEF REACTIONS 12/03/99 Jurisprudence Workshop 06/25/99 Molecule of Emotions 04/09/99 Depression and Anxiety 05/19/97 Cultural Grief 09/14-16/95 Annual Hospice Conference 04/14/94 Empowering Resistive Client II 06/09/93 Empowering Resistive Clients 09/17-19/92 Annual Mental Health Conference SUBSTANCE ABUSE AND DOMESTIC VIOLENCE 10/14/98 Working with Aggression in group Therapy 09/23/97 Domestuc Violence 09/17/97 Substsance Abuse 05/16-17/94 FPS - Motivational Interviewing - Jill Kenney 05/3-14/94 Teen Baseline TOF - Drug Prevention 10/5-9/93 Baseline TOF - Drug Prevention 04/23-24/92 Domestic Violence Conference San Luis Valley Comprehensive Community Mental Health Center CUNIC OFFICE ADMIN AND CLINIC OFFICE 1015 FOURTH STREET CLINIC OFFICE 522 ALAMOSA AVENUE ALAMOSA.CO 81101 402 FOURTH STREET ALAMOSA.CO 81101 TDD 719-589-3671 MONTE VISTA.CO 81 144 719-589-3673 719-589-3671 719-852-5186 FAX 719-589-1521 . FAX 719-589-9136 FAX 719-852-3043 August 6, 1996 26041 Woodland Ave. Esparto, CA 95627 Dear Colleagues: I have worked very closely with Lori in the Family Preservation program. Lori has been a wonderful asset to this program and to all her colleagues at Mental Health. More importantly, her dedicated and skillful service to our clients has greatly benefitted many SLV families. Lori's skills are numerous. She is well organized and very conscientious. She has excellent speaking and writing skills. Her forte is her ability to work with all kinds of people, and work through difficult interpersonal situations. Lori has consistently impressed me with her resilience and problem solving skills in dealing with some of the most chaotic and resistive families. In working with these families, Lori has also come to know the needs of SLV families and has become an expert in resources that are available throughout the Valley. She has worked in every county in the Valley. Despite carrying a full caseload of challenging cases, Lori took "time off" for herself by making solid contributions to other programs. I was amazed to see Lori doing good work for such things as the Mental Health Center's Wilderness Program, the Boys and Girls Club of Alamosa, the Multicultural Awareness Committee and the Drug and Alcohol Baseline program. She attended trainings in all of these programs and then consistently returned to share her expertise and take responsible roles in each, and handling the mix of responsibilities effectively. Lori has a strong philosophical commitment to the empowerment of the oppressed. Lori will direct people toward healthy, fun relationships. Lori will earn the confidence of the people with whom she works: staff, clients, and community leaders. I highly recommend her. Sincerely, 012 M.A. Offering Comprehensive Mental Health Core For The Entire Son Luis Volley ANNA LANE 4386 County Road P.8, Unit B Wiggins, CO 80654 (970)483-6164 SUMMARY OF QUALIFICATIONS Insightful,team oriented agency counselor who quickly establishes rapport with clients and facilitates outcomes by consistently communicating respect and belief in clients'ability to do well. Special skills include: * Bilingual - Spanish * Crisis Management * Adult Trauma * Child Abuse * Supervision * Play Therapy EDUCATION M.A. Agency Counseling University of Northern Colorado,Greeley, CO B.A. Computer Information Sciences Regis University, Denver, CO B.A. Languages: Spanish and Chinese Indiana University, Bloomington,IN Numerous professional courses in: childhood development, substance abuse,play therapy and PTSD-crisis counseling. CERTIFICATION/LISCENSURE LPC - #2658 NCC -National Certified Counselor-#54047 RPT-Registered Play Therapist - Pending CISM- Critical Incident Stress Management PROFESSIONAL EXPERIECE Loveland Counseling Connections,Loveland, CO July 2003-Present Psychotherapist • Provide referrals for low-income clients to therapists who accept some Pro Bono work in the Larimer County area. • Consultation with the doctors concerning mental health issues and diagnosis. Counsel Spanish speaking adults, children, and couples with a wide range of emotional problems for the Larimer Center of Mental Health in Loveland. Salud Health Clinic, Brighton, CO Nov. 2003-Present Psychotherapist • Providing counseling to patients referred by the doctors. This includes performing the initial assessment and providing one to one counseling. • Provide a mental health screen to patients and brief therapy interventions, including psycho educational materials. • Consultation with the doctors concerning mental health issues and diagnosis. Counsel adults, children, and couples with a wide range of emotional problems, including clients who are Spanish speaking Centennial Mental Health Center,Fort Morgan, CO 1998- June 2003 Mental Health Professional III • Providing counseling to court ordered and self-referred clients including performing the initial assessment, administering the mental status exam, creating treatment plans and providing one to one counseling, treatment termination plans, testifying in court on dependency and neglect cases, and participating on the Child Protection Team. • Provide on call crisis management including evaluations for 72 hour holds. • Provide supervision to individuals and group supervision in play therapy. • Counsel adults, children, and couples with a wide range of emotional problems, including clients who are Spanish speaking. BOULDER COUNTY HEALTH DEPARTMENT,Boulder, CO 1997 - 1998 Substance Abuse Counseling Intern • Provided counseling to court ordered and self referred clients including performing initial assessment, administering mental status exam, creating treatment plans and providing one to one counseling and executing treatment terminations. • Counseled with clients who suffered from various forms of mental illness, differing forms of substance abuse, couples issues, and anger management. BOULDER COUNTY SHERIFF'S DEPARTMENT, Boulder, CO 1995- 2000 Outreach Advocate • Provide crisis counseling and support to crime Victims including initial contact, providing referrals and status updates in both Spanish and English, reducing the stress in being a victim of crime. VOICES FOR CHILDREN,Boulder, CO 1989— 1999 Court Appointed Special Advocate • Monitored children weekly for Guardians Ad Litem appointed to protect the children's rights in child abuse and neglect cases. • Evaluated children and families to ensure that their needs are met by a wide range of human services organizations while in the judicial system. IBMIISSC,Boulder, CO 1982- 1998 System Support 1988 - 1998 • Improved customer satisfaction using diplomacy by leading a 3 -4 person team in providing the customer with requested services. • Achieved quick turn around in resolving problems,which contributed to improved customer relations. Electronic Technician 1982- 1988 WESTERN ELECTRIC, Broomfield, CO 1979 - 1982 Electronic Technician Diagnosed digital and analog circuit packs that went into a mini-recorder unit. PROFESSIONAL MEMBERSHIPS American Counseling Association Sherri R. Malloy,Ph.D. Licensed Clinical Psychologist Office: Home: Ackerman and Associates, P.C. 24 Alles Drive 1750 25th Avenue, Suite 101 Greeley, Colorado 80631 Greeley, CO 80634 (970)351-7218 (970)353-3373 Education Ph.D. Double Major: Child Clinical Psychology; Clinical Psychology. August 1993 University of Colorado, Boulder. Licensed as Psychologist 1-5-95 M.A. Department of Psychology, Clinical Program. University of July 1989 Colorado, Boulder. B.A. Major:Psychology; Minor: Spanish. Arizona State University. May 1987 Summa Cum Laude. Teaching Cert. Roston Montessori Teacher Training Institute. August 1977 Orange,California. Montessori Elementary Education Certificate. Clinical Experience April 1998- Clinical Psychologist,Ackerman&Associates, Greeley,Colorado. present Provide outpatient psychotherapy to children,adolescents, adults & families. Family preservation home-based services. Assessment &consultation. Consultation to foster and adoptive families. August 1991- Child and Family Psychotherapist,Mental Health Center of Boulder March 1997 County,Boulder, Colorado.Provided outpatient psychotherapy to children and their families. Parent,teacher, and other agency consultation. Consultation to foster and adoptive families. September 1992- Psychology Intern; Denver General Hospital,Denver, Colorado. August 1993 Outpatient assessment,consultation,and treatment To children, adolescents, and adults; Inpatient treatment to adolescents&their families. Consultation to multidisciplinary hospital staff. Attended regular seminars and case conferences. Completed an additional rotation in neuropsychology. August 1990- Psychotherapist, University of Colorado,Farrand Residence Hall. May 1992 Provided individual, conjoint, and group psychotherapy to Farrand residents. Psychiatric consultation to faculty and staff. Presented seminars and workshops to faculty, staff, and students. 