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Home My WebLink About20001700 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 FY00-CORE 19000 Revision (RFP-FYC-00008) Contract Award Period Name and Address of Contractor Beginning 06/01/2000 and Ackerman and Associates P.C. Ending 0`!/31/2001 Intensive Family Therapy Family Group Decision Making 1750 25'" Avenue, Suite 101 Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Improve both individual and family functioning Award is based upon your Request for P-oposal (RFP) through in-home and in-office services. The and the Addendum REP information, the RFI' program has a capacity of 4 families per specifies the scope of services and conditions of award. month, (48 per year) involving the nuclear Except where it is in conflict with th s NOFAA in family, professionals involved in the case, and which case the NOFAA governs, the REP upon which with individual members of the extended this award is based is an integral part of the action. family. Special conditions I) Reimbursement for the Unit of Services wil l be based Cost Per Unit of Service on a designated per family group confer Nice. 2) The designated rate will be paid for onl3 direct face to Rate Per Family Group $ 2.000 00 face contact with the child and/or family, as evidenced Based on Average Capacity. by client-signed verification form, as specified in the unit of cost computation. Enclosures: 3) Unit of service costs cannot exceed the c esignated rate and yearly cost per child and/or family _ }_Signed RFP:Exhibit A 4) Payment will only be remitted on cases open with, and Supplemental Narrative to RFI': Exhibit B referrals made by the Weld County Department of Recommendation(s) Social Services. 5) Requests for payment must be an original submitted to Conditions of Approval the Weld County Department of Social .'services by the end of 25th calendar day following the end of the month of service. The provider must submi requests for payment on forms approved by Weld County Department of Social Services. Appr als: Program fficial: By By t ti arbara J. Kirkmeyer, Chair Judy . Grie , Directo Board of Weld County Commissioners Weld ounty epartment of Social Services Date: CXo -.?6-.2exp Date: ( o/ ;;_U/(X.) 2000-1700 SIGNED RFP EXHIBIT A INVITATION TO BID DATE:February 28, 2000 BID NO: RFP-FYC-00008 QQ RETURN BID TO Pat Persichino, Director of General Services A< 915 10th Street, P.O. Box 758, Greeley, CO 80632 F iow SUMMARY mast cry_ Request for Proposal (RFP-FYC-00008) for:Family Preservation Program--Intensive Family Them Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 23, 2000, Tuesday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5- 101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement (C.R.S. 26-5.3-101). The Placement Alternatives 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 Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists, typically with all family members, to improve family communication, function, and relationships. 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 - - C. 4O (After receipt of order) � T BE SIGNED IN INK If PM NI) .14rrPn TYPED OR PRINTED SIGNATURE VENDOR b1LP(h(l(1 t at) A ct `o� .c;je _ A�C� (Name) H @ itten\Signature By Authorized A Officer or Agent of Vender ADDRESS �I (C> N�`!h R TITLE 3 Op OU(),C1i c;P P C-I*s �- DATE ,3 2 O3- PHONE # QMb The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 L RFP-FYC-00008 Attached A INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 2000/2001 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 2000-2001 BID #RFP-FYC-00008 NAME OF AGENCY: AGkerinct/‘ Oat &≤ocetf-7-es l�P c . _ADDRESS: / 75`O i-S t'h /nn fr tee__ Sue -t—L. /o/ Cre e/y C p J0C 2 PHONE: f710 ) 3S 3 -- 3373 ( Fny. ?/O35-3 32? 7) �J CONTACT PERSON: \o y c e C huhp r /Cc-Ae/.4, 4TITLE: / .S'yc pl,o/ft/,_c (-- DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists.typically with all family members. to improve family communication. functioning.and relationships. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1. 2000 Start End May 31.2000 / End / TITLE OF PROJECT: f n• e ( y 6/—‘247, P 4-44 /0,--\ AA K /ice \ ,-. .-- b -�o -o _Nam and Ignature of Person Preparing Document Date _Name nd , ignature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids,please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids,please indicate which of the required sections have not changed from Program Fund Year 2000-2001 to Program Fund Year 2000-2001. Indicate No Change from FY 1998-1999 _ / Project Description N H _ ✓ Target/Eligibility Populations _ ✓ Types of services Provided _✓ Measurable Outcomes _ ✓ Service Objectives _ ✓ Workload Standards __V Staff Qualifications _t Unit of Service Rate Computation _ ✓ Program Capacity per Month _AL Certificate of Insurance Page 26 of 32 A RFP-FYC-00008 Attached A Date ofMeeting(s)with Social Services Division Supervisor: March 3, 2000, March 8, 2000 Comments by SSD Supervisor: s ,t I� f c 12 t i''d `Lit Y Aug / A z w' y' �, -r�, fi. t Ht.' pricl Alt]— ., CI., X7p i ( r� , A i o- i / . lp r � r a )`c Y( it-, II 0 Name and Signature of SSD Supervisor Date 7 r ,� 0-,•t_ , /_,'.1Q _i Andrea Lee Page 27 of 32 RFP-FYC-00008 Attached A Program Category Intensive Family Therapy Program Bid Category Project Title rn Grcne aect«,., - m Vendor HGhv Acs-oc- PROJECT DESCRIPTION Provide a brief one-page description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one-page brief description of the proposed target/eligibility populations. At a minimum your description must address: A.. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Sub-total of individuals who will have access to 24 hour services. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Address if your project will provide the service minimums as follows: A. Comprehensive, diagnostic and treatment planning with the family and other service providers. B. Therapeutic intervention with flexibility to bring in other services, if needed. C. Co-facilitated therapeutic services provided by one or more qualified family therapists. D. Therapy that is designed to resolve conflicts and disagreement within the family, contributing to child maltreatment, running away, and to the behavior constituting status offenses. Provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that PAC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES Provide a two-page description of your expected measurable outcomes of the project. Address the measurable outcomes for each area as described below: Page 28 of 32 RFP-FYC-00008 Attached A A. Children receiving services do not go into placement. B. Families remain intact. C. Reunification of children with families. D Improvements in parental competency, parent/child conflict management as determined or measured by pre and post placement functional tests. E. More cost efficient services through the Intensive Family Therapy Program than the placement of the child. F. Therapeutic outcomes include fundamental changes in the family functioning and dynamics. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Provide a one-page description of your expected service objectives and quantitative measures. Address, at a minimum, the following ways the project will: A. Improve Family Conflict Management- Mediation and counseling designed to resolve conflicts and disagreement within the family contributing to child maltreatment, running away and other offenses. B. Improve Parental Competency- capacity of parents to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision. C. Improve Ability to Access Resources - services shall assist parents to work with other sources in the community and ahead the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Provide a one page description of the project's work load standards and quantitative measures. Address, at a minimum, the following areas: A. Number of hours per day, week or month. B. Number of individuals providing the services. C. Maximum caseload per worker. (Generally 12 families per worker. Eight to 10 families per worker if the worker provides case management services to the families on the caseload.) L) Modality of treatment E. Total number of hours per day/week/month (Minimum average of two hours of sen ice per family per week. F. Total number of individuals providing these services. Ci. The maximum caseload per supervisor. (Minimum of 6 workers per supervisor.) E.. Insurance. Page 29 of 32 RFP-FYC-00008 Attached A VII. STAFF QUALIFICATIONS Provide a one-page description of staff qualifications and address, at a minimum, the following: A. Will your staff who are providing direct services have the minimum qualifications in education and experience. Describe. E3. Total number of staff available for the project. C. Will staff have expertise in family therapy as demonstrated by specialized training, workshops and experience. D. Will staff have a minimum of eight hours per year of continuing education; i.e. courses. workshops, and/or review of literature to be documented by county. E. Will staff have a minimum of one hour per week of clinical supervision provided by someone with advanced skills in Intensive Family Therapy. F. Will the clinical supervisor(s) be involved in regular training to keep current in state-of-the-aul counseling modalities and findings. Page 30 of 32 RFP-FYC-00008 v'II Attached A VIII. COMPUTATION OF DIRECT SERVICE RATE Set. b`" ,` ey- �`t Sl( �'tcc crr This form is to be used to provide detailed explanation of the hourly rate your organization will charge the Core Services Program for the services offered in this Request for Proposal. This rate may only be used to bill the Weld County Department of Social Services for direct, face-to-face services provided to clients referred for these services by the Department.'Fequests 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 invoi'ed 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 Hours [A] Total Clients to be Served to Clients [B] Total Hours of Direct Service for Year - CO(? Hours [C] (Line [A] Multiplied by Line [B] ,�l� Cost per Hour of Direct Services > (i 00 Per Hour [D] Total Direct Service Costs $ 7 0 Ca [El (Line [C] Multiplied by Line [D] ) Administration Costs Allocable to Program $ 770©O [F] Overhead Costs Allocable to Program $ 39 erne _ [G] Total Cost, Direct and Allocated, of Program$ / a O O C) O _ [H] Line [E] Plus Line [F] Plus Line [c] ) Anticipated Profits Contributed by this Program $ O O [I] Total Costs and Profits to be Covered by this Program(Line [H] Plus Line [I] ) $ / G' d �' _ [J] Total Hours of Direct Service for Year /-+ O O (Must Equal Line [C] ) �t- Rate per Hour of Direct, Cace-to-FacelService to be Charged to Weld County Department of Da or Social Services $ .. [L] /' ll ee Loo &7 Page 31 of 32 tle_ tti."✓-�`E-se-�t2 (,l,-Q2 ,�.� 1�.�, �.^ '�cr"�5t' tD t2FP-FYC-00008 Attached A Day Treatment Programs Only: Direct Service House Per Client Per Month [M] Monthly Direct Service Rate $ - [N] [A] This is an estimate of the total hours of direct, face-to-face service each client will receive from the time he or she enters the program until completing the program. [s] This is an 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, 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 tc this amount. [I] 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 [JI 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 for Proposal. [M] Tc be completed by prospective providers of the Day Treatment Program only, this line represents the estimated number of hours per month your organization will provide direct, face-to-face services per client. [N] To be completed by prospective providers of the Day Treatment Program services only, this line represents the actual direct, face-to-face monthly service rate at which you will be requesting payment for the services provided under the conditions of this Request for Proposal . Calculated by multiplying Line [L] by Line [M] . Page 32 of 32 Project Description 2000-2001 Family Group Decision Making Overview: Ackerman and Associates P.C. began its program of Family Group Decision Making on February 1, 1998 for families undergoing expedited permanency planning. For other families that met PAC eligibility criteria, we began offering these services on June 1, 1998. This is an application to continue these services. We will continue to use formats and procedures developed for the contract that began on February 1, 1998. The Family Group Decision Making model involves extensive planning with the nuclear family of the index child, coordination among all professionals involved in the case and consultation with individual members of extended family followed by a structured meeting adapted from the Scandinavian model family group meeting format with the professionals and the extended family unit. Criteria for participation in the Family Group Decision Making process will uniformly be: 1. that the family has been court ordered to participate in this process. 2 at least one child of this extended family (the index child) will immediately be placed or is already placed in foster care. The program has been very successful and highly regarded by participants, WCDSS and the 19th Judicial District, based upon its operation over the last two years and the completion of approximately sixty conferences. The purpose of the Family Group Decision Making model is to engage the family in its broadest configuration of the extended family, and to have them determine their recommendations for the placement of the child that meets the full requirements of the child protection statutes. Purpose: The purpose of the the Family Group Decision Making conference is for the family members themselves to reach agreement on 1) the permanent placement of the child and 2) what is needed to resolve the problems that have caused this placement. The model was first developed in New Zealand as an alternative to having the courts decide child placement. Our model incorporates some adaptations which originated in Scandinavia which includes professionals in the meeting, offers a somewhat more structured approach to participant interactions and provides some psychological distance from Social Services for the participants. We have also increased physical security in the meeting process itself. 1 The main idea is that the extended family unit must take responsibility for solving its own problems. The interest of the state is the protection of the child. The family likely has substantial strengths that can be utilized through this model to assist in protecting the child. The Family Group Decision Making model may limit what may be perceived by some as government sponsored intrusion into the family. We believe we are successful as the providers for the expedited permanency planning contract and the past year's non expedited Family Group Decision Making contract based on 1)our extensive training and success in mediation (particularly in relation to conflict resolution within families), and 2) our training in the Family Group Decision Making model 3) our training in related models and 4) extensive professional training in psychology and counseling. The model recognizes the need to involve parents and extended family members in the process of protecting and recommending permanent plans for these children. Details of how this process works are provided below. Design: The family group decision making process consists of 25 hours of billable services at a rate of $80.00 per hour. This produces a case rate maximum for each of $2000. In previous contracts we had a provision for increasing the fee for very large groups, but this was so rarely used that we have dropped this from the current bid. Typically,the Family Group Decision Making is based upon the following patterns of work. 1. Once the referral is made to Ackerman and Associates, we will contact the caseworker and identify the family history in terms of both mental health and medical needs. 2. An initial meeting will take place with the "nuclear" family At this meeting the Family Group Decision Making model will be explained and the family will help to identify the extended family members who will be contacted. 3. Family members will be contacted. Also professionals involved in the case such as the guardian ad litem, attorneys, caseworker, medical and psychological providers will be contacted. Ideally, all who are contacted will be able to attend the next meeting. Those who cannot will be represented based on their written report as best as possible by the team of conference facilitators. 4. The Family Group Decision Making conference will take place as follows: A.The first hour will be to establish the process and set the ground rules for how the process will occur. Two trained facilitators will be present at this stage. One will have the role to guide the process and reports for family members who could not be present. The other will represent the professionals who have gathered the information 2 who are not present. The professionals will only be able to attend this first part of the Family Group Decision Making. It is the responsibility of the facilitators to then assist the family in finding the outcome likely to be acceptable in terms of adequate detail and specificity to likely insure the protection of the child. The number at this conference is the total number of individuals represented in person or by proxy through the facilitators. A typical conference will have less than 25 represented. The average conference in our experience has nine adult family members and five professionals who present. The two facilitators are not counted in this total. B. After this initial period of time and a period of time that allows the facilitators to assess that there is a functional group process for this task, the facilitators will leave the room but are available in the next room. This second part of the meeting is the private Family Group Decision Making conference. It is attended only by family members and no record is kept of its discussions. The reasoning for this is it is an undeniable truth that the family process will operate differently with outsiders present than it will in private. If the family needs mediation assistance or clarification of the previously discussed viewpoints the facilitator can be called back in. In our experience, this process varies in length with different families. Where there is little connection with different kinship units of the extended family, in some cases the facilitators are needed throughout the process. C. When the family reaches a group decision, the plan is presented. The facilitator responds to seek clarification and detail in the plan. D. On those aspects that are not clear, the family has the opportunity to rework the plan and present once more. E. At the end of the complete process a written document containing the plan is prepared for the court. 1= .The plan is a recommendation to the court from the extended family which can then be accepted, modified or rejected by the court. G. WCDSS will need to follow the case for implementation compliance for the period of time ordered by the court. H. RESULTS: Over the last two years we have completed approximately 60 family group conferences. All have produced a written plan for WCDSS and the courts to consider. The average conference meeting lasts four to five hours. The preparations for the meeting have included in almost all cases discovery of additional relatives willing to adopt one or all of the children needing placement because of the anticipated loss of parental rights in the foreseeable future. 85-90% of cases have major components of their plans adopted by social services and the courts as best 3 we can determine. A majority have their plans adopted in full with minor changes only. An internal evaluation of outcomes is ongoing. Family members have been included across the US and in Mexico and in several cases international considerations for child placement were involved in the conferences. Use of telephone conference calling has limited costs. Use of secure facilities such as the jail conference room has allowed participation of incarcerated parents in the process and permitted parents with restraining orders the ability to participate in the decision making about foster placement or family adoption of their own children. Based on this model Dr. Ackerman has had accepted, by an international conference on family group decision making, a proposed workshop on developing a consensus on family group conferences. This meeting will take place in June of 2000 in Madison W. Target/Eligibility Populations A. Total number of clients to be served in this twelve month program has been calculated as follows. Four families per month times twelve months equals forty eight families per year. If we assume a nuclear family size of five, two adults and three children, then the total client pool to be served is 240 individuals. If we add to this five extended family members for each parent this adds ten to the conference and 480 to the yearly total which is now 720. If we assume there are at least five professionals associated with a case this adds an additional 240 per year for a total of 960 people. This projects a typical family group conference as consisting of 20 people plus the two facilitators. Our average family group size last year was 14. This would be a projection of about 650-700 individuals at conferences if the four families per month were attained. Depending on the ages of the children they may or may not be present. The above calculation assumes we are dealing with a "single nuclear family pattern This assumption has often proved invalid. Most families have been divorced and are blended families, some divorced more than once. Some will involve teens who had children with different partners outside of the legal relationships of marriage and involve complexities as to who should be attending. Some will involve grandparents or other more distant relatives who desire custody. B. Distribution of clients. Total number of clients we will serve is approximately 60 index children or more as calculated above. Our experience suggests that for the nuclear family we would expect approximately 120 of these would be adult members of the family and approximately 150 would be minors. The age distribution of the children would tend toward the very young children in expedited permanency planning and to older children in PAC referrals. A family group conference in a case of alleged criminal abuse that has not been 4 adjudicated or of ongoing spouse abuse or incestual sexual abuse that has not been admitted to, needs to be considered on a case by case basis. It is not the purpose of the family group conference to determine guilt or innocence of any party in an alleged criminal act. If this can be understood by all parties in the family, the Family Group Decision Making conference can occur ( and several of this type have taken place). It is the purpose of the process to protect the child. No matter what has occurred in the family as to the allegations and the outcome of any criminal adjudication, the production of the family's recommendations as to the protection of the child is the primary purpose of the Family Group Decision Making process. We have learned that our initial guarded impression of a case's potential for success in a family conflict resolution situation, based on the written record, has often proved to be pessimistic. It appears that where intensive family interaction is concerned as in Family Group Decision Making conferences, that an analysis of the written record alone often undervalues surprising problem solving strengths of even very dysfunctional families. C. Families Served. We would anticipate serving sixty family units. All the Family Group Decision Making Conferences will involve extended family members who might be considered a separate family unit. For simplicity, we count the referred family and all its extended family unit as one family unit. D. Sub total who will receive bicultural/bilingual services. We have a Hispanic member of the staff (Emily Jaramillo-Bansberg) who is fluent in Spanish. One of the facilitator's (Joyce Shohet Ackerman) doctoral work was on Hispanic patient's mental health treatment patterns compared to Anglo patients in Weld County. She also has four years of direct cross cultural experience with an American Indian population. We anticipate we can serve up to 100 percent of the total referred in a bicultural manner We have been able to and will continue to provide bilingual services for any family who needs them. As to the final document for the court, it can be formulated in Spanish. However, an English translation of the document must also be prepared at that time if the family has bilingual members present. The reason for this is to avoid future disputes over translation. E. We can provide services in South County if Social Services can provide a site to do such work. Alternatively, we are able to provide services on Saturday in our Greeley location for any family. This may assist South County families in scheduling without interference with work schedules. F. Accessibility. On weekdays all providers of Ackerman and Associates are accessible through a 24 hour answering service and pager system. On weekends, this 24 hour access reaches the provider on call all of whom are Ackerman and Associates' providers. 5 G. Maximum per month. The program maximum is five families per month. H. The monthly average capacity is two - four families per month. I. The average stay in the program is a maximum of eight weeks This is from the time of referral to the completion of the Family Group Decision Outcome : The Safety Plan for the Index child. Types of Services Provided We will provide the services described in the sections above called the Family Group Decision Making model. The basic assumptions that underlie this model are: 1 The people who get most deeply impassioned about a particular case of child abuse are the parents and the relatives of the abused child. 2. The people who have the most investment in protecting the child are the parents and relatives. 3 The people who understand the family structure and how decisions get made are the members of the family. 4 Families hold information that social workers and other professionals cannot access. 5. Harnessing forces related to kinship cannot be done by exerting legal authority. 6. There are status structures within families that social workers and other professionals may never know about or fully understand. 7. There are myths, stories, legends and secrets within families that social workers may never know about. 8. Families make decisions behind closed doors regardless of what professionals do or do not do. In terms of the criteria for the PAC process: A. Comprehensiveness Family Group Decision Making does not attempt to provide a comprehensive assessment or diagnosis of the family in a traditional psychotherapeutic model. It does allow the family assisted by the facilitators to develop an offer to the court produced by the family that addresses the placement needs of the child. Like mediation from which it is derived, Family Group Decision Making brings "ownership" of the treatment plan because of the process through which it was developed. Further, it brings obligation to carry through with the plans that 6 have been formulated through a process with participation by all family members. B. Access to other services: The therapeutic interventions that the family specifies in the safety plan that they produce go back to the caseworker and to the Court. The family has flexibility to include in the agreement the services it perceives it needs to implement successfully the actions they specify. The caseworker can then match up these services with the goals stated. C. Team based Treatment: All Family Group Decision Making are co-facilitated at the formal meeting and all have a team of two therapists working with the family. This requires the team to have a detailed level of communication and is designed to keep the process operating on the projected expedited time line we have set forth. All providers are professionally trained mental health providers in their own categories of Psychology, Professional Counselor or therapist. Currently seven providers, including four psychologists, two professional counselors and one bilingual psychotherapist make up Ackerman and Associates. All the providers have extensive experience in family therapy as well as specialty skills that they bring to a conference. One hundred percent of the 40 families projected for 2000 - 2001 will be treated within a team model. D. Conflict Resolution: The Family Group Decision Making Model is designed specifically to resolve the needs of a child for protection within his or her extended family. In this model, the emphasis is on the word resolution. The extended family will sit together in what may likely be a unique experience. The purpose of this project is for the family to focus its combined effort to resolve a specific problem. The index child would not have come into the Social Services system if there was not underlying conflict or disorganization on the part of the index nuclear family. Decisions about how to keep the child out of that conflict will be developed by the extended family members. This is an excellent model for reduction of conflict and provision of resolution in a systematic way. Many people state strong support for family values as a slogan. As a society we have few mechanisms that really allow families as units to use their own value system to solve their own problems. This is indeed one such opportunity for families to do so. Measurable outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... 7 11. Did the nuclear family accept the Family Group Decision Making format and assist in setting up the conference? 2. Was contact successfully made with all specified parties and did those who could not attend provide sufficient information to the conference. 3. Did the family produce a plan to prevent placement or achieve reunification or set up a relative placement that was acceptable to social services and to the court ? This data will be extracted from the case file. Summative outcomes After the Family Group Decision Making meeting, the caseworker follows the family for assurance that the courts recommendations are being implemented. On a quarterly basis after the completion of the Family Group Decision Making conference, we will contact the supervisor and document for our file the status of the family at that time point. The following four areas should be assessed at about six months after the Family Group Decision Making meeting by asking the caseworker. A. Did the child receiving services not go into placement? B. Did the families remain intact?. C. Was there reunification of children with their families?. Did this take place within the nuclear family or within the extended family? 0. Has there been an improvement in parental competency and parent child conflict management? Additional questions related to A-D above might include. Was a termination hearing avoided or modified through the use of the FGDM process? Did the index child find a placement in the extended family? Is this the case for siblings of the index child as well? Was a family proposed plan adopted in whole or in part by the court? E. Cost effectiveness is very high. The FGDM process also offers the possibility to collect data from the case worker in the form of an estimate of what the length of time this family would have been in placement if there had been no Family Group Decision Making. Based on this estimate and using the rate per month for foster placement costs compared to the cost of our program the projected savings from avoiding foster placement could be estimated. For most of these families where there is a placement within the extended family, the vast majority in our experience to date the cost of foster care will end for the county. Most families that reach this stage will be kept out of many months ( or years) of placement if an acceptable plan can be formulated that will decrease resistance to extended family placement. 8 F. Does this program produce fundamental change in family dynamics? Let's define fundamental changes as those changes that persist for two months after the conference. It would be possible to measure the caseworker's perception of the family in relation to this question. At six months after the conference is completed we expect to see basic change in family dynamics but these will be hard to quantify. _Certainly. there are substantial changes in the operating structure of the extended family in relation to the index children of the cases conducted to date. Please note that we have not budgeted for ongoing evaluation of this project and suggested evaluations would need to be conducted separately from this proposed work. Service objectives We have the following service objectives: A. Improvement of family conflict management. Family Group Decision Making is specifically designed to resolve conflicts that either precipitated the likely imminent placement of the child or which prevent the reunification of the child with the family. The model teaches the family how to use its own strengths to resolve problems The Family Group Decision Making process provides a demonstration to the family that even very serious long standing difficulties can be worked out through this modification of the mediation process. B. Improved parental competency In this treatment model Family Group Decision Making should assist the parents in the nuclear family in identifying sources of support and guidance in their own extended family. The help that may be provided by strengthening such a link could include modeling appropriate child rearing strategies of other relatives in areas of discipline, protection, instruction and supervision. The Family Group Decision Making conference can clarify how other members of the family have handled child rearing practices and age appropriate expectations different members of the family had for their own children. Some of these parents are having their rights terminated and a relative of the index child will assume the parenting responsibilities. In these cases it is not a question of an improvement in competency for the biological parent. Rather the family is selecting a more competent relative to assume the nurturing roles the biological parent has failed to provide. C. The ability of the family to access resources, is enhanced by the Family Group Decision Making process. The need for a specific service should become apparent as the family develops the strategy to resolve the immediate conflict. When that need is written down as a component of the offer for resolution, it can be followed up by the courts and the caseworker. The strength of the Family Group Decision Making process, like that of other mediation processes, is the identification by the family of the resources they need to gain access to. Families that need further assistance in implementing the goals that are set can be referred to the GAP program or other 9 resources to assist in implementation such as life skills programs. The methods used to ascertain if the service objectives have been met would be through a report by the caseworker at six months after the completion of the Family Group Decision Making conference. Workload Standards A. The program has a capacity of four families per month. This is approximately one hundred hours of therapist time per month. There are three full time therapists available for this program. The program will occupy about 20% of these three therapists time. Note that there is a need to allow an exemption for this program in terms of the Face to Face rule usually within the PAC programs. While there are approximately 10 hours of face to face work there are at least fifteen hours of direct data gathering and planning of the Family Group Decision Making structure that should be counted as direct service and not as indirect time in this model.The Family Group Decision Making model relies upon telephone contact and written or faxed follow up. There are a large number of the participants ( at least fifteen in the meeting on average). The need for telephone data gathering is also crucial for individuals of the extended family who live large distances away from Weld County. Telephone contacts have included California, Utah, Washington, New Mexico, Arizona, Nebraska, Kansas, Wyoming, South Dakota, Florida and other states. Extensive contact around Colorado including the western slope and southern Colorado has occurred by phone. 'Work has also occurred by phone with Mexico. These costs are built into our administrative portions of the bid. Occasionally a conference call is used to include members of the family from long distances in the formal meeting. This is cost efficient as it reduces travel costs but we request that this item be passed through as a reimbursement expense. We document the call through specific phone bills related to the conference meeting. We also budget $30 for meals at the Family Group conference and this is passed through to social services with receipts for the date of the group conference usually held between 5:30 PM and 11:00 P.M. B and C. There are seven providers/four psychologists, two professional counselors, and one bilingual psychotherapist who make up Ackerman and Associates. Joyce Ackerman who supervises this contract is certified as a mediator. This group will have conducted about 70 Family Group Decision Making conferences before June 1 , 2000. D. The modality of treatment is the Family Group Decision Making model described under the design section. A disclosure for all participants in this process and other support documents are available upon request if the reviewers wish to inspect them. E. Hours /month The total number of therapist treatment hours is 25 per family. This totals to 100 hours per month for four families per month. A total of 1200 hours per year is projected. 10 F. Staff There are seven individual providers supported by two office professionals in the practice. G. Supervisor This contract would be supervised by Joyce Shohet Ackerman, Ed. D. who would monitor the project for compliance. Staff Qualifications A. and B. Staff Qualifications Seven staff are available for the project. They exceed the minimum qualifications specified as documented below. The staff are: Joyce Shohet Ackerman, Ed.D., Licensed Psychologist and mediator; Laurence P. Kerrigan Ph.D., Licensed Psychologist; Emily Jaramillo-Bansberg, M.A., psychotherapist; Karen Bender, M.A., L.P.C., Nicole Warnygora, M.A., L.P.C., Sherri Malloy (Gonzales), Ph.D., licensed psychologist; and Susan Bromley, Psy. D., M.S.W., Licensed Psychologist/Licensed Social Worker. We anticipate the key staff in this program to be Ackerman, Jaramillo-Bansberg and Malloy with utilization of other providers either in specialized roles or in data gathering. C. Training The staff has extensive training in family therapy and mediation as documented by their extensive work experience. Collectively, the seven providers have held licenses in their field for a total of more than 60 years. Resumes are available if desired. Specific training has been taken by Ackerman in the Family Group Decision Making model. In addition, we are the current contracted providers of Family Group Decision Making conferences for expedited permanency planning. We also have an additional year of experience in non-expedited cases through last years contract. Dr. Ackerman has recently been notified of her proposed professional presentation on Family Group Decision Making being accepted by the American Humane Society's international meeting of the Family Group Conference. This is mentioned as documentation we are providing leadership in this field. D. Continuing education As a part of their work in the private sector all providers in this group maintain continuing education programs more than the minimum eight hours required. They participate in workshops and other activities. These continuing education requirements arise from other contractual arrangements with managed care companies. E. Supervision All providers, except one, are independently licensed and not required to have clinical supervision. Emily Jaramillo-Bansberg, M.A. is working toward professional liscensure and is supervised by Sherri Malloy in that process. All the staff have advanced skills in intensive family therapy. The supervisor will monitor the 11 specifications made in this proposal. F. Supervisor continuing education. The supervisor of the project is involved in ongoing training to keep current with her profession through advanced workshops and seminars and as a member of the Colorado Council of Mediators and the American Psychological Association and through attendance at an International meeting in June of 2000. Unit of service rate computation We have chosen to offer a rate of $80 per hour of total time per therapist. As in prior proposals and with the consent of the county we have capped the amount we can bill for any conference. Our proposal for that cap for 2000- 2001 is $2000 regardless of the size of the conference or the length of work beyond 25 hours required. This is analogous to last years contract where the cap was based on $75 per hour and total limited to $1875. Conferences which are canceled or are very small and do not need justify the full capped fee will be billed for time expended at $80 per hour. For this year we have removed a mechanism for billing for very large families beyond the cap which we had in last years proposal but never utilized. The rate of compensation is $48 per therapist per hour and $32 indirect cost per hour for an hourly rate of$80. Our usual rate for services is $99.50 per hour. Note that the County through special action of the County Commissioners have removed the restriction for all contact being face to face for this unique program. The costs are calculated as based on actual time of interaction with family members either face to face or by telephone. This is necessary because of large distances by which the extended family is often separated and by the nature of this process itself. The costs of avoiding continued long term foster placement which are offset when appropriate within extended family placements are made make a this highly cost effective program. Budget Justification Each Family Group Decision Making conference uses up to twenty five hours (per family unit) of therapist time. We use the figure of 48 evaluations per year to generate the total hours of the project which equal 1200 hours. 1200 hours times $80 equals $96,000 as the maximum budget for the project. A more probable figure based on our past two years of experience would be 40 meetings at $80,000 per year. Our per hour rates are below those reasonable and customary for providers of the level and training assembled in this proposal. We are voluntarily setting a cap of twenty five hours of billable time for each unit. PAC money is tracked through a computer data base system called MediMac which we have used for the past 60 months. We are in the process of transferring our accounts to a new and faster system. The system allows us to track payments by 12 client and by source of payment and any payment through the PAC will be tracked in this manner. No special issues are present related to project audit to our knowledge and a random independent comprehensive audit of Ackerman and Associates programs has been conducted in a previous year for which no discrepancies were found. An annual audit will be conducted. Ackerman and Associates P.C. is a type S professional for profit corporation and not a 501.c.3. We generated a profit of 2.9% on gross revenue for the year 1999. New Standards for responsibility for 2000- 2001 are addressed below: Section III D - I This is a time limited model which is capped at a maximum of 25 hours. In rare instances, a Family Group conference was withdrawn by Social Services or a family refused to participate. In those case, only hours used were billed. Cost overruns are not possible based on the design of the program. No renewals will be accepted. In the past one or two repeat family group conferences have been held when an additional child was born and taken into protective care by social services. In our experience these repeat family group conferences are not appropriate unless some kind of marked and substantial change in the family systems can be documented. The family group process is completed within two months of referral. As such we do not anticipate any problems with the pattern of flow of the delivery of these conferences unless there are uneven patterns of referral from Social Services. No clients are currently expected to carry over into 2000- 2001 for the current year but we will inform the department if such cases develop. Finally we will comply with the the case plan, monthly report and other reporting requirements. In general we bill Social Services at the completion of each FGDM conference as this simplifies the process which takes about six weeks. We would like to continue to do so. This does mean that for many cases the case plan, the monthly progress report and the report closing the case will arrive simultaneously at the end of each billing cycle. 13 Branch B/A Producer# Issue Date Renewal/Rep;acement No. 32 A 0002360 04/27/1999 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2032570 1. NAMED INSURED: ACKERMAN AND ASSOCIATES PC ADDRESS 1750 25TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) 2. POLICY PERIOD: From 05/01/1999 To 05/01/2000 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: LIMITS OF LIABILITY PREMIUM Professional Liability $1,000,000 $3,000,000 $i ,686.00 each Incident Aggregate i. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: ( ) Sole Proprietor (including Independent Contractors) ( ) Partnership (X ) Corporation OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the Declarations; or b) the effective date of the earliest claims-made polic\ issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/1992 7. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsemenos): PLO-2008 ( 10/94 ) POE-8004 PLE-2167 PLE-208 I P0N-2003 PLE-8036 ( 09/97 ) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 INTERSTATE IN.stJKANCE CROUP PLP-2012 (06/93) (Elec.) Breach B/A Producer # Issue Date R_enewal,ReJ-lAce neatt 'vvo__ 32 A 0002.360 05/05/1999 PL .aiE PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2050203 NAMED INSURED: SUSAN PLOCK BROMLEY PSYD ADDRESS 1621 13TH AVENUE (Number & Street, Town, GREELEY CO 80631 Counts, State & Zip No.) POLICY PERIOD: From 04/01/1999 To 04/01/2000 (12:01 A.M. Standard Time At Location Of Designated Premise,i _. COVERAGE: LIMITS OF LIABILITY PREs.IlUs.1 Professional Liability S1,000,000 S3,000,000 S 99. Oo each Incident Aggregate BUSINESS OF THE INSURED: Psychology :. THE NAMED INSURED IS: X ) Sole Proprietor (including Independent Contractors) ( ) Partnership ( ) Curnorat:on ) OTHER: b. This policy shall only apply to incidents which happen on or after: a) the polic)/ eth cut t date shown on the Declarations; or b) the effective date of the earliest claims-made polIc. issued by the Company to which this policy is a renewal; or c) the date specified in my endorsement hereto. 04/05/1996 This policy is made and accepted subject to the printed conditions of this policy togcthet with. the prosistons, stipulations and agreements contained in the following form(s) or endonevneni(>l PLJ -2008 ( 10/94 ) POE -8004 PLE -2167 PLE - 2081 P0N-2003 PLE-8035 ( 09/97 ) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 mammommw INTERSTATE INSURANCE GROUP MMEMMEMMISMW PLP-2O12 (06/93) (Elec.) �_P EEO? 194:%Ed LASER. Issue Date: 01/06/00 ll The Reciprocal PROFESSIONAL LIABILITY OCCURRENCE ``J2' Alliance INSURANCE POLICY FOR Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ACA Insurance Trust,Inc. 5999 Stevenson Avenue ACA i ssyrrtieet Policy Number: CL10073400 Administered by: Alexandria,VA 223043300 TRUST Toll Fret 1400-347.66471261 ITEM DECLARATIONS INDIVIDUAL POLICY 1. NAMED INSURED: Norma Karen Bender 2. ADDRESS: 1104 Twin Peaks Circle Longmont, CO 80503-2170 3. POLICY PERIOD: From: 02/04/00 To: 02/04/01 12:01 A.M.Standard Time at Location of Designated Premises 4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges: COVERAGE PREMIUM A. PROFESSIONAL LIABILITY S 290 . 00 B. GENERAL LIABILITY S 0 . 00 TOTAL PREMIUM: S 290 . 00 5. LIMITS OF LIABILITY: $1 , 000 , 000 each Incident or each.Occurrence $3 , 000 , 000 in the Aggregate 6. THE NAMED INSURED IS: Sole Proprietor(incl.Individual) Partnership Corporation X Other(refer to Item 7 below) 7. BUSINESS OF THE NAMED INSURED: Part-Time Self-Employed (Rating Category) Counselor/Human Development Professional 8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and agreements contained in the following forms)or endorsement(s): CPL•0004-0199 CPL.0005-0199 CPL•0006.0199 NOTICE THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. CPL•0005.0199.00 THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY 12/03/99 -- A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY 444 RENEIAL •** NOTICE A LOWER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION 'SEXUAL MISCONDUCT" IN THE POLICY). DECLARATIONS POOCY NO 801-000500E ACCOUNT NO: CC-KERL175-0 0099745E NAME AND ADDRESS OF INSURED ITEM L(b) ADDITIONAL NAMED INSUREDS LAURENCE P . KERRIGAN. PITH.0. 1750 25TH AVE. SUITE ► 101 GREELEY. CO 80631 TYPE OFORG: INDIVIDUAL ITEM 2 ADDITIONAL INSUREDS: ITEM 3 POLICY PERIOD. FROM: 12/01/99 TO. 12/01/00 12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS S A1 EE, UEREIN ITEM 4 LIMITS OF LIABILITY. (a) $ 1 .000.000 EACH WRONGFUL ACT OR SERIES OF COOL I NULUS REEPE_A'E OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE b) $ 5.000 DEFENSE REIMBURSEMENT (c) $ 3.000 .000 AGGREGATE ITEM 5 PREMIUM SCHEDULE. CLASSIFICATION NUMBER RATE ANNUAL PREMIUM -I 1ST PSYCHOLOGIST 1 1254.00 1 .254.00 DEFENSE LIMIT .00 SURPLUS LINES TAX 1 37.62 INSPECTION FEE 1 2 .51 TEM 5 RETROACTIVE DATE. 12/01/91 TOTAL PREMIUM: 1 .294. 