HomeMy WebLinkAbout20011405.tiff RESOLUTION
RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR FOSTER
PARENT CONSULTATION AND AUTHORIZE CHAIR TO SIGN - LORI KOCHEVAR
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 Foster Parent Consultation 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 Lori Kochevar, 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 Foster Parent Consultation 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 Lori Kochevar, 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
, ti ( J % WELD CO TY, COLORADO
ATTEST: M '11i0) , /X861 I �,
-1M M. J. Geile, C it
Weld County Clerk tot , . : :,,�;r
r. j!e l .irl
Y.1.--74.‘4_,
� �/ �p / �al
Glenn VaatPiu
BY: /a .t 4_, / J
Deputy Clerk to the Board ' `1-L-1 f� �^ �(
Willie r.
APP AS T RM: [�
l vi E. Long
unty n )
Robert D. Mas en
2001-1405
SS0028
DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 80632
IiiWEBSITE:
www.co.weld.co.us
Administration and Public Assistance(970)352-1551
C. Child Support(970)352-6933
COLORADO
MEMORANDUM
TO: M. J. Geile, Chair Date: May 23, 2001
Board of County Commissioners
FR: Judy Griego, Director
Weld County Departme of S ial Se ices
RE: PY 2001-2002 Notification of Financial Assistance Awards (NOFAA) under Core
Services Funds-Lori Kochevar
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 proposal's under a
Request for Proposal process and are recommending approval of these bids.
Lori Kochevar
Foster Parent Consultation: Program capacity provides for service for 27-50 foster
parents per year. Training hours would average five hours with an expected 225 to 450
hours of foster parent training per year. Four hours of individualized services per week
for foster parents, serving 208 client hours per year. $75 per individual rate, $45 per
group rate.
If you have any questions, please telephone me at extension 6510.
of
2001-1405
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-CORE-0007
Revision (RFP-FYC-01-060)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2001 and Lori Kochevar.
Ending 05/31/2002 Foster Parent Consultation
810 12 Street
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial Assistance
The program is designed on a strength-based Award is based upon your Request for Proposal (RFP).
family preservation model of service. Model is The RFP specifies the scope of services and conditions
proactive,as well as promptly responsive to foster of award. Except where it is in conflict with this
parents in order to decrease placement disruption NOFAA in which case the NOFAA governs, the RFP
for foster children. The program provides upon which this award is based is an integral part of the
extensive training opportunities for foster parents action.
to enable them to meet state requirements for
ongoing professional development. Consultation Special conditions
is short-term, solution orientated planning to
facilitate empowerment of foster parents. Services 1) Reimbursement for the Unit of Services will be based
accessed through paging system. Capacity is 27- on an hourly rate per child or per family.
50 foster parents per year.Training hours average 2) The hourly rate will be paid for only direct face-to-face
five hours with an expected 225 to 450 hours of contact with the child and/or family as evidenced by
foster parent training per year. Four hours of client-signed verification form, and as specified in the
individualized services per week for foster unit of cost computation.
parents, serving 208 client hours per year. 3) Unit of service costs cannot exceed the hourly and
yearly cost per child and/or family.
Cost Per Unit of Service 4) Rates will only be remitted on cases open with, and
Hourly Rate Per $75.00 referrals made by the Weld County Department of
Hour Rate per Group $45.44 Social Services.
Unit of Service Based on Approved Plan 5) Requests for payment must be an original and submitted
to the Weld County Department of Social Services by
Enclosures: the end of the 25th calendar day following the end of
X Signed RFP:Exhibit A the month of service. The provider must submit
Supplemental Narrative to RFP: Exhibit B requests for payment on forms approved by Weld
Recommendation(s) County Department of Social Services.
Conditions of Approval
Approvals. Program Official:
By //`Y / By riego,
M. J.beile,Chair Judy A. Direcct
Board of Weld County Commissioners Weld Cohlnty Department of Social Services
Date: 05/3o/c,200/ Date: S JZ 3/0 I
/! 0200/ - /'/O5
Signed RFP: Exhibit A
Lori Kochevar
RFP: 01-060-Foster Parent Consultation
INVITATION TO BID
016-00
DATE:February 28, 2001 BID NO: 016-00
RETURN BID TO: Pat Persichino, Director of General Services
915 10th Street, P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (016-00) for: Family Preservation Program—Foster Parent
Consultation
Family Issue's Cash Fund or Family Preservation
Program Funds
Deadline: March 23, 2001, Tuesday, 10:00 a.m.
The Families, Youth and Children Commission, an advisory commission to the Weld County Department of
Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of
Weld County Commissioners' authority under the 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 Foster Parent Consultation Program must
provide services that focus on providing psychological consultations and parenting support to foster parents
which are designed to improve foster parent competency, family conflict management, and effectively
accessing community resources. This program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work 7�
Delivery Date rr/042 A Li LLC S eccApAtip,fits (J-
(After receipt of order) BID MUST BE SIGNED IN INK
Lb : icochcwr nets, Lit_ ( 1C-
TYPED OR PRINTED SIGNATURE
VENDOR inn trzbewr /YE [}t at, & ,r4/1 g 3 Lam- ( !t
(Name) Han ritten Signature By Authorized
Officer or Agent c of Vender
ADDRESS �Iv !W ' s& TITLE i)ea Pow
(Tee. ne co ci DATE .3 , 2z /G/
PHONE# r/�7 JS of 0-0
7_3
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 30
016-00 Attached A
FOSTER PARENT CONSULTATION 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#016-00
L n
NAME OF AGENCY: .�1 I5 chevgr /12S. 41° , L. L,
ADDRESS: VD IaNIi ,3t Ere CD ,so 3/
PHONE: (970 ) 35a- 's73 n 'i
CONTACT PERSON: Ldr; /Cable ^ TITLE: 9L o/1 I 1'/l /�/J%'1(4°
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation
Program Category must provide services that focus on teaching life skills designed to facilitate implementation of
the case plan by improving household management competency.parental competency. fami y conflict
management and effectively accessing community resources.
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:
AMOUNT REQUESTED:
ru *h g Lit tic Jaa/o 1
e and Signature of Person Preparing Document Date
Si inamm y uE. b * /�'C&trrL LC ms Lc. L 3 AI of
Name and Signature Chief dministrative 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
Target/Eligibility Populations
Types of services Provided
Measurable Outcomes
Service Objectives
Workload Standards
Staff Qualifications
Unit of Service Rate Computation
Program Capacity per Month
Certificate of Insurance
Page 24 of 30
016-00 Attached A
Date of Meeting(s)with Social Services Division Supervisor:
Comments by SSD Supervisor: _
1
ame and Signat re of SSD supervisor Date
Page 25 of 30
Foster Parent Consultation Program
Purpose: The purpose of the Foster Parent Consultation Program is to provide on
going support and training to foster parents so that they are better able to provide
positive healing relationships for the children they serve.
Design: This program is designed on a strength based family preservation model of
service. This model is proactive as well as promptly responsive to the foster parents
in order to decrease placement disruption for foster children. This program provides
prompt phone consultation initially and then work with foster parents in accordance
to their needs. In our experience, the need for intense consultation decreases after
the initial solution orientated planning sessions. This program also provides
extensive training opportunities so foster parents can easily meet the state
requirements for ongoing professional development. Consultation services are
always confidential for voluntary participants.