2 Malloy August 1988- Emergency Psychiatric Services Clinician, Mental Health Center August 1992 of Boulder County, Boulder, Colorado. Evaluation and disposition planning for clients with psychiatric emergencies. Composed a training manual for emergency psychiatric clinicians January 1988- Psychotherapy Intern,Raimy Psychology Clinic, May 1992 Department of Psychology,University of Colorado, Boulder. Provided outpatient psychotherapy to adults,families, and children. Parent and teacher consultation. February 1986- Intake Clinician;Group Facilitator, Tri-City Behavioral Health July 1987 Center, Mesa,Arizona. Conducted intakes for the adult team. Facilitator for children's psychotherapy groups. Administrative and Supervisory Experience - April 1998- Private consultation and supervision provided to colleagues and to Present unlicensed practitioners who are working toward licensure. Jan 1996- Team Leader,Mental Health Center of Boulder County, Boulder, May 1998 Colorado. Clinical and administrative supervision of a team of psychologists and psychotherapists. Budgeting. Supervision of support staff. Coordinate outpatient services/consultation to joint- agency programs, including Head Start, Specialized Foster Care, Fost-Adopt, 1178, School-Based Services,Boulder Day Nursery, and People's Clinic. August 1990- Adult Team Coordinator, Raimy Psychology Clinic,Department August 1991 of Psychology, University of Colorado, Boulder. Chaired the adult team meetings and case conferences. Assisted clinic director with administrative tasks. August 1990- Peer Counselor Supervisor,Farrand Residence Hall, University of May 1991 Colorado, Boulder. Developed and implemented a peer counseling training program. Provided ongoing training and supervision to peer counselors. January 1989- Supervisor in Training, Raimy Psychology Clinic, August 1991 Department of Psychology,University of Colorado,Boulder. Received training and supervision in supervisory techniques. Supervised the psychotherapy of first-year clinical psychology graduate students. June 1989- Adult Team Intake Coordinator, Raimy Psychology Clinic, August 1990 Department of Psychology, University of Colorado, Boulder. Intake and disposition of psychotherapy clients. 3 Malloy September 1989- Clinical Supervisor,Emergency Psychiatric Services Team, August 1992 Mental Health Center of Boulder County, Boulder, Colorado. Trained and supervised Masters level student interns in emergency clinical assessment techniques, legal and procedural practices, and psychological report writing. February 1988- Volunteer Trainer,Maslin House for Chronically Mentally Ill, May 1989 Mental Health Center of Boulder County,Boulder,Colorado. Recruited and trained volunteer college students to work with the chronically mentally ill population at this facility. Publications December 1994- Columnist:The Boulder County Parent, a monthly publication of the April 1998 Parenting Place,Boulder,Colorado. Circulation: 8,000. Topics include child development and parenting concerns. Teaching Experience January 2001- Instructor,University of Northern Colorado,Greeley, CO May 2001 Graduate Level Play Therapy Practicum August 1989- Psychology Instructor,Front Range Community College, May 1992 Boulder Campus,Colorado. Fall 1988 Head Teaching Assistant, Department of Psychology, University of Colorado, Boulder. Trained and supervised graduate level Teaching Assistants. August 1987- Teaching Assistant, Department of Psychology,University of May 1989 Colorado, Boulder. August 1977- Montessori Elementary Teacher, Roston Montessori School, May 1983 Orange, California; and subsequently,Tempe Montessori School, Tempe,Arizona. Taught preschool through second grade classes. Responsibilities included academic program planning and implementation, supervising teacher assistants, conducting parent- teacher conferences, academic record-keeping, and giving educational presentations to parents. August 1976- Student Teacher,Roston Montessori Teacher Training Institute, August 1977 Anaheim, California. Taught in a Montessori classroom under the supervision of a certified Montessori teacher. Duties were the same as in the entry above. 4 Malloy Presentation Topics and Trainings Given Legal and Emotional Aspects of Adoption Reactive Attachment Disorder Transitions for Children in Foster Care Play Therapy Engaging so-called"resistant"clients Psychotherapy with adolescents and their families Case Conferences Parent-Toddler Attachment Patterns Child Abuse Child Psychopathology Stress Management Workshop Depression and Risk of Suicide in College Students Research Projects Adult Attachment Style and College Functioning(Doctoral Dissertation), 1992 Parent-Toddler Attachment Relationships(Masters Thesis), 1990 Post-Divorce Visitation Patterns and Parent-Toddler Attachment, 1988 Effects of Divorce on Children, 1987 Mental Health Center Client Satisfaction Study, 1986 Clinical Assessment Trained in the use of the following assessment tools: WISC-III MMPI Draw-a-Person Kinetic Family Drawing Thematic Apperception Test Rorschach Inkblot Test Sacks Sentence Completion Test Strong-Campbell Interest Inventory Professional Affiliations 1997- 1998 Member: Internal Review Board MHCBC 1996-1997 Member: Professional Advisory Board, Mental Health Center of Boulder County 1991- 1992 Co-Chair: Multi-Ethnic Action Committee, Department of Psychology,University of Colorado, Boulder. • 5 Malloy 1991- 1993 Member:American Psychological Association, Division 12, Clinical Child Psychology. 1989- 1991 Member: Multi-Ethnic Action Committee,Department of Psychology, University of Colorado,Boulder. 1988- 1989 Student Representative: Department of Clinical Psychology, University of Colorado, Boulder. 1987- 1989 Member: Developmental Psychology Research Group, Department of Psychology,University of Colorado,Boulder. 1987-present Member: (Intermittent)American Psychological Association. Honors and Awards 1988 Department of Clinical Psychology Scholarship;University of Colorado,Boulder. 1987 Phi Beta Kappa 1987 Academic Scholarship,Arizona State University, Tempe, Arizona. 1986 Phi Kappa Phi Honor Society 1986 Golden Key National Honor Society 1979 West Valley College Track Team, West Valley, California; State Champions. 1977 Fellowship Award; Roston Montessori School, Orange, California. Other Experience 1996-1999 Vice President(elected), Suburban Ditch Company, Greeley, Colorado. 1983- 1985 Small Business Owner/Operator: Graphicolor, Phoenix, Arizona. Photography and advertising design. Commercial and portrait photography, advertising design, sales, supervised salespeople, performed administrative tasks. 1982- 1985 Dance Aerobics Instructor, International Fitness Center, Mesa, Arizona. Choreographed dance routines,taught classes regularly, made public presentations on behalf of the fitness club, and participated in an ongoing certification/training program in exercise physiology and dance choreography. 