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Home My WebLink About960765.tiff RESOLUTION RE: APPROVE FAMILY PRESERVATION PROGRAM PLAN FOR 1996-1997 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 Family Preservation Program Plan for 1996-1997 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, Division of Child Welfare Services, commencing June 1, 1996, and ending May 31, 1997, 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 Family Preservation Program Plan for 1996-1997 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, Division of Child Welfare 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 1st day of May, A.D., 1996. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO 4, FA Wa-444• , Barbara J. Kirkmeyer, hair ISG. 4,ti� ty Clerk to the Board r orge-E Baxter,1r0T ��( eputy Clerl t the Board Dale K. Hall A V D AS TO Constance L. Harbert ty Attorne tlx:- (7 J % l t / fini W7-Ft:Webstei- f 960765 1.61 5777 1-6 FAMILY PRESERVATION PROGRAM CORE SERVICES PLAN FY1996-97 FOR WELD COUNTY(IES) REQUEST FOR STATE APPROVAL OF FAMILY PRESERVATION PROGRAM PLAN (80/20 Funding) This Family Preservation Program Plan (FPP) is hereby submitted for Weld County Department of Social Services (Indicate county name(s) and lead county if this is a multi- county plan), for the period June 1, 1996 through May 31, 1997. The Plan includes the following: • "Statement of Assurances"; • Statement of which of the five (5) required FPP services will be provided or purchased and a list of county optional services to be provided or purchased; i.e., County Designed and/or Transition Service; • Completed program description of each proposed "County Designed Service"; • Completed program description of each proposed "Transition Service;" • Completed "Information on Fees" form; • Completed "Direct Service Delivery" form; • Completed "Purchase of Service Delivery" form; • Completed "Overhead Cost" form; • Completed "Summary Sheet By Individual Service" form; • Completed "Final Budget Page" form; • Completed "State Board Summary". This Family Preservation Program 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 FPP 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 FPP Plan is Kathy Lorch , and can be reached at telephone number (970) 352-1551. extension 6250 . If this plan is proposed by two or more counties, the required signatures below are to be completed by each county, as appropriate. Please attach an additional signature page as needed. lf><�llll�� ( � A y/19/�/(c Signal e, DIRECTOR, OUpNY DEPARTMENT OF SOCIAL SERV E DATE II , vv Lit , CHAIR, P ACEMENT ALTE ATIVES COMMISSION DATE '1 '14 o, LN-7 Z9-610/A76 tlLg e, CHAIR, BOARD • COU QTY COMMISSIONERS DATE 1 960765 REQUEST FOR STATE APPROVAL OF FAMILY PRESERVATION PROGRAM PLAN Family Issues Cash Fund (FICF) (100% Funding) This Family Preservation Program Plan (FPP) is hereby submitted for Weld County Department of Social Services (Indicate county name(s) and lead county if this is a multi- county plan), for the period June 1, 1996 through May 31, 1997. The Plan includes the following: • "Statement of Assurances"; • Statement that the five (5) required FPP services will be provided or purchased and a list of county optional services to be provided or purchased; i.e., County Designed and/or Transition Service; • Completed program description of each proposed "County Designed Service"; • Completed "Information on Fees" form; • Completed "Direct Service Delivery" form; • Completed "Purchase of Service Delivery" form; • Completed "Overhead Cost" form; • Completed "Summary Sheet By Individual Service" form; • Completed "Final Budget Page" form; • Completed 100% FICF Summary Form. This Family Preservation Program 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 FPP 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 FPP Plan is Ka y Lorch , and can be reached at telephone number (97O) 352-1551. extension 6250. If this plan is proposed by two or more counties, the required signatures below are to be completed by each county, as appropriate. Attach an additional signature page as needed. a y 4,qo Signature, CTO , COUN D ARTMENT OF SOCIAL SERVIC DATE ., . "1B61cif , CH-AIR, BOARD OF COUNTY COMMISSIONERS DATE 2 REQUEST FOR STATE APPROVAL OF CORE SERVICES PLAN Family Issues Cash Fund (FICF) (100% Funding) This Core Services Plan is hereby submitted for Weld County Department of Social Services (Indicate county name(s) and lead county if this is a multi-county plan), for the period June 1, 1996 through May 31, 1997. The Plan includes the following: • "Statement of Assurances"; • Statement that the Core Service of Mental Health will be purchased from the Mental Health Center serving the region or area unless the needed Mental Health Service is not available from the Mental Health Center or unless the county was approved to grandfather in providers in FY 1995-96; • Statement that the Core Service of Drug/Alcohol will be purchased from either the local ADAD certified contractor or ADAD certified provider; • Completed program plan for each Core Service to be provided; • Completed "Information on Fees" form; Completed "Purchase of Service Delivery" form; • Completed "Overhead Cost" form; • Completed "Summary Sheet By Individual Service" form; • Completed "Final Budget Page" form; and • Completed 100% FICF Summary Form. This Core Services Plan has been developed in accordance with guidelines provided by the State Department of Human Services and is hereby submitted to the Colorado Department of Human Services, Division of Child Welfare Services for approval. If the enclosed proposed Core Services 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 FPP Plan is Kathy Lorch , and can be reached at telephone number (9701 352-1551. extension 6250 . If this plan is proposed by two or more counties, the required signatures below are to be completed by each county, as appropriate. Attach an additional signature page as needed. I� I UL1/jq/4✓o41€1-;; IREC OR., CO1.IffY PARTMENT OF SOCIAL SERVIC,FSDATE_�/,iALAa j ti teyrti C(� �•_ ture, CHAIR, BOARD OF COUNTY COMMISSIONERS DATE 3 FAMILY PRESERVATION PROGRAM PLAN CORE SERVICES PLAN STATEMENT OF ASSURANCES Weld County(ies) assures that, upon approval of the Family Preservation Program Plan (FPP) and Core Services Plan, the following will be adhered to in the implementation of the Plan: 1. Operation will be in conformity with the provisions of the Plan; 2. Operation will be in conformity with the provisions of State rules; 3. Family Preservation Program and Core Services, provided or purchased, will be accessible to children and their families who meet the eligibility criteria; 4. 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 Family Preservation or Core Services Program; 5. Services will recognize and support cultural and religious background and customs of children and their families; 6. No out-of-state travel will be paid for with FPP or Core Services funds; 7. All forms used in the completion of the FPP and Core Services plan will be State prescribed or State approved forms; 8. FPP FTE/Personal Services costs authorized for reimbursement by the State Department will be used only to provide FPP Services authorized in the county(ies)' approved FPP Plan; 9. The purchase of services will be in conformity with State purchase of service rules including contract form, content, and monitoring requirements; and 10. Information regarding services purchased or provided will be reported to the State Department for program, statistical and fmancial purposes in conformity with State rules. 