HomeMy WebLinkAbout20031057.tiff RESOLUTION
RE: APPROVE 2003-2004 CORE SERVICES AND CHAFEE FOSTER CARE
INDEPENDENCE PROGRAM PLAN AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with the 2003-2004 Core Services and
Chafee Foster Care Independence Program Plan from 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, to the Colorado Department of Human Services, Division of
Child Welfare Services, commencing June 1, 2003, and ending May 31, 2004, with further
terms and conditions being as stated in said plan, and
WHEREAS, after review, the Board deems it advisable to approve said plan, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, ex-officio Board of Social Services, that the 2003-2004 Core Services
and Chafee Foster Care Independence Program Plan from 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, to the Colorado Department of Human Services, Division of
Child Welfare Services, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said plan.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 30th day of April, A.D., 2003.
BOARD OF COUNTY COMMISSIONERS
WE OUNTY, COLO DO
ATTEST: 4,
D vid E. L g, Chair
Weld County Clerk to ftle 0:0,1 = �
f�' � e et. Robert D asden, Pro-Tem
BY: ��r� „��'ti /r
Deputy Clerk to the Board -
M. J. Geile
O AST •
//vf
WilliakeA
oun ` y I
5�. Glenn Vaad
Date of signature:
2003-1057
7;0 . �,S ( 2 B Kc i e ) SS0030
CORE SERVICES and
CHAFEE FOSTER CARE INDEPENDENCE
PROGRAM PLAN
FY 2003-2004
FOR
WELD
COUNTY(IES)
REQUEST FOR STATE APPROVAL OF PLAN
® Independence Program(CFCIP),otherwise all statements throughout this document will be considered not
applicable.
This Core Services Plan is hereby submitted for Weld
[Indicate county name(s) and lead county if this is a multi-county plan], for the period June 1, 2003, through
May 31,2004. The Plan includes the following:
4 Completed"Statement of Assurances";
4) Completed Statement of the eight(8)required Core services to be provided or
purchased and a list of county optional services, County Designed Program
Services,to be provided or purchased;
$ Completed program description of each proposed"County Designed Service";
$ Completed"Information on Fees"form;
$ Completed"Direct Service Delivery"form;
$ Completed"Purchase of Service Delivery"form;
$ Completed"Projected Outcomes"form;
$ Completed"Overhead Cost"form;
4, Completed"Final Budget Page"fort;
$ Completed"State Board Summary";and,
4) Completed"100%Funding Summary"form.
This CFCIP plan is hereby submitted for Weld [Indicate county name(s)and lead county
if this is a multi-county plan],for the period October 1, 2003,through September 30,2004. The Plan includes
the following:
4) Completed"Request for State Approval"form
4) Completed"State of Assurances"form
$ Completed"Chafee Foster Care Independence Program"format
$ Completed"Direct Service Delivery"and/or"Purchased Service Delivery"
form
$ Completed"Youth Direct"form
$ Completed"Final Budget page"
This Core Services and Chafee Foster Care Independence Program Plan has been developed in accordance with
State Department of Human Services rules and is hereby submitted to the Colorado Department of Human
Services, Division of Child Welfare Services for approval. If the enclosed proposed Core Services and/or
Chafee Foster Care Independence Program Plan is approved,the plan will be administered in conformity with
its provisions and the provisions of State Department rules.
The person who will act as primary contact person for the Core Services Plan is,_David Aldridge and can be
reached at telephone number _970.352.1551, ext. 6290 . The primary contact person for CFCIP is _Mark
Lindquist and can be reached at telephone number_970.352.1551 ext.6266_.
If two or more counties propose this plan,the required signatures below are to be completed by each county,as
appropriate. Please atta an additional signature page as needed.
0 473U/(1�
Signature, CT OUN DEPARTMENT OF SOCIAL SERVICES DATE
1 POtt O1 kCk- Pal n i i s a.ua 4 3O 03
tatur8jC Sig PLAC ME TERNATIVES COMMISSION DATE
oe `i -3O-0
Signature,CHA ,BOARD OF CO COMMISSIONERS DATE
I./
2
x663-O57
CORE SERVICES
STATEMENT OF ASSURANCES
Weld County(ies) assures that, upon approval of the Core
Services-Chafee Foster Care Independence Program Plan the following will be adhered to in the
implementation of the Plan:
Core Services Assurances:
• Operation will conform to the provisions of the Plan;
• Operation will conform to State rules;
• Core Services Program Services, provided or purchased, will be accessible to
children and their families who meet the eligibility criteria;
• Operation will not discriminate against any individual on the basis of race,sex,
national origin, religion, age or handicap who applies for or receives services
through the Core Services program;
• Services will recognize and support cultural and religious background and
customs of children and their families;
• Out-of-state travel will not be paid for with Core Services funds;
• All forms used in the completion of the Core Services plan will be State
prescribed or State approved forms;
• Core FTE/Personal Services costs authorized for reimbursement by the State
Department will be used only to provide Core Services authorized in the
county(ies)'approved Core Services Plan;
• The purchase of services will be in conformity with State purchase of service
rules including contract form,content,and monitoring requirements;and
• Information regarding services purchased or provided will be reported to the
State Department for program,statistical and financial purposes.
