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Home My WebLink About971083.tiffWeld County Department of Social Services Notification of Financial Assistance Award (NOFAA) for Placement Alternatives Commission (PAC) Funds Type of Action Contract Award No. X Initial Award FY97-PAC- Revision 17000 (RFP-PAC-97008) Contract Award Period Name and Address of Contractor Beginning 06/01/97 and Ackerman Ending 05/31/98 and Associates, P.C. Short-term IFT 1750 25 Avenue, Suite 101 Greeley, CO 80631 Computation of Awards Description Unit of Service Short term intensive therapy to a maximum of forty- eight famlies. The service offers a range, on average, of two hours weekly solution focused treatment, over a three week period. The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal (RFP), and Addendum RFP Information. The RFP specifies the scope of services and conditions of award. Except where it is in conflict with this NOFAA in which case the NOFAA governs, the RFP upon which this award is based is an integral part of the action. Special conditions Cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based on an hourly Hourly Rate Per $ 93.99 rate per child or per family. 2) The hourly rate will be paid for only direct face to face contact with the child and/or family, Unit of Service Based on Approved Plan Enclosures: as evidenced by client -signed verification form, and as specified in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly, and yearly cost per child and/or family. 4) Payment Signed RFP; Exhibit A will only be remitted on cases open with, and referrals made by the Weld County Department of Social Services. VAdde um RFP Information; Exhibit B 5) Requests for payment must be submitted to the Weld County Department Condition(s) of Approval of Social Services by the end of the third business day following the end of the month of service. Approval • By AtZit-,e 4 Program Official: By UtgetiOi eor e Baxter . }� Board of Weldcounty Co i s Date: 9 7 P1Date:�c�� Judy Griego Directo Weld ounty epartme of Social Services n t/ 7 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilingual/bicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971181 ,• INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97008 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (REP -PAC -96008) for: Deadline: March 25, 1997, Tuesday, 10:00 a.m. Fami y Preservation Program --Intensive Family Therapy Program Family Issues Cash Fund or Family Preservation Program Funds The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5- 101) and Emergency Assistance for Families with Children at Imminent Risk of Out -of -Home Placement (C.R.S. 26-5.3-101). The Placement Alternatives Commission wishes to approve services targeted to run from June 1, 1997 through May 31, 1998, at specific rates for different types of service, the County will authorize approved vendors and rates for services only. The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists, typically with all family members, to improve family communication, function, and relationships. This program announcement consists of five parts, as follows: PART A...Administrative Information PART B.. .Background, Overview and Goals PART C...Statement of Work Delivery Date (After receipt of order) VENDOR PART D. Bidder Response Format PART E. ..Bid Evaluation Process ACkerthe o w� ssBCrwTi..P�. (Name) ADDRESS /7rO -5 -i{\ Art *lot Greel? 6o. 101.3/ PHONE# 97o 3c3-33')3 BID MUST BE SIGNED IN INK To/Le 2ko1er EAS TYPED OR PRINTED SIGNATURE d tten Signature By Authorized cer or Agent of Vender TITLE /restd2...r/Pycfpi5 DATE 3/°r -Y/9 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 971083 RFP-PAC-97008 BA moo. INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL ,:.: FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97008 A / Mo-,, G�-�v� A SSo Graz ,c NAME OF AGENCY 6/Le /O/ Greet co t263/ ADDRESS: 11) SO A -S vim.. u -e- S „u-te PHONE: f %/ ) 3 -3373 CONTACT PERSON: SO 2iC - A-e$Prtr•N,- DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists. typically with all family members. to improve family communication. functioning and relationships 12 -Month approximate Project Dates: Start June I.1997 ✓ End May 31.1998 V TITLE OF PROJECT: ire ye4Ttr Ai&A -r n Name and Signature of Person Preparing 12 -month contract with actual time lines of: Start End sierPl .rte n -Z en Co VS. 9 x e--)—rfC-CV. ature Chief Administrative Officer Applicant Agency MANDATORY PROPOSAL REOUIREMENTS Please initial to indicate that the following required sections are included in this proposal: Measurable Outcomes _/ Staff Qualifications Project Description — / Unit of Service Rate Computation ✓ Target/Eligibility Populations ✓ Service Objectives — ✓ Types of services Provided it Workload Standards / Program Capacity ilars Month{ Certificate of Insurance Date of Meeting(s) with Social Services Division Supervisor: M A n c -G\ I , I S 9 1 Comments by SSD Supervisor: R rwt'M 4-4.4- . Name and Signature of SSD Supervisor L t71c2 t.c SSe ?/a /97 Date 971053.. Project Description Implementing behavioral goals - Intensive short term solution focused therapy to avoid out of home placement Overview: Ackerman and Associates P.C. proposes to use a time limited, solution focused therapy model to assist in the implementation of Discrete Care Plans, court ordered care plans and to assist in implementing the results of mediation. The purpose of this highly structured time limited system id to implement care plans so families can avoid out of home placement. Families needing such plans who are immanently at risk of outplacement , who need to be reunified and meet the PAC criteria or who face imminent reunification failure are appropriate for referral in this model. The model provides up to six hours of therapy over no more than a two month period, for families at imminent risk of outplacement or needing reunification. Three populations will be served: Group #1. Those who completed mediation with our PAC funded program, but need, as determined by their caseworker, help fully implementing their contracts. Failure to receive such help would result in substantial delay in reunification or imminent risk of outplacement. Group #2. Those who did not utilize mediation and whose case worker concludes are having difficulty accepting and implementing a Discrete Care Plan. That difficulty would result in imminent placement or is preventing reunification Group #3. Those who are considered by their caseworker or by the court to need focused therapeutic assistance to implement a court ordered plan. Failure to receive such help would result in failure of the court ordered plan and result in either substantial delay in reunification or immediate risk of outplacement. Purpose: The purpose of the time limited, solution focused therapy is to implement the changes needed to either prevent placement of reunify the family. Such psychological needs are responsive to short term therapy because they have a very clear focus. For Group #1 Our mediation program has demonstrated a very high success rate with families who have been referred to negotiate how they will solve their own problems. Those in mediation have "ownership" of the plan they formulate. Nearly all have avoided placement. About half have succeeded in achieving long term change. We propose to use this program of implementing behavioral change to support those 1 97109,3 families who have difficulty making their contracts work in establishing a process of change and who need extra time to solidify the gains they made in mediation. For Group #2 A family's Discrete Care Plan is expected to assist them to change in a way that is in the best interests of the child, avoids placement or achieves reunification. Unfortunately, the level of acceptance of the Discrete Care Plan is sometimes less than ideal and may result in return to a status where PAC sponsored intervention is appropriate. Elimination of psychological barriers to the Discrete Care Plan can be achieved through solution focused therapy by enhancing the level of control the family has in achieving the goals of the plan. In families that are resisting intervention by social services and are about to enter ( or again enter) foster placement, short term therapy would focus on the implementation of the care plan goals and build a sense of ownership in the solutions achieved. If foster placement is necessary, this model should shorten the length of foster placement and therefore its cost. For Group #3 When the court has ordered a care plan for a family, there is obviously a perception of diminished control on the part of the parents. The court has told the family what to do, but at least psychologically, only in a general sense how to do it. What is the role that family has in how the plan will be implemented since they must be the ones to change? The therapeutic role is one of achieving accommodation and acceptance of the courts care plan. What are the ways the family will decide to change to meet the requirements of the court in the shortest possible time? Finding the answers to this question is the overall purpose of the short term therapy with Group # 3 and these answers will be available to the court in a period of time that is very short. Design: The time limited, solution focused therapy consists of no more than six hours of therapy in a period of no greater than two months. Some families may need intensive two hour sessions over a brief period such as a few weeks to prevent placement or achieve reunification. Others may need shorter sessions over a longer period to prevent them from relapsing and needing to return to foster placement. In others, the level of psychological resistance may suggest a need for six weeks of sessions one hour per week or three sessions per week over two weeks. The key design feature is to achieve implementation of the goals that are developed whether those were through mediation, the Discrete Care Plan or the court ordered care plan. The therapeutic needs of the diversity of families requires clinical flexibility on the part of the therapists in scheduling. Scheduling also needs to be done considering other criteria particularly cost effectiveness. Other Considerations: There is no risk of the program running up excessive costs for any one family because of the six session limit to treatment. If the family can't succeed in six hours they need a more intensive treatment program. Since intensive in patient treatment programs traditionally have been a major source of cost for the expenditure of PAC funds locally, including a less expensive goal focused short term model is appropriate. One modality that can be used is an intensive out patient treatment approach where the six sessions 2 would be over a short time period. The evaluation at the end of the six hours will specify any unresolved issues in cases where further treatment is needed. Given our success rate with these problems in mediation, we anticipate the use of this low cost treatment approach which has a maximum of $540 per family may prove to be extremely cost effective and a very useful intermediate step before in patient treatment for appropriate referrals The program is very easily measured because it will always have a clear starting point for each family. The evaluation strategy will seek to define the level of success achieved in complying with the goals of therapy as specified by their mediation plan, Discrete Care Plan or court ordered plan respectively. Resolved and unresolved issues will be explicitly stated in the evaluation for each family and sent to the caseworker at the conclusion of the six sessions of treatment. Finally, this program appears to fill a need for the Weld County Department of Social Services on at least two levels. First, based on discussions we have had with our supervisor the program appears to fill a gap that truly exists in the continuum of care for families that meet the PAC criteria. Second, this is a lower cost intervention design which may be cost efficient in avoiding more expensive alternatives to placement. Target/Eligibility Populations A. Total number of clients to be served in this twelve month program has been calculated as follows. Three families per month times twelve months equals thirty-six families per year. If we assume a family size of five, two adults and three children, then the total client pool to be served is 180 individuals. That number includes at least 36 individuals who face either imminent outplacement or need reunification. These calculations make an assumption of a relatively even distribution between the three groups. We have the capacity to serve more than this number if demand for the services is there. We project our maximum capacity as forty eight families and expect 36 families to be served. B. Distribution of clients. Total number of clients we will serve is approximately 180 as calculated above. We would expect approximately 72 of these would be adult members of the family and approximately 108 would be minors. We estimate that they would be distributed across the age range from 1 to 17. The older children would most likely be teenagers in conflict with their family most often concerning issues related to their maturation into adults. The younger group will consist of children of no particularly predictable age whose parents are in conflict usually in relation to instability in the marriage, neglect or abuse. Neglect or abuse may be present in either group. C. Families Served. We anticipate serving thirty-six family units. D. Sub total who will receive bicultural/bilingual services. We have a 3 member of the staff Carmen Jimenez who is a licensed master's level clinical social worker fully fluent in Spanish. She is also Hispanic. She has specific training in solution focused therapy and specializes in working with children, teenagers and families. We anticipate we can serve twenty-five percent or more of the total referred in a bilingual bicultural manner. All of the staff have extensive cross cultural experience. Lori Kochevar has six years of experience treating Families in the San Luis Valley. Joyce Ackerman and Steven Patrick have each spent several years working in American Indian reservation populations. Larry Kerrigan has more than twenty years experience as a therapist in Greeley and Susan Bromley is both a social worker and a psychologist with extensive experience training students in cross cultural sensitivity. E. We can provide services in South County if Social Services can provide a site to do such work. If that were available, we would schedule a full day of stiort term solution focused treatments with at least four families on the same day. Therefore, we would have to have at least four active cases in South county each time we traveled there. Alternatively, we are able to provide services (including bilingual services) on every Saturday in our Greeley location for any family. This may assist South County families in scheduling without interference with work schedules. Perhaps the Department has a small allocation of transportation funds for families that need them that may apply to this circumstance of needing to come to Greeley for this program. F. Accessibility. On weekdays, all providers of Ackerman and Associates are accessible through or office secretary and after hours through a 24 hour answering service and pager system. On weekends, this 24 hour access reaches the provider on call who is always a licensed Mental Health provider. G. Maximum per month. The program maximum is four families per month. H. The monthly average capacity is three families per month. I. The average stay in the program is six hours over no more than a two month period. Scheduling would be flexible and would attempt to maximize effective treatment in terms of achieving the best avoidance of placement or the most efficient return from placement. Types of Services Provided We propose to provide up to six hours of short term solution focused treatment. We would use a flexible scheduling model which would allow the therapist clinical judgment in meeting the needs of the family and maximizing the cost effectiveness of the treatment. Evaluation of the process would take place at the last session which must be a separate hour from other treatment. This is because a general evaluation format would need to be partially completed by the therapist prior to the evaluation. This requirement exists because the data collected would be tied to the specific goals 4 971.093 the family developed in relation to their own mediation contract, their Discrete Care Plan or their court ordered plan. For those families that do not need all six sessions, the last session will be the summation and evaluation session. For those that do need the six sessions, the sixth session will serve that purpose. The final session explicitly summarizes for the family what they have achieved and what they need to continue to work on. It also creates a structured record in the same format for all families so the program can be evaluated on how well it succeeded in helping implement specific changes that correlate with accelerated reunification or are associated with avoiding placement. In terms of the criteria for the PAC process: A. Comprehensiveness: Solution focused therapy does not attempt to provide a comprehensive assessment or diagnosis of the family in a traditional psychotherapeutic model. It focuses the family on rapidly achievable solutions to the problems related to either their mediation contract, their Discrete Care Plan or their court ordered care plan. We would require that the referred families have their Discrete Care Plans and their court ordered plans as applicable shared with the program at the time of referral. B. Access to other services: The purpose of short term therapy is to explicitly solve problems and lower barriers to compliance with the care plan. If the solution to a concern involve the referral to other services the caseworker will be notified and at the conclusion of treatment and that service can be arranged for the client if they have not done so. C. Co-Facillitation: Because there will be six providers of short term focused therapy in the same group, each provider will have the opportunity to consult with other providers of similar services. We will use a consultation mechanism which preserves client anonymity. The therapy sessions will be conducted by a single provider. D. Conflict Resolution: In terms of group one, those who completed mediation, the goal of the treatment would to be to implement the plans made in mediation. That means to help the family use their contract to prevent conflict from overwhelming the family again. In terms of group two, the Discrete Care Plan group, conflict resolution would focus of the type of conflict that brought them into contact with Social Services. What needs to be done to resolve that conflict now? How can that conflict be ameliorated or prevented in the future? These are the type of questions for group two. For group three, the conflict has been adjudicated. There is a court ordered plan. In addition to the type of questions relevant to group #2 above a key goal is acceptance of the court plan. In short term therapy the family will define and implement how they will make the court ordered plan work in their own lives. 5 971 ST Measurable outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. In terms of formative measures we have the following... 1. Did the family follow through with the referral from their caseworker? 2. Did the family attend the sessions that were scheduled? 3. Did the family need all six possible hours allowed? 4. Did the family complete the evaluation portion of the program? We expect a 100% follow through for contacting us. This data will be based on a comparison of referral documents received compared to the record of appointments of the family. We expect 95% to attend a first session. 90% to attend a second or further session. We expect that 85% will complete five or more sessions and that all who attended at least one session will complete an evaluation with the therapist in their last session. Summative outcomes At the evaluation session which is the final session the family has with us we determine the following information. Is the child still in the home or been returned from placement? How well has the mediation contract, Discrete Care Plan or court ordered plan been completed? What family behaviors are different compared to their behavior before solution focused treatment. The other long term or summative outcomes listed below are also determined at this time. A. The child receiving services does not go into placement. This will be known to the therapist at each session and recorded in the therapist's notes. At the evaluation session the length of time between the referral to the end of treatment will be recorded. In the prevention of outplacement one mode of scheduling may be to maintain contact as long as possible to provide very brief maintenance sessions as needed within the two month time limit. Others may need more intensive support initially with less maintenance. Thus, the pattern and timing of sessions will be noted and analyzed. We expect 70% of the index children referred to avoid placement. B. Families remain intact. The concept of remaining intact has at least two components. First, does the family remain psychologically intact . Even if the child is not living at the parents physical residence, the family unit including the index child maintains the psychological goal of staying a family unit. A family may also remain physically intact. Physically intact means the child remained or returned to the parents 6 971033 residence as specified in the treatment plans. We expect 70% of the families referred to remain physically intact and an additional ten% to remain psychologically intact as a result of this model. In our experience psychological intactness is usually accompanied by less formal care relationships than foster care such as living with other relatives who were previously not willing to assist. C. Reunification of children with their families. Short term therapy should be very amenable for the reunification of families because the family will have a Discrete Care Plan and perhaps also a court ordered plan to follow. The nature of the therapy would keep these goals focused before the family. We would expect reunification therapy to be more intense in terms of being done over a shorter time frame. We would measure the length of time between initiation of short term therapy and the reunification in these cases. We expect that 70% of the families will be reunified by this process. D. Improvement in parental competency and parent child conflict management are expected to occur in all families who complete treatment. The persistence of these changes can be measured at the evaluation session by self report. Parental competency questions will be linked to the treatment plans. Did the families achieve the behaviors needed to meet the goals of the treatment plan? E. Cost effectiveness. The cost of this program is projected at $540 per family for six sessions. If outplacement is shortened by one week or reunification accelerated by one week the program pays for itself. For every month of placement avoided $2500 is saved. The program is expected to be extremely cost effective. Further if any patients can use this program as an alternative to either inpatient or day treatment programs by using an intensive outpatient approach over a period of a week or two, cost effectiveness increases very substantially as a lower cost program is replacing a higher priced program to achieve a similar outcome. F. Does this program produce fundamental change in family dynamics? The process of solution focused therapy has the family define the behavioral goals for itself early in the process. At the last session these goals will be listed and the family will report 1.if that goal has been met and 2. if they think the change is likely to last for more than two months from that date. Item two provides a benchmark for evaluation of ongoing behavioral change. Service objectives We have the following service objectives: A. Improvement of family conflict management. The goals of the mediation 7 977.03 contract, the Discrete Care Plan or the court ordered care plan are centered on improving family conflict management and preventing conflict which the goals stated child imminently at risk. The treatment goals of short term therapy are those documents as we have defined this proposal. Therefore improvement in conflict management is a central focus of this work. B. Improved parental competency in PAC sponsored programs seems to center appropriate on each parent developing more age appropriate and family system strategies. In dealing with conflicts with their child especially with teenagers, the areas of discipline, protection, instruction and supervision often need examination and practice to attain sustainable solutions. With younger children the therapy gives the parents the opportunity to implement and better define the roles each parent expects of the other. Those parental behavioral goals specified in the mediation contract, Discrete Care Plan or the court ordered plan will be the ones worked on. C. The abilit of the famil to access resources is a strength of the short term therapy model. Short term therapy has one of its origins in programs designed to assist employees. That origin called the employee assistance plan or EAP model specialized in directing people to the specific resources they needed in a very focused approach. The services recommended are determined by the explicit (and implicit) problems presented. Determination of additional services needed is a standard portion of short term therapy. Usually in the first session, goals are clarified and in the subsequent sessions resources are specified that are needed to help reach those goals. Since this proposal treats families who already have a written plan of clear goals for each or the three groups, families will recognize and be able to access the services they need. The methods used to document the service objectives will be a comparison of the stated goals of the treatment plan with the summative evaluation completed in the last session. For the project we will report on the type of goals and how well they were achieved using this short term treatment model, the numbers of children who were reunited or avoided placement and the other summative criteria listed under measurable objectives. Workload Standards A. The proaram has a spapS of four families per month. We anticipate an average of three. This is approximately eighteen hours of face to face meetings per month. At yeah meeting, one At our rate oftherapist$93.99 per hour the cost is $20,302. 216 hours of therapist time per r.B and C. There are six licensed providers four psychologists, one professional counselor and a bilingual master's level social worker who will provide these services. All have specific training in short term solution focused care treatment. All have work experience as providers for managed care companies who use this model in 8 9171 0.c 7 treatment. Ackerman and Associates is the retained provider company of a major managed care company that serve this county as the mental health component of a major HMO company - FHP. A description of the providers is attached as an appendix. Short term solution focused therapy models grew out of the work of Nicholas Cummings Ph.D. one of the founders of this managed care company which is called Merit behavioral care Systems.. Each of the providers will have about six families they treat over the year. D. The modality of treatment is a short term solution focused treatment. E. Hours /month The total number of therapist hours is 18 per month or 216 per year. F. Staff There are six individual providers supported by two secretaries in the practice G. Supervisor This contract would be supervised by Joyce Shohet Ackerman Ed.D. who would monitor the project for compliance. All providers are individually licensed and do not require clinical supervision. H Insurance All providers carry one million three million liability, Ackerman and associates carries an additional one million three million liability policy on the group and a general liability policy which meets the required criteria for this application is on file with the county and is provided through Farmers Insurance. Staff Qualifications A. and B. Staff Qualifications Six staff are available for the project. They exceed the minimum qualifications specified as documented below The staff are Joyce Shohet Ackerman Ed.D. Licensed psychologist, Lori Kochevar M.S. Licensed Professional Counselor, Laurence P. Kerrigan Ph.D. Licensed psychologist, Carmen Jimenez MSW, Licensed Social Worker and Susan Bromley Psy. D. Licensed psychologist and se providers are now Steven ea Ppfor aPsychologist. ma aged care companies (FHP, Choicue'on Health, focused therapy providers Champus). C. Training The staff has extensive training in family therapy and short term therapy as documented by their extensive work experience. Collectively, the six providers have held licenses in their field for a total of 60 years with a range of 1-20 years and an average length of licensure of about 10 years. Resumes are available. D. Continuing education As a part of their work in the private sector all providers in this group maintain continuing education programs more than the minimum eight hours required. They participate in workshops and other activities. This proposals continuing education requirements coincide with the requirements of other contractual arrangements with managed care companies and are being met on an ongoing basis 9 97109,: by members of the group. E. Supervision All providers are independently licensed and not required to have clinical supervision. All the staff have advanced skills in intensive family therapy. The supervisor will monitor the specifications made in this proposal. F. Supervisor continuing education The supervisor of the project is involved in ongoing training to keep current with her professioh through advanced workshops and seminars. Ackerman and Associates P.C. of which the supervisor is the president is now in its third year as one of two retained provider offices for a major managed care company in Weld county. By contract we provide up to 1000 short term therapy sessions per year. The average patient completes treatment in four to five sessions in that model. This company MBC which holds the mental health contract for FHP is one of the largest short term therapy oriented managed care companies in America. They cover approximately one out of every five people insured in this area. Dr. Ackerman manages this short term solution focused therapy contract. Unit of service rate computation We have calculated the unit of service rate based on the instructions . We used 1996 data for our agency which had four full time equivalents as direct service providers and slightly more than one full time secretary over the fiscal year. The year 1996 involved some transition for this company with a number of provider changes due to the rapidly changing nature of the managed care mental health market place. Using overall figures for the agency we arrived at a figure of $93.99 which is a 34 cent decrease in our rate from the prior year.. Overall in 1995 our expense related to providers salaries were that providers salaries were 65 % of costs and non -providers salaries and overhead were 35% of the costs. The formula used in the PAC format produces a provider contribution of 49.72 / 94.33 or 53% in 1995 and a rate of 54.23/93.99 for 1996 or 58% of costs. Budget Justification Each mediation uses twelve hours of therapist time and the one month follow up uses one hour. The six month follow up is not billed as a service, but is an inherent part of the evaluation process. We use the figure of twenty four evaluations per year to generate the total face to face hours of the project which equal 312 hours. 