HomeMy WebLinkAbout960477.tiff RESOLUTION
RE: APPROVE LIFE SKILLS PROGRAM BID PROPOSAL APPLICATION FOR FAMILY
PRESERVATION PROGRAM FROM HEALTH DEPARTMENT TO SOCIAL SERVICES 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 a Life Skills Program Bid Proposal
Application for the Family Preservation Program from the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Weld County Health
Department, to the Weld County Department of Social Services, commencing June 1, 1996, and
ending May 31, 1997, with further terms and conditions being as stated in said application, and
WHEREAS, after review, the Board deems it advisable to approve said application, 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, that the Life Skills Program Bid Proposal Application for the Family Preservation
Program from the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Health Department, to the Weld
County Department of Social Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 20th day of March, A.D., 1996.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
14 E i' 9 rMa?
FXCI IRFI7
Barbara J. Kirkmeyer hair
ieci Clerk to the Board r
q\ O • � écterCT
U � !�*uty Cler f o the Board
Dale K. Hall
AP AS TO FO FXCI ISFII
Constance L. Harbert/�Y
C my Attorn y // ./ r Cf i
. . ter
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INVITATION TO BID
DATE: January 30, 1996 BID NO: RFP-PAC-96005
RETURN BID TO: Pat Persichino, Director of General Services
915 10th Street, P.O. Box 758, Greeley, CO 80632
SUMMARY
Request for Proposal (RFP-PAC-96005)for: Family Preservation Program--Life Skills Program
Family Issues Cash Fund or Family Preservation
Program Funds
Deadline: March 26, 1996, Tuesday, 10:00 a.m.
The Placement Alternatives Commission,an advisory commission to the Weld County Department of Social
Services, announces that competing applications will be accepted for new grants pursuant to the Board of
Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5-
101)and Emergency Assistance for Families with Children at Imminent Risk of Out-of-Home Placement
(C.R.S. 26-5.3-101). The Placement Alternatives Commission wishes to approve twelve month programs
targeted to run from June 1, 1996 through May 31, 1997, at targeted funding levels of increments up to
$327,972.00. The Life Skills Program must provide services that focus on teaching life skills and are
designed to facilitate implementation of the case plan by improving household management competency,
parental competency, family conflict management and effectively accessing community resources. This
program announcement consists of five parts, as follows:
PART A...Administrative Information PART D...Bidder Response Format
PART B...Background, Overview and Goals PART E...Bid Evaluation Process
PART C...Statement of Work �y
Delivery Date 'i►IQ.lC A c2/ , x`74(..0 -
(After receipt of order) BID Mit-ST BE SIGNED IN INK 03/20/96
Weld County Board of Commissioners
George Baxter, Chair Protem
TYPED OR PRINTED SIGNATURE
VENDOR Weld County Health Department
(Name) H written Signature By Authorized
Officer or Agent of Vender
John S. Pickle, Director
ADDRESS 1517 16th Avenue Court TITLE Weld County Health Department
Greeley, CO 80631 DATE 03/20/96
PHONE # (970) 353-0586
The above bid is subject to Terms and Conditions as attached hereto and incorporated.
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RFP-PAC-96005
LIFE SKILLS PROGRAM BID PROPOSAL
FAMILY PRESERVATION PROGRAM
1996/1997 BID PROPOSAL APPLICATION
PROGRAM FUNDS YEAR 1996-1997
BID#RFP-PAC-96005
NAME OF AGENCY: Weld County Health Department
ADDRESS: 1517 16 Avenue Court, Greeley, Colorado, 80631
PHONE: (970) 353-0639
CONTACT PERSON: Kathy Shannon. R.N.. M.S. TITLE: Nursing Supervisor
DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills Program Category must provide
services that focus on teaching life skills and are designed to facilitate implementation of the case plan by improving
household management competency, parental competency, family conflict management and effectively accessing community
resources.