4 960765 FAMILY PRESERVATION PROGRAM SERVICES CORE SERVICES TO BE PROVIDED/PURCHASED Place an (A) or a (P) to indicate which of the following Family Preservation Program Services will be provided/purchased in accordance with State Department rules: "A" indicates currently available to clients, "P" indicates that the service has previously not been available to clients; however, the county plans to purchase/provide in 96-97. A Home Based Intensive Family Intervention Service (Staff Manual Volume 7, 7.503.61) A Intensive Family Therapy Service (Staff Manual, Volume 7, 7.503.62) A Sexual Abuse Treatment Service (Staff Manual, Volume 7, 7.503.63) A Day Treatment Service (Staff Manual, Volume 7, 7.503.64) A Life Skills Service (Staff Manual, Volume 7, 7.503.65) Check which of the following apply and that will be purchased in accordance with State Department guidelines: A The Core Service of Mental Health will be provided by the Weld Mental Health Center. The Core Service of Mental Health will be provided by another provider. A The Core Service of Drug/Alcohol Treatment will be provided by a certified ADAD contractor. _ The Core Service of Drug/Alcohol Treatment will be provided by a certified ADAD provider. List county optional services of "County Designed Service" which will be provided/purchased in accordance with State Department rules (Staff Manual Volume 7.503.66): • List Transition Service(s) which will be provided/purchased in accordance with State Department rules (Staff Manual, Volume 7, 7.503.67).The service must have been approved in FY 94-95 & 95-96 in order to be provided in FY 96-97. 5 960765 • MENTAL HEALTH SERVICE INFORMATION Mental Health Service Provider Name(s) Weld Mental Health Center Mental health services are approved as a part of the county(ies)' FPP/Core Services Plan on an annual basis. Presently, for a mental health service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. The information listed below is to be submitted in the form of a Mental Health Services Plan and is to be included in the County(ies)' Family Preservation Program/ Core Services Plan. 1. Eligible Population A. Each child shall meet the criteria of: 1. Colorado's out of home placement criteria 2. Child is at imminent risk of out-of-home placement 3. The county defined child population, and 4. A manageable level of risk of harm to the child B. Children may also meet the following criteria: 1. Children in out-of-home placement in need of an expedited procedure for permanent placement. 2. Ineligible Population A. Children who meet the above criteria and are Medicaid eligible are not eligible for these services 3. Types of Service Provided A. Psychological evaluation: Families, children, and adolescents who are eligible and in need will be provided screening, evaluations, and other assessment services intended to provide information needed by the staff of the Department of Social Services. The evaluation procedures will be designed to produce useful responses to specific referral questions mutually developed by the evaluator(s) and WCDSS staff. The parties will also collaborate to identify any existing information that needs to be obtained or collateral contacts that need to be made prior to the completion of the evaluation. The WMHC will provide the WCDSS a written report upon completion of the assessment which clearly states methods used, contacts made, tests administered, results, and recommendations relevant to the referral questions. The content of this assessment will be made available to the family and other relevant parties, subject to the APA ethical standards and other legal considerations. B. Interactional evaluations of children and their families - NA. C. Individual, group, family and couples mental health therapy - NA. D. Medication evaluations - NA. 6 960765 E. Other services deemed necessary for the prevention of placement of children - Consultation: A Licensed psychologist will be available to directly consult with caseworkers of the WCDSS regarding the integration of assessment results into the overall care plans for children, adolescents, and families. This may include issues pertaining to the evaluation of suicidal clients and the need for inpatient placement or other levels of intervention. This individual would be available to assist in obtaining written feedback from Center clinicians regarding the rationale for decision on these issues. Court Testimony: The Psychologist providing the above services or any other mental heath practitioner providing services listed below will be available for court testimony when given proper notification. 4. Service Objectives A. Preventing imminent placement of children B. Reunifying children in out-of-home placement with their families. C. Preventing placement in a more restrictive level of care D. Developing expedited procedures for permanent placement of children 5. Service Time Frames A. Service time frames shall be specifically established for each service. B. Service time frames shall be intense, short term, and limited to one year. C. The Mental Health Service must be submitted and approved annually by the State Department The turn-around time on evaluations will be no more than forty-five (45) days from the point of referral. Consultation services will be available on a continuous basis and court testimony will be provided as needed. 6. Measurable Outcomes - measurable service outcomes and how the county proposes to measure and analyze the outcomes is to be developed and proposed as a part of the county department's Family Preservation Program Mental Health Plan. Measurable outcomes shall: A. Relate to service objectives B. Be specific and measurable C. Be objectively determined D. Relate to cost effectiveness E. Prevent out of home placement F. Reunify children with their families This design will shorten the time required to obtain evaluation results following a social service referral. The proposed will also increase the social service staff access to the practitioner when questions about evaluation results or implementation occur. A greater frequency of contacts 7 960765 between the evaluation practitioner and the social service staff will occur. Faster and more timely responses from the Children and Family Services Outpatient Program will occur and therapeutic interventions will be better coordinated between agencies. All of these outcomes can be quantified and compared with status prior to implementation of the proposed plan. It is proposed that the Directors of the Department of Social Services and the Mental Health Center jointly assign measures that will serve as specific outcome targets. • Emergency consultations will occur within twenty-four (24) hours of request. • All psychological evaluations will have clear recommendations and methods that will be accepted by the court. • Seven (7) to ten (10) assessments will be accomplished each month. • Intervention will be available within twenty-four (24) hours of request for routine referrals and immediately for emergency referrals. • For involved referrals, there will be a measurable reduction in the need for out-of-home placements. 