HomeMy WebLinkAbout20011631.tiff RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR CORE SERVICES AND
AUTHORIZE CHAIR TO SIGN - LUTHERAN SOCIAL SERVICES OF COLORADO,
DBA LUTHERAN FAMILY SERVICES, INC.
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 a Child Protection Agreement for Core
Services 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 Lutheran
Social Services of Colorado, dba Lutheran Family Services, Inc., commencing June 1, 2001,
and ending May 31, 2002, with further terms and conditions being as stated in said agreement,
and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, ex-officio Board of Social Services, that the Child Protection
Agreement for Core Services 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 Lutheran Social Services of Colorado, dba Lutheran Family Services, Inc., be,
and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the following vote on the 20th day of June, A.D., 2001, nunc pro tunc June 1, 2001.
BOARD OF UNTY COMMISSIONERS
orlia%, WELD C TY, COLORADO
ATTEST: _
��wr I . J. Geile, Chair
Weld County Clerk to the L.- ;10:9
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BY. ac Li „y,0� (1Z? • ,Glenn Vaad, Pro-Tem
O.Deputy Clerk to t-h�eYcBoard �' ' /^�
Wi ' H. Jerke
APPRC VE S TO M: a� c •C
a id E. Long
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Robert D. Masden
2001-1631
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Administration and Public Assistance(970)352-1551.
Child Support(970)352-6933
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COLORADO
MEMORANDUM
TO: M.J. Geile, Chair Date: June 14, 2001
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services
.44tial,to
RE: Child Protection Agreement for Core Servi s Between the Weld
County Department of Social Services and Lutheran Social
Services of Colorado, DBA, Lutheran Family Services, Inc.
Enclosed for Board approval is a Child Protection Agreement for Core Services between
the Weld County Department of Social Services and Lutheran Social Services of
Colorado, DBA, Lutheran Family Services, Inc.
The major provisions of the Agreement are as follows:
1. The term of the Agreement commences June 1, 2001, and ends May 31, 2002.
2. The Department agrees to reimburse Lutheran a total not to exceed $38,000 for:
A. Adoption, Foster Care, and Expedited Permanency Planning Home
Studies at $728 for a full study and $364 for an update study.
B. Background checks for two adults in the family of$104.
C. Relinquishment Counseling at $107 per hour.
If you have any questions, please telephone me at extension 6510.
2001-1631
Contract No. 01-CPS-9
CHILD PROTECTION AGREEMENT FOR CORE SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AND LUTHERAN SOCIAL SERVICES OF COLORADO, DBA, LUTHERAN FAMILY
SERVICES, INC.
This Agreement,made and entered into the 1ST day of June, 2001,by and between the Board
of Weld County Commissioners, on behalf of the Weld County Department of Social Services,
hereinafter referred to as "Social Services," and Lutheran Social Services of Colorado, DBA
Lutheran Family Services, hereinafter referred to as "Lutheran Family Services."
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from
and with appropriate agencies; and
WHEREAS, Expedited Permanency Planning and the Colorado Children's Code requires,
among other things, Social Services to provide adoption studies and home studies of eligible clients;
and,
WHEREAS, the Colorado Department of Human Services has provided Child Welfare
Regular Administration and Expedited Permanency Planning funds; and
WHEREAS, Social Services and Lutheran Family Services desire to enter into an agreement
in providing adoption studies and home studies.
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree
as follows:
1. Term
This Agreement shall become effective on June 1, 2001, upon proper execution of this
Agreement and shall expire May 31, 2002.
2. Scope of Services
Services shall be provided by Lutheran Family Services to any person(s) eligible for child
protection services in compliance with Exhibit A "Scope of Services," a copy of which is
attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule," a copy of
which is attached and incorporated by reference.
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"Payment Schedule"shall establish the maximum reimbursement,which will be paid
from Child Welfare Regular Administrative and Expedited Permanency Planning
Funds during the duration of this Agreement.
b. Lutheran Family Services shall submit an itemized monthly bill to Social Services
for all costs incurred and services provided pursuant to Exhibit A of this Agreement
in accordance with criteria established by Social Services. The Contractor shall
submit all itemized monthly billings to Social Services no later than the twenty-fifth
(25) day of the month following the month the cost was incurred.