6 Malloy Addendum Graduate Coursework: Child Development/Psychopathology Developmental Psychology Developmental Psychopathology Child Psychotherapy Clinical Practicum(six semesters) Theory and Issues in Developmental Psychology Personality/Psychotherapy Advanced Psychopathology Advanced Personality Theory Clinical Study of the Individual Adult Psychotherapy Family Research and Therapy Research Methodology/Statistics General Statistics(two semesters) Research Practicum(four semesters) Research Problems in Clinical Psychology Assessment Projective Testing Objective Testing Courses for Distributed Minor Multicultural Psychology Community Mental Health Marriage and Family Counseling Behavioral Neuroscience:Clinical and Pathological Perspective Updated 11-11-02 Appendix C SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B RECOMMENDATIONS X CONDITIONS DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY,CO.80632 Website:www.co.weld.co.ua Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 O • April 6,2004 COLORADO Lori Kochevar,LLC 810 12th Street Greeley,CO 80631 Re: RFP 04005: Lifeskills RFP 006-00:Foster Parent Consultation RFP 006-00:Home Study,Relinquishment Counseling Dear Ms.Kochevar: The purpose of this letter is to outline the results of the Bid process for PY 2004-2005 and to request written confirmation from you by Wednesday,April 14,2004. A. Results of the Bid Process for PY 20042005 The Families,Youth and Children(FYC)Commission recommended approval of the bid,RFP 006-00 Foster Parent Consultation, for inclusion on our vendor list with no recommendations. The Families,Youth and Children(FYC)Commission recommended approval of the bid,RFP 04005,Lifeskills, for inclusion on our vendor list with the following conditions. Condition 1:The provider shall provide a written explanation of the$20 increase in rate from last year's program(2003-2004)to this year's program(2004-2005.) Condition 2:The provider shall provide in writing a more detailed assessment of how progress will be measured. Condition 3: The program will not exceed the 24-hour limit,with the second 12 hours of services contingent upon the outcome of the first 12 hours. • If the parent(s)were not able to bond within the first 12 hours,the family would be referred to an interactional level of intervention.Further,a letter would be submitted to the court with recommendations to end the bonding nurse program and progress to an interactional and/or psychological evaluation.The bonding provider,caseworker,and program area supervisor will communicate progress.A staffing will be scheduled if appropriate. 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. f Page 2 Lori Kochevar,LLC,Results of Bid Process 2004/2005 All conditions will be incorporated as part of your Bid and Notification of Financial Assistance Award(NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the condition,you must provide in writing reasons why.A meeting will be arranged to discuss your response.Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and conditions.Please respond in writing to Gloria Romansik,Weld County Department of Social Services,P.O.Box A,Greeley,CO, 80632,by Wednesday,April 14, 2004,close of business. If you have questions concerning the above,please call Gloria Romansik at 352.1551, extension 6230. Sincerely, • lig ctor cc: Juan Lopez,Chair,FYC Commission Gloria Romansik, Social Services Administrator Page 1 of 2 • Elaine Furister From: lorik [lorikanddave@earthlink.net] Sent: Thursday,April 15, 2004 7:39 AM To: Elaine Furister Subject: RE: Home Study Bid Elaine, Thank you for emailing me this information. Please attach this to the letter I delivered to you yesterday. • Action:A motion was approved to recommend the acceptance of the following Bid for Program Year 2004-2005 with the following condition. A. Lori Kochevar, LLC Condition: The provider is approved for Foster Care Home Studies only. This is because of the higher bid rate for Adoption Home Studies. Response: I would like to clarify that I understand this condition to mean that we are approved to take referral for Foster Care Home Studies and Adoption Studies from the Foster Care Coordinators. The Bid for the higher rate was for Home Studies that are reoffered from the Child Protection Unit because of the increased cost of paying for background checks, the extensive amount of information typically uncovered in background checks, and the increased number of no-shows, travel time, and resistance encounter by clients that are often unmotivated to complete the home study. In order not to confuse this with Foster Care home studies that often serve as adoptive home studies we may consider calling the home studies referred by the Child Protection Unit, Child Welfare Home Studies. I understand this condition to mean that we are approved for all home studies referred through the Foster Care Coordinators and are not approved for home studies referred by the Child Protection Unit. Feel free to contact me for further clarification. Thank you for the opportunity to serve the families in Weld County, Sincerely, Lori Kochevar,M.S. LPC Lori Kochevar, M.S. LPC 810 12th Street, Greeley Co 80631 www.aspacetogrow.com Original Message From: Elaine Furister [mailto:furistef@co.weld.co.us] Sent: Wednesday, April 14, 2004 7:50 AM To: lorik@aspacetogrow.com Subject: Home Study Bid Lori, 4/15/2004 Page 2 of 2 The following is an excerpt from the Minutes of the FYC Commission Evaluation Committee. Please respond to your acceptance of the condition in the letter to the Department. The condition will be included in your Notification of Financial Assistance. If you have further questions,please let me know. ■ Action:A motion was approved to recommend the acceptance of the following Bid for Program Year 2004-2005 with the following condition. A. Lori Kochevar, LLC Condition: The provider is approved for Foster Care Home Studies only. This is because of the higher bid rate for Adoption Home Studies. Incoming mail is certified Virus Free. Checked by AVG anti-virus system(http://www.grisoft.com). Version: 6.0.639/Virus Database:408-Release Date:3/22/2004 Outgoing mail is certified Virus Free. Checked by AVG anti-virus system(http://www.grisoft.com). Version: 6.0.639/Virus Database:408-Release Date: 3/22/2004 4/15/2004 Lori Kochevar, MS LPC 810 12`s Street Greeley Co 80631 Weld County DSS PO Box A co ar'n Greeley Co 80631 Cie" pe ot. al V es OF Re: RFP 04005; Lifeskills APR ¢ Re: RFP 006-00: Foster Parent Consultation 2004 Dear Ms. Griego, This letter serves as written confirmation that I received the results of the Bid Process for PY 2004-2005 except for RFP 006-00: Home Study, Relinquishment Counseling. Elaine is currently sending me this part of the letter. The following is the response requested by the conditions for the RFP 05005, Lifeskills. Condition 1: Written explanation of$20 increase in rate from last year. Last years bid of$65 per hour of service did not cover program expenses, as demonstrated .by the actual program budget from 6/1/03-12/31/03 that was submitted to John Cruise 1/04. The actual budget indicated that the program cost $80.43 per hour of service. I believe the $65 hourly bid was inadequate to cover cost because of a low estimate on my part for the costs for this first time bid, as well as,the decreased number of referrals to cover this programs percentage of fixed costs. In hopes of increasing the number of referrals to this program we have made two significant changes. First, we have added two additional Masters level therapists,which are Licensed Professional Counselors, and therefore have raised the rate for providers by $5 an hour. The actual costs of running the program and the increase in rate for the provider are the costs that have increased the bid by $20. In addition,we are currently in the process of locating a home to rent were family visits can occur. This will expand our ability to provide supervised visitation and exchanges in a home setting. One benefit, of this shift to a neutral home setting is that the clinician can get a clearer assessment of the parent's ability to bond with and set appropriate limits with their children in a typical environment . This setting also gives more opportunity for interactional coaching of needed skills with the parents. Having additional space for visitation will also alleviate some of the congestion at the Social Service visitation rooms. We are hoping that by providing a home setting for assessment and coaching during visitation and more bonding specialist with a variety of expertise that the number of referrals to this program will increase. With an increased number of referrals, the fixed cost per session hour will decrease, henceforth covering the additional cost of renting more space for this program. Condition 2: Detailed assessment of how progress will be measured. The provider shall complete the Pre and Post Bonding Assessment for child and parent and/or the AIMS Developmental Indicators of Emotional Health as clinically appropriate at the initial interview, after 12 hours or intervention, and as a final measurement at 24 hours of intervention. See sample of measurements in Appendix to this letter. These measurements of progress will be forwarded to the caseworker with the monthly progress reports. Condition 3: The program will not exceed the 24 hour limit,with the second 12 hours of service contingent upon the outcome of the first 12 hours. The only change that we would like to suggest in this part is that the first sentence changes to a process goal. It the parent(s)were not able to begin the bonding process within the first twelve hours, and then the family would be referred to an interactional and/or psychological evaluation. B. All staff changes will be reported to DSS Thank you for this opportunity to again serve the families of Weld County. Please let me know if you are in need of any further clarification. Sincerely, /� (1±1' It Lori Kochevar I� S. LPC AIMS: Developmental Indicators of Emotional Health idclinesforrs tJjosocia1 Pracice . _. 