HomeMy WebLinkAbout20001546 RESOLUTION
RE: APPROVE NOTIFICATION OF FINANCIAL ASSISTANCE AWARD FOR CORE
SERVICES FUNDS AND AUTHORIZE CHAIR TO SIGN -WELD COUNTY
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
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 Core Services Funds 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 Weld County Department of Public Health and Environment, commencing
June 1, 2000, and ending May 31, 2001, 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 Core Services Funds 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 Weld County Department of Public Health and Environment 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 26th day of June, A.D., 2000, nunc pro tunc June 1, 2000.
BOARD OF COUNTY COMMISSIONERS
i��►�►� WELD COUNTY, COLORADO
14,ATTEST: limili��/:' A. , i
111RV = Barbara J. Kirkmeyer,'Chair J
Weld County Clerk tot•''t'•{ •�0 i
, EXCUSED
��� M. J. eile, Pro-Tem
BY: a�.. A. x r �' .,;
Deputy Clerk to the Bo.�i' l� �� r
Geor E. Baxter
APPROCAS TO F
(' a e . Hall
_fxt
e6unty Attorney _ EXCUSED
Glenn Vaad
CC.'55 itheid tt#w/6/ .)e of o7,irek)0,diiMreo'tlin4 roninani 20 831546
Weld County Department of Social Services
Notification of Financial Assistance Award
for Families,Youth and Children Commission (FYC) Funds
Type of Action Contract Award No.
X Initial Award FY00-PAC-8000
Revision (RFP-FYC-0005)
Contract Award Period Name and Address of Contractor
Beginning 06/01/2000 and Weld County Department of Public Health and Environment
Ending 05/31/2001 Life Skills
1555 N 17 Avenue
Greeley, CO 80631
Computation of Awards Description
Unit of Service The issuance of the Notification of Financial Assistance
Award is based upon your Request for Proposal(RFP).
Improve parental capacity to keep the children in The RFP specifies the scope of services and conditions
the home, to reunite the children who are placed of award. Except where it is in conflict with this
in foster care, and sustain the lowest level of care. NOFAA in which case the NOFAA governs, the RFP
A maximum of 16 families served for 6-8 months upon which this award is based is an integral part of the
(24-32 weeks) average of one-two hours per action.
week. Special conditions
1) Reimbursement for the Unit of Services will be based
Cost Per Unit of Service on an hourly rate per child or per family.
2) The hourly rate will be paid for only direct face to face
Hourly Rate Per $ 104.15 contact with the child and/or family, as evidenced by
Unit of Service Based on Approved Plan 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.
Enclosures: 4) Payment will only be remitted on cases open with, and
X Signed RFP:Exhibit A referrals made by the Weld County Department of
Supplemental Narrative to RFP: Exhibit B Social Services.
Recommendation(s) 5) Requests for payment must be an original submitted to
the Weld County Department of Social Services by the
Conditions of Approval m
end of the 25 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:
Byy U�A�& l�1/4l/ l / k lIyLLJ By
arbara J. Kirkmeyer, Chair 0 Judy A Grie Director
Board of Weld County Commissioners Weld " ounty epartment of So ial Services
Date: e% Date: ty
2000-1546
SIGNED RFP
EXHIBIT A
INVITATION TO BID
RFP-FYC 00005
DATE:February 28, 2000 BID NO: RFP-FYC-00005
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-00005) for:Family Preservation Program--Life Skills Program Family
Issues Cash Fund or Family Preservation Program Funds
Deadline: March 23, 2000, 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, 2000,through May 31, 2001, at specific rates for different types of service, the county will
authorize approved vendors and rates for services only. The Life Skills Program must provide services that
focus on teaching life skills which are designed to improve household management competency,parental
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 ///(�
Delivery Date March 22, 2000 (A �/� God al v (\/
(After receipt of order) BID MUST BE SIGNED IN INK