7. Rate Structure/Service Provider- The standards of accountability, professionals and staff expertise are applicable. Counties are to purchase Mental Health Services from the local mental health center unless the mental health center does not offer the needed service or unless the County was approved to grandfather in certain mental health providers in FY 1995-96. Mental Health Core Service is not eligible for overhead. Activity Descriptions: Activity Code Rate Per Hour Psychological Evaluations Eval $60.00 Court Testimony Court $60.00 Consultation & Education C&E $60.00 $43,772.00 Mental Health $43.772.00 WCDSS $87,544.00 TOTAL 1 Q � 1910 Signature, DIRE OR, COUNTY D AR ENT OF SOCIAL SERVICE BATE 1/ / 4 9 ec_C),A0_,_ y 3 �� Signature, DIRE TOR, MENTAL HEALTH CENTER DATE 8 960766 DRUG/ALCOHOL TREATMENT SERVICE INFORMATION Drug/Alcohol Treatment Service Provider Name(s) Island Grove Regional Treatment Center Inc. Drug/alcohol treatment services are approved as a part of the county(ies)' FPP/Core Services Plan on an annual basis. Presently, for a drug/alcohol service to be extended beyond one year, this portion of the plan must be submitted and approved annually by the State Department. The information listed below is to be submitted in the form of a Drug/Alcohol Treatment Services Plan and is to be included in the County(ies)' Family Preservation Program/ Core Services Plan. 1. Eligible Population A. Each child shall meet the criteria of: 1. Colorado's out of home placement criteria 2. Child is at imminent risk of out-of-home placement 3. The county defined child population, and 4. A manageable level of risk of harm to the child B. Children may also meet the following criteria: 1. Children in out-of-home placement in need of an expedited procedure for permanent placement 2. Types of Service Provided A. Drug/alcohol evaluation relating to the family situation B. Prevention and education services C. Individual, group, and family substance abuse treatment D. AA model mentoring E. Out Patient services F. Other services deemed necessary for the prevention of placement of children 3. Service Objectives A. Preventing imminent placement of children B. Reunifying children in out-of-home placement with their families. C. Preventing placement in a more restrictive level of care D. Developing expedited procedures for permanent placement of children 4. Service Time Frames A. Service time frames shall be specifically established for each service. B. Service time frames shall be intense, short term, and limited to one year. C. The Drug/Alcohol Treatment Service plan must be submitted and approved annually by the State Department. 9 960765 5. Measurable Outcomes - measurable service outcomes and how the county proposes to measure and analyze the outcomes is to be developed and-proposed as a part of the county department's Family Preservation Program/Core Service Plan. Measurable outcomes shall: A. Relate to service objectives B. Be specific and measurable C. Be objectively determined D. Relate to cost effectiveness E. Prevent out of home placement F. Reunify children with their families 6. Staff Qualifications - Staff providing services must be ADAD certified. 7. Rate Structure/Service Provider - Whether service is purchased from certified ADAD contractors or private providers the standards of accountability, professionals and staff-expertise are applicable. (Certified ADAD contractors are those contractors who contract with the State ADAD Division and receive federal funding to provide services separate from Family Issues Cash Fund. The Core Service of Drug/Alcohol Treatment is not eligible for overhead. $43,772.00 TOTAL Signature, D CTOI) OUNT PAR 'MENT OF SOCIAL SERVITES DATE Signs DIRECTOR, ADAD DATE • 10 960765 ISLAND GROVE REGIONAL TREATMENT CENTER, INC. Est. 1974 AGREEMENT FOR ALCOHOL AND DRUG SERVICES This Agreement between Island Grove Regional Treatment Center, Inc. (Island ; Grove) and Weld County Department of Social Services (Social Services) is entered intoojor,. the purpose of providing alcohol and drug services to eligible clients under the Child Welfare Law Suit Settlement Agreement in the core service category of alcohol and drug service's-for the period, June 1, 1996 through May 31, 1997. The Agreement for alcohol and drug services shall run continually unless otherwise stated in written form with 30-days notice of any changes. Social Services is not limited to a specific number of referrals nor required to refer a certain number; the Agreement can only be limited based on ability to reimburse for services requested in a given funded year. The maximum contract amount for Fiscal Year 1996-97 is"$ 43,700. 1. Target/Eligible Population Social Services will determine eligibility for services under this Agreement from active Child Welfare caseloads. In addition to meeting eligibility criteria through Social Services, the referred individuals or families must have an identified alcohol or drug use issue. 2. Types of Service(s) Provided An overview of services offered by Island Grove is attached (Attachment A, ADAD 1996-97 Fee Schedule). Included is the cost for each item and defmitions of each service are described in Attachment B. It is recommended that based on the differential assessment a "Treatment Plan" will be formulated and a "Services Plan" (types of services, length of program, initial cost estimate) developed in conjunction with the case worker, appropriate family members of the identified referred case and the Island Grove counselor. Social Services may choose to prioritize services or offer the full menu of services based on individual need as determined by the assessment. Estimates as to length of treatment will be in the Services Plan. 1 The First Choice in Affordable Alcohol/Drug Services P.O.Box 5100•Greeley,CO 80631-0100•FAX(970)356-1349 9 ( 9A9 Detox/ResidentiaVAdministration•(970)356-6664 p Community Counseling Center•(970)351-6678 601y16 - -�� _ Agreement for Alcohol and Drug Services Page 2 of 3 3. Service Objectives The objective is to reduce the family or individual problems that are related to their alcohol and drug use patterns in an attempt to preserve the family structure and keep the youth/child(ren) from out of home placement or to expedite the return home or move the youth/child(ren) to a less restricitive placement. 4. Service Time Frames Service time frames are in part determined individually by the Treatment Plan and service that is requested. The Definition of Services (Attachment B) provides estimates in regards to length of treatment. The 'Services Plan' will further define agreed upon services and length of initial approval for services. 5. Measurable Outcomes The measurable outcomes will be based individually on the "Treatment Plan" for those cases in which ongoing services are recommended. Island Grove's individual treatment plan will determine the 'Service Plan' which will be approved by Social Services. Assessments are time limited; the completion of the service and a letter of results sent to the case worker may be the immediate goal/desired outcome. In addition to the individualized treatment plan, each program has specific measurable outcomes. Attached are program outcomes for the Special Connections program and the Domestic Violence program (Attachment C). Additionally, domestic violence and outpatient services uses the treatment progress evaluation form to determine progress in several areas, the use of Pre and Post Tests are used in the following programs: Special Connections, Domestic Violence, DUI, and Fast Track Adolescent. 6. Staff Qualifications The primary contact person at Island Grove Center for Social Service referrals is Robert (Bob) Keenan, M.A., CAC II. Mr. Keenan will be responsible for either performing the service or referring the service to another appropriate staff person. Attached is a sheet listing contacts for specific programs. You can contact these individuals directly if you prefer. All clinical services will be performed by staff certified as Alcohol & Drug Abuse Counselors Level II or above. Island Grove is a licensed alcohol and drug program through the Alcohol & Drug Abuse Division, Colorado Department of Human Services. (Attachment D, License). 