3
CHAFEE FOSTER CARE INDEPENDENCE PROGRAM PLAN
STATEMENT OF ASSURANCES
Weld County(ies)assures that,upon approval of the
Core Services-Chafee Foster Care Independence Program Plan the following will be adhered to in the
implementation of the Plan:
Chafee Foster Care Independence Program statement of assurances:
• Funds shall be used exclusively for the purposes specified in the plan;
• Funds shall not be used to supplant,duplicate or replace existing child welfare funds and;
• Funds shall not be used for county budget shortfalls;
• Assistance and services will be provided to youth who have left foster care because they have attained
18 years of age,and have not attained 21 years of age[Section 477(b)(3)(A)];
• Not more than 30 percent of the amounts allocated for CFCIP for a fiscal year
will be expended for room and board for youth who have left foster care because they have attained 18
years of age, and have not attained 21 years of age[Section 477(b)(3)(B)];
• None of the amounts paid to the County Department from its allocation will be expended for
room and board for any child who has not attained 18 years of age [Section 477(b)(3)(C)];
• The County Department will make every effort to coordinate the CFCIP program receiving
funds with other Federal and State programs for youth(especially transitional living youth projects
funded under part B of title III of the Juvenile Justice and Delinquency Prevention Act of 1974);
abstinence education programs, local housing programs,programs for disabled youth(especially
sheltered workshops),and school-to-work programs offered by high schools or local workforce
agencies [Section 477(b)(3)(F)];
• Adolescents participating in the program under this section will participate directly in designing their
own program activities that prepare them for independent living and the adolescents will be required to
accept personal responsibility for living up to their part of the program[Section 477(b)(3)(H)];and
• The County Department agrees to enforce standards and procedures to prevent fraud and abuse in the
programs carried out under the plan.
4
CORE SERVICESTO BE PROVIDED/PURCHASED
Place an "X" to indicate which of the following Core Services Program Services will be provided/purchased in accordance with
State Department rules:
X Home Based Intervention
X Intensive Family Therapy
X Sexual Abuse Treatment Services
X Day Treatment
X Life Skills
X Special Economic Assistance
X Mental Health Services
X Substance Abuse Treatment Services
List below"County Designed Service"that will be provided/purchased in accordance with State Department rules:
X North Colorado Medical Center-PsychCare,Youth Passages,Adolescent Partial Hospitalization and Day
Program
FAMILY STABILITY SERVICES TO BE PROVIDED/PURCHASED
Due to budget reallocations for state fiscal year 2003-2004, funding is not available for the Family Stability Services based on
Senate Bill 01-012. If a county would like to provide Family Stability Services as outlined in Colorado Department of Human
Services Staff Manual Volume 7, at 7.310, with Child Welfare Block, Temporary Assistance to Needy Families (TANF), or
county only funds(FSS falls under the Child Welfare Block),please contact Melinda Romero at 303.866.5962 for details and plan
requirements.
5
CORE SERVICE
COUNTY DESIGNED SERVICE
Service Name: North Colorado Medical Center--PsychCare,Youth Passages,Partial Hospitalization and Day Program
Optional services approved as a part of the county's Core Services Plan are approved on an annual basis. For a County Designed
Service to be extended beyond one year,this portion of the plan must be submitted and approved annually by the State Department.
Given that County Designed programs are not standardized across counties, it is important to provide detailed information as
outlined below. This information can be use to justify continued funding of the program with the legislature. The information listed
below is to be completed for each County Designed Service to be included in the County(ies)'Core Services Program Plan.
1. Describe the service and components of the service,define the goals of the program.
2. Define the eligible population to be served.
3. Define the time frame of the service.
4. Define the workload standard for the program:
• number of cases per worker,
• number of workers for the program,and
• worker to supervisor ratio.
5. Define the staff qualifications for the service,e.g.,minimum caseworker III or equivalent,see 7.303.17 for guidelines.
• Define the performance indicators that will be achieved by the service,see 7.303.18.
• Identify the service provider.
• Define the rate of payment(e.g.,$250.00 per month).
1. Adolescent Partial Hospitalization is a program designed to address the multifaceted needs of adolescents experiencing significant
emotional,behavioral,educational,interpersonal,familial problems,and adolescents suffering from a wide range of psychiatric
disorders and chemical dependency.Day program is conducted in English while family sessions can be conducted in Spanish through a
Bilingual therapist.Transportation for South County families provided through Weld BOCES and RE-8.
