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Home My WebLink About20041635.tiff RESOLUTION RE: APPROVE FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS WITH VARIOUS PROVIDERS FOR LIFESKILLS PROGRAMS 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 Lifeskills Programs between the County of Weld,State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and the following providers,commencing June 1,2004,and ending May 31,2005,with further terms and conditions being as stated in said awards: 1) Youth Emancipation and Services, Inc. 2) Ackerman and Associates, P.C. 3) Lori Kochevar, LLC 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 Lifeskills Programs between the County of Weld,State of Colorado, by and through the Board of County Commissioners of Weld County,on behalf of the Department of Social Services, and 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. 2004-1635 SS0031 do: SS C , S� nr` 33--nc7 FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR LIFESKILLS PROGRAMS PAGE 2 The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 16th day of June, A.D., 2004, nunc pro tunc June 1, 2004. ,I' 1 pis BOARD OF COUNTY COMMISSIONERS `_csa4, ////////�//11A/A//A,/////// /d/� WELD\ Cf\�10UNT(\Y, COLORADO 1I1 1861 ((futfi _ E / //Y�//v D i *1 A//A Robert D. Masden, Chair �. 'o • tin Clerk to the Board NOD ,,,,,� William . Je e, Pro-Tem eputy Clerk to the Board M. eile PR ED AS T : David Long ounty`Att ney Glenn Vaad Date of signature: 4 -,4`3 -Of 2004-1635 SS0031 153 a DEPARTMENT OF SOCIAL SERVICES (71, 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 FR: Judy A. Griego, Director, Social Services . oL4 l.L Vyvu'j k. RE: Notification of Financial Assistance Awards for Life Skills Programs with Various Providers Enclosed for Board approval are Notification of Financial Assistance Awards (NOFAAs) for Life Skills 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 Life Skills Programs. These services are for children,youth, and families receiving child welfare services. Generally these Life Skills services are for families primarily in the home that teach household management, effectively accessing community resources,parenting techniques, and family conflict management. 3. Providers will be reimbursed according to various rates as provided below: Vendor Name Rate C_A v�Youth Emancipation&Services,Inc. $81.29 per hour ( B.. lr�Ackerman and Associates P.C. $80.00 per hour Lori Kochevar LLC $85.00 per hour D. Child Advocacy Resource&Education(c.a.r.e)— $69.49 per hour Family Advocate Program 2004-1635 E. Child Advocacy Resource&Education(c.a.r.e)— $41.08 per hour(supervised visit) House-Visitation $71.58 per hour(interactional visit) F. Lutheran Family Services—Home Based $65.15 per hour Parent Coach Program G. Lutheran Family Services—Visitation $69.79 per hour(monitored visit) $94.91 per hour(therapeutic visit) $94.72 per hour(in-home transition) $59.85 per hour(case consultation) $46.31 per hour(transportation) H. Transitions Psychology Group, LLC $85.68 per hour 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-0022 Revision (FY-FYC-04005) Contract Award Period Name and Address of Contractor Beginning 06/01/2004 and Youth Emancipation & Services, Inc. Ending 05/31/2005 Lifeskills 3400 16 Street,Bldg. 6, Suite MM Greeley, CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Family therapy,mentoring, group therapy, Assistance Award is based upon your Request for support groups, lifeskills instruction,parenting Proposal (RFP). The RFP specifies the scope of education, employment, and crisis intervention services and conditions of award. Except where it services. This program is structured to serve is in conflict with this NOFAA in which case the youth 16 %s to 18 years of age. Total number of NOFAA governs,the RFP upon which this award clients to be served is 80.This is an estimate of is based is an integral part of the action. 20 family units. Bilingual-bicultural services are Special conditions expected for 12 families. It is estimated that 5-10 1) Reimbursement for the Unit of Services will be families will be served from South Weld based on a monthly rate per child or per family. County. Maximum capacity is 8 families 2) The monthly rate will be paid for only direct face concurrently, monthly average capacity is 6, to face contact with the child and/or family or as average stay is 12 weeks, average hours per specified in the unit of cost computation. week is 2-6 hours, dependent on phase of 3) Unit of service costs cannot exceed the hourly and service.. yearly cost per child and/or family. 4) Payments will only be remitted on cases open Cost Per Unit of Service with, and referrals made by the Weld County Hourly Rate Per $ 81.29 Department of Social Services. 5) Requests for payment must be an original Unit of Service Based on Approved Plan submitted to the Weld County Department of Social Services by the end of the 25th calendar day Enclosures: following the end of the month of service. The X Signed RFP:Exhibit A provider must submit requests for payment on X Supplemental Narrative to RFP: Exhibit B forms approved by Weld County Department of Recommendation(s) Social Services. X Conditions of Approval 6) The Contractor will notify the Department of any changes in staff at the time of the change. Approvals: Program Official: v By 1 By Robert D. Masden, Chair Jud . Gr.e ,Direct Board of Weld County Commissioners Wel oun epaitcu t of Social Services Date: JUN 1 6 2004 Date: /2S/o1 rX 4J —/E-5 SIGNED RFP-EXHIBIT A Cin INVITATION TO BID OFF-SYSTEM BID B001-04 (04005 -04011 and 006-00) DATE: February 11, 2004 BID NO: RFP-FYC-04005 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-04005) for:Colorado Family Preservation Act--Life Skills Program Emergency Assistance Program Deadline: March 5, 2004, Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Program 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 Life Skills Program must provide services that focus on teaching life skills,which are designed to improve household management competency, parental competency, family conflict management and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work n Delivery Date )/ti?, �� /�.�1 '��, (After receipt of order) BITS MUST BE SIGNED IN INK J//a/1/e5 >J /1-bAd /194/ L/'G TYPED OR/ PRINTED SIGNATURE VENDOR /OUTH C71AAIC/PAT7CAf cif//C,5 x/)(11{ z C (Name) Handwritten Signature By Authorized ��J'y".��/}/) cif Officer or Agent of Vender ADDRESS J/`�v /4 S, o ',,_z//L�///tTITLE E xFGu Two toeccTUic'_. COPeFL=f/ LD31163V DATE 3 -5- O'/ PHONE# 9/0- 553-1677 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 33 - Off-System Bid B001-04 (RFP-FYC-04005) Attached A LIFE SKILLS PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2004/2005 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2004-2005 TOFF-SYSTEM BID B001-04 (04005) NAME OF AGENCY: Y6 cur/-1 PA AI C/Pf1T7DAl E (E,eV/eats, 1.UG • ADDRESS: ,3DO /4 rN %eider, e'ai,/a al G, , Sae it /41Jf7 C,�1�fy �D PHONE: 970 - 353 -5S 77 CONTACT PERSON: .."Asy/ta P. / /S 24' TITLE: 5,r,!Gu nw 1)/recc,Dir DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills 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,effectively accessing community resources,and encouraging goal setting and pro-social values. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1, 2004 Start End May 31, 2005 2 End TITLE OF PROJECT: 1,4M/2 '1 XNruAJ5/v SEe✓/a3 1',70622 -4<1SE2) AMOUNT REQUESTED:: '2/ 7/s'. SD //iftStsitt/ L/C D•Y N and Signature of Person Preparing Document Date Judy A. Griego,Director Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REOUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 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 Unit of Service Rate Computation Program Capacity per Month Certificate of Insurance Assurance Statement Page 27 of 33 - Off-System Bid B001-04 (RFP-FYC-04005) Attached A ice-OfMeeting(s)with Social......................................... Comments by SSD Supervisor: cy9 a<9 ) v...2) 9 -f - w -e >At c s Name and Signature of SSD Supervisor Date Page 28 of 33 Youth Emancipation & Services, Inc. 340016`h Street,Building 6, Suite MM Greeley,CO 80634 970-353-5577 RFP-FYC-04005 Family Preservation Program Category: The Life Skills Program Bid Proposal (Attachment A) Project Title: Family Intensive Services Home-based Vendor:Youth Emancipation& Services,Inc.(YES) Contact Person: James P.Nelson MA,LPC 0 I. PROJECT DESCRIPTION What is YES,Inc.? Youth Emancipation& Services, Inc., (YES), is a private not-for-profit Colorado corporation. It is a cooperative venture of several youth service professionals who live and work in Weld County. This group of concerned professionals has come together to provide Weld County families with needed services, such as assessment,life skills education, individual,group and family therapy, emancipation preparation, family and community mediation services, and monitored apartment living. Our Mission The mission of YES is to be of service to families in Weld County who are at risk of broader involvement with the legal and social services systems. We seek to assist youth who have had a difficult adolescence to transition to adulthood in a responsible and sustainable manner. To accomplish our mission we will: 1. Network effectively with area professionals in the youth service field to identify needs which are under- served, and likely to respond favorably to a timely preventive intervention. 2. Develop quality programming designed to meet these targeted needs. 3. Partner with human service agencies, foundations and benefactors to generate community resources to provide services in the most effective way possible. 4. Provide top-quality stewardship of,and accountability for,community resources. 5. Provide ongoing evaluation of the effectiveness of services we provide in order to make improvements in what we do. 6. Provide timely reports to our referral sources to keep them informed of our effectiveness. 7. Remain responsive to the needs of the community, open to new ideas and opportunities to be of service, while consolidating gains and expanding family resources. The Founders of YES are Masters level therapists who have had many years of experience in family therapy, social science research, community needs assessment, individual therapy, group therapy, mediation, and supervision. We have worked extensively with at risk teens and their families, in both a residential treatment and non-residential settings. FISH Families Program This program is structured to preserve and strengthen families through life skills training, coaching, and mentoring,assistance in building a community support network, reducing family conflict while increasing conflict resolution skills. At the same time,the family may have youth in conflict who are in need of support throughout this process, and this project is designed to provide this support as well. (See Section III."Types of Services Provided".) The FISH Families Program is designed for families who need assistance in developing competency in household management,parenting skills, managing family conflict, and finding as well as engaging community resources. These families often include relatives,friends, or others who are enlisted to help care for children in the absence of competent biological parents. Such families come from a variety of cultural and socio-economic backgrounds. Therefore, services will be delivered in a culturally sensitive way,by bi-lingual staff when appropriate. Each family will be assigned a Masters level licensed therapist(LPC,LSW,LCSW,or LMFT)who will act as Intervention Coordinator. This person will deliver therapy, case management,and coordinate mentoring, collateral services, and classroom instruction.Family contact will take place primarily during late afternoons, early evenings, and weekend hours when families are not at school or work. Crisis Intervention services will be available 24 hours a day, seven days a week, by phone. All areas of Weld County will be served, including the fast-growing South County area. 1 B. TARGET/ELIGIBLE POPULATION A. Total number of clients served: 80 persons By serving 20 family units,half of which are composed of 2 parents and half of which are composed of 1 parent, and averaging 2.5 children per household(one of whom may be an emancipating youth),the total of clients impacted will be 80. B. Total individual clients and their ages: 80 individuals Families may include children of any age,emancipating youths, and adults of any age*, including grandparents or other elders who are primary caregivers. C. Total family units:20 families The program is designed for families and youth who do not currently meet the eligibility criteria for other life skills and/or emancipation programming,but who are struggling in their present home environment and are at risk of being removed.We will also work with families who have adolescents between the ages of 16 1/2 and 18 who's struggle to emancipate from the family home is promoting a high degree of family conflict. D. Bicultural/bilingual services: 12 families. Youth of any cultural and/or ethnic origin will be served. YES staff is culturally aware** and are an ethnically and culturally diverse group. Consideration of and respect for established cultural patterns is an ingrained value in this organization.We currently employ and actively recruit bi-lingual mentors, counselors and therapists. E. Clients receiving services in South Weld County:5-10 families. This constitutes 25-50%of the total case load. This figure was arrived at by comparing population totals from north-central Weld with totals for the South Weld cities. F. Access to 24 hour service:20 families All client families will have access to 24 hour crisis intervention services through a 24 hour answering service. Each family's Intervention Coordinator,or designated on-call therapist,will respond to calls within two(2)hours. G. Maximum Program Capacity: 8 families concurrently. Maximum caseload for an intervention team will be 4 families. We will have two teams in place if awarded a contract.This insures that appointments can be kept without double-booking, support groups and classes will be of optimal size. However,if the Department would like to expand the program,we would be open to expansion. H. Monthly Average Capacity: 6 families I. Average stay in the program: 12 weeks J. Average hours per week in the program: Phase 1. (1 month): 6 hours per week. Phase 2. (1 month): 4 hours per week Phase 3. (1 month): 2 hours per week Tracking Phase,(3 months): 5 hours per week *Only primary caregivers with an I.Q. of 80 or higher will be served.While we realize that there is often a lack of services available for developmentally delayed individuals, this population is outside our area of expertise. **Weld County is a culturally diverse population center in Northern Colorado. Therefore, services will be delivered in a culturally sensitive manner. YES currently employs staff members who are aware of the issues of acculturation, enculturation and assimilation which are relevant in the present social milieu. Every effort will be made to provide a staff/client match with these issues in mind. YES currently employs Spanish speaking, culturally competent staff to deliver program services. Case Planning and Case Management Services: The YES staff will meet with the Dept of Social Services caseworker and the client family to design an individual program to meet the family's needs and will report to the caseworker on a timely basis to keep caseworker informed of progress(at least monthly). This affords an opportunity to set goals and strategize with family members and caseworker to facilitate and track success. The YES staff member will coordinate with the youth and family to access other needed community resources as well. 2 III. Types of Services Provided A. Mentoring Services Mentoring: The impact of a knowledgeable and diligent mentor with sophisticated counseling skills,working with families in their home environment cannot be underestimated. The ability to identify the opportunities to stimulate change,work with the key members of the system, and see that right action is taken at the right time, is very powerful in bringing about positive change. Our Intervention Coordinators have expressed frustration with the limitations of working with families in an office or institutional setting. They much prefer the opportunity to work in the family's own environment and be able to initiate timely change through friendly,person-to-person interaction, demonstrating and modeling appropriate practices. Parenting Skills: YES Team will teach parenting skills, such as: • Effective boundary and limit setting, • Affection,nurturing, and positive reinforcement, • Importance of consistency and dependability, • Effective and safe discipline methods, • Monitoring and maintaining health, • Accessing behavioral assistance when needed. Life Skills Instruction: YES staff will deliver self-paced instruction in Life Skills. The curriculum includes: • Nutrition, menu planning, food shopping, and preparation, • Home Safety, maintenance, cleaning and repair, • Employability assessment,job-specific prospecting, application and interviewing skills,and follow-up, • Home budgeting, money management,banking, • Transportation,needs and affordability, • Finding and leasing an apartment, purchasing a home, • Clothing, shopping, maintenance and repair, • Time management and goal setting, • Personal values, social skills, refusal skills,and sound decision-making, • Community values, living with neighbors,coping with others' expectations, • Understanding and managing anger • Accessing Community Resources • Alternative dispute resolution, problem solving, • Continuing education options Family Conflict Management: When internal conflict reduces the family's ability to work together to achieve common goals and interests,the YES team will teach dispute resolution skills to reduce stress and foster an atmosphere of cooperation rather than contention. The degree of conflict within the family will be measured using an assessment devise at the initiation of services, and at the termination of services. The Intervention Coordinator will be experienced in Family Therapy and Mentoring and will establish appropriate treatment goals and assist the family in working toward the accomplishment of those goals. Extended family and important others will be included in the process as indicated in the treatment plan. Group Therapy/Support Groups: It will be invaluable for those who are in the process of emancipating and/or actually living on their own to have a sounding board in which to discuss and process issues related to the difficult challenges of adult living. Groups will be facilitated by a licensed master's level therapist who has experience in group therapy with this challenging yet rewarding population. 3 Accessing Community Support System: YES team will expand the family's connections with agencies in their community which they can access when needs arise. The team will then assist them in filling any gaps in the system through establishing personal contacts at agencies which provide health and medical services, legal assistance, etc. Families must find and develop criteria for using local physical and mental healthcare providers. YES Team will assist family and emancipating youth to match providers with resources and location, develop resources for known chronic health concerns, and balancing treatment and prevention to avoid acute episodes. Home Location and Leasing: Finding appropriate housing can contribute a great deal toward success. YES Team will teach housing acquisition skills and will assist the families to obtain safe affordable housing. Staff will also work with the youth and family to furnish and decorate the new home. Employment: When appropriate,key family members will be given a career assessment and skills evaluation,vocational interest measure,and get a full interpretation in order to determine what career area is most advantageous. Clients will be helped to write a resume,fill out applications for employment,taught how to interview appropriately, and otherwise assisted in finding employment with a future. B. Visitation: In-Home Visit Protocols: YES Team members will visit the client family in their home in order to assess parenting skills, levels of interpersonal and system—wide conflict, physical and emotional safety, and household management competency. These visits are conducted according to written protocols that relate directly to the goals and objectives contained in the Family Service Plan. Intervention priorities are clear to both the family and the Team.No time is wasted in intervening in areas where assessments show competency to be adequate. Intervention is focused on areas needing immediate improvement. Visits are scheduled at times which are designed to have the greatest impact in promoting change through specific activities or exercises designed to improve competencies. Visits are documented and the level of family response and benefit is recorded and signed by the designated family representative. Team members are trained to work with primary caretakers to improve their skills while strengthening their role in the family system. Emergency Telephone Response:YES maintains 24 hour telephone access for clients as well as caseworkers. Intervention Coordinators(or a designated on-call therapist)will be available to contact the family or individual in the event of an emergency. Protocol calls for intervention over the phone as the first step. If phone intervention proves to be insufficient,the responding therapist will assess the level of severity of the incident and take appropriate action, including calling police, ambulance, etc., if danger is imminent. Crisis Intervention(Personal Visit): If the situation would not pose a safety problem for the staff member,they may visit the home on an emergency basis. Otherwise, a safe neutral meeting place will be maintained in the event of the need for person-to-person contact outside the home, or the family may choose to come to the office. Intervention Coordinators and on-call personnel are trained in crisis intervention procedures and follow pre-determined written protocols. 4 IV. Measurable Outcomes A. Household Management a. We expect that household management competency will improve as a result of our involvement. Progress in household management competency will be monitored and reported as household members complete their goals as observed by YES Team staff. A comparison of pre and post referral assessment scores will also quantify progress made. i. Life Skills competencies will be measured using the same assessment instrument that will be given upon initiation of the referral. ii. Staff will note completion of each Life Skills unit as it occurs and report monthly. iii. Emancipating youth who are in the home at the time of referral to our agency will have successfully transitioned to a home of their own and be performing satisfactorily(as reflected in monthly step-down service reports), at termination of the case. B. Parental Competency a. We expect that there will be a measurable improvement in parenting ability among the adult(s)in the family as a result of our involvement. Improvements in parental competency, reduction in parent/child conflict, and improvements in household management will be reflected in completion of Skills Units, higher scores on post tests(referral competency assessments). b. These scores will be compared in the form of bar graphs on each unit which will be attached to the case termination report. c. Monthly reports will be delivered to the department no later than the 15th day of the month following delivery of services. Termination Summaries will be delivered no later than 25 days after the termination of YES Team involvement in the case. C. Working Independently with Other Resources a. Each Unit in the Life Skills Curriculum corresponds with several community resources which can be introduced to broaden each family's support system. The YES Team will introduce families to representatives of these local state and federal agencies during the course of service. D. Intact Families a. We will verify that families have remained in tact for at least 6 months. A contact summary/progress report will be prepared on each referral, for at least this period of time. This information will be mailed to the department caseworker or supervisor in written form no later than 30 days after the close of the month. Information on the family's goals and their accomplishment will be included in the report. b. Youth who are currently in long-term placement, and who are in the process of reunification at the time of referral,will be living in their family home,and will not be in residential placement,DYC custody, or under adult judicial proceedings within 12 months of the termination of YES services. Qualitative reports will be accumulated into quarterly summaries which will be used for Continuous Quality Improvement purposes. These will also be released to the department if requested. YES staff will prepare an annual report listing the number of referrals given, referrals accepted, and will chart the disposition of each case on a grid,giving a thorough and detailed breakdown of each case, as well as totals by month, and annual totals. YES will have each client sign a contact sheet at the time of each visit and will be prompt and timely in filing billing and case management forms with the Department. 