Failure to submit monthly billings in accordance with the terms of this agreement
shall result in Lutheran Family Services forfeiture of all rights to be reimbursed for
such expenses. In the event of a forfeiture of reimbursement, Lutheran Family
Services may appeal such circumstance to the Director of Social Services. The
decision of the Director of Social Services shall be final.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon
the availability of Child Welfare Regular Administrative and Expedited Permanency
Planning funds to Social Services.
d. Social Services shall not be billed for, and reimbursement shall not be made for time
involved in activities outside of those defined in Exhibit A. Work performed prior
to the execution of this Contract shall not be reimbursed or considered part of this
Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,
Lutheran Family Services shall comply with the administrative requirements,cost principles
and other requirements set forth in the financial Management Manual adopted by the State
of Colorado. The required annual audit of all funds expended under Family Issues Cash Fund
must conform to the Single Audit Act of 1984 and OMB Circular A-128.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. Lutheran Family Services shall provide proper monthly invoices and verification of
services performed for costs incurred in the performance of this agreement.
b. Social Services may withhold any payment if Lutheran Family Services has failed
to comply with the Financial Management Requirements, program objectives,
contractual terms, or reporting requirements. In the event of a forfeiture of
reimbursement, Lutheran Family Services may appeal such circumstance to the
Director of Social Services. The decision of the Director of Social Services shall be
final.
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Contract No. 01-CPS-9
c. Lutheran Family Services will notify Weld County Department of Social Services
in writing when 25 adoption/foster care home study referrals have been made. This
will not include EPP home studies.
6. Assurances,
Lutheran Family Services shall abide by all assurances as set forth in the attached Exhibit
C, which is attached hereto and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, Lutheran Family Services shall strictly
adhere to all applicable federal and state laws, orders, and all applicable standards,
regulations, interpretations or guidelines issued pursuant thereto. This includes the
protection of the confidentiality of all applicant/recipient records,papers, documents, tapes
and any other materials that have been or may hereafter be established which relate to this
Contract. Lutheran Family Services acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 els seq and its
implementing regulation, 45 C.F.R. Part 80 eet, seq.; and
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its
implementing regulation, 45 C.F.R. Part 84; and
the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 I. seq. and its
implementation regulation, 45 C.F.R. Part 91; and
Title VII of the Civil Rights Act of 1964; and
the Age Discrimination in Employment Act of 1967; and
the Equal Pay Act of 1963; and
the Education Amendments of 1972; and
Immigration Reform and Control Act of 1986, P.L. 99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
national origin, and, sex, religion and handicap, including Acquired Immune Deficiency
Syndrome (AIDS) or AIDS related conditions, covered under Section 504 of the
Rehabilitation Act of 1973, as amended, cited above. Included if 45 C.F.R. Part 74
Appendix G 9, which requires that affirmative steps be taken to assure that small and
minority businesses are utilized, when possible, as sources of supplies, equipment,
construction and services. This assurance is given in consideration of and for the purpose
of obtaining any and all federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a
complaint either with the Colorado Department of Human Services or with the U.S.
Department of Health and Human Services, Office for Civil Rights.
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8. Certifications
Lutheran Family Services certifies that, at the time of entering into this Contract, it has
currently in effect all necessary licenses, approvals, insurance, etc. required to properly
provide the services and/or supplies covered by this contract.
9. Monitoring and Evaluation
Lutheran Family Services and Social Services agree that monitoring and evaluation of the
performance of this Agreement shall be conducted by Lutheran Family Services and Social
Services. The results of the monitoring and evaluation shall be provided to the Board of
Weld County Commissioners and the Lutheran Family Services Board.
Lutheran Family Services shall permit Social Services, and any other duly authorized agent
or governmental agency, to monitor all activities conducted by the contractor pursuant to the
terms of this Agreement. As the monitoring agency may in its sole discretion deem
necessary or appropriate, such program data, special analyses, on-site checking, formal audit
examinations,or any other reasonable procedures. All such monitoring shall be performed
in a manner that will not unduly interfere with agreement work.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Social Services or designee may exercise the following remedial actions
should s/he find Lutheran Family Services substantially failed to satisfy the scope of work
found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to
mean incorrect or improper activities or in action by Lutheran Family Services. These
remedial actions are as follows:
a. Withhold payment to Lutheran Family Services until the necessary services or
corrections in performance are satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by Lutheran Family
Services cannot be performed or if performed would be of no value to the Social
Services. Denial of the amount of payment shall be reasonably related to the amount
of work or deliverables lost to Social Services;
c. Incorrect payment to Lutheran Family Services due to omission, error, fraud, and/or
defalcation shall be recovered from Contractor by deduction from subsequent
payments under this Agreement or other agreements between Social Services and
Lutheran Family Services, or by Social Services as a debt due to Social Services or
otherwise as provided by law.
