HomeMy WebLinkAbout20000887.tiff RESOLUTION
RE: APPROVE 2000-2001 CORE SERVICES PROGRAM PLAN AND AUTHORIZE CHAIR
TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with the 2000-2001 Core Services Program
Plan from the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, to the
Colorado Department of Human Services, commencing June 1, 2000, and ending May 31,
2001, with further terms and conditions being as stated in said plan, and
WHEREAS, after review, the Board deems it advisable to approve said plan, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, ex-officio Board of Social Services, that the 2000-2001 Core Services
Program Plan from the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Social Services, to the
Colorado Department of Human Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said plan.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 19th day of April, A.D., 2000.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: yéKirkmeyer /
Weld County Clerk to tht 80. '. a �
61 e ' M. eile, Pro-Tem
BY: jed.eA
Deputy Clerk to the :-�. �i -- /�✓
'Vu N 4 eor•- E. Baxter
APPR�VED AS TC,E;c:/
D e . Hall
Coa ty Attney 4'1
Glenn Va
2000-0887
�C �S SS0027
dd DEPARTMENT OF SOCIAL SERVICES
PO BOX A
GREELEY,CO 808,32
Administration and Public Assistance(970)352-1561
Child Support(970)3524933
hiDe
COLORADO
Memora ndum
To: Barbara Kirkmeyer, Chair, Board of County Commissioners Date: April 17, 2000
From: Judy A. Griego, Director/ tit, (1 Chill
Re: Core Services Program P1a r FY 000-20t1
Enclosed for Board approval is the Core Services Program Plan for the program year 2000-
2001 (June 1, 2000, through May 31, 2001.) The Families, Youth and Children Commissior
recommends, that the Board approve the plan for $983,802.02.
The recommended individual program funding with the Core Services Program Plan is as
follows:
Alive/E $ 54,198.40
Home Based Intensive $ 164,603.33
Intensive Family Therapy $ 141,189.73
Life Skills $ 141,538.86
Day Treatment Services $ 269,781.16
Sexual Abuse Treatment $ 52,548.54
ADAD Contract $ 52,398.00
Mental Health Contract $ 97,544.00
Special Economic Assistance $ 10 000.00
Total $ 983,802.02
If you have any questions, please telephone me at extension 6510.
Enclosure
JG:mr
2000-08,7
j$Cx.s Z 7
CORE SERVICES
INDEPENDENT LIVING
PROGRAM PLAN
FY 2000-2001
FOR
WELD
COUNTY(IES)
—0Yei
REQUEST FOR STATE APPROVAL OF PLAN
PIf this box is checked please complete all portions of the plan related to Independent Living,otherwise all statements
oughout this document will be considered not applicable.
This Core Services Plan is hereby submitted for Weld [Indicate county name(s)and
lead county if this is a multi-county plan],for the period June 1,2000,through May 31,200L The Plan includes the following:
$ Completed"Statement of Assurances";
$ Completed Statement of the eight(8)required Core services to be provided or purchased and a list
of county optional services,County Designed Program Services,to be provided or purchased;
$ Completed program description of each proposed"County Designed Service";
$ Completed"Information on Fees"form;
4) Completed"Direct Service Delivery"form;
4) Completed"Purchase of Service Delivery"form;
4) Completed"Projected Outcomes"form;
4) Completed"Overhead Cost"form;
$ Completed"Final Budget Page"form;
$ Completed"State Board Summary";and,
$ Completed"100%Funding Summary"form.
This Independent Living Plan is hereby submitted for Weld [Indicate county
name(s) and lead county if this is a multi-county plan], for the period July 1, 2000, through June 30,2001. The Plan includes the
following:
$ Completed"Request for State Approval"form
4) Completed"State of Assurances"form
4) Completed"Independent Living Service Information"format
4) Completed"Direct Service Delivery"and/or"Purchased Service Delivery"form
$ Completed"Youth Direct"form
$ Completed"Final Budget page"
This Core Services and Independent Living Plan has been developed in accordance with State Department of Human Services rules
and is hereby submitted to the Colorado Department of Human Services, Division of Child Welfare Services for approval. If the
enclosed proposed Core Services and/or Independent Living Plan is approved,the plan will be administered in conformity with its
provisions and the provisions of State Department rules.
The person who will act as primary contact person for the Core Services Plan is Frank Aaron , and can be reached at
telephone number 352-1551 ext 6210 . The primary contact person for Independent Living is
Joyce Hause and can be reached at telephone number 352-1551 ext 6245
If two or more counties propose this plan,the required signatures below are to be completed by each county, as appropriate. Please
attach an addi..nal signature age a ceded.