MARK E. WALLACE
TYPED OR PRINTED SIGNATURE
Weld County Department of IA/0kC�� //I /C����/l�nj Q�c
VENDOR public Health and EnvironmentV l 1,'V .V'�-"(�
(Name) Handwritten Signature By Authorized
Officer or Agent of Vender
Director of Weld County Department of
ADDRESS 1555 N 17TH Avenue TITLE Public Health and Environment
Greeley, CO 80631 DATE 3(2 i ( 2-071-0
PHONE # (970) 304-6420
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
Page 1 of 33
RFP-FYC-00005 Attached A
LIFE SKILLS PROGRAM BID PROPOSAL AND
REQUEST FOR CONTINUATION OF AWARD UNDER FPP CORE SERVICES FUNDING
FAMILY PRESERVATION PROGRAM
2000/2001 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 2000-2001 •
BID #RFP-FYC-00005
NAME OF AGENCY: Weld County Department of Public Health and Environment
_ADDRESS: 1555 N 17TH Avenue Greeley, CO 80631
_PHONE:1970 ) 304-6420
CONTACT PERSON: Becky Mc Mahan TITLE: Registered Nurse
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: TheLife Skills Program Category must
provide services that focus on teachi g life skills designed to facilitate implementation of the case plan by improving
household management competency.parental competency. family conflict management and effectively accessing
community resources
12-Month approximate Project Dates: _ 12-month contract with actual time lines of:
Start June 1.2000 Start Time 1,2000
End May 31. 2001 End May 11 . 7001
TITLE OF PROJECT: Identification and Care Management of Families With Attachment Bonding Issues
AMOUNT REQUESTED:
Raharra Mr Mahan. RN. BSN Child Health Program O
Name and Styze tyf laring ifsument Date
Mark Wallace. MD Director 3fri I -0D
Name and Signature Chief Administrative Officer Applicant Agency Date
MANDATORY PROPOSAL REOULREMENTS
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 1999-2000 to Program Fund year 2000-2001.
Indicate No Change from FY 1999-2000
Project Description NO
Target/Eligibility Populations NO
Types of services Provided NO
Measurable Outcomes NU
Service Objectives NO
Workload Standards YES
Staff Qualifications NO
Unit of Service Rate Computation YES
Program Capacity per Month YES
Certificate of Insurance
Page 26 of 33
RFP-FYC-00005 Attached A
Date of Meeting(s) with Social Services Division Supervisor: c)— n C' C
Comments by SSD Supervisor:
{ke(2(1v, . (A p-L . r, - --i -<1‘4"- , 11-�
—fie C � ,C �7 V.v, L
"- f 12Q (2k —C r
j (/ /j p
ii_ �� ��y--`fi t. (n n ,,, A 1 1`c--.---< �i�-Q'y\ frier-4 w �-L."—' 1.
/1 M1 yy/ p
_Signature of SSD Supervisor Date
Page 27 of 33
Bonding and. Attachment Intervention Program
I. Project Description
Definition:
Bonding is that emotional relationship between infant and mother which allows the child to
know basic trust and a sense of security. The child who experiences a strong nurturing bond with a
primary caretaker (ideally, the birth mother), will develop a sense of trust, good self esteem, and reciprocal
behavior with others. These are the tools that make it possible for her/him to form and maintain loving
lasting relationships in the future. Children who do not experience this nurturing, bonding behavior will
not learn to trust, will be insecure and will feel they do not belong. They tend to become controlling
and defiant in their behavior. They will be difficult for parents to manage. These are the babies who
resist cuddling, the children who are disruptive in the day care and class room and the teenagers who are
found in juvenile halls. They fail to develop a conscience and may develop what is referred to as Reactive
Attachment Disorder.
Precipitating Factors:
Children who experience separation from the birth mother from conception through age two are
at high risk for developing Reactive Attachment Disorder. Situations which contribute to this are
prenatal influences such as substance abuse or a high level of stress during the pregnancy. Premature
birth, recurrent illness, hospitalization, abuse, neglect, and poor parenting skills also have a negative
effect on the bonding process.