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12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby-designated
representatives of the respective parties. Either party may from time to time designate in
writing a new or substitute representative(s):
For Social Services:
Frank Aaron M.S.W. Social Services Administrator
Name Title
For Lutheran Family Services:
Jim Barclay. President & C.E.O._
Name Title
13. Notice
All notices required to be given by the parties hereunder shall be given by certified or
registered mail to the individuals at the addresses set forth below. Either party may from
time to time designate in writing a substitute person(s)or address to which such notices shall
be sent:
To: Social Services To: Lutheran Family Services
Judy A. Griego.Director Jim Barclay. President & C.E.O
P.O. Box A 3800 Automation Way#200
Greeley. CO 80632 Ft. Collins. CO 80525
14. Litigation
Lutheran Family Services shall promptly notify Social Services in the event that Lutheran
Family Services learns of any actual litigation in which it is a party defendant in a case which
involves services provided under this Agreement. Lutheran Family Services within five(5)
calendar days after being served with a summons, complaint, or other pleading which has
been filed in any federal or state court or administrative agency, shall deliver copies of such
document(s) to the Social Services Director. The term "litigation" includes an assignment
for the benefit of creditors, and filings in bankruptcy,reorganization and/or foreclosure.
15. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written
notice and is subject to the availability of funding.
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Contract No. 01-CPS-9
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding
between the parties with respect to the subject matter hereof, and may not be changed or
modified except as stated in Paragraph 10 herein.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above
Jb�ov e�written.
ATTEST: �� �p�//// /401.1"4%
WELD COUNTY 0 • BOARD OF COUNTY
CLERK TO THE BOARD I l . • COMMISSIONS WELD COUNTY,
COLO
y: �/��� By �Ll v
B ���z
Deputy Clerk •
M. J. Geile, Chair (06/20/2001)
O DASD
ty Atto
WELD COUNTY DEPARTMENT LUTHERAN FANU ,Y SERVICES,
INC.
OF SOCIAL SERVICES
By: By: ,/
Ju y . Gri o, Direct arc ay, r sident CEO
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Contract No. 01-CPS-9
EXHIBIT A
SCOPE OF SERVICES
1. Target/Eligible Population
The population to be served under this contract includes (1) families who wish to adopt
children from Weld County Department of Social Services, (2) relinquishment counseling
for parents who are considering relinquishing children, (3) applicants for foster care
certification, and(4) children identified as expedited permanency planning.
2. Types of Services to be Provided-Adoption. Foster Care. and Expedited Permanency
Planning Home Study Content
These studies will be conducted in compliance with the uniform format utilized
by the State of Colorado Department of Human Services since October 1, 1999
(Exhibit `D'). A written home study will be provided to Weld County Department
of Social Services.
All Lutheran Family Services staff members conducting home studies will be
listed on the State of Colorado Department of Human Services home study vendor
list, having applied for inclusion(Exhibit `E').
A. Background Checks
The following background checks will be completed unless otherwise indicated
on the referral form. This background check will be completed for all individuals
living in Colorado.
• Fingerprints sent to CBI on Weld County Department of Social Services
cards, results will be returned directly by CBI to Weld County Department of
Social Services. Lutheran Family Services will distribute, collect and submit
the fingerprint cards. Lutheran Family Services will pay CBI the processing
fee. If the individual has lived in the state less than two years, an FBI search
will be requested.
• Department of Motor Vehicles
• Local County DSS search for open case
• Reference questionnaires will be sent out and returned to Lutheran Family
Services with SASE
• Local police department
• Central Registry
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All original background check information will be forwarded to the Weld County
Department of Social Services with the written home study. A copy will be
retained in our files for the mandated length of record retention.
B. Capacity
Lutheran Family Services has been accommodating 10-15 home studies at any
given time. Lutheran Family Services is willing to hire additional staff to
complete these home studies if there is demonstration of a sustained need by Weld
County Department of Social Services.
C. Fee Schedule
Tier One: $104.00
This covers the cost of background checks on two adults in the family. Additional
adult background checks will be charged out at $52 per adult.
Tier Two: $728.00
This fee is the fee for a full home study (plus cost of background check) on a two-
parent (adult) family. Additional adults included in the home study will be
charged out at a rate of$250 each.
Tier Three: $364.00
This fee is for a home study update. The original written home study needs to be
provided to Lutheran Family Services. This fee does not include a repeat of the
background check on the family.
An individual referral form will be submitted for each family that will be billable
as a separate study for the same children.
D. Service Objectives
The objective is to have quality adoptive home studies done in a timely manner.
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E. Service Time Frames
Six weeks from initiation, time frame is subject to timely submissions by family
being studied, including fingerprints, Central Registry check, application, and
reference information.
F. Measurable Outcomes
a) More expedient placement of children
b) Quality adoptive home studies that are done in a timely manner
3. Relinquishment Counseling
A. This service will be conducted with Weld County Department of Social Services'
guidelines (Exhibit 'F')
B. The service will be completed and court ready within two weeks after receipt of
the referral.
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Contract No. 01-CPS-9
EXHIBIT B
PAYMENT SCHEDULE
1. Fee Schedule
Weld County Department of Social Services agrees to reimburse to Lutheran Family
Services, Inc. $728.00 plus cost of background check(s) for each Adoptive, Foster Care
and Expedited Permanency Planning(EPP)home study, and $107.00 per hour for
relinquishment counseling, a total not to exceed $38,000.00 for the 2001-2002 contract
year.