5 V. Service Objectives-Mentoring A. Improve Household Management Competency 1. Household management competence will be measured by YES Team observation and completion of Life Skills learning units having to do with the operation of a household. B. Improve Parental Competency 1. To assist clients in adopting and passing along to their children, an improved and more effective life style, YES Team will teach child rearing and parenting skills, such as: • Effective boundary and limit setting, • Affection, nurturing,and positive approval, • Importance of consistency and dependability, • Effective and safe discipline methods, • Monitoring and maintaining health, • Accessing behavioral assistance when needed. 2. YES Team members will use the Family Strengths Assessment to determine the degree of parental competency at referral, and will include in the family treatment plan steps to consolidate assets and develop areas of weakness. Post-intervention results will determine what gains have been made. C. Improve Ability to Access Community Resources YES team will assess the family's connections with agencies in their community which they can access when needs arise. The team will then assist them in filling any gaps in the system through establishing personal contacts at agencies which provide health and medical services, legal assistance, etc. The family,and the emancipating youth,will have a complete selection of resources and personal contacts at each community resource by the end of the intervention. D. Improve Goal Setting and Pro-social Values It is the objective of the YES Team to educate client families in pro-social values. Team members model pro-social values when at all times. The life skills curriculum and parenting skills curriculum both contain embedded value statements which are designed to meet these criteria. Much of the content in both program components have to do with setting realistic and attainable goals and then being effective at accomplishing them. Specifically, the Time Management and Goal Setting Unit and the Social and Community Values Units,are devoted to these topics and have exercises which are directed toward improvement in these areas. (See page 3,above) Service Objectives-Visitation A. Observations and written documentation at the time of each visit includes: 1. general(household and personal)cleanliness 2. interactions between parent and child(physical and verbal) 3. adequacy of meals and nutrition 4. mental health issues 5. home safety(young children's access to dangerous chemicals, medicines,etc.) 6. present of drugs and alcohol 7. family cohesion as demonstrated by levels of interpersonal conflict, 8. cordiality of verbal communication among family members etc. Extensive use of the WAS Scales is made at the time treatment commences, and as treatment progresses. Scales are selected from the battery during the treatment planning phase based upon the goals which are established by the family,caseworker, and other involved parties. 6 VI. Workload Standards Intervention Coordinators(Licensed Masters level staff),will be assigned based on a ratio of 3:2, (direct contact hours to non-direct hours). Mentors are assigned based on a ratio of 4:1. A. Phase 1. (1 month): 6 hours per week. Phase 2. (1 month): 3 hours per week Phase 3. (1 month): 2 hours per week Phase 4. (Tracking): (3 months) 1 hour per month B. Total number of staff providing services will vary with the number of referrals. Under the present circumstances,the maximum number of families which can be accommodated by one team is 8 per month(average of 6). However,if the sustainable caseload is larger than 20 families per year, we are willing and able to expand to accommodate more.Expansion to accommodate a larger caseload has been planned for in our Strategic Plan. We have currently identified 6 employees for this project, (3 Intervention Coordinators and 3 Mentors). We will begin with one team(I Coordinator, 1 Mentor,and 1 Supervisor)and see how the referral base develops. C. Maximum caseload per worker is 8. D. Modality of treatment will vary with the family's needs and the treatment plan. However, generally, we are planning for a combination of Family Systems based In-Home Family Therapy, Parenting Coaching,and Mentoring. E. Total number of hours per case will average 30 hours. F. Total number of persons who will initially provide services is 3. This figure is expandable. G. Maximum caseload for each Supervisor is 6 Supervised Masters level therapists, each with 8 cases. H. (See Attached Affidavit of Insurance) 7 • VII. Staff Qualifications A. YES personnel have extensive experience in Marriage and Family Therapy,Individual and Group Therapy with adolescents,Emancipation Programming, Social Work, Case Management,Family and Community Mediation. We employ one Licensed Marriage and Family Therapist with 12 years of post-masters clinical experience,one Licensed Professional Counselor with 10 years of post-masters experience, and an MSW with 4 years of post-masters experience. In addition, we employ 3 mentors who have bachelors degrees in psychology, social work or other human services fields, and 3-7 years of supervised work experience. B. Staff is qualified according to Staff Manual Volume VII, Section 7.303.17, and Section 7.0006, Q.of the Colorado Department of Human Services Regulations. C. Total Number of staff available for this project is 6(1 LMFT Supervisor, 1 LPC Family Mediator, 1 MSW Case Manager/Intervention Coordinator,and 3 Mentors). Licensed staff are experienced in risk assessment. Mentors are not. All Emergency on-call staff are licensed masters level practitioners. D. All staff have in excess of the minimum experience requirements to satisfy the regulation. 8 PROGRAM BUDGETS COMPUTERIZED ACTUAL • PROGRAM A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 51 B TOTAL CLIENTS SERVED 20 C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 1,020 D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) $45.00 E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $45,900 F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $23,040 G OVERHEAD COSTS ALLOCABLE TO PROGRAM $11,565 H TOTAL DIRECT,ADMINISTRATION 8 OVERHEAD COSTS(E+F+G) $80,505 I PROFITS CONTRIBUTED BY THIS PROGRAM $2,415 J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $82,920 K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 1,020 L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE (J/K)K) $81.29 CE� TATEMENT I V AT E i declare to the best of my knowledge and belief that the statements made on this document are true and complete and tl and er t ual unit costs supporting the compensHt-ion paid orsto be paid under this co are accurate,comp) a and includes no duplicate costs al and that I am the CEO or duly authorized agent of H *fiiAA/r/fA-7714/ y (//Ce SI C. WO • PINNIACOL 7501 E Lowry 230 Denver,CO 80230-7008 ASSURANCE www.pinnecol.com Policy Information Page POLICY #: 4076991 POLICY TYPE: ADVANCE ITEM I. INSURED: AGENT: YOUTH EMANCIPATION & SERVICES FRONT RANGE INSURANCE GROUP LLC 3400 16TH ST, BLDG 6 MM P. O. BOX 270550 GREELEY CO 80634 FT. COLLINS, CO 80527 (303) 233-1804 ST / 7.00 UNLESS OTHERWISE STATED,THIS POLICY COVERS: LOCATIONS - ALL USUAL WORKPLACES OF THE INSURED AT OR FROM WHICH OPERATIONS COVERED BY THIS POLICY ARE CONDUCTED AND ARE LOCATED AT THE ADDRESS LISTED ABOVE. ITEM 2. POLICY PERIOD: FROM 01/24/2004 TO 02/01/2005 12:01 A.M.MOUNTAIN STANDARD TIME ITEM 3. A. WORKERS'COMPENSATION INSURANCE: PART ONE OF THE POLICY APPLIES TO THE WORKERS' COMPENSATION LAW OF THE STATES LISTED HERE: COLORADO B. EMPLOYERS LIABILITY INSURANCE: PART TWO OF THE POLICY APPLIES TO WORK IN EACH STATE LISTED IN ITEM 3 A. THE LIMITS OF OUR LIABILITY UNDER PART TWO ARE: BODILY INJURY BY ACCIDENT $100.000 EACH ACCIDENT BODILY INJURY BY DISEASE $100,000 EACH EMPLOYEE BODILY INJURY BY DISEASE $500.000 POLICY LIMIT C. OTHER STATES INSURANCE: PART THREE OF THE POLICY APPLIES TO THE STATES.IF ANY.LISTED HERE: NONE (CONTACT US FOR INFORMATION OUTSIDE THE STATE OF COLORADO) D. THIS POLICY INCLUDES THE ATTACHED ENDORSEMENTS AND SCHEDULES: ITEM 4. WE WILL DETERMINE THE.PREMIUM FOR THIS POLICY BY OUR MANUALS OF RULES.CLASSIFICATIONS. RATES AND RATING PLANS. ALI.INFORMATION REQUIRED BELOW IS SUBJECT TO VERIFICATION AND CHANGE BY AUDIT. THE STATEMENTS OF ESTIMATED ADVANCE PREMIUM ARE.ALSO PART OF THIS POLICY. TRIOILII i;vinvri, JA%nru 0 Mtl n9NN, Vpp,O1 Pail - • . +• . . .. . .-,., ...,s -e u -u.. - s u'r o a c i n -u i o U H I U 1 N H L u U Y Y 0227055 Administrative Offices 580 Walnut Street CA 80 03 ( E d .10/01.10/01 I GREAT Cincinnati, Ohio 45202 AMERICAN. Tel: 1-513-389-5000 »'"",•"`•"° Policy : CAP 537 -41 -48 00 BUSINESSPRO BUSINESS AUTO COVERAGE FORM DECLARATION PAGE ITEM ONE Named Insured YOUTH EMANCIPATION & SERVICES Policy Period 09/ 15 /2003 09 / 15 /2004 Form of Business: CORPORATION ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos." "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage. LIMIT Coverages Covered The Most We Will Pay Premium Autos For One Accident or Loss • Entry of one or more of the symbols from the COVERED AUTOS Section of the Business Auto Coverage Form show which autos are covered autos . LIABILITY 7 , 8 , 9 $500 , 000 S 1 , 136 . 0C JPERSONAL INJURY 5 S 118 . 0C OTECTION tor equivalent No - Fault coverage ) ADDED PERSONAL INJURY S PROTECTION (or equivalent Added No- Fault coverage ) PROPERTY PROTECTION S INSURANCE (Michigan only ) 'AUTO MEDICAL PAYMENTS 2 CO - S5 , 000 S 2 . 00 'UNINSURED MOTORISTS 2 CO - $500 , 000 S 43 . 00 UNDERINSURED MOTORISTS S (when not included in Uninsured Motorists Coverage ) BUSINESSPRO (Reg . U .S . Pat . Off . ) CA 80 03 10/01 ( Page 1 of 6 ) SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B _ RECOMMENDATIONS X CONDITIONS G ' IN HO Youth Emancipation&Services April 9, 2004 Judy Griego, Director Weld County Department Social Services P.O. Box A Greeley, CO 80632 Dear Ms Griego, We have received your letter of April 7, notifying us that our bid to provide services under RFP 04005 and RFP 04010 have been accepted(with additional conditions). As requested, we are notifying you in writing of our commitment to meet your conditions regarding; a.)notification of changes in staff at the time of change, and b.) revise the bid to conform more closely to Option B criteria. I will contact Andrea Lee regarding Option B criteria that we may have missed in our offer, and make changes in a timely manner. Our intent was certainly to provide all services requested by the department. Thank you very much for your continued support and for the opportunity to continue serving the youth of Weld County and their families. Sincerely, es P. Nelson MA, LPC Executive Director 1600 31st Avenue•Greeley,CO 80631•tele:970.356.5603•fax:970.356.7280•www.griffinyes.org•email:gh@griffinyes.org a t 4,4 p Inv DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY,CO.80632 Webslte:www.co.weld.co.us '11 Administration and Pubik Assistance(970)352-1551 Child Support(970)352-6933 111 O COLORADO , April 7,2004 Jim Nelson,MA,LPC Youth Emancipation&Services,Inc. 3400 16 Street,Bldg 7,Suite MM Greeley,CO 80634 Re: RFP 04005:Lifeskills RFP 04010: Option B,Home Based Services Dear Mr.Nelson: The purpose of this letter is to outline the results of the Bid process for PY 2004-2005 and to regdest written 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 bid,RFP 04005,Lifeskills, for inclusion on our vendor list with no recommendations. 2. The Families,Youth and Children(FYC)Commission recommended approval of the bid,RFP 04010,Option B, Home Based Services, for inclusion on our vendor list with the following condition Condition:The provider would rewrite the bid to meet the Option B program criteria. 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. 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. S(ncerely, J y Ago,D' ctor cc: Juan Lopez,Chair,FYC Commission VVV 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 04-CORE-LS-0002 Revision (RFP-FYC-04005) Contract Award Period Name and Address of Contractor Beginning 06/01/2004 and Ackerman and Associates P.C. Ending 05/31/2005 Lifeskills 1750 25th Avenue, Suite 101 Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Home based visitation and mentoring. Program Assistance Award is based upon your Request for consists of(1)assessment, goal setting,and Proposal (RFP) and the Addendum RFP information. compiling treatment goals; (2)mentoring to The RFP specifies the scope of services and achieve treatment goals through home-based conditions of award. Except where it is in conflict interactions, and(3)visitation observations, with this NOFAA in which case the NOFAA governs, recommendations and directed teaching to the RFP upon which this award is based is an integral implement changes in visitation setting. part of the action. Maximum number of families per month is 10. Bilingual/bicultural services. Special conditions 1) Reimbursement for the Unit of Services will be based Cost Per Unit of Service on a designated per family group conference. 2) The designated rate will be paid for only direct face to Hourly Rate Per $80.00 face contact with the child and/or family, as Unit of Service Based on Approved Plan evidenced by client-signed verification form, as Enclosures: specified in the unit of cost computation. 3) Unit of service costs cannot exceed the designated X Signed RFP:Exhibit A rate and yearly cost per child and/or family. X Supplemental Narrative to RFP: Exhibit B 4) Payment will only be remitted on cases open with, Recommendation(s) and referrals made by the Weld County Department X Conditions of Approval of Social Services. 5) Requests for payment must be an original submitted to the Weld County Department of Social Services by the end of 25th calendar day following the end of the month of service. The provider must submit requests for payment on forms approved by Weld County Department of Social Services. 6) The Contractor will notify the Department of any change in staff at the time of the change. Approvals: Program Official: By tQ Robert D.Masden, Chair Jud . Gri;go,Dire or Board of Weld County Commissioners Wed ounty Department of Social Services Date: JUN 1 6 2004 Date: 5/25/Uv SIGNED RFP-EXHIBIT A INVITATION TO BID OFF-SYSTEM BID B001-04 (04005 -04011 and 006-00) DATE: February 11, 2004 BID NO: RFP-FYC-04005 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street,P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-04005) for:Colorado Family Preservation Act--Life Skills Program Emergency Assistance Program Deadline: March 5, 2004,Friday, 10:00 a.m. The Families,Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Program 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 Life Skills Program must provide services that focus on teaching life skills,which are designed to improve household management competency,parental competency, family conflict management and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date % 4 �� (After receipt of order) B S BE SIGNED IN INK TYPE O PRINTED SIGNATURE VENDOR k\41tVii)c tr\ \ 1��M iCmS �C (Name) H tten\Signature By Authorized Officer or Agent of Vender ADDRESS \Th C\ �� I�U TITLE .9GCvS M k DATE 3 O Li PHONE# 1 C C The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 33 Off-System Bid B001-04 (RFP-FYC-04005) Attached A LIFE SKILLS PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2004/2005 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2004-2005 OFF-SYSTEM BID B001-04 (04005) NAME OF AGENCY: r\ kkk-(Y1Ctn CI PCI {IBI ,�� ci\C 7 /� 1 Q ADDRESS: n Y'1� � n ,NOG{\ - �i.a ,1 P k C`\ ( -C2\W‘ . Cc 4C, ..N5 PHONE: C'_ 3 --D,3r)2Th. CONTACT PERSON: (� `L��C (11 Q(l )t=64-c--.\ TITLE: -`G 1 (c A DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills 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, effectively accessing community resources, and encouraging goal setting and pro-social values. 12-Month approximate Project Dates: — 12-month contract with actual time lines of: Start June 1, 2004 Start End May 31,2005 1 s` End �M TITLE OF PROJECT: f\C .1 1Q }Il .,\ TS c‘.6\\ kCvyci 111 AMOUNT REQUESTED:t 1 k, Cj O O / sauce i\C I`1"-(WA q h- Name and atur of Person Preparing Document Date Judy A. Griego,Director ` ``�`° ` ' ` IC"--",:US-6.• 3 3 , Name and Signature Chief Admini ative Officer Applicant Agency Date MANDATORY PROPOSAL REOUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2003- 2004 to Program Fund year 2004-2005. Indicate No Change from FY 2003-2004 to 2004-2005 Project Description JZ Target/Eligibility Populations _, . Types of services Provided �ZI Measurable Outcomes ✓ Service Objectives Workload Standards Staff Qualifications Unit of Service Rate Computation V/ Program Capacity per Month V Certificate of Insurance Assurance Statement Page 27 of 33 Off-System Bid B001-04 (RFP-FYC-04005) Attached A ------ - t,-�-------------------------------- Date of Meeting(s)with Social Services Division Supervisor: R 1 B A0 1 Comments by SSD Sup�egvisor:/V 0 C JP-2' 11° fLe G- /aria Ro rnA n5; /S a/1aAy Name and Signature of SSD Supervisor Date Page 28 of 33 Off-System Bid B001-04 (RFP-FYC-04005) Attached A Program Category Life Skills Program Bid Category Project Title R ria,pate,- Lc 1-e, 5441/1 Pro ra Vendor a42e ran Cc,. or-ft /hsoctAtea P. c. . PROJECT DESCRIPTION Provide a brief one-page description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a brief one-page description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. The monthly maximum program capacity. G. The monthly average capacity. H. Average stay in the program (weeks). I. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Address if your project will provide the service minimums as follows: A. Mentoring: Address, at a minimum,the following ways the project will: 1. Teach, model, and coach adaptive strategies; 2. Model and influence parenting practices; 3. Teach relational skills; 4. Teach household management, including prioritizing, finances, cleaning, and leisure activities; 5. Actively help to establish community connections and resources; 6. Encourage goal setting and pro-social values. B. Visitation: Address, at a minimum,the following ways the project will: 1. Monitor parent/child interactions for physical and emotional safety; 2. Document clinical observations; 3. Strategize for teaching and modeling parenting skills; 4. Teach relational skills; 5. Encourage goal setting and pro-social values; 6. Plan structured activities in visitation to help achieve the objectives of the treatment plan. Page 29 of 33 PROGRAM BUDGETS /15-0O3,,z,- �p /hz r�P /kdr� J r e+mot PROGRAM P� Nome khmt � A silk lrOroPl-ranryJ r»,.( imejTn-4,sr�e- MANun `d"/ .,-, &ratr.. \ TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT a b ,36 ALL_ DJ- Ys ,s- ; TOTAL CLIENTS TO BE SERVED 6,0 67 o /00 /00 .f ,3` AO TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) /9Oo / 100 (' goo 1 Rio / 6;o G 00 ) COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) S/.oo 5/. c y r:00 GO.oo *Tito ge.0o TOTAL DIRECT SERVICE COSTS C%POD f/ fa° 7Cuf/3?tco 7JP.� 27)60 `l goo ADMINISTRATION COSTS NON-DIRECT ALLOCABLE TO PROGRAM 9 a-oo !08'00 6 per vrPo 94/00 q 2,9-a .7600 I OVERHEAD COSTS ALLOCABLE TO PROGRAM 33 S00 SO Yob ?GOcv Ae oo 3`7 .O0 Y{/a0 t,TG oo I TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) /o9-000 /S3000 MT) 4Stoop 1),00°o /aycoo rfgo0o I ANTICIPATED PROFITS CONTRIBUTED BY THIS PROGRAM 0 G O 0 0 o TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) /c4-000 1,S g yoo0 (¢0000 /P-`/,Coo YBcoo TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(C) /.2.00 /gq3 � //a2°O /6 O G 00 RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE TO BE CHARGED TO WELD COUNTY SOCIAL SERVICES(J/K) 80.00 gray e0.00 /00.00 86. 40 g0,OO IF.// I liz E a. IONAt STATEMENT_>, CAI o��,,,.,,� CAD declare to the best of my knowledge and belief that the statements made on this document are true and complete and that the wage rates id o he factual unit costs supporting the compensation paid or to be paid under this contract are accurate,complete and includes no duplicate costs and id that I am the CEO or duly authorized agent of 41-hlat?t mnb ry rd l%,, t t 1 C'. Q pad/ ado i'rM d/ w.: _O, s = 10160 , UI�\(* 11A�neir W Ur16 ax1 )) o . ia.,- 'i NIMt ,y D (Al15 = y . o K nay e ., Arty Ap1/i!c) 3 fr ail rry. p rha. Co“..-4,_ . Aro to (rzoo r.+1 AP" Gda/lorsj q. 4 au. c....1..41/(/tXYoAS Art ,^ tr$..Q . 42 O 4 ! � / f \ \ \k \ ) |!1 :::::::::::11: : GGG ■ ■ t \ } } 1 . ! i_..- ,,, -,-:2 i / §| / « \ ill e§§�22282 2■2■ | ■ > - 2 »± 5 \ / i } !if L ) | | §»a��22 ! §S ■ ■ ! \ L \ « � - : ll t `| a ! ' A. 1 ill §11§22828 a§§ : | / } \ 2 2 |§ ' V ° / / 5 | �Sl�§a| | �2� | | » / f ~ t \ §| ! 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'.j, v Y J 3p y of a 1.1 < v gi 44444444444444 €44444 -< 01 cc -c ]II 8aaaaaaaaaaaa2 a a 8 1 ili e y I. 888888888888888888 8 8 8 ti 1 §I 888888888888888888 a a a E § o .1 8 k � g \ O $( at F F� O $ 888888888888888888 8 8 8 aaaaaaaaaaaasaaaaa a a a l el 0 g8 ti-, xo w n L . 8 8 8 �8 8 aaaaaaaaaaaaaaaaa a a a G IR <g 8� �o 9r2� 888888888.88888.8888 8 8 8 C3! 888888888888888888 a a a SRO wol co ,+ H gl T K �o b 0. F o r 888888888888888888 8 8 8 y a Pgl aaaaaaaaaaaaaaaaas a a a �o o o ZW1...LYYY F vg 888888888888888888 8 8 HI aaaaaaaaaaaaasaaae a a Ail 8 @! r -I. w -- o d 2942°222222224422€ 2 _ < D 8 a o 8 8 8 8 )` a Project Description, 2004-2005 Life skills mentoring and visitation program Overview: Ackerman and Associates, P.C. proposes to deliver, for a second year, a life skills home based visitation and mentoring program for 2004-2005. We have had a very successful past eight years of operation delivering a variety of programs for core services clients through WCDSS. This proposal combines a number of our successful programs and incorporates our accumulated experiences. Target families are either facing imminent out of home placement or the family has a member who has returned from foster placement. However, it is envisioned that the life skills eligible families may be more amenable, based upon caseworker and supervisor assessment, to a directed learning approach as opposed to others who need more intensive treatment to avoid placement or be reunified with their children. As such, the life skills activities consist of the following activities: Part one: Assessment, goal setting and compiling a set of written treatment goals. Total five hours Part two: Mentoring to achieve the treatment goals through home based interactions. Up to fifteen hours Part three Visitation observations, recommendations for parental change and directed teaching to implement those changes in a visitation setting. Up to ten hours These short term solution focused services are designed to help maintain placement at home or to help reunification succeed and to produce lasting change in parental interactions to avoid future return into WCDSS services pool. Strategies are included in this proposal to time limit the delivery of services to an initial assessment and feedback followed by up to twenty five hours of directed learning services. The mentoring portion of the directed learning services are focused on the treatment goals that are derived from the initial assessment and the caseworkers plan for the family as documented in the referral. The visitation portion of the delivered services derives from observations of parent child interactions and the creation of a directed learning program for the parent to modify observed behaviors to improve interaction with the index child. Entry into the second and third part of the program would involve construction of very clearly defined and measurable goals for the family to achieve during the program. Such goal construction would be completed and accepted by the client by the end of the fifth hour of contact. Purpose: We propose to provide life skills services in Weld County usually in the client's home. These services: 1. Produce a detailed treatment plan during the first five hours of contact, 2. Provide mentoring services to parents whose children are at risk of imminent placement or whose behaviors prevent reunification. These mentoring services derive from the assessment and treatment plan created in part one. Activities are to consist of : teaching, modeling and coaching to influence parental and adaptive strategies, teaching relational skills especially age appropriate child parent expectations and activities, interpersonal, listening and child rearing skills, teaching household management including setting goals and achieving them for prioritizing finances, cleaning and leisure activities, actively helping the parent access needed community connections, learning how to gain access to resources and encouraging early goal setting and socially appropriate values. 