Why Services are Important- Foster Parents have the difficult role of providing a
loving relationship and a structured home environment to children whom have most
often been severely abused and or neglected. These children often have a distorted
sense of self Children in the Foster Care system often act out their feelings of
unworthiness by displaying behavior that is destructive to self and others. Foster
parents need to be able to access consultation services quickly to assist them in
better understanding what the child/children are going through and how to respond
to their behavior. As caretakers they also need awareness and skills to address their
own issues in order to not repeat maladaptive interactional behavior with the foster
children.
Consultation - Consultation will consist of short term, solution orientated
planning that facilitate empowerment of the foster parents. Services will be able to
be accessed through a paging system and will be provided in an expedient manner.
It is common for caregivers to feel anxious, overwhelmed, depressed and or
resentment when working with children that are experiencing all of these same
feelings. Receiving a response from an objective consultant in a timely manner can
help the foster parents to regain their composure and confidence to act instead of
react to the challenging behavior exhibited by many foster children.
1
Target / Eligibility Population
A. Total number of clients to be served in the twelve month program has been
calculated as follows. We would provide nine training's a year of which we
estimate that there would be an average of five participants at each training. Each
training would average five hours. Henceforth, at nine training's a year, x five
hours, x five participants this program would provide 225 training hours a year. We
anticipate that on the other components of this program that we would spend four
hours a week providing services for foster parents. Henceforth, 4 hours a week x 52
weeks provides 208 client hours a year. We anticipate that the average foster parent
using our services would attend 15 hours of training a year and 7 hours of
consultation a year, which would mean that we would serve 27 individual foster
parents a year. Total number of client hours provides over one year would be 433
hours.
B. Distribution of clients. On average most foster parents provide services for
approximately four foster children a year. Each foster child is in placement an
average of 6 months. By providing support and consultation services for 27 foster
parents these services improve that quality of care for approximately 216 children in
the placement system.
C. Families Served. We anticipate serving 27 foster families.
D. Sub total who will receive bicultural / bilingual services. All services
provided will be in a manner which is sensitive to the culture of origin of the family.
All of the therapist have extensive training in cultural competency issues. In
addition, Lori Kochevar was the chair of the multicultural task force that
successfully implemented multicultural training's throughout the San Luis Valley.
Due to our experience in bicultural settings, all individuals in our program will
receive bicultural services. Carmen Jimenez a bilingual bicultural provider would be
available for any Spanish speaking families and written program materials will also
be available in Spanish.
E. Consultation services will be available in South Weld County. Currently 11 out
of 70 foster families reside in South Weld County. Given this ratio, we anticipate
that four of the families we serve will reside in South Weld County. Services will
be available where the foster parents live.
F. The monthly maximum program capacity - Experiential training could serve
up to 10 foster parents which doubles our capacity to 450 training hours a year, or
2
37.5 training hours a month. If needed, we could expand the number of hours we
am available for consultation to 6 hours a week, which would make available 24
hours of consultation services a month.
G. The monthly average capacity - The monthly average capacity of this program
is 16 hours of consultation services and 19 training hours.
H. Average stay in the program - The average stay in this program would be 7
weeks.
I. Average hours per week in the program would be one hour a week. From
experience, most foster families choose to use more hours when they are initially
dealing with an issue and then cut back after the first few solution orientated
planning sessions have occurred.
Services Provided
A. Consultation and Foster Parent Support will be provided around these and
other key issues that will assist foster parents: initial placement adjustment,
transition, separation and loss, effective discipline for children raised with
inconsistent parenting, behavioral management, child development, the effects of
visitation, legal risk and commitment issues, importance of documentation , and
balancing your own/couples/ biological children's /birth families/ systems/foster
children's needs. Both consumer elicited and mandated consultation for critical care
foster parents and corrective action plans will be provided.
B. Training - Lori Kochevar will provide a wide variety of participatory learning
experiences that enhance the foster parents ability to provide a relationship that is
attuned to the unique needs of each child they serve. Experiential based training's
will be provided for between 3-10 foster parents. Lori will elicit recommendations
from both foster care coordinators as well as current foster parents to choose the
content area for training's, to ensure that current training needs are met. Lori will
provide 45 hours of training for up to 90 foster parents. Refer to Appendix A for a
list of Training's that Lori has developed and facilitated. Many of these training's
were developed specifically for Foster Parents, while others were created for
families, school personnel, and service providers across the state. Both consumer
elicited and mandated training's for foster parents under corrective action
plans will be provided.
C. Mandated consultation for critical care foster parents and corrective action plans
will be provided.
3
D. Therapeutic services for foster children will not be provided in a home where
consultation services are in place.
E. Team building staffing - At the foster parents request and if the caseworker is
willing, a team building meeting with the foster parent and the caseworker will be
held to address ongoing concerns and to develop a solution oriented plan. This will
be coordinated with the administration at DSS. This will help develop a unified plan
and address any miscommunication or differences in opinion before court. This will
increase the probability that the systems involved are able to work together for the
best interest of the foster children in their collective care. All assessments and
recommendations will be shared directly with the children's caseworker.
F. In this program consultation funds will not be used to fund therapy or drug
and alcohol services for foster parents. If deemed appropriate a referral to a
mental health provider, or ADAD professional will be made. All federal laws will
be followed including the confidential reporting of suspected child abuse.
Program Components:
1. Consultation - Both foster parent elicited and mandated consultation for critical
care foster parents and corrective action plans will be provided. Short term,
problem solving services will facilitate empowerment of the consumer. It is
imperative that foster parents have access to a variety of resources to support their
own psychological well being and to prevent burnout.
2. Trainings - will provide a wide variety of participatory learning experiences
that enhance the foster parents ability to provide a relationship that is attuned to the
unique needs of each child they serve. Both consumer elicited and mandated
training's will be provided. Refer to appendix A for a list of training's.
3. Resource and Referrals - This program will facilitate the development of
internal and external resources to enhance the foster parents ability to meet the
demanding requirements of their role. Foster parents will be able to access written
information on specific diagnostic, behavioral, and developmental issues specific to
the foster children's special needs. See appendix A for a partial listing of topics
available. In addition, it is important to link foster parents to appropriate community
resources and with each other. We will facilitate knowledge of and encourage use
of available community resources , and make appropriate referrals. See Appendix
A for listing of current community resources available to Foster parents.
4
4. Team building staffing - When requested by the foster parent and agreed upon
by the caseworker the consultant will facilitate a group meeting with the foster
parent and the case worker. This staffing will be coordinated with the
administration at DSS. The focus of the team building will always be on the foster
child's needs. We will address ongoing concerns and develop a solution oriented
plan. This will increase the probability that we are able to work together for the
best interest of the foster children in the systems care.
5. Support groups - We will organize and facilitate in depth exploration of issues
that effect certain sub groups of foster parents ie., critical care, foster adopt, ect..).
Foster parents will be encouraged to support each other. This creates a natural
ongoing support system.
Measurable Outcomes
When clients are self-referred to this program they will choose training's, goals, and
objectives according to their perceived needs. In the case where the foster parent is
sent for disciplinary action or critical care, the consultant and the foster care
coordinators will help design specific outcome measures appropriate to the situation.
It is important to understand that as in any training or consultation process that these
skills, concepts, and techniques need to be understood and practiced before foster
parents will be able to consistently apply them with the children they serve.
A. After involvement in this program component foster parents will be able to
identify an improvement in their ability to deal competently with household
management issues, as measured by a pre and post assessment inventory - Volume 7
Compliance Checklist.
• Increased knowledge of and understanding of Volume 7 requirements for foster
parents.
• Increased understanding of importance of documentation and timelines
concerning medical, dental and, medication monitoring
• Increased awareness of state and federal requirements in Volume 7 regarding
higher standards of care required by foster homes.