Payment pursuant to this Contract, if Child Welfare Regular Administrative funds,
whether in whole or in part, is subject to and contingent upon the continuing availability
of Child Welfare Regular Administrative funds for the purpose hereof. In the event that
said funds, or any part thereof,become unavailable as determined by Social Services,
Social Services may immediately terminate this Contract or amend it accordingly.
2. Payment pursuant to this Contract, if Expedited Permanency Planning funds,whether in
whole or in part, is subject to and contingent upon the continuing availability of
Expedited Permanency Planning funds for the purpose hereof. In the event that said
funds, or any part thereof, become unavailable as determined by Social Services, Social
Services may immediately terminate this Contract or amend it accordingly.
3. Weld County Department of Social Services agrees to pay travel mileage costs for any
study that requires to travel over 100 miles one way. Weld County Department of Social
Services agrees to pay at a rate of 30.50 per mile in excess of 200 miles round trip.
Lutheran Family Services agrees to provide documentation of mileage traveled.
4. Relinquishment Counseling will be reimbursed at a rate of$107.00 per face to face
contact hour.
5. A fee of$50.00 will be paid to Lutheran Family Services by Weld County Department of
Social Services for out of office 'no shows'. This fee will be paid for home study 'no
shows' as well as those involving relinquishment counseling. Unsuccessful efforts to
contact the client(s)must be documented.
Expenses incurred by Lutheran Family Services, in association with said project prior to
the term of this agreement, are not eligible Social Services expenditures and shall not be
reimbursed by Social Services.
Social Service referrals will not be sent to collections by Lutheran Family Services for
default of co-pay/fees. Services will be performed regardless of client's refusal or
inability to pay co-pay.
Lutheran Family Services will collect any applicable sliding scale co-pays and credit
Social Services for any payments received on the monthly billing statements.
6. Submittal of Vouchers
Lutheran Family Services shall prepare and submit monthly the itemized voucher and
certify that the services authorized were provided on the date indicated and the charges
made were pursuant to the terms and conditions of Exhibit A.
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Contract No. 01-CPS-9
EXHIBIT C
ASSURANCES
1. Lutheran Family Services agrees it is an independent contractor and that its officers and
employees do not become employees of Weld County, nor are they entitled to any
employee benefits as Weld County employees, as the result of the execution of this
Agreement.
2. Weld County, the Board of County Commissioners of Weld County, its officers and
employees, shall not be held liable for injuries or damages caused by any negligent acts
or omissions of Lutheran Family Services or its employees, volunteers, or agents while
performing duties as described in this Agreement. Lutheran Family Services shall
indemnify, defend, and hold harmless Weld County, the Board of County Commissioners
of Weld County, its employees, volunteers, and agents. Lutheran Family Services shall
provide adequate liability and worker's compensation insurance for all its employees,
volunteers, and agents engaged in the performance of the Agreement upon request,
Lutheran Family Services shall provide Social Services with the acceptable evidence that
such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the
parties or their officers or employees may possess, nor shall any portion of this
Agreement be deemed to have treated a duty of care with respect to any persons not a
party to this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the
County of Weld, State of Colorado, to expend funds not otherwise appropriated in each
succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for
any reason held or decided to be unconstitutional, such decision shall not effect the
validity of the remaining portions. The parties hereto declare that they would have
entered into this Contract and each and every section, subsection,paragraph, sentence,
clause, and phrase thereof irrespective of the fact that any one or more sections,
subsections, paragraphs, sentences, clauses, or phrases might be declared to be
unconstitutional or invalid.
6. No officer, member or employee of Weld County and no member of their governing
bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or
the proceeds thereof.
7. Lutheran Family Services assures that they will comply with the Title VI of the Civil
Rights Act of 1986 and that no person shall, on the grounds of race, creed, color, sex, or
national origin,be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under this approved Contract.
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Contract No. 01-CPS-9
8. Lutheran Family Services assures that sufficient, auditable, and otherwise adequate
records that will provide accurate, current, separate, and complete disclosure of the status
of the funds received under the Contract are maintained for three (3)years or the
completion and resolution of an audit. Such records shall be sufficient to allow
authorized local, Federal, and State auditors and representatives to audit and monitor
Lutheran Family Services.
9. All such records, documents, communications, and other materials shall be the property
of Social Services and shall be maintained by Lutheran Family Services, in a central
location and custodian, in behalf of Social Services, for a period of three (3)years from
the date of final payment under this Contract, or for such further period as may be
necessary to resolve any matters which may be pending, or until an audit has been
completed with the following qualification: If an audit by or on behalf of the federal
and/or state government has begun but is not completed at the end of the three (3)year
period, or if audit findings have not been resolved after a three(3) year period, the
materials shall be retained until the resolution of the audit finding.
