HomeMy WebLinkAbout20032399.tiff RESOLUTION
RE: APPROVE FOUR NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR
HOME STUDIES AND RELINQUISHMENT COUNSELING WITH VARIOUS
VENDORS 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 Home Studies and Relinquishment Counseling 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 July 1, 2003, and
ending June 30, 2004, with further terms and conditions being as stated in said awards, 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 Home Studies and Relinquishment Counseling 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.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 20th day of August, A.D., 2003, nunc pro tunc July 1, 2003.
BOARD OF COUNTY COMMISSIONERS
COUNTY, COLORA O
ATTEST: Lair
id . Lo , C it
Weld County Clerk to the Board
R ert asden, Pro-Tern
lerk to the Board
M. J. Geile J.ISM M:O Willia e
;ount -Attor ey p4
--�--'� Glenn Vaad
Date of signature: O-a-12-3
2003-2399
SS0030
Weld County Department of Social Services
Notification of Financial Assistance Award
for Child Welfare Regular Administration &EPP Funds
Type of Action Contract Award No.
X Initial Award 02-CPS-21
Revision (RFP-06-000)
Contract Award Period Name and Address of Contractor
Beginning 07/01/2003 and Lutheran Family Services
Ending 05/31/2004 3800 Automation Way, Suite 200
Fort Collins, CO 80525
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Each home study is"worth"24 hours and will Assistance Award is based upon your Request for
be spread over a four-week period of time for a Proposal(RFP). The RFP specifies the scope of
weight of 6 hours per week.Relinquishment services and conditions of award. Except where it is
counseling will be provided on an hourly basis. in conflict with this NOFAA in which case the
Estimated time for relinquishment counseling is NOFAA governs,the RFP upon which this award is
three hours of direct service per person. based is an integral part of the action.
Bilingual and South County services available. Special conditions
Fee includes background checks and necessary 1) Reimbursement for the Unit of Service will be based
interviews for a two-parent family.* on a rate per home study; home study update, and
Cost Per Unit of Service relinquishment counseling session.
Hourly Rate Per 2) Reimbursement requests must be an original with an
Relinquishment Counseling $ 107.00 original signature from the provider and/or designee.
Rate per Study 3) Reimbursements requests must include the date the
Full Home Study $850.00 home study, update, or relinquishment counseling was
Full Home Study without completed. The request must reflect the referral
Background Check $750.00 number assigned to each home study, the amount
Updated Home Study $425.00 billed for each home study, and the month the service
Additional adults in home was provided.
Per adult $250.00* 4) Payment will only be remitted on referrals made by
the Weld County Department of Social Services.
Unit of Service Based on Approved Plan 5) Requests for payment must be an original submitted to
the Weld County Department of Social Services by
the end of the 25th calendar day following the end of
Enclosures: the month of service. The provider must submit
X Signed RFP:Exhibit A requests for payment on forms approved by Weld
Supplemental Narrative to REP: Exhibit B County Department of Social Services.
Recommendation(s)
X Conditions of Approval Approvals: Program fficial:
By b..._c4
� � By ` (3-tut
( �
David E. Long, Cha•ir ������JJJ���j 0 2003 Judy . Grie Director
Board of Weld County Commi Toners Weld unty partment of Social Services
Date: Date: 3 ( +5
cZo3-- 2399
EXHIBIT A
HOME STUDY BID
F T
Off-System Bid No. 010-03 RFP-FYC-06-000 Attached A
HOME STUDY, UPDATE, & RELINQUISHMENT COUNSELING BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER
CHILD WELFARE ADMINISTRATION FUNDING
2003-2004 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
BID Off—System Bid 010-03 RFP-FYC-06-000
NAME OF AGENCY: Lutheran Family Services
ADDRESS: 3800 Automation Way. #200, Ft. Collins CO 80525PHONE: (97) 356-6080
CONTACT PERSON: Julie Box TITLE: Program Manager
DESCRIPTION OF HOME STUDY PROGRAM CATEGORY: Adoption, Foster Care, and Expedited Permanency Planning
Home Studies in compliance with the uniform format utilized by the State of Colorado Depaitment of Human Services since
October 1, 1999 (Attached A).
11-Month approximate Project Dates: 12-month contract with actual time lines of:
Start June 1, 2003 Start
End May 31, 2004 End
TITLE OF PROJECT: Home Studies/Relinquishment Counseling
Julie B x ({/13/43
Name a Signature of reparin ocument Date
James Barclay
Name a d Signature ief Admi trative Officer Applicant Agency at
MANDATORY PROPOSAL REQUIREMENTS
For new 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 Year 2002-2003 to Program
Year 2003-2004.
Project Description _ Project Description
Sample Home Study 4.* Sample Home Study
Target/Eligibility Populations sts Target/Eligibility Populations
',1-t General General
SACultural/Eligibility Populations SO Cultural/Eligibility Populations
Types of services provided Types of services provided
4,1-Measurable Outcomes ,51.* Measurable Outcomes
. „4( Service Objectives s:k Service Objectives
At Workload Standards Workload Standards
Staff Qualifications ' Staff Qualifications
I4-1 Unit of Service Rate Computation I. Unit of Service Rate Computation
At Program Capacity per Month Program Capacity per Month
41{ Certificate of Insurance
Page 22 of 33
INVITATION TO BID
DATE:May 28, 2003 Off System Bid No. 010-03 RFP FYC 06-000
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 06-000) for: Adoption, Foster Care, and Expedited Permanency
11 Planning Home Studies, and Relinquishment Counseling
aunt 2-0
Deadline: X28, 2003, Friday, 10:00 a.m.
The Families, Youth and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that competing applications will be accepted for approved vendors pursuant to the
Board of Weld County Commissioners' authority pursuant to Colorado Statute and the Weld County Home
Rule Charter. The Families, Youth and Children Commission wishes to approve services targeted to run
from June 1, 2003, through May 31, 2004, at specific rates for home studies, home study updates, and
relinquishment counseling services. The County will authorize approved vendors and rates for services only.
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
.Tampa D. $arrlay
TYPED Or ` •il TED SIGNATURE
VENDOR Lutheran Family Services
(Name) : d 'tten ignature'y Autho zed
Officer o Agent of nder
ADDRESS 3800 Automation Way, #200 i' TITLE Presid nt/C 0
Ft. Collins, CO 80525 / DATE
PHONE # (970) 356-6080 ��
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 33
t
Off-System Bid No. 010-03 RFP-FYC-06-000 Attached A
(/-7.4
Date of Meeting(s)with Social Services Division Supervisor:
Comments by SSD pervisor:
/AS 74 do bnt ✓
� a iuvfu Gyp' s - r
•
• la
/f t
' AO ��' J
6/76a
Nam ignature of SSD Su isor Date
Page 23 of 33
June, 2003
Home Studies, Relinquishment Counseling
Lutheran Family Services of Colorado
I. PROJECT DESCRIPTION
Lutheran Family Services of Colorado (LFS) is a community-based agency with an experienced
staff that offers a wide range of services to children, families and adults. It is a non-profit
agency, which has provided human services to Colorado since 1948. Although the agency was
established as an affiliate of the Lutheran Church, it is an equal opportunity agency that provides
services to all individuals without consideration of religious beliefs, race, ethnicity, sex or
economic status.
Lutheran Family Services has been providing home study and relinquishment counseling
services to Weld County Department of Social Services for about four years. Lutheran Family
Services uses the Foster Family Assessment System developed by ACTION for Child
Protection. A written, narrative home study will be provided to Weld County DSS. All of our
staff is currently on the state vendor list for adoptive home study providers.
Additionally,we have the experience and expertise to provide relinquishment counseling in a
timely fashion.
II. SAMPLE HOME STUDY
A sample home study is attached to this proposal.
Ill. TARGET/ELIGIBILITY POPULATIONS:
The population to be served under this contract includes: families who wish to adopt children
from Weld County Department of Social Services; relinquishment counseling for parents who are
considering relinquishing children and applicants for foster care certification.
LFS has been providing home study services to Weld County for four years and has never
turned down a referral because we were 'full'. Occasionally there has been a delay in assigning
the study, due to the need to complete other studies first. We assign cases based on a
direct/indirect service ratio. The ratio is currently 50% direct, 50% indirect. Home studies are
given nine hours of direct service and twelve hours indirect service. One change we plan to
implement is to ask staff to complete their portion of the home study in four weeks (instead of
six) so that we incorporate supervisory review into our time frame of six weeks. All of our
clinicians are cross-trained to provide a variety of clinical services including therapy, clinical case
management, relinquishment counseling or home studies. Therefore, we can assign a home
study to any staff person who has an 'opening' on their caseload. These numbers reflect the
work of one FTE:
A. Total Number of Clients to be served:
Each home study is 'worth'24 hours and will be spread over a four-week period of time for a
weight of 6 hours per week. One FTE (40 hours) could complete 6 home studies every four
weeks (every month). One FTE could complete 72 home studies per year.
Relinquishment counseling will be provided on an hourly basis like some of our core service
hourly services, ex: Home Based Therapy. One FTE can provide 1040 hours of direct service
Lutheran Family Services Home Studies/Relinquishment Counseling
per year. We estimate the relinquishment counseling takes an average of three hours of direct
service per person. One FTE could counsel 347 individuals.
B. Total Individual clients and the children's ages.
The number of individuals and ages of children is completely dependent on the demographics of
the families referred for services. We do not limit our services to families with children of
specific ages.
C. Total family units.
One FTE could complete 72 home studies per year. We are willing to hire additional staff if the
Department demonstrates a sustained need for services.
D. Subtotal of individuals who will receive bicultural/bilingual services
LFS currently has one bilingual staff person qualified to provide this service. LFS has the
capacity to contract for bilingual services and currently has contracts with two bi-lingual clinical
social workers. If they were unavailable at the time the service is needed, we would have to put
the family/individual on a waiting list or refuse the referral. We have not refused any bilingual
referrals this year.
E. Subtotal of individuals who will receive services in South Weld County.
LFS does not limit our services to specific geographical areas so we will provide services in the
Southem part of Weld County as they are referred. Additionally, we have offices in the Denver
Metro and Colorado Springs areas and can provide this service from those locations.
F. Subtotal of individuals who will have access to 24-hour service.
All of the families/individuals we work with have access to our emergency, after-hours service.
Each clinician is responsible for giving their contact numbers to the families they are working
with.
G. The monthly maximum program capacity.
LFS currently has 11 staff members in the foster care program who are qualified to perform this
service. If these clinicians only provided home studies that would equal 66 home studies per
month.
H. The monthly average capacity.
We expect that one full time clinician can manage the volume of home studies we have received
this year. At the present rate of referral, we would plan to complete 10 home studies per month.
I. Average stay in the program (weeks)
Our goal is to complete home studies within six weeks of implementation of the home study. We
are estimating that relinquishment counseling averages 3 weeks.
J. Average hours per week in the program.
Families who are having a home study completed will average 3 hours of direct service per
week.
Weld County 2
Home Studies/Relinquishment Counseling
RFP-FYC 06-000
Lutheran Family Services Home Studies/Relinquishment Counseling
Individuals receiving relinquishment-counseling services will average 1 hour per week of direct
service.
IV. TYPES OF SERVICES TO BE PROVIDED
Adoption and Foster Care Home Studies
Lutheran Family Services uses the Foster Family Assessment (FFA) System developed by
ACTION for Child Protection. This is the format that was taught in state sponsored training.
That format is the format used in the fictitious home study. A narrative home study is produced
using the FFA system. These home studies are 'adoptive quality' and meet the state prescribed
format. There is no difference between adoption, foster care or kinship care home studies. All
of the staff that will complete home studies has applied for inclusion on the state vendor list.
Home study updates will be completed using the FFA System and there will be a reduced fee
charged.
The following background checks will be completed unless otherwise indicated on the referral:
• Fingerprints sent to CBI on Weld County Department of Social Services fingerprint
cards, results will be returned directly by CBI to Weld County DSS. LFS will distribute,
collect and submit the fingerprint cards. The fee for the submission of these cards will
be covered by LFS. If the applicant has lived in the state for less then two years, an FBI
search will be requested. This additional fee will also be covered by LFS.
• Department of Motor Vehicles (results returned to LFS)
• Local county DSS search for open or past cases (results returned to LFS)
• Five reference questionnaires will be sent out with a SASE (results returned to LFS)
• Local police department (results returned to LFS)
• Central Registry (results returned to LFS)
All original background check information will be forwarded to Weld County DSS with the written
home study. A copy will be retained in the LFS files.
Since Lutheran Family Services is a child placement agency we have all of the forms and
processes in place necessary to complete these background checks. Additionally, we can
provide a safety inspection of the home, if requested, at no additional fee to the county.
Relinquishment Counseling Services
Relinquishment counseling services will be provided to all adult individuals referred for this
service by Weld County Department of Human Service as well as to their children age 12 and
older. Services will be provided individually and we will submit a written report and the
appropriate affidavits.
V. MEASURABLE OUTCOMES
The goal for each home study referral is to complete a comprehensive, written home study within
six weeks of initiation of the home study. The outcome will be measured through timely
submission of the home study to the referring caseworker. We will also track the number of
home studies referred that we did not accept and the number of home studies referred and
subsequently cancelled by the department.
Relinquishment counseling referrals will be tracked and measured in the same way as home
studies.
Weld County 3
Home Studies/Relinquishment Counseling
RFP-FYC 06-000
Lutheran Family Services Home Studies/Relinquishment Counseling
VI. SERVICE OBJECTIVES
The Lutheran Family Services service objectives are the same as the measurable outcomes,
that is: the completion of quality home studies, updates and relinquishment counseling services.
All home studies will be completed using the state endorsed FFA System and will be reviewed by
the clinical supervisor responsible for this program prior to submission.
The clinical supervisor responsible for this program will review and approve the report prior to
submission to the county.
VII. WORKLOAD STANDARDS
Please see the previous section "Target/Eligibility Populations°for a detailed explanation of our
workload standards. In summary, cases are assigned based on a direct/indirect service ratio.
Our clinical staff carry a variety of cases including: regular foster care, therapeutic foster care,
foster parent consultation, parent education, clinical groups, home based therapy (family
preservation) as well as home studies and relinquishment counseling. Our supervision standard
is one FTE supervisor for every seven FTE professional staff members. The requested
minimum standards for insurance have been met and documentation provided.
VIII. STAFF QUALIFICATIONS
Direct service providers assigned to this program are qualified by one of the following:
• a masters degree in social work or a masters degree in another human service field; and/or
• a bachelor's degree in social work or a bachelor's degree in another human service field and
at least two years' post-degree experience in family and children's services.
•
All staff in this program will be encouraged to secure a minimum of 32 hours per year of
continuing education training. All staff will receive weekly supervision from a supervisor
experienced in family assessment and counseling. The clinical supervisor will be required to
secure a minimum of 32 hours per year of continuing education training.
We currently have eleven qualified FTE's available to provide services in this program.
Additionally, we have contracts with three more individuals to provide this service as needed.
IX. COMPUTATION OF DIRECT SERVICE RATE
Total Hours of Direct Service Per Client 12 Hours (A)
Total Clients to be Served 87 Clients (B)
Total Hours of Direct Service for Year 1044 Hours (C)
(Line [A] Multiplied by Line [B])
Cost Per hour of Direct Services 24 Per Hour(D)
(salary, benefits, travel)
Total Direct Service Costs $25,056 (E)
(Line [C] Multiplied by Line [D])
Administrative Cost Allocable to Program $49,532 (F)
Overhead Costs Allocable to Program $37,354 (G)
Weld County 4
Home Studies/Relinquishment Counseling
RFP-FYC 06-000
Lutheran Family Services Home Studies/Relinquishment Counseling
Total Cost, Direct and Allocated, of Program $111,940 (H)
Line [E] plus Line [F] plus Line [G]
Anticipated Profits Contributed by this Program $0 (I)
Total Costs and profits to be covered by this Program $111,940 (J)
Line [H] plus Line [I]
Total Hours of Direct Service for Year 1044 (K)
Rate Per Hour of Direct, face-to-face Service to be Charged $107 (L)
to Weld County Department of Social Services
This hourly rate is what we will charge for each hour of direct service of relinquishment
counseling provided.
Home studies are charged at a flat rate: for a full home study with background check: $850
for an updated home study: $425
for a full home study without background check: $750
This fee includes the background check and all necessary interviews for a two-parent family.
The assessment of additional adults living in the home will necessitate an additional fee of$250
per adult.
Historically, about 20% of home studies referred have subsequently been cancelled through no
fault of LFS. We would like to propose a flat fee of$300 for any home study that was initiated
and where we provided a minimum of 3 hours of direct, face-to-face contact.
X. PROGRAM CAPACITY BY MONTH
This program is a component of our Foster Care Services Program, which includes foster care,
and family preservation services. As outlined in this proposal, our capacity is based on the
number of staff we have and a direct/indirect service ratio. Clinical staff are trained to provide
services in any of the program components, so there is not a minimum client capacity necessary
to support this program.
We are willing to hire additional staff if we assess that the county is presenting a sustained need
for expansion of our capacity, so there is also not a maximum capacity per month.
Weld County 5
Home Studies/Relinquishment Counseling
RFP-FYC 06-000
twit
1-I
J-s� Date Sent 3 jam- ,{.�_
Sent Tom—�
c'" -4\ 4T FOSTER FAMILY ASSESSMENT �'' ` 1�+s
GaTv,re.
FOSTER FAMILY SUMMARY INFORMATION
Worker's Name: Kathy Holdeman Application Date 1/23/03 Approval Date
Applicants:
Foster Parent #1
last name _ first names middle name: -
Birth Ma Male Female X
Work Phone: N/A Race: Caucasian Religion: Christian
Foster Parent#2
last name:_ first name:MIL middle name: '
Birth date: ale Male X Female -
Work Phone: Race Caucasian Religion: Christian
Date of Marriage:
Home Phone a E-mail
Address
City: _ State Colorado Zip: WM—
Household Members:
Name Status Age Sex
Wife 28 M ❑ F
Min Husband 30 ME F ❑
Child 5 M ❑ F
Child 3 M ® F ❑
SOO Child 5 mo. ME F ❑
ADDITIONAL REQUIRED HOME STUDY ASSESSMENT
INFORMATION
Listing of Contact Dates During Assessment
(dates of group study sessions, individual and joint interviews, home visits, collateral
contacts):
Date Contact length
2/19/03 Individual home visit interview with 2 '/3 hours
also observed)
2/19/03 Home visit/interview with '/4 hour
2/20/03 Individual interview withal 2 hours
3/1/03 Joint interview withal 2 '/2 hours
3/6/03 Joint interview with •—r
To be Joint interview with
determined
References Contacted:
Weld County Department of Social Services has the responsibility to complete
Name Relationship/status Letter or Worker
Dictation on file?
Yes ❑ No ❑
Yes ❑ No ❑
Yes ❑ No ❑
Yes ❑ No ❑
Other Record Checks:
The Weld County Department of Social Services has the responsibility to
complete background checks.
Letter or Worker
Name status
Dictation on file?
Weld County law
enforcement Yes ❑ No ❑
Central Registry Yes ❑ No ❑
CBI Yes ❑ No ❑
DMV Yes ❑ No ❑
Weld County DSS Yes ❑ No ❑
Record contains information from prior foster home studies or other public records
including N/A
Licensing Information
Assessment of family and home indicate that the home meets all requirements.
Yes ❑ No ❑
This home meets requirements with the following exception(s)
Liability insurance information is included in my home study file Yes ❑ No ❑
(Complete after Finalization of FFA)
Type of Child Approved for Placement per Assessment:
Age Range: 0 to 5 years Sex: MX F X Race: no preference
Sibling Group, size, sex, and other considerations: will consider siblings on a case-
by-case basis
Special Needs/Conditions of Child(ren) appropriate and inappropriate for this home:
APPROPRIATE:
Subject to the results of the background checks, reference checks, completion of
training and home inspection the le family are appropriate to be certified
foster parents. are interested in children from zero to five years
of age. They have requested that children be younger than their daughter,
born in . The will accept a child of either sex and of
any race/culture/religion. are open to a range of mild to
moderate behaviors. They are open to some physical and mental handicaps.
These preferences are consistent with the results of the home study.
,, have a positive attitude toward birth families and reunification.
This, in combination with their interest in providing straight foster care rather
than adoption, make them a likely match for children who are working toward
reunification. This would be especially true for birth parents who could benefit
from interactions with their child's foster parents.
INAPPROPRIATE:
US have three birth children living in the home, ages five and three
years and a five-month old. Children who represent a risk to the safety of their
children would not be appropriate placements. Examples of such behaviors
would include aggression, cruelty to animals and children, sexual acting out and
extreme oppositional behavior. Children who required more one-on-one
nurturing than would be possible with the other children are not an appropriate
match. Children who require physical care above that expected for the age range
would be inappropriate. Consideration should be given to the additional burden
that a particular child would place on the family.
Worker date Supervisor date
FAMILY ASSESSMENT AND UPDATE
Update: X DATE: March 3, 2003
Family Name: Ma
Worker Name: Kathy Holdeman
5
PURPOSE OF HOME STUDY: a are interested in becoming foster
parents for children from ages zero to five years of age through The Weld County
Department of Social Services.
Parent Force
1. History Element: Social History/Background Check, Character and Suitability (Adults)
What is the parents' childhood and adult history? Consider the individual's cultural context in
your description. When updating or re-certifying, describe new or significant information that
indicates a change from previous assessment.
Specific areas include: personal history of abuse, marriages, divorces, births, deaths; issues of grief
and loss, employment; education; physical/mental health; childbearing or infertility; arrests or legal
encounters; relationships (including other races/cultures); number and type of foster/adoptive
placements (CPS, Juvenile Justice, other); placement success or disruption; other information.
Parent# 1 INNS
ai was born on�, at Shepard Air Force Base, Texas to SO
A. She has two half sisters,la and _ They were out of the home by the
time ems was born. She has one half-brother,m, who lived with his father. eat
has one sister,_ who is two years older. An adopted sister, joined the family
when eas age twelve. will be discussed later in the home study.
The family moved from Texas to California for a couple of months when _was a child.
They then moved to Kokomo, Indiana, for the next eight years. Her father was stationed in
Alaska for a year when she was five, but the family remained in Indiana. When she was eight or
nine they moved to Omaha, Nebraska, where they lived for four years until her father retired.
Following retirement the family moved to Parker, Colorado, where her father found employment
as a pilot for United Airlines.
Various family homes were middle class usually in the suburbs with nice yards and a dog. The
family had sufficient income. - parents were conservative with their spending,
allowing them to take what was described as great vacations. The family lived a very stable life.
father was a pilot for the Air force. He was reported to be an alcoholic prior to the
birth of WM*older sister. liela never saw him take a drink. I describes her
father as great when she was a little kid. She always knew that she was his favorite. She would
go places with him, like the lumber store, and liked to build and paint with him. After the age of
twelve, she began to draw away from him as she thought through what she saw her Dad doing.
For example, he would say mean things to her mother and if one came home late, he would not
talk to you for a week, father was very opinionated, believing that he could do
anything better than anyone else. describes her father as having become increasingly
6
paranoid to the point where she suspects that he needs psychiatric help. She has not talked to him
since the birth ofSin 1999.
all mother was an involved, stay at home mother. Her mother was the Girl Scout
leader, active in PTO, sports and band. rdescribes her mother as gentle, respectful and
strict. ea had a positive relationship with her mother. _mother had a drink
with alcohol one time a year at most. Her mother still lives in Parker, Colorado, and a
visits her at least once a month.
iparent's marriage ended in 2000, but had been deteriorating prior to that time. Her
father refused to seek counseling for the marriage. a father wanted the children to take
sides and when a did not, he perceived it as her having chosen her mother. NIES
describes life as tense, unpredictable and walking on pins. There was no domestic violence to the
best of her knowledge. Her father moved out of the family home in 1998. Her parents fought
over every detail of the divorce. As a child, i perceived her parents relationship to be
the norm. She can now see how it shaped her perception of men and people in ways that she has
had to unlearn.
Family rules during a childhood varied by parent. Her mother's rules were aimed at
teaching children to be responsible and think for themselves, develop self-control, acting in a
trustworthy manner and not to jump on the bed. Her father was very authoritarian. He wanted
you home at 12:00 pm not 12:01. Although _never gave him any reason not trust her,
he treated her as if he did not. Discipline included some spanking when la was younger
than age eight. Spanking was done with a wooden spoon by her mother and by her father's hand.
Although she knows she was spanked she does not remember the spankings. Both parents
disciplined. When she was older, was grounded, lost privileges and things were taken
away, such as the use of the car.VIII states she was a good kid, even as a teen, and was
seldom disciplined.
a sister, sm. is two years older. They were playmates when they were young. As
they grew older, they had little in common, although they got along ok. When- was a
sophomore in high school, they became friends and remain so. i lives in Parker,
Colorado, never married and has an eight-year-old son. - is in regular contact with her
sister.
While living in Omaha, Nebraska, her family did foster care. They cared for a total of four foster
children. The family later adopted one child, an Ns was three months older than a
la and they became the best of friends. When the family moved to Colorado,S was not
able to come with the family. She remained in Nebraska, for one ear until her father's parental
rights could be terminated. At that time, she was adopted by parents. illa moved
out to a friend's house during her junior year of high school with the support ofe
mother. ` father alwa s treated a as a second-class citizen. The situation
deteriorated untils and father could not get along and it was deemed in the
best interest for IS to move out. remains friends with e, who currently lives
in Spain with her husband.
MS liked school and did well. She found school easy, was on the honor roll, and
frequently took advanced level classes. She liked the social aspects of school and had friends
with similar values.a began dating as a sophomore. She mete as a junior
7
and developed a serious relationship. a graduated from high school a semester early, in
December of 1994.
a moved out of her mother's home in March of 1995, and in with her boyfriend. 1.1
de were married six months later, on October 30, 1995. Swas
attracted by how different he was from others bo s she knew. He came from a divorced family
where his mother smoked pot and cussed. had always known she wanted to marry and
have children and felt special when she was around _ a moved to Texas, for
six months after the marriage, while_ completed basic training for the Air Force.
After basic training, Ina and her then husband moved to Italy for a three-year tour of duty.