1 -3 ITLM EXTENDED REPORTING PERIOD 2 .251 .24 ADDITIONAL PREMIUM (If exercised). $ • ITEM 3 POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY. 322138 (7/95 ED. ) 822137 AUTHORIZED COMPANY REPRESENT Ar N' THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. Br.tnch B A Producer # Issue Date Renewal"Renlace.rent 8U 32 A 0002360 03/02/1999 RFNEI-, L PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. l:em DECLARATIONS CERTIFICATE NUMBER: 45P- 2055185 • NAMED INSURED: SHERRI MALLOY PHD -ADDRESS 24 ALLES DRIVE Number (\ Street. Town, GREELEY CO 80631 County. State 411. Zip No.) POLICY PERIOD: From 04/01/1999 To 04/01/2000 ( 12:01 A.M. Standard Time At Location Of Designated Premised COVERAGE: LIMITS OF LIABILITY F RE vIIL` l Professional Liability $1 ,000,000 $3 , 000,000 Sbu5 . t each Incident Aggregate 4. BUSINESS OF THE INSURED: Psychology 8. [HE NAMED INSURED IS: X ) Sole Proprietor (including Independent Contractors) ( ) Partnership Cun.„�uu OTHER: This policy ,hall only apply to incidents which happen on or after: a) the policy efl( cm date shown on the Declarations; or b) the effective date of the earliest claims-made acLc, issued bo the Company to which this policy is a renewal; or c) the date specified ir uty endorsement hereto. 04/01/1998 This polio is made and accepted subject to the printed conditions of this polio togeeth( F will1 the pi ovisions. stipulations and agreements contained in the following form(s) or endoi,rme:i N) P _ J-2008 ( 10/941 POE-8004 PLE-2167 PLE -2081 PON- 2003 PLE-8035 ( 09/97 ) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke-Van Orsdel. Incorporated Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 INTERSTATE INSURANCE GROUP PLP-2UC (06,93) (Elec.) _;-5 794! (Ea LASER, tV trttb I NA I IUNAL INSURANCE COMPANY MENTAL HEALTH PRACTITIONER'S PROFESSIONAL LIABILITY POLICY DECLARATIONS F.enewal of No. NOTICE: A SUB-LIMIT OF LIABILITY APPLIES TO "CLAIMS" ARISING OUT OF "SEXUAL MISCONDUCT". POLICY NO. 2200009922-991 ITEM 1 NAME AND ADDRESS OF INSURED: SEND ALL INQUIRIES TO: Nicole Ray Warnygora ROCKPORT INSURANCE ASSOCIATES 1 800 Angelo Court PROGRAM ADMINISTRATOR Fort Collins, CO 80528 P O BOX 1809 ROCKPORT, TX 78381-1809 1-800-423-5344 ITEM 2 ADDITIONAL INSUREDS: NONE ITEM 3: DESCRIPTION OF BUSINESS: MENTAL HEALTH PRACTITIONER(S) ITEM 4: POLICY PERIOD: FROM 05/20/1999 TO 05/20/2000 12:01 am STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HERE ITEM 5: LIMITS OF LIABILITY: $ 1,000,000 EACH WRONGFUL ACT OR EACH OCCURRENCE SUBJEC' '0 =, $25,000 SUB-LIMIT OF LIABILITY FOR ALL "WRONGFUL ACTS" INVOLVING "SEXUAL MISCONDUCT". $ 3,000,000 AGGREGATE ITEM 6. PREMIUM SCHEDULE: CLASSIFICATION NUMBER RATE ANNUAL PREMIUM CATEGORY M2 1 263.00 S 263.00 TOTAL PREMIUM S 263.00 ITEM 7 POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY: 190.00 0195, 189.00 0195, EEO 25 501 12 98, 193.00 0195,194.00 0195 May 21 , 1999 P6/0,41I6 AUTHORIZED COMPANY REPRESENTATIVE 159 00 0195 © Everest National Insurance Company, 1995 MEMORANDUM OF INSURANCE Date Issued 11/03/1999 Memorandum Holder This memorandum is issued as a matter ACKERMAN & ASSOCIATES ATTN DONNA of information only and confers no SUITE 101 rights upon the holder_ This 1750 25 AVENUE memorandum does not amend, extend GREELEY CO 80634 or alter the coverages afforded by the Certificate listed below. Company Affording Coverage Producer Chicago Insurance Company Kirke Van Orsdel 1776 West Lakes Parkway Covered Person (Status) Owner West Des Moines, Iowa 50398 EMILY L JARAMILLO-BANSBERG MA --A-- Employee This is to certify that the Certificate listed below has been issued to the insured named herein for the policy period indicated, notwithstanding any requirement, term or condition of any contract or other document wii.h respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Certificate Type of Insurance Number Effective Date Expiration Date Limits Professional each incident 1 ,000, 000 Liability or occurrence Occurrence 80M-4003488 11/01/1999 11/01/2000 3,000,000 in the aggregate each incident General Liability or occurrence Occurrence in the aggregate Should the above described Certificate be canceled Insured before the expiration date thereof, the issuing company w% 11 endeavor to mail written notice to the named Memorandum Holder, but failure to mail such EMILY L JARAMILLO-BANSBERG MA notice shall impose no obligation or liabilty of any 183 50 AVENUE PLACE kind upon the company, its agents or representatives. GREELEY CO 80634 Authorized Representative: ,, .Titan e ti- /RUCK INSURANCE EXCHANGE n FARMERS INSURANCE EXCHANGE O FIRE INSURANCE EXCHANGE • E9•MP1 j MEMBERS of FARMERS INSURANCE GROUP OF COMPANIES ��•r••n•n\ HOME OFFICE: 4680 WILSHIRE BLVD.,LOS ANGELES,CALIFORNIA 90010 !„�-'o�•��R amed . DR JOYCE SHOHET ACKERMAN PC Prat Insured Count Mailing 1750 25TH AVE SUITE 101 Prematic Acct No. Address 07-04-362 04576-38-07 GREELEY CO 80631 Agent Policy Number Type of The named insured Is an individual unless otherwise stated: C Partnershl ® Corp. Business OFFICE EDJoint Venture Li Organization (Other than Partnership or Joint Venture 2 Policy Period from 07/01/99 (not prior to time applied for) to 07/01,00 12:01 a.m.Standard Time. If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to continue this insurance,we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums,rules and forms then in effect. 3. Insured location same as mailing address unless otherwise stated: 1750 25TH AVE SUITE 101 GREELEY CO 80631 4. Mortgage Holders Loan# Loan# S. Premium$ 492.00 ❑ "X"If Mortgage Holder Pays 6. Policy Forms and Endorsements attached at Inception: E0079-ED1 2521551290 565310-ED2 S0700-ED3 E6036-EII1 E4168-ED1 E4004-ED1 E4216-ED1 E3026-ED1 7. We provide insurance only for those coverages Indicated by a specific limit or by an al COVERAGES LIMITS OF INSURANCE DEDUCTIBLE A-Building $ SECTION 1 B-Business Personal Property S250 applies unless other $ 50,000 o Lion Indicatedr'I r anR C-Loss of Income(Not exceeding 12 consecutive months) A 15S1oo❑$5oo "E Property CTUAL LOSS SUSTAINED NONE OPTIONAL COVERAGES and Swimming Pool/Fences and Walkways _. Loss of X Building Glass(Blanket) $ Aboveplies Income X Outdoor Sign Coverage REPLACEMENT COST ule applies 1 U 0 '_ Valuable Papers(In addition to$1000 included.) $ 100 option other $ option inUr 9 Earthquake Damage rated See Coverages x A,B,&C of the applicable ins. limit. SECTION II D-Buslness Liability-Including Products and Completed Operations.(Annual aggregate applies for all occurrences LIMITS LIABILITY during the policy period.) (Annual Aggregate) Liabili $ 1,000,000 ty E-Fire Legal Liability$75,000 included unless other option indicated by an and ❑$100,000❑$150,000 each occurrence(Subject to the annual agereagate shown for Coy. 0) Medicals F-Medical Payments to Others(Subject to the annual aggregate $5,000 each person shown for Coverage 0.) Limit of Liability 0Professional Llablll (Annual Aggregate) ty(see attached endorsement) $ E I-V COVERED SECTION III Agreement I-Employee Dishonesty DEDUCTIBLE $5,000 NONE Agreement II-Broad Form Money and Securities-Inside $1,000 $250 Agreement III-Broad Form Money and Securities Outside $1,000 $250 Crime Agreement RI-Medical Payments $500 each person NONE _Agreement V-Forgery or Alterations $2,500 NONE 56-5108 2-92 2ND EDITION Countersigned Authorized Representative JOYCE SHOHET ACKERMAN, ED.D. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 Phone: 353-3373 PERSONAL DATA SHEET Date of Birth: August 3, 1950 Health: Excellent Married, two children CERTIFICATION/LICENSURE Licensed Clinical Psychologist, State of Colorado since 1984 Listed in National Register of Health Service Providers in Psychology since 1986 Staff Privileges, North Colorado Medical Center, Greeley, Colorado since 1985 Certified Teacher (K-12) for Emotionally Disturbed, Learning Disabled and retarded. Certified Teacher, Elementary Level PROFESSIONAL MEMBERSHIP American Psychological Association Colorado Psychological Association Colorado Psychological Association- elected board member 1986-1989 HONORS President's Award - Colorado Psychological Association, 1989 EDUCATION 1978 - 1981 Ed.D. in Counseling Psychology University of Northern Colorado December 1981 graduate 1972 - 1974 M.S. in Education (E.D./L.D.) Lesley College, Cambridge, Massachusetts August 1974 graduate 1968 - 1971 B.S. in Special Education and Elementary Education with a minor in psychology Boston University, Boston, Massachusetts December 1971 graduate PROFESSIONAL EXPERIENCE 1981 - PRESENT Clinician in private practice in Northern Colorado. Among responsibilities are: Diagnosis, therapeutic intervention and referral for adults, families, children and groups. Primary areas are: anxiety disorders, mood disorders and adjustment disorders. Typical problems include: trauma, physical abuse, job stress. Orientation used-primarily cognitive- behavioral therapy. Also, developing, organizing and presenting workshops and consultative programs to community, schools, organizations and agencies. Approximately 30 hours per week. 1986 - Present Consulting psychologist on interdisciplinary team for in-patient rehabilitation program. Progressive Care Rehabilitation Center, Greeley, Colorado. Medical Director Dr. Judith Vaughan, Neurologist. Adults with traumatic injuries-Primary problems are: psychological aspects of physical rehabilitation, grief counseling, and brief group counseling using cognitive-behavioral goal oriented therapy. Approximately 10 - 15 hours per week. 1989 - 1992 Head Injury Treatment Team North Colorado Medical Center, Greeley. Approximately 5 hours per week. Team coordinator - Dr. John McVicker, Neurosurgeon. 1986 - 1989 Consulting Psychologist for Family Recovery Center (in-patient substance abuse/chemical dependency program), North Colorado Medical Center, Greeley, Colorado. Coordinator Ruth Wick R.N. Approximately 5 hours per week. 1986 - 1989 Provider and Coordinator for Mental Health Services in Northern Colorado for Peak Health Care (HMO). Peak mental health services utilized a three session model for initial services followed by referral. Activities included coordination of Psychological and Psychiatric Services for approximately the last two years of the contract. Peak was purchased From Lincoln National by Biodyne in late 1989. Peak Supervisor - Elaine Taylor Approximately 10 hrs./week. 1983 - 1986 Psychologist subcontractor for a Vietnam Veteran's Counseling Program funded by the Veteran's Administration. Principal Contractor Dr. Robert Stewart 1980 - 1987 Part time faculty member with responsibilities for classes, workshops and community programs in parenting skills. Family/Life Education Program Aims Community College, Greeley, Colorado August 1980 Clinical Internship on Children's Team of to Community Mental Health Center. Responsibilities August 1981 included: consultation to schools and community programs; therapy for children and families; and assessment of diverse mental health programs. Assistant program Evaluator-Developed evaluation tools to determine cross-cultural perceptions of expectations and satisfaction with services. Supervisors - Dr Joan Gillespie and Dr. Laurence P. Kerrigan. Weld Mental Health Center, Greeley, Colorado (Full time). Adults, Adolescents, Families. Primary areas anxiety disorders, mood disorders and adjustment disorders. Typical problems included: trauma, physical abuse substance abuse, job stress. Orientation used- Primarily cognitive-behavioral therapy. 1980 Group Facilitator-Regional and National Conferences in cross-cultural community needs. Flagstaff, Arizona - Colorado Springs, Colorado August 1975 Chairperson of the Department of Education and to Behavioral Science at an accredited, Indian controlled Jully 1978 community college on the Navajo Reservation. Administration responsibilities included: Supervision and evaluation of faculty; budget preparation and management; curriculum development and integration of Navajo culture; personnel recruitment and selection; class scheduling and program development. Also, faculty member with academic responsibilities for instruction in Psychology, Child Development and Counseling courses, advising and counseling students. Navajo Community College, Tsaile, Arizona (Full time) September 1974 Education Specialist and counselor at an Indian to controlled primary and secondary school on the August 1975 Navajo Reservation. Coordinated community resource program which included: Counseling, Student assessment, prescriptive programming, , staff development and curriculum. Also, adjunct faculty for the University of New Mexico and for Navajo Community College at the Rough Rock Demonstration school, Rough Rock, Arizona. (Full time) September 1972 Designed and coordinated Learning Center Program to for Dedham Public Schools. A program and crisis June 1974 intervention center for emotionally disturbed children. Responsibilities included: Diagnostic prescriptive programming, counseling, supervision and training of aides, tutors and volunteers, and consultation with regular classroom teachers. Also organized group and individual meetings with parents. Also, adjunct faculty for Curry College assisting in in-service instruction for Dedham School System employees. Dedham Public Schools, Dedham, Mass. (Full time) February 1972 Learning Disabilities Specialist. Consultation to staff, to prescriptive programming and teaching school age June 1972 children. Somerville Public Schools, Somerville, Mass. (Full time) Summer 1971 Chosen as state mental health intern. coordinated Tutoring Center for emotionally disturbed children. Responsible for: tutoring children, supervising aides, (high school dropouts) and consulting with psychiatric staff. Somerville Mental Health Clinic, Somerville, Mass. WORKSHOPS AND SPECIAL TRAINING 1993 - August Hospital Practice for Psychologists APA National Convention in Toronto, Canada- "Psychology and National Health Reform", "National Health Insurance: Policy Considerations, Benefit Designs, and Economic Realities", and "Marketing: Psychology's Key to National Health Reform. 1993 "Using the New MMPI-2 and MMPI-A" Mountain Crest Hospital, Denver, Colorado. 1993 Disaster Relief Training. Alan Keck, through Colorado Psychological Association, Denver, Colorado. 1992 - Fall Short Term Therapy. Bernard Bloom, University of Northern Colorado, Greeley, Colorado. 1990 - Fall National Cognitive Rehabilitation Conference, Richmond, Virginia. 1990 - Summer Post graduate training: 1. Adult Neuropsychological Method based on Lezak Neuropsychological assessment, 1983. 2. Child Neuropsychology, Dr. Hynd. 3. Child Neuropsychological Methods. 1989 Provider of Neuropsychological evaluations for Vocational Rehabilitation, Greeley, Colorado. 1S88 Cognitive Rehabilitation Training Program, Dr. Sena, Ph.D., Colorado Springs, Colorado. 1988 - Present Psychologist - Head Injury Treatment Team at North Colorado Medical Center, Greeley, Colorado. 1987 Halstead Reitan Neuropsychological Assessment Training. Ralph Reitan, Ph.D., Washington, D.C. Summer 1986 Albert Einstein School of Medicine, Workshop on Adolescent Therapy, Cape Cod, Mass. 1985 to present North Colorado Interdisciplinary Team of Child Custody Member and participant. Fall 1985 Interdisciplinary Workshop on Child Custody, Keystone, Colorado. Summer 1984 Workshop in Clinical Use of Hypnosis, Boston, Mass. Winter 1983 Workshop on In-patient Programs for Service Related Disorders, Cheyenne Veterans Administration Hospital. Fall 1983 Veteran's Administration Workshop on Post Traumatic Stress Syndrome, Denver Veteran's Center. Fall 1981 Post-Doctoral Supervised Candidate for Licensure to (psychology) under Gale R. Giebler, Ph.D. Licensed Winter 1984 Psychologist and Susan Spilman, Ph.D., Licensed Psychologist. 1980 - 1981 Intern-Weld County Sexual Abuse Team, Greeley, Colo. Summer 1981 Independent Study of Child Sexual Abuse, University of Northern Colorado. Spring 1981 Interdisciplinary Workshop on Assessment of Sexual Assault, Boulder Social Services. Summer 1979 Biofeedback Training related to labor and delivery. Summer 1974 Participant in Institute on Obstacles to Learning. Joint Symposium between McLean psychiatric Hospital, Harvard University and Lesley Graduate School. Cambridge, Massachusetts. Summer 1973 Kennedy Memorial Hospital, Boston, Massachusetts. Participant, Summer Aphasia Institute. PUBLICATIONS Ackerman A., Ackerman J.S., Kelley K, Hale K. Family Planning Attitudes of Traditional and Acculturated Navajo Indians. Key Issues in Population and Food Policy. University Press of America, pp. 178-171 (1979). Ackerman, J.S., Client Expectations and Satisfaction with Community Mental Health Center Services: A Cross-Cultural Analysis Between Hispanics and Anqlos. Published Doctoral Dissertation, University of Northern Colorado. copyright 1981. FACULTY VITA May 1999 NAME: BROMLEY, Susan Plock SOCIAL SECURITY NUMBER: 483-50-9243 POSITION: Associate Professor of Psychology Department of Psychology College of Arts and Sciences University of Northern Colorado Greeley, CO 80639 HOME ADDRESS: 1621 13th Avenue Greeley, CO 80631 TELEPHONE: Office: (303) 351-2236 Home: (303) 352-8750 EMATh:sbromley@lbentlev unco.edu EDUCATION: Year(s) Degree Institution Area of Study 1983 PsyD University of Denver Clinical Psychology School of Professional Psychology Denver, Colorado 1968 MSSA Case Western Reserve University Casework (MSW) School of Applied Social Sciences Cleveland, Ohio 1965 BA Mt. Holyoke College Economics/Sociology South Hadley. Massachusetts WORK EXPERIENCE --Professional Academic: Years Institution/Organization Position Responsibilities 1996-Pres University of Northern Colorado Assoc. Professor Psychology Teaching/Research 1985-96 University of Northern Colorado Asst. Professor Psychology Teaching/Research 1983-84 University of Northern Colorado Asst Professor Psychology Teaching WORK EXPERIENCE --Professional Non-Academic' "etfrfsl Institution/Organization aosition Responsibilities 1996-present Ackerman and Associates Psychologist Clinical 1984-85 Kaiser Permanente Psychotherapist Clinical Lakewood. Colorado 979-80 Bethesda Mental Health Center Psychology Intern Clinical/ Denver, Colorado Administrative 1968-79 Denver General Hospital Clinical Social Worker/ Clinical/ Denver. Colorado Supervisor Administrative AREA OF SPECIALIZATION: Behavioral Medicine/Pain Management/Clinical Hypnosis RESEARCH AREAS/INTERESTS: Hypnosis/Pain Assessment and Management/Women's Issues/Teaching Methods PROFESSIONAL ACTIVITIES: Colorado Licensure: Psychology License#1086 PUBLICATIONS --Professional/Juried: Musgrave-Marquart, D., Bromley, S.P. &Dalley,M.B. (1997)"Personality,academic attribution, and substance abuse as predictors of academic achievement in college students". Journal of Social Behavior and Personality 12(2). 501-511_ Karlin, N.J. and Bromley, S.P. (1996). Differences in caregivers of demented and lucid chronically ill fanuh members. Journal of Alzheimer's Disease and Related Disorders and Research Retzlaff, P. and Bromley, S. (1994). Counseling personality disorders. In Ronch, J.L., VanOrnum, W. & Stith ell. N C. (Eds)The counseling sourcebook A practical reference on contemporary issues. New York: Crossroad Publishing group. pp.466-474. Bromley, S. and Hewitt, P. (1992). Fatal attraction: The sinister side of women's conflict about career and fanuh Journal of Popular Culture. 26(3), pp. 17-24 Retzlaff, P and Bromley, S. (1991). "A Multi-Test Alcoholic Taxonomy: Canonical Coefficient Clusters". Journal of Clinical Psychology.47(2), pp. 299-309. Bromley, S.P. (1985). "Treatment of Pain: Theory and Research"in Zahourek, R. (Ed.). clinical Hypnosis and Therapeutic Suggestion. New York: Grune and Stratton. Reprinted in Zahourek, R. (Ed.) (1990). New York' Bruner/Mazel, Inc., pp. 77-98.. PROFESSIONAL PRESENTATIONS --furled: Nickisson, J.W. and Bromley, S.P. (1999) "Hypnosis: Attitudes, knowledge and experience among psychology and nursing students'. Accepted for a paper presentation at the American Psychological Association Convention. Boston August) Campbell, J. S., Titus, J. and Bromley S. P. (1998). "Neuroanatomy teaching technique for introductory psychology students. Poster presented at the joint WPA/RMPA convention, Albuquerque, NM. (April) Bromley, S. (1997) (Chair)"Linking through honors programs:The cross-discipline course). Paper presentation as part of a symposium titled"Creating links between psychology'and other disciplines"., American Psychological Association Convention, Chicago. (August) Bromley, S. , Gilliam D., & Johnson, T. (1995). "Assessment of student created tests as an evaluation method' Poster presented at the American Psychological Association Convention, New York City. (August) Bromley, S. (1994). "Student created tests as an evaluation method". Poster presented at 16th Annual National Institute on the Teaching of Psychology, St. Petersburg. Florida. Karlin, N. and Bromley. S. (1992). " Similarities and differences for caregivers of demented and lucid ctuoni.aIly ill" Poster presented at the Rocky Mountain Psychology Association Convention, Boise. Idaho. (April) Montoya, K.J. and Bromley, S. ( Chair) (1992). "Changes in undergraduate counseling styles in an introductory counseling theories course" Paper presented at the Rocky Mountain Psychology Association Convention, Boise Idaho (April) 2 Bromley, S. (1992). " Connected learning methods to faciliate research understanding". Paper presentation as part of panel titled, 'Teaching techniques in the social sciences", Western Social Science Association Convention, Denver, Colorado. (April) Bromley, S., Ramirez, S., and McCoy, J. (1991). " Impact of a health psychology course on student health beliefs" Poster presented at the Rocky Mountain Psychology Association Convention, Denver, Colorado. (April) Karlin, N. and Bromley, S. (1991). " Support,burden and affect among caregiver of dementia and nondementia patients". Poster presented at the American Psychology Association, San Francisco, California. (August) Bosley. G. and Bromley, S. (1990). Post death ritual in a Colorado community. Paper presentation at the American Psychology Association, San Francisco, California. (August) Bromley, S. (1990). "Husbands at Childbirth: Who Does It Help?" Paper presentation at Far West Popular Culture Association, Las Vegas, Nevada(January). Hewitt, P. and Bromley S. (1989). "Images of Work and Intimacy in Turning Point'and'Fatal Attraction"'. Paper presentation National Convention of Popular Culture Association and American Culture Association, St. Louis Missouri. (Session Chair) Retzlaff,P.and Bromley,S. (1989). "The Basic Personality Inventory: Alcoh Sub-Group Identification". Poster session at the Joint Convention of the Rock Mountain Psychological Association and Western Psychological Association, Reno Nevada. Bromley. S. (1988). "Our Culture Affects Our Pain." Paper presentation, National Convention of Popular Culture Association and American Culture Association, New Orleans, LA. (March). Bromley, S. (1987). "Husband-Assisted Autohypnosis for Labor and Delivery: A Clinical Model". Paper presented at Rocky Mountain Psychological Association, Albuquerque, New Mexico(April). Bromley, S. and Loy, P. (1987). "Politics of PMS". Paper presentation Association of Women Psychologists. Denver, Colorado (March). PROFESSIONAL PRESENTATIONS --Invited: Strongin, D. &Bromley, S. (1999). Student and faculty reactions to the introduction of a graduate ethics course. In Miller, R. (Chair)Ethics in college teaching. Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins. CO(April) Bromley, S. (1999). Issues of religion and spirituality with therapists and clients. In S. Bromley(Chair) Religion and spirituality in research, practice and the classroom- Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins, Co(April) Bromley, S. (1998) Hypnosis,psychology and managed care. In S. Bromley(Chair)Complementary, nontraditional and indigenous healing practices. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Bromley, S. (1998). Complementary healing methods: A psychological and artistic exploration. In L.. Wickerlgren (Chair). Interdisciplinary courses involving psychology: A sampler. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Handelsman, M.M., Bromley, S.P. & Davis, S.F. (1995). "Clinical Psychologist. Counseling Psychologist.. Clinical Social Workder, or Psychology Professor: Which Degree is Right for Me?" Psi Chi invited panel presentation. Rock\ Mountain Psychological Association, Boulder. CO(April). 13romley, S. (Co-Chair), Seibert,P. (Co-Chair),Knuckey,D., Bohlin,M.,Zaweski, C., Watson, D., Hammon, 1) West, K. &Robins, J. (1994). "Training the Teaching Assistant" Invited Panel Presentation , Rocky Mountain Psychological Association, Las Vegas, Nevada(April) 13romley, S. (1993). "Hypnosis in Dentistry." Presentation at Monthly Meeting of Weld County Dentistn Association, Greeley, Colorado(February). Bromley, S. (1993). "Learning about the author as a way to understand research." Presentation at "Teaching 7 ake Out". CTUP Special Event. WPA/RMPA Convention,Phoenix, Arizona(April). Allen, M. and Bromley, S. (1993). Co-Chairs Two CTUP Special Event Sessions, "Teaching Take Out: Experiences in Collaborative Learning", Western Psychological Association/Rocky Mountain Psychological Association Convention, Phoenix, Arizona(April). Bromley, S. (1993). Chair, Invited Symposium, "Psychological and Social Perspectives on Male Violence Against Women", Western Psychological Association/Rocky Mountain Psychological Association Convention, Phoenix Arizona (April). Bromley, S. (1992). "Enhancement of student research and writing skills in any course". CTUP Workshop presented at the Rocky Mountain Psychology Association Convention, Boise. Idaho. (April) Bromley, S. and Karlin, N. (1992). "General and health locus of control of adult caregivers". Poster session at f he UNC Research Forum, Greeley, Colorado. Bromley, S. (1992). Panel member in Mental Health Symposia for Victim Compensation Convention as part of the Colorado Organization for Victim Assistance Conference. (Estes:Park/October) Bolocofski, Bromley, Foster and Mean (1988). "Hypnosis: Research and Clinical Perspectives," symposium presentation, Colorado Psychological Association, Greeley (March). Bromley, S. (1986). "Pain: A Psychological Event". Presentor-20th Annual Emotional Crisis Workshop. University of Northern Colorado, Greeley, Colorado(July). LECTURES—Invited: Bromley, S. (1998)"Psychological methods of pain control" Invited lecture for the annual meeting of the Weld County Arthritis Society. Bromley, S. (1998). "Hypnosis for pain control of arthritis" Invited lecture for"Brown Bag" lunch series sponsored by the Greeley Medical Clinic. Bromley. S. (1998) "Headache Control -Psychological Methods". Invited lecture as part of a seminar titled"Coping with headache". Sponsored by the Greeley Medical Clinic Bromley, S. & Ackerman J. (1998). "What to do to handle burnout" A workshop conducted for foster parents working with Weld County Social Services Bromley, S. (1995). Keynote speaker for Golden Key Honor Society Induction Ceremony, University of Colorado. Boulder. Co. (November) Bromley. S (1992). Keynote speaker for Sophomore Honor Society Induction Ceremony. 13rom1ey. S. (1991) Featured speaker. UNC Acadmic Honors Convocation. (April) Bromley, S. (1991). Banquet speaker Emotional Crisis Workshop, Greeley, Colorado. (July) 4 GRANTS: Bromley, S ( 1994)Honors Grant($500)to attend research training at the Society for Clinical Hypnosis meeting, San Francisco(October) Bromley, S. (1994). Research and Publications award of$1500.00. `Assessment protocols to measure the efficacy of hypnotic treatment for injured workers. (Karlin, N. and Bromley, S. (1990). Research and Publications award of$2,4440.00. "Control, support, burden and affect differences among dementia and non-dementia caregivers" 13OOK /GRANT REVIEWS Grant review for Boise State Department of Education(1995) Review of Santrock, J. (1991). The science of mind and behavior. W.C. Brown and Benchmark. Review of McKee. P. ec Thiem, J. (1993). Real life; Ten stones of aging. University of Colorado Press. PROFESSIONAL CONSULTATION/PRACTICE: Yearts) Institution/Organization Role 1996-presnt Ackerman and Associates Clinical Psychologist 1988 Bonnel Good Samaritan Center Pain Management Consultant and'1 raiser 1984-85 Denver Metropolitan Dental Care Consultant in Pain Management 1984 Iowa Association of Registered Physical Therapists Hypnosis for Pain Management Consultant And Teacher PROFESSIONAL ASSOCIATION PARTICIPATION: Membership 1986-present Rocky Mountain Psychological Association 1988-present American Psychological Association(Divisions 2, 30, 35) 1989-present Greeley Area Mental Health Network 1987-88 Association of Women in Psychology 1980-89 Colorado Psychological Association [988 CPA Program Committee Member for Spring Meeting--Greeley Coordinator SERVICE: -1'XTERNAL: NATIONAL SERVICE: 1994-present Rocky Mountain Coordinator-American Psychological Association, Division 2 -Teaching of Psychology 1992-94 Co-Chair, Rocky Mountain Region Council of Teachers of Undergraduate Psychology (C'CUP, 1991-94 Mountain States Regional Academic Coordinator. Golden Key National Honor Society REGIONAL/STATE SERVICE: 1999 -Moderator for Stanley G. Hall Lecturer- Viney, W. (1999). A larger canopy for psychology: linifiang themes and pragmatic empiricism. Presented at the Rocky Mountain Psychological Association Convention, Fi Collins. CO(April) 1989- present Rocky Mountain Psychology Association 1998-1999 Ex-Officio Board Member As Division 2 Coordinator 1992-1998 Board Member 1995- 1998 Elected Chair, Groups Under-Represented in Psychology Committee 1992-94 Co-Chair, Groups Under-Represented in Psychology Committee 1991 Coordinator of Student Volunteers, RMPA Convention, Denver, Colorado 5 1995 Psychology Chair-CCHE Faculty to Faculty Conference(October) COMMUNITY SERVICE: 1998 Member, Weld County Medical Society Commitee on Alternative and Complementary Healing 1997-1998 UNC Loaned Executive -United Way of Weld County 1991- 1996 Board Member, 19th Judicial District Victim Compensation Board 1995-96 Chair 1990-93 Board Member, Weld County Area Agency on Aging 1992-93 Chair 1991-92 Vice-Chair 986-Present Exam Supervisor- American Institute for Property and Liability Undenvriters/Insurance Institute of America 1987-present Clinical Psychologist -pro-bono work with individual clients and community training INTERNAL: DEPARTMENTAL 1993-present Member, Department Executive Committee 1985-88. 995-present Co-Advisor Psi Chi National Honor Society 1996-1999 Guest lecturer for Psi Chi Grad Night on getting into clinical/counseling grad programs 1989-91,93, 95-present Department Representative, CCHE Faculty to Faculty Conference 1987 - 94 Department Representative to graduation ceremonies 1986-94 Library Representative 1983, 86 89, 90-93,97,98 Member. Faculty Search and Screen Committee 1999-92 Member, Psychology Department Undergraduate Committee(Chair 1992) 1987-88 Co-Coordinator Semester Conversion Committee COLLEGE: 1992,93,96,97 Member of faculty invited to teach in the Cluster Program 1990-93 Graduation Marshall, Arts& Sciences 1988-89 Member, Arts and Sciences Teacher Education Committee 1986-89 Chair, Interdisciplinary Committee to develop and revise Human Development Major in the College of Arts and Sciences and Psychology Department UNIVERSITY: 1992-94 1996-Present Member-Research and Publications Board 1993-94 Chair -Elect 1988-present Founding Co-Advisor, Golden Key Honor Society 1997-95 Member- UNC Women's Commission 1992-94 Co-Chair- Assessment Task Force 1989-90 Faculty Representative. Student Fee Allocation Committee 1986-89 Member, Faculty Senate 1988-89 Secretary 1987-88 Vice-Chair 1986-87 At-Large Member. Executive Committee 1986-89 Member, Academic Policies Committee 1986-87 Member. Elections Committee 1988 Representative, Western States Faculty Leadership Conference, Reno. 1988 Senate Representative. Statewide Commission Advisory Committee 1988 Advisor, In-Touch Helpline 1985-86 Volunteer Therapist, UNC Counseling Center GRADUATE STUDENT COMMITTEES--Doctoral: 1998 Committee Member, Shu-Shin Lu, Professional Psychology 1997-prsnt Committee Member. Christine Rogers, Professional Psychology 1995-1997 Committee Member, Lisa Ing, Special Education 1994-pres Committee Member, Marla Gallagher, Educational Psychology 1')93 Committee Member, Hsiu-Lan Ma, Science Ed. -Oral Comprehensives 1993 Committee Member, Jerry Buford, School Psychology,"Treatment of depressive symptoms of early adolescents". 1993-1998 Committee Member, Pat Flanagan, CSPA,Orals, "A comparison of attitudes and practices oL teaching faculty regarding student academic dishonesty at a two year and four year institution" 1991 Committee Member, Mike Propriano, School Psychology 19911-94 Committee Member, Paul Lantz, School Psychology, 1989 Committee Member. Mike Peters, Vocational Rehabilitation ."The Effectiveness of Voca9on_il Evaluation for Various Disabling Conditions 1987 Committee Member. Ane Marie Kajenckii, English, " The Concept of Free Association 'i Vitomia Woolf s The Waves" 1986 Committee Member, Fuming Liao, Mechanical Kinesiology, "Development and Validation at :1 Method for Providing Immediate Feedback Information on Speed and Angle of Release u Shotputting" GRADUATE STUDENT COMMITTEES --Masters: 1998 Vanessa Ewing, Committee Member 1997 Stephanie Blasi, Committee Member ['197 John Nickisson, Chair 7994 David Watson, Committee Member 1994 Tiernan Mcllwaine, Committee Member 1994 Jerrod McCoy, Committee Member 1'193 Sheldine Runyan.Committee Member ['193 Sue Cole, Committee Chair, "Influences on Occupational Goals of Selected Male and Female College Students", 1'190 Jerry Benner, Committee Member 1999 Kurtis Armstrong, Committee Member. "Attitudinal Consequences of Pre-Employment and Random Employee Drug Testing" 1989 Michelle Hozer. Committee Member 7 989 Anne Schnittgrund, Committee Chair, " Age and Electrothermal Biofeedback Training". 1'188 Cherri Hockett, Committee Member, "The Effects of Turnover on Those Who Remain in an Organization" 1988 Tonv Ambrosio, Committee Member. "The Belief in a Just-World and the AIDS Epidemic- Predictors of Attitudes Towards Individuals with AIDS" 1188 Steve Foster.Committee Chair. "Hypnotic Susceptibility As a Function of Locus of Control and Director Indirect Inductional Deepening and Suggestion Style" 1988 Lisa Dillon.Committee Chair, "Cognitive-Behavioral Approach to the Treatment of Elderl\ Rheumatoid Arthritis Subjects" 1'187 Deanna Holmes, Committee Member 1987 Darlene Nold, Committee Member, "Reading and Writing Assessment Tests as Predictors of Success in the Basic Peace officer Academy at Aims Conmmnity College" 987 Dan May, Committee Member 1'186 Jeff Schiels, Committee Member. "The Reformulated Hypothesis: Is Its dominator of Learned Helplessness Literature Justifiable?" 986 Linda Coulthard-Moms. Committee Member. "Biofeedback of Cortical Slow Wave Potentials Hand Temperature and Muscle Tension in Normal and Attention Deficit Disorder with Hyperactivity Children" TEACHING: Honors Activities 1099 UNC Research Day, Faculty Panel Coordinator, " Complementary Healing Methods" 1999 Thesis Coordinator-Kristin Pietryzick, Jennifer Kimberling, Cristine Dickey 1997 Thesis Co-Advisor Kelly Kinser 1997 Honors Connection Course development -Alternative Healing Methods 1996-pres Honors Co-Coordinator, Psychology Department 1989-94 Honors Coordinator, Psychology Department 1994 Thesis Co-Advisor, Diane Musgrave,"The Relationships Among Personality Traits, Alcohol, Caffeine, and Nicotine Consumption, and Academic Performance in College Students" 1'994 UNC Researh Day, Faculty Panel Coordinator, "Hypnosis: Theory and Research" 1993 UNC Research Day.Faculty Panel Coordinator, "Non-traditional Theories of Therapy Serving Women and Minorities". 1993 Thesis Co-Advisor. Linda Norman, "Clozapine and Event Related Brain Potentials in Schizophrenics" 1992 Thesis Advisor, Deborah Knuckey, "The Effect of Touch on AffectAmong Strangers Under Mildly Stressful Conditions" 1992 UNC Research Day, Faculty Panel Coordinator 1992 UNC Research Day, Faculty Panel Coordinator(2 student panels) "Sex Roles and Psychology", The Power of Social Influence 1989 Thesis Advisor, Geri Bosley, "Post Death Ritual in a Small Colorado Community" 1988 Thesis Advisor, Pam Clasen. "The Use of Relaxation and Imagery Techniques in Pain Management" 1989 Honors Connection Course Development courses Taught' (1-4 Scale with 1 as Highest) ('1-5 Scale with 5 as highest) DATE COURSE TITLE FIRS ENR AVG RATING 'W 198 8 PSY 101 IntroSeminar Psychology 1 43 W 1987 PSY 101 IntroSeminar Psychology 1 16 1.12 W 1986 PSY 101 IntroSeminar Psychology 1 32 1.24 F 1997 PSY 120 Principles of Psychology 4 107 3.76 F 1996 PSY 120 Principles of Psychology 4 119 F 1993 PSY 120 Principles of Psychology 4 119 1.64 F 1991 PSY 120 Principles of Psychology 4 161 1.67 F 1981 PSY 120 General Psychology 3 42 ---- Sp 1984 PSY 121 Intro to Psychology I 4 40 ---- Sum 1988 PSY 230 Human Growth & Development 5 5.5 _-- Sp 1988 PSY 230 Human Growth & Development 5 60 158 'W 1988 PSY 230 Human Growth & Development 5 90 1.38 F 1987 PSY 230 Human Growth & Development 5 45 I 54 W 1987 PSY 230 Human Growth & Development 5 75 1.54 Sp 1987 PSY 230 Human Growth &Development 5 90 -- Sum 1986 PSY 210 Human Growth & Development 5 47 -- F 1986 PSY 230 Human Growth & Development 5 80 I.36 W 1986 PSY 210 Human Growth & Development 5 80 1 42 'nr; 1986 PSY 230 Human Growth & Development 5 52 1.27 F 1985 PSY 210 Human Growth &Development 5 56 1.57 F 1985 PSY 230 Human Growth &Development 5 85 1.56 Sp 1984 PSY 265 Social Psychology 3 26 ---- 'iv 1984 PSY 265 Social Psychology 3 23 ---- Sp 1998 PSY 121 Health Psychology 3 40 4.11 F 1998 PSY 121 Health Psychology 1 19 4.08 Sp 1997 PSY 323 Health Psychology 3 44 4.37 S F 1995 PSY 323 Health Psychology 3 47 Sp 1994 PSY 323 Health Psychology 3 41 1.69 F 1992 PSY 323 Health Psychology 3 49 Sp 1992 PSY 423 Health Psychology 3 42 1 69 F 1990 PSY 423 Health Psychology 3 1 66 F 1988 PSY 423 Health Psychology _3 35 1.36 Sp 1986 PSY 330 Child&Adolescent Psych 3 27 14 Sp 1993 PSY 331 Maturity&Aging 3 40 Sp 1991 PSY 331 Maturity & Aging 3 46 1.62 F 1989 PSY 331 Maturity & Aging 3 23 1.45 F 1988 PSY 331 Maturity & Aging 3 27 1 40 Sp 1988 PSY 430 Maturity& Aging 3 44 158 Sp 1987 PSY 430 Maturity&Aging 3 34 -- Sp 1986 PSY 430 Maturity&Aging 3 36 1 52 F 1998 PSY 455 Abnormal Psychology 3 49 4 24 Sp 1997 PSY 455 Abnormal Psychology 3 49 4 03 F 1995 PSY 455 Abnormal Psychology 3 32 Sp 1993 PSY 355 Abnormal Psychology 3 37 Sp 1992 PSY 355 Abnormal Psychology 3 42 1 26 Sp 1991 PSY 355 Abnormal Psychology 3 37 I37 F 1990 PSY 355 Abnormal Psychology 3 1 46 S❑ 1990 PSY 355 Abnormal Psychology 3 31 Sp 1990 PSY 355 Abnormal Psychology 3 37 1 38 Sp 1990 PSY 355 Abnormal Psychology 3 42 1 53 Sp 1989 PSY 355 Abnormal Psychology 3 78 1 51 Sp 1986 PSY 358 Abnormal Psychology 3 41 154 W 1984 PSY 358 Abnormal Psychology 3 31 Su 1998 PSY 350 Theories of Personality 3 20 4.10 Su 1990 PSY 357 Theories of Personality 3 21 1.45 W 1988 PSY 357 Theories of Personality 3 40 1 57 F 1987 PSY 357 Theories of Personality 3 55 1 38 VV 1987 PSY 357 Theories of Personality 3 37 133 F 1986 PSY 357 Theories of Personality 3 54 -- F 1983 PSY 357 Theories of Personality 3 51 F 1998 PSY 407 Intro to Counseling Theories 3 20 4 31 Sp 1998 PSY 407 Intro to Counseling Theories 3 20 4.42 F 1997 PSY 407 Intro to Counseling Theories 3 15 4 71 F 1996 PSY 407 Intro to Counseling Theories 3 19 F 1995 PSY 407 Intro to Counseling Theories 3 19 Sp 1994 PSY 407 Intro to Counseling Theories F 1993 PSY 407 Intro to Counseling Theories 3 24 1 32 Sp 1993 PSY 407 Intro to Counseling Theories 3 22 F 1992 PSY 407 Intro to Counseling Theories 3 25 1 I8 Sp 1992 PSY 407 Intro to Counseling Theories 3 22 12 I F 1991 PSY 407 Intro to Counseling Theories 3 44 126 Sp 1991 PSY 407 Intro to Counseling Theories 3 33 1 21 F 1990 PSY 407 Intro to Counseling Theories 3 Sp 1990 PSY 407 Intro to Counseling Theories 3 16 1 12 F 1989 PSY 407 Intro to Counseling Theories 3 24 I30 Sp 1989 PSY 407 Intro to Counseling Theories 3 18 1 31 F 1987 PSY 407 Intro to Counseling Theories 3 26 121 F 1986 PSY 407 Intro to Counseling Theories 3 41 1.57 Sum 1987 PSY 499 Psychology of Sex Roles 3 16 1 18 Sum 1989 PSY 508 Emotional Crisis Workshop I-2 39 *** "Frontiers of Mental Health 9 And Education" Sum 1988 PSY 508 Emotional Crisis Workshop 2-3 63 "Mind/Body Interactions" Sum 1987 PSY 508 Emotional Crisis Workshop 2-3 106 "Relationships" Sum 1991 PSY 595 Health Psychology 3 15 Sp 1998 PSY 620 Assessment& Interviewing 2 9 4 31 F 1992 PSY 620 Assessment &Interviewing 2 12 1.66 F' 1990 PSY 620 Assessment &Interviewing 2 1.02 F 1988 PSY 620 Issues in Behavioral Medicine 3 5 2.08 F' 1997 PSY 621 Practicum College Teaching 2 10 4.77 F 1996 PSY 621 Practicum College Teaching 2 10 F 1993 PSY 621 Practicum College Teaching 2 13 1 45 F 1992 PSY 621 Practicum College Teaching 2 13 FV 1984 PPSY 670 Tests and Measurements 3 20 Sp 1997 HON 200 Honors Connections Seminar Alternative Healing Methods 2 20 3.67 of 4 Sp 1989 HON 200 Honors Connection Seminar II: 2 9 *** "Love" Sum 1986 Elderhostel "Dream On" NC (25) Sum 1987 Elderhostel "Mind/Body Interactions" NC 19 *** courses Developed 1997 HON 200. Alternative Healing Methods 1991- PSY 595, Issues in Health Psychology, Sunuucr 1989- 23rd Annual Emotional Crisis Workshop. Frontiers of Mental Health and Education. Summer 1988- PSY 620, Assessment in Behavioral Medicine, Fall (Revised Spring 1998) 1988- PSY 423_ Health Psychology. Fall 1988- 22nd Annual Emotional Crisis Workshop, Mind/Body Interactions, Summer 1987- 21st Annual Emotional Crisis Workshop. Relationships. Summer 1987- Mind/Body Interactions - Eldcrhostcl Program, Summer 1987- PSY 499. Psychology of Sex Roles - Summer 1986- Dream On-Elderhostel, Summer Directed Studies Graduate: 1995- Cynthia Holley- Hypnosis 1994 - Tara Johnson, Hypnosis Theory and Practice 1994 - Marla Gallagher, Sociometric Processes 1994 - Marla Gallagher, Cluster Development in Intro Psychology Classes 1992 - Bntce Holoman. Hypnosis Research and Practice 1988 - Paul Jantz, Hypnosis for Pain With Children I'988 - Lori Kochevar. Women as Leaders 1988 - Jem Israel, Alan Shaw, Issues in Health Psychology 1988 - Steve Foster. Michele Hozer. Teaching Apprenticeship 1')87 - Tony Ambrosio, Hypnosis Models 1986- Candy Disch. Psychological Testing [!ndergraduate: 1998 Jennifer Altman -Exercise and Psychology 1996- Kindra Sanchez-Biracial Identity 1'996 - Jenna Weatherbee -Pain Coping Styles 1995- Allison Ellis - Psychological Theories in Business Management 1995 - Holli Elrick. Counseling and the Hearing-Impaired Child 1994 - Lenis Garza, Etiology of Schizophrenia IP 1994 - Suzanne Bodetko, Autogenic Training 1994 - Rebecca Furstenberg, Impact of Alzheimer's Disease on Families 1994 - Bonnie Sarton,Hypervigilence in Youth(Hon 351) 1993 - Mary Jo Hamilton.Hypnosis Theory 1994 - Greg Schooley,Forgiveness as a Therapy Tool 1993 - Jason DeBueno, Youth Advocacy 1993 - Kelley Ferguson - Women in Psychology 1993 - David Rosenberg -Offender Programs 1992 - Robin Trostel, Analysis of Learning Styles 1992 - Robin Trostel. Health Locus of Control 1992 - Roberta Inman,Family Violence and Lesbians (Hon 351) 1991 - Mark Kahl, Back Pain 1991 - Tracy Moulton, Treatment of Sexual Abuse 1991 - Mice McPherson. African American Women and Higher Education 1991 - Jody Humer, Hypnosis: Theory and Practice 1990 - Jimmie Berg, Women's Learning Styles 1989 - Elary Violett, Cognition and Pain Management 1989 - Gen Bosley, Chris Snodgrass,Bev Foster, Elan' Violets, Issues in Personality 1989 - Penny Vaughn, Female Pioneers in Social Work 1989 - Lori Peterson. Pain and the Elderly 1988 - Peer Training for Hotline Service 1987- Tracy Bob, Issues in Child Abuse 1987 - Julie Stoddard, Grief and Divorce 1987- Eric Bouch. Hypnosis Models 1987 - Mike Lesser, Assessment in Sport Psychology 1986 - Lynne Sheffield. Childhood and Loss 1986 - Jennifer March, Adolescence Praclica 1998- Andrea Lamb-Hypnosis and golf performance 1998- Reberr:r Varoula- Women's Place 1998_ Greeley Medical Clinic-Gay Lemons, Renae Smith 1998- Ackerman and Associates-Amy Mmmel, Kristin Pietrzyk, Jennifer Kimberling, Greg Pedersen 1997- Greeley Medical Clinic-Lori thirst, Barbara Glode, Ann Marie McCullen, Jeff Titus 1993 - Greg Schooley, Breavement Research 1993 - Di Smice, Women's Commission 1992 - Mary Jo Hamilton, Hypnosis Research 1992 - Carol Sexton. Psychology Testing 1992 - Lisa Schlott, Learning Styles PROFESSIONAL DEVELOPMENT ACTIVII IES: Workshops Clinics Symposia Conferences: (Excluding Conferences as a Presenter) 1999- EMDR training and Level 1 certification 1998 Qualitative research lecture series -UNC 1298- Lewis M Temuan Western Regional Teacher's Conference sponsored by APA Division2 in conjunction with the WPA/RMPA joint convention. I'998- "Spirituality and health in counseling", CAHEC Workshop, Greeley 1998- `Divorce Busting: Solution oriented brief therapy with couples". Colorado Assoc. Marriage and Fain ih 1997 - Health Maintenance- Legal and Ethical Issues 1997- Body and Soul: Healing in the 90's 1996- Celebrating our Essence! Women's Health and Spirituality 1995 - International Society for Clinical and Experimental Hypnosis -Research Workshop. San Francisco C A (30 morc hours toward certification) 1989 - "Minding the Body. Mending the Mind". CAHEC Workshop, Ft. Collins 1988 - "Demystifying Publishing". CAHEC Workshop, NCMC. Greeley 1985 - "Attention( Deficit Disorders in Children", Meichenbatun, Denver 1980 - International Society for Clinical and Experimental Hypnosis -30 certification hours. Denver Numerous other workshops on Parent Loss, Child Abuse, Grantsmanship, Short-Term Treatment, Supervision Pain Management. Medical Terminology. Depression. Personality Disorders Courses Taken Credit. 1994- EPRE 603 -Analysis of Variance .lialit 993 - EPRE 602 -Elements of Statistics 1990- EPRE 700 -Advanced Research Methods ('ontimdng Education Credit: 976- C.U. Medical School -Medical Ethics 972 - C.U. School of Nursing -Hypnosis(10 weeks) 1969 - University of Chicago -Kubler-Ross. Death and Dying HONORS AND AWARDS: 998- Distinguished Service Award-Rocky Mouintain Psychological Association :998- Arts and Sciences Teacher of the Year Award-one of thre in Social Sciences :'.998- "Wonderful Outstanding Woman" Award -Highlighted in October newsletter- Women Resource Center :'993 - Commencement Banner Carrier. Arts and Sciences 1.993, 91,89, 88 - Mortar Board Favorite Professor 992 - Sudent Representative Council University Professor of the Year 1992 - Student Representative Council University Advisor of the Year 989 - Arts and Sciences Achievement Award 1988 - Honors Advisor of the Year 1984 - Psi Chi. University of Northern Colorado Chapter 1982-8$ - Writing Associateship -Rocky Mountain Women's Institute hh bt,,, FC4 3r-b51- E14 9/28/99 CURRICULUM VITAE N. Karen Bender, MA, LPC 1104 Twin Peaks Circle Longmont, Colorado 80503 Phone: 303-678-8940 BUSINESS ADDRESS: 2919 W. 17th Ave.. Suite 214 Longmont, Colorado 80503 Phone: 303-678-0268 MARRIED: Brice J. Bender, MD, April 26, 1974 CHILDREN: Sara C Bender, born 3/13/79 and Melissa K. Bender. born 9/8/80 EDUCATION: Bachelor of Arts, Chemistry University of Colorado at Denver, 1977 Master of Arts in Agency Counseling, Emphasis in Marriage and Family University of Northern Colorado, 1993 Externship: Mental Health Center of Boulder County, Longmont Branch, Community Support Services Team, Sept. '92 to June '93 Currently enrolled in Professional Psychology Doctoral Program University of Northern Colorado (course work nearly completed) WORK EXPERIENCE. Feb. '94 to present- Private practice, Individual adult clients and couples, Longmont. Fall '95: Counselor and presenter in multidisciplinary PMS program. Longmont Clinic. March '95 to May '96: Domestic Violence Counselor, Longmont Coalition for Women in Crisis, Individual adult clients; women's groups: domestic v'olence curriculum, support, and parenting. June '93 to Sept. '93: Therapist, Mental Health Center of Boulder County, Longmont Branch, Women's Issues Group. Sept. '84-Dec. '86: Cardiopulmonary Technologist, part-time Longmont United Hospital, 1950 W. Mountain View Ave., Longmont, Colorado 80501. June '79-April '82: Supervisor, Pulmonary Laboratory, Presbyterian/St. Luke's Medical Center, 601 E. 19th Ave., Denver, CO 80203 Jan. '76-June '79: Supervisor, Pulmonary Laboratory, St Joseph Hospital, 1835 Franklin St., Denver, CO 80206 1975-1979 Clinical Instructor, Front Range Community College, 3645 W. 112th Ave . Westminster, CO 80030. VOLUNTEER EXPERIENCE Sept. '98 to Sept. '99: Doctoral Student Representative. Division of Professional Psychology. University of Northern Colorado. Sept '94 to Mar. '95: Volunteer therapist: Longmont Coalition for Women in Crisis. Individuals and groups: domestic violence curriculum and parenting. Jan. '94 to July '95: Volunteer therapist: St. Vrain Valley Child Development Council, Inc., Head Start Program. Individuals, families, parent support groups that include parenting curriculum. June '93 to Aug. '93: Volunteer Co-therapist: Mental Health Center of Boulder County. Drug Treatment Team, Women's Group: History of Sexual and Drug Abuse. Co-therapist: Use Franseen. June '93 to July '93: Volunteer Co-therapist: Mental Health Center of Boulder County, Longmont Branch. Children's group: Attention Deficit Disorder. Co- therapists: John Fallon, MSW, and John Carson, Ph.D. Nov. '91 to May '92' Volunteer individual counselor: University of Northern Colorado Counseling Center Feb. 1991 to Feb. 1992: Master's Student Representative. Division of Professional Psychology, University of Northern Colorado. Sept. '91 to Oct. '91: Volunteer Counselor: A Woman's Place, Greeley, Co 1990 to 1992: Scholarship Committee for American Association of University Women. 