Si gnarr t�` �f'��UNI1'D TMI• IT OF SOCIAL SERVICES D E
Sign
. JJ y— /e/ - 2000
Sin alr_, p P ACEMENT ALTERNATIVES COMMISSION DATE
L-/�Ti ,',Jlc"t:' .(--J - - iJ
Signature, HAIR,BOARD OF C• Cs) MISSIONERS DATE
Barbara J. Kirkmeyer
2
CORE SERVICES-INDEPENDENT LIVING PROGRAM PLAN
STATEMENT OF ASSURANCES
Weld County(ies) assures that, upon approval of the Core Services-
Independent Living Program Plan the following will be adhered to in the implementation of the Plan:
Core Services Assurances:
• Operation will conform to the provisions of the Plan;
• Operation will conform to State roles;
• Core Services Program Services, provided or purchased, will be accessible to children and their
families who meet the eligibility criteria;
• Operation will not discriminate against any individual on the basis of race, sex, national origin,
religion,age or handicap who applies for or receives services through the Core Services program;
• Services will recognize and support cultural and religious background and customs of children and
their families;
• Out-of-state travel will not be paid for with Core Services funds;
• All forms used in the completion of the. Core Services plan will be State prescribed or State
approved forms;
• Core FTE/Personal Services costs authorized for reimbursement by the State Department will be
used only to provide Core Services authorized in the county(ies)'approved Core Services Plan;
• The purchase of services will be in conformity with State purchase of service rules including
contract form,content,and monitoring requirements;and
• Information regarding services purchased or provided will be reported to the State Deparument for
program,statistical and financial purposes.
Independent Living statement of assurances:
1. Independent Living funds shall not be used for room and board;
2. Funds shall be used exclusively for the purposes specified in the plan;
3. Funds shall not be used to supplant,duplicate or replace existing child welfare funds and;
4. Funds shall not be used for county budget shortfalls.
3
CORE SERVICES
TO BE PROVIDED/PURCHASED
Place an"X" to indicate which of the following Core Services Program Services will be provided/purchased in accordance with
State Department rules:
X Home Based Intervention
X Intensive Family Therapy
X Sexual Abuse Treatment Services
X Day Treatment
X Life Skills
X Special Economic Assistance
X Mental Health Services
_g Substance Abuse Treatment Services
List below"County Designed Service"that will be provided/purchased in accordance with State Department rules:
4
CORE SERVICE
COUNTY DESIGNED SERVICE
Service Name: None
Optional services approved as a part of the county's Core Services Plan are approved on an annual basis. For a County Designed
Service to be extended beyond one year,this portion of the plan must be submitted and approved annually by the State Department.
Given that County Designed programs are not standardized across counties, it is important to provide detailed information as
outlined below. This information can be use to justify continued funding of the program with the legislature. The information listed
below is to be completed for each County Designed Service to be included in the County(ies)'Core Services Program Plan.
1. Describe the service and components of the service,define the goals of the program.
2. Define the eligible population to be served.
3. Define the time frame of the service.
4. Define the workload standard for the program:
• number of cases per worker,
• number of workers for the program,and
• worker to supervisor ratio.
5. Define the staff qualifications for the service,e.g.,minimum caseworker III or equivalent,ee7.303.17 for guidelines.
• Define the performance indicators that will be achieved by the service,see 7.303.18.
• Identify the service provider.
• Define the rate of payment e.g.,$250.00 per month.
5
INFORMATION ON FEES
Please check the following that applies:
X Fees will not be assessed for Core Services Program Services. (STOP. Remainder of information does not need to be
completed.)
Fees will be assessed for the following services:Check those that apply:
Home Based Intervention
Intensive Family Therapy
Sexual Abuse Treatment
Day Treatment
Life Skills
Special Economic Assistance
Mental Health Services
Substance Abuse Treatment Services
County Designed Service(List Services Below)
Fee assessment formula is the same for all services. State the formula here(attach additional sheets as needed).
Fee assessment formula varies with service. State formula used for each service.