1\11%1O IENV POINTS OF OBSERVATION (11 I STIO\5 Strengths Concerns YQ want to talker' L'I 'ACIIMENT. .. ATTACIIME.NT an:dnpg$og tfieAR4 ❑ parent is at ease when holding baby ❑ parent appears stiff or awkward when holding baby questionnaire? ❑ parent describes baby in positive terms ❑ parent is unable to describe baby or uses primarily negative terms . orierrral.Ar4 eat and ❑ parent shows concern over baby's crying or distress ❑ parent does not appear to"bear"or react/respond to tPEll-$iirtg: baby's cries I:-How'arethints.going with ❑ parent appears pleased with being father/mother U parent shows little or no pleasure in being a father/ you,youc baby and the mother baby's otherpart ut? ❑ parent looks at baby often,is attentive and smiles at ❑ parent does not look at baby,seems uninvolved, ?: 'l'R ne about the delivery. baby detached or mechanical .4..,Arestotkgrth*the,th,w with ❑ parent touches baby tenderly ❑ parent does not touch baby except to accomplish a your itetvb'etiy?Are you basic child care task/parent touches baby abruptly, getting enough sleep?: aggressively,or impassively 4. is your baby easier or Mom difficult to takecare of than INTERACTION -INTERACTION you had imagined? ❑ baby molds to parent's body U baby recoils,arches,or stiffens when held by parent 5: Are you planning to return ❑ baby appears alert ❑ baby appears lethargic,parent does not describe -fo work' Havcyon deciged periods when baby is alert svbu avtll care-foryour ❑ parent seeks to protect baby from possible harm ❑ parent appears unaware of possible harm;no effort 'b uy? (e.g.,covers when cold,comforts after shot,guards made to offer protection to baby 6. Is there anything worrying baby from falling off table) you since the.birth of your ❑ parent feeds baby according to baby's signals of ❑ parent appears intrusive,rushed or slow at feeding hunger and satiation baby,does not seem attuned to baby's signals of hunger and satiation Slie"Ca{egrfdPelauoItsksp. ❑ parent holds baby in face-to-face position for O parent does not hold baby in face-to-face position; Y= feeding;eye contact is established positions baby away from body to feed;eye contact I Are you eioying your not established baby? ❑ parent talks to baby ❑ no verbalization to baby 2- Are you breast orbottlb 'feeding?Row are-the aASTERX 1-IASI EI Y feedrogs MAW O parent shows confidence in role as parent Cl parent appears more anxious,depressed or 3. Ax.yonle*lingcomfort - overwhelmed than expected able or uneettain using your own juttgmentabou@. U parent has appropriate awareness of baby's abilities ❑ parent expects baby to do more than baby can,or feeding,clothing diapering, appears unaware of baby's innate abilities bathing"and playing with Cl parent effectively uses a variety of techniques to ❑ parent does not try different things to comfort baby your baby? comfort or help baby settle but stays with one technique even if it appears not 4. to help baby lbw is-Your GabYsleb:Per $. now does youriam1lf pea ❑ parent is able to perform basic child care tasks ❑ parent is not able to perform basic child care skills 'about thebaby? (e.g.,puffing on clothing,diapering,feeding) 4,OEolt SUPPORT: ❑ parent asks for help or information ❑ parent appears hesitant or unable to ask for help or information ❑ parent appears sufficiently rested and healthy ❑ parent appears overwhelmed,tired,stressed or unhealthy ❑ family appears and/or reports having adequate ❑ family appears and/or reports having inadequate housing,transportation,finances and child care housing,transportation,finances and child care 8/5/96 ©copyright,Project AIMS AIMS: Developmental Indicators of Emotional Health 2 MONTHS 'Guidelinesioc PsychosocialTractice INTERVIEW POINTS OF OBSERVATION QUESTIONS N y Strengths Concerns ,B ou waaf jii talk2bout ATTACHMENT ATTACHMENT i> g f`inut`Sjre AIMS! ❑ parent is at ease when holding baby ❑ parent appears stiff or awkward when holding baby Uetponnaire? - ❑ parent describes baby in positive terms ❑ parent is unable to describe baby or uses primarily negative terms p nWi asrinenr�mbT ❑ baby is able to be comforted by parent ❑ baby remains distressed despite parental efforts • ea 6efngf CIparent shows concern over baby's crying or distress ❑ parent does not appear to"hear or react/respond 1. ffowatt, eel g? to baby's cries 2 ;,kre'394 ¢,}1n_g.enough: --31e —ill!oyoufself? INTERACTION INTERACTION -4e'yp.vlfth.faltrbaliyl. 1 ❑ baby molds to parent's body ❑ baby recoils,arches,or stiffens when held by • :-Ltime'Witll fanlUyand parent friends? ❑ parent able to calm baby down when distressed ❑ parent is unable to calm baby 3.,h,thereatplitillgictlpur ❑ baby appears alert,socially involved ❑ baby appears lethargic,apathetic,socially mind tbal;you would'Iiketo uninvolved u' y? ❑ parent's stimulation of baby is appropriate ❑ parent appears intrusive,over-stimulating,or under-reactive toward baby - ,?nitief twnshP ❑ parent and baby make eye contact ❑ no eye contact between parent and baby ❑ parent seeks to protect baby from possible harm ❑ parent appears unaware of possible harm 1. ;Row are things going with (e.g.,covers when cold,comforts after shot,guards rqurbaby?', baby from falling off table) 2 How ar yoyaandlhebaby. dotogwltbuth�fi?" MASTERY MASTERY 'I4oyoti have xpq; Ciat ❑ parent appears confident in parent role ❑ parent appears more anxious,depressed or Awotrtes Ontlryourbabli? overwhelmed than expected Ypur.family? A: now does your family;feet la parent is able to perform basic child care tasks CI parent is not able to perform basic child care skills (e.g.,putting on clothing,diapering,holding) about theMby? ❑ parent is prepared for baby's needs(e.g.,brings ❑ parent is ill-prepared for meeting baby's needs bottle,toy,diaper) 'SUPPORT SUPPORT ❑ parent asks for help or information ❑ parent appears hesitant or unable to ask for help or information ❑ parent is responsive to information,advice or other ❑ parent rejects offers of help forms of help ❑ parent appears rested and healthy ❑ parent appears overwhelmed,tired,stressed or unhealthy ❑ family appears and/or reports having adequate ❑ family appears and/or reports having inadequate housing,transportation,finances and child care housing,transportation,finances and child care 4/96 0 copyright,Project AIMS AIMS: Developmental Indicators of Emotional Health 4 MONTHS Guidelinesfur'I?'sycla9oowia1‘Pr.acticer IN-FERN IE\\ POIN IS OI OBSLR\ A-I LO\ QL ES I IONS " , , 4rB -, ,f ,,. Strengths Concerns > oy t A;TwTACHMENTT A "I CHMENT as ❑ parent is at ease when holding baby ❑ parent appears stiff or awkward when holding baby t-,- U parent describes baby in positive terms ❑ parent is unable to describe baby or uses primarily negative terms jd4�urraf�ddf' triten'°nd ❑ baby shows preference for parent ❑ baby shows no preference for parent W,e/Fbegrg I. Ti ipr, eehn CI parent maintains close proximity to baby O parent makes no effort to maintain close proximity Y g? ❑ parent is pleased by positive comments made ❑ parent 2. Ate YOU getting enough: ' b appears unaffected by positive comments about baby about baby —sl�? mce gyo lt7 - INTERACTION —help withryour babyTCTiQN ❑ baby molds to parent's body U baby recoils,arches,or stiffens when held by ;-time withfamityand parent .ftaende ❑ parent's stimulation of baby is appropriate ❑ parent seems intrusive,overstimulating,or 3. nave you fotnid,a,babysitter- under-reactive toward baby Who you like?Have you Oparent and baby make eye contact n out without your babj!. y O no eye contact between parent and baby yet? ❑ parent seeks to protect baby from possible harm ❑ parent appears unaware of possible harm 4. I:s there.nnythin'on your (e.g.,covers when cold,comforts after shot, ike to guards baby from falling off table) nm lhat youwould l tdk' ttoday? ❑ baby is able to signal needs to parent ❑ baby is difficult to read and unable to signal needs effectively Basic Care and Relationship O baby appears to enjoy people and things U baby appears uninvolved with people and things 'wit"B'aby: I.