Intervention:
The purpose of this program is to provide support and information in order to assist parents in
establishing or rebuilding a broken bond. Early intervention is a crucial factor in working with children
and parents in this area. As the child becomes older, he is more resistive to learning trust. The goal of
this program is to keep children with their biological parents when this is a safe and healthy
environment. The program could also assist adoptive/foster parents with the bonding process in order
to eliminate failed placements and frequent moves. The more often a child's placement is changed, the
more difficult it is for her/him to learn to trust the adults in his/her life and the higher the risk for the
child of developing Reactive Attachment Disorder.
Evaluation:
Symptoms of disruption in bonding and attachment occur on a continuum from mild to severe.
The public health nurse, who responds to the initial referral, will evaluate the child and parents for
evidence of bonding and attachment concerns. A community therapist will further evaluate children
who show evidence of more severe problems, with further consultation by the Attachment Center at
Evergreen as needed. Becky McMahan, a public nurse with extensive experience in pediatric health
care and Ginger Maki, a nurse educator with training in parent and family issues, will work closely with
referred families. Weekly nurse home visits will be focused on redirecting the parenting process. Dr.
Marilee Smith, a family therapist in our community who has experience working with children who have
Page 2
attachment and bonding problems, will provide an evaluation and determine appropriate therapy for the
children and families referred to her. Margaret Meinecke, a therapist from The Attachment Center in
Evergreen, will provide consultation and evaluation as more complicated cases are referred to her. This
family centered collaborative model has been an effective tool over the past five years.
Direction and Closure:
An important part of the public health nurse evaluation is to identify the degree of bonding and
attachment issues of the child, level of parental frustration, and the strength and commitment of the
family. The public health nurse will work with the family in the home or at the site of the parent-child
visits for a predetermined period of time. Interventions will not only be directed toward the parent-child
interaction, but toward the individual needs of the parent and child. Sessions will provide direction and
closure around bonding issues. Ultimate closure is reached when the parent/child relationship is
reestablished, fears and insecurities diminish, and outside assistance is no longer needed. The goal is for
the child to return to or remain with the birth parent. If this is not possible, a foster or adoptive parent
can be assisted in a similar manner to address the bonding issues of the child. The goal of this program
is to assure that the child is in a placement which is physically safe and emotionally healthy.
II. Target and Eligibility Population
Identification:
Services will be provided upon referral from the Department of Social Services (DSS) for
families who are experiencing difficulty with attachment and bonding issues. Children must be at risk
for being removed from the current home environment or at risk for continued placement outside of the
home. History of poor health, parental abuse, neglect, lack of parenting skills, substance abuse and
domestic violence all place children at high risk for attachment and bonding problems. Infants born
prematurely, and infants and children separated from their biological mother are also at high risk for
bonding issues.
Focus an Limitation:
A total of sixteen family units will be served, with children's ages being from birth to age eight.
These family units could include all family members who have a relationship with the identified child.
The family must be willing to invest in an ongoing relationship with the public health nurse and be
committed to improving the home environment for the safety and emotional well being of the child. If
the children are in foster placement, efforts will be made to work with foster parents and biological
parents to assist in reunification of families. We will assist in the transition from foster to adoptive
families to ensure that the placement will be successful.
Page 3
Time Line Expectations:
Referrals for all Weld County families, regardless of geographic location, will be served. Weld
County's population includes a high number of monolingual Hispanic families. Children in these
families will be served through provision of an interpreter. Families would remain in the program for six
to eight months (twenty-four to thirty-two weeks) initially, based on DSS case worker's referral and
progress of the family. The average hours per week per family would be one or two hours. A family
would begin with one to two hours of service per week for the first three to four months. In the case
that the family is progressing toward healthy goals, weekly visits would be decreased to one hour per week
or one hour biweekly. The client contact would decrease as the child and parent showed stronger
bonding relationship and the parent gave evidence that she/he was able to provide a safe, loving
environment for the child.