6
HOME BASED INTERVENTION SERVICES
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Code 1700,1800, 1900
Definition
7.303.1 A Home Based Intervention: Services provided primarily in the home of the client and includes a variety of services which can include therapeutic services,
concrete services,collateral services and crisis intervention directed to meet the needs of the child and family.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part. Include only amounts that
are to be charged to Core Services. Staff positions to be included are employee Merit System/equivalent positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12 '
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent Salary Total Monthly Number Total Direct
Number Monthly Fringe Travel Operate Salary Salary Funded by Direct Service of Service Cost
Salary Funded by Funded by Regular Cost Month
80/20 100% Admin (3+4+5+6) of Cost
NONE
%
TOTAL
INTENSIVE FAMILY THERAPY
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Codes 1710, 1810, 1910
Definition
7303.1 B Intensive Family Therapy:Therapeutic intervention typically with all family members to improve family communication,functioning,and relationships.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are employee Merit System/equivalent positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 I 12
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent Salary Total Monthly Number Total Direct
Number Monthly Fringe Travel Operate Salary Salary Funded by Direct Service of Service Cost
Salary Funded by Funded by Regular Cost Month
80/20 100% Admin (3+4+5+6) of Cost
NONE
. e
TOTAL
8
LIFE SKILLS
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Codes 1720, 1820, 1920
Definition
7.303.1 C Life Skills:Services provided primarily in the home that teach household management,effectively accessing community resources,parenting techniques,
and family conflict management.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are employee Merit System/equivalent positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent Salary Total Monthly Number Total Direct
Number Monthly Fringe Travel Operate Salary Salary Funded by Direct Service of Service Cost
Salary Funded by Funded by Regular Cost Month
80/20 100% Admin (3+4+5+6) of Cost
NONE
� 4
TOTAL
DAY TREATMENT
DIRECT SERVICE DELIVERY - CORE SERVICES PROGRAM
CFMS—Function Codes 1730, 1830,1930
Definition
7303.1 D Day Treatment:Comprehensive,highly structured services that provide therapy and education for children.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are employee Merit System/equivalent positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12
Position Job Tide Gross Monthly Monthly Monthly Percent of Percent of Percent Salary Total Monthly Number Total Direct
Number Monthly Fringe Travel Operate Salary Salary Funded by Direct Service of Service Cost
Salary Funded by Funded by Regular Cost Month
80/20 100% Admin (3+4+5+6) of Cost
•
NONE
•
TOTAL
10
SEXUAL ABUSE TREATMENT SERVICES
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS—Function Codes 1740, 1840, 1940
Definition
7.303.1 E Sexual Abuse Treatment:Therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization sexual dysfunction,sexual
abuse perpetration,and to prevent further sexual abuse and victimization.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part. Include only amounts that
are to be charged to Core Services. Staff positions to be included are employee Merit System/equivalent positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent Salary Total Monthly Number Total Direct
Number Monthly Fringe Travel Operate Salary Salary Funded by Direct Service of Service Cost
Salary Funded by Funded by Regular Cost Month
80/20 100% Admin (3+4+5+6) of Cost
NONE
TOTAL
11
COUNTY DESIGNED SERVICE
DIRECT SERVICE DELIVERY - CORE SERVICES PROGRAM
CFMS—Function Codes 17_., 18_,19_
Definition
7.303.1 J County Designed Services: innovative and/or otherwise unavailable service proposed by a county that meets the goals of the Core Services Program.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in part.Include only amounts that
are to be charged to Core Services. Staff positions to be included are employee Merit System/equivalent positions and employee contract positions.
1 2 3 4 5 6 7 8 9 10 lI 12
Position Job Title Gross Monthly Monthly Monthly Percent of Percent of Percent Salary Total Monthly Number Total Direct
Number Monthly Fringe Travel Operate Salary Salary Funded by Direct Service of Service Cost
Salary Funded by Funded by Regular Cost Month
80/20 100% Admin (3+4+5+6) of Cost
NONE
TOTAL
12
HOME BASED INTERVENTION SERVICE
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1700, 1800. 1990
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Units Payment Rate Cost Per Number of Total Cost
Provider Service* of Service/Month per Unit of Month Months of Per Provider
Number Service (4 x 5) Cost (6 x 7)
•
Ackerman & Associates 02916 H 99.50
Lutheran Family Services 045080 H 103.00
TOTAL $158,787.00
• -Identification of unit is: H=Hour, D=Day,W=Week, M=Month, E=Episode
13
INTENSIVE FAMILY THERAPY
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1710,1810,1910
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Units Payment Rate Cost Per Number of Total Cost
Provider Service* of Service/Month per Unit of Month Months of Per Provider
Number Service (4 x 5) Cost (6 x 7)
Gap #2
Ackerman & Associates 02916 H 99.50#1 2,0c0. _l, g/hr
�i35
Ackerman & Associates 02916 H
* Ackerman & Associates (IT) 02916 H 99.50/hr
North Colo Medical Center 63973 H 82.35
Mediation Comm Training H 150.60
4
Island Grove Reg. T.C. 02917 H 98.75
Alternative Homes for Youth 92446 H 76.01/hr
tblM
Lutheran Family Services 45080 group 1;800.00/grp
Lutheran Family Services 45080 group Serv. 150.00/grp/hr
* Ackerman & Associates 02916 H 199.00 TOTAL $136,187.00
*- Identification of unit is: H =Hour, D=Day,W=Week, M =Month E=Episode
14
LIFE SKILLS
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1720,1820,1920
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Units Payment Rate Cost Per Number of Total Cost
Provider Service* of Service/Month per Unit of Month Months of Per Provider
Number Service (4 x 5) Cost (6 x 7)
Weld County Youth Alternatives
dba Partners 17967 H 16.50
Greeley Dream Team 11909 H 38.69
Weld County Health Dept 09755 H 104.15
CARE - Parent Advocate 62085 H 42.46
CARE 62085 H 32.23
TOTAL $136,524.00
* - Identification of unit is: H=Hour,D=Day, W=Week, M=Month E=Episode
1.