3. Provide observation and mentoring at visitation services in our offices, a supervised visit location or in parent's home. We are not proposing to offer visitation services on routine basis to assure physical and emotional safety, though we will provide that service when we are the only professionals supervising the visit. Our primary activity in this format, because all providers are licensed mental health professionals, will be in documenting clinical observations, to create a plan for the teaching and modeling of parenting skills based upon observed and reported areas of difficulty, and to proactively plan future activities to help the parent learn appropriate relational and parenting skills specific to their personal needs. In this way, either through our agency or through other agencies WCDSS can use the plans created. Overall, the program will help parents set appropriate and socially proactive goals for themselves and for their interactions with their children. Design: The strength of this proposal rests upon the experience and expertise of the staff of Ackerman and Associates. The strength of our staff in this project, in experience, in bilingual/bicultural service delivery and in the prior delivery of home-based services and goal directed short term therapy services for WCDSS clients to over several hundred client families are considerations we think are important for the reviewers of this proposal. Emily Jaramillo, M.A., is a bilingual licensed professional counselor from the Greeley community with a master's degree in counseling. She also self-identifies as Hispanic. She has worked in the Family Recovery Center and in educational support for minority students at UNC as well in private practice, including work for Home Based clients for several years. Valerie Larson, M.S.W. is a licensed clinical social worker with experience in family issues, sexual abuse of children and intervention. She has worked in residential treatment prior to joining Ackerman and Associates and has been a home based provider over the last year. Dr. Joyce Ackerman, Licensed Psychologist, is director of Ackerman and Associates and clinical supervisor of the program. John Gray M.A. L.P.C. is a caseworker who has extensive experience in family systems oriented treatment in a variety of social services settings Bill Kelly MA is a psychotherapist with extensive experience in educational systems specializing in school related issues. The skill sets necessary to implement parts one through three described above are enhanced by the experience levels of this staff. Each part is designed to stand alone although part one needs to precede either parts two or three. If WCDSS desired only the visitation component or the mentoring component either of these could be selected providing a number of ways to tailor the cost of the program to the needs of the client and the department. For example, part one only would be five hours of service, part one and two would be up to twenty hours of service, part one and three would be up to fifteen hours of service and if all parts were required that would total up to thirty hours of service. Target/Eligibility Populations A. Total number of clients to be served. Five families per month times twelve months equal sixty families per year. If we assume a family size of six, two adults and four children, the total client pool to be served is 360 individuals. That number includes at least 60 individuals who face either imminent out of home placement or who need reunification services. B. Distribution of clients. Total number of clients we will serve is approximately 360 as calculated above. Our experience suggests we would expect approximately 120 of these to be adult members of the family and approximately 240 to be minors. The age of distribution of the index case children would tend toward the younger children based on our experience with WCDSS. We estimate that about one third of the index children would be older than ten with an average age of about 14 and about two thirds would be under ten. The older group would most likely be teenagers in conflict with their family. The younger group will consist of children of no particularly predictable age whose parents are in conflict usually in relation to instability in the marriage. Mentoring and visitation needs will be age sensitive. C. Families Served. We would anticipate serving up to 60 family units. D. Sub total who will receive bicultural/bilingual services. As stated above, Emily Jaramillo Montoya is a master's level counselor (who is also Hispanic of Mexican American heritage) who can provide services in Spanish or English. She will serve up to one fourth of the projected caseload. This represents a maximum of 15 families. Thus, one fourth of the projected total will be able to be conducted bilingually. All of the services provided (for a maximum of 60 families) would be done in a manner that is sensitive to the culture of origin of the family. E. Accessibility. All providers of Ackerman and Associates are accessible through a 24 hour answering service, cell phone and pager system. On weekends, our 24 hour access reaches the provider on call who is always a licensed Mental Health Provider. These providers are Laurence Kerrigan, Ph.D., Susan Plock Bromley, Psy.D , Emily Jaramillo Montoya, M.A. L.P.C., Joyce Ackerman, Ed.D.,Valerie Larson, M.S.W., L.C.S.W., John Gray M.A. L.P.C. F. Maximum per month. The program maximum is ten families accepted into the program per month. H. The monthly average capacity is five families per month. I. The average stay in the program is defined under the purpose section of this proposal. It is five hours for part one, fifteen hours for part two and ten hours for part three. Types of Services Provided We will provide the following solution focused services to all families in the program. Specific details that further define these services are in the section of this bid called Service Objectives. We are using the following strategies to help families attain desired outcomes: 1. Assessment and evaluative services are provided in the first five hours. The structure of the evaluation is based upon the referral criteria provided by WCDSS. 2. Mentoring services derive from the assessment and provide services similar to those provided by solution focused goal oriented short term interventions. Techniques to achieve parental redirection include teaching, modeling appropriate behaviors, and coaching a parent though a scenario commonly encountered that presents problems for that parent. For example choices that may endanger a child or create a situation of potential neglect will serve as opportunities to develop more socially appropriate behaviors. 3. Teaching relational skills especially age appropriate child parent expectations and activities, interpersonal, listening and child rearing skills will be an important component of the mentoring program. 4. Teaching household management including setting goals and achieving them for prioritizing finances, cleaning and leisure activities will be an additional area covered under the mentoring program. 5. Access to needed resources is also an area addressed in the life skills program. This requires actively helping the parent access needed community connections and teaching how to gain access to resources. 6. Overall, the process of educational change needs to direct the parent toward a consistent and self desired pattern of setting appropriate goals early on as opposed to responding to crisis situations and in developing behavior patterns which reflect a commitment to social responsibility in the best interest of the child. 7. Visitation which is our primary activity in this format (because all providers are licensed mental health professionals), will be in documenting clinical observations. Our purpose is to create a plan for the teaching and modeling of parenting skills based upon observed and reported areas of difficulty. We can share this plan with other life skills providers or can proceed to implement it if directed to do so by the caseworker. 8. Based on these visitation observations and recommendations, a plan for future activities to help the parent learn appropriate relational and parenting skills specific to their personal needs can be developed by the caseworker. This would be useful if the need for services exceeds the time allotted under this funding source for establishing behavioral changes sufficient to close the active case. 9. Services are provided in the client's home environment as much as possible to increase accurate assessment, therapist credibility with the client, and the probability the client will incorporate the material they learn into daily family activities. 10.The visitation and mentoring portions of the program promote the development of skills-based intervention to empower the client to handle family situations without the help of others. Overall, the program will help parents set appropriate and socially proactive goals for themselves and for their interactions with their children. Specific techniques that will be incorporated in the delivery of life skills include: 1. Stress reduction and anger management skills. 2. Communications, problem solving, and negotiation skills to enhance interpersonal effectiveness and develop relational skills.. 3. Practice in hands on parenting skills using a coaching model to provide feedback, reinforcement, and clarification as to appropriate child management skills based on reported and observed behaviors.. 4. Money management including budgeting and resource acquisition. Only brief services in this area are possible under the current time limitations. Extensive needs in this area will be referred to a life skills program. 5. Other activities of daily living including recreational activities related to enhancing family development, spiritual support, community involvement and maintenance of physical and emotional well being. Types of referral services that may be needed include: • Drug and Alcohol Services Referrals to alcohol and drug treatment programs including Island Grove and Family Recovery Center are available. • Health Care Referrals are also routinely available in our practice. Referrals to Sunrise Health Center, Monfort's Children's Clinic and The Family Residency Program are also available. • Job training referrals are available through the Job Services and through Vocational Rehabilitation. Crisis Intervention: Twenty four hour access is assured for the families to reach the providers. We have secretarial and office staff support 9-5 Monday through Friday at Ackerman and Associates, P.C. We maintain a twenty four hour, 365 day a year access system through our answering service. All providers can be reached through pagers by the answering service. In-home services for crisis intervention are available through this on call system. We have a rotating call system within the providers of Ackerman and Associates. Measurable Outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following: 1. Was the family assessment in part one completed? 2. Is the family making progress with the treatment plan for each component as outlined in the service objectives as requested on the case referral? 3. Has the family followed through with recommendations and referrals during the course of each part of the life skills program? Summative Outcomes: Over the duration of the twenty hour treatment, we determine the following information: Is the child still in the home? How well are the changes from treatment persisting? This measures if family behavior is different compared to their behavior before treatment. Specific summative goals are listed below. A. Improvement in household competency will be measured by clinical assessment. This will be measured by recording the status of the household at the outset and the conclusion of services using a checklist and documenting changes in the monthly report. B. Improvement in Parental competency and parent child conflict management will be measured by clinical assessment. A narrative in the monthly summary of treatment of the family will be provided. This is based on a review of the treatment on a month to month basis. This narrative will document the therapist's judgment of changes in parental competency. Success or failure to make progress will be discussed in monthly reports. C. Parents can work independently with other sources in the community and within local state and federal governments. Documentation of the resource needs of the family and how the family accesses these needed resources will be made by clinical observation and documented in the monthly reports. D. Families receiving life skills treatment will remain intact six months after discharge from the services. This information can be obtained by checking with the referring caseworker at Social Services at the six month time point after conclusion of services. E Families completing the program will have improved competency level reduced risk on a standardized assessment. The providers will rate the adult family member(s) at the time of case closure on a standardized parent child inventory that measures parental interaction and satisfaction with parenting and be able to compare this to the same measure taken earlier in the process. Service Objectives We have the following service objectives: Mentoring A. Improvement of parental competency. The program is specifically designed to resolve conflicts and teach management skills for parents. A solution focused treatment approach is used. Specifically, treatment will be focused on behaviors that either 1. Precipitated the likely imminent placement of the child or 2. Which prevent the reunification of the child with the family. The initial goal of services is to assist the family in finding behavioral solutions to the existing conflict and behavioral shortcomings related to child parent interactions.. Each provider is skilled in family systems work and solution focused therapy. Other aspects of conflict management include parent child conflict resolution, problem solving skills development and application of negotiation and communication skills. Activities of daily living care, provision of nutrition, hygiene shelter, discipline protection instruction and supervision are the context that constitute parental competency. Life Skills concentrates on the parents developing more age appropriate strategies. In dealing with conflict with their child, especially with teenagers, the areas of discipline, protection, instruction and supervision seem most responsive to improvement. With younger children the therapy gives the parents the opportunity in their own home to practice and to clarify the roles each parent expects of the other and what is expected of the child. This model of home-based care is able to improve parental performance based on the experience that this staff brings to this proposal. Some examples of these service objectives include delivery of services in the following skill areas (although not all families will need all skills improved or to work on all topics): improvement of parenting skills related to discipline and management of child behavior, emotional skills set development such as anger management, identification of depression or anxiety related behavior, and techniques for dealing with frustration, interpersonal skills development and assertiveness skills. B. Improve household safety and management. One aspect of the treatment plan is associated with maintaining a safe household environment. Some families may need help in behaviors related to having a home adequately cleaned, maintained and stocked with food and supplies. C. The program will provide access to needed services as documented in the treatment plan for each family. Specific types of referrals may include the following drug and alcohol treatment, school issues, probation coordination, domestic violence resources, victim's assistance or other referrals. D Improved Goal settings and Pro-social values derive as a direct consequence of service objective A-C above. Setting goals to complete the learning needed based on an agreement at the outset of the life skills program is inherently a learning experience in positive goal setting. Visitation A. Improve parenting skills through directed learning based upon direct observations to promote physical and emotional safety. Use of activities specifically structured as is done by us for child custody and special advocacy activities will form a basis of creating a detailed treatment plan which will combine the referred problem set with additional observations made in the visitation process. By the parent accepting the treatment goals of the life skills program, the parent commits to a process of goal setting and moves to shift attitudes to a more socially positive value set. Workload Standards A. The program has a capacity of ten families per month with an average of five families per month. the amount of time per family per week will depend on the family need but is anticipated to be two to three hours per week. Life skills enrollment should be completed four to ten weeks after referral depending on the level of services required. B. We have four licensed mental health providers for this program who will be life skills specialists. • Valerie Larson, M.S.W., L.C.S.W., is a licensed social worker who has residential treatment experience especially with sexually abused children and who has worked with us on home based interventions over the past two years. • Emily Jaramillo Montoya, M.A., L.P.C., received her masters in Agency Counseling. Prior to joining Ackerman and Associates, P.C., she had a wide range of work in mental health including treatment for alcoholic patients and support of minority college students. She is fluent in Spanish. Her undergraduate major was in Criminal Justice and Sociology. She has worked for three years in home based treatment delivery. • John Gray, M.A., L..P.C., has extensive experience in family systems work and crisis intervention • Bill Kelly, M.A. is a psychotherapist who has special interests in teens and in school and educational intervention. All of our staff members are highly regarded by the caseworkers based on feedback we have received from supervisors. Three psychologists complete the staff of Ackerman and Associates and serve as back up and support for the Life Skills Specialists. The back up group is available on call to assist them as well as to consult on intervention strategies on an anonymous case presentation basis. The psychologists are Joyce Ackerman, Ed..D., Laurence Kerrigan, Ph.D., and Susan Bromley, Psy.D. C. Of the up to 60 families the caseload is projected at 15 families with each provider over twelve month period —two or three families per provider per month D. The modality of treatment is home-based solution focused short term therapy, directed learning, coaching, modeling and teaching. As well, referral and support will be offered as described above. E. Hours/weeks. The total number of therapist hours is 30 maximum per family or a total for the budget calculation of 1800 hours per year based on our projected average of 60 families. The hourly fee is requested at $80 as documented in the rate calculation section. F. Staff. There are four individual providers supported by two office professionals in the practice. There are also three psychologists who provide on call support and back up services. G. Supervisor. This contact would be supervised and clinically managed by Joyce Shohet Ackerman, Ed.D., who monitors the project for compliance. The maximum caseload for the supervisor is ten families per month. H. Insurance. Ackerman and Associates, P.C. carries one million three million liability coverage for professional liability on the corporation and its associates and each associate also carries the same level of coverage individually. In addition, Ackerman and Associates, P.C. carries a general liability policy related to accident or injury on our premises through Farmer's Insurance. Each provider carries individual automobile insurance. Staff Qualifications A. All staff members who will be life skills providers exceed the minimum qualifications needed for this project in both education and experience as described above. B. Staff available for the project consists of the four life skills specialists and three licensed psychologists C.. Current Mandated Training: All of the above are trained at the master's degree or higher as mental health professionals. They have professional training in assisting individuals and families to achieve desired and directed behavioral change as reflected in their licensure by the state of Colorado. D. All of the life skills specialists and all the psychologists have knowledge of risk assessment and are skilled in the application of that knowledge especially in relation to the assessment of risk of harm to self or others. Unit of service rate computation We have calculated the unit of service rate based in the instructions. We used 2003 data for our agency modified per requirements for low bid as of this fiscal year review process. Using overall figures for the agency we arrive at a figure of$85 per contact hour. The profit for Ackerman and Associates for all programs was less than 1% of gross revenues in 2002. The proposed cost is $85 per face to face contact hour. This is consistent with our operating fees for face to face therapy hour as allowed in other protocols we do with WCDSS and provides essentially the same ratio of provider fees to overhead costs consistent with the goals we set for all contractual relationships for our providers. Reduction in costs this year reflects a decrease in doctoral level psychologist participation in this program and a reduction in direct fees charged to WCDSS by Ackerman and Associates providers. Budaet Justification A trained accountant who works as an independent subcontractor with Ackerman and Associates tracks contract funds. No special issues are present related to project audit to our knowledge. Ackerman and Associates programs were audited in a random audit (conducted by Anderson and Whitney) after its first year of operation with no deficiencies. Audit of this program conducted on a yearly basis over several years, by Anderson and Whitney, has detected no deficiencies. Ackerman and Associates, P.C. is a type S professional for profit corporation and not a 501.c.3. Specific standards of responsibility for the 2004-2005 year have been addressed in the body of the proposal. an average age of about 14 and about two thirds would be under ten. The older group would most likely be teenagers in conflict with their family. The younger group will consist of children of no particularly predictable age whose parents are in conflict usually in relation to instability in the marriage. Mentoring and visitation needs will be age sensitive. C. Families Served. We would anticipate serving up to 60 family units. D. Sub total who will receive bicultural/bilingual services. As stated above, Emily Jaramillo Montoya is a master's level counselor (who is also Hispanic of Mexican American heritage) who can provide services in Spanish or English. She will serve up to one fourth of the projected caseload. This represents a maximum of 15 families. Thus, one fourth of the projected total will be able to be conducted bilingually. All of the services provided (for a maximum of 60 families) would be done in a manner that is sensitive to the culture of origin of the family. E. Accessibility. All providers of Ackerman and Associates are accessible through a 24 hour answering service, cell phone and pager system. On weekends, our 24 hour access reaches the provider on call who is always a licensed Mental Health Provider. These providers are Laurence Kerrigan, Ph.D., Susan Plock Bromley, Psy.D , Emily Jaramillo Montoya, M.A. L.P.C., Joyce Ackerman, Ed.D.,Valerie Larson, M.S.W., L.C.S.W., John Gray M.A. L.P.C. F. Maximum per month. The program maximum is ten families accepted into the program per month. H. The monthly average capacity is five families per month. I. The average stay in the program is defined under the purpose section of this proposal. It is five hours for part one, fifteen hours for part two and ten hours for part three. Types of Services Provided We will provide the following solution focused services to all families in the program. Specific details that further define these services are in the section of this bid called Service Objectives. We are using the following strategies to help families attain desired outcomes: 1. Assessment and evaluative services are provided in the first five hours. The structure of the evaluation is based upon the referral criteria provided by WCDSS. 