They had good times together although he was into the party scene and drank a lot. -
decided she wanted to have a child since that had alwa s been her goal and because she was
bored. - was born on in Italy. When _was age three,
IMIla moved to Washington DC. She lived and worked there for five months then moved to
Colorado, to be near her grandpa who was ill. After four months, she returned to her husband in
Italy. estates, "He didn't care about family." a wanted another child resulting
in Me conception. -was born in Texas on after the
couple was transferred back to the states. - reports that she and her then husband had
nothing in common. He wanted to play and party. They were arguing a great deal including
yelling, screaming and one incident of his pushing SS - gave him the
ultimatum to go with her to counseling or she would leave. He chose for her to leave. le
returned to Parker, Colorado.
has never had any regrets about her decision to divorce. In the immediate aftermath
of the divorce, ' states, "I had to hate him for a while." She resented his lack of
responsibility toward her and the children. With time she overcame her negative feelings. While
she worked two jobs, he would not call or pay child support. After a year, al was
transferred to Colorado S rings, Colorado. Although he was closer, he still did not have contact
with his children. states, "He never really loved himself so couldn't love a wife and
kids."
_ lived in a house next door to where hand his brother lived. She worked two
jobs, one as a waitress and the other with ARK of Colorado, as an advocate for Developmentally
Disabled parents. In some cases the children were living with their parents, some children were
in foster care and others had been adopted out. helped with parenting skills and other
advocacy situations.
-'as attracted to her future husband by his intelligence, patience, kindness and that he
was interesting to talk with. She had known a brother in high school. _ spent
a great deal of time talking with_ This continued after he went to Holland, via telephone
calls and emails. She went to Holland for a two-week visit in November of 2000. After his
return from Holland, in March of 2001, they lived together until their marriage on �.
a moved to Fort Collins, Colorado, in June of 2001, to attend Colorado State University
in Ag Business. She attended school until December of 2002. Her original plan was to return to
school this coming fall but may now delay this plan so that she can stay home with the children.
has also considered taking an online course. -original reason for seeking a
degree was to provide a better financial future for her children. Since her marriage to all
8
the financial aspect of a college degree are no longer needed.
SIIIIMalla lived in a house in Old Town Fort Collins, which was too small for their
needs for one year. They then moved into an apartment still in Fort Collins for seven months
while they were building their current home in MS Colorado.
_had a miscarriage a year ago. It was early in her pregnancy and she had felt that
somethin was not quite right. She became pregnant again shortly afterwards and gave birth to
on
Mal
designed and had their home custom built with the assistance of a
father. They did a lot of the work themselves. There are still some minor areas that they are in
the process of completing.
Rating: 3_5
Parent #2:
ISOM was born on to elf and in S
Colorado. One younger brother, , joined an on . The family moved
several times around the Golden area before his parents built a house outside of Parker,
Colorado, when Mat was age eight. The family lived on twenty acres, but due to the rural
nature of the surroundings, he and his brother had the run of a thousand acres. There were no
close neighbors but the children frequently had playmates over.
_ father was a homebuilder. a describes his father as a well-respected, self-
made man. This quiet, serious man did not get down and la much with his young son, but did
share his son's interest in cars when he was a teenager. father drank no more than one
beer or glass of wine several times a week.
MEM describes his mother as patient, always there and wonderfully consistent. She was a
stay-at-home mother providing secretarial and receptionist duties for her husbands business.
lilaviews his parent's marriage as a model relationship based on respect and tolerance.
never witnessed his parent's fight or argue in front or within hearing of their children.
There was no evidence of domestic violence. He recognizes as an adult that they had hard times
that challenged them during his childhood. His parents presented a united front to the children in
decisions and discipline. Their marriage remains as strong as ever. They remain in the same
home in Parker, Colorado. has regular contact with his parents.
_ describes his relationship with his only brother, 0, as playmate and best friend. His
brother is three years younger and is currently a firefighter near Parker, Colorado.
Family rules were understood but not spoken or written. Children were expected to behave,
including using good manners. a states, "Screaming or yelling at each other was not an
option." Dinnertime was considered family time and all members were expected to be present.
Other expectations included trying your best, stay out of trouble, and helping the family. The
children helped their father with his work from when they were young, earning fifty cents to pick
9
up trash around a job site. When older, the sons were expected to work to earn money for
themselves. Displaying a lack of effort or not working when you said you would, would get one
into trouble. Everyone developed a work ethic. Discipline included spanking when the children
were younger. However, the spankings were so infrequent that did not remember any
specifics. Other forms of discipline included the loss of privileges, grounding and his parents
telling the children that they were very disappointed.
IMIMMI was in good health during his childhood. He had no serious injuries or surgeries. When
asked about traumas during childhood, he relayed the death of his paternal grandmother of
cancer when he was thirteen. The road to her death had been long and tortured. After her death,
his grandfather sold his mountain property and moved away. In addition to the grief over the loss
of his grandparents, it also resulted in the loss of summer visits where had been able to
ride horses. Other losses included his paternal grandfather's peaceful death of cancer while he
was in college and the death of a maternal grandmother, who he did not know very well, four
years ago. -reports no physical or sexual abuse.
The NMIfamily did not attend church other than at Easter and Christmas. a still believes
that God is in his life.
Illat enjoyed school, graduating in 1991, from Ponderosa High School. He attended public
schools, which he describes as white, middle class and suburban. His best friend was a one-half
Indian adopted child and there was one black family in the neighborhood. MEM was exposed
to more diversity in socio-economic level and race/culture with the children of his father's
friends in the building industry. was active in basketball, wrestling, baseball and was
on the honor role, frequently taking advanced level courses. a dated casually in high
school. reports that he never used drugs but did drink beer in high school. After
graduating from High School,enlisted in the Air Force National Guard. He served for
six years. After basic training, served one weekend a month in Cheyenne, Wyoming, as
a jet engine mechanic for C 130 cargo planes. Part of the rational for joining the National Guard
was to get assistance in paying for college. a attended the University of Wyoming, in
Laramie. mareports that he liked to party and go to bars in college. He states that, although
he drank more than he should, alcohol consumption never created a problem in his functioning.
After graduation, he got out of that lifestyle completely. He graduated in 1996, with a BS in civil
engineering.
Following graduation from college, a obtained employment at Church and Associates as
an engineer. He worked for them during a summer while he was at college and from 1996 until
1999.a bought a condominium and a rental house in Parker, Colorado, with his brother,
St They were able to get a great deal that he states set him up financially. The brothers lived
together in the condominium for one year before selling the condominium and moving into the
house they had been renting out. They gutted and remodeled this house. OS and his
brother continued to live together until marriage.
Shad two relationships after college that he describes as semi-serious. There was no
thought of marriage on his part.
The future a lived next door to the house that-and his brother lived in. She
was working at a restaurant whereiregularly ate. S spent increasing amounts of
time with his future wife. He states, "It felt perfect from the beginning."1 was attracted
10
by his future wife's energy. She was working two jobs and raising two very young children on
her own. a states, "I take to kids...fell in love with them right away."
In October of 2000, was asked to go to Holland on a sub-contract basis as part of an Oil
Conglomerate. The company paid for all expenses first class. ONIIIIS got to know
each other better through telephone calls and emails. After six weeks, they paid for the future
de to come over for a two-week visit. Six weeks later, he was able to come home for the
Christmas holidays. By March of 2001, the Conglomerate began to fall apart resulting in the
Italian company that took over replacing employees with Italian employees. ' returned
to Colorado, spending most of his time at his future wife's house. MINIMIlla lived
together for seven or eight months before their marriage.
In June of 2001, the couple moved to Fort Collins, Colorado, since was considering
attending Colorado State University. At that time, the couple became engaged. They were
married onallEMS, in Parker, Colorado.
a was able to transfer his employment with the same company from Denver to Fort
Collins. They lived in a house in Old Town Fort Collins that was too small for their needs for
one year. They then moved into an a artment, still in Fort Collins, for seven months while they
were building their current home. MIS was able to get his share of the money out of the
house that he had bought with his brother, enabling the couple to build a custom home in Eaton,
Colorado.
In November of 2001, brought up the issue of 0.111111 adopting the children
with their father. The father had been very lax in visitation. At first, the children's birth father
said absolutely not. MUM informed him that he would not need to pay child support if he
agreed to the adoption and a day later, he agreed. The children's father requested a visit last
December, but did not show. At this time, he has been told that he has no right to see the children
and not to call. MID reports that he thought about the fact that the children were not his
during their first year together, but now thinks of them as his kids. i remembers MINIM
MIS getting married and her participation in the wedding. She will occasionally ask about
her other father. does not ask about his birth father and _ was not sure how
much he remembers. iew of the children's father is that he is a good guy who has
drug/alcohol problems and poor financial management skills.
In 1999, ' changed employers to JR Engineering. S states that his former
employer was very focused on geo-technical systems and thus had limited potential. His new
employer offers more diversity and substantially more money. However, that comes at the cost
of sometimes feeling lost in the numbers of a large company. His employer has also laid-off half
of the employees due to the economy. 'maintained a good relationship with his former
employer and still works with them a lot on projects they have in common.
-reports that he is in good health. He drinks alcohol, usually beer with dinner maybe
twice a week.
Rating: 3_5
11
Parent Force
2. Adult General Functioning Element: Character and Suitability How does the adult
function with respect to daily management and general adaptation? When updating or re-
certifying, describe new or significant information that indicates a change from the previous
assessment.
Specific areas include: previous emotional problems, mental illnesses, substance abuse issues, or
marital/relationship problems that may have an impact on a child(ren); problem solving
capacity/history, response/reaction to stress, ability to communicate, styles of communication,
cognitive functioning; ability to make judgments/decisions and capacity to/history of follow through;
use of defense mechanisms; levels of self-esteem; awareness of own capabilities and limitations;
ability to control emotions; adaptation to infertility (if appropriate); levels of impulse control;
expression of emotions/feelings/general temperament; attitudes towards people of
similar/different races, cultures, religions; attitudes toward and response to sexual contact between
children;homophobia.
Parent it 1:a
intelligent, has high energy and is a caring individual. She has a good sense of her
abilities and limitations. She presents as open and honest.
EothS identify EMI as the more impulsive of the two, wanting to do what
ever is planned right away. She will research what she is interested in but does not like to wait
once a decision is made in her e es. When faced with a difference of opinion she will continue to
look for a way to bring around to what she wants. She describes herself as driven,
determined and highly motivated. This drive is a possible source of conflict within the marriage,
as _continues to push for what she wants even in the face of la difference of
opinion. This is seen through the couple's recounting decisions about when to have a baby
together, getting another cat and adopting a dog. This interaction style does not appear to present
marital difficulty at present, but is seen as a potential source of weakness in the relationship.
has a history of positive problem solving and demonstrating appropriate judgment and
decisions.
a presents as an energetic, passionate, emotional individual. She presents as able to
handle multiple tasks without appearing ruffled, as seen in participating in the home visit
interviews with her three children present.
MEM experiences stress over stuff that she feels she cannot control. Examples would be
behavior and financial issues. She deals with stress by finding something else to do, like going
out somewhere, or coming up with fun activities.Ma works to keep stresses in perspective
rather than giving them more energy than they deserve.
SIM reports that she deals with anger directly by talking to the other person. She feels that
she is easy to read but that others seldom have to read what she is feeling because she tells them.
el presents as having adequate impulse control.
12
Communication is direct and important to this cou le. The each listen well to what the other
person says with respect and understanding. have a good awareness of each
other's personality and coping mechanisms. They view each other as easy to read. While i
do not keep things from each other, they believe that children do not need to know
the things that are adult responsibilities.
When their life is not going as planned,aincrease the level of communication
and will brain storm options.
_has no reported or observable mental or emotional health issues. There is no evidence
of substance abuse issues. - reports that she will have a mixed alcohol drink or wine at
most once or twice a month._ reports no law enforcement involvement. She is reported
to be in good health and takes no medication other than birth control pill, acne medication and
occasionally Tylenol.
EMIR reports that she is accepting of differences in race, culture, religion and lifestyles. She
states, "Although I may not agree with attitudes, beliefs and lifestyles I know people feel as
deeply about theirs as I do mine, and I respect that."
would address sexual contact between children directly based on the ages and
circumstances of the incident. She experienced this type of situation when she discovered her
daughter then age three or four and her nephew age five or six getting naked in the bedroom.
She separated the children, told them that it was never appropriate to play without clothes with
others (kids or adults). She then took her nephew aside, pointed out that he was older and knew
better, that she was very disappointed in him, that the same rule exists at his mother's and
grandparent's homes. If the behavior were repeated, he would not be allowed to come over to
their house. In a evaluation, the incident was based on curiosity that was appropriate for
their ages and responded well to the setting of firm boundaries and teaching right from wrong. If
the incident had occurred again, she would have limited the nephew's right to visit and talked to
his parent. Her nephew did ask that Ma not tell his mother, which she agreed to. a
as handling of the situation presents as appropriate to the circumstances with the exception
of not talking to the nephew's parent about the behavior. Keeping this secret caused concern on
this workers part.
a does not currently attend a church. She would like to do so in the future. She
describes her beliefs as Christian including God, hope, faith and trust.
Rating: 3.5
_ Parent#2: S
VMS presents as an intelligent, logical and personable individual. He appears controlled and
thoughtful in interactions.
anhas a long history of problem solving ability and appropriate judgments and decisions.
He uses his logic to carefully consider the choices available.
a experiences stress when he cannot see the end of a problem. The type of things that
13
create stress are financial and not achieving goals...abelieves that people build their own
stress and he tries not to put himself in situations that contribute to stress. He states, "I do what I
can do and that is enough." He tries to keep a balance between work and home. He deals with
stress by being analytical in finding a solution or finding times and activities that take him away
from thinking about stressful situations. He views his home and family as one of those places to
escape from stress.
MiNe deals with times he is angry directly through communication and problem solving.
Both- report that ale does not let much bother him. Both believe that he
deals with things well. He uses spreadsheets and other forms of writing to organize and cope.
When he is upset, he is likely to sleep poorly.
Communication is direct and important to this couple. They each listen well to what the other
person says with respect and understanding. They have a good awareness of each other's
personality and coping mechanisms. They view each other as easy to read. While they do not
keep things from each other, they believe that children do not need to know the things that are
adult responsibilities.
i is not an impulsive individual either in emotions or in decisions. He remains even-
keeled and thinks situations through to possible outcomes. This is a distinctive difference from
his wife's more impulsive, do it sooner attitude. This difference is a possible source of conflict
within the marriage, al...IIcontinues to push for what she wants even in the face ofd
US disagreement. This is seen through the couple's recounting decisions about when to have
a baby together, getting another cat and adopting a dog. This interaction style does not appear to
be presenting marital issues as present, but is seen as a potential weakness in the relationship.
S displays good insight into his abilities and limitations. He has adequate self-esteem.
alle view each other as easy to read. While they do not keep things from each
other, they believe that children do not need to know the things that are adult responsibilities. As
a result, they are careful to discuss adult topics, such as financial considerations and the decision
to do foster care out of earsight of the children.
NEM has no reported or observable mental or emotional health issues. There is no evidence
of substance abuse or other addictions. I reports that he will drink a beer or occasionally
two at most a couple of times a week, usually with dinner._states that he has had no law
enforcement involvement. is is in good health and does not currently take any
medications. - has a positive attitude toward diversity of race, religion, culture and
sexual orientation.
a was asked how he would handle sexual contact between children in the joint interview.
He did not remember at first the incident several years ago between r and anall
nephew. He stated he would address sexual contact between children directly based on the a es
and circumstances of the incident.at took the lead on handling the situation.
agrees with how the incident was handled.
-reports that his greatest strength as a parent will be his patience. In observation with
his children, alla was calm, direct and careful that they understood what he was
communicating.
14
Silliadoes not attend church at present. He states that his wife would like to find a church to
attend in the future. His philosophy is that religion provides a great framework for a successful
life. MEMOencourages Christian beliefs in the home.
Rating: 3.5
Parent Force
3. Parenting -- Discipline Element: What are the disciplinary approaches used by the
potential foster or adoptive parent, including the typical context? When updating or re-
certifying, describe new or significant information that indicates a change from the previous
assessment.
Specific areas include: view of the role of discipline (teaching, punishment, safety, etc.);
parenting practices in the family in terms of expectations, frustrations, supervision, and
disciplinary approaches. Specifically include discipline used with their own children,
grandchildren, daycare, etc.; other information.
Parent #1: i
Slab views discipline as the way that you teach children to make good decisions so that
they can be productive individuals.
Techniques that - uses with her children include time out, taking away things or
privileges. She believes in holding children responsible for their behavior. For example, when
they do something wrong they are expected to apologize to the person. la sees the
creation of a predictable routine and schedule as tools that help children learn self-disci line.
ale strives to achieve a balance between being flexible and predictable.
believes that children learn best what is modeled for them, so is very aware of what her behavior
is teaching her children.
_ demonstrated varied and appropriate discipline techniques. She took into
consideration the age of the child, their personality, whether it was a recurring issue and whether
teaching, consequences or safety were the primary goal. She remained calm and in control when
the children grew tired of sharing their mother with this worker for the interviews. Her
expectations were appropriate and clearly communicated.
ak reported that they used spanking with a for a brief time when he was youn er
but found that it was not effective. She reported that she did not like how it made her feel.
areports that her discipline and parenting have evolved with added experience.
Rating: 3_5
Parent#2:d
Me views discipline as teaching a child how to function as an adult.
15
Techniques than uses include time out and taking away toys or privileges. He will also
use communicating that a child has disappointed you or that you expected more of the child as
techniques. lingla demonstrated a good understanding that this technique could be used in an
abusive manner when the personality of the child and the way in which it is said is not taken into
careful consideration. He also volunteered that this would not work with a child who did not
have a relationship where they cared what you thought.
In observation of interactions with his three children, _ presented as calm, direct and in
charge. He demonstrated awareness of the underlying reason behind the children's behavior.
His ex ectations were appropriate and different for the two very different children in the home.
used an appropriate balance of letting the children solve the problem, nurturing and
consequences with a focus on safety and self-esteem.
Factors, which Mat would take into consideration when deciding on parenting techniques,
included their age, temperament, personality, sensitivity level and the circumstances.
Rating: 3_5
Parent Force
4. Parenting— General Element: What are the overall, typical, pervasive parenting practices
used by the applicant? Do not include discipline. When updating or recertifying, describe
new or significant information that indicates a change from the previous assessment.
Specific areas include: knowledge of child development and expectations of children,
parenting/child rearing practices in the family in teens of sensitivity, concern, provision of basics;
comfort with parent role; ability to parent transracial/transcultural child(ren) or with special
needs and/or disabilities; school attendance of all children; parent's school involvement; bonding;
dress, hygiene, general appearance of children; parent's ability to meet children's emotional needs
(time alone with parent, etc.); checking with county departments for any reports of child
maltreatment and investigations; other information.
Parent#1: S
Spresents as knowledgeable about child development.! reports that she has
taken child development classes in high school and college, worked with DD parents and their
children (some of whom were in foster care), had foster siblings and has a half-sister with Down
Syndrome. expectations for her children are appropriate. She reports that one of
her weakness as a parent may be that her expectations are too high. While her expectations are
high, they are appropriate for her birth children. In interviews, she presents as able to adapt
expectation to meet the child's individual need taking into consideration appropriate factors,
such as chronological and developmental ages, personality, temperament, what they have
experienced and been taught and the circumstances. _ will need to be vigilant that her
expectations are appropriate for the children in care.
IMP believes that children learn best what is modeled for them, so is very aware of what
her behavior is teaching her children. She treats children with respect and understanding while
16
holding them responsible for their behavior. an.is interested in getting more information
about Parenting with Love and Logic since the brief overview she received during the pre-
certification training fit well with her overall philosophy.
presents as very comfortable in the role of parent. She managed the interviews and
three children with skill, remaining calm, addressing the children's need, redirecting and
consequencing appropriate to the situation. In discussing her children, she demonstrated insight
into the ways that their differences in personality make different approaches work better or
worse. She has a proven history of adapting to the needs of the child rather than trying to fit the
child to the parenting style.
values education and plans to be an active part of the educational process. Her
children are not yet in school.
le has the ability to parent children from different race/religion/cultures. She has the
ability to meet their emotional needs. Her children were well attached, clean and appropriately
dressed.
The Weld Count Department of Social Servic's will conduct the background checks ons
MIMS state that they have never been investigated for child
maltreatment.
Rating: 3_5
Parent#2:
M has an appropriate eneral knowledge of child development. His experience with
children is limited to raising and over the last two years and to parenting his
five-month-old son. His expectations for his children were appropriate to their high level of
functioning. -will need to monitor his expectation for children who function at a lower
level to be sure they are appropriate to that child.
demonstrates insights into his children and how their temperament and personality
require different styles of parenting. This insight was observed in his interactions with inlit
and gras
-values education and plans to be an active part of the educational process. His children
are not yet in school.
el has the ability to parent children from different race/religion/cultures. He has the
ability to meet their emotional needs. The children were well attached, clean and appropriately
dressed.
The Weld County Department of Social Service will conduct the background checks on ea
state that they have never been investigated for child
maltreatment.
Rating: 3.5
17
Child Force
5. Child Functioning Element: How does the child function on a daily basis? When re-
licensing describe significant information that indicates a change from the previous
assessment.
Specific areas include: general temperament, expression of emotions/feelings, typical behaviors,
presence and level of peer relationships, school performance, known mental health disorders
including substance abuse (organic/inorganic); issues of independence/dependence; issues related
to raciaUcultural identity; other information.
Child # 1: age 5
NMI is an intelligent, very verbal, strong willed child. She presents as developmentally
normal. She willingly sat down to talk to this worker about her likes and dislikes. She likes
babies, cats, dogs, horses and the color pink. _likes to be the focus of attention. Although
she is willing to share attention, she will attempt to regain attention if she feels she has none.
_ has a tendency to be bossy with adults and her brother, demonstrating a lack of
understanding of the difference between helpful and bossy. This tendency is reported, and
observed to be, handled by both parents in a clear manner that corrects the behavior without
damaging her self-esteem.
MS views herself as the oldest child. This role is important to her and should be respected.
has a tendency to physically move her brother when she wants him to move and to place
her hands on other's faces to get full attention.
a is described by her parents as being very literal in her communication style. For example,
— uses humor and teasing. SIM is quick to correct others when they make a joke like
"Clifford the Big Red Frog" instead of"Clifford the Big Red Dog."
_appears to have a healthy, strong attachment to both parents. Oa was present during
two of the home visit interviews. — demonstrated the ability to function independently
while her parents were busy with occasion periods where she checked in, got the needed
attention from the parent and then returned to independent play.
Sis reported to be in good health.
have not discussed foster care with their children on more than general terms.
Rating: 3_5
Child # 1 age 3
AMR is an intelligent, developmentally appropriate three-year-old. He is full of energy and
curiosity.ow. is described by his parents as sensitive with his feelings easily hurt. a
does not mind not being the center of attention and is content to play on his own. He was present
18
for two of the home visit interviews. He demonstrated appropriate balance of
independence/dependence for his age.
Shandled the addition of a new baby in the home well. He had participated in the sibling
class, through the hospital as well as having library books read to him on the subject. There has
only been one occasion when he expressed the desire for the baby to go back. 1.1111,is viewed
by his parents as well adjusted and very adaptable.
i has a well-developed sense of humor for his age and gets the jokes and teasing that his
older sister misses.
a appears to have a healthy, strong attachment to both parents.
is reported to be in good health.
St have not discussed foster care with their children on more than general terms.
Rating: 3_5
Child # 1:a- age 5 months
is a healthy, happy, easy going five month old. He is alert and demonstrated healthy
signs of attachment to both parents.
Rating: 3_5
Family Force
6. Family Functioning Element: Current Status of the Family, Family System, Lifestyle
How does the family function, communicate and interact? Consider the family's cultural context
as you describe family functioning. When updating or re-certifying, describe new or significant
information that indicates a change from the previous assessment.
Specific areas include: family structure and flexibility; clarity of roles and boundaries (including
roles children), who is in charge, how family decisions are reached, the level and type of
communication used, the presence and use of affection, marital issues, unresolved infertility issues of
couple (if appropriate), presence/absence of family violence, open/closed to trans-racialltrans-
cultural/religious experiences; general feelings/climate within the family; other information.
The OD family appears to function in a positive, effective manner. This couple report and are
observed to have similar values, a respect for each other, trust and a willingness to accept and
allow their differences. The family atmosphere is calm and loving. They demonstrate open
communication and report that they discuss all topics, keeping no secrets. Roles within the
family structure are clear and flexible. S handles the financial matters while Sis
the source of the income. They feel that this results in them each having full awareness of the
status of the finances.
19
When asked who is in charge in the home, they each chimed in with "both". MPS
acknowledges that since his wife spends so much more time with the children that the children
sometimes view her as the one in charge. a state that they work together as a
team. This was observed during interviews in interactions with the children.
report and appear to have a strong relationship. They state that they seldom
have disagreements. The last disagreements reported were over the timin of the decision to
have a baby and whether to get a dog. There is a distinctive difference in lets do it
now attitude and _ more thoughtful, conservative approach. Although this does not
appear to be an issue at present, it is a potential source of marital discord. It will be important
that OISIS each have an equal part in decisions about foster care and that they
carefully listen and respect the others opinion, since the difference in styles compliment and
balance each other.
Ma report occasional minor differences of opinions on the handling of a
particular situation with a child. When that occurs they support the choice that the other parent
made when action has already been taken or discuss how to handle it as appropriate. They are
each willing to compromise. feel that the handle differences in needs for
intimacy, personal space and time management well. report no domestic
violence. There do not appear to be any marital issues that would affect the family's ability to do
foster care.
Affection is shown in the aill family by hugs, holding hands, sitting near each other, smiles
praise and speech. The general climate of the home is relaxed and loving. It is kid friendly. a
- present an appropriate balance between work/family, individual/family needs and
kids/marital needs.
Rating: 4
Family Force
7. Family Support Network Element: Child Safety and Well-Being, Availability of Support
System. What is the quality of supportive relationships (formal and informal) outside the home?
Consider the family's cultural context as you describe their support network. When updating or
re-certifying, describe new or significant information that indicates a change from the previous
assessment.
Specific areas include: nature of extended family support; support of unrelated persons (friends,
confidantes); involvement/support of organizations, clubs, churches, agencies; involvement/support
of neighbors, business and social associates; other information.
MIIMMINIMMii appear to have a strong support network.'view each other
as their primary source of support.`has the support of his mom, dad and brother.a
dm reported that she feels that she could go to her mother-in-law, her own mother and sister,
J for su ort. Their extended family has a history of accepting new family members
(including and her two children) and diversity. Each individual also named friends
that are a source of support.