2. 96 adolescents(10-18 years)per year,and/or(range of 5-18 years),8 monthly average capacity.
3. 40 hours per week,for 6-10 weeks.Average hours in intensive outpatient program per week is 12.
4. Total number of staff is(7 full time,MD part time)available for project based on projected average daily census of 12.(per diem
therapists and team assistants will be added if census dictates).Two staff members to five children ages 5 years to 13 years(minimum
is 1 staff member to 8 children.)Two staff members to six children ages 16 years and over(minimum is one staff member to 10
children.Staff members include two teachers,three behavioral health therapists,one behavioral health team assistance,one behavioral
health youth clinical coordinator.Seven hill-time staff members dedicated solely to adolescent services with per diem therapists and
staff available as needed.MD contracted to see patients a minimum of once per week.
5. Hourly rate is$19 per hour.Provider is North Colorado Medical Center-PsychCare,Youth Passages.
6
INFORMATION ON CORE SERVICE FEES
Please check all that apply:
X Fees will not be assessed for Core Services Program Services.
If above line is checked,STOP. Remainder of information does not need to be completed.
The following fees apply for the programs checked above.
Fees will be assessed for the following services:Check those that apply:
Home Based Intervention
Intensive Family Therapy
Sexual Abuse Treatment
Day Treatment
Life Skills
Special Economic Assistance
Mental Health Services
Substance Abuse Treatment Services
County Designed Service(List Services Below)
Fee assessment formula is the same for all services. State the formula here(attach additional sheets as needed).
Fee assessment formula varies with service. State formula used for each service.
7
New Core Service Detail
Please indicate in the table below any new Core Service Detail and the approved contract to which they belong.
Contract Resource/Provider New Service Detail
Stillwater Services Intensive Family Therapy, Contact# 03-CORE-IFT-0001
Address: PO Box 336058, Greeley, CO 80633
Ackerman and Associates, P.C. Lifeskills, Contact# 03-CORE-LS-0002
Address: 1750 25 Avenue, Suite 101, Greeley, CO 80634
El Mundo de Esperanza (A World of Hope) Lifeskills, Contract# 03-CORE-LS-0003
Address: PO Box 336058, Greeley, CO 80633
Lori Kochevar, LLC Lifeskills, Contract# 03-CORE-LS-0006
Address: 810 12 Street, Greeley, CO 80631
North Colorado Medical Center-Youth Passages Lifeskills, Contract # 03-CORE-LS-0005
Address: 1801 16 Street, Greeley, CO 80631
Lutheran Family Services (Home Based Parent Coach) Lifeskills, Contract#03-CORE-LS-0006
Address: 3800 Automation Way, Suite 200, Fort Collins, CO
80525
Lutheran Family Services (Visitation) Lifeskills, Contract# 03-CORE-LS-0007
Address: 3800 Automation Way, Suite 200, Fort Collins, CO
80525
Weld County Department of Human Services Lifeskills
Address: 1551 N 17 Avenue, Greeley, CO, 80631
Avalon Correctional Services, Inc. Substance Abuse
(The Villa at Greeley, LLC) 7650 North Washington, Denver, CO 80229
8
HOME BASED INTERVENTION SERVICES
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Code 1700, 1800
Definition
7.303.1 A Home Based Intervention: Services provided primarily in the home of the client and includes a variety of services which can include therapeutic services,
concrete services,collateral services and crisis intervention directed to meet the needs of the child and family.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
. are to be charged to Core Services. Staff positions to be included are County Core Services employee positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent of Percent Total Number Total
Number Monthly Fringe Travel Operate Salary Salary Salary Salary Monthly of Direct
Salary Funded by Funded by Funded by Funded by Direct Month Service
80/20 100% TANF Regular Service of Cost Cost
1700 1800 Admin Cost
(3+4+5+6)
TOTAL
9
INTENSIVE FAMILY THERAPY .