12-Month approximate Project Dates: 12-Month contract with actual time lines of:
Start June 1. 1996 Start
End May 31, 1997 End
TITLE OF PROJECT: Identification and Case Management for Families with Attachment Problems
AMOUNT REQUESTED: $27,164.00
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I�alt lees 1�S✓lainc / ! igAterg�/i"' i1/'. (52 in'
Name and Signature of Person Pfeparing Document Date
N
Administra we Office Applicant Agency ignature Chief pp g y Date
MANDATORY PROPOSAL REQUIREMENTS
Please initial to indicate that the following required sections are included in this proposal:
Project Description / Measurable Outcomes K. Staff Qualifications
_ Target/Eligibility Populations Service Objectives Unit of Service Rate Computation
Types of Services Provided Workload Standards ;Y , Budget Description
Date of Meeting with Social Services Division Supervisor: January 26, 1996
Comments by SSD Supervisor: Continue with increase age of the eligible children from six years to eight years. Also
provide more training to case workers and day care centers about identification of children with attachment disorders.
Name and Signature of SSD Supervisor Date
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Identification and Case Management for Families with Attachment Problems
PROJECT DESCRIPTION
The Attachment Center at Evergreen, Inc. was founded by Dr. Foster Cline over 20 years ago, and
continues today under the direction of Paula Pickle, L.C.S.W. It is served by specially trained therapists
who work with the most severely affected children. They conduct two-week intensive care therapeutic
sessions with children who are placed in therapeutic homes with foster parents who have been trained to
meet their special needs. They also conduct quarterly workshops for parents and professionals struggling
to work with children with Attachment Disorders. An Attachment Disorder(AD) is a condition in which
individuals have difficulty forming loving, lasting, intimate, relationships. In the most severe situations, the
children fail to develop a conscience and do not learn how to trust others. The children are also at high
risk for child abuse as caregivers struggle to deal with the children's behavior.
The Weld County Health Department(WCHD) in conjunction with the Attachment Center at Evergreen,
Inc. would screen children from zero to eight years of age for attachment disorders. All children seen will
be referred from the Department of Social Services (DDS). A WCHD nurse has been trained by the
Attachment Center in screening and day to day interventions for parents. The goal is to identify nine
children who screen positive with an attachment disorder. For those children who's screen is positive, a
complete evaluation would be done by a therapist specializing in attachment disorders from the
Attachment Center. This therapist would make specific recommendations for intervention to be done by
the WCHD nurse in the family's home. All of the parents will be assisted with parenting skills, life
management skills, conflict management, and resource development. This assistance will help parents
cope with children at greater risk for abuse due to the attachment problems. The Attachment Center also
has therapeutic parents available for consults. Phone consults between the WCHD nurse and the
Attachment Center would be on-going. The Health Department also has two pediatric neurologists
available to.help with differential diagnoses when necessary. Each child who is diagnosed with an
attachment disorder would start with intensive intervention as necessary in all life skill areas. These home
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visits would decrease in intensity gradually as the child and family progress. It is our hope that if these
children are diagnosed early and receive appropriate intervention, their relationships can improve and they
can become respectful, responsible, and fun to be around.
Each family will be encouraged to join a parent support group which will help parents get the information
and services they need. Nationally, a parent network publishes a quarterly newsletter and gives formal
and informal support and advice.
Weld County Health Department nurses currently provide well-child exams, developmental screenings,
hearing screenings, day care consultations, home visit case management, and resource linkage for all
children. They also administer the Health Care Program for Children with Special Needs (HCP)which
helps pay for children to be seen by specialists such as neurologists, cardiologists, orthopedic specialists,
and ear, nose, and throat specialists. This Attachment Disorder grant adds another needed component to
existing services.
II. TARGET POPULATION/ELIGIBILITY REQUIREMENTS
The number of clients receiving intervention would be nine initially. However, this number could be higher
if there are siblings in a family. The number of children screened could be many more with only a small
percentage screening positive for AD. In our first year, two screened positive, while three children
received intervention and six were screened and referred to appropriate resources. During the week of
March 11, 1996, we have had four new referrals, at least two of whom are probably truly AD.