20
al do not presently attend a church although they are planning to in the near
future. They do not belong to any clubs or organizations.
Rating: 4
Family Force
8. Demographic Element: Finances, Home Safety Inspection, Employment, Community
Makeup What are the demographics of the family? Consider the family's cultural context as
you describe demographics. When updating or re-certifying, describe new or significant
information that indicates a change from the previous assessment.
Specific areas include: economic resources; employment; home (additions/remodeling with square
footage); neighborhood and community (include raciaUcultural/religious integration); health
problems; financial self-sufficiency; stresses related to demographics and how handled (e.g.,
medical, bankruptcy, family moves, household members leaving); other information.
live in a new 2500 square foot home in a new development in Eaton,
Colorado. Their home has five bedrooms and three baths. They, have lived in the home, which
they helped build since Christmas of 2002. They have done a considerable amount of the work
on the home and still have some unfinished projects, such as the tile on the kitchen counter and
backsplash. The yard, which is at this point dirt, is not fenced. There were no safety issues
observed. The Weld County Department of Social Services will conduct the home inspection.
view their neighborhood and town as a safe secure place to live. Their
development is a primarily Caucasian, upper middle class neighborhood. The town has a
significant Hispanic population but does not have much diversity of other cultures.
le has been employed at JR Engineering in Fort Collins, Colorado, since 1999. His
annual income is $50,000. Income is sufficient to meet the family's needs. They will not be
relying on foster care as a source of income. a views his employment as stable although
the company has had lay offs in recent times.
Si and their children are reported to be in good health. There have been no
stressors to the family outside of the normal ones that accompanied the birth of a child and
building and moving into a new home.
Rating 4
Birth Family Force
9. Viewpoint of Birth Parents Element: How do the parents view child maltreatment,parents
who maltreat their child(ren),parents who place their children in foster care, and parents whose
children are placed by a court in foster care? When updating or re-certifying, describe new or
significant information that is a change from the previous assessment and examine the attitude
toward the birth family and understanding/support of positive relationships and/or memories of
21
birth family.
Specific areas include: training completed or needed concerning the parent's viewpoint of birth
parents when updating or re-certifying, contact with birth parents and learning gained from the
experience; general learning regarding birth parents; other information.
Parent#1:=
alla had a very positive view and understanding of birth parents.
MSS demonstrates understanding and awareness of issues related to birth parents. When
asked about factors that might contribute to abuse of neglect she reports that lack of skills,
support system, not knowing that there was a different way to function, not knowing how to
make a change and their own experiences. She believes that people can learn and change.
OEM is hopeful that children in her home will be able to go back to their parents when ever
possible. In this, she viewed herself as unique among other individuals in pre-certification
training. She believes that her lack of desire to adopt will be an asset in working with a birth
parent on reunification.
is open to contact with birth parents as long as the adult has positive to offer to their
child. If there is no benefit or there is harm then she would not be supportive of contact.
Rating: 4
Parent#2: a
Ma demonstrates understanding and awareness of issues related to birth parents. He views
individuals as capable of changing when they want to. He states, "Everyone makes mistakes."
He believes that parents should be given a chance to change always keeping the best interest of
the child in mind.
When asked what factors might contribute to someone abusing or neglecting a child he named
lack of education, lack of skills, drug/alcohol use, mental illness, cognitive deficits, lack of
financial resources, domestic violence, poor self esteem, their own history and a multi-
generational pattern of abuse/neglect.
his open to contact with birth parents when it is in the best interest of the child. He
would not want them coming to his home but feels that meeting and having conversations with
the birth parents will be helpful to the child.
Rating: 3_5
Birth Family Force
10. Viewpoint of Foster Children Element: How does the parent view children placed in
foster care? Any differences in view based on type/age/race/culture/religion of the child? When
updating or re-certifi)ing describe new or significant information that indicates a change from
22
the previous assessment.
Specific areas include: feelings toward and treatment of foster children (general, and
specific to their foster children, if updating or re-certifying); training completed or needed
concerning parent's viewpoint of foster children; when updating or re-certifying,
consider presentation of children to community (sensitivity, advocacy); other information.
Parent #1:i
S has a good understanding of how foster children might feel. She is insightful in
recognition of the range of feelin s they experience and that behavior might be their way of
expressing those feelings. views foster children as children first. She demonstrated
understanding that the separation and loss they experience was an important aspect of the trauma
a child has experienced. S believes that children would rather be with their parents most
of the time.
aviews her role as foster parent to provide a safe, secure home, full of love and patience
and which acknowledges the child's loyalty to their birth family. She would base her parenting
on reading each child and respond on a case-by-case basis. InitiallyS1would work on
setting and respecting appropriate boundaries while she learned the child's history and
temperament.
SI has completed the two Weld County trainings and is scheduled to complete the CORE
training by the end of March of 2003. One interview occurred the day after attendance at a class.
appears to have heard and incorporated the information given. It was clear that she
ands had discussed some of the issues presented in depth.
While INS was showing this worker around her home, she stated that the age and sex of
the child would determine which room the child was placed in. Her daughter, Ins has a
double bed in her room.S was considering having a little girl share her daughter's bed if
regulations allowed. i was referred to the County certification worker on this issue.
This worker was concerned over _lack of awareness of the potential risk of having
two children share a bed.
Rating: 3.5
Parent#2:S
views foster children as children first. He expects them, like all children, to have
different needs and temperaments and would respond to them as individuals. Sbelieves
that the presence of their children in the home will help a foster child feel safe sooner.
la demonstrated an understanding that behavior has meaning. He would expect to see
reactions to triggers that remind a child of abuse or neglect. all views one aspect of his
role to carefully read children before responding. Interactions would be based on the child's
history, temperament and the situation.
OShas completed the two Weld County trainings and is scheduled to complete the CORE
training by the end of March of 2003. One interview occurred the day after attendance at a class.
23
It was clear that he had discussed some of the issues presented in depth with MEL
Rating: 3.5
Foster Family Force
11. Preparation Element: How prepared is the family for adoption/fostering?How able is the
family to provide children with relevant racial, cultural, and religious experiences? Include
issues related to visitation with birth relatives and reunification as appropriate. When updating
or re-certifying, describe new or significant information that indicates a change from the
previous assessment.
Specific areas include: family's own children's current view of fostering, including jealousy
issues; parents' specific capabilities as related to foster parenting; training completed or needed
concerning impact of fostering/adoption; when re-licensing consider effects of foster parenting
on extended family; attachment to foster children, and feelings about foster children who may
have left the home; other information.
The idea to become foster parents was originally based on her experience in a
family that did foster care and adopted a child. knew very little about foster care
growing up. MNIIMEMMINII have talked about doing foster care off and on since they were
married. !is open that he opposed the idea at first. His concern is that they would be
taking on more than they could handle. His attitude will provide a good balance for
more optimistic attitude toward what she can handle. a states that he is quickly coming
around as he learns more about the need. aft have given consideration to the
effect that fostering will have on them each individually and as a couple.
SI have appropriate expectations of their role as foster parent. They listed their
role as foster parent as general care, documentation, providing a picture of the child to the
professionals, fostering the emotional relationships between the child and their siblings and birth
parents, facilitating visits between the child and their family and providing transportation. They
understand that the foster child will have a number of people in their lives and listed siblings,
birth parents, caseworker, therapist, GAL, schools, WIC and doctors as examples. They are
accepting of visitation and are open to contact as appropriate. Their goal is to help a child and
their birth parent work toward reunification.
Rating 4
Foster/Adoptive Family Force
12. Motivational Commitment Element: Motivation for a Child What is the nature and
level of motivation and commitment demonstrated by the family? Include infertility issues as
appropriate. When updating or re-certifying, describe new or significant information that
indicates a change from the previous assessment
Specific areas include: basis/reasons for motivation/commitment (e.g., status, financial. emotional,
24
adoption, own needs, service to community. etc.); other information.
Chas always wanted to do foster care, since her experience when her parents did foster
care and later adopted a child. She shared this desire with who had little exposure to the
concept of foster care. As r learned more about foster care, he has come to support the
decision to become foster parents. laIMIS want to provide a safe home to a child in
need.
Mak are seeking to do straight foster care with no plans to adopt. They have a
strong motivation, already had a significant level of understanding prior to the
beginning of the pre-certification classes. She has shared that information with _ The
couple have completed The Weld County Department of Social Services portion of the training
and are scheduled to complete the CORE training portion by the end of March of 2003.
Rating: 4
Intervention Force
13. Family Response Element: Relationship with County Department of Human Services,
Agency How capable are the potential parents to use agency involvement and to seek help on
their own?Include willingness of family to seek cross-cultural models and experiences. When re-
certifying, describe new or significant information that indicates a change from the previous
assessment.
Specific areas include: communication with agency staff; relationship with agency staff (includes
willingness to receive consultation/advice); relationship with other professionals; ability to share
information; ability to keep information confidential; ability to keep schedules and appointments;
willingness to be involved with birth family (as appropriate); resourcefulness in pursuit of services;
willingness to provide transportation; participation in foster/adoptive parent activities (e.g.,
newsletter, foster parent association/support groups, parties/picnics, assist with trainings,
provide/use respite care); other information. When updating or re-certifying also consider
preparation of foster children for removal from home (includes gathering belongings, handling good
byes). Indicate summary of training attended since last certification. Also identify any rule/contract
violations and corrective/action plan if appropriate.
SIIIS present as capable members of a team working in the best interest of the
child. They had a clear understanding of the importance, meaning and application of
confidentiality. They appear to have clear boundaries and understand their role and its
limitations. MOMMININe have the organizational skills to manage appointments and
documentation as required.
had a positive and open attitude toward learning new skills. They felt open to
accepting feedback from others. They have enjoyed the training attended to date and are looking
forward to the remainder of the training required. Both a were able to apply
what they have learned to their children and situations presented.
AIMS are open to attending regular training and to possibly attending the support
group. They were aware of the training available and knew how to access resources including in
25
an emergency.
Rating: 4
Intervention Force
14. Resource Element: Availability of Support Systems. What are the resources, external to
the family, which support the placement(s)?Includes ongoing training services and support
groups. When updating or re-certifying, describe new or significant information that indicates a
change from the previous assessment.
Specific areas include:the availability of support to the family 24 hours a day, including
agency/staff resources; other information.
The Weld County Department of Social Services (WCDSS) will have an on-call person available
twenty-four hours a day, to handle emergencies. A caseworker will have at least monthly
contact with the family. Additional consultation is available upon request. On-going training is
provided free of charge by the county. The WCDSS also provides a monthly foster and adoptive
parent round-table as a support and training tool. The Weld County Foster Parent Association
and County Food Bank are available to foster parents. A monthly foster care reimbursement and
mileage reimbursement will be paid.
Rating: 3_5
26
PARENT FORCE CHILD FORCE FAMILY FORCE BIRTH FAMILY FOSTER INTERVENTION
FORCE FAMILY FORCE FORCE
history 15 Child 15 Family function 4 Viewpoint of 3.5 Preparation 4 Family 4
function birth parent Response
Adult gen. 3.5 Family support 4 Viewpoint of 3_5 Motivation 4 Resource 3.5
function foster child Element
Parenting 15 Demographic 4
Discipline
Parenting 15
general
14 3_5 12 7 8 7_5 52
Conclusion
1. Add the ratings entered above in the 14 elements 52
(If no child in home, score "0" on "Child Functioning"in the Child Force)
2. Based on the rating in#1, identity the presence of positive parenting/effective family
functioning or the likelihood of disruption:
a. Very positive family field/No apparent risk (48 to 56)X
The presence of positive parenting and effective family functioning are apparent. There appear to be no conditions of
risk which exist;the parents capability to care for children is adequate.Based on appropriate matching,a child will
likely be/is enhanced by this placement.Indications are that a placement will be/is secure,productive and stable.
b. Generally positive family field/Minimal risk (37 to 47) _
Generally,there is evidence of positive parenting and effective family functioning.There are indications that there is a
balance between the capacity,conditions,and needs of the family and the needs of the child. There are minimal risks
present;the family is aware of and willing to address the areas of risk. Consideration should be given to continued
matching of the skills and abilities of the family with the needs of the child in order to insure that the child will
continue to be enhanced by the placement.
c. Somewhat positive family field/Low risk (22 to 36.5)
Although there is evidence of positive parenting and effective family functioning,there is an indication that the child
may not benefit/be benefiting from this placement and the placement may be problematic.There may be an imbalance
between the capacity,conditions,and needs of the family and the needs of the child. Consideration should be given to
the most pronounced risks and how manageable or adjustable they are.Documentation in the case record as to these
risks needs to be clear.When updating or re-certifying,a support/action plan should be entered into with the foster
family in order to manage the most pronounced risk elements,if they are considered serious enough to address.
d. Negative family field/Moderate risk (11 to 21.5)
Enough negative influences have been identified within the field so that there is a threat that the child will suffer/is
suffering directly from this placement and the placement may disrupt.There is an imbalance between the capacity,
conditions,and needs of the home and the needs of the child.Analysis of the most concerning risks needs to occur.
Clear documentation of these risks is imperative. If a placement exists when updating or recertifying,it is
recommended that consideration be given to removing the children from the home and that the family not be approved
for any future placements.
e. Very negative family field/Significant to High Risk...(0 to 10.5)
It is probable that the child will suffer/is suffering directly from this placement and the placement will disrupt.
27
Continued or future placements of a child could result in some form of maltreatment to the child. The agency needs to
inform the family of the areas of risk influences.All risk influences need to be documented in the case record.It is
recommended that if a placement exists,the child should be removed from the home.The home should not be approved
for any future placements.If ANY children reside in this family,consideration should be given to making a referral for
a CPS assessment.
3. Is there concern for maltreatment or likelihood of maltreatment in this home?
Yes No X
If yes, identify decisions and actions concerning responsibility to refer for a Child Protection
assessment:
4. Is there a concern for disruption/likelihood for disruption in the potential foster/adoptive home?
Yes No_X
If this foster/adoptive applicant family is currently providing foster care, does the family require
agency support to strengthen skills/abilities to remain a foster family?
Yes No N/A X
If the foster/adoptive applicant family is not providing foster care, are there decisions and
actions that can be taken to prevent future disruptions and strengthen the family?
Yes No X
If the answer to any of the above questions is "Yes," complete the Action/Support Plan designed
to remedy the disruptive condition(s) or to strengthen the family's skills/abilities.
•
H:\Peekhomestudy.doc
12/18/01
Evaluation and Decision:
Based upon all materials, interviews, and use of this system, the conclusion of the
assessment X or re-assessment is as follows:
A. Provide a general summary of the strengths and weaknesses of the family,
indicating any categories within the field, which raise concerns regarding the ability
of the family to parent children who may be or are now placed in the home. Address
the significance of any support plan that has been offered with regard to certification
or re-certification of the family.
bring many strengths to foster parenting. They present with a
strong marital relationship. Although different in temperament and personality,
they have formed a well functioning team. Communication and a commitment to
family are the reported cornerstones of their values. They have only been married
for two years, but have weathered several moves, lived in a small house with two
kids, built a custom house, and experienced a miscarriage.
allia has an optimistic, determined, can do attitude. She is more impulsive
and driven to make what she sees as the best choices happen.a has a
patient, thoughtful more conservative approach to life. This difference in style
does not appear to be the source of difficulty at this time. At present, the
differences provide a good balance that is viewed as a strength. It is, however, a
potential weakness in the relationship depending on whether they continue to
discuss issues and reach truly mutual decisions. In providing foster care it will
be important for an to listen and respect a insight and for Mr.
Peek to continue to express his point of view even in light of IMES
optimism and determination.
ea have been successful in raising three delightful, albeit very
different children. The children are well attached, respectful, and confident in
their place in the family. a demonstrate insight into their
children and take all factors into consideration in parenting. The expectations for
their birth children are high, although appropriate to the children. They will need
to monitor their expectations to ensure that they are not too high for an individual
foster child. S have a calm, child centered approach to their
family. They adapt parenting and discipline to the personality and needs of the
children. Their philosophy and discipline techniques have evolved with
experience. They are open to new ideas in parenting.
alEIMMINIES are seeking to do straight foster care and do not seek to adopt.
Combined with their willingness to work with birth parents toward reunification,
this is viewed as a strength. They have a good understanding of birth parent and
foster child issues. Their understanding is realistic and accepting.
H:\Peekhomestu dy,doc
12/18/01
During the course of the interviews, a shared that she did not tell her
nephews mother about sexual play upon the child's request and that she thought
it would be fun fora.. to share her bed with a foster child. These statements
raised concerns for this worker. It should be noted that have
not completed the pre-certification training at the time of the interviews.
The greatest weakness for the family is that they have three children under
the age of six. a appears to be able to manage three children in a calm,
loving manner. 'determination has the potential to be a strength when
she sticks with a child appropriately or a weakness when she sticks with a child
to the detriment of herself and her family. awareness and the couples
open communication minimize this risk.
B. Indicate your judgment as to the type of child(ren) that should be considered for this
family. When updating or re-certifying, consider: with which type of child does the
family excel? With which type of child does the family provide adequate care? Which
type of child likely does not benefit from placement in this family? Describe children in
terms of age, race, sex and general functioning.
Pending completion of the background checks, references, trainin and home
inspection this worker recommends certification of and
Safe are seeking to provide foster care to children of either sex who would
be younger than their five-year-old daughter. They would consider a sibling set
on a case-by-case basis. They are open to a range of 1Q and physical handicaps
although with an infant in the home they do not feel they could deal with an older
child who required additional physical care or carrying. They are open to a range
of behaviors. Behaviors would be considered based on the potential risk to the
children already in the home. These preferences fit with recommendations this
worker would make. Children who are aggressive, demonstrate cruelty to animals
or children, or could not tolerate sharing attention with three other children would
not be appropriate. Consideration should also be given to the fact that there are
already three children under the age of five in the home.
WorVer upervisor
In ‘/:o 3( (4/03
Date date
H:\Peekhomestudy.doc
12/18/01
'AUCIRD - - - - -----
-_ __ -_ --- -- _ 03/13/2003
PR•O ER Brla 0 A '
MARSH ADVANTAGE AMERICA ONLY AND CONFERS NO eRIOHTS UPON THE ,CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
160 SPEAR STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFPORDING COVERAGE
SAN FRANCISCO,CA 94105 --
COMPANY GUIDEONE SPECIALTY MUTUAL NSURANCE
A
INSURED COMPANY GUIDEONE MUTUAL INSURANCE COMPANY
B
LUTHERAN FAMILY SERVICES OF COLORADO _ _ _. ..__ - _ ._. _ ___ __ _ .._. _ __ _ _. _
383 SOUTH HARLAN,SUITE 200 COMPANY
DENVER,CO 80228 _ C __ _ .- __-. - _ -.- ._. _ - -.._. _
COMPANY
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INDICATED.NOTNATHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED M Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER DATE(*POLICY EFFECTIVE POLICY FllMRATON1 LIMITS
LTR PATE(*MOONY) DATE IMMIDdY'Y)
'GENE'RALLIASIUTY 1213-263 7/1/02 7/1/03 GENERAL AGGREGATE 3 3,000.000
A X COMMERCIAL GENERAL LIABILITY PRODUCTS•COMPIOP AGG E "37066,D0cr"
1 CLAIMS MADE (X9 OCCUR PERSONAL I1.0403/I1.0403/INJURY Jf ••- T,OW,OD�
--OWNER'S&CONTRACTOR'S PROT EACHOCCURRENCE I .-170607006-
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WORKERS COMPENSATION AND I TTOITTe uM TS A iEn, — — _ —
EMPLOYERS'LIABILITY EL EACH ACCIDENT I
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DEBCRIYi WTTQP LN•EIM IIIROSIMAnurisivalci.tatimaal.1MY SS
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED (CG 2026)AS RESPECTS GENERAL LIABILITY ONLY IN CONNECTION
WITH CONTRACT SERVICES PROVIDED BY THE INSURED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
r-- WELD COUNTY SOCIAL SERVICES EXPIRATION DATE THEREOF. TIE ISSUING COMPANY WILL ENDEAVOR TO MAIL
ATTN:JUDY A.GREIGO, DIRECTOR 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT,
PO BOX A BUT FAILURE TO MAIL SUCH NOTICE'MALL IMPOSE NO OBLIGATION OR LIABILITY
GREELEY,CO 80632 OF ANY KIND UPON THE COMPANY, ITC AGENTS OR REPRESENTATIVES
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EXHIBIT B
SUPPLEMENTAL NARRATIVE TO RFP
RECOMMENDATIONS AND CONDITIONS
DEPARTMENT OF SOCIAL SERVICES
P BOX A
CO
•
GREELEY, 80632
'1 WEBSITE:www.eo.weld.co.us
11 € Administration and Public Assistance(970)352-1551
Child Support(970)352-6933•
COLORADO July 9,2003
Sharon Thomas,Director
_ Lutheran Family Services
3800 Automation Way,Suite 200
Fort Collins CO 80525
Re: Off System Bid No.010-b3 RFP FYC 06-000-Home Study,Home Study Update,and
Relinquishment Counseling
Dear Ms.Thomas:
The purposes of this letter are to outline the results of the Home Study Bid process for PY 2003-2004 and
to request written information or confirmation from you by Friday,July 18,2003.
A. Results of the Bid Process for PY 2003-2004
The Families,Youth and Children(FYC)Commission has reviewed your bid according to the
criteria established in the bid and provides conditions as follows:
Condition 1:Bilingual-bicultural workers must be listed on the State Vendor List and must be
clinically qualified to do the home study,update,or relinquishment counseling.
Condition 2:The sample home study submitted with the bid did not include the worker's
recommendations.The FYC Commission requests that the worker's recommendations for the
sample home study be submitted.If approved,all home studies must include the
recommendations.
B. Required Response by FYC Bidders Concerning FYC Commission Conditions
The Weld County Department of Social Services is requesting your written response to the FYC
Commission's conditions.Please respond,in writing,with your acceptance or your non-
acceptance of the above stated conditions to Gloria Romansik,Weld County Department of Social
Services,P.O.Box A,Greeley,CO,80632,by Friday,July 18,2003,close of business.
If you wish to arrange a meeting to discuss the above conditions,please do so through Elaine
Furister,352.1551,extension 6295,and one will be arranged prior to July 18,2003.
cerely,
y . ego,Du for
c Dick Palmisano,Chair,FYC Commission
Gloria Romansik,Social Services Administrator
FAMIL y
2w �G
of Colorado
R,
"Services that heal strengthen,and provide hope"
July 15, 2003
Gloria Romansik
- Weld County Department of Social Services
P.O. Box A
Greeley CO 80632
Re: Off System Bid No. 010-03 RFP FYC 06-000-Home Study,Home Study
Update, and
Relinquishment Counseling
Dear Ms. Romansik:
The purpose of this letter is in response to your letter regarding the Home Study Bid
process for PY 2003-2004 requesting written information or confirmation on the
following;
A. Results of the Bid Process for PY 2003-2004
Condition 1: Bilingual-bicultural workers will be listed on the State Vendor
List and are clinically qualified to do the
home study, update, or relinquishment counseling.
Condition 2: Please refer to the attached sample home study recommendation.
This is the same home study sample submitted with the original Bid PY 2003-
2004 with the recommendations. The recommendations on the attached sample
are highlighted for easy reference. Please contact this program manager if the
Department needs further clarification.
B. Required Response by FYC Bidders Concerning FYC Commission
Conditions
Lutheran Family Services accepts the above stated conditions regarding the Bid
PY 2003-2004 for home studies,updates and relinquishment counseling.
Please contact Julie Box, LCSW, 970.266.1788, extension 111, if you have any
further questions.
3800 Automation Way, Suite 200 • Fort Collins, CO 80525-3433 • (970) 266-1788 • Fax (970) 266-1799 • www.lfsco.org
�j}�)ACCREDITED ^1 An Affiliate of
't Helps Lutheran Immigration
`� H �tti 1/" t MOM YYY111 and Refugee Service
(4'H
of Colorado
"Services that heal strengthen, and provide hope"
cerely`,��"7
J e Box, LCSW� � ISO
3800 Automation Way, Suite 200 • Fort Collins, CO 80525-3433 • (970) 266-1788 • Fax (970) 266-1799 • www.lfsco.org
JZSL ACCREDfTED ��„ *� 0
wed way
xx xx. It An Affiliate of
l n Lutheran Immigration
d Refugee Service
During the course of the interviews, a shared that she did not tell her
nephews mother about sexual play upon the child's request and that she thought
it would be fun for to share her bed with a foster child. These statements
raised concerns for this worker. It should be noted that allaMONS have
not completed the pre-certification training at the time of the interviews.
The greatest weakness for the family is that they have three children under
the age of six. IMESappears to be able to manage three children in a calm,
loving manner. determination has the potential to be a strength when
she sticks with a child appropriately or a weakness when she sticks with a child
_ to the detriment of herself and her family. ..la awareness and the couples
open communication minimize this risk.
B. Indicate your judgment as to the type of child(ren) that should be considered for this
family. When updating or re-certifying, consider: with which type of child does the
family excel? With which type of child does the family provide adequate care? Which
type of child likely does not benefit from placement in this family? Describe children in
terms of age, race, sex and general functioning.
yr. kiss.P
Pending completion of the background checks, referen es, trainin and me
inspection this worker recommends certification of and
/urs. Pe are seeking to provide foster care to children of either sex who would
be younger than their five-year-old daughter. They would consider a sibling set
on a case-by-case basis. They are open to a range of IQ and physical handicaps
although with an infant in the home they do not feel they could deal with an older
child who required additional physical care or carrying. They are open to a range
of behaviors. Behaviors would be considered based on the potential risk to the
children already in the home. These preferences fit with recommendations this
worker would make. Children who are aggressive, demonstrate cruelty to animals
or children, or could not tolerate sharing attention with three other children would
not be appropriate. Consideration should also be given to the fact that there are
already three children under the age of five in the home.
` 5 .; off/.Jr_� t ,wUt i- t,t)
WorKer jupervisor
5// .7491 310/0
Date ate
H1Peekhomestudy.doc
12/18/01
Weld County Department of Social Services
Notification of Financial Assistance Award
for Child Welfare Regular Administration& EPP Funds
Type of Action Contract Award No.
