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HomeMy WebLinkAbout20011393.tiff RESOLUTION RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE FOR OPTION B - HOME BASED INTENSIVE AND AUTHORIZE CHAIR TO SIGN -ACKERMAN AND ASSOCIATES, P.C. 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 Notification of Financial Assistance Award for Option B - Home Based Intensive 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 Ackerman and Associates, P.C., commencing June 1, 2001, and ending May 31, 2002, with further terms and conditions being as stated in said award, and WHEREAS, after review, the Board deems it advisable to approve said award, 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 Notification of Financial Assistance Award for Option B - Home Based Intensive 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 Ackerman and Associates, P.C., be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said award. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 30th day of May, A.D., 2001. BOARD OF COUNTY COMMISSIONERS WELD CO TY, COLORADO ATTEST: MkS jEIG `, Thtr Weld County Clerk to tlje ' ar. � lenn Va , - e BY: Deputy Clerk to the Boas'+U N fr, ♦ I Wi ' m . Jerke APPROVE AS F . vid E Long n^ my At orn Robert D. as en 2001-1393 fa : <5 5 SS0028 DEPARTMENT OF SOCIAL SERVICES PO BOX A GREELEY,CO 80632 1 WEBSITE:www.co.weld.co.us Administration and Public Assistance(970)352-1551 , Child Support(970)352.6933 COLORADO MEMORANDUM TO: M. J. Geile, Chair Date: May 23, 2001 Board of County Commissioners FR: Judy Griego, Director (, m Weld County Departme of S cial rvi es RE: PY 2001-2002 Notification of Financial Assistance Awards (NOFAA) under Core Services Funds-Ackerman& Associates, P.C. Enclosed for Board approval are the PY 2001-2002 Notifications of Financial Assistance Awards (NOFAA) for Families, Youth, and Children Commission (FYC) Core Services Funds, which are for the period of June 1, 2001,through May 31, 2002. The Families, Youth and Children Commission (FYC)reviewed proposals under a Request for Proposal process and are recommending approval of these bids. Ackerman and Associates, P.C. A. Option B, Home Based Intensive: A maximum of 84 families for an average of three hours per week of in-home services for a 20-week period. The average length of stay will be 60 hours. Rate is$99.50/hour per unit of service. B. Intensive Family Therapy: 1. Mediated Family Conflict Resolution and Short-term Intensive Family Therapy-Goal Achievement Program (GAP): A maximum of 14 families per month. Average capacity is,five families per month (60 per year). Maximum stay is 20 hours over a five-month period. The program has a capacity of providing Bicultural-bilingual services to 15 families per year. Rate is$99.50/hour. Page 1 of 2 MEMORANDUM TO M.J. GEJLE, CHAIR WELD COUNTY BOARD OF COMMISSIONERS RE: CORE SERVICE NOFAA PY 2001-2002 2. Family Group Decision Making: A maximum of four families per month (48 per year) involving the nuclear family,professionals involved in the case, and individual members of the extended family. Rate is$2,000 per family group conference. C. Sex Abuse Treatment: Projected maximum total per year is estimated at 36 families, the average monthly capacity is three families, the maximum stay is 46 sessions over a 12-month period. Group treatment is provided at an equivalent of five individual hour-long sessions. Rate is$99.50/hour. D. Foster Parent Consultation: Group training for a maximum of 12 participants with an average of four participants per group. Average stay is 12.5 hours. Telephone consultations for crisis management are available for a maximum of one-half hour per call. This program anticipates serving 60 family units. Rate is $90 an hour. Group rate per client is$45/hour. If you have any questions, please telephone me at extension 6510. of Page 2 of 2 Weld County Department of Social Services Notification of Financial Assistance Award for Families,Youth and Children Commission(Core)Funds Type of Action Contract Award No X Initial Award FY01-PAC-2001 Revision (RFP-FYC-(01010) Contract Award Period Name and Address of Contractor Beginning 06/01/2001 and Ackerman and Associates,P.C. Ending 05/31/2002 Option B—Home Based Intensive 1750 25th Avenue, Suite 101 Greeley,CO 80634 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Improve both individual and family functioning Award is based upon your Request for Proposal(RFP). through in-home services. Service to a maximum The RFP specifies the scope of services and conditions of 84 families. The service offers a range, on of award. Except where it is in conflict with this average, of three hours per week of in-home NOFAA in which case the NOFAA governs, the RFP services for a 20-week period. The average length upon which this award is based is an integral part of the of stay will be 60 hours. action. Special conditions Cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based Hourly Rate Per $99,50 on an hourly rate per child or per family. Unit of Service Based on Approved Plan 2) The hourly rate will be paid for only direct face-to-face contact with the child and/or family, as evidenced by client-signed verification form,and as specified in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly, and yearly cost per child and/or family. 4) Rates will only be remitted on cases open with, and enclosures: referrals made by the Weld County Department of X Signed RFP:Exhibit A Social Services. X Supplemental Narrative to RFP: Exhibit B 5) Requests for payment must be an original and submitted X Recommendation(X) to the Weld County Department of Social Services by X Conditions of Approval the end of the 25th calendar day following the end of the month of service. The provider must submit requests for payment on forms approved by Weld County Department of Social Services. Approvals: Program Official: By 2 BY M. J. G ile,Chair Judy Gri ,Dir ctor Board of Weld County Commissioners Weld ounty Department of Social Services Date: -3j --02OO/ Date: 5 3 of a0/-/393 Signed RFP: Exhibit A Ackerman & Associates RFP: 01010-Option B, Home Based Services INVITATION TO BID bas eel b/'7-toA 8 DATE:February 28, 2001 BID NO: RFP-FYC-01010 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-01010) for:Family Preservation Program--Home Based Intensive Family Intervention Program Family Issue's Cash Fund or Family Preservation Program Funds Deadline: March 23,2001,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 under the Statewide Family Preservation Program(C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement(C.R.S. 26-5.3-101). The Families, Youth and Children Commission wishes to approve services targeted to run from June 1, 2001,through May 31,2002, at specific rates for different types of service. The County will authorize approved'vendors and rates for services only. The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited,phased in intensity,and produce positive change which protects children,prevents or ends placement, and preserves families. 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 March 19. 2001 (After receipt of order) T BE SIGNED IN INK Joyce Shohet Ackerman, Ed.D. TYPED OR PRINTED SIGNATURE VENDOR Ackerman And Assoiciates P.C. tw\� 08,—) (Name) written Signature By Authorized 111 Officer or Agent of Vender ADDRESS 1750 25th Avenue Suite 101 TITLE President, Licensed Psychologist Crccley, CO 80631 DATE March 19, 2001 PHONE# X3333 The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 RFP-FYC-01010 Attached A HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL AND REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING FAMILY PRESERVATION PROGRAM 2001-2002 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2001-2002 BID#RFP-FYC-01010 NAME OF AGENCY: Ackerman and Associates P.C. ADDRESS: 1750 25th Avenue, Greeley, Co 30634 PHONE: ( 970) 353- 3373 ( fax 920 1c1-1174) CONTACT PERSON: Joyce Shohet Ackerman Ed.D. 111LE: President, Licensed Psychologist DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Home Based Intensive Family Intervention Program is a family strength focused home-based services to families in crisis which are time limited.phased intensity. and produce positive change which protects children.prevents or ends placement.and preserves families 12-Month approximate Project Dates: — 12-month contract with actual time lines of: Start June 1.2001 Start End May 31,2002 End TITLE OF PROJECT: Ackerman Home Based Option B Program Jayco Shnh°t 4rkermanFd D March 15, 2(101 Name and Signature of Person Preparing Document Date Joyce Shohet Ackerman Ed.D. czw.,e ,N,, C� ,., _ 0ib . 