All the clients billed to PAC will be referred from the Department of Social Services and should be between
the ages of infancy (newborn) and eight years of age. A total of nine family units would be served. These
family units would include any family members that have a relationship with the identified child and who
are willing to invest in an ongoing relationship.
•
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About 25% of Weld County's population is HiSpanic, so we would expect that two to three of our clients will
be Hispanic. However, the Hispanic clients will not be limited to two or three. If all of the families who
were suspected to be struggling with AD were Hispanic(this would be very unusual), they would be
screened and treatedregardless of their race or language. We are currently screening a Guatemalan
family.
Between 30% and 40%of Weld County population is in south Weld County. Therefore, we would
estimate that 30%to 40% of our referred population will be from south Weld County. All referrals from
Social Services will be accepted regardless of the families' location within the county. In the 1995/ 1996
grant year, two of our three families were from south Weld County. Of the newest four, one is from south
Weld County.
The maximum monthly program will be about four to five families receiving intervention. Additional
families (one to two)could be screened at the same time. The average capacity will be three to four
families undergoing intervention and one to two families receiving screening. The average number of
hours of intervention per family will be around five hours per week. This will also vary depending on the
family's need.
The average stay in the program will be six to eight months. If further time is needed however, the
families' length of intervention will be based on need. If the caseworker and AD home visitor agree that a
different kind of intervention would be more beneficial after two to three months, that will happen.
Frequently, members of these families need counseling in addition to or instead of life skills support.
III. Services to be Provided
Anticipatory guidance for each developmental stage of the child will be taught. How to change the
environment to promote safety and improved hygiene will be demonstrated. Interaction with the children
will be modeled and coached whether it be alternative positions for breastfeeding or how to hold a child for
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safety when he/she is raging. Household management issues such as budgeting, cleaning, maintenance,
purchasing, menu planning, and food preparation will be addressed as the need and interest of the family
arises.
Parenting or suggestions for re-parenting, child rearing, and discipline will be the biggest component for
this grant. The importance of eye contact, gentle touch, soothing movement, and smiles will be stressed.
Demonstrations of how to play with a child such as singing together, reading together, and playing games
together will be given. Working with a child and the importance of such things as doing chores together or
completing projects together will be stressed to encourage self-esteem, mutual reliance, and goal setting.
Modeling the listening skills necessary to encourage verbal expression of feeling, acceptance of feelings,
and exploring choices for handling feeling will be a major emphasis. Consequences for the child's choices
will be coached.
Referrals to community resources and the facilitation of linkages will be another component of this grant.
Follow-up on all referrals with the family and involved agencies will be done to assure linkage occurs.
Reducing parental isolation through a parent support group will be offered to the community at large. This
group will focus on providing information to all parents in the community interested and on giving support
to those who are struggling with an AD child. All of these services will be offered to all families screened
by the grant, as we currently do with all families for whom the Health Department provides case
management, through a program known as"Working in the Neighborhood for Growth and Success"
(WINGS). This program facilitates each family to identify their strengths and needs and then develop a
plan to help with the needs.
IV. Measurable Outcomes
All of the families screened will be asked to complete three screening tools with the assistance of the
nurse. One refers specifically to AD and will be completed by the nurse and family initially and every three
months during the time the family is participating in the grant. The same tool will be used with the families
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six months after their participation in the grant ends to help assess the impact the intervention may have
had on the family and whether or not the family is still intact. Another tool is the Parenting Stress Index
(PSI)to measure the families' ability to parent and need for respite. This includes the families' ability to
work independently with other resources in the community. Respite is often a need of children with AD,
and would be discussed with DSS case workers as the need arises.
A third tool that incorporates all the other aspects of the life skills services, such as household
management, cleaning, budgeting, nutrition, etc., and adds other areas, such as family isolation and
environmental risks (paint chips), has been developed as part of the Health Department's regular case
management program, WINGS. The tool will also be set up as a Likert Scale and indicate how families
are doing in several aspects of child rearing and household management. See attachments A, B, and C
for examples. These tools will continue to be refined as time goes on. The PSI has been too long for
most of our families to complete.