X Initial Award 03-HS-0029
Revision (RFP-06-000)
Contract Award Period Name and Address of Contractor
Beginning 07/01/2003 and Transitions Psychology Group
Ending 05/31/2004 804 11th Avenue
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Capacity for three new referrals per month,two Assistance Award is based upon your Request for
new referrals per month for updates, and four Proposal (REP). The RFP specifies the scope of
referrals per month for relinquishment services and conditions of award. Except where it is
counseling. Total monthly capacity is nine in conflict with this NOFAA in which case the
families, with a monthly average of six families. NOFAA governs, the RFP upon which this award is
Approximately 15 clients would receive based is an integral part of the action.
Bilingual-bicultural services, and an estimated Special conditions
46 clients would receive services in South Weld 1) Reimbursement for the Unit of Service will be based
County. The average stay in the program is five on a rate per home study; home study update,and
weeks, with an average of two hours relinquishment counseling session.
participation per week. Services are available in 2) Reimbursement requests must be an original with an
English, Spanish, and Japanese. original signature from the provider and/or designee.
3) Reimbursements requests must include the date the
Cost Per Unit of Service home study, update, or relinquishment counseling was
completed. The request must reflect the referral
Rate per Study number assigned to each home study, the amount
Full Home Study $875.00 billed for each home study, and the month the service
Updated Home Study $525.00 was provided.
Relinquishment Counseling $250.00 4) Payment will only be remitted on referrals made by
the Weld County Department of Social Services.
Unit of Service Based on Approved Plan 5) Requests for payment must be an original submitted to
the Weld County Department of Social Services by
the end of the 25th calendar day following the end of
the month of service.The provider must submit
Enclosures: requests for payment on forms approved by Weld
X Signed RFP:Exhibit A County Department of Social Services.
Supplemental Narrative to RFP: Exhibit B
Recommendation(s)
X Conditions of Approval
Approva : Program Official:
By C By
David E. Long, Chair Judy . o,Directo
Board o 1 C unty Com issioners Wel oun epartment of Social Services
Date: L�i U 2003 Date: g 3 03
EXHIBIT A
HOME STUDY BID
Off-System Bid No. 010-03_?P-FYC-06-000 Attached A
HOME STUDY, UPDATE, & RELINQUISHMENT COUNSELING BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER
CHILD WELFARE ADMINISTRATION FUNDING
2003-2004 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
BID Off-System Bid 010-03 RFP-FYC-06-000
NAME OF AGENCY: Trani h'0}16 ft,' th 0109 GT ro til f r L.L G
ADDRESS: QOM I I n"` kve, Circe(e1 i c,0 Sao3I PHONE: (uic (P-I 1la-3
CONTACT PERSON: 6re50int CO3 Creed IDLE: couhGe(0ri cO-OW eyr
DESCRIPTION OF HOME STUDY PROGRAM CATEGORY: Adoption, Foster Care, and Expedited Permanency Planning
Home Studies in compliance with the uniform format utilized by the State of Colorado Department of Human Services since
October 1, 1999 (Attached A).
11-Month approximate Project Dates: 12-month contract with actual time lines of:
Start June 1,2003 Start
End May 31,2004 End
TITLE OF PROJECT: Hone Sil k1'
Jam i moe Nor f w1A V1 MPV LPL. (p-11 -03
Name and Signature of Person Preparing Document Date
JAW)i We-l- ari-Vhu vu/�,1 (a -161-O
Name and Signature Chief Administrative fficer Applicant Agency Date
MANDATORY PROPOSAL REQUIREMENTS
For new 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 Year 2002-2003 to Program
Year 2003-2004.
.it Project Description _Project Description
✓ Sample Home Study _Sample Home Study
✓ Target/Eligibility Populations _ Target/Eligibility Populations
/ General General
✓ Cultural/Eligibility Populations Cultural/Eligibility Populations
/ Types of services provided _Types of services provided
P Measurable Outcomes _ Measurable Outcomes
v Service Objectives _ Service Objectives
✓ Workload Standards Workload Standards
✓ Staff Qualifications Staff Qualifications
Unit of Service Rate Computation _ Unit of Service Rate Computation
7 Program Capacity per Month Program Capacity per Month
CertifrcateofInsurance
INVITATION TO BID
DATE:May 28, 2003 Off System Bid No. 010-03 RFP FYC 06-000
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 06-000) for: Adoption, Foster Care, and Expedited Permanency
Planning Home Studies, and Relinquishment Counseling
Deadline: June 20, 2003, Friday, 10:00 a.m.
The Families, Youth and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that competing applications will be accepted for approved vendors pursuant to the
Board of Weld County Commissioners'-authority pursuant to Colorado Statute and the Weld County Home
Rule Charter. The Families, Youth and Children Commission wishes to approve services targeted to run
from June 1, 2003, through May 31, 2004, at specific rates for home studies,home study updates, and
relinquishment counseling services. The County will authorize approved vendors and rates for services only.
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 64_6163
(After receipt of order) B)j� SIGNED IN INK
Gve �'�'``��(S • CYma,4
TYPED OI*RINTED SIGNATURE
VENDOR TIclrs hIoh5Pe,y 1DI09yGp,tI-,ii.
(Nan1e) Handwritten Signature By Authorized
Officer or Agent of Vender
ADDRESS sot.+- 11th Ave-. TITLE
Careele CO €O&3( DATE
PHONE# (q D) 3 �(p- Ila-3
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 33
Off-System Bid No. 010.03 RFP-FYC-06-000 Attached A
c/Veld S . ire-A077- 6-Ant
Date of Meeting(s)with Social Services Division Supervisor:
Comments by SSD Supervisor
lAir s -Cjieetto<rirt std. DIA es 4907, kA fit run' itifie-inzineattp5
Orsd� 9 7d *t?ucocc - 1940 yey I 714C bAw.e Study
PP /SOLI ea Sy *be s Dr*'/tx.'. 7A.e Cnnnse.,ntQ---
gdr a.s Reif get;/n7 pore In 1p4i l'r ,9%c.,( Er //, N,
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a`rl 3
ame and Signature of D S •- Date
Page 23 of 33
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COLORADO �� �� Lour v h f ElIr meen
ACTIVE
LICENSED PRO OU L
2296 2001 03
UED S
MOE- R N, M.A
ANSI PONS PSYCHOLO P.
10 11 FAVE SUITE 21
GREEL f,- CO 80631
BRUCE M. DOUGLAS -6,-�
DIRECTOR DIVISION OF REGISTRATIONS LICENSEES SIGNATURE
STATE OF COLORADO
DEPARTMENT OF REGULATORY AGENCIES '
DIVISION OF REGISTRATIONS \
PROFESSIONAL CQVNSELQR y'$ BD a 411
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LICENSpp PRog, COUNSELOR c c .4 '1 u.,-c 1'M-
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!I .DIVISION OFREGISTRATIONS
NUM ISSUED ` E9(;9JF�ES
%GREGORY SCOTT CREED, M.A. Si
1306 11TH AVENUE
GREELEY CO 80634
AA 11-6°C.
L NSEE' IGN U
•
Issue Date: 08/02/02
<NN The Reciprocal PROFESSIONAL LIABILITY OCCURRENCE
A/ Alliance INSURANCE POLICY FOR
Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN
DEVELOPMENT PRACTITIONERS
ACA Insurance Trust,Inc.5999 venue AcumeEnna
Policy Number: CL9OO945O2 Administered by: Alexaorhw,VA2238433ee TRUST
Tall Free 1.800.3476847 x284 -?-
ITEM DECLARATIONS INDIVIDUAL POLICY
1. NAMED INSURED: Gregory S. Creed
Transitions Psychology Group, LLC
2. ADDRESS:
804 11th Avenue
Greeley, CO 80631
3. POLICY PERIOD: From: 08/01/02 To. 08/01/03
12:01 A.M.Standard Time at Location of Designated Premises
4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges:
COVERAGE PREMIUM
A. PROFESSIONAL LIABILITY S 438 .50
B. GENERAL LIABILITY $ 117 . 00
TOTAL PREMIUM: $ 555 .50
5. LIMITS OF LIABILITY: $1, 000, 000 each Incident or each Occurrence $3, 000, 000 in the Aggregate
6. THE NAMED INSURED IS: Sole Proprietor(incl.Individual) Partnership
Corporation X Other(refer to Item 7 below)
7. BUSINESS OF THE NAMED INSURED: Self-Employed
(Rating Category) Counselor/Human Development Professional
8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and
agreements contained in the following form(s)or endorsement(s): CPL-00040199 CPL-0005.0199 CPL-0006.0199
NOTICE
THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE
INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE
FOR YOUR RISK RETENTION GROUP.
CPL-005R-1201.00
•
Issue Date: 08/02/02
�l The Reciprocal PROFESSIONAL LIABILITY OCCURRENCE
`y�,Alliance INSURANCE POLICY FOR
Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN
DEVELOPMENT PRACTITIONERS
ACA Inswence Trust Inc.
Policy Number: CL90094502 Administered by: 5899
�Stevensona. A 2IW3Avenu TAC3RUST
s
y aMria,VA zzson-aaoo
Tel Free 1.800.347.6647 x264
ITEM DECLARATIONS INDIVIDUAL POLICY
1. NAMED INSURED: Jami Moe-Hartman
Transitions Psychology Group, LLC
2. ADDRESS:
804 11th Avenue
Greeley, CO 80631
3. POLICY PERIOD: From: 08/01/02 To: 08/01/03
12:01 A.M.Standard Time at Location of Designated Premises
4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges:
COVERAGE PREMIUM
A. PROFESSIONAL LIABILITY S 375 .25
B. GENERAL LIABILITY $ 0 . 00
TOTAL PREMIUM: $ 375 . 25
5. LIMITS OF LIABILITY: $1, 000, 000 each Incident or each Occurrence $3, 000, 000 in the Aggregate
6. THE NAMED INSURED IS: Sole Proprietor(incl.Individual) Partnership
Corporation X Other(refer to Item 7 below)
7. BUSINESS OF THE NAMED INSURED: Self-Employed
(Rating Category) Counselor/Human Development Professional
8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and
agreements contained in the following form(s)or endorsement(s): CPL-0004-0199 CPL-0005.0199 CPL-0006-0199
NOTICE
THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE
INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE
FOR YOUR RISK RETENTION GROUP.
CPL-005R-1201.00
AMENDMENT - CHANGE ENDORSEMENT
THE RECIPROCAL ALLIANCE(RISK RETENTION GROUP)
This endorsement modifies insurance provided under the Professional Liability Occurrence Policy for
Professional Counselors and Human Development Practitioners.
The following spaces preceded by an asterisk I'1 need not be completed if this endorsement and the policy have the same inception date.
ATTACHED TO AND FORMING 'EFFECTIVE DATE 'ISSUED TO:
PART OF POLICY NO. OF ENDORSEMENT
CL90094502 08/01/02 Transitions Psychology Group, LLC
A. In consideration of an la additional premium ❑ return premium of $ 117 . 00
Coverage B.General Liability is ® added ❑ deleted,applicable to the following locations:
1 Transitions Psychology Group
804 11th Avenue
Greeley, CO 80631
Nothing herein contained shall be held to vary,alter,waive,or extend any of the terms,conditions,provisions.
agreements,or limitations of the above mentioned policy,other than as above stated.
<2. 08/02/02
Authorized Representative Date
CPL-0025.0299
Off-System Bid No. 010-03 RFP-FYC-06-000
Attached A
IX. COMPUTATION OF DIRECT SERVICE RATE
This form is to be used to provide detailed explanation of the hourly rate your
organization will charge Child Welfare Regular Administration funds for the
services offered in this Request for Proposal. This rate may only be used to bill
the Weld County Department of Social Services for direct, face-to-face services
provided to clients referred for these services by the Department. Requests for
payment based on units of service such as telephone calls, no shows, travel time,
mileage reimbursement, preparation, documentation, and other costs not involving
direct face-to-face services will not be honored. Likewise, billings must be for
hours of direct service to the client, regardless of the number of staff involved
in providing those services. Therefore, it is imperative that this rate be
sufficient to cover all costs associated with this client, regardless of the
number of staff involved in providing these services.
(Explanations for these Lines are Provided on the Following Page)
Total Hours of Direct Service per Client //��IO Hours (A]
l.(
Total Clients to be Served 'O Clients [B]
Total Hours of Direct Service for Year & 0 0 Hours [C]
(Line [A] Multiplied by Line [B]
Cost per Hour of Direct Services $ 50 Per Hour [D]
Total Direct Service Costs $ ?30/ 0 0 O [E]
(Line [C] Multiplied by Line [D) )
Administration Costs Allocable to Program $ 14 SO 0 [F]
Overhead Costs Allocable to Program $ q) a9 a-" [G]
Total Cost, Direct and Allocated, of Program$ 41/ ii a-' [H]
Line [E] Plus Line [F] Plus Line [G] ) 2!�
Anticipated Profits Contributed by this Program $ 2 O J J [I]
Total Costs and Profits to be Covered
by this Program(Line [H] Plus Line [I] ) $ 5a, `O p 5 [J]
Total Hours of Direct Service for Year (i70 0 [K)
(Must Equal Line [C] )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 28 [L]
Day Treatment Programs Only:
Direct Service House Per Client Per Month [M]
Monthly Direct Service Rate $ [N]
Page 26 of 33
Transitions Psychology Group, LLC
PROJECT DESCRIPTION
Transitions Psychology Group, LLC is a private counseling agency
consisting of a multidisciplinary team of human service professionals,
providing superior counseling and assessment services to children and
families in Northern Colorado. The purpose of the Home Study,
Update and Relinquishment Counseling Program is to provide
excellent services to expedite permanency placements of children in
Weld County.
A. Home Study
The Home Study segment of the program strives to effectively and
efficiently evaluate prospective adoptive homes and foster homes
in order to provide for safe, nurturing environments for children as
quickly as possible. A Home Study begins with an initial family
screening by a counselor from Transitions Psychology Group, LLC
(hereafter referred to as Transitions), which includes all members of
the household. During the screening, the home study program is
explained to the prospective family, the necessary consent forms
are completed, a cursory home inspection is performed and
background checks are initiated. The family then completes an
application. When the screening process is completed, a second
Transitions counselor meets with the prospective foster/adoptive
parents for a joint interview with followed by individual interviews
with each parent. Finally, the parental unit is interviewed again,
with part of this interview including other household members. The
results are compiled in a written report according to the State of CO
format and submitted to the referring caseworker.
B. Home Study Update
The Home Study Update program begins with a paper review of the
initial Home Study. A counselor from Transitions then interviews
the parental unit to discuss any changes in the family since the
initial Home Study. Following this interview, the counselor meets
with the entire household in order to inspect the home and evaluate
interactions among family members.
C. Relinquishment Counseling
The Relinquishment Counseling Program consists of two individual
sessions with each referred parent who is considering relinquishing
a child(ren). The sessions include all of the components of the
Weld County Department of Social Services Relinquishment
Counseling Outline.
1
Transitions Psychology Group, LLC
II. HOME STUDY EXAMPLE
The Sergeant Family
Names of Parents:
Steve Sergeant (DOB 4/16/62)
Cathy Sergeant (DOB 7/3/61)
Children's Names:
Aaron Sergeant (DOB 8/2/91)
Conner Sergeant (DOB 7/1/98)
1. History Element
• Steve Sergeant: Steve was adopted as an infant shortly after birth. His
birth mother gave him up for adoption, reportedly because she was young,
single and unable to care for an infant. He has never met his biological
parents as a condition of his adoption. A healthy infant overall, Steve
reached developmental milestones within normal parameters, except for
speech. His speech was slightly delayed but not to the extent that any
intervention was deemed necessary. Steve developed asthma and
allergies as a child that restricted his involvement in team sports; he has
since become very physically active. His adoptive family consisted of his
father, mother, and three younger siblings, all biological children of the
family. He has a sister who is four years younger than he, and two
brothers, three years and seven years younger. As with many couples,
Steve's adoptive mother was finally able to conceive after adopting a child.
Steve's father was the president of a local bank that was established by
his grandfather. He died in 1992 from brain cancer, which was a
prolonged and traumatic event for the family. Steve was a college
freshman at the time. Steve's mother had a college education and was an
elementary school teacher until the adoption, when she left her career to
focus on childrearing. Steve describes a very positive relationship with
both parents. Though his father worked very long hours during the week,
Steve fondly remembers family vacations and time with his dad on the
weekends. The family attended Christian church regularly. Steve
describes his childhood relationships with his siblings as amicable and
also reports significant interaction with his cousins who lived nearby. After
the death of his father, Steve developed a rift with his youngest brother,
Tom, because of"all the problems he created" for his mother. Tom got
married, had three children then later divorced. He has claimed
2
Transitions Psychology Group, LLC
bankruptcy due to "irresponsibility' and continually asks their mother for
financial assistance. Steve says he tries to "avoid" his brother now,
although he still worries about him. Steve's sister is lesbian and lives with
her partner of eight years in Boston. His younger brother lives in his
hometown, happily married with three children. Steve followed in the
footsteps of his father, working in banking. He holds a bachelor's degree
in business finance and currently is the vice-president of a local bank that
is expanding. Steve enjoys physical activity: he rides his touring bicycle,
swims regularly with his children, and participates in mountain sports like
skiing and hiking. He assisted in the timing of sporting events in the 2002
Olympics.
• Cathy was the product of a natural childbirth and reached developmental
milestones within normal limits. She claims she was an early walker, so
much so that she did not crawl sufficiently as a baby. As a result, she
says that she has "always been a little bit uncoordinated", despite the fact
that she lettered in basketball in high school. Cathy's father is a farmer in
central Kansas; her mother is a homemaker. She has two younger
brothers, two and four years her junior. They are both married and have
children. Cathy reports that she got along very well with her siblings.
However, she sometimes resented being the oldest as more was
expected out of her and her parents were more strict with her than they
were with her brothers. Her family was deeply involved with their church
and took several trips to Central America to perform volunteer work. She
describes these trips as "bonding time" for the family, an opportunity for
everyone to work together. Cathy visits her parents two to three times
each year and maintains weekly phone contact with her mother. There is
a history of depression on Cathy's side of the family. Her uncle, paternal
grandmother and two cousins have all suffered from depression of varying
degrees. Cathy's father has had some heart problems which required
double bypass surgery. Her grandfather died of a heart attack at age 73.
Cathy and Steve have two children: Aaron age 11 and Conner age four.
Cathy had a difficult pregnancy and labor with her second child, which
included severe morning sickness, back pain and delivery by emergency
cesarean section. She vowed to never get pregnant again. However,
both she and her husband want more children. Cathy has a bachelor's
degree in criminal justice. She worked in probation early in her career.
After having children and moving to this area, she works for Head Start as
a coordinator and parent educator. Cathy enjoys walks in the park near
their house, reading, and time at home with her children. She belongs to
a women's group from her church.
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Transitions Psychology Group, LLC
2. Adult General Functioning Element
• Cathy is successful in her career and competent as a mother. She is well-
liked by her coworkers and others working in her field. She presents at
annual conferences and trains Head Start workers in her area. Cathy is
intelligent with a good sense of humor and strong communication skills.
She appears to have normal cognitive functioning, although she reports
having "low self-esteem". Presenting and training have helped her
develop more confidence. Cathy shares that she gets into "melancholic
moods" from time to time, feeling lonely or sad. She would not describe
these times as depression and states she has never felt that her
symptoms were severe enough to require antidepressant medication.
During her melancholic moods she reports that she is still able to manage
her roles as an employee, mother and wife. She admits that she gets
short tempered with the children at these times. Cathy remains anxious
about her father's health, even though she knows he has modified his diet
and exercise habits. She says she is afraid he might die of a heart attack
like her grandfather. Cathy feels she has an open attitude towards people
of other races and cultural backgrounds. Having a sister-in-law that is
lesbian has helped her to be more accepting of homosexual orientations
and the time she spent in Central America has increased her cultural
awareness. When Cathy feels stressed by daily pressures she takes a
walk, reads or just does "something fun with the kids to forget it". Based
on her history and general attitude and presentation, Cathy seems to have
solid judgment, a strong capacity to make decisions and the ability to
follow through with her commitments.
• Steve is active, highly intelligent and balanced. He admits to getting
irritated by his brother's "poor decisions" but is able to allow his brother to
make his own choices. In his own life, Steve has made competent
decisions: he exhibits sound judgment and successfully in completes his
endeavors. He generally has positive interactions with his family and
coworkers, although he admits "loosing my temper occasionally. At these
times, rather than "blow his top", he tries to leave the office or go for a long
bike ride. After some time away, he is able to approach the issue or
situation with more patience. The death of his father was devastating to
Steve, resurfacing some issues about being adopted and "fatherless from
the beginning". He says he sometimes feels alone in the world but then
looks at his family and realizes how rich his life is. Steve struggled for a
while with his sister's "coming out" because of how it affected his mother.
Later, he came to accept his sister and her partner. He feels open to
alternate lifestyles and people of other races, cultures, religions and
backgrounds.
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Transitions Psychology Group, LLC
3. Parenting-Discipline
• Cathy and Steve have a lot of experience in parenting from birth to the
preteen years. Cathy possesses superior knowledge of parenting
practices because of her career and she effectively applies this knowledge
to parenting her own children. Steve will often defer to Cathy for discipline
matters although he will engage in discipline practices. He admits that he
will "swat" the younger child, Conner, on the bottom occasionally even
though in theory he does not believe in corporal punishment. Steve
prefers to use diversion or time-out strategies for Conner. Both parents
admit that Conner has been more of a challenge to their parenting skills.
He has more tantrums and is basically less compliant than their older
child, Aaron. Cathy and Steve take a position of authority as parents and
are not ruled by their children. At the same time, they seem to have
flexibility in their parenting practices. They have found themselves
becoming more "democratic" with Aaron now that he is almost 12-years
old. They have worked with Conner through most of his tantrum stage
and he now only occasionally has a tantrum. They say he finally realized
the tantrums "don't work". The parents have the expectation that the
children contribute to the household by doing some chores: Conner has
to pick up his toys and Aaron takes out the trash and feeds the animals.
The parents provide a fairly structured environment and regular schedule
for the children.
4. Parenting-Values and Practice
• Steve and Cathy are both concerned parents who are sensitive to their
children's needs. The children are involved in soccer, swimming, and
other activities. Mom and Dad help out with transportation and other
supportive activities with the teams. As parents they provide very well for
both of their children and believe they will provide equally well for any child
they may adopt. They are emotionally available for their children and are
directly involved in their children's education and development. Cathy
volunteers in her children's classes at school on a regular basis. Both
parents make it a point to attend all conferences and events at the school.
The children are well-dressed, have good hygiene, and have a healthy
appearance. The home is also well kept and appears to be a safe
environment for children. The family has every intention of including their
adopted child in the family environment as if the child were their own.
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Transitions Psychology Group, LLC
5. Children/Child Functioning
• Cathy and Steve are raising two wonderful children. The children were
open and friendly in the interviews, once they warmed up and felt more
comfortable with the interview process. Four-year old Conner is a bundle
of energy, just as his parents described him. He works hard to keep up
with his big brother who is relatively patient and kind. Eleven-year old
Aaron says his brother is "a pain", but his actions show that they have
generally positive interaction. Aaron recently finished his first year of
middle school and is doing well both academically and socially. Conner
finished preschool and will enter kindergarten in the fall. He seems eager
to start school. His mom said he did fairly well socially aside from
occasional fights with other children due to his competitive nature.
6. Family System
• As indicated in other sections of this report, the Sergeant family is
functioning at a fairly high level. They utilize effective communication
styles overall but some sarcasm and indirect communication was noted.
Cathy has a more indirect style of communication and Steve will
disengage when emotions become intense. On a scale of 1-10, 10 being
most effective, this family is at a 7-8 on communication. There is a clear
boundary between the parental and sibling subsystems. Parents have the
clear authority in the home and the parents agree on discipline strategies
and present a united front to the children. When Cathy is stressed, she
will "turn the kids over" to Steve. Because of the age difference between
the children, Aaron definitely has more privileges and responsibilities:
Steve will involve him in more adult activities like rugged camping trips
and helping out around the house. Both parents are affectionate and have
bonded with their children. Steve's mother in California and Cathy's
parents in Kansas visit often to see the grandchildren. They shower them
with gifts and attention. The grandparents typically stay for only short
periods (3-5 days), although Steve's mother will sometimes stay longer.
This does become a stress for the family because Steve is at work for
most of the day and Cathy is left with her mother-in-law whom she
believes "complains too much".
• Adult Relationship/Marriage: Despite being busy parents and career
people, this couple finds time to nurture their relationship. They try to
have a "date" every month. One of their favorite date activities is to have
a quiet dinner at a fancy restaurant. In separate interviews they both
denied any history of violence in their relationship and did not endorse any
power and control issues. Cathy and Steve make big decisions together,
but are fairly autonomous in smaller decisions, especially in their
respective domains. For example, Cathy takes care of shopping for the
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Transitions Psychology Group, LLC
boys and does not consult her husband on her purchases. Steve will not
necessarily consult his wife on his purchases of sporting equipment or
decisions about his races. They are comfortable with this arrangement for
the most part, although Cathy does express some irritation with Steve's
fervor about sports. She does not share his enthusiasm but can
understand his interest in sports and fitness, especially since he was
unable to participate in sports as a child. Having a third child was a point
of contention in their marriage until they decided to adopt. Steve wanted
to have another biological child but Cathy was against it. She could not
understand why he would not want to adopt, especially since he was
adopted as an infant himself.
• Both sides of the family are aware of the couple's desire to adopt and are
supportive. The family has always been emotionally supportive, and
Cathy's side of the family is especially close and supportive. They have
no family members living in the area, but they seem to have a well-
developed social network and are friends with the families of their
children's friends, indicating sufficient mutual support. They are well-
integrated into the community socially and into their respective work
environments.
8. Demographics
• The Sergeants are an upper middle-class family. Steve and Cathy handle
their finances well: they are proud of limiting debt and investing in rental
properties in the area. The couple's investment properties currently
produce a monthly income of $1,200 that supplements their employment
income. Their home is located in a quiet, established area of town. The
neighborhood is safe but few children live nearby. The couple has
adequate health insurance and life insurance policies. Plans have been
made and documented in their wills as to the care of their children in case
of untimely death of both parents. Please see attached documentation of
life insurance, health insurance, copies of driver's license, and automobile
insurance. They belong to a local Christian church and attend services
regularly. Their children have been involved in bible classes as well.