The monthly maximum number of families receiving intervention through home visitation will
be eight to ten. The monthly average home visitation capacity would be six to eight families. A family
could conceivably complete the program or be terminated early, depending on the individual
circumstances. A particular referral could be renewed for another six to eight months if the family is
working successfully toward reconciliation and more time is needed to secure the family unit. This
would be up to the discretion of the public health nurse, the therapist, the DSS case worker and the
family.
III. Services to Be Provided
Action Plan:
This program is designed to provide home visitation by a public health nurse, in order to assist
the family with identification of their needs and to develop a plan with successful outcomes. Although
working in the home with families is the ideal, this is not always possible due to placement of children
outside the home. In these cases we will work with parents and children at the a visit site as arranged by
the Department of Social Services case worker. Intervention includes providing parents with
information and supporting their efforts toward relating with the child. Through the parent's increased
knowledge and awareness of the importance of having a healthy bond with their child, they will begin to
better understand parent-child relationship and its effect on their child's behavior. The emotional status
of parents is a key component to the success of failure of this program. Parents may need a referral to
other professionals or agencies to assist them with addressing their own needs.
)Skills Level Objectives:
During visits with the parent and child, the nurse will teach and model parenting techniques
which enhance bonding, such as, cuddling, rocking, making eye contact, reading and talking
appropriately to their child. These interactions are basic to rebuilding the broken bond between the
Page4
child and the parent. Parents are also taught the types of discipline which are effective for a child with
bonding and attachment issues. The nurse works with the parent in the area of understanding the
developmental stages of their child and having appropriate expectations of the child. This would include
being able to anticipate behavior, providing play things for the child's age level and using appropriate
discipline. This is implemented by teaching, demonstration and positive coaching techniques given by
the public health nurse.
Goals:
Every day living skills are addressed per family assessment. Emphasis on providing a safe, and
stable environment is important for families whose children have experienced some degree of insecurity
as a result of inadequate bonding. Consistency and routine in the household are extremely important
for these children. Parents may need assistance to stabilize their own lives before they can offer that to
the child. The intervention will include assistance in household management skills. This would include
information about food and nutrition, laundry, cleaning, hygiene and money management. A stable
home environment is needed for these children order to develop a sense of trust and security.
Support Network:
Families will be assisted with referrals and information about other community agencies as the
need arises. Referrals range from medical issues to social concerns. Once families are knowledgeable
about community services, they will be encouraged to continue to access these agencies as needed.
An Understanding:
Families receive ongoing evaluation to support and acknowledge their progress. The nurse and
the family will work together to identify family strengths and develop a plan for the family's involvement
in the program. The family is encouraged to identify and verbalize their concerns on an ongoing basis.
The nurse and the parent work together to establish goals. Parents receive ongoing verbal evaluation to
support and acknowledge their progress and to set new goals as needed. The family and nurse will
mutually agree when goals of the plan are met.
IV. Expected Measurable Outcomes
Screening the Child:
All families will be screened with a tool designed to indicate the presence and degree of bonding
and attachment disorder. This screening identifies the problem behaviors of the child and gives an
indication of the parent's emotional status and degree of involvement with their child . (Copy attached)
By discussing the results of this screening, the nurse can assist families in identifying the needs of their
child. This discussion is helpful to the screener in determining the degree of commitment the parent
Page 5
has toward the parent-child relationships; giving the Public Health Nurse (PHN) insight into how best
to work with parents to improve parenting skills. The discussion may also open insights, improved
understanding and reassurance for the parent regarding their child's needs. This assessment will be
completed periodically through the referral period to measure the status of the family and will be shared
with the parents to assist in redefining goals. Results of the screening and on going assessments are
reviewed with the DSS caseworker on a consistent basis. Written monthly reports are also submitted by
the PHN to the caseworker.
Screening the Family:
The Home Visit Risking tool will be used to identify problems in the home which relate to
safety, social and health concerns. This tool focuses on a wide variety of risk factors in every day living.
(Copy attached) The tool allows the public health nurse to develop a working measurable plan with the
family. Concerns will be shared with the family arising from this assessment and include the families
own perception of problem areas. This tool will be used to identify strengths in the family and to
develop a plan with them for working to improve in specific areas. We will re-evaluate periodically with
parents to review progress and reappraise their concerns.