7. Rate Structure/Service Provider Fees will be assessed to Social Services per Island Grove Center's Fee Schedule (Attachment A). For referrals who are able to pay, Island Grove will utilize our sliding fee schedule. Fees collected from clients under this Agreement will be subtracted from the monthly summary bill. Social Services is responsible for the full 2 960765 Agreement for Alcohol and Drug Services Page 3 of 3 Rate Structure/Service Provider continued reimbursement of services at the rates listed on Attachment A. Social Service referrals will not be sent to collections by Island Grove for default of co-pay/fees. Services will be performed regardless of client's refusal or inability to pay co-pay. The Sliding Fee Schedule will only be applied to those services as noted on the fee schedule, all other fees will be charged directly to Social Services. Island Grove will collect any applicable sliding scale co-pays and credit Social Services for any payments received on the monthly billing statements. Monthly billing statements will be forwarded by the fifth (5th) of each month to the designated person (Frank Aaron) for verification and processing at Social Services. 1O ' 4-8-616 Ms.(1k.J. Dean, Executive Director Date Island Grove Regional Treatment Center, Inc. Signature Date Weld County Department of Social Services 4A(EA)\REQUEST.DOC 415/96 3 960765 INDEX OF AGREEMENT Agreement Page(s) 1-3 Program Contacts Page(s) 4-5 ADAD Contract Checklist of Services Requested Page(s) 6 Attachment A ADAD 1996-97 Fee Schedule Page(s) 7-9 Attachment B Definition of Services Page(s) 10-14 Attachment C Program Outcomes Page(s) 15 Attachment D Licenses Page(s) 16 960765 PROGRAM CONTACTS ASSESSMENTS: Alcohol and Drug Differential Assessment Robert (Bob) Keenan, M.A., CAC II (970) 356-6664 Jerry Williams, CAC III (970) 356-6664 Steven Quackenbush, M.A., Ed.S., CAC III (970) 351-6678 Domestic Violence Steven Quackenbush, M.A., Ed.S., CAC III (970) 351-6678 TREATMENT OPTIONS: Domestic Violence Group Therapy Primary counselor assigned to the case. (970) 351-6678 Family Therapy Robert (Bob) Keenan, M.A., CAC II (970) 356-6664 Biofeedback John Wilde, M.A., CAC III (970) 351-6678 Substance Abuse Group Therapy Primary counselor assigned to the case. (970) 351-6678 Adult Intensive Outpatient Jerry Williams, CAC III (970) 356-6664 Women's Group Primary counselor assigned to the case. (970) 351-6678 4 960765 Program Contacts Island Grove Regional Treatment Center, Inc. Page 2 of 2 SPECIAL PROGRAMS: Special Connections Esther McDowell, M.A., CAC III (970) 356-6664 Fast Track Adolescent Program Jennifer Gunnarson, B.A., CAC II (pending) Bilingual Adolescent Counselor (970) 356-6664 MISCELLANEOUS SERVICES: Case Aide/Case Management Services Robert (Bob) Keenan, M.A., CAC II (970) 356-6664 Expert Testimony Primary counselor assigned to the case. Case Consultation (Inter-Disciplinary Assessment Process) Robert (Bob) Keenan, M.A., CAC II (970) 356-6664 or If enrolled in program, primary counselor assigned to case Millon Test Greg White, M.A., LPC, CAC III (970) 351-6678 COMPLAINTS/CONCERNS/PRAISES: Ms. B.J. Dean, M.A., CAC III Executive Director (970) 356-2422 (356-6664 after hours) 6A(EA)UIEQUESf.DOC 45/96 5 960765 ISLAND GROVE REGIONAL TREATMENT CENTER, INC. Est. 1974 ADAD CONTRACT CHECKLIST OF SERVICES REQUESTED Name of Client Referred: Date of Birth: / / Last First Mo Day Yr ASSESSMENT: ❑ Alcohol/Drug Differential (No Co-Pay) O Domestic Violence (No Co-Pay) TREATMENT OPTIONS: ❑ Domestic Violence Group Therapy ❑ Family Therapy Case Worker Requests Co-Pay Waived Case Worker Requests Co-Pay Waived ❑ Individual Counseling O Biofeedback Case Worker Requests Co-Pay Waived Case Worker Requests Co-Pay Waived ❑ Substance Abuse Group Therapy O Adult Intensive Outpatient Case Worker Requests Co-Pay Waived Case Worker Requests Co-Pay Waived ❑ Women's Group Case Worker Requests Co-Pay Waived SPECIAL PROGRAMS • Special Connections: ❑ Assessment (No Co-Pay) O Group Counseling (No Co-Pay) O Individual Counseling (No Co-Pay) • Fast Track Adolescent Alcohol/Drug Assessment ❑ Assessment (No Co-Pay) O Family Counseling O Individual Counseling Case Worker Requests Case Worker Requests Co-Pay Waived Co-Pay Waived MISCELLANEOUS SERVICES: ❑ Case Aide/Case Management Services ❑ Expert Testimony O Case Consultation O Millon Test Case Worker Requesting Services: Telephone: (970) - Ext. Date: / / Additional Comments: Supervisor Signature: Date The First Choice in Affordable Alcohol/Drug Services ee(en)vesQo6scnoc P.O.Box 5100•Greeley,CO80631-0100•FAX(970)356-1349 �� Detox/Residential/Adminisiralion•(970)356-6664 Community Counseling Center•(970)351-6678 96�'76 �+� 6 Attachment A ADAD 1996-97 Fee Schedule 7 960765 ISLAND GROVE REGIONAL TREATMENT CENTER, INC. Est. 1974 ADAD FEE SCHEDULE 1996-97 Island Grove Regional Treatment Center, Inc. ASSESSMENTS: Alcohol and Drug Differential Assessment $ 85.00 (includes baseline Urinalysis Test) Domestic Violence $ 75.00 TREATMENT OPTIONS: Domestic Violence Group Therapy $ 25.00/session Co-Pay/Sliding Fee Family Therapy $ 60.00/session Co-Pay/Sliding Fee Individual Counseling $ 60.00/session Co-Pay/Sliding Fee Biofeedback $ 60.00/session Co-Pay/Sliding Fee Substance Abuse Group Therapy $ 25.00/session Co-Pay/Sliding Fee Adult Intensive Outpatient $ 50.00/session Co-Pay/Sliding Fee Women's Group $ 25.00/session Co-Pay/Sliding Fee 8 The First Choice in Affordable Alcohol/Drug Services P.O.Box 5100•Greeley,CO80631-0100•FAX(970)356-1349 9�-/ Detox/ResidentiaVAdministration•(970)356-6664 Community Counseling Center•(970)351-6678 960'765 a,_•` ADAD Fee Schedule, 1996-97 Island Grove Regional Treatment Center, Inc. Page 2 of 2 (April t, 1996) SPECIAL PROGRAMS: Special Connections Services (Treatment for pregnant women and postpartum women Medicaid reimbursement eligible.) • If on Medicaid, Island Grove will bill Medicaid directly • If not on Medicaid, fees are as stated below: Differential Assessment $ 85.00 Individual Counseling $ 60.00/session Group Counseling $ 25.00/session Health Education Services $ 15.00/session Fast Track Adolescent Alcohol/Drug Assessment Assessment $ 85.00 Family Counseling $ 60.00/session Co-Pay/Sliding Fee Individual Counseling $ 60.00/session Co-Pay/Sliding Fee MISCELLANEOUS SERVICES: Case Aide/Case Management Services $ 35.00/hour Expert Testimony $150.00/day or any part of a day Case Consultation $ 35.00/hour (Interdisciplinary Assessment Process) Millon Test $ 30.00 4A(EA)WEQUEST.DOC 4/5/96 9 960765 Attachment B Definition of Services Assessments Treatment Options Special Programs Miscellaneous Services 10 960765 DEFINITION OF SERVICES ASSESSMENTS: Alcohol and Drug Differential Assessment (2-Hours) Assessment will evaluate alcohol/drug involvement as well as mental health status, history of mental health issues, sexual history, legal history, and certain standard tests (ASAP, Drinking History Questionnaire, Family Environment Scale) may be given. Baseline Urinalysis Testing (7 Panel) is included. Summary of assessment with recommendations sent to referral agency. The 7-Panel baseline urinalysis test for alcohol and drugs screens for the following: Tests determine what drugs are present in client. THC Cutoff Level: 20 ng/ml Amphetamines Cutoff Level: 1000 ng/ml Cocaine Cutoff Level: 300 ng/ml Barbiturates Cutoff Level: 200 ng/ml Benzodiazepines Cutoff Level: 200 ng/ml Opiates Cutoff Level: 300 ng/ml PCP Cutoff Level: 25 ng/ml Domestic Violence Assessment (3-Hours) The following areas will be assessed: • Criminal History • Profile of Client's Violent Behaviors • Mental Health Status • Client's Potential for Violence • Medical History • Substance Abuse History • Suicidal/Psychological/Cultural History Summary of assessment with recommendations sent to referring agency. TREATMENT OPTIONS: Domestic Violence Group Therapy (average length of treatment, 24 to 36 weeks) Groups for both men and women are offered. The group addresses anger management, healthy relationships, male and female roles, and boundaries. Family Therapy (Average length of treatment, 8 to 16 sessions) Involves two or more family members and provides therapeutic intervention to improve family communications functioning and relationships. Length of participation dependent on client's goals and progress toward meeting goals. 