312 hours times $93.99 equals $29,325 as the total budget for the project if it had 100% of projected utilization.. These rates are reasonable and customary for providers of the level and training assembled in this proposal. PAC money is tracked through a computer data base system called MediMac which we have used for the past 16 months. the system allows us to track payments by client and by source of payment and any payment through the PAC will be tracked in this 10 971083 manner. No special issues are present related to project audit to our knowledge. Ackerman and Associates P.C. is a type S professional for profit corporation and not a 501.c.3. 11 971083 Program Category Project Title Vendor e t na. RFP-PAC-97008 Intensive Family Theraathoaram Bid Category e . ' w; SRorrt term. l,1-ICnri✓e }�j^fLW Z n rt i�n N_ Poster i�/a.ce ♦-1 C !1 .n re -a_ ASSOC-la-no— c P G' Attached A [. PROJECT DESCRIPTION Please provide a one page brief description of the project. II. TARGET/ELIGIBILITY POPULATIONS Please provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub -total of individuals who will receive bicultural/bilingual services. E. Sub -total of individuals who will receive services in South Weld County. F. Sub -total of individuals who will have access to 24 hour services. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Please provide a two page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Comprehensive, diagnostic and treatment planning with the family and other service providers. B. Therapeutic intervention with flexibility to bring in other services, if needed. C. Co -facilitated therapeutic services provided by one or more qualified fancily therapists. D. Therapy that is designed to resolve conflicts and disagreement within the family, contributing to child maltreatment, running away, and to the behavior constituting status offenses. Also, provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that PAC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and protessional services otherwise funded. IV. MEASURABLE OUTCOMES Please provide a two page description of your expected measurable outcomes of the project. Please address the measurable outcomes for each area as described below: A. Children receiving services do not go into placement. 25 971083 Attached A RFP-PAC-97008 B. Families remain intact. C. Reunification of children with families. D. Improvements in parental competency, parent/child conflict management as determined or measured by pre and post placement functional tests. E. More cost efficient services through the Intensive Family Therapy Program than the placement of the child. F. Therapeutic outcomes include fundamental changes in the family functioning and dynamics. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. VI. SERVICE OBJECTIVES Please provide a one page description of your expected service objectives and quantitative measures. Please address, at a minimum, the following ways the project will: A. Improve Family Conflict Management - Mediation and counseling designed to resolve conflicts and disagreement within the family contributing to child maltreatment, running away and other offenses. B. Improve Parental Competency - capacity of parents to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision. C iImprove Ability to Access Resources - services n the community and ahead the local, state, shall andfederal governme tswork with other sources . Describe the methods you will use to measure, evaluate, and monitor each service objective. WORKLOAD STANDARDS Please provide a one page description of the project's work load standards and quantitative measures. Please address, at a minimum, the following areas: A. Number of hours per day, week or month. B. Number of individuals providing the services. C. Maximum caseload per worker. (Generally 12 families per worker. Eight to 10 families per worker if the worker provides case management services to the families on the caseload.) D. Modality of treatment E. Total number of hours per day/week/month (Minimum average of two hours of service per family per week. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. (Minimum of 6 workers per supervisor.) H. Insurance. 26 971083 RFP-PAC-97008 VII. STAFF QUALIFICATIONS Si A # Attached A Please provide a one page description of staff qualifications and address, at a minimum, the following: A. Will your staff who are providing direct services have the minimum qualifications in education and experience. Describe. B. Total number of staff available for the project. C. Will staff have expertise in family therapy as demonstrated by specialized training, workshops and experience. D. Will staff have a minimum of eight hours per year of continuing education; i.e. courses, workshops, and/or review of literature to be documented by county. E. Will staff have a minimum of one hour per week of clinical supervision provided by someone with advanced skills in Intensive Family Therapy. F. Will the clinical supervisor(s) be involved in regular training to keep current in state-of-the-art counseling modalities and findings. 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. For differnt services the provider can request different direct service rates. An average rate can be used or a separate rate can be used for each type of service. Service rates may also be stated as a fixed amount for an assessment, court appearance, etc. If so completing this section would not be necessary. Service rates can be stated on a daily basis, as opposed to an hourly amount. Direct Time (Per Month) 1. Direct client contact Indirect Time 2. Completion of Paperwork 3. Travel 4. Court Appointments 5. Vacation 6. Sick Leave 7. Case management 8. Other 9. Subtotal 10. Total Time Available Per Month 11. Ratio of Direct to Total Time 77 I tours/ g C €J O O 3 9-1 grewIZ (Sum of 1-8) (1/10 = 11) 971083 a aaa Attached A RFP-PAC-97008 RATE COMPUTATION 6'"`-A rr' P13Ca lq4` Service Costs Direct Costs Salary Benefits Subtotal Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal Agency Overhead Rent Utilities Supplies Postage Travel Telephone Equipment Data Processing Other Total # of Employees Overhead Per Employee Overhead Per Total Hours Total Total Direct Direct Time Monthly Hourly Rate Hourly Rate % of Time Charge 23ssak 12SAS SV.23 S(1.23 /00 5Y-043 (2-8o2B CY.23 ,y"y 23 rot, .Sqf..23 O D v 0 0 0 0 l4v.t A «/M•^Tt AOgg 13.94 —l3,80 !oo> 13.80 2>8S9 /3,8L /3.a looms l3•SI. —Ili la c; /t., t tom- ey u. r v ^-le LI S If:. r' /J/ o [Le-.rs) p0 Direct Service Rate (Hour!!') (Daily if appropriate) 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 Hodtiy Rate - Cost divided by total direct hours. 99.79 Sett br tr st-I A c 0..k 28 971083 kit"- Lep DECLARATIONS O TRUCK INSURANCE EXCHANGE E FARMERS INSURANCE EXCHANGE Ell FIRE INSURANCE EXCHANGE SPECIAL SENTINEL MEMBERS of FARMERS INSURANCE GROUP OF COMPANIES PACKAGE HOME OFFICE: 4880 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90010 SUPER 1. Named . DR JOYCE SHOHET ACKERMAN PC Insured . Mailing ' . 1750 25TH AVE SUITE 101 Address . GREELEY CO 80631 The named insured is an individual unless otherwise stated Prod. Count Prematic Acc't No. 07-04-362 04576-38-07 Agent Policy Number Type of ❑ Partnershi Lx.J Corp. Business OFFICE ❑ Joint Venture Li Organization (Other than Partnership or Joint Venture) 2. Policy Period from 07/01 /96 (not prior to time applied for) to 07/01/97 12:01 a.m. Standard Time. If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to continue this insurance, we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums, rules and forms then in effect. 3. Insured location same as mailing address unless otherwise stated: 1750 25TH AVE SUITE 101 GREELEY CO 80631 4. Mortgage Holders Loan # Loan # 5. Premium $ 484.00 ❑ "X" if Mortgage Holder Pays 6. Policy Forms and Endorsements attached at inception: E0079-ED1 E6040-ED2 2521551290 565310-ED2 S0700-ED3 E6036-ED1 E4168-ED1 7. We provide insurance only for those coy COVERAGES LIMITS OF INSURANCE DEDUCTIBLE SECTION 1 Property and Loss of Income A -Building $ $250 applies unless other B -Business Personal Property $ 50 , 000 o Lion indicated�by anti tidsioo❑ssoo Us - C -Loss of Income (Not exceeding 12 consecutive months) ACTUAL LOSS SUSTAINED NONE OPTIONAL COVERAGES Swimming Pool/Fences and Walkways $ Above deduc- 3 X Building Glass(Blanket) REPLACEMENT COST tible applies $ 100 X Outdoor Sign Coverage $ 100 unless other 3 — Valuable Papers (In addition to $1000 included.) $ option indi- $ Gated. ❑ Earthquake Damage See Coverages A,B, & C % of the applicable ins. limit. SECTION II Liability and Medicals D -Business Liability - Including Products and Completed Operations. (Annual aggregate applies for all occurrences LIMITS OF LIABILITY (Annual Aggregate) during the policy period.) $ 1,000,00U E -Fire Legal ❑ $100,000 Liability $75,000 included unless other option indicated by an • $150,000 each occurrence (Subject to the annual aggreagate X shown for Coy. D) F -Medical Payments to Others (Subject to the annual aggregate shown for Coverage D.) $5,000 each person • Professional Liability (see attached endorsement) Limit of Liability (Annual Aggregate) $ SECTION III Crime I - V COVERED DEDUCTIBLE Agreement I -Employee Dishonesty $5,000 NONE Agreement II -Broad Form Money and Securities -Inside $1, 000 $250 Agreement III -Broad Form Money and Securities -Outside $1 , 000 $250 Agreement IV -Medical Payments $500 each 3:;rson NONE Agreement V -Forgery or Alterations $2,500 NONE 55-5308 2-82 2ND EDITION Countersigned Authorized Representative 971083 Brunch 32 B/A Producer # Issue Date A 0002360 '15.00 05/14/96 Renewal/Replacement No. RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS -MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE4 _TalSJ5-11t AIMS-Mg9.E_.POI Inc _PLEA c F REAn TI -IF POI ICY CARFFUI Di Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2032570 1. NAMED INSURED: ACKERMAN AND ASSOCIATES PC ADDRESS 1750 25TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) 2. POLICY PERIOD: From 05/01/96 To 05/01/97 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: Professional Liability LIMITS OF LIABILITY $1,000,000 $3,000,000 each Incident Aggregate PREMIUM $1,741.00 4. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: Sole Proprietor (including Independent Contractors) ( ) Partnership (X ) Corporation OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the Declarations; or () the effective date of the earliest claims -made policy issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/92 7. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s): PIA -2008 (10/94) POE -8004 PLE-2147 P0N-2003 PLE-2081 CHICAGO INSURANCE COMPANY 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: INTERSTATE INSURANCE GROUP PLP-2012 (06/93) (Elec.) CI [`-r3UU3 (7/91) (Ed. L /':;I Agent or Broker: Kirke -Van Orsdel, Incorporated Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll -free Number: 1-800-852-9987 971063 FROM : Ackerman and Associates PHONE NO. : 9703533374 May. 05 1997 04:31PM P4 Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80631 (970) 353-3373 fax: (970) 353-3374 May 2, 1997 Judy A. Griego, Director Weld County Department of Social Services P.O. BoxA Greeley Colorado 80632 Dear Ms. Griego: Re your letter dated April 17, 1997 concerning Ackerman and Associates Bid #2 on RFP -PAC bid 97008 related to preventing foster placement with short term intensive therapy. Additional Information 1. Concerning the proposed program evaluation, i.e. tools pre and post test instruments data collection used to monitor the effectiveness of the program. Evaluation of the success of the project will be based upon the outcome of the treatment as well as the process of the treatment. As the treatment is time limited, one evaluation component is the level of participation of the family in the treatment process. Measures here include the number of sessions attended and the presence of all parties at the treatment sessions. The outcome measures will be the development of a written evaluation progress the family has made in relation to their care plan. Each family will rate themselves in the last session as to whether they made excellent progress, good progress, fair progress or poor progress. Goals for each formative and summative area of evaluation are outlined in the proposal. 2. Will we be able to initiate direct services within five working days? We believe we are able to meet this requirement. We will be able to contact the parties, explain to them the process and schedule a time within five working days of the referral in most cases. Where the parties are living without a telephone, are unwilling to provide a correct contact phone or otherwise are difficult to contact, they would potentially take longer than five days to set up. Some cases could commence within five working days, but there are often between three and six participants in the family treatment sessions often with different schedules. Finding a suitable time within five days of referral will be our goal and we intend to offer a time within five days of referral. However, we will proceed with the treatment as expeditiously as possible if 9710 'r, FROM : Ackerman and Associates PHONE NO. : 9703533374 May. 05 1997 04:31PM PS such time is not workable for specific families. 3. Further Clarify services to South County residents. Residents of South County will be seen in our Greeley offices. We have the ability to schedule Saturday or evening appointments to minimize time lost from work for any clients, including those from South County. We can provide services in Spanish as explained in our proposal for any clients including those from South County. We can provide service in South County 1) if a site is available that is suitable, provided by WCDSS, and 2) a full day's work is scheduled in South County each time as described in our proposal. 4. Transportation: No transportation is provided nor is any proposed in our bid. If the Department chose to fund transportation from South County or elsewhere to our offices we would verify the fact that the client presented for appointments or otherwise participate in such a program. We hope this clarifies any questions you may have. Please contact me if any other information will assist you in your consideration of our bid. We look forward to continuing these very successful mediation services. Sincerely Joyce Shohet Ackerman Ed.D. Licensed Psychologist and President 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilingual/bicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 RFP-PAC-97008 Attached A INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97008 8, L I NAME OF AGENCY: A c.. -1Z -‘12r w -r4. Ass o c -to -t P. C. ADDRESS: (?SD 9-S-11 Ave--- - Swct 2- to J Greet, Co 8b43/ PHONE: (?lb 1 3r 3— 33 )3 / jI CONTACT PERSON: SP/Cz S�1 /trAkei'✓TITLE: Psych/ is r/ / rcit.18".r DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists. typically with all family members. to improve family communication_ functioning. and relationships. 12 -Month approximate Project Dates: Start June I. 1997 End May 31. 1998 ✓ (J TITLE OF PROJECT: In. t S t E-0-",177 12 -month contract with actual time lines of: Start End an Si ature of Person Preparing Docuthent d Si ature Chief Administrative Officer Applicant Agency Date 3 - et 7 Date MANDATORY PROPOSAL REOUIREMENTS Please initial to indicate that the following required sections are included in this proposal: Project Description _4L Target/Eligibility Populations Types of services Provided V Certificate of Insurance `Measurable Outcomes `Service Objectives ✓Workload Standards Staff Qualifications ✓Unit of Service Rate Computation _ Program Capacity per Month Date of Meeting(s) with Social Services Division Supervisor: Comments by SSD Supervisor \Av a ( L' (LA 1,'/'- M ARC-\ I l 7 Name and Signature of SSD Supervisor ( ( \fR 2 i-34 Date 971083 INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97008 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-96008) for: Family Preservation Program --Intensive Family T_ heranv Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 25, 1997, Tuesday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5- 101) and Emergency Assistance for Families with Children at Imminent Risk of Out -of -Home Placement (C.R.S. 26-5.3-101). The Placement Alternatives Commission wishes to approve services targeted to run from June 1, 1997 through May 31, 1998, at specific rates for different types of service, the County will authorize approved vendors and rates for services only. The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists, typically with all family members, to improve family communication, function, and relationships. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B...Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work Delivery Date (After receipt of order) VENDOR ADDRESS PHONE # ACk-e frVAe. AAA ASSOC Carl -4- (C (Name) . wt to i o i 11So Aye G l° -e t- Co goG 3/ 910 - 33-3- 3379 BID MUST BE SIGNED IN INK To yc e ≤& ke t— Aokirtkoat EA. J. TYPED OR PRINTED SIGNATURE en Signature By Authorized O cer or Agent of Vender TITLE DATE f(eii49_C BPS)/dv/Y,Jr 37zY79 7 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilingual/bicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) for Placement Alternatives Commission (PAC) Funds Type of Action X Initial Award Revision Contract Award Period Beginning 06/01/97 and Ending 05/31/98 Computation of Awards Unit of Service The mediation consists of service to a maximum of 48 families per year, three -two hour sessions with two mediators at each session, and a half- hour follow-up session. The first session consists of establishing the setting for mediation and the second session consists in large part of mediation of short term solution focused goals between the family members, and the third mediation session in establishing a written contractual agreement between the family members as to what they will do. Cost Per Unit of Service Hourly Rate Per $ 93.99 Unit of Service Based on Approved Plan Enclosures: ✓Signed RFP; Exhibit A Addendum RFP Information; Exhibit B ✓Condition(s) of Approval Approvals: By / t, eorg Baxter Board of W - Id �I) ounty Date: nes o� Contract Award No. FY97-PAC-4000 (RFP-PAC-97008) Name and Address of Contractor Ackerman and Associates P.C. Intensive Family Therapy - Mediation 1750 25th Avenue, Suite 101 Greeley, CO 80631 Description The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal (RFP) and Addendum RFP Information. The RFP specifies the scope of services and conditions of award. Except where it is in conflict with this NOFAA in which case the NOFAA governs, the RFP upon which this award is based is an integral part of the action. Special conditions 1) Reimbursement for the Unit of Services will be based on an hourly rate per child or per family. 2) The hourly rate will be paid for only direct face to face contact with the child and/or family, as evidenced by client -signed verification form, and as specified in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. 4) Rates will only be remitted on cases open with, and referrals made by the Weld County Department of Social Services. 5) Requests for payment must be submitted to the Weld County Department of Social Services by the end of the third business day following the end of the month of service. Program Official: By Judy A. riego Director Weld Cott tty D artment f So tal Services Date: J� 23(Y7 971083 RFP-PAC-97008 Attached A Program Category Project Title Vendor Intensive Family Therapy Program Bid Category _.. ttnsivt l4..ly /Keel 0 -Z -ion. Perr.,+. Ac-icerma.. &socca . P. c. I. PROJECT DESCRIPTION Please provide a one page brief description of the project. II. TARGET/ELIGIBILITY POPULATIONS Please provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub -total of individuals who will receive bicultural/bilingual services. E. Sub -total of individuals who will receive services in South Weld County. F. Sub -total of individuals who will have access to 24 hour services. G. The monthly maximum program capacity. H. The monthly average capacity. I. Average stay in the program (weeks). J. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Please provide a two page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Comprehensive, diagnostic and treatment planning with the family and other service providers. B. Therapeutic intervention with flexibility to bring in other services, if needed. C. Co -facilitated therapeutic services provided by one or more qualified family therapists. D. Therapy that is designed to resolve conflicts and disagreement within the family, contributing to child maltreatment, running away, and to the behavior constituting status offenses. Also, provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be sewed in each service component. Describe your internal process to assure that PAC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES Please provide a two page description of your expected measurable outcomes of the project. Please address the measurable outcomes for each area as described below: A. Children receiving services do not go into placement. 25 971053 RFP-PAC-97008 Attached A B. Families remain intact. C. Reunification of children with families. D. Improvements in parental competency, parent/child conflict management as determined or measured by pre and post placement functional tests. E. More cost efficient services through the Intensive Family Therapy Program than the placement of the child. F. Therapeutic outcomes include fundamental changes in the family functioning and dynamics. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. V. SERVICE OBJECTIVES Please provide a one page description of your expected service objectives and quantitative measures. Please address, at a minimum, the following ways the project will: A. Improve Family Conflict Management - Mediation and counseling designed to resolve conflicts and disagreement within the family contributing to child maltreatment, running away and other offenses. B. Improve Parental Competency - capacity of parents to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision. C. Improve Ability to Access Resources - services shall assist parents to work with other sources in the community and ahead the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. VI. WORKLOAD STANDARDS Please provide a one page description of the project's work load standards and quantitative measures. Please address, at a minimum, the following areas: A. Number of hours per day, week or month. B. Number of individuals providing the services. C. Maximum caseload per worker. (Generally 12 families per worker. Eight to 10 families per worker if the worker provides case management services to the families on the caseload.) D. Modality of treatment E. Total number of hours per day/week/month (Minimum average of two hours of service per family per week. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. (Minimum of 6 workers per supervisor.) H. Insurance. 26 971083 RFP-PAC-97008 Attached A VII. STAFF QUALIFICATIONS Please provide a one page description of staff qualifications and address, at a minimum, the following: A. Will your staff who are providing direct services have the minimum qualifications in education and experience. Describe. B. Total number of staff available for the project. C. Will staff have expertise in family therapy as demonstrated by specialized training, workshops and experience. D. Will staff have a minimum of eight hours per year of continuing education; i.e. courses, workshops, and/or review of literature to be documented by county. E. Will staff have a minimum of one hour per week of clinical supervision provided by someone with advanced skills in Intensive Family Therapy. F. Will the clinical supervisor(s) be involved in regular training to keep current in state-of-the-art counseling modalities and findings. 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. For differnt services the provider can request different direct service rates. An average rate can be used or a separate rate can be used for each type of service. Service rates may also be stated as a fixed amount for an assessment, court appearance, etc. If so completing this section would not be necessary. Service rates can be stated on a daily basis, as opposed to an hourly amount. Direct Time (Per Month) 1. Direct client contact Indirect Time 2. Completion of Paperwork 3. Travel 4. Court Appointments 5. Vacation 6. Sick Leave 7. Case management 8. Other 9. Subtotal 10. Total Time Available Per Month 11. Ratio of Direct to Total Time SPA b i �tis �Irc �twc 27 Hours of (o 2 O 0 C C 2 s-- 3 I (Sum of 1-8) 13 9l (1/10 = 11) 971083 RFP-PAC-97008 Attached A RATE COMPUTATION b nsA arr., F1sta-Q 199(, Service Costs Direct Costs Salary Benefits Subtotal Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal Agency Overhead Rent Utilities Supplies Postage Travel Telephone Equipment Data Processing Other Total # of Employees Overhead Per Employee Total Total Direct Direct Time Monthly Hourly Rate Hourly Rate % of Time Charge 23s'hrs/reHvk 1289.8 S1.23 SV.23 1OO 5K►43 128,26 51,27 ,01.,23 ioo S'tf.23 O O O C7 G O o O 0 id9 tr-- 2t 8' 4Y7 IS6 9 Y7 ,20t. S (a 0 l 38 2O2 1182 t4Y.SAra/n..rt 13. ft I3,8'6 /3. 8t /3.81 loo> 1 3.86 loo? /3.84 5- All tin ef u.t v Po r 0i soy r v "to vt 4e --t0 S9�• yo Overhead Per Total Hours gr. 9O 257 YA Direct Service Rate (Hourly) 99.79 (Daily if appropriate) Service Cost Defmitions 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 Hodtly state - Cost divided by total direct hours. SR Q ba tt' ?..ustiEscaktcre-1 c'tc�. 2& 971083 Project Description Intensive Family Mediation Program Overview: Ackerman and Associates PC. proposes to continue its program of intensive family therapy. We will continue to use the short term mediation model we created in 1994 which now has been in operation since that time for families in Weld County. The mediation model involves meetings with a family unit whose internal conflicts have caused them to beimminently at risk. They are either facing imminent out of home placement or the family has a member in foster placement and the purpose of the mediation is to reunify that family. Where truancy is an issue that may cause out of home placement, the mediation may also involve a school official. Caseworkers are encouraged to explore with us if mediation may assist them on a case by case basis. Purpose: The purpose of the mediation is to reach agreement among the family members on the behavioral changes that are needed within the family. Such changes have a very clear purpose. That purpose is to either prevent outplacement or to return the child from outplacement. Our experience in the past two years continues to demonstrate a very high success rate with families who have been referred by the caseworkers and where the courts have asked caseworker to refer for these services. A very high success rate at continuing to avoid outplacement that persists at least six months after the end of the mediation also continues. our experience in the last year indicates fewer families have been referred for reunification than for avoiding placement. Nevertheless, mediation to reunify families has also been very successful. Overall, the purpose of this request is to continue this program for the next twelve month period. Design: The mediation consists of three, two hour sessions with two mediators at each session. Typically, the first session consists of establishing the setting for the mediation. At the first session the family members each present their own viewpoint concerning the conflicts that have brought them into mediation. What does each member need changed so that the family either avoids placement or achieves reunification? The second session consists in large part of mediation of short term solution focused goals between the family members. The final mediation session has involved establishing a written contractual agreement between the family members as to what they will do to either avoid placement or achieve reunification. One month after the contract is developed the family has a short follow up session to ascertain their status and to refer them to additional resources as needed. Six months after initiation of the process, a follow up contact is made for evaluation of the stability of the outcomes. Other Considerations: We now have the capacity to serve two to four families per month in this program. This is an increase in program capacity compared to last year. The majority of our referrals have been for adolescents rather than for young children 1 971083 although the number of referrals for young children has risen in the past year. This increase meets a goal of increasing mediation for families with young children we had proposed in our last application. Some of the younger child cases are not appropriate for prevention of immediate outplacement through mediation due to the need to physically or sexually protect the children. However, mediation is particularly useful with families of younger children in the area of reunifying families. We would like to increase utilization for such cases. By the family members explicitly clarifying their own specific behaviors needed for reunification to occur, mediation would be expected to shorten the time between placement and reunification. In the case of impending divorce the family is not reunifying, but mediation can creating ongoing relationships that preserve the psychological concept of family. In addition, we document the outcome of the mediation three times. One is immediately at the contract signing. The second is at one month after the contract was completed. The third is six months after mediation was initiated. By ascertaining success at these discrete times, the project is very easily evaluated. We can also report a very high level of client satisfaction with the mediation services they have received under this program. Based on our past twenty four month experience with this model of mediation, we now can include minor variations in future treatment. One such variation would be mediations that include the family and a school official when truancy is the presenting problem. Other variations may emerge as the needs of the department become clarified with respect to mediation. We encourage the caseworkers to contact us directly to explore if mediation can help in specific cases. We would like to meet quarterly with supervisors or survey them by letter to explore the need for any modifications to serve PAC target families. Target/Eligibility Populations A. Total number of clients to be served in this twelve month program has been calculated as follows. Two families per month times twelve months equals twenty-four families per year. We have capacity for up to forty eight families per year. If we assume a family size of five, two adults and three children, then the average client pool to be served is 120 individuals. That number includes at least 24 individuals who face either imminent outplacement or need reunification. Over