3 -" -0 \ Nam and ignat�lre Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid.For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2000-2001 to Program Fund year 2001-2002. Indicate No Change from FY 2000-2001 to 2001-2002 . Project Description x _y'- Target/Eligibility Populations x _x_ Types of services Provided x x Measurable Outcomes x Service Objectives x Workload Standards x ___x_ Staff Qualifications minor changes x Unit of Service Rate Computation x ___x. Program Capacity per Month minor changes x Certificate of Insurance Page 26 of 32 RFP-FYC-01010 Attached A Date of Meeting(s)with Social Services Division Supervisor: JT D j Comments by SSD Supervisor: o. 4 patibvtui enk� U�P� Y/0 ituide abo,,ctok , I.utt ) Wu} 3 -4-6/ Name and Signature of S D Supervisor Date Page 27 of 32 RFP-FYC-0]010 Attached A Program Category Home Based Intensive Fami y Intervention Program Bid Category Project Title Ackerman Home based Option B Program Vendor Ackerman And Associates P.C. PROJECT DESCRIPTION Provide a brief one-page description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total 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. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Therapeutic Services-includes re-parenting, family therapy, support groups,problem solving, communication skills,parent-child conflict management, etc. B. Concrete Services -means concentrated assistance in the development and enhancement of parenting skills, stress reduction,problem solving, hands-on parenting,budget management, recreational activities, etc. C. Collateral Services-teaching families to work with other community agencies such as drug and alcohol,health care,job training, information and referral, advocacy, etc. D. Crisis Intervention Services -including in-home counseling and other interventions available on a 24-hour basis. 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 28 of 32 RFP-FYC-01010 Attached A IV. MEASURABLE OUTCOMES Provide a two-page description of your expected measurable outcomes of the project. Address the following measurable outcomes: A. Child remains in home at time case is closed. B. Improvements in parental competency,parent/child conflict management and household management competency as measured by pre and post placement functional tests. C. Children who are currently in their own home will remain in their own home 12 months after the completion of Home Based Intensive Family Intervention family preservation services. D. Children currently in long-term placement who are provided reunification Home Based Intensive Family Intervention services will return to their own home and not reenter out-of- home placement 12 months after completion of Home Based Intensive Family Intervention services. E. Families who receive either family preservation or reunification services will not have a substantiated abuse or neglect 12 months after completion of Home Based Intensive Family Intervention services. F. Cases which receive either family preservation or reunification services by Home Based Intensive Family Intervention will measure"LOW"on the risk assessment devise at service closure. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Provide a one page description of your expected service objectives and quantitative measures. Address, at a minimum, the following ways the project will: A. Improve Family Conflict Management-Mediation and counseling designed to resolve conflicts and disagreements between parents and their children contributing to child maltreatment, running away and other status offenses. B. Improve Parental Competency-capacity of parents to maintain sound relationships with their children and provide care,nutrition,hygiene,discipline,protection, instructions, and supervision. C. Improve Household Management Competency-capacity of parents to provide a safe household environment for their children through competent household cleaning and maintenance,budgeting and purchasing. D. Improve Ability to Access Resources- services shall assist parents in learning to obtain help from other sources in the community and within the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. Page 29 of 32 RFP-FYC-01010 Attached A VI. WORKLOAD STANDARDS Provide a one page description of the project's work load standards and quantitative measures. Address, at a minimum,the following areas: A. Number of hours per day,week or month. (Minimum intensity of 3 hours per week per family.) B. Number of individuals providing the services. C. Maximum caseload per worker. (Minimum family caseload of 8-10.) D. Modality of treatment. 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. VII. STAFF QUALIFICATIONS Provide a one page description of staff qualifications and address, at a minimum, the following: A. Will your staff, including supervisors,who are providing direct services have the minimum qualifications in education and experience in Staff Manual Volume VII, Section 7.303.17, and Section 7.0006,Q, Colorado Department of Human Services? Describe. B. Total number of staff,including supervisors, available for the project. C. Will your staff have received mandated new caseworker training? D. Will your staff have knowledge in risk assessment? E. Will your staff have completed the required State Home Based Intensive Family Services training component? Page 30 of 32 RFP-FYC-01010 Attached A VIII. COMPUTATION OF DIRECT SERVICE RATE This form is to be used to provide detailed explanation of the hourly rate your organization will charge the Core Services Program 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 & (dam Hours [A] Total Clients to be Served o / Clients [B] COtal Hours of Direct Service for Year 7 L D Hours [C] (Line [A] Multiplied by Line [B]Cost per Hour of Direct Services $ 3-3 70 Per Hour [D] Total Direct Service Costs $ 3 00 en' [E] (Line [C] Multiplied by Line [D] ) Administration Costs Allocable to Program $ [ 00)-h) [F] Overhead Costs Allocable to Program $ / 0 D Plc [G] Total Cost, Direct and Allocated, of Program$ CO I� 18.° [H] Line [E] Plus Line [F] Plus Line [G] ) Anticipated Profits Contributed by this Program $ O [I] Total Costs and Profits to be Covered / Y S D by this Program(Line [H] Plus Line [I] ) $ 5 ,, [3] Total Hours of Direct Service for Year O 1 O [g] (Must Equal Line [C] ) Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of $ 9 / TO [Ll Social Services Page 31 of 32 Project Description, 2001- 2002 Option B Home Based Services Overview: Ackerman and Associates, P.C. proposes to continue to deliver an Option B Intensive Home Based program. We have had a very successful years of operation with WCDSS. To date we have treated approximately 180 cases in Weld County. The proposal presented here incorporates our combined experiences. Target families are either facing imminent out of home placement or the family has a member who has returned from foster placement. These services are designed to help maintain placement at home or to help reunification succeed. Review of the case will occur at 30 and 45 hours of treatment. Treatment will be continued after thirty hours only if progress is being made. Purpose: We propose to continue to provide home-based services in Weld County that : 1. are strongly based in the principles of bilingual/ bicultural treatment, 2. are based upon a nationally recognized model for home-based family preservation, 3. continue to be promptly responsive to the needs of Social Services for feedback on the enrollment of families and the progress of families in the home-based treatment process, 4. continue to be effective at preventing placement of referred children, 5. place the needs of the child first and is consistent within that mandate while simultaneously being valued and appreciated by caseworkers, social services supervisors and the families that are being served, 6. conform to good management practices and are both cost effective and cost contained as set forth in the practice standards stated in the overview above and further in the project design below. Our target for prevention of placement is 85% which means of the projected up to 84 families in our program, no more than twelve families should have to ultimately receive placement during the program period. Design: Implementation of our program in Weld County has been quite successful in the last five years. This proposal incorporates changes and adaptations to this model as we have implemented it since 1996. We have also continued a number of mechanisms for 1) cost containment and 2) to limit renewals of clients beyond sixty hours of service. We believe this program should be time limited and results oriented 1 in the delivery of services. The goal for 2001-2002 for the program is to maintain tightened service delivery standards as follows: 1. To have 75% or more of clients referred need no more than sixty total hours of service. Those who continue will do so only because this is the most cost effective alternative available 2. A mid point review at 30 hours into the initial program will be conducted. The aim of this review is to identify families who have reached appropriate treatment goals who can either 1) stop or 2) who can step down to a more supportive or maintenance level of treatment. This "step-down" level will be delivered less often for the remainder of the program. Those who have entered a maintenance phase will have a review at 45 hours of treatment. Those who, at the 30 hour review, appear to have had a clinically insignificant level of progress on their case plan will be referred back to Social Services. 