1990-1991: Member Board of Directors for Longmont Coalition for Women in Crisis. PROFESSIONAL ORGANIZATIONS: Co-chairman, Public Relations, Information and Education Committee, Child and Family Advocacy Team (Boulder County Child Sexual Abuse Task Force), June '95 to August '97. Facilitator, Longmont Study Group, Colorado Society for the Study of Dissociation. May '95 to August '97. =•v•�c _- is:Oc 6K. BEN FPX 3©3-651-9514 Member: American Counseling Association, Colorado Counseling Association, and Eating Disorders Professionals of Colorado. Associate Member: American Psychological Association. PUBLICATIONS: N. Karen Estridge Bender Slonim, N. B., & Estridge, N. K. (1969). Ozone --An underestimated environmental hazard. Journal of Environmental Health, 31, 577. Slonim, N. B., & Estridge, N. K. (1970). The acid-base surface --- A 3- dimensional visual model. Rocky Mountain Medical Journal, 57, 59, Slonim, N. B., & Estridge, N. K. (1970). Carbon dioxide --- Environmental health aspects. Journal of Environmental Health, 33,171. Slonim, N. B., & Estridge, N. K. (1970). The acid-base surface: A three- dimensional visual model for analysis of acid-base information. Journal of Medical Education, 45, 828. Slonim, N.B., & Estridge, N. K. (1971). Carbon dioxide ---Environmental health aspects. In T. J. DeKornfeld (Ed.). Selected papers in inhalation therapy. Flushing, NY: Medical Examination Publishing, Co.. Inc. Slonim, N. B., & Bender, N. K. (1974). Responses to carbon dioxide containing atmospheres. In N. B. Slonim (Ed.). Environmental physiology. St. Louis: The ,'' V. Mosby Co. Slonim, N B., & Bender, N. K. (1976). A tabular history: Cardiopulmonary technology as a profession. CVP, The Journal of Cardiovascular and Pulmonary Technology , 4, 31. Bender N. K. (1977). Relevant respiratory physiology. The post-surgical patient, Spirometry. In V. Archuleta, O. B. Plumrner, and K. D. Hopkins, A demonstration model for the project"Training nurses to improve patient education, Boulder, Colo.: Western Interstate Commission for Higher Educati:m Bender, N. K. (1988). Future trends in education, SVVEA Bridge, 3, 5 (St. Vrain Valley Education Association) PRESENTATIONS: Fall '95: Co-presenter with Haven Howell. M.O., multidisciplinary PMS vograi• Longmont Clinic. October '98: Co-presenter with Sean O'Halloran and Christine Rogers: A Roundtable discussion entitled: "Facing our Clients' Trauma: Implications foi Counselors in Training," at Rocky Mountain Association for Counselor Educat nn and Supervision. RESUME Emily L. Jaramillo-Bansberg 183 50th Avenue Place Greeley,Colorado 80634 (970) 353-1388 Office Telephone: (970) 351-2417/Email: ejaramil@che.unco.edu EDUCATION • Master of Arts: Psychology/Counseling, University of Northern Colorado,Greeley, CO • Graduate Fellowship Study: Rutgers State University of New Jersey, Newark, NJ • Bachelor of Arts: Sociology, University of Northern Colorado, Greeley, CO EMPLOYMENT Associate Director The Center for Human Enrichment University of Northern Colorado,Center for Human Enrichment,Greeley, CO 80639 August 1997-Present Ensure efficient administration of the Student Support Services TRIO project which includes curriculrm and instruction, technology,advising,and tutoring. Review the non-competing continuation and annual I.crformance reports. Assist with the provision of professional opportunities for Center employees. Oversee tht state funded Bridging Opportunities Program that focuses on recruiting incoming freshmen and transfer sti ioents into the Center for Human Enrichment. Direct the Ronald E. McNair Postbaccalaureate Achievement Pr gram (see below). Director Ronald E. McNair Postbaccalaureate Achievement Program University of Northern Colorado, Center for Human Enrichment, Greeley, CO 80639 March 1996-Current Direct all efforts to ensure efficient administration of the McNair federal TRIO grant. Co-author U S. Department of Education McNair proposal. Responsible for the compilation, analyzation, and submission of Non-Competing Continuation and Annual Performance Reports to the Department of Education. Monitor project's federal and matching budgets, supervise and train staff members, and plan, develop, and direct all student scholar activities. Collaborate with campus departments in order to exceed program objectives. Responsible for coordinating, editing, and publishing the UNC McNair Scholars Journal. Identify, r_rruii, and select program scholars. Ensure the completion of scholars' academic research projects. Provide acac emit advising and guidance to McNair scholars. Direct the academic year research seminar series, the r t,idential Summer Research Internship, and other scholarly activities that prepare scholars for doctoral stud Coordinate research and scholarly activities between faculty mentors and McNair scholars. Counselor/Assistant Director Ronald E. McNair Postbaccalaureate Achievement Program University of Northern Colorado, Center for Human Enrichment, Greeley, CO 80639 October 1995 -February 1996 Assisted in the implementation of the McNair program (funded October 1995). Facilitated the recruitment and selection of McNair scholars. Compiled and submitted federal reports. Informed and collaborated with campu5 offices and departments. Implemented an academic workshop series based on student needs. Provided academic. advisement and guidance to McNair scholars. Assistant Coordinator,Academic Advising Student Support Services University of Northern Colorado, Center for Human Enrichment,Greeley, CO January 1995-August 1995 Provided academic advisement and guidance to federal TWO Student Support Service participants Maintained student record database. Assisted with the compilation of federal reports. Served as liaison to h o' athletic department and the financial aid office. Assisted in the supervision of peer advisors. Pro\ided technological assistance within the program. Assistant Coordinator,Macintosh Computer Laboratory Student Support Services University of Northern Colorado, Center for Human Enrichment,Greeley, CO 80639 August 1994-December 1994 Supervised, scheduled, evaluated, and trained lab employees. Provided technical assistance and advisement to federal TRIO Student Support Service participants in a learning environment. Maintained and ordered consumable computer supplies. Evaluated and ordered computer software and hardware. RELATED EXPERIENCE Admissions Office Assistant University of Northern Colorado, Admissions Office, Greeley, CO December 1985-December 1988 Assisted in the daily operations of the UNC Admissions Office. Received and reviewed applications and distributed accordingly. Filed, typed, and performed data-entry on all incoming freshman, transfer, re-entry, and non-traditional students. Trained and supervised co-workstudy employees on office procedures, FERIA, and the CCHE Index system. Provided general information to incoming students and parents. Co-Instructor University of Northern Colorado, Center for Human Enrichment CSPA 359: Paraprofessionals in Student Affairs, Academic Peer Advisors Co-facilitated the instruction for training of peer advisors who advised Student Support Service participants at the Center for Human Enrichment. Coordinated curriculum and instruction for pre-service and on-;omg training for a staff of fifteen peer advisors. Counselor Intern North Colorado Medical Center, Family Recovery Center, Greeley, CO January 1996-July 1996 Facilitated psychotherapy counseling groups and individual counseling for chemically dependent and eating disorder patients. Performed case management from admission to discharge. Presented psycho-educational information to patients, family members, and staff. Designed a portfolio brochure distributed to health cam and managed care providers. Clinical Care Assistant Weld Mental Health Center, Greeley, CO September 1994 - February 1995 Monitored and supervised the daily activities of chronically mentally ill patients in a learning/self- development environment. Facilitated group and individual counseling sessions. Coordinated patient recreational activities. Prepared written and oral reports. Correction Technician The Restitution Center, Greeley, CO February 1989- February 1990 Conducted informal counseling with non-violent felony offenders in a residential setting. Responsib'e for the supervision of clients. Distributed client medications as prescribed. Performed searches and confiscat'd contraband. Prepared written and oral reports. Instructed clients on self-development and new life .ipproat lies as alternative methods of coping. PRESENTATIONS • Moderator: "Research & Policy Affecting the Education of the Mexican Child in the 21st Century," University of Northern Colorado. • Moderator: Second Annual McNair Scholars Research Symposium and Graduate Education Conference. • Panelist: Minority Students in Graduate School, Colorado State University. • Presenter: Financing a Graduate Education, Applying to Graduate School, Cultural Sensitivity and Awareness, Hispanic Women in Higher Education, Introduction to the Internet, and Communicably; Across Cultures, University of Northern Colorado. • Presenter: Conflict Resolution, Communication Skills, and Setting Limits and Boundaries, North Colorado Medical Center. CAMPUS SERVICE: University of Northern Colorado Officer • Professional and Administrative Staff Council (President's Office) • Co-chairperson, Student Advisory Committee, Hispanic Cultural Center • Secretary, Macintosh Computing Society Member • Undergraduate Research Council • Cesar Chavez Cultural Center Cinco de Mayo Week Committee • Professional Development Award/Scholarship Committee • Relations with UNC Board of Trustees Committee • Salary Equity Committee • Exempt Staff Evaluation and Performance Committee • Team UNC Fund Raising Committee • Academic Excellence Week Task Force • Campus Advisory Committee, Cesar Chavez Cultural Center Other • Reviewer/Evaluator for "UNC Works In Progress"conference. • Submitted and published an article in the International Student Services' newsletter entitled, Communicating Across Cultures. PROFESSIONAL AFFILIATIONS • ASPIRE member(Association of Special Programs In Region Eight) • CABE member (Colorado Association of Bilingual Education) • NCEOA member (National Council of Educational Opportunity Associations) HONORS AND AWARDS • Distinguished Alumni, Department of Sociology, University of Northern Colorado • Fellowship, Graduate Study-Rutgers School of Criminal Justice Fellowship, Rutgers State Unix:(rsitv of New Jersey, Newark, NJ • Scholarship, National Hispanic Scholarship Fund • Scholarship, Candelaria Scholarship, University of Northern Colorado, Greeley, CO PROFESSIONAL DEVELOPMENT AND TRAINING • National McNair Scholars Research Symposium-6th Annual, Penn State, College Park, PA. • National Council of Educational Opportunities Association (NCEOA) Proposal Writing Conference, San Francisco, CA. • Reporting Student and Project Performance, Monterey Bay,CA. • First,Second, and Third Annual Rocky Mountain McNair Scholars' Research Symposium & Graduate Education Conference, Fort Collins,CO. • NCEOA 16th and 17th Annual Policy Seminar, Washington, DC. • NCEOA, Seminar on Relations with the U.S. Department of Education, Washington, DC. • NCEOA Proposal Writing Conference,San Juan,Puerto Rico. • Association of Special Programs in Region Eight(ASPIRE) Colorado Chapter, 1995-1998 State Meetings, Denver, Ft. Collins, CO. • Annual Rocky Mountain Teacher Education Consortium Conference,Greeley,CO. • Diverse Learners Academy, Leadville and Pueblo, CO. • National McNair Scholars Research Symposium, University of California, Irvine, CA. • Parent/Teacher Youth Leadership Conference, Breckenridge, CO. • National Association of Bilingual Education Conferences, Albuquerque,NM and Orlando, FL. • Northern Colorado Hispanic Chamber of Commerce Conference,Greeley,CO. • ASPIRE Regional Conference, Fargo, ND. • National McNair Scholars Research Symposium-4th Annual, Penn State, College Park, PA. • South East Association of Educational Opportunity Programs Conference, Director Training, Asheville, NC • Cultural Diversity Conference, Greeley, CO. PERSONAL STRENGTHS • Communicate: Ability and extensive experience in communicating with a diverse population. • Counsel: Formally trained to work with a variety of individuals in multiple settings • Leader: Ability to lead individuals and manage environments and situations. REFERENCES Dr. David Gonzalez University of Northern Colorado Division of Professional Psychology, McKee Hall Greeley, CO 80639 (970) 351-1639 Dr. Wendell Osorno University of Northern Colorado Division of Professional Psychology, McKee Hall Greeley, CO 80639 (970) 351-1635 Dollie Zamora Coordiator of Communication Greeley/Evans School District Six 811 15th Street Greeley, CO 80631 PERSONAL . DATA SHEET Identifying Information : Name : Laurence "Larry" P. Kerrigan , Ph . D. Address : 1706 19th Avenue Greeley, CO 80631 DOB: 9/20/32 Phone : ( 303 ) 353-3373 - business Degrees : BSC - Business Economics , from Creighton University , 1954 . MS - Economics , from St . Louis University , St . Louis , Mo . , 1963 . MA - Theology , from St . Mary ' s University , Regis College Campus , Toronto , Ontario , Canada , 1967 . Ph . L. - Philosophy, St . Louis University, St . Louis , Mo . 1960 , ( Ecclesial Degree ) . Ph. D. - California School of Professional Psychology , Berkeley/Alameda Campus , 1974 , Clinical Psychology . Currently a licensed psychologist in the state of Colorado . Educational Background : 1950-54 Creighton University , Business economics , 1954-56 Marquette University , Milwaukee , WI . , Classical studies and ascetical theology , 1956-57 Springhill College , Grand Coteau LA. Campus , Classical studies , 1957-60 St . Louis University , Philosophy and Economics , 1963-67 St . Mary ' s University, Toronto Campus , Theology , 1971-74 California School of Professional Psychology , clinical psychology , Berkeley/Alameda Campus Positions Held : 1969-71 Member of Board of Directors , Campion College , Prairie du Chien, WI . 1968-71 Director , Department of Psychology, Campion College 1971-74 Director of Student Counseling Center , Long Mountain College . 1975-80 Director of Short-term Children and Family Team , Weld Mental Health Center , Greeley , CO . 1975-87 Clinical Psychologist , Child and Family Team , Weld Mental Health Center , Greeley , CO . 1975-88 Co- founder of Weld County Child Protection Team, 1987-88 Member of Executive Board , Weld Mental Health Center , Greeley , CO . Honors Received : 1968-69 and Teacher of the year , Campion College . 1970-71 1972-73 Class Representative to Campus Executive Committee , and California School of Professional Psychology 1973-74 Work and Experiential Background : 1959-60 Counselor at Dismas Halfway House for ex-convicts , St . Louis , Missouri , 1960-63 Teacher-counselor-coach , Marquette Prep High School , Milwaukee , WI . 1964-67 Counselor-therapist at Street Haven and Sancta Maria Halfway Houses for women and at the Don ( metro ) Jail in Toronto , Canada. 1967-68 Teacher and Campus Counselor at Creighton University , Omaha, NB . 1968-71 Teacher at Campion College , Prairie du Chien , WI . , Director of Psychology Department , Department chairman . 1970-71 Director and Staff member of a total environment for Inter-city boys , late grade school age from Milwaukee , WI . 1971-73 Director of Student Counseling , Lone Mountain College , San Francisco , CA. Teacher at the Lone Mountain College , San Francisco , California. 1973-74 Psychologist Trainee at San Francisco Mental Health Center , Richmond District , Outpatient Care . 1974-75 Private Practice , So . Hay Human Services Center , San Diego , CA . Part-time instructor at California School of Professional Psychology , San Diego , CA. 1975-80 Director , Short-'Perm Therapy Team, Children and Family Unit , Weld Mental Health Center , Greeley , CO . [980-87 Member of Children and Family Therapy Team , Weld Mental Health Center , Greeley , CO . 1987- present Full time private practice with Joyce Sliohet Ackerman , Fd . D. , Licensed Psychologist , Greeley , CO . Part Lime practice at Weld Mental Health Center , Greeley , CO . Publication : Kerrigan , Laurence P . - The Relationship Between Therapie:L and Client ' s Perceptions of One Therapy Session . Published Doctoral Dissect.rrl. ion , IJnive rsit.y of Cati Moroi it School. of Professional Psychology . Copyright , 1971 . Workshops._and SpecialTraining : Since 1974 , l have attended an average of' about three workshops per year . Most of these workshops have presented specialized training in the following areas : Neuro-linguistic training , Autogenic and relaxation training , Visualization- Imagery- Hypnosis , Cognitive-Behavioral Therapy , Ericksonian approaches to hypnotherapy and psychotherapy, Family therapy , Strategic family therapy , Sexual abuse , dynamics and applied treatment , Paradoxical intention psychotherapy , and other related areas . In the last fifteen years , I have taught classes and conducted workshops in the following subjects : The Psychology of Dreams Emotional and Physical Health through Visualization and Imagery Western Psychotherapies and Eastern Ways of Liberation Cognitive and Behavioral Therapy Hypnosis in Pain and Habit Control The Psychology of Consciousness and Meditation Sherri R. Malloy, Ph.D. Licensed Clinical Psychologist Office: Home: Mental Health Center of Boulder County 24 Alles Drive 1333 Iris Avenue Greeley, Colorado 80631 Boulder, Colorado 80304 (970) 351-7218 (303) 413-6301 Education Ph.D. Double Major: Child Clinical Psychology; Clinical Psycholog) August 1993 University of Colorado, Boulder. M.A. Department of Psychology, Clinical Program. University of July 1989 Colorado, Boulder. B.A. Major: Psychology; Minor: Spanish. Arizona State University May 1987 Summa Cum Laude. Teaching Cert. Roston Montessori Teacher Training Institute. August 1977 Orange, California. Montessori Elementary Education Certith Clinical Experience August 1991- Child and Family Psychotherapist, Mental Health Center of R,, . ler March 1997 County, Boulder, Colorado. Provided outpatient psychotherap children and their families. Parent, teacher, and other agent consultation. September 1992- Psychology Intern; Denver General Hospital, Denver, Colorado, August 1993 Outpatient assessment, consultation, and treatment to children, adolescents, and adults; Inpatient treatment to adolescents & their families. Consultation to multidiscipl hospital staff. Attended regular seminars and case conferem. Completed an additional rotation in neuropsychology. August 1990- Psychotherapist, University of Colorado, Farrand Residence i May 1992 Provided individual, conjoint, and group psychotherapy to Far nd residents. Psychiatric consultation to faculty and staff. Preset 'd seminars and workshops to faculty, staff, and students. August 1988- Emergency Psychiatric Services Clinician, Mental Health Cent August 1992 of Boulder County, Boulder, Colorado. Evaluation and disposition planning for clients with psychiatric emergencies Composed a training manual for emergency psychiatric dint i..,is 2 Malloy January 1988- Psychotherapy Intern, Raimy Psychology Clinic, May 1992 Department of Psychology, University of Colorado, Bout& Provided outpatient psychotherapy to adults, families, ii: children. Parent and teacher consultation. February 1986- Intake Clinician; Group Facilitator, 'Fri-City Behavioral 1I - I th July 1987 Center, Mesa, Arizona. Conducted intakes for the adult Rs:I Facilitator for children's psychotherapy groups. Administrative and Supervisory Experience Jan 1996- Team Leader, Mental Health Center of Boulder County, Boars present Colorado. Clinical and administrative supervision of a re.: psychologists and psychotherapists. Budgeting. Supervi"!• support staff. Coordinate outpatient services/consultatic:, j3 agency programs, including 1-lead Start, Specialized Foster :are, Post-Adopt, 1178, School-Based Services, Boulder Day Nur cry, and People's Clinic. August 1990- Adult Team Coordinator, Rairny Psychology Clinic, Depar d August 1991 of Psychology, University of Colorado, Boulder. Chaired ti' aduu team meetings and case conferences. Assisted clinic dire v'th administrative tasks. August 1990- Peer Counselor Supervisor, Farrand Residence Hall, Univ.. .ry May 1991 Colorado, Boulder. Developed and implemented a peer co:i in g training program. Provided ongoing training and supervi peer counselors. January 1989- Supervisor in Training, Raimy Psychology Clinic, August 1991 Department of Psychology, University of Colorado, Bould. - Received training and supervision in supervisory tecbni;,. Supervised the psychotherapy of first-year clinical psyci> ,v graduate students. June 1989- Adult Team Intake Coordinator, Raimy Psychology Clini August 1990 Department of Psychology, University of Colorado, Bouldu,. �uLrke and disposition of psychotherapy clients. September 1989- Clinical Supervisor, Emergency Psychiatric Services Tearn August 1992 Mental Health Center of Boulder County, Boulder, Coloradl Trained and supervised Masters level student interns in emergency clinical assessment techniques, legal and prrn , r.31 practices, and psychological report writing. February 1988- Volunteer Trainer, Maslin House for Chronically Mentall, May 1989 Mental Health Center of Boulder County, Boulder, Colorarl Recruited and trained volunteer college students to work with the chronically mentally ill population at this facility. 3 Malloy Publications December 1994- Columnist: The Boulder County Parent, a monthly publication of the present Parenting Place, Boulder, Colorado. Circulation: 8,000. Topics include child development and parenting concerns. Teaching Experience August 1989- Psychology Instructor, Front Range Community College, May 1992 Boulder Campus, Colorado. Fall 1988 Head Teaching Assistant, Department of Psychology, University of Colorado, Boulder. Trained and supervised graduate level Teaching Assistants. August 1987- Teaching Assistant, Department of Psychology, University of May 1989 Colorado, Boulder. August 1977- Montessori Elementary/ Teacher, Roston Montessori School, May 1983 Orange, California; and subsequently, Tempe Montessori School, Tempe, Arizona. Taught preschool through second grade classes. Responsibilities included academic program planning and implementation, supervising teacher assistants, conducting parent- teacher conferences, academic record-keeping, and giving educational presentations to parents. August 1976- Student Teacher, Roston Montessori Teacher Training Institute, August 1977 Anaheim, California. Taught in a Montessori classroom under the supervision of a certified Montessori teacher. Duties were the same as in the entry above. Presentation Topics and Trainings Given Play Therapy Engaging so-called "resistant" clients Psychotherapy with adolescents and their families Case Conferences Parent-Toddler Attachment Patterns Child Abuse Child Psychopathology Stress Management Workshop Depression and Risk of Suicide in College Students 4 Malloy Research Projects Adult Attachment Style and College Functioning (Doctoral Dissertation), 1992 Parent-Toddler Attachment Relationships (Masters Thesis), 1990 Post-Divorce Visitation Patterns and Parent-Toddler Attachment, 1988 Effects of Divorce on Children, 1987 Mental Health Center Client Satisfaction Study, 1986 Clinical Assessment Trained in the use of the following assessment tools: W'ISC-III MMPI Draw-a-Person Kinetic Family Drawing Thematic Apperception Test Rorschach Inkblot Test Sacks Sentence Completion Test Strong-Campbell Interest Inventory Professional Affiliations 1997- present Member: Internal Review Board MHCBC 1996-1997 Member: Professional Advisory Board, Mental Health Center of Boulder County 1991- 1992 Co-Chair: Multi-Ethnic Action Committee, Department of Psychology, University of Colorado, Boulder. 1991- 1993 Member: American Psychological Association, Division 12, Clinical Child Psychology. 1989- 1991 Member: Multi-Ethnic Action Committee, Department of Psychology, University of Colorado, Boulder. 1988- 1989 Student Representative: Department of Clinical Psychology, University of Colorado, Boulder. 1987- 1989 Member: Developmental Psychology Research Group, Department of Psychology, University of Colorado, Boulder. 1987- present Member: (Intermittent) American Psychological Association. 5 Malloy Honors and Awards 1988 Department of Clinical Psychology Scholarship; University of Colorado, Boulder. 1987 Phi Beta Kappa 1987 Academic Scholarship, Arizona State University, Tempe, Arizona. 1986 Phi Kappa Phi Honor Society 1986 Golden Key National Honor Society 1979 West Valley College Track Team, West Valley, California; State Champions. 1977 Fellowship Award; Roston Montessori School, Orange, California. Additional Training Regular participation in bi-monthly seminars, case conferences and supervision held at the Mental Health Center of Boulder County. Readings and professional conferences in the field of clinical psychology. Other Experience 1996-present Vice President (elected), Suburban Ditch Company, Greeley, Colorado. 1983- 1985 Small Business Owner/Operator: Graphicolor, Phoenix, Arizona. Photography and advertising design. Commercial and portrait photography, advertising design, sales, supervised salespeople, performed administrative tasks. 1982- 1985 Dance Aerobics Instructor, International Fitness Center, Mesa, Arizona. Choreographed dance routines, taught classes regularly made public presentations on behalf of the fitness club, and participated in an ongoing certification/training program in exercise physiology and dance choreography. 6 Malloy Addendum Graduate Coursework: Child Development/Psychopathology Developmental Psychology Developmental Psychopathology Child Psychotherapy Clinical Practicum (six semesters) Theory and Issues in Developmental Psychology Personality/Psychotherapy Advanced Psychopathology Advanced Personality Theory Clinical Study of the Individual Adult Psychotherapy Family Research and Therapy Research Methodology/Statistics General Statistics (two semesters) Research Practicum (four semesters) Research Problems in Clinical Psychology Assessment Projective Testing Objective Testing Courses for Distributed Minor Multicultural Psychology Community Mental Health Marriage and Family Counseling Behavioral Neuroscience: Clinical and Pathological Perspective Nicole Warnygora 3200 Azalea Drive it K-4 Fort Collins, Colorado 80526 (970) 407-1578 Education Master of Arts Agency Counseling: Marriage and Family Therapy August 9, 1998 University of Northern Colorado, Greeley, Colorado, G.P.A. 4.0/4.0 Bachelors of Arts Major: Psychology Minor: Political Science May 23, 1993 Augsburg College, Minneapolis, Minnesota, G.P.A. 3.5/4.0 Experience Mental Health Therapist North Range Behavioral Health, Carson Children's Center/Children's Acute Treatment Unit, Greeley, Colorado • Provided individual therapy to children in a day treatment program • Provided family therapy to the children and families • Facilitated a children's group • Evaluated, diagnosed, and created treatment plans for children • Consulted with parents, teachers, psychiatrist, social worker, and the courts to ensure quality and continuity of care • Collaborated with teachers, parents, and social workers, to enable the child to have a successful transition to public school Test Supervisor Career Services Center, University of Northern Colorado, Greeley, Colorado (8/95 - Present) • Coordinated national testing program including administration of the ACT, SAT, and GRF • Trained, hired and supervised testing personnel Child and Family Therapist Intern North Range Behavioral Health, Greeley, Colorado (1/97 -- 6/97) • Provided individual therapy to children, and provided family therapy • Facilitated a children's group for clients in a day treatment program • Evaluated, diagnosed, and created treatment plans for a variety of children • Consulted with parents, teachers, social workers, and the courts to insure quality and continuih in client care and treatment • Provided services to a diverse population including deaf clients Childcare Relief Worker Families First, Aurora, Colorado (2/96 — 10/97) • Created a safe environment for children ages 3 -12 who were removed from parental homes • Responded, assessed and made referrals for crisis phone calls • Facilitated group discussion for children at the crisis center • Monitored parental phone calls and visits to ensure safety for the children Nicole Warnygora, Page 2 Habilitation Counselor/ Program Coordinator Paragon Services Incorporated, Duluth, Minnesota (1/94 - 8/95) ♦Developed programs to assist dual diagnosis clients achieve independence • Supported families with children with emotional disturbances or developmental disabilities and were at risk for out of home placement • Supervised and trained staff • Coordinated services to provide consistency between service providers Program Coordinator Nekton Services Incorporated, Duluth, Minnesota (7/93 - 12/93) • Coordinated the set-up of a group home for three autistic young women • Developed program plans and daily activities • Supervised, coordinated, scheduled, and trained staff • Designed a training manual and trained staff personnel in functional American Sign 1,anguasce Family Counselor Intern Minneapolis Crisis Nursery, Minneapolis, Minnesota (9/92 - 5/93) • Responded, assessed and made referrals for crisis phone calls • Performed short-term personal counseling with parents • Provided behavioral assessments and programs for children in the homes of clienis Program Counselor / Program Coordinator Dungarvin Alternative Services Inc., Saint Paul, Minnesota (9/91 - 7/93) • Coordinated client assessments with the interdisciplinary team • Completed behavior analysis for the purpose of program development • Developed and implemented programs for children who were developmentally disabled and emotionally disturbed in their home environment Counselor Day Care Systems Incorporated, Superior, Wisconsin (Summers 1988, '89, '90, &'')1 ) • Responsible for the care of three children with autism • Implemented programs during the summer to provide fun for the children Volunteer Kindergarten Teacher, Saint Paul's Church, Duluth, Minnesota Tutor, Minneapolis, South High School Tutor, Multi-Cultural Center, Augsburg College, Minneapolis, Minnesota Honors & Award for Excellent Student Employee, Career Services, University of Northern Colorado 1 ')* Activities Non — Resident Scholarship for Academic Excellence, 1996 Weld County United Way Special Needs Child Care Committee, 1999 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 FY00-CORE-005 Revis ion (RFP-FYC-00008) Contract Award Period Name and Address of Contractor Beginning 06/01/2000 and Ackerman and Associates P.C. Ending 05'31/2001 Sex Abuse Treatment 1750 25th Avenue, Suite 101 Greeley, CO 80631 Co imnutation of Awards Description Unit of Service The issuance of the Notification of Financial yssistance This program is specifically designed to treat Award is based upon your Request for Pi oposal (REP). victims of sexual abuse and the perpetrator of the The RFP specifies the scope of services and conditions abuse in order to avoid out-of-home placement, of award. Except where it is in con Met with thus shorten out-of-home placement, and/or reunited NOFAA in which case the NOFAA go%em. , the REP the families. The projected maximum total per upon which this award is based is an inte:p'al part of:he year is estimated at 36 families, 3 families per action. month. The average monthly capacity is 2 families. The maximum stay is 46 sessions over Special conditions a 12—month period. Group treatment provided at one F.alf the hourly rate. 1) Reimbursement for the Unit of Services wil l be based on an hourly rate per child or per family. 2) The hourly rate will be paid for only direct face to Face Cost Per Unit of Service contact with the child and/or family as evidenced by Hourly Rate Per $99.50 client-signed verification form, and as smecilied in ;he Unit of Service Based on Approved Plan unit of cost computation. 3) Unit of service costs cannot exceed the Loud), and Enclosures: yearly cost per child and/or family. _X Signed RFP:Exhibit A 4) Rates will only be remitted on cases open with, and X Supplemental Narrative to RFP: Exhibit B referrals made by the Weld County Department of X Recommendation(s) Social Services. 5) Requests for payment must be an original and submitted Conditions of Approval to the Weld County Department of Social Services by the end of the 25th calendar day following the end of the month of service. The provider mast submit requests for payment on forms approved by Weld County Department of Social Services • Approvals: Program Official: / B y d1 t /clic ClA P,G1/h By _ arbara J. Kirkmeyer, hair (fo Judy A iego hector Board of Weld County Commissioners Weld . unty Department of Social Services Date: ai`�(Q-A?vc7o _ Date: r 1 0700J__ r700 — _ SIGNED RFP EXHIBIT A INVITATION TO BID RFP-FYC 00007 DATE:February 28, 2000 BID NO: RFP-FYC-00007 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-00007) for:Family Preservation Program--Sexual Abuse Treatment Program Family Issues Cash Fund or Family Preservatim 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 competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners' authority under the Statewide Family Preservation Program (C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement(C.R.S. 26-5.3-101). The Families,Youth and Children Commission wishes to approve: services targeted to run from June 1, 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 Sexual Abuse Treatment Program must provide for therapeutic intervention through one or more modalities to prevent further sexual abuse perpetration or victimization. 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 S 2C` >C= \ �� a� �� (After receipt of order) CBS MU T BE SIGNED IN INK o av PIT k't -v a r\ TYPED) OR PRINTED SIGNAI]'URE VENDOI. ksfrzfernekAci N -k� v- (Name) I-14nd tteh Signature By Authorized Officer or Agent of Vendor ADDRESS i {h I1 UC 1, TITLE ?'p\r r CA( \. DATE 3 - 2_ G -G> <_ PHONE# ( \- -cat)) T -3:=3°Y3 _ The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 32 RFP-FYC-00007 Attached A SEXUAL ABUSE TREATMENT 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-00007 NAME OF AGENCY: r\-C,\c-Lss.S-rest . it (• nr'y �ti1-`c`-c:cm.\`" Is„.. ADDRESS: I ‘7".rjC;, - --AY) (AL{ 'c\\.)(--- -->t)v A s--, 1C, \ 9 \ P6- \(171:N �' _- A PHONE: 1S3 .�-) =3 3 CONTACT PERSON „�� E �c tic-rr-lcb dN TITLE: c c rAi ei\--A, DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Sexual Abuse Treatment Proem mus' pprovide for thei aneutic intervention through one or more modalities to prevent further sexual abuse aernetratio i or victimization. 12-Month approximate Project Dates: _ 12-month contract with actual time lines of Start June 1. 2000 Start _ End May 31.2001 EJn2dI- { r� D A TITLE OF PROJECT: I-� GL ��"(�.-. �.>( i �Q�T_y�-� �� . AMOUNT REQUESTED: '1 I4 17 ? 3?. ("'D Ca-- aYEA'._- A -,y� ;�� . 3 mac, --occ Name and . gnat re of Person Preparing Document Date �,y . �u ` �av> �, \-� � c� c_�`- Name ai Li ature thief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids, please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids, please indicate which of the required sections have not changed from Program Fund Year 1999-2000 to Program Fund year 2000-2001_ Indicate No Change from FY 1999-2000 w'0 _ ✓ Project Description Target/Lligibility Populations __izi Types of services Provided V. Measurable Outcomes Service Objectives __iz Workload Standards _,_[ Staff Qualifications _,. Unit of Service Rate Computation Program Capacity per Month -Certificate of Insurance V Page 25 of 32 RFP-FYC-00007 Attacht d A Date of Meeting(s) with Social Services Division Supervisor: 3/f 9/ O C- . Commentsby.SSD Supervisor: ,you ac a i/wta.-- yw cc .7174e7 .c�a-�- L .mo �'i077orkn ----- —.—�0 716 .'Ye OK �cac.-cu�c.c c- ct-a-c e t w-r i z.c.a. Name and Signature of SSD Supervisor Date Page 26 of 32 RFP-FYC-00007 Attached A Program Category Sxufpl Abuse Treatment pProgram Bid Category Project Title /7 r-rr hie PLO &tefA itt o r^eec- .rw , /'rove Vendor r. 'rr.n c .t /1-s5vc>t -t.. I,. G. PROJECT DESCRIPTION Provide a one page brief description of the project. II. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a milimum your description must address: A. Total number of clients to be served. B. Total individual clients to be served. Please describe if your clients are: 1. Victims under age 18. 2. Perpetrators under age 18. 3. Adult incest perpetrators. 4. Non-abusing spouse 5. Relatives (under 18) in the household of incest victims and/or incest perpetrators C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. Subtotal of individuals who will provide 24-hour access to services. G The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. IIL TYPE OF SERVICES TO BE PROVIDED Please provide a two page description of the types of services to be provided. Please address i i your project will provide the service minimums as follows: A. Comprehensive, diagnostic and treatment planning with the family and other service providers. B. Therapeutic intervention with flexibility to bring in other services if needed. C. Therapeutic services through a variety of modalities including: individual, family, group, marital, data, etc. D. Therapy designed to address issues and behaviors related to sexual abuse victimize ion. sexual dysfunction, sexual abuse perpetration, and to prevent further sexual abuse. E. Specialized intake/investigation function for families with sexual abuse allegations Also, provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g mental health capitation services, ADAD and professional services otherwise funded. Page 27 of 32 RFP-FYC-00007 Attached A IV. MEASURABLE OUTCOMES Please provide a two page description of your expected measurable outcomes of the project. Please address the following measurable outcomes: A. Reduced rate of recidivism of sexual abuse perpetration within a stated time frame. B. Decrease in re-victimization. C. Prevent victim perpetration. D. A percentage of child abuse incest victims receiving services do not go into placement. E. Improvement in parental competency as measured by pre and post placement functional test F. More rapid reunification of children with families. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Please provide a one page description of your expected service objectives and quantitative neasures. Please address, at a minimum, the following ways the project will: A Improve Parental Competency- Capacity of parents to maintain sound relationships and appropriate physical and emotional boundaries with their children, and to empower non- abusing parents and victims. B. Improve Family Conflict Management - Mediation and counseling designed to resolve conflicts and disagreements within the family contributing to child maltreatment and sexual abuse. C. Improve Personal and Individual Competencies - Primarily in terms of self-esteem, vice im awareness, awareness and management of one's own personal history of victimization, sex education, peer relationships enhancement, establishing appropriate physical and emotional boundaries, assertive in lieu of aggressive behaviors, and assuming responsibility [hr one's own behavior. D. Improve Ability to Access Resources- Services shall assist parent in learning to ob.ain help from other sources in the community and within local, state, and federal govemmei its. Describe the methods you will use to measure, evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Please provide a one page description of the project's work load standards and quantitative measures Please address, at a minimum, the following areas: A. Number of hours per day, week or month. B. Number of individuals providing the services. Page 28 of 32 RFP-FYC-00007 Attached A C. Maximum caseload per worker in the intake function and in the Sexual Abuse Treatment. D. Modality of treatment E. Total number of hours per day/week/month. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. H. The modality of treatment. I. Insurance. VII. STAFF QUALIFICATIONS Please provide a one page description of staff qualifications and address, at a minimum, the following: A. Will your staff who are providing direct services have the minimum qualifications education and experience? Describe. B. Total number of staff available for the project. Page 29 of 32 RFP-FYC-00007 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 Ccuntp Department of Social Services for direct, face-to-face services provided to clients referred for these services by the Department . Requests for payment based on units of service such as telephone calls, no shows, travel time, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise, billings must be for hours of direct service to the client, regardless of the number of staff involved in providing those services . Therefore, it is imperative that this rate be sufficient to cover all costs associated with this client, regardless of the number of staff involved in providing these services . (Explanations for these Lines are Provided on the Following Page) OteltiAPA 4r‘ Total Hours of Direct Service per Client Hours [A] Total Clients to be Served 3 (O Clients [B] Total Hours of Direct Service for Year _ 1 ([2]c Hours [C] (Line [A] Multiplied by Line [B] Cost per Hour of Direct Services $ 7a Per Hour [D] Total Direct Service Costs $ 9 js 6 '3 go ___ FE] (Line [C] Multiplied by Line [D] ) Administration Costs Allocable to Program $ ≥ d C'3. y1'/ __ [F] S.C �o Overhead Costs Allocable to Program $ _ [u] Total Cost, Direct and Allocated, of Program$ I� J 7 e 60 Line [E] Plus Line [F] Plus Line [0] ) / Anticipated Profits Contributed by this Program $ 9?& 0 [ ] . Total Costs and Profits to be Covered Page 30 of 32 RFP-FYC-00007 Attached A by this Program(Line [H] Plus Line [I] ) $_ i"� I ��4 �8 — [3] Total Hours of Direct Service for Year _ f W -J G' ___ IK] (Must Equal Line [C] ) - �,i��. / 5 Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of /' r /.�' t ILL Social Services $. �y ti - IL] ?99 cv Day Treatment Programs Only: ,t ! Direct Service House Per Client Per Month _ ti, 4, — Hi Monthly Direct. Service Rate [Nl [A] This is an estimate of the total hours of direct, face-to-face service ea_h client will receive from the time he or she enters the program until completing the program. [B] This is an 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, 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 cat' the program for activities such as travel, phone conversations, "no-shows, " discussions with involved parties, meeting preparation, and report completion . [GI This represents the Agency Overhead costs, such as Rent, Utilities, Supplier , 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 . [II This represents the total amount of profit your firm expects to realize es , result of operating this program. Any difference between Lines [H] and [.] mdst be substantiated by an amount indicated on this line. [L] This is the actual direct, face-to-face hourly service rate at which you wi . L be requesting payment for the services provided under the conditions of this Request for Proposal . [M] To be completed by prospective providers of the Day Treatment Program on_y, this Page 31 of 32 ➢2FP-FYC-00007 Attached A line represents the estimated number of hours per month your organization w provide direct, face-to-face services per client. [N] To be completed by prospective providers of the Day Treatment Program services only, this line represents the actual direct, face-to-face monthly service rate at: which you will be requesting payment for the services provided under the conditions of this Request for Proposal . Calculated by multiplying Line L] by L ne [MI . Page 32 of 32 Project Description 2000-2001 Sexual Abuse Family Education and Treatment Program The Ackerman and Associates SAFE Treatment Program Project Description: Ackerman and Associates P.C. proposes to provide in 2000- 2001 a new, time limited, outcome focused therapy model for treatment of the non- offending parent, the victim and siblings of the victim in sexual abuse cases. The program is proposed in four parts: ( each of these parts may be used as part of an integrated program, may stand alone or be used in combination with other treatment regimens.) A. The development of the prescriptive safety education and treatment plan of the family unit. This will take place over no more than twelve sessions and should average six sessions. B The implementation of the plan with the non-offending parent to increase safety and avoid repetition of sexual abuse in the family unit. This will take place over no more than 15 sessions. Up to ten of these sessions would be for individual treatment. Up to an additional five of these individual session times would be converted to ten hours of group work. (Throughout the proposal, whenever we discuss group work, note that it will be billed as one hour of individual treatment for each two hours of group treatment .) C Treatment for the child who was abused and for the siblings over a maximum of fifteen sessions to develop skills for future safety and to reestablish trust. This includes family issues that need to be addressed with the children. D A protocol of therapy designed to maintain skills developed while tapering the frequency of support visits. This will take place over no more than ten sessions designed to be delivered on a twice a month basis over a maximum of five months. This provides an additional support program for those families in need of the service. For any family who is not appropriate to continue in the treatment model due to severity, they will be transferred at any program review ooint. The program has two review points in addition to an initial review to determine the appropriateness of the family to this program. Program Review point #1: Completion of the case plan and written acceptance by the therapist, the family in treatment and the caseworker of the treatment plan. This will occur at approximately session ten of part A. It will specify the goals to be achieved in part B and part C which will proceed simultaneously over the next two or three months. 1 Program Review point # 2: A midpoint treatment evaluation after 10 sessions of the treatment plan in part B and part C. The purpose of the mid point evaluation is to answer these questions. 