-It lane about a typical day MASTERY MASTERY - with-your y. ❑ parent appears confident in parent role ❑ parent seems more anxious,depressed,or 2.•Whatnot/.iipgsisyour- overwhelmed than expected baby doing? U parent effectively uses a variety of techniques to ❑ parent makes little or no effort to calm or comfort 3. Doyou feel that life with comfort baby baby your baby has begun to ❑ t is able to settledown? Parce perform basic child care tasks O parent is not able to perform basic child care tasks (e.g.,putting on clothing,diapering) 4. Do you have any special' ❑ is for baby's `.wohiea abUtt iroueboy? parent prepared y' needs(e.g.,brings ❑ parent is ill-prepared for meeting baby's needs your family? bottle toy,diaper) 5. Haw doesyo r family feel ❑ baby shows a beginning range of emotions ❑ baby demonstrates little affect about thebaby? .. SUPPORT t ❑ parent asks for help or information Cl parent appears hesitant or unable to ask for help or information ❑ parent is responsive to information,advice or other O parent rejects offers of help forms of help ❑ parent appears rested and healthy ❑ parent appears overwhelmed,tired,stressed or unhealthy ❑ family appears and/or reports having adequate ❑ family appears and/or reports having inadequate housing,transportation,finances and child care housing,transportation,finances and child care 4/96 0 copyright,Project AIMS PRE AND POST ASSESSMENT Bonding Program Name: Date: Date: 1. Parents will be able to show improved competency in parenting practices. • Increased awareness of the emotional needs of the children. • Increased understanding of bonding and how poor bonding affects the child • Increased positive responses to the child • Increased ability to interact with the child in a manner which enhances bonding • Increased awareness of the developmental age of the child and practice age appropriate expectations. • Child will show increased response to the parent. • Child will show increased respect for the parent • Increased understanding of punishment vs. discipline • Increased ability to utilize discipline measures which are not emotionally detrimental to the children 2. Parents will develop a greater understanding of the components that are necessary to insure a lasting family relationship. • Increased ability to place the children a position of high priority in the home. • Increased ability to continue to utilize the parental and relationship skills learned in the program. • Increased ability to recognize and meet own needs. • Increased ability to maintain sources of support in the community for self and children. • Increased awareness of the ongoing emotional needs of the children. 3. Parents will be able to improve household management competency as measured by a pre and post assessment of skills needed to maintain a safe and secure home. • Increased resources to provide for the family needs • Improved ability to maintain a clean, healthy environment PRE AND POST BONDING ASSESSMENT Child Parent Date: Date: Check: Avoids eye contact Resists being-held-stiffens body, / Pulls away front touch Does not respond to mothers voice-avoids, ignores Resists feeding when mother holds bottle- prefers propped bottle Somber, sad expression, withdrawn Lack of responsive smile Prefers to play away from mom, does not check in with mom periodically _ I! Decreased stranger awareness,prefers others to mom Eating problems, gorging, refusal, FT Destructive of own or others property, frequently breaks own toys High pain tolerance,self-abusing behaviors _/ Clingy, whiney, fussy baby,hard to console Defiant, resistive behavior _/ Manipulative Senseless lying Hyperactive behavior,unable to be still or to focus, !� Sullen, quiet and withdrawn Frequent tantrums,often lasting for unusually long 4 time /_ Developmental delays, learning, speech,motor / Speech delays or speech is difficult to understand _/ Hurtful to others or animals Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission (Core)Funds Type of Action Contract Award No. X Initial Award FY 04 05-CORE-0037 Revision (PY 04-05 RFP-FYC-006-00) Contract Award Period Name and Address of Contractor Beginning 06/01/2004 and Transitions Psychology Group,LLC Ending 05/31/2005 Foster Parent Consultation 810 11 Avenue Greeley,CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Program incorporates the elements of Assistance Award is based upon your Request for assessment, foster parent consultation and Proposal(RFP). The RFP specifies the scope of support groups,biological child support groups, services and conditions of award. Except where it is individual psychological consultation with foster in conflict with this NOFAA in which case the parents, and mandated training for foster parents. NOFAA governs,the RFP upon which this award is Services to Weld County foster parents. Foster based is an integral part of the action. parent consultations will be provided through group consultation services for a maximum of Special conditions five groups per month, 6-10 participants per group. Individual consultation services will only 1) Reimbursement for the Unit of Services will be based be provided when approved by the Resource on a per group rate. Services Manager or Child Welfare 2) Payment will only be remitted on cases open with, Administrator of Social Services. and referrals made by the Weld County Department of Social Services. Cost Per Unit of Service 3) Requests for payment must be an original submitted to the Weld County Department of Social Services by Group Rate per $ 350.00 the end of the 25th calendar day following the end of Hourly Rate per Individual Consultation $ 90.00 the month of service. The provider must submit Based on Approved Plan responses for payment on forms approved by Weld County Department of Social Services. Enclosures: 4) Requests for payment must include original client X Signed RFP: Exhibit A verification signatures (blue or red ink preferred)and X Supplemental Narrative to RFP: Exhibit B dates and hours of service. Recommendation(s) 5) The Contractor will notify the Department of any X Conditions of Approval change in staff at the time of the change. Approvals: Program Official: By By Robert D.Masden, Chair Jud . Gri o, Direc r Board of Weld County Commissioners Wel County Department of Social Services Date: G I it/Qy Date: £/25Jo1 axe 4/. S SIGNED RFP-EXHIBIT A ti , r ^QUEST FOR QUALIFICATIONS a OFF'SYSTEM BID B001-04(RFQ-006-00) DATE:February 11,2004 RFQ NO: 006-00 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Qualification(006-00) for: Colorado Family Preservation Act—Foster Parent Consultation,Emergency Assistance Program • Deadline: March 5, 2004,Friday, 10:00 a.m. The Families,Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Act(C.R.S. 26-5.5-101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement Act(C.R.S. 26-5.3-101). The Families,Youth and Children Commission wishes to approve services targeted to run from June 1, 2004,through May 31,2005, at specific rates for different types of service,the county will authorize approved vendors and rates for services only. The Foster Parent Consultation Program must provide services that focus on providing psychological consultations and parenting support to foster parents which are designed to improve foster parent competency, family conflict management, and effectively accessing community resources. This program announcement consists of five parts, as follows: • PART A...Administrative Information PART D...Qualifier Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) RFQ MUST BE SIGNED IN INK GYsehor1 S' Crctc` TYPED DR/PRINTED SIGNATURE -rrah5it165 VENDOR Q�alp LAM bra up i 1.14- /_ , cJ (Name) `Handwri Signature By Authorized Officer oi'Agent of Vender ig� ii'h ADDRESS T � '3 Oe) ( TITLE 'kAQC DATE ;/s-to PHONE# sq--o) %3 b-t la-3 The above RFQ is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 28 Off-System Bid Number B001-04 (RFP-FYC 006-00A) Attached A FOSTER PARENT CONSULTATION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING COLORADO FAMILY PRESERVATION ACT 2003-2004 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2003-2004 OFF SYSTEM BID B001-04 (006-00A) NAME OF AGENCY: _Transitions Pyschology Group, LLC _ ADDRESS: 804 11th Avenue, Greeley, CO 80631 PHONE: (970) 336-1123 CONTACT PERSON: Gregory S Creed TITLE: co-owner DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation Program Category must provide services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household management competency, parental competency, family conflict management and effectively accessing community resources. 