3. Of the remaining 25% or less who we anticipate will need more than sixty hours of treatment, two out of three will complete treatment for the episode they were referred for in 30 additional hours or less. Specifically, continuation would be in increments of 15 hours and a thorough review by the clinician and the caseworker would be documented. A decision would be made by this team at sixty and seventy five hours if further treatment is needed prior to proceeding into the next 15 hour segment. 4. All families who need more than 60 hours of treatment will either be: * referred to a specific life skills program, * referred to short term intervention programs such as GAP to finalize treatment, * stepped down to a maintenance mode of treatment in a home based renewal either once every two weeks or once a month or * referred back to social services for determination of future treatment if needed Other Considerations: The strength of our staff in this project, in experience, in bilingual/bicultural service delivery and in the delivery of home-based services to over one hundred client families are considerations we think are important for the reviewers of this proposal. Nicole Wamygora, MA, Licensed Professional Counselor and Doctoral Candidate in School Psychology, has extensive experience in work with children from extremely disturbed backgrounds and a year of hands-on experience with our home based 2 program. Dr. Sherri Malloy, Licensed Clinical Psychologist, was formerly director of the Children's team of the Boulder Mental Health Center and has several years of experience in Home Based Option B Program delivery with us here in Weld County. Emily Jaramillo, MA is a bilingual psychotherapist provider from the Greeley community with a masters degree in counseling. She also self-identifies as Hispanic. She has worked in the Family Recovery Center and in educational support for minority students at UNC as well as in private practice, including work for Home Based clients in the past several years. She is currently in the final stages of obtaining her Licensed Professional Counselor certification from the state having completed both supervision and the qualifying examination. Dr. Joyce Shohet Ackerman, Licensed Psychologist, is director of Ackerman and Associates and clinical supervisor of the program. Cassie Yackley, M.S., L.P.C. - is a licensed professional counselor and a doctoral candidate in psychology who has extensive experience with older children and teens and their families and who has experience in home based delivery of services. Other staff are listed later in this proposal. We seek to continue to be on the list of approved vendors for the provision of these services. TargetlEligibility Populations A Total number of clients to be served . Seven families per month times twelve months equals 84 families per year. If we assume a family size of six, two adults and four children, then the total client pool to be served is 504 individuals. That number includes at least 84 individuals who face either imminent out of home placement or who need reunification services. B. Distribution of clients,Total number of clients we will serve is approximately 504 as calculated above. Our experience suggests we would expect approximately 168 of these to be adult members of the family and approximately 336 to be minors. The age distribution of the index case children would tend toward the younger children based on our experience with home-based intensive therapy. We estimate that about one third of the index children would be older than ten with an average age of about 14 and about two thirds would be under ten. The older group would most likely be teenagers in conflict with their family. The younger group will consist of children of no particularly predictable age whose parents are in conflict usually in relation to instability in the marriage. 3 C. Families Served. We would anticipate serving up to 84 family units. D. Sub total who will receive bicultural/bilingual services. As stated above, Emily Jaramillo is a master's level counselor who can provide services in Spanish or English. She will serve up to one third of the projected caseload. This represents a maximum of 27 families. Thus, one third of the projected total will be able to be conducted bilingually. All of the services provided (for a maximum of 84 families) will be done in a manner which is sensitive to the culture of origin of the family. E. We can provide services in South County and have done so in the last year: We anticipate that up to one third of the projected case load of 84 families may reside in the South County Area. F. Accessibility. All providers of Ackerman and Associates are accessible through a 24 hour answering service, cell phone and pager system. On weekends, our 24 hour access reaches the provider on call who is always a licensed Mental Health Provider. These providers are Laurence Kerrigan, Ph.D., Susan Bromley, Psy D, Sherri Malloy Ph.D., Joyce Ackerman Ed.D, Karen Bender M.S. L.P.C., Cassie Yaddey, MS L.P.C. and Nicole Wamygora M.A., L.P.C. As soon as Emily Jaramillo is certified as a Licensed Professional Counselor by Colorado she will be added to the call list. This is expected in the next month or two. G. Maximum per month. The program maximum is 10 families accepted into the program per month for a maximum capacity of 120 families per year. H. The monthly average capacity is seven families added to the program per month for an anticipated load of 84 families over the year. I. The average stay in the program is three hours per week over an average of a twenty week period, (sixty hours). For some families the sixty hours of treatment may be delivered over a longer or shorter period with more services delivered early in the program and less per week toward the end of the treatment. This is a design where services are more intense during a crisis and decrease gradually as clinically appropriate. The average length of stay will be sixty hours. Specific restrictions on the average stay in the program are described in the design section of this proposal. Types of Services Provided We will provide the following services to all families in the program. Specific details which further define these services are in the section of this bid called service objectives. Our model is summarized below: We are using the following strategies to increase effectiveness with families: 4 1. An immediate initial response to the crisis is made because people who are in crisis are often more motivated to change. This has proven to be an excellent opportunity for client/therapist bonding. 2. The therapist focuses on the family's presenting problem. This increases the client's motivation to work on that problem. Clients are perceived in this model as having the best information about themselves and their lives. Everyone has strengths, skills and unique cultural experiences. Recognition of these experiences and respect for the family usually lead to positive working relationships. From this working relationship a scope of work to be achieved over the sixty hours or less of treatment is formulated and signed off by the therapist and the client(s). This becomes the case management plan and will be completed before the completion of the tenth hour of therapy. 3. Services are provided in the client's natural environment as much as possible to increase accurate assessment, therapist credibility with the client, and the probability the client will incorporate the material they learn into daily family activities. Some services and group work will be available in the office setting. 4. The practice is available on a 24 hour basis to address client concems. Such access increases the ability to monitor for potentially dangerous situations and provide immediate assistance in crisis situations. 5. Home Based Services uses skills-based intervention to empower the client to handle life situations without the help of others. This also lessens the need for ongoing long term intervention. 