11 960765 Definition of Services Page 2 of 4 Individual Counseling (Average length of treatment, 6 to 12 Sessions) Primary client is seen on an individual basis. Length of participation dependent on client goals and progress toward goals. Biofeedback Sessions (Average length of treatment. 4 to 8 Sessions) The client will be monitored individually through sensitive computerized biofeedback instruments. The goal of biofeedback is self regulation--learning how to regulate both mental and physical processes for health and improved functioning. Biofeedback is used to reduce stress and to. demonstrate control over mental and physical impulses and develop deep relaxation techniques. Substance Abuse Therapy (Average Length of Treatment, 12 to 20 Sessions) A group to enhance positive coping skills by focusing on their lifestyle dealing with use and abuse of chemicals. Adult Intensive Outpatient (Average Length of Treatment, 4 to 12 Weeks) An intensive outpatient group therapy track that offers groups every evening, Monday through Friday, and a family program on the weekends. This program will include medical aspects of addiction and adult relapse education components focusing on the understanding the relapse process as well as group process (focuses on individual issues relating to their abuse of alcohol). The program length and participation level will be individualized based on the presenting issues and other factors. Women's Group (Average Length of Treatment, 12-36 Sessions) A gender-specific group addressing issues affecting women and their relationships, such as family violence, co-dependency, self-esteem and stress management. SPECIAL PROGRAMS: Special Connections Services (Through pregnancy and up to one year postpartum) A gender-specific program that focuses on healthy babies, appropriate child care, prenatal care, birth control, developmental stages of the baby, parenting skills, relationship issues, and other issues as identified by the counselor. Services include group and individual therapy, case management and family health education. Fast Track Adolescent Alcohol/Drug Assessment (Treatment is 5-days inpatient) A residential alcohol and drug evaluation for adolescents that includes specific testing and family involvement. (Refer to Page 3-4 of Definition of Services). 12 960765 Definition of Services Page 3 of 4 MISCELLANEOUS SERVICES: (refer to 1996-97 Fee Schedule) Case Aide This position will assist in family visits to determine how the family is functioning together while in the home, and to improve the family's ability to access resources in the community. The case aide can take direction from the primary therapist assigned to the family or the Social Services case worker. Duties to be performed by the case aide include, but are not limited.to providing transportation to therapy, doctors appointments and court, supervised visits, child care while family is in treatment, run errands such as filling prescriptions, shopping, and assisting in living skill development, assist the family in developing other service links and miscellaneous functions to facilitate the stabilization of the family. (Case Aide tasks will be mutually agreed upon between counselor and case worker and identified in the 'Services Plan'.) Milton Test: A standardized psychological test which measures functioning level in 22 personality disorders and clinical syndromes for adults (8th grade reading level; > 18; available in Spanish). Fast Track Adolescent Program The Fast Track Adolescent Program was developed on a time frame of five (5) days of evaluation and education. The targeted population ranges from 13 to 18 years of age who demonstrate substance abuse problems. The goal is to have these adolescents discover positive alternatives to their current use behavior. The program consists of a comprehensive differential assessment compiling personal and collateral information as well as data obtained from the Substance Abuse Subtle Screening Inventory (SASSI) and the Adolescent Self-Assessment Profile (ASAP) instruments. This data is utilized to develop an individualized treatment plan. Clients receive a minimum of three individual sessions with the focus on achieving their treatment goals and attend three groups per day with the primary focus on education and motivational topics. Family therapy is encouraged as a part of the client's treatment. On the fifth day, a discharge planning session will be implemented focusing on appropriate referrals addressing the needs and motivation of the adolescent and family. 13 960765 Definition of Services Page 4 of 4 Fast Track Adolescent Program continued Island Grove is able to bill for the additional services provided through our Fast Track Program through this contract. (Room and Board and our standard detox programming will be billed to our ADAD contract.) These additional services include an Alcohol/Drug Differential Assessment ($85.00), Family Therapy ($60.00), and up to three (3) Individual Counseling Sessions ($60.00/session), for a maximum total charge of $300 against our contract (currently at $43,700). The daily groups and discharge planning session is included in the standard detox program. Referral Process to Fast Track Program: 1. Contact Jennifer Gunnarson (bi-lingual) at (970) 356-6664. If she is not on duty, inform the staff person that Social Services is referring a Fast Track adolescent and give the youth's case worker's name so that the Fast Track staff can contact the case worker when they return to duty. 2. We can also back into this program should a youth come into detox from another referral source and Island Grove staff identify that it is an active social services client. If this occurs, we can initiate a call to your department to verify forwarding of a written assessment to the case worker and subsequent billing under this contract. 4A(EA)\REQUEST.OOC 4/5/96 14 960765 Attachment C • Program Outcomes (Special Connections/Domestic Violence) • Treatment Progress Evaluation (Domestic Violence/Community Counseling Center Outpatient) • Criteria for Completion of Domestic Violence Treatment • FAST TRACK Pre and Post Test 960765 - 1 , _ , > = H0 x e s i g W b h ...2' ( 2i e ez t 0 OI 8— 8 I I i z I _. aR e2 y o $ I C•1 CID I W O ZR X z 1 co I ti .- M N i i .. .. ; I k 0 la G N I J N %I i rp L l0� d OI !Of CI Z Eo °I `� ro -21 2 gym , W • t € m o • Or U ro ro 0 m! s U (a 0 m y i= f iQ I 1 1 — CD n g0� '� GI EL cn s`; ee, a WU } I I I `� ' m ti E t NI m C! C ' i Z � t;i _ € o; vI of x m -II' o U 3' U I .5 U _ U O ¢ U o " o " o " o1 ka V Fd ;� 6 � ono w J W -a, Z CA 7 y ' L �! N d d .O A of c� N g ED u , t U W o g o c O W m Lo ¢ tS l o "�I d W W Cl. 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U 3 0 Ca W iH >- L O v >i H i+i -ri ti U •Oi i E C HI") 001) ° o ° � L; roIn 960'S5 ISLAND GROVE COMMUNITY COUNSELING CENTER TREATMENT PROGRESS EVALUATION FORM Center for Men's Issues/ Subject Name: Domestic Violence Treatment Date: Group Leader: CoFac: INSTRUCTIONS: Please rate the person named above on each of the listed criteria. Rate him/her 'using the 0 to S scale below based on your impressions and observations. Return the form to file. 5 = extremely present 4 = very present 3 = somewhat present 2 = a little present 1 =very little present 0 = no opinion, uncertain, not applicable WEEK NO 9 118 , 27 ,36 Attendance: arrives at group session on time;socializes or lingers afterward contacts program in advance; has legitimate excuses for absences. Non-Violence . has not recently physically abused partner, children, or others, no apparent threats, intimidation, or manipulation. Sobriety: attends meetings sober; not high or drunk; no apparent abuse of alcohol or drugs during week; complying to ordered or referred drug and alcohol treatment. Acceptance: admits personal problem with alcohol exists; not minimizing, prattling, or excusing the problem; realizes responsibility for abuse; 'C j identifies contribution to problems