7
•
Transitions Psychology Group, LLC
9. Birth Family
• The couple would be open to adopting a Hispanic or Asian child and have
seriously considered adopting a child from Central America because of
Cathy's experience there. They stated that they would probably not
consider adopting an African American child because they do not believe
they could accommodate her cultural needs and racial identity needs due
to lack of resources in their community. This couple states that they prefer
to adopt a younger girl, but are willing to adopt any child up to 11 years of
age.
• Cathy and Steve have mixed feelings towards the birth families of foster
and adopted children. They have some trepidation about the legal
process, fearing that they could become attached to a child then loose the
child back to the birth parents. They have no tolerance for mistreatment of
children and have stated they would want to protect their adopted child at
all costs. At the same time, they recognize the importance of telling the
child about her birth parents and are open to the possibility of visitation. It
bothers Steve that he was not allowed to know anything about his birth
parents so he says he would not want to put his child in that situation.
Depending on the conditions of the adoptions, they might be open to
supporting a limited relationship with the birth family.
• The couple sees foster/adoptive children as children in need of a home.
They see younger children as more appealing for adoption because of
bonding issues and a desire for the child to fit into the family at a young
age.
• Cathy and Steve are willing to work with a child that has suffered neglect
or abuse, but they are relatively certain they do not want to adopt a child
with any moderate to severe congenital birth disorders. They are also
dubious about children with severe attachment issues.
10.Foster/Adoptive Family Preparation
• The family is relatively well prepared for adoption. They have discussed
options and preferences. Their older child expresses eagerness to adopt
a new child. The younger child is more ambivalent, partially because he
does not understand and partially because of jealousy. The couple is
aware of his needs and we have discussed ways to ease the transition for
their children and ways to involve them in the process. The older son has
already been involved in many conversations with his parents concerning
the issue of adoption and has talked with a friend his age whose family
adopted a baby from Korea.
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Transitions Psychology Group, LLC
11.Motivation/Commitment
• Part of the reason this couple has decided to adopt locally, as opposed to
internationally, is because they strongly believe that children right here at
our doorsteps need help and a home. They feel called to accept one of
these children into their home and to adopt her into their family. Steve,
who originally did not want to adopt, has begun to see this as an
opportunity to "pay back" the good fortune that was given to him. Cathy
says she loves children and wants to help children in need.
• Intervention
The couple is open to any intervention that may be recommended. They
are also willing to seek out cultural experiences for their child as
appropriate, depending on ethnicity of the child placed in their home.
12.Resource(s) Needed to Support the Placement
• As mentioned above, the family has an intact support network. However,
it will be beneficial for them to be in contact with more families who have
adopted or are in the process of adopting. They will need to be referred to
any services deemed necessary for the child. They are willing to
accommodate the child's needs.
• At this point, I would recommend that Steve have brief individual
counseling to look at his reaction to the adoption process and how that
ties into his feelings about being adopted and not knowing his birth family.
Just as the death of his father impacted him in an unexpected way, this
adoption could impact him in unexpected ways. It would be preferable to
explore some of those issues now instead of waiting for them to surface in
unpredictable ways after the adoption. He is open to the counseling and
has this benefit available through his health insurance plan.
13.Training
• Cathy has extensive experience in child development issues because of
her work with the Head Start program. Cathy and Steve have attended a
24-hour adoptive and foster family introductory training. They need to be
connected with the ongoing support group at this time to continue their
training and support.
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Transitions Psychology Group, LLC
14.Conclusions/Recommendations
• I would highly recommend this family to adopt a child. They have a strong
potential of providing for and meeting the needs of a foster/adoptive child.
As mentioned earlier, individual counseling for Steve is recommended at
this time to work trough his own adoption issues. The marriage is healthy
and is not in need of couples work. The children will benefit from meeting
other families who have adopted. This will help to make the situation
more real and they can get tips from other children their age.
III. TARGET/ELIGIBILITY POPULATIONS
The Home Study, Home Study Update and Relinquishment Counseling
program serves adults of Weld County who are interested in foster
parenting, becoming adoptive parents or relinquishing children and are
referred by the Weld County Department of Social Services. Transitions
does not discriminate based on race, color religion, national origin or sex,
in accordance with State and Federal laws, rules and regulations.
The Transitions program can accept up to three new referrals each month
for home studies, two new referrals per month for updates and four
referrals per month for relinquishment counseling. Thus, the monthly
maximum program capacity would be nine families, with an average of six
active families per month. Annually, the program could serve 36 families
for home studies, 24 families for updates and 48 individuals for
relinquishment counseling. The total number of clients served during the
contract period would be approximately 153, varying based on the
demographics of the families referred for home studies (i.e. one or two-
parent households). Approximately 15 clients would receive bilingual
services and an estimated 46 clients would receive services in South Weld
County. Transitions can provide services in English, Spanish and
Japanese. The average stay in the program would be five weeks, with
families participating an average of two hours per week.
IV. TYPE OF SERVICES TO BE PROVIDED
Transitions will provide Home Studies, Home Study Updates and
Relinquishment Counseling. These services will not supplant existing
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Transitions Psychology Group, LLC
services in the community, as these services are not currently funded by
mental health capitation services, ADAD or other funding.
A. Home Study
1. Family Screening
A counselor from Transitions meets with all members of the
household. The home study process will be explained and to the
prospective family and consent forms will be completed. An initial
home inspection will be performed at this time and fingerprints and
data necessary to complete the background checks will be
collected. The family will then complete a written application.
2. Parental Unit Interview
When the screening process is completed, a second Transitions
counselor will meet with the prospective parent(s) to review the
application and to evaluate the parental unit and his/her/their ability
to function as caretaker(s) of children. The appointments for the
remaining steps in the home study will be scheduled at this time to
further accelerate the process.
3. Individual Interviews
Following the parent interview session, in households with more
than one parent, each parent will be interviewed individually.
These interviews focus on evaluating each parent's general
functioning, personal history and views on childrearing and
motivation to be a foster/adoptive parent.
4. Final Interview
The parental unit will again be interviewed with all members of the
household present in order to complete data gathering. The
second counselor would then have the opportunity to observe
family interactions and complete the home inspection.
5. Team Consultation
The two Transitions counselors involved in the home study with the
family and the Transitions supervisor will meet to staff the case,
identifying conclusions and delineating specific recommendations.
A report will then be submitted to the referring WCDSS caseworker
following the State of Colorado format and including original
background check information. These steps will be completed
within six weeks of the date of the referral from WCDSS.
B. Home Study Update
1. Review of the Initial Home Study
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Transitions Psychology Group, LLC
A paper review of the existing Home Study will be completed. The
Transitions counselor will then contact the referring caseworker to
determine the focus for the Home Study Update.
2. Parental Unit Interview
Parent(s) will be interviewed by a Transitions counselor in order to
re-evaluate strengths and determine whether improvements have
been made on needs areas.
3. Family Interview and Home Inspection
The Transitions counselor will inspect the home and assess
interactions among family members.
4. Supervisory Consultation
The Transitions counselor will meet with the Transitions supervisor
to staff the case and make recommendations. A report will then be
submitted to the WCDSS caseworker.
C. Relinquishment Counseling
1. Individual Parent Consultation
A Transitions counselor will meet with the referred parent to
address questions from the WCDSS relinquishment counseling
outline.
2. Follow-up Consultation and Review
The Transitions counselor will again meet with the referred parent
to review the relinquishment outline, check for understanding and
address any further questions. The counselor will also make any
necessary referrals and recommendations for other services at this
time.
3. Report
A summary of the services provided that addresses all of the
questions in the WCDSS Relinquishment Counseling Outline will be
submitted to the referring WCDSS caseworker within one month of
the referral.
V. MEASURABLE OUTCOMES
A. More Expedient Placement of Children
Transitions will track the date of referral from the WCDSS caseworker and
the date reports are submitted back to WCDSS. There will be no more
than six weeks that transpire between the date of the referral and the date
the report is submitted for Home Studies. Reports for Home Study
Updates and Relinquishment Counseling will be submitted within one
month of the referral date. Submitting the reports within these time limits
will enable WCDSS caseworkers to place children more quickly.
Additionally, to further facilitate caseworker decisions regarding
placement, Transitions will perform an internal review of each Home Study
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Transitions Psychology Group, LLC
and Update to insure that it includes definitive conclusions and specific
recommendations regarding the viability of referred families to become
foster or adoptive homes.
B. Quality Adoptive Home Studies Done in a Timely Manner
Transitions home studies will be performed only by degreed human
service professionals. Proof of each counselor's education will be
submitted to WCDSS. A multidisciplinary team approach will be utilized to
staff each home study referral before the final report is completed and
recommendations are made. This will be measured by each member of
the team signing off on the final report. Transitions will further ensure
quality by doing an internal review of all reports. The reviewer will
document that the review has been completed. Transitions will track
referral dates for Home Study, Home Study Updates and Relinquishment
Counseling services as well as the submission dates of the corresponding
report. Home Studies will be submitted within six weeks from the referral
date and Home Study Updates and Relinquishment Counseling reports
will be submitted within one month from the referral date.
C. Number of Acceptable Home Studies Submitted
The Transitions counselor submitting the homes study will follow-up with
the referring WCDSS caseworker to verify that the Home Study, Home
Study Update or Relinquishment Counseling report is acceptable.
Transitions staff will then document the follow-up contact to track the
number of acceptable studies submitted.
VI. SERVICE OBJECTIVES
A. Provide Quality Home Studies. Updates and Relinquishment
Counseling for Adoptive Parents, Foster Parents and WCDSS
Clients
1. Transitions Home Studies, Home Study Updates and
Relinquishment Counseling will be performed only by degreed
human service professionals. Proof of each counselor's education
will be submitted to WCDSS. All of the services provided will be
performed by Master's level counselors, with the exception of the
initial family screening in the Home Study, which will be performed
by a bachelor's level life skills specialist.
2. A multidisciplinary team approach will be utilized to staff each
home study referral before the final report is completed and
recommendations are made. This will be measured by each
member of the team signing off on the report.
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Transitions Psychology Group, LLC
3. Transitions will perform an internal review of all reports to check
for overall quality, writing skills, definitive conclusions and specific
recommendations. The reviewer will document that the review has
been completed.
4. The Transitions counselor submitting the home study will follow-
up with the referring WCDSS caseworker in order to ensure that the
Home Study, Home Study Update or Relinquishment Counseling
report is acceptable. Transitions staff will then document the
follow-up contact to track the number of acceptable studies
submitted.
VII. WORKLOAD STANDARDS
A. Number of Hours Per Day, Week or Month
Families in the Home Study Program will participate for a minimum of
two hours per week for a maximum of six weeks. Home Study Update
families will participate for a minimum of one hour per week for one
month. WCDSS clients referred for Relinquishment Counseling will
participate for a minimum of two hours during the month of service.
B. Number of Individuals Providing the Services
Each Home Study will be performed by two individuals, one life skills
specialist who conducts the initial screening and a counselor who
provides the remaining direct services to the family. A licensed
psychologist will also be involved in the Home Study in a supervisory
capacity, to assist with evaluation and recommendations, but will not
have direct contact with the referred family. Home Study Updates will
be performed by one master's level counselor, but will also have the
team component for evaluation and recommendations.
Relinquishment counseling will be performed by one master's level
counselor.
C. Maximum Caseload Per Worker
Each counselor will not carry more than three open Home Studies or
Updates at any time. Counselors will not carry more than two
Relinquishment Counseling cases at a time.
D. Modality of Service
Home studies will consist of individual, couple and family service
modalities with the referred family as well as case management, case
reviews and supervision without the family members present.
E. Total Number of Hours per Dav/Week/Month
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Transitions Psychology Group, LLC
Transitions will provide approximately 15 hours of direct services per
week and 55 hours per month.
F. Total Number of Individuals Providing These Services
Six. Transitions has two co-owners, both Licensed Professional
Counselors, available to provide these services along with one
bachelor's level life skills specialist to perform family screenings and
support activities and one licensed psychologist to provide supervision
and case consultation. Two additional masters level licensed
professional contractors are also available.
G. The Maximum Caseload per Supervisor
The Transitions supervisor will not exceed 12 open cases for Home
Studies/Updates.
H. Insurance
Transitions is insured through the American Counseling Association's
Insurance Trust, currently underwritten by the Reciprocal Alliance. The
limits of liability are $1,000,000 per occurrence and $3,000,000
aggregate.
A. All Transitions staff, including supervisors, who are providing direct
services have a minimum of a bachelor's degree in a human
service field. The supervisor has a Doctorate in Psychology and is
a licensed psychologist. Most staff involved in the program have
Master's degrees in Counseling and are Licensed Professional
Counselors in the State of CO. Transitions staff have training and
expertise in family systems and experience working with social
services, foster/adoptive parents and foster/adopted children. The
supervisor has had three years of experience performing home
assessments.
B. Transitions has six staff members, including a supervisor, available
for the project.
15
John Kruse-Additional bid info Page 1 j
From: "Jami Moe-Hartman"<moe-hartman.jami@attbi.com>
To: <krusexje@co.weld.co.us>
Date: 6/26/03 9:17PM
Subject: Additional bid info.
Per your 6-26-03 phone conversation with Greg Creed, the bids for
Transitions Psychology Group, LLC are as follows:
Full home study(approximately 35 total hours of services)= $975
Home study update (approximately 18 hours of services)=$525
Relinquishment counseling (approximately 5 hours of services)=$250
If you have any further questions, please contact me at 381-1417. Thank
you.
Jami Moe-Hartman, MA, LPC
Transitions Psychology Group, LLC
EXHIBIT B
SUPPLEMENTAL NARRATIVE TO RFP
RECOMMENDATIONS AND CONDITIONS
rata"."3/48%\\411; 14.
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
' WEBSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
COLORADOO Child Support(970)352.6933
111
July 11,2003
Jami Moe-Hartman MA,LPC
Transitions Psychology Group
804 11 Avenue
Greeley,CO 80631
Re: Off System Bid No.010-03 RP?FYC 06-000-Home Study,Home Study Update,and Relinquishment
Counseling
•
Dear Ms.Moe-Hartman:
The purposes of this letter are to outline the results of the Home Study Bid process for PY 2003-2004 and to
request written information or confirmation from you by Friday,July 18,2003.
A. Required Resubmittal of Rate Computation
•
The rate computation in your bid is not among the lowest qualified bids.To continue as a viable
bidder in this process,you are invited to resubmit rate computations that may include the bid as
lowest qualified.
B. Results of the FYC Commission Review
The Families,Youth and Children(FYC)Commission has reviewed your bid according to the criteria
established in the bid and provides conditions as follows: •
Condition 1:The Notification of Financial Assistance Award(NOFAA)shall include language to show
that background checks are included in the approved rate per home study,update,and/or
relinquishment counseling.
Condition 2:Bilingual-bicultural workers must be listed on the State Vendor List and must be clinically
qualified to do the home study,update,or relinquishment counseling.
Condition 3:The FYC Commission requests that you address how your agency will provide Bilingual-
Bicultural services.
B. Required Response by FYC Bidders Concerning FYC Commission Conditions and Resubmittal
of Rate Computation
The Weld County Department of Social Services is requesting your written response to the FYC
Commission's conditions and your resubmittal of your rate computation.Please'spend,in writing,
with your acceptance or your non-acceptance of the above stated conditions in Items A and B to Gloria
Romansik,Weld County Department of Social Services,P.O.Box A,Greeley,CO,80632,by Friday,
July 18,2003,close of business.
If you wish to arrange a meeting to discuss the above conditions,please do so through Elaine Furister,
352.1551,extension 6295,and one will be arranged prior to July 18,2003.
Sincerely, '
J y A. ego,Dir or
c Dick Palmisano,Chair,FYC Commission
Gloria Romansik,Social Services Administrato
<771
•ice r , 80411tAvenue
• . •• . . Greeley, CO 80631
• .41141, 1,4: • Phone/FAX(970)336-1123 /j
•
• •ee rt .
iii
Transitions
Gloria Romansik
Weld County
Department of Social Services
PO Box A
_ Greeley, CO 80632
July 16, 2003
Re: Off System Bid No. 010-03 RFP FYC 06-000-Home Study Update, and
Relinquishment Counseling
Dear Ms. Romansik,
We are writing in response to Judy Griego's letter concerning the results of the
Home Study Bid Process dated July 11, 2003. Please see the items below that
address your questions:
A. Required Resubmittal of Rate Computation
Please see attached copy of the Rate Computation.
In our original bid we quoted a price of$975 per completed home study.
Our new computation reflects a fee of$875 per completed home study.
The new computation reflects this change in the total cost. We have taken
into account the needs of your department to keep costs to a minimum
and the needs of our agency to maintain viable programs.
B. Results of the FYC Commission Review
Condition 1: The costs of background checks are included in the rates for
home study, updates, and relinquishment counseling. This was our
original intent.
Condition 2: Transitions has recently submitted the application to be on
the vendor list. Our bilingual-bicultural staff member is included in that
application. He should meet the qualifications.
Condition 3: Greg Creed, MA, LPC, co-director and counselor with
Transitions, is our bicultural-bilingual staff member. He has five year's
experience counseling Spanish speaking monolingual and bilingual
families and individuals. He has lived overseas for nine years and is fluent
in both Spanish and Japanese. He worked at the Center for International
Students at the University of Northern Colorado from 1996-1999 as
program coordinator working with students, faculty, and community
members of diverse backgrounds.
Please feel free to contact us at the above number or by cell phone, Jami Moe-
Hartman, 381-1417 or Greg Creed, 590-1424. Thank you very much for your
consideration.
Sincerely,
Gregory S. Creed, MA, LPC Jami Moe-Hartman, MA, LPC
Co-director Co-director
77--._n
• Jrni Me-H oarhnan, MA,LPC
s Gregory S.Creed,MA,LPC
Off-System Bid No.010-03 RFP-FYC-06-0110 •` + 804 11th Avenue
Attached A Transitions Greeley, CO 80831
IR. COMPUTATION OF DIRECT snRVICS RATS
This form is to be used to provide detailed explanation of the hourly rate your
organisation will charge Child Welfare Regular Administration funds for the
services offered in this Request for Proposal. This rate may only be used to bill
the Weld County Department of Social Services for direct, face-to-face services
provided to clients referred for these services by the Department. Requests for
payment based an units of service such as telephone calls, no shows, travel time,
mileage *mist, preparation, documentation, and other costs not involving
direct face-to-face services will not be honored. Likewise, billings must be for
hours of direct service to the client, regardless of the number of staff involved
in providing those services. Therefore, it is imperative that this rate be
sufficient to cover all costs associated with this client, regardless of the
number of staff involved in providing these services.
(Explanations for these Lines are Provided on the Following Page)
Total Hours of Direct Service per Client I 0 Hours IA]
Total Clients to be served (/0 Clients (B]
Total Hours of Direct service for Year (O O 0 Hours IC]
(Line (AI Multiplied by Line (BI
Cost per Hour of Direct Services $ • " 4 Per Sour [DI
Total Direct Service Costs $ .1.123, 0 0 O Is]
(Line [C] Multiplied by Line [DI)
Administration Costs Allocable to Program $ = Q�,Sn p� IF]
Overhead Costs Allocable to Program $ '1/ ari (GI
Total Cost, Direct and Allocated, of Program$ 4 S• -1 1 a'' (HI
Line (E] Plus Line (F] Plus Line IC))
•
Anticipated Profits Contributed by this Program $ .a,033 III
Total Costs and Profits to be Covered
by this Program(Line [HI Plus Line II] ) $ 4?/g [al
Total Hours of Direct Service for Year !0O 0 [KI
(Must Equal Line (CI)
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $
Day Treatment Programs Only;
Direct Service House Per Client Per Month (MI
Monthly Direct Service Rate $ IE]
•
Dom')A at 21
Weld County Department of Social Services
Notification of Financial Assistance Award
for Child Welfare Regular Administration&EPP Funds
Type of Action Contract Award No.
X Initial Award 03-HS-0028
Revision (RFP-06-000)
Contract Award Period Name and Address of Contractor
Beginning 07/01/2003 and Ackerman and Associates, P.C.
Ending 05/31/2004 1750 25th Avenue, Suite 101
Greeley, CO 80634
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
Home study format is based on 24 hours of Assistance Award is based upon your Request for
work, 8-10 hours of direct professional services Proposal (RFP). The RFP specifies the scope of
plus 10 hours of services, including required services and conditions of award. Except where it is
background checks. Updates include 6-8 hours in conflict with this NOFAA in which case the
of direct professional services and 3-5 hours of NOFAA governs,the RFP upon which this award is
other services to adopt another child,plus based is an integral part of the action.
requisite background checks. Relinquishment Special conditions
counseling for a maximum of 2 hours per parent. 1) Reimbursement for the Unit of Service will be based
Program capacity is 4 home studies or updates on a rate per home study; home study update,and
per month and 16 hours of relinquishment relinquishment counseling session.
counseling per month. The average stay is 2) Reimbursement requests must be an original with an
expected to be one month for a home study, and original signature from the provider and/or designee.
two weeks for each parent in relinquishment 3) Reimbursements requests must include the date the
counseling. Bilingual-bicultural services home study, update, or relinquishment counseling was
available through current staff. completed. The request must reflect the referral
Cost Per Unit of Service number assigned to each home study, the amount
Hourly Rate per billed for each home study,and the month the service
Relinquishment Counseling $100.00 was provided.
(2-hour maximum) 4) Payment will only be remitted on referrals made by
Rate per Study the Weld County Department of Social Services.
Full Home Study $800.00 5) Requests for payment must be an original submitted to
Updated Home Study $640.00 the Weld County Department of Social Services by
the end of the 25`"calendar day following the end of
Unit of Service Based on Approved Plan the month of service. The provider must submit
requests for payment on forms approved by Weld
Enclosures: County Department of Social Services.
X Signed RFP:Exhibit A
Supplemental Narrative to RFP: Exhibit B
Recommendation(s)
X Conditions of Approval
Approvalsc!<\w�J € Program Of ficial
B
Y� Y l0._ rkff
David E. Long, Chair Judy . Gri ri Direct
Board of W ssioners Weld untty epartment of Social Services
Date: ��� Date: y s (l>
D13 cQ<399
EXHIBIT A
HOME STUDY BID
. - ` .
INVITATION TO BID
DATE:May 28, 2003 Off System Bid No. 010-03 RFP FYC 06-000
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 06-000) for: Adoption, Foster Care,and Expedited Permanency
Planning Home Studies, and Relinquishment Counseling
Deadline: May 28, 2003,Friday, 10:00 a.m.
The Families,Youth and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that competing applications will be accepted for approved vendors pursuant to the
Board of Weld County Commissioners' authority pursuant to Colorado Statute and the Weld County Home
Rule Charter. The Families,Youth and Children Commission wishes to approve services targeted to run
from June 1, 2003,through May 31, 2004, at specific rates for home studies,home study updates, and
relinquishment counseling services. The County will authorize approved vendors and rates for services only.
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 1�
Delivery Date G/) 7103
(After recei fa of order) BID T BE SIGNED IN INK
%Thoe, C , AQ man �k( �
TYPE OR PRINTED SIGNATURE
VENDOR human a4-frsacs&coes \ sq, . _,r,.s. �tcAt
(Name) H 't�Signature By Authorized
O or Agent of Vender
ADDRESS 1'(S Rue.. TITLE J�v tlsn'k
rl ( 6 t DI DATE 6 r7-O 3
PHONE# Uti0 3 es Pis
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 33
• Off-System Bid No. 010-03 RFP-FYC-06-000 Attached A
HOME STUDY,UPDATE, & RELINQUISHMENT COUNSELING BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER
CHILD WELFARE ADMINISTRATION FUNDING
2003-2004 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
BID Off-System Bid 010-03 RFP-FYC-06-000
NAME OF AGENCY: h&.v teem.
ADDRESS: 1 ax-th Rue - ¶ L) tOl PHONE: (qv a :fr.-„;
CONTACT PERSON: \,..\ / Iclio{n(n9- IIiLE: 9�g�44�1'
DESCRIPTION OF HOME STUDY PROGRAM CATEGORY: Adoption,Foster Care,and Expedited Permanency Planning
Home Studies in compliance with the uniform format utilized by the State of Colorado Department of Human Services since
October 1, 1999(Attached A).
11-Month approximate Project Dates: 12-month contract with actual time lines of:
Start June 1,2003 Start
End May 31, 2004 End
11.1LE OF PROJECT: Ackerryse,. lit>" Star Pi ynt*
-70yrtLS• \-mate
sue. oQa. fl :t-cith L/ "7/
•
Na •e . Signature of Person Preparing Document Date
c t-, , trx�e � k cl.\)0 , le/ l '7/ o a
Name and ignathre Chief Administrative Officer Applicaht Agency Date
MANDATORY PROPOSAL REQUIREMENTS
For new 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 Year 2002-2003 to Program
Yea/2003-2004.
V Project Description Project Description
✓ Sample Home Study _Sample Home Study
1/ Target/Eligibility Populations Target/EligibilityPopulations
✓ General General
./ Cultural/Eligibility Populations Cultural/Eligibility Populations
✓Types of services provided Types of services provided
✓ Measurable Outcomes _ Measurable Outcomes
• Service Objectives Service Objectives
✓ Workload Standards Workload Standards
✓ Staff Qualifications _ Staff Qualifications
✓ Unit of Service Rate Computation _ Unit of Service Rate Computation
✓ Program Capacity per Month Program Capacity per Month
4/ Certificate ofInsurance pr P.(e W)T1 LvCQ5•S
Page 22 of 33
•
Off-System Bid No. 010-03 RFP-FYC-06-000 Attached A
Tune- 3 otoa,3
Date of Meeting(s)with Social Services Division Supervisor:
Comments by D Supervisor:
7:11 ui d ,et- &4-00-04%-.7r � dales 7a -€ 147 I
.mac /Able lam/
GD r-9 ie4tinv,
C/a_r/ar
re and Signature of SSD i .- so Date
Page 23 of 33
Off-System Bid No. 010-03 RFP-FYC-06-000
Attached A
Program Category Home Study,Update, and Relinquishment Counseling
Project Title L Ac4termn.ar. Hs mt. Stk +t. . "r"-,,—
Vendor Ac-ke./ mpr. /7sroc(a .e. P.C .
PROJECT DESCRIPTION
Provide a brief, one-page description of the project.
II. SAMPLE HOME STUDY
Provide a fictitious home study written using the State format.