DAY TREATMENT
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1730, 1830, 1930
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Units Payment Rate Cost Per Number of Total Cost
Provider Service* of Service/Month per Unit of Month Months of Per Provider
Number Service (4 x 5) Cost (6 x 7)
North Colo Medical Center 63973 M M 2,059.20
Alternative Homes for Yotth 92446 M 1,490.41
North Range Behavioral Health 80103 M 1,510.00
TOTAL $260,310.00
* - Identification of unit is: H=Hour,D=Day, W=Week,M=Month E=Episode
16
SEXUAL ABUSE TREATMENT
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1740,1840,1940
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Units Payment Rate Cost Per Number of Total Cost
Provider Service* of Service/Month per Unit of Month Months of Per Provider
Number Service (4 x 5) Cost (6 x 7)
WCDSS Varies
Island Grove Regional T.C. Rate Sheet
Ackerman & Associates 99.50
I
TOTAL $50,626.00
* - Identification of unit is: H=Hour, D=Day, W=Week, M=Month E=Episode
17
SPECIAL ECONOMIC ASSISTANCE
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1855,1955
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Units Payment Rate Cost Per Number of Total Cost
Provider Service* of Service/Month per Unit of Month Months of Per Provider
Number Service (4 x 5) Cost (6 x 7)
Various Providers
J
TOTAL 14,000 100%
•
•
,O
1O
MENTAL HEALTH SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1845,1945
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Payment Rate Cost Per Number of Total Cost
Provider Service* Units of per Unit of Month Months of Per Provider
Number Service/Month Service (4 x 5) Cost (6 x 7)
North Range Behavioral Health H
* Ackerman & Associatee H 90.00
* Lutheran Family Serv. H 103.00
. j
t
* First Right of Refusal Waived for Foster Parent Consultation 1 am 106,000 100%
* -Identification of unit is: H=Hour, D=Day,W=Week, M=Month E=Episode
19
SUBSTANCE ABUSE TREATMENT SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 1840,1940
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Units Payment Rate Cost Per Number of Total Cost
Provider Service* of Service/Month per Unit of Month Months of Per Provider
Number Service (4 x 5) Cost (6 x 7)
Island Grove Regional T.C 02917
TOTAL 61,018.00 100%
* -Identification of unit is: H =Hour, D=Day, W=Week, M=Month, E=Episode
GV
COUNTY DESIGNED SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS—Function Codes 17_,18_,19_
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Units Payment Rate Cost Per Number of Total Cost
Provider Service* of Service/Month per Unit of Month Months of Per Provider
Number Service (4 x 5) Cost (6 x 7)
None
TOTAL
* - Identification of unit is: H=Hour, D=Day, W=Week, M =Month E=Episode
21
PROJECTED CORE SERVICES OUTCOMES FOR
PERFORMANCE INDICATORS
FOR FY 2000-2001
`'p
Home Base 6 57 3 66
Intensive Family Therapy 47 54 42 143
Life Skills 5 76 28 109
Day Treatment 14 19 11 44
Sexual Abuse Treatment 4 36 0 40
Mental Health Treatment 10 0 0 10
Substance Abuse Treatment 0 105 0 105
Special Economic Assistance 0 126 0 126
County Design(List) None None None None
Alive E 10 65 5 80
--,-Client meets 86%or more of the treatment goals
2-Client meets between 85%-25%of the treatment goals
3-Client meets 24%or less of the treatment goals
22
CORE SERVICES PROGRAM
OVERHEAD COST
DIRECT SERVICE
A. Total Salary/Fringe/FraveUOperating Costs of Line
Service Workers and their Immediate Supervisors
13. Formula Percentage Allowed for Overhead Costs 15%
C. Provided Service Overhead Costs(A X B)
2. I'URCHASED SERVICE
A. Purchased Service Dollar Amount $/42,434.00
B. Formula Percentage Allowed for Overhead Costs _ 3,60_
$0-50,000 =5% $50,001 -100,000=4.9%
For each$50,000(in total expenditure)increase the overhead
decreases by.1 %.