6. Specific review of use of services will be conducted at 30 and 45 hours of treatment. The client will participate in these reviews as a requirement for the continuation of services. A.Therapeutic Services: We will provide the following services and document the delivery of these services using an individualized treatment plan for each family. Progress on this treatment plan will be reported to the caseworker on a monthly basis. The family treatment plan will be developed during the first thirty days of contact and as early as clinically appropriate but not later than hour ten of treatment. The plan will address the concerns identified by the WCDSS caseworker who fills out the family referral form as well as those raised through a clinical assessment of the family by the therapist, either Nicole Wamygora, M.A., L.P.C., Cassie Yacldey, M.S., L.P.C., Emily Jaramillo, M.A., L.P.C. or Sherri Malloy, Ph.D. Clinically appropriate intervention strategies will be chosen by the therapist working with the family. Inherent in these modalities is the need to show progress on the goals stated in the case treatment 5 plan. In most families served by this program a selection of the following modalities will be utilized based on the individualized list of identified family needs: 1. Re-parenting including emotional support to address those issues related to the parents' family of origin, and parenting role models. 2. Family therapy to address structural and issue related difficulties the family is experiencing. 3. Support Groups to address couples' communication, alcohol and drug issues and other issues as identified. 4. Problem solving and negotiation skills to enhance the client's interpersonal effectiveness in implementing change. 5. Communications skills to enhance general aspects of interpersonal effectiveness. 6. Parent child conflict management skills to enhance the parent's ability to set effective limits for the child in a nurturing manner. Note that while the modalities outlined are general and may not apply to all families in all cases, the choice of clinical mode of treatment will be determined by the desire to produce documentable change over the period of treatment in relation to the specific problem for which the family has come to the attention of the Social Services System. There is obviously a tension between general improvement for the family unit and specific improvement in current behaviors and likely patterns of behavior that are detrimental to child safety. This tension needs to be reflected in the case plan and therapy must focus on achieving child safety and family improvement sufficient to protect the child within the treatment time limits in this program. B. Other Services: In addition to the therapeutic interventions described above, client families must be able to apply those concepts and skills to their own specific needs and experiences. They must be able to put these ideals into practice in their own family in order to protect their children. Their ability to do so is what we term concrete skills acquisition. We use the term concrete skills acquisition to describe the incorporation of behavioral management practices into the daily life of the family. This is distinct from the functional aspects of concrete services which are described later. Progress in this area and in other aspects of treatment will be documented in the family treatment chart. 6 Behavioral Components of Concrete Services: Specific aspects of the family behavior where concrete skill acquisition is documentable and usually necessary for family success to either prevent placement or retain a child who has been returned to the home include: 1. Development/enhancement and maintenance of parenting skills including nurturing, limit setting and appropriate child management. 2. Stress Reduction and Anger Management Skills. 3. Communications , problem solving and negotiation skills to enhance interpersonal effectiveness. 4. Practice in hands on parenting skills using a coaching model to provide feedback, reinforcement and clarification as to appropriate child management skills. 5. Money management including budgeting and resource acquisition. 6. Other activities of daily living including recreational activities related to enhancing family development, spiritual support, community involvement and maintenance of physical and emotional well being. Functional Aspects of Concrete Services In addition to helping clients learn and use concrete behavioral skills as described above, many client families need what we term functional concrete skills. These are skills at meeting the physical needs of daily living. By assisting the client to determine how to improve access to the basic needs of daily living, the therapist helps the family obtain and plan for its basic support. When a family's basic needs for food, shelter and safety are met, they are better able to focus on acquisition of skills and on emotional recovery. We will seek to help families identify resources so that they can meet basic needs from within the income available to them. This allows the family to prioritize their own needs in the areas of transportation, financial assistance, clothing, housing, food, toys, household repair and cleaning, child care, legal assistance medical services or other goods or service. Most families will need assistance in a few of these areas and it is not anticipated that all families will need all of these areas of service mentioned above. C. Collateral Services: Collateral services involve connecting the family with the services they need in the community. Such services may include: • Drug and Alcohol Services. Such services are available on an outpatient basis through Ackerman and Associates, P.C. within the services we propose here for mild to moderate levels of problems with addictions. Referrals to other alcohol and drug 7 treatment programs including Island Grove and Family Recovery Center are available as well. • Health Care Referrals are also routinely available in our practice. Referrals to Sunrise Health Center and The Family Residency program are also available. •Job training referrals are available through the Job Services and through Vocational Rehabilitation. Case management is an important role for the providers of the home-based services in that our providers will help the family access services they need. D.Crisis intervention: Twenty four hour access is assured for the families to reach the providers. We have secretarial and office staff support 9-5 Monday through Friday at Ackerman and Associates, P.C. We maintain a twenty four hour, 365 day a year access system through our answering service. All providers can be reached through pagers by the answering service. In-home services for crisis intervention are available through this on call system. The Home Based specialists are on call during the week nights and on weekends we have a rotating call system within the providers of Ackerman and Associates. Measurable Outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following: 1. Did the family accept the referral from their caseworker? 2: Did we accept the family to our program? 3. Is the family making progress with the treatment plan for each component as outlined in the service objectives? 4. Has the family followed through with recommendations and referrals during the course of treatment? Summative outcomes: Over the duration of the six month treatment, we determine the following information. Is the child still in the home? How well are the changes from treatment persisting? This measures if family behavior is different compared to their behavior before treatment. Specific summative outcomes are listed below. 8 A The child receiving services does not go into placement and remains at home at the time the case is closed. This will be measured by recording the status of the child at the time the case is closed. B. Improvement in Parental competency and parent child conflict management will be measured by pre and post clinical assessment A monthly summary of family conditions will be constructed based on a review of the treatment on a month to month basis and when the case is closed. This narrative will document the therapist's impression of changes in parental competency compared to baseline. Failure to make progress will be discussed at the 30 and 45 hour review sessions. C. Children will remain in the home twelve months after the case is closed. This criterion can be measured at the twelve month follow up contact by the caseworker. D. Children who were reunified will still be in the home twelve months after the case is closed . This criterion can be measured at the twelve month follow up contact by the caseworker. E. Treated families will not have a substantiated abuse or neglect twelve months after the case is closed. This information can be obtained by checking with the referring caseworker at Social Services at the same time as points C and D above are assessed. F. Families will be rated "low" on the risk assessment device at closure of the case. The providers will rate the family at the time of case closure on: 1. adherence and success with the treatment plan, 2. pre/post changes as documented in the discharge summary 3. clinical impression of future success. As well, other rating instruments in use by social services for monitoring home-based programs will be completed as requested. Service objectives We have the following service objectives: A. Improvement of family conflict management The program is specifically designed to resolve conflicts that either precipitated the likely imminent placement of the child or which prevent the reunification of the child with the family. The initial goal of services is to assist the family in finding behavioral solutions to the existing conflict. Each provider is skilled in family systems work by experience and training. Other aspects of conflict management include addressing conflicts between the parent and the children, conflict resolution based problem solving skill development, development and practice of negotiation and group communication skills. 