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Codes 1710, 1810
Definition
7.303.1 B Intensive Family Therapy:Therapeutic intervention typically with all family members to improve family communication,functioning,and relationships.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are County Core Services employee positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent of Percent Total Number Total
Number Monthly Fringe Travel Operate Salary Salary Salary Salary Monthly of Direct
Salary Funded by Funded by Funded by Funded by Direct Month Service
80/20 100% TANF Regular Service of Cost Cost
1700 1800 Admin Cost
(3+4+5+6)
TOTAL
10
LIFE SKILLS
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Codes 1720,1820
Definition
7.303.1 C Life Skills: Services provided primarily in the home that teach household management,effectively accessing community resources,parenting techniques,
and family conflict management.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are County Core Services employee positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent of Percent Total Number Total
Number Monthly Fringe Travel Operate Salary Salary Salary Salary Monthly of Direct
Salary Funded by Funded by Funded by Funded by Direct Month Service
80/20 100% TANF Regular Service of Cost Cost
1700 1800 Admin Cost
(3+4+5+6)
TOTAL
11
DAY TREATMENT
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Codes 1730,1830
Definition
7303.1 D Day Treatment:Comprehensive,highly structured services that provide therapy and education for children.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are County Core Services employee positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent of Percent Total Number Total
Number Monthly Fringe Travel Operate Salary Salary Salary Salary Monthly of Direct
Salary Funded by Funded by Funded by Funded by Direct Month Service
80/20 100% TANF Regular Service of Cost Cost
1700 1800 Admin Cost
(3+4+5+6)
TOTAL
12
SEXUAL ABUSE TREATMENT SERVICES
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Codes 1740,1840
Definition
7.303.1 E Sexual Abuse Treatment:Therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization sexual dysfunction,sexual
abuse perpetration,and to prevent further sexual abuse and victimization.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are County Core Services employee equivalent positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent of Percent Total Number Total
Number Monthly Fringe Travel Operate Salary Salary Salary Salary Monthly of Direct
Salary Funded by Funded by Funded by Funded by Direct Month Service
80/20 100% TANF Regular Service of Cost Cost
1700 1800 Admin Cost
(3+4+5+6)
TOTAL
13
COUNTY DESIGNED SERVICE -
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Codes 17_, 18_
Definition
7.303.1 J County Designed Services: innovative and/or otherwise unavailable service proposed by a county that meets the goals of the Core Services Program.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are County Core Services employee positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent of Percent Total Number Total
Number Monthly Fringe Travel Operate Salary Salary Salary Salary Monthly of Direct
Salary Funded by Funded by Funded by Funded by Direct Month Service
80/20 100% TANF Regular Service of Cost Cost
1700 1800 Admin Cost
(3+4+5+6)
1
TOTAL
14
HOME BASED INTERVENTION SERVICE
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1700,1800
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
2 3 4 5 6 7 8 9 10 11
PROVIDER NAME Trails Amount of Amount of Amount Unit of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract of Service* of Units Rate per Month of Per Provider
Number Funded by Funded by Contrac of Unit of (7 x 8) Months (9 x 10
80/20 100% t Service/ Service of
1700 1800 Funded Month Cost
by
TANF
Ackerman & Associates, 2916 N/A H 200 $80.00 $16,000.00 12
P.C.
Lutheran Family Services 45080 N/A H 60 $100.56 $6,033.60 12
Stillwater Services,LLC 1509626 N/A II 113.33 $69.99 $7,931.97 12
North Colorado Medical 63973 N/A H 160 $67.09 $10,734.40 12
Center-Youth Passages
Totals $57,847.56 $34,538.04 540.33 $325.64 $40,699.97
TOTAL $92,385.60
• -Identification of unit is: H=Hour,D=Day,W=Week,M=Month, E=Episode
Note: Columns 7,8,and 9 reflect maximum capacities for services
15
INTENSIVE FAMILY THERAPY
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1710,1810
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
2 3 4 5 6 7 8 9 10 11
PROVIDER NAME Trails Amount of Amount of Amount Unit of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract of Service* of Units Rate per Month of Per Provider
Number Funded by Funded by Contrac of Unit of (7 x 8) Months (9 x 10
80/20 100% t Service/ Service of
1700 1800 Funded Month Cost
by
TANF
Ackerman&Associates, 2916 N/A H 50 80.00 $4,000.00 12
P.C.
Mediation, 17967 N/A H 20 $150.60 $3,012.00 12
Communication,and
Training,Inc.
North Colorado Medical 63973 N/A H 40 $67.15 $2,686.00 12
Center-Youth Passages
Lutheran Family Services 45080 N/A H 12.5 $96.70 $839.38 12
Stillwater Services 1509626 N/A H 100 $65.02 $6,502.00 12
Totals $57,847.56 $34,538.04 229.5 $467.47 $17,039.38
TOTAL $92,385.60
*-Identification of unit is: H=Hour,D=Day,W=Week,M=Month E=Episode
Note:Columns 7, 8,and 9 reflect maximum capacities for services
16
LIFE SKILLS -
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1720, 1820
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
2 3 4 5 6 7 8 9 10 11
PROVIDER NAME Trails Amount of Amount of Amo Unit of Number Payment Rate Cost Per Numb Total Cost
-, Resource/Provider Contract Contract tint of Service* of Units per Unit of Month er of Per Provider
Number Funded by Funded by Contr of Service (7 x 8) Month (9 x 10
80/20 100% act Service/ s of
1700 1800 Fund Month Cost
ed by
TAN
F
Ackerman&Associates, 2916 N/A H 300 $80.00 $24.000.00 12
P.C.