• Increased awareness of and adherence to household cleaning, safety, and
maintenance requirements outlined in Volume 7.
• Increased awareness of resources available to assist with budgeting and
purchasing resources for foster children.
5
B. After involvement in this program component foster parents will be able to
identify an improvement in their parental competency as measured by a pre and post
assessment of skills needed to implement non-power based parenting effectively.
• Increased adherence to and understanding of state and federal requirements
regarding discipline policies.
• Increase understanding of characteristics of children raised with inconsistent
parenting.
• Increase ability to use and identify alternative discipline strategies.
• Increase ability to acknowledge and listen to the child's concerns with empathy.
• Increase recognition of communication barriers.
• Increase ability to set effective limits using choices and enforceable statements.
• Increase ability to use empathy and consequences effectively.
• Increase ability to facilitate problem solving skills in foster children.
• Increase understanding of the importance of positive relationship message when
delivering negative content message.
• Increased ability to redirect mis-behavior.
• Increased understanding of foster children's need to learn about cause and effect
thinking in an emotionally neutral non blaming environment.
C. Foster parents will increase their ability to access resources independently so
that they are able to improve their ability to meet the specialized needs of each
individual foster child they serve. This will be measured by self report on
evaluations completed by foster parents after consultation and training's and
tracking the number of referrals made by this program.
• This program will facilitate empowerment for foster parents by providing clear
user friendly information about the resources available in the community and
within the local, state, and federal government.
D. Foster parents will obtain higher skills and competency levels in fulfilling their
role in providing a healing relationship for children in out of home placement. This
will be measured and monitored through the development of individualized
consultation service objectives which will be evaluated at the exit interview by the
foster parent and the consultant.
• Increased ability to accept the child as s/he is
• Increased ability to deal with child's behavior in the context of a healing
relationship.
• Increased ability to support what the foster child is going through.
• Increased understanding of dynamics of child abuse and neglect.
• Increased understanding of developmentally appropriate expectations and the
effects of trauma on development.
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• Increased understanding of the factors influencing the child's reaction to parent
separation and loss.
• Increase understanding of cultural competency issues that effect foster parenting.
• Increase understanding of roles and dynamics of children that grow up in homes
where parents have substance abuse issues.
• Increased ability to anticipate special emotional needs.
• Increased attunement to attachment and bonding issues.
• Increased understanding of the need for foster children to have empowering
corrective experiences.
• Increased understanding of regressive behavior and the need for reparative
bonding within the relationship.
• Increased understanding of the need for consistency and structure to establish
trust.
• Increased understanding of the effects severe boundary violations have on
children and how to facilitate the development of health boundaries in children.
E. Foster parents will positively meet their own and the needs of their biological
children's in adjusting to and dealing with the presence of foster children in the
home. This will be measured and monitored through the development of
individualized consultation service objectives which will be evaluated at the exit
interview by the foster parent and the consultant.
• Increased ability to set and maintain outside interests and relationships.
• Increased ability to communicate effectively with the multiple systems involved
in foster children lives.
• Increased ability to set and teach children how to set effective physical and
emotional boundaries.
• Increase awareness of symptoms of burnout.
• Increase understanding of the importance of knowing when to access support.
• Increased awareness of grief and loss issues for foster families when foster child
reunifies with family of origin.
• Increased awareness of inappropriate coping strategies (we.e.., substance use,
denial, eating, fault-finding, passivity, revenge, withdrawal or excessive worry,
etc...).
• Increased ability to use appropriate coping strategies (we.e.., diversions, balance,
conflict resolution, flexibility, networking, affirmations, assertiveness, contact,
enforceable limits, linking, organization, problem solving, re-labeling, providing
choices, time management, relaxation, self-care, exercise, commitment, prayer,
worship, surrender, etc...).
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Service Objectives
We have the following service objectives:
A. Improvement of household management competencies. It is imperative that
foster parents are aware of and uphold regulations outlined in Volume 7 regarding
the need to maintain a safe household environment, that is adequately cleaned and
maintained. In addition, foster parents need to be able to budget their resources so
that they are able to provide for the children they serve. Specific aspects on this
service objective may include the following; training, consultation and referrals.
This component will be measured through the foster parents ability to reach specific
individualized consultation goals, a pre and post assessment tool and program
evaluations.
B. Improved parental competencies. Foster parents need to have the capacity to
maintain a solid relationship with each other, with their own biological children and
with the foster children they serve. In addition, foster parents need to provide
developmentally appropriate care, nutrition, hygiene, discipline, protection,
guidance and supervision. This service objective will be met through training and
consultation. This component will be measured through the foster parents ability to
reach specific individualized consultation goals, a pre and post assessment tool and
program evaluations.
C. Improve ability to access resources. Foster parents shall be empowered to
access resources in the community, as well as resources available thorough the
local, state and federal government. This program will encourage networking with
other foster parents. This service objective will be provided through training,
linking, consultation, and referrals. This component will be measured through foster
parent evaluations, ability to reach specific individualized consultation goals, and
record of number of referrals made.
Workload Standards
A. The program has the capacity to serve between 27- 50 foster parents. Each
training would average five hours. With between 5 to 10 participants, this provides
between 225 to 450 foster parent training hours a year. Consultants would spend
four hours a week providing individualized services for foster parents. Henceforth,
4 hours a week x 52 weeks provides 208 client hours a year.
8
B. Staff- There are five Family Preservation Specialists. Lori Kochevar M.S.,
L.P.C., LLC will serve as a provider and the program supervisor for Mary
Mumby-Grahm L.C.S.W. , Carmen Jimenez L.C.S.W., Shannon Anderson M.A.,
and Shelly Cox M.A. All providers have extensive experience in Family Services
as documented in the attached resumes.
C. The caseload will be between 2 - 10 families per therapist. The caseload of
each therapist will depend on matching the specific needs of the referred family with
the therapist area of specialty.
D. The modality of treatment is consultation, support groups,. and training.
Referral and linking services will be provided.
E. Hours - Total number of clinical time devoted to this program equals one hour a
day, five hours a week, and twenty hours a month.
F. Staff- The providers are supported by part time bookkeeping and clerical
personnel.
G. Supervisor- This contract would be supervised part time by Lori Kochevar
M.S. L.P.C. who would monitor the project for program compliance and clinical
excellence.
H. Insurance - - Lori Kochevar M.S., L.P.C., LLC carries one million three million
liability on the company and each one of the independent contractors connected to
this bid. In addition, Lori Kochevar M.S., L.P.C., LLC carries a general liability
policy related to accident or injury on the premises. The State of Colorado is named
as an additional insured on this policy. Each individual provider also carries a one
million three million liability insurance. Both general and group liability coverage's
are attached. All therapist providing services are self employed and choose to be
exempt from workman's compensation and Employer's liability insurance.
Staff Qualifications
A. All the providers exceed the minimum qualifications needed for both
education and experience. All providers have their Master Degree in Counseling.
In addition, the therapists have between 5-15 years a piece providing services for
families. See Resumes in Appendix C.
9
B. Staff available for this project consists of five experienced consultants that have
a similar core value of clinical excellence. We believe in providing strength-based,
family-focused services that empower the families we serve. Another strength of
our staff is our diverse areas of specialties.
• Lori Kochevar a licensed professional counselor has extensive experience and
training in providing services and supervision using the family preservation
model. She has specialized training in substance abuse, trauma, grief, and
domestic violence. In the last nine years Lori has developed and facilitated over
thirty training's that emphasize experiential learning opportunities. Many of
these training's were developed specifically for Foster Parents, while others were
created for families, school personnel, and service providers across the state.