C. Allowed Amount for Overhead Costs(A X B) 26,727.62
D. Base Overhead Cost Allowed $500.00
Purchased Service Overhead Costs(C D) L27.227.67
3. TOTAL OVERHEAD COSTS(IC+2E) $ 27,227.62
DISTRIBUTION OF OVERHEAD COSTS AMONG SERVICES*
SERVICE Provided Service Purchased Service Total Overhead
Overhead Costs Overhead Costs Costs
I. Home Based Intervention $5,816.33 $5,816.33
2. Intensive Family Therapy $5,002.73 5 002.73
3. Sexual Abuse Treatment
$1 ,922.54 $1 ,922.54
4. Day Treatment $9,471 . 16 9 47116
5. Life Skills
$5,014.86 5 014.86
6. County Designed Service
[ COLUMN TOTALS $27,227.62 $27,227.62
* Formula to determine overhead cost by service:
Step 1: total provided service cost(by service) x 15%=provided service overhead cost
Step 2:total purchased service cost(by service) x % listed in 2B=Y
$500 divided by the number of purchased service=Z, then Y + Z=overhead cost
Step 3: Provided service overhead cost plus purchased service overhead cost equals total overhead cost.
23
GENERIC COST SUMMARY SHEET
1. Account Code
2. Total number of children to be served by provided services
3.. Total number of children to be served by purchased services
4.. Average number of children(total 2+3)to be served monthly
5. Total number of families to be served
6. Average number of families to be served monthly
7. Employee FTE number(should be the total staff listed on Direct Service
Delivery Page)
8. Provided cost
Overhead cost(From Overhead cost summary sheet)
Total provided cost
9.. Monthly provided cost per child
[this is determined by dividing the total provided cost by the number
of children to be served from provided services and then dividing that
total by the number of months the service will be provided.]
10. Purchased cost
Overhead cost(From Overhead cost summary sheet)
Total purchased cost
11. Monthly purchased cost per child
[this is determined by dividing the total purchased cost by the number of
children to be served from purchased services and then dividing that
total by the number of months the service will be provided.]
12. TOTAL COST REQUESTED [Total provided cost
Total purchased cost]
13. Total 80/20 service cost requested
14. Total 100%service cost requested
24
FINAL BUDGET PAGE
FY 2000-2001
CORE SERVICES
& INDEPENDENT LIVING PROGRAM
CFMS Service Name Other Other Independent Total Funds Total Funds Total Funds
FUNCTION DSS Source Living 80/20 100%
CODE Funds Funds Funds
1905 ALIVE E $54,198.40 $54 108 40
1783 Home Based Intervention $132,845.93 $31,757.40 $164.003.33
1784 Intensive Family Therapy • $113,952.33 $27,237.40 $141.18973
•
1785 ---Lifeskills $114,234.06 $27,304.80 $141.538.86
1786 Day Treatment • $217,719.16 $52,062.00 $269.781 16
1787 Sex Abuse Treatment $42,423.34 $10,125.20 $ 53.548 54
1889 ADAD Contract $ 52,398.00 $51.798 00
1888 Mental Health Contract $ 97.544.00 $ 97.544 X00
1877 Special Economic Assistance $ 10,000.00 $ 10.000 00
TOTALS $54,198.40 $621,174.82 $308,428.80 $983,802.02
CFMS Function Codes l7xx denotes 80/20 funded Core Service
CFMS Function Codes 18xx denotes 100% funded Core Service
CFMS Function Codes 19xx denotes 100% funded Core Service
CFMS Function Codes 2875 Independent Living Purchased or Direct Services
CFMS Function Codes 2850 Youth Direct
25
STATE BOARD SUMMARY
CORE SERVICES PROGRAM
FY 2000-2001-80!20 El NDING
COUNTY(IES) WELD
Services Provider or Age of Child 4 of Families 4 Children Served , Cost Per Child Per Cost Per Year
Number of FTE Served Per Month Per Month Month
Home Based I Various 0-17 27 67.5
$ 164.01 $132.845.93
Intervention
Intensive Family I Various 0-17 j 38 95.0 $ 99.96 $113,952.33
Therapy I
Lifeskills Various 0-17 39 97.5 S 97.63 $114,234.06
Day Treatment Various 5-17 16 16 $1,133.95 $217,719.16
Sex Abuse Various 0-17 14 14 $ 252.52 $ 42,423.34
Treatment F
County Design NONE NONE NONE NONE NONE NONE
I �
ADAD Island Grove N/A N/A N/A N/A N/A
Regional Treatment
Center I
Mental Health ' North Range N/A N/A N/A ' N/A N/A
Behavioral Health
Special Economic Various N/A N/A N/A N/A N/A
Assistance
.ALIVE/E Various N/A N/A N/A N/A N/A
I
TOTAl. 8.20 CORE 5621,174.82
26
STATE BOARD SUMMARY
CORE SERVICES PROGRAM
FY 2000-2001-100% FUNDING
COUNTY(IES) WELD
Services Provider or A e of Child it of Families 0 Children Served j Cost Per Child Per Cost Per Year
Number of FTE Served Per Month Per Month Month
ALIVE:E I 16-21 17 17 f 5 266.68 $54.198.40
I ALIVE'E I 16-21 J- -- - � - I
Home Based Various 0-17 27 67.5 S 39.20 � 531 757.40
Intervention
Intensive Family 1 Various 0-17 38 F 95.0 5 23.89 5 27,237.40
Therapy
Lifeskills Various 0-17 39 97.5 $ 23.34 S 27.304,80
I I I
Day Treatment Various 5-17 16 16 $ 271.17 $ 52,062.00
Sex Abuse Various + 0-17 14 14 $ 60.27 $ 10,125.20
Treatment
County Design NONE NONE NONE NONE NONE NONE
ADAD J Island Grove 0 33 82.5 S 52.93 $52,398.00
Regional Treatment
Center
Mental Health North Range 0 8 20 $ 406.43 597,544.00