1. How much progress has been made to date in relation to the treatment plan? 2. Is it probable the family will complete the treatment in part B and Part C within the session limits specified. At this point a written report will be compiled as to the need for phase D, and if there is a need for an extension of sessions in phase B and C. If an extension is requested the reasons why this is needed will be specified. An extension, if needed, will be limited to twelve sessions. The criteria for making judgments about the family's progress will be based upon their completion of the prescriptive treatment plan and the adequacy of that treatment plan to protect the child and family from repeat offenses in relation to sexual abuse. Families not making progress will be discussed with the caseworker and as needed referred to other programs. Please note that the end point of treatment is not necessarily intended to be the full and complete resolution of all psychodynamic issues precipitated by the sexual abuse event. Such issues will likely continue to emerge as the child enters different stages of development into adulthood. If further funds are needed for full and complete restoration of mental health (beyond that required for family safety) these funds should be obtained from the perpetrator and/or through victim's assistance and other funds. The purpose of this program is to recommend to WCDSS whether the incident of the actual abuse has been resolved sufficiently to provide for the ongoing physical and mental health and safety of the non offending parent, the child victim and siblings at the time of discharge from the program. The purpose of this highly structured system is to assist family members to achieve careful implementation of safety and child protection plans. Through role modeling, psychoeducational group and individual work with adults, and through child therapy in individual and on a group basis, families will progress along a structured treatment course. Treatment will move from recognition of the factors that lead to the sexual abuse in their particular case to developing an effective plan to eliminate the resurfacing of these factors and repetition of these kind of events in the future. Of the four phases of the program , Part A would be limited to 12 sessioncdelivered over a six week period. Part B and C would be limited to fifteen sessions each, delivered concurrently, over no more than four months. The step down phase of the program Part D would be limited to no more than 10 sessions over no less than four and no more than six months. Reviews for the need to continue in the program would 2 occur in month one , month three and month five. Our goal would be to have 50% of referred families complete treatment by the conclusion of parts B and /or C. Families will need the sexual abuse family education and treatment program ( the SAFE-Treatment Program) because the sexual abuse and its implications have either 1. imminemtly placed the children at risk of outplacement from the non offending parent or parents, 2. created a need to be reunified or 3. the family is facing imminent reunification failure or 4. have failed to implement the behaviors required of them Our model does not treat the adult offender. Where that offender is the parent (usually the father or step father) and reunification is the agreed upon course of action desired, we would only assist the parties in developing a formal reunification plan after the offender has completed treatment in another program and then only in selected cases. Our model is expected to work best with younger children and younger teens. It is expected to be especially useful where the non offending parent is herself a victim of sexual or physical abuse in her home of origin, or who has a highly disrupted home of origin from other causes. The program will provide continuity for the non offending parent and the children through each family having a coordinator within Ackerman and Associates. That coordinator will also coordinate the case and be the contact for the case worker and lead the clinical team on the family. The coordinator will also track the goals of treatment and organize the aspects of treatment within our clinical team approach. Clinical teams will discuss each case as necessary. Purpose: The purpose of the time limited, outcome (safety) focused (as opposed to psychodynamically focused) therapy is to implement the changes needed to insure future safety from further sexual abuse. The model assumes a clinical team oriented family systems approach of education and treatment and seeks clearly defined behaviors and outcomes that will insure safety. The role of the non offending parent in the sexual abuse will be explored, looking for points where protection can be strengthened in the future. Exploration of the life experiences of abuse or neglect of the non offending parent in the home of origin will be part of the psychoeducational work that will be needed by many of the families. In order to develop a treatment plan for addressing the sexual abuse which has brought the family into social services, the first part of the model will be the development of the psychological scope of work that will need to be completed. What are the goals needed to insure future safety? This will be developed through a review of the case, psychological testing if indicated, assessment of the victim and of the victim's siblings. From there, clearly defined, achievable, structured behavioral changes that are needed to insure future safety of the child will be developed into a written plan.When signed by the therapist and non offending parent, this plan becomes the treatment goals for the family in relation to the safety of the child. Time lines and work to be achieved by phase are listed below: 3 Part A. The development of the prescriptive treatment plan of the family unit over approximately six weeks with a goal of the program for prescriptive assessment to average six sessions. The prescriptive treatment plan involves interviews with the non offending parent (up to four hours) two hours of case review, two hours of assassment and interpretation, and up to four hours of assessment of other family members. Part B: The implementation of the plan with the non offending parent to assure safety and avoidance of repetition of sexual abuse in the family unit over no more than 15 sessions. It is anticipated that ten hours of these 15 sessions can be through group work ( at a cost equivalent of five individual hour long sessions) For the non offending parent a mentoring of psychoeducational process of identifying factors that contributed to the abuse and dealing with these factors will be explored. This will be particularly important if negligence or home of origin issues are present. We postulate that a large percentage of the non offending parents will either have been themselves sexual abuse victims or have come from significantly dysfunctional backgrounds. Such a psychological history would be amenable to a mentoring approach. Part C For the child, the restoration of trust and safety assurance after the abuse incident itself would be the goal of child treatment. If appropriate and if the offending parent has successfully completed treatment and if the victim and non offending parent are appropriate for reunification, steps toward reunification may progress in selected cases. Part D A step down protocol of therapy of no more than ten sessions designed to be delivered on no more than a twice a month basis for supportive transition from the support program, for those families in need of this extended service. Other Considerations: There is no risk of the program running up costs above those budgeted for any one family because we propose a treatment cap for social services funds for any family at 46 sessions or $4577. While this cost is high, it is a maximum figure per family. We plan that one half of those who complete treatment will need 36 sessions or less for a fee of$3582. or less. The average cost per enrollee is projected to be about $4000 We have set our maximum at 36 families for treatment under this contract. We anticipate eighteen - twenty four families will more likely be treated. For three case managers this provides a caseload of eight to twelve families to coordinate over the contract. Additional services would be supported either through victims assistance or through insurance. The program does not seek renewals above the cap of 46 sessions unless this is the lowest cost option appropriate for achieving success as determined by the case worker and supervisor. Even within the renewal request, we would limit a renewal to twelve additional sessions per approval. If resolution cannot be achieved by a family within 36 - 46 sessions of competent psychological 4 psychological approach alone to supporting family safety could reasonably judged to be a failure. In our opinion, it should be extremely rare for a case to go on this long and then fail. The majority of cases of this type should have been ended at one of the review points in treatment. We propose that no family should continue in our treatment program after two successive negative ratings ( i.e. progress being made is well below expectation) at review points as determined by social services and the therapist involved. Target/Eligibility Populations A Total number of clients to be served in this twelve month program has been calculated as follows. Three families per month times twelve months equals thirty-six families per year. If we assume a family size of four, one adult and three children, then the total client pool to be served is 144 individuals. That number includes at least 36 individuals who are victims and 36 non offending parents with the remaining 72 being siblings and other household members. Our projected maximum total for 2000 -2001 is 36 families. We expect to treat between 18 and 24 families. B. Distribution of clients. Maximum number of clients we will serve is approximately 144 as calculated above. We would expect approximately 36 of these would be adult members of the family (Non offender) and approximately 108 would be minors. We estimate that they would be distributed across the age range from 1 to 17. There would be 36 index children victims and 72 siblings. We do not accept adult perpetrators into this treatment program We only accept them for work on reunification or ongoing issues of family contact short of reunification on a case by case basis. C. Families Served. We anticipate serving 18 - 24 family units. With no more than 36 being served under this contract D. Sub total who will receive bicultural/bilingual services. We anticipate we can serve 50% or more of the total referred in a bilingual manner. All of the staff have extensive cross cultural experience. E. We can provide services in South County if Social Services can provide a site to do such work. We anticipate the majority of the sexual abuse treatment work will be done at our Greeley offices. F. Accessibility. On weekdays, all providers of Ackerman and Associates are accessible through our office secretary and through cell phones and pagers. After hours we maintain a 24 hour answering service and pager system. On weekends, this 24 hour access reaches the provider on call who is always a licensed Mental Health provider. We also provide Saturday sessions. 5 G. Maximum oer month,The program maximum is three families per month. H. The monthly average capacity is two families per month. I. The average stay in the program is expected to be 36 sessions over a six month period. The maximum stay is 46 sessions over a 12 month period. Group treatment would be provided at a rate of one half of the proposed session rate of this bid sc each session of group treatment would be two hours of time billed as equivalent to one hour of individual treatment. A number of scenarios may be used to reduce the cost of this program. For example, assessment might be mostly complete through activities of others and this would reduce costs in Part A. The child may need less treatment, or the treatment of the non offending parent be easier than expected reducing the costs of parts B and C. The need for ongoing support may be in less than fifty percent of those who complete treatment, reducing the cost of D. However, we have tried to make the best estimates for the average length of stay. Types of Services Provided We propose to provide up to a maximum of 46 sessions of outcome focused treatment and anticipate completion of treatment for at least half the non offending parent, the child victim and siblings in 36 sessions or less over a six month period. We would use a model which would address the family's safety needs and maximize the cost effectiveness of the treatment. These are described under the project description and purpose described above. Our program will meet the service minimums through the following activities. We will provide comprehensive diagnostic and treatment planning for the family through part A described above. This includes a prescriptive treatment plan for the non offending parent and a specialized intake procedure for the child victim as required in item IIIE of this bid RFP. We do not intend to serve as a replacement for investigative services related to criminal prosecution as there are other programs better suited to this task. Nevertheless, the intake format we use is designed to address the psychosocial needs of the non offending parent to enable her to recognize how the abuse is often a partial consequence of a family dynamic which resulted in failure to protect the child and not only as a result of the isolated and secret actions of the perpetrator. Our services use a variety of modalities including play therapy, group therapy for the child and for the non offending adult, individual therapy and family therapy (without the offending parent being in treatment with our program) The primary goal of treatment is to address the prevention of further sexual abuse, to 6 use psychoeducational techniques to work with the non offending parent to avoid repetition of behavioral patterns that have failed to fully protect the children and to help the non offending parent and child victim recover from sexual abuse victimization. Our program does not treat the offending parent. Our program has been designed so each portion is able to stand alone. If it is likely to be more effective, for any reason, to have treatment done in a modular fashion by different agencies, our program design makes this a relatively simple option to implement. For quantitative measures we plan to rely upon the instrument developed by the North Carolina Family Assessment Scale as a starting point. While that format is oriented to home based treatment, we will adapt their methodology, with their permission, or purchase or develop our own after a review of the available instruments to document progress in relation to relative improvement in key areas of the treatment process. To use the North Carolina Family Assessment Scale as an example of this approach, for each area being measured the therapist will score from -3 to +3 where -3 is a severe problem and +3 is substantial strength. Three areas of measurement will be made: For the non offending parent : income adequacy, housing adequacy, financial management ability, overall parental capability, discipline practices, current mental health , prior victimization recovery , progress in recovery from the referral sexual abuse incident, drug and alcohol use, level of bonding with children, extended family support, and overall rating of the non offending parent at each point in treatment (review point one, review point two and completion of treatment.) For family safety: overall family safety, presence of physical abuse of a child during follow up, presence of sexual abuse of child during follow up, presence of emotional abuse of a child during follow up, presence of neglect of child during follow up, presence of domestic violence during follow up, prognosis for future sexual abuse of the child and justification of clinicians statement. Clinicians's estimate for risk of future physical abuse of child and justification for clinician's statement, prognosis of future emotional abuse of child and justification for clinician's statement, clinician's estimate of potential to return to conditions may facilitate repetition of sexual or physical abuse after completion of program and justification for clinician's statement. For the child victim (and siblings as aporopriate); The overall well being of the child, the child's mental health, child's positive/negative behaviors( specified), school performance during follow up, relationship with non offending parent, relationship with offending parent (from social services), relationship with siblings, relationship with peers, motivation to maintain ongoing relationships with family, clinician's assessment of the level of overall resolution obtained to 7 with family, clinician's assessment of the level of overall resolution obtained to date in relation to sexual abuse. The numbers to be treated in each service component are a maximum of 36 non offending adults a maximum of 36 child victims and 72 siblings. The ratio of victims to siblings may be altered depending on the number of cases of multiple victims in the same family. To insure the FYC resources do not duplicate existing services in the community, we will coordinate with the social services caseworker to limit our costs, as appropriate, if other programs can provide the specified services in each case. This will take place at each review point. Measurable outcomes A. To achieve a reduced rate of recidivism of sexual perpetration does not apply as we do not accept perpetrators into this treatment program. B. Decrease in revictimization should be substantial and persistent. The program is set up to empower the non offending parent to identify situations where victimization is likely and to reduce these occurrences. We set a goal of 90% of families who complete treatment will not be revictimized in the next two years. This number assumes that after treatment is completed the non offending parent not reenter a marital relationship to the offending parent. We set a goal of 40% at two years post treatment to avoid revictimization if marital reunification occurs with the offending parent in the next year. C. Prevention of victim perpetration. For those victims who complete treatment and because of the likely age of the victims, three to thirteen, victim perpetration will be rare. Ninety percent will not become perpetrators within a two year period after completion of the treatment. D. We project that 80% of the non offending parents will complete treatment. For these non offending parents we project that 85% will keep their children for at least two years after the treatment regimen is completed. E. Improvement of parental competency will be measured by pre and post testing, We expect 80% of non offending parents to complete the phase B training. F. While we do not expect more rapid reunification with biological family nor with the offending parent, we do expect the acquisition of life skills in anger management and increase in psychoeducational knowledge and subsequent risk reduction for return to an abusive environment. Quantitative measures for determining these goals would be by file review at two 8 years post treatment and determination of if a new case has opened in the county in that time. Individuals no longer in the county ( who had moved or could not be reached) would be lost to follow up. The data would have to be tabulated by the case worker at the end of the two year time frame as we are not budgeted for such long term evaluation. Service objectives: This proposal meets all the service objective for the non offending parent and the victim. The areas for improvement are documented in the quantitative measures that will be rated for the non offending parent at the two review points and at the completion of therapy as listed under the measurable objectives section. These areas include the required components of improving parental competency, improving family conflict management, improving personal and individual competent, and improving ability to access resources for the non offending parent. Work load standards: Number of hours per month is based on 36 families per year in treatment. This is three families per month on averages. (This is the same as six families having 18 hours each or 12 families having nine hours each per month). A total of 108 per month is the monthly average = @ $10,746 service projection per month or $128,956 per year as the most likely projection. The maximum projection is for $163,772 based on all families needing 46 sessions. The monthly maximum is projected at $13,478 Number of providers . We have seven providers described below. Joyce Ackerman Ed.D. ,licensed psychologist, has spent eighteen years in practice in Weld County. She has extensive child related experience. She will serve as administrative coordinator of this program. Larry Kerrigan, Ph.D., licensed psychologist, has more than twenty years experience as a therapist in Greeley working through the Weld Mental Health Center and Ackerman and Associates. He has extensive child protection experience. He will rotate call and be available for individual sessions with teens, particularly with male siblings who may need a male therapist or who potentially have experienced sexual abuse from the offending parent. Susan Bromley, Psy.D., is both a social worker and a licensed psychologist with extensive experience. She will serve in this program in an on call capacity on weekends, on a rotating basis with other providers. She was involved with the passage of the Colorado Child Abuse Law and served on the first Denver County Child Abuse Committee. In Weld County she was a member of the 19th Judicial District Victims Compensation Board for five years and was chair for a year. 9 Sherri Malloy ( Gonzales), Ph.D. who has bicultural experience at the Boulder Mental Health Center as director of the Children's Team can use a brief play therapy model to assist the child and document the impact of the sexual abuse on the younger children and siblings. She will also be one of the case coordinators. Nicole Warnygora, M.A., L.P.C., has experience with latency age children in psychiatric settings and has been providing services for Ackerman and Associates, P.C., since 1998 in both home based and foster parent support. She is a doctoral student in school psychology and will assist with conducting the psychological, personality, and projective testing in this program. She will also coordinate group treatment of children and serve as a case coordinator. She also has clinical experience with bicultural families. Karen Bender, M.A., L.P.C., is our lead therapist in treatment of adult non offenders. Her personal life experiences have included recovery from childhood sexual abuse and she brings unique skills to this process along with her formal training. She will conduct the adult groups for non offending parents and the individual therapy for the non offending parent. She has extensive training in treating adult victims of sexual abuse and domestic violence. She will also serve as a case coordinator, primarily where the non offending parent is also a sexual abuse or physical abuse victim. Emily Jaramillo-Bansberg, M.A., is a master's level clinical psychotherapist fluent in Spanish. She has specific training in solution focused therapy and specializes in working with children, teenagers and families. She will provide our bilingual services, She has experience in criminal justice, and in drug abuse treatment as well as in Family Group Decision Making Conferencing,home based treatment and foster parent support consultation. She will serve as a case coordinator. Maximum caseload is four - five families at a time over a six month period Modality of treatment: Part A assessment Part B psychoeducational group and individual therapy Part C individual and play therapy, group therapy - children's safety group Part D family, child or individual therapy as required. Hours per month: We expect to average 108 hours per month and will set a maximum of 138 hours per month. Seven individuals provide or assist with these services. Maximum case load per case supervisor is nine in 12 months for this program Maximum families accepted for treatment in one year is 36 families. Insurance of one million/three million professional malpractice is carried by all 10 providers and by Ackerman and Associates, P.C., for the corporation. General liability is carried through Farmers insurance in excess of the required minimum. Staff qualifications are stated above and resumes are attached to this proposal. Bid is calculated as follows: therapy time for individual treatment or assessment is at $99.50 per contact hour. Therapy in group time is at that rate for two hours of contact time. The maximum for this contract for thirty six families if all required 46 sessions of individual treatment would be 1656 sessions for a maximum of $163,772. The expected cost of the proposal based on an average of two families per month would be $85,968. 11 MEMORANDUM OF INSURANCE Date Issued 11/03/1999 Memorandum Holder This memorandum is issued as a matter ACKERMAN & ASSOCIATES ATTN DONNA of information only and confers no SUITE 101 rights upon the holder. This 1750 25 AVENUE memorandum does not amend, extend GREELEY CO 80634 or alter the coverages aflorded H the Certificate listed below. Company Affording Coverage Producer Chicago Insurance Company Kirke Van Orsdel 1776 West Lakes Parkway Covered Person (Status) Uwllei� West Des Moines, Iowa 50398 EMILY L JARAMILL0-BANSBERG MA --x Employee This is to certify that the Certificate listed below has been issued to the insured named herein for the policy period indicated, notwithstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be issued or may pertain, the insurance afforded by tie Certific.te described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits sho'xn may have been reduced by paid claims. Certificate Type of Insurance Number Effective Date Expiration Date Limits Professional Liability each incident 1 ,000,000 or occurrence Occurrence 80M-4003488 11/01/1999 11/01/2000 3.000,000 in the aggregate each incident General Liability or occurrence Occurrence in the aggregate Should the above described Certificate be canceled Insured before the expiration date thereof , the issuing company will endeavor to mail written notice to the named Memorandum Holder, but failure to mail such EMILY L JARAMILLO-BANSBERG MA notice shall impose no obligation or liabilty of any 183 50 AVENUE PLACE kind upon the company, its agents or representatives. GREELEY CO 80634 Authorized Representative: . ,� e titer EVEREST NATIONAL INSURANCE COMPANY MENTAL HEALTH PRACTITIONER'S PROFESSIONAL LIABILITY POLICY DECLARATIONS Renewal of No NOTICE: A SUB-LIMIT OF LIABILITY APPLIES TO "CLAIMS" ARISING OUT OF "SEXUAL MISCONDUCT". POLICY NO. 2200009922-991 ITEM 1 : NAME AND ADDRESS OF INSURED: SEND ALL INQUIRIES TO: Nicole Ray Warnygora ROCKPORT INSURANCE ASSOCIATES 1 8OO Angelo Court PROGRAM ADMINISTRATOR Fort Collins, CO 80528 P 0 BOX 1809 ROCKPORT, TX 78381-1809 1-800-423-5344 ITEM 2 ADDITIONAL INSUREDS: NONE ITEM 3: DESCRIPTION OF BUSINESS: MENTAL HEALTH PRACTITIONERISI ITEM 4: POLICY PERIOD: FROM 05/20/1999 TO 05/20/2000 12:01 am STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED r-ERE'N ITEM 5: LIMITS OF LIABILITY: 8 1,000,000 EACH WRONGFUL ACT OR EACH OCCURRENCE SUES,EC1 0 525,000 SUB-LIMIT OF LIABILITY FOR ALL "WRONGFUL TS' INVOLVING "SEXUAL MISCONDUCT". S 3,000,000 AGGREGATE ITEM 6. PREMIUM SCHEDULE: CLASSIFICATION NUMBER RATE ANNUAL PREMIUM CATEGORY M2 1 263.00 $ 263.00 TOTAL PREMIUM S 263.00 ITEM 7 POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY: 190.00 0195, 189.00 0195, EEO 25 501 12 98, 193.00 0195,1 94.00 0195 May 21 , 1999 A1,0CC P6Va/1)(1 AUTHORIZED COMPANY REPRESENTATIVE 189 00 0195 © Everest National Insurance Company, 1995 r Branch B,A Producer# Issue Date RenewalRejL acement Nu 32 A 0002360 03/02/1999 RENEWAL - PSYCHOLOGISTS PROFESSIONAL LIABILI fY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: -(52-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2055185 NAMED INSURED: SHERRI MALLOY PHD ADDRESS 24 ALLES DRIVE (Number & Street, Town, CREELEY CO 80631 County, State & Zip No.) 2. POLICY PERIOD: From 04/01/1999 To 04/01/2000 (12:01 A.M. Standard Time At Location Of Designated Piet-Ls( 3. COVERAGE: LIMITS OF LIABILITY F RE MIL. 31 Professional Liability 51 ,000,000 53, 000, 000 S ,cds , 0, each Incident AggregJb/ BUSINESS OF THE INSURED: Psychology THE NAMED INSURED IS: i X 1 Sole Proprietor (including Independent Contractors) ( ) Partnership I ) ('or , ,rat, OTHER: 4_ This policy shall only apply to incidents which happen on or after: a) the policy eft( ca date shown on the Declarations; or b) the effective date of the earliest claims-made sued be the Company to which this policy is a renewal; or c) the date specified in ins endorsement hereto. 04/01/1998 ihn polies is made and accepted subject to the printed conditions of this polies tog tit vv'r, the prosisions. stipulations and agreements contained in the following forms) or en.l pi ,men i, P - J - 2008 110/94 ) POE -8004 PLE - 2167 PLE - 20E31 P0N- 2003 PLE-8035 ( 09/97 ) CHICAGO INSURANCE COMPANY' 55 E. MONROE STREET. CHICAGO. ILLINOIS a0n03 REPRESENTATIVE: Agent or Broker: Kirke-Van Orsdel. Incorporated Office Address: 1776 West Lakes Parkwas Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-999 MMMINIMMII INTERSTATE INSURANCE (CROUP MMIMMESSIME PLP-2uI2 (06 93) (Elec.) EXECUTIVE RISK SPECIALTY CO. THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY 12/03/99 - A PSYCHOLCC ISIS PROFESSIONAL LIABILITY POLICY 44♦ RENEWAL 444 NOTICE. A LOWER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEX'JAL MISCONDUCT(SEE THE SPECIAL PROVISION"SEXUAL MISCONDUCT" IN THE POLICY). DECLARATIONS POLICY NO. 801-0005006 ACCOUNT NO: CC-KERL175-0 0099745E ITC M I la) NAME AND ADDRESS OF INSURED ITEM 1 (b) ADDITIONAL NAMED INSUREDS LAURENCE P . KERRICAN• PH.O. 1750 25TH AVE. SUITE 4101 GREELEY. CO 80631 TYPE OFORG: INDIVIDUAL ITEM 2 ADDITIONAL INSUREDS: ITEM 3 POLICY PERIOD. FROM: 12/01/99 TO: 12/01/00 12:01 A M STANDARD TIME AT THE ADDRESS OF THE INSURED AS STA'-ED MERE N ITEM 4 LIM TS OF LIABILITY (a) $ 1.000.000 EACH WRONGFUL ACT OR SERIES OF CONT,NDO >. RE E , OR INTERRELATED WRONGFUL ACTS OR LICE URIC= NCE b) $ 5.000 DEFENSE REIMBURSEMENT (c) $ 3.000 .000 AGGREGATE ITEM 5 PREMIUM SCHEDULE: _ CLASSIFICATION NUMBER RATE ANNUAL PREMIUM 1ST PSYCHOLOGIST 11254 .00 1 .254.00 DEFENSE LIMIT .00 SURPLUS LINES TAX 1 37.62 INSPECT ICN FEE 1 2 .51 • ITEM 6 RETROACTIVE DATE 12/01/91 TOTAL PREMIUM: 1 •254. 1 ITEM - EXTENDED REPORTING PERIOD J ADDITIONAL PREMIUM (If exercised). $ 2 •265 .24 ITEM .S POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY- r- -- 322138 (7/95 ED. ) 822137 -- --- -- ---- - AUTHORIZED COMPANY REPRESE:N f<TIVE Issue Date: 01/06/00 Th PROFESSIONAL LIABILITY OCCURRENCE < i?a1Pt0Cnce INSURANCE POLICY FOR Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ACA insurance Trust.Mc. 5999 Stevenson Avenue Au INS94(i. Policy Number: CL10073400 Administered by: Alexandria.VA 22304-3300 TRUST Toll Fret.14100-347.66471284 ITEM DECLARATIONS INDIVIDUAL POLICY 1. NAMED INSURED: Norma Karen Bender 2. ADDRESS: 1104 Twin Peaks Circle Longmont, CO 80503-2170 3. POLICY PERIOD: From: 02/04/00 To: 02/04/01 12:01 A.M.Standard Time at Location of Designated Premises 4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges: COVERAGE PREMIUM A. PROFESSIONAL LIABILITY $ 290 . 00 B. GENERAL LIABILITY $ 0 . 00 TOTAL PREMIUM: $ 290 . 00 5. LIMITS OF LIABILITY: $1, 000 , 00 0 each Incident or each Occurrence $3 , 000 , 000 in the Aggregate 6. THE NAMED INSURED IS: Sole Proprietor(incl. Individual) Partnership Corporation X Other(refer to Item 7 below) 7. BUSINESS OF THE NAMED INSURED: Part-Time Self-Employed (Rating Category) Counselor/Huma.n Development Professional 8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and agreements contained in the following form(s) or endorsement(s): CPL-0004.0199 CPL-0005.0199 CPL-0006.0199 NOTICE THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. CPL.0005-0199.00 Dedham Public Schools, Dedham, Mass. (Full time) February 1972 Learning Disabilities Specialist. Consultation to staff, to prescriptive programming and teaching school age June 1972 children. Somerville Public Schools, Somerville, Mass. (Full time) Summer 1971 Chosen as state mental health intern. coordinated Tutoring Center for emotionally disturbed children. Responsible for: tutoring children, supervising aides, (high school dropouts) and consulting with psychiatric staff. Somerville Mental Health Clinic, Somerville, Mass. WORKSHOPS AND SPECIAL TRAINING 1993 - August Hospital Practice for Psychologists APA National Convention in Toronto, Canada- "Psychology and National Health Reform", "National Health Insurance: Policy Considerations, Benefit Designs, and Economic Realities", and "Marketing: Psychology's Key to National Health Reform. 1993 "Using the New MMPI-2 and MMPI-A" Mountain Crest Hospital, Denver, Colorado. 1993 Disaster Relief Training. Alan Keck, through Colorado Psychological Association, Denver, Colorado. 1992 - Fall Short Term Therapy. Bernard Bloom, University of Northern Colorado, Greeley, Colorado. 1990 - Fall National Cognitive Rehabilitation Conference, Richmond, Virginia. 1990 - Summer Post graduate training: 1. Adult Neuropsychological Method based on Lezak Neuropsychological assessment, 1983. 2. Child Neuropsychology, Dr. Hynd. 3. Child Neuropsychological Methods. 1989 Provider of Neuropsychological evaluations for Vocational Rehabilitation, Greeley, Colorado. 1988 Cognitive Rehabilitation Training Program, Dr. Sena, Ph.D., Colorado Springs, Colorado. 1988 - Present Psychologist - Head Injury Treatment Team at North Colorado Medical Center, Greeley, Colorado. 1987 Halstead Reitan Neuropsychological Assessment Training. Ralph Reitan, Ph.D., Washington, D.C. Summer 1986 Albert Einstein School of Medicine, Workshop on Adolescent Therapy, Cape Cod, Mass. 1985 to present North Colorado Interdisciplinary Team of Child Custody Member and participant. Fall 1985 Interdisciplinary Workshop on Child Custody, Keystone, Colorado. Summer 1984 Workshop in Clinical Use of Hypnosis, Boston, Mass. Winter 1983 Workshop on In-patient Programs for Service Related Disorders, Cheyenne Veterans Administration Hospital. Fall 1983 Veteran's Administration Workshop on Post Traumatic Stress Syndrome, Denver Veteran's Center. Fall 1981 Post-Doctoral Supervised Candidate for Licensure to (psychology) under Gale R. Giebler, Ph.D. Licensed Winter 1984 Psychologist and Susan Spilman, Ph.D., Licensed Psychologist. 1980 - 1981 Intern-Weld County Sexual Abuse Team, Greeley, Colo. Summer 1981 Independent Study of Child Sexual Abuse, University of Northern Colorado. Spring 1981 Interdisciplinary Workshop on Assessment of Sexual Assault, Boulder Social Services. Summer 1979 Biofeedback Training related to labor and delivery. Summer 1974 Participant in Institute on Obstacles to Learning. Joint Symposium between McLean psychiatric Hospital, Harvard University and L.esley Graduate School. Cambridge, Massachusetts. Summer 1973 Kennedy Memorial Hospital, Boston, Massachusetts. Participant, Summer Aphasia Institute. PUBLICATIONS Ackerman A., Ackerman J.S., Kelley K, Hale K. Family Planning Attitudes of Traditional and Acculturated Navajo Indians. Key Issues in Population and Food Policy. University Press of America, pp. 178-171 (1979). Ackerman, J.S., Client Expectations and Satisfaction with Community Mental Health Center Services: A Cross-Cultural Analysis Between Hispanics and Andlos. Published Doctoral Dissertation, University of Northern Colorado copyright 1981. Nicole Warnygora 3200 Azalea Drive it K-4 Fort Collins, Colorado 80526 (970) 407-1578 Education Master of Arts Agency Counseling: Marriage and Family Therapy August 9, 1998 University of Northern Colorado, Greeley, Colorado, G.P.A. 4.0/4.0 Bachelors of Arts Major: Psychology Minor: Political Science May 23, 1993 Augsburg College, Minneapolis, Minnesota, G.P.A. 3.5/4.0 Experience Mental Health Therapist North Range Behavioral Health, Carson Children's Center/ Children's Acute Treatment Unii. Greeley, Colorado • Provided individual therapy to children in a day treatment program • Provided family therapy to the children and families • Facilitated a children's group • Evaluated, diagnosed, and created treatment plans for children • Consulted with parents, teachers, psychiatrist, social worker, and the courts to ensure quality and continuity of care • Collaborated with teachers, parents, and social workers, to enable the child to have a successtiirl transition to public school Test Supervisor Career Services Center, University of Northern Colorado, Greeley, Colorado (8/95 - Present) • Coordinated national testing program including administration of the ACT, SAT. and GRF. • Trained, hired and supervised testing personnel Child and Family Therapist Intern North Range Behavioral Health, Greeley, Colorado (1/97— 6/97) • Provided individual therapy to children, and provided family therapy • Facilitated a children's group for clients in a clay treatment program • Evaluated, diagnosed, and created treatment plans for a variety of children • Consulted with parents, teachers, social workers, and the courts to insure quality and continurty in client care and treatment • Provided services to a diverse population including deaf clients Childcare Relief Worker Families First, Aurora, Colorado (2/96— 10/97) • Created a safe environment for children ages 3 -12 who were removed from parental homes • Responded, assessed and made referrals for crisis phone calls • Facilitated group discussion for children at the crisis center • Monitored parental phone calls and visits to ensure safety for the children Nicole Warn ygora, Page 2 Habilitation Counselor/ Program Coordinator Paragon Services Incorporated, Duluth, Minnesota (1/94 - 8/95) ♦Developed programs to assist dual diagnosis clients achieve independence • Supported families with children with emotional disturbances or developmental disabilities and were at risk for out of home placement • Supervised and trained staff • Coordinated services to provide consistency between service providers Program Coordinator Nekton Services Incorporated, Duluth, Minnesota (7/93 - 12/93) • Coordinated the set-up of a group home for three autistic young women • Developed program plans and daily activities • Supervised, coordinated, scheduled, and trained staff • Designed a training manual and trained staff personnel in functional American Sign Language Family Counselor Intern Minneapolis Crisis Nursery, Minneapolis, Minnesota (9/92 - 5/93) • Responded, assessed and made referrals for crisis phone calls • Performed short-term personal counseling with parents • Provided behavioral assessments and programs for children in the homes of clients Program Counselor/ Program Coordinator Dungarvin Alternative Services Inc., Saint Paul, Minnesota (9/91 - 7/93) • Coordinated client assessments with the interdisciplinary team • Completed behavior analysis for the purpose of program development • Developed and implemented programs for children who were developmentally disabled and emotionally disturbed in their home environment Counselor Day Care Systems Incorporated, Superior, Wisconsin (Summers 1988, '89, '90, &.'9 I) • Responsible for the care of three children with autism • Implemented programs during the summer to provide fun for the children Volunteer Kindergarten Teacher, Saint Paul's Church, Duluth, Minnesota Tutor, Minneapolis, South High School Tutor, Multi-Cultural Center, Augsburg College, Minneapolis, Minnesota Honors & Award for Excellent Student Employee, Career Services, University of Northern Colorado 1996 Activities Non — Resident Scholarship for Academic Excellence, 1996 Weld County United Way Special Needs Child Care Committee, 1999 ne-.-r.�rcS•i -eC_P.�,.. i..;'_�5.' k ?aa.,°'+s'.,�-- - 'T "'.. _...v _ FACULTY VITA May 1999 NAME: BROMLEY, Susan Plock SOCIAL SECURITY NUMBER: 483-50-9243 POSITION: Associate Professor of Psychology Department of Psychology College of Arts and Sciences University of Northern Colorado Greeley, CO 80639 HOME ADDRESS: 1621 13th Avenue Greeley, CO 80631 TELEPHONE: Office: (303) 351-2236 Home: (303) 352-8750 EMAIL:sbromley(albentley unco.edu EDUCATION: Year(s) Degree Institution Area of Study 1)83 PsyD University of Denver Clinical Psychology School of Professional Psychology Denver, Colorado 1968 MSSA Case Western Reserve University Casework (MSW) School of Applied Social Sciences Cleveland, Ohio 1't65 BA Mt. Holyoke College Economics/Sociology South Hadley. Massachusetts WORK EXPERIENCE --ProfessionalAcademic: Year(s) Institution/Organization Position Responsibilities 1996-Pres University of Northern Colorado Assoc. Professor Psychology Teaching/Research 1'x85-96 University of Northern Colorado Asst. Professor Psychology Teaching/Research 1983-84 University of Northern Colorado Asst Professor Psychology Teaching 'A ORK EXPERIENCE --Professional Non-.4cadenric- Y'ar(s) Institution/Organization flosition Resoonsibilitiec I'r96-present Ackerman and Associates Psychologist Clinical 1984-85 Kaiser Permanente Psychotherapist Clinical Lakewood. Colorado `9-8n Bethesda Mental Health Center Psychology Intern Clinical/ Denver. Colorado Administrative 1968-79 Denver General Hospital Clinical Social Worker/ Clinical/ Denver. Colorado Supervisor Administrative AREA OF SPECIALIZATION: Behavioral Medicine/Pain Management/Clinical Hypnosis RESEARCH AREAS/INTERESTS: Hypnosis/Pain Assessment and Management/Women's Issues/Teaching Methods PROFESSIONAL ACTIVITIES: Colorado Licensure: Psychology License#1086 PUBLICATIONS --Professional/furled Musgrave-Marquart, D., Bromley, S.P. &Dailey,M.B. (1997)"Personality, academic attribution, and substance abuse as predictors of academic achievement in college students". Journal of Social Behavior and Personality 12(2), 501-511. Karlin, N.J. and Bromley, S.P. (1996). Differences in caregivers of demented and lucid chronically ill family members. Journal of Alzheimer's Disease and Related Disorders and Research Retzlaff, P. and Bromley, S. (1994). Counseling personality disorders. In Ronch, J.L., VanOrnum, W. & Stillwell, N.C. (Eds)The counseling,sourcebook: A practical reference on contemporary issues. New York: Crossroad Publishing group. pp.466-474. Broniley, S. and Hewitt, P. (1992). Fatal attraction: The sinister side of women's conflict about career and family. Journal of Popular Culture. 26(3), pp. 17-24. Retzlaff, P. and Bromley, S. (1991). "A Multi-Test Alcoholic Taxonomy: Canonical Coefficient Clusters". Journal of Clinical Psychology 47(21, pp. 299-309. Broniley, S.P. (1985). "Treatment of Pain: Theory and Research" in Zahourek, R. (Ed.). Clinical Hypnosis and Therapeutic Suggestion. New York: Grupe and Stratton. Reprinted in Zahourek, R. (Ed.) (1990). New York Bruner/Mazel, Inc., pp. 77-98.. PROFESSIONAL PRESENTATIONS --Jtrried: Nickisson, J.N. and Bromley, S.P. (1999) "Hypnosis: Attitudes,knowledge and experience among psychology and nursing students". Accepted for a paper presentation at the American Psychological Association Convention. Boston. (August) Campbell, J. S., Titus, J. and Bromley S. P. (1998). "Neuroanatorny teaching technique for introductory psychology students. Poster presented at the joint WPA/RMPA convention, Albuquerque, NM. (April) Bromley. S. (1997) (Chair)"Linking through honors programs: The cross-discipline course). Paper presentation as part of a symposium titled"Creating links between psychology and other disciplines"., American Psychological Association Convention, Chicago. (August) Bromley, S , Gilliam D., &Johnson, T. (1995). "Assessment of student created tests as an evaluation method'. Poster presented at the American Psychological Association Convention, New York City. (August) Bromley, S (1994) "Student created tests as an evaluation method". Poster presented at 16th Annual National Institute on the Teaching of Psychology, St. Petersburg, Florida. Karlin, N. and Bromley. S. (1992). " Similarities and differences for caregivers of demented and lucid chronically ill". Poster presented at the Rocky Mountain Psychology Association Convention,Boise, Idaho. (April) Montoya, K.J. and Bromley, S. ( Chair) (1992). " Changes in undergraduate counseling styles in an introductory counseling theories course". Paper presented at the Rocky Mountain Psychology Association Convention. Boise. Idaho (April) Bromley, S. (1992). " Connected learning methods to faciliate research understanding". Paper presentation as part of panel titled, `Teaching techniques in the social sciences", Western Social Science Association Convention, Denver, Colorado. (April) Bromley, S., Ramirez, S., and McCoy, J. (1991). " Impact of a health psychology course on student health beliefs" Poster presented at the Rocky Mountain Psychology Association Convention,Denver, Colorado. (April) Karlin, N. and Bromley, S. (1991). " Support, burden and affect among caregiver of dementia and nondementia patients". Poster presented at the American Psychology Association, San Francisco, California_ (August) Bosley, G. and Bromley, S. (1990). Post death ritual in a Colorado community. Paper presentation at the American Psychology Association, San Francisco, California. (August) Bronilev, S. (1990). "Husbands at Childbirth: Who Does It Help?" Paper presentation at Far West Popular Culture Association, Las Vegas, Nevada (January). Hewitt. P. and Bromley S. (1989). "Images of Work and Intimacy in'Turning Point'and'Fatal Attraction"' Paper presentation National Convention of Popular Culture Association and American Culture Association, St I.out. Missouri. (Session Chair) Rerzlaff,P and Bromley, S.(1989). "The Basic Personality Inventory: Alcoh Sub-Group Identification". Poster session at the Joint Convention of the Rock Mountain Psychological Association and Western Psychological Association Reno. Nevada. Bromley, S. (1988). "Our Culture Affects Our Pain."Paper presentation, National Convention of Popular Culture Association and American Culture Association, New Orleans, LA. (March). Bromley, S. (1987). "Husband-Assisted Autohypnosis for Labor and Delivery: A Clinical Model" Paper presented at Rocky Mountain Psychological Association, Albuquerque, New Mexico(April). Eiromley, S. and Loy, P. (1987). "Politics of PMS". Paper presentation Association of Women Psychologists, Denver, Colorado(March). PROFESSIONAL PRESENTATIONS --Invited: Strongin, D. & Bromley, S. (1999). Student and faculty reactions to the introduction of a graduate ethics course In Miller, R. (Chair) Ethics in college teaching. Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins_CO(April) Bromley, S. (1999). Issues of religion and spirituality with therapists and clients. In S. Bromley(Chair) Religion and spirituality in research, practice and the classroom. Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins, Co (April) Bromley. S. (1998) Hypnosis, psychology and managed care. In S.Bromley(Chair)Complementary, nontraditional and indigenous healing practices. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations. Albuquerque. (April) Bromley, S. (1998). Complementary healing methods: A psychological and artistic exploration. In I.. Wickerlgren (Chair). Interdisciplinary courses involving psychology: A sampler. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Handelsman, M.M., Bromley, S.P. & Davis, S.F. (1995). "Clinical Psychologist, Counseling Psychologist Clinical Social Workder, or Psychology Professor: Which Degree is Right for Me?" Psi Chi invited panel presentation, Rocky Mountain Psychological Association, Boulder, CO(April). i Bromley, S. (Co-Chair), Seibert, P. (Co-Chair),Knuckey,D., Bohlin, M., Zaweski, C., Watson, D., Hammon, D West, K. &Robins, J. (1994). "Training the Teaching Assistant" Invited Panel Presentation , Rocky Mountain Psychological Association, Las Vegas, Nevada(April) Bromley, S (1993). "Hypnosis in Dentistry." Presentation at Monthly Meeting of Weld County Dentists Association, Greeley, Colorado(February). Bromley, S. (1993). "Learning about the author as a way to understand research." Presentation at "Teaching Take Out", CTUP Special Event. WPA/RMPA Convention. Phoenix, Arizona(April). Allen, M. and Bromley, S. (1993). Co-Chairs Two CTUP Special Event Sessions, "Teaching Take Out: Experiences in Collaborative Learning", Western Psychological Association/Rocky Mountain Psychological Association Convention, Phoenix, Arizona (April). Bromley, S. (1993). Chair, Invited Symposium, "Psychological and Social Perspectives on Male Violence Against Women", Western Psychological Association/Rocky Mountain Psychological Association Convention, Phoenix. Arizona(April). Bromley, S. (1992). " Enhancement of student research and writing skills in any course". CTUP Workshop presented at the Rocky Mountain Psychology Association Convention, Boise, Idaho. (April) Bromley, S. and Karlin, N. (1992). "General and health locus of control of adult caregivers". Poster session at the UNC Research Forum, Greeley, Colorado. Bromley, S. (1992). Panel member in Mental Health Symposia for Victim Compensation Convention as part of the Colorado Organization for Victim Assistance Conference. (Estes Park/October) Bolocofski, Bromley, Foster and Mean(1988). "Hypnosis: Research and Clinical Perspectives," symposium presentation, Colorado Psychological Association, Greeley(March). Bromley, S. (1986) "Pain: A Psychological Event". Presentor- 20th Annual Emotional Crisis Workshop. University of Northern Colorado. Greeley, Colorado(July). LECTURES--Invited: Bromley, S. (1998)"Psychological methods of pain control" Invited lecture for the annual meeting of the Weld County Arthritis Society. Bromley, S (1998). "Hypnosis for pain control of arthritis" Invited lecture for"Brown Bag" lunch series sponsored by the Greeley Medical Clinic. Bromley, S. (1998) "Headache Control -Psychological Methods". Invited lecture as part of a seminar titled "Coping with headache". Sponsored by the Greeley Medical Clinic. Bromley. S. & Ackerman J. (1998). "What to do to handle burnout" A workshop conducted for foster parents working with Weld County Social Services. Bromley. S. (1995). Keynote speaker for Golden Key Honor Society Induction Ceremony, University of Colorado, Boulder. Co. (November) Bromley, S. (1992). Keynote speaker for Sophomore Honor Society Induction Ceremony. Bromley. S. (1991) Featured speaker. UNC Acadmic Honors Convocation. (April) Bromley. S. (1991). Banquet speaker Emotional Crisis Workshop, Greeley, Colorado. (July) 4 GRANTS: Bromley, S ( 1994)Honors Grant ($500)to attend research training at the Society for Clinical Flypnosis meeting, San Francisco(October) Bromley, S. (1994). Research and Publications award of$1500.00. "Assessment protocols to measure tli.: cfficac), of hypnotic treatment for injured workers. Karlin, N. and Bromley, S. (1990). Research and Publications award of$2,4440.00."Control, support, bin den and affect differences among dementia and non-dementia caregivers". BOOK /GRANT REVIEWS: Grant review for Boise State Department of Education (1995) Review of Santrock, J. (1991). The science of mind and behavior. W.C. Brown and Benchmark. Review of McKee. P. &Thiem. J. (1993). Real life; Ten stories of aging. University of Colorado Press. PROFESSIONAL CONSULTATION/PRACTICE: year(s) Institution/Organization Role 1996-presnt Ackerman and Associates Clinical Psychologist 1988 Bonne' Good Samaritan Center Pain Management Consultant and I rawer 1984-85 Denver Metropolitan Dental Care Consultant in Pain Management 1984 Iowa Association of Registered Physical Therapists Hypnosis for Pain Management Consultant And Teacher PROFESSIONAL ASSOCIATION PARTICIPATION: Membership 1986-present Rocky Mountain Psychological Association 1988-present American Psychological Association(Divisions 2, 30, 35) 1989-present Greeley Area Mental Health Network 1987-88 Association of Women in Psychology 1980-89 Colorado Psychological Association 1988 CPA Program Committee Member for Spring Meeting--Greeley Coordinator SERVICE: EXTERNAL: NATIONAL SERVICE: 1994-present Rocky Mountain Coordinator-American Psychological Association, Division 2 -Teachwg of Psychology I 992-94 Co-Chair, Rocky Mountain Region Council of Teachers of Undergraduate Psychology(C'T'tJP) 1991-94 Mountain States Regional Academic Coordinator. Golden Key National Honor Society REGIONAL/STATE SERVICE. 1999 - Moderator for Stanley G. Hall Lecturer- Viney, W. (1999). A larger canopy for psychology: Unifying themes and pragmatic empiricism. Presented at the Rocky Mountain Psychological Association Convention, F: Collins. CO(April) 1989- present Rocky Mountain Psychology Association 1998-1999 Ex-Officio Board Member As Division 2 Coordinator 1992-1998 Board Member 1995- 1998 Elected Chair, Groups Under-Represented in Psychology Committee 1992-94 Co-Chair, Groups Under-Represented in Psychology Committee 1991 Coordinator of Student Volunteers_RMPA Convention, Denver, Colorado 5 1995 Psychology Chair-CCHE Faculty to Faculty Conference(October) COMMUNITY SERVICE: 1998 Member, Weld County Medical Society Commitee on Alternative and Complementary Healing 19971998 UNC Loaned Executive- United Way of Weld County 1991- 1996 Board Member. 19th Judicial District Victim Compensation Board 1995-96 Chair 1990-93 Board Member. Weld County Area Agency on Aging 1992-93 Chair 1991-92 Vice-Chair 1' 86-Present Exam Supervisor- American Institute for Property and Liability Undenvriters/Insurance Institute of America 1987-present Clinical Psychologist -pro-bono work with individual clients and community training INTERNAL: DEPARTMENTAL: 1993-present Member, Department Executive Committee 1985-88. 