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1, 2004 Start June 1, 2004 End May 31, 2005 End May 31, 2005 TITLE OF PROJECT: _Transitions Foster Family Consulting AMOUNT REQUESTED: ti S50. / group q05°° / ih4i vi4t to farmµve-Har Thati 03/05/0( Name and Signature of Person Prepa ' Document Date .12 C--ei cre�o�y cviced ame d Si ature 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 roject Description ate. arget/Eligibility Populations Types of services Provided Measurable Outcomes Service Objectives Workload Standards taff Qualifications Unit of Service Rate Computation rogram Capacity per Month Certificate of Insurance Assurance Statement 02/27/2004 FRI 12:43 FAX /2003/003 . .. . ., Off-System Bid No. 0002-04 RFP-FYC-006-00B Attached A /��p 7 �tc afi •, j ,##4 Gp . Date of Meeting(s)with Social Services Division Supervisor: enta by SSD Supervisor• ,.. ij'Aer 744,,,a_tecds7 de-19445;), 1‘_,A -17• alatioisnad ofest Afer--#47 1 . , piagaraga7. ate • • / Name and Signature of SS upervisor Date Foster Parent Consultation Transitions Psychology Group, LLC 1 2004-2005 • • •• Program Category: Foster Parent Consultation • • Project Title: Transitions Foster Family Consulting • • • •• • Vendor: Transitions Psychology Group, LLC •• • W� Transitions PSYCHOLOGY GROUP, LLC I. PROJECT DESCRIPTION Transitions Psychology Group, LLC (Transitions) is a private counseling agency consisting of a multidisciplinary team of human service professionals providing superior counseling, assessment and consultation services to children and families in Northern Colorado. The mission of the Foster Family Consulting Program is to enhance the overall quality and safety of foster care for children in Weld County by supporting foster families. The purpose of the Foster Family Consulting Program is to provide psychological consultations and support to foster parents and their children in order to promote foster family retention, increase foster parent competencies, improve family conflict management, and improve ability to utilize appropriate community and government resources. The design of the Foster Family Consulting Program incorporates the elements of assessment, foster parent consultation and support groups, biological child support groups, individual psychological consultation with foster parents, and mandated training for foster parents. All of the components are intended to encourage foster family retention through the experience of successful foster parenting. As facilitators, Transitions will promote the program activities to all foster families in Weld County. Transitions Foster Family Consulting is based on the belief that foster families possess inherent strengths and that these strengths can be shared in foster parent networks in order to bolster parenting effectiveness and satisfaction in fostering children. Access to information and resources is a vital part of promoting behavioral change and increased effectiveness in parenting. Transitions Foster Family Consulting strives to empower foster parents through reduction of isolation, viewing the foster parents as experts, mutual sharing of information on community and government resources, encouraging positive parent-child interactions, and promoting continual self-motivated development of parenting competencies. Programs that provide social support have direct and indirect influences on the family: health, sense of Foster Parent Consultation Transitions Psychology Group, LLC 2 2004-2005 well-being of the foster parents, family functioning, parent-child interaction, and child behavior and child development are all potential areas of impact. Transitions Foster Parent Consulting is geared towards creating a ripple effect of positive change within and among families that will continue beyond the scope of the program. II. TARGET/ELIGIBILITY POPULATIONS The Transitions Foster Family Consulting program serves foster families in Weld County. Foster parents are directly served through foster parent support groups, individual foster parent consultation, and mandated training for foster parents under corrective action plans. Biological children of foster families are also directly served through support groups. Finally, the foster children are served indirectly through improved foster parent-child interaction, and subsequently improved behavior and personal development. Transitions does not discriminate based on race, color, religion, national origin or sex, in accordance with State and Federal lawn, rules, and regulations. Transitions will offer four foster parent support groups and one biological sibling support group each month. The groups will be held on different days and times in order to better accommodate busy foster family schedules. A. The Foster Family Consulting Program will serve an estimated 100 clients. B. Members of the same family will be eligible to participate in the services, thus approximately 65 family units will be served. C. Up to 42 individuals will be eligible for bilingual/bicultural services. D. 24 Individuals will be able to receive individual consultation in South Weld County. Transitions would also be willing to hold one Foster Parent Group per month in Ft. Lupton if space were available, serving an additional 18 clients in South Weld County. E. The monthly capacity per group is 10 participants F. The monthly average capacity per group is 8 participants G. The average stay in the program is 26 weeks for group participants who participate on a monthly basis and 6 weeks for individual consultation participants. H. Transitions will host an average of one group per week. III. TYPE OF SERVICES TO BE PROVIDED A. Consultation and Foster Parent Group Support 1. Foster Parent Screening- Transitions will conduct an assessment with all families entering the program. Solution-focused scaling of content areas and ecological maps will be utilized to determine the current Foster Parent Consultation Transitions Psychology Group, LLC 3 2004-2005 functioning of each family and to establish goals. The content areas that will be evaluated include parenting competencies, household management competencies, support network, family conflict management, biological and foster children's needs, motivation and commitment. 2. Group sessions— Foster parents will be give the opportunity to chose between four consultation and support groups, each offered once per month. Groups meet for 1% hours at Transitions' offices. Members will be encouraged to attend the same group monthly but will be allowed to attend more than one group per month, based on need and approval or recommendation of Weld County. Members will also be allowed to attend alternate groups, with advanced notice to Transitions, when they have scheduling conflicts. Transitions intends to create cohesiveness in each group, and at the same time, we want to maintain enough flexibility to accommodate foster family needs and busy schedules. Groups will be time-limited, running for six months. The support group offers a unique opportunity for foster families to create a supportive network and to share useful information on community resources and parenting successes. The groups are intended to remain proactive and preventative in nature, and counselors will structure groups so as not to become mere complaint sessions or social hours. Transitions counselors are trained to be facilitate the group process, to consult, and to respect and encourage the participation and contribution of each member. Transitions will solicit ideas for group themes from the participants based on their specific needs so the group will remain relevant and helpful. 