Behavioral Health j
Special Economic Various 0 1 3 8 5 104.12 $10,000.00 Assistance _ -- — — — — — __-- —
TOTAI. 100"t, CORE 8362.62720
27
v TYtnj l n.VLil\TV JViYLIY1tifi Jr1LL 1 £ I LUUU-LUUI
I Contact Person Phone Number
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Ackerman &
Ackerman & Associates 02916 Associates Hour 99.50 1783
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Lutheran Family Lutheran Family
Services 45080 Services Hour 103.00 1783
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Mediation Communication Mediation Communication
Training Training Hour 150.60 1784
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Island Grove Regional Island Grove Regional
Treatment Center 02917 Treatment Ctr Hour 98.75 1784
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Lutheran Family Lutheran Family
Sarvires 45080 Services—FGDM Hour 1,800.00 group 1784
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Lutheran Family Lutheran Family
Services 45080 Services—Group Svcs Hour 150.00/grp/1r 1784
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
( Ackerman &
Ackerman & Associates 02916 Associates—GAP Hour 99.50 1784
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Ackerman &
Ackerman & Associates 02916 Associates—MFCR Hour 199.00 1784
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Ackerman &
Ackerman & Associates 02916 Associates—FGDM Group 2.000.00 1784
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
North Colorado IFT
Psych Care 63973 Youth Passages Hour 82.35 1784
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Alternative Homes Alternative
for Youth 92446 Homes for Youth Hour 76.01 I
CWEST Provider Name i CWEST Provider# Provider Name Unit of Service Rate of Payment I Object Code I Account Code
28
CWEST CODING SUMMARY SHEET FY 2000-2001
' Contact Person ' Phone Number '
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Weld County Youth
Alternatives 17967 Partners Hour 16.50 1785
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Greeley Greeley
Dream Team 11909 Dream Team Hour 38.69 1785
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Weld County Weld County
Health Department 09755 Health Department Hour 104. 15 1785
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Child Advocacy C.A.R.E.
Resource & Education 62085 Family Advocate Hour 42.46 1785
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Child Advocacy C.A.R.E.
Reaourrg & Education 62085 Visitation Hour 32.23 1785
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Weld County Department WCDSS Contracted
of Social Services 45082 Generic SAT Hour Provider Rate I 1787
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Island Grove Regional Island Grove-Saft
Treatment Center 02917 Regional Treatment Hour Rate Sheet 1787
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Ackerman &
Ackerman & Associates 02916 Associates — SAT Hour 99.50 1787
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
North Range North Range
Behavioral Health 80103 Behavioral Health Month 1,520.00 I 1786
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Alternative Homes Alternative Homes
for Youth 92446 for Youth Month 1,490.41 1786
1 CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment I Object Code Account Code
FAckerman & Foster Parent
IAssociates Consultation Hour 90.00 j N/A
1 CWEST Provider Name ; CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
28
CWEST CODING SUMMARY SHEET FY 2000-2001
Contact Person Phone Number
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
Lutheran Family Foster Parent
Services Consultation Hour 103.00
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment , Object Code Account Code
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
i
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
CWEST Provider Name CWEST Provider# Provider Name Unit of Service Rate of Payment Object Code Account Code
CWEST Provider Name CWEST Provider# I Provider Name Unit of Service Rate of Payment i Object Code I Account Code I
I I I I I
CWEST Provider Name j CWEST Provider# Provider Name Unit of Service Rate of Payment_ ! Object Code I Account Code 1
28
PURCHASE OF SERVICE CONTRACT
CORE SERVICES PROGRAM
I. THIS CONTRACT,made this day of , 1998 by and between the _
County Department of Social Services at ,hereinafter called"County"
and (address)
(name) (address)
_ ,hereinafter called"Contractor".
(Tax I.D.or Social Security Number)
2. This contract will be effective from until
3. County agrees to purchase and Contractor agrees to provide
(Core Service)
to at at other such
(population to be served) (location service is to be provided)
location as shall facilitate the provision of such services. This service is described in Staff Manual Volume 7, Section
,and,if appropriate,the State approved County Core Service Plan.