9 B. Improved parental competency in this treatment model centers on the parents developing more age appropriate strategies. In dealing with conflicts with their child especially with teenagers, the areas of discipline, protection, instruction and supervision seem most responsive to improvement. With younger children the treatment gives the parents the opportunity in their own home to practice and to clarify the roles each parent expects of the other and what is expected of the child. This model of home-based care is able to improve parental performance based on the experience that this staff brings to this proposal. Some examples of these service objective include delivery of services in the following skill areas ( although not all families will need all skills improved or work on all topics.) The areas in need of delivery for a specific family would be determined by their specific case plan. Some parenting skills include: Helping parents recognize behaviors that need change. Improving parental behaviors that help maintain change in the child's behavior through appropriate reinforcement of desired behaviors. Having parents apply appropriate and logical consequences designed to reinforce appropriate child behavior. Use of appropriate strategies to reduce negative behaviors without the need for physical means of control or punishment. Learning skills to listen to children in an active manner. Minimizing predictable arguments by using first person statements to state what the parent needs. Developing problem solving capabilities specific to the child and the family dynamics. Emotional skills include: Learning to manage anger. Recognition of depression and anxiety as common conditions and the commitment to obtain treatment for the condition. Evaluation of self esteem levels in parents and children. Recognition of the detrimental role of inappropriate anger, impulsivity or self criticism in parenting and raising children. Learning how to handle frustrating or crisis situations that repeatedly occur in the home. Developing a plan for relaxation and respite time. Interpersonal Skills include: Developing skills in relation to common social or problem situations that create difficulties in the home or family. Leaming to give and accept feedback. Monitoring and parenting age appropriate sexual behavior in children and teens. Assertiveness skills include: Learning the difference between assertive and aggressive both in parenting style and in children's behaviors. Learning to deal with sibling rivalry issues. Creating an environment of mutual respect and perceived fairness. Other Intervention Topics that may be useful for the family treatment Developing formats to keep track of changes in the family such as a journal, a treatment plan, a budget, an appointment management system. helping with homework, finding a job or appropriate age related activities for teens. Recognizing the strengths and positive attributes of the family and reinforcing these. Identifying roles in the family and reframing those expectations that contribute to negative family dynamics by establishing or clarifying family expectations and rules. 10 C. Improve household safety. One aspect of the treatment plan is associated with maintaining a safe household environment, and in some families adequately cleaned and maintained and stocked with food and supplies. Service objectives assisting in the acquisition of the following areas as appropriate to the needs of a family might include: Obtaining appropriate employment, transportation, clothing or food. Participation in eligible assistance programs. Identifying appropriate child care or babysitter resources. A household safety plan developed and implemented. D. The program will provide access to needed services as documented in the treatment plan for each family. Specific types of referrals may include the following: Counseling, drug and alcohol treatment, suicide prevention, school counselors and staff concerning school performance of the children, domestic violence and coordination between these types of referrals. Workload Standards A. The program has a capacity of ten families per month with an average of seven families per month. The families will receive an average of three hours per week for twenty weeks with a maximum length of service being five months and a maximum number of hours per family being sixty. All families will be treated within this framework regardless of the family composition. B. We have four providers for this program who will be home based specialists. They are Nicole Wamygora M.A. L.P.C., Cassie Yackley M.S. L.P.C., Emily Jaramillo M.A., L.P.C. and Sherri Malloy Ph.D., Licensed Clinical Psychologist Nicole Warnygora, M.A., L.P.C. is also a doctoral candidate in School Psychology at UNC. She has extensive experience with severely disturbed children including day treatment program experience. She has been providing Option B services over the several years. Emily Jaramillo, M.A., L.P.C., Licensed professional Counselor, received her masters in agency counseling from UNC. Prior to joining Ackerman and Associates, she had a wide range of work in mental health including treatment for alcoholic patients and support of minority college students. She is fluent in Spanish. Her undergraduate major was in Criminal Justice and Sociology. Sherri Malloy, Ph.D. is a Licensed Clinical Psychologist specializing in children. She was director of the Children's Team at the Boulder Mental Health Center. She has worked in home based delivery in Weld County during the past three years. All of our staff are highly regarded by the caseworkers based on feedback we have received from supervisors. Cassie Yackley M.S. L.P.C. is a doctoral candidate in psychology at UNC and a provider at Ackerman and Associates during the past year. She has experience in 11 Home based treatment in Weld county and has extensive experience with teens in various treatment settings. The three psychologists who complete the staff of Ackerman and Associates serve as back up and support for the Home Based Specialists and are available on call to assist them as well as to consult on intervention strategies on an anonymous case presentation basis. The psychologists are Joyce Shohet Ackerman, Ed.D., Laurence Kerrigan, Ph.D., and Susan Bromley, Psy.D., As well, Karen Bender, M.A. Licensed Professional Counselor has extensive experience in treating adults for domestic violence and in the treatment of adults who have suffered sexual abuse. Other providers may be added at a later time. C. Of the up to 84 families the caseload is projected at twenty one families with each of the four provider. D. The modality of treatment is home-based care using our adaptation of the home builders model. As well, referral and group treatment and support will be offered as described above. E. Hours/weeks The total number of therapist hours is 60 per family over six months or a total for the budget calculation of 3600 per year based on our projected average. Maximum capacity is the same as this level. The hourly fee is requested at $99.50 as documented in the rate calculation section. F. Staff There are three individual providers supported by two office professionals in the practice. There are also three psychologists and another licensed professional counselor who provide on call support and back up services. G. Supervisor- This contract would be supervised and clinically managed by Joyce Shohet Ackerman, Ed.D. who would monitor the project for compliance. The maximum caseload for the supervisor is five families per month. l-f. Insurance - Ackerman and Associates, P.C. carries one million three million liability coverage for professional liability on the corporation and its associates and each associate also carries the same level of coverage individually. In addition, Ackerman and Associates, P.C. carries a general liability policy related to accident or injury on our premises through Farmer's insurance. Staff Qualifications A. All staff members who will be Home Based Specialists exceed the minimum qualifications needed for this project in both education and experience as described above. B. Staff available for the project consist of the four Home Based specialists and three 12 licensed psychologists and a Licensed Professional Counselor. C. Current