2. Mentoring services derive from the assessment and provide services similar to those provided by solution focused goal oriented short term Budget justifications to accompany bid worksheet: The worksheets are based on 2002 and 2003 income data from Jan 1 2002 through December 31 2003 for Ackerman and Associates P.C. Ackerman and Associates is Category S Professional Corporation which does not publicly trade stock. As such we will make our 2002 and 2003 accounting data available to WCDSS services to verify the percentages below upon written request. Approximate totals can be calculated from data given here. .For 2002 53%of the income of Ackerman and Associates was derived from core services contracts with WCDSS. 32%was derived from insurance or patient payments, 8% from mediation and other court related work, 3 %from other contracts and 4% from other sources. In 2003 the income from core services programs represented 17.2%of all sources of income. On the expense side, salaries of employees in 2002 totaled 23% of expenses and payments to provider(subcontractors)total 56%of expenses making salaries and fees for services rendered by providers 79 percent of expenses. The proportion of provider fees for services attributable to core social services payments are 57.5%of the subcontractors' fees. Our formula for paying providers is based upon 60% of the billed fee for all work done through Ackerman and Associates. The difference represents uncollected billing from WCDSS based on individual disputed technical issues and items either closed or under going review. In 2003 we paid providers sixty percent of fees we collected from core services The remaining 21% of expenses in 2002 representing slightly more than $100,000 dollars include heat light, rent, contract labor other than providers, accounting and insurance costs, legal services, travel, telephone, advertising, mailing supplies and other costs. IN 2003 costs associated with provision of core services accounted for 19%of our expenses.Net profits represented less than one half of one percent of gross earnings in 2002 In 2003 core services represented a net loss of about 5%while all earnings of the corporation produced a net income after expenses of 5.1% In 2003 the rates of referrals decreased dramatically secondary to state budget shortfalls. This created the above situation because certain work particularly in secretarial time and in accounting and tracking services did not decrease. Do Payments from WCDSS over or under support Ackerman and Associates? Taking the total income received by Ackerman and Associates as the base and dividing this into the income produced by all social services core contract work produces a multiplier of 0.53. This is to say the 0.53 time expenses not otherwise attributable to a specific program is used to calculate the appropriate attributable expenses assigned to WCDSS. Call this amount cost A Adding this number with the actual payment to subcontractors from WCDSS (Cost B) and assigning .53 times salary costs (cost C) produces a total amount called D where D is the sum of A+B+C • • 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 80901-1054 coverage afforded by the policies shown below. INSURED Company 1 Truck Insurance Exchange Alan & Joyce Ackerman 1750 25th Ave Ste.101 .ireeley, CO 80634 overages This is to certify that the policies of insurance listed Below have been issued to the insured named above for the policy period ndicated. Notwithstanding any requirement,term or condition of any contract or other document with respect to which this certificate nay 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 $5,000 Automobile Liability Umbrella Liability Worker's Compensation rtificate Holder Cancellation :Id County Bank Should any of the above described policies be cancelled before the expiration date thereof. .35 73rd p' Ave the issuing company will endeavor to mail 30 days written notice to the certificate holder ians, CO 80621 named to the lefi, but failure to mail such notice shall impose no obligation or liability of any kind upon the company,its agents or representatives. Authorized Representative EXECUTIVE RISK SPECIALTY CO. 1/20/04 - A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY *** RENEWAL *** NOTICE:A LOWER LIMIT.OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION"SEXUAL MISCONDUCT"IN THE POLICY). POLICY NO: DECLARATIONS ITEM 1. (a)NAME ANDA7DDRES OF INSURED: TEMI2 NA CO-KERL175ED 0099745B ITEM 1. (b)ADDITIONAL NAMED INSUREDS: LAURENCE P. KERRIGAN, PH.D. 1750 25TH AVE. SUITE #101 GREELEY, CO 80634 TYPE OF ORG: INDIVIDUAL TEM 2. ADDITIONAL INSUREDS: VEM3. POLICY PERIOD: FROM: 12/01/03 TO: 12/01/04 12:01A.M.STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: BM 4. LIMITS OF LIABILITY: (a)$ EACH WRONGFUL ACT OR SERIES OF CONTINUOUS,REPEATED 1, 000, 000 OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE (b)$ 5, 000 DEFENSE REIMBURSEMENT (c)3 3 , 0tt, 000 AGGREGATE ENT S. .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 4 6. RETROACTIVE DATE: 12/01/91 TOTAL PREMIUM: 1, 229 .11 4 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM(if exercised):$ 2, 150 . 68 NO DISCOUNT INCLUDED f S. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY 138 (7/95 ED. ) B22137 �� T�1 PERSONAL- DATA SHEET ;- Identifying Information: Name : Laurence "Larry" P. Kerrigan, Ph. D. Address : DOB: Phone : ness Decrees : 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 , ( EcclesiPh . D. - California a Degree ) . School of Professional Psychology, Berkeley/Alameda Campus , 1974 , Clinical Psychology. Currently a licensed psychologist in the state of Colorado . Educational Educational Bacic�round : 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 fi 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 . • 1975,88 Co-founder of Weld County Child Protection Team, 1987-88 Member of Executive Board, Weld Mental Health Center, Greeley, CO . Honors Received: 1968-69 and Teacher of the year, Campion College . 1970-71 1972-73 Class Representative to Campus Executive Committee , and California School of Professional Psychology 1973-74 . Work and Experiential Background : 1959-60 Counselor at Dismas Halfway House for ex-convicts , St. Louis, Missouri , 1960-63 Teacher-counselor-coach, Marquette Prep High School , Milwaukee , WI . 1964-67 Counselor-therapist at Street Haven and Sancta Maria Halfway Houses for women and at the Don ( metro ) Jail in Toronto , Canada. 1967-68 Teacher and Campus Counselor at Creighton University , Omaha, NB. 1968-71 Teacher at Campion College , Prairie du Chien, WI . , Director of Psychology Department , Department chairman. 1970-71 Director and Staff member of a total environment for Inter-city boys , late grade school age from Milwaukee, WI . 1971-73 Director of Student Counseling , Lone Mountain College , San Francisco , CA. Teacher at the Lone Mountain College , San Francisco , California. 1973-74 Psychologist Trainee at San Francisco Mental Health .Center, Richmond District , Outpatient Care . 1974-75 Private Practice, So. Bay Human Services Center, San Diego, CA. Part-time instructor at/California School of Professional Psychology, San Diego , CA. 1}975-80 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 . Norksiiops ADO Special 'I_rniii!HI: • 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, Lricksonian 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-Plry-sitc-al- llea.lth 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 POSmON: Associate Professor of Psychology Department of Psychology College of Arts and Sciences University of Northern Colorado Greeley,CO 80639 HOME ADDRESS: TELEPHONE: O five:(303)351-2236 Home: (303)352-8750 EMAII.:sbromicy@bentley.unco.edu EDUCATION: Year(sl DC= Institution Area of Study 1983 Psy4 University of Denver Clinical Psychology School of Professional Psychology Denver, Colorado 1968 MSSA Case Western Reserve University Casework (MSW) School of Applied Social Sciences Cleveland,Ohio $ 1965 BA Mt.Holyoke College Economics/Sociology South Hadley,Massacbnrs WORK EXPERIENCE—Professional Academic: Years) Institution/Organizatibn Position Responsibilities 1985-Pits 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: Yearts) Institution/Orgnnvation 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 Worked 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—Professional/Juried: Musgrave-Marquart,D.,Bromley, S.P. &Dailey,M.B. (1997)"Personality,academic attribution,and substance abuse as predictors of academic achievement in college students".Journal of Social Behavior and Personality )/.(2), 501-511. Karlin,N.J.and Bromley, S.P. (19%).Differences in caregivers of demented and lucid chronically ill family members. Journal of Alzheimer's Disease and Related Disorders and Research Retzlaff,P. and Bromley, S. (1994).Counseling personality disorders.In Ronch,J.L.,VanOmum,W. &Stillwell, N.C. (Fits)The counseling sourcebook: A practical reference on contemporary issues. New York: Crossroad Publishing group.pp.466-474. Bromley, S. and Hewitt,P. (1992). Fatal attraction:The sinister side of women's conflict about career and family. Journal of Popular Culture. 26(3),pp. 17-24. Retzlaff,P.and Bromley, S. (1991). "A Multi-Test Alcoholic Taxonomy:Canonical Coefficient Clusters". Journal of Clinical Psychology.47(2) pp.299-309. Bromley, S.P. (1985). "Treatment of Pain:Theory and Research" in Zahourek,R. (FA).Clinical Hypnosis and Therapeutic Suggestion. New York: Gnaw and Stratton. Reprinted in Zahourek,R. (Ed.)(1990). New York: Bnmer/Mazel,Inc.,pp. 77-98.. PROFESSIONAL PRESENTATIONS--Juried: Bromley, S. (1997)(Chair)"Linking through honors programs: The cross-discipline course).Paper presentation as part ofa-symposium titled"_Creatingainks between psychology and other disciplines".,American Psychological Association Convention, Chicago. (August) Bromley, S. , Gilliam D., &Johnson,T. (1995). "Assessment of student created tests as an evaluation method". Poster presented at the American Psychological Association Convention,New York City. (August) Bromley, S. (1994). "Student created tests as an evaluation method". Poster presented at 16th Annual National Institute on the Teaching of Psychology, St. Petersburg,Florida. Karlin,N. and Bromley. S. (1992). "Similarities and differences for caregiver of demented and lucid chronically ill". Poster presented at the Rocky Mountain Psychology Association Convention,Boise,Idaho. (April) Montoya,K.J. and Bromley, S. (Chair)(1992)."Changes in undergraduate counseling styles in an introductory counseling theories course". Paper presented at the Rocky Mountain Psychology Association Convention,Boise, Idaho(April) Bromley, S. (1992). "Connected learning methods to faciliate research understanding". Paper presentation as part of panel titled, `Teaching techniques in the social sciences",Western Social Science Association Convention, Denver, Colorado. (April) 2 Bromley, S.,Ramirez, S.,and McCoy,J. (1991)."Impact of a health psychology course on student health beliefs". Poster presented at the Rocky Mountain Psychology Association Convention,Denver,Colorado. (April) Karlin,N.and Bromley, S. (1991)."Support,burden and affect among caregiver of dementia and nondementia patients". Poster presented at the American Psychology Association, San Francisco,California. (August) Bosley, G. and Bromley, S. (1990). Post death ritual in a Colorado community. Paper presentation at the American Psychology Association, San Francisco,California.(August) Bromley, S. (1990). "Husbands at Childbirth: Who Does It Help?"Paper presentation at Far West Popular Culture Association,Las Vegas,Nevada(January). Hewitt,P. and Bromley S. (1989). "Images of Work and Intimacy in'Turning Point'and'Fatal Attraction'. Paper presentation National Convention of Popular Culture Association and American Culture Association, St.Louis, Missouri. (Session Chair) Retzlaf,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 Chi invited panel presentation,Rocky Mountain Psychological Association,Boulder,CO(April). _Bromley;S. (Co-Chair), Seibert,P.(tom-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:Fxprriences in Collaborative Learning", Western Psychological Association/Rocky Mountain Psychological Association Convention,Phoenix, Arizona(April). Bromley, S. (1993). Chair, Invited Symposium, "Psychological and Social Perspectives on Male Violence Against Women", Western Psychological Association/Rocky Mountain Psychological Association Convention,Phoenix, Arizona(April). 3 Bromley, S. (1992). "Enhancement of student research and writing skills in any course". CTUP Workshop presented at the Rocky Mountain Psychology Association Convention,Boise,Idaho.(April) Bromley,S.and Karlin,N.(1992). "General and health locus of control of adult caregivers". Poster session at the UNC Research Forum,Greeley,Colorado. Bromley, S. (1992). Panel member in Mental Health Symposia for Victim Compensation Convention as part of the Colorado Organization for Victim Assistance Conference. (Estes Park/October) Bolocofski,Bromley,Foster and Mean(1988). "Hypnosis:Research and Clinical Perspectives,"symposium presentation, Colorado Psychological Association,Greeley(March). Bromley, S. (1986). "Pain:A Psychological Event". Presentor-20th Annual Emotional Crisis Workshop, University of Northern Colorado,Greeley,Colorado(July). LECTURES--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 aging.University of Colorado Press. PROFESSIONAL CONSULTATION/PRACTICE: Year(s) Institution/Organization Role 1996-presnt Ackerman and Associates Clinical Psychologist 1988 Bonnel Good Samaritan Center Pain Management Consultant and Trainer 1984-85 Denver Metropolitan Dental Care Consultant in Pain Management 1984 Iowa Association of Registered Physical Therapists Hypnosis for Pain Management Consultant And Teacher 4 • PROFESSIONAL ASSOCIATION PARTICIPATION: Membership 1986-present Rocky Mountain Psychological Association 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- 1996 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 8/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 CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY PURCHASING GROUP POLICY NUMBER: 45-0002000 Item DECLARATIONS CERTIFICATE NUMBER:45P- 2050203 1. Named Insured SUSAN PLOCK BROMLEY ADDRESS Number&Street,Town,County,State&Zip No.) 2. Policy Period: 12:01 A.M.Standard Time At From: To: Location of Designated Premises 04/01/2003 04/01/2004 3. COVERAGE l LIMITS OF LIABILITY PREMIUM $ 1,000,000 each Professional Liability incident I $3,000,000 aggregate $ 859.00 4. BUSINESS OF THE INSURED: PSYCHOLOGY 5. The Named Insured is: X Sole Proprietor(Including independent contractors) Partnership _ Corporation _ Other. 6. This policy shall only apply to incidents which happen on or after a)the policy effective date shown on the 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 r 7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions,stipulations and agreements contained in the following form(s)or endorsement(s). PLP-2012(06/93),PLJ-2008(Rev.10/94),,PLE-8035(09/97),PLE-8036(09/97),PLE-2167(07/00),POE-8004(05/88)(Ed. *10/93),PLE-2081 Current,PON-2003(08/02) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET,CHICAGO, ILLINOIS 60603 Near North Insurance Brokerage REPRESENTATIVE: Agent or broker: In Association with Trust Risk Management Services 875 N Office address: ate1900 Michigan Ave City, State,Zip: Chicago,IL 60611-1803 Toll-Free Number. 1-8n-637-9700 PLP-2012(06/93) APA- fir: 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 lime 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, Dedham MA WORKSHOPS AND SPECIAL TRAINING 1996 Biodyne training workshop adolescent treatment in short term therapy, Tom Kalous, Ph.D. 1995 Biodyne Training Workshops in short term therapy Julian Ang, Ph.D. 1994 Certification in family mediation,CDR Associates, Boulder CO 1993 Disaster Relief Training. Alan Keck, through Colorado Psychological Association, Denver CO 1993 August Hospital Practice for Psychologists Summer 1981 Independent Study of Child Sexual Abuse, University of Northern Colorado Spring 1981 Interdisciplinary Workshop on Assessment of Sexual Assault, Boulder Social Services Summer 1979 Biofeedback Training related to labor and delivery. Summer 1974 Participant in Institute on Obstacles to Learning. Joint Symposium between McLean psychiatric hospital, Harvard University and Lesley Graduate School,Cambridge MA Summer 1973 Kennedy Memorial Hospital,Boston MA. Participant,Summer Aphasia Institute. PUBLICATIONS Ackerman A.,Ackerman,J.S.,Kelley K. Hale K. Family Planning Attitudes of Traditional and Acculturated Navajo Indians. Key Issues in Population and Food Policy. University Press of America, pp. 178-171 (1979) Ackerman,J.S.,Client Expectations and Satisfaction with Community Mental Health Center Services: A Cross-Cultural Analysis Between Hispanics and Anglos. Published Doctor Dissertation, University of North Colorado. Copyright 1981. • • BRANCH B/A PRODUCER NUMBER DATE OF ISSUE - PRIOR CERTIFICATE NUMBER 23 A 0004087 04/01/2003 Renewal PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY NOTICE:THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY PURCHASING GROUP POLICY NUMBER: 45-0002000 Item DECLARATIONS CERTIFICATE NUMBER:45P- 2032570 1. Named Insured Ackerman and Associates PC 175025th Ave ADDRESS Greeley,CO 80634-4943 Number&Street,Town,County,State&Zip No.) 2. Policy Period: 12:01 A.M.Standard Time At From:. To: Location of Designated Premises 05/01/2003 05/01/2004 3. COVERAGE LIMITS OF LIABIUTY 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 fie Declarations: orb) the effective date of the earliest claims-made policy issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/1992 7. This policy is made and accepted subject to the printed conditions in this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s). PLP-2012(06/93), PU-2008(Rev. 10/94), , PLE-8035(09/97), PLE-8036(09/97), PLE-2167(07/00), POE-8004(05/88)(Ed. '10/93), PLE-2081 Current, PON-2003(08/02) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 Near North Insurance Brokerage REPRESENTATIVE: Agent or broker: in Association with Trust Risk Management Services Office address: 875 N Michigan Ave Ste 1900 City, State, Zip: Chicago, IL60611-1803 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 j • Conducted individual, group,and family therapy for day treatment and residential 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 rase 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 and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE C0VERAGE(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/ T 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-Ph.D.-EDUCATIONAL ADMINISTRATION,UNIVERSITY OF COLORADO 1964-MA-SECONDARY EDUCATION,ST.LOUIS UNIVETTY 1954-BS-MATHEMATICS,CREIGIITON UNIVERSITY SCHOOL EXPERIENCE 7ERS ITY- 2002-2003- Adjunct Professor,Regis University,Denver,CO 1999-Professor Emeritus,Regis University,Denver,CO 1983-1999-Chair,Professor of Education,Regis University,Denver,CO 1978-1983-Assistant Professor,Elementary and Secondary Fducahon,University of Minnesota-Morris 1970-1973-Assistant Professor,Education Department, Regis University,Deliver,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. 1966667,6870 Teacher/Administrator/Coach In Denver Catholic High Schools- 1960-1963 Teacher/Coach Marquette University High School,MIlwa°1me,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,LIMA,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 Chinn Associate Professor of History and former Associate Academic Dean,Regis University, 3333 Regis Blvd.,Denver C0,80221 3034584914 Mr. James Neuman,MSW-LSW,Private Psychotherapist,Supervisor of My Practice, 1011)W.26 Ave., Paramount Bldg.,Wheat Ridge CO 303-233-9371 Dr. Allan Service,Provost,Regis University,3333 W.Regis Blvd,Denver,CO 80221,3034581843 • • CNAHealthcare Providers Service ®1 11 SO Organization Purchasing Group HP SO Plaza, anat..rasa.s..amapnea� Chicago,IL 60685 c`�"ertificat2 of Producer Branch Prefix Policy Number Policy Period from: 12:01 AM Standard Time on: 07/04/03 018098 970 HPG 273003448-8 to• 12 01 AM St retard Time n• 07104./9 Named Insured and Address Program Administrator Healthcare Providers Service Organization WILLIAM P KELLY 159 East County Line Road 11429 W BURGUNDY AVE Hatboro, PA 19040-1218 LITTLETON CO 80127-5870 --^— Medical Specialty: Code: Insurance Provided by Clinical Counselor 72990 American Casualty Co. of Reading, PA CNA Plaza 265 Chicago, IL 60685 COVERAGE PARTS LIMITS OF LIABILITY A. PROFESSIONAL LIABILITY Professional Liability $1,000 000.00 each claim 86,000 .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 proceedin On nn aoctreaate 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 $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 Sc Non Owned Auto None Fire & Water Legal Liability None None None Personal Liabilit 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 Heaths-are Providers%ewice Organization is idivision of Affinity Insurance Services,Inc.;in NY and NIt.AIS Affinity Insurance Agency;in MN and OK,MS Affinity Insurance Agency.Inc.;end in CA.AIS Affinity Insurance Agency,Inc.dba Aon Direct Insurance Administrators License#0795465. Master Policy: 188711433 A Keep this document in a safe place. This and �},, A illA �� your cancelled check act as proof of coverage. �t.aa. EMILY L. JARAMILLO, M.A. EDUCATION 1996,Master of Arts,Agency-Counseling University of Northern Colorado,Greeley,Colorado , 1993, Graduate Fellowship Study, Criiranrilogy Rutgers State University,Newark,New Jersey:. 1988,.B"achelor of Arts, Soeiology/Crinnnul Justice with emphasis,in Psychology Unrversity of North' 'O.olorado, Gfeeley,Colorado, PROFF$5IONAL EXPERIENCE 1998-Present Psychotherapist,Ackrerman"&Assoeiates, GreeIey,,CO . _ Provide intensive home based family t)rerapy"to families referred by'-the Department - of Social Services. Provide mediation Services to families. Co-facilitate family • decision making conferences for permanent:placement of children. Provtde'short- term, solution-foci{sed therapy. Provide therapy to individuals referred from Employee Assistance Programs. Facilitate foster parent training workshops:' Provide foster parent•consultation. Practice is supervised bySherri Malloy, Ph D., Licensed - Clinical;Psycholo''gist ' 199f 1 999 Director,McNair Schaia rs.Program, University of Northern C •olorado,Greeley,.CO Provided°counseling,guidance,and academic advising to students who weree low- income,first-generation college students, and.of_a nwtor{ty group. Identified,critical personal; familial,cultural, academic,and financial issues to aid in khe development of. individual success'plans. Planned, developed,and implemented scholarly'activrties" ..1::._„i:.