• Shannon Anderson has a dual masters degree in Marriage and Family therapy
and Art therapy. She has a rich history as a caseworker that enhances her
knowledge of the therapeutic needs, treatment of, and resources available for
children, adolescents and their families.
• Mary Mumby-Grahm is a licensed clinical social worker with clinical expertise
in educational psychology and learning differences. She has extensive
experience in identifying and accessing resources as a teacher and a social
worker for families with specific developmental needs.
• Carmen Jimenez is a bilingual bicultural licensed clinical social worker with
clinical expertise in medical social work. She is trained as a family preservation
specialist and has extensive experience in providing bilingual services.
• Shelly Cox has her masters degree in Community Counseling. She specializes in
providing psychological assessments and sex offender treatment. She has
extensive experience and training in providing in-home family preservation
services.
Along with being skilled consultants, due to our extensive background as therapists
we are knowledgeable of the systems (i.e.. biological families, social services,
mental health services, legal services, etc..) that foster parents need to interface with
as advocates for the children that are placed with them.
10
Appendix A
14
TRAININGS
FACILITATED:
FAMILIES/COUPLES
1997 - Family Preservation Services
1998 - Creating Health/Balance in Reltionships
1997 - Parenting Group
05/30/97 Team Building For Families
FOSTER PARENTING
03/10/00 Healthy Transitions for Foster Children
02/26/00 What Does a Foster Child Hear? Messages Underlying Discipline
1999 - Enhancing Communication Skills
07/10/99 ADHD - How to Create Peaceful Moments
1999 - Advanced Parenting for Foster Parents
03/27/99 Helping Foster Parents Deal with Attachment Issues
01/12/99 Multicultural Diversity- A Celebration of Differences
1998 - Love and Logic Parenting for Foster Parents
08/8/98 Understanding Differences
04/4/98 Stress Management 101
04/4/97 Interpersonal Effectiveness for Foster Parents
INTERPERSONAL EFFECTIVENESS
05/15/97 Goal Setting 101
02/7/97 Effective Communication for Mental Health Workers
1997 - Young Women's Group: A therapeutic self discovery group
06/21/96 Stress Management for Health Care Professionals
04/13/96 Interpersonal Effectiveness and Team Building
01/23-25/96 Interpersonal Effectiveness for School Personnel
07/13/94 Multicultural Diversity Training of Facilitators (TOF)
03/1-7/92 Career Exploration
DRUG AND ALCOHOL PREVENTION
03/11/00 There's an Elephant in the Living Room
3/27-28/95 Family Preservation Services: Motivational Interviewing
1994 - Teen Baseline : Drug Prevention
5/13-14/94 Impact of Sexual Addiction on Families: Family Sculpting
1993 - Baseline : Drug Prevention
COMMUNITY DEVELOPMENT
09/6/97 Day of Caring - United Way Service Day
04/22/97 Golden Rule - Unted Way Awards for Excellence
04/19-20/96 Non-Profit Board Development
04/19/95 Building a Strong Non-Profit Board
07/13-15/95 Philanthropy Days - Organizer
03/1/92 International Women's Week Organizer
Lori Kochevar M.S. L.P.C. LLC
♦♦♦
Stretching our Strengths♦810 12th Shea♦Greeley CO 80631
Phone(970) 352-8873•Fax(970)352-8879
Additional Resource
• Consultation Program - Call Dee or Barb for Info 352-1551 Ex 6293 or 9292
• Clothing Allowance - $200 per child per calendar year, see forms
• Foster Parent Library - Extensive collection of books and Videos, located at DSS
• Weld-Foster Parent Association- See brochure. Call Linda King 506-9754
• Food Bank- Medicaid side & Weld Foster Parent Association, 100 pounds a month.
• Round Table Lunches- Monthly at DSS with Dee and Barb
• State Foster Parent Association - Call Beverly Holtz at (303) 463-7989
• Training's- Look in Newsletters
• Rocky Mountain Children 's Law Center- (303) 871-6410
• Court Appointed Special Advocates- Contact Marsha at 353-3400
• Guardian ad Litem (GAL)- Appointed for your child by the court
• Monthly Newsletter- Sent by Barb and Dee
• Child Find- See brochure and contact Brenda at 330-3842
• Children's Hospital Evaluation - (303) 861-6410
• North Range Behavioral Health - 346-1166
• Medicaid 1800 511- 5010 (Access) 1-800221-3943 (Regular services)
• Sunrise Clinic - 353-9403
• North Colorado Family Medicine - Scheduling 346-2818 356-2424
• Monforts Clinic- 352-8898
• Dentistry for the Handicapped Orthodontics and other dentistry 1-800-466-8129
• Smile High Dentistry (303)825-2295
• HCP- orthodontics (303) 678-6064
• Statewide list Drs. & GDS - take Medicaid(303) 866-4562
• Donated Dental Services 298-1910
• Child Car Safety check- Greeley Fire Department-Mike Medhearst 350-9500
• Recreation Center- 350-9400 Free class each session for foster children
• Larimer- Foster Parent Association- (970) 669-3047
• Probation Department- 356-4000 ext 3870
• Boys and Girls Club- 353-5109
• National Youth Sports Program- Summer camp ages 10-16 351-1996
Lori Kochevar M.S. L.P.C. LLC
♦•♦
Stretching our Strengths•810 12th Street♦Greeley CO 80631
Phone(970) 352-8873 1 Fax(970) 352-8879
Additional Information Available
Specific Issues
• Fetal Alcohol Syndrome
• Eating Disorders
• Sexuality
• Guidelines for Substance Abused Infants
• Medication for Children with Behavior and Emotional Problems
• Attachment - Healthy and Disorders
• Infant Stimulation Activities
• Professional Burnout
• Discipline
• Communication difficulties with multiple systems
• Attention Deficit disorder
• Trauma
Problem Behaviors
• Tantrums
• Name - Calling
• Verbal Aggression
• Anger Management
• Delinquency
• Lying
• Self Injury
• Bed Wetting
• Drug Abuse
For these topic our any other issue you need information on
Please feel free to call Lori at 352-8873
for additional resources.
III i •
RISK FACTOR CHECKLIST
INTAKE ASSESSMENT
ACCEPTABLE LOW MODERATE HIGH
1.Severity of Abuse/Access of •Not Applicable •Minor injury/noninjury •Mild/Multiple marks/bruises on •Severe injury
Perpetrator •Parent is protective dr supportive torso,aims,and legs. •Old and new injuries.
of child. •Parent has history of ongoing or •Ongoing history of harsh
•Parental discipline maybe use of excessive discipline. physical discipline.
arbitrary and occasionally uses •Parent makes direct threats on a •Marks or bruises to child under 2
scare tactics. daily basis to child's sense of years.
•Alleged perpetrator of sexual security. •Parent makes direct and dramatic
abuse has no unsupervised access •Per Ixhator has some access. threats to child's emotional
to the child and is not in the home. security
•Perpetrator in home.
2 Severity of Neglect •Not Applicable •Child has unkempt appearance. •Undisposed trash. •Substantial safety and health
•House disorderly but not a hazard. •Parent reveals frequent inability to hazards in home.