Outside Agency Support:
Parents are encouraged to work with community agencies to assist with their needs. The public
health nurse serves as a liaison between the family and the agency involved to facilitate a positive
experience and outcome. This is measured by a family's commitment in keeping appointments,
providing the necessary paperwork, and being responsible to the
agencies requirements.
If at the end of the referral time, the PHN does not see improvement in the family situation,
she will request a renewal of the referral to the program. The PHN will also explore with the case
worker and other involved professionals, other avenues of service which might be helpful to the family.
The PHN will make one phone contact with the family six months after completion of the program to
determine their current status.
V. Service Objectives
Periodic Review:
We would expect that parents would first come to understand the need to provide a safe, healthy
home environment for their children. Through direct modeling, providing information, improved
home interaction and, in some cases, referral to other community resources, we would expect to see
positive changes in the home. This will by monitored by observation and comparison to initial
concerns.
Page 6
We hope to see an increased awareness of parents for the importance of bonding with their
children and the nurturing behavior required of them to ensure their child's sense of security. We expect
parents to come to a better understanding of the importance of being a nurturing parent. Through
educational literature, discussion, demonstration, we would expect to see an improved ability and effort
to provide a physically safe home environment with an emotionally secure parent-child connection. We
anticipate improvement in the parents ability to provide age appropriate interactive activities, with limit
setting, and healthy discipline measures appropriate for the age of the child. These activities would be
monitored and measured through observation of the nurse and parent input.
Using Resources:
Once we have introduced parents to available resources, we would expect parents to access these
resources to meet their needs. Experiencing trust and support through community resources is a
healthy step toward establishing family connectedness. After being assisted initially through this
program, the families may continue to access services independently as needed. Learning the right
phone calls to make and the necessary paper work to be filled out are steps down the road to parent
competence.
Empowerment:
An important goal of this program is to empower parents. Many parents who have children with
attachment or bonding issues feel isolated and angry. They may be angry at the children because they
are difficult to parent, or they may be angry with a system which may cause them to believe they are not
good parents. They may doubt their own ability to parent. By offering the tools of this program with
its positive support, we hope to see a parent with heightened self-esteem and a family with vibrant signs
of life and well-being.
VI. Workload Standards
A. Public health nurses will provide 64 hours per month of nurse time. Eight to ten hours per
month will be provided by community therapist. Twenty-four hours of consultation time will be
provided over the course of the year by a therapist from Evergreen.
B. The services will be provided by four individuals, two public health nurses, a community
therapist, and a consultant from Evergreen.
C. The public health nurses will be providing intervention for maximum of 8-10 clients in a
month's duration.
D. The modality of treatment will be home visits (or at other locations as designated by DSS)
provided by the public health nurses one to two hours per week. Office visits will be modality of
Page 7
E. treatment for families referred to therapist. The consultation from Evergreen will be available
for the public health nurse, community therapist, and family as the need arises.
E. As A-D above.
G. As A-D above.
H. Covered by county insurance—no copy attached.
VII. Staff Qualifications
Becky McMahan R.N., B.S.N.
Becky meets the educational requirements for nurses at the Weld County Health Department
with a Bachelor's degree in nursing. She has previous experience of fourteen years working in pediatric
nursing in the hospital setting. Becky has been with the Health Department for four and a half years
with her primary program focused in Attachment Disorder. She works as program charge nurse for the
Well Child Clinic held once a week and home visitation to high risk infants. Becky has received
training through the Attachment Center at Evergreen, and continues to keep abreast on current
development related to the field.
Ginger Maki, R.N., M.A., C.H.E.S.
Ginger has had ten years experience in nursing at a variety of settings. She also has seventeen
years of experience as a health educator in a hospital and community setting. She has received training
in parenting, bonding and attachment. Ginger has had experience in behavior change counseling and
facilitating support groups.