- .. i nationally: Developed and'drrected academic year research seminars., Coordinated `. research activities;;for,scholars preparing fox"doctoral study.. Directed all efforts to ensure efficient admuiistration of a federal grant. Monitored project budget, _" 'supervised-and trained staff members. 1995-1996" ''- Assistant`Director;McNair Scholars Program, University of Northern Colorado Provided counseling guidance,and acadermc'advising to students who were low income, first-generation,and of a'minority group. Identified critical personal,"familial, . cultural,academic,and financial issues fo aid'in the development of individual success-plans. Coordinated-the 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 daily hygiene. Coordinated and implemented client life-skills and social-skills activities. CONTINUING EDUCATION/SEMINARS Jurisprudence Workshop for Psychotherapists Family Preservation Basic and Advanced Training Supervised;Practicum in Family Preservation Reaching Children through Play Therapy Play Therapy and Therapeutic Care Fire Starter Training Diverse Learners Academy Counseling At-Risk Students Cultural Diversity Conference Parent/Child Hispanic Youth Leadership Conference PRESENTER/FACILITATOR The Terrific Twos Prenatal Insults and Long Term Effects Social,Emotional&Sexual Development Infancy through Adulthood Cognitive&Physical Development Infancy through Adulthood Parenting with Love& Logic Eating Disorders Cultural Sensitivity,and Awareness Communicating Across Cultures Conflict Resolution/Communication Skills Setting Limits&Boundaries HONORS/AWARDS Hispanic Leader of the Year,Cesar Chavez Center, University of Northern Colorado, 1999 Keynote Speaker, Latina Youth Leadership Conference, University of Northern Colorado, 1998 Distinguished Alumni, Department of Sociology, University of Northern Colorado Fellowship, Graduate Study, Rutgers State University of New Jersey Scholarship, National Hispanic Scholarship Fund Scholarship,Candelaria-Sc'hotai ship • -MEMOL%NJM OF.1N7RN 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. Company Affording Coverage Producer Chicago Insurance Company Seabury & Smith Owner 1-776-West-likes-Parkway --Covered Person (Status) West Des Moines, Iowa 50398 EMILY L 7ARAMILLO—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 _ deseribed.herein issuhjectro all the terms, exclusions_and..ronditionsof-such Certificater-Th mits-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 80M-4003488 11/01/2003 11/01/2004 3,000,000 in the aggregate - ---------__._.-- - each incident General Liability or occurrence Occurrence . in the aggregate Should the above described Certificate be canceled Insured before the expiration date thereof, 'the issuing company will endeavor to mail written notice to the L SARAMILLO-BANSBERG MA LPC named Memorandum Holder, but failure to mail such EMILY 50 AVENUE PLACE notice shall impose no obligation or liabilty of any 183 83E50Y CO 80634 kind upon the company, its agents or representatives. Authorized Representative: John M.Gray Education Master of Arts: Professional Psychology, emphasis: Agency Counseling, University of Northern Colorado,Greeley,Colorado Graduation: August 1995 1996 Nationally Certified Counselor,NBCC February 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 sessio ssnent Team Attend and contribute to the goals of Manage . Conduct Individual and Family Supervisor. Multi-Systemic Therapy Team February 02 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 compli ance with MST principles and methods . Conduct supervision sessions individually and in groups . Report to home office in South Carolina . Report to in-house administration results and status of program . Responsible for hiring and terminations of personnel in program Mental Health Therapist: Outpatient Therapist Center for Mental Health, Montrose,CO 1997-1999 Mental Health Therapist: Family Preservation Team Weld Mental Health,Greeley,Colorado 1995-1996 . Conduct family therapy in various settings . Conduct individual/group therapy . Coordinate Mental Health groups . Report progress oral and written Facilitate cooperative working environment between systems involving families Mental Health Therapist: Acute Treatment Unit Weld Mental Health,Greeley, Colorado 1994-1995 . Conduct individual/group therapy . Supervise clinical staff . Facilitate professional growth among staff . Maintain clinical integrity of Alt . Conduct emergency room evaluations . Report progress of clients and performance of staff oral and written Mental Health Therapist: Heath Junior High Greeley, Colorado 1995-1996 . Facilitate anger management groups for the retention of at-risk youth . Coordinate needs of school with needs of at-risk youth in facilitation of groups Extern: Psych-care,Greeley,Colorado 1995 . Co-facilitate group therapy sessions in a clinical setting . Coordinate direction of group in conjunction with psychiatrist, director, and all members of therapy team Clinical Care Assistant: Acute Treatment Unit, Weld Mental Health, Greeley, Colorado 1993-1994 . Assist MELT in leading groups . Operate emergency mental health hotline . Participate in in-house professional growth training Instructor: Mesa State College Teaching Montrose,CO 1997-2002 Experience Taught Classes in: . Social Psychology .. Social Problems . Marriage and Family Introduction to Sociology Teacher/Director,G&B Academy,Seoul, Korea 1p 6 curriculum for new ESL program . develop train and advise ESL steachers . coordinate programs for 'University of Northern Colorado,Greeley, Colorado Instructor 1990-1993 Courses taught Minorities . Sociology of . Introduction to Sociology Aims Community College, Greeley/Loveland,Colorado Instructor 1990-1993 Courses Taught: Sociology Minorities . Introduction f Eduto cation ology Sociology of Minot High School, Minot,North Dakota Coach—wrestling 1985-87 Presentations "The use of the Looking Glass Self in Therapy," presentedlied Sociology. At the Conference for App 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 e002O1/18/04 FRI 10:25 FAX 515 243 5180 SEAWAY & SMITH• r x ,'��r••.JISSIICI ar-t 01/15/2004 Insured This memorandum is issued as a matter of information only and confers no Jolts Cam rights upon the holder. This 230 N WHITCOMB memorandum does not amend, extend FORT COLLINS Co 80524 or alter the coverages afforded by the Certificate listed below. Prodacer Company Affording Coverage Chicago Insurance Company Seabury & Smith 1776 West Lakes Parkway Covered Person (Status) Owner West Des Moines, Iowa 50398 Employee JOM M GRAY This is to certify that the Certificate listed below has been issued to the insured named herein for the policy period Indicated, notwithstanding any requirement, term or condition of any 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 80}1_4005346 12/01/2003 12/01/2004 / in the aggregate $3,000,000 seneral Liability each incident OT occurrence Occurrence in the aggregate Memorandum Holder horized Representative: SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B _ RECOMMENDATIONS X CONDITIONS 04/13/2004 12: 21 ''d/035.3.3..i(4 HI;KbKMHN5 rHUt UG/GL Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 (970)353-3373 fax(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. Respectfiill , Joyce Shohet c erman, Ed.D. t Licensed Psychologist President, Ackerman and Associates, P.C. - a (1 DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY,CO.80632 Website:www.co.weld.co.rs Administration and Public (970)352-1551 Child sport(970)352-6933 • T 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 REP 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, cto 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 04-CORE-LS 0004 Revision (RFP-PAC-04005) Contract Award Period Name and Address of Contractor Lori Kochevar LLC Beginning 06/01/2004 and Life Skills Program Ending 05/31/2005 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 Supervised visitation for the family during the Proposal (RFP). The RFP specifies the scope of time the bonding specialist is working with services and conditions of award. Except where it is them. The program offers information, in conflict with this NOFAA in which case the education, and modeling of behaviors that NOFAA governs, the RFP upon which this award is promote bonding, to assist the parent in their based is an integral part of the action. relationship with the child. Service to a total of Special conditions 60 families during the 12-month period, 8-10 families served at any given time, 24 hours of 1) Reimbursement for the Unit of Services will be based one-on-one supervised visitation with the on an hourly rate per child or per family. bonding specialist per family. 2) The hourly rate will be paid for only direct face-to- face contact with the child and/or family, as Cost Per Unit of Service evidenced by client-signed verification form,and as specified in the unit of cost computation. Hourly Rate Per $ 85.00 3) Unit of service costs cannot exceed the hourly and Unit of Service Based on Approved Plan yearly cost per child and/or family. Enclosures: 4) Payment will only be remitted on cases open with, X Signed RFP: Exhibit A and referrals made by the Weld County Department X Supplemental Narrative to RFP: Exhibit B of Social Services. Recommendation(s) 5) Requests for payment must be an original submitted X Conditions of Approval to the Weld County Department of Social Services by the end of the 25th calendar day following the end of the month of service.The provider must submit requests for payment on forms approved by Weld County Department of Social Services. 6) The Contractor will notify the Department of any changes in staff at the time of the change. Approvals: Program Official: By Y..,,,,9\& \V�L0„--, By a cfi. Robert D. Masden, Chair Judy . Gri o,Director1 Board of Weld County Commissioners Weld p�rtmenlpf Social Services S Date: JUN 1 6 2004 Date: / 0 �65i.)4/-//� S5 SIGNED RFP-EXHIBIT A • INVITATION TO BID OFF-SYSTEM BID B001-04(04005 -04011 and 006-00) DATE: February 11, 2004 BID NO: RFP-FYC-04005 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O.Box 758, Greeley, CO 80632 SUMMARY Request for Proposal(RFP-FYC-04005) for:Colorado Family Preservation Act--Life Skills Program Emergency Assistance Program Deadline: March 5, 2004, Friday, 10:00 a.m. The Families,Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Program 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 Life Skills Program must provide services that focus on teaching life skills,which are designed to improve household management competency,parental competency, family conflict management and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK Loh !eua r TYPED OR PRINTED SIGNATURE VENDOR CIeNOatlietit V 73'15 mS C LCD (Name) Handwritten Signature By Authorized Officer or Agen t"of "Vender ADDRESS aki S�2CQ'�' TITLE'`--- 67005423 CD a'063/ DATE 3J3 ' D`7! PHONE# a -373 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 33 ' Off-System Bid B001-04 (RFP-FYC-04005) Attached A LIFE SKILLS PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2004/2005 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2004-2005 OFF-SYSTEM BID B001-04 (04005) NAME OF AGENCY: ( //�� ADDRESS: .hal fir/J As ts_' Lit AM Qijao 124u' C PHONE: 6972) 3Sa -2273 CONTACT PERSON: C!3& /$≤ 9.V4.l TITLE: CS�C�yy��,LY/70.t DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills 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, effectively accessing community resources, and encouraging goal setting and pro-social values. 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: \J,f2p C[,Jrt a AMOUNT REQUESTED: �as 117-3 tic ocAaro s Ut L LC 3/316 .3(6 4' Name and Signature of Person Preparing Document Date Judy A. Griego,Director Name and Signature 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 y4--Project Description �K Target/Eligibility Populations oU - — ,fK Types of services Provided RK Measurable Outcomes U- Service Objectives AK Workload Standards �K LK Staff Qualifications g,,,l } an 3t y� (`t7 l Y ad" -Unit of Service Rate Computation K- }` ^C) Y-1 Program Capacity per Month ,/j- Certificate of Insurance Page 27 of 33 Off-System Bid B001-04 (RFP-FYC-04005) Attached A Date of Meeting(s)with Social Services Division Supervisor: 7 / l 9 to T� ^ Comments by SSD Supervisor: C)/I_,clr-40y\ lnrc Q Q p'Le-F---Lp a /ter — � � e Dv �p , S1 0 G /or; q gba)Gr,5, ,24es i4 a/ , 9/ Name and Signature of SSD Supervisor Date Page 28 of 33 THE BONDING PROGRAM Purpose: The purpose of the Bonding Program is to provide support and information in order to assist parents in building a stronger emotional relationship with their children. The focus of this program is to teach parents how to create an emotionally safe and secure environment for their children in the home. The goal of this program is to keep children with their biological parents. Design: This program will provide supervised visitation for the family during the time the bonding specialist is working with them. The program provides modeling of how to build nurturing relationships with the family during visitation in the home or at the Department of Social Services. The program is designed to access the response of the parent to the child and the child's response to the parent. Assessment will include the parent's commitment and ability to make changes in parenting which will enhance the emotional relationship. From this assessment, a Case Management Plan for intervention will be developed which addresses the strengths and deficiencies of the relationship. This program is based on a strength-based family preservation model of service. This program offers information, education and modeling of behaviors that promote bonding, to assist the parent in strengthening the relationship with their children. Other topics regarding parenting and children (including discipline, growth and development, health and safety) will be addressed during the sessions. Establishing a strong emotional parent-child relationship will be the underlying foundation for teaching other child related issues. Why Services are Important: Bonding is a deep and lasting relationship which develops between the caregiver and the child during the first two years of life. The strength of this bond has a profound affect on every aspect of the child's nature. The child, who develops a strong sense of nurturing from his mother, will develop: a sense of trust, a good self-esteem, positive reciprocal interaction with others and an ability to function as a healthy adult. In addition, an adult who had a positive bonding experience with his mother will be able to establish an emotionally healthy foundation for his own children. A child who does not experience the development of a strong bond with the parent will be prone to difficulties with relationships, antisocial behavior and learning difficulties. When these children grow up, they are often unable to regulate their emotions or their behavior. Any event that separates the ' from the mother either physically or emotionally during the ears of life, places the child at risk for inadequate bonding. Lack of bonding in a parent-child relationship can occur for several reasons. Children who experience frequent moves within a foster care system become resistive to bonding. When the mother experiences a high level of stress during pregnancy, suffers from depression or is involved in substance abuse, she may not be emotionally available to nurture the child. Domestic violence may cause a child to develop fear and distrust of the parent making bonding difficult. Children who experience abuse/neglect are at high risk for bonding difficulties. Children who are not well bonded do not learn to trust. They have a difficult time building strong meaningful relationships throughout life. This may be reflected in early childhood through angry, defiant and controlling behavior. The child may also have difficulty dealing with authority figures throughout his life. The lack of a strong parent-child bond may also interfere with the child's learning ability. These children may have difficulty focusing in the classroom. They are often emotionally and developmentally delayed. Due to the impact inadequate bonding may have on the future of the child and our society, it is imperative that intervention begin as early as possible in the child's life. TARGET /ELIGIBILITY POPULATION A. Total ber of clients to be served: The program will serve a total f 60 amilies during the twelve-month period. Each bonding specialist will serve eight to ten families at one given time period. Each family will receive 24 hours of one-on-one supervised visitation with the bonding specialist. This would provide 27 hours of 2 intervention with families per week, 120 hours per month. Total number of client hours provided per year would be 1440 hours. B. Total number of clients and ages: Based on the approximation that the average family is made up of four children and one parent, the total number of clients for the year could be 240 clients. Focus will be on children whose ages are birth to three years of age. When the family includes older children, they will be included in the family intervention. C. Total number of families served: A total of 60 families will be served during the year. D. Sub-total of individuals who will receive bilingual/bicultural services: All services provided would be in a manner that is sensitive to the family's culture of origin. The program manager and specialists have extensive training in cultural competency issues. Lori Kochevar chaired the multicultural task force that successfully implemented multicultural training throughout the San Luis Valley. Becky McMahan has worked with families from various cultural roots. She has a sense of respect for the family's cultural beliefs and practices. Anna Lane, a bilingual provider, will be available for any Spanish speaking families. Due to our experience in bicultural settings, all individuals in our program will receive bicultural services. E. Sub-total of individuals who will receive services in South County: The program could serve three to four families in South County during a given time period. Based on referrals in past years, this would be an adequate estimate. Services will be provided for families where they reside as determined by Social Services. F. The monthly maximum program capacity: If needed, we could expand the number of hours we are available for services to 35 hours per week, which would make available 140 hours per month. G. The monthly average capacity: The monthly average capacity of this program is six to eight families. 3 H. Average stay in the program: The average stay in the program would be six months. It is felt that clients have adequate opportunity to make positive changes in parenting styles in that period of time. I. Average hours per week in program: Initially, each family would receive services two hours per week, unless a different number of hours is requested by the caseworker for clinical reasons. After the first twelve weeks, sessions will decrease as recommended by the treatment team. Number of hours of service and length of service vary according to the individual family situation. SERVICES TO BE PROVIDED A. Through mentoring, the program will address the following areas: 1. Teach, model and coach adaptive strategies: The bonding specialist will teach through use of visual aides, demonstration and verbal interaction with the parent and child. She will use demonstration of bonding behaviors. She will guide the parent and child through activities that utilize bonding skills and encourage a positive emotional interaction between the parent and child. She will support the parent with encouragement and recognition of positive changes. 2. Model and influence parenting practices: During the visits with the parent and child, the bonding specialist will influence and direct parenting practices through education of the parent. The parent will be given opportunity to gain increased awareness of the child's developmental level and have a better understanding of expectations which are appropriate to the child's age. The bonding specialist will have opportunity to model for and guide the parent during the visitation. 3. Teach relational skills: The parent will receive information and guidance regarding nurturing behaviors which, when put into practice, will enhance relationships. The bonding specialist will guide and support the parent as she makes efforts 4 to utilize new skills. Just as the mother has difficulty in her attempts to make changes in her parenting and bonding behaviors, the poorly bonded child struggles to respond to those changes. This can be discouraging to the parent who will be offered support and encouragement. 4. Teach household management, including prioritizing, finances, cleaning, and leisure activities: The program will address everyday living concerns faced by the family through observation and initial assessment. The bonding specialist will address issues such as the safety and health of the family as related to hygiene and care of the living quarters. The bonding specialist will increase the parent's awareness of the importance of structure and consistency in the home routine for the children and the parent. This will be a process of education presented through verbal and written materials. 5. Actively help to establish community connections and resources: the bonding specialists are well informed about community resources. She will be able to direct the client to resources as needed and to assist with accessing those resources. This would include offering the information to the client, setting up an initial appointment, and possibly meeting the parent at a designated appointment as a support person. This could also include guiding the parent to Play Groups or other activities that would offer opportunities for social interaction for the child and parent. A Resource Guide will be used in the intervention with the family. (Appendix A) 6. Encourage goal setting and pro-social values: When working with the family in the above areas, the bonding specialist will assist the parent in developing goals that the parent recognizes as important to the welfare of the child and the family. Goals will be developed with the parent and put into writing, to be reviewed periodically together. Through this experience, it is hoped that the client would develop a greater awareness of how to function successfully in society. 5 B. Visitation: 1. Monitor parent-child interactions for physical and emotional safety: Supervised visitation by the bonding specialist will be made in the home of the client, our home setting for visitation, or in a location designated by the Department of Social Services. During the visitation, the bonding specialist will be attentive to the interactions between the child and parent. She will guide, direct and model behavior with the parent and child as a means of increasing parent awareness regarding ways to provide an emotionally and physically safe environment. 2. Document clinical observations: The bonding specialist will utilize The Family Visitation Evaluation Form (Appendix A), developed specifically for the program, to document clinical observations made during the visitation. The form will be filled out at the time of the visit or prior to the following visit. The client receives a copy and is asked to review it with the bonding specialist at the end of the visit or at the beginning of the visit. The parent is the asked to sign the form. This allows the client written feedback from each visit. The parent and caseworker receive a copy and the bonding specialist keeps one copy for her records. The bonding specialist keeps her own notes in addition for each visit and from these submits a monthly report to the caseworker, the supervisor of Life Skills Programs and a billing person. 3. Strategize for teaching and modeling parenting skills: Demonstration is most often the most effective strategy for increasing parent awareness and teaching new skills. As events unfold during a visit, it is effective to be able to point out emotional or physical safety concerns as the issues arise. It is also effective to offer support and positive feedback to the parent and the child as positive events occur during the visit. It is through this process of redirecting and recognition of a parent's efforts that the she begins to understand her own sense of success. 