•Meals irregular but adequate. care for or protect child. •Leaves child unsupervised for
•Child does not receive routine •Meals go unprovided and child is excessive periods of time and/or
medical/dental care but no ill chronically hungry environment poses a threat
effects on the child. •Unattended medical/dental •Neglect results or could result in
•Parent is periodically unattuned to problems causing child severe injury or illness.
child's needs. discomfort. •Parent consistently withholds
•Some periods of unsupervised affection and'time,child.
care and child has no access to or •Non-organic failure to thrive.
knowledge of resources. '•Significant developmental delays
•Parent avoids interaction with due to neglect.
child to meet emotional needs.
3.Age/Handicapping •thild partakes in appropriate •12 years of age and over,displays •6-12 years. •Infancy to 5 years old or older
Conditions of Child activities outside of home. no handicapping conditions. •Requires some level of adult child who is severely disabledor
•Is visible to others. •Is able to obtain help. assistance to care for and protect handicapped.
•Child shows no symptoms of self,based upon age and •Unable to care for or protect self
developmental lags. conditions. without extensive adult
assistance and supervision.
•Child not visible to others outside
of household.
4.Previous Reports of •No prior reports of abuse to •One unsubstantiated prior report •Mote than one prior report. •Previous substantiated reports of
AbuselNeglect agency. •One previously substantiated severe abuse/neglect.
abuse/neglect or several •Children in the past have been
unsubstantiated reports from placed due to abuse/neglect.
various sources. •Termination of parental rights on
one or more children.
Appendix B
15
LORI KOCHEVAR, M.S., L.P.C.
2118 19th Avenue
Greeley, CO 80631
(970) 353-6568
EDUCATION:
University of Southern Mississippi, M.S.
Counseling Psychology,
Cumulative GPA 3.8
University of Northern Colorado, B.A.
Pre-Professional Psychology,
Cumulative GPA 3.5
PROFESSIONAL
EXPERIENCE:
5/95 - PRIVATE PRACTICE THERAPIST, STRETCHING
OUR STRENGTHS
Serve others through a creative process that stretches participants
strengths and provides an environment for authentic healing. Facilitate
opportunity for individuals, families, and groups to participate in body
centered spiritually based psychotherapy. Interpersonal dynamic
facilitation for community development, team building, stress
reduction, anger management, parenting, and personal effectiveness
are available.
5/95 - 9/96 DIRECTOR, VALLEY COMMUNITY FUND
Serve and manage Board of Directors to strengthen the internal
structure of the agency to increase fundraising capabilities.
Responsibilities include: access state, government, and businesses
to participate in payroll deduction, grant writing, marketing, coordination
of special events and community trainings, and disbursement of funds.
5/92 - 5/95 FAMILY PRESERVATION SPECIALIST, SAN LUIS VALLEY
MENTAL HEALTH CENTER
Provide intensive home-based treatment for families that are at risk of
having youth removed from the home. Intervention emphasizing
strength-based approaches, including psychotherapy, skill building
(parenting, communication, anger control, problem-solving, etc.),
educational support, and assistance in obtaining support for concrete
needs. Management duties: public relations, supervise students,
hire staff, and provide training for staff and community.
3/92 - 5/95 WILDERNESS THERAPIST, SAN LUIS VALLEY MENTAL
HEALTH CENTER
Provide intensive tent-based treatment for youth ages 8-17. Facilitate
opportunities for young people to learn skills in leadership, team work,
decision making, dealing with stress, facing fears, and building
responsibility. Use outdoor challenge course experience such as
rafting, backpacking, mountaineering, and rock climbing to provide skills
based learning opportunities.
5/89 - 5/91 CONSULTANT, GRADUATE ASSISTANT, UNIVERSITY
AFFLILIATED PROGRAM, UNIVERISTY OF SOUTHERN
MISSISSIPPI
Participating in an interdisciplinary team that provides assistance for
community-based child care centers who serve children with
disabilities and their families. Responsibilities include: Grant writing,
development and presentation of awareness training, assessment of
learning environment and handicapping conditions. Provide
consultation for teachers and parents using a coaching model, skills-
based training, and evaluation of improvement.
1/89 - 5/89 TEACHING ASSISTANT, UNIVERSITY OF NORTHERN
COLORADO
Teach skills for report writing and use of computer programs, PC Write
and Labstat. Teach weekly labs and grade lab reports.
4/86 - 9/89 RECREATION SUPERVISION, BOYS AND GIRLS
CLUB OF GREELEY
Providing guidance and support for at-risk youth, fundraising, program
planning, facilitate teenage drug and pregnancy prevention program,
family and community involvement, organization and supervision of
field trips, and participation in local and national staff development
training.
INVOLVEMENT:
FOUNDER, BOARD MEMBER, BOYS AND GIRLS CLUB OF
ALAMOSA
Spearhead community organization to obtain Boys and Girls Club.
Organize fundraising, board development, marketing, and regional and
national networking.
MEMBER, SAN LUIS VALLEY COALITION FOR YOUTH
SERVICES .
Member of steering committee and chairperson of the multicultural task
force.
CONFERENCES:
SPIRITUAL
2000 Hakomi Training
11/05/99 Mariane Williamson - Enchanted Love
10/22-24/99 Shapeshifting: Shamanic Tranformation
1999 Women Who Run With the Wolves - Jungian
10/5-17/99 Phoenix Rising: Yoga Therapy Levels 1 and 2
09/24-26/99 Energy Medicine - Donna Eden
08/19/99 James Redfield -The Celestine Prophecy
08/14/99 Ruth and Naomi - Women's Partnerships
04/24/99 Substanability and Spirituality
04/23/99 Time, Money and the Meaning of Life
03/19/99 Gandhi's Search for Meaning
10/23/98 Spirituality and Religion
06/06/98 Tying it all Together - Biblical Overview
03/28/99 Transformation -Job of the Old Testament
03/06/98 Matthew Fox - Spirituality of Compassion
11/6-9/97 Common Boundaries: Joy of Creation
07/10-13/97 Body and Soul Conference
04/26/97 Day of Prayer
04/19/97 Contemplative Living
1997 Catholic Biblical School
11/6-10/96 Common Boundaries: Intentional Living
1993-1995 Creative Process
COMMUNITY DEVELOPMENT
1/7-8/00 Foster Parent Core Training
10/30/99 Matrix Leadership
10/21-22/96 Working as Partners with Managed Care
04/02-05/95 Leadership for Executive Directors
03/29/95 Fundsaving Workshop
Fall 1995 Leading Edge/Business
02/09-13/95 Challenge by Choice: Ropes Course
05/20-22/94 Organizational Conflict Management: CSAP
05/06/94 CPR and First Aid Certification
02/01-/4/94 Multicultural Conference
11/30/93 Exploring Multiculturalism Within
10/13/93 Conflict Mediation Training
08/11-14/92 Multicultural Training: CSAP
05/12-26/89 Women as Leaders
FAMILIES
06/4-6/99 Passionate Marriage
10/15-19/98 Marriage and Family Conference
05/16-17/98 Relationship Enhancement
12/08-9/97 Family Group Decision Making
10/06/97 Family Group Decision Making
05/2-3/97 Marriage and Family
9/15-16/94 Family Preservation - Supervision
07/20/94 Jim Fay Parenting
07/13/94 Family Sculpting
4/26-27/93 Family Sculpting
Spring 1993 Redirecting Chidren's Behavior
02/06/93 Meaningful Family Comunication
07/070-8/92 Active Parenting
03/16-19/92 Family Preservation Training
09/20-21/90 Parents and Professionals United
CHILDREN AND ADOLESCENTS
09/10/99 Testifying in Child Abuse Caes
07/12/99 Firestarting - Prevention and Intervention
01/29/99 Play Therapy
12/11/98 Attachment Disorders
10/18/97 Art Therapy for Children
04/04/97 Attachment Disorder
10/11-13/96 International Play Therapy Conference
07/8-9/94 Play Therapy
09/26/93 Traumatic Stress Reactins in Children
03/11-14/93 Child Adolescent Conference
Spring 1993 Play Therapy Class
02/16-17/91 Strategic Therapy for Adolescence
10/11-13/90 C.H.A.D.D. Conference on ADHD
05/30-6/1/90 Early Intervention
12/05/89 Play Assessment
TRAUMA AND GRIEF REACTIONS
12/03/99 Jurisprudence Workshop
06/25/99 Molecule of Emotions
04/09/99 Depression and Anxiety
05/19/97 Cultural Grief
09/14-16/95 Annual Hospice Conference
04/14/94 Empowering Resistive Client II
06/09/93 Empowering Resistive Clients
09/17-19/92 Annual Mental Health Conference
SUBSTANCE ABUSE AND DOMESTIC VIOLENCE
10/14/98 Working with Aggression in group Therapy
09/23/97 Domestuc Violence
09/17/97 Substsance Abuse
05/16-17/94 FPS - Motivational Interviewing - Jill Kenney
05/3-14/94 Teen Baseline TOF - Drug Prevention
10/5-9/93 Baseline TOF - Drug Prevention
04/23-24/92 Domestic Violence Conference
San Luis Valley
0 Comprehensive Community
Mental Health Center
CLINIC OFFICE
ADMIN AND CLINIC OFFICE 1015 FOURTH STREET CLINIC OFFICE
522 ALAMOSA AVENUE ALAMOSA,CO 81101 402 FOURTH STREET
ALAMOSA,CO 81101 TDD 719-589-3671 MONTE VISTA, CO 81 144
719-589-3673 719-589-3671 719-852-5186
FAX 719-589-1521 FAX 719-589-9136 FAX 719-852-3043
August 6, 1996
26041 Woodland Ave.
Esparto, CA 95627
Dear Colleagues:
I have worked very closely with Lori in the Family Preservation program. Lori has
been a wonderful asset to this program and to all her colleagues at Mental Health.
More importantly, her dedicated and skillful service to our clients has greatly benefitted
many SLV families.
Lori's skills are numerous. She is well organized and very conscientious. She has
excellent speaking and writing skills. Her forte is her ability to work with all kinds of
people, and work through difficult interpersonal situations. Lori has consistently
impressed me with her resilience and problem solving skills in dealing with some of the
most chaotic and resistive families. In working with these families, Lori has also come to
know the needs of SLV families and has become an expert in resources that are
available throughout the Valley. She has worked in every county in the Valley.
Despite carrying a full caseload of challenging cases, Lori took "time off' for herself
by making solid contributions to other programs. I was amazed to see Lori doing good
work for such things as the Mental Health Center's Wilderness Program, the Boys and
Girls Club of Alamosa, the Multicultural Awareness Committee and the Drug and
Alcohol Baseline program. She attended trainings in all of these programs and then
consistently returned to share her expertise and take responsible roles in each, and
handling the mix of responsibilities effectively.
Lori has a strong philosophical commitment to the empowerment of the oppressed.
Lori will direct people toward healthy, fun relationships. Lori will earn the confidence of
the people with whom she works: staff, clients, and community leaders. I highly
recommend her.
Sincerely,
Offering Comprehensive Mental Health Care For The Entire San Luis Valley
Shannon A. Anderson
1512 10th Avenue Greeley, Colorado 80631
(970) 378-0896 (303) 692-2609
Education
Degree: Master of Arts in Marriage and Family Therapy and
Art Therapy
August, 1997
College of Notre Dame
CPA: 4.0
Degree: Bachelor of Arts in Art/Art History
May, 1993
University of the Pacific
GPA: 3.86
Experience
Colorado Department of Public Health and Environment
Division of Health Promotion and Disease Prevention
Office of Suicide Prevention
Title; Director, 11/00 to present
Director of state program for suicide prevention, including designing and
managing a public awareness campaign, grant writing, training, conducting
a statewide needs assessment, managing a budget and grants program, and
coordinating statewide prevention efforts.
Weld County Department of Social Services
Youth Services
Title: Youth Services Caseworker III, 11/99 to 11/00
Provided casework services to adolescents and families with delinquency,
interpersonal relationships, social, mental health and suicide issues.
Services included culturally sensitive assessment and treatment plan design,
as well as case management. Also included communicating with various
mental health agencies to assess for needed services.
Transitions Professional Psychology Group
Title; Therapist, 6/99 to present
Provide mental health services through art therapy. childladolescent/adult
therapy in individual, group, and family sessions, Also provide consultation
and education services on the practice of art therapy and mental health
issues.
County of San Mateo Human Service Agency
Child Welfare Services, Prevention and Early Intervention
7ltle: Family Focus Therapist, 9/96 to 6/97
Provided therapeutic services and case management to children ages 5 to 10
in individual, group, and family counseling. Provided
parent education and therapeutic services to adults in couples and
individual counseling.
Centennial Developmental Services
Community Integrated Employment Services
Title: Supported Employment Specialist, 1/94 to 7/95
Researched jobs and prepared developmentally disabled adults for job search
though resume writing, social skills, and interviewing skills counseling.
Qualifications
❑ Specialized knowledge of behavioral, social, and relationship treatment
issues, including experience within the juvenile and family court system
a Specialized knowledge of art therapy theory and practice
❑ Specialized knowledge of the therapeutic needs of children and adolescents
❑ Experience serving multicultural individuals and families, including
Hispanic, Tongan, Native American,Asian-American, and African-American
ethnicities,
o Unique educational experience in the application of therapeutic skills in
recognizing and addressing behavioral symptoms in suicidal individuals
o Experience working with different providers and individuals within mental
health systems
a Ability to formulate culturally sensitive case plans and follow through with
the objectives of the case plan
o Knowledge of state and federal laws pertaining to child welfare
a Served on the screening board for Juvenile Intensive Supervision Probation
❑ Member of the Suicide Prevention Coalition of Colorado
o Experience writing and evaluating grant proposals
eN P. 03
MARY MUMBY-GRAHAM
LICENSED CLINICAL SOCIAL WORKER
LICENSE tl/991347
38280 WCR 19
Fort Collins, CO 80524
970-686-9015
OBJECTIVE:
To provide for the highest good and well being of all my clients using my teaching and counseling
experience, through ongoing skills in counseling, crisis intervention, written and verbal
communications, and systems networking and coordination with a multidisciplinary, holistic
approach_
EMPLOYMENT HISTORY:
1998-Present - Clinical Social Worker/Partner, InnerHeahh(Fort Collins) and
Linden Street House(Greeley)
Established a practice specializing in the mental health counseling and treatment of children,
adolescents, families and women. Created two practices in Fort Collins and Greeley, Colorado to
provide more and diverse patient care
1990 - 1991 - Clinical Social Worker, Pathways
Provided a practice focused on psychotherapy, spiritual awareness and a healing journey for all
patients. Specialties included treatment with children, adolescents,families and women.
1987 - 1994 - School Community Facilitator/Social Worker, Weld County School#6
Provided family intervention and assessment counseling. Directed teacher support and consultation_
Handled abuse and dealt with department of Social Services, referrals,follow-up, in-services and
SPED staffings.
1986 - Medical Social Worker, Mercy Medical Center
Performed high-risk screening identified specific psychosociai, medical and financial needs.