Child Advocacy Resource 62085 N/A H 87 $62.07 $5,400.09 12
&Education-Parent
Advocate Program
Child Advocacy Resource 62085 N/A H 156.25 Low Intensity $4,414.06 12
&Education-Visitation $28.57;
High Intensity
90 $57.65; $5,188.50
62.5 Transportation
$22.99 $1,436.88
El Mundo de Esperanza(A N/A H 380 $42.19 $16,032.20 12
World of Hope)
Lori Kochevar,LLC 5820 N/A H 84 $65.00 $5,460.00 12
North Colorado Medical 63973 N/A H 160 $67.15 $10,744.00 12
Center-Youth Passages
Lutheran Family Services- 45080 N/A H 87 $62.01 $5,394.87 12
Mentoring
17
Lutheran Family Services- 45080 N/A H 160.33 Interactional $14,742.34 12
Visitation Visitation
$91.95;
55.25 Visitation $3,564.73
$64.52;
208 Transportation $9,000.16
$43.27
Lutheran Family Services- 45080 N/A H 93.33 $62.01 $5,787.39 12
Home Based Parent Coach
Weld County Youth 17967 N/A H 74.67 $17.00 $1,269.39 12
Alternatives-DBA Partners
Weld County Department N/A H 163 $18.10 $2,942.88 12
of Human Services
($13.92 + $3
Fringe)
Totals $193,454.13 $146,786.67 1,998.33 $767.38 $
112,434.61
TOTAL $340,240.80
*-Identification of unit is: H=Hour, D=Day, W=Week, M=Month E=Episode
Note:Columns 7, 8,and 9 reflect maximum capacities for services
18
DAY TREATMENT -
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1730,1830
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
2 3 4 5 6 7 8 9 10 11
' PROVIDER NAME Trails Amount of Amount of Amount Unit of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract of Service* of Units Rate per Month of Per Provider
Number Funded by Funded by Contrac of Unit of (7 x 8) Months (9 x 10
80/20 100% t Service/ Service of
1700 1800 Funded Month Cost
by
TANF
North Range Behavioral 6220 N/A D 164 $89.14 $14,618.96 12
Health
Alternative Homes for 2016 N/A H 919.33 $14.67 $13,486.57 12
Youth
Totals $29,309.43 $17,499.27 1090.33 $111.81 $28,105.53
TOTAL $46,808.70
*-Identification of unit is: H=Hour,D=Day,W=Week,M=Month E=Episode
Note: Columns 7,8,and 9 reflect maximum capacities for services
19
SEXUAL ABUSE TREATMENT -
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1740,1840
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
2 3 4 5 6 7 8 9 10 11
" PROVIDER NAME Trails Amount of Amount of Amount Unit of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract of Service* of Units Rate per Month of Per Provider
Number Funded by Funded by Contrac of Unit of (7 x 8) Months (9 x 10
80/20 100% t Service/ Service of
1700 1800 Funded Month Cost
by
TANF
Ackerman&Associates, 2916 N/A H 135 $80.00 $10,800 12
P.C.
Alternative Homes for 2016 N/A H 192 $42.58 $8,175.36 12
Youth
Adolescent&Individual 1518534 N/A H 36.25 $55.06 $1,995.93 12
Therapy
Totals $28,923.78 $17,269.02 370.25 $185.64 $20,971.29
TOTAL $46,192.80
* -Identification of unit is: H=Hour,D=Day,W=Week,M=Month E=Episode
Note:Columns 7, 8,and 9 reflect maximum capacities for services
20
SPECIAL ECONOMIC ASSISTANCE
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1855
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
2 3 4 5 6 7 8 9 10 11
PROVIDER NAME Trails Amount of Amount of Amount Unit of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract of Service* of Units Rate per Month of Per Provider
Number Funded by Funded by Contrac of Unit of (7 x 8) Months (9 x 10
80/20 100% t Service/ Service of
1700 1800 Funded Month Cost
by
TANF
Various Providers 45062 N/A $10,000.00 N/A E 3.2 261.78 837.70 12
TOTAL $10,000.00
Note: Columns 7,8,and 9 reflect 2002-2003 averages
21
MENTAL HEALTH SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1845
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
2 3 4 5 6 7 8 9 10 11
PROVIDER NAME Trails Amount of Amount of Amount Unit of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract of Service* of Units Rate per Month of Per Provider
Number Funded by Funded by Contrac of Unit of (7 x 8) Months (9 x 10
80/20 100% t Service/ Service of
1700 1800 Funded Month Cost
by
TANF
North Range Behavioral 80103 None $97,544.00 N/A H 97.94 $83.20 $8,128.64 12
Health
TOTAL $97,544.00
* -Identification of unit is: H=Hour,D=Day,W=Week,M=Month E=Episode
22
SUBSTANCE ABUSE TREATMENT SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1840