the past year, we did about two thirds of our work related to prevention of outplacement. Up until the onset of financial reductions in the current funding cycle we were projecting full utilization and will now likely meet the current budget due to increased utilization in the past few weeks B. Distribution of clients. Total number of clients we will serve is approximately 120 as calculated above. Our experience suggests we would expect approximately 48 of these would be adult members of the family and approximately 72 would be minors. The age distribution of the children would tend toward the older children 2 971083 based on our experience with Weld County Social Services. We estimate that about 50 would be older than ten with an average age of about 14 and about twenty would be under ten. The older group would most likely be teenagers in conflict with their family most often concerning issues related to their maturation into adults. The younger group will consist of children of no particularly predictable age whose parents are in conflict usually in relation to instability in the marriage. We prefer to not attempt mediation in a case of ongoing spouse abuse or sexual abuse. This is because one of the requirements for mediation to succeed is the ability of the parties to speak without inherent threat of retribution. However, individual cases should be discussed with us by the caseworker. C. Families Served. We would anticipate serving twenty-four family units. Occasionally, we find that the family mediation may involve extended family members who might be considered a separate family unit. For simplicity, we count the referred family as the family unit. If increased demand is needed we have capacity to serve more families as stated above. D. Sub total who will receive bicultural/bilingual services. We have a Hispanic member of the staff (CJ) who is a licensed social worker fully fluent in Spanish. One of the mediator's (JSA) doctoral work was on Hispanic patient's mental health treatment patterns compared to Anglo patients in Weld County. We anticipate we can serve up to twenty-five percent or more of the total referred in a bicultural manner and, with the proviso stated below, the same number in a bilingual setting. We can provide bicultural/bilingual services for any family who needs them so long as there is sufficient English proficiency to conduct the mediation primarily in English with occasional Spanish translation. We can provide services completely in Spanish for other types of counseling. However, mediation requires a very high level of fluency on the part of both mediators for the complete mediation to be conducted in Spanish. Those families who are strictly monolingual in Spanish may be served by other modalities within Ackerman and Associates, such as short term solution focused therapy. In the past year we have done several mediations in this combined Spanish and English modality and these have been sucessful. E. We can provide services in South County if Social Services can provide a site to do such work. If that were available, we would schedule several mediations on the same day. Therefore, we would have to have at least two referrals for mediation in South County each time we traveled there. Alternatively, we are able to provide services on every Saturday in our Greeley location for any family. This may assist South County families in scheduling without interference with work schedules. Perhaps the Department has a small allocation of transportation funds for families that need them that may apply to this circumstance of needing to come to Greeley for mediation. F. Accessibility. On weekdays all providers of Ackerman and Associates are accessible through a 24 hour answering service and pager system. On weekends, this 3 971083 24 hour access reaches the provider on call who is always a licensed Mental Health provider. G. Maximum per month. The program maximum is four families per month. H. The monthly average capacity is two families per month. I. The average stay in the program is six hours over a three week period (one two hour session per week), a one hour follow up at one month and a six month follow up by telephone. (The six month follow up is not a billed service, but is only evaluative.) J. The average hours in the program is three two hour sessions and a one half hour followup with two mediators at all sessions. Types of Services Provided We will continue to provide mediation services for referred families using meetings with the family for two hour periods over a three week period. At the first meeting each family member states their viewpoint about the conflict and what they feel needs to change to avoid placement outside the home or to achieve reunification. The second and third sessions are when we clarify the various positions taken and negotiate agreement. These agreements have almost always resulted in maintaining the child in the home environment. Occasionally, the family agrees to avoid involuntary outplacement by soliciting the voluntary assistance of other family members for a place for the child to live temporarily. Every time we have reached agreement we have either prevented outplacement to foster care or achieved reunification. The only failures that have resulted in this process occur when one party midway into the mediation refuses to participate further. This has happened twice during approximately twenty mediations. Over the past 24 months, the program's success rate has been consistently at approximately 90% as measured by the achievement of an effective written agreement to avoid placement or return the child to the home. Most have a high level of satisfaction with the process, but a minority on follow up has found that the contract has not been followed as closely as the parties desired at the time the contract was developed. We would like to have a mechanism for follow up with families that will help them implement their mediation agreements and have proposed such as a separate proposal in this cycle. In terms of the criteria for the PAC process: A. Comprehensiveness: Mediation does not attempt to provide a comprehensive assessment or diagnosis of the family in a traditional psychotherapeutic model. It does allow the family assisted by the mediators to develop a contractual agreement for what the family must do to either avoid outplacement or achieve reunification. This amounts to a treatment plan that the family has a high level of commitment to. Mediation brings 4 971083 "ownership" of the treatment plan because of the process through which it was developed. In our experience, 90% of the families so far treated have developed a treatment plan in the form of a contract. The operating principle seems to be that if we can get a family through the first mediation session they will complete an agreement. B. Access to other services: The therapeutic interventions that the family specifies in their contract go back to the caseworker. We have the flexibility to include in the agreement the family reaches, the services the family feels it needs to implement their contractual goals. The caseworker can then match up these services with the goals stated. The families who reached the contracting stage of the process avoided out placement or achieved reunification as measured at the one month follow up. C. Co-Facillitation: All mediations are co-facillitated by two therapist/mediators. All providers are fully licensed by Colorado as mental health providers in their own categories of Psychology, Professional Counselor or Social Worker. Currently six providers, including Four psychologists, one professional counselor and one social worker make up the teams. All the providers have extensive experience in family therapy. One hundred percent of the 24 families will be treated within a co-facillitated model. D. Conflict Resolution: The mediations are designed specifically to resolve conflict within a family unit. Running away, threats of running away and other acting out behaviors of teenagers are particularly amenable to mediation. Where child maltreatment is due to neglect rather than active abuse, neglectful behavior has also been treatable within the mediation model. Spouse Abuse and sexual abuse of a child are usually not treatable within the framework of the mediation model, although we have succeeded in several mediations where the adults were separated by a restraining order, where the parties would only meet at the police station and one mediation took place with of an officer of the jail immediately outside the door. We expect that one hundred percent of the clients referred will fit within this form of treatment We intend to provide the types of services described above to twenty-four or more families in 97-98 grant year. No other program is providing this type of service at this time for this population of at risk parents and children. therefore these funds from PAC will not supplant existing or available services in the community. Measurable outcomes Measurable outcomes are of two varieties. One type is termed formative outcomes and the other type is called summative outcomes. Formative outcomes measure how the program is proceeding while the treatment takes place. Summative outcomes are the results of the treatment. 5 971083 In terms of formative measures we have the following... 1. Did the family follow through with the referral from their caseworker? 2. Did the family attend the three mediation sessions. 3. Did the family produce a final contract agreement for preventing placement or achieving reunification? 4. Did the family attend a one month follow up session? In our experience in the past twenty four months we have experienced a high follow through for contacting us. As an example of a case where in one case where no contact was made with the index child the parent had essentially lost control of this older teenagers behavior and the child was not living with the parent. Even in that case we did receive contact from the parent but could not get the family unit to treatment as the index child would not show for the scheduled mediation. Except for the above cases one hundred percent attended a first session. 95% attended a second session. 90% attended the third session and completed contracts. Of those completing contracts, all completed the one month follow up. The data on attendance and production of contracts and follow up are from the family's records. Summative outcomes At one month after completion of the contract and at six months or later after completion of the contract we determine the following information. Is the child still in the home? How well has the contract been adhered to? This measures if family behavior is different compared to their behavior before mediation. The other long term or summative outcomes listed below. A. The child receiving services does not go into placement. In the 1994-96 project only one child went into foster placement. That child was in a family which failed to complete the mediation process. We have prevented placement through Social Services in approximately 95% of referred families. One other family failed to complete the process. The child of that case is living with friends as far as we know. The six month follow ups on these families are not yet due for measurement. All but one family avoided formal foster placement. Similar results in our project for 1996 -97 for families who negotiate a mediated contract were achieved. B. Families remain intact. The concept of remaining intact has at least two components. One is does the family remain psychologically intact. Specifically even if the child is not living at the parents physical residence, the family unit (including the index child) maintains the psychological goal of staying a family unit. This is a rare outcome of mediation. More importantly approximately 90% of referred families have remained intact by the definitions of the PAC criteria. If we include psychological intactness we are looking at a 95% success rate since the start of the project. 6 971083 The five percent who fail at mediation do so because they do not participate in the process. Uniformly families we could not help either drop out at the end of the first session or never make it to the first session. C. Reunification of children with their families. While a minority of our referrals are for reunification, those referrals have achieved reunification in all cases based on the one month follow up. In the next year we would collect this data in the same manner and projected the rate of success to be 80% or better. D. Improvement in parental competency and parent child conflict management are expected to occur in all families who complete treatment. The persistence of these changes can be measured at one month. We examine the satisfaction level of the parents with the mediation process and determine the parent's relationship with the index child at those times. We will measure these criteria by parental self report and by their reported satisfaction with the mediation process at one month after the contract is completed. Formal pre and post testing is not appropriate in the mediation format. Post testing at one month follow up may be appropriate if needed to document the status of the family in more depth than we have proposed. E. Cost effectiveness. Our mediation program appears to prevent outplacement or to assist reunification and these effects last for at least six months. The cost of one family's treatment (approximately $1,200) could be compared to the cost for at least six months of foster care or $15,000. We would call this the maximum cost effectiveness ratio. In that situation, approximately 12 placement dollars would be spent compared to every one spent on mediation. A minimum cost effectiveness might be calculated as follows. The mediation process takes at least three weeks and costs approximately $1,100 at that point. Three weeks of foster care costs approximately $1,900. So even if the mediation results in the child immediately going to placement at the time the contract is written, at least $800 has been deferred. Let us consider a third possibility. We will assume a figure between the minimum and maximum values used above. Such an assumption might be that the child would have been in placement an average of two months if mediation did not occur. Using that scenario, the cost of placement would be about $5000 while the cost of mediation would be about $1,200, a saving using mediation of $3800 dollars. These calculations suggest the cost effectiveness of this program is very substantial. We can demonstrate this high rate of cost effectiveness because we provide a carefully structured time limited intensive service. F. Does this program produce fundamental change in family dynamics? Let's define fundamental changes as those changes that persist to the one month follow up. We measure based on self reported behaviors and compare to those behaviors the family agreed to in the contract. Using this method we can measure if fundamental change has occurred. Using the one month criteria, we project that 75% of the families will have the changes persist to one month. Using this limited definition 7 971083 we can document change in family dynamics. The persistence of change could be solidified by the short term therapy we have proposed separately that would assist families in compliance and implementation of the goals they set for themselves. that program would also greatly benefit families who have not gone through the mediation process. Service objectives We have the following service objectives: A. Improvement of family conflict management. The mediation program is specifically designed to resolve conflicts that either precipitated the likely imminent placement of the child or which prevent the reunification of the child with the family. So long as the conflict does not center specificallyon sexual abuse of the child or ongoing serious physical abuse of a child or spouse, mediation can assist the family in finding behavioral solutions to the existing conflict. Further, mediation provides a demonstration to the family that even serious long standing difficulties can be worked out. Mediation should encourage the family members to work toward a structure in which more open communication can be encouraged. B. Improved parental competency in this treatment model seems to center on the parents developing more age appropriate strategies. In dealing with conflicts with their child especially with teenagers, the areas of discipline, protection, instruction and supervision seem most responsive to improvement. With younger children the mediation gives the parents the opportunity in a relatively formal setting to clarify the roles each parent expects of the other. Relative to expectations concerning child rearing practices and in age appropriate expectations they can have for the child, mediation seems able to improve parental performance based on the follow ups conducted. C. The ability of the family to access resources is enhanced by the mediation process. When the need for a specific service becomes apparent to the family during the mediation, that need is stated as an item in the family contract. The strength of the mediation process is the identification by the family of the resources they need to gain access to. The contract is sent to Social Services that assists in follow up. We have also proposed a separate program to promote implementation of the goals families make. The methods used to ascertain if the service objectives are met include the reported satisfaction level of the families with the mediation process at one month and six months. At one month and six months we compare how the family reports it is doing to the objectives they set for themselves in their contracts as well as to the criteria stated in the measurable objectives section of this document. 8 971083 Workload Standards A. The program has a capacity of four families per month with an average of two families per month. Based on the average,this is approximately thirteen hours of face to face meetings per month. At each meeting two mediators are present. This represents 26 hours of therapist time per month or 312 hours of therapist time per year. At $90.00 per hour the cost is $28,080. At the 1994-96 rate of 89.27, the cost would have been 27,852.24. Our 1996 rate was approved at $94.33. Our 1997 rate based on our 1996 fiscal data is $93.99 which projects a budget total of $29,325. B. &C. There are six licensed providers three psychologists, two professional counselors and a social worker who will provide these services. Each provider will be invoved with between six to twelve families. The selection of the mediator teams is cliically determined by Dr. Ackerman who is a trained family mediatoir and who has trained the providers in these techniques. D. The modality of treatment is an intensive mediation model for conflict resolution. E. Hours /month The total number of therapist/mediator treatment hours is 26 per month or 312 per year based on our projected average. Maximum capacity is twice this level. F. Staff There are six individual providers supported by two secretaries in the practice G. Supervisor This contract would be supervised by Joyce Shohet Ackerman Ed.D. who would monitor the project for compliance. H Insurance All providers carry one million three million liability, Ackerman and associates carries an additional one million three million liability policy on the group and a general liability policy which meets the required criteria for this application is on file with the county and is provided through Farmers Insurance. Staff Qualifications A. and B. Staff Qualifications Six staff are available for the project. They exceed the minimum qualifications specified as documented below The staff are: Joyce Shohet Ackerman, Ed.D., Licensed Psychologist and mediator;Lori Kochevar M.S.,Licensed Professional Counselor; Laurence P. Kerrigan Ph.D., Licensed Psychologist; Carmen Jimenez, MSW, Licensed Social Worker, Susan Bromley, Psy. D., Licensed Psychologist and Steven Patrick, licensed psychologist. 9 971083 C. Training The staff has extensive training in family therapy and mediation as documented by their extensive work experience. Collectively, the six providers have held licenses in their field for a total of 60 years with a range of 1-20 years and an average length of licensure of about 10 years. Resumes are available if desired D. Continuing education As a part of their work in the private sector all providers in this group maintain continuing education programs more than the minimum eight hours required. They participate in workshops and other activities. These continuing education requirements arise from other contractual arrangements with managed care companies. E. Supervision All providers are independently licensed and not required to have clinical supervision. All the staff have advanced skills in intensive family therapy. The supervisor will monitor the specifications made in this proposal. F Supervisor continuing education The supervisor of the project is involved in ongoing training to keep current with her profession through advanced workshops and seminars and as a member of the Colorado Council of Mediators. Unit of service rate computation We have calculated the unit of service rate based on the instructions . We used 1996 data for our agency which had four full time equivalents as direct service providers and slightly more than one full time secretary over the fiscal year. The year 1996 involved some transition for this company with a number of provider changes due to the rapidly changing nature of the managed care mental health market place. Using overall figures for the agency we arrived at a figure of $93.99 which is a 34 cent decrease in our rate from the prior year.. Overall in 1995 our expense related to providers salaries were that providers salaries were 65 % of costs and non -providers salaries and overhead were 35% of the costs. The formula used in the PAC format produces a provider contribution of 49.72 / 94.33 or 53% in 1995 and a rate of 54.23/93.99 for 1996 or 58% of costs. Budget Justification Each mediation uses twelve hours of therapist time and the one month follow up uses one hour. The six month follow up is not billed as a service, but is an inherent part of the evaluation process. We use the figure of twenty four evaluations per year to generate the total face to face hours of the project which equal 312 hours. 312 hours times $93.99 equals $29,325 as the total budget for the project if it had 100% of projected utilization.. These rates are reasonable and customary for providers of the level and training assembled in this proposal. PAC money is tracked through a computer data base system called MediMac which 10 9710Sf we have used for the past 16 months. the system allows us to track payments by client and by source of payment and any payment through the PAC will be tracked in this manner. No special issues are present related to project audit to our knowledge. Ackerman and Associates P.C. is a type S professional for profit corporation and not a 501.c.3. 11 971083 DECLARATIONS 0 TRUCK INSURANCE EXCHANGE E FARMERS INSURANCE EXCHANGE O FIRE INSURANCE EXCHANGE SPECIAL SENTINEL MEMBERS of FARMERS INSURANCE GROUP OF COMPANIES PACKAGE HOME OFFICE: 4680 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90010 SUPER 1. Named . DR JOYCE SHOHET ACKERMAN PC Insured . Mailing ' . 1750 25TH AVE SUITE 101 Address . GREELEY CO 80631 Agent Policy Number Type of The named insured is an individual unless otherwise stated: ❑ Partnership (XJ Corp. Business OFFICE ❑ Joint Venture LJ Organization (Other than Partnership or Joint Venture) 2. Policy Period from 07/01/96 (not prior to time applied for) to 07/01 /97 12:01 a.m. Standard Time. If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we electtocontinue this insurance, we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums, rules and forms then in effect. 3. Insured location same as mailing address unless otherwise stated: 1750 25TH AVE SUITE 101 GREELEY CO 80631 Prematic Acc't No. Prod. Count 07-04-362 04576-38-07 4. Mortgage Holders Loan # 5. Premium $ 484.00 ❑ 'X" if Mortgage Holder Pays Loan # 6. Policy Forms and Endorsements attached at inception: E0079-ED1 E6040-ED2 2521551290 565310-ED2 S0700-ED3 E6036-ED1 E4168-ED1 7. We provide insurance only for those coverages indicated by a specific limit or by an El COVERAGES LIMITS OF INSURANCE DEDUCTIBLE SECTION 1 Property and Loss of Income A -Building $ $250 applies unless other oI�tion indicated �b an IElsiootssoo Us B -Business Personal Property $ 50 , 000 NONE C -Loss of Income (Not exceeding 12 consecutive months) ACTUAL LOSS SUSTAINED OPTIONAL COVERAGES Swimming Pool/Fences and Walkways $ Above deduc- $ tible applies $ 100 X Building Glass(Blanket) REPLACEMENT COST unless other $ X Outdoor Sign Coverage $ 100 option Indi- $ _ Valuable Papers (In addition to $1000 included.) $ cated. ❑ Earthquake Damage See Coverages A,B, & C % of the applicable ins. limit. SECTION II Liability and Medicals 0 -Business Liability - Including Products and Completed Operations. (Annual aggregate applies for all occurrences LIMITS OF LIABILITY (Annual Aggregate) during the policy period.) $ 1, 000 , 000 E ■ -Fire Legal Liability $75,000 included unless other option indicated by an $100,000 0 $150,000 each occurrence (Subject to the annual aggreagate X shown for Coy. D) F -Medical Payments to Others (Subject to the annual aggregate shown for Coverage D.) $5,000 each person ■ Professional Liability (see attached endorsement) Limit of Liability (Annual Aggregate) $ SECTION III Crime i.'7 I - V COVERED DEDUCTIBLE Agreement I -Employee Dishonesty $5,000 NONE Agreement II -Broad Form Money and Securities -Inside $1,000 $250 Agreement III -Broad Form Money and Securities -Outside $1,000 $250 Agreement IV -Medical Payments $500 each person NONE Agreement V -Forgery or Alterations $2,500 NONE 58-5308 2-92 2ND EDITION Countersigned Authorized Representative 91106 Branch B/A Producer # Issue Date 32 Renewal/Replacement No. A 0002360 '°15.00 05/14/96 RENEWAL PSYCHOLOGISTS PROFESSIONAL LIABILITY CLAIMS -MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS Al -CI �IMMADE and Iw PI EASE a[nn THE PO I Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2032570 1. NAMED INSURED: ACKERMAN AND ASSOCIATES PC ADDRESS 1750 25TH AVENUE (Number & Street, Town, GREELEY CO 80631 County, State & Zip No.) 2. POLICY PERIOD: From 05/01/96 To 05/01/97 (12:01 A.M. Standard Time At Location Of Designated Premises) 3. COVERAGE: LIMITS OF LIABILITY PREMIUM Professional Liability $1,000,000 $3,000,000 $1,741.00 each Incident Aggregate 4. BUSINESS OF THE INSURED: Psychology 5. THE NAMED INSURED IS: ( ) Sole Proprietor (including Independent Contractors) ( ) Partnership (X ) Corporation ( ) OTHER: 6. This policy shall only apply to incidents which happen on or after: a) the policy effective date shown on the Declarations; or b) the effective date of the earliest claims -made policy issued by the Company to which this policy is a renewal; or c) the date specified in any endorsement hereto. 05/01/92 7. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s): PLJ-2008 (10/94) POE -8004 PLE-2147 PLE-2081 PON-2003 CHICAGO INSURANCE COMPANY 55 E. iMONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke -Van Orsdel, Incorporated Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll -free Number: 1-800-852-9987 SI INTERSTATE INSURANCE GROUP alle PLP-2O12 (06/93) (Elec.) PL P8003 v/11, (Fri . l!,,I 4'74 nine, FROM : Ackerman and Associates PHONE NO. : 9703533374 May. 05 1997 04:30PM P2 May 2, 1997 Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80631 (970) 353-3373 fax: (970) 353-3374 Judy A. Griego, Director Weld County Department of Social Services P.O. Box A Greeley Colorado *0632 Dear Ms. Griego: Re your letter dated April 17, 1997 concerning Ackerman and Associates Bid #1 on RFP -PAC bid 97008 (Intensive mediation services) Additional Information 1. Concerning the proposed program evaluation, i.e. tools pre and post test instruments data collection used to monitor the effectiveness of the program. This program has been ongoing for approximately two and a half years. During that time, the tools we have developed include an intake form, a contract which explains the nature of the mediation process, a format for the creation of a mediated agreement, a one month follow up procedure and a six month follow up procedure. These materials along with the family produced drafts of ideas that shaped the final mediated agreement constitute the data set on each family. The evaluation questions are straight forward. Did the family follow through in scheduling the mediation process? Did the mediation proceed through three sessions or was it terminated early? If so, for what reasons was it terminated? Did the mediation process result in a mediated agreement which settled the dispute and either lead to prevention of placement or reunification? Was the family still intact at the one month and the six month follow up points? 971083 FROM : Ackerman and Associates PHONE NO. : 9703533374 May. 05 1997 04:30PM P3 2. Will we be able to initiate direct services within five working days? We believe we are able to meet this requirement. We will be able to contact the parties involved in the mediation, explain to them the process of the mediation and schedule a time for the mediation within five working days of the referral in most cases. We consider these efforts a part of our direct service. It often takes 30- 45 minutes explaining the mediation process to each party in the dispute. Such work is done by a trained mediator who is also a licensed mental health professional. Where the parties are living without a telephone, are unwilling to provide a correct contact phone or otherwise are difficult to contact would be the cases that would potentially take longer than five days to set up the mediation. Some mediations could commence within five working days, but there are often between three and six participants in the mediation. These parties are in conflict or they would not have been referred to the mediation and often do not easily agree to a time to meet the other party. In addition, two mediators are required for each mediation. All this means having all the parties and the mediators find a suitable time to actually start treatment within five days of referral may not always be possible. However, we will proceed with the mediation as expeditiously as possible. 3. Further Clarify services to South County residents. Residents of South County will be seen in our Greeley offices. We have the ability to schedule Saturday or evening appointments to minimize time lost from work for any clients, including those from South County. We can provide services in Spanish as explained in our proposal for any clients including those from South County. 