1995-present Co-Advisor Psi Chi National Honor Society 1996-1999 Guest lecturer for Psi Chi Grad Night on getting into clinical/counseling grad programs 1989-91,93, 95-present Department Representative, CCHE Faculty to Faculty Conference 1087 - 94 Department Representative to graduation ceremonies 1')86-94 Library Representative 1983, 86 89, 90-93,97,98 Member. Faculty Search and Screen Committee 1')90-02 Member,Psychology Department Undergraduate Committee(Chair 1992) 1 987-88 Co-Coordinator Semester Conversion Committee COLLEGE: 1992.93,96,97 Member of faculty invited to teach in the Cluster Program 1990-93 Graduation Marshall, Arts& Sciences 1988-89 Member, Arts and Sciences Teacher Education Committee 1')86-89 Chair, Interdisciplinary Committee to develop and revise Human Development Major in the College of Arts and Sciences and Psychology Department UNIVERSITY: 1992-94 1996-Present Member-Research and Publications Board 1993-94 Chair-Elect 1988-present Founding Co-Advisor, Golden Key Honor Society 1993-95 Member-UNC Women's Commission 1992-94 Co-Chair- Assessment Task Forcc 1989-90 Faculty Representative- Student Fee Allocation Committee 1986-89 Member, Faculty Senate 1988-89 Secretary 1987-88 Vicc-Chair 1986-87 At-Large Member. Executive Committee 1986-89 Member, Academic Policies Corm-Mace 1986-87 Member, Elections Committee 1988 Representative, Western States Faculty Leadership Conference, Reno. 1988 Senate Representative. Statewide Commission Advisory Committee 1988 Advisor, In-Touch Hclplinc 1985-86 Volunteer Therapist, UNC Counseling Center i� GRADUATE STUDENT COMMITTEES--Doctoral: 1998 Committee Member, Shu-Shin Lu,Professional Psychology 1997-prsnt Committee Member, Christine Rogers, Education Professional Psychology 1995-1997 Committee Member,Lisa Ing, Spec 1994-press Committee Member,Marla Gallagher,Educational Psychology 1993 Committee Member,Hsiu-Lan Ma, Science Ed. -Oral Comprehensives 1993 Committee Member, Jerry Buford, School Psychology."Treatment of depressive symptoms of early adolescents". 1993-1998 Committee Member,Pat Flanagan, CSPA,Orals,"A comparison of attitudes and practices of teaching faculty regarding student academic dishonesty at a two year and four year institution," 199111 Committee Member,Mike Propriano, School Psychology 1990-94 Committee Member, Paul Jantz, School Psychology, 1989 Committee Member. Mike Peters, Vocational Rehabilitation ,"The Effectiveness of Vocational Evaluation for Various Disabling Conditions 1987 Committee Member, Ane Marie Kajenckii, English."The Concept of Free Association in V rgiPi9 Woolf s The Wavcs" 1980 Committee Member,Fuming Liao,Mechanical Ki:nesiology."Development and Validation of a Method for Providing Immediate Feedback Information on Speed and Angle of Release in Shotputting" GRADUATE STUDENT COMMITTEES --Masters: 1998 Vanessa Ewing, Committee Member 1997 Stephanie Blasi, Committee Member 1997 John Nickisson. Chair 1994 David Watson, Committee Member 1994 Tiernan McIlwaine, Committee Member 1994 lerrod McCoy, Committee Member 1993 Sheldine Runyan,Committee Member 1997 Sue Cole, Committee Chair,"Influences on Occupational Goals of Selected Male and Female Collcgc Students". 1900 Jerry Benner, Committee Member 1909 Kurtis Armstrong, Committee Member. "Attitudinal Consequences of Pre-Employment and Random. Employee Dnig Testing" 1989 Michelle Hozer. Committee Member 1989 Anne Schnittgrund, Committee Chair," Age and Electrothermal Biofeedback Training 1088 Cherri Hockett.Committee Member, "The Effects of Turnover on Those Who Remain in an Organization" 1 )88 Tony Ambrosio.Committee Member, "The Belief in a Just-World and the AIDS Epidemic: Predictors of Attitudes Towards Individuals with AIDS" 1088 Steve Foster, Committee Chair. "Hypnotic Susceptibility As a Function of Locus of Control and Director Indirect Inductional Deepening and Suggestion Style" 1988 Lisa Dillon. Committee Chair "Cognitive-Behavioral Approach to the Treatment of Elderly Rheumatoid Arthritis Subjects" 1987 Deanna Holmes, Committee Member Writing Assessment Tests as Predictors of 1987 Darlene Nold, Committee Member, "Reading and Success in the Basic Peace officer Academy at Aims Community College" 1987 Dan May, Committee Member Hypothesis: Is Its dominator of Learned 1986 Jeff Schiels.Committee Member, "The Reformulated Hypo I lelplessness Literature Justifiable?" 1986 Linda Coultha d re ands. Committee ittee Tension Normal and flackks ion f Cortical iSl Slow day with Potential Potential'. Hand Tempe Hyperactivity Children" TEACHING: Honors Activities' 1999 UNC Research Day, Faculty'Panel Coordinator, " Complementary Healing Methods" 1999 Thesis Coordinator-Kristin Pietryzick, Jennifer Kimberling,Cristine Dickey 1997 Thesis Co-Advisor Kelly Kinser 1997 Honors Connection Course development-Alternative Healing Methods 1996-pres Honors Co-Coordinator,Psychology Department 1989-94 Honors Coordinator, Psychology Department 1994 Thesis Co-Advisor, Diane Musgrave,"The Relationships Among Personality Traits, Alcohol, Caffeine_ and Nicotine Consumption, and Academic Performance in College Students" 1994 UNC Researh Day, Faculty Panel Coordinator, "Hypnosis: Theory and Research" 1993 UNC Research Day, Faculty Panel Coordinator,"Non-traditional Theories of Therapy Serving Women aid Minorities". 1993 Thesis Co-Advisor, Linda Norman, "Clozapine and Event Related Brain Potentials in Schizophrenics" 1992 Thesis Advisor,Deborah Knuckey, "The Effect of Touch on AffectAmong Strangers Under Mildly Stressful Conditions" 1992 UNC Research Day, Faculty Panel Coordinator 1992 UNC Research Day, Faculty Panel Coordinator(2 student panels)"Sex Roles and Psychology", The Power of Social Influence 1989 Thesis Advisor, Geri Bosley, "Post Death Ritual in a Small Colorado Community" 1988 Thesis Advisor,Pam Clasen, "The Use of Relaxation and Imagery Techniques in Pain Management" 1989 Honors Connection Course Development Courses Taught- (1-4 Scale with 1 as Highest) (*1-5 Scale with 5 as highest) DATE COURSE TITLE l-IRS ENR AVG RA TIN(' 1' 198 8 PSY 101 IntroSeminar Psychology 1 43 -- W 1987 PSY 101 IntroScminar PsychoLogy 1 16 1.12 1986 PSY 101 IntroSeminar Psychology 1 32 1.24 F 1997 PSY 120 Principles of Psychology 4 107 3.76 F 1996 PSY 120 Principles of Psychology 4 119 F 1993 PSY 120 Principles of Psychology 4 119 164 F 1991 PSY 120 Principles of Psychology 4 161 1.67 F 1983 PSY 120 General Psychology 3 42 ---- Sp 1984 PSY 121 Intro to Psychology 1 4 40 ---- Sum 1988 NY 230 Human Growth & Development 5 55 ---- Sp 1988 PSY 230 Human Growth &Development 5 60 1.58 W 1988 PSY 230 Human Growth &Development 5 90 1."18 F 1987 PSY 230 Human Growth &Development 5 45 1.54 W 1987 PSY 230 Human Growth &Development 5 75 154 Sp 1987 PSY 230 Human Growth &Development 5 90 -- Sum 1986 PSY 230 Human Growth &Development 5 47 -- F 1986 PSY 230 Human Growth &Development 5 80 1.36 W 1986 PSY 230 Human Growth &Development 5 80 1.42 W' 1986 NY 230 Human Growth &Development 5 52 1.27 F 1985 PSY 210 Human Growth &Development 5 56 153 F 1985 PSY 230 Human Growth &Development 5 85 1.56 Sp 1984 PSY 265 Social Psychology 3 26 ---- 33' 1984 PSY 265 Social Psychology 3 23 ---- Sp 1998 PSY 323 Health Psychology 3 40 4.1 I F 1998 PSY 323 Health Psychology 3 39 4.08 Sr 1997 PSY 323 Health Psychology 3 44 4.37 S F 1995 PSY 323 Health Psychology 3 47 :Sp 1994 PSY 323 Health Psychology 3 41 1.69 F 1992 PSY 323 Health Psychology 3 49 Sp 1992 PSY 423 Health Psychology 3 42 1.69 F 1990 PSY 423 Health Psychology 3 1 66 F 1988 PSY 423 Health Psychology 3 35 1.36 Sp 1986 PSY 330 Child& Adolescent Psych 3 27 14 Sp 1993 PSY 331 Maturity&Aging 3 40 Sp 1991 PSY 331 Maturity & Aging 3 46 1 62 F 1989 PSY 331 Maturity & Aging 3 23 1.45 F 1988 PSY 331 Maturity &Aging 3 27 1.40 Sp 1988 PSY 430 Maturity& Aging 3 44 1 58 Sp 1987 PSY 430 Maturity& Aging 3 34 -- Sp 1986 PSY 430 Maturity& Aging 3 36 1 52 F 1998 PSY 455 Abnormal Psychology 3 49 4 24 Sp 1997 PSY 455 Abnormal Psychology 3 49 4 03 F 1995 PSY 455 Abnormal Psychology 3 32 Sp 1993 PSY 355 Abnormal Psychology 3 37 Sp 1992 PSY 355 Abnormal Psychology 3 42 1 26 Sp 1991 PSY 355 Abnormal Psychology 3 37 137 1' 1990 PSY 355 Abnormal Psychology 3 1 46 Su 1990 PSY 355 Abnormal Psychology 3 31 Sp 1990 PSY 355 Abnormal Psychology 3 37 1 38 `gip 1990 PSY 355 Abnormal Psychology 3 42 153 Sp 1989 PSY 355 Abnormal Psychology 3 78 1 51 Sp 1986 PSY 358 Abnormal Psychology 3 41 1 54 lV 1984 PSY 358 Abnormal Psychology 3 31 Su 1998 PSY 350 Theories of Personality 3 20 4 II) Su 1990 PSY 357 Theories of Personality 3 21 145 1 V 1988 PSY 357 Theories of Personality 3 40 1 57 F 1987 PSY 357 Theories of Personality 3 55 138 'V 1987 PSY 357 Theories of Personality 3 37 133 P 1986 PSY 357 Theories of Personality 3 54 -- F 1983 PSY 357 Theories of Personality 3 51 F 1998 PSY 407 Intro to Counseling Theories 3 20 4 3I Sp 1998 PSY 407 Intro to Counseling Theories 3 20 4 42 F 1997 PSY 407 Intro to Counseling Theories 3 15 4 71 F 1996 PSY 407 Intro to Counseling Theories 3 19 F 1995 PSY 407 Intro to Counseling'Theories 3 19 Sp 1994 PSY 407 Intro to Counseling Theories 3 F 1993 PSY 407 Intro to Counseling Theories 3 24 1 32 Sp 1993 PSY 407 Intro to Counseling'Theories 3 22 F. 1992 PSY 407 Intro to Counseling Theories 3 25 1 18 Sp 1992 PSY 407 Intro to Counseling Theories 3 22 1.21 F 1991 PSY 407 Intro to Counseling Theories 3 44 136 Sp 1991 PSY 407 Intro to Counseling Theories 3 33 1.21 F 1990 PSY 407 Intro to Counseling Theories 3 Sp 1990 PSY 407 Intro to Counseling'Theories 3 16 1.12 F 1989 PSY 407 Intro to Counseling Theories 3 24 120 Sp 1989 PSY 407 Intro to Counseling Theories 3 18 1.31 F 1987 PSY 407 Intro to Counseling Theories 3 26 1.21 F 1986 PSY 407 Intro to Counseling Theories 3 41 1.57 Sum 1987 PSY 499 Psychology of Sex Roles 3 16 1.18 Sum 1989 PSY 508 Emotional Crisis Workshop 1-2 39 *** "Frontiers of Mental Health O And Education" Sum 1988 PSY 508 Emotional Crisis Workshop 2-3 63 "Mind/Body Interactions" Sum 1987 PSY 508 Emotional Crisis Workshop 2-3 106 "Relationships" Sum 1991 PSY 595 Health Psychology 3 15 Sp 1998 PSY 620 Assessment&Interviewing 2 9 431 P 1992 PSY 620 Assessment &Interviewing 2 12 1.66 F 1990 PSY 620 Assessment& Interviewing 2 1,02 P 1988 PSY 620 Issues in Behavioral Medicine 3 5 2.08 F 1997 PSY 621 Practicum College Teaching 2 10 4.77 F 1996 PSY 621 Practicum College Teaching 2 10 F 1993 PSY 621 Practicum College Teaching 2 13 145 F 1992 PSY 621 Practicum College Teaching 2 13 R' 1984 PPSY 670 Tests and Measurements 3 20 Sp 1997 HON 200 Honors Connections Seminar: Alternative Healing Methods 2 20 3 67 of 4 Sp 1989 HON 200 Honors Connection Seminar II: 2 9 *** "Love" Sum 1986 Elderhostel "Dream On" NC (25) Sum 1987 Elderhostel "Mind/Body Interactions" NC 19 *** Courses Developed: 1997 HON 200, Alternative Healing Methods 1991- PSY 595,Issues in Health Psychology, Summer 1989- 23rd Annual Emotional Crisis Workshop, Frontiers of Mental Health and Education. Summer 1988- PSY 620, Assessment in Behavioral Medicine, Fall (Revised Spring 1998) 1988- PSY 423. Health Psychology. Fall 1988- 22nd Annual Emotional Crisis Workshop,Mind/Body Interactions, Summer 1987- 21st Annual Emotional Crisis Workshop, Relationships- Summer 1987- Mind/Body Interactions -Elderhostel Program, Summer 1987- PSY 499. Psychology of Sex Roles - Summer 1986- Dream On -Elderhostel, Summer Directed Studies' Graduate: 1995- Cynthia Holley. Hypnosis 1994 - Tara Johnson, Hypnosis Theory and Practice 1994 - Marla Gallagher. Sociometric Processes 1994 - Marla Gallagher, Cluster Development in Intro Psychology Classes 1992 - Bruce Holoman, Hypnosis Research and Practice 1488 - Paul Jantz, Hypnosis for Pain With Children 1988 - Lori Kochevar. Women as Leaders 1988 - Jcrri Israel, Alan Shaw. Issues in Health Psychology 1988 - Steve Foster, Michele Hozer.Teaching Apprenticeship 1987 - Tony Ambrosio, Hypnosis Models 1986 - Candy Disc!), Psychological Testing Undergraduate: 998 Jennifer Altman - Exercise and Psvchology 1996- Kindra Sanchez -Biracial Identity 1996 - Jenna Weatherbee - Pain Coping Styles 1995- Allison Ellis -Psychological Theories in Business Management 1995 - Holli Elrick. Counseling and the Hearing-Impaired Child 1994 - Lewis Garza, Etiology of Schizophrenia 11� 1994 - Suzanne Bodetko, Autogenic Training 1994 - Rebecca Furstenberg, Impact of Alzheimer's Disease on Families 1994 - Bonnie Sarton, Hypervigilence in Youth(Hon 351) 1993 - Mary Jo Hamilton,Hypnosis Theory 1994 - Greg Schooley,Forgiveness as a Therapy Tool [993 - Jason DeBueno. Youth Advocacy [993 - Kelley Ferguson -Women in Psychology [993 - David Rosenberg -Offender Programs [992 - Robin Trostel, Analysis of Learning Styles 1992 - Robin Trostel,Health Locus of Control [992 - Roberta Inman,Family Violence and Lesbians(Hon 351) 1991 - Mark Kahl, Back Pain [991 - Tracy Moulton, Treatment of Sexual Abuse 1991 - Alice McPherson, African American Women and Higher Education 1991 - Jody Humer, Hypnosis: Theory and Practice [990 - Jimmie Berg, Women's Learning Styles 1989 - Elary Violett, Cognition and Pain Management 1989 - Geri Bosley, Chris Snodgrass, Bev Foster. Elary Violett, Issues in Personality 1989 - Penny Vaughn, Female Pioneers in Social Work 1989 - Lori Peterson. Pain and the Elderly 1928 - Peer Training for Hotline Service 1987 - Tracy Boh, Issues in Child Abuse 1987 - Julie Stoddard, Grief and Divorce 1987 - Eric Bouch, Hypnosis Models 1987 - Mike Lesser, Assessment in Sport Psychology 1986 - Lynne Sheffield, Childhood and Loss 1986 - Jennifer March, Adolescence Practica 1998- Andrea Lamb-Hypnosis and golf performance 1998- Rebecca Varoula- Women's Place 1998: Greeley Medical Clinic-Gay Lemons, Renae Smith 1998- Ackerman and Associates-Amy Munnel,Kristin Pietrzyk, Jennifer Kimberling, Greg Pedersen 1997- Greeley Medical Clinic-Lori Darst, Barbara Glode, Ann Marie McCullen, Jeff Titus 1993 - Greg Schooley,Breavement Research 1993 - Di Sluice, Women's Commission 1992 - Mary Jo Hamilton, Hypnosis Research 1992 - Carol Sexton. Psychology Testing 1992 - Lisa Schlott. Learning Styles PROFESSIONAL DEVELOPMENT ACTIVI I'IES: Workshops. Clinics. Svmyosia Conferences: (Excluding Conferences as a Presentor) 1999- EMDR training and Level 1 certification 1998 Qualitative research lecture series -UNC 1998- Lcwis M. Tuition Western Regional Teacher's Conference sponsored by APA Division2 in conjunetien with the WPA/RMPA joint convention. 1908- "Spirituality and health in counseling", CAHEC Workshop, Greeley 1998- 'Divorce Busting: Solution oriented brief therapy with couples".Colorado Assoc Marriage and Family 1997- Health Maintenance -Legal and Ethical Issues 1997- Body and Soul: Healing in the 90's 1996- Celebrating our Essence: Women's Health and Spirituality 1995 - International Society for Clinical and Experimental Hypnosis -Research Workshop, San Francisco.C 4 (30 more hours toward certification) 1989 - "Minding the Body. Mending the Mind". CAHEC Workshop. Ft. Collins 11 1988 - "Demystifying Publishing", CAHEC Workshop, NCMC. Greeley 1985 - "Attentional Deficit Disorders in Children", Meichenbaum, Denver 1980 - International Society for Clinical and Experimental Hypnosis - 30 certification hours.Denver Numerous other workshops on Parent Loss, Child Abuse, Grantsmanship, Short-Term Treatment, Supervision, Vain Management.Medical Terminology, Depression.Personality Disorders Courses Taken Credit: 1994- EPRE 603 - Analysis of Variance .Leib t: 993 - EPRE 602 -Elements of Statistics 4990- EPRE 700 -Advanced Research Methods Cy/tinning Education Credit: 1976 - C.U. Medical School-Medical Ethics 1972 - C.U. School of Nursing -Hypnosis (10 weeks) ;1.969 - University of Chicago-Kubler-Ross. Death and Dying IIONORS AND AWARDS: 1998- Distinguished Service Award-Rocky Mouintain Psychological Association [998- Arts and Sciences Teacher of the Year Award-one of thre in Social Sciences ['198- "Wonderful Outstanding Woman" Award-Highlighted in October newsletter- Women-•; tesourcc Center 1993 - Commencement Banner Carrier, Arts and Sciences 1993, 91,89, 88 - Mortar Board Favorite Professor [992 - Sudent Representative Council University Professor of the Year [?'>2 - Student Representative Council University Advisor of the Year [089 - Arts and Sciences Achievement Award 1988- Honors Advisor of the Year ['>84 - Psi Chi. University of Northern Colorado Chapter 1'182-83 - Writing Associateship-Rocky Mountain Women's Institute inc.; F:K EE" F . X03-651-9514 9/28/99 CURRICULUM VITAE N. Karen Bender, MA, LPC 1104 Twin Peaks Circle Longmont, Colorado 80503 Phone: 303-678-8940 BUSINESS ADDRESS: 2919 W. 17th Ave.. Suite 214 Longmont, Colorado 80503 Phone: 303-678-0268 MARRIED: Brice J. Bender, MD, April 26, 1974 CHILDREN: Sara C Bender, born 3/13/79 and Melissa K. Bender, born 9/8/80 EDUCATION: Bachelor of Arts, Chemistry University of Colorado at Denver, 1977 Master of Arts in Agency Counseling, Emphasis in Marriage and Family University of Northern Colorado, 1993 Externship: Mental Health Center of Boulder County, Longmont Branch, Community Support Services Team, Sept. '92 to June '93 Currently enrolled in Professional Psychology Doctoral Program University of Northern Colorado (course work nearly completed) WORK EXPERIENCE: Feb. '94 to present Private practice, Individual adult clients and couples, Longmont. Fall '95: Counselor and presenter in multidisciplinary PMS program. Longmont Clinic. March '95 to May '96: Domestic Violence Counselor, Longmont Coalition for Women in Crisis, Individual adult clients; women's groups: domestic v',olence curriculum, support. and parenting. June '93 to Sept. '93: Therapist, Mental Health Center of Boulder County, Longmont Branch, Women's Issues Group. Sept. '84-Dec. '86: Cardiopulmonary Technologist, part-time Longmont United Hospital, 1950 W. Mountain View Ave., Longmont, Colorado 80501. June '79-April '82: Supervisor, Pulmonary Laboratory, Presbyterian/St. Luke's Medical Center, 601 E. 19th Ave., Denver, CO 80203 - Jan. '76-June '79: Supervisor, Pulmonary Laboratory, St Joseph Hospital, 1835 Franklin St., Denver, CC 80206 1975-1979 Clinical Instructor, Front Range Community College, 3645 W. 112th Ave.. Westminster, CO 80030. VOLUNTEER EXPERIENCE Sept. '98 to Sept. '99: Doctoral Student Representative, Division of Professional Psychology. University of Northern Colorado. Sept '94 to Mar. '95: Volunteer therapist: Longmont Coalition for Women in Crisis. Individuals and groups: domestic violence curriculum and parenting. Jan. '94 to July '95: Volunteer therapist; St. Vrain Valley Child Development Council, Inc., Head Start Program. Individuals, families, parent support groups that include parenting curriculum. June '93 to Aug. '93: Volunteer Co-therapist: Mental Health Center of Boulder County. Drug Treatment Team, Women's Group: History of Sexual and Drug Abuse, Co-therapist: Lisa Franseen. June '93 to July '93: Volunteer Co-therapist: Mental Health Center of Boulder County, Longmont Branch. Children's group: Attention Deficit Disorder. Co- therapists: John Fallon, MSW, and John Gerson, Ph.D. Nov. '91 to May '92 Volunteer individual counselor: University of Northern Colorado Counseling Center. Feb. 1991 to Feb. 1992: Master's Student Representative. Division of Professional Psychology, University of Northern Colorado. Sept. '91 to Oct. '91: Volunteer Counselor A Woman's Place, Greeley, Co 1990 to 1992: Scholarship Committee for American Association of University Women. 1990-1991: Member Board of Directors for Longmont Coalition for Women in Crisis. PROFESSIONAL ORGANIZATIONS: Co-chairman, Public Relations, Information and Education Committee, Child and Family Advocacy Team (Bouider County Child Sexual Abuse Task Force), June '95 to August '97. Facilitator, Longmont Study Group, Colorado Society for the Study of Dissociation, May '95 to August '97. _c✓. a i1:ua BK.. BEN FF-X 303-551-9514 = _ Member American Counseling Association, Colorado Counseling Association. and Eating Disorders Professionals of Colorado. Associate Member: American Psychological Association. PUBLICATIONS: N. Karen Estridge Bender Slonim, N. B., & Estridge, N. K. (1969). Ozone —•-An underestimated environmental hazard. Journal of Envir0nmental_bealth, 31, 577. Slonim, N. B., & Estridge, N. K. (1970). The acid-base surface --- A 3- dimensional visual model. Rocky Mountain Medical Journal. 57, 59. Slonim, N. B., & Estridge, N. K. (1970). Carbon dioxide --- Environmental health aspects. Journal of Environmental Health, 33,171. Slonim, N. B., & Estridge, N. K. (1970). The acid-base surface: A three- dimensional visual model for analysis of acid-base information. Journal of Medical Education, 45, 828. Slonim, N.B., & Estridge, N. K. (1971). Carbon dioxide ---EnvIronmental health aspects. In T. J. DeKornfeld (Ed.). Selected papers in inhalation therapy. Flushing, NY: Medical Examination Publishing, Co.. Inc. Slonim, N. B., & Bender, N. K. (1974). Responses to carbon dioxide containing atmospheres. In N. B. Slonim (Ed.). Environmental physiology. St. Louis: The C. V. Mosby Co. Slonim, N. B., & Bender, N. K. (1976). A tabular history: Cardiopulmonary technology as a profession. CVP, The Journal of Cardiovascular and Pulmonary Technology , 4, 31. Bender, N. K. (1977). Relevant respiratory physiology. The post-surgical patient, Spirometry. In V. Archuleta, O. B. Plummer, and K. D. Hopkins, A demonstration model for the proeCt"Training Humes to improvepatient education, Boulder, Colo.: Western Interstate Commission for Higher Education. Bender, N. K. (1988). Future trends in education, SVVEA Bridge, 3, 5. (St. Vrain Valley Education Association) PRESENTATIONS: Fall '95: Co-presenter with Haven Howell, M.D., multidisciplinary PMS program, Longmont Clinic. October '98: Co-presenter with Sean O'Halloran and Christine Rogers: A Roundtable discussion entitled: "Facing our Clients' Trauma: Implications foi Counselors in Training," at Rocky Mountain Association for Counselor Educaton and Supervision. RESUME Emily L. Jaramillo-Bansberg 183 50th Avenue Place Greeley,Colorado 80634 (970) 353-1388 Office Telephone: (970) 351-2417/ Email: ejaramil@che.unco.edu EDUCATION • Master of Arts: Psychology/Counseling, University of Northern Colorado,Greeley, CO • Graduate Fellowship Study: Rutgers State University of New Jersey, Newark, NJ • Bachelor of Arts: Sociology, University of Northern Colorado, Greeley, CO EMPLOYMENT Associate Director The Center for Human Enrichment University of Northern Colorado, Center for Human Enrichment, Greeley, CO 80639 August 1997- Present Ensure efficient administration of the Student Support Services TRIO project which includes curricul;tm and instruction, technology,advising,and tutoring. Review the non-competing continuation and annual f crformanco reports. Assist with the provision of professional opportunities for Center employees. Oversee the state funded Bridging Opportunities Program that focuses on recruiting incoming freshmen and transfer sti cents into the Center for Human Enrichment. Direct the Ronald E. McNair Postbaccalaureate Achievement Program (see below). Director Ronald E.McNair Postbaccalaureate Achievement Program University of Northern Colorado, Center for Human Enrichment, Greeley, CO 80639 March 1996-Current Direct all efforts to ensure efficient administration of the McNair federal TRIO grant. Co-author ( .S. Department of Education McNair proposal. Responsible for the compilation,analyzation, and subrr'ission of Non-Competing Continuation and Annual Performance Reports to the Department of Education. Mo'ttor project's federal and matching budgets, supervise and train staff members, and plan, develop, and d erect ,ill student scholar activities. Collaborate with campus departments in order to exceed program objecti des. Responsible for coordinating, editing, and publishing the UNC McNair Scholars Journal. Identify, r vruit, and select program scholars. Ensure the completion of scholars'academic research projects. Provide acac eani: advising and guidance to McNair scholars. Direct the academic year research seminar series, the r-.sidt :itial Summer Research Internship, and other scholarly activities that prepare scholars for doctoral stud Coordinate research and scholarly activities between faculty mentors and McNair scholars. Counselor/Assistant Director Ronald E. McNair Postbaccalaureate Achievement Program University of Northern Colorado, Center for Human Enrichment,Greeley, CO 80639 October 1995 - February 1996 Assisted in the implementation of the McNair program (funded October 1995). Facilitated the recruitment and selection of McNair scholars. Compiled and submitted federal reports. Informed and collaborated 6,ith campus offices,and departments. Implemented an academic workshop series based on student needs. Provided academic advisement and guidance to McNair scholars. Assistant Coordinator,Academic Advising Student Support Services University of Northern Colorado, Center for Human Enrichment,Greeley, CO January 1995-August 1995 Provided academic advisement and guidance to federal TRIO Student Support Service participants Maintained student record database. Assisted with the compilation of federal reports. Served as liaison to the athletic department and the financial aid office. Assisted in the supervision of peer advisors. Pros ided technological assistance within the program. Assistant Coordinator,Macintosh Computer Laboratory Student Support Services University of Northern Colorado,Center for Human Enrichment, Greeley,CO 80639 August 1994-December 1994 Supervised, scheduled, evaluated, and trained lab employees. Provided technical assistance and advisement to federal TRIO Student Support Service participants in a learning environment. Maintained and ordered consumable computer supplies. Evaluated and ordered computer software and hardware. RELATED EXPERIENCE Admissions Office Assistant University of Northern Colorado, Admissions Office, Greeley, CO December 1985-December 1988 Assisted in the daily operations of the UNC Admissions Office. Received and reviewed applications and distributed accordingly. Filed, typed, and performed data-entry on all incoming freshman, transfer. re-entry, and non-traditional students. Trained and supervised co-workstudy employees on office procedures, FERPA, and the CCHE Index system. Provided general information to incoming students and parents. Co-Instructor University of Northern Colorado, Center for Human Enrichment CSPA 359: Paraprofessionals in Student Affairs, Academic Peer Advisors Co-facilitated the instruction for training of peer advisors who advised Student Support Service participants at the Center for Human Enrichment. Coordinated curriculum and instruction for pre-service and on-ping training for a staff of fifteen peer advisors. Counselor Intern North Colorado Medical Center, Family Recovery Center, Greeley, CO January 1996-July 1996 Facilitated psychotherapy counseling groups and individual counseling for chemically dependent aid eating disorder patients. Performed case management from admission to discharge. Presented psycho-educational information to patients, family members, and staff. Designed a portfolio brochure distributed to health care and managed care providers. Clinical Care Assistant Weld Mental Health Center, Greeley, CO September 1994- February 1995 Monitored and supervised the daily activities of chronically mentally ill patients in a learning/self- development environment. Facilitated group and individual counseling sessions. Coordinated patient recreational activities. Prepared written and oral reports. Correction Technician The Restitution Center, Greeley, CO February 1989 - February 1990 Conduced informal counseling with non-violent felony offenders in a residential setting. Responsib'e for the supervision of clients. Distributed client medications as prescribed. Performed searches and confiscated contraband. Prepared written and oral reports. Instructed clients on self-development and new life approaches as alternative methods of coping. PRESENTATIONS • Moderator: "Research & Policy Affecting the Education of the Mexican Child in the 21st Centur\," University of Northern Colorado. • Moderator: Second Annual McNair Scholars Research Symposium and Graduate Education Conference. • Panelist: Minority Students in Graduate School, Colorado State University. • Presenter: Financing a Graduate Education, Applying to Graduate School, Cultural Sensitivity and Awareness, Hispanic Women in Higher Education, Introduction to the Internet, and Communicating Across Cultures, University of Northern Colorado. • Presenter: Conflict Resolution, Communication Skills, and Setting Limits and Boundaries, North Colorado Medical Center. CAMPUS SERVICE: University of Northern Colorado Officer • Professional and Administrative Staff Council (President's Office) • Co-chairperson, Student Advisory Committee, Hispanic Cultural Center • Secretary, Macintosh Computing Society Member • Undergraduate Research Council • Cesar Chavez Cultural Center Cinco de Mayo Week Committee • Professional Development Award/Scholarship Committee • Relations with UNC Board of Trustees Committee • Salary Equity Committee • Exempt Staff Evaluation and Performance Committee • Team UNC Fund Raising Committee • Academic Excellence Week Task Force • Campus Advisory Committee, Cesar Chavez Cultural Center Other • Reviewer/Evaluator for "UNC Works In Progress"conference. • Submitted and published an article in the International Student Services' newsletter entitled, Communicating Across Cultures. PROFESSIONAL AFFILIATIONS • ASPIRE member (Association of Special Programs In Region Eight) • CABE member (Colorado Association of Bilingual Education) • NCEOA member (National Council of Educational Opportunity Associations) HONORS AND AWARDS • Distinguished Alumni, Department of Sociology, University of Northern Colorado • Fellowship, Graduate Study-Rutgers School of Criminal Justice Fellowship, Rutgers State University of New Jersey, Newark, NJ • Scholarship, National Hispanic Scholarship Fund • Scholarship, Candelaria Scholarship, University of Northern Colorado, Greeley, CO PROFESSIONAL DEVELOPMENT AND TRAINING • National McNair Scholars Research Symposium-6th Annual, Penn State, College Park, PA. • National Council of Educational Opportunities Association (NCEOA) Proposal Writing Conference, San Francisco, CA. • Reporting Student and Project Performance,Monterey Bay,CA. • First, Second, and Third Annual Rocky Mountain McNair Scholars' Research Symposium & Graduate Education Conference, Fort Collins,CO. • NCEOA 16th and 17th Annual Policy Seminar, Washington, DC. • NCEOA, Seminar on Relations with the U.S. Department of Education, Washington, DC. • NCEOA Proposal Writing Conference,San Juan,Puerto Rico. • Association of Special Programs in Region Eight (ASPIRE) Colorado Chapter, 1995-1998 State Meetings, Denver, Ft. Collins, CO. • Annual Rocky Mountain Teacher Education Consortium Conference,Greeley,CO. • Diverse Learners Academy, Leadville and Pueblo, CO. • National McNair Scholars Research Symposium, University of California, Irvine, CA. • Parent/Teacher Youth Leadership Conference, Breckenridge, CO. • National Association of Bilingual Education Conferences, Albuquerque,NM and Orlando, FL. • Northern Colorado Hispanic Chamber of Commerce Conference,Greeley, CO. • ASPIRE Regional Conference, Fargo, ND. • National McNair Scholars Research Symposium-4th Annual, Penn State, College Park, PA. • South East Association of Educational Opportunity Programs Conference, Director Training, Asheville, NCG • Cultural Diversity Conference, Greeley, CO. PERSONAL STRENGTHS • Communicate: Ability and extensive experience in communicating with a diverse population. • Counsel: Formally trained to work with a variety of individuals in multiple settings • Leader: Ability to lead individuals and manage environments and situations. REFERENCES Dr. David Gonzalez University of Northern Colorado Division of Professional Psychology, McKee Hall Greeley, CO 80639 (970) 351-1639 Dr. Wendell Osorno University of Northern Colorado Division of Professional Psychology, McKee Hall Greeley, CO 80639 (970) 351-1635 Doll ic Zamora Coordiator of Communication Greeley/Evans School District Six 811 15th Street Greeley, CO 80631 PERSONAL DATA SHEET Identifying Information: Name : Laurence "Larry" P. Kerrigan, Ph . D . Address : 1706 19th Avenue Greeley , CO 80631 DOB : 9/20/32 Phone : ( 303 ) 353-3373 - business Degrees : BSC - Business Economics , from Creighton University, 1954 . MS - Economics , from St . Louis University , St . Louis , Mo . , 1963 . MA - Theology, from St. Mary ' s University , Regis College Campus , Toronto , Ontario , Canada, 1967 . Ph . L. - Philosophy, St . Louis University, St . Louis , Mo . 1960 , ( Ecclesial Degree ) . Ph. D. - California School of Professional Psychology , Berkeley/Alameda Campus , 1974 , Clinical Psychology . Currently a licensed psychologist in the state of Colorado . Educational Background : 1950-54 Creighton University , Business economics , 1954-56 Marquette University, Milwaukee , WI . , Classical studies and ascetical theology , 1956-57 Springhill College , Grand. Coteau LA. Campus , Classical studies , 1957-60 St . Louis University , Philosophy and Economics , 1963-67 St . Mary ' s University, Toronto Campus , Theology , 1971-74 California School of Professional Psychology , clinical psychology, Berkeley/Alameda Campus Positions Held : 1969-71 Member of Board of Directors , Campion College , Prairie du Chien, WI . 1968-71 Director , Department of Psychology, Campion College . 1971-74 Director of Student Counseling Center , Long Mountain college . 1975-80 Director of Short-term Children and Family Team, Weld Mental Health Center , Greeley , CO . 1975-87 Clinical Psychologist , Child and Family Team , Weld Mental Health Center , Greeley , CO . 1975-88 Co-founder of Weld County Child Protection Team, 1987-88 Member of Executive Board , Weld Mental Health Center , Greeley, CO . Honors Received : 1968-69 and Teacher of the year , Campion College . 1970-71 1972-73 Class Representative to Campus Executive Committee , and California School of Professional Psychology 1. 973-74 Work and Experiential Background_ 1959-60 Counselor at Dismas Halfway House for ex-convicts , St . Louis , Missouri , 1960-63 Teacher-counselor-coach, Marquette Prep High School , Milwaukee , WI . 1964-67 Counselor-therapist at Street Haven and Sancta Maria Halfway Houses for women and at the Don ( metro ) Jail in Toronto , Canada. 1967-68 Teacher and Campus Counselor at Creighton University , Omaha, NB. 1968-71 Teacher at Campion College , Prairie du Chien , Wi . , Director of Psychology Department , Department chairman. 1970-71 Director and Staff member of a total environment. for Inter-city boys , late grade school age from Milwaukee , WI . 1971-73 Director of Student Counseling , Lone Mountain College , San Francisco , CA . Teacher at Lhe Lone Mountain College , San Francisco , California. 1973-74 Psychologist Trainee at San Francisco Mental Health Center , Richmond District , Outpatient Care . 1974-75 Private Practice , So . Bay Human Services Center , San Diego , CA . Part-time instructor at California School of Professional Psychology , San Diego , CA . 1975-80 Director , Short-Term Therapy Team, Children and Family Unit , Weld Menta]. Health Center , Greeley CO . 1980-87 Member of Children and Family Therapy Team , Weld Mental Health Center, Greeley , CO . 1987- present Full time private practice with Joyce Shohet Ackerman , Ed . 1). , Licensed Psychologist , Greeley , CO . Part time practice aL Weld Mental Health Center , Greeley , CO . Publication : Kerrigan , Laurence 1' . - The Relationship Between Therapist and Client ' s Perceptions of One Therapy Session . Published Doctor;t1. Dissertation , University of California School of Professional Psychology . Copyright , 1971 . Workshops and Special Training : Since 1974 , 1 have attended an average of• about three workshops per year . Most of these workshops have presented specialized training in the following areas : Neuro-linguistic training , Autogenic and relaxation training , Visualization-Imagery-- Ilypnosis , Cognitive-Behavioral Therapy, Erickson tan approaches to hypnotherapy and psychotherapy, Family therapy, Strategic family therapy , Sexual abuse , dynamics and applied treatment , Paradoxical intention psychotherapy , and other related areas . In the last fifteen years , I have taught classes and conducted workshops in the following subjects : The Psychology of Dreams Emotional and Physical Health through Visualization and Imagery Western Psychotherapies and Eastern Ways of Liberation Cognitive and Behavioral Therapy Hypnosis in Pain and Habit Control. The Psychology of Consciousness and Meditation Sherri R. Malloy, Ph.D. Licensed Clinical Psychologist Office: Home: Mental Health Center of Boulder County 24 Alles Drive 1333 Iris Avenue Greeley, Colorado 80631 Boulder, Colorado 80304 (970) 351-7218 (303) 413-6301 Education Ph.D. Double Major: Child Clinical Psychology; Clinical Psychology. August 1993 University of Colorado, Boulder. M.A. Department of Psychology, Clinical Program. University of July 1989 Colorado, Boulder. B.A. Major: Psychology; Minor: Spanish. Arizona State University. May 1987 Summa Cum Laude. Teaching Cert. Roston Montessori Teacher Training Institute. August 1977 Orange, California. Montessori Elementary Education Certificatc. Clinical Experience August 1991- Child and Family Psychotherapist, Mental Health Center of Boulder March 1997 County, Boulder, Colorado. Provided outpatient psychotherapy' u children and their families. Parent, teacher, and other agency consultation. September 1992- Psychology Intern; Denver General Hospital, Denver, Colorado. August 1993 Outpatient assessment, consultation, and treatment to children, adolescents, and adults; Inpatient treatment to adolescents & their families. Consultation to multidisciplinary hospital staff. Attended regular seminars and case conferences. Completed an additional rotation in neuropsychology. August 1990- Psychotherapist, University of Colorado, Farrand Residence Hail. May 1992 Provided individual, conjoint, and group psychotherapy to Farrand residents. Psychiatric consultation to faculty and staff. Presented seminars and workshops to faculty, staff, and students. August 1988- Emergency Psychiatric Services Clinician, Mental Health Cents: August 1992 of Boulder County, Boulder, Colorado. Evaluation and disposition planning for clients with psychiatric emergencies. Composed a training manual for emergency psychiatric clinicians 2 Malloy January 1988- Psychotherapy Intern, Raimy Psychology Clinic, May 1992 Department of Psychology, University of Colorado, Boulder. Provided outpatient psychotherapy to adults, families, and children. Parent and teacher consultation. February 1986- Intake Clinician; Group Facilitator, "Fri-City Behavioral Health July 1987 Center, Mesa, Arizona. Conducted intakes for the adult team. Facilitator for children's psychotherapy groups. Administrative and Supervisory Experience Jan 1996- Team Leader, Mental Health Center of Boulder County, Boulder, present Colorado. Clinical and administrative supervision of a team of psychologists and psychotherapists. Budgeting. Supervision of support staff. Coordinate outpatient services/consultation to ,oint- agency programs, including Head Start, Specialized Foster Care, Fost-Adopt, 1178, School-Based Services, Boulder Day Nursery and People's Clinic. August 1990- Adult Team Coordinator, Raimy Psychology Clinic, Department August 1991 of Psychology, University of Colorado, Boulder. Chaired the ad-alt team meetings and case conferences. Assisted clinic director with administrative tasks. August 1990- Peer Counselor Supervisor, Farrand Residence Hall, University ul May 1991 Colorado, Boulder. Developed and implemented a peer counseling training program. Provided ongoing training and supervision to peer counselors. January 1989- Supervisor in Training, Raimy Psychology Clinic, August 1991 Department of Psychology, University of Colorado, Boulder, Received training and supervision in supervisory techniques. Supervised the psychotherapy of first-year clinical psychology graduate students. June 1989- Adult"l'eam Intake Coordinator, Raimy Psychology Clinic, August 1990 Department of Psychology, University of Colorado, Boulder. Intake and disposition of psychotherapy clients. September 1989- Clinical Supervisor, Emergency Psychiatric Services Team, August 1992 Mental Health Center of Boulder County, Boulder, Colorado. Trained and supervised Masters level student interns in emergency clinical assessment techniques, legal and procedural practices, and psychological report writing. February 1988- Volunteer Trainer, Maslin House for Chronically Mentally Ill, May 1989 Mental Health Center of Boulder County, Boulder, Colorado. Recruited and trained volunteer college students to work with the chronically mentally ill population at this facility. 3 Malloy Publications December 1994- Columnist: The Boulder County Parent, a monthly publication of the present Parenting Place, Boulder, Colorado. Circulation: 8,000. Topics include child development and parenting concerns. Teaching Experience August 1989- Psychology Instructor, Front Range Community College, May 1992 Boulder Campus, Colorado. Fall 1988 Head Teaching Assistant, Department of Psychology, University of Colorado, Boulder. Trained and supervised graduate level Teaching Assistants. August 1987- Teaching Assistant, Department of Psychology, University of May 1989 Colorado, Boulder. August 1977- Montessori Elementary Teacher, Roston Montessori School, May 1983 Orange, California; and subsequently, Tempe Montessori School, Tempe, Arizona. Taught preschool through second grade classes. Responsibilities included academic program planning and implementation, supervising teacher assistants, conducting parent- teacher conferences, academic record-keeping, and giving educational presentations to parents. August 1976- Student Teacher, Roston Montessori Teacher Training Institute, August 1977 Anaheim, California. Taught in a Montessori classroom under the supervision of a certified Montessori teacher. Duties were the same as in the entry above. Presentation Topics and Trainings Given Play Therapy Engaging so-called "resistant" clients Psychotherapy with adolescents and their families Case Conferences Parent-Toddler Attachment Patterns Child Abuse Child Psychopathology Stress Management Workshop Depression and Risk of Suicide in College Students 4 Malloy Research Projects Adult Attachment Style and College Functioning (Doctoral Dissertation), 1992 Parent-Toddler Attachment Relationships (Masters Thesis), 1990 Post-Divorce Visitation Patterns and Parent-Toddler Attachment, 1988 Effects of Divorce on Children, 1987 Mental Health Center Client Satisfaction Study, 1986 Clinical Assessment Trained in the use of the following assessment tools: VVISC-III MMPI Draw-a-Person Kinetic Family Drawing Thematic Apperception Test Rorschach Inkblot Test Sacks Sentence Completion Test Strong-Campbell Interest Inventory Professional Affiliations 1997- present Member: Internal Review Board MHCBC 1996-1997 Member: Professional Advisory Board, Mental Health Center of Boulder County 1991- 1992 Co-Chair: Multi-Ethnic Action Committee, Department of Psychology, University of Colorado, Boulder, 1991- 1993 Member: American Psychological Association, Division 12, Clinical Child Psychology. 1989- 1991 Member: Multi-Ethnic Action Committee, Department of Psychology, University of Colorado, Boulder. 1988- 1989 Student Representative: Department of Clinical Psychology, University of Colorado, Boulder. 1987- 1989 Member: Developmental Psychology Research Group, Department of Psychology, University of Colorado, Boulder. 1987- present Member: (Intermittent) American Psychological Association. 5 Malloy Honors and Awards 1988 Department of Clinical Psychology Scholarship; University of Colorado, Boulder. 1987 Phi Beta Kappa 1987 Academic Scholarship, Arizona State University, Tempe, Arizona. 1986 Phi Kappa Phi Honor Society 1986 Golden Key National Honor Society 1979 West Valley College Track Team, West Valley, California; State Champions. 1977 Fellowship Award; Roston Montessori School, Orange, California. Additional Training Regular participation in bi-monthly seminars, case conferences and supervision held at the Mental Health Center of Boulder County. Readings and professional conferences in the field of clinical psychology. Other Experience 1996-present Vice President (elected), Suburban Ditch Company, Greeley, Colorado. 1983- 1985 Small Business Owner/Operator: Graphicolor, Phoenix, Arizona. Photography and advertising design. Commercial and portrait photography, advertising design, sales, supervised salespeople. performed administrative tasks. 1982- 1985 Dance Aerobics Instructor, International Fitness Center, Mesa, Arizona. Choreographed dance routines, taught classes regularly , made public presentations on behalf of the fitness club, and participated in an ongoing certification/training program in exercise physiology and dance choreography. 6 Malloy Addendum Graduate Coursework: Child Development/Psychopathology Developmental Psychology Developmental Psychopathology Child Psychotherapy Clinical Practicum (six semesters) Theory and Issues in Developmental Psychology Personality/Psychotherapy Advanced Psychopathology Advanced Personality Theory Clinical Study of the Individual Adult Psychotherapy Family Research and Therapy Research Methodology/Statistics General Statistics (two semesters) Research Practicum (four semesters) Research Problems in Clinical Psychology Assessment Projective Testing Objective Testing Courses for Distributed Minor Multicultural Psychology Community Mental Health Marriage and Family Counseling Behavioral Neuroscience: Clinical and Pathological Perspective Branch BiA Producer # Issue Date Renewal'Rep acen ct 32 A 0002360 05/05/1999 DUPL1' ,.TE PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 4SP- 2050203 NAMED INSURED: SUSAN FLOCK BROMLEY PSYD ADDRESS 1621 13TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) POLICY PERIOD: From 04/01/1999 To 04/01/2000 (12:01 A.M. Standard Time At Location Of Designated Pre'risesl 3. COVERAGE: LIMITS OF LIABILITY PRE`.IIU\I Professional Liability $1 ,000,000 $3,000,000 S7 )9.(1) each Incident Aggregate 4, BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: x ) Sole Proprietor (including Independent Contractors) ( ) Partnership ( ) Corparati.. OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy efte tn,- late shown on the Declarations; or b) the effective date of the earliest claims-made poli:• nsued by the Company to which this policy is a renewal; or c) the date specified in tam, endorsement hereto. 04/05/1996 This policy is made and accepted subject to the printed conditions of this policy togethe \kith the provisions. stipulations and agreements contained in the following form(s) or endor*rne-o ,1 PLu-2008 ( 10/94 ) POE-8004 PLE-2167 PLE -20131 P0N-2003 PLE -8035 ( 09/97 ) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 MMIMMMMMO INTERSTATE INSURANCE GROUP MUMMMMEmm IMP-2012 (06/93) (Elec.) Oiai BEd LASEni Branch B/A Producer# Issue Date Renewal/Replacement 7 No. 32 A 0002360 0 7 1999 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2032570 NAMED INSURED: ACKERMAN AND ASSOCIATES PC ADDRESS 1750 25TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) 2. POLICY PERIOD: From 05/01/1999 To 05/01/2000 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: LIMITS OF LIABILITY PR.ENIIUNI Professional Liability $1 ,000,000 $3,000,000 $1 ,686.0C each Incident Aggregate 4. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: ( ) Sole Proprietor (including Independent Contractors) ( ) Partnership (X ) Corpt cation ( ) OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the Declarations; or b) the effective date of the earliest claims-made pulico issued by the Company to which this policy is a renewal; or c) the date specified in .Inv endorsement hereto. 05/01/1992 7. Phis policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsrmentls): PLJ-2008 ( 10/94 ) POE-8004 PLE-2167 PLE-2081 P0N-2003 PLE-8036 ( 09/97 ) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 simimilmmw INTERSTATE INvtJRANCE G R c.)L I' PLP-2012 (06/93) (Elec.) TRUCK INSURANCE EXCHANGE E FARMERS INSURANCE EXCHANGE ❑ FIRE INSURANCE EXCHANGE f9 Mf•{ MEMBERS of FARMERS INSURANCE GROUP OF COMPANIES �4"i�",5")� R I / HOME OFFICE:4680 WILSHIRE BLVD.,LOS ANGELES,CALIFORNIA 90010. DR JOYCE SHOHET ACKERMAN PCP . Couni 1750 25TH AVE SUITE 101 Prematic Acc't No. s 07-04-362 04576-38-07 GREELEY CO 80631 Agent Policy Number Type of The named insured is an individual unless otherwise stated: El Partnershi ® Corp. Business OFFICE CIJoint Venture LJ Organization(Other than Partnership or Joint Venture) 2. Policy Period from 07/01/99 (not prior to time applied for) If this policy replaces other coverages overages that end at noon standard time on the same day thiis policy begins,Ss t�Time. coverage ends. This policy will continue for successive policy periods as follows: If we ect t ccontnue thi this slinsurance,twekwillfrenew this t policye1 you pay the required renewal premium for each successive policy period subject to our premiums,rules and forms then in effect. 3. Insured location same as mailing address unless otherwise stated: 1750 25TH AVE SUITE 101 GREELEY CO 80631 4. Mortgage Holders Loan# Loan# 5. Premium$ 492.00 ❑ "X"if Mortgage Holder Pays 6. Policy Forms and Endorsements attached at inception: E0079-ED1 2521551290 565310-ED2 S0700-ED3 E6036-ED1 E4168-ED1 E4004-ED1 E4216-ED1 E3026-ED1 7_We provide insurance only for those coverages indicated by a specific limit or by an Ell — COVERAGES LIMITS OF INSURANCE DEDUCTIBLE A-Buildinc $ SECTION 1 8-Business Personal Property $250 applies unless Other $ 50,000 o tion Indicated,,b..yr anEx� C-Loss of Income(Not exceeding 12 consecutive months) {sioo❑ssoo LJs Property OPTIONAL COVERAGES ACTUAL LOSS SUSTAINED NONE and Swimming Pool/Fences and Walkways Loss of R' Building Glass(Blanket) REPLACEMENT COST$ Above appu uc Income '' Outdoor Sign Coverage unless applies 1 0.0 Valuable Papers(In addition to$1000 included.) $ 100 unless other $ option Indl- ElEarthquake Damage cased See Coverages % SECTION II 0-Business Liability-including Products and Completed AA&C of the applicable ins. limit. Operations.