10. Lutheran Family Services assures that authorized local, federal and state auditors and
representatives shall, during business hours, have access to inspect any copy records, and
shall be allowed to monitor and review through on-site visits, all contract activities,
supported with funds under this Contract to ensure compliance with the terms of this
Agreement. Contracting parties agree that monitoring and evaluation of the performance
of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
11. This Contract shall be binding upon the parties hereto, their successors, heirs, legal
representatives, and assigns. Lutheran Family Services or Social Services may not assign
any of its rights or obligations hereunder without the prior written consent of both parties.
12. Lutheran Family Services certifies that Federal appropriated funds have not been paid or
will be paid, by or on behalf of Lutheran Family Services, to any person for influencing
or attempting to influence an officer or employee of an agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any federal grant,
the making of any federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any Federal contract,
loan, grant, or cooperative agreement.
13. Lutheran Family Services assures that it will fully comply with the Children's Code
regulations promulgated, and all other applicable federal and state laws, rules and
regulations. Lutheran Family Services understands that the source of funds to be used
under this Contract is: Family Issues Cash Funds.
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Contract No. 01-CPS-9
14. Lutheran Family Services assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by a federal
department of agency.
b. Have not, within a three-year period of preceding this Agreement, been convicted
of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, state, or local)transaction or contract under a public transaction;
violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a
government entity(federal, state, or local)with commission of any of the offenses
enumerated in paragraph 11(b) of this certification; and
d. Have not within a three-year period preceding this Contract, had one or more
public transactions (federal, state, and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with
Social Services when Lutheran Family Services also maintains a relationship with a third
party and the two relationships are in opposition. In order to create the appearance of a
conflict of interest, it is not necessary for the contractor to gain from knowledge of these
opposing interests. It is only necessary that the contractor know that the two relationships
are in opposition.
During the term of the Contract, Lutheran Family Services shall not enter any third party
relationship that gives the appearance of creating a conflict of interest. Upon learning of
an existing appearance of a conflict of interest situation, Lutheran Family Services shall
submit to Social Services, a full disclosure statement setting forth the details that create
the appearance of a conflict of interest. Failure to promptly submit a disclosure statement
required by this paragraph shall constitute grounds for Social Services' termination, for
cause, of its contract with Lutheran Family Services.
16. Lutheran Family Services shall protect the confidentiality of all applicant records and
other materials that are maintained in accordance with this Contract. Except for purposes
directly connected the administration of the Child Protection,no information about or
obtained from any applicant/recipient in possession of Lutheran Family Services shall be
disclosed in a form identifiable with the applicant/recipient or a minor's parent or
guardian. Lutheran Family Services shall have written policies governing access to,
duplication and dissemination of, all such information. Lutheran Family Services shall
advise its employees, agents and subcontractors, if any, that they are subject to these
confidentiality requirements. Lutheran Family Services shall provide its employees,
agents, and subcontractors, if any, with a copy or written explanation of these
confidentiality-requirements before access to confidential data is permitted.
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17. Proprietary information for the purposes of this contract is information relating to a
party's research, development, trade secrets,business affairs, internal operations and
management procedures and those of its customers, clients or affiliates,but does not
include information (1) lawfully obtained from third parties, (2)that which is in the
public domain, or(3) that which is developed independently.
Neither party shall use or disclose directly or indirectly without prior written
authorization any proprietary information concerning the other party obtained as a result
of this Contract. Any proprietary information removed from the State's site by Lutheran
Family Services in the course of providing services under this Contract will be accorded
at least the same precautions as are employed by Lutheran Family Services for similar
information in the course of its own business.
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EXHIBIT I)
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- • - = - - - ASSESSMENT-OF-FOSTER HOME AND ADOPTIVE HOME
A. Content of the Assessment
The assessment shall include, but not be limited to, the following:
1. Social History/Background —Adult(s)
History Element What is the foster/adoptive parents' childhood
and adult history? Consider the individual's cultural context in your •
description. -
Specific areas include: unusual circumstances regarding birth; early
childhood; developmental factors; family composition/dynamics;
family history of medical and emotional health; use of drugs or
alcohol; strengths of relationships and lessons learned from less
positive relationships; Siblings— past and present relationship with
each. Parent(s)—education, occupation, personality, family
discipline practices (as a child/adolescent); past and present
relationship with each. Personal - physical, sexual or emotional
abuses history and how issues have been dealt with; use of drugs
or alcohol; physicaVmental health (include addictive personality
qualities, history of gambling or pornography); childbearing or
infertility; arrests or legal encounters; relationships (including other
races/cultures); marriages, divorces, births (include number of
pregnancies and number of children born to the individual);
employment; education; number and type of foster/adoptive
placements (child protective services, juvenile justice, other);
placement success or disruption; other information.