4. Transportation: No transportation is provided nor is any proposed in our bid. We hope this clarifies any questions you may have. Please contact me if any other information will assist you in your consideration of our bid. We look forward to continuing these very successful mediation services. Sincerely, MLis JbLaC�.c�l CD�? Joyce Sholtet Ackerman Ed.D. Licensed Psychologist and President 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilinguallbicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) for Placement Alternatives Commission (PAC) Funds Type of Action Contract Award No. FY97-PAC-3001 (RFP-PAC-97008) X Initial Award Revision Name and Address of Contractor Contract Award Period Island Grove Regional Treatment Center Intensive Family Therapy Program 1140 M. Street Greeley, CO 80631 Beginning 06/01/97 and Ending 05/31/98 Description Computation of Awards The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal (RFP) and Addendum RFP Information. The RFP specifies the scope of services and conditions of award. Except where it is in conflict with this NOFAA in which case the NOFAA governs, the RFP upon which this award is based is an integral part of the action. Special conditions Unit of Service This program is specially designed to assist individuals and families with their substance abuse issues. Up to a maximum of 200 family units over 12 months, 6 units active at any one time, and estimated average stay in intensive therapy to be 16 weeks. (in -home or in -clinic) Cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based on an hourly rate per child or per family. 2) The hourly rate will be paid for only direct face to face contact with the child and/or family, and as specified in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. 4) Payment will only be remitted on cases open with, and referrals made by the County Department of Social Services. 5) Requests for payment must be submitted to the Weld County Department of Social Services by the end of the third business day following the end of the month of service. Hourly Rate Per $ 90.00 Unit of Service Based on Approved Plan Enclosures: Signed RFP; Exhibit A tZtAddendum RFP Information; Exhibit B Condition(s) of Approval Program Official: By Approvals: s� By�� Judy :. Grieg , Director f / Weld unty a gp�artment if Social Services Date: + b 3/ Q 7 cor e. Baxter Board of Weld County Co Date: L'h6o�Y /97 litr 4 n F_ (( ) �, Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilinguaUbicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 INTENSIVE FAMILY THERAPY FAMB_Y PRESERVATION PROGRAM DEPARTMENT OF SOCIAL SERVICES WELD COUNTY 1997/1998 BID PROPOSAL RFP-PAC 197008 1 l l 7 1 l 1 1 Island Grow Regional Treatment Center 1140 7P Street Greeley, Colorado 80631 971083 INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97008 IETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RFP-PAC-96008) for: Family Preservation Program --Intensive Family Therapy Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 25, 1997, Tuesday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.RS. 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, 1997 through May 31, 1998, at specific rates for different types of service, the County will authorize approved vendors and rates for services only. targeted funding levels of increments up to $155,787.00. The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists, typically with all family members, to improve family communication, function, and relationships. This program announcement consists of five parts, as follows: PART D...Bidder Response Format PART E...Bid Evaluation Process PART A...Administrative Information PART B...Background, Overview and Goals PART C...Statement of Work Delivery Date (After receipt of order) VENDOR Island Grove pwional Treatment (Name) Center ADDRESS P.O. Box 5100 Greeley, CO 80631 BID MUST BE SIGNED IN INK Esther McDowel1 TYPED OR PRINTED SIGNATURE Handwritten Signature By Authorized Officer or Agent of Vender TITLE Coordinator Special Prnjramc DATE March 21, 1997 PHONE 4 (9701 356-6664 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 971083 S RFP-PAC-97008 INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97008 NAME OF AGENCY: Island Grove Regional Treatment Center, Inc. ADDRESS: 1140 'M' Street, Box 5100, Greeley, CO 80631-0100 PHONE: (970) 356-6664 CONTACT PERSON: Esther McDowell TITLE: Coordinator of Special Programs DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists, typically with all family members, to improve family communication, functioning, and relationships. 12 -Month approximate Project Dates: Start June 1, 1997 End: May31, 1998 X 12 -month contract with actual time lines of: Start June 1, 1997 End: May31, 1998 TITLE OF PROJECT: Intensive Family Therapy Program Esther McDowell. M.A.. CAC III 3 7 / _ y7 Name and Signature of Person Preparing Document Date B.J. Dean. M.A.. CAC III Name aSignature Chief Administrative Officer Applicant Agency 3-Iq-q1 Date MANDATORY PROPOSAL REQUIREMENTS Please Initial to Indicate that the following required sections are included In this proposal: liAProject Description Measurable Outcomes 'staff Qualifications @ATarget/Ellgibllity Populations Service Objectives %^^ Unit of Service Rate Computation t��((�j ypes of Services Provided (r Workload Standards TAmProgram Capacity per Month ertlficate of Insurance Date of Meeting(s) with Social Services Division Supervisor. Comments by SSD Supervisor. //Er'j RE C�( l< r jr %a w. 1Cq\ t_✓t- r ii" �-yi`��, ,n Ali �12 i' � 'ice✓ J �C"i C' .i-� �'t-/r'. �C y . ;,--)-r c Af /l/� L y../(p/ 11C=Ace d ,c, . M_ Name and Signature of SSD Supervisor Date 971083 RFP - PAC - 97008 Intensive Family Therapy Program Bid Category Intensive Family Therapy - Family Preservation Program Island Grove Regional Treatment Center, Inc. I. PROJECT DESCRIPTION Most families face enough 'ordinary" challenges to test even the most well-balanced and healthy family units. Add an accompanying element such as substance abuse by any of its members, the disruption can be so extensive that parents face losing their substance -involved children or children lose their addicted parents to the control of chemicals. These high -risk situations need high-powered responses. The Island Grove Center's Intensive Family Therapy Program has designed such a response for our Weld County families. The IFT program is specifically geared to assist the substance -involved family system in restructuring their lives free of this undermining influence. Using a "systems perspective," our staff focuses on building family strengths with the goal of reunifying the family and retaining children safely in their homes. Each referred family is provided with in -home or in -clinic family sessions. Solution - based models of family therapy have demonstrated success in working with this population in a time -efficient, goal -directed manner. The clinical staff has expertise in both marriage and family therapy, as well drug and alcohol abuse counseling. This combination of skills provides our staff with the tools to pave opportunities for families to choose more responsible and positive ways of living. The frequency of sessions and the duration of the program is assessed and determined by the clinical team, in collaboration with the case worker and the Involved family. In addition to family sessions, play therapy, and case aide support, group therapy and other auxiliary services can be accessed by individual family members. Truly, an individualized and customized family treatment plan can be a reality. The following menu is available to augment and reinforce goal attainment with the approval to bill other authorized funding, such as the'ADAC Menu": • Sobriety support groups • Domestic violence education and therapy • Substance abuse education • Women's Therapy Group • Pregnant Women's services • Vocational assessment and planning • Antabuse monitoring • Urinalysis and breathalyser testing As demonstrated in the past, our family services team will maintain and nurture collaborative relationships with case workers to facilitate timely, flexible, and appropriate services to support the case plan. 3 971083 II. TARGET/ELIGIBILITY POPULATIONS Our Intensive Family Therapy team will serve eligible, substance -involved families within Weld County. Due to the proven demand, we are currently capable of carrying an average of 25 family cases at any given time, for a total of 105 family units over the upcoming funding period. We have the flexibility to expand the availability of our team to accommodate a maximum monthly capacity of 32 families. This could include more than 200 children within these families, from preschool ages on up, within the year. Length and intensity of treatment vary among the families, depending on the severity of their challenges and their willingness to utilize the resources available to them. We estimate the average duration of the program to cover a sixteen -week span, with an average of two contacts per week for an estimate of three clock hours of contact. Later stages of this time period, would typically decrease services to bi- monthly contacts. The upper end of the intensity could involve twelve hours of contact per week, for a brief period, in the most extreme cases. Our referred families will be contacted within two business days to arrange for the initial assessment. Depending on the family's schedule, the assessment will occur, typically in -home, within seven business days from the moment of referral. In the event of crisis, all referred family members will have access to 24 -hour response through our detoxification unit and available on -call family services counselors. Services to South Weld County families have previously comprised approximately one-third of our total enrollment. Estimating 35 families from our total family units, this could involve approximately 140 individuals. We have been responding to these families through accessing our Ft. Lupton office or providing in -home sessions in the further outlying areas such as Dacono, Hudson, or Frederick. Recognizing the need for bilingual/bicultural services, we are prepared to serve up to twelve Spanish-speaking families this year. If a family refuses treatment or appears inappropriate for outpatient services, we will immediately contact the case worker and discuss other referral possibilities. This may include referrals to Intensive Outpatient, residential services, or other special program areas. 4 971083 III. TYPES OF SERVICES TO BE PROVIDED A. Comprehensive, diagnostic assessments and treatment planning: Family services counselors will complete an in-depth family assessment during the initial home visit for all accepted referrals, to determine to what extent substance involvement and other factors impact the family's functioning, as well as identifying strengths the family brings to their situation. The Browning Outcomes Survey Scale (BOSS) and the Family Adaptation and Cohesion Scale (FACES) will be used to gather a pre and post treatment measure. The Department of Human Services - Alcohol and Drug Abuse Division is also currently developing a mandatory family assessment tool for ADAD contractors. We are anxiously awaiting the arrival of this instrument to integrate into our family enrollment and treatment planning process. The family's primary counselor will partner with the family to develop a treatment plan that will prioritize and specify measurable objectives, incorporating the goals of accessing community resources and other providers as needed. The case aide position we have designed to assist the family services team, is available to insure that clients who need transportation to attend sessions have it, to help in the family progress data collection, and to assist in home visits. B. Therapeutic interventions that may include an array of auxiliary services: In addition to weekly family therapy sessions and available case management services, individual family members and DSS case workers may find it beneficial to supplement the IFT service base with other Island Grove Center's offerings or additional community support. The IFT family member could have, at their disposal, therapy groups for women's issues, education and therapy for domestic violence offenders, counseling support and education for pregnant and postpartum women (Medicaid reimbursable), vocational assessment, substance abuse education, detoxification, residential treatment, urinalysis, and breathalyser monitoring. Virtually every related and necessary service can be accessed within Weld County at Island Grove Center or via the collaborative relationships that Island Grove has with an extensive list of other community provider. There are many caring and competent professionals invested in the families that we share. Other funding streams, such as the ADAD Menu, have been utilized in the past, to access existing Island Grove services when authorized by the case worker. We estimate that 50% of our referred IFT families, could benefit from being involved in additional monitored services. C. Co -facilitated therapeutic services by qualified family therapists: Many family sessions are facilitated by pairs of master's level family therapists. This strategy, usually comprised of a male and female team, is utilized when 5 971083 therapeutically beneficial to the family. It is not employed indiscriminantly, due to the efforts to contain costs and to manage staff time and coverage, yet may comprise 25% of the family sessions. Other staff combinations have been useful to meeting the specific needs of individual family members. For example, Bob Keenan may provide the family therapy services, and Kristen Arnold may counsel the adolescent girl in that family separately for a period of time. The perspectives and information shared in this duo, enhance the progress of the involved family. D. Therapy that is designed to resolve conflicts and disagreement within the family...: Family counselors will consistently use solution -based models of family therapy. Solution building and outcome -based strategies have demonstrated success within the brief and managed care models of service provisions. Focusing on a family's strengths, this model integrates well with the services of other providers. The therapy is designed to empower families to implement respectful and responsible conflict skills, restore family boundaries, and discover life without the abusive involvement with drugs and alcohol. The instruments chosen, the BOSS and FACES, specifically indicate measures of communication skills, family goal attainment, and levels of conflict. IV. MEASURABLE OUTCOMES A. Children receiving services do not go into out -of -home placement: We can anticipate that 80% of families completing all recommended treatment, will not lose children to placement. Our communication with case workers will verify these outcomes. B. Families remain intact: Similarly, we expect that 80% of families completing this program, will remain intact and continue to improve. Post -discharge version of the BOSS should indicate sustained positive changes. It will be administered by the case aide six months after the family is discharged. Results will be collected and reported quarterly. C. Reunification of children with families: The program design for IFT, by its nature will include, ideally, as many family members in the solution -building process as there are in the systemic problem. Without this involvement, the progress toward reunification is slow, and much more difficult. Our goal is set at 85% satisfactory completion percentage of all families referred. Satisfactory completion is defined as all significant family members were included in the treatment plan and completed stated goals prior to discharge. D. Improvements in parental competency, parent/child conflict management...: Therapeutically, the focus of much skill -building will be in regard to the areas of competency and conflict. We feel the BOSS instrument will give us a measure 6 971083 of these areas within the sub -scales. We may investigate adding a specific instrument if we can research an appropriate measure that could encompass a broad range of children's ages. There are desired obvious behavioral outcomes we want to see, such as kids not running away, no reported incidents of abuse, etc. All of these incidents will be recorded as the counselor becomes informed, recorded in the case file, and data brought together within the submitted quarterly reports. E. Cost efficient IFT services in comparison to placing the child: We estimate our average monthly treatment costs per family to be under $400. With an average satisfactory completion time frame of four months, the high end of the total costs would still be only at $1600. F. Therapeutic outcomes include fundamental changes in the family functioning and dynamics: We believe that the regular administration of the pre and post BOSS and FACES will indicate improvement in significant family functioning. Other indicators will be recorded such as child's school performance, any out -of -home placement decisions, and observed communication progress within sessions. V. SERVICE OBJECTIVES A. Improve Family Conflict Management: Family sessions are targeted toward demonstrating family skill -building in conflict resolution and appropriate communication. In addition to the instruments mentioned throughout the proposal, the family's individual treatment plan will indicate progress or continued deficits. B. Improve Parental Competency: Instruments such as the BOSS and FACES will provide measures of the quality of the relationships within the family. The case aide home visit reports will also indicate basic safety, supervision, and nutrition needs being met. Additional referrals to participate in other provider's parenting classes will be recommended as needed. Specialized materials have been purchased and utilized to address the family impact of substance abuse. Investigation of valid instruments regarding parenting attitudes and behaviors will continue and be piloted, as needed. C. Improve Ability to Access Resources: The program's responsibility, in addition to establishing a working, therapeutic atmosphere for the family, is to be a vehicle, literally, at times, to connect families to their communities. Concretely, our case aide, and if necessary our clinical staff, will arrange for transportation of family members to sessions and other agency or community resources, as it applies to the completion of the treatment plan. As a result, the family may continue these sustaining relationships long after their "treatment" 7 971083 ends. We feel that this very practical component to our services is crucial to accomplishing the "leading -the -horse -to -water" phase of treatment success. Our case aide, as well as the documentation within the case files, will indicate the community net that is being woven with the family that is reinforcing their positive directions. Our minimal goal for each family, is that one or more of its members establish at least two appropriate community contacts during their course of treatment. These could include such links as peer support groups for sobriety, Ala -Non, Job Service, United Way agency volunteering, Food Bank, recreation center involvement, or Sunrise Community Health, etc. VI. WORKLOAD STANDARDS A. Number of hours per day, week, or month: Families are generally involved in one family session per week, 1.0 to 1.5 hours in duration. Newly enrolled families will additionally have a case aide contact from .5 to 1.0 hours per week. One or more family members may have additional individual sessions of 1.0 hours per week and/or auxiliary support services ranging from 1.0 to 3.0 hours per week. A minimum average would be 2 hours/week, but could range up to 12, if even only periodically. We clearly want the family to have all possible resources and services available to them. On the other hand, we want to individualize the response to the presenting needs, without always assuming that "more is better". B. Number of individuals providing the services: We have access to five degreed counselors, two interns, and a case aide. C. Maximum caseload per worker: With a staggered caseload, in that families will be at a range of service needs, and with the assistance of our case aid, our counselors can handle a case load of twelve families. Their administrative duties are kept to a minimum so that full attention can be focused on direct services. D. Modality of treatment: All IFT core services will be on an outpatient basis. E. Total number of hours per week: Our Weld County families will be receiving well over 100 hours of service per week. F. Total number of individuals providing these services: 8 G. Maximum caseload per supervisor: 8 H. Insurance: Flood and Peterson Insurance Company - See attached documentation 8 971083 VII. A Robert Keenan, Family Services Lead Counselor M.A.- Agency Counseling, emphasis in Marriage and Family Therapy CAC III Experience: 3 years Intensive Family Therapy 8 years general family therapy Kristen Arnold, Counselor - Women and Family Services M.Ed. - Counseling Psychology CAC II - pending Experience: 2 years Play Therapy 4 years general family therapy Freida Lombardi, Counselor - Women and Family Services M.A. - Rehabilitation Counselor Ed.S. - Counseling Psychology Additional training in play therapy techniques CAC III Experience: 3 years Intensive Family Therapy 14 years general family therapy In addition to this core clinical staff, whose education and experience is specifically in family services, we also have available a master's level contractor, a bilingual counselor, case aide, clerical assistance, administrative project supervisor, and additional contracted clinical supervisor. All staff will have a minimum of 16 clock hours of continuing education annually. Bob Keenan, our full-time Lead Counselor and contact person for the IFT program, has a large role in the clinical monitoring of the program's daily operation. He interacts with all involved staff numerous times per week and trackscase load6 , e service hours f his work week. e provided, and responds to on -call crises, comprising approximately He supplements this ongoing supervision with periodic in -services, presenting alone or with Dr. William Walsh, our contracted Clinical Supervisor. He has recently authored in an article on the topic of Narrative Therapy, featured by Dr. Walsh for The Family Journal, Vol. 5, #4. Dr. Walsh meets twice each month with our clinical team for 1.5 to 2.0 hours/each session. Dr. Walsh, Director of the Marriage and Family Program at the University of Northern Colorado, is a well -respected clinician and scholar of innovative models of family therapies. He is well -versed and practiced in the ongoing professional development of the field, in addition to mentoring bright and enthusiastic professionals such as Bob Keenan. 9 971083 FPP - INTENSIVE FAMILY THERAPY ISLAND GROVE REGIONAL TREATMENT CENTER, INC. COMPUTATION OF DIRECT SERVICE RATE BUDGET DESCRIPTION 11 EXPECTED FAMILY UNITS TO SERVE PER WEEK ANTICIPATED SESSION HOURS PER WEEK A. FAMILY SESSIONS (11 FAMILIES @ 2 HR) ANTICIPATED SESSION HOURS PER YEAR ANNUAL PROJECTED PROGRAM COST DIRECT SERVICE RATE PER HOUR (ACTUAL) (FAMILY AND GROUP) DIRECT SERVICE RATE PER HOUR (BID RATE) (FAMILY AND GROUP) 10 22 1144 $107,466.85 $95.00 $90.00 FPP - INTENSIVE FAMILY THERAPY PROJECTED COSTS -3/20/97 BUDGET DESCRIPTION TOTAL TOTAL DIRECT MONTHLY TIME MONTHLY HRLY RATE HRLY RATE % OF TIME CHARGE DIRECT STAFF COSTS BOB KEENAN (139 HRS/MO) $2079.57 $1200 51200 80.2% 51,667.66 KRISTEN ARNOLD (121 HRS/MO) 51,931.67 $11.14 $11.14 69.8% 51,348.45 FREIDA LOMBARDI (80 HRS/MO) 52178.75 $12.57 512.57 46.2% $1,005.58 CASE AIDE (75 HRS/MO) 51,316.67 57.60 57.60 43.3% $569.71 CONTRACT THERAPIST (10 HRS/MO) $250.00 $25.00 525.00 100.0% 5250.00 BENEFITS $2,016.73 $287 5287 $1,218.64 DIRECT STAFF COST SUBTOTAL $9,773.39 $71.18 $71.18 56.060.04 INDIRECT PROGRAM COSTS PROJECT MANAGEMENT SUPERVISION Esther McDowell (25 HRS/MO) $3,33520 Benefits $867.15 $19.24 $5.00 $19.24 $5.00 14.4% 5481.04 5125.07 CLERICAL Accounting/Secretarial (12 HRS/MO) 56,019.86 $13.89 513.89 2.8% . $166.70 Benefits 51,565.15 $3.61 $3.61 $43.34 CLINICAL SUPERVISION W. Walsh (3.5 HRS/MO) $85.00 $85.00 $297.50 TRAINING $300/stall X 5 staff 51,500.00 $1,500.00 5125.00 CUENT TESTING INSTRUMENTS BOSS, FACES, other (2 TESTS/FAMILY) 52,000.00 $2000.00 $166.67 COUNSELOR SERVICE MILEAGE 800 mites/month @ .25/mile VEHICLE COSTS 35% of monthly agency vehicle cost MEETING COSTS/INSEITVICES 25 meetings/year @ S20/meeting INDIRECT COSTS SUBTOTAL AGENCY OVERHEAD $203.00 $200.00 $128.48 $128.48 $500.00 $500.00 $200.00 $128.48 $41.67 PayrolVBenefrts Business/Travel Expense Training/Education Prof Fees/Advertising Rent/Buildings/EquIPment Data Processing Office Equipment/Supply Utilities Other Total # OF EMPLOYEE FTE'S MONTHLY OVERHEAD PER EMPLOYEE FTE OVERHEAD PER TOTAL HOURS MONTHLY DIRECT PROGRAM COST DIRECT SERVICE RATE (HOURLY) $19,556.23 $630.00 51,660.42 51,362.50 $455.27 $1,127.08 $966.10 $654.17 $201.25 526,633.00 63.5 $419.42 5242 51,775.47 $1,120.06 $8,955.57 SEE DIRECT SERVICE RATE COST SHEET 971083 tRD. CERTIFICATE OF IN ER d & Peterson Insurance Inc First Street n, CO 80615 ISLAND GROVE REGIONAL TREATMENT CENTER INC P O BOX 5100 GREELEY, CO 80632 RAN ■� DATE (MM/DD/ I) SuRANCE03/20/97 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY Inc. AFrontier Insurance Compan , COMPANY BSt. Paul Ins. C COMPANY C COMPANY D IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SAGES DOCUMENT BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD T OR OTHER RTIFICATE�MAY BES ISS ED OR MAYS PERRTTA E TH INSURANCE AAFFORDED BYY THE POLICMENT, TERM OR CONDITION OF ANY CIES DESCRIBE HD EREEIN IS SUBJECTPTOTTO WHICH THIS ALL THE TERMS, CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION DATE (MMIDDIYY) DATE(MMIDDIYY) 04/01/97 TYPE OF INSURANCE ENERAL LIABILITY OMMERCIAL GENERAL LIABILITY ]CLAIMS MADE X OCCUR IW NER'S & CONTRACTOR'S PROT LUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS POLICY NUMBER GLSCO1013804 FK06602680 04/01/97 04/01/98 04/01/98 LIMITS GENERAL AGGREGATE $3,000,000 PRODUCTS-COMPIOP AGO s3, 000,000 PERSONAL ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any one Ike) $50, 000 1,000,000 $1, 000_,_000 ED EXP (Any one person) :5,000 COMBINED SINGLE LIMIT $1, 000, 000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ L INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL OTHER PROF LIAB 0200001362 04/01/97 04/01/98 EACH OCCURRENCE $ AGGREGATE STATUTORY LIMITS EACH ACCIDENT DISEASE -POLICY LIMIT DISEASE -EACH EMPLOYEE $1,000,000 PER OCC. $3,000,000 AGGREGATE $ $ $ LD COUNTY, COLORADO, BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, ITS RIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS IPLOYEES AND AGENTS , AND THE STATE OF COLORADO ARE NAMED AS ADDITIONAL lee Attached Schedule.) RTIFICATE HOLDER WELD COUNTY, COLORADO 915 10 STREET GREELEY, CO 80631 :ORB 25-S (3193)1 of 2 #S 81622/M81621 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT RE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF N KIND. UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUT ZED REPRESENTA'NE 971083 DESCRIPTIONS (Continued from page 1.) 4SUREDS AS THEIR INTEREST MAY APPEAR IN REGARDS TO THE OPERATIONS OF THE NAMED INSURED. CISGEM 252 (3/93)2 O1 2 itS81.622/M81621 97'108- 111:11. C E RTI E'ICATE OF INSU ar Insurance Assoc., Inc. 28th Street ar CO 80301 303-444-4443 Fax No. Island Grove Regional Treatment Center P.O. BoxCO5100 Greeley80631 ... _. AGES 3 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE TO WHICH THIS POLICY PERIOD ITIFICATE NOTWITHSTANDING ANY ISSUED OR MAY PERTAIN, N, THEINSURANCE OAFFFO AFFORDED BY THE POLNDITION OF ANY ICES DESCRIBED HEREIN IS SUBJACT OR OTHER DOCUMENT ECT ECT TO ALL THE TERMS, ;LUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN RnEDUCEDP Y PAID CLAIMS. LIPY EXPIRATION DATE IMM/DDMI) RALICE CSR LI ISLAG' THIS CERTIFICATE IS ISSUED AS A MATTER1 OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE DATE (MM/DDTYY) 03/18/97 TYPE OF INSURANCE NERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR OWNER'S & CONTRACTOR'S PROT UTOMOBILE LIABILITY ANY AUTO AU. OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EXCL OFFICERS ARE: CRIPTION OF OPHNTIONSILOCATIONSIVEHICLFS/SPECIAL ITEMS Commissioners of ertificate holder:lWelde ount nColorado, Board of County aid County its Employees COMPANY D PRODUCTS- COMP/OP AGG PERSONAL & ADV INJURY EACH OCCURRENCE FIREDAMAGE 1 COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per ect) ;i.nI I AUTO ONLY - EA ACCIDENT :RTIFICATE HOLDER'.- )CC0004791 Weld County Colorado and Board of County Commissioners of Weld County Greeley CO 80631 CORD 26-S (3/93) - WRLDC-1 10/01/96 10/01/97 CANCELLATION _._.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL *60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES' AUTHORIZED R NTA EXCEPT FOR NONPAYMENT OF PREhtA " `'`"`t&RD CORPORATION X1993 971083 ISLAND GROVE TREATMENT CENTER, INC. REGIONAL Est. 1974 April 28, 1997 Judy Griego, Director Weld County Department of Social Services P.O. Box A Greeley, CO 80632 RE: RFP-PAC Bid #97008 (Intensive Family) Dear Ms. Griego: I am responding, as requested by the Placement Alternatives Commission's Evaluation Committee, in order to provide additional clarification to the following areas regarding Island Grove's Intensive Family Therapy proposal. 1. Further explain the proposed program evaluation, i.e., tools, pre and post-test instruments, data collection, used to monitor the effectiveness of your program. The Browning Outcomes Survey Scale (B.O.S.S.) is a three-part instrument administered to the family at admission, discharge from the program, and at a post - discharge follow-up at six months. This self -report questionnaire provides several benefits to the therapist in obtaining a picture of the client's needs and problems in order to form a treatment plan. The client reports how life is perceived from their "world," as well as providing subscale values that are plotted on profile sheets. Each respondent is able to complete the survey in 10-15 minutes. The three test versions are attached for your review. cart The subscales are as follows: 1. Perception of severity of the problem 2. Awareness of what causes the problem 3. Physical or medical impact 4. Work or school impact 5. Interpersonal relations impact 6. How others see the problem 7. How problem impacts self-esteem 8. Awareness and use of resources 9. Present competence of handling the problem A Behavioral Health Agency Specializing in Alcohol/Drug Abuse P.O. Box 5100 • Greeley, CO 80631-0100 • FAX (970) 356-1349 Detax/Special Programs/Administration • (970) 356-6664 Community Counseling Center • (970) 351-6678 Fort Lupton Branch • (9701957-6365 971083 ),A% 10. Perception of the future 11. Self-destructive habits and patterns 12. Effectiveness in finding solutions It's major weakness is that it scales only the family's perceptions, not the therapist's. Consequently, we have added an additional component, The Family Adaptability and Cohesion Scale (FACES). Attached is the normative information on this instrument. Although this too, is a self -report scale, it lends itself to allowing the counselor to complete the items in evaluation the family. This data has been collected in the past fiscal year by our academic intern and compiled in a bound report available for your review. We will continue to collect and analyze our findings. We are now in the process of creating a database of family demographics, as well as assessment scores, and out -of -home placement outcomes on Microsoft Access software. This will enable us to more readily pull out relevant data throughout the next funding year. This will be included in the quarterly reports and the annual summary to be submitted to the PAC committee. 