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
- 2 3 4 5 6 7 8 9 10 11
PROVIDER NAME Trails Amount of Amount of Amount Unit of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract of Service of Units Rate per Month of Per Provider
Number Funded by Funded by Contract * of Unit of (7 x 8) Months (9 x 10
80/20 100% Funded by Service/ Service of
1700 1800 TANF Month Cost
Signal 27818 None $52,398.00 N/A E N/A See Menu N/A 12
of Services
Avalon Correctional $52,398.00 N/A E N/A See Menu
Services,Inc. of Services
The Villa at Greeley,LLC
$52,398.00 $52,398.00
TOTAL $104,796.00
* -Identification of unit is: H=Hour,D=Day,W=Week,M=Month, E=Episode
23
COUNTY DESIGNED SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 17 ,18
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
2 3 4 5 6 7 8 9 10 11
PROVIDER NAME Trails Amount of Amount of Amount Unit of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract of Service* of Units Rate per Month of Per Provider
Number Funded by Funded by Contrac of Unit of (7 x 8) Months (9 x 10
80/20 100% t Service/ Service of
1700 1800 Funded Month Cost
by
TANF
North Colorado Medical 63973 $62,282.54 $37,185.96 N/A H 3200 $19.00 $60,800.00 12
Center-Youth Passages
TOTAL $99,468.50
* -Identification of unit is:H=Hour,D=Day,W=Week,M=Month E=Episode
Note: Columns 7, 8,and 9 reflect maximum capacities for services
24
PROJECTED CORE SERVICES OUTCOMES FOR
PERFORMANCE INDICATORS
FOR FY 2003-2004
Service Over 85%' 85%-25"%2 Under 25%3 Total Clients Served
Home Base 12 18 25 55
Intensive Family Therapy 18 22 99 139
Life Skills 12 74 37 123
Day Treatment 10 2 3 15
Sexual Abuse Treatment 23 12 8 43
Mental Health Treatment 43 0 0 43
Substance Abuse Treatment 0 171 0 171
Special Economic Assistance 38 0 0 38
County Design(List) 19 4 8 31
'-Client meets 86%or more of the treatment goals
2-Client meets between 85%-25%of the treatment goals
3-Client meets 24%or less of the treatment goals
25
CORE SERVICES PROGRAM
OVERHEAD COST
1. DIRECT SERVICE
A. Total Salary/Fringe/Travel/Operating Costs of Line
Service Workers and their Immediate Supervisors
B. Formula Percentage Allowed for Overhead Costs 15%
C. Provided Service Overhead Costs(A X B)
2. PURCHASED SERVICE
A. Purchased Service Dollar Amount J769,880.00
B. Formula Percentage Allowed for Overhead Costs 3.6%
$0-50,000 =5% $50,001 -100,000=4.9%
For each$50,000(in total expenditure)increase the overhead
decreases by.1%.
C. Allowed Amount for Overhead Costs(A X B) $27,715.68
D. Base Overhead Cost Allowed $500.00
E. Purchased Service Overhead Costs(C+D) $27,394.66
3. TOTAL OVERHEAD COSTS(IC+2E) $27,215.68
DISTRIBUTION OF OVERHEAD COSTS AMONG SERVICES*
SERVICE Provided Service Purchased Service Total Overhead
Overhead Costs Overhead Costs Costs
1. Home Based Intervention $3,325.88 $3,325.88
2.Intensive Family Therapy $3,325.88 $3,325.88
3. Sexual Abuse Treatment $1,662.94 $1,662.94
4.Day Treatment $1,685.11 $1,685.11
5. Life Skills $14,135.00 $14,135.00
6.County Designed Service $3,580.87 $3,580.87
COLUMN TOTALS $27,715.68 $27,715.68
*Formula to determine overhead cost by service:
Step 1: total provided service cost(by service)x 15%=provided service overhead cost
Step 2: total purchased service cost(by service)x%listed in 2B=Y
$500 divided by the number of purchased service=Z,then Y+Z=overhead cost
Step 3: Provided service overhead cost plus purchased service overhead cost equals total overhead cost.
26
r
GENERIC COST SUMMARY SHEET
1. Account Code
2. Total number of children to be served by provided services
3. Total number of children to be served by purchased services
4. Average number of children(total 2+3+12)to be served monthly
5. Total number of families to be served
6. Average number of families to be served monthly
7. Employee FTE number(should be the total staff listed on Direct Service
Delivery Page)
8. Provided cost
Overhead cost(From Overhead cost summary sheet)
Total provided cost
9. Monthly provided cost per child
[this is determined by dividing the total provided cost by the number
of children to be served from provided services and then dividing that
total by the number of months the service will be provided.]