4. Teach relational skills: Parents will be educated through visual aides and verbal information about bonding and ways the parent 6 can enhance the relationship with the child. During visitation, the bonding specialist will point out behaviors of the child which relate to an insecure bond and direct the parent to tools she can use to offer the child more emotional support. The bonding specialist will also use demonstration and modeling to assist the parent's understanding of her child's needs and healthy responses to those needs. 5. Encourage goal setting and pro-social values: During the visitation, much of the focus will be on the emotional interactions between parent and child. As the parent comes to a better understanding of her child's needs and how her own behaviors affect the child, she will be better able to focus on her own goals. The bonding specialist will work with the parent to develop goals that are within the parent's understanding. Those goals will be reviewed with the client periodically and enhanced or changed as the parent progresses. Through the increased awareness of her responsibility as a parent and her self- discipline in changing parenting patterns, she may develop a greater awareness of social values that allow her to function more successfully in society. 6. Plan structured activities in visitation to help achieve the objectives of the treatment plan: The bonding specialist will plan and implement activities that will enhance the interactions between parent and child. The focus of these activities is to encourage the basic modes of emotional connection; holding, touching, rocking, eye contact, talking, pleasant facial expression and feeding. This would include demonstration of various activities that encourage those behaviors. Activities such as peek-a-boo, looking in the mirror and rolling the ball back and forth (which encourage eye contact) will be demonstrated. Parents will also be encouraged to read books to the child to encourage closeness. Emphasis will be placed on assisting parent's response to the child's behavior through modeling and guiding at the time of the behavior. Through these interactions, the bonding specialist will be able to offer education and demonstration to increase the parent's awareness of appropriate expectation of the child at his current developmental stage. Other activities would be to practice making physical contact 7 and face-to-face posturing. Activities will be practiced according to the age of the child and the parent/child relationship at a particular point in the intervention. MEASUREABLE OUTCOMES At the time the family is accepted into the bonding program, bonding will be assessed through observation and through use of a Bonding Assessment Tool, which is based on input from the parent and parent-child interaction (Appendix A). This will include assessment of the level of bonding the child has experienced and identify behaviors that indicate areas of concern. The bonding specialist will discuss concerns with the parent and develop a Case Management Plan. This will be an outcomes-based plan that will be shared and reviewed periodically with the parent. A. After involvement in this program the parent will be able to provide a safe secure home for the children. This includes health, safety, and provision for every day needs. The parent will have: • Resources to provide for the child's basic needs, such as adequate housing and resources for providing food and clothing on a consistent reliable basis. • Increased awareness of daily planning for the child's needs and providing a stable environment by establishing routines around mealtime, after school activities, bath time and bedtime. • Increased understanding of the nutritional needs of the family and a means of providing for those needs. • Increased awareness of the exposure of the children to health and safety risks when the home is not well maintained. • The ability to focus spending on the basic needs of the family as a priority over other expenditures. 8 B. After involvement in this program parents will be able to realize increased competency in their parenting. Parent will demonstrate through her behaviors: • Increased awareness of the emotional needs of the child and demonstrate nurturing behaviors meant to enhance their bonding. • Increased demonstration of nurturing behaviors in parent-child interactions. • Increased awareness of the emotional and physical developmental age of the child and responses that are fitting for that child. • Increased knowledge and understanding of child's behavior as related to bonding issues. • Increased use of discipline measures that are effective (not damaging to the relationship) and is consistent in the use of those measures. After involvement in this program, the child will: • Indicate through his behavior that he has an increased sense of security and trust in the parent. • Demonstrate an increased emotional bond with the parent. • Behave appropriately in social situations. • Begin top progress developmentally with expected achievement. C. After involvement in the program the parent will have increased ability to access resources in the community independently in order to better meet the needs of the child and family. • This program will empower the parent to access community resources by providing information and initial support and guidance. The parent will have an increased knowledge of resources available and show confidence in seeking out resources independently, making appointments, keeping appointments and following up with services. D. Parents who complete the program will obtain higher skill and competency levels in order to provide the child with a safe, secure home. The Parent will provide the nurturing needed to enhance the 9 child's sense of security. Parents will be able to identify factors that have a positive affect on family unity and security. In order to keep the family together after six months from discharge, the parent will: • Be able to prioritize the needs of the children over the parent's own needs. • Will recognize and have ways of meeting their own needs. • Maintain awareness of enhanced family relationships and continue to utilize skills gained during the program. • Have in place identified and used sources of support in the community. • Be aware of the need for continued focus on and attention to the emotional needs of the child. E. Families who participate in the program will develop skills and awareness that will increase their competency as parents. Increased competency will be measured through documentation occurring at each visit through use of an outcomes-based Case Management Plan developed at the time of entry into the program. Risk factors will be identified at the time the initial plan is written. This will be reviewed with the parent and updated as goals are met and as changes occur in the parent-child relationship. SERVICE OBJECTIVES The program has the following service objectives: MENTORING: A. Improvement of household management competencies: It is imperative that parents understand and show competence in the practice of keeping a clean, well-maintained home for the health and safety of the children. It is expected that parents will manage the household finances in a manner that allows for the children to 10 be nutritionally healthy, clean, and adequately dressed. It is expected that the parents will consider the child's health and emotional safety when planning leisure activities for themselves and the children as they develop increased awareness of health and safety issues. Included in household management is the parent's ability to maintain structure and consistency in the child's life in the home. This objective will be measured through the parent's ability to reach specific goals as defined in the Case Management Plan relating to household concerns. B. Improve parental competency: • Parents will have the capacity to provide a safe environment for the children, both physically and emotionally. Parents will show competency in being able to protect and keep the child safe. Parents must be aware of the need for structure in the home in order to enhance the child's security. • Parents will indicate through their behavior, their understanding of bonding and nurturing behavior that serves to enhance the child's sense of security. It is crucial to the well being of the child that the parent be able to continue to utilize strategies to maintain and enhance the relationship. • The child will show in his responses to the parent that he feels safe and secure. • Parents will demonstrate their understanding and their ability to utilize parenting techniques that are effective and emotionally healthy for the child. This includes use of adaptive strategies for discipline and behavior management, offering age- appropriate activities, and conveying expectations that are age- appropriate. • Parents will recognize the importance of being a dependable caretaker for the child. It is necessary to the well-being and emotional growth of the child that the parent be both emotionally and physically available to the child in a consistent manner. The parent must understand that this is the foundation for building and maintaining trust. 11 • Parents will acknowledge their responsibility for providing a healthy diet for the children. They must offer the child healthy and adequate food. • It is important that the parent take responsibility for attending to the child's hygiene. The parent must guide the child in hygiene issues and model good practices. This includes basic everyday hygiene, such as bathing, hand washing, changing clothes and care of teeth. The parent must make every effort to provide the necessary tools for practicing good hygiene. This service objective will be measured through use of the Case Management Plan objectives (the use of a pre and post assessment tool) and the Family visitation evaluation form. C. Improve ability to access community connections and resources: • After being in this program, parents will have information regarding resources in the community and an understanding of how to access them. Parents will be empowered to make the necessary steps to resolve their concerns. This objective will be measured with use of Case Management Plan objectives and the parent's demonstration of utilizing resources independently, making and keeping appointments. (Resource List, Appendix A) D. Improve goal setting and pro-social values: • Parents will experience a sense of success, as they are able to utilize new skills and achieve goals set early in the program. With that sense of success, the parent will realize the value of goal setting and be able to apply it to other areas of life. This objective will be measured through use of Case Management Plan anticipated outcomes and observation which indicate the parent's use of goal setting. 12 VISITATION: A. Improve parenting skills,parent/child interactions and relational skills for physical and emotional safety throughout structured activities in, and documentation of, visitations to achieve the objectives of the treatment plan: • The parent will show increased ability to put into practice the skills that are demonstrated during the visitation and will use the skills independently, without the continued guidance of the bonding specialist. • The parent will have an understanding of ways to make an emotional connection with the child. It is crucial for the emotional health of the child that the parent be committed to that emotional connection. • The child will show positive response to the parent's efforts to make emotional connection. • The parent will demonstrate her capacity to protect the child from physical harm. She will take the initiative to set limits and follow through in order to protect the child. These objectives will be measured and progress documented in face-to-face visitation with the family. WORKLOAD STANDARDS A. Number hours per day,week or month: The program has the capacity to serve up to 60 families. The bonding specialists would spend up to 27 hours a week providing services. Henceforth, 27 hours a week x 52 weeks, provides 1440 client hours a year. B. Staff: There are three bonding specialists and a program supervisor. Lori Kochevar M.S., L.C.P., LLC will serve as the program supervisor for Becky McMahan R.N, Anna Lane M.A., L.P.C., and Lisa Downs M.A., L.P.C. All providers have extensive experience in Family Services and Attachment and Bonding as documented in the attached resumes 13 C. Caseload: The caseload will be between 2-10 families per bonding specialist. The caseload of each specialist will depend on matching specific needs of the referred family with the area of specialty of the bonding specialist. D. Modality of treatment will be supervised visitation that provides a psycho-education regarding of attachment and bonding. Referral and linking services will be provided. E. Hours: Total number of clinical hours devoted to this program equals 6 hours a day, 27 hours a week, and 108 hours a month. F. Staff: The providers are supported by part time bookkeeping and clerical staff. G. Supervisor: This contract would be supervised part time by Lori Kochevar M.S., L.P.C., who will monitor the 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 one million three million-liability insurance. Both the general and group liability coverage's are attached. All specialists providing services are self-employed and choose to be exempt from workman's compensation and Employer's liability insurance. STAFF QUALIFICATIONS A. All the providers meet the minimum qualifications needed for both education and experience. Providers have a Masters Degree in Counseling or Registered Nurse License. In addition, specialists have between 6-21 years each in providing services for families. See resumes in Appendix C. 14 B. Staff available for this project consists of three experienced specialists who have a core value of clinical excellence. We believe in providing strength-based, family-focused services that empower the families we serve. Strength of our staff is in 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 received her Masters degree from the University of Southern Mississippi. She has specialized training in substance abuse, trauma, grief, domestic violence, attachment and family systems. • Anna Lane is licensed professional counselor who is a 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 and mental health specialist. She has experience child and family therapy and in the treatment of children dealing with trauma, and attachment disorders. • Becky McMahan has had extensive experience in the area of child health care. She received her R.N. from the Mennonite Hospital School of Nursing - Bloomington, Illinois. She worked as pediatric nurse for fourteen years. The past 7 1/2 yrs she was a public health nurse where she was in charge of the bonding program and other pediatric related programs. • Lisa Downs is a licensed professional counselor and a registered play therapist. She received her Master's degree from She has experience working with children and families in both the mental health and school setting. Her expertise includes working with families that have been affected by drug or alcohol addiction, play therapy, and women's issues. As well as being skilled bonding specialists, due to our extensive background in the community, we are knowledgeable of the systems (i.e. biological families, social services, mental health services, legal services, etc.) that parents need to interface with in order to effectively meet the needs of their children. 15 APPENDIX A 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 • Increased ability to provide structure and consistency in the home structure the home • Increased awareness of the nutritional needs of the children • Increased awareness of health and safety risks in the home • Increased ability to keep the child safe 4. Increased ability to utilize resources available in the community. • Increased knowledge of community resources. • Increased understanding of how to access services. • Increased confidence in seeking services. • 5. The child will: • Indicate through his behavior, that he has increased sense of security with the parent. • Demonstrate increased emotional bond with the parent. • Behave appropriately in social interactions. • Begin to progress developmentally with expected achievement. The items checked above indicate areas of concern. A circled item indicates improvement. Parent: Bonding Specialist: Date: 2 FAMILY VISITATION EVALUATION FORM Name: Date: Location: • Greetings: Good-byes: Activities: Planned _ Spontaneous Age Appropriate Interactions: Initiated by: Parent Child Touch Holding Eye contact Voice Smile Description of Interactions: Limit Setting, Discipline: Food Offered: Streiu ths: Sug�i estions: Did interactions or activities reflect lccdlhack liven last visit? Parent: Bonding Nurse: ORIGINAI.-TO CLIENT YELLOW COPY-RN PINK COPY-CASE WORKER lu 02,0 I M•IwprilesrbMcMahan/farniivvisitattunevaluanonform PRE AND POST BONDING ASSESSMENT Child Parent Date: Date: Check: Avoids eye contact Resists being- held-stiffens body, _/_ Pulls away from 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 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 _I_ 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 time _/_ Developmental delays, learning, speech, motor _/_ Speech delays or speech is difficult to understand _/_ Hurtful to others or animals • TYPES OF ATTACHMENT TYPE DESCRIPTION BEHAVIORS -primary emotion is sadness Isolated (Avoidant) -passive aggressive —flat affect -thinking process-"no one will ever be there -appear depressed for me—"I can take care of myself" -avoid closeness -physical closeness or touch brings feelings of -talk under their breath-mutter of overwhelming sadness to the child -become enraged with forced -openly angry and defiant only when threatened closeness with closeness or need -not stranger friendly -priority is survival -almost never do what they are -place little value on other people asked to do -usually don't do school work -argue constantly Evasive (Anxious) -Fear is the predominate emotion -extremely superficially charming -tear of abandonment -seek physical closeness, don't usually don't resist -over friendly with strangers -thinking process-" no one will love me for -seek constant attention, often who I am" with incessant chatter and -extremely passive aggressive intrusion into adult space -act afraid to cover sadness and anger -never tell the truth-senseless -emotional responses unpredictable, based on lying what child thinks others want -manipulate friendship- seek closeness, but often inadvertently hurt person offering it -poor sense of own emotions -prefer superficial relationships Defiant (Ambivalent) -predominate emotion-anger/rage -charming to strangers -primary thinking error- " no one will give me -long lasting tantrums the "goodies", I won't ever get any, so I need -do not speak clearly, mumble to take • -hostile -manipulate to get needs met -cruel to others and animals -place no value on other except to get needs met -act out anger openly -act out sexually -lack of conscience -openly defiant,oppositional -no empathy -allow touch as a way to manipulate -fascinated with blood, fire and gore Bizarre (Disorganized) -free floating anxiety, threatening to push -charming with strangers into psychotic thinking -intense tantrums -thinking pattern-multiple continuous bizarre -respond to touch briefly errors -lots of chatter, make up own -distorted sense of reality words -often had drug or alcohol exposure in utero -frequent mood changes -neurological damage common -primitive sense of conscience -remorse is soon forgotten -learning difficulties, lowered IQ levels on testing -will seek out closeness for brief periods -overwhelmed by own emotions Symptoms common to all types: -poor eye contact, need to be in control, impulsive, demanding, lack of cause and effect thinking, hoarding and sneaking food, stealing, poor conscience development, lying, persistent arguing, poor cause and effect thinking, refusal to take responsibility for actions, brief and few friendships- RESOURCE LIST BONDING PROGRAM 810- 12th Street—Greeley.CO 80631 Phone(970-352-8879 HEALTH Monfort Children's Clinic 100 N. I Ith Avenue ( 970) 352-8898 Sunrise Community Health Center 1028 5th Avenue (970) 353-9403 Urgent Care 1900 16th Street (970) 3531661 NCMC 1801 16th Street (970) 3524121 North Colorado Family Medicine 1600 23rd Avenue (970)353-2424 Scheduling 346-2818 Quick Care 2928 W. 10'h Avenue (970) 351-8181 Weld County Department of Public Health 1555 N. 17th Avenue (970) 304-6420 Family Connects 2985 W. 29th ST. # A (970) 330-3842 North Range Behavioral Health 1306 11th Avenue (970) 346-1166 353-3686 CLOTHING Church Women United 1030 11th Avenue (970) 353-7144 Salvation Army 1 1 19 6th Avenue (970) 353-1444 Adventist Community Services 612- 23`d Ave (970) 356-3740 Budget Baby Shop 130111th Avenue (970) 351-8427 Life and Light Community Church 110 N. 25th Avenue (970) 353-3451 Baby Stuff and More 2126 9th Street (970) 353-2229 DENTAL CARE Monfort Children's Clinic 100 N. 11th Avenue (970) 3528898 Sunrise 10285th Avenue (970) 353-9403 FOOD WIC 1028 5TH avenue (970) 353-9403 Weld Food Bank 104 l I'h Avenue (970) 356-2199 Share Colorado 1311- 1 1'h Avenue (970) 353-6433 Salvation Soup Kitchen 1119 6th Street (970) 353-1441 Supplemental Foods • 104 1 1°i Avenue (970) 356-2199 PARENTING CLASSES CARE 3700 Golden Street, Evans (970) 3566751 HOUSING Greeley Housing Authority 315 N 11th Avenue (970)352-1551 ext. 6541 Hudson Housing Authority 1151 Main/Hudson 1- 303- 536-4501 Ft. Lupton Housing Authority 400 2nd Street/ Ft Lupton 1-303-857-4400 RENT/DEPOSITE ASSISTANCE Catholic Charities Northern 2500 15' Avenue Bldg C-B (970) 353-6433 Mi Casa Tu Casa 1311 3`d Street (970) 352 -6417 Salvation Army 1119 6th Street (970) 353-1441 APPENDIX B RESUME Rebecca McMahan 3720 Boulder Street Evans, CO 80620 Home Phone: 339-5522 Experience: 1995-2003- Weld County Department of Public Health and Environment Greeley, Co. • Staff nurse on Child Health Team. Responsibilities included charge nurse of the well-child clinic, home visitation for post-partum cases, follow up with referrals from other agencies to respond to a concern regarding an infant or child. • Development and implementation of the Bonding Program in 1995. Continued to develop and serve as bonding nurse until 12/31/03 when the program was terminated due to funding. • Instrumental in starting and coordinating a parent support group for parents of children with attachment issues, 1996-1998. 1981-1995- North Colorado Medical Center Greeley, CO • Staff Nurse on Pediatrics Unit- Provided nursing care for infants, children and young adults with acute and chronic illnesses • Provided support and education for parents of those children 1974-1975- School Nurse with Weld County School District 6 1970-1974- NCMC (Weld County Hospital at that time) • Pediatric staff nurse 1968 and 1969- Summer Migrant Health nurse in southern eastern Colorado for Colorado State Health Department • Program included home visitation • Directing clients to local and state resources • Arranging for evening clinics at local physician offices 1966-1968- Lutheran Hospital — Denver, Co. • Staff nurse — emergency room 1964-1966-Pioneer Memorial Hospital - Rocky Ford, CO. • Staff Nurse Education: 1975-1976-Pediatric Nurse Practitioner Program- University Hospital 1970- Bachelor of Science Degree in Nursing University of Northern Colorado, Greeley, CO 1961-1964- Mennonite Hospital School of Nursing - Bloomington, Illinois Diploma- RN-three year program Continuing Education and Inservices 1995-1996 — Training at The Attachment Center at Evergreen, CO. Focused on attachment and bonding and the parenting of children with attachment concerns. -Training with therapeutic foster parent in her home —8 hours • -This foster mom came to Greeley 8 hours x5, to offer guidance when bonding program began and to assist with the Parent support group 1996,1997,1999-Attendence at ATTACh Conference-a three day conference which offers current information for parents and professions in the field of attachment and bonding. Presenters are therapists, psychologists, therapeutic foster parents, adoptive parents and biological parents. :997,1998,1999,2000- Annual summer conference at the Attachment Center at Evergreen- Annual one day seminar updating new resources and research in the field of bonding. !999- FIRST (Family-Infant Relationship Training) NCAST ( Nursing Child Assessment Satellite Training Program) Assessment of Parent-Child Interaction-Interdisciplinary Training 1997-Training for the Prevention and Treatment of Maltreatment of Children with Disabilities- Loveland, CO- hour training 1997-Fetal Alcohol Syndrome-Greeley, CO —7 hour training 1999- Play Therapy in Therapeutic Care of Children in Foster Care- Presented by Ken Swartzenberger — Greeley, CO —8 hour 2001- Operation Kids Child Passenger Safety Class — presented by Union Colony Fire/ Rescue- 8 hour class- Greeley, CO 2001- Emotional Disorders in Children- presented by Patricia Kerwin, PhD.