(Annual aggregate applies for all occurrences LIMITS OF LIABILITY {Annual Aggregate) during the policy period.) $ 1,000,000 Liability E-Fire Legal Liability$75,000 Included unless other option Indicated by an ® and ❑$100,000 0$150,000 each occurrence(Subject to the annual aggreagate shown for Coy. 0) Medicals F-Medical Payments to Others(Subject to the annual aggregate shown for Coverage D.) $5,000 each person Limit of Liability ❑Professional Liability(see attached endorsement) (Annual ABA agate) $ ®I-V COVERED _ SECTION III Agreement I-Employee Dishonesty DEDUCTIBLE Agreement II-Broad Form Money and Securities-Inside $ ,0 00 NONE Agreement III-Broad Form Money and Securities-Outside $11,000 $250 $ C $5 2rime _Agreement IV-Medical Payments 000 NON Agreement V-Forgery or Alterations $2,0 5 each person NONE ,500 NONE 56.5308 2-92 2ND EDITION Countersigned Authorized Representative JOYCE SHOHET ACKERMAN, ED.D. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 Phone: 353-3373 PERSONAL DATA SHEET Date of Birth: August 3, 1950 Health: Excellent Married, two children CERTIFICATION/LICENSURE Licensed Clinical Psychologist, State of Colorado since 1984 Listed in National Register of Health Service Providers in Psychology since 1986 Staff Privileges, North Colorado Medical Center, Greeley, Colorado since 1985 Certified Teacher (K-12) for Emotionally Disturbed, Learning Disabled and retarded. Certified Teacher, Elementary Level PROFESSIONAL MEMBERSHIP American Psychological Association Colorado Psychological Association Colorado Psychological Association- elected board member 1986-1989 HONORS President's Award - Colorado Psychological Association, 1989 EDUCATION 1978 - 1981 Ed.D. in Counseling Psychology University of Northern Colorado December 1981 graduate 1972 - 1974 M.S. in Education (E.D./L.D.) Lesley College, Cambridge, Massachusetts August 1974 graduate 1968 - 1971 B.S. in Special Education and Elementary Education with a minor in psychology Boston University, Boston, Massachusetts December 1971 graduate PROFESSIONAL EXPERIENCE 1981 - PRESENT Clinician in private practice in Northern Colorado. Among responsibilities are: Diagnosis, therapeutic intervention and referral for adults, families, children and groups. Primary areas are: anxiety disorders, mood disorders and adjustment disorders. Typical problems include: trauma, physical abuse, job stress. Orientation used-primarily cognitive- behavioral therapy. Also, developing, organizing and presenting workshops and consultative programs to community, schools, organizations and agencies. Approximately 30 hours per week. 1986 - Present Consulting psychologist on interdisciplinary team for in-patient rehabilitation program. Progressive Care Rehabilitation Center, Greeley, Colorado. Medical Director Dr. Judith Vaughan, Neurologist. Adults with traumatic injuries-Primary problems are: psychological aspects of physical rehabilitation, grief counseling, and brief group counseling using cognitive-behavioral goal oriented therapy. Approximately 10 - 15 hours per week. 1989 - 1992 Head Injury Treatment Team North Colorado Medical Center, Greeley. Approximately 5 hours per week. Team coordinator - Dr. John McVicker, Neurosurgeon. 1986 - 1989 Consulting Psychologist for Family Recovery Center (in-patient substance abuse/chemical dependency program), North Colorado Medical Center, Greeley, Colorado. Coordinator Ruth Wick R.N. Approximately 5 hours per week. 1986 - 1989 Provider and Coordinator for Mental Health Services in Northern Colorado for Peak Health Care (HMO). Peak mental health services utilized a three session model for initial services followed by referral. Activities included coordination of Psychological and Psychiatric Services for approximately the last two years of the contract. Peak was purchased From Lincoln National by Biodyne in late 1989. Peak Supervisor - Elaine Taylor Approximately 10 hrs./week. 1983 - 1986 Psychologist subcontractor for a Vietnam Veteran's Counseling Program funded by the Veteran's Administration. Principal Contractor Dr. Robert Stewart 1980 - 1987 Part time faculty member with responsibilities for classes, workshops and community programs in parenting skills. Family/Life Education Program Aims Community College, Greeley, Colorado August 1980 Clinical Internship on Children's Team of to Community Mental Health Center. Responsibilities August 1981 included: consultation to schools and community programs; therapy for children and families; and assessment of diverse mental health programs. Assistant program Evaluator-Developed evaluation tools to determine cross-cultural perceptions of expectations and satisfaction with services. Supervisors - Dr. Joan Gillespie and Dr. Laurence P. Kerrigan. Weld Mental Health Center, Greeley, Colorado (Full time). Adults, Adolescents, Families. Primary areas anxiety disorders, mood disorders and adjustment disorders. Typical problems included: trauma, physical abuse substance abuse, job stress. Orientation used- Primarily cognitive-behavioral therapy. 1980 Group Facilitator-Regional and National Conferences in cross-cultural community needs. Flagstaff, Arizona - Colorado Springs, Colorado August 1975 Chairperson of the Department of Education and to Behavioral Science at an accredited, Indian controlled July 1978 community college on the Navajo Reservation. Administration responsibilities included: Supervision and evaluation of faculty; budget preparation and management; curriculum development and integration of Navajo culture; personnel recruitment and selection; class scheduling and program development. Also, faculty member with academic responsibilities for instruction in Psychology, Child Development and Counseling courses, advising and counseling students. Navajo Community College, Tsaile, Arizona (Full time) September 1974 Education Specialist and counselor at an Indian to controlled primary and secondary school on the August 1975 Navajo Reservation. Coordinated community resource program which included: Counseling, Student assessment, prescriptive programming, , staff development and curriculum. Also, adjunct faculty for the University of New Mexico and for Navajo Community College at the Rough Rock Demonstration school, Rough Rock, Arizona. (Full time) September 1972 Designed and coordinated Learning Center Program to for Dedham Public Schools. A program and crisis June 1974 intervention center for emotionally disturbed children. Responsibilities included: Diagnostic prescriptive programming, counseling, supervision and training of aides, tutors and volunteers, and consultation with regular classroom teachers. Also organized group and individual meetings with parents. Also, adjunct faculty for Curry College assisting in in-service instruction for Dedham School System employees. SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B RECOMMENDATION(S) C PY Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 (970)353-3373 fax(970)353-3374 May 20, 2000 Weld County Department of Social Services Attn: Judy Griego PO Box A Greeley, CO 80632 Dear Judy, This letter is in response to your letter of May 10, 2000, concerning recommendations and/or conditions of our bids. I have discussed these with Frank Aaron and have incorporated clarification to these recommendations and conditions at his suggestion. Concerning: 1 . RFP 006-00 Foster Parent Consultation; We accept the condition that we will notify WCDSS a minimum of 30 days in advance if we anticipate over expenditure of the $40,000.00 allocated 2. RFP 00008#1 Family Group Decision Making: We accept the condition that the food allowance is for EPP referrals only. 3. RFP 00008#2 Goal Achievement Program (GAP) Intensive Family therapy: We accept without conditions or recommendations. wit 4. RFP 00008#3 Mediated Conflict Resolution, Intensive Family therapy: We accept the condition that referrals will be issued initially for one therapist. We will request a new referral if a second therapist is needed. 5. RFP #00010 Option B We accept the recommendation that time spent with the family will be limited to four hours per week. (If no progress is being made, we will do everything possible to limit the duration to 30 hours and transition the client to other services.) If progress is being made, we will continue at a "step-down" level to a maximum of 60 hours and will provide a treatment report summary for WCDSS. (If at 60 hours a small number of families require limited extra services, it will be up to 15 hours at a time.) 6. RFP #00007 Sex Abuse Treatment We accept the recommendation that a goal of Part A,B, and C, is to serve no more than six months. Part D, maintenance, is however intended to provide up to ten hours over no less than four months to maintain skills for safety. Maintenance up to one year is often necessary when sexual abuse has occurred. Sincerely, Joyce Shohet Ackerman, Ed.D. Licensed Psychologist JSA/cs int Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 (970)353-3373 fax(970)353-3374 May 20, 2000 Weld County Department of Social Services Attn: Judy Griego PO Box A Greeley, CO 80632 Dear Judy, This letter is in response to your letter of May 10, 2000, concerning recommendations and/or conditions of our bids. I have discussed these with Frank Aaron and have incorporated clarification to these recommendations and conditions at his suggestion. Concerning: 1 . RFP 006-00 Foster Parent Consultation: We accept the condition that we will notify WCDSS a minimum of 30 days in advance if we anticipate over expenditure of the $40,000.00 allocated 2. RFP 00008#1 Family Group Decision Making: We accept the condition that the food allowance is for EPP referrals only. 3. RFP 00008#2 Goal Achievement Program (GAP) Intensive Family therapy: We accept without conditions or recommendations. 4. RFP 00008#3 Mediated Conflict Resolution. Intensive Family therapy: We accept the condition that referrals will be issued initially for one therapist. We will request a new referral if a second therapist is needed. 5. RFP #00010 Option B We accept the recommendation that time spent with the family will be limited to four hours per week. (If no progress is being made, we will do everything possible to limit the duration to 30 hours and transition the client to other services.) If progress is being made, we will continue at a "step-down" level to a maximum of 60 hours and will provide a treatment report summary for WCDSS. (If at 60 hours a small number of families require limited extra services, it will be up to 15 hours at a time.) 6. RFP #00007 Sex Abuse Treatment We accept the recommendation that a goal of Part A,B, and C, is to serve no more than six months. Part D, maintenance, is however intended to provide up to ten hours over no less than four months to maintain skills for safety. Maintenance up to one year is often necessary when sexual abuse has occurred. Sincerely, Joyce Shohet Ackerman, Ed.D. Licensed Psychologist JSA/cs f b, DEPARTMENT OF SOCIAL SERVICES PO BOX A CO GREELEY,C 80832 Administration and Public Assistance(970)352-1561 Child Support(970)352-8933 hiDe COLORADO May 10, 2000 Ms. Joyce Ackerman, Ed. D. Ackerman and Associates, P.C. 1750 25 Avenue Suite 101 Greeley CO 80631 Re: RFP 006-00 Foster Parent Consultation RFP 00008 #1 Family Group Decision Making-Intensive Family Therapy RFP 00008 #2 Goal Achievement Program-Intensive Family Therapy RFP 00008 #3 Family Conflict Resolution-Intensive Family Therapy RFP 00010 Option B RFP 00007 Sex Abuse Treatment Dear Ms. Ackerman: The purpose of this letter is to outline the results of the RFP Bid process for PY 2000-2001 and to request written information or confirmation from you by Wednesday, May 24, 2000. A. Results of the RFP Bid Process for PY 2000-2001 On April 20, 2000, the Families, Youth and Children (FYC) Commission approved the RFP(s) listed above for inclusion on our vendor list. The FYC Commission attached the following recommendations and/or conditions regarding your RFP bid(s). 1. RFP 006-00, Foster Parent Consultation: Condition: The Department of Social Services shall be notified a minimum of 30 days prior to over expenditure. The budget for PY 2000-2001, June 1, 2000, through May 31, 2001, is $40,000. 2. REP 00008 #1, Family Group Decision Making, Intensive Family Therapy: Condition: Food allowance will he paid for EPP referrals to Family Group Decision Making(FGDM),; however, there will be no food allowance paid under Core Services referrals. Page 2 Ackerman and Associates, P.C. Results of RFP Bid Process for PY 2000-2001 3. RFP 00008 #2, Goal Achievement Program (G.A.P.), Intensive Family Therapy: Approved with no conditions or recommendations. 4. RFP 00008 #3, Mediated Family Conflict Resolution, Intensive Family Therapy: Condition: Referrals will be issued initially for one therapist. A new referral wit be needed for assignment of two therapists. 5. RFP 00010, Option B Recommendation: The time spent with the family will be limited to four hours, rather than six. Step-down can be used for ongoing services. Everything possible must be done to limit the duration to 30 hours and transition the client to other services. 6. RFP 00007, Sex Abuse Treatment Recommendation: The program goal is to serve no more than six months. Any change from this must be explained in the case plan and limited to that duration. B. Required Response by FYC Bidders Concerning FYC Commission Recommendations and Conditions The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and conditions. Please respond in writing lo Frank Aaron, Weld County Department of Social Services, P.O. Box A, Greeley, CO, 80632, by Wednesday, May 24, 2000, close of business, as follows: 1. FYC Commission Recommendations: You are requested to review the FYC Commission recommendations and to: a. accept the recommendation(s) as written by the FYC Commission, or b. request alternatives to the FYC Commission's recommendation(s): or c. not accept the recommendation(s) of the FYC Commission. • Please provide in writing how you will incorporate the recommendation(s) into your bid. If you do not accept the recommendation, please provide written reasons why. All approved recommendations under the NOFAA will be monitored and evaluated by the FYC Commission. Page 3 Ackerman and Associates, P.C. Results of RFP Bid Process for PY 2000-2001 2. FYC Commission Conditions: All conditions will be incorporated as part of your RFP Bid and Notification of Financial Assistance Award (NOFAA). If you do not accept the condition(s), you will not be authorized as a vendor unless your mitigating circumstances are accepted by the FYC Commission and the Weld County Department of Social Services. If you do not accept the condition, you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the RFP Bid and Notification of Financial Assistance Award. If you wish to arrange a meeting to discuss the above conditions and/or recommendations, please do so through Elaine Furister, 352.1551, extension 6295, and one will be arranged prior to Wednesday, May 24, 2000. Sincerely, tly A. riego, DI ctor cc: Esteban Salazar, Chair, FYC Commi ion Frank Aaron, Social Services Administrator JG:ef 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 FY00-CPS-2 Revision (RFP-FYC-006-00) Contract Award Period Name and Address of Contractor Beginning 06/01/2000 and Ackerman and Associates, P.C. • Ending 05/31/2001 Foster Parent Consultation • 1750 25" Avenue Suite 101 Greeley, CO 80634 Cbmnutation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal (REP). This program provides foster parent consultative The RFP specifies the scope of services tnd conditions services in the areas of(1)consultation and foster of award. Except where it is in conflict with this parent support, (2) mandated corrective action NOFAA in which case the NOFAA govern;, the RFP consultation, and (3) mandated critical care upon which this award is based is an integral part of the consultation. The programs will be provided action. through individual services in the home of the foster parent or in the office. Group training will Special conditions be provided for a maximum of 12 participants with an average of five participants per group. 1) Reimbursement for the Unit of Services will he based Telephone consultations for crisis management on an hourly rate per child or per family will be available for a maximum of one-half hour 2) The hourly rate will be paid for only direct face to face per call. This program anticipates serving 40 contact with the foster parent and/or family, and as family units. The program's capacity is able to specified in the unit of cost computation. serve more than these 40 families. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. Cost Per Unit of Service 4) Payment will only be remitted on foster parents. and referrals made by the Weld County Department of Hourly Rate Per $ 90.00 Social Services Certified Foster Parents 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 the end of the 25"calendar day following,the end of the Enclosures: X Signed RFP:Exhibit A month of service. The provider must submit requests Y Supplemental Narrative to RFP: Exhibit B for payment on forms approved by the Weld County Department of Social Services. Recommendation(s) X Conditions of Approval Appro als: / Program Official: ByiB_j A11C1� //4 By -Barbara J. Kirkmeyer, Chair o Judy . Gri Director Board of Weld County Commissioners Weld. unty Department of Social Services ! v -,R6-c2orr Date: 1/ .o/uuDate: SIGNED RFP EXHIBIT A INVITATION TO BID 006-00 DATE:February 28, 2000 BID NO: 006-00 RETURN BID TO: Pat Persichino, Director of General Services • 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (006-00) for: Family Preservation Program—Foster Parent Consultation 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 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 Delivery :Date a — a o- o v � C Z (After receipt of order) HCI 1 US'T BE SIGNED IN INK l31/4ter-rncs r'1 b 11 TYPED OR PRINTED SIGNATURE VENDOR frmcntV `� �� C stcs 11C LO�� „ t •ti (Name) kan written Signature By Authorized O .leer or Agent of Vender ADDRESS 1"1.�C� l t Rif` TITLE :---t r\r t i- 1 — S IF \C,1 Ger c,t•ca1/4_\ (_r• . DATE 2 - 20 - c'c PHONE # E4'-1 C' The above bid is subject to Terms and Conditions as attached hereto and incorporated. Page 1 of 31 006-00 Attached A FOSTER PARENT CONSULTATION 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 #006-00 NAME OF AGENCY: man r ti 1n(-1 ADDRESS: h7 .5 C+ 3 5T - i C n - OCR y PHONE: am ) 3 5 '3 - 3 3`7 3 CONTACT PERSON: --"3-c-t,t fA kcw-rnri TITLE: f'�,/c htvv(Th,-,.\,--IA-- DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Foster Parent Consultation Program Cate eory must provide services that focus on teaching life skills designed to facilitate imolementationof the case plan by improving household management competency.parental competency. family conflict management: and effectively accessing community resources. 2-Month approximate Project Dates: _ 12-month contract with actual time lines of: Start June 1. 2000 Start End Mav 31. 2001 End TITLE OF PROJECT: AMOUNT REQUESTED: 3 - Name, d Sittature of Person Preparing Document Date Name an Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS For both new bids and renewal bids, please initial to indicate that the following required sections are included in this Proposal for Bid. For renewal bids, please indicate which of the required sections have not changed from Program Fund Year 1999-2000 to Program Fund year 2000-2001. Indicate No Change from FY 1999-2000 _ ,/ Project Description Not Applicable _ v TargeuEligibility Populations _ ,/ Types of services Provided v Measurable Outcomes _ v Service Objectives _ ✓ Workload Standards _ 1,, Staff Qualifications v Unit of Service Rate Computation _v Program Capacity per Month _ v Certificate of Insurance Page 24 of 31 006-00 Attached A Date of Meeting(s) with Social Services Division Supervisor: _ 3// S j cm c Comments by SSD Supervisor: _ ��, 1 ��7' t;-C �,\ 6✓i r ,/AL2c.�--, y (rider? /7-7P- n G� —e �� JJ& -� is .A-r, - - Z -< ..kz1), e J -- �t-2.�,� �v- �� 1,-(e-a--7_1,-(e-a--7_ ,jilt- I � - I7U L- .. thitiCLt d e�c cC� •/ r�tt-� 2r r 1 - e) /151 Name and Signature of SS rvisor Date ---?// 732_ Page 25 of 31 006-00 Attached A Program Category Foster Parent Consultation Project Title Vendor PROJECT DESCRIPTION Provide a brief one-page description of the project.. II. TARGET/ELIGIBILITY POPULATIONS Provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub-total of individuals who will receive bicultural/bilingual services. E. Sub-total of individuals who will receive services in South Weld County. F. The monthly maximum program capacity. G. The monthly average capacity. H. Average stay in the program (weeks). I. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Provide a two-page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Consultation and Foster Parent Support around placement issues, behavioral management, foster home issues involving biological children in the home, transition and loss issues, work with foster parents and caseworkers around interpretation and implementation of treatment plans, discipline in the home, group training for foster parents-access to training materials, work with foster adopt parents on legal risk and commitment issues, visitation issues, and solution oriented planning. B. Mandated training for foster parents under corrective action plans and follow-up services as needed. C. Mandated consultation services for identified critical care foster parents. D. Assure the foster parent consultation will not be provided by a professional staff member who is providing therapeutic services to foster children in the same home. E. Assure that all assessments, clinical recommendations, and other opinions derived by the contractor in the performance of this contract will be shared directly with the assigned caseworker of the children involved. If there is disagreement over the implementation of the treatment plan with the caseworker, a meeting shall be held with the contractor, assigned caseworker, foster parents, and the caseworker's supervisor. The objective will be to determine a unified departmental response for the court. The contractor will not use the legal system to oppose the department's recommendations. Page 26 of 31 006-00 Attached A F. Agrees to comply with 19-1-120 C.R.S., which requires that reports of child abuse and any identifying information in those reports are strictly confidential. Provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that FYC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES Provide a two-page description of your expected measurable outcomes of the project. Address the following measurable outcomes: A. Improvement of household management competency as measured by pre and post assessment instruments. B. Improvement of parental competency as measured by pre and post assessment instruments. C. Foster parents can independently work with other sources in the community and within the local, state, and federal governments. D. Foster parents have demonstrated higher skill and competency levels in fulfilling their designated function for children in out-of-home placement. E. Foster parents have positively met the needs of their biological children in adjusting to and coping with the presence of foster children in the home. Describe your quantitative measures: Also, describe the methods you will use to measure., evaluate, and monitor each quantitative measure. V. SIR VICE OBJECTIVES Provide a one-page description of your expected service objectives and quantitative measures. Address, at a minimum, the following ways the project will: A. Improve Household Management Competency - capacity of parents to provide safe household environment for their children through competent household cleaning and maintenance, budgeting and purchasing. B. Improve Parental Competency- capacity of parents to maintain sound relationships with their children and foster children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision. C. Improve Ability to Access Resources - services shall assist parents to work with other sources in the community and ahead the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Provide a one-page description of the project's workload standards and quantitative measures. Address, at a minimum, the following areas: A. Number of hours per day, week or month. Page 27 of 31 --- --- - --- 006-00 Attached A B. Number of individuals providing the services. C. Maximum caseload per worker. D. Modality of treatment E. Total number of hours per day/week/month. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. H. Insurance. - VII. STAFF QUALIFICATIONS Provide a one-page description of staff qualifications and address, at a minimum, the following A. Will your staff who are providing direct services have the minimum qualifications in education and experience? Describe. B. Total number of staff available for the project. Page 28 of 31 006-00 Attached A ' III . COMPUTATION OF DIRECT SERVICE RATE This form is to be used to provide detailed explanation of the hourly rate your organization will charge the Core Services Program for the services offered in this Request for Proposal'. This rate may only be used to bill the Weld County Department of Social Services for direct , face-to-face services provided to clients referred for these services by the Department . Requests for payment based on units of service such as telephone calls, no shows, travel time, mileage reimbursement, preparation, documentation, and other costs not involving direct face-to-face services will not be honored. Likewise, billings must be for hours of direct service to the client, regardless of the number of staff involved in providing those services . Therefore, it is imperative that this rate be sufficient to cover all costs associated with this client, regardless of the number of staff involved in providing these services . (Explanations) for , hese Lines are Provided on the Following Page) T l Hours of Direct Service per Client 30 at Hours [A] Total Clients to be Served 96 Clients [B] Total Hours of Direct Service for Year 1' -oo Hours [C] (Line [A] Multiplied by Line [B] Cost per Hour of Direct Services $ .C Per Hour [D] Total Direct Service Costs $ 'y goo [E] (Line [C] Multiplied by Line [D] ) Administration Costs Allocable to Program $ 7 �U [F] Overhead Costs Allocable to Program $ &O y U O [G] Total Cost, Direct and Allocated, of Program$ (,)C ti% �n [H] Line [E] Plus Line [F] Plus Line [G] ) Anticipated Profits Contributed by this Program $ .±-9t G [I ] Total Costs and Profits to be Covered by this Program(Line [H] Plus Line [I] ) $ �G y C C C-_ [J] Total Hours of Direct Service for YearGEC [K] Page 29 of 31 006-00 Attached A (Must Equal Line [C] ) Rate per Hour of Direct, Face-to-Face Service to be Charged to Weld County Department of $ p7�,, oc [L] Social Services 77 Day Treatment Programs Only: Direct Service House Per Client Per Month [M] Monthly Direct Service Rate $ _ [N] [A] This is an estimate of the total hours of direct, face-to-face service each client will receive from the time he or she enters the program until completing the program. [B] This is an 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, 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 . [I] This represents the total amount of profit your firm expects to realize as a result of operating this program. Any difference Page 30 of 31 ,'.,.r y.-r, rl^d't+n• -: e;..4-?‘,.s,,4) 006-00 Attached A 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 for Proposal . [M] To be completed by prospective providers of the Day Treatment Program only, this line represents the estimated number of hours per month your organization will provide direct, face-to-face services per client . [N] To be completed by prospective providers of the Day Treatment Program services only, this line represents the actual direct , face-to-face monthly service rate at which you will be requesting payment for the services provided under the conditions of this Request for Proposal . Calculated by multiplying Line [L] by Line [M] . Page 31 of 31 Project Description 2000-2001 ACKERMAN AND ASSOCIATES' FOSTER PARENT SERVICES I.. Overview:Ackerman and Associates, P.C. has provided Foster Parent Consultation Services to Weld County over the past three years. We propose to continue to provide foster parent consultative services in the following areas: 1. Voluntary Consultation and Foster Parent Support concerning: a. placement issues, b behavioral management, c. foster home issues involving the biological children in the home, d transition and loss issues, e. assist in the interpretation and implementation of treatment plans in coordination with foster parents and caseworkers in accord with the requirements of the contract, f. discipline in the home, and including a 24 hour telephone access line for foster parent questions - the Cool Line, g. training for foster parents and access to training materials, including group and individual training for continuing education credits. Also, in selected cases, "Internet Searches" to help identify resources, such as support groups for foster parents with children with specific conditions, h. work with foster adopt parents on legal risk and commitment issues, visitation issues and solution oriented planning. We will provide such services to those foster parents who voluntarily seek such services for the benefit of themselves, their children and foster children. 2. Mandated Corrective Action Consultation in the above areas to those foster parents who are under corrective action orders and to provide them follow up services as needed. The services listed in No. 1 above will be provided. 3. Mandated Critical Care Consultation services for identified critical care foster parents. The services listed in No. 1 above will be provided We will provide these programs through individual) services in the home of the foster parent or in our offices. Group training will be provided for a maximum of twelve participants with an average of five participants per group. Telephone consultations for crisis management will be available for a maximum of one half hour per call, Yearly maximums per foster parent are set in the proposal to prevent excessive 1 expenditure for any individual foster parent. Renewals for any family beyond this amount will need to be approved by the foster parent supervisor in writing. Target/Eligibility Populations A. Total number of clients to be served in this twelve month program has been calculated as follows. There are approximately seventy foster family homes under WCDSS sponsorship. Our past work has reached about 40-50% of these homes with one or more contacts per year. The majority of these contacts have been in training for continuing education credit. That number includes at least 30 individuals who are foster parents. We have the capacity to serve more than this number if demand for the services is there especially in seminars and training. We projected our maximum capacity for last year as seventy families and expected 40 families to be served. B. Distribution of clients, On a program by program basis we expect to serve, 20-30 families for continuing education credits in groups, about five families for corrective action, about six families for critical foster care, and about 15 families for individual consultation in their homes. We will set an upper limit on services received by any one family in volunteer contact to 30 hours over the year unless approved in writing by the foster parent supervisor. C. Families Served,We anticipate serving 40 family units. D. Sub total who will receive bicultural/bilingual services. We anticipate we can serve 100% of families who need these services in a bilingual manner. All of the staff have extensive cross cultural experience. We have an Hispanic member of the staff, Emily Jaramillo-Bansberg, M.A. , who is a master's level clinical psychotherapist and who is fluent in Spanish. She has been assisting in foster parent consultation for the last year. Joyce Ackerman, Ed.D. has spent several years working in American Indian reservation populations and with Hispanic mental health in Greeley since 1981. Larry Kerrigan, Ph.D. has more than twenty years experience as a therapist in Greeley working with the Hispanic population through the Weld Mental Health Center. Susan Bromley, M.S.W., Psy.D. is both a social worker and a psychologist with extensive experience training students in cross cultural sensitivity. Sherri Malloy ( Gonzales), Ph.D., who has bicultural experience at the Boulder Mental Health Center also has been doing foster parent support work for the past year. Nicole Warnygora, M.A., L.P.C., who also has worked with our foster parent program over the past year and Karen Bender, M.A., L.P.C. each have clinical experience with bicultural families. E. We can provide services in South County if Social Services can provide a site to do such work. We understand there are less than 15% of foster families in South County 2 at the present time. Home based consultation in South County will be available at the level needed for this contract. F. Accessibility. On weekdays, all providers of Ackerman and Associates are accessible through our office secretary and through cell phones and pagers. After hours we maintain a 24 hour answering service and pager system. On weekends, this 24 hour access reaches the provider on call who is always a licensed Mental Health provider. We also provide Saturday sessions. G. Maximum oer month. The program maximum is estimated below by program area Group training or workshops 100 hours per month billed as 50 hours a month at bid rate. Individual Consultation in homes forty hours a month Mandated Training for Corrective Action forty hours a month Mandated Training Critical Care forty hours a month. Cool line maximum per contact is one-half hour of billing. No individual can produce more than ten cool line contacts (five hours) per year. No more than 60 hours total per year can be billed to the services provided over the Cool Line. Monthly patterns are difficult to estimate. The yearly maximum for the contract is set at 600 hours at $90 per hour. In fact, many services in group are billed at the group rate of$45 per credit hour so three hundred billable hours for group actually represent 600 hours of training. The contract billable maximum for any combination of services is $54,000 per contract year. H. The monthly average capacity is 50 hours per month. I. The average stay in the program is expected to be 15 hours over a four month period for forty families. The maximum stay is 30 hours over a one year period except in the mandated programs. Group treatment would be used at a rate of one half of the proposed rate of this bid so each hour of group treatment would be equivalent to one half hour of individual treatment. Types of Services Provided 1. Consultation and Foster Parent Support on a voluntary basis concerning: a. placement issues, b behavioral management, c. foster home issues involving the biological children in the home, d transition and loss issues, 3 e. assist in the interpretation and implementation of treatment plans in coordination with foster parents and caseworkers in accord with the requirements of the contract. Please note, we have added language related to implementation of case plans as it relates to section IIIE of this proposal concerning disagreements with the treatment plan to the end of this section. f. discipline in the home, and including a 24 hour telephone access line for foster parent questions - the Cool Line g. training for foster parents and access to training materials, including group and individual training for continuing education credits, h. work with foster, adopt parents on legal risk and commitment issues, visitation issues and solution oriented planning. 2. Mandated Corrective Consultation in the above areas to those foster parents who are under corrective action orders. We will provide them follow up services as needed. We will also provide such services to those foster parents who voluntarily seek such services for the benefit of themselves, their children and foster children. 3. Mandated Critical Care Consultation services for identified critical care foster parents. A partial list of the types of workshops we have provided over the last three years follows: Separation and Loss, Understanding Prescription Medications, Discipline, Assertiveness with Systems, Drug Abuse, Eating Disorders, Child Development. Sexual Abuse and Sexual Behavior- What's Normal With Young Children, Sexual Abuse and Sexual Behavior- What's Normal With Teens, Recovery From Prenatal Trauma - What To Expect, Anger Management, Stress Reduction, Parenting Round Tables, Parenting with Love and Logic. We have provided Corrective Consultation Services over the past year. We have been providing these services over the past three years for Weld County Department of Social Services Foster Parents. Our longest running program experience has been in continuing education and individual consultation. Our newest program has been in critical care consultation begun about six months ago. For the mandated programs we have developed response standards to 1) insure that we deliver services promptly and 2) report to social services if there is any difficulty in compliance with the corrective actions required. The mandated consultation programs are analogous to home based delivery of services in respect to keeping in 4 dose contact with the caseworker or in this case the foster parent supervisor. In our opinion, the voluntary use of Foster Parent Consultation Services is a different case. Up to this point, we have used an Employee Assistance Model in the delivery of consultation services to those who voluntarily seek them. Such a model requires the foster parent to be assured that they have confidentiality in discussing their issues with the consultant and that the consultant does not function as a conduit for all issues discussed with the caseworker. Such confidentiality is useful and necessary in some circumstances such as the cool line. Many foster parents perceive that seeking instruction may be seen by Social Services as a sign of personal deficiency on the part of the foster parent. Seeking of appropriate consultation should be actively encouraged. The maintenance of a non-adversarial and non-punitive atmosphere is especially important for consultation. We propose to continue to use such a framework for work with foster parents except under strictly defined circumstances. These circumstances constitute a clarification of the language to section III E of the RFP for this bid. These strictly defined circumstances relate to those foster parents only as consultation relates to item le above - differences in the implementation of the treatment plan as perceived by the consultant between social services and the foster parent. The following language reflects agreements we have had in place with Social Services for the last year (and have not needed to make use of). We propose to continue to operate under this successful mechanism. VVhere perceived differences clearly appear to relate to child safety, the consultant will be bound by law to report to Social Services. Where the differences in interpretation of the care plan clearly do not involve child safety, the consultant will seek to have the foster parent and the caseworker discuss these directly. In instances where the desires of the foster parent and those of social services clearly differ in relation to some aspect of the foster placement treatment plan and where there is no apparent issue of child safety involved, the mechanism outlined in section IIIE would seem to apply. However, the consultants will not serve as advocates for the parents or for social services in such cases of dispute. Our role with the foster parent is to provide training, not to conduct assessments to discover the failures of the foster parent or to seek to alter the treatment plan for the foster child. Neither will the consultants serve as a conduit primarily for collecting information for the caseworker on the foster parent in a dispute. As trust is essential to this process, we have worked in and intend to continue to work in an environment of trust with all parties. Hopefully, any dispute can be discussed to find common ground in a meeting with the foster parents, the caseworker, the foster parent supervisor, the case workers supervisor and the consultant should such instances arise. As contractors, we will not 5 initiate action with the courts on a consultation case. If under subpoena for any reason such that we are required to appear before a court, we will inform the court of this contractual restriction. We will also be obligated to obey the requirements of the court should such a situation arise. We also assure WCDSS that no individual providing therapy to a foster child in a foster home will concurrently provide consultation in that home. We will provide Quantitative measures for group courses similar to the format used in Continuing Medical Education for medical providers. This is a one page pre and post test format administered before and at the end of each workshop. We will also provide a workshop evaluation form for each workshop. We will establish a work plan for individual consultation and show completion of that work plan through documented chart notes. Foster parents will be referred to other resources in the community for provision of services if they need such resources. We will develop a checklist for services that may be of use to foster parents outside of WCDSS funds and include this completed worksheet in each file. A copy will be given to the foster parent and so documented in the chart. A disclosure stating these procedures will be signed by every foster parent prior to treatment (with the exception of the cool line). Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... 1. How did the foster family come into the foster parent support program? (voluntary or mandatory)? 2. Did the family attend the workshops they signed up for? 3. Did the foster parent complete the evaluation forms? 4. Did the foster parent need the Cool Line?, individual consultation?, 5 How many hours of total contact did the foster parent have and how many credits were earned? Summative outcomes A. Was there improvement in household management competency as measured by pre and post assessment? We will use a pre and post assessment instrument based on a self rating of improvement for this area. 6 B. Was there improvement in parenting competency as measured by pre and post assessment? For the workshop setting, the pre and post measurement will be knowledge based and measure information obtained through the workshop. For individual consultation, an individual consultation plan will be developed in the first hour and completed and reviewed in the final hour of consultation to ascertain if the consultation goals were met. C. Were Foster parents enabled to better work with other sources in the community and the local state and federal government? Knowledge of resources will be determined from a listing of resources by the participants at the outset and the conclusion of the consultation. D. Did foster parents demonstrate higher skills and competency levels in fulfilling their roles for children in out of home placements? This will be set up in the same way for individual and for group treatment as above. Group treatment will be a pre and post knowledge assessment. Individualized treatment will be based on change from the initial to the final session as documented in a summary of the consultant's notes. E. Did foster parents meet the needs of their biological children in adjusting to and £going with foster children in their home? A self report question of this type will seek the opinion of the foster parent in each evaluation either individual or group. The question may read like this: The information you have learned through this program for foster parents might help you meet the needs of your own biological children in adjusting or coping with having foster children in your home. For you, personally, do you think the information you have learned will a. help very much, b. help somewhat, c. help just a little d. not help but it won't make it more difficult, e. not help and make it somewhat more difficult f. not help and make it much more difficult 7 Service objectives We have the following service objectives: A. Improvement of Household Management Competency By using a checklist for individual consultation, we will ascertain if the parents are requesting assistance in relation to issues related to maintaining a safe household environment. The check list will include the foster parents assessment if assistance is needed in the following areas - household cleaning, household maintenance, budgeting or purchasing. We expect this to be a minor area of work except in families where corrective action may be needed. B. Improvement of parental competency We expect this to be the major area of work with regard to the foster parent's support program. Particular service goals for each foster parent family will be documented in their chart. A summary of the foster parents participation will be made for all months of participation. C. The ability of the family to access resources By using a checklist for families in individual consultation concerning resources related to specific areas of need, the referrals to local and governmental resources will be documented. In addition, for some families an Internet Search will be run to identify further resources to assist them with specific questions if these concerns have not already been answered. This Internet option will likely be of use for families with foster children who have unusual medical or psychological needs. For those in a workshop, listing of resources by participants before and after the workshop will reflect increased knowledge of resources. The methods used to document the service objectives will be a comparison of the goals of the individual plan for the family with the progress report completed each month for all families in individual treatment. For those in group treatment, a pre workshop/post workshop form will be used. Examples of these types of evaluation tool are appended to this proposal. Workload Standards A. The program has a capacity of 100 hours per month. The total per year will not exceed 600 hours. We anticipate an average of fifty. At each meeting, one therapist is present. This represents 600 hours of therapist/client time per year. At our rate of $90 per hour, the cost maximum is $54,000 per year. The monthly average is $4500 if we assume a use of 15 hours of the program by forty families over the year. We have structured the bid to include the cool line as the only service that is not face to face. We have set its maximum use per any individual at five hours total and set its 8 maximum level at 60 hours for the year (a maximum of 10% of the services) or a total of $5400 maximum that can be billed for Cool Line services. B . There are seven providers -- four licensed psychologists, two professional counselors and a bilingual master's level therapist who will provide these services. All have specific training in helping to assist individuals in behavioral changes. All have experience in psychoeducational instruction. C. The maximum caseload The monthly total average will be 50 hours. D. The modality of treatment is consultation for individual or group settings. E. Hours/month The total number of therapist hours is a maximum of 100 per month and a maximum of 600 per year. F. Staff There are seven individual providers supported by two administrative professionals in the practice. G. Supervisor This contract would be supervised by Joyce Shohet Ackerman, Ed.D.. who would monitor the project for compliance. Providers are individually licensed and do not require clinical supervision except for one therapist who is being supervised by a licensed psychologist in the practice. The maximum caseload per supervisor is 40 families per year. Caseload monitoring would be through tracking of time per foster parent. H Insurance All providers carry one million/three million professional liability. Ackerman and Associates carries an additional one million/three million liability policy on the group and a general liability policy which meets the required criteria for this application. Staff Qualifications A. and B. Staff Qualifications Seven staff are available for the project. They exceed the minimum qualifications specified as documented below. The staff are: Joyce Shohet Ackerman, Ed.D., Licensed Psychologist; Susan Bromley, Psy. D., Licensed Psychologist (and Licensed Social Worker); Emily Jaramillo-Bansberg, M.A., psychotherapist; Laurence P. Kerrigan, Ph.D., Licensed Psychologist; Sherri Malloy (Gonzales), Ph.D., Licensed Psychologist; Karen Bender, M.A., L.P.C. and Nicole Warnygora, M.A., L.P.C. All of these are solution-focused, therapy providers. C. Training The staff has extensive training in family therapy and short term therapy as documented by their extensive work experience. Collectively, six of the seven providers have held licenses in their field for a collective total of more than 60 years with a range of 1-20 plus years and an average length of liscensure of about 10 years. Resumes 9 are available upon request. D. Continuing education As a part of their work in the private sector all providers in this group maintain continuing education programs more than the minimum eight hours required. They participate in workshops and other activities. This proposal's continuing education requirements coincide with the requirements of other contractual arrangements and are being met on an ongoing basis by members of the group. E. Supervision Six of the seven providers are independently licensed and not required to have clinical supervision. One therapist , Emily Jaramillo-Bansberg, M.A , who is working toward liscensure, is supervised by Sherri Malloy (Gonzales), Ph.D., a licensed psychologist in the practice. All the staff have advanced skills in family therapy. The contract supervisor will monitor the specifications made in this proposal. F. Supervisor continuing education The supervisor of the project is involved in ongoing training to keep current with her profession through advanced workshops and seminars. Ackerman and Associates, P.C., of which the supervisor is the president, has more than ten years contracting experience for major managed care companies as short-term, solution-focused therapy providers in Weld County. By contract, we have provided more than 1000 short term therapy sessions per year for three of the last five years. Dr. Ackerman manages all short term solution focused therapy contracts for Ackerman and Associates, P.C. Unit of service rate computation We have a usual rate for therapy services of$99.50 per hour. Since these are consultation services, we are requesting a billing rate per hour of individual time of $90 per hour for individual or couples consultation. Group services will be billed at one half this rate per person as in these circumstances individual credits are being given for continuing education. The overall profit margin for Ackerman and Associates, P.C. for 1999 was 2. 