2. Adult General Functioning Element How does the adult function
with respect to daily management and general adaptation?
Specific areas include: problem solving capacity/history;
response/reaction to stress, ability to communicate, styles of
communication; cognitive functioning; ability to make
judgments/decisions and capacity/history to 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; expressions of
emotions/feelings/general temperament; attitudes towards people
similar/different races/alternative lifestyles, cultures, religions;
attitudes toward and response to sexual contact between children
(if appropriate); homophobia; substance use issues; mental health
issues; history of losses, strengths/weaknesses, ability to make
decisions; values.
3. Parenting— Discipline: What are the disciplinary approaches used
by the potential foster/adoptive parent, including the typical
context?
Specific areas include: view of the role/purpose of discipline
(teaching, punishment, safety, etc.); attitude towards corporal
punishment; parenting practices in the family in terms of
expectations, frustrations, supervision, and disciplinary approaches.
Ability to set limits, provide consistency, structure. Specifically
• include discipline used with foster children, birth and adopted
children, grandchildren, daycare, etc.; Flexibility in consequencing
behaviors; openness to new discipline techniques; typical
responses to control and power issues; experience with children;
other information.
4. Parenting — Values and Practice: What are the overall, typical,
pervasive parenting practices used by the applicant or
foster/adoptive parent?
Specific areas include: parenting practices in the family in terms of
sensitivity, concern, provision of basics; comfort with parent/foster
parent role; expectation for mutual attachment; ability to parent
transraciaVtranscufural child if appropriate; school attendance of all
children; parent's school involvement; dress, hygiene, general
appearance of children; rules and responsibilities of children in the
home; attitudes towards education, religion, and community
activities parent's ability to meet birth, foster and adopted children's
emotional needs (time alone with parent, parent's ability to
individuate children, etc.); knowledge of child development and
special needs children; any reports of child maltreatment and
investigations; If applicant has been a foster parent prior to the
adoption application include such things as: inclusion of foster
children in vacations and; treatment of birth and adoptive vs. foster
children (eating, privileges, clothing etc.); other information.
5. Children (Include all children birthed or parented)
Child Functioning: How does the child function on a daily basis?
Specific areas include: general temperament, expressions 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 including emancipation of children;
•
- - -- "child's ability to-accept a foster/adoptive chili in the.family;-issues=- -
related to racial/cultural identity; other information.
6. Family System
Family Functioning: How does the family function, communicate,
and interact? Consider the family's cultural context as you describe
family functioning.
• Specific areas include: family structure and flexibility; clarity of
roles and boundaries (including roles of/with foster children), who is
in charge, how family decisions are reached, the level and type of
communication used, the presence and use of affection, identify
other persons who are permanent residents in family; ancillary
family functions such as care of elderly parents or other family
members— roles and responsibilities as well as time commitments,
distance factors, etc open/cbsed to transracial, transcultural, and
religious experiences; general feelings/climate within the family;
other information. When completing the assessment, the Quality
Standards for 24-Hour Child Care section 7.714 should be
consulted.
Adult Relationships/Marriage: What effects has
fostering/adopting had on family relationships? What effect will a
defiant/acting out child/adolescent have on the entire
family/marriage?
Specific areas include: discuss current marriage, marital issues;
unresolved infertility issues of couple (if appropriate);
presence/absence of family violence; decision making; discuss
conflict/stress on marriage; communication; strengths and
weaknesses of relationship. If the family has been providing foster
care at the time of the adoption consider effects of fostering on
family relationships including marital.
7. Family Support Network: 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.
Specific areas include: nature of extended family support; support
of nonrelated persons (friends, confidantes); openness of family to
mentors/other adult input in children's lives; involvement/support of
organizations, clubs, churches, agencies; involvement/support of
neighbors, business and social associates; if this adoption applicant
family has been providing foster care consider extended family and
- -- - - - friends' relationship with foster children; relationships with other -.
-
foster parents/families; other information.
8. Demographics: What are the demographics of family? Consider
the family's cultural context as you describe demographics. Inform
family that a subsidized adoption may be available based on the
child's eligibility.
Specific areas include: assess financial situation; employment;
Description of home, neighborhood (include current
• racial/cultural/religious integration and community resources);
health problems (include life and health insurance information);
financial dependence on foster care; stresses related to
demographics and how handled (e.g., medical, bankruptcy, family
moves, household members leaving); references; valid drivers
license and car insurance; other information.
9. Birth Family
Viewpoint of Birth Parent(s): How do the foster/adoptive
parent(s)view maltreatment, parents who maltreat their children,
parents who place their children in foster care, and parents whose
children are placed by a court in foster care? When re-licensing,
examine the attitude toward the birth family and
understanding/support of positive relationships and/or memories of
birth family. What will they tell child about their birth parent(s) at
different developmental stages?