4. County agrees to purchase and contractor agrees to furnish units of service at the cost of
per unit of service for a maximum amount of this contract of$
5. The parties agree that the Contractor's relationship to the county is that of an independent Contractor.
6. The parties agree that payment pursuant to this Contract is subject to and contingent upon the continuing availability
of funds for the purpose thereof.
7. County agrees:
a) To determine child eligibility and a s appropriate,to provide information regarding rights to fair hearings
b) To provide Contractor with written prior authorization on a child or family basis for services to be purchased.
c) To provide Contractor with referral information including name and address of family, social,medical, and
educational information as appropriate to the referral.
d) To monitor the provision of contracted service.
e) To pay Contractor after receipt of billing statements for services rendered satisfactorily and in accordance with this
Contract.
8. Contractor agrees:
a) Not to assign any provision of this Contract to a subcontractor.
b) Not to charge clients any fees related to services provided under this contract.
c) To hold the necessary license(s)which permits the performance of the service to be purchased,and/or to meet
applicable State Department of Human Services qualification requirements.
d) To comply with the requirements of the Civil Rights Act of 1964 and Section 504, Rehabilitation Act of 1973
concerning discrimination on the basis of race,color,sex,age,religion,political beliefs, national origin, or
handicap.
e) To provide the service described herein at cost not greater than that charged to other persons in the same
community.
1) To submit a billing statement in a timely manner,no later than 45 days after services. Failure to do so may resul•.
in nonpayment.
g) To safe guard information and confidentiality of the child and the child's family in accordance with rules of the
Colorado Department of Human Services and the County Department of Social Services.
h) To provide County with reports on the provision of services as follows:
• Within _weeks of enrollment/participation,submission of a treatment plan for the child/child's
family with specific objectives and target dates. The treatment plan is subject to county approval.
• At intervals of months, from the time of enrollment/participation,submit reports that include
progress and barriers in achieving provisions of the treatment plan.
29
a) To provide access for any duly authorized representative of the County or the Colorado Department of Human
Services until the expiration of five(5)years after the final payment under this Contract, involving transactions
related to this Contract.
b) Indemnify County,Colorado Department of Human Services from the action based upon or arising out of damage
or injury,including death,to persons or property caused or sustained in connection with the performance of this
contract or by conditions created thereby,or based upon any violation of any statue,regulation,and the defense of
any such claims or actions.
9. In addition to the foregoing,the County and Contractor also agree:
10. Termination: Either party may terminate this Contract by thirty(30)days prior notification in writing.
County Director's Signature Contractor's Signature
Date Contractor's Title
Date
Original to Contractor
Copy to the Case File
Copy to County Bookkeeping
Copy to State Accounting
30
INDEPENDENT LIVING SERVICE
NARRATIVE SUMMARY
See Attached Narrative:
Service Name:
The county's Independent Living services are approved as a part of the county's annual plan. This portion of the plan must be
submitted and approved annually by the State Department.
Given that services are not standardized across counties, it is important to provide detailed information as outlined below. The
information listed below is to be completed an included with the annual plan.
1. If this is a regional plan,list the counties involved and identify the fiscal agent.
2. Describe the service and components of the service,define the goals of the program. Including how the county will network
with community or governmental agencies such as Domestic Violence, Mental Health, Office of Self-Sufficiency, Education
etc.
3. Define the eligible population to be served.
4. Define the time frame of the service.
5. Define the workload standard for the program:
number of cases per worker
number of workers for the program.
6. Identify the service provider.
7. Indicate funding source i.e. Independent Living,Child Welfare Block etc.
* Use this form only for services funded by INDEPENDENT LIVING FUNDS OR CHILD WELFARE BLOCK FUNDS
For Core Services funds the county needs to complete the"County Designed"form.
31
INDEPENDENT LIVING SERVICE NARRATIVE SUMMARY
This proposed service is the same service Weld County has provided in the past through Independent Living
Funding.This proposal is being made to convert the program to the CORE Services Funding.
1.This is not a regional plan.
2.Describe service and components of the service.
➢ Assessment
➢ Establishing the Independent Living Treatment Plan
Independent Living Groups involving budgeting, interviewing and employment skills,
community resources, choosing an appropriate apartment, meeting health and social
needs etc.
➢ Individualized Training as needed.
➢ Monthly monitoring.
➢ Assistance in locating employment, housing, educational financial aid and other services.
➢ Twice a year progress reports and discharge reports.
➢ Ongoing consultation and information sharing with the caseworker/ case manager,
placement providers and other treatment providers.
➢ Follow up monitoring as the youth desires after emancipation until age 21.
Define goals of the service.Emancipation and improved independent living skills.