Using techniques: takes conscious steps to avoid violence; refers to time- outs, self-talk, conflict resolution skills etc; does homework assignments Help-seeking: seeks information about alternatives; discusses options with others in the group; calls other participants for help; open to referrals and future support. Process conscious: lets others speak one at a time; acknowledges others' contributions: asks questions of others without interrogating; heeds direction of counselors. Actively engaged: attentive body language and non-verbal response; maintains eye contact, speaks with feeling; follows topic of discussion with comments. Self-disclosure: reveals struggles, feelings, fears and self -doubts; not withholding or evading issues: not sarcastic or defensive. Sensitive language: respectful of partner and opposite sex in general; avoids using sexist language; willing to address others who are abusive. TOTAL SCORE [50 possible] After-Care Plan: 960765 ISLAND GROVE COMMUNITY COUNSELING CENTER TREATMENT PROGRESS EVALUATION FORM Subject Name: Group Leader: CoFac: Date: INSTRUCTIONS: Please rate the person named above on each of the listed criteria. Rate him/her using the 0 to 5 scale below based on your impressions and observations. Return the form immediately to the evaluation contact person. 5 = extremely present 4 = very present 3 = somewhat present 2 = a little present 1 = very little present 0 = no opinion, uncertain, not applicable WEEK NO. 8 ( 14 , 24 , 30 Attendance: arrives at group session on time;socializes or lingers afterward contacts program in advance; has legitimate excuses for absences. Sobriety: attends meetings sober, not high or drunk; no apparent abuse of alcohol or drugs during week; complying to ordered or referred drug and alcohol treatment. Acceptance: admits personal problem with alcohol exists; not minimizing, blaming, or excusing the problem; realizes responsibility for abuse; identifies contribution to problems Using techniques: takes conscious steps to avoid alcohol abuse . Help-seeking: seeks information about alternatives; discusses options with others in the group; calls other participants for help; open to referrals and future support. Process conscious: lets others speak one at a time; acknowledges others' contributions; asks.questions of others without interrogating; heeds direction of counselors. Actively engaged: attentive body language and non-verbal response; maintains eye contact; speaks with feeling; follows topic of discussion with comments. Self-disclosure: reveals struggles, feelings, fears and self-doubts; not withholding or evading issues: not sarcastic or defensive. TOTAL SCORE [40 possible] After-care Plan • 960765 THE CENTER FOR MEN'S ISSUES ISLAND GROVE COMMUNITY COUNSELING CENTER CRITERIA FOR COMPLETION OF RECOMMENDED TREATMENT The minimum length of treatment is 36 sessions, meeting weekly, either in group sessions (90 minutes minimum) or individual sessions (50 minutes minimum). In order for a client to fulfill treatment obligations and to be discharged as compliant without recommendations for additional treatment, the following criteria must be met. However, the treatment provider may reduce the length of treatment to 24 weekly sessions if the client meets the criteria in bold print. 1. The client will not have engaged in y physical abuse throughout the term of treatment. Has been free of all forms of violence as defined in section 3.0 from the inception of treatment according to victim and client reports. 2. The client will have ceased to harass or intimidate the victim or any one associated with the victim in their case. 3. The client will have abstained from alcohol throughout the term of treatment or, if alcohol abstinence is not a recommendation of treatment, the client will have used alcohol only in a responsible manner as deemed appropriate by the attending counselor. 4. The client will not have engaged in the use of illegal or abuse of any legal substances. 5. The client will have openly disclosed information pertinent to her or his recovery in a timely and responsible manner and will have participated proactively in therapy. 6. The client will have fully complied with all court orders, agency attendance policies, and have paid all treatment fees in full. 7. The client will have received a passing grade on the CMI examination and be capable of demonstrating comprehension of critical concepts such as time-out, cycle of violence and types of abuse. 8. The client will have accepted responsibility for violent behavior. 9. The client will have a low probabality of continued violence based on lethality evaluation. 10. The client has no obsessional thinking regarding jealousy, or blaming victim for real or perceived injuries to self-esteem. Has no obsession • with abandment issues, or attempts to locate the vicitm, if separated. Client signature Date Counselor signature Date 960765 Adolescent Survey Pre and Post Test Adolescent Survey The survey will be color-coded, with the survey completed on the fast day and on the fifth day. Parent Survey The Parent Survey will be completed over the phone three months after the adolescent has been discharged from the program. 960765 ISLAND GROVE REGIONAL TREATMENT CENTER Detox Clinic Adolescent Survey Scoring Key False answers on questions 5, 6, 7 , 10, 14 and 15 = 1 point. All other questions that are True = 1 The higher the score will measure the total effectiveness of treatment in areas of the family, peer influence, values toward drug and alcohol use, emotions at time of admission and discharge, as well as education, and after-care-plan. An increase in total score at discharge indicates improvement in functioning and total effectiveness of treatment. Maximum points = 25 960765 ISLAND GROVE REGIONAL TREATMENT CENTER Detox Clinic Adolescent Survey Here at Island Grove Treatment Center we are concerned about your input. Please mark True or False on the following questions. (This is not a test. ) 1. I am willing to give up the use of alcohol/drugs. _T F 2. I have a problem with alcohol and/or drugs that I need help with. _T _F 3 . Marijuana can have long term health risks. _T _F 4 . I feel comfortable going home. _T _F 5. I don't have any problems. _T _F 6. I feel angry. _T _F 7 . I know where I am going after I leave Detox. _T _F 8 . My family cares about my alcohol/drug use. _T _F 9. I can talk to my family about how I feel. _T _F 10. My friends make good choices. _T _F 11. I feel my friends have a lot of say in what I do. T F 12 . I feel I need to stop using alcohol/drugs. _T _F 13 . I have experienced consequences from my alcohol/ drug use. _T _F 14 . I need alcohol/drugs. _T _F 15. I can stop using alcohol/drugs at anytime. _T _F 16. Taking alcohol/drugs can have harmful effects. _T _F 17 . There is help available for people who use alcohol/drugs. T _F 18 . Alcohol/drugs can cause me to do things I would not normally do. _T _F 19. I care about myself and my life. _T _F 20. I feel it is important that my family is involved in my recovery. _T _F 960765 Adolescent Survey Page Two 21. I want help for my alcohol/drug use. T F 22 . I feel cared for as a person. T F 23 . I can have legal problems because of using alcohol/drugs. _T F 24 . I feel good. T F 25. I have the ability to make decisions. 960765 ISLAND GROVE REGIONAL TREATMENT CENTER Detox Clinic Follow up Parent Survey 1. My son/daughter followed through on referrals given to them from Island Grove Detox. 2 . I felt I was able to openly express concerns about my son/daughter with Island Grove staff. 3 . My son/daughter is currently drug free or was for a period of time after leaving detox. (If he/she was clean for a specific amount of time please specify for how long. ) 4 . I feel the family communicates better than before my son/daughter went to Island Grove. 