Mandated Training: Emily Jaramillo M.A. L.P.C., Nicole Wamygora M.A, L.P.C., Cassie Yackley M.S. L.P.C. and Sherri Malloy Ph.D all trained under supervision in this model. All of the above are trained at the masters degree or higher as mental heath professionals. D. All of the Home Based specialists and all the psychologists have knowledge of risk assessment and are skilled in the application of that knowledge especially in relation to the assessment of risk of harm to self or others. Procedures are in place for on call emergencies in this regard, as well. E. Will staff have required state home based training?. We have operated for the past four years without formal additional training beyond that described in paragraph C above. Unit of service rate computation We have calculated the unit of service rate based on the instructions. We used 2000 data for our agency. We offer that same rate in this proposal for 2001-2002 in an effort to reduce costs and stretch limited service dollars. Using overall figures for the agency we arrived at a figure of$99.50 per contact hour. Group rates are billed at one half this rate per hour. The profit for Ackerman and Associates for all programs was 2.9% of gross revenues in 1999. No profit was generated in FY 2000. Zero increases are proposed for this renewal. The volume of services for the home based program has been substantial and we anticipate it being maintained based on the success and popularity of the program with both families and caseworkers. As well, the modifications put into place in the design section should increase its cost efficiency. The proposed cost is $99.50 per face to face contact hour. This is consistent with our operating fees for face to face therapy hour as allowed in other protocols we do with WCDSS and provides essentially the same provider fees of approximately $60.00 per contact hour consistent with the goals we set for all contractual relationships for providers. Budget Justification PAC money is tracked through a computer data base system. The system allows us to track payments by client and by source of payment and any payment through the PAC will be tracked in this manner. No special issues are present related to project audit to our knowledge. Ackerman and Associates mediation program was audited in a random audit (conducted by Anderson and Whitney) after its first year of operation with no deficiencies. Audit of the program will be conducted on a yearly basis. 13 Ackerman and Associates, P.C. is a type S professional for profit corporation and not a 501.c.3. Specific standards of responsibility put in place for the 2000 -2001 year have been addressed in the body of the proposal for 2001-2002. Renewal of these standards is incorporated into this proposal. 14 MEMORANDUM Of INSURANCE Date Issued 05/24/2000 Insured This memorandum is issued as a ACKERMAN AND ASSOCIATES PC matter of information only and confers 1750 25TH AVENUE no rights upon the holder. This GREELEY CO 80631 memorandum does not amend, extend or alter the coverages afforded by the Certificate listed below. Company Affording Coverage Producer Chicago Insurance Company Kirke Van Orsdel 1776 West Lakes Parkway West Des Moines, Iowa 50398 Covered Person (Status) Owner x Employee JOYCE SHOHET ACKERMAN This is to certify that the Certificate listed below has been issued to the insured named herein for the policy period indicated, notwithstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Certificate Type of Insurance Number Effective Date Expiration Date Limits Professional Liability each incident $1,000,000 Claims-Made 45P-2032570 05/01/2000 05/01/2001 annual aggregate $3,000,000 Covered Person's Retroactive Date: 05/01/1992 Should the above described Certificate be canceled Memorandum Holder before the expiration date thereof, the issuing company will endeavor to mail written notice to the named Memorandum Holder, but failure to mail such GADRIAN notice shall impose no obligation or liabilty of any PO BOX 172687 kind upon the company, its agents or representatives. DENVER CO 80217 Authorized Representative: e ,Gs.�err 6LR • • Issue Date: 12/01/00 <� The Reciprocal PROFESSIONAL LIABILITY OCCURRENCE l Alliance INSURANCE POLICY FOR Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ACA Insurance Trust,Inc. 5999 Stevenson Avenue Au us fl Policy Number: CL10073401 Administered by: Alexandria,VA 22304.9900 '1 To6 Free:460034766471284 ,, • ITEM DECLARATIONS INDIVIDUAL POLICY 1. NAMED INSURED: Norma Karen Bender 2. ADDRESS: 1104 Twin Peaks Circle Longmont , CO 80503-2170 3. POLICY PERIOD: From: 02/04/01 To: 02/04/02 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 370 . 00 B. GENERAL LIABILITY $ 0 . 00 TOTAL PREMIUM: $ 370 . 00 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 iorm(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 0005.0199 00 Branch B/A Producer# Issue Date Renewal/Replacement No. 32 A 0002360 03/08/2001 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. I_cm DECLARATIONS CERTIFICATE NUMBER: 45P- 2050203 NAMED INSURED: SUSAN PLOCK BROMLEY PSYD ADDRESS 1621 13TH AVENUE • (Number & Street, Town, GREELEY CO 80631 Counts, State & Zip No.) • POLICY PERIOD: From 04/01/2001 To 04/01/2002 (12:01 A.M. Standard Time At Location Of Designated Premises) COVERAGE: LIMITS OF LIABILITY PREMlU\I Professional Liability $1 ,000,000 $3,000,000 $802. 00 each Incident Aggregate BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: ( A ) Sole Proprietor (including Independent Contractors) ( ) Partnership ( ) Corporation OTHER: c. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the Declarations; or b) the effective date of the earliest claims-made policy • issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 04/05/1996 This policy is made and accepted subject to the printed conditions of this policy together v,nh • the provisions, stipulations and agreements contained in the following form(s) or endorsem nil ; -PLu- 2008 110/94 ) POE-8004 ( 5/88) PLE-2167 ( 07/00) PLE -2081 P0N- 2003 PLE -8035 ( 09/97 ) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 K IAT[ BSI PLP-2O12 (06/93) (Elec.) PRIOR ACTS EXTENSION ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. In consideration of the premium charged for this policy, sub-paragraph B of Section I. COVERAGE, is deleted in its entirety and replaced by: B. At any time prior to the policy effective date shown on the Declarations if: (1) Such act or omission happens on or subsequent to the "prior acts date" liSted below; and (2) No Insured knew or could have reasonably foreseen that such act or omission might be expected to be the basis of a Claim or suit on the effective date of this policy or the first claims-made policy issued by the Company to which this policy is a renewal, whichever is earlier Prior Acts Date: 04/05/ 1996 ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. The premium for this endorsement is included in the premium shown on Additional Premium $ .na Declarations unless a specific amount is shown here. Return Premium $ ENDORSEMENT NO.: Effective: 04/01 /2001 s z:tacnec tc and forms part of your evidence of insurance no.: 45P-2050203 Issued by: the Company named in the Declarations Executive Offices: 55 E. Monroe Street Chicago, Illinois 60603 sec SUSAN PLOCK BROMLEY PSYD Late iss,;ec Authorized Representative: ud:' 2001 € -_ :5 5E. 'Ea '10193) (Elect • • MEMORANDUM OF INSURANCE Date Issued 11/07/2000 Memorandum Holder This memorandum is issued as a matter of information only and confers no ACKERMAN & ASSOCIATES ATTN DONNA rights upon the holder . This SUITE 101 memorandum does not amend, extend 1750 25 AVENUE or alter the coverages afforded by the GREELEY CO 80634 Certificate listed below. Producer Company Affording Coverage Chicago Insurance Company Seabury & Smith 1776 West Lakes Parkway Covered Person (Status) Owner West Des Moines, Iowa 50398 EMILY L JARANILLO—BANSBERG MA x Employee This is to certify that the Certificate listed below has been issued to the insured named herein for the policy period indicated, notwithstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Certificate Type of Insurance Number Effective Date Expiration Date Limits Professional Liability each incident 1 ,000,000 or occurrence Occurrence 8011-4003488 11/01/2000 11/01/2001 3,000,000 in the aggregate General Liability each incident or occurrence Occurrence in the aggregate Should the above described Certificate be canceled Insured 5efore the expiration date thereof, the issuing company will endeavor to mail written notice to the named Memorandum Holder, but failure to mail such EMILY L JARAMILLO-BANSBERG MA notice shall impose no obligation or liabilty of any 183 50 AVENUE PLACE Kind upon the company, its agents or representatives. GREELEY CO 80634 Authorized Representative: .1w +• e may. 11/14/ 00 - A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY • *** RENEWAL *** NOTICE. A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS JF SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION"SEXUAL MISCONDUCT"IN THE POLICY). DECLARATIONS POLICY NO. 801-0005006 ACCOUNT NO: CO-KERL175-0 0099741S E:. ITEM I. (a}NAME AND ADDRESS OF INSURED: ITEM I. (b)ADDITIONAL NAMED INSUREDS: LAURENCE P. KERRIGAN, • PH.D. 1750 25TH AVE. SUITE #101 • GREELEY, CO 80631 TYPE OF ORG: INDIVIDUAL TEM 2. ADDITIONAL INSUREDS: TEM 3. POLICY PERIOD: FROM: 12/01/00 TO: 12/01/01 I x:01 A.M.STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED Hb.Li•. TEM 4 LIMITS OF LIABILITY: (a)S 1 , 000, 000 EACH WRONGFUL ACT OR SERIES OF CONTINUUL RC:' . . I ' OR INTERRELATED WRONGFUL ACTS OR (CI RRI I. (b)$ 5, 000 DEFENSE REIMBURSEMENT (c)$ 3 , 000, 000 AGGREGATE ITEM 5 PREMIUM SCHEDULE: CLASSIFICATION NUMBER RATE ANNUALPREMUSTI • 1ST PSYCHOLOGIST 1 1254 . 