V. Service Objectives
Based on these screening tools, measurable objectives will be developed with each family according to
their highest areas of need, and will be monitored throughout intervention. As objectives are met, new
ones will be developed in conjunction with the families to teach goal setting and self-reliance. An
additional support toward independence and self-reliance will be the parents' involvement in a community
support group as one of their objectives. This group will be ongoing and facilitated by people from the
Health Department, C.A.R.E., and C.S.U. graduate social work students. Objectives will include children's
safety for age appropriate hazards to teach parents how to maintain safe household environments. On-
going specific suggestions on how to meet the objectives will be given from in-home observations.
Many AD symptoms result from the main care giver's own emotional needs and specific objectives will be
developed as those are identified, whether they be involvement in parenting classes or receiving treatment
for depression or substance abuse. The Weld County Health Department nurse will help the family
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connect with all appropriate resources in government and non-government agencies, and objectives and
action plans will be established and monitored for progress.
VI. Workload Standards
This grant will pay for.4 of an F.T.E. or a nurse working 16 hours per week on this project. It will also
cover .1 F.T.E., or four hours per week, for an office technician (OT)who will assist with translating,
scheduling, and chart work. The maximum caseload for these part-time persons as stated earlier will be
four to five families per month. The supervisor will be provided by the Health Department to handle
administrative duties and.provide support, but will not be charged to the grant. This is Kathy Shannon,
R.N., M.S., who-supervises the Children's Services at the Weld County Health Department. She will be
the contact person for referrals. The nurse providing direct intervention with the families is Becky
McMahan, R.N., B.S. The Modalities for treatment have been addressed earlier in this proposal.
VII. Staff Qualifications
Becky McMahan meets the educational requirement for nurses at the Weld County Health Department
with a Bachelor's degree in Nursing. In addition, she has received individual on-site training at the
Attachment Center at Evergreen. Becky also has fourteen years of experience working in pediatric
nursing in the hospital setting.
Kathy Shannon has eighteen years of experience working at WCHD in all the Children's Services, as well
as additional years of experience in Public Health Nursing in Alamosa County and Jefferson County. She
has also worked with Head Start Programs and in public school settings.
The office technician available for this project is Rosa Tamez who has five years of experience as a
translator for WCHD and four years of experience as a Developmental screener for children at WCHD.
Rosa's experience in all Children's Services, including WINGS, has been very valuable. Her years of
interpretation give her an insight on cultural differences and parents' strengths and needs.
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SIGNS OF ATTACHMENT DISORDER ATTACHMENT A
ONE TO EIGHT YEARS OF AGE
CHILD'S NAME: BIRTH DATE:
PERSON SCORING:
SIGNS PROBLEM SEVERITY
NONE MILD MODERATE SEVERE
(never) (25% of the time) (50%of the time) (75%or more)
Lack of ability to give and receive affection.
(demands affection in a controlling way; abrupt,neutral,
unenthusiastic exchanges; absence of warm physical
contact; demanding and clingy)
Extreme control problems.
(persistent,frequent tantrums; hyperactivity evident)
Self-destructive behavior.
High threshold of discomfort.
(will not seek comfort if in pain)
Cruelty to others or animals.
(sadistid violent; bullies,threatens,or intimidates; initiates
physical fights; has used a weapon)
Counterfeit emotionality.
(phoniness)
•
Stealing, hoarding, or gorging.
(has broken into someone else's home,care,etc.; has stolen
items of non-trivial value; has stolen while confronting a
person,i.e.,mugging)
Speech pathology. •
(problems of speech development)
Lack of long-term childhood friends.
Abnormalities in eye contact.
•
Sexual obsession.
(Has forced someone into sexual activity)
Preoccupied with blood, fire, and gore.
(deliberately engaged in tire setting)
Superficial attractiveness and friendliness with
strangers.
(indiscriminate displays of affection)
Destruction of property.
Compulsive lying.
(devious; manipulative)
Defective conscience.
(no remorse) Difficult to observe.
Learning disorders. •
Problems with motor coordination.