9% of gross revenues. Budget Justification/ Standards of responsibility for 2000-2001 bids These rates are reasonable for providers of the licensed level and breadth of training assembled in this proposal. PAC money is tracked through a computer data base system called MediMac which we have used for the past 60 months. We are in the process of transitioning to a new accounting software. Both systems allows us to track payments by client and by source of payment and any payment through the PAC will be tracked in this manner No special issues are presently related to project audit to our knowledge and a 10 random project audit for WCDSS have shown no discrepancies. Audits will be conducted on a yearly basis. Ackerman and Associates, P.C. is a type S professional corporation and not a 501.c.3. Modifications to meet the bid requirements for 2000-2001 have been added as follows: Standard of responsibility Ill D: The RFP reflects the precise number of sessions needed to be effective, the number of sessions per week and the cost of each session. For this program there are fifteen to twenty sessions on either an individual or group basis. The cost of each session is $90 per individual or foster parent couple hour. Group sessions can be substituted for individual sessions at $45 per group hour. Two group hours is the equivalent of one individual/couple hour. Standard of responsibility Ill E : The RFP must eliminate renewals or reduce the cost of the renewal should it have to be reinstated. The mechanism to reduce renewals is that we have established a 30 hour per foster parent maximum for all treatment of any type. The only exception to this is in the two mandated training programs. These renewals after 30 hours will require a second authorization from social services after review of the progress of the case. A renewal will have a maximum of ten hours of additional treatment provided. The only reason for acceptance of a renewal is that Social Services believes ten additional hours will bring the foster home to status of compliance. Standard of responsibility Ill F: The RFP has a process for renewals sixty days ahead of the program termination. A maximum of thirty hours of service will be set for each foster parent in voluntary consultation. Only in mandated programs will this level be exceeded using the mechanism in the paragraph above concerning renewals. Standard of responsibility Ill G: The RFP reflects a maximum number of hours in three stages of the program. We anticipate the average use of the program to be approximately fifty hours per month. The pattern of use may not be even as the workshops are not offered every week and tend to be most heavily attended in the fall and spring with lowest attendance in the summer. It is unlikely the month to month total will always be at fifty but should average around fifty. Regardless, the program is capped at 600 hours of service, so no cost overrun for the year is possible. As this is a new rule and its implications for monthly averages are unclear at this time, we request a direct meeting with Social Services, in a timely manner, if there is any concern in relation to this standard of responsibility in the next fiscal year. Thus, we can remedy any potential concerns if they arise. For this program, the cumulative total expended divided by the months of the program completed (the moving average) would be the most useful measure of utilization in our opinion. 11 Standard of responsibility III H: The RFP requirement for a letter regarding carry over into the 2000-2001 project period is acknowledged. Clients in individual consultation who will carry over into this program will be reported at that time. Standard of responsibility I is acknowledged. The case management plan will be developed with the Foster Parent at their first meeting. A monthly report will be provided giving times of contact but not content of information discussed. A final narrative will be provided as to the fact the consultations occurred and the credits earned. Content of the consultation is not designed to be shared with Social Services except in mandatory training cases for corrective action. 12 Workshop Assessment Form This form is to be completed by participants prior to the start of the workshop Workshop name Workshop date Workshop leader Your name The workshop assessment form will consist of three to six questions related to the workshop content. 1 One question will relate to knowledge of household management competency if this topic is relevant to the workshop. 2 3, 4. and 5 Up to four questions will relate to either knowledge or to the irterpretation of a scenario related to parental competency. 6 One question will ask participants to list as many resources as they can related to the workshop topic. 13 Workshop Assessment Form This form is to be completed by participants at the completion of the workshop (questions 1-6 are identical to the pre workshop assessment) Workshop name Workshop date Workshop leader Your name The workshop assessment form will consist of three to six questions related to the workshop content. 1. One question will relate to knowledge of household management competency if this topic is relevant to the workshop. 2. 3, 4. and 5 Up to four questions will relate to either knowledge or to the interpretation of a scenario related to parental competency. 6. One question will ask participants to list as many resources as they can related to the workshop topic. Question 7 The information you have learned through this program for foster parents might help you meet the needs of your own biological children in adjusting or coping with having foster children in your home. For you, personally, do you think the information you have learned will a. help very much, b. help somewhat, c. help just a little, d. not help but it won't make it more difficult, e. not help and make it somewhat more difficult, f. not help and make it much more difficult Please provide any additional comments about the workshop in the space below. Thank You. 14 Individual family consultation plan Family Name Consultant 1 . What are three specific goals of this consultation? 1. 2. 3. 2.We will do the following to complete goal one. 3. We will do the following to complete goal two. 4. We will do the following to complete goal three. At the outset of the consultation, ask the foster parent to list resources they know about related to these three goals. Are there issues of budgeting, purchasing, household maintenance or household cleaning that will be addressed in this consultation. If so specify below. Are there issues of parenting family dynamics, discipline, sibling rivalry, family cooperation, specific behavior problems or other family concerns that will be addressed in this consultation? Specify these below. For families in mandated corrective action, a formal assessment, the 15 Parental Stress Index , will be completed. Family Progress Report for consultant's notes (Monthly report will only report number of consultations worked on. Unless there is a clear area of concern for the adequate performance of the Foster Parent role, content will not be reported to WCDSS) If an area of concern is present that is not clearly reportable please discuss with contract administrator, Joyce Ackerman, Ed.D. If an area of concern is clearly reportable as child abuse, make the required report promptly.) Family Name Consultant Date of consultation Progress toward goal Plan for next consultation Date of consultation Progress toward goal Plan for next consultation Date of consultation Progress toward goal Plan for next consultation 16 r Branch B/A Producer# Issue Date Renewal/Replacement No. 32 A 0002360 04/27/1999 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2032570 1. NAMED INSURED: ACKERMAN AND ASSOCIATES PC ADDRESS 1750 25TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) 2. POLICY PERIOD: From 05/01/1999 To 05/01/2000 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: LIMITS OF LIABILITY PREMIUM Professional Liability $1 ,000,000 $3,000,000 $1,686.00 each Incident Aggregate 4. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: ( ) Sole Proprietor (including Independent Contractors) ( ) Partnership (X ) Corporation OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy effecti e date shown on the Declarations; or b) the effective date of the earliest claims-made policy issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/1992 7. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsemeni(s): PLJ-2008 ( 10/94) POE-8004 PLE-2167 PLE-2081 P0N-2003 PLE-8036 ( 09/971 CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 offi I's IERSIATE INc,t'RANCE G FI O lJ v PLP-2012 (06/93) (Elec.) .. LASER! Branch B/A Producer # Issue Date Renewal.Repi.tce:t,ent N. 32 A 0002360 05/05/1999 DUPLICATE PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY. _ Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2050203 1. NAMED INSURED: SUSAN PLOCK BROMLEY PSYD ADDRESS 1621 13TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) POLICY PERIOD: From 04/01/1999 To 04/01/2000 (12:01 A.M. Standard Time At Location Of Designated Premise.. 3. COVERAGE: LIMITS OF LIABILITY PREMIUM Professional Liability $1 ,000,000 53,000,000 S799.C 0 each Incident Aggregate 4. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: ( X ) Sole Proprietor (including Independent Contractors) ( ) Partnership ( ) Cori crat.s t OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy etecti)r date shown on the Declarations: or b) the effective date of the earliest claims-made noi: r. issued by the Company to which this policy is a renewal: or c) the date specified in in endorsement hereto. 04/05/1996 This policy is made and accepted subject to the printed conditions of this policy toghthe: with the provisions, stipulations and agreements contained in the following form(s) or endor,emert(,) PLu-2008 ( 10/94 ) POE -8004 PL.E -2167 PLE-2081 P0N -2003 PLE-8035 ( 09/97 ) CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke Van Orsdel Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 stmommway INTERSTATE INSURANCE GROUP MMMEMEMMIR PLP-'012 (0693) (Elec.) -_ 7 da Es LASER. Issue Date: 01/06/00 The Reci rocal PROFESSIONAL LIABILITY OCCURRENCE <4J1 Alliance INSURANCE INSURANCE POLICY FOR Risk Retention Group PROFESSIONAL COUNSELORS AND HUMAN DEVELOPMENT PRACTITIONERS ACA Insurance Trust.Inc. 5999 Stevenson Avenue ACA u syC±pe Policy Number: CL10073400 Administered by: Alexandria,VA 22304.3300 TRUST Tol Free•.1.800-347.8847 x284 .;._. ITEM DECLARATIONS INDIVIDUAL POLICY 1. NAMED INSURED: Norma Karen Bender 2. ADDRESS: 1104 Twin Peaks Circle Longmont, CO 80503-2170 3. POLICY PERIOD: From: 02/04/00 To: 02/04/01 12:01 A.M.Standard Time at Location of Designated Premises _ 4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges: COVERAGE PREMIUM A. PROFESSIONAL LIABILITY S 290 . 00 B. GENERAL LIABILITY S 0 . 00 TOTAL PREMIUM: S 290 . 00 5. LIMITS OF LIABILITY: $1 , 000 , 000 each Incident or each Occurrence $3 , 000 , 000 in the Aggregate 6. THE NAMED INSURED IS: Sole Proprietor(incl.Individual) Partnership Corporation X Other(refer to Item 7 below, 7. BUSINESS OF THE NAMED INSURED: Part-Time Self-Employed (Rating Category) Counselor/Human Development Professional 8. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and agreements contained in the following form(s)or endorsement(s): CPL•0004.0199 CPL•0005•0199 CPL•0006 0199 NOTICE THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. CPL 0005.0199.00 EXECUTIVE RISK SPECIALTY CO. THIS IS A CLAIMS MADE POLICY-PLEASE READ CAREFULLY 12/03/99 -- A PSYCHOLCGISTS PROFESSIONAL LIAEILITY POLICY •*• RENEWAL •+4 NOTICE. A LOWER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT(SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). DECLARATIONS POLICY NO. 801-0005006 ACCOUNT NO: CC-KERL175-0 0099745E "EM ' 'a' NAME AND ADDRESS OF INSURED. ITEM 1. (b) ADDITIONAL NAMED INSUREDS. LAURENCE P. KERRIGAN. PH.D. 1750 25TH AVE. SUITE A101 GREELEY. CC 80631 TYPEOFORG: INDIVIDUAL ITEM 2 ADDITIONAL INSUREDS. ITEM 3. POLICY PERIOD. FROM: 12/01/99 TO: 12/01/00 12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN i TEM 4. LIMITS OF LIABILITY. (a) S 1.000.000 EACH WRONGFUL ACT OR SERIES OF CONTINU )JS. REPEAT E '_ OR INTERRELATED WRONGFUL ACTS OR CI;CU.+'REN:L It)) S 5.000 DEFENSE REIMBURSEMENT (cl $ 3.000 .000 AGGREGATE ITEM 5 PREMIUM SCHEDULE I— CLASSIFICATION NUMBER RATE ANNUAL PREMIUM 1ST PSYCHOLOGIST 1 1254.00 1 .254.00 DEFENSE LIMIT .00 SURPLUS LINES TAX 1 ;.7.62 INSPECT ICh FEE 1 2.51 • • • TEN' Xi RETROACTIVE DATE 12/01/g 1 TOTAL PREMIUM 1 .294. 12 :TEM - EXTENDED REPORTING PERIOD ADO 'TONAL PREM!UM (It exercised): $ 2 •265_24_ ITEM B PO_.CY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY. 7f-- 322138 (7/95 E0. ) 622137 - - - -- --_-- AUTHORIZEDCOMPANYREPRESE:N TATI THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. r _ Branch B A Producer # Issue Date Renewal Rel lacemert No. 2 A 0002360 03/02/1999 FENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS-MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS-MADE POLICY, PLEASE READ THE POLICY CAREFULLY _ Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2055185 NAMED INSURED: SHERRI MALLOY PHD ADDRESS 24 ALLES DRIVE (Number & Street, Town, GREELEY CO 80631 Counts, State & Zip No.) 2. POLICY PERIOD: From 04/01/1999 To 04/01/2000 ( 12:01 A.M. Standard Time At Location Of Designated Pi eIT:i,L.) 3. COVERAGE: LIMITS OF LIABILITY PRI V ll_ A' Professional Liability S1 ,000, 000 S3,000,000 F 295 • 1 each Incident Aggregate 9. BUSINESS OF THE INSURED: Psychology THE NAMED INSURED IS: X 1 Sole Proprietor (including Independent Contractors) ( ) Partnership ( I C ,o, . a Fr OTHER: This polies ,hall only apply to incidents which happen on or after: a) the polies et act date shossn on the Declarations; or b) the effective date of the earliest claims-mauc po uesi bs the Company to which this policy is a renewal; or c) the date specified in (,n enaorsemeat hereto. 04/01/1998 This polies is made and accepted subject to the printed conditions of this polies ¢': eil sr ss - the pros i,ions. stipulations and agreements contained in the following form(,, or v P _u-2008 ' 0/941 POE -8004 PLE - 2167 PLE-2 - 31 �0N - 2003 PLE-8035 ( 09/971 CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke-Van Orsdel. Incorporated Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll-free Number: 1-800-852-9987 INTERSTATE INSURANCE CROUP PLR 2L!.2 (06 93) (Elec.) _-- '+_J iEz ,ASER' EVEREST NATIONAL INSURANCE COMPANY MENTAL HEALTH PRACTITIONER'S PROFESSIONAL LIABILITY POLICY DECLARATIONS Renewal of No. NOTICE: A SUB-LIMIT OF LIABILITY APPLIES TO "CLAIMS" ARISING OUT OF "SEXUAL MISCONDUCT". POLICY NO. 2200009922-991 ITEM 1: NAME AND ADDRESS OF INSURED: SEND ALL INQUIRIES TO: Nicole Ray Warnygora ROCKPORT INSURANCE ASSOCIATES 1800 Angelo Court PROGRAM ADMINISTRATOR Fort Collins, CO 80528 P 0 BOX 1809 ROCKPORT, TX 78381-1809 1-800-423-5344 ITEM 2 ADDITIONAL INSUREDS: NONE ITEM 3: DESCRIPTION OF BUSINESS: MENTAL HEALTH PRACTITIONERIS) ITEM 4: POLICY PERIOD: FROM 05/20/1999 TO 05/20/2000 12:01 am STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HERFr, ITEM 5: LIMITS OF LIABILITY: $ 1,000,000 EACH WRONGFUL ACT OR EACH OCCURRENCE SUEJECT TO 825,000 SUB-LIMIT OF LIABILITY FOR ALL "WRONGFUL aCTE- INVOLVING "SEXUAL MISCONDUCT". S 3,000,000 AGGREGATE ITEM 6: PREMIUM SCHEDULE: CLASSIFICATION NUMBER RATE ANNUAL PREMIUM CATEGORY M2 1 263.00 S 263.00 TOTAL PREMIUM S 263.0C ITEM 7 POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY: 190.00 0195, 189.00 0195, EEO 25 501 12 98, 193.00 0195,194.00 0195 May 21, 1999 gz(LP cVCL AUTHORIZED COMPANY REPRESENTA1IVE 189.00 0195 © Everest National Insurance Company, 1995 MEMORANDUM OF INSURANCE Date Issued 11/03/1999 Memorandum Holder This memorandum is issued as a matter ACKERMAN & ASSOCIATES ATTN DONNA of information only and confers no SUITE 101 rights upon the holder. This 1750 25 AVENUE memorandum does not amend, extend GREELEY CO 80634 or alter the coverages at-oriled by the Certificate listed below. Company Affording Coverage Producer Chicago Insurance Company Kirke Van Orsdel 1776 West Lakes Parkway Covered Person (Status) >wner West Des Moines, Iowa 50398 EMILY L 7ARAMILLO—BANSBERG MA x Employee This is to certify that the Certificate listed below has been issued to the insured named herein for the policy period indicated, notwithstanding any requirement, term or condition of any contract or other documert with respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Certificate Type of Insurance Number Effective Date Expiration Date LlmiN Professional Liability each incident 1 ,000. 000 or occurrence Occurrence 80M-4003488 11/01/1999 11/01/2000 3 ,000,000 in the aggregate each incident General Liability or occurrence Occurrence in the aggregate Should the above described certificate be canceled Insured before the expiration date thereof, the issuing company will endeavor to mail written notice to the named Memorandum Holder, but failure to mail such EMILY L SARAMILLO-BANSBERG MA notice shill impose no obligation or liabilty of any 183 50 AVENUE PLACE kind upon the company, its agents or representatives. GREELEY CO 80634 Authorized Representative: ear FTRUCK INSURANCE EXCHANGE Q FARMERS INSURANCE EXCHANGE FIRE INSURANCE EXCHANGE / IOW MEMBERS of FARMERS INSURANCE GROUP OF COMPANIES /r°I °°.II HOME OFFICE:4680 WILSHIRE BLVD.,LOS ANGELES,CALIFORNIA 90010 L9G ° DR JOYCE SHOHET ACBERMAN PC Count . 1750 25TH AVE SUITE 101Prematic Acct No. 07-04-362 04576-38-07 GREELEY CO 80631 Agent Policy Number Type of The named insured is an individual unless otherwise stated: ❑ Partnershl ® Corp. Business OFFICE ElJoint Venture LJ Organization(Other than Partnership or Joint Venture) 2. Policy Period from 07/01/99 (not prior to time applied for) to 07/01/00 12:01 a.m.Standard Time. If this policy replaces other coverages that end at noon standard time on the same day this policy begins,this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect-to continue this insurance,we will -enew this policy if you pay the required renewal premium for each successive policy period subject to our premiums,rules and forms then in effect. 3. Insured location same as mailing address unless otherwise stated: 1750 25TH AVE SUITE 101 GREELEY CO 80631 4. Mortgage Holders Loan# Loan# 5. Premium$ 492.00 ❑ "X"if Mortgage Holder Pays 6. Policy Forms and Endorsements attached at inception: E0079-ED1 2521551290 565310-ED2 S0700-ED3 E6036-ED1 E4168-ED1 E4004-ED1 E4216-ED1 E3026-ED1 7. We provide insurance only for those coverages indicated by a specific limit or by an al COVERAGES LIMITS OF INSURANCE DEDUCTIBLE A-Building $ SECTION 1 B-Bulness Personal Property $250 applies unless other $ 50,000 option Indicated by anEa C-Loss of Income(Not exceeding 12 consecutive months C�s1 oo[s 50o E s_ Property OPTIONAL COVERAGES ) ACTUAL LOSS SUSTAINED NONE and Swimming Pool/Fences and Walkways Loss of X Building Glass(Blanket) $ Above plies Income X Outdoor Sign Coverage REPLACEMENT COST uble applies 10 0 _, Valuable Papers(In addition to$1000 included.) $ 100 unless other $ option Indl- _ EEarthquake Damage cared See Coverages % SECTION II I>Business Liability-Including Products and Completed A,B,&C of the applicable ins. lint p LIMITS LIABILITY Operations.(Annual aggregate Aggregate) applies for all occurrences (Annual Aggregate)during the policy period) $ 1,000,000 Liability EI-Fire Legal Liability$75,000 included unless other option Indicated by an and 0$100,000❑$150,000 each occurrence(Subject to the annual aggreagate shown for Coy.D) Medicals F-Medical Payments to Others(Subject to the annual aggregate _. shown for Coverage D.) $5,000 each person Limit of Liability 0 Professional Liability(see attached endorsement) (Annual Agg egate) $ ®I-V COVERED __ SECTION III Agreement I-Employee Dishonesty DEDUCTIB_E $ Agreement II-Broad Form Money and Securities-Inside 1,000 NONE $1,000 $250 Agreement III-Broad Form Money and Securities-Outside Si1 ,000 $250 -- Crime. Agreement IV-Medlcal Payments $500 each person NONE -- Agreement V-Forgery or Alterations $2,500 NONE _ 55-S308242 2ND EDITION Countersigned Authorized Representative -- JOYCE SHOHET ACKERMAN, ED.D. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 Phone: 353-3373 PERSONAL DATA SHEET Date of Birth: August 3, 1950 Health: Excellent Married, two children CERTIFICATION/LICENSURE Licensed Clinical Psychologist, State of Colorado since 1984 Listed in National Register of Health Service Providers in Psychology since 1986 Staff Privileges, North Colorado Medical Center, Greeley, Colorado since 1985 Certified Teacher (K-12) for Emotionally Disturbed, Learning Disabled and retarded. Certified Teacher, Elementary Level PROFESSIONAL MEMBERSHIP American Psychological Association Colorado Psychological Association Colorado Psychological Association- elected board member 1986-1989 HONORS President's Award - Colorado Psychological Association, 1989 EDUCATION 1978 - 1981 Ed.D. in Counseling Psychology University of Northern Colorado December 1981 graduate 1972 - 1974 M.S. in Education (E.D./L.D.) Lesley College, Cambridge, Massachusetts August 1974 graduate 1968 - 1971 B.S. in Special Education and Elementary Education with a minor in psychology Boston University, Boston, Massachusetts December 1971 graduate PROFESSIONAL EXPERIENCE 1981 - PRESENT Clinician in private practice in Northern Colorado. Among responsibilities are: Diagnosis, therapeutic intervention and referral for adults, families, children and groups. Primary areas are: anxiety disorders, mood disorders and adjustment disorders. Typical problems include: trauma, physical abuse, job stress. Orientation used-primarily cognitive- behavioral therapy. Also, developing, organizing and presenting workshops and consultative programs to community, schools, organizations and agencies. Approximately 30 hours per week. 1986 - Present Consulting psychologist on interdisciplinary team for in-patient rehabilitation program. Progressive Care Rehabilitation Center, Greeley, Colorado. Medical Director Dr. Judith Vaughan, Neurologist. Adults with traumatic injuries-Primary problems are: psychological aspects of physical rehabilitation, grief counseling, and brief group counseling using cognitive-behavioral goal oriented therapy. Approximately 10 - 15 hours per week. 1989 - 1992 Head Injury Treatment Team North Colorado Medical Center, Greeley. Approximately 5 hours per week. Team coordinator - Dr. John McVicker, Neurosurgeon. 1986 - 1989 Consulting Psychologist for Family Recovery Center (in-patient substance abuse/chemical dependency program), North Colorado Medical Center, Greeley, Colorado. Coordinator Ruth Wick R.N. Approximately 5 hours per week. 1986 - 1989 Provider and Coordinator for Mental Health Services in Northern Colorado for Peak Health Care (HMO). Peak mental health services utilized a three session model for initial services followed by referral. Activities included coordination of Psychological and Psychiatric Services for approximately the last two years of the contract. Peak was purchased From Lincoln National by Biodyne in late 1989. Peak Supervisor - Elaine Taylor Approximately 10 hrs./week. 1983 - 1986 Psychologist subcontractor for a Vietnam Veteran's Counseling Program funded by the Veteran's Administration. Principal Contractor Dr. Robert Stewart 1980 - 1987 Part time faculty member with responsibilities for classes, workshops and community programs in parenting skills. Family/Life Education Program Aims Community College, Greeley, Colorado August 1980 Clinical Internship on Children's Team of to Community Mental Health Center. Responsibilities August 1981 included: consultation to schools and community programs; therapy for children and families; and assessment of diverse mental health programs. Assistant program Evaluator-Developed evaluation tools to determine cross-cultural perceptions of expectations and satisfaction with services. Supervisors - Dr Joan Gillespie and Dr. Laurence P. Kerrigan. Weld Mental Health Center, Greeley, Colorado (Full time). Adults, Adolescents, Families. Primary areas anxiety disorders, mood disorders and adjustment disorders. Typical problems included: trauma, physica abuse substance abuse, job stress. Orientation used- Primarily cognitive-behavioral therapy. 1980 Group Facilitator-Regional and National Conferences in cross-cultural community needs. Flagstaff, Arizona - Colorado Springs, Colorado August 1975 Chairperson of the Department of Education and to Behavioral Science at an accredited, Indian controlled July 1978 community college on the Navajo Reservation. Administration responsibilities included: Supervision and evaluation of faculty; budget preparation and management; curriculum development and integration of Navajo culture; personnel recruitment and selection; class scheduling and program development. Also, faculty member with academic responsibilities for instruction in Psychology, Child Development and Counseling courses, advising and counseling students. Navajo Community College, Tsaile, Arizona (Full time) September 1974 Education Specialist and counselor at an Indian to controlled primary and secondary school on the August 1975 Navajo Reservation. Coordinated community resource program which included: Counseling, Student assessment, prescriptive programming, , staff development and curriculum. Also, adjunct faculty for the University of New Mexico and for Navajo Community College at the Rough Rock Demonstration school, Rough Rock, Arizona. (Full time) September 1972 Designed and coordinated Learning Center Program to for Dedham Public Schools. A program and crisis June 1974 intervention center for emotionally disturbed children. Responsibilities included: Diagnostic prescriptive programming, counseling, supervision and training of aides, tutors and volunteers, and consultation with regular classroom teachers. Also organized group and individual meetings with parents. Also, adjunct faculty for Curry College assisting in in-service instruction for Dedham School System employees. Dedham Public Schools, Dedham, Mass. (Full time) February 1972 Learning Disabilities Specialist. Consultation to staff, to prescriptive programming and teaching school age June 1972 children. Somerville Public Schools, Somerville, Mass. (Full time) Summer 1971 Chosen as state mental health intern. coordinated Tutoring Center for emotionally disturbed children. Responsible for: tutoring children, supervising aides, (high school dropouts) and consulting with psychiatric staff. Somerville Mental Health Clinic, Somerville, Mass. WORKSHOPS AND SPECIAL TRAINING 1993 - August Hospital Practice for Psychologists APA National Convention in Toronto, Canada- "Psychology and National Health Reform", "National Health Insurance: Policy Considerations, Benefit Designs, and Economic Realities", and "Marketing: Psychology's Key to National Health Reform. 1993 "Using the New MMPI-2 and MMPI-A" Mountain Crest Hospital, Denver, Colorado. 1993 Disaster Relief Training. Alan Keck, through Colorado Psychological Association, Denver, Colorado. 1992 - Fall Short Term Therapy. Bernard Bloom, University of Northern Colorado, Greeley, Colorado. 1990 - Fall National Cognitive Rehabilitation Conference, Richmond, Virginia. 1990 - Summer Post graduate training: 1. Adult Neuropsychological Method based on Lezak Neuropsychological assessment, 1983. 2. Child Neuropsychology, Dr. Hynd. 3. Child Neuropsychological Methods. 1989 Provider of Neuropsychological evaluations for Vocational Rehabilitation, Greeley, Colorado. 1988 Cognitive Rehabilitation Training Program, Dr. Sena, Ph.D., Colorado Springs, Colorado. 1988 - Present Psychologist - Head Injury Treatment Team at North Colorado Medical Center, Greeley, Colorado. 1987 Halstead Reitan Neuropsychological Assessment Training. Ralph Reitan, Ph.D., Washington, D.C. Summer 1986 Albert Einstein School of Medicine, Workshop on Adolescent Therapy, Cape Cod, Mass. 1985 to present North Colorado Interdisciplinary Team of Child Custody Member and participant. Fall 1985 Interdisciplinary Workshop on Child Custody, Keystone, Colorado. Summer 1984 Workshop in Clinical Use of Hypnosis, Boston, Mass. Winter 1983 Workshop on In-patient Programs for Service Related Disorders, Cheyenne Veterans Administration Hospital. Fall 1983 Veteran's Administration Workshop on Post Traumatic Stress Syndrome, Denver Veteran's Center. Fall 1981 Post-Doctoral Supervised Candidate for Licensure to (psychology) under Gale R. Giebler, Ph.D. Licensed Winter 1984 Psychologist and Susan Spilman, Ph.D., Licensed Psychologist. 1980 - 1981 Intern-Weld County Sexual Abuse Team, Greeley, Cola. Summer 1981 Independent Study of Child Sexual Abuse, University of Northern Colorado. Spring 1981 Interdisciplinary Workshop on Assessment of Sexual Assault, Boulder Social Services. Summer 1979 Biofeedback Training related to labor and delivery. Summer 1974 Participant in Institute on Obstacles to Learning. Joint Symposium between McLean psychiatric Hospital, Harvard University and Lesley Graduate School. Cambridge, Massachusetts. Summer 1973 Kennedy Memorial Hospital, Boston, Massachusetts. Participant, Summer Aphasia Institute. PUBLICATIONS Ackerman A., Ackerman J.S., Kelley K, Hale K. Family Planning Attitudes of Traditional and Acculturated Navajo Indians. Key Issues in Population and Food Policy. University Press of America, pp. 178-171 (1979). Ackerman, J.S., Client Expectations and Satisfaction with Community Mental Health Center Services: A Cross-Cultural Analysis Between Hispanics and Analos. Published Doctoral Dissertation, University of Northern Colorado. copyright 1981. Nicole Warnygora 3200 Azalea Drive#K-4 Fort Collins, Colorado 80526 (970) 407-1578 Education Master of Arts Agency Counseling: Marriage and Family Therapy August 9, 1998 University of Northern Colorado, Greeley, Colorado, G.P.A. 4.0/4.0 Bachelors of Arts Major: Psychology Minor: Political Science May 23, 1993 Augsburg College, Minneapolis, Minnesota, G.P.A. 3.5/4.0 Experience Mental Health Therapist North Range Behavioral Health, Carson Children's Center/Children's Acute Treatment Unit, Greeley, Colorado • Provided individual therapy to children in a day treatment program • Provided family therapy to the children and families • Facilitated a children's group • Evaluated, diagnosed, and created treatment plans for children • Consulted with parents, teachers, psychiatrist, social worker, and the courts to ensure quality and continuity of care • Collaborated with teachers, parents, and social workers, to enable the child to ht.ve a successful transition to public school Test Supervisor Career Services Center, University of Northern Colorado, Greeley, Colorado (8/95 - Present) • Coordinated national testing program including administration of the ACT, SAT, and GRF • Trained, hired and supervised testing personnel Child and Family Therapist Intern North Range Behavioral Health, Greeley, Colorado (1/97— 6/97) • Provided individual therapy to children, and provided family therapy • Facilitated a children's group for clients in a day treatment program • Evaluated, diagnosed, and created treatment plans for a variety of children • Consulted with parents, teachers, social workers, and the courts to insure qualit) and continuity in client care and treatment • Provided services to a diverse population including deaf clients Childcare Relief Worker Families First, Aurora, Colorado (2/96 — 10/97) • Created a safe environment for children ages 3 -12 who were removed from parental homes • Responded, assessed and made referrals for crisis phone calls • Facilitated group discussion for children at the crisis center • Monitored parental phone calls and visits to ensure safety for the children • Nicole Warnygora, Page 2 Habilitation Counselor/Program Coordinator Paragon Services Incorporated, Duluth, Minnesota (1/94 - 8/95) ♦Developed programs to assist dual diagnosis clients achieve independence • Supported families with children with emotional disturbances or developmental disabilities and were at risk for out of home placement • Supervised and trained staff • Coordinated services to provide consistency between service providers Program Coordinator Nekton Services Incorporated, Duluth, Minnesota (7/93 - 12/93) • Coordinated the set-up of a group home for three autistic young women • Developed program plans and daily activities • Supervised, coordinated, scheduled, and trained staff • Designed a training manual and trained staff personnel in functional American Sign ,anguage Family Counselor Intern Minneapolis Crisis Nursery, Minneapolis, Minnesota (9/92 - 5/93) • Responded, assessed and made referrals for crisis phone calls • Performed short-term personal counseling with parents • Provided behavioral assessments and programs for children in the homes of clients Program Counselor/ Program Coordinator Dungarvin Alternative Services Inc., Saint Paul,Minnesota(9/91 - 7/93) • Coordinated client assessments with the interdisciplinary team • Completed behavior analysis for the purpose of program development • Developed and implemented programs for children who were developmentally disabled and emotionally disturbed in their home environment Counselor Day Care Systems Incorporated, Superior, Wisconsin (Summers 1988, '89, '90, &'91) • Responsible for the care of three children with autism • Implemented programs during the summer to provide fun for the children y' Volunteer Kindergarten Teacher, Saint Paul's Church, Duluth, Minnesota Tutor, Minneapolis, South High School Tutor, Multi-Cultural Center, Augsburg College, Minneapolis, Minnesota Honors & Award for Excellent Student Employee, Career Services, University of Northern Colorado 1996 Activities Non— Resident Scholarship for Academic Excellence, 1996 Weld County United Way Special Needs Child Care Committee, 1999 FACULTY VITA May 1999 NAME: BROMLEY, Susan Plock SOCIAL SECURITY NUMBER: 483-50-9243 POSITION: Associate Professor of Psychology Department of Psychology College of Arts and Sciences University of Northern Colorado Greeley, CO 80639 HOME ADDRESS: 1621 13th Avenue Greeley, CO 80631 TELEPHONE: Office: (303)351-2236 Home: (303) 352-8750 EMAIL:sbromley!a�bentley,unco.edu EDUCATION: Years Degree Institution Area of Study 1983 PsyD University of Denver Clinical Psychology School of Professional Psychology Denver, Colorado 1968 MSSA Case Western Reserve University Casework (MSW) School of Applied Social Sciences Cleveland, Ohio 1965 BA Mt. Holyoke College Economics/Sociology South Hadley, Massachusetts WORK EXPERIENCE --Professional Academic: Year(s) Institution/Organization Position Responsibilities I 996-Pres University of Northern Colorado Assoc. Professor Psychology Teaching/Research 1985-96 University of Northern Colorado Asst. Professor Psychology Teaching/Resear t 1983-84 University of Northern Colorado Asst. Professor Psychology Teaching WORK EXPERIENCE --Professional Non-Academic: Years) Institution/Organization Position Responsibilities 1996-present Ackerman and Associates Psychologist Clinical 1984-85 Kaiser Permanence Psychotherapist Clinical Lakewood, Colorado 979-80 Bethesda Mental Health Center Psychology Intern Clinical/ Denver, Colorado Administrative 1968-79 Denver General Hospital Clinical Social Worker/ Clinical/ Denver. Colorado Supervisor Administrative AREA OF SPECIALIZATION: Behavioral Medicine/Pain Management/Clinical Hypnosis RESEARCH AREAS/INTERESTS: Hypnosis/Pain Assessment and Management/Women's Issues/Teaching Methods PROFESSIONAL ACTIVITIES: Colorado Licensure. Psychology License#1086 ELBLICATIONS --ProfessionaHJuried: Musgrave-Marquart,D.,Bromley, S.P. &Dailey,M.B. (1997)"Personality,academic attribution, and substance abuse as predictors of academic achievement in college students".Journal of Social Behavior and Personality 12(2). 501-511. Karlin, N.J. and Bromley, S.P. (1996). Differences in caregivers of demented and lucid chronically ill family members. Journal of Alzheimer's Disease and Related Disorders and Research Retzlaff. P. and Bromley, S. (1994). Counseling personality disorders. In Ronch, J.L., VanOrnum. W. & Stillwell. N.C. (Eds)The counseling sourcebook: A practical reference on contemporary issues. New York: Crossroad Publishing group. pp.466-474. Bromley, S. and Hewitt, P. (1992). Fatal attraction: The sinister side of women's conflict about career and family. Journal of Popular Culture. 26(3), pp. 17-24. Retzlaff, P. and Bromley, S. (1991). "A Multi-Test Alcoholic Taxonomy: Canonical Coefficient Clusters" Journal of Clinical Psychology.47(2), pp. 299-309. Bromley, S.P. (1985). "Treatment of Pain: Theory and Research"in Zahourek, R. (Ed.). Clinical Hvpnosi:;and Therapeutic Suggestion. New York: Grune and Stratton. Reprinted in Zahourek, R. (Ed.) (1990). New York Bruner/Mazel, Inc., pp. 77-98.. EROFESSIONAL PRESENTATIONS --Jur/ed: Nickisson, J.W. and Bromley, S.P. (1999)"Hypnosis: Attitudes,knowledge and experience among psycho.ogy and nursing students". Accepted for a paper presentation at the American Psychological Association Convention, Boston. (August) Campbell, J. S_ Titus, J. and Bromley S. P. (1998). "Neuroanatomy teaching technique for introductory psychology students. Poster presented at the joint WPA/RMPA convention, Albuquerque, NM. (April) Bromley. S. (1997)(Chair)"Linking through honors programs: The cross-discipline course). Paper presentation as part of a symposium titled"Creating links between psychology and other disciplines"., American Psychological Association Convention. Chicago. (August) Bromley, S. , Gilliam D., &Johnson, T. (1995). "Assessment of student created tests as an evaluation n.elhod". Poster presented at the American Psychological Association Convention, New York City. (August) Bromley, S (1994). "Student created tests as an evaluation method". Poster presented at 16th Annual Na:loud Institute on the Teaching of Psychology, St. Petersburg, Florida. Karlin, N. and Bromley, S. (1992). " Similarities and differences for caregivers of demented and lucid chronically ill" Poster presented at the Rocky Mountain Psychology Association Convention, Boise, Idaho. (April Montoya, K.J. and Bromley, S. (Chair) (1992). " Changes in undergraduate counseling styles in an introductory counseling theories course". Paper presented at the Rocky Mountain Psychology Association Convention. Boise. Idaho (April) Bromley, S. (1992). " Connected learning methods to faciliate research understanding". Paper presentation as part of panel titled 'Teaching techniques in the social sciences", Western Social Science Association Convention, Denver, Colorado. (April) Bromley, S., Ramirez, S., and McCoy, 1. (1991). " Impact of a health psychology course on student health beliefs" Poster presented at the Rocky Mountain Psychology Association Convention,Denver, Colorado. (April) Karlin, N. and Bromley, S. (1991). " Support,burden and affect among caregiver of dementia and nondementi.i patients". Poster presented at the American Psychology Association, San Francisco, California. (August) Bosley, G. and Bromley, S. (1990). Post death ritual in a Colorado community. Paper presentation at the American Psychology Association, San Francisco, California. (August) Bromley, S (1990). "Husbands at Childbirth: Who Does It Help?" Paper presentation at Far West Popular Culture Association,Las Vegas, Nevada (January). Hewitt. P. and Bromley S. (1989). "Images of Work and Intimacy in'Turning Point'and'Fatal Attraction". Paper presentation National Convention of Popular Culture Association and American Culture Association, St. Louis Missouri. (Session Chair) Retzlaff,P.and Bromley, S. (1989). "The Basic Personality Inventory: Alcoh Sub-Group Identification". Poster session at the Joint Convention of the Rock Mountain Psychological Association and Western Psychological Association. Reno. Nevada. Bromley, S. (1988). "Our Culture Affects Our Pain." Paper presentation, National Convention of Popular Culture Association and American Culture Association, New Orleans, LA. (March). Bromley, S. (1987). "Husband-Assisted Autohypnosis for Labor and Delivery: A Clinical Model". Paper presented at Rocky Mountain Psychological Association, Albuquerque, New Mexico(April). Bromley, S. and Loy. P. (1987). "Politics of PMS". Paper presentation Association of Women Psychologists, Denver, Colorado(March). PROFESSIONAL PRESENTATIONS--Invited: Strongin,D. & Bromley, S. (1999). Student and faculty reactions to the introduction of a graduate ethics course In Miller, R. (Chair)Ethics in college teaching. Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins, CO(April) Bromley, S. (1999). Issues of religion and spirituality with therapists and clients. In S. Bromley(Chair)Religion and spirituality in research, practice and the classroom. Symposium conducted at the Rocky Mountain Psychological Association, Ft. Collins, Co(April) Bromley. S. (1998)Hypnosis, psychology and managed care. In S. Bromley(Chair)Complementary, nontraditional and indigenous healing practices. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Bromley, S. (1998). Complementary healing methods: A psychological and artistic exploration. In L. Wicl:erlgren (Chair). Interdisciplinary courses involving psychology: A sampler. Symposium conducted at the combined meetings of the Western and Rocky Mountain Psychological Associations, Albuquerque. (April) Handelsman, M.M., Bromley. S.P. &Davis, S.F. (1995). "Clinical Psychologist, Counseling Psychologist. Clinical Social Workder, or Psychology Professor: Which Degree is Right for Me?"Psi Chi invited panel presentation, Rocks Mountain Psychological Association. Boulder, CO(April). Bromley, S. (Co-Chair), Seibert,P. (Co-Chair),Knuckey, D., Bohlin,M.,Zaweski, C., Watson, D., Hamnion, U., West,K. &Robins, J. (1994). "Training the Teaching Assistant" Invited Panel Presentation, Rocky Mountain Psychological Association, Las Vegas, Nevada(April) Bromley, S. (1993). "Hypnosis in Dentistry."Presentation at Monthly Meeting of Weld County Dentistry Association, Greeley, Colorado(February). Bromley, S. (1993). "Learning about the author as a way to understand research." Presentation at "Teach ng'false Cut",CTUP Special Event. WPA/RMPA Convention.Phoenix. Arizona(April). Allen. M. and Bromley, S. (1993). Co-Chairs Two CTUP Special Event Sessions, "Teaching Take Out: Eppertences in Collaborative Learning", Western Psychological Association/Rocky Mountain Psychological Association Convention, Phoenix, Arizona (April). Bromley, S. (1993). Chair, Invited Symposium, "Psychological and Social Perspectives on Male Violence Against Women", Western Psychological Association/Rocky Mountain Psychological Association Convention, Phcenix Arizona (April). Bromley, S. (1992). "Enhancement of student research and writing skills in any course". CTUP Workshcp presented at the Rocky Mountain Psychology Association Convention. Boise, Idaho. (April) Bromley, S. and Karlin, N. (1992). "General and health locus of control of adult caregivers". Poster session at the UNC Research Forum, Greeley, Colorado. Bromley, S. (1992). Panel member in Mental Health Symposia for Victim Compensation Convention as pin of the Colorado Organization for Victim Assistance Conference. (Estes Park/October) Bolocofski, Bromley, Foster and Mean(1988). "Hypnosis: Research and Clinical Perspectives," symposium presentation, Colorado Psychological Association, Greeley(March). Bromley, S. (1986). "Pain: A Psychological Event". Presentor- 20th Annual Emotional Crisis Workshop University of Northern Colorado. Greeley, Colorado(July). LECTURES--Invited: Bromley. S. (1998) "Psychological methods of pain control' Invited lecture for the annual meeting of the \Velc County Arthritis Society. Bromley. S. (1998) "Hypnosis for pain control of arthritis" Invited lecture for"Brown Bag" lunch series sponsored In the Greeley Medical Clinic. Bromley, S (1998) "Headache Control -Psychological Methods". Invited lecture as part of a seminar titled"Coping with headache". Sponsored by the Greeley Medical Clinic. Bromley, S. & Ackerman J. (1998). "What to do to handle burnout" A workshop conducted for foster parents working with Weld County Social Services Bromley, S (1995). Keynote speaker for Golden Key Honor Society Induction Ceremony, University of Colorado, Boulder. Co. (November) Bromley, S. (1902). Keynote speaker for Sophomore Honor Society Induction Ceremony. Bromley. S. (1991)Featured speaker. UNC Acadmic Honors Convocation. (April) Bromley, S. (1991).. Banquet speaker Emotional Crisis Workshop, Greeley, Colorado. (July) GRANTS: Bromley, S( 1994)Honors Grant($500)to attend research training at the Society for Clinical Hypnosis meeting. San Francisco(October) Bromley, S. (1994). Research and Publications award of$1500.00. "Assessment protocols to measure the efficacy of hypnotic treatment for injured workers. Karlin,N. and Bromley, S. (1990). Research and Publications award of$2,4440.00. "Control, support,burd_n and affect differences among dementia and non-dementia caregivers". B�+)K/GRANT REVIEWS: Grant review for Boise State Department of Education(1995) Review of Santrock. J. (1991). The science of mind and behavior. W.C. Brown and Benchmark. Review of McKee. P. et Thiem. J. (1993). Real life; Ten stories of aging. University of Colorado Press. PROFESSIONAL CONSULTATION/PRACTICE: trSil Institution/Organization Role 1996-presnt Ackerman and Associates Clinical Psychologist 1988 Bonnet Good Samaritan Center Pain Management Consultant and Mailer 1984-85 Denver Metropolitan Dental Care Consultant in Pain Management 1984 Iowa Association of Registered Physical Therapists Hypnosis for Pain Management Consultant And Teacher PROFESSIONAL ASSOCIATION PARTICIPATION: Membership 198o-present Rocky Mountain Psychological Association 1988-present American Psychological Association(Divisions 2, 30, 35) 19'89-present Greeley Area Mental Health Network 1987-88 Association of Women in Psychology 19'80-89 Colorado Psychological Association 1988 CPA Program Committee Member for Spring Meeting--Greeley Coordinator SERVICE: EXTERNAL: NATIONAL SERVICE: 1994-present Rocky Mountain Coordinator-American Psychological Association, Division 2 - Teachi tg of Psychology 1992!14 Co-Chair, Rocky Mountain Region Council of Teachers of Undergraduate Psychology (CTUP) 1991-94 Mountain States Regional Academic Coordinator, Golden Key National Honor Society REGIONAL/STATE SERVICE: 1999 -Moderator for Stanley G. Hall Lecturer-Viney. W. (1999). A larger canopy for psychology: Unifying themes and pragmatic empiricism. Presented at the Rock}-Mountain Psychological Association Convention, It Collins, CO(April) 1989- present Rocky Mountain Psychology Association 1998-1999 Ex-Officio Board Member As Division 2 Coordinator 1992-1998 Board Member 1995- 1998 Elected Chair, Groups Under-Represented in Psychology Committee 1992-94 Co-Chair, Groups Under-Represented in Psychology Committee 1991 Coordinator of Student Volunteers. RMPA Convention, Denver Colorado 1995 Psychology Chair-CCHE Faculty to Faculty Conference(October) COMMUNITY SERVICE: 1998 Member, Weld County Medical Society Commitee on Alternative and Complementary Healing 1997-1998 UNC Loaned Executive-United Way of Weld County 1991- 1996 Board Member. 19th Judicial District Victim Compensation Board 1995-96 Chair 1990-93 Board Member.Weld County Area Agency on Aging 1992-93 Chair 1991-92 Vice-Chair 1986-Present Exam Supervisor- American Institute for Property and Liability Undenvriters/Insurance !nstitute of America 1987-present Clinical Psychologist -pro-bono work with individual clients and community training Ir;l ERNAL' DEPARTMENTAL: 1993-present Member, Department Executive Committee 1985-88. 1995-present Co-Advisor Psi Chi National Honor Society 1't96-1999 Guest lecturer for Psi Chi Grad Night on getting into clinical/counseling grad programs 1989-91,93, 95-present Department Representative, CCHE Faculty to Faculty Conference 1987 - 94 Department Representative to graduation ceremonies 1986-94 Library Representative 1)83, 86 89, 90-93,97,98 Member. Faculty Search and Screen Committee 1'790-92 Member, Psychology Department Undergraduate Committee(Chair 1992) 1487-88 Co-Coordinator Semester Conversion Committee COLLEGE: 1992,93,96.97 Member of faculty invited to teach in the Cluster Program 1990-93 Graduation Marshall, Arts& Sciences 1988-89 Member, Arts and Sciences Teacher Education Committee 1986-89 Chair, Interdisciplinary Committee to develop and revise Human Development Major in the College of Arts and Sciences and Psychology Department UNIVERSITY: 1992-94 1996-Present Member-Research and Publications Board 1993-94 Chair-Elect 1988-present Founding Co-Advisor, Golden Key Honor Society 1992-95 Member-UNC Women's Commission 1992-94 Co-Chair- Assessment Task Force 989-90 Faculty Representative. Student Fee Allocation Committee .986-89 Member.Faculty Senate 1988-89 Secretary 1987-88 Vice-Chair 1986-87 At-Large Member. Executive Committee 1986-89 Member, Academic Policies Committee 1986-87 Member. Elections Committee 1988 Representative, Western States Faculty Leadership Conference, Reno 1988 Senate Representative. Statewide Commission Advisor' Committee 1988 Advisor. In-Touch Hclplinc 1985-86 Volunteer Therapist, UNC Counseling Center C GRADUATE STUDENT COMMITTEES--Doctoral: 1998 Committee Member, Shu-Shin Lu, Professional Psychology 1997-prsnt Committee Member, Christine Rogers, Professional Psychology 1995-1997 Committee Member, Lisa Ing, Special Education 1994-pres Committee Member,Marla Gallagher, Educational Psychology 1993 Committee Member,Hsiu-Lan Ma, Science Ed. -Oral Comprehensives 1993 Committee Member, Jerry Buford, School Psychology, "Treatment of depressive symptoms o1 early adolescents". 