5. My son/daughter seems to be making alcohol/drug free choices. 6. My son/daughter has changed his/her friends. 7 . I feel our family is functioning well. 8. On a scale of 1-10, (with one being the lowest and ten being the highest) where would you rate your family before detox and after. 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I cite,.X.,...‘ to z w r U H •" a • a 1/4g PI ;,1 7.47;4(fek‘c, et F ri o v O F ° .,: Q a o g� > w r 9t V a owe a DI E4 ma ° �) a: .�y�� m N O x E 1 o ' • �. irk „-,---t-744.4.--... .. = O N O tL ,T•I 0 El 0 a�Y15 '� / �.,.:•",r_�`.s "111 C7 x m ..��T/ iI W zt �Y Inky' CZ z k .max. Q T tfin • 1 :yy: _ pT{ '.,list.. 1 a" y rl O 'q &,.4"4`. !^ W •w 0Ca ,. •ce.` O +Q dl ^�-•,•'; .. un rmTr ' m rrrrrn ,�,��. nii� �„ n „i > �` d J L J "71.,t L J , L J 960765 CORE SERVICES ECONOMIC ASSISTANCE PLAN Funding available; $10,000/year or $833/month How accessed: Caseworkers will fill out the request form and submit to their supervisor for approval. Bow approved: Caseworker will attend weekly out-of-county staffing meeting where the merits of their request will be reviewed. Approval will require three supervisor signatures. Criteria: As described by Special Economic Assistance guidelines. Service reporting: One supervisor will be responsible for recording expenditures, families served, objectives of service, and results. Caseworkers will fill out evaluation form and advise supervisor of results. Supervisor will be responsible for quarterly reports. Measurable outcomes: Included will be specific service purchased, effect on placement or reunification, expense, number of individuals serviced, and objective of service. Process: Approved requests will be sent to the business office to obtain the need voucher. $10,000.00 TOTAL (� ` AM Signature, D OR, OUNTY EP MENT OF SOCIAL SERVItESI DATE 11 960765 INFORMATION ON FEES Please check the following which apply: X Fees will not be assessed for Family Preservation Program Services. (STOP. Remainder of information does not need to be completed.) Fees will not be assessed for Core Services. Fees will be assessed for the following services: Check those that apply: Home Based Intensive Family Intervention Intensive Family Therapy Sexual Abuse Treatment Day Treatment Life Skills Mental Health Services X Drug/Alcohol Services *No fee for assessments, sliding scale fee for some services based on client. See attached menu of services. County Designed Service (List Services Below) Transition 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. 12 960765 � }// \ rn � )) / i )to ^ / 8 S. ° � - / w 2 0 \ dj � \ ` . bt W / \ � ) \ ] Zii * � A. § ri 5 2 / X ' I en - Q Eli V.0 _ \ \ ll / / f / ) \ ifi @ ) 4 � du e ° . / 4 \ II § 4O48 Id 4 \ ` 0 0 \ = 0 o II ~ u z c g \ \ © H g = id it; ° ) ) \ • ) A. ) \ , ) G , 960765 ca ra` F \ ft� \ \ cci - - _ ; - \ 44 /C ) .--4 .4 .-I ) @ / � 5 8 r Fl 00 ! ! » 0? u « & \ a 0 U \ \ \ t • \ \ O O / &� ` � \ \ \ Loa� k & � 0 / / ! II § � � ] ! $ 3 � ) § j \ `) , ; ) / § ] E , , , / § � \ ? 0 * II § d e § -) o _ _ \ (42 co 2 2 ' / 0.) II / " \\ ) ! I G \ § \ 5 § II j ) \ \ } 0 ) - § ) % ] / \ g \ ( \ q § 0 § ) / ) ) ! 1 * 960765 . . �. . . . ` - 2 < a g 8 8 $ $ K 8 / $ 4 \ ^ ! ; & _ ) a J . � ) 4. /! ) N N N N N N k t O IS Cr? El • © fit 8 ( % 8 ; 8 ± m } 7 ! 2 o } k — _ « » Co0 G.' \ \ r ) \ ! awo ° & § e & 2 / 2 / 0 * ` j j \ \ \ \ ) § § § (ce, 2 /\ \ \ ( \ II to _ wad � ` ) � ) ® \ ) k \ 3 / 0 § & k ® ° - en re;a Lei , / § ›. II 4450 E ` \ w ..t.' ± © x x _ _ _ _ / 0 @ i o o O U `k\ k , 0 \ k ( ( ( / \ m 0 03 ] { ) ® \ 2 n ) / ( ) | 0 2 ^ \ •) a. g ° k • \ f / \ } \ \ I a ; 960765 `)k\ 8. 8 8 8 E 7 ! # � ! k k & i P. \ cu ! ± % Ol - - - - \ ! o k C } t @ a m 8 ` \ k - & Ca 7 \ 0 = a \ / _ ) / g . . 2 § 2 \ & ` §is k/ '0 8 2 A' .8 » � \ 69• co - - ©d § ( a \ w § \ jS II H0kg � t 2 \ / j { ` ) \ j - 44- ETA - z � \ kk / ` on II ° d8 § - )/ \ a - ° _ _ , _ \ ° wo H j I o a H ~ § \ \ ( § ! : ) _ § ` Fol II 5 71 .4g \ } -8 .- co \ ` § ) ( k 0 ) \ \ I. 0 I 2 2 \} ) k § ! ; «, z / . . . 960765 , ) / t 8 8 R � \ F. « I .48 / \ ii- ` u w O ) . e n w \ � ) z E 13 K ) ZA a u ` } \ Ca) \ u i = ) { � f \= / \ / k &03 C. ] E-, k \ \ cn / H e ) ) ! " / ? k , ® k * t-- -, \ d \ \ ) o \ \ U ) k , °04 i § 2 8 E - \ ) ` `• Cl 0 f i w . _ ` § \ ) r \ (.1) cm ° U . u = j 0 ' j ® § § ) ] U. , ° O j \ ea lai 2 § \ ) ) \ . ) 0 ) \ \ * 960765 FAMILY PRESERVATION PROGRAM OVERHEAD COST 1. PROVIDED SERVICE A. Total Salary/Fringe/Travel/Operating Costs of Line Service Workers and their Immediate Supervisors B. Formula Percentage Allowed for Overhead Costs 15% C. Provided Service Overhead Costs (A X B) 2. PURCHASED SERVICE A. Purchased Service Dollar Amount $707.431.00 B. Formula Percentage Allowed for Overhead Costs 3.7% $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) $ 26,174.95 D. Base Overhead Cost Allowed $500.00 E. Purchased Service Overhead Costs (C + D) $ 26,674.95 3. TOTAL OVERHEAD COSTS (1C + 2E) DISTRIBUTION OF OVERHEAD COSTS AMONG SERVICES SERVICE Provided Service Purchase Service Total Overhead Costs Overhead Costs Overhead Costs 1. Home Based Services (A) $0.00 $ 0.00 $ 0.00 2. Home Based Services (B) $0.00 $ 1,667.18 $ 1,667.18 3. Intensive Family Therapy $0.00 $5,001.54 $5,001.54 4. Sexual Abuse Therapy $0.00 $ 3,334.36 $3,334.36 5. Day Treatment $0.00 $6,668.72 $6,668.72 6. Life Skills $0.00 $10,003.08 $10,003.08 7. County Designed Service $0.00 $ 0.00 $ 0.00 8. Transition Service $0.00 $ 0.00 $ 0.00 COLUMN TOTALS $26,674.88 $26,674.88 * 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. 18 960765 HOME BASE SERVICES, OPTION B COST SUMMARY SHEET 1. Account Code (either 17XX or 18XX) 1783 2. Total number of children to be served by provided services 0 3. Total number of children to be served by purchased services 12 4. Average number of children(total 2 +3) to be served monthly 4 5. Total number of families to be served 12 6. Average number of families to be served monthly 4 7. Employee FTE number (total staff listed page 14) 0 8. Total cost from page 14 0 Overhead cost (Chart on 25, line 2, column 1) 0 Total provided cost 0 9. Monthly provided cost per child 0 [this is determined by dividing the total provided cost (8.) by (2.) and then dividing that total by the number of months the service will be provided.] 10. Total cost from page 20 $37.823.00 Overhead cost (Chart on 25, line 2, column 2) $ 1.667.18 Total purchased cost $39.490.18 11. Monthly purchased cost per child $ 822.71 [this is determined by dividing the total purchased cost (10.) by (3.) and then dividing that total by the number of months the service will be provided.] 12. TOTAL COST REQUESTED [(8.)+(10.)] $39.490.18 13. Total 80/20 service cost $25.830.44 14. Total 100% service cost requested $13.659.74 19 960765 • INTENSIVE FAMILY THERAPY COST SUMMARY SHEET 1. Account Code (either 17XX or 18XX) 1784 2. Total number of children to be served by provided services 0 3. Total number of children to be served by purchased services 52 4. Average number of children(total 2 +3) to be served monthly 26 5. Total number of families to be served 52 6. Average number of families to be served monthly 26 • 7. Employee FTE number (total staff listed page 15) 8. Total cost from page 15 0 Overhead cost (Chart on 25, line 3, column 1) 0 Total provided cost 0 9. Monthly provided cost per child 0 [this is determined by dividing the total provided cost (8.) by (2.) and then dividing that total by the number of months the service will be provided.] 10. Total cost from page 21 $141 291.00 Overhead cost (Chart on 25, line 3, column 2) $ 5.001.54 Total purchased cost $146.292.54 11. Monthly purchased cost per child $ 468.89 [this is determined by dividing the total purchased cost (10.) by (3.) and then dividing that total by the number of months the service will be provided.] 12. TOTAL COST REQUESTED [(8.)