(may appear accident prone)
Oppositional, resistant, defiant, and controlling
behavior.Parents very frustrated or angry. 960477
ATTACHMENT B
PARENTING STRESS INDEX (PSI)
Administration Booklet
Richard R. Abidin
Institute of Clinical Psychology
University of Virginia
Directions:
In answering the following questions,please think about the child you are most concerned
about.
The questions on the following pages ask you to mark an answer which best describes
your feelings. While you may not find an answer which exactly states your feelings, please
mark the answer which comes dosest to describing how you feel. YOUR FIRST REACTION
TO EACH QUESTION SHOULD BE YOUR ANSWER.
Please mark the degree to which you agree or disagree with the following statements by
filling in the number which best matches how you feel. If you are not sure, please fill in #3.
1 2 3 4 5
Strongly Agree Not Disagree Strongly
Agree Sure Disagree
Example: 1 2O 3 4 5 I enjoy going to the movies. (If you sometimes
enjoy going to the movies, you would fill in #2.)
Form 6 — Copyrighted 1983
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1 2 3 4 5
Strongly Agree Not Disagree Strongly
Agree Sure Disagree
1. When my child wants something, my child usually keeps trying to get it.
2. My child is so active that it exhausts me.
3. My child appears disorganized and is easily distracted.
4. Compared to most, my child has more difficulty concentrating and paying attention.
5. My child will often stay occupied with a toy for more than 10 minutes.
6.\ My child wanders away much more than I expected.
7./ My child is much more active than I expected.
(� My child squirms and kicks a great deal when being dressed or bathed.
9.) My child can be easily distracted from wanting something.
10. My child rarely does things for me that make me feel good.
11. Most times I feel that my child likes me and wants to be close to me.
12. Sometimes I feel my child doesn't like me and doesn't want to be close to me.
13. My child smiles at me much less than I expected.
14. When I do things for my child I get the feeling that my efforts are not appreciated very much.
15. Which statement best describes your child?
1. almost always likes to play with me,
2. sometimes likes to play with me,
4. usually doesn't like to play with me,
5. almost never likes to play with me.
16. My child cries and fusses:
1. much less than I had expected,
2. less than I expected,
3. about as much as I expected,
4. much more than I expected,
5. it seems almost constant.
17. My child seems to cry or fuss more often than most children.
18. When playing, my child doesn't often giggle or laugh.
19. My child generally wakes up in a bad mood.
20. I feel that my child is very moody and easily upset.
21. My child looks a little different than I expected and it bothers me at times.
22. In some areas my child seems to have forgotten past leamings and has gone back to doing things
characteristic of younger children.
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1 2 3 4 5
Strongly Agree Not Disagree Strongly
Agree Sure Disagree
23. My child doesn't seem to learn as quickly as most children.
24. My child doesn't seem to smile as much as most children.
25. My child does a few things which bother me a great deal.
26. My child is not able to do as much as I expected.
27. My child does not like to be cuddled or touched very much.
28. When my child came home from the hospital,I had doubtful feelings about my ability to handle
being a parent.
29. Being a parent is harder than I thought it would be.
30. I feel capable and on top of things when I am caring for my child.
31. Compared to the average child,my child has a great deal of difficulty in getting used to changes in
schedules or changes around the house.
32. My child reacts very strongly when something happens that my child doesn't like.
33. Leaving my child with a babysitter is usually a problem.
34. My child gets upset easily over the smallest thing.
35. My child easily notices and overreacts to loud sounds and bright lights.
36. My child's sleeping or eating schedule was much harder to establish than I expected.
37. My child usually avoids a new toy for a while before beginning to play with it.
38. It takes a long time and it is very hard for my child to get used to new things.
39. My child doesn't seem comfortable when meeting strangers.
40. When upset, my child is:
1. easy to calm down,
2. harder to calm down than I expected,
4. very difficult to calm down,
5. nothing I do helps to calm my child.
41. I have found that getting my child to do something or stop doing something is:
1. much harder than I expected,
2. somewhat harder than I expected,
3. about as hard as I expected,
4. somewhat easier than I expected,
5. much easier than I expected.