199'1-1998 Committee Member. Pat Flanagan, CSPA, Orals, "A comparison of attitudes and practices of teaching faculty regarding student academic dishonesty at a two year and four year institution 1991 Committee Member, Mike Propriano, School Psychology 1990-94 Committee Member, Paul Jantz, School Psychology, 1989 Committee Member.Mike Peters, Vocational Rehabilitation . "The Effectiveness of Vocational Evaluation for Various Disabling Conditions 1987 Committee Member, Ane Marie Kajenckii, English, "The Concept of Free Association in Virzi nia Woolf The Waves" 19'36 Committee Member. Fuming Liao, Mechanical Kinesiology. "Development and Validation of Method for Providing Immediate Feedback Information on Speed and Angle of Release in Shotputting" GRADUATE STUDENT COMMJI ILES --A fasters: 19't8 Vanessa Ewing, Committee Member 1997 Stephanie Blasi, Committee Member 1997 John Nickisson. Chair 1994 David Watson, Committee Member 1994 Tiernan Mcllwaine, Committee Member 1994 Jerrod McCoy, Committee Member 1993 Sheldine Runyan, Committee Member 19'l3 Sue Cole, Committee Chair, "Influences on Occupational Goals of Selected Male and Female Ccllegc Students". 1990 Jerry Benner, Committee Member 19'lt1 !Curtis Armstrong, Committee Member. "Attitudinal Consequences of Pre-Employment and Random Employee Drug Testing" 1989 Michelle Hozer.Committee Member 1989 Anne Schnittgrund, Committee Chair, " Age and Electrothermal Biofeedback Training". 1988 Cherri Hocken, Committee Member. "The Effects of Turnover on Those Who Remain in an Organization" 19X8 Tony Ambrosio. Committee Member. "The Belief in a Just-World and the AIDS Epidemic Predictors of Altitudes Towards Individuals with AIDS" 1988 Steve Foster, Committee Chair, "Hypnotic Susceptibility As a Function of Locus of Control and Director Indirect Inductional Deepening and Suggestion Style" 19"38 Lisa Dillon. Committee Chair. "Cognitive-Behavioral Approach to the Treatment of Elderly Rheumatoid Arthritis Subjects" 1987 Deanna Holmes, Committee Member 19^t7 Darlene Nold, Committee Member, "Reading and Writing Assessment Tests as Predictors of Success in the Basic Peace officer Academy at Aims Community, College" 19'87 Dan May, Committee Member 19'.8 ' Jeff Schiels. Committee Member. "The Reformulated Hypothesis: Is Its dominator of Learned Helplessness Literature Justifiable?" 19: 4 Linda Coulthard-Morris. Committee Member. "Biofeedback of Cortical Slow Wave Potentials_ Hand Temperature and Muscle Tension in Normal and Attention Deficit Disorder with Hyperactivity Children" TEACHING: HHnors Activities 1999 UNC Research Day, Faculty Panel Coordinator, " Complementary Healing Methods" 1999 Thesis Coordinator-Kristin Pietryzick, Jennifer ICimberling, Cristine Dickey 1997 Thesis Co-Advisor Kelly Kinser 1997 Honors Connection Course development-Alternative Healing Methods 1996-pres Honors Co-Coordinator,Psychology Department 1989-94 Honors Coordinator, Psychology Department 1994 Thesis Co-Advisor, Diane Musgrave, "The Relationships Among Personality Traits, Alcohol, Caffeine. and Nicotine Consumption, and Academic Performance in College Students" 1994 UNC Researh Day,Faculty Panel Coordinator,"Hypnosis: Theory and Research" 1993 UNC Research Day,Faculty Panel Coordinator, "Non-traditional Theories of Therapy Serving Women and Minorities". 1991 Thesis Co-Advisor,Linda Norman, "Clozapine and Event Related Brain Potentials in Schizophrenics" 1992 Thesis Advisor, Deborah Knuckey, "The Effect of Touch on AffectAmong Strangers Under Mildly Stressful Conditions" 1992 UNC Research Day, Faculty Panel Coordinator 1992 UNC Research Day, Faculty Panel Coordinator(2 student panels)"Sex Roles and Psychology", The Power of Social Influence 1989 Thesis Advisor, Geri Bosley, "Post Death Ritual in a Small Colorado Community" 1988 Thesis Advisor, Pam Clasen, "The Use of Relaxation and Imagery Techniques in Pain Management" 1989 Honors Connection Course Development Courses Taught' (1-4 Scale with 1 as Highest) (*I-5 Scale with 5 as highest) DATE COURSE TITLE HRS ENR AVG.RA TIN G W 198 8 PSY 101 IntroSeminar Psychology 1 43 — 1V 1987 PSY 101 IntroSeminar Psychology 1 16 1.12 W 1986 PSY 101 IntroSeminar Psychology 1 32 1.24 F 1997 PSY 120 Principles of Psychology 4 107 3.76 F 1996 PSY 120 Principles of Psychology 4 139 F 1993 PSY 120 Principles of Psychology 4 119 1.64 F 1991 PSY 120 Principles of Psychology 4 161 1.67 F 1983 PSY 120 General Psychology 3 42 ---- Sp 1984 PSY 121 Intro to Psychology I 4 40 ---- Sum 1988 PSY 230 Human Growth &Development 5 55 ---- Sp 1988 PSY 230 Human Growth &Development 5 60 1.58 W 1988 PSY 210 Human Growth &Development 5 90 1.38 F 1987 PSY 230 Human Growth &Dcvclopmcnt 5 45 1.54 W 1987 PSY 230 Human Growth &Development 5 75 1.54 Sp 1987 PSY 230 Human Growth &Dcvclopmcnt 5 90 -- Sum 1986 PSY 210 Human Growth & Development 5 47 -- F 1986 PSY 230 Human Growth &Development 5 80 1.36 W 1986 PSY 230 Human Growth &Development 5 80 1.42 W 1986 PSY 230 Human Growth &Dcvclopmcnt 5 52 1.27 F 1985 PSY 230 Human Growth &Development 5 56 1 53 F 1985 PSY 230 Human Growth &Dcvclopmcnt 5 85 156 Sp 1984 PSY 265 Social Psychology 3 26 ---- NV 1984 PSY 265 Social Psychology 3 23 ---- Sp 1998 PSY 171 Health Psychology 3 40 4.11 F 1998 PSY 323 Health Psychology 3 39 4.08 Sp 1997 PSY 311 Health Psychology 3 44 4.37 S F 1995 PSY 323 Health Psychology 3 47 Sp 1994 PSY 323 Health Psychology 3 41 1.69 F 1992 PSY 323 Health Psychology 3 49 Sp 1992 PSY 423 Health Psychology 3 42 1.69 F 1990 PSY 423 Health Psychology 3 1.66 F 1988 PSY 423 Health Psychology 3 35 1.36 Sp 1986 PSY 330 Child&Adolescent Psych 3 27 1 4 Sp 1993 PSY 331 Maturity& Aging 3 40 Sp 1991 PSY 331 Maturity &Aging 3 46 1 62 F 1989 PSY 331 Maturity & Aging 3 23 1.45 F 1988 PSY 331 Maturity & Aging 3 27 1 40 Sp 1988 PSY 430 Maturity&Aging 3 44 1.58 Sp 1987 PSY 430 Maturity& Aging 3 34 -- Sp 1986 PSY 430 Maturity& Aging 3 36 1.52 F 1998 PSY 455 Abnormal Psychology 3 49 4 24 Sp 1997 PSY 455 Abnormal Psychology 3 49 4.03 F 1995 PSY 455 Abnormal Psychology 3 32 Sp 1993 PSY 355 Abnormal Psychology 3 37 Sp 1992 PSY 355 Abnormal Psychology 3 42 1.26 Sp 1991 PSY 355 Abnormal Psychology 3 37 1.37 F 1990 PSY 355 Abnormal Psychology 3 1 46 Su 1990 PSY 355 Abnormal Psychology 3 31 Sp 1990 PSY 355 Abnormal Psychology 3 37 138 Sp 1990 PSY 355 Abnormal Psychology 3 42 1.53 Sr) 1989 PSY 355 Abnormal Psychology 3 78 1.51 Sp 1986 PSY 358 Abnormal Psychology 3 41 1.54 W 1984 PSY 358 Abnormal Psychology 3 31 S 1998 PSY 350 Theories of Personality 3 20 4.10 Su 1990 PSY 357 Theories of Personality 3 21 1 45 W 1988 PSY 357 Theories of Personality 3 40 1.57 F 1987 PSY 357 Theories of Personality 3 55 1.38 W 1987 PSY 357 Theories of Personality 3 37 1.33 F 1986 PSY 357 Theories of Personality 3 54 -- F 1983 PSY 357 Theories of Personality 3 51 F 1998 PSY 407 Intro to Counseling Theories 3 20 4.31 Sp 1998 PSY 407 Intro to Counseling Theories 3 20 4 42 F 1997 PSY 407 Intro to Counseling Theories 3 15 4.71 F 1996 PSY 407 Intro to Counseling Theories 3 19 F 1995 PSY 407 Intro to Counseling Theories 3 19 sr, 1994 PSY 407 Intro to Counseling Theories 3 F 1993 PSY 407 Intro to Counseling Theories 3 24 132 Sp 1993 PSY 407 Intro to Counseling Theories 3 22 F 1992 PSY 407 Intro to Counseling Theories 3 25 1.18 Sp 1992 PSY 407 Intro to Counseling Theories 3 22 1.21 F 1991 PSY 407 Intro to Counseling Theories 3 44 1 26 Sp 1991 PSY 407 Intro to Counseling Theories 3 33 1.21 F 1990 PSY 407 Intro to Counseling Theories 3 Sp 1990 PSY 407 Intro to Counseling Theories 3 16 1 12 F 1989 PSY 407 Intro to Counseling Theories 3 24 130 Si 1989 PSY 407 Intro to Counseling Theories 3 18 1 31 F 1987 PSY 407 Intro to Counseling Theories 3 26 121 F 1986 PSY 407 Intro to Counseling Theories 3 41 1.57 Sim 1987 PSY 499 Psychology of Sex Roles 3 16 1 18 Sint 1989 PSY 508 Emotional Crisis Workshop 1-2 39 *** "Frontiers of Mental Health ,1 And Education" Sum 1988 PSY 508 Emotional Crisis Workshop 2-3 63 "_MindBody Interactions" Sum 1987 PSY 508 Emotional Crisis Workshop 2-3 106 "Relationships" Sum 1991 PSY 595 Health Psychology 3 15 Sp 1998 PSY 620 Assessment &Interviewing 2 9 4 31 f' 1992 PSY 620 Assessment& Interviewing 2 12 1.66 F 1990 PSY 620 Assessment & interviewing 2 1 02 f' 1988 PSY 620 Issues in Behavioral Medicine 3 5 2.08 f' 1997 PSY 621 Practicum College Teaching 2 10 4 77 1996 PSY 621 Practicum College Teaching 2 10 F' 1993 PSY 621 Practicum College Teaching 2 13 145 f' 1992 PSY 621 Practicum College Teaching 2 13 t1' 1984 PPSY 670 Tests and Measurements 3 20 f 1997 HON 200 Honors Connections Seminar: Alternative Healing Methods 2 20 3 67 of 4 Sp 1989 HON 200 Honors Connection Seminar IL 2 9 *** "Love" Sum 1986 Elderhostel "Dream On" NC (25) Scum 1987 Elderhostel "Mind/Body Interactions" NC 19 *** S'ourses Developed: 1997 HON 200.Alternative Healing Methods 1991- PSY 595,Issues in Health Psychology, Sumner 1989- 23rd Annual Emotional Crisis Workshop. Frontiers of Mental Health and Education. Summer 1988- PSY 620. Assessment in Behavioral Medicine, Fall (Revised Spring 1998) 1988- PSY 423. Health Psychology. Fall 1988- 22nd Annual Emotional Crisis Workshop, Mind/Body Interactions, Summer 1987- 21st Annual Emotional Crisis Workshop. Relationships. Summer 1987- Mind/Body Interactions - Elderhostel Program, Summer 1987- PSY 499. Psychology of Sex Roles - Summer 1986- Dream On -Elderhostel, Summer Directed Studies' Graduate 1995- Cynthia Holley. Hypnosis 1994 - Tara Johnson. Hypnosis Theory and Practice 1994 - Marla Gallagher. Sociometric Processes 1994 - Marla Gallagher, Cluster Development in Intro Psychology Classes 1992 - Bruce Holoman. Hypnosis Research and Practice 1988 - Paul Jantz. Hypnosis for Pain With Children 1 988 - Lori Kochevar. Women as Leaders 1988 - Jeri Israel. Alan Shaw, Issues in Health Psychology I a88 - Steve Foster. Michele Hozer Teaching Apprenticeship 1287 - Tony Ambrosio, Hypnosis Models 1986 - Candy Disch. Psychological Testing Undergraduate' l'•)98 Jennifer Altman - Exercise and Psychology 1996- Kindra Sanchez -Biracial Identity 1996 - Jenna Weatherbee -Pain Coping Styles 1995- Allison Ellis -Psychological Theories in Business Management 1905 - Holli Elrick. Counseling and the Hearing-Impaired Child 1994 - Lewis Garza, Etiology of Schizophrenia In 1994 - Suzanne Bodetko, Aulogenic Training 1994- Rebecca Furstenberg, Impact of Alzheimer's Disease on Families 1994 - Bonnie Sarton,Hypervigilence in Youth (Hon 351) 1993 - Mary Jo Hamilton, Hypnosis Theory 1994 - Greg Schooley,Forgiveness as a Therapy Tool 1993 - Jason DeBueno, Youth Advocacy 1993 - Kelley Ferguson-Women in Psychology 1993 - David Rosenberg -Offender Programs 1992 - Robin Trostel, Analysis of Learning Styles 19'92 - Robin Trostel. Health Locus of Control 1992 - Roberta Inman,Family Violence and Lesbians (Hon 351) 1991 - Mark Kahl, Back Pain 1991 - Tracy Moulton,Treatment of Sexual Abuse 1991 - Alice McPherson. African American Women and Higher Education 1901 - Jody Hurner, Hypnosis: Theory and Practice 1990 - Jimmie Berg. Women's Learning Styles 1989 - Elary Violett, Cognition and Pain Management 1989 - Geri Bosley. Chris Snodgrass,Bev Foster.Elary Violett. Issues in Personality 1989 - Penny Vaughn, Female Pioneers in Social Work 1989 - Lori Peterson.Pain and the Elderly 1988 - Peer Training for Hotline Service 1987- Tracy Boh, Issues in Child Abuse 1'87- Julie Stoddard, Grief and Divorce 1987 - Eric Bouch. Hypnosis Models 1987 - Mike Lesser, Assessment in Sport Psychology 1986 - Lynne Sheffield. Childhood and Loss 1986 - Jennifer March, Adolescence Practica 1')98- Andrea Lamb-Hypnosis and golf performance 1998- Rebecca Varoula- Women's Place 1')98: Greeley Medical Clinic -Gay Lemons,Renae Smith 1'198- Ackerman and Associates- Amy Minnie!, Kristin Pietrzyk,Jennifer Kimberling, Greg Pedersen 1')97- Greeley Medical Clinic-Lori Darst,Barbara Glode, Ann Marie McCullen, Jeff Titus 1993 - Greg Schooley,Breavement Research 1'193 - Dt Smice, Women's Commission 1992 - Mary Jo Hamilton, Hypnosis Research 1'992 - Carol Sexton. Psychology Testing 1992 - Lisa Schlott. Learning Styles PROFESSIONAL DEVELOPMENT ACTIVITIES: Workshops.Clinics_Symiposia. Comferences: (Excluding Conferences as a Presentor) 1999- EMDR training and Level 1 certification 1998 Qualitative research lecture series -UNC 1998- Lewis M. Ternan Western Regional Teacher's Conference sponsored by APA Division2 in conjunction with the WPA/RMPA joint convention. 1 998- "Spirituality and health in counseling", CAHEC Workshop, Greeley, 1 998- 'Divorce Busting: Solution oriented brief therapy with couples". Colorado Assoc. Marriage and Family 1997 - Health Maintenance -Legal and Ethical Issues 1997- Body and Soul: Healing in the 90's 1096- Celebrating our Essence: Women's Health and Spirituality 1995 - International Society for Clinical and Experimental Hypnosis -Research Workshop. San Francisco.( A (30 more hours toward certification) 1989 - "Minding the Body. Mending the Mind". CAHEC Workshop. Ft. Collins 11 1988 - "Demystifying Publishing". CAHEC Workshop. NCMC. Greeley 1985 - "Attentional Deficit Disorders in Children",Meichenbaum, Denver 1980- International Society for Clinical and Experimental Hypnosis -30 certification hours. Denver Numerous other workshops on Parent Loss, Child Abuse, Grantsmanship, Short-Term Treatment, Supetv sion. Pain Management.Medical Terminology. Depression, Personality Disorders collfSes Taken C'redi c 1994- EPRE 603 - Analysis of Variance udir: 1993 - EPRE 602 -Elements of Statistics 1990- EPRE 700 - Advanced Research Methods Continuing Education Credit: 1976- C.U. Medical School -Medical Ethics 1972 - C.U. School of Nursing -Hypnosis(10 weeks) 1969 - University of Chicago -Kubler-Ross. Death and Dying I1ONORS AND AWARDS: 1998- Distinguished Service Award-Rocky Mouintain Psychological Association 1998- Arts and Sciences Teacher of the Year Award-one of thre in Social Sciences 1998- "Wonderful Outstanding Woman" Award-Highlighted in October newsletter- Women's Resource Center 1993 - Commencement Banner Carrier. Arts and Sciences 1993, 91,89, 88 -Mortar Board Favorite Professor 1992 - Sudent Representative Council University Professor of the Year 199? - Student Representative Council University Advisor of the Year 1989 - Arts and Sciences Achievement Award 1988 - Honors Advisor of the Year 1984 - Psi Chi. University of Northern Colorado Chapter 1982-83 - Writing Associateship-Rocky Mountain Women's Institute 1' bk 6'6`. F=:i, 10:1 651-551a 9/28/99 CURRICULUM VITAE N. Karen Bender, MA, LPC 1104 Twin Peaks Circle Longmont, Colorado 80503 Phone: 303-678-8940 BUSINESS ADDRESS: 2919 W. 17th Ave.. Suite 214 Longmont, Colorado 80503 Phone: 303-678-0268 MARRIED: Brice J. Bender, MD, April 26, 1974 CHILDREN: Sara C Bender, born 3/13/79 and Melissa K. Bender, born 9/8/80 EDUCATION: Bachelor of Arts, Chemistry University of Colorado at Denver, 1977 Master of Arts in Agency Counseling, Emphasis in Marriage and Family University of Northern Colorado, 1993 Externship: Mental Health Center of Boulder County, Longmont Branch, Community Support Services Team, Sept. '92 to June '93 Currently enrolled in Professional Psychology Doctoral Program University of Northern Colorado (course work nearly completed) WORK EXPERIENCE: Feb. '94 to present Private practice, Individual adult clients and couples, Longmont. Fall '95: Counselor and presenter in multidisciplinary PMS program. Longmont Clinic. March '95 to May '96: Domestic Violence Counselor, Longmont Coalition for Women in Crisis, Individual adult clients; women's groups: domestic v!olence curriculum, support, and parenting. June '93 to Sept. '93: Therapist, Mental Health Center of Boulder County, Longmont Branch, Women's Issues Group. Sept. '84-Dec. '86: Cardiopulmonary Technologist, part-time Longmont United Hospital, 1950 W. Mountain View Ave., Longmont, Colorado 80501. June '79-April '82: Supervisor, Pulmonary Laboratory, Presbyterian/St. Luke's Medical Center, 601 E. 19th Ave., Denver, CO 80203 Jan. '76-June '79: Supervisor, Pulmonary Laboratory, St. Joseph Hospital, 1835 Franklin St., Denver, CO 80206 1975-1979 Clinical Instructor, Front Range Community College, 3645 W. 112th Ave.. Westminster, CO 80030. VOLUNTEER EXPERIENCE Sept '98 to Sept. '99: Doctoral Student Representative. Division of Professional Psychology. University of Northern Colorado. Sept '94 to Mar. '95: Volunteer therapist: Longmont Coalition for Women in Crisis. Individuals and groups: domestic violence curriculum and parenting. Jan. '94 to July '95: Volunteer therapist: St. Vrain Valley Child Development Council, Inc., Head Start Program. Individuals, families, parent support groups that include parenting curriculum. June '93 to Aug. '93: Volunteer Co-therapist Mental Health Center of Boulder County. Drug Treatment Team, Women's Group: History of Sexual and Drug Abuse. Co-therapist: Lisa Franseen. June '93 to July '93: Volunteer Co-therapist: Mental Health Center of Boulder County, Longmont Branch. Children's group: Attention Deficit Disorder. Co- therapists: John Fallon, MSW, and John Gerson, Ph.D. Nov. '91 to May '92: Volunteer individual counselor: University of Northern Colorado Counseling Center Feb. 1991 to Feb. 1992: Master's Student Representative, Division of Professional Psychology, University of Northern Colorado. Sept. '91 to Oct. '91: Volunteer Counselor: A Woman's Place, Greeley, Co 1990 to 1992: Scholarship Committee for American Association of University Women. 1990-1991: Member Board of Directors for Longmont Coalition for Women in Crisis. PROFESSIONAL ORGANIZATIONS: Co-chairman, Public Relations, Information and Education Committee, Child and Family Advocacy learn (Boulder County Child Sexual Abuse Task Force), June '95 to August '97. Facilitator, Longmont Study Group, Colorado Society for the Study of Dissociation, May '95 to August '97. p. _c __ li:LL Bic, BEN. FFi: 3©3-651—S51.7 Member: American Counseling Association, Colorado Counseling Association, and Eating Disorders Professionals of Colorado. Associate Member: American Psychological Association. PUBLICATIONS: N. Karen Estridge Bender Slonim, N. B., & Estridge, N. K. (1969). Ozone —An underestimated environmental hazard. Journal of Environmental Health, 31, 577. Slonim, N. B., & Estridge, N. K. (1970). The add-base surface --- A 3- dimensional visual model. Rocky Mountain Medical Journal, 67, 59. Slonim, N. B., & Estridge, N. K. (1970). Carbon dioxide --- Environmental health aspects. Journal of Environmental Health, 33,171. Slonim, N. B., & Estridge, N. K. (1970). The acid-base surface: A three- dimensional visual model for analysis of acid-base information. Journal of Medical Education. 45, 828. Slonim, N.B., & Estridge, N. K. (1971). Carbon dioxide ---Environmental health aspects. In T. J. DeKornfeld (Ed ). gelggcted papers in inhalation therapy. Flushing, NY: Medical Examination Publishing. Co.. Inc. Slonim, N. B., & Bender, N. K. (1974). Responses to carbon dioxide containing atmospheres. In N. B Slonim (Ed.). Environmental physiology. St. Louis: The C. V. Mosby Co. Slonim, N. B., & Bender, N. K. (1976). A tabular history: Cardiopulmonary technology as a profession. CVP, The Journal of Cardiovascular and Pulmonary Technology , 4, 31. Bender. N. K (1977). Relevant respiratory physiology. The post-surgical patient, Spirometry. In V. Archuleta, O. B. Plummer, and K. D. Hopkins, A demonstration model for the project"Training nurses to improve_patient education, Boulder, Colo.: Western Interstate Commission for Higher Education. Bender, N. K. (1986). Future trends in education, SVVEA Bridge, 3, 5 (St. Vrain Valley Education Association) PRESENTATIONS: Fall '95: Co-presenter with Haven Howell, M.O., multidisciplinary PMS program, Longmont Clinic. October '98: Co-presenter with Sean O'Halloran and Christine Rogers: A Roundtable discussion entitled: "Facing our Clients' Trauma: Implications foi Counselors in Training," at Rocky Mountain Association for Counselor Educat on and Supervision. • RESUME Emily L.Jaramillo-Bansberg 183 50th Avenue Place Greeley,Colorado 80634 (970) 353-1388 Office Telephone: (970) 351-2417/Email: ejaramil@che.unco.edu EDUCATION • Master of Arts: Psychology/Counseling, University of Northern Colorado,Greeley, CO • Graduate Fellowship Study: Rutgers State University of New Jersey, Newark, NJ • Bachelor of Arts: Sociology, University of Northern Colorado, Greeley, CO EMPLOYMENT Associate Director The(.enter for Human Enrichment University of Northern Colorado, Center for Human Enrichment, Greeley, CO 80639 August 1997-Present Ensure efficient administration of the Student Support Services TRIO project which includes curricul im and instrcction, technology,advising,and tutoring. Review the non-competing continuation and annual Lerformance reports. Assist with the provision of professional opportunities for Center employees. Oversee the state funded Bridging Opportunities Program that focuses on recruiting incoming freshmen and transfer sh'cents into the C:rater for Human Enrichment. Direct the Ronald E. McNair Postbaccalaureate Achievement Pr 'grain (see below). Director Ronald E. McNair Postbaccalaureate Achievement Program University of Northern Colorado, Center for Human Enrichment, Greeley, CO 80639 March 1996-Current Direc all efforts to ensure efficient administration of the McNair federal TRIO grant. Co-author l I.S. Department of Education McNair proposal. Responsible for the compilation, analyzation, and submission of Non-Competing Continuation and Annual Performance Reports to the Department of Education. Mtetitot project's federal and matching budgets, supervise and train staff members, and plan, develop, and direct all student scholar activities. Collaborate with campus departments in order to exceed program objectives Responsible for coordinating, editing, and publishing the UNC McNair Scholars Journal. Identify, r_,n,it, and select program scholars. Ensure the completion of scholars' academic research projects. Provide acac emic advising and guidance to McNair scholars. Direct the academic year research seminar series, the r sidential Summer Research Internship, and other scholarly activities that prepare scholars for doctoral stud Coordinate research and scholarly activities between faculty mentors and McNair scholars. Counselor/Assistant Director Ronald E. McNair Postbaccalaureate Achievement Program University of Northern Colorado, Center for Human Enrichment, Greeley, CO 80639 October 1995- February 1996 Assis i,ed in the implementation of the McNair program (funded October 1995). Facilitated the recruitment and selection of McNair scholars. Compiled and submitted federal reports. Informed and collaborated with campus offices and departments. Implemented an academic workshop series based on student needs. Provided academic advisement and guidance to McNair scholars. Assistant Coordinator,Academic Advising Student Support Services University of Northern Colorado, Center for Human Enrichment,Greeley, CO January 1995-August 1995 Provided academic advisement and guidance to federal TRIO Student Support Service participants. Maintained student record database. Assisted with the compilation of federal reports. Served as liaison to the athletic department and the financial aid office. Assisted in the supervision of peer advisors. Prodded technological assistance within the program. Assistant Coordinator,Macintosh Computer Laboratory Student Support Services University of Northern Colorado,Center for Human Enrichment, Greeley, CO 80639 August 1994-December 1994 Supervised, scheduled, evaluated, and trained lab employees. Provided technical assistance and advisement to federal TRIO Student Support Service participants in a learning environment. Maintained and ordered consumable computer supplies. Evaluated and ordered computer software and hardware. RELATED EXPERIENCE Admissions Office Assistant University of Northern Colorado, Admissions Office, Greeley, CO December 1985-December 1988 Assisted in the daily operations of the UNC Admissions Office. Received and reviewed applications and distributed accordingly. Filed, typed, and performed data-entry on all incoming freshman, transfer. re-entry, and non-traditional students. Trained and supervised co-workstudy employees on office procedures, FcRPA, and the CCHE Index system. Provided general information to incoming students and parents. Co-Instructor University of Northern Colorado, Center for Human Enrichment CSPA 359: Paraprofessionals in Student Affairs, Academic Peer Advisors Co-facilitated the instruction for training of peer advisors who advised Student Support Service participants at the Center for Human Enrichment. Coordinated curriculum and instruction for pre-service and on-going training for a staff of fifteen peer advisors. Counselor Intern North Colorado Medical Center, Family Recovery Center, Greeley, CO January 1996-July 1996 Facilitated psychotherapy counseling groups and individual counseling for chemically dependent and eating disorder patients. Performed case management from admission to discharge. Presented psycho-educational information to patients, family members, and staff. Designed a portfolio brochure distributed to heal'h care and managed care providers. Clinical Care Assistant Weld Mental Health Center, Greeley, CO September 1994- February 1995 Monitored and supervised the daily activities of chronically mentally ill patients in a learning/self- development environment. Facilitated group and individual counseling sessions. Coordinated patient recreational activities. Prepared written and oral reports. Correction Technician The Resl:itution Center, Greeley, CO February 1989- February 1990 Conducted informal counseling with non-violent felony offenders in a residential setting. Responsib e for the supervision of clients. Distributed client medications as prescribed. Performed searches and confiscated contraband. Prepared written and oral reports. Instructed clients on self-development and new life approaches as alternative methods of coping. PRESENTATIONS • Moderator: "Research & Policy Affecting the Education of the Mexican Child in the 21st Century," University of Northern Colorado. • Moderator: Second Annual McNair Scholars Research Symposium and Graduate Education Conference. • Panelist: Minority Students in Graduate School, Colorado State University. • Presenter: Financing a Graduate Education, Applying to Graduate School, Cultural Sensitivity and Awareness, Hispanic Women in Higher Education, Introduction to the Internet, and Communicating Across Cultures, University of Northern Colorado. • Presenter: Conflict Resolution, Communication Skills, and Setting Limits and Boundaries, North Colorado Medical Center. CAMPUS SERVICE: University of Northern Colorado Officer • Professional and Administrative Staff Council (President's Office) • Co-chairperson, Student Advisory Committee, Hispanic Cultural Center • Secretary, Macintosh Computing Society Member • Undergraduate Research Council • Cesar Chavez Cultural Center Cinco de Mayo Week Committee • Professional Development Award/Scholarship Committee • Relations with UNC Board of Trustees Committee • Salary Equity Committee • Exempt Staff Evaluation and Performance Committee • Tcam UNC Fund Raising Committee • Academic Excellence Week Task Force • Campus Advisory Committee, Cesar Chavez Cultural Center Other • Reviewer/Evaluator for "UNC Works In Progress"conference. • Submitted and published an article in the International Student Services' newsletter entitled, Communicating Across Cultures. PROFESSIONAL AFFILIATIONS • ASPIRE member (Association of Special Programs In Region Eight) • CABE member (Colorado Association of Bilingual Education) • NCEOA member (National Council of Educational Opportunity Associations) HONORS AND AWARDS • Distinguished Alumni, Department of Sociology, University of Northern Colorado • Fellowship, Graduate Study-Rutgers School of Criminal Justice Fellowship, Rutgers State Unkersty of New Jersey, Newark, NJ • Scholarship, National Hispanic Scholarship Fund • Scholarship, Candelaria Scholarship, University of Northern Colorado, Greeley, CO PROFESSIONAL DEVELOPMENT AND TRAINING • National McNair Scholars Research Symposium-6th Annual, Penn State, College Park, PA. • National Council of Educational Opportunities Association (NCEOA) Proposal Writing Conference, San Francisco, CA. • Reporting Student and Project Performance, Monterey Bay,CA. • First, Second, and Third Annual Rocky Mountain McNair Scholars Research Symposium Sr Graduate Education Conference, Fort Collins,CO. • NCEOA 16th and 17th Annual Policy Seminar, Washington, DC. • NCEOA, Seminar on Relations with the U.S. Department of Education, Washington, DC. • NCEOA Proposal Writing Conference,San Juan,Puerto Rico. • Association of Special Programs in Region Eight (ASPIRE) Colorado Chapter, 1995-1998 State Meetings, Denver, Ft. Collins, CO. • Annual Rocky Mountain Teacher Education Consortium Conference,Greeley,CO. • Diverse Learners Academy, Leadville and Pueblo, CO. • National McNair Scholars Research Symposium, University of California, Irvine, CA. • Parent/Teacher Youth Leadership Conference, Breckenridge, CO. • National Association of Bilingual Education Conferences, Albuquerque,NM and Orlando, FL. • Northern Colorado Hispanic Chamber of Commerce Conference, Greeley, CO. • ASPIRE Regional Conference, Fargo, ND. • National McNair Scholars Research Symposium-4th Annual, Penn State, College Park, I'A. • Scuth East Association of Educational Opportunity Programs Conference, Director Training, Asheville, NC • Cultural Diversity Conference, Greeley, CO. PERSONAL STRENGTHS • Communicate: Ability and extensive experience in communicating with a diverse population. • Counsel: Formally trained to work with a variety of individuals in multiple settings • Leader: Ability to lead individuals and manage environments and situations. REFERENCES Dr. David Gonzalez University of Northern Colorado Division of Professional Psychology, McKee Hall Greeley, CO 80639 (970) 351-1639 Dr. Wendell Osorno University of Northern Colorado Division of Professional Psychology, McKee Hall Greeley, CO 80639 (970) 351-1635 Dollie Zamora Coordiator of Communication Greeley/Evans School District Six 811 15th Street Greeley, CO 80631 PERSONAL . DATA SHEET Identifying Information: Name : Laurence "Larry" P. Kerrigan, Ph. D. Address : 1706 19th Avenue Greeley, CO 80631 DOB: 9/20/32 Phone : ( 303 ) 353-3373 - business Degrees : BSC - Business Economics , from Creighton University , 1154 . MS - Economics , from St . Louis University , St . Louis , Mo . , 1963 . MA - Theology , from St . Mary ' s University , Regis College Campus , Toronto , Ontario , Canada, 1967 . Ph. L. - Philosophy, St . Louis University, St . Louis , Mo . 1960 , ( Ecclesial Degree ) . Ph . D. - California School of Professional Psychology , Berkeley/Alameda Campus , 1974 , Clinical Psychology . Currently a licensed psychologist in the state of Colorado . Educational Background : 1950-54 Creighton University , Business economics , 1954-56 Marquette University , Milwaukee , WI . , Classical studies and ascetical theology , 1956-57 Springhill College , Grand Coteau LA. Campus , Classical studies , 1957-60 St . Louis University , Philosophy and Economics , 1963-67 St . Mary ' s University, Toronto Campus , Theology , 1971-74 California School of Professional Psychology , clinical psychology, Berkeley/Alameda Campus Positions Held: 1969-71 Member of Board of Directors , Campion College , Prairie du Chien, WI . 1968-71 Director , Department of Psychology, Campion College . 1971-74 Director of Student Counseling Center , Long Mountain College . 1975-80 Director of Short-term Children and Family Team Weld Mental Health Center , Greeley , CO . 1975-87 Clinical Psychologist , Child and Family Team, Weld Mental Health Center, Greeley, CO . 1975-88 Co-founder of Weld County Child Protection Team, 1987-88 Member of Executive Board , Weld Mental Health Center , Greeley , CO . Honors Received : 1968-69 and Teacher of the year, Campion College . 1970-71 1972-73 Class Representative to Campus Executive Committee , and California School of Professional Psychology 1973-74 Work and Experiential Background : 1959-60 Counselor at Dismas Halfway House for ex-convicts , St . Louis , Missouri , 1960-63 Teacher-counselor-coach , Marquette Prep High School , Milwaukee , WI . 1964-67 Counselor-therapist at Street Haven and Sancta Maria Halfway Houses for women and at the Don ( metro ) Jail in Toronto , Canada. 1967-68 Teacher and Campus Counselor at Creighton University, Omaha, NB. 1968-71 Teacher at Campion College , Prairie du Chien , WI . , Director of Psychology Department , Department chairman. 1970-71 Director and Staff member of a total environment for Inter-city boys , late grade school age from Milwaukee , WI . 1971-73 Director of Student Counseling , Lone Mountain College , San Francisco , CA. Teacher at the Lone Mountain College , San Francisco , California. 1973-74 Psychologist Trainee at San Francisco Mental Ilealth Center , Richmond District , Outpatient Care . 1974-75 Private Practice , So . Day Human Services Center San Diego , CA . Part-time instructor at California School of Professional Psychology , San Diego , CA . 1975-80 Director , Short-Term Therapy Team, Children and Family Unit , Weld Mental Health Center , Greeley , CO . 1980-87 Member of Children and Family Therapy Team, Weld Mental Health Center , Greeley , CO . 1987- present Full time private practice with Joyce Shohet Acicermar , Ed . D. , Licensed Psychologist , Greeley , CU . Part time practice aL Weld Mental Health Center , Greeley , CU . Publication : Kerrigan , Laurence P . - The Relationship Between Therapist and Client ' s Perceptions of One Therapy Session . Published Doctoral Dissertation , University of California School of Professional Psychology . Copyright , 1974 . Worjcshopsand Special Training : Since 1974 , 1 have attended an average of- about three workshops per year . Most of these workshops have presented specialized training in the following areas : Neuro-linguistic training , Autogenic and relaxation training , Visualization-Imagery- Hypnosis , Cognitive-Behavioral Therapy , Ericksonian approaches to hypnotherapy and psychotherapy, Family therapy, Strategic family therapy , Sexual abuse , dynamics and applied treatment , Paradoxical intention psychotherapy , and other related areas . In the last fifteen years , I have taught classes and conducted workshops in the following subjects : The Psychology of Dreams Emotional and Physical Health through Visualization and Imagery Western Psychotherapies and Eastern Ways of Liberation Cognitive and Behavioral Therapy Hypnosis in Pain and Habit Control The Psychology of Consciousness and Meditation Sherri R. Malloy, Ph.D. Licensed Clinical Psychologist Office: Home: Mental Health Center of Boulder County 24 Alles Drive 1333 Iris Avenue Greeley, Colorado 80631 Boulder, Colorado 80304 (970) 351-7218 1303) 413-6301 Education Ph.D. Double Major: Child Clinical Psychology; Clinical Psychology. August 1993 University of Colorado, Boulder. M.A. Department of Psychology, Clinical Program. University of July 1989 Colorado, Boulder. B.A. Major: Psychology; Minor: Spanish. Arizona State University. May 1987 Summa Cum Laude. Teaching Cert. Roston Montessori Teacher Training Institute. August 1977 Orange, California. Montessori Elementary Education Certificate. Clinical Experience August 1991- Child and Family Psychotherapist, Mental Health Center of Boulder March 1997 County, Boulder, Colorado. Provided outpatient psychotherapy 10 children and their families. Parent, teacher, and other agency consultation. September 1992- Psychology Intern; Denver General Hospital, Denver, Colorado. August 1993 Outpatient assessment, consultation, and treatment to children, adolescents, and adults; Inpatient treatment to adolescents & their families. Consultation to multidisciplinary hospital staff. Attended regular seminars and case conferences. Completed an additional rotation in neuropsychology. August 1990- Psychotherapist, University of Colorado, Farrand Residence !LII. May 1992 Provided individual, conjoint, and group psychotherapy to Farrand residents. Psychiatric consultation to faculty and staff. ]'resented seminars and workshops to faculty, staff, and students. August 1988- Emergency Psychiatric Services Clinician, Mental Health Conti r August 1992 of Boulder County, Boulder, Colorado. Evaluation and disposition planning for clients with psychiatric emergencies. Composed a training manual for emergency psychiatric clinicians 2 Malloy January 1988- Psychotherapy Intern, Raimy Psychology Clinic, May 1992 Department of Psychology, University of Colorado, Boulder. Provided outpatient psychotherapy to adults, families, and children. Parent and teacher consultation. February 1986- Intake Clinician; Group Facilitator, Tri-City Behavioral Health July 1987 Center, Mesa, Arizona. Conducted intakes for the adult team. Facilitator for children's psychotherapy groups. Administrative and Supervisory Experience Jan 1996- Team Leader, Mental Health Center of Boulder County, Boulder, present Colorado. Clinical and administrative supervision of a team of psychologists and psychotherapists. Budgeting. Supervision of support staff. Coordinate outpatient services/consultation to joint agency programs, including Head Start, Specialized Foster Cam. Post-Adopt, 1178, School-Based Services, Boulder Day Nurser v, and People's Clinic. August 1990- Adult Team Coordinator, Raimy Psychology Clinic, Department August 1991 of Psychology, University of Colorado, Boulder. Chaired the adult team meetings and case conferences. Assisted clinic director w'th administrative tasks. August 1990- Peer Counselor Supervisor, Farrand Residence Hall, Universit _4 May 1991 Colorado, Boulder. Developed and implemented a peer counseling training program. Provided ongoing training and supervision to peer counselors. January 1989- Supervisor in Training, Raimy Psychology Clinic, August 1991 Department of Psychology, University of Colorado, Boulder. Received training and supervision in supervisory techniques. Supervised the psychotherapy of first-year clinical psychology graduate students. June 1989- Adult Team Intake Coordinator, Raimy Psychology Clinic, August 1990 Department of Psychology, University of Colorado, Boulder. Intake and disposition of psychotherapy clients. September 1989- Clinical Supervisor, Emergency Psychiatric Services Team, August 1992 Mental Health Center of Boulder County, Boulder, Colorado. Trained and supervised Masters level student interns in emergency clinical assessment techniques, legal and procedural practices, and psychological report wTiting. February 1988- Volunteer Trainer, Maslin House for Chronically Mentally III, May 1989 Mental Health Center of Boulder County, Boulder, Colorado. Recruited and trained volunteer college students to work with the chronically mentally ill population at this facility. 3 Malloy Publications December 1994- Columnist: The Boulder County Parent, a monthly publication of 11w present Parenting Place, Boulder, Colorado. Circulation: 8,000. Topics include child development and parenting concerns. Teaching Experience August 1989- Psychology Instructor, Front Range Community College, May 1992 Boulder Campus, Colorado. Fall 1988 Head Teaching Assistant, Department of Psychology, University of Colorado, Boulder. Trained and supervised graduate level Teaching Assistants. August 1987- Teaching Assistant, Department of Psychology, University of May 1989 Colorado, Boulder. August 1977- Montessori Elementary Teacher, Roston Montessori School, May 1983 Orange, California; and subsequently, Tempe Montessori School. Tempe, Arizona. Taught preschool through second grade classes. Responsibilities included academic program planning and implementation, supervising teacher assistants, conducting pare ii- teacher conferences, academic record-keeping, and giving educational presentations to parents. August 1976- Student Teacher, Roston Montessori Teacher Training Institute, August 1977 Anaheim, California. Taught in a Montessori classroom under the supervision of a certified Montessori teacher. Duties were the same as in the entry above. Presentation Topics and Trainings Given Play Therapy Engaging so-called "resistant" clients Psychotherapy with adolescents and their families Case Conferences Parent-Toddler Attachment Patterns Child Abuse Child Psychopathology Stress Management Workshop Depression and Risk of Suicide in College Students 4 Malloy Research Projects Adult Attachment Style and College Functioning (Doctoral Dissertation), 1992 Parent-Toddler Attachment Relationships (Masters Thesis), 1990 Post-Divorce Visitation Patterns and Parent-Toddler Attachment, 1988 Effects of Divorce on Children, 1987 Mental Health Center Client Satisfaction Study, 1986 Clinical Assessment Trained in the use of the following assessment tools: WISC-III MMPI Draw-a-Person Kinetic Family Drawing Thematic Apperception Test Rorschach Inkblot Test Sacks Sentence Completion Test Strong-Campbell Interest Inventory Professional Affiliations 1997- present Member: Internal Review Board MHCBC 1996-1997 Member: Professional Advisory Board, Mental Health Center of Boulder County 1991- 1992 Co-Chair: Multi-Ethnic Action Committee, Department of Psychology, University of Colorado, Boulder. 1991- 1993 Member: American Psychological Association, Division 12, Clinical Child Psychology. 1989- 1991 Member: Multi-Ethnic Action Committee, Department of Psychology, University of Colorado, Boulder. 1988- 1989 Student Representative: Department of Clinical Psychology, University of Colorado, Boulder. 1987- 1989 Member: Developmental Psychology' Research Group, Department of Psychology, University of Colorado, Boulder. 1987- present Member: (Intermittent) American Psychological Association. 5 Malloy Honors and Awards 1988 Department of Clinical Psychology Scholarship; University of Colorado, Boulder. 1987 Phi Beta Kappa 1987 Academic Scholarship, Arizona State University, Tempe, Arizona. 1986 Phi Kappa Phi Honor Society 1986 Golden Key National Honor Society 1979 West Valley College Track Team, West Valley, California; State Champions. 1977 Fellowship Award; Roston Montessori School, Orange, California. Additional Training Regular participation in bi-monthly seminars, case conferences and supervision held at the Mental Health Center of Boulder County. Readings and professional conferences in the field of clinical psychology. Other Experience 1996-present Vice President (elected), Suburban Ditch Company, Greeley, Colorado. 1983- 1985 Small Business Owner/Operator: Graphicolor, Phoenix, Arizona. Photography and advertising design. Commercial and portrait photography, advertising design, sales, supervised salespeople, performed administrative tasks. 1982- 1985 Dance Aerobics Instructor, International Fitness Center, Mesa, Arizona. Choreographed dance routines, taught classes regularly, made public presentations on behalf of the fitness club, and participated in an ongoing certification/training program in exercise physiology and dance choreography. 6 Malloy Addendum Graduate Coursework: Child Development/Psychopathology Developmental Psychology Developmental Psychopathology Child Psychotherapy Clinical Practicum (six semesters) Theory and Issues in Developmental Psychology Personality/Psychotherapy Advanced Psychopathology Advanced Personality Theory Clinical Study of the Individual Adult Psychotherapy Family Research and Therapy Research Methodology/Statistics General Statistics (two semesters) Research Practicum (four semesters) Research Problems in Clinical Psychology Assessment Projective Testing Objective Testing Courses for Distributed Minor Multicultural Psychology Community Mental Health Marriage and Family Counseling Behavioral Neuroscience: Clinical and Pathological Perspective SUPPLEMENTAL NARRATIVE TO RFP: EXHIBIT B CONDITIONS OF APPROVAL Ply Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80634 (970)353-3373 fax(970)353-3374 May 20, 2000 Weld County Department of Social Services Attn: Judy Griego PO Box A Greeley, CO 80632 Dear Judy, This letter is in response to your letter of May 10, 2000, concerning recommendations and/or conditions of our bids. I have discussed these with Frank Aaron and have incorporated clarification to these recommendations and conditions at his suggestion. Concerning: 1 . RFP 006-00 Foster Parent Consultation: We accept the condition that we will notify WCDSS a minimum of 30 days in advance if we anticipate over expenditure of the $40,000.00 allocated 2. RFP 00008#1 Family Group Decision Making: We accept the condition that the food allowance is for EPP referrals only. 3. RFP 00008#2 Goal Achievement Program (GAP) Intensive Family therapy: We accept without conditions or recommendations. 4. RFP 00008#3 M iat d Conflict Resol ti�� on. Intensive Family therapy: We ccept the for one therapi t. Wedwill request a new referralition that rerrals will e issued lly referral if a second therapist is needed. 5. RFP #00010 Option B We accept the recommendation that time spent with the family will be limited to four hours per week. (If no progress is being made, we will do everything possible to limit the duration to 30 hours and transition the client to other services.) If progress is being made, we will continue at a "step-down" level to a maximum of 60 hours and will provide a treatment report summary for WCDSS. (If at 60 hours a small number of families require limited extra services, it will be up to 15 hours at a time.) 6. RFP #00007 Sex Abuse Treatment We accept the recommendation that a goal of Part A,B, and C, is to serve no more than six months. Part D, maintenance, is however ours over no less four months tod maintain skiied to lllls for safety.e up to ten Maintenance than Ma ntena ce up to one year is often necessary when sexual abuse has occurred. Sincerely, Joyce Shohet Ackerman, Ed.D. Licensed Psychologist JSA/cs C DEPARTMENT OF SOCIAL SERVICES PO BOX A CO GREELEY,C 90832 Administration and Public Assistance(970)352-1561 ' Child Support(970)352.8933 COLORADO May 10, 2000 Ms. Joyce Ackerman, Ed. D. Ackerman and Associates, P.C. 1750 25 Avenue Suite 101 Greeley CO 80631 Re: RFP 006-00 Foster Parent Consultation RFP 00008 #1 Family Group Decision Making-Intensive Family Therapy RFP 00008 #2 Goal Achievement Program-Intensive Family Therapy RFP 00008 #3 Family Conflict Resolution-Intensive Family Therapy RFP 00010 Option B RFP 00007 Sex Abuse Treatment Dear Ms. Ackerman: The purpose of this letter is to outline the results of the RFP Bid process for PY 2000-2001 and to request written information or confirmation from you by Wednesday, May 24, 2000. A. Results of the RFP Bid Process for PY 2000-2001 On April 20, 2000, the Families, Youth and Children (FYC) Commission approved the RFP(s) listed above for inclusion on our vendor list. The FYC Commission attached the following recommendations and/or conditions regarding your RFP bid(s). 1. RFP 006-00, Foster Parent Consultation: Condition: The Department of Social Services shall be notified a minimum of 30 days prior to over expenditure. The budget for PY 2000-2001, June 1, 2000, through May 31, 2001, is S40,000. 2. RFP 00008 #1, Family Group Decision Making, Intensive Family Therapy: Condition: Food allowance will be paid for EPP referrals to Family Group Decision Making (FGDM),; however, there will be no food allowance paid wide' Core Services referrals. Page 2 Ackerman and Associates, P.C. Results of RFP Bid Process for PY 2000-2001 3. RFP 00008 #2, Goal Achievement Program (G.A.P.), Intensive Family Therapy: Approved with no conditions or recommendations. 4. RFP 00008 #3, Mediated Family Conflict Resolution, Intensive Family Therapy: Condition: Referrals will be issued initially for one therapist. A new referral will he needed for assignment of two therapists. 5. RFP 00010, Option B Recommendation: The time spent with the family will be limited to four hours, rather than six. Step-down can be used for ongoing services. Everything possible must be done to limit the duration to 30 hours and transition the client to other services. 6. RFP 00007, Sex Abuse Treatment Recommendation: The program goal is to serve no more than six months. Any change from this must be explained in the case plan and limited to that duration. B. Required Response by FYC Bidders Concerning FYC Commission Recommendations and Conditions The Weld County Department of Social Services is requesting your written response to the FYC Commission's recommendations and conditions. Please respond in writing to Frank Aaron, Weld County Department of Social Services, P.O. Box A, Greeley, CO, 80632, by Wednesday, May 24, 2000, close of business, as follows: 1. FYC Commission Recommendations: You are requested to review the FYC Commission recommendations and to: a. accept the recommendation(s) as written by the FYC Commission, or b. request alternatives to the FYC Commission's recommendation(s); or c. not accept the recommendation(s) of the FYC Commission. • Please provide in writing how you will incorporate the recommendaiion(s) into your bid. If you do not accept the recommendation, please provide written reasons why. All approved recommendations under the NOFAA will be monitored and evaluated by the FYC Commission. Page 3 Ackerman and Associates, P.C. Results of RFP Bid Process for PY 2000-2001 2. FYC Commission Conditions: All conditions will be incorporated as part of your RFP Bid and Notification of Financial Assistance Award (NOFAA). If you do not accept the condition(s), you will not be authorized as a vendor unless your mitigating circumstances are accepted by the FYC Commission and the Weld County Department of Social Services. If you do not accept the condition, you must provide in writing reasons why. A meeting will be arranged to discuss your response. Your response to the above conditions will be incorporated in the RFP Bid and Notification of Financial Assistance Award. If you wish to arrange a meeting to discuss the above conditions and/or recommendations, please do so through Elaine Furister, 352.1551, extension 6295, and one will be arranged prior to Wednesday, May 24, 2000. Sincerely, lay A. riego, Dr ctor cc: Esteban Salazar, Chair, FYC Commi ion Frank Aaron, Social Services Administrator JG:ef Hello