+(10.)] $146.292.54 13. Total 80/20 service cost $ 95.689.62 14. Total 100% service cost requested $ 50.602.92 20 960765 LIFE SKILLS COST SUMMARY SHEET 1. Account Code (either 17XX or 18XX) 1785 2. Total number of children to be served by provided services 3. Total number of children to be served by purchased services 82 4. Average number of children(total 2 +3) to be served monthly 27 5. Total number of families to be served 82 6. Average number of families to be served monthly 27 7. Employee FTE number (total staff listed page 16) 8. Total cost from page 16 0 Overhead cost (Chart on 25, line 4, column 1) 0 Total provided cost 0 9. Monthly provided cost per child 0 [this is determined by dividing the total provided cost (8.) by (2.) and then dividing that total by the number of months the service will be provided.] 10. Total cost from page 22 $181.981.10 Overhead cost (Chart on 25, line 4, column 2) $ 10.003.08 Total purchased cost $191.984.18 11. Monthly purchased cost per child $ 592.54 [this is determined by dividing the total purchased cost (10.) by (3.) and then dividing that total by the number of months the service will be provided.] 12. TOTAL COST REQUESTED [(8.)+(10.)] $191.984.18 13. Total 80/20 service cost $125.576.41 14. Total 100% service cost requested $ 66.407.77 21 960765 DAY TREATMENT SERVICES COST SUMMARY SHEET 1. Account Code (either 17XX or 18XX) 1786 2. Total number of children to be served by provided services 3. Total number of children to be served by purchased services 36 4. Average number of children(total 2 +3) to be served monthly 135 5. Total number of families to be served 36 6. Average number of families to be served monthly 12 7. Employee FTE number (total staff listed page 17) 8. Total cost from page 17 0 Overhead cost (Chart on 25, line 5, column 1) 0 Total provided cost 0 9. Monthly provided cost per child 0 [this is determined by dividing the total provided cost (8.) by (2.) and then dividing that total by the number of months the service will be provided.] 10. Total cost from page 23 $240.941.00 Overhead cost (Chart on 25, line 5, column 2) $ 6.668.72 Total purchased cost $247.609.72 11. Monthly purchased cost per child $ 1.528.45 [this is determined by dividing the total purchased cost (10.) by (3.) and then dividing that total by the number of months the service will be provided.] 12. TOTAL COST REQUESTED [(8.)+(10.)] $247.609.72 13. Total 80/20 service cost $161.960.95 14. Total 100% service cost requested $ 85.648.77 22 960765 SEXUAL ABUSE TREATMENT SERVICES COST SUMMARY SHEET 1. Account Code (either 17XX or 18XX) 1787 2. Total number of children to be served by provided services 0 • 3. Total number of children to be served by purchased services 21 4. Average number of children(total 2 +3) to be served monthly 7 5. Total number of families to be served 21 6. Average number of families to be served monthly 7 7. Employee FTE number (total staff listed page 18) 8. Total cost from page 18 0 Overhead cost (Chart on 25, line 6, column 1) 0 Total provided cost 0 9. Monthly provided cost per child 0 [this is determined by dividing the total provided cost (8.) by (2.) and then dividing that total by the number of months the service will be provided.] 10. Total cost from page 24 $78.720.00 Overhead cost (Chart on 25, line 6, column 2) $ 3.334.36 Total purchased cost $82.054.36 11. Monthly purchased cost per child $ 976.84 [this is determined by dividing the total purchased cost (10.) by (3.) and then dividing that total by the number of months the service will be provided.] 12. TOTAL COST REQUESTED [(8.)+(10.)] $82.054.36 13. Total 80/20 service cost $53.671.57 14. 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BOX A C.L.EF;i"� GREELEY, COLORADO 80632 TO THE Administration and Public Assistance (970) 352-1551 Child Support(970) 352-6933 C Protecitve and Youth Services (970) 352-1923 • Food Stamps (970) 356-3850 COLORADO Fax (970) 353-5215 April 29, 1996 MEMORANDUM TO: Barbara J. Kirkmeyer, Chair, Board of Weld County Commissioners FR: Judy A. Griego, Director, Social Services, frUT OLkO 0 RE: Family Preservation Program Plan for 1996-1997 Enclosed for Board approval is the Family Preservation Program Plan for 1996-1997, beginning June 1, 1996 through May 31, 1997. The total budget for the Plan is $848,747 with $462,729 (80% federal/state shares to 20% local share funds) and $386,018 (100% local share funds). The Plan comprises four sections as follows: 1. Core Services Plan: The Core Services Plan was developed as a result of a bid process conducted under the auspices of the Board of Weld County Commissioners. The Placement Alternatives Commission (PAC) reviewed the final bid recommendations developed by a PAC bid review subcommittee; however, the Placement Alternatives Commission did not act on the bid recommendations as a whole because the majority of PAC members had potenti I or real conflict of interest issues. a. Total funds for Core Services are $707,431 of which $680,756 is direct purchase of service funds and $26,675 are administration funds. b. Direct purchase of service programs consist of: Agency Program Total 1) Weld Mental Health Home Based Option B $ 37,823 2) Weld Social Services Sexual Abuse Treatment $ 46,000 3) Island Grove Treatment Sexual Abuse Treatment $ 32,720 4) Child Advocacy Resource Life Skills Program $ 76,041 5) Weld Health Department Life Skills Program $ 24,144 6) Dream Team Life Skills Program $ 20,340 7) A Woman's Place Life Skills Program $ 15,768 8) Center for Parents Life Skills Program $ 26,000 9) First Steps Life Skills Program $ 19,688 10) Ackerman and Associates Intensive Family Therapy $ 28,080 11) Weld Mental Health Intensive Family Therapy $ 87,138 960765 MEMORANDUM April 29, 1996 Page 2 12) Island Grove Treatment Intensive Family Therapy $ 26,073 13) Weld Mental Health Day Treatment $ 40,590 14) Alternatives Home Day Treatment $ 65,592 15) Youth Passages Day Treatment $ 84,600 16) Weld Social Services Day Treatment $ 50,159 Total $680,756 2. Mental Health Services Plan: The Mental Health Services Plan provides for matching resources from the Family Issues Cash Fund (100% Federal/State share funds) on behalf of the Weld County Department of Social Services and Weld Mental Health, Inc. a. Total funds available are $87,544 of which $43,772 is matching funds from Weld Mental Health and $43,772 is matching funds from the Weld County Department of Social Services. b. Weld Mental Health will provide psychological evaluations for non-medicaid clients identified by Social Services, court testimony, and consultation & education for case workers. 3. Drug/Alcohol Treatment Services Plan: The Island Grove Regional Treatment Center Inc., will provide drug/alcohol treatment services for clients identified by Social Services. a. Total funds available from the Family Issues Cash Fund are $43,772 on behalf of Island Grove Treatment Center and the-Weld County Department of Social Services. The funds are not matched as described in the Mental Health Services Plan. b. Island Grove Regional Treatment Center will provide evaluations, prevention and education services, treatment, mentoring, and outpatient services. 4. Special Economic Assistance Plan: Under the Child Welfare Settlement Agreement, the State was required to make available to counties funds which would provide direct services to families. a. The State, through the Family Issues Cash Fund, will provide $10,000 for Weld County to provide direct services according to the guidelines provided by the State. Expenditures cannot exceed $400 per year per family. b. Direct services must result in reunification of the family or avoid placement of children in foster care. Direct services may include emergency housing/rent vouchers, transportation, and other emergency services. • If you have any questions, please telephone me at extension 6200. 960765 Hello