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1 2 3 4 5
Strongly Agree Not Disagree Strongly
Agree Sure Disagree
42. Think carefully and count the number of things which your child does that bothers you. For
example.dawdles, refuses to listen,overactive,cries,interrupts,fights,whines,etc.Please fill in
the number which includes the number of things you counted.
1. 1-3
2. 4-5
3. 6-7
4. 8-9
5. 10+
43. When my child cries it usually lasts:
1. less than 2 minutes,
2. 2-5 minutes,
3. 5-10 minutes,
4. 10-15 minutes,
5. more than 15 minutes.
44. There are some things my child does that really bother me a lot.
45. My child has had more health problems than I expected.
46. As my child has grown older and become more independent,I find myself more worried that my
child will get hurt or into trouble.
47. My child turned out to be more of a problem than I had expected.
48. My child seems to be much harder to care for than most.
49. My child is always hanging on me.
50. My child makes more demands on me than most children.
51. I can't make decisions without help.
52. I have had many more problems raising children than I expected.
53. I enjoy being a parent.
54. I feel that I am successful most of the time when I try to get my child to do or not do something.
55. Since I brought my last child home from the hospital,I find that I am not able to take care of this
child as well as I thought I could. I need help.
56. I often have the feeling that I cannot handle things very well.
57. When I think about myself as a parent I believe:
1. I can handle anything that happens,
2. I can handle most things pretty well,
3. sometimes I have doubts, but find that I handle most things without any
problems,
4. I have some doubts about being able to handle things,
5. I don't think I handle things very well at all.
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1 2 3 4 5
Strongly Agree Not Disagree Strongly
Agree Sure Disagree
58. I feel that I am:
1. a very good parent,
2. a better than average parent.
3. an average parent,
4. a person who has some trouble being a parent,
5. not very good at being a parent.
59. What were the highest levels in school or college you and the child's father/mother have
completed?
Mother.
1. 1-8th grade
2. 9-12th grade
3. Vocational or some college
4. College graduate
5. Graduate or professional school
60. Father.
1. 1-8th grade
2. 9-12th grade
3. Vocational or some college
4. College graduate
5. Graduate or professional school
61. How easy is it for you to understand what your child wants or needs?
1. very easy,
2. easy,
3. somewhat difficult,
4. it is very hard,
5. I usually can't figure out what the problem is.
62. It takes a long time for parents to develop close, warm feelings for their children.
63. I expected to have closer and warmer feelings for my child than I do and this bothers me.
64. Sometimes my child does things that bother me just to be mean.
65. When I was young, I never felt comfortable holding or taking care of children.
66. My child knows I am his or her parent and wants me more than other people.
67. The number of children that I have now is too many.
68. Most of my life is spent doing things for my child.
69. I find myself giving up more of my life to meet my children's needs than I ever expected.
70. I feel trapped by my responsibilities as a parent.
71. I often feel that my child's needs control my life.
72. Since having this child I have been unable to do new and different things.
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1 2 3 4 5
Strongly Agree Not Disagree Strongly
Agree Sure Disagree
73. Since having a child I feel that I am almost never able to do things that I like to do.
74. It is hard to find a place in our home where I can go to be by myself.
75. When I think about the kind of parent I am, I often feel guilty or bad about myself.
76. I am unhappy with the last purchase of clothing I made for myself.
77. When my child misbehaves or fusses too much I feel responsible,as if I didn't do something right.
78. I feel everytime my child does something wrong it is really my fault.
79. I often feel guilty about the way I feel towards my child.
80. There-are quite a few things that bother me about my life.
81. I felt sadder and more depressed than I expected after leaving the hospital with my baby.
82. I wind up feeling guilty when I get angry at my child and this bothers me.
83. After my child had been home from the hospital for about a month, I noticed that I was feeling
more sad and depressed than I had expected.
84. Since having my child, my spouse (male/female friend) has not given me as much help and
support as I expected.
85. Having a child has caused more problems than I expected in my relationship with my spouse
(male/female friend).