III. TARGET/ELIGIBILITY POPULATIONS
Provide a one page brief description of the proposed target/eligibility populations. At a minimum
your description must address:
A. Total number of clients to be served.
B. Total individual clients and the children's ages.
C. Total family units.
D. Sub-total of individuals who will receive bicultural/bilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. Sub-total of Individuals who will have access to 24-hour service.
G. The monthly maximum program capacity.
H. The monthly average capacity.
I. Average stay in the program(weeks).
J. Average hours per week in the program.
IV. TYPE OF SERVICES TO BE PROVIDED
Provide a two-page description of the types of services to be provided. Please address if your project
will provide the service minimums as follows:
A. Home Studies,Updates, and Relinquishment Counseling as referred by the Weld County
Department of Social Services.
Provide your quantitative measures as they directly relate to each service. At a minimum,include a
number to be served in each service component. Describe your internal process to assure that FYC
resources will not supplant existing and available services in the community; e.g.mental health
capitation services, ADAD,and professional services otherwise funded.
Page 24 of 33
Off-System Bid No. 010-03 RFP-FYC-06-000
Attached A
V. MEASURABLE OUTCOMES
Provide a two-page description of your expected measurable outcomes of the project. Address the
following measurable outcomes:
A. More expedient placement of children.
B. Quality adoptive home studies that are done in a timely manner.
C. Outcomes will be defined by the number of acceptable home studies submitted.
Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate,
and monitor each quantitative measure.
VI. SERVICE OBJECTIVES
Provide a one-page description of your expected service objectives and quantitative measures.
Address, at a minimum,the following ways the project will:
A. Provide quality home studies, updates, and relinquishment counseling for Adoptive,Foster
Parents, and Department of Social Services clients.
Describe the methods you will use to measure, evaluate, and monitor each service objective.
VII. WORKLOAD STANDARDS
Provide a one-page description of the project's workload standards and quantitative measures.
Address, at a minimum,the following areas:
A. Number of hours per day,week or month. (Minimum hours per week per family.)
B. Number of individuals providing the services.
C. Maximum caseload per worker.
D. Modality of service.
E. Total number of hours per day/week/month.
F. Total number of individuals providing these services.
G. The maximum caseload per supervisor.
H. Insurance.
VIII. STAFF QUALIFICATIONS
Provide a one-page description of staff qualifications and address, at a minimum,the following:
A. Will your staff, including supervisors,who are providing direct services meet the minimum
qualifications in education and experience required and be listed on the State of Colorado
Department of Human Services vendor list, having applied for inclusion. Describe.
B. Total number of staff, including supervisors, available for the project.
Page 25 of 33
•
Off-System Bid No. 010-03 RFP-FYC-06-000
Attached A
IX. COMPUTATION OF DIRECT SERVICE RATE
This form is to be used to provide detailed explanation of the hourly rate your
organization will charge Child Welfare Regular Administration funds for the
services offered in this Request for Proposal. This rate may only be used to bill
the Weld County Department of Social Services for direct, face-to-face services
provided to clients referred for these services by the Department. Requests for
payment based on units of service such as telephone calls, no shows, travel time,
mileage reimbursement, preparation, documentation, and other costs not involving
direct face-to-face services will not be honored.. Likewise, billings must be for
hours of direct service to the client, regardless of the number of staff involved
in providing those services. Therefore, it is imperative that this rate be
sufficient to cover all costs associated with this client, regardless of the
number of staff involved in providing these services.
(Explanations for these Lines are Provided on the Following Page)
Total Hours of Direct Service per Client 10p _ Hours (Al
Total Clients to be Served I a Clients [B)
Total Hours of Direct Service for Year qt0 Hours [C]
(Line [A] Multiplied by Line (B)
itggaCost per Hour of Direct Services $ ,( .. Per Hour [D]
Total Direct Service Costs $ 43 [E]
(Line [C] Multiplied by Line [D] )
Administration Costs Allocable to Program $ 3YO - [F]
Overhead Costs Allocable to Program $ UrX� [G]
Total Cost, Direct and Allocated, of Program$ 3f7VD. . [H]
Line [E] Plus Line [F] Plus Line [G] ) -
Anticipated Profits Contributed by this Program $ 0 [I]
Total Costs and Profits to be Covered
by this Program(Line [H] Plus Line [I] ) $ 31,10® [J]
Total Hours of Direct Service for Year 7 0 O [K]
(Must Equal Line [C] )
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ D" ® [L]
Day Treatment Programs Only:
Direct Service House Per Client Per Month NA [M]
Monthly��� Direct Service/Rate $ ter xnNf • q 1� �[N/]Ar
y���
/ t (I�N a I M�►n� cot. . -tI. I �� J f4 4 i/` " •�/r'^'� „'
ear it -' - . 4 yo,oo r cor Howe S1-4+ feet tin-4
'qg°o.00 r .X fag. if stet-Ay .
Page 26 of 33
Ackerman and Associates P.C.
Bid#RFP FYC 06-000
Due June 20, 2003
10:00 AM
Proposed Bid:
Home study rate= $800.00 for the study*
Home Study Update rate=$640.00 for the update*
Relinquishment Counseling per two hour unit= $200.00 per relinquishment referral (per
parent)
Project Description 2003 - 2004
ACKERMAN AND ASSOCIATES' HOME STUDY AND
ADOPTION RELINQUISHMENT SERVICES
Overview: Ackerman and Associates, P.C. has provided Foster Parent
Consultation Services to Weld County over the past six years. We propose to
initiate:
1. A home study program for new or existing cases where a family
study is needed to certify an adoption placement is in the best interest
of the specified potential adoptee and the adoptive family. A new home
study is referred to in the proposal simply as a home study. A home
study that is for an existing case, where an appropriate home study
has been completed previously and where new information is required
is termed a home study update.
2. The home study program would be required of new foster parent
homes.
3. Relinquishment counseling is designed to assure that each parent
relinquishing the child is fully aware of, in agreement with and capable
of making a decision related to relinquishment. We propose to provide
up to two hours of relinquishment counseling as specified by Colorado
and Weld County. Such services will be referred individually for each
parent relinquishing their rights and giving their child permanently to
another family in an adoption process.
We will provide these programs primarily through services in the home of the
family intending to adopt, the new foster parent home or in our offices. Services
will consist of:
1. A home study format of twenty hours of work based on eight to ten
hours of direct professional services plus ten hours of other
services, such as required background checks for a home that has
not previously had an appropriate home study. Work performed will
meet the state criteria for an appropriate home study as attached to
the fictional case study appended to this bid.
2. A home study format of eleven hours based on six to eight hours of
direct professional services to update an appropriate home study
and three to five hours of other services to adopt another child plus
requisite background checks .The update will meet the state criteria
for an appropriate home study.
1
3. Two hours of relinquishment counseling services for each parent
billed in one hour increments. The billing format is designed to
recognize that the parents may be estranged or one unavailable for
the process. A maximum of two hours per referral is set in this
process,. The relinquishment counseling report will document the
criteria set forth in the WCDSS outline and the Colorado
relinquishment guidelines for relinquishment for each parent.
A primary strength of this proposal is the extensive experience of the
licensed staff of our mental health professionals, psychologists and
certified counselors. The goal of this agency is to: 1. assure that a
placement is in the best interest of the adoptee and the family
intending to adopt. 2. recommend fairly for or against the placement
with clear explanation for those recommendations 3. recommend
activities and work needed to improve or enhance the adoptive
process and outcomes for the adoptive child. 4. assure that
relinquishment is fully understood within the context of the Weld county
and Colorado process.
Target/Eligibility Populations
A. Total number of clients to be served in a twelve-month program has
been calculated as follows. Up to four home studies, either as complete
home studies or updates, per month for a maximum of 48 per year is the
anticipated capacity of our program
B. Distribution of clients. We anticipate that about 1/3 of studies will be for
new foster parents. About one third will be for kinship placements and the
remaining third for adoption outside the kinship system. This assumes a
maximum of approximately one hundred and twenty hours of counseling
services for relinquishment across 30 cases of relinquishment.(sixty
referrals)
C. Families Served. We anticipate serving 48 family units for home study
and thirty mothers and thirty fathers for relinquishment counseling.
D. Sub total who will receive bicultural/bilingual services. We anticipate
we can serve up to 50% of families who need these services in a bilingual
manner. All of the staff have extensive cross cultural experience.
We have 2 Hispanic members of the staff, Emily Jaramillo, M.A., L.P.C. and
Evelin Gomez, Ph.D., LPC who are fluent in Spanish. Joyce Ackerman, Ed.D.
has spent several years working in American Indian reservation populations
and with Hispanic mental health in Greeley. She has practiced in Greeley
since 1981. Evelin Gomez, Ph.D. L.P.C. has also worked in clinical
assessment of drug and alcohol abuse and in counseling for families. Valerie
a
Larson, MSW has experience in home based assessment and in sexual
abuse treatment of children.
E. Accessibility. On weekdays, all providers of Ackerman and Associates
are accessible through our office secretary and through cell phones and
pagers. After hours ,we maintain a 24 hour answering service and page
system. On weekends, the 24 hour access reaches the provider on call
who is always a licensed Mental Health provider.
F. Maximum per month. The program maximum is estimated at four home
studies and sixteen hours of relinquishment counseling per month
G. The monthly average capacity is two home studies and eight hours
of relinquishment counseling per month.
H. The average stay in the program is expected to be one month for a home
study, and two weeks for each parent in relinquishment counseling with up
to two one hour sessions of individual treatment.
Types of Services Provided
Home study: The home study will consist of the following procedures (20 hours)
1. An initial meeting with both parents desiring to adopt or to be
certified as foster parents. (two hours)
2. Each parent will complete a detailed questionnaire designed to
assist the interview process and return it prior to the next
appointment. (four hours)
3. Each parent will complete the required activities for a background
check . ( 4-6 hours)
4. Interview and observation of all family members in the home
setting. (two hours)
5. Additional meetings with parents ,children or others as needed. (one
to two hours)
6. Home study report and recommendations. ( one to two hours)
A sample home study report is attached.
Home study update: ( 11 hours)
1. An initial meeting with both parents desiring to adopt or to be certified
as foster parents. (two hours) .
3
2. Each parent will complete a detailed questionnaire designed to assist
the interview process and return it prior to the next appointment. (four
hours)
3. Interview and observation of all family members in the home setting.
(two hours)
4. additional data review or collection as needed. (one to two hours)
5.. home study report and recommendations. (one to two hours)
Relinquishment counseling:
1. Relinquishment counseling will consist of focused discussion based on
the required WCDSS outline for provision of relinquishment services and
the State of Colorado guidelines for relinquishment counseling
2. We also assure WCDSS as we have in the past that no individual
working with Ackerman and Associates and providing therapy or having
any other relationship with clients being served will provide home study or
relinquishment, thus avoiding any conflict of interest.
3. Up to two hours per referral (per parent) will be provided under
relinquishment counseling services.
Measurable Outcomes are specified as 1. acceptability of Home Study reports
to WCDSS. Our goal is for 100% of our home study reports are acceptable to
WCDSS Foster parent and adoptive services. 2. Timeliness of reports: Our goal
is that 90% of reports will be completed within one month of referral for those
whose background checks are processed within this period and that 100% of
reports (i.e. the remaining ten percent) will be completed within eight weeks of
referral. By adhering to these standards, we would expect that the department
could expedite permanent placement of children assuming that failure to provide
high quality home studies in a timely manner has been the factor which has
limited the rate of placement.
Service Objectives
One aspect of all home studies will be to assess parental competency
We expect that all reports will comment on strengths and weakness of the
potential adoptive home. Very serious weaknesses that rise to a clinical potential
for injury to the adoptive child may disqualify a family as prospective adopters in
the judgment of WCDSS. However it is expected that the majority of reports will
suggests strategies for improvement where areas of deficiency are noted where
N
these deficiencies in themselves do not negate the potential of the home to serve
an adoptive role for the specified child. Some of the areas may include:
Improvement of parental competency
The ability if the family to access resources
Application of parental competencies in daily activities.
After a full assessment of the family and home recommendations are made in
each of these areas
The attached study report indicates how we have applied the state mandated
format to a fictional example of a case study.
Workload Standards
The program has a capacity of 48 home studies and relinquishment counseling
for thirty mothers and thirty fathers.
There are seven providers—three licensed psychologists, three professional
counselors and a licensed clinical social worker. All have specific training in
individual and family assessment and in counseling skills.
The maximum caseload a maximum of four home studies and 16 hours of
relinquishment counseling is projected per month.
The modality of treatment is face to face assessment and background checks
by written format. A questionnaire and other formats will be developed to
standardize the content of the home study.
Hours/month a maximum of four home studies and 16 hours of
relinquishment counseling is projected per month.
Staff There are 7 individual providers supported by two administrative
professionals in practice as well as contracted staff for billing and accounting.
Supervisor This contact would be supervised by Joyce Shohet Ackerman,
Ed. D., who would monitor the project for compliance. Providers are
individually licensed and do not require clinical supervision. The maximum
caseload per supervisor is 48 families per year.
Insurance All providers carry one million/three million liability policy
Ackerman and Associates carries an additional one million/three million
liability policy on the group and a general liability policy, which meets the
required criteria for this application. Co-listing of the state of Colorado on
Ackerman and Associates insurance for professional liability is required by
the procedures of the State vendor list.
S
Staff Qualifications
. Staff Qualifications Four staff are available for the project. They exceed the
minimum qualifications specified as documented below. The staff members are:
Joyce Shohet Ackerman, Ed. D., Licensed Psychologist; Licensed Psychologist
(and Licensed Social Worker); Emily Jaramillo M.A., L.P.C., Evelin Gomez,
Ph.D., L.P.C. and Valerie Larson, M.S.W., L.C.S.W.
Training The staff has extensive training in family therapy and short term
therapy as documented by their extensive work experience. All listed providers
have applied to be vendors on the state list for home study providers.
Continuing education As a part of their work in the private sector, all providers
in this group maintain continuing education programs more than the minimum
eight hours required. They participate in workshops and other activities. This
proposal's continuing education requirements coincide with the requirements of
other contractual arrangements and are being met on an ongoing basis by
members of the group.
Supervision All of the providers are independently licensed and not required to
have clinical supervision. All the staff have advanced skills in family therapy and
in individual and family assessment. The contract supervisor will monitor the
specifications made in this proposal.
Supervisor continuing education The supervisor of the project is involved in
ongoing training to keep current with her profession through advanced
workshops and seminars. Ackerman and Associates, P.C., of which the
supervisor is the president, has more than ten years contracting experience. Dr.
Ackerman has done extensive evaluation work in child custody and in special
advocate cases and Associates P.C. Dr. Ackerman manages all contracts for
Ackerman and Associates, P.C.
Unit of service rate computation
We have a usual rate for therapy services of$80 per hour for master's level
therapists. For home study professional time outlined above we are requesting a
rate of$800 for a full home study and $640 for a home study update. For
relinquishment counseling we will bill up to two hours of therapy services and
time for writing a report ($200 per referral). Costs of filing background checks
and other required assessments will be paid by the prospective adopters. Direct
and indirect costs and how these relate to overall expenses of the corporation
are shown on the required bid sheet.
Standards of responsibility for 2003-2004 bids
Ackerman and Associates, P.C. is a type S professional corporation and not a 501.c.3.
L
(Fictional)
ADOPTIVE PARENT EVALUATION
(Produced for Bid Number RFP-FYC 06-000)
February 12, 2017
RE: Mr. and Mrs. Rodriguez— Smith
Regarding adoptive home study for then placement of: Tamara Jones, age six
Evaluators: Joyce Shohet Ackerman, Ed.D., Licensed Psychologist
Valerie Larson, M.S.W., LCSW
Referral:
This home study was referred by the Weld County Department of Social Services to
evaluate the Rodriguez-Smith Family for permanent adoptive placement. The following
individuals were evaluated:
Mr. Fredrick John Rodriguez— Smith, Born July 29, 1966
Mrs. Mary Rodriguez— Smith, Born August 28, 1967
Felize Angelina Rodriquez- Smith, Born February 23, 1995
Samuel Jacob Smith, Born October 19, 1986
Mr. Rodriguez - Smith is a 38-year-old male who has been married for 10 years. He and
his wife Mrs. Mary Rodriguez- Smith have a little girl, Felize, age 7. He has a son
Samuel Jacob Smith age 16 from a previous marriage. Currently Mr. Rodriguez- Smith
is a principal of an elementary school in Greeley, Colorado. He and his wife are very
interested in becoming permanent adoptive parents and have participated enthusiastically
in this evaluation.
Brief description of the child being considered for adoption: Tamara Jones is a six year
old Caucasian female who has been in foster placement since age one. She was separated
from her biological parents as a result of child abuse which resulted in termination of
parental rights. The child abuse involved being shaken resulting in a mild brain injury
consistent with traumatically acquired cerebral palsy with mild right side hemiplegia.
She has been living in three different foster homes, the first from age 1 to age three and
the second from age three to age four. She is currently in first grade performing at an
average level.
Fred Rodriguez-Smith
According to Mr. Rodriguez- Smith, he grew up in Denver, Colorado. He indicated that
he had a good relationship with both of his parents, John and Marjorie Smith. His mother
was a"stay at home mom" who graduated high school. His father has attended two years
of post high school training in Auto Mechanics and was an auto mechanic who ran his
own garage, until his retirement three years ago. Mr. Rodriguez - Smith recalled that his
father was the primary disciplinarian in the home and used spanking for discipline.
7.
According to Mr. Rodriguez= Smith, he is not sure whether spanking was inappropriate.
He does not feel that he was abused as a child.
Mr. Rodriguez- Smith was raised as a Methodist. He has not been very involved in the
Methodist church recently. However, he stated that his family was fairly involved in the
church when he was growing up, and that his family of origin still attends church
• regularly. Mr. Rodriguez= Smith will occasionally go with his wife and daughter to
services at their Catholic church. Mr. Rodriguez= Smith reports that his parents are
somewhat upset that Felize was baptized Catholic, and do not like that she has never
attended Methodist services. However, Mr. Rodriguez- Smith also reports that the issue
has never been discussed in front of Felize, and that this has not affected his parent's
relationship with Felize.
Mr. Rodriguez= Smith reported that most of his childhood was"relatively normal". He
has good interactions with his two siblings, one younger brother and an older sister. Both
siblings are grown and live in the Colorado area at this time. He sees his older sister
several times a year and has minimal contact with his younger brother, who he states is
"into a bachelor's lifestyle" at this time.
Mr. Rodriguez - Smith reported that his father used to drink beer occasionally on
weekends, however he does not believe that his father was an alcoholic. He indicated
that he perceived that his mother was often moody, although he did not know if she had
ever been diagnosed with depression.
Mr. Rodriguez- Smith graduated high school and attended college in Denver, Colorado,
at the University of Colorado in Denver, where he studied education. While he was in
college, he met his first wife, Patricia, and they were married shortly after she became
pregnant. The pregnancy was unplanned. They were divorced one year later. Mr.
Rodriguez- Smith stated that the relationship was "rocky." Mr. Rodriguez- Smith
believes the marriage failed because they were too young to be married. He believes that
he was not able to make the compromises and decisions necessary to keep a marriage
healthy. Mr. Rodriguez- Smith continues to have contact with his 16-year-old son, Sam,
who he sees approximately two weekends a month. He married his current wife, Mrs.
Rodriguez- Smith about one year after they met approximately ten years ago. They met
at a singles bar and started dating soon after that.
Drug and Alcohol History/Mental Health History:
Mr. Rodriguez- Smith reports that he drinks socially two to three times a month, but he
denies having any problem with drug or alcohol abuse. He did report some history of
depression around the break up of his marriage about 15 years ago and about that time he
did have some mild suicide ideation. However, since that time he denies further suicidal
ideation and he has had no history of mental health treatment. Mr. Rodriguez - Smith
denies any current depression, suicide or homicide ideation. He smoked cigarettes in
college but quit about 14 years ago. Currently, the home is a smoke free environment.
8
Mr. Rodriguez= Smith did display some sadness when relating his and his wife's struggle
to get pregnant. He was appropriately upset when discussing the two miscarriages he and
his wife have experienced.
Legal History:
As a minor, he volunteered that he had one arrest for shoplifting. He reported that he did
ten hours of community service and was never in jail. However, other than this he
reports that he has no significant involvement with the law.
Employment History:
Mr. Rodriguez- Smith worked as a third grade teacher for seven years. He then worked
as assistant principal at the same school for approximately three years. He was recently
promoted to principal. It is apparent that Mr. Rodriguez- Smith can keep steady
employment, as he has worked at the same school for approximately 10 years.
Previous Experience with Foster Care/Beliefs about Adoption:
He has had no prior experience in working with foster care or adoptive children. He
stated that this review process was a little overwhelming for him at first. He said that he
was not sure what to expect. However, he reported that he is excited about being
considered as an adoptive father and willingly participated in this evaluation. He stated
that he was willing to follow any recommendations that are made. He seemed eager to
do what was necessary to become a good adoptive parent.
Adult General Functioning:
Our assessment of Mr. Rodriguez- Smith indicated that he has fairly well organized day-
to-day functioning. He was dressed appropriately and he was fully oriented to person,
place and time. He has a good work history, and is able to stay on task. He also presents
measurable success in his work situation, as demonstrated by his recent promotion.
Based on interview and assessment of adult general functioning, he seems to be well
within the normal range for adults his age. He exhibited a normal range of emotional
feelings and responses. He did exhibit some sadness when talking about several areas,
especially as to the frustration that he and his wife have had in their fertility problems and
the miscarriages that they have experienced. He exhibited a positive attitude towards
others. He has good skills in working with other individuals, particularly other adults, as
he works with parents on a routine basis. Hobbies include target shooting and hunting.
Parenting and Discipline Styles:
When observed with Felize, Mr. Rodriguez- Smith acted appropriately. Felize seemed
comfortable with her father. Mr. Rodriguez - Smith displayed affection through hugs.
9
Both Feline and Mr father initiated interactions. Felize followed directions, most of the
time, when her father asked her to complete a task.
Mr. Rodriguez- Smith used primarily verbal discipline while being observed with Felize.
He most often tried reasoning with her. Mr. Rodriguez= Smith was fairly patient with
Felize. There were a few instances when he seemed to get frustrated, but he did not raise
his voice at Felize or make negative comments to her.
Mr. Rodriguez- Smith stated dining interview that he first tries to reason with both his
son and his daughter. He then tries grounding or removing privileges. He states that
Felize is kept on the same schedule year round. When Felize is not in school during the
summer, she is in day care at a licensed facility. Occasionally, Mrs. Rodriguez- Smith's
mother will take Felize for a day trip to the zoo or swimming pool.
Parenting Values and Practice:
Mr. Rodriguez- Smith believes that children need consistency and structure. He stated
that he sees what lack of structure can do to young children when he is at work. Mr.
Rodriguez - Smith stated that, as a child, he was spanked occasionally. He stated that he
has mixed feelings about using corporal punishment. He does not believe that he was
abused as a child. However, he reported that his educational training made him
reconsider the spanking his own children. Mr. Rodriguez - Smith stated that he spanked
Sam on only one occasion that he can recall, and that Felize has never been spanked by
either him or Mrs. Rodriguez= Smith. Mr. Rodriguez Smith stated that he preferred to
reason with his children and found consequences, such as removal of privileges, to be
very effective with both his children.
Mr. Rodriguez - Smith stated that he believes parents should be involved in their
children's lives. Whenever possible, Mrs. Rodriguez Smith, or her mother, go with
Felize on field trips and the family regularly goes to parks or movies on the weekends.
Mr. Rodriguez- Smith reported that his parents liked Mrs. Rodriguez - Smith, and that
they always got along well. Mr. Rodriguez- Smith stated that he knew about the abuse
issues Mrs. Rodriguez Smith remembered concerning her own father, Mr. Rodriguez.
He stated that he understood that his wife wanted Felize to know her grandfather, but did
not want Felize to be alone with Mrs. Rodriguez - Smith's father.
Mrs. Mary Rodriguez— Smith:
Family and background:
Mary Rodriguez grew up in the San Luis Valley of Colorado and moved to Denver with
her family when she was ten. Her parents were divorced when she was eleven.
Mrs. Rodriguez - Smith's family is Hispanic and predominately Catholic. Mrs.
Rodriguez - Smith's mother and her siblings are practicing Catholics and are very
(0
involved in the church. Mrs. Rodriguez= Smith stated that she, her mother, and Felize go
to church regularly. Mrs. Rodriguez= Smith reported that Mr.Rodriguez Smith and her
family get along well. Mrs. Rodriguez e Smith reports that she still has very strong
religious beliefs.
Mrs. Rodriguez= Smith related that her family has always been close, and spent a lot of
time together. However, she reported that she only sees her father approximately three
times a year. Mrs. Rodriguez• Smith stated that she is not particularly close to her father
since her mother and her father divorced when she was eleven. She reported
remembering her father hitting her mother and yelling. She stated that she remembers
hiding in the closet with some of her siblings on one occasion. She stated that she
doesn't remember much about her father and his relationship with her mother and
siblings. She said that she and Felize visit her father a few times during the year, usually
in the summer. She reported Felize and her father getting along well. Mrs. Rodriguez-
Smith stated that she wants her daughter to know her grandfather, but isn't comfortable
leaving the two alone, due to her memories of past physical abuse of her mother by her
father.
She is currently a day care provider at a preschool. This is her first marriage. She was
raised primarily by her mother after her parents were divorced when she about eleven
years old. She has four older siblings. According to Mrs. Rodriguez Smith, her father
was physically abusive to her mother and she has had little contact with her father until
she was a teenager. According to Mrs. Rodriguez- Smith, she has a relatively good
relationship with her four siblings who live in the area. Although she recalls her father
being abusive to her mother, she is not aware that her father was ever physically abusive
to her or to her siblings.
She reports one previous serious relationship when she was in high school. She was
engaged for a while but broke off the engagement after her senior year in high school.
This is her first marriage.
Drug and Alcohol History/Mental Health:
She reports no history of involvement with drugs or alcohol, beyond a glass of wine or a
beer occasionally. She does believe that her father did have a serious drinking problem,
but is not aware that anyone else in the family has had a problem. She stated that she had
never smoked cigarettes.
Employment History:
She indicated that she worked part time as a Nurse's Aide after high school, and then
after completing some training, received a certificate to be a day care provider. She
worked full time as a day care providers for the Pencil Fence School in Greeley until she
was married and she has been working on a part-time basis in day care since that time.