Specific areas include: when re-licensing, contact with birth
parents and learning gained from the experience; general learning
regarding birth parents;.attitude toward openness in adoption;
ability and willingness to transport to and from visits; attitudes
toward teens and families with different values; ability to help
children cope with separation, loss, and grief; other information.
Viewpoint Towards Foster/Adopted Child(ren): How does the
parent view children placed in foster care? My differences in view
based on type/age/race/culturaUreligion of the child?
Specific areas include: perceptions about what sorts of children are
available, feelings/attitude toward and treatment of foster/adopted
children) (general, and specific to their foster/adopted children if
re-licensing or placement currently exists); consider presentation of
foster/adopted children to community (sensitivity, advocacy);
attitudes toward teen issues (like same sex sexual preferences;
being sexually active, being bi-racial, and tolerance of adolescent
_ behaviors);_behaviors not acceptable to family,_and..any-that are- -. _
questionable based on overall study results and reference input;
capacity to deal with academic problems, school behaviors, and/or
ongoing need for involvement with the special education system;
knowledge of developmental tasks; tolerance of adolescent
behaviors; degree of difficulty the family can handle; type of child
desired and appropriate; other information.
10. Foster/Adoptive Family Preparation: How prepared is the family
for fostering/adoption? How able is the family to provide
• foster/adoptive children with racial, cultural, and religious
experiences? Include issues related to visitation with birth relatives
and reunifications as appropriate. When re-licensing, 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/adoption, including jealousy issues; ability of foster family
children to deal with older child in home; parents' specific
capabilities as related to foster/adoptive parenting; ability of
foster/adoptive family to deal with dysfunctional child(ren)/youth;
ability to be flexible in meeting the multiple needs of child (e.g. time
necessary to deal with wrap around services, involvement with
other agencies and services, tolerate treatment team members in
home, expedited permanency and legal risk factors); when re-
licensing consider effects of foster parenting on extended family;
attachment to foster/adoptive children, and feelings about foster
children who may have left the home; other information.
11. Motivation/Commitment: What is the nature and level of
motivation and commitment demonstrated by the family? How is
the family preparing themselves for fostering/adoption? Include
fertility issues as appropriate.
Specific areas include: basis/reasons for motivation/commitment
(e.g., status, financial, emotional, adoption, own needs, service to
community, etc.); ability to re-evaluate and adjust expectations;
child care plans; ability for parent to take Family Medical Leave;
other information.
12. Intervention
Family Response: How capable are the potential foster/adoptive
parent(s) to use agency involvement and to seek help on their
own? Include willingness of family to seek cross-cultural models
and experiences.
Specific areas include; relationship with agency staff(includes.
willingness to receive consultation/advice); relationship with other
professionals; ability to share information; willingness to keep
information confidential; willingness to keep schedules and
appointments; willingness to initiate or continue prescribed services
or medications; resourcefulness in pursuit of services; participation
in foster/adoptive parent activities (e.g., newsletter, foster/adoptive
parent association/support groups, parties/picnics, and provide/use
respite care); when re-licensing also consider preparation of foster
children for removal from home (includes gathering belongings,
• handling good byes. Also identify any rule/contract violations and
corrective/action plan, if appropriate; cooperate with the courts,
past involvement with social services; other information.
13. Resource(s) Needed to Support the Placement: What are the
resources, external to the foster/adoptive family, which support the
placement(s)?
Specific areas include: the availability of support to the family 24
hours a day, including agency/staff resources; other information.
How are they educating themselves at caring for abused and
neglected children?
14. Training: What kind(s) of training(s) is the parent now enrolled,
needs to enroll in or completed related to foster/adoptive parenting?
Include ongoing training services and support groups. .). Indicate
summary of training attended since last licensure.
Specific areas include: training completed or needed regarding
chronological vs. developmental age functioning of children; the
• parent's viewpoint of birth parents/family; regarding developmental
stage of the adoption relationship and effects on family functioning,
regarding adolescent issues; concerning parent's viewpoint of
foster children' when re-licensing.
15. Conclusions/Recommendations: Does the parent have the
ability to provide and meet the safety needs of the foster/adoptive
child? What condition(s) need remedying or strengthening?
Describe the type of children) that should be considered for this
family by age, sex, race, legal risk and special needs (such as
medical, physical, emotional).
Contract No. 00-CPS-9
EXHIBIT E
Page 1 of 1
•
•
APPLICATION FOR INCLUSION -ADOPTION HOME ASSESSMENT VENDOR LIST
. Full Name of Applicant Agerx County Dept.,or Indivi lszal _K Licensed.,CAild Placement
-FEIN Number-or _..
Agency -Provider Number Social Security Number
Mailing Address _
Daytime Telephone Message Telephone
Street P.O.Box,RR. City Slate Zip Code ( ) ( )---
Ph Area Code-Number Area Code-Number
ysical Address(t different from above)
Email address Fax Number
Street,P.O.Box,RR. City State Zip Code .