Cheryl Weinmeister, R.N., B.S.N.
Cheryl is the Child Health Supervisor since 1998, and has been at the Health Department since
1992. Cheryl's experience includes six years working with children who have special needs. Cheryl is
committed to the programs goals and objectives, and is aware of the time allotted to assure success.
Becky Cervantes, Interpreter
Becky is the interpreter and office technician for the program. She is bilingual and works in the
Child Heath Team. She assists with clerical duties for this program and is available to serve as an
interpreter when needed.
Dr. Marilee Smith Psy.D.
Marilee is a psychologist working in Weld County. In 1997, she has received specialized
Page8
training in the treatment of children with bonding and attachment issues.
Margaret Meinecke
Margaret is a therapist from The Attachment Center at Evergreen. She has 10 years experience
as a private practice clinician with families.
CHILD'S NAME: DUB:
PERSON SCORING:
PROBLEM SEVERITY
SIGNS OF ATTACHMENT DISORDER
NONE MILD MODERATE SEVERE
* BIRTH TO ONE YEAR * (never) (25% of time) (50% of time) (75%or more)
• Failure to respond with recognition to face of primary caretaker in first
6 months
` Infrequent vocalizations, i.e., babbling, crying
• Delayed milestones creeping, crawling, sitting
" Resistant to physical contact or appears stressed by it; rigid, unyielding
• Excessive fussiness, irritability
• Passive or withdrawn
Poor muscle tone, flacid
t i I LU J (VHIVI t: Uu C:
'ERSON SCORING:
SIGNS OF ATTACHMENT DISORDER PROBLEM SEVERITY
* ONE TO FIVE YEARS * NONE MILD MODERATE SEVERE
(never) (25% of time) (50% of time) (75%or more)
Excessively clingy, whiny
Persistent, frequent tantrums, sometimes escalating apparently beyond -
child's control
High threshold of discomfort. Seemingly oblivious to temperature
discomfort, may pick sores and scabs until bloody without manifesting pain.
Unable to occupy himself in a positive way without involving others •
Resistant to being held
Demands affection in a controlling way on child's terms
•
Intolerant of separation from primary caretakers except on child's terms
Intolerant of separation from primary caretakers except on child's terms
Indiscriminate displays of affection, sometimes to total strangers
Problems of speech development
Problems of motor coordination, may be considered accident prone
Hyperactivity evident
By five, may be manipulative, devious, destructive, hurtful to pets, •
frequently lying
Feeding problems
•
ONE TO EIGHT YEARS OF AGE
•
CHILD'S NAME: BIRTH DATE:
PERSON SCORING:
SIGNS PROBLEM SEVERITY
NONE MILD MODERATE SEVERE
(never) (25% of the time) (50% of the time} (75%or more)
Lack of ability to give and receive affection. •
(demands affection in a controlling way; abrupt,neutral, •
unenthusiastic exchanges; absence of warm physical
contact; demanding and clingy)
Extreme control problems.
(persistent,frequent tantrums; hyperactivity evident)
Self-destructive behavior.
High threshold of discomfort.
(will not seek comfort if in pain)
Cruelty to others or animals.
(sadistic/violent; bullies,threatens,or intimidates; initiates
physical fights; has used a weapon)
Counterfeit emotionality.
(phoniness)
Stealing, hoarding, or gorging.
(has broken into someone else's home,care,etc.; has stolen
items of non-trivial value; has stolen while confronting a
person,i.e.,mugging)
Speech pathology.
(problems of speech development)
Lack of long-term childhood friends.
•
Abnormalities in eye contact.
Sexual obsession.
(Has forced someone into sexual activity)
Preoccupied with blood, fire, and gore.
(deliberately engaged in fire setting)
Superficial attractiveness and friendliness with
strangers.
(indiscriminate displays of affection)
Destruction of property.
Compulsive lying.
(devious; manipulative)
Defective conscience.
(no remorse) Difficult to observe.
Learning disorders.
Problems with motor coordination.
(may appear accident prone)
Oppositional, resistant, defiant, and controlling
behavior.