I
Previous Experience with Foster Care/Beliefs About Adoption:
She is very much looking forward to the possibility of being an adoptive mother. She
very much loves her child, seven year old Felize and she and her husband have tried to
have more children. She has had two miscarriages in the last five years. They, due to
religious reasons, are not interested in using in vitro fertilization techniques for fertility
problems. Mrs. Rodriguez= Smith was very cooperative during the evaluation and is
very much looking forward to the possibility of being an adoptive parent. She has not
previously been a foster parent.
Adult General Functioning:
Mrs. Rodriguez-Smith appeared to be well organized and within normal expectations for
an adult her age. She, on assessment and observation, was fully oriented to person place
and time and exhibits a stable work history. She appears to be functioning within normal
ranges cognitively. Mrs. Rodriguez- Smith also exhibited some sadness and, at times,
seemed to have some mild depressive symptoms. Since she is from a large family, she
very much wants some additional children, and she is very sad that they have not been
able to have children on their own. She very much wants to adopt a child and hopes to
adopt other children in the future. Hobbies include reading and sewing, particularly
quilting.
She does have good work skills and interactions with people. Most of her interactions are
with young children as she works in a setting with extremely young children.
Parenting and Discipline Styles:
Interviewed independently, Mrs. Rodriguez Smith appears to share many of the values
expressed by her husband in regard to parenting and discipline style. In general, Mary has
stronger feelings against the use of corporal punishment than Fred and it appears that this
has been a topic of discussion concerning how to raise Felize. In a number of areas
related to discipline and child rearing Mary would often begin a sentence ... "Fred and I
have talked about that and we think....", indicating a joint style for planning and
implementing child care decisions
Observation of her with Felize reveals a very comfortable and warm relationship between
mother and child, with appropriate role behaviors for each.
Parenting Values and Practice:
Except in the area of religious life and the role religious life should play in child
development, Mary's value and belief systems appear to mirror her husbands. She has a
stronger conviction than Fred as to the role the church plays in the development of
character and moral behavior in a child. Fred feels these values arise from family and
from the parental examples the children see. However, he is not opposed to formal
religious training. As such, religious practice and training of Felize has become in this
11..
family system consistent with Mary's views and this is not an area of debate between
Fred and Mary.
Children/Child Functioning:
Felize
•
Felize is a 7 year old girl who is currently in second grade. Felize was interviewed
individually at home and observed at school. During the observation, she seemed well
adjusted to her class. She participated in class activities, was outgoing, and interacted
appropriately with other children her age. Felize and her teacher reported that she gets
good grades and maintains a"B" average. Felize appears to have friends in her class and
she and her parents reported that she meets with and plays with some of her classmates
outside of school. Felize goes to her friend's birthday parties and is allowed to go over to
their houses to play on the weekends. Felize is also allowed to have friends over at their
house. Felize is not yet allowed to spend the night at her friend's houses. Felize also has
friends in her neighborhood that she plays with after school and on the weekends.
Felize reported a good relationship with her half.brother, Sam. She stated that Sam
would play with her and the other neighborhood children when he was with the family
for the weekend. Felize said that Sam had "stuck up" for her when an older
neighborhood kid told her she couldn't play with them. She reported that she liked
having an older brother and that she wanted to be a"big sister".
Felize reported during her interview that she loves her mom and dad. She reported that
she really liked playing with her cousins, and was excited about having a baby brother or
sister. Felize also reported enjoying the time she spent with Grandma—her maternal
grandmother. She said that she liked school and had a"best-friend" from school that she
spent time with on many weekends. Felize stated that she didn't get to see Mrs.
Rodriguez s Smith's father very much, but that he had always been"nice" to her.
Issues of sibling rivalry and adjustment based on similarity in age can be anticipated
between Felize and Tamara if Tamara is adopted into the family. However, these issues
are not expected to be difficult to resolve but should be understood by the parents, Felize
and Tamara through family discussion and additional help if needed.
Sam
A brief interview was conducted with Sam. He presented as a soft spoken and polite
young man who considers his mother his primary parent and who seems to enjoy being
with his father and his step mom and step sister. He is supportive of his father's desire to
adopt a child. He denies any history of involvement with legal authorities. He says he
gets primarily B's in school, and sometimes an A and sometimes a C. He likes science
but doesn't like math. He denies drug use but admits to a beer sometimes at a party with
his friends. He says that he has not been physically abused as a child. He is interested in
dating and is enjoying his driver's license, which he earned a few moths ago. When asked
(3
about interactions with Felize he states that he likes to see her on weekends. He has
grown up as an only child and enjoys the role of being a big brother when he is at his
dad's home. He anticipates he would feel the same way toward the adopted child
He states that his father is strict but uses grounding when he is at his dad's home as a
means of punishment. This hasn't happened much since he became a teen as he only
spends a few days a month with dad and he realizes it is easier to"get along" for this .
time, because the parent who he's responsible to for most of the month is his mom.
Family System/Family Support Network
During the observation the family appeared to relate well to each other. Mother and
father were able to coordinate their time and energy, and were able to adequately
supervise and interact with both Sam and Felize. Both Mr. and Mrs. Rodriguez Smith
interacted with each of the children. Mrs. Rodriguez- Smith and Sam appeared to relate
well to each other. Sam was willing, usually, to follow directions from either Mr. or Mrs.
Rodriguez— Smith, though he appeared somewhat bored occasionally. The parents were
able to communicate with the children in a positive way. Given Sam's age as a teen, his
behaviors appear to be within normal parameters for this type of observation.
The family appears well organized and appropriately structured. Extended family support
is present especially with a high level of involvement from the maternal aunts and
grandmother.
Adult Relationships Marriage:
Mr. and Mrs. Rodriguez= Smith reported ongoing issues with fertility after Felize was
born. Mrs. Rodriguez- Smith had a difficult pregnancy and had an emergency c-section.
After Felize was born, Mrs. Rodriguez- Smith became pregnant twice, and both times
miscarried. Mr. and Mrs. Rodriguez - Smith stated that they decided to try to adopt
children because the miscarriages seem to prevent them from having the large family
they desire. Both Mr. and Mrs. Rodriguez s Smith report that they realize adopting a
child is going to be a big adjustment for their family, but believe that they have the
resources to successfully make that transition.
Mr. and Mrs. Rodriguez-.Smith appear to have a strong relationship. They may need
further training in communication and conflict resolution. They appear able to
successfully resolve conflict, however they do occasionally fight in front of the children.
Mr. and Mrs. Rodriguez Smith both report strong extended family ties. Mr. and Mrs.
Rodriguez- Smith appear to be able to successfully and appropriately discipline their
children and both have training and expertise in childcare and development.
Demographics:
Parental age and education levels are appropriate to the adoption of a child of any age
without apparent issues. Mary and Fred both endorse a Christian upbringing, with a
ty
practice of Catholicism primarily in the household at this time. Strong extended family
support is apparent particularly on the mother's side. Both parents are registered to vote.
Both possess valid driver's licenses. They own two vehicles, both of which are insured.
Income is reported in the medium to high medium range and appears stable. Background
checks revel no criminal history or sexual abuse history on either parent. Motor vehicle
records indicate an occasional parking ticket. One motor vehicle accident in a school
parking lot is noted for Fred, who apparently was hit by another car that was being
backed out into traffic.
Birth Family:
Both Mary and Fred exhibit a range of emotions regarding their opinions of families who
mistreat children or who need to have their children placed in Foster care or adoption.
They are generally empathetic that financial or economic problems can beset almost
anyone. They can understand how disability, or circumstance can create a need for foster
placement or that an unplanned pregnancy can create a need for adoption. They have a
harder time accepting that a child may be neglected or abused as a result of drug abuse
without this leading most of the time to an adoptive situation. They feel that when
physical or sexual abuse of a child is present, it is difficult to see these as a result of a
temporary or transient problem for the birth parents. The concept that these might be the
product of a treatable condition in the parental home or that one parent may be more fit
than another and obtain the children back from a foster to adopt home appeared to be
ones they had not considered. They seem much more willing to be involved in a
permanent placement than in a foster parent to adoption placement.
They recognize the need to convey to an adopted child positive images of the birth
parents. They believe the adopted child should be told they were adopted in an age
appropriate manner. How and what a child is told is dependent on the age and personality
of the child. If they were to adopt a child both Fred and Mary express discomfort at the
prospect of open and ongoing contact with the birth parents. They would like to know
information about the birth parents, especially medical history to appropriately help the
adoptive child. They express discomfort concerning an open adoption if the birth parents
will have future access to the child. If such contact were mandatory, they would want it at
their sole discretion.
Capacity of this family to deal with educational issues in childrearing is considered
superior to many other potential applicants based on education and work history.
Behaviors that are not acceptable were stated as drug use, bullying, and stealing or
purposeful destruction of property.
Foster/Adoptive Family Preparation:
This family is well prepared for permanent adoptive placement, but need further training
if they will be in a foster care to adopt scenario. They are not interested in foster care for
15-
the purposes of birth family reunification as their reason for adoption is family growth
and expansion.
They state they are open to training and intervention with the Department of Social
Services.
Obvious preparations for possible adoption have occurred. Felize is aware of the family
changes that will occur, i.e. where a new child will sleep, her role as a big sister and
seems appropriately excited for a child her age. Mary and Fred both recognize increased
time commitments needed for provision of care and services. Mary's time is more
flexible than Fred's in this regard.
Motivation/Commitment:
Motivation and commitment of this family for a permanent adoption placement is high.
Family leave is available to Fred. However, as he has a lighter load of work in the
summer, he hopes for a late spring placement to assist in the early months of the adoption
as the best time for his schedule. Mary has less constraint on the time of the adoption as
she has more flexibility in the intensity of her part time work. One issue of note is that
Fred and Mary will continue to try to have children and will continue to adopt other
children, as they both desire a large family.
Intervention: Both parents are open to intervention and suggestions for alternatives to
solve problems as evidenced by their interaction throughout this evaluation and by their
stated willingness to work as foster parents. However, they seem most highly motivated
to be permanent adoptive parents.
Resources to Support the Placement: The maternal grandparent's role in the family
provides potential emergency twenty four hour coverage. Both parents are willing to
work with community resources and WCDSS on an ongoing basis. Both parents agree to
take recommended training regarding the foster parent role and an adoption preparation
course.
Training: Described below in Conclusions/Recommendations
Conclusions/Recommendations:
1. The Smith-Rodriguez family is appropriate for permanent adoptive placement of
this child with special needs. As the child has special developmental physical
needs a course for both parents in parenting a child with special needs is
recommended.
2. Brief consultation by the family with their minister is recommended to help
integrate the child into the home. Additional mental health resources if needed
should be obtained by the family if the need becomes apparent
3. A plan for the likely needs of the adoptive child and needed parental actions that
can be foreseen related to developmental delays or issues of attachment should be
Ic'
the basis of consultation with the caseworker over the first month or two of the
placement.
4. A few sessions of brief counseling with Felize to help her accept the addition to
her family are recommended.
5. Development of a plan for telling the child about birth parents at age appropriate
stages is appropriate.
6. Based on the extensive attachment needs that Tamara presents, Mary should be
prepared to spend at least one year full time in the home and work with the child's
therapist to met the transition needs of the adopted child.
7. Safety issues seem to be minimal. However, given Fred's hobby involves
firearms, any guns kept in the home will be maintained in a locked cabinet and
have safety locks installed. Fred will complete a certified gun safety course, if he
has not previously done so.
8. As to the characteristics of an adoptive child, Fred and Mary stated no preference
for sex. While they prefer a child under age three and prefer a child of mixed
Anglo—Hispanic origin or of Hispanic origin, placement of Tamara in the
Smith's home appears to be appropriate and is recommended by the evaluators.
Respectfully submitted
Joyce Shohet Ackerman, Ed.D., Licensed Psychologist
Valerie Larson, M.S.W., Licensed Clinical Social Worker
I7
EXHIBIT B
SUPPLEMENTAL NARRATIVE TO RFP
RECOMMENDATIONS AND CONDITIONS
•
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 00632
1 WESSITE:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352.6933•
COLORADO July 9,2003
Joyce Ackerman Ed.D.
Ackerman&Associates,P.C.
1750 25th Avenue, Suite 101
Greeley,CO 80631
Re: Off System Bid No.010-03 RFP FYC 06-000-Home Study,Home Study Update,and
Relinquishment Counseling
Dear Ms.Ackerman:
The purposes of this letter are to outline the results of the Home Study Bid process for PY 2003-2004 and
to request written information or confirmation from you by Friday,July 18,2003.
A. Results of the Bid Process for PY 2003-2004
The Families,Youth and Children(FYC)Commission has reviewed the bid according to the
criteria established in the bid and provides conditions as follows:
Condition 1:The Notification of Financial Assistance Award(NOFAA)shall include language to
show that background checks are included in the approved rate per home study,update,and/or
relinquishment counseling.
Condition 2:Bilingual-bicultural workers must be listed on the State Vendor List and must be
clinically qualified to do the home study,update,or relinquishment counseling.
Condition 3:The unnumbered page immediately following the budget sheet,page 26 of 33,shows
text marked with asterisks.The FYC Commission requests that your agency clarify the meaning of
the asterisks.
B. Required Response by FYC Bidders Concerning FYC Commission Conditions
The Weld County Department of Social Services is requesting your written response to the FYC
Commission's conditions.Please respond,in writing,with your acceptance or your non-
acceptance of the above stated conditions to Gloria Romansik,Weld County Department of Social
Services,P.O.Box A,Greeley,CO,80632,by Friday,July 18,2003,close of business.
If you wish to arrange a meeting to discuss the above conditions,please do so through Elaine
Furister,352.1551,extension 6295,and one will be arranged prior to July 18,2003.
Sincerely,
Ju A. ' go,Dire or
c Dick Palmisano,Chair,FYC Commission
Gloria Romansik,Social Services Administrator
Ackerman and Associates P.C.
1750 25th Avenue, Suite 101
Greeley, Colorado 80634
970-353-3373
Judy Griego, Director
WCDSS
PO Box A
Greeley, Colorado 80632
Attention: Gloria Romansik
Hand delivered July 18, 2003
Per your letter of July 9 ( received July 11, 2003)
1. Condition one is accepted. We had understood that actual charges for background
check were deferred to the parties being investigated. Has this been changed by this
provision? Administrative costs are covered in the proposal, but not the fee payable to
CBI that may apply. We had understood this to be covered by the department directly. If
this is in error, we request clarification from the WCDSS and the FYC commission.
2 . Condition two is in process of being completed.. Submission of Emily Jaramillo and
Evelin Gomez (our bilingual providers) was submitted in June 2003 and a query received
July 2 and responded to on July 8, 2003. We await the final letter from the Colorado
Department of Human Services. On this basis, we are in process of completion of
condition two and expect it to be met as soon as the Agency responds.
3. The asterisks have no meaning and are in this proposal in error. They came from a
prior proposal where there was not a formal bid sheet and relate to the fact that at that
time the page was submitted in lieu of a formal bid sheet. The asterisks should have been
deleted in this proposal.
Please contact me if you have any questions. We look forward to working with WCDSS
in the delivery of Home Study and Relinquishment Counseling services.
Sincerely,
Joyce Acke n Ed.D
Ackerman and Associates P.C.
Weld County Department of Social Services
Notification of Financial Assistance Award
for Child Welfare Regular Administration&EPP Funds
Type of Action Contract Award No.
X Initial Award 03-HS-0030
Revision (RFP-06-000)
Contract Award Period Name and Address of Contractor
Beginning 07/01/2003 and North Colorado Medical Center-Youth Passages
Ending 05/31/2004 928 12 Street
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial
The total number of client family units to be Assistance Award is based upon your Request for
served in this program is 72. This is estimated at Proposal (RFP). The RFP specifies the scope of
six evaluations per month for 12 months. services and conditions of award. Except where it is
Subtotal of individuals who receive in conflict with this NOFAA in which case the
Bilingual/bicultural services is 36; subtotal of NOFAA governs, the RFP upon which this award is
individuals who receive South county services is based is an integral part of the action.
36. The monthly maximum capacity is 10 client Special conditions
family units. 1) Reimbursement for the Unit of Service will be based
on a rate per home study; home study update,and
Cost Per Unit of Service relinquishment counseling session.
2) Reimbursement requests must be an original with an
Hourly Rate Per original signature from the provider and/or designee.
Relinquishment Counseling $ 67.00 3) Reimbursements requests must include the date the
home study,update, or relinquishment counseling was
Rate per Study completed.The request must reflect the referral
Full Home Study $800.00 number assigned to each home study,the amount
Updated Home Study $500.00 billed for each home study, and the month the service
was provided.
Unit of Service Based on Approved Plan 4) Payment will only be remitted on referrals made by
the Weld County Department of Social Services.
5) Requests for payment must be an original submitted to
the Weld County Department of Social Services by
Enclosures: the end of the 25th calendar day following the end of
X Signed RFP:Exhibit A the month of service.The provider must submit
Supplemental Narrative to RFP: Exhibit B requests for payment on forms approved by Weld
Recommendation(s) County Department of Social Services.
X Conditions of Approval
Approv Program Official:
By By
David E. Long, Chair Judy Gri ,Direc r
Board of kii0 County Com ssioners Weld unty, e artment of Social Services
Date: u 2 0 2003 Date: �� � C
a'Co33f
EXHIBIT A
HOME STUDY BID
Off-System Bid No. 010-03 RFP-FYC-06-000 Attached A
HOME STUDY, UPDATE, & RELINQUISHMENT COUNSELING BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER
CHILD WELFARE ADMINISTRATION FUNDING
2003-2004 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2003-2004
BID Off—System Bid 010-03 RFP-FYC-06-000
NAME OF AGENCY: North Colorado Medical Center - Youth Passages
ADDRESS: 928 12th St . , Greeley, CO 80631 PHONE: ( )(970) 352-1056
CONTACT PERSON: Karen Nicholson Ti.1IE: Behavioral Health Therapist II
DESCRIPTION OF HOME STUDY PROGRAM CATEGORY: Adoption,Foster Care, and Expedited Permanency Planning
Home Studies in compliance with the uniform format utilized by the State of Colorado Department of Human Services since
October 1, 1999(Attached A).
11-Month approximate Project Dates: 12-month contract with actual time lines of
Start June I,2003 Start
End May 31,2004 End
IT1LEOFPROJECT: NCMC Youth Passages
David Rastatter 6/ 17/03
Name and Signature of P on ,eparing D ument Date
Jon Sewell
/8/o 3
\lame and Signature Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REQUIREMENTS
'or new and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid.
'or renewal bids,please indicate which of the required sections have not changed from Program Year 2002-2003 to Program
'ear 2003-2004.
x Project Description
x Sample Home Study _Project Description
x Target/Eligibility Populations _Sample Home Study
_ TargeUEligibilityd
opu]ations
x General _General
x Cultural/Eligibility Populations Cultural/Eligibility Populations
x Types of services provided _Types of services provided
X Measurable Outcomes Measurable Outcomes
x Service Objectives _ Service Objectives
K Workload Standards _ Workload Standards
c Staff Qualifications Staff Qualifications
c Unit of Service Rate Computation
{_ Program Capacity per Month — Unit ao Capacity ac Rate Month
nutation
c Certificate of Insurance Program per
Page 22 of 33
•
Off-System Bid No. 010-03 RFP-FYC-06-000 Attached A
Cir/a3
Date of Meeting(s)with Social Services Division Supervisor:
Comments by SSD Supervisor:
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Name and Signature of SSD Supervisor Date
Page 23 of 33
Off-System Bid No. 010-03 RFP-FYC-06-000
Attached A
Program Category Home Study, Update, and Relinquishment Counseling
Project Title Youth Passages
Vendor North Colorado Medical Center
PROJECT DESCRIPTION
Provide a brief, one-page description of the project.
II. SAMPLE HOME STUDY
Provide a fictitious home study written using the State format.
III. TARGET/ELIGIBILITY POPULATIONS
Provide a one page brief description of the proposed target/eligibility populations. At a minimum
your description must address:
A. Total number of clients to be served.
B. Total individual clients and the children's ages.
C. Total family units.
D. Sub-total of individuals who will receive bicultural/bilingual services.
E. Sub-total of individuals who will receive services in South Weld County.
F. Sub-total of Individuals who will have access to 24-hour service.
G. The monthly maximum program capacity.
H. The monthly average capacity.
I. Average stay in the program(weeks).
J. Average hours per week in the program.
W. TYPE OF SERVICES TO BE PROVIDED
Provide a two-page description of the types of services to be provided. Please address if your project
will provide the service minimums as follows:
A. Home Studies, Updates, and Relinquishment Counseling as referred by the Weld County
Department of Social Services.
Provide your quantitative measures as they directly relate to each service. At a minimum, include a
number to be served in each service component. Describe your internal process to assure that FYC
resources will not supplant existing and available services in the community; e.g. mental health
capitation services,ADAD, and professional services otherwise funded.
Dg RP ?A of 11
I. PROJECT DESCRIPTION
Youth Passages has been an FYC provider for nine years. Throughout that
time we have provided high quality intensive treatment to youths
experiencing significant emotional, behavioral, psychiatric, educational,
interpersonal, familial and chemical dependency problems. Treatment
modalities that we specialize in include: milieu, individual, group,
experiential, behavioral and family therapy. Our family therapy program,
which addresses issues specific to traditional, blended, adoptive and foster
families, is one of the strengths of our service delivery system. Youth
Passages staff possesses specific expertise in effectively evaluating family
systems and living situations. This information is utilized to formulate
treatment interventions and court recommendations. We feel this skill base
will be an asset in working with the type of families referred for Home
Studies, Home Study Updates and Relinquishment Counseling.
The Youth Passages Home Study, Home Study Update and Relinquishment
Counseling program (HSRC) will meet or exceed all fifteen specific
reporting requirements specified for Home Studies and Relinquishment
Counseling as outlined in Off-System Bid No. 010-03 FRP-FYC-06-000.
The primary therapist who will complete these evaluations is a Licensed
Marital and Family Therapist who has previous employment experience as a
social services caseworker. If the need arises we can assign a Licensed
Master's Level bilingual therapist who has successfully provided FYC
services to the department for three years. To ensure high quality service
delivery Youth Passages staff will attend all related mandatory training
offered by Weld County Department of Social Services.
1
•
II. SAMPLE HOME STUDY
Client Name: CarinM Matthew M
Date of Birth: 2/24/1994 4/1/1999
Legal Guardian: Weld County Department of Social Services
Case Worker: Dave C.
PO Box A
Greeley, Co 80632
(970) 352-1551 ext. #4
People interviewed:
Name: Bob Lucy
Date of birth: 1/23/1964 12/8/1966
Relationship to children Family friend Family friend
Address: 1640 Pond Drive
Boulder, Colorado 80637
Phone #: home (303) 377-6767 work (303) 377-2999 (Bob)
Cell (303) 217-4455 (Lucy)
Interview dates: May 14, 2003 and May 21, 2003
PURPOSE OF THE HOME STUDY
This home study was requested by Weld County DSS to determine if Bob
and Lucy, long-time friends to the M. family, can provide a stable, nurturing
long-term placement for Carin and Matthew. There are currently no known
family members who are available to provide long-term care for these
children.
FAMILY HISTORY
Bob descends from a Norwegian farming family from Sioux Falls, S. D. His
family consisted of one older sister and one younger brother. Bob's birth
2
and childhood development were unremarkable. He reached his childhood
milestones as appropriate, as did his siblings. Bob's health was good; he had
chicken pox at age 4, broke his arm falling from a tractor at age 8, and had
his tonsils out when he was 11.
Bob completed high school and then attended college in Vermillion, S.D.
where he earned a bachelor's degree in Business. As a high-school student
Bob wrestled and played football. He was a fairly popular student but chose
to spend time with a small group of friends.
Bob reports that he and his family got along well. His parents were devoted
Lutherans and held to fairly traditional, conservative values. The family
attended church together each Sunday and participated regularly in church
activities. Due to this influence Bob was a fairly "normal" kid who only
drank beer occasionally after a football game and never tried drugs.
Bob related well to both his brother and sister and reported only the typical
sibling rivalry between them. Bob's dad was the disciplinarian, and his
mom was the homemaker. According to Bob it took only a few spankings at
the hand of his dad for him to understand his behavior had consequences. In
the times when discipline was needed Bob would lose privileges and have to
do extra chores around the farm.
At age 10 Bob's grandmother was in an accident and died. This was a very
difficult loss for the entire family and Bob and his family spent 3-4 evenings
at the home of the senior pastor, "processing" the death of his grandmother.
This is the closest thing to counseling Bob experienced in his youth.
In College Bob met Lucy. They began to date his junior year and were
engaged two years later. They married after Bob graduated, and Lucy was a
junior.
Lucy descends from an American father and a Spanish mother. She and her
younger sister grew up in Boulder, Colorado. The family moved three times
when Lucy was young, but they always remained in the city of Boulder. Her
family regularly attended a charismatic church since the time she was 7
years old.
3
Lucy's birth and childhood development were unremarkable, and she
reached childhood milestones at appropriate ages. Her sister, Pam, however,
was born with a disease similar to Cerebral Palsy. She suffered minimal
brain damage due to complications during her birth. As a result, Pam
required extensive home health medical care which was provided by her
family and a hired home-health care agency. Lucy spent many hours caring
for Pam, and though she does not resent this Lucy definitely believes she
missed out on a lot of social activities by staying home with Pam.
Lucy's health was generally good and she experienced common childhood
illnesses, including croup, chicken pox, and pinkeye. Lucy did experience
earaches as a toddler and as a result had tubes put in her ears. At age 14 she
had her appendix removed.
Lucy graduated from high school with honors, and moved to Vermillion to
attend college. Her desire to move out of state was motivated in part by the
desire to be free from caring for her sister. Lucy studied business and
completed her degree in four years. Her junior year in college she married
Bob, and he worked while she completed her senior year.
Lucy reports that her family was very close, partially due to the need they
had to care for Pam. They were strong participants in the Assemblies of
God church and often attended church together, taking Pam in her wheel
chair. Though Lucy's faith provided strength to her, it also created
frustration because she hoped God would heal Pam. Lucy's disillusionment
and confusion about this led her to step away from her faith when she moved
away to college.
While Lucy has no history of alcohol use she does admit to smoking pot off
and on in high school. She reports it was only recreational use and stopped
smoking when she married Bob.
Lucy was compliant with her parent's rules and reports that discipline
consisted of being grounded from the phone or the car, and "being talked to"
by both of her parents together.