3. Re-evaluation-Following the sixth group session, the Transitions counselor and foster parent will again use the solution-focused scaling of content areas to measure progress. If stated goals have been met, the foster parent completes the group or defines new goals. If the goals have not been met, the parent will have the option to continue in another series of group sessions with Weld County approval or be referred to other services. B. Individual Foster Parent Consultation Transitions will make a request to the Social Services Foster Program for individual psychological consultation with an individual foster parent(s) when a situation of critical and urgent nature arises that cannot effectively be dealt with in the support group format. The criteria for the request would include the risk of imminent removal or danger to a foster child. Transitions will utilize models of parent consultation only and will maintain clear boundaries for the intervention so as not to confuse the consultation with therapy. Appropriate referrals for counseling or other necessary Foster Parent Consultation Transitions Psychology Group, LLC 4 • 2004-2005 services will be made on professional assessment at the time of the intervention. Consultations will be limited to six direct contact hours. C. Mandated Training for Foster Parents Transitions will accept referrals for mandated training of foster parents under corrective action plans and follow-up services. The goals on the action plan will be central to the intervention. Progress towards goals will be tracked and measured pre and post using solution-focused scaling. D. Training to Satisfy State Training Requirements Transitions consultation and foster parent support groups will contain monthly educational components designed to meet the specific needs of the group's membership. Up to one training credit a month could be recorded for each critical care foster parent participating in the group, with Weld County approval. E. "Get Real" (Support Group for Biological Children of Foster Parents) The biological children of foster families need support too, so to help lower family stress, Transitions will offer this unique support group. The groups are intended to be fun, informative, and to create an atmosphere of safety and support for biological children. The groups will be time-limited: They will meet monthly for six sessions per group. Transitions would expect most of the interested participants to fall in the age range of 8-13. If however, more teenage children plan to attend, an additional group could be formed to better accommodate their needs. F. Assurances Transitions assures that foster parent group consultation will not be provided by a professional staff member who is providing therapeutic services to foster children in the same home. Transitions works in collaboration with case workers assigned to the children involved. All assessments, clinical recommendations, and opinions derived in consultation will be directly shared with the caseworker. Transitions strives to have all components of the system working together and will attend any necessary staffing meetings with caseworkers, foster parents, and supervisors involved in the case. In accordance with 19-1-120 C.R.S., reports of child abuse and identifying information are held in strict confidence. IV. MEASURABLE OUTCOMES Transitions will measure outcomes based on participant self-anchored scales on solution-focused oriented goals, on participant self-report of progress in content areas on 1-10 scales and ecological mapping. The self-anchored Foster Parent Consultation Transitions Psychology Group, LLC 5 • 2004-2005 scales allow the consultant to formulate solutions in collaboration with the participant, from the participant's view of the problem and tapping into the participant's resources. People are more accepting of help and have a greater sense of empowerment in this approach. This approach also fosters self-efficacy and less dependence on "the system" for solutions. The self- anchored scales are essentially a single-case AB research design. The content areas for the pre and post assessments include, but are not limited to, household management, parental competencies, support network, specific skills and competencies related to caring for children in foster care, family stress levels, family communication and interpersonal relations, sense of well-being, problem solving and coping, family resources, and meeting the needs of biological children in the home. Progress will be measured by identifying changes on the 1-10 scaling for each content area. On the ecological maps, progress will be measured by the change in the number of family supports and services offered by each support. V. SERVICE OBJECTIVES The Transitions Foster Parenting Consulting program service objectives have direct links to assessment, measurable outcomes, and participant goals. The screening begins to shape participants' expectations for the program because content areas are directly covered. If foster parents' concerns fall outside of the content areas or go beyond the content areas in severity, they would be screened from the consultation group and the proper referrals would be made. Through the screening, Transitions will also have a better idea of participant needs and common goals. These needs and goals will become the focus of the groups. Depending on needs, special groups could be formed focused on topics such as sexualized behaviors, supporting foster children through separation and loss or specific discipline problems. Transitions will perform a foster parent screening on each referred family, using solutions-focused scales to rate the family on household management competency, parental competency and the ability to access resources, among other measures. A. Improve Household Management Competency The capacity of parents to provide a safe household environment will me measure pre and post intervention using a 10-point scale. The scale will rate the family on competent household cleaning, household maintenance, budgeting and purchasing. B. Improve Parent Competency The capacity of parents to maintain sound relationships with their children and foster children and provide care, nutrition, hygiene, discipline , protection, instructions and supervision will also be measured using the Foster Parent Consultation Transitions Psychology Group, LLC 6 • 2004-2005 pre and post Foster Parent Screening, including quantitative ratings on a 1-10 scale. C. Improve Ability to Access Resources Work with ecological maps will assist foster parents to access resources in the community and within local, state, and federal governments. Comparisons between the pre- and post-intervention on ecological maps will quantify the improvements in the family's ability to access resources, as the objective would be to increase the number of resources identified on the map and/or the number of valuable services provided by the resources. Alternately, eliminating resources that were not considered helpful but are consuming family time and energy would also be an objective. VI. WORKLOAD STANDARDS Transitions will have a maximum of five groups per month. That number includes four foster parent groups and one biological child group. As Transitions intends for most issues to be addressed in the group sessions, few requests for individual consultation are anticipated. Transitions anticipates one request for individual consultation per month. There will be four professionals available to provide services on the program with a maximum caseload per worker of four groups per month and maintaining four open consultation cases. The program uses the following modalities of treatment: support group, psychological consultation. Transitions' professionals also perform case management and case consultation and attend staff meetings associated with the program. Total number of work hours per week would range from 10-15 hours. Two counselors would be providing the majority of the services, but Transitions has four professionals available to provide the services if necessary. The supervisor will not directly serve clients, but will consult on the program as needed. The supervisor can carry a maximum caseload of 50 families per year in this capacity. Each Transitions counselor carries individual professional liability insurance with minimum limits of$1,000,000 per occurrence and $3,000,000 aggregate. Transitions workplace liability is included in the co-owners' $1,000,000 per occurrence and $6,000,000 aggregate policy limits. Transitions is insured through the Healthcare Providers Service Organization (HPSO). VII. STAFF QUALIFICATIONS All staff members involved in the Foster Parent Consulting program have a minimum of a master's degree in a counseling related field and are licensed professionals. Current staff members are Licensed Professional Counselors (LPC), but we would accept the related licenses of Licensed Clinical Social Worker, Licensed Marriage and Family Therapist or Licensed School Psychologist. The Transitions supervisor is a