86. Since having a child my spouse(or male/female friend)and I don't do as many things together.
87. Since having my child, my spouse (or male/female friend) and I don't spend as much time
together as a family as I had expected.
88. Since having my last child, I have had less interest in sex.
89. Having a child seems to have increased the number of problems we have with in-laws and
relatives.
90. Having children has been much more expensive than I had expected.
91. I feel alone and without friends.
92. When I go to a party I usually expect not to enjoy myself.
93. I am not as interested in people as I used to be.
94. I often have the feeling that other people my own age don't particularly like my company.
95. When I run into a problem taking care of my children I have a lot of people to whom I can talk to
get help or advice.
6
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1 2 3 4 5
Strongly Agree Not Disagree Strongly
Agree Sure Disagree
96. Since having children I have a lot fewer chances to see my friends and to make new friends.
97. During the past six months I have been sicker than usual or have had more aches and pains than I
normally do.
98. Physically, I feel good most of the time.
99. Having a child has caused changes in the way I sleep.
100. I don't enjoy things as I used to.
101. Since I've had my child:
1. I have been sick a great deal,
2. I haven't felt as good,
4. I haven't noticed any change in my health,
5. I have been healthier.
STOP HERE — unless asked to do items below
During the last 12 months,have any of the following events occurred in your immediate family?Please
check on the answer sheet any that have happened.
102. Divorce
103. Marital reconciliation
104. Marriage
105. Separation
106. Pregnancy
107. Other relative moved into household
108. Income increased substantially (20% or more)
109. Went deeply into debt
110. Moved to new location
Ill. Promotion at work
112. Income decreased substantially
113. Alcohol or drug problem
114. Death of dose family friend
115. Began new job
116. Entered new school
117. Trouble with superiors at work
118. Trouble with teachers at school
119. Legal problems
120. Death of immediate family member
7 960477
WINGS Attachment C
HOME VISITING - RISKING TOOL
Child's Name D.O.B.
Score and date administered,please score on scale of 1-5 with 5 being the highest risk.
I HEALTH VII COMMUNICATION
A. NO PRIMARY PHYSICIAN A. LITERACY
B. UNINSURED B. PRIMARY LANGUAGE
C. UNDERINSURED C. HEARING IMPAIRED
D.NO. OF HOSPITALIZATION D. HEARING
E . NO. OF DR. VISITS (over or under use)
F. VISITS TO OTHER PROVIDERS (over or under use)
G. E.R. VISITS (for acute care non emergency.) IX ASSISSTANCE WITH ACTIVITIES OF
OF DALIY LIVING
II ECONOMIC RISKS A. RESPITE
A. UNEMPLOYED B. REHABILATION
B. HOMELESS 1. OCCUPATIONAL
C. INADEQUATE HOUSING (UNSAFE) 2. PHYSICAL
D. LOW INCOME 3. SPEECH
E. NUTRITION
F. CLOTHING X MEDICATION REVIEW
G. CHILD CARE
III VIOLENCE RISK XI LEGAL ISSUES
A. DOMESTIC VIOLENCE
B. ELDER VIOLENCE
C. CHILD ABUSE/NEGLECT XII EDUCATIOAL LEVEL
D. SEXUAL ASSAULT
F. GANG INVOLVEMENT
XII FAMILY STRUCRURE
IV MENTAL HEALTH CONCERNS A. SINGLE PARENT
A. GRIEF ASSISTANCE B. RUNAWAYS
B. VICTIM ASSISTANCE C. LIVING WITH NO PARENTS
C. ADDICTIONS D. TEEN PARENT
D. SUICIDE(PREVENTION/POSTVENTION)
E. DEPRESSION XIV DIAGNOSTIC CODE
V ISOLATION-GEOGRAPHIC
VI ENVIRONMENTAL RISKS
A. POTTERY
B. WATER
C. LEAD
D. RAW MILK
E. AIR
F, CLUTTER-UNSANITARY CONDITIONS
VII TRANSPORTATION
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1 �
RFP-PAC-96005 Attached A
A. Will your staff who are providing direct services have the minimum qualifications in
education and experience. Describe.