After Lucy completed her college degree she and Bob moved to Boulder and
opened a restaurant. They managed the business together and were very
4
successful with their first restaurant. Bob decided to open a second
restaurant in Longmont. Even though the prospects appeared good early on
they had to close the restaurant within two years of opening. Their
perspective on the closing was optimistic since their first restaurant
continued to do very good business.
In 1996 Bob was forced to close the restaurant due to re-zoning by the city
of Boulder. He pursued legal action against the city to prohibit the closure
but was unsuccessful. The legal and the emotional cost to Bob and Lucy
was high and it created tremendous stress on their marriage. As a result they
chose to see a marriage therapist for 4 months as they attempted to deal with
the stress of losing a business they loved. They felt the counseling was very
helpful and effective.
Bob and Lucy have no biological children. After trying to conceive for 2
years without success they decided to seek the help of an infertility
specialist. The trials were not successful and because the cost was very
prohibitive Bob and Lucy were not able to repeat the procedures. The grief
that accompanied their infertility was the most difficult for Lucy and she
admits that she has some residual anger at God for this.
As a result they decided they wanted to adopt children, or become foster
parents. Both see the opportunity to care for Carin and Matthew as the
perfect opportunity.
GENERAL FUNCTIONING
During a business workshop in 1998 Bob was given the Myers-Briggs Type
Indicator (MBTI). His report indicated he was an ISTJ, introvert, sensing,
thinking,judging. After reviewing the results Bob agreed that the indicator
was accurate. To summarize here, Bob is an introvert who gains energy from
being alone more than with groups. He has strong friendships with 2-3 other
men, and his wife and believes he is self-disclosing with all of them, Lucy
the most. He prefers to look at situations by paying attention to the
information present in front of him, and tends to be logical when making
decisions. He is a very driven man who likes new challenges and believes it
is important to finish what he starts. Because Bob is logical and detail
oriented he tends to overlook emotions. He admits that he prefers not to
5
spend a lot of time worrying about something, or getting upset about things.
Instead, he thinks them through and tries to fix them. Bob's communication
is "short and sweet", communicating only the minimal amount of
information necessary in a conversation.
Lucy has not taken the MBTI assessment, but in comparing herself to Bob
she believes she is also an introvert, preferring quiet time and her own space,
but also enjoys going out with friends or other couples more than Bob. Lucy
prefers to look at situations by paying attention to the information present in
front of her. She diverts from Bob by making decisions primarily based on
her values and how she feels about the situation.
Lucy reports she is less driven than Bob, and though she likes to do good
work, she is much more relaxed about schedules and details.
Both Bob and Lucy believe they are good communicators, including when
they are angry. Lucy will cry more often when angry and Bob rarely cries
about anything. He admits that at times he is not aware of his own emotions
and it takes a number of conversations with Lucy for him to get at "the
whys" of what may be bothering him.
PARENTING - DISCIPLINE
Both Bob and Lucy agree that discipline is an important component of
parenting. They want to be "a united front" as they teach and discipline
Carin and Matthew and agree that they will share the responsibility equally.
Both agree that their hopes and expectations in this area are purely
conjecture since they have never had children.
They have read books (Parenting with Love and Logic and Boundaries with
Kids) and feel this has given them a strong starting point. Yet they also
realize most of the immediate active parenting will have to come from Lucy
since Bob will be at work full-time. They also believe that the exact
consequences for misbehavior may depend on the differences between Carin
and Matthew, including their age difference.
They agree that they favor taking away privileges, adding chores and
possibly utilizing time-out for Matthew. Both state they will not employ
corporal punishment.
6
Bob and Lucy believe the point of discipline is to teach and help a child
grow, not just to punish. They both admit to being a little nervous to see
how this plays out "in real life" once the children move in.
Currently there is no plan to use day care.
PARENTING—VALUES AND PRACTICE
Bob and Lucy have compiled a list of what they consider the "family non-
negotiables".
They want Carin and Matthew to be well provided for (i.e. clothes, toys,
etc...)but state they will be cautious about being too excessive in this area.
School attendance is required, and they would like to see both kids maintain
at least a "B" average. Extra-curricular activities will be encouraged.
A daily chore list will be established, at age-appropriate levels, and both kids
will earn allowance. A portion of their allowance will be put into a savings
account.
The family will have family meetings once a week to talk about how
everybody is doing, and to plan activities together. The family will attend
church together most Sundays.
Both kids will be provided the opportunity to participate in 2-3 activities per
year, such as swimming lessons or soccer, so they are exposed to various
activities and skills.
Depending on the disposition regarding Carin and Matthew's parents, Bob
and Lucy are hoping to eventually adopt the children. With this in mind,
,and due to the history of abuse perpetrated on the children by their biological
parents, it is Bob and Lucy's preference that the parents have no contact
with Carin and Matthew. They will, however, abide by the court rulings on
this matter.
CHILDREN
Bob and Lucy have no children.
7
FAMILY SYSTEM
Family Functioning
Based partially on his Norwegian/Lutheran upbringing Bob brings the
following dynamics to his relationships with others. He tends to have strong
opinions and often will share them in a diplomatic, confident manner. Bob
knows clearly what he expects with, and from, others and rarely deviates
from his own rules. He professes that overall his thinking is black and
white, right or wrong. When he makes a decision it is most often with strong
conviction and he stands by his decisions. Because of this it can be difficult
to change his opinion and doing so requires a thorough explanation and
discussion of the issue. Early on in their marriage Bob rarely changed his
opinions, but over the years he has "softened" and will listen to others (Lucy
and co-workers) as they express differing opinions. Bob acknowledges that
he is more willing to change his mind now than when he was younger.
Generally Bob holds to what he describes as a "traditional line" when it
comes to rules and values, and anticipates that will remain the same when he
cares for Carin and Matthew.
The influence of Lucy's Hispanic heritage is exemplified through her core
family values. Lucy's parents taught her to respect and love her family and
honor her parents. The one striking divergence from traditional Hispanic
values is that her parents raised her in a home where parents shared equal
roles in the family. Her church background encompassed strong evangelical
values, with tolerance for differences in others, and some flexibility with
rules. Lucy is quite verbal and will process her thoughts out loud with
whomever she is talking. She often solicits the thoughts and opinions of
,others when it comes to making a decision, yet is very clear within herself
about what she wants.
Bob and Lucy are openly affectionate with each other (this can be
uncomfortable for Bob), and Lucy openly hugs other friends and co-
workers. In terms of affection, both of them agreed that they want to openly
demonstrate care and respect for each other in front of the children. It is
their hope that Carin and Matthew will learn how to care for and respect
others and appropriately express these feelings.
8
Lucy travels to Longmont every other week to visit with her sister Pam, who
is being cared for in an assisted living facility. Though she acknowledges
feeling an obligation to do this, she willingly visits Pam and notes that it is
so much easier now than when she was caring for Pam on a daily basis.
Lucy would like to bring Carin and Matthew with her occasionally so that
they can learn to socialize with, and even help care for, people with
handicaps.
Bob and Lucy feel that their marriage is stronger at present than it ever has
been. Both believe they have adequately grieved their inability to have
biological children and Lucy is able to express this tearfully, but with
resolve. Lucy believes there will always be some degree of sorrow over the
fact that she herself could not carry and birth a baby.
FAMILY SUPPORT NETWORK
Bob and Lucy appear to have a strong support network. Both are active in
church social activities as their schedules permit. Lucy is in a women's
bible study and Bob participates in a men's accountability group that meets
every other Tuesday morning.
Bob feels close friendship with his assistant manager at the restaurant, as
well as a few other friends. Bob's family continues to live in South Dakota
and they have expressed an excitement for Bob and Lucy regarding caring
for Carin and Matthew. The hope of Bob's family is that they can all spend
time together in the summer and every Thanksgiving when his family travels
to Colorado for the holiday. Lucy's family supports her wishes to care for
the kids, and Lucy's parents are very excited about the prospect of becoming
grandparents.
DEMOGRAPHICS
Home
Bob and Lucy live in a 4-bedroom ranch-style home east of Boulder. Their
home rests on 2 acres of land, with a front and back yard, and a small field
behind the back yard. Their neighborhood is older, and there is ample space
9
between homes. Because they have lived in the home for 12 years they
know all of their neighbors, and have met the children in three homes on
their street. Two of the neighbors have children close in age to Carin and/or
Matthew.
Financial status
For the tax year 2002 Bob and Lucy's gross income was $68,000. They
anticipate a similar income in 2003 from their restaurant. They have limited
investments in mutual funds and stocks.
In February 2003 they refinanced their home on a 15-year loan. Bob and
Lucy took out a small home-equity loan when they refinanced so that they
can buy furniture for both of the kids' rooms and pay for clothes and other
essentials.
They own both of their cars, and have an outstanding credit card debt of
$650.00.
Once the children live in their home they will be added to Bob's current
health insurance plan. In their estimation they believe they will be able to
provide for a family of four financially without too much problem.
BIRTH FAMILY
Bob and Lucy have been friends with Carin and Matthew's parents for 6
years. They have been aware of the problems in the home and have been
there on a number of occasions to support and encourage Jim and Barb. As
.the situation became more unstable in the home Lucy did try and offer
counsel, especially to Barb, but felt she was rebuffed. Bob became angry
and began to detach from Jim, primarily, in his words, because it did not do
any good to try and help.
In 2001 Bob and Lucy offered to care for the children for the summer so that
Jim and Barb could get the help they needed without having to worry about
caring for Carin and Matthew. Barb seemed appreciative of the offer, but
declined. To date there is tension between the couples, and because it is the
hope of Bob and Lucy to adopt they would like to have contact with the
10
children discontinued, "at least until the kids are settled in with us".
FOSTER/ADOPTIVE FAMILY PREPARATION
Bob and Lucy have attended the county foster parent trainings and have
completed the home licensing process. They attended a "Growing Kids
God's Way" series at their neighbor's church, and though they agreed to
many of the principles they disagreed with what they felt were "rigid
behavioral expectations". Bob and Lucy plan to attend a different parenting
series in the future.
Bob and Lucy are unsure of how to deal with visitation from Carin and
Matthew's grandparents. They do not wish to isolate the children from
family members who love them, yet they want to protect the kids from
potential indirect harm of mom and dad. On this issue Bob and Lucy would
like outside counsel that incorporates the children's wishes.
MOTIVATION/COMMITMENT
Bob and Lucy express a high level of motivation to care for Carin and
Matthew. Their motivation is evidenced by reading books to strengthen
their parenting skills, discovering who the neighborhood children are for
possible friendships with Carin and Matthew, financial preparation to 'make
rooms' for the kids, and completing all necessary licensing requirements to
date.
,Bob and Lucy have longed to be parents for many years. They have an
established relationship with the kids, and have shown a high level of care
and concern about their welfare for 6 years. Lucy admits her longing for
children feels a little more urgent due to their inability to have children.
They agree they do not know all there is to know about parenting, but, as all
parents do, they will learn as they go. Bob and Lucy are financially stable
and possess a strong support network through their faith community and
other friendships that will be a benefit to them as foster/adoptive parents.
They feel a slight apprehension about the adjustment from having a lot of
personal freedom to, at all times, considering the needs of a 9 year old and a
4 year old.
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INTERVENTION
Bob and Lucy have agreed that they are open to seeking help from outside
resources when necessary. When pressed by this evaluator Bob admitted he
would be slower to seek help than Lucy, but that he would never oppose
help if Lucy or he really believed it was needed.
TRAINING/RESOURCES
Bob and Lucy have attended and completed all required DSS and licensing
classes. They completed one parenting class and are waiting to hear from
the Rocky Mountain Marriage and Family Institute about an up-coming
parenting class for families with special needs, i.e. abuse, adoption, behavior
concerns.
OBSERVATIONS
Based on the home study the undersigned submits the following
observations:
1. The home and neighborhood are safe and appropriate for Carin and
Matthew.
2. The financial status of Bob and Lucy is adequate to provide for Carin
and Matthew.
3. The expressed level of acceptance and excitement of the extended
family to include Carin and Matthew in their family is high.
4. The support system for Bob and Lucy is strong.
5. Bob and Lucy are very motivated and committed to caring for Carin
and Matthew.
6. The tension between Bob and Lucy and Jim and Barb does create
concerns.
7. Bob and Lucy do not yet understand the process of terminating
parental rights.
8. Bob's stoic nature and preference not to express emotion may create
difficulty for him to express empathy towards the children.
12
9. The emotional roller coaster of infertility and the longing within Lucy
to care for these children may contribute to her being an enabling or
permissive parent.
RECOMMENDATIONS
Based on the home study, the undersigned recommends the following:
1. Bob and Lucy should be considered as a viable foster/adoption home
for Carin and Matthew.
2. Bob and Lucy need information from DSS about the relinquishment
process and a written plan regarding visitation between Jim and Barb
and Carin and Matthew.
3. Parental visitation should be limited and supervised.
4. Bob and Lucy need counsel from DSS regarding grandparent
visitation, both now and in the future, if parental rights are terminated.
5. Carin and Matthew should participate in therapy with a skilled play
therapist that specializes in the treatment of domestic violence.
Evaluator Date
13
III. TARGET/ELIGIBILITY POPULATIONS
(Be Specific)
Yes/No Explain How This Item Will Be Met
A.72 Total number of clients to be served in the 6 evaluations/month for 12 months
program.
B. 72 Total individual clients who are children With younger children (under age 4) the parents may be the
under age 18 primary client
C. 72 Total family units
D. 36 Sub-total of individuals who will receive Youth Passages will employ one full time bilingual therapist to
bicultural/bilingual services provide services for this program.
E. 36 Sub-total of individuals who will We will accept a limited percentage (50%) of cases for which
receive services in South Weld County we will provide services in the client's home in South Weld
County.
F. 72 Subtotal of individuals who will have
access to 24 hour services. PsychCare/FRC is staffed with licensed professionals 24 hours
per day, 365 days per year. These staff members will collect
G. 10 The monthly maximum program relevant case information and communicate it to the direct
capacity service provider.
H. 6 The monthly average capacity
I. 6 Average stay in the program (weeks)
J. 2-4 Average hours per week in the program
15
IV. TYPE OF SERVICES TO BE PROVIDED
The Youth Passages Home Study, Home Study Update and Relinquishment
Counseling program (HSRC) will meet or exceed all fifteen specific
reporting requirements specified for Home Studies and Relinquishment
Counseling as outlined in Off-System Bid No. 010-03 FRP-FYC-06-000.
The primary therapist who will complete these evaluations is a Licensed
Marital and Family Therapist who has previous employment experience as a
social services caseworker. If the need arises we can assign a Licensed
Master's Level bilingual therapist who has successfully provided FYC
services to the department for three years. To ensure high quality service
delivery Youth Passages staff will attend all related mandatory training
offered by Weld County Department of Social Services.
Quantitative Measures
A. 100% of clients referred by Weld County Department of Social
Services for a Home Study or Home Study Update will be fully
evaluated on the fifteen specific reporting requirements specified
for Home Studies as outlined in Off-System Bid No. 010-03 FRP-
FYC-06-000. The background checks will be completed and the
written report submitted to Weld County Department of Social
Services within six weeks of our receipt of the referral.
B. 100% of clients referred by Weld County Department of Social
Services for Relinquishment Counseling will be fully evaluated on
their understanding of the fifteen specific categories specified for
Relinquishment Counseling as outlined in Off-System Bid No.
010-03 FRP-FYC-06-000. The written report will be submitted to
Weld County Department of Social Services within the
individualized timeframe specified for each case.
Weld County Department of Social Services will be the only referral source
for these types of services. As a result, we will only bill Weld DSS for
services rendered pursuant to this agreement.
16
V. MEASURABLE OUTCOMES
A. 100% of our home studies and relinquishment counseling cases
will be completed within the timeframe specified by the
department. Our timeliness will positively impact the mandate to
place children in an expedient manner.
B. 100% of our home studies will consist of high quality clinical
evaluations. 100% of our reports will be well written and
submitted to the department within the timelines outlined in Off-
System Bid No. 010-03 FRP-FYC-06-000.
C. 100% of our submitted home studies will be defined by the
department as acceptable.
We will ensure quality reports by presenting them for internal clinical
review by supervisors prior to submitting them to Weld County Department
of Social Services.
VI. SERVICE OBJECTIVES
Youth Passages will ensure the provision of quality home studies, updates
and relinquishment counseling for Adoptive, Foster Parents and Department
of Social Services clients by hiring only highly qualified and well trained
licensed Master's Level therapists. These therapists will receive ongoing
clinical supervision and their reports will be reviewed by a supervisor prior
to submission to the department. 100% of our home studies, updates and
relinquishment counseling reports for Adoptive, Foster Parents and
Department of Social Services clients will consist of high quality clinical
evaluations. 100% of our reports will be well written, address the mandated
evaluation topics and submitted to the department within the timelines
outlined in Off-System Bid No. 010-03 FRP-FYC-06-000.
17
VII. WORKLOAD STANDARDS
A. The person providing this service for North Colorado PsychCare
will be a per diem therapist who will not work more than 12 hours
per day, 40 hours per week, or 173 (on average) per month. One
bilingual Master's Level therapist will be available to assist on
special needs or high census periods.
B. 2
C. Maximum caseload per therapist - 6
D. The treatment modality will vary depending upon the requested
service. All submitted reports will meet standards outlined in Off-
System Bid No. 010-03 FRP-FYC-06-000.
E. Total Number of Hours of Service -
2-4 hours per day on days clients are seen
4-8 hours per week
16-32 hours per month
F. Total number of individuals providing these services-
1 per diem therapist
1 bilingual therapist available for special needs cases or high
census periods
G. Maximum caseload per supervisor - 15
H. Insurance - See attached certificate of insurance
18
•
VIII. STAFF QUALIFICATIONS
A. The Behavioral Health Therapist(s)providing services will have a
minimum of a Master's Degree in psychology, counseling, social
work or a related field, possess a current Colorado licensure and
will be listed on the State of Colorado Department of Human
Services vendor list, having applied for inclusion..
B. Two staff members will be available for the direct service phase of
this project with one additional staff member providing
supervision.
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VERIFICATION OF COVERAGE ISSUE DATE:Jan. 17, 2003
Issuer Banner Health System
IThis verification of coverage is issued as a matter of information only,and coes not extend or alter the coverage carriec by Earner Health System.
'COVERED PARTY COMPANIES PROVIDING COVERAGE
COMPANY
BANNER HEALTH SYSTEM LETTER A SAMARITAN INSURANCE FUNDING,LTD.
11441 N.12TH STREET COMPANY
;PHOENIX, AZ 35006 LETTER B
COMPANY
LEITER C
COMPANY
LETTER D
COVERAGES
THIS IS TO CERTIFY THAT THE INSURANCE COVERAGE LISTED BELOW IS CARRIED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
JERIFICATICN OF COVERAGE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS
AND CONDITIONS OF THE POLICIES OF INSURANCE CARRIED BY BANNER HEALTH SYSTEM.
CO
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXP.DATE LIMITS
1 HOSPITAL PROFESSIONAL& SIFL 2003 01/01/03 01/01/04 PL EACH LOSS $10,000,000
GENERAL LIABILITY GL EACH LOSS $10,000,000
GL AGGREGATE 510.000.000
HOSPITAL PROFESSIONAL HPL EACH LOSS 5
LIABILITY HPL AGGREGATE $
HOSPITAL PROFESSIONAL HPL EACH LOSS $
LABILITY HPL AGGREGATE IS
MEDICAL PROFESSIONAL PER MEDICAL INCIDENT $
LIABILITY ANNUAL AGGREGATE $
EXCESSLABIUTY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION STATUTORY LIMITS S
AND EMPLOYER'S LIABILITY $
EMPLOYER'S LIABILITY
DMMENTS.
INNER HEALTH SYSTEM HAS ARRANGED TO HAVE COVERAGE EXTENDED TO NORTH COLORADO MEDICAL
ENTER.
ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE .60'./E DESCRIBED PCUCCES BE CANCELLED CR MATERIAL:2f
WHOM IT MAY CONCERN CHANGED BEFORE THE EXPIRATION DATE,BANNER HEALTH SYSTEM WILL ENDEAVOR
TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER.BUT FAILURE TO
MAIL SUCH NOTICE SHALL IMPOSE NQ LIABILITY OF ANY'KIND UPON BANNER
HEALTH SYSTEM.!TS INSURERS OP$T' E!P AGENT!CR REPRESENTATIVEE.
'AUTHORIZED REPRESENTATIVE . 2 r, h
.'eJ NG:503-.G. I
tsu£Iacaties
Home Study
Home Study Update
ML Relinquishment 1:1
2003-2004
Number of
Statistic: Hours/Case Cases
Home Study 15 50
Home Study Update 8 15
ML Relinquishment 1:1 3 7
Total Cases 72
Revenue Per Case
Home Study $ 800 $ 40,000
Home Study Update $ 500 $ 7,500
ML Relinquishment 1:1 Per Hour
$ 67 $469
Gross Revenue $ 47,969
Deductions:
No Shows $ 800
Net Revenue $ 47,169
Expenses:
Salary ML Therapist
(696 case 72 triptime) 768 $ 18,432
Salary Clinical Coordinator 195 $ 5,460
Other(BA,Reimb,MR,etc) 72 $ 864
Sub Total Salaries $ 24,756
Benefits 20% $ 4,951
Sub Total Salaries/Benefits $ 29,707
Non-Salary expense:
Mileage 50 MilesRndTrip 36 $ 648
Background Checks$60ea 130 $ 7,800
Postage 72 $ 72
Sub Total Non-Salary $ 8,520
Total Expense $ 38,227
Contribution Maipin $ 8,942
EXHIBIT B
SUPPLEMENTAL NARRATIVE TO RFP
RECOMMENDATIONS AND CONDITIONS
reTh
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
' WESSITE:www.co.weld.ao.us
VIII Administation and Public Assistance(970)352-1551
Child Support(910)3524933
COLORADO July 9,2003
Dave Rastatter'
North Colorado Medical Center-Youth Passages
- 928 12 Street •
Greeley,CO 80631
Re: Off System Bid No.010-03 RFP FYC 06-000-Home Study,Home Study Update,and
Relinquishment Counseling
Dear Mr.Rastatter:
The purposes of this letter are to outline the results of the Home Study Bid process for PY 2003-2004 and
to request'written information or confirmation from you by Friday,July 18,2003.
A. Results of the Bid Process for PY 2003-2004
The Families,Youth and Children(FYC)Commission has reviewed the bid according to the
criteria established in the bid and provides conditions as follows:
Condition 1:The Notification of Financial Assistance Award(NOFAA)shall include language to
show that background checks are included in the approved rate per home study,update,and/or
relinquishment counseling.
Condition 2:Bilingual-bicultural workers must be listed on the State Vendor List and must be
clinically qualified to do the home study,update,or relinquishment counseling.
B. Required Response by FYC Bidders Concerning FYC Commission Conditions
The Weld County Department of Social Services is requesting your written response to the FYC
Commission's conditions.Please respond,in writing,with your acceptance or your non-
acceptance of the above stated conditions to Gloria Romansik,Weld County Department of Social
Services,P.O.Box A,Greeley,CO,80632,by Friday,July 18,2003,close of business.
If you wish to arrange a meeting to discuss the above conditions,please do so through Elaine
Furister,352.1551,extension 6295,and one will be arranged prior to July 18,2003.
Sincerely,
J A. ego, s l
c Dick Palnnsano,Chair,FYC Commission
Gloria Romansik,Social Services Administrator
•
Psychcare/Family Recovery Center
North Colorado Medical Center
Banner Health System
Judy Griego
Director
Weld County Department of Social Services
. P.O.Box A
Greeley,CO 80632
July 21,2003
Re: Off System Bid No.010-03 RFP FYC 06-000
Dear Ms. Griego:
North Colorado Medical Center agrees to the recommendations put forth by the FYC Commission in
reference to Off System Bid No. 010-03 RFP FYC 06-000 which requires: 1)the expense of background
checks to be covered in the approved rate and will be paid for by PsychCare/FRC;and 2)bilingual-
bicultural workers will be listed on the State Vendor List and must be clinically qualified to do the home
study,update,or relinquishment counseling.
If you wish to discuss this issue further,please do not hesitate to contact me.
S' er: y,
David Rastatter
Clinical Resources Coordinator
.it 1!IPII;24 , , , DEPARTMENT OF SOCIAL SERVICES
PO BOX A
CO
GREELEV,C 80632
VI
I WEBSITE:www.co.weld.co.us
_ Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
t
COLORADO
• MEMORANDUM
TO: David E. Long, Chair Date: August 18, 2003
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services,, Ct C 1µ-Q
y L
RE: Notifications of Financial Assistance Awa ds (NOFAAs) with
Vendors—Home Studies and Relinquishment Counseling
Enclosed for Board approval are Notifications of Financial Assistance Awards
(NOFAAs)with vendors for Home Studies and Relinquishment Counseling. The
Families, Youth, and Children (FYC) Commission completed its Request for Proposal
(RFP)process and recommends that these vendors be funded through Child Welfare
Administration Funding. These vendors meet the qualifications of the RFP including
Colorado Department of Human Services requirements. The NOFAAs were discussed
and reviewed at the Board's Work Session held on August 18, 2003.
The major provisions of the NOFAAs are as follows:
1. The term of the NOFAAs is July 1, 2003 through June 30, 2004.
2. The recommended vendors are: Ackerman & Associates, Lutheran Family
Services, Youth Passages of North Colorado Medical Center, and Transitions
Psychology Group.
3. The vendors agree to provide home studies for potential adoptive and foster care
homes and relinquishment counseling according to the RFP including State
requirements.
4. Total funding for the NOFAAs is $100,000. Each vendor will be reimbursed
according to the rates provided below:
2003-2399
MEMORANDUM Page 2
Commissioner Long
August 18, 2003
Relinquishment Full Home Updated Home Comments
Agency Hourly Rate Study Rate Study
Ackerman&Associates $100.00 $800.00 $640.00 Bilingual Spanish and
(2-hour maximum) South County Services
Lutheran Family $107.00 $850.00 $424.00 Bilingual Spanish and
Services (additional adult South County Services
at$250 each)
Youth Passage of North $67.00 $800.00 $500.00 Bilingual Spanish and
Colorado Medical South County Services
Center
Transitions Psychology $250.00 $875.00 $525.00 Bilingual Spanish&
Group Japanese and South
County Services
If you have any questions,please telephone me at extension 6510.
Hello