10. Purchased cost
Overhead cost(From Overhead cost summary sheet)
Total purchased cost
11. Monthly purchased cost per child
[this is determined by dividing the total purchased cost by the number of
children to be served from purchased services and then dividing that
total by the number of months the service will be provided.]
12. TOTAL COST REQUESTED [Total provided cost
Total purchased cost]
13. Total 80/20 service cost requested
14. Total 100%service cost requested
27
FINAL BUDGET PAGE
FY 2003-2004
CORE SERVICES
&
CHAFEE FOSTER CARE INDEPENDENCE PROGRAM
CFMS Service Name Other Other Chafee Foster Total Funds Total Funds Total TOTAL
Function DSS Source Care 80/20 100% FSS FUNDS
Code Funds Funds Independence 100%
1700 1800
Funds
1905 CHAFEE Foster Care
Independence Program
1783 Home Based Intervention None None None $57,847.56 $34,538.04 None $92,385.60
1784 Intensive Family Therapy None None None $57,847.56 $34,538.04 None $92,385.60
1785 Lifeskills None None None $193,454.13 $146.786.67 None $340,240.80
1786 Day Treatment None None None $29,309.43 $17,499.27 None $46,808.70
1787 Sex Abuse Treatment None None None $28,923.78 $17,269.02 None $46,192.80
1889 ADAD Contract None None None $52,398.00 $52,398.00 None $104,796.00
1888 Mental Health Contract None None None None $97,544.00 None $97,544.00
1877 Special Economic Assistance None None None None $10,000.00 None $10,000.00
County Design None None None $62,282.54 $37,185.96 None $99,468.50
TOTALS $482,063.00 $447,759.00 $929,822.00
CFMS Function Codes 17xx denotes 80/20 funded Core Service
CFMS Function Codes 18xx denotes 100%funded Core Service
CFMS Function Codes 2850 Chafee Foster Care Independence Program Purchased,Direct Services and Youth Direct
CFMS Function Codes 2810 Room&Board Reimbursement For Emancipated Youth
CFMS Functions Codes for Family Stability Services will be determined by funding source: Child Welfare Block or County Funds. Please contact Melinda Romero at
303.866.5962 for more information.
28
STATE BOARD SUMMARY
CORE SERVICES PROGRAM
FY 2003-2004 80/20 FUNDING
COUNTY(IES) Weld
Services Resource/Provider or #of Families #Children Cost per Child Cost per Year
Number of FTE Age of Child Served Per Served Per Per Month
Month Month
Home Based Various 0-17 5 13 $370.82 $57,847.56
Intervention
Intensive Family Various 0-17 12 30 $160.69 $57,847.56
Therapy
Lifeskills Various 0-17 10 25 $819.51 $245,852.13
Day Treatment Various 5-17 15 1.25 $1,953.96 $29,309.43
Sex Abuse Various 0-17 4 10 $241.03 $28,923.78
Treatment
County Design North Colorado Medical 5-18 2.58 2.58 $2,011.71 $62,282.54
Center-PsychCare,Youth
Passages
TOTAL 80/20 CORE $482,063.00
29
100%FUNDING SUMMARY
CORE SERVICE PROGRAM .
FY 2003-2004
COUNTY(IES) Weld
Services Resource/Provider or #of Families #Children Served Cost per Child Cost per Year
Number of FTE Age of Child Served Per Month Per Month per Month
__. ADAD Signal N/A 14 35 $124.76 $52,398.00
Mental Health North Range N/A 3.55 8.9 $913.33 $97,544.00
Behavioral Health
Special Economic Various N/A 3.2 8 $104.17 $10,000.00
Assistance
CHAFEE Foster Various N/A
Care Independence
Home Based Various 0-17 5 13 $221.40 $34,538.04
Intervention
Intensive Family Various 0-17 12 30 $95.94 $34,538.04
Therapy
Lifeskills Various 0-17 10 25 $489.29 $146,786.67
Day Treatment Various 5-17 1.25 1.25 $1, 166.62 $17,499.27
Sex Abuse Various 0-17 4 10 $143.01 $17,269.02
Treatment
County Design North Colorado 5-18 2.58 2.58 $1,201.10 $37,185.96
Medical Center-
I PsychCare,Youth
Passages
TOTAL 100%CORE $447,759.00
30
PURCHASE OF SERVICE CONTRACT
Core Services Program
1. THIS CONTRACT,made this day of ,200_by and between the
County Department of Social Services at ,hereinafter called"County"
and (address)
(name) (address)
,hereinafter called"Contractor".