2. While not specifically addressed in the Invitation to Bid, it is the expectation of the Placement Alternative Commission that all providers will initiate service interventions within five working days, i.e., commencement of direct services, other than assessment alone. Will you be able to meet this requirement? We make attempts to contact the family on the same day we get the referral faxed from the caseworker. For sure, it happens within 48 hours if the family has a phone. Our first assessment visit has usually occurred in the home as soon as the family can schedule time with our counselors. Additional sessions are immediately scheduled to follow within the week. Direct services cannot begin without first an assessment session. Regular sessions or home visits are scheduled after that. "Direct services", if not counting assessment, may not begin within 5 days, but most probably 8 working days from the point of referral. We have no waiting list, and services are provided in an expedient manner. 3. Further clarify services provided to South County clients. We are providing a full range of Intensive Family Therapy services to south Weld County residents. We utilize our Ft. Lupton office, as well as in -home therapy. Several of our team are assigned clients in this area including Bob Keenan, Kristen Arnold, Judy Ashley, and our bilingual contractor, Anna Martinez. Our response is quick and our services accessible. As stated in the body of the initial grant, approximately one-third of our case load resides in south Weld County. Their needs are significant and of programmatic importance to us. 971083 4. Further clarify proposed provision for transportation, including South County. Because of the in -home option for some families, and our counselors traveling to them, we are not aware of transportation being a major issue for our IFT families. We do have a case aide who is available to transports, as well as an ongoing account with Shamrock Taxi, with whom we can arrange pick-ups for our clients. I hope this response has been adequate in clarifying the expressed concerns. Our staff certainly desires to be of utmost service to DSS caseworkers and Weld County families. Please contact me at (970) 356-6664 or by fax at 356-1349 if additional questions or concerns arise. Sincerely, Esther McDowell, M.A., CAC III Coordinator of Special Programs 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) ACFunds for ceent Alternatives Commission (P) ..-- Type of Action Contract Award No. X Initial Award FY97-PAC-2002 Revision (RFP-PAC-97008 Contract Award Period Name and Address of Contractor Beginning 06/01/97 and Weld Mental Health Center, Inc. Ending 05/31/98 Intensive Family Therapy Program 1306 11th Avenue Greeley, CO 80631 Computation of Awards Description Unit of Service The issuance of the Notification of Financial Assistance Award is based upon your Request for The service offers an average of three hours Proposal (RFP) and the Addendum RFP Information. weekly of home- and clinic -based mental health The RFP specifies the scope of services and conditions services for up to 26 weeks to each client family, of award. Except where it is in conflict with this maximum annual program capacity of 40. NOFAA in which case the NOFAA governs, the RFP Includes treatment services are provided to upon which this award is based is an integral part of recipients of IFT services, such as: therapeutic, the action. collateral, and crisis intervention. Special conditions Cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based Hourly Rate Per $ 43.98 on an hourly rate per child or per family. Unit of Service Based on Average Capacity 2) The hourly rate will be paid for only direct face to face Enclosures: contact with the child and/or family, as evidenced by client -signed verification form, and as specified in the Signed RFP; Exhibit A unit of cost computation. Condition(s) of Approval; Exhibit B 3) Unit of service costs cannot exceed the hourly, and yearly cost per child and/or family. ✓ Supplemental Narrative to RFP 4) Payment will only be remitted on caess open with, and referrals made by the Weld County Department of Social Services. 5) Requests for payment must be submitted to the Weld County Department of Social Services by the end of the third business day following the end of the month of service. Approval . ` Program Official: By BY W deorge Baxter Judy . Gri o, Dire r Board of Weld aunty Co is a Wel oun Depa nt o Social Services Date: ua . Date: 5/a 31 4 7 '1i 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilinguaUbicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97008 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-96008) for: Family Preservation Program --Intensive Family Therapy Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 25, 1997, Tuesday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that competing applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5- 101) and Emergency Assistance for Families with Children at Imminent Risk of Out -of -Home Placement (C.R.S. 26-5.3-101). The Placement Alternatives Commission wishes to approve twelve month programs targeted to run from June 1, 1997 through May 31, 1998, at specific rates for different types of service, the County will authorize approved vendors and rates for services only. targeted funding levels of increments up to $155,787.00. The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists, typically with all family members, to improve family communication, function, and relationships. This program announcement consists of five parts, as follows: PART A...Administrative Information PART B...Background, Overview and Goals PART C. Statement of Work Delivery Date (After receipt of order) VENDOR ADDRESS PHONE # PART D...Bidder Response Format PART E...Bid Evaluation Process Weld Mental Health Center, Inc. BID MUST BE SIGNED IN INK Dale F. Peterson TYPED OR PRINTED SIGNATURE (Name) Handwritten Signature By Authorized Officer or Agent of Vender 1306 11th Avenue Greeley, CO 80631 (970) 353-3686 TITLE DATE Executive Director 3/12/97 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 971083 RFP-PAC-97008 Attached A INTENSIVE FAMILY THERAPY PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97008 NAME OF AGENCY: Weld Mental Health Center, Inc. ADDRESS: 1306 11th Avenue Greeley, CO 80631 PHONE: ( 970) 353-3686 CONTACT PERSON: Dan E. Dailey TITLE: Program Director DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Intensive Family Therapy Program must provide for therapeutic intervention through one or more qualified family therapists. typically with all family members to improve family communication. functioning. and relationships. 12 -Month approximate Project Dates: Start June 1. 1997 End May 31 1998 TITLE OF PROJECT: Intensive Family Therapy AMOUNT REQUESTED: Dan E. Dailey Name and Signature of Person Pre ; i g Document Dale F. Peterson 12 -month contract with actual time lines of: Start End 3/12/97 Date 3/12/97 Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REOUIREMENTS Please initial to indicate that the following required sections are included in this proposal: Project Description Target/Eligibility Populations Types of services Provided Certificate of Insurance Measurable Outcomes Service Objectives Workload Standards Date of Meeting with Social Services Division Supervisor: Staff Qualifications Unit of Service Rate Computation Program Capacity per Month Comments by SSD Supervisor: Name and Signature of SSD Supervisor 24 X027-92 Date 971083 I. PROJECT DESCRIPTION The Intensive Family Therapy (IFT) project of the Weld Mental Health Center (WMHC) has been serving client families for the past six years. It is the least intensive offering of the WMHC's Family Preservation Team's (FPT) continuum of treatment projects that includes Homebuilders (Option A), the Mobile Mental Health Service (Option B), and the Sexual Abuse Treatment Service. Its services focus on family strengths and include work in the areas of•problem solving techniques, child management practices, stress management techniques, and the appropriate use of available resources and support systems. We seek to be able to continue to offer this service to at least 20 families at any given time who need, in the assessment of their Weld County Department of Social Services (WCDSS) caseworker, this level and type of care. The service offers an average of three hours weekly of home- and clinic -based mental health services for up to 26 weeks to each client family. If the family needs an extended period of similar services to reach its objectives, a 26 week extension, if approved, will be provided with the level of services remaining at three hours per week. The actual extension will be jointly agreed upon by the family, the IFT worker, and the WCDSS caseworker pending approval of the plan by a WCDSS internal agency review and by WCDSS administration. The WCDSS caseworker will document the reason for extension in the family's case record. Four primary types of treatment services are provided to recipients of IFT services: therapeutic, concrete, collateral, and crisis intervention. Each family admitted to the project will have a comprehensive services plan developed for them that spells out the specific services to be delivered in each of these four categories. The plan describes how a child and his or her family will be treated in order to rapidly respond to and remedy the crisis in the family that presents the risk of an out - of -home placement of a child occurring or which precludes the safe return of a child already in -placement. The IFT services will concentrate on four service objectives in our efforts to achieve the goal of safely maintaining the child in her or his home or of safely returning the child to her or his home. These objectives are to improve the family's ability to resolve and manage conflicts within the family, to improve parental competency, to improve the household's management competency, and to improve the family's ability to gain access to needed resources. IFT workers use a wide variety of interventions to accomplish the goals negotiated with the client family. A majority of the time in treatment will be spent in family therapy with smaller amounts in individual therapy. Individual sessions are often used to help an individual to accelerate the rest of the treatment process or to focus efforts to break a therapeutic impasse. 971083 II. TARGET/ELIGIBILITY POPULATIONS The monthly capacity of the IFT is at least 20 families with an average monthly capacity of 15 families. The IFT will accept as many additional families as need this level of care. Each family will receive an average of three hours of direct care weekly. While IFT services will be available for up to 12 months, we will work to achieve an average length of stay in the project of six months. Not less than 40 families will be served annually given this average length of stay. Referred children will range in age from birth through 17 years. All available and appropriate nuclear family members of the child and those members of her or his extended family deemed necessary to the treatment process will be incorporated into services. At least one parent must consent to work with the project with the goal of maintaining or reunifying the family. At least 25% of the families will receive bicultural/bilingual services. Services will be available throughout Weld County with at least 25% being delivered to families from the southern portion of the county. All families will have access to emergency services 24 hours per day, seven days per week. An initial assessment will determine if a referred family is capable of having a child in placement at the time of referral return home within three months of services initiation, if there is a reasonable possibility that services can bring about sufficient improvement in parental competency to allow a child to safely reside at home or return home, and if a manageable level of risk of harm to each referred child exists. Children referred will meet or be at high risk to meet the following out - of -home placement criteria: "Criteria 1. Dysfunction of the child and/or the family is within at least one of the following conditions that bring about the issue of out - of -home placement: a. The child has no parent or guardian, and the child has no appropriate and willing relatives with whom he or she may live; or, b. The child is in need of protection. The child is in need of protection when there has been actual abuse or neglect as defined in C.R.S. 19-3-102, or the child's continued presence in the home is likely to result imminently in physical or emotional injury; or, c. The child has medical, physical, or nursing care needs to the degree that 24 hour out -of -home care is required; or, d. There is a finding of mental illness as provided in C.R.S. 1973, 27-10-101 or the child has severe psychological problems of such a nature that requires 24 hour out -of -home care as documented by a certified psychologist or licensed psychiatrist, or preferably by a certified mental health center; or, e. The child's behavior constitutes a danger to the community as demonstrated by commission of an act which would have a Class I, II, or III Felony if committed by an adult or by other repeated felonious acts; and Criteria 2.Community resources which are appropriate and necessary to maintain the child in his/her own home must be absent or exhausted; and, Criteria 3.Out-of-home placement is most likely to remedy the dysfunction that is raising the issue of placement out of the child's own home." 971083 III. TYPE OF SERVICES TO BE PROVIDED All families referred and accepted into IFT services will receive home - and clinic -based as appropriate. It is anticipated that serviceswillinitially be offered in the clients' homes with a gradual transition to the clinic as the families become increasingly competent. All services will be delineated in a service plan tailored to the specific needs of each client family and designed with the collaboration of the client family and their WCDSS caseworker. Each family will be provided therapeutic, concrete, collateral, and crisis intervention services. Therapeutic services will include (when appropriate), but not be limited to individual and family therapy, education in problem solving, lessons in communication skills, and training in parent -child and parent -parent conflict management. IFT therapy, designed to capitalize on existing individual and collective strengths within the family and to empower families, focuses on resolving conflicts and disagreements within the family, specifically those that are contributing to child maltreatment, running away, and to the behaviors constituting status and legal offenses. Co -therapy, using the services of other qualified family therapists as co -facilitators, will be used when necessary to accomplish the family's goals in treatment. Psychiatric services including evaluation and the prescribing and monitoring of psychotropic medications are available to each of the client families as are psychological services such as psychological testing and evaluation. Access to such services will be based on the family's needs and on an agreement between the WCDSS caseworker and the SAT mental health worker that the services are necessary to fulfill the treatment plans that are in effect. Concrete services will include, when appropriate and not limited to, training of the family in the areas of development and enhancement of parenting skills, stress management and reduction, problem solving, anger and impulse control, budget and general household management, and the planning of family activities and recreation. Collateral services will focus on preparing and teaching families to gain access to and work constructively with other community agencies whose services would benefit them. They will be paired with the case management services that will be provided as needed by each family. These services consist of referral, linkage, monitoring, advocacy, and service planning. They are utilized to maximize each client family's ability to benefit from treatment and to ensure that each family has access to and receives appropriate services from other agencies. Crisis intervention services, whether provided in the family's home, in the child's school, in the mental health or other clinic, in other settings, or over the phone, will be continually available. These services will be provided by both the assigned IFT therapist and by the emergency system of the larger WMHC. Upon receipt of a referral, the IFT staff will contact the referring WCDSS caseworker to begin the service planning process including the study of all pertinent information about the family. Together, they will 971083 III. TYPE OF SERVICES TO BE PROVIDED, continued establish a plan to introduce the assigned therapist to the family and ensure that the family understands the nature of the IFT service and agrees to participate in the service. Family members will be advised of their rights in receiving mental health care, of the obligations their assigned therapist has in regard to them, and of the credentials of the assigned therapist. Services to the family will start at the first opportunity. Initially, the IFT worker will work with the family to assess its strengths and weaknesses. Based on this assessment, the service plan, emphasizing the family's strengths, will be further developed and initially implemented. Appropriate releases of information will be obtained to permit the flow of information between those agencies and individuals with whom the family already interacts and with those whose services the family will need. The delivery of the core services outlined will maintain this emphasis on the strengths of the family while closely monitoring the safety of the at risk child(ren) occurs. Each member of the family is engaged at an appropriate level given her or his position in the family and developmental readiness. Not only are the collective strengths of the family shored up, the individual strengths of each family member are studied, enhanced, and utilized in such a manner as to improve the life situation of each member and the family as a whole. The IFT therapist continually reassesses her or his intervention to determine what other services may be necessary to enhance the family's abilities to achieve its goals. As the ability of the family to provide safety and security for its members is enhanced, the service plan is updated to secure the gains made to date, to evaluate what is working and what is not working, to generally improve the family's capacity to effectively handle the crisis that lead to the initial referral as well as other crises the family may encounter, and to generalize that improvement across the family's general level of functioning. The IFT's services are culturally sensitive and competent. They are designed, as much as is possible, to be consistent with the culture and belief systems of the client families. Training to educate and sensitize our staff to the needs and cultural differences of the residents of Weld County occurs on a regular basis. 9710133 IV. MEASURABLE OUTCOMES Each family member admitted to outpatient services of the WMHC will be evaluated at admission and at discharge from IFT services using the Assessment and Discharge Form developed by the Colorado Office of Mental Health Services. This form provides a wide range of inquiry into an individual's levels of functioning. Also to be used are the Family Preservation Program Admission and Termination Evaluation Forms. These look specifically at the effects of the FPT program. Copies of these forms are attached at the end of this proposal. Attached are samples (not of data from FPT services but of data from the Adult Acute Treatment Unit which is an adult residential treatment program of the WMHC) of data reporting and analyzing that will be performed for FPT in the upcoming fiscal year by the WMHC Program Evaluation Office. Through the IFT project, the WMHC will work to enable families with children at risk of out -of -home placement or who already have children placed out of their homes to care for those children in a healthful, safe, and nurturing manner in the home environment. Specific goals and objectives are to: Goal A. Rapidly improve and stabilize family functioning, in a cost efficient manner relative to out -of -home placement costs, to enable the family to care for the children in the home setting. Objective a. Provide family preservation services starting within three days of referral to client families to either prevent out -of -home placements of children and adolescents in foster and group homes, residential child care facilities, juvenile detention facilities, and in psychiatric hospitals (family preservation services) or to return youths from such facilities to their family homes within three months of referral (family reunification services.) Objective b. Provide these services in a cost efficient manner so that the cost of the IFT intervention is less than the cost of the out - of -home placement it displaced. Goal B. Improve the overall functioning of the client families via improved family conflict management, improved parental competency, improved household management competency, and an improved ability to gain access to and use appropriate resources in the community to enable the families to appropriately care for their children in their own homes on a long term basis. Objective a. Eighty-five percent of the families that successfully complete either family preservation or reunification services through the IFT project will measure significantly lower on the risk assessment scales at time of termination of services. Objective b. At discharge, six, and 12 months after the successful termination of services, 90% of the families will remain intact. Objective c. Seventy-five percent of children currently in long term placement who are provided reunification services will return to their own homes and not reenter out -of -home placement within 12 months of completion of services. Objective d. Fewer than 10% of discharged children will enter another family preservation service unless such transfer is deemed to be in the best interest of the children. Objective e. Fewer than 10% of the children served will be in a more costly placement at discharge and fewer than 15% will be in such a 9'71083 IV. MEASURABLE OUTCOMES, continued placement six months after discharge. Objective f. Eighty percent of the families receiving either family preservation or reunification services will not have a substantiated incident of abuse or neglect filed against them during the course of their treatment nor within 12 months of their successful completion of services. 971083 V. SERVICE OBJECTIVES In working with families to achieve the goal of improving their abilities to manage family conflict in a safe, constructive manner, the IFT worker will strive to accomplish the objective of resolving conflicts between the parents, the children, and the parents and children so that no maltreatment of the children occurs, no domestic violence occurs, no children run away from home, and no children commit status or legal offenses. Success in meeting this goal will be measured by family, caseworker, and therapist reports that the objectives were met. The family will also be asked to report on their subjective improvements in this area. To meet the goal of improving overall parental competency, the objectives of increasing the parents' abilities to develop and maintain sound, caring, effective relationships with each other and with their children will be assessed. An additional objective will be to enhance the abilities of the parents to provide as well as possible for their family's care, nutrition, hygiene, discipline, protection, education, and supervision. Again, the parents and children will be polled as to their subjective opinions about the improvements they have made as will the therapist and caseworker. The third service goal of the project is to improve household management competency. The objective here is to enhance the capacity of the parents to provide and to teach the children to provide safe household environment through competently managing the home to include cleaning, repairing, and maintaining the home, budgeting, and purchasing. Families who do not have a working financial budget will develop and adhere to one with the aid of the therapist. The family, therapist, and caseworker will document the improvements made in this area. The fourth service goal of IFT services is to improve the family's abilities, individually and collectively, to find and use appropriate resources. Treatment and case management services will assist the family to learn more effective means to obtain needed help from other sources in the community and from local, state, and federal governments. The families will report, and their caseworker and therapist will confirm gains in this goal and objective. 971083 VI. WORKLOAD STANDARDS A worker in the Family Preservation Team (FPT) of the WMHC will have a caseload of not more than eight IFT families at any one time dependent on the nature of her or his total caseload. He or she will provide an average minimum of three hours of direct family preservation services per IFT family per week. This does not include the time required to be spent receiving clinical supervision or in-service training nor the travel time to reach the families served. Also not included in the weekly three hours average is the up to one hour per week of case management services required to assist the family achieve its goals and objectives. The equivalent of two and one-half full time employees of the FPT will provide IFT services to client families at any given time. Additional staff will be employed to meet increased demand for IFT services. Direct supervision of the IFT project occurs within the larger FPT. This team, as designed and as presently proposed in this document and others, will be comprised of seven individuals: six mental health workers and one administrative supervisor. The proposed ratio of mental health workers to administrative supervisors will never exceed six to one. The supervisor, currently Sonja Faris, MA, reports directly to the director, currently Dan E. Dailey, BA, of the Children and Family Services Program (CFSP) of the WMHC. He reports directly to the Executive Director of the WMHC, Dale F. Peterson, MSW, MHA. The supervisor provides clinical oversight and administration directly to the project as well as clinical supervision to all newly employed members of the team for at least the first six months of their employment after which an employee may be permitted to choose a clinical supervisor from among the other qualified staff of the WMHC. She, in turn, is clinically supervised by Mr. Dailey. Also in the clinical and administrative chains of command are the WMHC's Medical Director, Theron G. Sills, MD and Clinical Director, William Crabbe, PhD, MHA. A board certified child psychiatrist, Russ Johnson, MD, and two board certified general psychiatrists, James Medelman, MD and Jeff Huff, MD, are available to consult with the FPT staff and to psychiatrically evaluate family members in need of such services. The present treatment staff fully assigned to the FPT are Josephine Lucero, MA, Holly Moore, MSW, Rich Hedlund, MA, and Sonja Faris, MA. Their efforts are augmented by other staff, including Meg Baker, LCSW, Greg Bjork, MA, Lin Moersen, MSW and Pat Orleans, LCSW from the WMHC when necessary to carry out the service plan of a client family. 971083 VII. STAFF QUALIFICATIONS All staff of the WMHC's FPT will, as a minimum, meet the qualifications necessary to be a Caseworker III within the state social services system. Caseworker Ills must have at least obtained a bachelor's degree in one of the human behavioral science fields and have not less than two years of full time professional social casework experience or its equivalent after having completed the baccalaureate degree. All present members of the team have master's degrees in the human services fields from accredited universities and have at least two years experience working with children and families. Due to the use of the team approach, the members of the team, while specializing in the provision of family preservation services, carry a diverse caseload in that each may provide a combination of the four different types of family preservation services offered by the WMHC. The equivalent of, as a minimum, at least two and one-half full time employee will be available to provide IFT services to client families at any given time. All the present staff of the team have completed at least eight hours of continuing education relevant to their job descriptions and will continue to do so on an annual basis. At this time, all members of the FPT have attended and completed the State Home Based Intensive Family Services training program, or its equivalent, as well. Any new members hired will receive this training as soon as possible after they begin their employment with us. Psychiatric and psychological evaluations will be performed by individuals licensed to practice their individual specialties in Colorado. Each member of the FPT will be knowledgeable in family and individual dynamics and in the treatment of a wide variety of family problems as demonstrated by specialized training, workshops, and experience in working with families. Each FPT member working with a family within the IFT project will receive a monthly minimum of four hours of clinical supervision from a WMHC staff member with advanced skills in intensive family therapy. This supervision will address such things as diagnostics, treatment planning, use of the self in the treatment relationship, strategies of intervention, dealing with resistance, and obstacles to the treatment process. Clinical supervisors will also be involved in regular training to keep current in state-of-the-art counseling modalities and findings. 971083 VIII. COMPUTATION OF DIRECT SERVICE RATE Direct Time (Per Month Per PTE) Hours 1. Direct client contact 103.92 Indirect Time 2. Completion of Paperwork 3. Travel 4. Court Appointments 5. Vacation 6. Sick Leave 7. Case Management 8. Other 9. Subtotal 10. Total Time Available Per Month 11. Ratio of Direct to Total Time 8.66 13.70 1.00 14.00 8.00 19.32 4.73 69.41 173.33 (Sum of 1-8) 0.60 (1/10 = 11) The services of IFT are heavily personnel intensive. The above computation based on one full-time staff members reflects this. Every effort will be made to minimize the non -service aspect of this project although clearly it is in the clients' best interests to have their care well documented. Thus, paperwork time is calculated at approximately one hour per month per client family. Travel to and from client families' homes is based on past experience and also the design of the project that encourages increasing use of the clinic as the treatment setting as therapy progresses and more responsibility is transferred to the families. Court time works out to an average of a few minutes per client family per month. Again, this figure is based on our past experience with this project. Staff of the WMHC who have been employed for at least two years accrue 1.75 days, or 14 hours, of vacation and 1.00 days, eight hours, of sick leave per month. That portion of the case management services performed when the client is present will be recorded as direct service time, the remainder as indirect service time. The "Other" category above primarily reflects time spent in supervision and in training to maintain and enhance therapeutic knowledge and skills. 