Created a system for crisis intervention counseling/networking with human service agencies which
included family meetings, follow-up, case load supervision, illness adjustment. Oversaw staff and
medical team member interactions. Conducted support groups for nurses and facilitated weekly
discharge planning meetings.
1985 — 1986 - School Social Worker, Internship,District RE-8 Ft Lupton Middle School
Attended staffings and child study meetings, assessed children's specific needs, provided guidance
between administrators, counselors and teachers. Set up and attend home visits and telephone
conferences with middle school students and/or parent. Worked with Weld County Mental Health,
Social Services and Probation personnel. Attended court hearings; prepared and updated records
and reports on all clients; classroom observation,group work, crisis intervention and created and
oversaw the self-concept classes for the gifted and talented program.
MFR-i6-u1 FRI 21 :25 P. 04
1984 — 1986 - Aerobic Instructor/Desk Manager, Ft. Collins Athletic Club
Choreographed and lead aerobic classes. Trained patrons how to effectively use free weights and
Nautilus equipment. Counseled patrons regarding exercise and health. Managed front desk, which
included bookkeeping, cashier, sales and marketing, scheduling, organizing and public relations.
1982— 1984 - Teacher, Third Grade, Cache La Poudre Elementary
Prepared and administered classroom studies and tests. Balanced personal, school and district
teaching objectives. Supervised playground activity. Provided counseling support for both students
and parents.
•
EDUCATION:
• State Licensed and Board Certified Licensed Clinical Social Worker, 1994
• Masters Degree in Social Work (MSW), Colorado State University,May 1986
• BA Elementary Education, Arizona State University, 1981.
• High School, College Prep, Grand Junction High School, 1977.
CLINICAL SPECIALIZATIONS:
• Counseling Adolescents, Children, Families and Women
• Child Development and Special Needs/Exceptional Children
• Language/Communication Styles
• Educational Psychology, Learning Differences, ADD. ADHD
• Alcohol and Drug Abuse
• Depression and Anxiety Disorders
• Healing Abuse; Sexual,Emotional, Physical
• Supervised Visitation/Consultation
RECOGNITION
• Rituals Officer in Delta Gamma Sorority
• Life Saving Certificate Life Guard/Swimming Instructor/CM Certificate
• Deans List Arizona State University
• Certified Aerobics Instructor
• Preschool Board Member, Faithsteps, Windsor
• Parent 'Volunteer, Windsor School District
• Coach for Windsor Parks and Recreation
• Member of E,O Women's Organization,
• Member Weld County Pro Bono Committee, Board Member
• Golden Rule Award for Pro Bono services, Weld County
• Member National Association of Social Work
• Member Colorado Association of Play Therapy
PROFESSIONAL REFERENCES:
• Available upon request
• PERSONAL REFERENCES:
• Available upon request
Shelly Cox
348 49th Avenue Place
Greeley, CO 80634
970-378-1953
EDUCATION
Master of Arts, Community Counseling
Mankato State University, Mankato Minnesota
June 1996
Bachelor of Science, Psychology
University of Northern Colorado, Greeley Colorado
December 1985
Skill Areas
In-Home Therapy and skills development/Family Preservation
Treatment of children and adolescents with emotional/behavioral disorders
Chemically dependent adolescents and families
Sex offender assessment, treatment and relapse prevention
Psychological Assessment and testing
Group Facilitation
Family Therapy
Treatment planning/Case management
Consultation and Staff Training
EMPLOYMENT EXPERIENCE
Counseling Services of Southern Minnesota - Therapist
100 Freeman Drive
St Peter, MN 56002
507-931-8040
Feb 23, 1997-Nov 15, 2000
-In-Home Family and Individual Therapy
-In-Home Skills Development
-Outpatient Individual, Couples and Family Therapy
-Psychological Assessment and Testing
-Sex offender assessment, treatment and relapse prevention
Leo a. Hoffmann Center/St Peter Counseling Center- Therapist
105 3rd Street
St Peter, Minnesota 56002
507-931-6122
October 26, 1992-Feb 23, 1997
- Intensive In- Home family therapy and skills development
-In-patient Sex offender group and family therapy
-Outpatient clinical assessment and evaluation
-Outpatient adolescent sex offender specific group therapy
-Outpatient sex offender specific family therapy
-In-Home Sex Offender Relapse Prevention Therapy
-Multifamily group therapy and retreats
-supervision of the mentor program
New Beginnings Treatment Center- Senior Counselor
1225 Redwood
Fort Collins, Colorado 80521
September 1990 -August 1992
-group, individual and family therapy
-treatment plan development
- educational lectures
-patient advocate
-community education
Other Experience
Riverview Clinic- Psychological Testing Assistant
501 Holly Lane
Mankato Minnesota 56001
Loyola High School - Family Support Group Facilitator
Good Counsel Drive
Mankato, Minnesota 56001
References available upon request
CARMEN M. JIMENEZ
MSW, LCSW
3304 26m St. Greeley, CO 80634 Hm # (970) 339-8345
Fax # (970) 346-8776
Objective: Psychotherapist/Medical Social Worker
SUMMARY OF QUALIFICATIONS
O Eight years experience in mental health
O Five years experience in medical social work
O State of Colorado License in Clinical Social Work
O Master's Degree in Social Work with an emphasis in Generalist Social Work
O Medicare provider
O Bilingual and bi-cultural in Spanish
O Specializing in work with victims of abuse and trauma
O Trained in mediation, issues in the workplace, and substance abuse
O Skilled in hospice work and life transition issues
WORK EXPERIENCE /ACCOMPLISHMENTS
08/98 - COMPASION COUNSELING, Greeley, Colo.
Pres. Carmen Jimenez, MSW, LCSW - Sole Proprietor
Individual and group psychotherapy services to families, children, and
adolescents. Contractual work with managed care and insurance com-
panies. Provider on the Crime Victim Compensation Board of the 19th
Judicial District of Weld County. Consultation and mental health counseling
to residents in nursing facilities. Consultation with the Weld County Juvenile
Diversion Program. Medicare and Colorado Access provider.
06/00-ASSOCIATED PROFESSIONAL HOME HEALTH CARE, INC.
Pres. Medical Social Work(Part-time)
Social work services to patients who are home-bound which include community
resource planning, brief therapy, counseling for long-range planning, advocacy.
10/98 - LEIS HOME AND COMMUNITY CARE, Greeley, Colo.
10/99 Medical Social Work
Social work services to home-bound patients which included community resource
planning, counseling for long-range planning and decision-making, financial
resource management, short-term therapy.
• Page 2
02/98 - MONFORT'S CHILDRENS CLINIC, Greeley, Colo.
03/99 Medical Social Worker(Part-time)
Intensive family outreach program advocating for the needs of under-privileged
families served by the Clinic.
• Supervision of interns from Colorado universities
• Development of psychosocial needs assessment
• Psychosocial needs assessments& Family education of medical issues
• Individual counseling of children and families, with emphasis on play
therapy and systems models
• Extensive interagency networking
07/96 -PREFERRED HOME HEALTH
11/98 Social Services Director
Social work services to home-bound patients which included community resource
planning, counseling for long-range planning and decision-making, financial
resource management, short term therapy.
• Instituted the Social Work Department; developed the Policies and
Procedures Manual; systematized Medicare guidelines
• Participation in Quality Improvement Standards
• Extensive interagency networking
02/96 -ACKERMAN& ASSOCIATES, P.C., Greeley, Colo.