B. Total number of staff available for the project.
VIII. COMPUTATION OF DIRECT SERVICE RATE
Estimate the following on a monthly basis. If you have more than one employee use this sheet to
summarize their time usage. If you are having any difficulty in estimating time have the employee
track their time for a week.
Direct Time (Per Month)
Hours
1. Direct client contact 39
Indirect Time
2. Completion of Paperwork 43
3. Travel 12
4. Court Appointments
5. Vacation
6. Sick Leave
7. Case management 18
8. Other
9. Subtotal 73
10. Total Time Available Per Month 112 (Sum of 1-8)
11. Ratio of Direct to Total Time .30 (1/10 = i 1)
26
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RPF-PAC-96005
IX. BUDGET DESCRIPTION
Service Costs
Monthly Total Total Direct % of Time Direct Time
Hourly Rate Hourly Rate Charge
Direct Costs
Salary 2,395.42 13.82 27.64 27.64
Benefits 407.22 2.35 4.70 4.70
Subtotal 2,802.64 16.17 32.34 32.34
Indirect Costs
Supervision
Salary 3,300.20 19.04 63.46 10% 6.35
Benefits 561.03 3.24 10.80 10% 1.08
Clerical
Salary 1,729.83 9.98
Benefits 294.07 1.70
Subtotal 2,023.90 33.96 7:43
Agency Overhead
Rent
Utilities
Supplies
Travel
Telephone
Equipment
Data Processing
Other
Total $27,955.25 (Total Monthly WCHD Nursing Division Overhead)
#of F.T.E.'s 39.24 WCHD Nursing Division (monthly)
Overhead Per
Employee 712.42 (monthly)
Overhead Per
Total Hours 4.12 (monthly) 4.12 (direct time charge)
Direct Service Rate 43.89 (direct time charge)
Service Cost Definitions
Direct Costs -Salary and benefits for employees providing direct services to clients. Indirect Costs-Salary and benefits for
employees providing supervision or clerical support for staff providing direct services. Agency Overhead-Monthly cost for
rent supplies, postage, etc. If the agency building is owned use estimated market rent for the building. #of Employees-Total
number of employees in the agency building. Overhead Per Employee- Divide the total agency overhead by the total number
by 173 hours. Direct Service Rate-The rate is the hourly charge to provide service taking into consideration compensation
and overhead. It can be used as a rough measure to compare services that are uniform in nature. It should not be used to
compare services that are different with more expensive components of labor such as psychiatric consultation. Total Hourly
Rate- Cost divided by total hours available. Total Direct Hourly Rate -Cost divided by total direct hours. 960477
Budget Proposal
Total Amount Requested = $27,164
Budget Total Amount Reouested Other
Direct Costs
Staff salaries $13,453 $13,453
Provider payments $ 7,000 $ 7,000
Program Coord. $ 2,674 $2,674
Indirect Costs
Director $ 4,442 $4,442
Secretary $ 2,429 $ 2,429
Travel $ 600 $ 600
Overhead $ 4,163 $ 3,682 481
Total $34,761 $27, 164 $7,597
Justification
CHN 0.4 FTE $11,498
Fringe 1,955
$13,453
OT 0.1 FTE $ 2,076
Fringe 353
$ 2,429
Attachment Center $ 7,000
Total number to be served = 9
Annual rate per child/family = $3,018
Monthly rate per child/family = $252
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MEMORAnDU
Barbara Kirkmeyer, Chair March 18, 1996
COLORADO To Board of County Commissioners Date
From John Pickle, Director, Health Department<yL'v"
Subject: RFP Social Service Family Preservation Funds
Enclosed for Board approval is a proposal requesting funds from Social Service State Family Preservation
Funds to provide services for children with Attachment Disorder. This is a diagnosis for which we have
identified a gap in service in Weld County. This proposal would help us bring in experts in this field. It will
expand our outreach into the community and facilitate more collaboration with other agencies working with
children in Weld County.
I recommend your approval of this proposal.
Enclosure.
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