971083 Attached A REP -PAC -97008 RATE COMPUTATION Direct Costs Salary Benefits Subtotal Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal Agency Overhead Rent Utilities Supplies Postage Travel Telephone Equipment Data Processing Other Total # of Employees Overhead Per Employee Overhead Per Total Hours Monthly $ 6250.00 1500.00 7750.00 Service Costs Total Total Direct Hourly Rate Hourly Rate $ 14.45— $ 24.04 5.77 17.92 29.81 $ 6500.00 $ 18.79 $ 25.00 -17611.-00 3.61 6.00 1700.00 9.83 16.35 408.00 2.36 3.92 $10168.00 34.59 $ 51.27 $17727 5100 4781 1850 4200 3217 3100 4000 20049 $64024 141.9 $ 451.19 2.61 Direct Time % of Time Charge 100.00 $ 24.04 100.00 5.77 100,00 29.81 25.00 $ 6.25 25.00 1.50 18.75 3.07 18.75 C 16.06 $ 2.61 $ 43.98 Direct Service Rate (Hourly) (Daily if appropriate) c ice Cyst Definitions direct to clients. Indirect Costs - Salary and benefits for employees providing Direct sionto- clerical erary andbenefits for taffpremployees providing Agency Overhead - Monthly cost for rent, supplies, postage, etc. Ifthe e agency Overhead supervision or ed support forstaff market e g building. building is owned use estimated rent for the building. # of Employees - Total number of employees in the agency rge to provide Per Employee - Divide the total agency overhead by the total number by 173 hours. Direct Service Rate - Te rate is tthe hourly uniform in nature. service taking into consideration compensation and overhead. It can be used as a rough measure to compare ttare confn. ature. l It should not be used to compare services that are different with more expensive components of labor such as psychiatric Hourly Rate - Cost divided by total hours available. Total Direct Hourly Rate - Cost divided by total direct hours. 28 971083 IX. RATE COMPUTATION: BUDGET DESCRIPTION Personnel costs are predominant in this budget. The above figures represent the equivalent of 2.50 full-time clinical staff of the WMHC working within the IFT to deliver those clinical, case management, support, and supervisory services required by individual services plan and the requirements set forth in this proposal. Direct services personnel costs equal $29.81 per direct service hour, or 67% of the total of $43.98. Supervisory costs are $7.75, or 17%, of the total direct time cost. The clerical support services costs are $3.81, or 8%, of the total. The agency overhead of $2.61 amounts to only 5% of the total cost per hour. Psychiatric and psychological services are available at an hourly rate of $76.00 for those clients needing them and will be billed separately from other clinical services. All PAC funds will be accounted for separately within the overall budget of the WMHC. Each project is regarded as a distinct cost center. The WMHC, including its use of PAC funds, is independently audited annually. PROGRAM CAPACITY BY MONTH The IFT is designed to function with a minimum staff contingent of 2.50FTE, serving an average of 20 children and their families at any given time throughout the upcoming fiscal year. The WMHC will be pleased to accept as many additional families as are determined to need this level and type of care. We will develop sufficient staffing patterns to accommodate any and all families needing the IFT service. 971083 ASSESSMENT/DISCHARGE Sheet 1 AGENCY GAF SCORE CLIENT ID MEDICAID ID ADMISSION DATE: mm/dd/yv f VICTIM PROBLEMS Check ALL that Apply Ever Sexual Abuse Victim Ever Physical Abuse Victim Ever Verbal Abuse Victim Neglect PROBLEM SEVERITY RATE the CURRENT P-SEV (PROBLEM SEVERITY) for each area using the following scale: None Slight Moderate I - 2 - 3 - 4 - 5 - Severe Extreme 6 - 7 - 8 - 9 CURRENT P-SEV Check ALL Problems that Apply EMOTIONAL WITHDRAWAL Blunted Affect Reticent - Distant DEPRESSION Depressed Bored Sad ANXIETY Anxious Tense Obsessive HYPER AFFECT Mania Sleep Deficit Pressured Speech Underactive Passive Reserved Worthless Hopeless Desolate Fearful Panic Restless gitated Mood Swings Accelerated Speech SUICIDE / DANGER TO SELF Suicide Ideation Suicide Plan Past Suicide Attempt._- Self Injury Danger to Self t40) Vacant - Subdued Detached Lonely Dejected Sleep Problem Nervous Phobic Guilt Overactive Elevated Mood Suicide Attempt - Self Mutilation THOUGHT PROCESSES Bizarre - Suspicious Disorganized Illogical CUGNITIVE PROBLEMS Memory Concrete Attention Span Delusions Paranoid Derailed Magical Thought Hallucinations Repeated Thought Loose Associations Unwanted Thought Confused Intellect Impaired Judgment Disoriented Lacks Self -Awareness SELF -CARE / BASIC NEEDS (Doesn't) Care for Self Manage Money Provide Food _ _ Provide Housing Manage Personal Environment Make Use of Available Resources Hygiene _ Gravely Disabled (t' S;27.1(1)'.. RESISTIVENESS Uncooperative Guarded Antagonistic 7/05 Evasive Wary Denies Problems Resistive Oppositional Refuses Treatment CURRENT P-SEV AGGRESSIVENESS Aggressive Belligerent Defiant Check ALL that Apply Hostile Threatening Intimidating SOCIO-LEGAL PROBLEMS Disregards Rules Legal Problems Fire Setter Probation Dishonest Offenses / Prop. _Destroy Property Parole Angry "Notorious" Uses/Cons Others —Offenses/Persons Pending Charges VIOLENCE / DANGER TO OTHERS (Client to Others) Violent Sexual Abuser Homicide Attempt Danger to Others Assaultive Homicidal Idea (C12S 14.44}, Physical Abuser Homicidal Threats ROLE PERFORMANCE (Work / School) Absenteeism Performance _Behavior _Terminations _Learning Disabilities _Not Employable _Doesn't Read/Write _Doesn't Eam Unstable Work/School Hist FAMILY PROBLEMS (Client Problems in Family) No Family w/Relative w/Parenting No Contact w/Family w/PaMer —w/Parent w/Child Acting Out FAMILY ENVIRONMENT (Environment Causes Problems for Client) _Family Instability _Separation _Custody _Family Legal Unstable Home Environment Family History of Mental Illness FAMILY VIOLENCE (Toward Client or Family Member) Sexual Assault Verbal Assault INTERPERSONAL PROBLEMS w/Friend Social Skills _Establishing Relationships Maintaining Relationships Physical Assault SUBSTANCE ABUSE PROBLEMS _Alcohol _Drug(s) Dependent _Addicted _Interferes with Responsibilities _DUI/DUID _Family History of Substance Abuse MEDICAUPHYSICAL _Acute Illness _Chronic Illness _CNS Disorder _Nutrition Eating Disorder Physical Handicap Diuretic Encopretic _Medical Care Needed _Developmental Disability Penn. Disab ility Attention Deficit Disorder — Injury by Abuse/Assault SECURITY / MANAGEMENT ISSUES _Restraint Seclusion _Security Walkaway/Fcrapr Surveillance locked Unit Time Out Medication Compliance Close Supervision Behavior Management Suicide Watch OVERALL DEGREE OF PROBLEM SEVERITY CHANGE IN OVERALL PROBLEM SEVERITY I=Much Worse 5=Sou.,s.lrat Better 6=Better 7=Much Better 2=Worse 3=Somewhat Worse 4=No Change 971083 CLIENT I.D. # DATE OF ADMISSION ASSESSMENT/DISCHARGE Sheet 2 Very Low Moder Low Function Function 1 Very Low Moder Low Function Function Very Low Moder Low Function Function Very Low Moder Low Function Function Very Low Moder Low Function Function Very Low Moder Low Function Function STRENGTHS / RESOURCES Check ALL CURRENT STRENGTHS / RESOURCES individual has. ECONOMIC RESOURCES Employment Transportation _ Medicaid/Medicare EDUCATION / SKILL RESOURCES Education Job Skills PERSON RESOURCES Spouse Other Family PERSONAL STRENGTHS Insight Judgment Emotional Stability Adaptability Tolerance Appearance Thought Clarity _Empathy Housing SSI/SSDI Intelligence Interpersonal Skills _Parent (s) Friend (s) Financial Medical Insurance Language Skills Child (ren) Others Responsibility Resourcefulness Health LEVEL -OF -FUNCTIONING (LOF) Check ONE Response for Each LOF Area SOCIETAL / ROLE FUNCTIONING Avenge Moder High Very High Function Function Function 3 5 6 7 8 9 1 2 INTERPERSONAL FUNCTIONING Average Moder High Very High Function Function Function 2 3 4 5 6 7 8 9 DAILY LIVING / PERSONAL CARE FUNCTIONING Avenge Moder High Very High Function Function Function 1 2 3 6 9 PHYSICAL FUNCTIONING Average Moder High Very High Function Function Function t 2 g COGNITIVE / INTELLECTUAL FUNCTIONING Average Moder High Function Function 2 3 4 5 6 7 9 OVERALL LEVEL OF FUNCTIONING Average Moder High Very High Function Function Function 9 Very High Function 9 2 4 5 6 7 8 9 ACTION TYPE 01=Admission 02 -Activate 03 -Update 04=Inactivate 05=Dischargc CHANGE IN LEVEL OF FUNCTIONING I=Much Worse 2 -Worse 3=Somewhat Worse 4=No Change 5=Somewhat Better 6=Better 7=Much Better I I PROGRAM (Manual Input Only) II =Correction to Admission 12=Correction to Activation 13 =Correction to Update 14=Correction to Inactivation 15=Correction to Discharge EFFECTIVE DATE. rnm/ddtyy DATE FORM COMPLETED:mrn/dd/y LAST CONTACT DATE: nun/dd/yy CURRENT DIAGNOSIS CURRENT/EXPECTED RESIDENCE: 1= Corrections/Jail 2=Inpatient 3=Nursing Home 4=Residential - Mental Health 5=Residential Non- Mental 6=Boarding Home 7 -Homeless -in Shelter 8=Homeless-on Street 9 -Otter Independent Living Arrangements CURRENT / EXPECTED LIVING ARRANGEMENT. 1=Lives w/Both Parents 2=Lives w/Onc Parent 3=Live9 w/Spouse and/or Other Relatives) CURRENT / EXPECTED EMPLOYMENT. 1=Employed-Full Time 2=Employed-Part Time 3=Homemaker not Otherwise Employed 4=Sheltered Employment 4 -Lives Alone 5 -Lives w/Unrelated Person(s) 5 -Not in Labor Force 6=Unemployed less than 3 Months 7 -Unemployed 3 Months or More IS =Armed Forces Active Military Duty INACTIVE / DISCHARGE TYPE OF TERMINATION: STAFF/AGENCY INITIATED CLIENT INITIATED 1=Discharged/( ransferred 2=TX Completed/No Referral 3=TX Completed/Follow-up 4=Evaluation Only 5 —Inactive for I Year TERMINATION REFERRAL: NOTE: Use 61 "Self" if no Referral This Geld will contain one of the following codes if.rtuon type =05 or 15: Personal referrals - 61 - Self; 6h-Family/relative: 63 - friend/Employer/Clergy, Medial/Psychiatric referrals - 68 - Outpatient psychiatric; 69 - Private psychiatrist; 70 - Other private MH practitioner: 71- Ctfi9IP; 72- CA40/FL; 73 - Colorado Mental Health CentereCnnics. 74 -Nursing home; 75 - Community residential organization. 76 - Alcohol/On= treatment facility; 77 - Medical practitioncq 78-Ceneral hospital inpatient psychiatric program: 79 - Other inpatient psychiauic program; Social service/FAucation referrals - 6=Patient/Client Died 7=Patient/Client Terminated 81 - Serial service agency; 82 - Agency for the Developmental disabled'. 83 - Voalional rehabilitation facility; 84 - Educational system/school: 85 - Shelter for homeless/abused; Legal referrals - 9I - Law enforcement, 92 - Court (including juvenile), 93 - Correctional facility; 94- Probation/parole, All other reeerrai sources - 98 - Other. XX - Referral source not known. 111111111 I DISCIPLINE: I=ron DEGREE Drone 2=associate 3=bachclors 4 —masters 5=Phl)/PsyD/FAD STAFF ID / STAFF SIGNATURE 2—lnh worker 3= nursing 4=social work S=psychology 6=psychiatry 7 -other 6 -MD 7 -other 971083 FAMILY PRESERVATION PROGRAM ADMISSION EVALUATION FORM Client Name Client Id1F Diagnosis: Primary Secondary Date of Birth School Grade City Admit Date Center Medicaid Yes No (Check One) Sex Ethnicity Who had custody of youth at time of referral to FPP Where was youth residing at time of admission to FPP (Be specific) Date of initial referral for FPP services Date of first contact by FPP therapist FPP Therapist Previous mental health services (explain) Special Behaviors or Circumstances/Reasons for referral PAST PRESENT Yes No Yes No Suicidal Violence toward others Runaway Behavior Social Isolation Legal Charges Domestic Violence On Probation Victim Physical Abuse Victim Sexual Abuse Alcohol Use Use of Inhalants Other Drug Use Learning Disabilities Special Education Bed Wetting Encorpresis Others (specify GAF SCORE AT ADMISSION TO FPP OVERALL PROBLEM SEVERITY SCORE LEVEL OF FUNCTIONING SCORES AT ADMISSION TO FAMILY PRESERVATION PROGRAM (RATE ALL SIX AREAS) Very Moder Aver. Moder. High Low Low High Func. 1 2 3 4 5 6 7 8 9 SOCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING 971083 FAMILY PRESERVATION PROGRAM TERMINATION EVALUATION FORM Client Name Client Id# Discharge date from FPP List all different types of FPP services used Discharge Diagnoses: Primary Secondary Who has custody of child at time of termination from FPP? Where was child living immediately after termination from FPP? Who will follow youth after discharge? Special Behaviors or Circumstances Suicidal Violence toward others Runaway Behavior Social Isolation Legal Charges On Probation Victim Physical Abuse Victim Sexual Abuse Alcohol Use Use of Inhalants Other drug use Learning Disabilities Special Education Bed Wetting Encorpresis Domestic Violence Others (specify) PRESENT Yes No GAF SCORE AT DISCHARGE OVERALL PROBLEM SEVERITY SCORE LEVEL OF FUNCTIONING SCORES AT DISCHARGE FROM FAMILY PRESERVATION PROGRAM (RATE ALL SIX AREAS) SOCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING Very Moder Aver. Moder. High Low Low High Func. 1 2 3 4 5 6 7 8 9 971083 Weld Mental Health Center Adult Acute Treatment Unit Client Admission and Termination Data August 1, 1995 - June 30, 1996 Global Assessment Functioning Scores Mean 20 ATU - Data for non -Medicaid clients ATU - Data for all Medicaid clients Mean 20 40 r-7 _____ Admissions: n = 247 Terminations: n = 245 40 60 �J Admissions: n = 131 ® Terminations: n = 131 LcAdmissions: n = 116 Terminations: n = 114 60 971083 Weld Mental Health Center Adult Acute Treatment Unit Client Admission and Termination Data August 1, 1995 - June 30, 1996 ATU - Data for all clients 0 Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellechel Functioning Overall Level of Functioning Problem Seventy Score Mean 4 6 8 a Admissions = 247 ifMti Terminations = 245 ATU - Data for non -Medicaid clients 0 Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Functioning Overall Level of Functioning Problem Severity Score 2 Mean 4 6 8 ATU - Data for Medicaid clients C=1 Admissions = 131 MI Terminations= 131 0 Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intelleotial Functioning Overall Level of Functioning Problem Severity Score Mean 4 8 1 a Admissions= 116 1 ITerminations = 114 � 971083 12- 1997 8 34A1.1 FPor-1 P. 2 .CORN. CERTIFICATE OF INSURANCE: DATE WMIODAT) 03/12/97 PRODUCER Flood & Peterson Ins. Inc. P. O- Box 578 4687 W. 18th Street THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Greeley, CO 80632 COMPANIES AFFORDING COVERAGE COMPANY ASt. Paul Ins. Co. INSURED Weld Mental Health Center 1306 11th Avenue COMPANY e Greeley, CO 80631 coMPANY C COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE PC)LKuES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAACO ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUE€MENT, TERM OR CONDrR1ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS tenIo-CATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMIFS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. co LIR TYPE OF INSURANCE POLICY NUMBER 1'OLICYFiEECTNE �OUCYEXPRANO1 DATE(MM/DO/n) 1i DATE(MM/DD/YY) UNITS A GENERALLIABILT X FK06002791 COMMERCIAL GENERAL UABIL rTY 01/01/97;01/01/98 I I GENERAL AGDREGATE s1000,000 PRODUCTS.COMPIOP AGO 31 000, 000 CLAIMS MADE X OCCUR PERSONAL A ACP/ INJURY 31,000,000 OWNER'SA CONTRACTOR'S PITCH EACH OCCURRENCE 31, 000, 000 FIRE DAMAGE (Any cos ore) s100,000 MEDE)e(Any ono Amon) ss, 000 AUTOMOBILE I LABILITY COMBINED SINGLE LIMIT $ BODILY INJURY (Pr Orson) 3 BODILY INJURY (Per AKIpntJ 3 PROPERTY DAMAGE 3 MIRAGE LIABILITY ANY AUTO AUTO ONLY.EA ACCIDENT 3 OTHER THAN AUTO ONLY: Y EACH ACCIDENT 3 III AGGREGATE T EXCESS LLABIUTY UMBRELLA FORM THAN VMBRut* fORM EACH OCCURRENCE 3 AGGREGATE __—L_OTHER 3 WORICRB COMNENEA-nON EMPLOYERS LJABILT THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERSARE: AND ........ INCL, EXCL `STATUTORY LIMrrs EACH ACCIDENT 3 DISEASE -POLICY LIMIT i$ OISEAS€-EACH EMPLOYEE 3 A OTHER Prof. Liab. Claims Made FKO6002791 01/01/97 01/01/98 $1,000,000 ea. pers. S3,000,000 total lim. DESORPTION OF OPERATIONS/LOCATIQNSNEHICLESIWECIAL ITEMS Retro date 7/1/86 CER1IFICAYEBOLbEn Weld County Placement Alternatives Committee c/o Weld County Department of Social Security SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPRATWN DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAR_ ajl_DAYSWRTTTEN NOTICETOTHECERTTICATEHoLDERNAMEOTDTHE LEFT, BUT FAIL TO CHN LIMPOSE NO B LIGATION ORLUBILITT ANY N THE MPANY R OR ESENTATIVES. 800 8th Avenue Greeley, CO 80631 AOORDa-s0041 oTl #S81049/14$1047 -. A I A(1ESENT p.. oACORD.. TIDN1DO, 971083 woos Amanes walgaJd Overall Level of Functioning 6uluogound leolsAyd Daily Living/Personal Care Functioning Interpersonal Functioning Societal Role Functioning Global Assessment Functioning c K c K C K c K c K c K c K Z K C j 30 30 CO 30 30 • 30 C. CO C, v CD CD M W= W 7 W= CD= W= W 1 1 1 1 -, 1 1 1 A V cn N A • cn CD " V A J N a A W � V -a CO G3 ca - CO CA CO W A A - m A CO V O (D A N V A CO A CO CS) A O cz A V N V cn V - A W A - A CD OD A J W W p N CO W W cn - W N - O _. W - O W - CO A co c0 A CO V N CO N a a p cri -a CO W W - A co _.a - co - CO - cn - CO A CO N cm 01 cn co A W r` a Cn J 01 CO O A -3 O (1 (.13 A 'co D a 3 cn y O c co _3 7 N O D n 3 N y 0 co CD 3 D) 0 D 3 y O) O 7 W 3 J N 0 O W 7 4l Non -Medicaid Clients stuall3 pleolpeIN co Q C .�. in D C, co C CD fa• al CD c C W CD O) O 3 CD � co (A c .=r ci ✓ F a CR o' a CD 1 al 0) O C 0) 0) iejue IaiueW plats 971083 Weld Mental Health Center, Inc. 1306 11th Avenue • Greeley, Colorado 80631 • (970) 353-3686 • FAX (970) 353-3906 May 1, 1997 Judy A. Griego, Director Weld County Department of Social Services P.O. Box A Greeley, Colorado 80632 Re: Your 4/17/97 letters concerning WMI-IC PAC bids Dear Ms. Griego and Members of the PAC Evaluation Committee: This is to provide the Evaluation Committee of the PAC with additional information as you requested in your letter. If they have additional questions or concerns, they may contact me directly. Our response is divided into sections pertinent to each of the programs for which questions were raised by the committee. Each "bullet" denotes the WMHC response to each question as "bulleted" in your letters. I trust this letter and the various attachments will resolve the concerns and answer the questions of the PAC Evaluation Committee. I look forward to the awarding of the contracts. Since -ly, Dan E. Dailey, Di -ctor Children and Family Services enc. Robert R Merz President Carla Lujan Vice -President Alvina Derrera Secretary Sharon Metin083 Treasurer WMHC response to PAC concerns Page 2 of 15 With regard to RFP-PAC Bid 97006 concerning day treatment services at the Carson Children Center (CCC,) the following is submitted: All services at the CCC are monitored as briefly described in our bid. Since submission of the bid, the Family Preservation Program Admission Evaluation Form and the Family Preservation Program Termination Evaluation Form have been modified to more specifically respond to evaluation of our day treatment services. Copies of the original and modified forms may be found in Appendix A. These are being implemented now at the CCC to collect data and evaluate the services the children there are receiving and have received as well as to monitor the effectiveness of the services. The bid also described the use, and included copies, of the Admission & Discharge Forms devised by Colorado Mental Health Services. All students at the CCC are evaluated and monitored through these instruments as mentioned in the bid whether or not their services are being paid with PAC funds. As you can see, these assessments, made on each client, include the Global Assessment of Functioning (GAF) from Axis V of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), level of functioning scales, overall level of functioning scores, the overall problem severity score, as well as specific pre- and post-test treatment measures on a variety of special behaviors or circumstances. Appropriate statistical analyses of this information will be utilized to assess the results of the treatment services provided. These analyses will focus both on the microcosm of the treatment results on each child and also on the macrocosm of overall program effectiveness. Additionally, the overall Program Evaluation Plan of this agency describes how services at the CCC and elsewhere within the Weld Mental Health Center (WMHC) will be monitored and evaluated. A copy of this plan is included as Appendix B to this letter. The initiation of day treatment services within five days of referral by someone at the Weld County Department of Social Services (WCDSS) may be a problem in some cases. It must be kept in mind that, as a minimum, the referral process involves not only the WMHC but Weld County School District Six as well. Whenever possible, this time guideline will be followed. When it cannot be followed, the WMHC will provide whatever level of services is indicated to bridge the gap between referral and the onset of CCC services. Admitting a child to the CCC within five days of referral will likely be a problem when one or more of the following conditions exist: 1. The child being referred does not have an existing Individualized Educational Plan (IEP), that is, the child is not currently enrolled as a special education student in her or his home school; 2. All 12 day treatment "slots" (see below) at the CCC are filled; 3. The child's home school district does not agree to the placement; and/or 4. The process to determine the appropriateness of the "match" between the child 971083 WMHC response to PAC concerns Page 3 of 15 and the CCC may not be completed within this time frame due to: a. The gathering of all relevant materials necessary to accurately determine the appropriateness of placement takes more than five days; or b. Convening of the CCC screening committee may not be possible within the five days from receipt of a referral. The current capacity of the CCC is twelve students (hence the 12 slots referred to above) at any one time although we are licensed to provide day treatment services for up to 25 children. The present CCC site is suitable only to provide services of this type to 12 or fewer children. All services of the CCC are available to clients from South County. The vast majority of those services will, however, be delivered at the Evans, Colorado site of the day treatment program. It will often be necessary for the families of the students to travel for family therapy sessions and other site -based services. Aftercare and ancillary services to children from southern Weld County who have completed the CCC program will be available through the Ft. Lupton office of the WMHC. Also, when appropriate, services designed to facilitate the transition of a child graduating from the CCC to his or her home school in South County will be available in Ft. Lupton. Students of the CCC are transported to the site primarily by the home school district. Parents, at times, choose to bring their children to school. The mental health component of the CCC does not offer or provide transportation services except possibly when the child is in residence at the WMHC's Children's Acute Treatment Unit. When necessary and called for in the mental health service plan, a CCC therapist may travel to the home and/or home school of a student. Again, this is not anticipated to be a major aspect of a child's involvement with the CCC. When making the transition from the CCC back to one's home school, the transition worker(s) will assist in the transporting of children as necessary. This is not an expense to be billed to PAC as it is carried by either the University of Northern Colorado or by Weld County School District Six. Through careful, initial screening of an applicant for admission to the CCC, it is our intent to have all of our students successfully complete the day treatment program and successfully reintegrate in their home school districts. Despite our cautious approach, we have found it more realistic to estimate that 90% of the CCC students will graduate from the program. The time frame for a child to return to public school after successfully completing the program at the CCC ranges from six months to two years. Many factors influence this, such as the age of the child at admission, the severity and acuity of the child's treatment and educational needs, her or his prior mental health treatment history and level of 971083 WMHC response to PAC concerns Page 4 of 15 response to that treatment, and the reasons the child is being referred in the first place. Children have been referred to the CCC for a multitude of reasons, including: 1. they were at risk of being placed out of their home or foster home due to the severity of their presentation both at home and at school; 2. they were returning to the community after a residential child care facility placement or psychiatric hospitalization and needed a step-down level of care before reentering public school; 3. they were falling increasingly behind educationally in their home school due to, at least in part, emotional problems; and 4. their home school could not meet their educational and mental health needs. The day treatment program develops an individualized plan based on the unique combination of strengths and needs each referred child brings to the CCC. Just as with estimating length of stay in the CCC program, the transition plan used to facilitate a child's return to public school is individualized to each child. Attached as Appendix D is "Planning for Transition: A Collaborative Process" that was jointly developed by Weld County School District Six, the Special Education Department of the University of Northern Colorado, and the WMHC. This pamphlet offers an overview to the strategies employed by the CCC as well as the general timeline used in the transition process. The PAC is being billed for day treatment services when the referral originates within the WCDSS or when the WCDSS agrees to support a child's placement at the CCC. You will recall that the original request for the CCC in fiscal year 1996-97 to the PAC was for sufficient funds to cover the day treatment needs of nine children. The award made by PAC covered only three slots and was later increased by approximately one slot. The WMHC has attempted to underwrite the mental health component of the CCC with an array of financial resources to enhance its stability and longevity. These resources include PAC, Medicaid, Title IV, private insurances, and private pay. It must be kept in mind that Medicaid, whether it be capitated or general, is a payor of last resort by statute. That is to say, all other sources of revenue to cover a treatment service must be exhausted before -Medicaid -may -be -billed: When a -child -has not met eligibilitycriterraestablished - by the State or by PAC, other resources including Medicaid have been used. When a child does meet these same eligibility criteria, we are bound to approach you for financial assistance. 971083 WM IC response to PAC concerns Page 5 of 15 With regard to RFP-PAC 97007 concerning the provision of Sexual Abuse Treatment, the following is submitted: At the time the response to the request for proposals was submitted, the details of the treatment program for offense specific sex offender treatment and other aspects of this set of services were being developed and, hence, were not submitted with the proposal. The treatment of sexual offenders will represent a collaboration between Alternative Homes for Youth (AHY,) Individual and Group Therapy Services (IGTS,) and the Weld Mental Health Center (WMHC.) IGTS is the only currently approved treatment program in this region for adjudicated sex offenders and has been involved in this specialty service for several years. They are generally recognized as the leading sex offender treatment resource in this region and typically provide some subcontracted services to all other providers in this area. The head of that agency, Mery Davies, M.A. is also responsible (in conjunction with a representative of the Probation Department) for performing statewide training to providers and other individuals involved with this population. The plan calls for two therapists from each of the three organizations to become and remain formally qualified in this area of treatment. AHY staff are already in this process and WMHC staff will be beginning in June, 1997. Upon achieving qualified status, this pool of therapists will be drawn upon to function as co -therapists for groups, thus ensuring that there will always be an adequate number of approved staff. Until that occurs, the currently qualified staff of IGTS will be responsible for the provision of offense specific sex offender treatment on a subcontracted basis. This program design is intended to represent a unique collaboration between private and public entities, utilizing the strengths of each. This treatment program will meet all standards, whether they be the current national and State standards for adult sexual offenders or the emerging State standards for the treatment of juvenile sexual offenders. • Program evaluation of this project is an intriguing proposition due to the complexity of its design. As you are aware, this project is designed to meet a widely varied set of populations who have had their lives effected by sexual abuse. In some families, we may be treating victims and co -victims only. In others, the perpetrator of the sexual violence will be treated as well. Whatever the service needs are of each client family, however, a unified approach will be made to study the effectiveness of what we are doing. The Assessment & Discharge Forms as well as the Family Preservation Program Admission and Termination Evaluation Forms (Appendix A) will be used to monitor each family's progress as well as the effectiveness of the overall program. As you can see, these assessments, made on each client, include the Global Assessment of Functioning (GAF) from Axis V of the DSM-IV, a variety of level of functioning scales, overall level of functioning scores, the overall problem severity score, as well as specific pre- and post- test treatment measures on a variety of special behaviors or circumstances. Appropriate statistical analyses of this information will be utilized to assess the results of the treatment services provided. These analyses will focus both on the treatment results for 971083 WM1E-IC response to PAC concerns Page 6 of 15 each child and also on overall program effectiveness. The specialized assessments of sexual offenders referred to this project will be similarly used. Again, the WMHC Program Evaluation Plan (Appendix B) will guide the overall monitoring and evaluating of the project. • The majority of the components of our Sexual Abuse Treatment services will be available to all clients within five working days of the receipt of the referral by the WMHC Children and Family Services Program Director. This is stated, again, with the caveat of the WMHC needing to have access to the referring WCDSS caseworker and to the members of the family being referred to accomplish this fairly rapid turnaround. Why an initial assessment is not considered by you to be an integral part of the provision of direct services eludes us. This is something we can, perhaps, discuss at a later time. When offense specific sexual offender treatment is sought, one of the initial points of contact will be to provide the assessment of the offender which is routinely a four or more week process. Clearly, more than five days will elapse between referral and completion of that assessment. • The extensive range of sexual abuse treatment services proposed to you will be available to all clients in need of such services in Weld County. The home -based aspects of the program will be delivered, as the name implies, in the homes of our clients. This includes a majority of our proposed work to maintain the physical integrity of families whenever possible and our work to hasten