08/98 Contractual Position in Private Practice
Individual psychotherapy services to families, children, adolescents. Mediation
services for Dept. of Social Services. Interpretation services in Spanish for
psychological evaluations and Social Security eligibility. Intensive home-based
psychotherapy services to families referred to the Family Preservation Program.
11/95 - NORTH RANGE BEHAVIORAL HEALTH, Greeley, Colo.
07/96 Mental Health Therapist
Individual psychotherapy services to children referred to the Children's Division.
Many of these children were from under-privileged families, and had severe
experiences of trauma and abuse. Facilitated groups for adolescent females of
sexual abuse.
05/93 —CENTENNIAL MENTAL HEALTH,Fort Morgan, Colo.
11/95 Mental Health Therapist
Individual psychotherapy services to families, children, and adolescents.
Psychotherapist for the Obra Program in geriatric settings. Therapist for the
Community Support Program, working with persons with chronic mental illness.
• Assisted with the development of the Logan County and Morgan
County Adult Protection Teams
• Emergency psychological evaluations and initiation of 72 hour holds
• Psychosocial group work and teaching of self-management skills to
persons with chronic mental illness
• Extensive out-patient psychotherapy and case management services
with spanish-speaking clients
Page 3
09/91 -COLORADO STATE UNIVERSITY
05/93 GRADUATE PROGRAM,Ft. Collins, Cob.
06/81 - CITY OF FORT COLLINS, Fort Collins, Cob.
08/91 Community Development Block Grant Program
Administrative Assistant
Work with non-profit agencies under the U.S. Housing and Urban Development
Program for community development and housing rehabilitation projects.
Extensive work with low-income families and persons with disabilities.
EDUCATION
Master's Degree in Social Work, Summer 1993
Colorado State University, Fort Collins, Colorado
Graduate School Research Positions:
• Colorado Division of Mental Health, Rural Crisis Grant, Fort Logan,
Denver, Cob.
• Centennial Mental Health, Sterling, Cob.
• Fostering Families Project, Fort Collins, Cob.
Bachelor of Arts Degree, Social Work, Fall 1987
Colorado State University, Fort Collins, Cob.
REFERENCES
Jalein Arnold, RN, BSN
1955 23'd Ave.
Greeley, CO 80631 #(970) 356-6023
Leonor Willis, LPC
3417 W. 17th St.
Greeley, CO 80631 #(970) 352-8045
Carmen Haynes, MSW
Juvenile Diversion Program
District Attorney's Office
915 Tenth St.
Greeley, CO 80632 #(970) 356-4010
Pat Orleans,LCSW
North Range Behavioral Health
1306 11th Ave.
Greeley, CO 80631 #(970) 353-3686
Appendix C
16
FOSTER PARENT CONSULTATION BUDJET
A.Tf, TA3L,3,, a .: . TOTAL OROMP 01EMIIE�L111L
B xt a A ,,...4:..v: '`J TI 27
clot* 169
W '"M ,. a.O1 3,, , is " << a s
ties
d ia+ 5Y`- r,,,,, ,,, 1:
� T �. It
pbr�,-h � 44 RW M4 8`r� �
220
#r t 'a y .
.,z
J. '12047
3/23/01
Appendix D
17
AIDORDE CERTIFICATE OF INSURANCE ISSDE DATE(MM,OC:Y'r)
March 21 , 200.1
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
ACA :Insurance Trust, Inc . DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE '
5999 Stevenson Avenue _FtQLICIESBELQW._.,,_,-_
Alexandria, VA 22304-3300 COMPANIES AFFORDING COVERAGE
COMPANYA The Reciprocal Alliance
LETTERRisk Retention Group
COMPANY
INSURED LETTER B
Lori J. Kochevar ,N. S. , LPC, LLC COMPANvC
810 12th Street LETTER
I
Greeley, CO 80631 LETTER
P
COMPANY E
LETTER
COVERAGES - -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TC THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR CTHEP DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED CR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATNNJ LIMITS
LTR DATE(MINDDIYYI DATE WM/DDITY)
GENERAL LIABILITY GENERA'_AGGREGATE 53 ,000, 000
X COMMERCIAL GENERA LIABILITY PRODLICTF-OOMP/OP AGG. $
CLAIMS MADE X,OCCUR. PERSONAL&ADV.INJURY 6
OWNER'S E CONTRACTOR'S PROT. EACH OCCURRENCE 11 ,000, 000
FIRE DAMAGE(Any one Ive) $
MED.EXPENSEVMyme PH0011 E
AUTOMOBILE LIABILITY COMBINED SINGLE
ANY AUTO LIMIT
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRE()AUTOB BODILY INJURY
S
N0NOWNE0 AUTOS - (Per PCClcen;)
GARAGE LIABILITY
PROPERTY DAMAGE S
Excess LIABILITY EACH OCCURRENCE S
UMBRELLA FOAM AGGREGATE S
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION
EACH ACCIDENT E
AND
DISEASE—POLICY LIMIT
EMPLOYERS'LIAOIUTT
DISEASE—EACH EMPLOYEE E
OTHER
Professional CL 125098 00 9-17-00 9-17-01 $1 , 000 , 000 per, occ
Liability $3 ,000 , 000 agrr.
DESCRIPTION Or OPERATIONSiLOOATIONS/VEHICLESOPECIAL ITEMS
Professional Counselor/Professional bodywork counselor
Independent Contractors : Mary Mumdy-Graham , LCSW, Shelley Cox. MA, Shannon
Anderson, MA, Carmen Jimenez, LCSW
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Additional, Insured : EXPIRATION DATE THEREOF. THE SSUIN3 COMPANY WILL ENDEAVOR TO
State of Colorado MAIL DAYS WRITTEN NGTICE TO THE CERTIFICATE HOLDER NAMED TO THE '
c/o Weld County Social Service?. LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL ,MPOSE NO OBLIGATION OR
P. O. BOX A LIABAutILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES
ureP_leVr CO frig c.tTh2. @S9 YE / / ,cy
063 ) "C//EN < </y/
ACORD 25-S(7/90) CACORD CORPORATION 1990
[ -d L9ZSEZ2SI0L llHJv IJCdd YId9C',V lO0Z- lZ-C
—GX �_Ar. it !Uv�,H .., Null 'fie ���� k) �. P. 2
a FARMERS
Active ClientVision 3 . 4 Agent# 070457
Last Name Kochevar First Name ',fir_ last HR Rev 8/30/02
Bus# 970 352-8873
Address 23830 WCR 42 ;use
Auto Policy Information Last NUM, Date : 2!24/01.
for Policy # 133124227
Vehicle : 96 TF$CEEL U Facesheet Ef£ Dt : 08 28 91
Vehicle ID # : JTLBOSZLXT0136345 Company : FIE Package : 20/60
Driver : L KOCHEVAR- SULLIVAN License Plate # :
Age : 34 008 : 04 27 66 Occupation : 84 Marital Status : S
Drivers. License #: 921247906 Rel . to HH: P
Renewal Date : 08 Z8 01 Prematic # : Status : SOK
Cancel Gate : 00 0'.) 00 Series :
Symbol : K Rate Class : 1A TerritoryiCCF: 07 Points/DIP : 00
Multi- Car Discount : Y Auto/Hume , Renters Discount : N
`• _lab : 100!300/100 UM/UMPD : 100/300/ CCD : 10n0 COLL : 1000
Medical/PIP : R1-- PPC COLL Plus : Towing : A
F3=Exit F5 =Panel Selection F6= History F8=Next F9=Pre"ious
FI1=Prim Evidence :f Insurance F12=Cancel
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