Licensed Psychologist. Currently Foster Parent Consultation Transitions Psychology Group, LLC 7 2004-2005 we have four staff members available for the program, three counselors and one supervisor. VIII. UNIT OF SERVICE RATE COMPUTATION Rates are $350 per group and $85 per direct contact hour for individual foster parent consultation and mandated training for foster parents as stipulated by Weld County. Healthcare Providers Service CNAOrganization Purchasing Group ®HPSO CNA Plaza, Chicago,IL 60685 (I:Certtftcate of ;11xtsurauce Producer Branch Prefix Policy Number Policy Period from: 12:01 AM Standard Time on: 07/04/03 018098 970 HPG 270170686-8 to: 12:01 AM Standard Time on: 07/04/04 Named Insured and Address Program Administrator Healthcare Providers Service Organization GREGORY S CREED 159 East County Line Road 804 11TH AVENUE Hatboro, PA 19040-1218 GREELEY CO 80631-3246 Insurance Provided Medical Specialty: Code: by Clinical/RehabilitationCounselor 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, IL 60685 COVERAGE PARTS LIMITS OF LIABILITY A. PROFESSIONAL LIABILITY _ • . . Professional Liability $1,000,000.00 each claim $6,000,000.00 aagreaate Good Samaritan Liability Included above Personal Injury Liability Included above Malplacement Liability Included above B. Coverage Extensions License Protection $5,000.00 per proceeding $12,500.00 aggregate Defendant Expense Benefit $5,000.00 aggregate Deposition Representation $1,250.00 per deposition $2,500.00 aggregate Assault $5,000.00 per incident $12,500 .00 aggregate Medical Payments $1,000.00 per person $50,000.00 aggregate First Aid $1,250.00 aggregate Damage to Property of Others $250.00 per incident $5,000.00 aggregate C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy. Workplace Liability Included in A. Professional Liability Limit shown above Fire and Water Legal Liability Included above subject to $150,000 sub-limit Personal Liability I $500,000.00 aggregate D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy. Workplace Liability None None Hired Auto & Non Owned Auto None Fire & Water Legal Liability None None Personal Liability I None Total Premium $250.00 Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 G-144872-A G-144959-A G-121500C G-121501C G-123846C-05 G-121503C G-121489-ACA Healthcare Providers Service Organization is a division of Affinity Insurance Services.Inc.;in NY and NH,MS Affinity Insurance Agency,in MN and OK,MS Affinity Insurance Agency,Inc;and in CA,MS Affinity Insurance Agency,Inc-dba Aon Direct Insurance Admudsirators License#0795465. Master Policy: 188711433 your this document in a assafe plof The and I your cancelled check act proof of coverage. fry‘t Chairman of the Board Secretary • Healthcare Providers Service CNA Organization Purchasing Group C L�HPSO CNA Plaza, tu..k&..PA..a..,s.,.+..o....:..o..' I Chicago,IL 60685 Certificate (" ftcate cif „I-Insurance xnc.e Producer Branch Prefix Policy Number Policy Period from: 12:01 AM Standard Time on: 07/04/03 018098 970 HPG 270170798-8 to_: 12:D1 AM Standard Time on: 07/D4/04 Named Insured and Address Program Administrator Healthcare Providers Service Organization JAMI MOE HARTMAN 159 East County Line Road 804 11TH AVENUE Hatboro, PA 19O40-1218 GREELEY CO 80631-3246 Medical Specialty: Code: Insurance Provided by i Clinical/RehabilitationCounselor 72990 American Casualty Co. of Reading, PA • CNA Plaza 26S Chicago, IL 60685 COVERAGE PARTS LIMITS OF LIABILITY i A. PROFESSIONAL LIABILITY Professional Liability $1,000,000.00 each claim $6.000,000,00 aggregate Good Samaritan Liability Included above Personal Injury Liability Included above Malplacement Liability Included above B. Coverage Extensions License Protection $5,000.00 per proceeding $1 .500.00 aggregate Defendant Expense Benefit $5,000.00 aggregate Deposition Representation $1,250.00 per deposition $2,500.00 aggregate Assault $5,000.00 per incident $12,500.00 aggregate Medical Payments $1,000.00 per person $50,000.00 aggregate First Aid $1,250.00 aggregate Damage to Property of Others $250.00 per incident $5,000.49 aggregate C. WORKPLACE LIABILITY Coverage part C. does not apply if Coverage part D. is made part of this policy. Workplace Liability Included in A. Professional Liability Limit shown above Fire and Water Legal Liability Included above subject to $150,000 sub-limit Personal Liability I $500,000.00 aggregate D. GENERAL LIABILITY Coverage part D. does not apply if Coverage part C. is made part of this policy. Workplace Liability - None _ None Hired Auto & Non Owned Auto None Fire & Water Legal Liability None None Personal Liability I None Total Premium $250.00 Policy forms and endorsements attached at inception QUESTIONS? CALL: 1-800-982-9491 G-144872-A G-144959-A G-121500C G-121501C G-123846C-05 G-12I503C G-121489-ACA Healthcare Providers Service Organization is a division of Affinity Insurance Services,Inc:in NY and Nil,MS Affinity Insurance Agency,in MN and OK,AIS Affinity Insurance Agency,Inc..and in CA.Am Affinity Insurance Agency.Inc.dba Aon Direct Insurance Administrators License 00795465. Master Policy: 188711433 2t1,44417A*9-- Keep this document in a safe place. This and cApy4. 1 {7 fyour cancelled check act as proof of coverage. �,r� f J+`P Chairman of the Rnard Secretary SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B RECOMMENDATIONS X CONDITIONS •• •• 80411 "Avenue RECEIVED BY • •�� •• Greeley, CO 80631 • •••• • , Phone: (970)33 -1123 • . FAX: (970)351-0182 APR 1 3 2004 • ••• • . W Transitions PSYCHOLOGY GROUP.LLC April 13, 2004 Gloria Romansik Weld County Department of Social Services P.O. Box A Greeley, CO 80632 Re: RFP 04005: Lifeskills RFP 006-00: Foster Parent Consultation RFP 006-00: Home Study, Relinquishment Counseling Dear Ms. Romansik, Please accept this letter as our written confirmation for the results of the Core Service bid evaluation process PY 2004-2005. Transitions Psychology Group, LLC accepts all of the programs bid for: 1. RFP 04005: Lifeskills 2. RFP 006-00: Foster Parent Consultation 3. RFP 006-00: Home Study, Relinquishment Counseling Transitions also accepts Condition B as stated in your notification letter dated April 6, 2004. The condition is as follows: "the provider will notify the Department of any change in staff at the time of the change." As an agency, we are very appreciative of the opportunity to work with you in these programs that mean so much to our community. We look forward to continuing a productive and mutually beneficial relationship with the Department of Social Services. Please feel free to contact us, if you have any questions. Sincerely, --(g5Q)Cift Gregory S. Creed, MA, LPC Jami Moe-Hartman, MA, LPC Co-Owner Co-Owner DEPARTMENT OF SOCIAL SERVICES fa P.O.BOX A GREELEY,CO.80632 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 O COLORADO April 6,2004 Greg Creed, Co-owner Transitions Psychology Group,LLC 804 11 Avenue Greeley,CO 80631 . Re: RFP 04005: Lifeskills RFP 006-00: Foster Parent Consultation RFP 006-00: Home Study,Relinquishment Counseling Dear Mr. Creed: 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 Through the 2004-2005 Core Services bid evaluation process,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 04005: Lifeskills 2. RFP 006-00: Foster Parent Consultation 3. RFP 006-00: Home Studies,Relinquishment Counseling B. The Families,Youth,and Children Commission recommended the followine 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 Bid and Notification of Financial Assistance Award (NOFAA). If you do not accept the condition(s),you will not be authorized as a vendor unless the FYC Commission and the Weld County Department of Social Services accept your mitigating circumstances. If you do not accept the condition, you must provide in writing reasons why. A meeting will be arranged to discuss your response:Your response to the above conditions will be incorporated in the Bid and Notification of Financial Assistance Award. Page 2 Transitions Psychology Group,LLC/Results of Bid Process 2004/2005 The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and conditions.Please respond in writing to Gloria Romansik,Weld County Department of Social Services,P.O.Box A,Greeley,CO, 80632,by Wednesday,April 14, 2004,close of business. If you have questions concerning the above,please call Gloria Romansik at 352.1551,extension 6230. Sincerely, J y A. 'ego, cto cc: Juan Lopez, Chair,FYC Commission Gloria Romansik, Social Services Administrator Hello