the safe return of children from out -of -home placements to their homes. At present, we have no plans to offer offense specific sexual offender treatment in the South County area. This is primarily a numbers consideration. The groups for both adult and adolescent sexual offenders will be offered at the offices of IGTS in downtown Greeley. If a sufficient number of individuals requiring such treatment are referred by the WCDSS and other referral sources, a group will be offered in Ft. Lupton. When group therapy is indicated for referred victims of sexual abuse, the families will be asked to choose between Ft. Lupton and Greeley sites of the WMHC. Our past experience with this population suggests that some families prefer to travel to Greeley for such services rather than be treated closer to their homes. This again assumes that a sufficient number of referred victims of sexual abuse will be made concerning South County residents to populate such groups there. At present, there are three groups in the Greeley office of the WMHC for child and adolescent victims of sexual abuse. In summary, home- and clinic -based services for individual and family therapy will be available in South County as needed to meet client demand. Offense specific treatment for adults and adolescents will always be available in Greeley and will be developed in Ft. Lupton if sufficient clients are referred who need this aspect of our services. • We do not intend to provide transportation of clients on a regular basis as part of this 971083 WMHC response to PAC concerns Page 7 of 15 project. The travel portion of the requested budget will largely be spent getting therapists to the homes of clients for home -based aspects of the services. When necessary and when clinically appropriate, clients will be transported for treatment and/or case management purposes. This will occur only in a small proportion of cases. A complete assessment of those individuals referred for offense specific sexual offender treatment will be performed. This assessment and others are currently available and, thus, do not need to be developed prior to implementation of this service. The adult and juvenile clients will come in for the first appointment after all the demographic information has been gathered. Necessary forms are completed at this first appointment such as Mandatory Disclosure, Contract of Agreement, Release of Confidential Information. The evaluation procedure is explained to the client in detail and all questions are answered. The first meeting typically lasts approximately two hours and involves clinical interviews. An additional meeting is held where the clinical interview is completed and further psychological testing accomplished. It is important to keep in mind that the client will be at our offices generally on at least two or three different occasions to complete all the necessary testing and interviews. Clients are generally involved with us each week during the four week assessment period. During the psychological testing, a variety of tests can be used. The choice of the actual tests to be used in each referral is dependent on individual aspects of the case. The primary tests used, given reading and comprehension above a sixth grade level, are: Minnesota Multiphasic Personality Inventory -II (MMPI-II); Multiphasic Sexual Inventory (MSI); Hare Psychopathy Checklist - Revised (PCLR); Beck Depression Inventory; Wilson Sexual Fantasy Questionnaire; Sone Sexual History; Child Molester Scale (CHI -MO); Sexual Social Desirability Scale (SSDS); Empathy Scale (Empat); Able Becker Cognition Scale; Attitudes Toward Women Scale; IGTS Offender History Questionnaire; IGTS Forensic Interview; Expulsion/Regression Scale; Domestic Violence Inventory; Penile Plethysmograph; and Sex Offender Specific Polygraph. These tests are used in conjunction with the clinical interview and any collateral 971083 WMHC response to PAC concerns Page 8 of 15 information that is received. Most reports will have between four and six different tests used to support each recommendation. Once all the clinical information has been collected, tests given and results interpreted, and collateral information read, the report is written. At a weekly staff meeting typically held on Mondays, each case is staffed and reviewed. No client will be formally accepted into our treatment program until the case is discussed at this meeting and all staff members agree on the recommendations. The report is then finished and is proofread by another staff member before being sent to the referral source and others who may have an interest in it, provided sufficient releases have been signed. Similar procedures for assessment are used in evaluating juveniles although many of the sex offender specific tools are not developed for use with or validated on them. As a result, the number of appropriate tests for juveniles is reduced. All juveniles above the age of 15 will have administered to them the: Minnesota Multiphasic Personality Inventory -A (MMPI-A); Juvenile Multiphasic Sexual Inventory; Juvenile Culpability Scale; High School Preference Questionnaire (HSPQ); Wilson Sex Fantasy Questionnaire; IGTS Forensic Interview; and IGTS Offender History Questionnaire. If necessary, a Penile Plethysmograph and a Sex Offender Specific Polygraph can be given in addition to the above. For clients under the age of 15 years, the number of sex offense specific tools is reduced even further. Therefore, the clinical interview, the Juvenile Culpability Scale, and the High School Preference Questionnaire (if the youth is above the age of 13) are used. For youthful clients that are developmentally disabled, the clinical interview is used as well as the Juvenile Culpability Scale. In all cases, the clinical interview is maintained as a vital source of information. A strong relationship with the referral source is sought as well. In addition, for the juvenile, releases of information are sent to his or her school to obtain information about the client's behavior, academic performance, and other information such as the results of intelligence testing as well as any other testing that may have been completed by the school. We also involve ourselves with the school counselor to increase the flow of information that is crucial in providing a good assessment. If an offender is accepted into our program, polygraphs will be a required condition of his or her participation in the program. The polygraphers utilized in our program are Lawson Hagler of Loss Accountability Services and Gwen Knipscheer of Alverson and 971053 WMHC response to PAC concerns Page 9 of 15 Associates, both of whom are skilled in the use of sex offender polygraph and are approved by the State Sex Offender Board. Polygraphs are available on a monthly basis at the IGTS offices. This assists the client by not necessitating travel to Denver. Penile Plethysmography (PPG) is utilized to measure the sexual interests and arousal patterns of an individual, in this case a sex offender. This is critical to the treatment of sex offenders as we and others have found that often many of them are aroused by more than three paraphilias at any one time. PPG is a tool that has been utilized since the 1960's to accurately assess whether or not an individual is sexually aroused by a particular stimulus or set of stimuli. The tests involve the client being subjected to a variety of sexual scenarios in which they may or may not be interested. Measurements of penile tumescence are then taken from the client to determine in which of these scenarios they are and are not sexually interested. This is performed on adults at the assessment stage. With juveniles, it is usually done as a condition of their treatment and not necessarily at the time of initial assessment. PPG will not be done on individuals below the age of 15. Juvenile PPG utilizes a different set of stimulus cues than are used for adults. IGTS has the only approved PPG lab in Weld County. This lab, which uses state of the art techniques, is currently the most extensive such lab on Colorado's Eastern Slope. In addition, PPG is utilized to verify whether or not behavioral techniques taught to each client are in effect. Clients will often report that the tools being taught to them to manage their fantasies or to control urges are functioning but in PPG testing it may be found, however, that the client is utilizing the tool incorrectly or that the tool is not, in fact, working. PPG is the only way to specifically identify which tools are functioning well for each client. It may be used similarly as a bio-feedback tool to enable clients to show their physiological responses to using a behavioral technique. It can also be used to show under what circumstances a client might be able to improve a technique's effectiveness. The WCDSS caseworker referring a sexual offender to this service will receive a copy of the offense specific assessment done concerning that individual to include whatever recommendations are being made providing an appropriate release of information is signed by the offender. We anticipate the vast majority of offenders being evaluated will agree to such a release. At the same time, we do anticipate some reluctance from some offenders, particularly those whose criminal or civil cases are still pending. An offender who is unwilling to have his or her assessment released will be considered for expulsion from the project with the final decision in this regard resting with the WCDSS caseworker and the mental health therapist. The offense specific sexual offender treatment aspect of this service will be provided by staff from AHY, IGTS, and the WMHC as staff members from each of those organizations become approved to provide such services. As noted above, such services 971083 WMHC response to PAC concerns Page 10 of 15 will be provided on IGTS premises until such time as there are enough South County referrals to justify a group being conducted in Ft. Lupton.. As mentioned above, the only currently approved providers of this type of treatment are on the staff of the IGTS. Staff of AHY and WMHC will complete the necessary training to become approved providers as rapidly as possible. Complementary training to add the knowledge necessary to respond appropriately to the treatment needs of these individuals will be accomplished via inservice training and attendance at workshops. There was no formalized offense specific sexual offender treatment included in our proposal last year. Our offer was to provide family therapy and other services to those families in which a parent was the perpetrator of sexual abuse once that offending parent was cleared by his or her therapist who was providing offense specific treatment to participate in such treatment. The offer this year expands last year's by including offense specific treatment that meets the agreed upon state guidelines as now established for adult offenders and as anticipated for adolescent offenders. This is one of the purposes for our collaboration with AHY and IGTS. We will agree to a $25.00 rate (i.e. $25.00 per individual per group session) for offense specific sexual offender treatment. Similarly, we will offer that same rate setup for any group treatment (e.g. group therapy for victimized children, for non -abused siblings, for non -perpetrating parents, etc) provided to anyone referred in conjunction with the overall Sexual Abuse Treatment service. Other aspects of the program will be billed at the $42.25 rate stipulated in our bid, except for plethysmographs and polygraphs at the respective rates quoted in our proposal. 971083 WMHC response to PAC concerns Page 11 of 15 With regard to RFP-PAC 97008 concerning the provision of Intensive Family Therapy (IFT,) the following is submitted: Our previously submitted bid outlined the outcome measures and service objectives the IFT incorporates into its work with clients. This includes quarterly reports to the PAC concerning these items. The overall picture is also monitored here by the program evaluation component of the WMHC based on the data gathered by the therapists in working with the families and in consulting with the referring WCDSS caseworkers. The Colorado Mental Health Services Assessment & Discharge Forms and the WMHC Family Preservation Program Admission and Termination Evaluation Forms (Appendix A) provide data for additional program evaluation. These assessments, made on each client, include the Global Assessment of Functioning (GAF) from Axis V of the DSM-IV, numerous level of functioning scales, overall level of functioning scores, the overall problem severity score, as well as specific pre- and post-test treatment measures on a variety of special behaviors or circumstances. Appropriate statistical analyses of this information will be utilized to assess the results of the treatment services provided. These analyses will focus on treatment results for each child/family and also on overall program effectiveness. The comprehensive WMHC Program Evaluation Plan is included as Appendix B. We also monitor, for each referral and in the aggregate, the date of referral by a WCDSS caseworker, the date we receive the referral, the date we initially respond to a referral, and the date direct services started. Any referral made to the IFT services will result in service initiation within five working days of the referral being received by the WMHC's Children and Family Services Program Director provided we have access to the family being referred and to the WCDSS caseworker making the referral. It is interesting that you separate assessment from direct services because it is the initial assessment that is used to chart at least the early course of our interventions with individuals and families. Our bid outlines the process of collaboration with the referring caseworker to make sure the best interests of the clients are at the forefront of our efforts. Central to this is the initial appropriate and thoughtful assessment of a family's issues, strengths, and needs. This assessment and the resultant plan are then modified as additional information becomes available or as change occurs. The IFT services are available throughout Weld County. Those services available to residents of South County differ in no way from those available anywhere else. The staff of the IFT travel to the homes of the clients when it is appropriate to do so to deliver the home -based services that are a hallmark of IFT. If it becomes appropriate and/or necessary to switch to clinic -based services for IFT clients, these services are available at the Ft. Lupton office of the WMHC or at other sites as may be needed. Psychiatric 971083 WMEIC response to PAC concerns Page 12 of 15 services are available at the Ft. Lupton office of the WMHC for adults and adolescents living in southern Weld County. South County children in need of psychiatric services must be brought, at least at the present time, to the Greeley office of the WIVITIC. We are seeking to provide comprehensive psychiatric services in Ft. Lupton at a future time. Psychological evaluation services are available when indicated to all South County residents at the Ft. Lupton office. We made no offer to provide transportation of clients referred to IFT services. The travel portion of the budget covers our expenses in getting an IN I clinician to a site to deliver services to a family when it is so indicated. We will, when indicated and appropriate, transport clients from one site to another to facilitate treatment and/or case management services. Typically in the past such transportation was involved to move clients from their foster homes in the Greeley area to the home of their parent in a distant location. This was regarded as an extension of getting a therapist to a site to perform the services and, as such, freed the foster parents and the caseworker from performing the task. Again, it is not our intent to provide transportation to clients on a regular basis. 971083 WMHC response to PAC concerns Page 13 of 15 With regard to RFP-PAC 97010 concerning the provision of Mobile Mental Health Services (Option B,) the following is submitted: As outlined above and in our response to the request for proposals, program evaluation is an integral part of our services. The forms contained in Appendix A and the WMHC Program Evaluation Plan (Appendix B) assist us in this endeavor. These assessments; — made on each client, include the Global Assessment of Functioning (GAF) from Axis V of the DSM-IV, level of functioning scales, overall level of functioning scores, the overall problem severity score, as well as specific pre- and post-test treatment measures on a variety of special behaviors or circumstances. Appropriate statistical analyses of this information will be utilized to assess the results of the treatment services provided. These analyses focus both on the treatment results for each child and also on overall effectiveness of the Option B services. An example (see Appendix C) of such a monitoring report is included for your study so that you can see what we are doing with the data gathered. We also track, for each referral and in the aggregate, the date of referral by a WCDSS caseworker, the date the referral is received at the WMHC, the date of initial response to a referral, and the date Option B direct services started. Referrals made by WCDSS caseworkers to Option B services will result in the initiation of direct services, other than assessment alone, to a family within five working days of the receipt of the referral by the WMHC's Children and Family Services Program Director when that family is available and agreeable to services and when the referring caseworker is accessible for an initial consultation. Again, it is interesting that the initial assessment is not viewed as part of the "commencement of direct services" when it is viewed by us as the essential beginning of direct services. A good, comprehensive assessment immediately following referral sets the stage for all that follows. It also forms one of the early bridges between our treatment staff and the WCDSS caseworkers to achieve the appropriate level of collaboration needed to successfully intervene with the client families. As has always been the case, all Option B services are uniformly available throughout Weld County. Option B treatment staff will travel to client homes or other sites to provide the needed care. It was our estimate that at least one-fourth of the families to he served will be residents of South County and that services to those families will be delivered in South County. As is the case with IFT services discussed above, clinic - based treatment services, when required, will be delivered at our Ft. Lupton office as will psychological evaluation services. Adult and adolescent psychiatric outpatient services will be delivered at the WMHC's Ft. Lupton office unless the client desires to come to Greeley. At the present time, outpatient psychiatric services for children will be available only at the WMHC's Greeley office. Again, our plan is to provide such services 971083 WMHC response to PAC concerns Page 14 of 15 in Ft. Lupton as soon as recruitment efforts are successful for a properly credentialed psychiatrist. It is not in our plan to transport clients referred to Option B level services except when such transportation is required to meet a family's treatment needs and when no other reasonable resource exists to provide such transportation. What is in the plan is to travel to clients' homes to deliver services there as long as it is appropriate to do so. A concern of ours in this regard, and one that is heightened by the potential nine month duration of Option B services, is that providing virtually all mental health services in the clients' home can foster a dependence that is not in the best interests of the family. When we determine that such a risk exists, and with the approval of the referring WCDSS caseworker, we will make a transition from home -based to clinic -based services or to a hybrid of the two. The Option B services are the second most intensive offered within the WMI-IC's continuum of family preservation services. They are exclusively outpatient home- and clinic -based treatment and case management services although inpatient and residential services are available, if needed, outside of the contract with the PAC. The team leader of our Family Preservation Services, Sonja Faris, MA, LPC, provides administrative supervision to all and clinical supervision to some members of that team. As described in our response to the "Workload Standards" section of the RFP, she clinically supervises new members of the team for at least the first six months they are on staff. If additional supervision is needed at any time, it is available at the direction of the WMHC Children and Family Services Program Director (currently Dan Dailey, B.A.) and/or the WMHC Clinical Director (currently Bill Crabbe, Ph.D., M.H.A..) After six months employment, staff are eligible to request a clinical supervisor other than the team leader. The decision regarding that request is the responsibility of the WMHC Children and Family Services Program Director. At present, Ms. Faris is administratively supervising the equivalent of four full-time employees. The maximum the team leader will be permitted to supervise is six full-time equivalents. Each member of the Family Preservation Services team carry a mixed caseload. For example, one may work with families from any of the service types. Thus, it is difficult to describe caseloads as the term is used in the request for proposals. For the sake of discussion, a family preservation worker here will carry a number of cases so that the total amount of direct services provided weekly is approximately 20 which enables sufficient time for indirect services, travel, paperwork, and other activities necessitated by the job. This could be configured in a number of ways: 1. four Option B families at the five hours per week direct service level; or 2. two Option B families at the five hour level and three at the three hour; or 3. seven Option B families at the three hour level; or 4. other similar combinations. 971083 WMHC response to PAC concerns Page 15 of 15 Option B services are defined by the State to be up to nine months in duration. We adapted this guideline in our proposal to you but also suggested that an average length of stay would be six months. We further stated that during the first three months a family is involved in Option B services, up to five hours of direct services could be delivered weekly. A reduction to three weekly hours of direct services was projected after the initial three months of care or sooner if warranted. This level would then be maintained until termination of Option B services. We requested the ability to serve at least four families at any given time at the five hour level or up to seven families at the three hour level. Projection of actual levels of usage of this service is complicated by the likely occurrence of some number of families being served at the five hour level and yet another number being served at the three hour level. 971083 CARSON CENTER ADMISSION EVALUATION FORM Client Name Client Id# Diagnosis: Primary Secondary Date of Birth School Grade City Admit Date Center Admit CARSON Medicaid Yes _ No (Check One) Sex Ethnicity Who has custody of child at time of admission to CARSON Which School and School District Referred the Child? Was the child in any type of special education program prior to admission to the Carson Center? Yes No If yes please describe Is there evidence by history of the child's mother using drugs or alcohol during pregnancy? _ Yes _ No If yes, please describe Outpatient Therapist (if any) Address/Phone Special Behaviors or Circumstances/Reasons for referral PAST PRESENT Yes No Yes No Suicidal Ideation Suicidal Gestures/Attempts _ Physical Aggression Poor Peer Relationships Self Mutilating Behavior Social Isolation Problems in Anger Management Conflict Resolution Problems ADHD Type Behavior Victim Physical Abuse Victim Sexual Abuse _ Generally Unmanageable Poor Impulse Control Very Short Attention Span Learning Disabilities Special Education Others (specify GAF SCORE AT ADMISSION OVERALL PROBLEM SEVERITY SCORE LEVEL OF FUNCTIONING SCORES AT ADMISSION (RATE ALL SIX AREAS) Very Moder Aver. Moder. High Low •Low High Func. 1 2 3 4 5 6 7 8 9 StCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING 971083 CARSON CENTER UNIT TERMINATION EVALUATION FORM Client Name Client Id# Discharge Carson Center Discharge Diagnoses: Primary Secondary If psychotropic meds were used please list below. 1. 2. 3. Who has custody of child at time of termination from Carson Center? Where will child be living immediately after discharge from Carson? Who will follow youth after discharge? Which School and School District will the child go to? What type of special programming will the child receive? (be specific) Special Behaviors or Circumstances Present at time of Termination Suicidal Ideation Suicidal Gestures/Attempts Physical Aggression Poor Peer Relationships Self Mutilating Behavior Social Isolation Problems in Anger Management Conflict Resolution Problem ADhD Type Behavior Victim Physical Abuse Victim Sexual Abuse Generally Unmanageable Poor Impulse Control Very Short Attention Span Learning Disabilities Special Education Others (specify GAF SCORE AT DISCHARGE OVERALL PROBLEM SEVERITY SCORE AT TERMINATION LEVEL OF FUNCTIONING SCORES AT TERMINATION (RATE ALL SIX AREAS) Very Moder Aver. Moder. High Low Low High Func. 1 2 3 4 5 6 7 8 9 SOCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING 971093 FAMILY PRESERVATION PROGRAM ADMISSION EVALUATION FORM Client Name Client Id# Diagnosis: Primary Secondary Date of Birth School Grade City Admit Date Center Medicaid Yes No (Check One) Sex Ethnicity Who had custody of youth at time of referral to FPP Where was youth residing at time of admission to FPP (Be specific) Date of initial referral for FPP services Date of first contact by FPP therapist FPP Therapist Previous mental health services (explain) Special Behaviors or Circumstances/Reasons for referral PAST PRESENT Yes No Yes No Suicidal Violence toward others Runaway Behavior Social Isolation Legal Charges Domestic Violence On Probation Victim Physical Abuse Victim Sexual Abuse Alcohol Use Use of Inhalants Other Drug Use Learning Disabilities Special Education Bed Wetting Encorpresis Others (specify GAF SCORE AT ADMISSION TO FPP OVERALL PROBLEM SEVERITY SCORE LEVEL OF FUNCTIONING SCORES AT ADMISSION TO FAMILY PRESERVATION PROGRAM (RATE ALL SIX AREAS) Very Moder Aver. Moder. High Low Low High Func. 1 2 3 4 5 6 7 8 9 SOCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING 971053 FAMILY PRESERVATION PROGRAM TERMINATION EVALUATION FORM Client Name Client Id# Discharge date from FPP List all different types of FPP services used Discharge Diagnoses: Primary Secondary Who has custody of child at time of termination fran FPP? Where was child living immediately after termination from FPP? Who will follow youth after discharge? Special Behaviors or Circumstances PRESENT Yes No Suicidal Violence toward others Runaway Behavior Social Isolation Legal Charges On Probation Victim Physical Abuse Victim Sexual Abuse Alcohol Use Use of Inhalants Other drug use Learning Disabilities Special Education Bed Wetting Encorpresis Domestic Violence Others (specify) GAF SCORE AT DISCHARGE OVERALL PROBLEM SEVERITY SCORE LEVEL OF FUNCTIONING SCORES AT DISCHARGE FROM FAMILY PRESERVATION PROGRAM (RATE ALL SIX AREAS) Very Moder Aver. Moder. High Low Low High Func. 1 2 3 4 5 6 7 8 9 SOCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING 971083 ASSESSMENT/DISCHARGE Sheet 1 AGENCY GAF SCORE 1 I I II [fill MEnICAID lD I I I CLIENT ID ADMISSION DATE: mm/del/vv VICTIM PROBLEMS Check ALL that Apply Ever Sexual Abuse Victim Ever Physical Abuse Victim Ever Verbal Abuse Victim Neglect PROBLEM SEVERITY RATE the CURRENT P-SEV (PROBLEM SEVERITY) for each area using the following scale: None Slight Moderate Severe Extreme 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 CURRENT P-SEV Check ALL Problem that Apply EMOTIONAL WITHDRAWAL Blunted Affect Reticent Distant DEPRESSION Depressed Bored Sad ANXIETY _Anxious Tense Obsessive res. 1 HYPER AFFECT Mania Sleep Deficit _Pressured Speech Underactive Passive Reserved Worthless Hopeless Desolate Fearful Panic Restless Agitated Mood Swings Accelerated Speech SUICIDE / DANGER TO SELF Suicide -Ideation Suicide Plan Danger to Self (4; s 'j ; )( Vacant Subdued Detached Lonely Dejected Sleep Problem Nervous Phobic Guilt Overactive Elevated Mood Suicide Attempt Self Mutilation THOUGHT PROCESSES Bizarre Suspicious Disorganized Illogical Delusions Paranoid Derailed _Magical Thought C, NITIVE PROBLEMS _Memory Concrete Hallucinations Repeated Thought Loose Associations Unwanted Thought _Confused _Intellect _Unpaired Judgment Disoriented _ _Attention Span _Lacks Self -Awareness SELF -CARE / BASIC NEEDS (Doesn't) _Care for Self Manage Money Provide Food _ _Provide Housing Manage Personal Environment Make Use of Available Resources Hygiene _Gravely Disabled (QS 27:?1Q) RESISTIVENESS Uncooperative Guarded Antagonistic 7/95 Evasive Wary Denies Problems Resistive Oppositional Refuses Treatment CURRENT P-SEV AGGRESSIVENESS Aggressive _Belligerent Defiant Check ALL that Apply Hostile Threatening Intimidating SOCIO-LEGAL PROBLEMS Disregards Rules _Legal Problems Fire Setter Probation Dishonest Offenses / Prop. _Destroy Property Parole Angry "Notorious" Uses/Cons Others Offenses/Pewons _Pending Charges VIOLENCE / DANGER TO OTHERS (Client to Others) Violent Sexual Abuser Homicide Attempt Danger to Others Assaultive Homicidal Idea (CRS 27:40) Physical Abuser Homicidal Threats ROLE PERFORMANCE (Work / School) _Absenteeism _Performance _Behavior _Terminations _Learning Disabilities Not Employable _Doesn't Read/Write _Doesn't Earn _Unstable Work/School Hist FAMILY PROBLEMS (Client Problems in Family) No Family No Contact w/Family w/Partner _w/Relative w/Child w/Parent _w/Parenting Acting Out FAMILY ENVIRONMENT (Environment Causes Problems for Client) _Family Instability Separation _Custody _Family Legal Unstable Home Environment _Family History of Mental Illness FAMILY VIOLENCE (Toward Client or Family Member) Sexual Assault Verbal Assault INTERPERSONAL PROBLEMS w/Friend Social Skills Establishing Relationships Maintaining Relationships Physical Assault I _ - _ SUBSTANCE ABUSE PROBLEMS Alcohol Addicted DUI/DUID MEDICAL/PHYSICAL Acute Illness Nutrition Enuretic Drug(s) Dependent Interferes with Responsibilities Family History of Substance Abuse _Chronic Illness CNS Disorder Eating Disorder Physical Handicap _Encopretic Medical Care Needed _Developmental Disability Pam. Disability Attention Deficit Disorder Injury by Abuse/Assault SECURITY / MANAGEMENT ISSUES Restraint Seclusion Security _Walkaway/Escape Surveillance Locked Unit _ Time Out Medication Compliance Close Supervision Behavior Management Suicide Watch OVERALL DEGREE OF PROBLEM SEVERITY CHANGE IN OVERALL PROBLEM SEVERITY I=Much Worse 2=Wore 3=Somewhat Worse 4=No Change 5 -Somewhat Better 6=Better 7=Much Better 971083 WMHC FORM 260 CLIENT LD. # DATE OF ADMISSION ASSESSMENT/DISCHARGE Sheet 2 STRENGTHS / RESOURCES Check ALL CURRENT STRENGTI IS / RESOURCES individual has ECONOMIC RESOURCES Employment Transportation Medicaid/Medicare EDUCATION / SKILL RESOURCES Education lob Skills PERSON RESOURCES Ilousing SSI/SSDI Intelligence Interpersonal Skills Spouse _ _ Parent (s) _Other Family _Friend (s) PERSONAL STRENGTHS Insight Judgment _ _Emotional Stability _Adaptability Tolerance Appearance _ Thought Clarity Empathy Financial Medical Insurance Language Skills Child (I -en) Others Responsibility Resourcefulness Health LEVEL -OF -FUNCTIONING (LOF) Check ONE Response for Each LOF Area SOCIETAL / ROLE FUNCTIONING Very Low Moder Low Function Function Average Moder High Very High Function Function Function 1 2 3 4 5 6 7 INTERPERSONAL FUNCTIONING '.emvVery Low Moder Low Function Function Very Low Function 8 9 Average Moder High Very High Function Function Function 2 3 4 5 6 7 8 9 DAILY LIVING / PERSONAL CARE FUNCTIONING 1 2 Very Low Moder Low Function Function Very Low Moder Low Function Function 2 Moder Low Avenge Function Moder High Very High Function Function Function 3 4 5 6 7 8 PHYSICAL FUNCTIONING Average Function 9 Moder High Very High Function Function 2 3 4 5 6 7 8 9 COGNITIVE / INTELLECTUAL FUNCTIONING Average Function Moder High Very High Function Function 3 4 5 6 7 8 9 OVERAI I LEVEL OF FUNCTIONING Very Low Moder Low Function Function 1 Average Function Moder High Function 2 3 4 5 6 7 8 Very High Function 9 1 CHANGE IN LEVEL OF FUNCTIONING I=Much Worse 2=Worse 3=Somewhat Worse 4 -No Change 5=Somewhat Dever 6=Better 7 -Much Better PROGRAM AC rION TYPE 01 =Admission 02=Activate 03 -Update 0/1 Inactivate 05 -Discharge -I I (Manual Input Only) I I =Correction to Admission I2=Correction to Activation 13 -Correction to Update 14=Correction to Inactivation 15-Coneoion to Discharge EFFECTIVE DATE: nun/ddryv DATE FORM COMPLETED:mm/dd/y LAST CONTACT DATE: minidd/yy CURRENT DIAGNOSIS CURRENT/ EXPECTED RESIDENCE I=Corrections/Jail 2=Inpatient 3 -Nursing Home 4=Residential - Mental Health 5 -Residential Non- Mental 6 -Boarding Home 7 -Homeless -in Shelter 8 -Homeless -on Street 9 -Other Independent Living Arrangements CURRENT / EXPECTED LIVING ARRANGEMENT. 