-4
•
Parents very frustrated or angry.
F.
WINGS Attachmentt
HOME VISITING - RISKING TOOL
Name D.O.B.
Score and date administered, please score on scale of l-5 with 5 being the highest risk.
I HEALTH VII COMMUNICATION
A.NO PRIMARY PHYSICIAN A. LITERACY
B. UNINSURED B. PRIMARY LANGUAGE
C.UNDERINSURED • C. HEARING IMPAIRED
D.NO. OF HOSPITALIZATION D. HEARING
E .NO. OF DR.VISITS (over or under use)
F. VISITS TO OTHER PROVIDERS (over or under use)
G. E.R_VISITS (for acute care non emergency.) IX ASSISSTANCE WITH ACTIVITIES OF
OF DALIY LIVING _
II ECONOMIC RISKS A. RESPITE
A.UNEMPLOYED B. REHABILATION
B. HOMELESS 1. OCCUPATIONAL
C. INADEQUATE HOUSING(UNSAFE) 2. PHYSICAL
D. LOW INCOME 3. SPEECH
E.NUTRITION
F. CLOTHING X MEDICATION REVIEW
G. CHILD CARE
III VIOLENCE RISK XI LEGAL ISSUES
A. DOMESTIC VIOLENCE
B. ELDER VIOLENCE
C. CHILD ABUSE/NEGLECT XII EDUCATIOAL LEVEL
D. SEXUAL ASSAULT
F. GANG INVOLVEMENT
XII FAMILY STRUCRURE
IV MENTAL HEALTH CONCERNS A. SINGLE PARENT
A. GRIEF ASSISTANCE B. RUNAWAYS
B. VICTIM ASSISTANCE C. LIVING WITH NO PARENTS
C. ADDICTIONS D. I LEN PARENT
D. SUICIDE (PREVENTION/POSTVENTION)
E. DEPRESSION XIV DIAGNOSTIC CODE
V ISOLATION-GEOGRAPHIC
VI ENVIRONMENTAL RISKS
A. POTTERY
B. WATER
C LEAD
D. RAW MILK
F_ AIR
I- CLIFF I ER - UNSANITARY CONDITIONS
RFP-FYC-00005
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 Soc=ial 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 55
Hours [A]
Total Clients to be Served 16
Clients [B]
Total Hours of Direct Service for Year 880
(Line [A] Multiplied by Line [B] Hours (C]
Cost per Hour of Direct Services $ 53.00
_ Per Hour [D]
Total Direct Service Costs $ 46,640
(Line [C] Multiplied by Line [D] ) (EI
Administration Costs Allocable to Program $ 37,322
(F]
Overhead Costs Allocable to Program $ 7,694
(G]
Total Cost, Direct and Allocated, of Program$ 91,656
Line [E] Plus Line [F] Plus Line [G] ) (H]
Anticipated Profits Contributed by this Program $ -0`
[I]
Total Costs and Profits to be Covered
by this Program(Line (H] Plus Line (I) ) $ 91,656
(J]
Total Hours of Direct Service for Year 880
[K)
Page 31 of 33
RFP-FYC-00005
Attached A
(Must Equal Line (C1 ) •
Rate per Hour of Direct, Face-to-Face Service
to be Charged to Weld County Department of
Social Services $ 104.15
(Ll
Day Treatment Programs Only:
Direct Service House Per Client Per-Month
(Ml
Monthly Direct Service Rate $
NI
(A] This is an estimate of the total hours of direct, face-to-face service
e(each
client will receive from the time he or she enters the program until completing
the program.
(B] This is at estimate of the number of clients who will be served during the period
from June 1, 2000, through May 31, 2001.
(D] This represents the average hourly salary and benefits that your organization
pays its direct service providers plus any costs which are directly attributable
to the face-to-face session with the client.
[F] This represents the salary and benefits of direct service, supervisory,
ry, and
clerical personnel which are not incurred in providing direct, face-to-face
service to the client, but can be allocated to this program for time spent on the
program for activities such as travel, phone conversations, "no-shows, "
discussions with involved parties, meeting preparation, and report completion.