(Tax I.D.or Social Security Number)
2. This contract will be effective from until
3. County agrees to purchase and Contractor agrees to provide
(Core Service)
to at at other such
(population to be served) (location service is to be provided)
location as shall facilitate the provision of such services. This service is described in Staff Manual Volume 7,Section
7.303.1 , and, if appropriate,the State approved County Core Service Plan.
4. County agrees to purchase and contractor agrees to furnish units of service at the cost of
per unit of service for a maximum amount of this contract of$
5. The parties agree that the Contractor's relationship to the county is that of an independent Contractor.
6. The parties agree that payment pursuant to this Contract is subject to and contingent upon the continuing availability
of funds for the purpose thereof.
7. County agrees:
a) To determine child eligibility and a s appropriate,to provide information regarding rights to fair hearings
b) To provide Contractor with written prior authorization on a child or family basis for services to be purchased.
c) To provide Contractor with referral information including name and address of family, social,medical, and
educational information as appropriate to the referral.
d) To monitor the provision of contracted service.
e) To pay Contractor after receipt of billing statements for services rendered satisfactorily and in accordance with this
Contract.
8. Contractor agrees:
a) Not to assign any provision of this Contract to a subcontractor.
b) Not to charge clients any fees related to services provided under this contract.
c) To hold the necessary license(s)which permits the performance of the service to be purchased,and/or to meet
applicable State Department of Human Services qualification requirements.
d) To comply with the requirements of the Civil Rights Act of 1964 and Section 504,Rehabilitation Act of 1973
concerning discrimination on the basis of race,color, sex, age,religion,political beliefs,national origin,or
handicap.
e) To provide the service described herein at cost not greater than that charged to other persons in the same
community.
f) To submit a billing statement in a timely manner,no later than 45 days after services. Failure to do so may result
in nonpayment.
g) To safe guard information and confidentiality of the child and the child's family in accordance with rules of the
Colorado Department of Human Services and the County Department of Social Services.
h) To provide County with reports on the provision of services as follows:
• Within weeks of enrollment/participation,submission of a treatment plan for the child/child's
family with specific objectives and target dates. The treatment plan is subject to county approval.
• At intervals of months,from the time of enrollment/participation,submit reports that include
progress and barriers in achieving provisions of the treatment plan.
31
a) To provide access for any duly authorized representative of the County or the Colorado Department of Human
Services until the expiration of five(5)years after the final payment under this Contract,involving transactions
related to this Contract.
b) Indemnify County, Colorado Department of Human Services from the action based upon or arising out of damage
or injury,including death,to persons or property caused or sustained in connection with the performance of this
contract or by conditions created thereby,or based upon any violation of any statue,regulation,and the defense of
any such claims or actions.
9. In addition to the foregoing,the County and Contractor also agree:
10. Termination: Either party may terminate this Contract by thirty(30)days prior notification in writing.
County Director's Signature Contractor's Signature
Date Contractor's Title
Date
Original to Contractor
Copy to the Case File
Copy to County Bookkeeping
Copy to State Accounting
32
a
jiti DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website:www.co.weld.co.us
Wil
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
O
• MEMORANDUM
COLORADO
TO: David E. Long, Chair Date: April 28, 2003
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services 4,v:,1, ,(., -- titrC'
RE: FY2003-2004 Core Services and Chafee Foster Care Independence
Program Plan
Enclosed for Board approval is the FY2003-2004 Core Services and Chafee Foster Care
Independence Program Plan. The Plan was discussed and reviewed at the Board's Work Session
of April 28,2003.
The Core Services and Chafee Foster Care Independence Program Plan is comprised of two parts
as follows:
1. Core Services Program Plan encompasses services for those children, youth, and
families who are involved in the child welfare system or at risk of placement out of
the home.
A. The period of the plan is June 1, 2003 through May 31, 2004.
B. The budget for the Core Services Program is $929,822 with $482,063 in 80%
Federal/State resources and 20% county, and$447,759 in 100%Federal
resources.
C. The Plan consists of services to be provided, through vendors, and such services
will include home based intervention, intensive family therapy, sexual abuse
treatment, day treatment, life skills, special economic assistance, mental health
services, substance abuse treatment, and county designed service.
2. Chafee Foster Care Independence Program Plan provides for services to youth who
are transitioning out of the foster care system to self-sufficiency.
A. The period of the plan is October 1, 2003 through September 30, 2004.
B. The budget for the Chafee Program is $88,603.56 of which $57,793.56 will pay
for Caseworker personnel costs and$23,810 for direct services to youth.
C. The Plan consists of services including independent living groups, independent
living support groups, emergency economic assistance,mentoring program, and
emancipation economic assistance.
If you have any questions,please telephone me at extension 6510.
2003-1057
Hello