Area Code-N�r
Is application made for —Child Placement Agency Personnel If application is made for public or private agency,total
County Department Personnel number of personnel assigned to adoptive home
Individual(includes county contract assessment workload.
workers)
If individual,state all other employment obligations: Name of Professional Liability Insurance Company: —
Name of Employer His/week
Amount of Coverage:
Affirm That State of Colorado is fisted as co-insured:
_Yes _No
Total number of personnel to perform Home Assessments:
Total number of hours/week devoted to Home Assessments:
REQUIRED ATTACHMENTS:
1. List of all employees who will perform home assessments,including each
a. Degree(Bachelors,Masters or Doctorate in a Human Service related held such as Psychology,Sociology
Child Development,Social Work,Health and Education from an accredited college or university.)There is no
substitution for education requirement.
b. Years of experience performing home assessments(three years
protection,foster care or meet thexpe experience in child placement,child
who meets the above criteria supervise
individual or does not the requirement,an individual
-2. Proof of Insurance. ��n^5e him her.
3. Copy of each person's diploma.
4. Description of primary agency or indvidual functions and relevant activities that will enhance involvement in the
adoption home assessment process.
NOTE
1. A,separate application must be filed for each agency or individual.
2. Submission of application does not guarantee the agency or individual shall be included on the Vendor List.
The completed application and supporting documentation should be sent to:
State Department of Human Services
Division of Child Welfare Services
Attn: Adoption Unit, 1575 Sherman Street, Denver, CO 80203
Contract No. 00-CPS-9
EXHIBIT F
WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
RELINQUISHMENT COUNSELING OUTLINE
Background of case:
Where are the children, why are they in custody of Weld County Department of Social Services?
Reason(s)for relinquishment:
Other options considered:
How long have the parent(s)been considering relinquishment?
Relinquishment does not automatically absolve the parent(s) of financial responsibility for the
child(ren). The courts will make a determination.
Savers all rights—is permanent
Does the parent(s)feel pressured by anyone?
Is relinquishment in the child's best interest?
What will relinquishment change for the child?
Is a final good-bye visit necessary?
Who is the attorney?
Who is G.A.L.?
Who is the caseworker?
Native American Status:
Page 1 of 3
DISTRICT COURT, COUNTY,COLORADO
Case No. ,Division
AFFIDAVIT OF RELINQUISHMENT COUNSELING
The People of the State of Colorado
In the Matter of the Petition of:
and Petitioner(s)
For the relinquishment of a Child, (child's name)
I• of County Department of Social
Services/Child Placement Agency,state that I provided counseling to
on (date)concerning Petitioner's Petition of Relinquishment filed in the
District Court, County,State of Colorado.
I. The nature and extent of counseling included the following:
❑ Information to Petitioner concerning the permanence of the decision to relinquish and the impact of the decision
on Petitioner now and in the future.
❑ Information was obtained from Petitioner about the complete medical and social histories of both the child's
parents.
❑ If Petitioner was pregnant,Petitioner was referred for medical care and a determination of eligibility for medical
assistance.
❑ Information about alternatives to relinquishment and a referral to private and public resources that may meet
the parents'needs.
❑ Information about relinquishment services nee'ssary to protect the interests and welfare of the child if the child
was born in a state institution.
❑ Information that if Petitioner applies for public assistane for Petitioner or the child, Petitioner must cooperate
with the Child Support Enforcement Unit for the establishment of a child support order.
❑ That all information,except non-identifying information as defined in Section 19-1-103(80), CRS,obtained in
the course of relinquishment counseling,is confidential,unless the parent provides written information or a court
orders a release of information.
❑ Other counseling provided:
2.
❑ The afrant has prepared a letter as"Exhibit A"that outlines the process of relinquishment counseling in more
detail.
JOE 453 0/97 AFFIDAVIT OF RELINQUISHMENT COUNSELING __.
3.
❑ The child is a member of,or eligible to be a member of,an Indian tribe as defined by the Indian Child Welfare
Act.
❑ The child is not a member of, or eligible to be a member of, an Indian tribe as defined by the Indian Child
Welfare Act.
4.
❑ A copy of the child's original birth certificate is attached to this Affidavit.
❑ A copy of the application for an original birth certificate is attached to this Affidavit.
5.
❑ No payments,gifts,assistance,gonk or services were given,promised or offered to Petitioner in connection with
the pregnancy,birth,or proposed relinquishment of the child.
❑ The following payments, gifts, assistance, goods or services were given, promised or offered to Petitioner in
connection with the pregnancy,birth,or proposed relinquishment of the child.
6. The following recommendations were made:
Date ,dam
Subscribed under oath before me on
Deputy Clot/Notary Public
My commission expires:
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