00 1 , 254 . 00 DEFENSE LIMIT "" SURPLUS LINES TAX 1 37 . 011 INSPECTION FEE 1 2 . 51 ! • !TEM 6 RETROACTIVE DATE: 12/01/91 TOTAL PREMIUM: 1 , 294 . 13 ITEM 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM(ifexercised):$ 2, 265 . 24 ITEM S. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY 922138 (7/95 ED. ) B22137 • THIS IS\OT A BILL. PREMIUM HAS BEEN PAID. .AUTO! RIZED COMPANY REPRF>F\I' ! s t \PA22U0:95) Americw(Pt of 'emnal 4gen.` TS linvds ' Branch B/A Producer# Issue Date Renewal/Replacement No. 32 A 0002360 02/29/2000 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2055185 1. NAMED INSURED: SHERRI MALLOY PHD ADDRESS 24 ALLES DRIVE g,A';r (Number & Street, Town, GREELEY CO 80631 tt?= County, State & Zip No.) 2. POLICY PERIOD: From 04/01/2000 To 04/01/2001 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: LIMITS OF LIABILITY PREMIUM Professional Liability $1,000,000 $3,000,000 $598.00 each Incident Aggregate 4. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: Sole Proprietor (including Independent Contractors) ( ) Partnership ( ) Corporation ) OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the Declarations; or b) the effective date of the earliest claims-made policy issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 04/01/1998 7. 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): PLJ-2008 ( 10/94) POE-8004 PLE-2167 PLE-2081 P0N-2003 PLE-8035 ( 09/97 ) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 INTERSTATE INSURANCE • GROUP PLP-2012 (06/93) (Elec.) ;•-.PLPE003(7/94)(Ed. LASER) EVEREST NATIONAL INSURANCE COMPANY MENTAL HEALTH PRACTITIONER'S PROFESSIONAL LIABILITY POLICY DECLARATIONS Renewal of No. 2200009922-991 NOTICE: A SUB-LIMIT OF LIABILITY APPLIES TO "CLAIMS" ARISING OUT OF "SEXUAL MISCONDUCT". POLICY NO. 2200009922-001 ITEM 1: NAME AND ADDRESS OF INSURED: SEND ALL INQUIRIES TO: Nicole R Warnygora ROCKPORT INSURANCE ASSOCIATES 1800 Angelo Court PROGRAM ADMINISTRATOR Fort Collins, CO 80528 P 0 Box 1809 ROCKPORT, TX 78381.1809 1-800423.5344 ITEM 2: ADDITIONAL INSUREDS: NONE ITEM 3: DESCRIPTION OF BUSINESS: MENTAL HEALTH PRACTITIONERIS) ITEM 4: POLICY PERIOD: FROM 05/20/2000 TO 05(20/2001 12.0' am STANDARD TIME AT THE ADDRESS OF THE INSURED A5 STATED HEREIN ITEM 5: LIMITS OF LIABILITY: $ 1,000,000 EACH WRONGFUL ACT OR EACH OCCURRENCE SU3JEC r -0 A $25,700 SUB-LIMIT OF LIABILITY FOR ALL"WRONG%L4 ACTS' • INVOLVING 'SEXUAL MISCONDUCT'. $ 3,000.000 AGGREGATE ITEM 6: PREMIUM SCHEDULE: CLASSIFICATION NUMBER BAIL ANNUAL PREMIUM CATEGORY M2 1 263.00 $ 263.00 TOTAL PREMIUM $ 263.00 ITEM 7: POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY: 190.00 0195, 189.00 0195, EEO 25 501 12 98, 193.00 0195 Apnl28, 2000 PvV `i` W' _ AUTHORIZED COMPANY REPRESENTATIVE 189.00 0195 C Everest National Insurance Company, 1996 Issue Date: 09/08/00 �C> The Reciprocal PROFESSIONAL LIABILITY OCCURRENCE ��� Alliance INSURANCE POLICY FOR Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ACA Insurance Trust Mc. 5999 Stevenson Avenue +_ussb&'5u - Policy Number: CL12494600 Administered by: Aleaandria.VA223040000 TRUST Toll Free:1.800347.6647 2284 ITEM DECLARATIONS INDIVIDUAL POLICY 1 NAMED INSURED: Cathleen Yackley 2. ADDRESS: 1020 Wabash Street #6-203 Fort Collins, CO 80526-0000 2. POLICY PERIOD: From: 09/05/00 To: 09/05/01 12:01 A.M. Standard Time at Location of Designated Premises A. 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 395 . 00 B. GENERAL LIABILITY $ 0 . 00 TOTAL PREMIUM: S 395 . 00 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 IRatingCategory) Counselor/Human Development Professional 9 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 fermis)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. CP1-0005 0199 00 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON,O WISCONSIN yy5��37783.0001 PROOFAOF INSURANCEICARD Policy No: 0869-0235-01-84-FPPA-CO Eff Data: 11-3-2000 Exp Date: 5-3-2001 1999 PONT GAS VIN: 1G2NE52E3XM811960 C RI PD UM UIM COMP COLL PIP ERS JARAMILLO, EMILY 183 50TH AVENUE PL GREELEY CO 80634-4718 Agent: CHRISTINA GALINDO Agent Phone: (9701 346-9358 • COLORADO INSURANCE CARD INSURED KERRIGAN,LARRY P MUTL POLICY-NUMBER 200 0862-D28.06B VT YR 1988 MAKE HONDA 0FFECTI VE MODEL ACCORD OCT 262 APR 282001 VIN JHMCA5529JC117334 AGENT RICK WALLACE PHONE (970)356.6237 1671-625 A BODILY INJURY/PROPERTY DAMAGE LIABILITY P1 NO•FAULT D COMPREHENSIVE G 100 DEDUCT COLLISION H,U SEE REVERSE SIDE FOR ADDITIONAL COVERAGE INFORMATION COLORADO INSURANCE CARL) INSURED BROMLEY,JOHN MUTL VOL • POLICY NUMBER 6537520•F07.06C EFFECTIVE YR 1984 MAKE VOLVO DEC 072000 TO JUN 072001 MODEL 240 VIN YV1AX$155E15$3112 AGENT MARK LARSON PHONE (970)356.4700 THE COVERAGE PROVIDED BY THE POUCY MEETS THE MINIMUM UABILTTY LIMITS PRESCRIBED BY LAW. A BODILY INJURY/PROPERTY DAMAGE LIABILITY P3 NO FAULT•PPO(SLOAN'S LAKE) D SO DEDUCT COMPREHENSIVE G 100 DEDUCT COLUSION H,RI,U 9&E REVERSE SIDE FOR ADDITIONAL COVERAGE INFORMATION USAA CASUALTY INSURANCE COMPANY IA Stock !mum. Company) Slue 06 07 vne POLICY NUMBER f o 9800 Fredericksburg Road San Antonio, Texas 78288 Co D29b29 Tort 00211 02 59C 7103 5 COLORADO AUTO POLICY POLICY PERIOD: 112:01 A.M. standard time) RENEWAL DECLARATIONS EFFECTIVE OCT 17 1999 TO APR 17 2000 ct. _ ( ATTACH TO PREVIOUS POLICY ) OPERATORS Imed Insured and Address 01 SHERRI R MALLOY-GONZALEZ 07 DAVID M GONZALEZ SHERRI R MALLOY-GONZALEZ 24 ALLES DR GREELEY CO 80631 -6829 VEH USE • WORK/SCHOOL scription of Vehicle(s) Miles Days YEAR TRADE NAME MODEL BODY TYPE MILEAGE IDENTIFICATION NUMBER SYM T �n Week 5 94 HONDA CIVIC LX SED 4D 10000 1HGEG8666RL030869 11 W 02 3 7 99 TOYOTA SIENA LE/XLE WAG 4X2 5D 10000 4T3ZF13C9XU091812 15 P PROGRESSIVES Insurance IdentificationCard- COLORADO V California Casual Name of Insurer: P . PROGRESSIVE SPECIALTY INSURANCE COMPANY P.O. CALIFORNIA CASUALTY 3NDE ITT EXCHANGE. BOX 39700 P.O. BOX 31557 COLORAM SPRINGS CO B0949-9700 ' TAMPA, FL 33831-3557 Cowithoo D Name of Insured: EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE ALAN H ACKERMAN Effective Date: 01/08/01 INSURED: WARNYGORA TODD 6 NICOLE 1800 ANGELO CT • Listed Drivers: FORT COLLINS CO 80528 JOYCE S ACKERMAN Exration/08/02ate: 01 . RACHEL ACKERMAN EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER 08/09/00 08/09/01 1022312594 - - YEAR MAKE/MODEL VIN Policy Number. AA 70109900-0 99 TOYOTA TACOMA %CB 4TAWN72N9XZ569122 CLAIMS: 800-800-9410 SERVICE 800-800-9910 Year Make/Model Vehicle Identification Number 1992 HONDA - 1HGCB7877NA198218 O COLORADO NEW HAMPSHIRE INSURANCE CARD INSURANCE CARD INSURED. YAGKL INSURED BENDER,BRICEJ a N KAREN BONNEMA,DOUG MUTL MUTL POLICY NUMBER 6011. VOL POLICY NUMBER C054252-D14.06C VOL YR 1996 MAKE HONDA F11 29A EFFECTIVE YR 2000 MAKE TOYOTA EFFECTIVE MODEL CIVIC DEC 11 2000 TO JUN 1S 2001 MODEL AVALON OCT 142000 TO APR 142001 VIN 1HGEJ1140TL022250 VIN 9T1BF2888yU04657t AGENT RICH YACYSHYN AGENT JEFF PFEIFFER PHONE (602)224-5296 2011476 PHONE (303)651-0111 THE COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBED BY LAS. AB BODILY INJURY/PROPERTY DAMAGE LIABILITY A BODILY INJURY/PROPERTY DAMAGE L iGILITY C MEDICAL PAYMENTS P1 NO-FAULT D 50 DEDUCT COMPREHENSIVE D 500 DEDUCT COMPREHENSIVE 0 250 DEDUCT COLLISION II,Rt U StE REVERSE SIDE FORADDITIONAL COVERAGE INFORMATION G 500 DEDUCTCOLUSNDN R1,U SEE REVERSE SIDE FOR ADDITIONAL COVERAGE INFORMATION DECLARATIONS ['TRUCK INSURANCE EXCHANGE X❑ FARMERS INSURANCE EXCHANGE ❑ FIRE INSURANCE EXCHANGE SPECIAL ❑ FARMER{F� SENTINEL MEMBERS of FARMERS INSURANCE GROUP OF COMPANIES ♦`tear •s PACKAGE HOME OFFICE:4680 WILSHIRE BLVD..LOS ANGELES,CALIFORNIA 90010 3 -" T SUPER Prod. 1. Named . DR JOYCE SHOHET ACKERMAN PC Count Insured Prematic Acc't No. . Mailing . 1750 25TH AVE SUITE 101 Address . 07-04-362 04576-38-07 GREELEY CO 80631 Agent Policy Number Type of The named insured is an individual unless otherwise stated: O Partnershi ® Corp. Business OFFICE D Joint Venture LJ Organization(Other than Partnership or Joint Venture) 2. Policy Period from 07/01/00 (not prior to time applied for) to 07/01/01 12:01 a.m.Standard Time. If this policy replaces other coverages that end at noon standard time on the same day this policy begins,this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows:If we elect to continue this insurance,we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums,rules and forms then in effect. 