- Cheyene, WY. 8 hour 2001-"Early Life Experience and Brain Development: How we can Help Our Children Reach Their Potential"- Bruce Perry 2002- "Breastfeeding:A Gold Medal Beginning"- presented by Marianne Neifert, MD. 4 hours MARGARET E. MEINECKE, LCSW, CAC III Individual, Couples and Family Therapies Licensed Clinical Social Worker Certified Addictions Counselor, Level III 5911 S. Middlefield Road, Suite 103 Littleton, CO 80123 (303) 973-1064 August 11, 2002 Weld County Health Department 1555 North 17th Avenue Greeley, CO 80631 Re: Becky McMahan To Whom It May Concern: On May 8, 2002 I met with Ms. McMahan for three hours to discuss clinical issues related to her work with the Weld County Health Department. Specifically reviewing cases of at-risk infants and parent-child bonding and attachment. Becky and her colleague, Trish McClain, noted challenges in reaching some parents with dysfunctional attitudes and discipline practices. We also talked about some parents' poor interpersonal skills that would likely result in weak and/or insecure family bonds. An integral part of Ms McMahan's work involves helping parents develop healthy relationships with their children by providing clear limits with kindness and consistency. By teaching the importance of physical safety, intellectual stimulation and emotional support, she helps parents provide for the overall health and well-being of their children. Ms. McMahan has a professional attitude and models respect and integrity in all her clinical relationships with parents and children. She is known for her calm and kind approach that helps her effectively deliver strong messages about the importance of child safety and health. She is a valuable advocate for at-risk children and a strong proponent of healthy parenting skills that provide safe, secure and loving homes for children. It is truly a privilege to confer with Ms. McMahan. Respectfully submitted, i ))Tai Q . Margaret Mbi ecke, LCSW/CAC III Colorado License# 991541 • • . 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 prrrats that stretches participants strengths and provides an environment for authentic healing. Facilitate opportunity for individuals, families, and groups to participate in body centered spiritually based psychotherapy. Interpersonal dynamic facilitation for community development, team building, stress reduction, anger management, parenting, and personal effectiveness are available. 5/95 - 9/96 DIRECTOR, VALLEY COMMUNITY FUND Serve and manage Board of Directors to strengthen the internal stricture of the agency to increase fundraising capabilities. Responsibilities include: access state, government, and businesses to participate in payroll deduction, grant writing, marketing, coordination 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 Marian Williamson - Enchanted Love 10/22-24/99 Shapeshifting: Shamanic Tranformation 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 Multicultural 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 REFERENCES: Larry Mayer, M.A. Director of Family Preservation Program 26041 Woodland Avenue Esparte, CA 95627 (916) 787-4329 Sherri Malloy, Ph.D. Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, CO 80634 (970) 353-3373 Carey Bryant, Executive Director Boys and Girls Club of Greeley 2400 W. Fourth Street P.O. Box 812 Greeley, CO 80632 (970) 353-1590 Sue Young, M.A., L.P.C. 2755 County Rd. 47/10 Alamosa, CO 81101 (719) 589-4531 Barb Jetley, M.A., L.P.C. P.O. Box 982 Pagosa Springs, CO 81147 (970) 264-2200 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 I 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 a.4secsment, 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 hefc..ed 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 weeldy 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. IBM/ISSC,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 Lisa R. Downs Colonial Building 324 E. RR Ave. Suite #300 Ft. Morgan, CO 80701 ibelieve35@aolcom Education UNIVERSITY OF NORTHERN COLORADO, Greeley, CO M.A. in Community Counseling Graduated: December 2002 UNIVERSITY OF NORTH DAKOTA, Grand Forks, ND B.A. in Psychology, Minor in Music Graduated: May 1990 TABOR COLLEGE, Hillsboro, KS General Education, Sports and Music Scholarships 1985-1986 Professional Experience Crossroads Counseling Center: Outpatient Therapist/Child Therapist Self-Employed (March 2003 to present) Mental Health Professional: Outpatient Therapist Centennial Mental Health Center (December 2000 to March) Ft. Morgan, Colorado • Attend weekly staff meetings, &participate in individual and group supervision sessions • Conduct individual& group intakes&screens • Work with clients who need brief therapeutic intervention as well as those who need intense long-term care • Perform on-call crisis intervention; hospitalizations if required • Conduct home visits as needed for individual, group or family therapy • Individual play therapy sessions both in the office and at the schools • Consult with co-workers to assess client progress and treatment interventions • Case management with schools, parents, and local human services department • Completed Registered Play Therapy Certification and Licensed Professional Counselor Certification Therapist Intern: Outpatient Team Centennial Mental Health Center (May 1999 to December 2000) • Co-facilitated therapeutic groups for girls ages 6-11 and 12-15 • Diagnosed clients and planned corresponding treatment strategies • Performed UA's and Breathalyzer tests with substance abuse clients • Provided counseling and support to adults and children with developmental delays Practicum: Master's Program University of Northern Colorado, Greeley, Colorado (Spring 1999) • Scheduled and treated individual clients • Observed peers through a one-way mirror • Conceptualized and treated individuals from different theoretical orientations School Psychologist Para-Professional: Undergraduate Experience High Plains Educational Cooperative, Ulysses, Kansas • Consulted with teachers about behavioral strategies for those with special needs • Observed children with developmental delays as well as gifted children • Provided counseling to parents of children with special needs in the school setting • Provided achievement testing and behavioral assessments Related Activities President 1998 SHRINKS (Students Helping Reach Individuals Needing Knowledge & Support) Professional Affiliations International Association for Play Therapy Colorado Association of Play Therapy American Counseling Association Workshops Trauma, Mind and the Body Systemic and Cultural Based Play Therapy with Children and Families Play Therapy Conference 2001, 2002 and 2003 Inattention and Hyperkinetics in ADHD School-based Play Therapy Jungian Theory and Play Therapy Play Therapy Techniques and Methods Effective Strategies for Helping Couples and Families Treating Behavioral Problems is Child's Play Adolescent and Child Mental Health Conference History of Play Therapy Family Systems Legal and Ethical Issues Cultural Sensitivity Lisa R. Downs 4925 WCR 83 Roggen, CO 80653 Home (303) 514-6129 Work (970) 867-3770 SUMMARY OF OUALIFICATIONS Insightful, creative, dedicated counselor who quickly establishes rapport with children and adults of all ages. Able to facilitate change and outcomes by consistently communicating respect and holding a belief that children, adults and families have the ability to heal. Special skills include but are not limited to: *Trained child/play therapist *Child and Adult Trauma *Children's Groups *Supervision skilled *Crisis Management *Severe Mental Illness EDUCATION May 1996-December 2000 M.A. Community Counseling University of Northern Colorado, Greeley, CO August 1986-December 1990 B.A. Psychology, Minor in Music University of North Dakota, Grand Forks,ND August 1985-May 1986 General Education, Music & Sports Scholarships Tabor College, Hillsboro, KS Numerous professional courses and workshops attended to specialize in: child development, divorce, play therapy, social skills training and crisis counseling. CERTIFICATION/LICENSURE L.P.C. -#3374 N.C.C. National Certified Counselor-#67252 A.C.A. American Counseling Association Member-#06115160 R.P.T. Registered Play Therapist Certification - T-862 FEB-16-2004 15:34 . .0 03 Print Date 02/16/04 HEALTHCARE PROVIDERS • 0 SERVICE ORGANIZATION PURCHASING GROUP CERTIFICATE OF INSURANCE n l•..t q'q^+ _, "° 1=: N;� E`AY"`.4_.R-t��✓"2 I�' eW '+l4 c^.� ( Wili i-l4-w Ort•?\rcnF-, rKTo ir-• va n M'..a ltiej 018098 970 HPG 0273177648 from:12:01 AM Standard Time on:02/26/04 to: 12.01 AM Standard Time on:0 • 05 4thi—: - 7."-.rte e-s_y R 3s r-r T f n.. . nfr > L Y 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 Specialty: " "r e°" a x �" Clinical Geuiselor.Firm., Code:72990 Ain. a—as ' � ng : Amencan Casualty Co. of Reading; PA CNA Plaza 26$Chicago, IL 60685 ;7'11i:r:. -..-1 4z �... 7rz;os.-...- .. _vie '� 'licn--- 3li sue 'Pr''7' i, ry.4 > �,uu-:'Si:.tt:..,„ .,.z'w.•s.._0..§04:. I -t: _... . u.k_:ww.n.,..+-..«»;a.; '"-e- 1:'-bra A. PROFESSIONAL LIABILITY Professional Liability(PL) $ 1,000,000 each claim $ 6,000,000 aggregate --.. o amaritan iabi i y included above _ yea FiFicir fnlry Luiability included above _ a,,, fnt� i —IOW iL aEhfy included above ,w, , �'f, B. COVERAGE EXTENSIONS:ticense _ Expense � r roceedtrty $ 25,000 aggregate_. Dapositionr Fte�resen�aTfon � - � S�OIN ,0� � � 10,000 aggregate tito t$#0.— $ —1-07-00-0— aggregate— Ai iu1F $ 1 000 per incident`VT$ 25,000 — aggregate - Medic.i rayments ---r-2 000 r rson 00 0 a--..__99re_9te girst _— Aid r —� 00 a to Property of Others $ , at $_2.5. ._ --____-ooi rate— Damage 2,500 per incident $ 10,000 aggregate C. WORKPLACE LIABILITY Coverage pan C.Workplace Liability does not app y if Coverage pen 0.General Liability*made pad of this potty. Workplace Liability none Fire&Water Legal Liability none Personal Liability none D. GENERAL LIABILITY Coverage part 0.General Liability does not*platy I(Coverage pan C.Workplew Liabaily a meth.Port of this prosy. -------.__.-------- General Liability (GL) $1,000,000 each occurrence $1,000,000 aggregate — ire a—ti STTtinOwtied7Cuto incu il-GL-Iimit`a`6ove -- ' sktys7t.ta : cf tr,r.t4 Fire &Water Legal Liability included in GL limit above subject to $250,000 sub-limit Personal Liability ; " ,', sa47- ....none Total Premium: $ 4 3 3. 0 0 QUESTIONS?CALL: 1-888-288-3534 .: 7. N�'Y..^.�,Y Jvf 1..e,-'_1��,.au-��.::.:.�.fL CL:..Ii.2.._IE.:.4:_tr;' :11... ;:::71 :::::-i1;::. ...:....,xcx.,.l,..w.l,.ra..s...C.:>.0 ...n.a.k,..,L,LIt..w...nLW:6.. G-121500 C G-121501-C G-144872-A G-144959-A G-123846-005 G-121504-C G-123827-B G-141239-A Master Policy#188711433 loco this document in a safe place. II and proof of payment are wldence of your insurance coverage. 6.4-i„....-4 L.-.4....-ri.- tit' ca,,,,44,A elk i‘• ' k- Chairmen of the Board Secretary G-141241-A(07/2001) Coverage Change Date: Endorsement Chancre Date: FEB-1S-2904 15,36 P.03 9= HEALTHCARE PROVIDERS GENERAL UABILITY 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.UABILITY 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) Pace I of I TOTAL P.03 APPENDIX C • PROGRAM BUDGETS COMPUTERIZED ACTUAL PROGRAM Outstide DSO Home Study FP Home Study CIImt Relinquishment Bonding A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 1 1 1 24 B TOTAL CLIENTS SERVED 50 20 10 60 C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 50 20 10 1,440 D COST PER HOURS OR DAYS OF DIRECT SERVICES(.E/C) $650.00 $750.00 $168.00 $45.00 E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $32,500 $15,000 $1,880 $64,800 F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $869 $7,342 $3,968 . $694, $42,$29 G OVERHEAD COSTS ALLOCABLE TO:PROGRAM $8,133 $5,545 $2,465 $123 $8,133 H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+O) $45,388 $21,433 $2,497 $115,562 I PROFITS CONTRIBUTED BY THIS PROGRAM $3,400 $2,450 $25 $6,841 J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $48,788 $23,883 $2,522 $122,403 K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 50 20 10 1,440 L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE (J/K) $975.76 $1,194.15 $252.24 $85.00 1 ill 88888888888888 8 888888 8 8 88e85t8e8S88888 8 855888 A s o 0 8 !ii 0 88888888888888 8 888888 8 8 Igs585iiii8558s 585588 a $ ¢ an I I sX 2 8 8 Ijil i V g 88888888888888. 8 8888.8.8 8 8 III i + » 0 2 o 8 8 C 88888888888888 8 888888 8 8 p s lsaSanannza k Ygsasi a 0 CII . f P ' R 8 8 �e R E E 88888888888888 8 888888 8 8 5s855s55552555 4 888888 s 4 a 141 sa U 3 s s 8 8 a 5 E p 88888888888888 8 888888 8 8 F 8888888s888S188 Y 858888 8 8 Iii Gill g 8 9i 44494999989999 222/22 88888888888888 8 8 8 ill ssseeessssesss 2 s e ,A 111 • 12 II! 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" MI xe i 888888888888888888 $ 8 8 gar-asssssssssssss $ g 1 s 8 8 '2-4 R s a E ' Ig 1 4. i ""4t 0 e p y� p p p p p y� �p p LL 822888888888888888 $ 8 A U ' g Fi g118ss8888888sss s § $ e2 . a 82!888a88888888888 m s $ 4' 54222222222ssss F F Is8 s »» » S e Fl ggggg 1 aaaaR sa 80 222222229992222222 2 Tr88888 8 8 Inn $ 1 niesa a 5 III 1 Ili 1 a gal 6 m 0 a - SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B RECOMMENDATIONS X CONDITIONS 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 12th Street Greeley Co 80631 Weld County DSS PO Box A eia C Sc, 0 ` Greeley Co 80631 C°'e/ S '' v e Cni°Sent, pt Of Unit Re: RFP 04005; Lifeskills APR 1 Re: RFP 006-00: Foster Parent Consultation 4 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, /� )C�t Lori Kochevar IVI S. LPC AIMS: Developmental Indicators of Emotional Health delihes for,Ps ejosocialcPcactice INTERN WW POINTS OF OBSERVATION Ql 1 S FIONS Strengths Concerns Y " oases +mwafn ro.�rr-rei ;NrTACT•IMENT anythrpgtrom t[ieAibtfi ❑ 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 iP. catpl Arljrtatigeat'turd ❑ parent shows concern over baby's crying or distress ❑ parent does not appear to"hear"or react/respond to ' ,. baby's cries fteSei L Now At .tongs oicg with O parent appears pleased with being father/mother ❑ parent shows little or no pleasure in being a father/ you,youciiaby and fine mother baby's otherparent? ❑ parent looks at baby often,is attentive and smiles at O parent does not look at baby,seems uninvolved, 2. Tame about the delivery., baby detached or mechanical 3,pro pgn atitfi dglieip(pith ❑ parent touches baby tenderly ❑ parent does not touch baby except to accomplish a yournew'bkgy7 Are you basic child care task/parent touches baby abruptly, getting enough sleep?. aggressively,or impassively 4. Is your baby easter or more difficult to take care of than INTERACTION INTERACTION you had imagined? U baby molds to parent's body ❑ baby recoils,arches,or stiffens when held by parent 5. Are you;plarteinp to return O baby appears alert ❑ baby appears lethargic,parent does not describe to-work?Havejoudecided; periods when baby is alert wltt avrllcare foryour ❑ parent seeks to protect baby from possible harm ❑ parent appears unaware of possible harm no effort *baby? (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 baby?. hunger and satiation baby,does not seem attuned to baby's signals of hunger and satiation HtfefOCgrearhaelertfoas/pp U parent holds baby in face-to-face position for ❑ parent does not hold baby in face-to-face position; 'Sap.. Y feeding;eye contact is established positions baby away from body to feed;eye contact I.,Ate you enjoying your not established :baby? ❑ parent talks to baby ❑ no verbalization to baby 2. Are you breast orbottlo. 'feeding?-How=are the MASTERY MASTERY. feedihgsVize ❑ parent shows confidence in role as parent ❑ parent appears 3. Ara oateeU comfort mdthan repetedanxious,depressed or y ugoverwhelmed expected able or uncertain using your down judgment about ❑ parent has appropriate awareness of baby's abilities ❑ parent expects baby to do more than baby can,or feeding,elotlung,diapering, appears unaware of baby's innate abilities bathing and playing with. ❑ 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 to help baby 4....,How is your-babylcl"ppipg?_ s_ now does:your"family feu], ❑ parent is able to perform basic child care tasks U parent is not able to perform basic child care skills 'about the baby? (e.g.,putting on clothing,diapering,feeding) EiEPOIPT' 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 '`Guidelines fotPsychostoeial Practice INTERVIEW POINTS OF OBSERVATION QUESTIONS Strengths Concerns en ouwant;tptaaaiabout ATTACHMENT ATTACHMENT anypnng_ ront`lhe AIMS ❑ parent is at ease when holding baby ❑ parent appears stiff or awkward when holding baby gyestionnaire? -.. . ❑ parent describes baby in positive terms ❑ parent is unable to describe baby or uses primarily negative termssti ''arenlaf:Ad.7t(,sprrent t ❑ baby is able to be comforted by parent ❑ baby remains distressed despite parental efforts efFbefngr ❑ parent shows concern over baby's crying or distress ❑ parent does not appear to"hear"or react/respond 1 Howareyouttelulg? to baby s cries 2.:4X0uS0Uwg.etougli -�5161*p3' ! dime to yourself? '-INTERACTION INTERACTION `"` gjg!5Fi 7 yofitbaby2 ❑ baby molds to parent's body ❑ baby recoils,arches,or stiffens when held by thnwwith family and parent friends? ❑ parent able to calm baby down when distressed ❑ parent is unable to calm baby 3- Is there arlYtMug'Onyour ❑ baby appears alert,socially involved ❑ baby appears lethargic,apathetic,socially mind that you would like tm uninvolved ,' � ? ❑ parent's stimulation of baby is appropriate ❑ parent appears intrusive,over-stimulating,or under-reactive toward baby ro-CurectrliReIaaons1up. ❑ parent and baby make eye contact ❑ no eye contact between parent and baby 'Baby' U parent seeks to protect baby from possible harm ❑ parent appears unaware of possible harm 1..Saw are things going with 0urbaby? (e.g., • • _ covers when cold,comforts after shot,guards y baby from falling off table) 2::.How argyouiand be baby. tmg wt MASTI RX MASTERY -. *Do;yOuhase.rnlg. i,wlal ❑ parent appears confident in parent role ❑ parent appears more anxious,depressed or womes about your baby? overwhelmed than expected YOttr family? ❑ parent is able to perform basic child cam tasks CIparent is not able to perform basic child care skills 4.' How does your family feel (e.g.,putting on clothing,diapering,holding) about the baby? ❑ 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 GuideO es for Psyclaoso allfractice INTERN LE N\ POINTS OC OBSEKV ATIO\ Qt ES"CIO\S Strengths Concerns ,4 '00; #4 ,' ATPACHI4 IeT ATTACHMENT � � - ❑ parent is at ease when holding baby ❑ parent appears stiff or awkward when holding baby iuesu`onnarre? ❑ patent describes baby in positive terms ❑ parent is unable to describe baby or uses primarily negative terms ratenfal Aditannent and ❑ baby shows preference for parent ❑ baby shows no preference for parent D Dig`` parent maintains close proximity to baby O f. 'How'are:you'feeling? parent makes no effort to maintain close proximity 2. Areyou enough: ' ❑ parent is pleased by positive comments made ❑ parent appears unaffected by positive comments jetting B about baby about baby -'--.time tgyouxseit? - RACTI'ON —help>fnthyour baby? LRYG"FION ❑ baby molds to parent's body ❑ baby recoils,arches,or stiffens when held by tune wi{ltfamily and parent ,fd° ? ❑ parent's stimulation of baby is appropriate ❑ parent seems intrusive,overstimulating,or 3. Have you found a,babysitter under-reactive toward baby who you like?ut ve your ou ❑ parent and baby make eye contact ID no eye contact between parent and baby been out without baby Y yet? ❑ parent seeks to protect baby from possible harm ❑ parent appears unaware of possible harm (e.g..covers when cold,comforts after shot, 4. In there any[hingon Your -tmn. t:Yon-would like to guards baby from falling off table) 4� .. talk abotut today? ❑ baby is able to signal needs to parent ❑ baby is difficult to read and unable to signal needs effectively Basic Care and Relationsh p ❑ baby appears to enjoy people and things ❑ baby appears uninvolved with people and things 1.',TeA'me abquta typical day .MASTERY MASTER Y withy. ❑ parent appears confident in parent role ❑ parent seems more anxious,depressed, pressed,or 2•-Whatnewaings is your overwhelmed than expected baby doing? ❑ parent effectively uses a variety of techniques to ❑ parent makes little or no effort to calm or comfort 3. Do you feel that life with comfort baby baby your babg ban begun to - ❑ parent is able toperform basic child care tasks Oparent is not able to perform basic child care tasks setae down? (e.g.,putting on clothing,diapering) 4. .'Dayou baveaay a parent prepared baby's ( 8 brings parent ill-prepared meeting Y ��r`'d ❑ is re for needs e. ., O is ill- re ared for baby's needs women ilyufaiour'babr bottle,toy,diaper) yourfaMAY? 5.-:How does your family feel lababy shows a beginning range of emotions ❑ baby demonstrates little affect about the baby? SUPPORT sur-mgt ❑ 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 O copyright,Project AIMS PRE AND POST ASSESSMENT Bonding Program Name: Date: Date: I. 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 from touch Does not respond to mothers voice-avoids, ignores / Resists feeding when mother holds bottle- prefers propped bottle _ _ I Somber, sad expression,withdrawn Lack of responsive smile Prefers to play away from mom, does not check in with mom periodically Decreased stranger awareness,prefers others to MOM Eating problems, gorging, refusal, FT _I_ 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 I Hyperactive behavior,unable to be still or to focus, Sullen, quiet and withdrawn Frequent tantrums, often lasting for unusually long time / Developmental delays, learning, speech,motor / Speech delays or speech is difficult to understand _/ Hurtful to others or animals DEPARTMENT OF SOCIAL SERVICES (14 ‘Daie3/44.4%;;; P.O.BOX A GREELEY,CO.80632 IWebsite:www.co.weld.co.us Administration and Public Assistance(970)352-1551 Child Support(970)3524933 O COLORADO April 6, 2004 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. 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, • tAtilju . aeg°' ctor 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 05-CORE-0038 Revision (RFP-FYC-04005 Contract Award Period Name and Address of Contractor Beginning 06/01/2004 and Transitions Psychology Group Ending 05/31/2005 Lifeskills 804 11 Avenue Greeley, CO 80031 Computation of Awards Description Unit of Service Family Foundations offers two areas of service The issuance of the Notification of Financial (1)Lifeskills Coaching, which is a structured Assistance Award is based upon your Request for mentoring(coaching)program, beginning with Proposal (RFP). The RFP specifies the scope of an assessment; and(2)Parent-Child Interaction services and conditions of award. Except where it is Therapy(PCIT)that utilizes learning theory and in conflict with this NOFAA in which case the play therapy concepts to facilitate warm and safe NOFAA governs, the RFP upon which this award is relationships. The expected capacity of the based is an integral part of the action. Lifeskills Coaching program is 32 families, monthly maximum program capacity is 8 family Special conditions units, with an active capacity of 6 family units. Average stay in the program is 12 weeks, with 1) Reimbursement for the Unit of Services will be based an estimated five hours of service per week. on a monthly rate per child or per family. 