(G) This represents the Agency Overhead costs, such as Rent., Utilities, Supplies,
Postage, Travel Reimbursement, Telephone Charges, Equipment, and Data Processing
which are not incurred in providing direct, face-to-face service to the client,
but can be allocated to this program for time spent on the program for activities
such as travel, phone conversations, "no-shows," discussions with involved
parties, meeting preparation, and report completion.
(H] This represents the Grand Total Costs directly attributable or allocable to this
program. It should be a reasonable assumption that if you decided to discontinue
this program, your agency would realize a reduction in costs approximately equal
to this amount.
(Il This represents the total amount of profit your firm expects to realize as a
result of operating this program. Any difference between Lines (H] and [J] must
be substantiated by an amount indicated on this line.
(L] This is the actual direct, face-to-face hourly service rate at which you will be
requesting payment for the services provided under the conditions of this Request
Page 32 of 33
PREPARATION OF BUDGET FOR 2000-2001 PAC GRANT
Item A: Total Hours of Direct Service Per Client
Becky McMahan 768 hours direct client contact this year
Marilee Smith 108 hours direct client contact this year
Margaret Meinede 8 hours direct client contact this year
Total 884 hours direct client contact this year
884 hours divided by 16 clients = 55.25 hour per client (rounded to 55 hours per
client).
Item D: Average Hourly Salary
B. McMahan $24.15 hourly salary plus benefits
M. Smith 80.00 hourly rate
M. Meineke 50.00 hourly rate
Total $154.15
$154.15 divided by 3 =$51.39 average hourly salary (We used $53 as we
anticipate an increase in hourly rate from Margaret Meineke of the Attachment
Center.
Item F: Administration Costs
Attachment Center
5 hours consultation for each of 4 trips during the year= 20 hours
6 hours of phone consultations
3 hours travel time 4 times a year = 12 hours
20 + 6 + 12 = 38 hours
$50 x 38 hours = $1,900.00
Mileage= 180 miles round trip 4 times a year at $.305 per mile
1800 x 4 x .305 = $219.60
Meals: $8 per lunch for two people 4 times a year
$8 x 2 x 4 = $64.00
Total support from Attachment Center: $1,900.00+ $219.60+ $64 = $2,183.60
Becky McMahan
3 hours support time per week per client for 8 clients for 26 weeks times 2 to
equal cost for 16 clients each in the program for 6 months (26 weeks)
$24.15 x 3 x 8 x 26 x 2 = $30,139.20
Becky Cervantes
2 hours support time per month, hourly salary and benefits = $13.65
$13.65 x 2 x 12 = $327.60
Cheryl Weinmeister - Supervisor
36 hours a year support time, hourly salary and benefits = $28.39
$28.39 x 36 = $1,022.04
Linda Carlson - Director, Preventive Health Services
24 hours a year support time, hourly salary and benefits = $36.35
$36.35 x 24 = $872.40
Judy Nero - Fiscal
36 hours a year support time, hourly salary and benefits = $28.04
$28.04 x 36 = $1,009.44
Mileage
2,517 miles x $.305 per mile = $767.69
Training
Training for staff members = $1,000.00
Administration Costs Summary
Attachment Center $ 2,183.60
Becky McMahan 30,139.20
Becky Cervantes 327.60
Cheryl Weinmeister 1,022.04
Linda Carlson 872.40
Judy Nero 1,009.44
Mileage 767.69
Training 1,000.00
Total $ 37,321.97
Item G: Overhead Costs —Used actual program expenses for 1/1/99 - 12/31/99
Supplies $ 481.62
Services 1,051.47
Misc. O/H 6,161.07
Total $7,694.16
Item H: Total Cost, Direct and Allocated of Program
$46,640 + $37,322 + $7,694 = $91,656
Item L: Rate per hour of Direct, Face to Face Service
$91,656 divided by 880 hours = $104.15 per hour
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