Describe networking with community or governmental agencies. If appropriate, workers may access the
following services for youth, utilize the following services for educational purposes and/or refer
youth to the following resources to assist in enhancing their emancipation plan. These services
may include: University of Northern Colorado, AIMS Community College, area school districts,
Educational Opportunity Center, the local Community Center Board- Centennial Developmental
Services, Colorado Vocational Rehabilitation Services, Weld Human Resources/Job Services,
Job Corps, Department of Social Security, Weld Health Department, Sunrise Community Health
Center, Plan de Salude Clinics, Planned Parenthood, Colorado Child Health Plan, Medicaid,
North Range Behavioral Health, UNC Counseling Center, North Colorado Medical Center,
North Colorado Psychcare, I sland Grove Regional Treatment Center, Alcoholics Anonymous,
Narcotics Anonymous, AL-ANON, Right to Read, Local Military Recruiters, Youth Link,
Greeley Recreation Center, Rodarte Center, Boy's and Girl's Club, Partners, Support Groups,
Women, Infants and Children Food Program, Weld Food Bank, Child Advocacy Resource and
Education, First Steps, Bright Beginnings, Salvation Anny, Transitional House, Guadelupe
Center, A Woman's Place, etc.
3. Define the eligible population to be served.Youth, ages 16-21, who are in placement in Weld
County or have been in placement and their goal is to emancipate- These youth may be referred
to the Weld County Independent Living Program by their Social Services caseworker from Weld
County or other Colorado counties. They may also be referred by the Division of Youth Services
case manager when they are placed in a community setting within Weld County or they return to
Weld County to emancipate. Youth placed at RCCF/RTC levels may not be referred until 60
days before their discharge from that program. Developmentally delayed youth will be assessed
but may not be appropriate as a result of the needs assessment and may be referred to the local
community center board for additional assistance.
Youth referred by Division of Youth Services case managers will be terminated from the
program or denied access to the program if they present a physical risk to the caseworkers.
4.Define the time frame of the service. The period of involvement can be five years if the youth
desires and continue to meet the eligibility criteria. The average length of involvement is two
years. A youth can refer himself or herself again before the 215t birthday, after the services have
been closed out.
5.Define the workload standard for the program.
➢ number of cases per worker: Each caseworker carries an average of 14-17 cases,
depending upon the demand.
➢ number of workers for the program: Weld County employs two half time Independent
Living caseworkers.
6.Identify the service provider. Weld County Social Services.
7.Indicate funding source.The majority of the funds are derived from the federal Independent
Living grant. Weld County supplements the program through the Child Welfare Block Grant and
the 80/20 County Match by providing for the costs involving supervision, travel, training, and
operating costs (supplies, equipment, capital outlay, rent and utilities, telephone, postage, and
printing).
DIRECT SERVICE DELIVERY FTE SERVICES
INDEPENDENT LIVING PROGRAM
CFMS—Function Code 2875
Definition
7.305.4 The purpose of the IV-E Independent Living Grant Initiative is to provide Independent Living resources to youth in out-of-home care who are at least 16 years of
age. The services shall supplement existing Independent Living resources and programs.
Indicate information for each line service worker for whom Independent Living funding is proposed in whole or in part. Include only amounts that are to be charged to Independent
Living.
I 2 3 4 5 6 7 8 9 10
Position Job Title Gross Monthly Monthly Monthly Percent of Total Monthly Number Total Direct
Number Monthly Fringe Travel Operate/ Salary Direct Service of Service Cost
Salary Training Funded by Cost Months (9x8x7)
2875 (3+4+5+6) of Cost
.5 FTE Caseworker III p.732.70 $294.56 $60.00 $80.00 2167.26 $2167.26 12 $26,007. 12
.5 FTE Caseworker III $1603.37 $272.57 $60.00 $80 00 $2015.44 $2015.94 12 $24 , 191 .2E
TOTAL $50, 198.40
32
PURCHASE OF SERVICE
INDEPENDENT LIVING PROGRAM
CFMS—Function Code 2875
Indicate information for each CWEST provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8
PROVIDER NAME CWEST Unit of Number of Payment Rate Cost Per Number of Total Cost
Provider Service* Units of per Unit of Month Months of Per Provider
Number Service/Month Service (4 x 5) Cost (6 x 7)
NONE
ti
TOTAL
* - Identification of unit is: H=Hour, D =Day,W=Week,NI=Month,E =Episode
33
YOUTH DIRECT SERVICE
INDEPENDENT LIVING PROGRAM
CFMS—Function Code 2850
Definition
7.416.1E Youth Direct Services shall be used according to federal guidelines as incentives for completing goals in the plan for transition to Independent Living and
other expenditures that will assist youth to emancipate and for which no other funding sources exist.
Indicate information for each provider from whom Independent Living services are proposed to be purchased.
2 3 4 5 7
PROVIDER Clients to Number of Payment Rate Cost Per Month Total Cost
NAME Be Served Clients Served per Unit of (4 x 5) Per Provider
per Service
Month
Weld Social
Services 80 34 $50 $333.33 $4000
TOTAL $4000
34
Hello