3. Insured location same as mailing address unless otherwise stated: 1750 25TH AVE SUITE 101 GREELEY CO 80631 4. Mortgage Holders Loan# Loan# 5. Premium$ 507.00 O "X"if Mortgage Holder Pays 6. Policy Forms and Endorsements attached at inception: 25-2880 E4103-ED2 565310-ED2 S0700-ED3 E6036-ED1 E4168-ED1 E4004-ED1 E4216-ED1 E3026-ED1 7. We provide insurance only for those coverages indicated by a specific limit or by an al COVERAGES LIMITS OF INSURANCE DEDUCTIBLE A-Building - $ $250 applies unless other SECTION 1 B-Business Personal Property $ 52,000 o tion indicated b an® fxl$ioo $500 U$_ C-Loss of Income(Not exceeding 12 consecutive months) ACTUAL LOSS SUSTAINED NONE Property OPTIONAL COVERAGES and Swimming Pool/Fences and Walkways $ Above deduc-$ Loss of X Building Glass(Blanket) REPLACEMENT COST able applies $ 100 Income " 'X Outdoor Sign Coverage $ 100 unless other $ Valuable Papers(In addition to$1000 included.) $ option indi- $ cated. El Earthquake Damage See Coverages % A,B.&C of the applicable ins.limit. SECTION II D-Business Liability-Including Products and Completed LIMITS OF LIABILITY Operations.(Annual aggregate applies for all occurrences (Annual Aggregate) during the policy period.) $ 1,000,000 Liability E-Fire Legal Liability$75,000 included unless other option indicated by an and 0$100,000❑$150,000 each occurrence(Subject to the annual aggreagate shown for Coy.D) Medicals F-Medical Payments to Others(Subject to the annual aggregate $5,000 each person shown for Coverage D.) Limit of Liability (Annual Aggregate) ❑Professional Liability(see attached endorsement) $ ®I-V COVERED DEDUCTIBLE SECTION III Agreement I-Employee Dishonesty $5,000 NONE Agreement II-Broad Form Money and Securities-Inside $1,000 $250 Agreement III-Broad Form Money and Securities-Outside $1,000 $250 Crime Agreement N-Medical Payments $500 each person NONE Agreement V-Forgeryor Alterations r / $2,500 NONE _ l 58-5308 2.32 END EDITION Countersigned l�.�L PUN-dike - Authorized Representative Attach.to your policy with the same number shown on this endorsement. e4103 2nd Edition Named Insured• DR JOYCE SHOHET ACKERMAN PC Agent Policy Number Address• 1750 25TH AVE SUITE 101 • GREELEY CO 80631 07-04-362 04576-38-07 • of the Company designated in the Insured Declarations Location (Same as above unless otherwise stated here) Effective Date 07/31/96 Limit of Liability$ 1,000,000 each occurrence $ 1,000,000 Annual Aggregate ADDITIONAL INSURED ENDORSEMENT (SPECIAL SENTINEL) In consideration of the premium we agree with you to the following: • 1. The insurance provided by this policy for bodily injury liability and property damage liability under Coverage D—Business Liability insurance will also apply to the additional insured named below,but only with respect to an occurrence arising out of the ownership, maintenance or use of that part of the Insured location occupied by you. 2. This insurance does not,apply to: (a) Any occurrence which takes place after you cease to occupy the Insured location. (b) Any structural alterations, new construction or demolition operations performed by or for any additional insured named below. 3. The additional insured will not be construed or deemed to be a subscriber to the Company issuing this policy. 4. The additional insured will not be or become liable for any premium payments due upon this policy. 5. If this policy is terminated for any reason we will give 30 (THIRTY) days notice in writing to the additional insured named below. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all other terms of the policy. Additional • STATE OP COLORADO Insured • C/0 WELD COUNTY SOCIAL SERVICES DEPT ATTN: JUDY GRIECO PO BOX A • • GREELEY CO 80632 L Countersigned Authorized Representative • FAWNERS - �xsuoxry 9r.<t0.T 2ND EDITION 645 1501 K-95 1501 �-�: Supplemental Narrative to RFP: Exhibit B Recommendation(s) Condition(s) RFP: 01010-Option B-Home Based Ackerman & Associates Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 (970)353-3373 fax(970)353-3374 May 21, 2001 Frank Aaron Weld County Department of Social Services 315 N. 11`h Avenue Greeley, Colorado 80631 Dear Frank: This letter is our written response as required by your letter dated May 11, 2001. FYC Recommendations: I. RFP 01-060 Foster Parents Consultation Acceptable 2. RFP 00008 # 1 FGDM Most of these recommendations are not recommendations to us that we can act on; rather they are WCDSS policy statements. I. Concerning not ordering FGDM for every EPP case. It is our understanding the FGDM was intended to help meet ASFA guidelines. We would like to know what other mechanism is being used to involve the extended family in these decisions. 2. No referrals will be made to Family Group Decision Making when a family member has been identified. Again, this is a new policy statement by WCDSS. The spirit of ASFA, as we have experienced it across the country, is to increase extended family input and responsibility in the process of selecting the "best" family member or non-family member for placement. I-low does the identification of a family member by the department meet this criteria? 3. The focus of this service must be on tenable solutions for the children. A tenable and permanent plan will be developed to assure success for the children. ,,.. The purpose of FGDM is to have the family develop and propose a tenable solution. It is the responsibility of the caseworker to define tenable prior to the meeting. It has been the caseworker's responsibility to inform the contractor, what parameters are or are not acceptable prior to the actual meeting. All caseworkers have done so. One caseworker has revised her statement of what is acceptable after the meeting took place. This created confusion and is not representative of the process. We do not accept the implication that this statement reflects a common problem with the process. We do accept this as a principle and it has always been our principle in how we do FGDM with WCDSS. 4. Concerning bilingual availability. Agreed. We have already made arrangements for a translator to be available, as needed. The historical context of why this statement appears to have arisen relates to a single complicated case (already referenced above) and is not representative of the activities of Ackerman and Associates. 5, RFP 01008 GAP Agreed. This is not different that what we proposed. 5. RFP 01010, Option B A. Recommendation: this is consistent with our proposal intent. B. Condition: The first three sentences assume we are working with a 60-hour model. The fourth sentence contradicts this. We request a meeting to clarify these conditions. It is difficult to plan family therapy in these complex families without knowing how much time will be available on a program basis. The proposal requires an effective change in the family environment, not treatment of symptoms. C. Comment: We cannot assure additional staff availability, unless we have consistent, ongoing relationships that provide stability for such expansion and planning. We will attempt to obtain additional bilingual services for the benefit of WCDSS and the county. 6. RFP 00007, Sex Abuse Treatment. We agree to utilize less than 15 hours in the assessment. Most cases have taken and will continue to take less than 12 hours for this portion. As needed, for complicated cases, (of which we had several), we need enough clinical time to appropriately assess the case. We would like a mechanism to receive supervisor approval if an extra hour or two is needed for complicated cases. SUMMARY: Ackerman and Associates very much appreciates and enjoys the opportunity to be a vendor for WCDSS and provide much needed quality services to your clients. However, we wish to express our concern that the tone of this letter is inappropriately negative. It is not, and has never been our intent to provide any amount of service beyond the amount approved and/or the amount clinically necessary. We are dealing with some severely dysfunctional families with high risks of suicide, homicide, and sexual and physical abuse. Vendors, DSS and the county need to support and work together to protect these children, families and the county. The department, in order to have appropriate cost containment, has adopted an "HMO type model" of oversight of the therapy process. While we agree with the need for cost containment (i.e. we have asked for no increase in this year's budget over last years), the county must have a mechanism to insure that the termination of the therapeutic process and/or the regulation of the therapeutic process to achieve cost containment does not put children or families at increased risk. Respectfully, 4N)-- Joyce Shohet Ackerman, Ed.D. Hello