2) The monthly rate will be paid for only direct face-to- Visitation program serves parents with children face contact with the child and/or family or as ages 2-7,up to 16 families per year, 8 families specified in the unit of cost computation. South county,and 8 families Bilingual. Average 3) Unit of service costs cannot exceed the hourly and stay is 12 weeks with 1 hour of participation per yearly cost per child and/or family. week. 4) Payments will only be remitted on cases open with, and referrals made by the Weld County Department Cost Per Unit of Service of Social Services. Hourly Rate Per $ 85.68 5) Requests for payment must be an original submitted to Unit of Service Based on Approved Plan the Weld County Department of Social Services by the Enclosures: end of the 25th calendar day following the end of the X Signed RFP: Exhibit A month of service. The provider must submit requests X Supplemental Narrative to RFP: Exhibit B for payment on forms approved by Weld County Recommendation(s) Department of Social Services. X Conditions of Approval 6) The Contractor will notify the Department of any changes in staff at the time of the change. Approvals: Program Official: By V U(. \ `� �tJi�1n-- By Robert D. Masden, Chair Judy . Grie ,Direct Board of Weld County Commissioners Weld oun e artment of Social Services Date: Date: ��ZS�(J4 SIGNED RFP-EXHIBIT A INVITATION TO BID OFF-SYSTEM BID B001-04(04005 -04011 and 006-00) DATE: February 11,2004 BID NO: RFP-FYC-04005 RETURN BID TO: Pat Persichino,Director of General Services 915 10th Street,P.O. Box 758,Greeley, CO 80632 SUMMARY Request for Proposal (RFP-FYC-04005) for:Colorado Family Preservation Act--Life Skills Program "• - Emergency Assistance Program Deadline: March 5, 2004,Friday, 10:00 a.m. The Families, Youth and Children Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Colorado Family Preservation Program 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 Life Skills Program must provide services that focus on teaching life skills,which are designed to improve household management competency,parental competency, family conflict management and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date G pry S •Gar{ (After receipt of order) BID MLST EE SIGNED IN INK PED *PRINTED SIGNATURE rYAVtyi�'1 oVl5 VENDOR Y5y loyj C%Yf7Upi LLG (Name) Handwritten Signature By Authorized 'i�^ � Officer or Agent of Vender epq,ADDRESS C1IP-2iPy i CO goo/ TITLE Ca-,k re``v- DATE j ISia(-) PHONE# (911 OP-( I The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 33 • • Off-System Bid B001-04(RFP-FYC-04005) Attached A LIFE SKILLS PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER CORE SERVICES FUNDING EMERGENCY ASSISTANCE PROGRAM 2004/2005 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2004-2005 OFF-SYSTEM BID B001-04(04005) NAME OF AGENCY: Trahslflnho P6yalotociy &roup1 L-L(, ADDRESS: (6041 11DI Ave. , omelet t (-O eole31 PHONE: Mt'0)3310-1 l2% CONTACT PERSON: 'Milli Hde-I'l4rf'Ylah TITLE: co-Owner DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills 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,effectively accessing community resources,and encouraging goal setting and pro-social values. 12-Month approximate Project Dates: 12-month contract with actual time lines of: Start June 1,2004 Start End May 31, 2005 OS a. TITLE OF PROJECT: fa ml I S=ri ul -hv Kb : La strA 1,[6 Goacti.l v'5 ). V151'ret t10 VI AMOUNT REQUESTED: prelnIM It/ 2099° /hour II *4)5.OOS J ailing' Moe-t rfrr,an 03105/D1 t' Name and Signature of Person Preparing Doc ent Date Judy A. Griego,Director V Name and Signature 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. 17 Indicate No Chance from FY 2003-2004 to 2004-2005 oject Description azget/Eligibility Populations Types of services Provided easurable Outcomes Service Objectives _ Workload Standards Staff Qualifications Unit of Service Rate Computation Program Capacity per Month Certificate of Insurance Assurance Statement Page 27 of 33 • • Off-System Bid B001-04 (RFP-FYC-04005) Attached A Date of Meeting(s)with Social Services Division Supervisor: °7a .S4—q� '� A Comments by SSD Supervisor: i - 1 • /ors R° Vine, K /a s/Q q. Name and Signature of SSD Supervisor Date • Page 28 of 33 • Life Skills Program Bid Proposal Transitions Psychology Group, LLC 1 2004-2005 • . �� • Life Skills Program Bid Proposal • • • • $ . Family Foundations: Life Skills Coaching • • z• ; : Transitions Psychology Group, LLC •• • •• . . 2004-2005 eel: Transitions PSYCHOLOGY GROUP, LLC I. PROJECT DESCRIPTION Transitions Psychology Group, LLC is a private counseling agency with a multidisciplinary team of human service professionals, including Licensed Psychologist and School Psychologist, Licensed Professional Counselors, Licensed Clinical Social Worker and other degreed paraprofessionals. Transitions provides superior counseling, assessment and consultation services to children and families in Northern Colorado. The purpose of Family Foundations: Life Skills Coaching, a mentoring program under the Life Skills Program Bid Category, is to teach skills that will improve household management — competencies, parental competencies, family conflict management and utilization of community resources in order to prevent imminent placement of children and/or reunify children in placement with their families. Transitions' Family Foundations: Life Skills Coaching is a structured mentoring program with specific objective that begins with a Life Skills Assessment (LSA). The LSA elicits family strengths and Reeds by evaluating content areas in the family through the use of participant self-anchored scales. The LSA provides a baseline score in each content area being evaluated. The Family Foundations life skills coach(will work with�the participating family members to identify priority areas on which to us an target goals. These goals become part of the action plan developed together with the family. The life skills coach will help the family to tap into strengths in order to find solutions to the current problems, teach skills related to the priority areas, provide opportunities for the participants to practice newly learned skills, and coach participants, consistently offering feedback and encouragement. Transitions' Family Foundations: Visitation is a Parent Child Interaction Therapy (PCIT) program that utilizes learning theory and play therapy concepts to facilitate warm and safe relationships. The visitation is a highly structured_ time limiteslprogram with strong teaching and practice components. Structured observations are u tlrto record and evaluate changes in parent/child interactions. Life Skills Program Bid Proposal Transitions Psychology Group, LLC 2 2004-2005 II. TARGET/ELIGIBILITY POPULATIONS Transitions estimates that the Coaching program will se 96 c' nts in the first program year. Of the total number of clients, approximate 48 of these clients would be children ages 0-18 years old. The probable number of family units accepted into the program would be 32. Half of the total number of clients (48) would be eligible for bicultural/bill rvices. One of the Transitions bachelor's level life skills staff is hiling , asis-one a supervisors. Up to 24 ✓ participants could receive services in utg h Weld Count The monthly--- maximum program capacity is eight family units,-IiVittia mo average of six active family units. The avera the program will b 12 eks, with each family participating an averag of five urs per week. Services will be more intensive at the outset of the program, then taper off gradually. Follow-ups will — Ci pci be provided at the end of three months and again at six months to help ensure that improvements have been maintained. The Visitation program is designed to se only parents with children ages two to seven. The program can serve up t 16 milies per year. Eight families could ,i receive bilingual services. Eight could receive services in South County. The v---- average stay in the program is twelve weeks, with participation of one hour per week. III. TYPES OF SERVICES PROVIDED A. Life Skills Coaching (Mentorinq): Through in home, office and community interventions, the Life Skills Coaching program will address the following: 1. Teach, model and coach adaptive strategies 2. Model and influence parenting practices 3. Teach relational skills 4. Teach household management, including prioritizing, finances, cleaning, and leisure activities 5. Actively help to establish community connections and access to community resources 6. Encourage goal setting and pro-social values Transitions will develop a Life Skills Assessment (LSA) that will be conducted pre and post intervention for each referred family, including scaled ratings in content areas. Transitions will utilize the assessment to identify strengths and needs in the content areas under household management competencies, parental competencies, family conflict management and utilization of community resources. The data from Life Skills Program Bid Proposal Transitions Psychology Group, LLC 3 2004-2005 the LSA will be used to develop goals and objectives for the action plans. B. Visitation: The Visitation program will provide the following services through a Parent Child Interaction Therapy (PCIT) model. 1. Monitor parent/child interactions for physical and emotional safety. A trained therapist will be present during the contact between the parent and child. 2. Document clinical observations: The therapist will monitor parent/child interactions and collect specific data, such as quality and type of play, number of positive interactions and the child's compliance with the parents requests. 3. Strategize for teaching and modeling parenting skills: The therapist acts as a coach during the sessions, directly teaching discipline techniques and re-teaching parenting errors. 4. Teach relational skills: The therapist teaches the parent play therapy concepts as a way to bond with the child. 5. Encourage goal setting and pro-social values: Reduction of parental stress through the use of PCIT often decreases the propensity that a parent will commit violent or neglectful acts towards the child. Developing a better relationship with the parent has been shown to improve the child's compliance with rules and requests. III. MEASURABLE OUTCOMES A. Improvement of household management competencies will be measured using a pre and post intervention screening, the Life Skills Assessment. The assessment will include self-anchored scales related to household management competencies. B. Improvement of parental competencies will also be measured using the LSA and documented observations of parenting skills. C. Parents can independently work with other sources in the community and within the local, state and federal governments as measured through the use ecological maps. Ecological maps document the participants' support network pre and post participation. Changes in the network can be measured over time. D. Transitions will conduct participant follow-up with Life Skills Coaching participants three months and six months after discharge. The Life Skills Program Bid Proposal Transitions Psychology Group, LLC 4 2004-2005 participant families will remain intact at the time of the six-month follow-up. E. Participants who complete the Life Skills services will have improved competency levels or reduced risk on a standardized assessment. Transitions will utilize the Parental Stress Index (PSI), the risk assessment tool or the FACES (Family Adaptability and Cohesion Evaluation Scales) II. These are quantitative measures used to assess levels of flexibility and cohesion in families. Families that have made significant positive changes while on the program would tend to move from more extreme family types on pre tests towards more balanced family types on post tests. V. SERVICE OBJECTIVES A. Mentorinq 1. Improve household management competencies, the capacity of parents to provide a safe household environment for their children through competent household cleaning and maintenance, budgeting, purchasing and leisure activities. This will be measured through the use of self-anchored scales and pre and post measures on the Life Skills Assessment. 2. Improve parental competencies, the capacity of parents to use adaptive strategies, maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instruction and supervision. Progress will be measured via the FACESII. 6. Improve ability to access community connections and resources, services that assist parents to work with other sources of help in the community and the local, state and federal governments. This will be measured by comparisons between pre and post ecological maps. 7. Improve goal setting and pro-social values. Families will establish and work on specific goals throughout the program. Their progress towards their goals will be documented along with their cooperation with the program. B. Visitation 1. Improve parenting skills, parent child/parent child interactions and relational skills and monitor for physical and emotional safety through structured activities and documentation of visitations to achieve the objectives of the treatment plan. M nitoring, teaching and documentation will 466/accomplished through the use of trained Master's level therapists and the PCIT model. Life Skills Program Bid Proposal Transitions Psychology Group, LLC 5 2004-2005 2. Improve goal setting and pro-social values through helping the parent experience feelings of success in parenting. • VI. WORKLOAD STANDARDS The Mentoring program will provide services for approximate) 3 i hours each week, divided between ) individual service providers. The maximum caseload per worker would be four family units. The primary modality of service for the mentoring program will be home visits. However, depending on the specific goals, in-person office meetings and community-based interventions would also be appropriate. Based on the agency maximum of eight families active in the program each month, the total number of hours per day would not exceed 12; the total number of service hours per week would not exceed 48; the hours per month would not exceed 206. Therapists in the visitation program will not carry a caseload of more than five ✓ families. The maximum hours per day for this portion of the program would be two. Program supervisors, therapists and life skills coaches carry minimum professional liability insurance of$1,000,000 per _ occurrence and $3,000,000 aggregate. VII. STAFF QUALIFICATIONS A. Transitions staff members, including supervisors, who are providing direct services meet or exceed the minimum qualifications in education and experience as defined in Staff Manual Volume VII, Section 7.303.17 and Section 7.0006, Q, Colorado Department of Human Services. Transitions staff members providing services under the life skills program area possess a minimum of a bachelor's degree — .' in human service or human development field and six months of A" relevant experience. Supervisors hold master's degrees and are — r, licensed as professional counselors or clinical social workers. Therapists in the visitation program have a minimum of a Master's _ degree in a human services field. B. Transitions has two contracted bachelor's level staff members& ; available for the mentoring portion of the project and two Maste s level therapists available for the visitation program. Additionally, Transitions has two supervisors in the program area, for a total of six available staff members for the Life Skills program area. Life Skills Program Bid Proposal Transitions Psychology Group, LLC 6 2004-2005 VIII.UNIT OF SERVICE RATE COMPUTATION PROGRAM BUDGETS COMPUTERIZED ACTUAL ' PROGRAM Home Studies Life Skills A TOTAL HOURS OR DAYS OF DIRECT SERVICE PER CLIENT 10 34 B TOTAL CLIENTS SERVED 72 32 C TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR YEAR(A X B) 720 1,088 D COST PER HOURS OR DAYS OF DIRECT SERVICES(E/C) E TOTAL DIRECT SERVICE COSTS FACE-TO-FACE $46,800 $57,600 F ADMINISTRATION COSTS NON-FACE-TO-FACE ALLOCABLE TO PROGRAM $9,525 $16,700 G OVERHEAD COSTS ALLOCABLE TO PROGRAM $6,875 $9,625 H TOTAL DIRECT,ADMINISTRATION&OVERHEAD COSTS(E+F+G) $63,200 $83,925 I PROFITS CONTRIBUTED BY THIS PROGRAM $7,000 $9,300 J TOTAL COSTS AND PROFITS FROM THIS PROGRAM(H +I) $70,200 $93,225 K TOTAL HOURS OR DAYS OF DIRECT SERVICE FOR THE YEAR(C) 720 1,088 L RATE PER HOURS OR DAYS OF DIRECT,FACE-TO-FACE SERVICE (J/K) $97.50 $85.68 CERTIFICATION STATEMENT I soul l we-ttn Mena In declare to the best of my knowledge and belief that the statements made on this document are true and complete and that the wage rates and other factual unit costs supporting the compensation paid or to be aid yynder this contractcontract are accurate,complete and includes no duplicate costs and and that I am the CEO or duly authorized agent of IYQVi5i t10Y)5 V4dCrl d I0✓[ uroupp, l DIRECT SERVICE COSTS COMPUTERIZED ACTUAL Minimum Budget Avenge Total %OF TIME SALARY %OF TIME SALARY • Degree #Of Salary/Bens Salaries/ 100% . SPENT ON AND SPENT ON AND DESCRIPTION or Cert FTEs @ 1.0 FTE Benefits/Other ALLOCATED PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM ..a. :*` A TOTAL CLIENT HOURS OR DAYS PER PROGRAM ,' d, ,ga..,-.- "'e_R-..,... B TOTAL CLIENTS TO BE SERVED PER PROGRAM =,y „ "° C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 720.00 1088.00 DIRECT LABOR FACE-TO-FACE POSITION,TITLE OR JOB FUNCTION Steff 'A` ° 3 ` ti YES ''`' �. $46,800.00 a '"'n`° $0.00 „� $0.00 NO sY $0.00 a $0.00 S18fT a $0.00 YES g $0.00 $ i $0.00 NO ^-' $0.00 --ESA,- 3 000 267,60 $0 00 ._., e r $0.00 NO $0.00 !., € r, $0.00 .,a h $0.00 NO s — $0.00 --1e„ '� t at 2 ,r a $0.00 NO " r. $0.00 "" $0.00 s $0.00 NO $0.00 $0.00 a ,.,. *k aer: $0.00 NO l' +. $0.00 i, aka; $0.00 "" r"' ,A� '�'' .: r .-. $0.00 NO _ $0.00 £'. $0.00 $0.00 NO $0.00 $0.00 -n.�l . a ., $0 00 NO $0 0 ... $0.00 $0.00 NO d sh $000 $0.00 $0.00 NO qt $0.00 .4„ $0.00 TOTAL DIRECT LABOR PER PROGRAM $46,800.00 $57,600.00 OTHER DIRECT COSTS PER PROGRAM FACE-TO-FAC€ ,3,. a ,. c a- .,r ei 4 YES $2,952.00 `a"»s $0.00 a .Se _t. NO v ,:c $0.00 1!,,,It $0.00 '-s " - NO P $0.00 r $0.00 '- a x, rr" - AT: NO ry- •°" $0.00 $0.00 � ' k + a t, - NO + .; $0.00 $0.00 ;Cr 9`a• NO .. ... aa.. $0.00 -.-AIWISIZii,Z7 $0.00 TOTAL OTHER DIRECT COSTS PER PROGRAM $2,952.00 $0.00 E GRAND TOTAL DIRECT SERVICE COSTS $49,320.00 $49,752.00 $57,600.00 :::11: 804 11th Avenue Greeley, CO 80631 Transition, ADMIN COST NON-FACE-TO-FACE COMPUTERIZED ACTUAL Minimum Budget Average Total %OF TIME SALARY %OF TIME SALARY %OF TIME • Degree #Of Salary/Bene Salaries/ 100% SPENT ON AND SPENT ON AND SPENT ON DESCRIPTION or Cert FTEs @ 1.0 FTE Benefits/Other ALLOCATED PROGRAM OTHER COSTS PROGRAM OTHER COSTS PROGRAM PROGRAM Home Studies Life Skills A TOTAL CLIENT HOURS OR DAYS PER PROGRAM 10 34 B TOTAL CLIENTS TO BE SERVED PER PROGRAM 72 32 C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 720.00 1088.00 DIRECT LABOR NOT FACE-TO-FACE -,a `F `�"". ) - YES Inti . $9,525.00 Sr, $16,700.00 e` fxs 'k rCj Fn NO -s.:_, $0.00 - $0.00 �, ';7 y4 . e NO ,..'° .a1_ $0 00 .sd $0 00 ,.'.4-1411i4;4.4 0420,:;.7z; Z` -a ,k. NO �- $0.00t,,,,400;40;.1-18?),.: $0.00 $"v s "-, .y. .. 4 $0.00 NO •"a $$0.00 0 00 f1,-,K,143-4,A,,, $0.00 A e u r .., s x ' `( $0.00 NO ° $0 00 '"` .�'1.4,a $0 00 .,�` d w �°a $0 00 F rx 5t $0.00 NO �,�� t : $0.00 $0 00 ., �, »�+ -- 3r $0.00 NO i $0.00 I $$$000.1000000 0 00 .. 3- c .. i $0.00 NO - + '�"ux $0.00 0 $0.00$0.00 ligk Eff TOTAL DIRECT LABOR PER PROGRAM NOT FACE-TO-FACE $0.00 $9,525.00 $16,700.00 OTHER DIRECT COSTS PER PROGRAM NOT FACE-TO-FACE n s ! �,� � � � ar ¢ 3�`iw"" �� .g. NO '` ti $0.00 �� r' rte. F & $0 00 gia °a i r R -4' c � r .�, .per �xa -,a NO x'-zy' :NO 0. $0.00 ,p $000 r+;w,t ,-, '. �' 3 s a:uzsf NO �' $0.00 y. $000 u ...a-r .� . ,_:_ . s$ -mss - -� "e.-`�d NO x; ' , $0.00 rro� $0.00 - m._..„m .,._. .. �. ...-.,�.4, NO M4 g $0.00 2n.�:ige. $000 ik stelliv TOTAL OTHER DIRECT COSTS NOT FACE-TO-FACE PER PROGRAM $0.00 $0.00 $0.00 F GRAND TOTAL DIRECT SERVICE COSTS NOT FACE-TO-FACE $0.00 $13.23 $9,525.00 $15.35 $16,700.00 °ei®.a ^, •:.ei!•5i .:; 804 11th Avenue :: .. Greeley, CO 80631 Transitions OVERHEAD COSTS AND PROFITS COMPUTERIZED ACTUAL ' . • • TOTAL ALLOCATED ALLOCATED ALLOCATED D 100% ALLOCATED OVERHEAD COSTS ALLOCATED OVERHEAD COSTS ALLOCATED OVERHEAD COSTS DESCRIPTION COSTS D TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM TO PROGRAM PROGRAM Home Studies Life Skills A TOTAL CLIENT HOURS OR DAYS PER PROGRAM $10.00 $34.00 B TOTAL CLIENTS TO BE SERVED PER PROGRAM $72.00 $32.00 C TOTAL HOURS OR DAYS PER PROGRAM FOR YEAR 720.00 1088.00 OVERHEAD ent �x " ''' i100400.014,41:144942.-W rt r $2750000...NO NO s ,009f $6,875.00 N .t' .. $9,625.00 �, + ';e-44 $0.00 :y„ R-,� $0.00 spa $0.00 $0.00 , ,,p F -x € NO a $0.00 1 ;0,_-'417.1,6-40:, $0.00 '"� $0.00 ,; - 0 00 $0.00 $0.00 '� 'k* - NO � $0.00i:,241,11**. $0.00 °` ;' $0.00 $0.00 z - $000 T .P*- $0.00 NO $0.00 �. k` _ $0.00 $0.00 .m t " -r,: �' € $ NO .,yam 3e' $0.00 y% Itt. $0.00 $0.00 3 NO ° .:"z $0.00 . $0.00 -- $0.00 : * y ,..j ,-r, ..,6 6 ..thattt'^` 'NO i „ $0.00 ,4 $0.00 $0.00 -` a r. t'r ,a �`, s-n=... i ' T:. _,w:NO .i `-". $0.00 '42„i.4,22:17,4 $0.00 " $0.00 ,. fi NO $0.00 _ - $000 xy $000 ' r '''NO i $0.00 , $0.00 $0.00 t r rc fig' -,53."'x'-" -'L x NO $0.00 '' $0.00 q $0.00 ,,, ; ;,�, li -, i NO w s₹ _ $0.00 $0.00 ;:g1;1:46,r1401::;:::11;::: $0.00 i -1 .: - ""�6-I x i;'NO , w $0.00 v $0.00 $0.00 rK "- , x . -r ,A lfi& $000 i - $0.00 $0.00 . . n: l""' $0.00 '$+ $0.00 $0.00 G TOTAL OVERHEAD COSTS $27,500.00 $6,875.00 $9,625.00 $0.00 I TOTAL ANTICIPATED PROFITS .- '*}� $7,000.00 ,�4i= .-a�;;Ee"l $0.00 � "",:, $0.00 TOTAL OVERHEAD AND ANTICIPATED PROFITS $27,500.00 $13,875.00 $9,625.00 $0.00 :.:• 804 11th Avenue ;: Greeley, CO 80631 Transitions • __________, - ' CNA Healthcare Providers Service Organization Purchasing Group ®HPSO CNA Plaza, 1 it J Chicago,IL 60685 Crex#- + cam'RO tftratr of tsuran.c.e Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 270170798-8 from' 12:01 AM Standard Time on: 07/04/03 Named Insured and Address Program Administrator Healthcare Providers Service Organization JAMI MOE HARTMAN 159 East County Line Road 804 11TH AVENUE Hatboro, PA 19040-1218 GREELEY CO 80631-3246 Medical Specialty: Code: Insurance Provided by Clinical/Rehabilitation Counselor 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, IL 60685 COVERAGE PARTS LIMITS OF LIABILITY A. PROFESSIONAL LIABILITY -. - -- __ -- - ----- Professional Liability $1,000,000,_00 each claim_ $6.000,000.00 aggregate Good Samaritan Liability Included above Personal Injury Liability Included above Malplacement Liability Included above B. Coverage Extensions License Protection . $5,000.00 per proceedina $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. -Work lace -Liability - --- -_. _ 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 AIS Affinity Ineuzance Agency;in MN and OK.AIS Affinity Insurance Agency,Inc.;and in CA,AIS Affinity Insurance Agency.Inc.dba ikon Direct Insurance Aduuniatrators License#0795465. Master Policy: 188711433 Cf."Yy4. fil Keep this document in a safe place. This and /...c..-.4_,/...c..-.4_, �,^� your cancelled check act as proof of coverage. Chairman - (If R f thr nard Secretary • CNA Healthcare Providers Service Organization Purchasing Group ®HPSO CNA Plaza, Chicago,IL 60685 (lertr t� "'+e"•"^°"e'^''^*.oT,:.e-- tftratr of (4Jneural-ter 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 Medical Specialty: Code: Insurance Provided by Clinical/Rehabilitation Counselor 72990 American Casualty Co. of Reading, PA CNA Plaza 26S Chicago, IL 60685 COVERAGE PARTS LIMITS OP LIABILITY " A. PROFESSIONAL LIABILITY---- ---- __ Professional Liability $1,000,000.00 each claim $6,000,000.00 aaareaate 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 aaareaate 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 aaareaate 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 Covers e 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 Nµ 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 Administrators License#0795465. Master Policy: 188711433 S-an Keep this document in a safe place. This and jtiff/ 1 Y ` your cancelled check as as proof of coverage.fyy4 Chairman of the Board • Secretary SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B RECOMMENDATIONS X CONDITIONS ritiat WHO By ••• Greeley, CO 80631 •;474 804 11th Avenue • • • Phone: (970)336-1123 APR 1 3 2004 • •�• ♦ • FAX: (970)351-0182 ��• • �• • • WELL) v.:n: : , L:_f 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, --(g5DC) Gregory S. Creed, MA, LPC Jami Moe-Hartman, MA, LPC Co-Owner Co-Owner DEPARTMENT OF SOCIAL SERVICES P.O.BOX A GREELEY, CO.80632 Webske:www.co.weld.co.us ' Admintstradon 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 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 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, ecto cc: Juan Lopez,Chair,FYC Commission Gloria Romansik, Social Services Administrator Hello