1=Lives w/Both Parents 2=Lives w/One Parent 3=Lives w/Spouse and/or Other Relatives) CURRENT / EXPECTED EMPLOYMENT. 1=Employed-Full Time 2=Employed-Pan Timc 3 -Homemaker not Otherwise Employed 4=Sheltered Employment 4 -Lives Alone 5=lives w/Unrelated Person(s) 5=Not in Labor Force 6=Unemployed less than 3 Months 7=Unemployed 3 Months or More 8 -Armed Forces Active Military Duty INACTIVE / DISCHARGE TYPE OF TERMINATION: STAFF/AGENCY INITIATED CLIENT INITIATED I = Discharged/Transferred 2=TX Completed/No Referral 3= -TX Completed/Follow-up 4=Evaluation Only 5=Inactive for I Year 6=Patient/CIent Died 7=Patient/Client Terminated TERMINATION REFERRAL . NOTE: Use 61 "Self' if no Referral This field will contain one of the following codes 1,c ion type v 05 oe 15: Persnualreferrals - 61 -Self; 61- Family/relative; 63 - FriadiEmplayerfClegy; Medical/Psychiatric referrals - 6i- Outpatient psychiatric; 69 - Private psychiatrist; 70 - Other private MSS practitioner. 71 -CM HYP; 71-Q-99aa1: 73 - Cnlorudo Mental Health Central/Clinics. 74 - Nursing home: 75 - Commusury residential organuaauon. 76 - Alcohol/Ding treatment facility: 77 - Medical practitioner. 76 - General hmpital inpatient psyehiatnc program, 79 - Other inpatient psychiatric program; Soda] service/Education referrals - Si - Social service agency. 83 - Agency for the D'flopmcntal disabled, O - Vocational rehabilitation fwliry; 84 - Educational system/school; 85 - Shelter for homeless/abused; Kcal referrals - 91 - Law enforcement: 91 • Cain (including juvenile). 93 - Correctional facility, 94- nrobation/parok, M1 other referral sources - 98 - Other. -Referral source not known. 1111 Inr ll STAFF ID / STAFF SIGNATURE DISCIPLINE- I -none 2=mh worker 3=nursing 4=social work 5= -psychology DEGREE: I=nonc 2 -associate 3=bachelors 4 -masters 5=1'hD/I'syD/FAD 6=MD 6 -psychiatry 7bthcr 7 -other 971083-. WELD MENTAL HEALTH ASSESSMENT AND SERVICE AGENCY PROGRAM EVALUATION PLAN OVERVIEW Program evaluation involves a multidimensional assessment of service effectiveness. The goal is to assure quality services are provided in a cost efficient manner that meets the needs of all recipients of MHASA services. Program Evaluation data is used to facilitate the planning and decision making process related to all clinical programs and services. The goal of the Program Evaluation Plan (PEP) is to produce data and reports that are practical and have maximum utility for the management decision making process. The PEP contains five areas of focus. These areas are ways to conceptualize the tasks within the plan. They are a means of developing and addressing key questions in the evaluation process. These areas are not mutually exclusive. To some extent they use common data or measures to address different questions or issues. The areas build upon each other to the extent that the data generated to answer a question in one area is used as a baseline measure in another area. The data and reports generated in response to the questions raised by these areas combine to provide a comprehensive assessment of all the services provided under the capitation plan. These areas are listed below and are described in more detail in the following sections of this plan. FIVE AREAS OF FOCUS OF PROGRAM EVALUATION PLAN Treatment Outcome Service Utilization Analysis Provider Profiling and Best Practices Quality Management Plan Evaluation of Management and Operation of Capitation Program The data collection methods, surveys, and measures used by the MHASA as part of its evaluation plan are being phased in during the first two years of the project. The collection of Level of Function data and the Global Assessment Function (GAF) Score data, described later in this section, was implemented for all clients during the first six months of the project. Additional client measures are being evaluated for implementation during the second year of the capitation project. A standardized consumer satisfaction survey used at termination and for open cases studies was implemented during the first year. Specialized surveys for client subpopulations will be implemented during the second year. As part of its overall plan for capitation, the MHASA has entered into a partnership with Behavioral Healthcare Incorporated and the Jefferson Center for Mental Health to become part of a comprehensive managed care data system known as the Data Warehouse. The Data Warehouse has the capacity to capture data from each of the MHASAs and store it in a common format. The Data Warehouse will produce ongoing reports required by the contract as well as customized reports for each of the MHASAs. By working together the MHASAs will be able to produce a more comprehensive and integrated web of data to enhance overall service delivery. 971083 A. TREATMENT OUTCOME APPROACHES AND MEASURES Treatment outcome is an essential part of the MiASA's approach to program evaluation because it directly addresses the effects of clinical services, the major indicator of service quality. Treatment outcome utilizes objective and subjective data sources in order to describe the effectiveness of intervention. Outcome data are used to facilitate the planning and decision making process related to all clinical programs and services. All data collected are available for analyses center -wide, organized by programs, by clinician, and by individual clients. Measures focus on a combination of clinical issues, client satisfaction, general mental health status, systmrwide access and service issues, mental health treatment and outcomes, and cost effectiveness. Treatment outcane measures at the MiASA focus on three domains: 1. Client Functioning Client Functioning is assessed by subjective and objective ratings by clinicians of consumers, using accepted standardized instruments. This occurs for clients in all programs, age groups, diagnostic groups, and Medicaid eligibility categories. Client functioning is also assessed in terms of objective indicators such as employment, level of independence (intensity of current residential status), housing status, socialization and life skills indicators. 2. Consumer Satisfaction Consumer satisfaction surveys are an established means of obtaining consumer assessment of satisfaction with services, and the consumers' perspectives on improvement and other variables. This information is valuable itself and forms an essential part of the overall assessment of quality of care. 3. Use of Treatment System Use of treatment system consists of objective service utilization data drawn from the management information system. This data consists of both positive and negative indicators of program effectiveness. Data on inpatient admission rates per population and readmission rates are well established measures. In aggregate, the information from the three domains forms a more complete picture of outcane than the data from any one domain. Program effectiveness has more than one perspective. A more complete picture of outcome is obtained when it is measured from more than one perspective and by more than one measurement approach. Outcome data that give a more complete picture yield information that enables program managers to make better decisions. Each of the three domains will be described in more detail in the following section. 1. MEASURES OF CLIENT FUNCTIONING In order to assess client functioning the M-1ASA uses a variety of measures for all clients in all programs. The following ratings of client functioning are performed at admission and termination from services for all MlASA clients. 1. The Global Assessment of Functioning (GAF) Score from Axis V of the DSM-IV is used as an overall measure of client functioning. The GAF has defined 971083 anchor points and is based on a methodology that has been refined since 1962. 2. The Level of Functioning Scales (LOF) from the Assessment/Discharge (A/D) Form consist of five individual scales and an overall level of functioning scale. There is also a change in level of functioning anchor scale. Anchor point definitions are provided. 3. The Overall Degree of Problem Severity Scale from the A/D is a single indicator of the degree of problem severity. Anchor point definitions are provided. The Life Skills Profile will be filled out for all clients admitted to the new Special Services Program (SSP). At a minimum, these profiles will be filled out at the time of admission to the SSP and when the client is transferred to another program or terminated from services. Ratings of client functioning occur, at a minimum, at admission and termination. For clients in treatment for longer periods of time, assessments are updated at six-month intervals. Clients served in special programs (such as the Children's Acute Treatment Unit and the Special Services Program) have assessments at admission and termination from these programs, in addition to other designated assessment points. The MHASA is examining other measures that yield data from the consumers' perspectives. The Basis 32 has achieved wide -spread use in a short period of time. It is a fairly simple instrument for the client to use and can be used with a variety of client populations. The MHASA is examining its potential use in the Community Support Program and other client programs. 2. USE OF THE SYSTEM Use of treatment system data is well established as an outcome measure in evaluating program and service impacts. As stated earlier, this data consists of both positive and negative indicators of program effectiveness. Indices or rates under study are those of immediate interest to program managers and decision makers. There is a high level of applicability of this data to the day-to-day clinical decision making process at the level of the program and individual provider. Measures are specific to individual programs and services. The following are some of the Use of System indicators that are being monitored: Patterns of client flow (e.g. percent of clients moving from the Acute Treatment Units to lesser or more restrictive settings) are indicators of resource utilization and impact of intervention. Hospitalization rates per 1000 served/recipients. Readmission rates to hospital within selected time periods. Median number of outpatient sessions/hours. Median length of outpatient treatment episode (LOS). 3. CONSUMER SURVEYS Consumer surveys are conducted on an ongoing basis. Clients who give permission are sent mail -out follow-ups at the time of termination of treatment services. A survey of clients currently in treatment is performed on an annual basis. Other consumer surveys are implemented in order to obtain information on the needs of client subgroups. A special survey addressing the needs of minorities will be 971083 completed in 1996. The array of consumer surveys completed, underway, or planned is contained in the description of surveys section that follows. DESCRIPTION OF CONSUMER, FAMILY MEMBER, AND COMMUNITY SURVEYS The MHASA began use of a revised and expanded consumer survey form in October, 1995. The survey form was expanded to include questions addressing key issues in the capitation project. Questions that address issues related to client access of services are included in the new survey. A question was added that asked clients if they were informed about the complaint and grievance procedure at the time of intake and whether they understood this information. Questions regarding the billing system, privacy, and the physical condition of the facilities were also added. The types of consumer surveys either underway or planned in the near future are described in the following section. A mail -out survey methodology has been used at Mental Health Centers for over twenty years and has proved to be a valuable means of obtaining consumer input. Historically, the return rate for mail -out surveys has been between 14% and 18%. It is a self selected survey methodology and significant numbers of MHASA clients are disinclined to take the time and effort to fill out a survey form. A telephone survey will increase the number of responses and the range of consumer input. The variety of consumer surveys will form an important part of the data base for evaluation of programs and individual therapists. A data base will be constructed that will contain significant client demographic, clinical, and service utilization information. This will enable the MHASA to analyze patterns within and across programs and to look at results obtained by different practioners both within the MHASA and in the External Provider Network. LIST OF SURVEYS: COMPLETED, ONGOING AND IN THE PLANNING PROCESS. a. Surveys of consumers after they have terminated from treatment. i. A consumer mail -out survey The new consumer survey was first mailed to clients after termination from therapy in October, 1995. At the time of intake, all clients are asked for permission for follow-up after therapy is terminated. This is indicated on the consent to treatment form and is entered into the client computer record. Each month a list of clients who have terminated treatment is produced. Permission to follow-up is indicated for each client on this list. Survey forms are sent to all clients who indicated permission for a follow-up contact. ii. A telephone survey using the same form as the mail -out survey was tested in May, 1996 and will be implemented on a permanent basis by July, 1996. Initially the telephone survey will be used to supplement the information obtained from the mail -out survey. At present the plan is to focus on clients who did not return a mail -out survey and whose mail -out survey letter was returned as undeliverable or moved and left no forwarding address. By the fall of 1996 sufficient data on the mail -out surveys will have been collected to determine if specific client subpopulations are underrepresented in this survey. These specific client subpopulations can be targeted using a telephone survey approach. 971053 b. Open Cases Surveys have been conducted for the past four fiscal years. This survey is mandated as part of the MHASA's contract with the State. The procedures for obtaining feedback from clients who are "open" or still being treated involves taking a random sample of clients who had been in treatment for a specified time period. During the first two years, clients had to be in treatment for at least a year to be included in the survey. During the last two surveys the MHASA was allowed to set its own parameters for inclusion in the open cases survey and it was decided to include clients who had been open for at least two months. The most recent survey was conducted in January, 1996. A report on the results of that survey has been completed. c. Family Members Survey. A survey of family members was conducted in June, 1996 by sending a specially designed survey form to all members of the Greeley Alliance for the Mentally I11 (GAMI). Data on this survey have been gathered and a report has been written. d. Integrated Service Access System (ISAS). A survey of consumer responses to the MHASA's emergency service and centralized intake program was conducted in October and November of 1995. A report was written and distributed to management and clinical staff throughout the MHASA. On the whole, the results were favorable and reflected a positive evaluation of the services provided by the ISAS program. 1+.w Because of the limited number of client responses in that survey (n=37) a more comprehensive survey of clients using the services of ISAS was begun on June 17th, 1996. This survey is still underway and will continue until at least fifty completed survey forms are returned by consumers. e. Clients in the External Provider Network (EPN) were sent surveys in June, 1996. The survey form had additional questions that addressed the degree to which the MHASA facilitated their decision to choose an independent private practioner and other questions as found on the standardized survey form used by the MHASA. We are awaiting the return of those survey forms so that data from these clients can be analyzed. f. A survey of Hispanic clients has been implemented. This survey form has an English version on one side and a Spanish version on the other side. Surveys were given to all open Hispanic clients age sixteen years and above who were in treatment for at least two months. This survey is still underway. g. External Provider Network (EPN). In June, 1996 a survey was sent to members of the MHASA's EPN. The survey asked for their assessment of the MHASA's orientation sessions regarding the implementation of the capitation project, subsequent training for members of the EPN, and other issues that relate to their participation in the capitation project. A report on this survey has been completed. h. Community Agencies and Professionals. A survey of community professionals and agencies will be conducted to obtain input regarding community perceptions of the services provided by the MHASA. It will include questions regarding the implementation of the capitation project. The survey will include private practice mental health professionals, physicians most likely to work with Medicaid recipients in areas related to mental health, the Weld 971083 County Department of Social Services, local law enforcement agencies and other individuals and agencies. It will be conducted during the second quarter of fiscal year 1996-97. B. SERVICE UTILIZATION ANALYSIS The types and amounts of services used by Medicaid and non -Medicaid clients are being analyzed. Included in this analysis is an examination of patterns of service utilization by programs and service types. • The distribution of services by Medicaid aid category, age group, ethnicity and gender will be compared to the Medicaid eligible distributions. This analysis addresses issues related to the extent to which the various subpopulations are served and the types and arrays of services they receive. It also addresses the degree to which there are any patterns of service delivery related to payor type. The geographic distribution of services by Medicaid aid categories will be analyzed. The analysis will examine the types and amounts of services provided to client subgroups listed above. This analysis addresses issues related to access and whether the MHASA has provided a wide array of services throughout the service area. Nneir The Service Utilization Analysis will also detail amounts and types of services as a function of level of impairment, target status as defined by Mental Health Services, diagnosis and level(s) of impairment as measured by the levels of functioning on the Assessment/Discharge form and the GAF score from Axis V of DSM IV. The relationship between changes in impairment and level of functioning and types and amounts of services received will be examined. The MHASA is using data from the "shadow billings" for units of service provided to capitated clients to determine the extent to which the benefits package has been implemented, as well as the degree to which different client subpopulations have utilized portions of the total benefit package. The above steps are concurrent with ongoing reviews of the array of clinical services to determine if the mix of services the MHASA currently offers matches the needs of the clients it serves. A key question for Service Utilization Analysis is, "What are the relationships between utilization of various modalities, number of treatment episodes, and treatment approaches?" This question is of special importance when applied to the use of inpatient treatment and other intensive treatment services. Factors that relate to higher use of inpatient and intensive residential treatment settings will be explored, as will those that relate to lower usage of high intensity services. Patterns of service utilization for clients enrolled in special programs are of special interest. The MHASA maintains specialized data bases on the Adult Acute Treatment Unit and for clients it places at the local inpatient unit. These data bases enable the MHASA to monitor utilization trends and assess factors related to length of stay, readmission rates, and successful placement in less intensive community placements. New data bases have been created for the Carson Children's Center, the day treatment program of the MHASA and Weld County School District Six, and the Children's Acute Treatment Unit. The data base on local inpatient admissions has been expanded to include all inpatient admissions. Additional data bases will be created as needed to evaluate special programs and services. 971083 C. PROVIDER PROFILING AND BEST PRACTICES The MHASA is building a data base from consumer surveys, service utilization data, client demographic and diagnostic data, and measures of client change data. These data will be used to determine program and individual provider effectiveness. The data will be analyzed to determine patterns and trends among the populations served and the programs and individual providers that serve them. Program and individual provider comparisons across the total Medicaid populations, selected subpopulations, and eligibility categories will be conducted. Patterns and trends that occur over time will also be examined.• It is important for the MHASA to monitor changes in patterns of service utilization to determine if there are relationships to changes in outcomes. In analyzing data for provider profiling adjustments are made to account for variations due to both provider and client characteristics. By statistically adjusting for age/sex differences and other key characteristics, sources of variation are investigated and identified. This is important in identifying sources of variation that cannot be attributed to client characteristics, and are shown to be caused by provider characteristics. These adjustments produce more "finely tuned" data and reports that enable managers who use them to make decisions based on the best possible data. In addition to standard criteria such as geography, income, race, age, and gender, criteria such as diagnosis and level of impairment will be built into the population definition data base. This enables the MHASA to examine provider -based utilization differences by level of impairment, diagnosis, and other clinical factors. The MHASA will utilize the enhanced capacities of the Data Warehouse to build profiles of best practices for delineated client subpopulations and the programs and individual providers that serve them. Program and individual provider profiles will be created that document outcomes in terms of consumer functioning and satisfaction. D. QUALITY MANAGEMENT PLAN (QMP) The QMP uses data provided by analyses of utilization patterns, outcome measures and special studies, consumer surveys, provider profiling and other data produced by the management information system (MIS) to support the continuous improvement of all services provided by the MHASA. The analyses of the implementation of the component parts of the QMP are used to make changes at the program and provider level. This is done by means of an ongoing feedback loop that is part of the QMP. This feedback loop involves management staff, Quality Assurance staff, Utilization Management staff, internal and external provider staff, support staff, other human service agency staff, and the recipients and their families. The MHASA has a QMP in place. Some of the measures and reporting functions are currently in use. Some measures are still being refined as continuing experience under capitation reveals important factors that need to be assessed. Other reports are being developed both internally and in conjunction with the other MEASAs in cooperative efforts that will ultimately enhance statewide service provision. 9'71083 E. EVALUATION OF MANAGEMENT AND OPERATION OF CAPITATION PROGRAM. The PEP must address key components or areas of the Capitation program. While some of these components form discrete areas on which to focus, others have Some degree of overlap. A number of components were briefly addressed in the proposal. These components have been expanded upon and are listed below. Evaluation begins with a question or questions to be addressed. For each of the components key questions are delineated. These questions determine what measures are needed. Methods of assessment are specified for each area. Specific surveys are used when appropriate. Objective assessment measures are indicated when obtainable. Subjective assessments are used when appropriate. The review process speaks to the manner and frequency of reviewing the status in each of the components. An evaluation report based on data from surveys and other sources will be prepared for each component. These reports will focus on questions and issues in the "what to measure" section. Recommendations for actions will be included when appropriate. These reports will be distributed to all management staff, with extra copies provided so that all staff on all programs have access to these results. Reactions to these reports are a source of input and -will be includedin the ongoing evaluation process. In aggregate, these reports will form the basis for highlighting strengths and weaknesses of the components of the Capitation Program. 1. POPULATION SERVED - WHAT TO MEASURE - KEY ISSUES How does the client population served by aid category and program compare to the age distribution and aid categories of Medicaid eligibles? How does the ethnic and gender distribution of clients served compare to the service area's ethnic and gender makeup? METHODS OF ASSESSMENT - An analysis of the amounts and types of services provided during the first eleven months of capitation will be conducted. The distribution of services by aid category, age group, ethnicity, andgender will be compared with the Medicaid eligible distributions. Differences in service patterns between populations served and eligible will be examined to determine their meaning and significance. REVIEW PROCESS There will be a review of the first year's data. Updates will be performed every six months to monitor changes in patterns of service utilization. This information will be utilized in the MHASA's overall planning process. 2. NOTIFICATION OF RECIPIENTS, RECIPIENT MIGRATION AND RETROACTIVE ASSIGNMENT OF RECIPIENTS TO MHASAs WHAT TO MEASURE - KEY ISSUES What efforts has the MHASA made to notify Medicaid recipients regarding the capitation program? What efforts were made prior to implementation of capitation and what efforts have been made since then? Is there information to judge whether these efforts have been sufficient or are 971083 other additional efforts warranted? What problems exist in terms of notifying the recipients? METHODS OF ASSESSMENT - Specific Measures and Indicators There will be a review of the procedures and action steps taken during the first year. Available historical data will be used to make comparisons with actual versus anticipated penetration rates. Any gaps in the notification process will be addressed and any new action steps detailed and implemented. REVIEW PROCESS The first year will be reviewed in summary. Monitoring of issues related to notification will occur on an ongoing basis. 3. BENEFIT PACKAGE — WHAT TO MEASURE - To what extent has the MHASA implemented the programs that were promised? Does the current benefit package meet the needs of recipients? If not, what additional services need to be added? Special Issues - To what extent are services meeting needs of minority groups and other special client populations? Are there adequate staff who are bilingual and who are bilingual and bicultural? Have there been any complaints regarding services for minorities and other special client populations? METHODS OF ASSESSMENT - Specific Measures and Indicators The first year's data will be used to detail the amount of services provided by each program. This will include the number of recipients receiving each service, a breakdown of recipients by aid categories receiving each service and the total number of units provided. This will be compared with available data on previous utilization patterns by program and by client. Newly implemented programs will be analyzed with respect to identified categories of need, with program planning efforts directed to areas of continuing unmet need. Special Issues - Specific minority surveys will be conducted to identify the availability of staff and the degree to which service needs are being met. The patterns of service utilization for minority recipients will be analyzed to determine if there are any significant variations from the non -minority recipients. A similar analysis will be conducted for special need client populations. REVIEW PROCESS The first year's data will be reviewed in summary. All elements of the benefit package will be reviewed on a semi-annual basis. Any revisions or other plans will be turned into action steps. Plans for meeting the needs of minority populations will be an integral part of the review. 4. COORDINATION WITH OTHER MEDICAL PROVIDERS - WHAT TO MEASURE - KEY ISSUES What are the perceptions of other medical providers of the accessibility, quality, and coordination of services? 971083 What concerns do other medical providers have about the capitation program? How well is the MHASA doing in meeting the needs of clients referred by other agencies? METHODS OF ASSESSMENT - Specific Measures and Indicators A survey will be conducted of physicians and other health care providers most likely to be involved in the provision of medical services to Medicaid recipients. Focus meetings will be held to educate and identify areas of ongoing confusion. All relevant providers will be informed of the agency's complaint procedure and any complaints will be analyzed. REVIEW PROCESS A survey is planned for 1996. Annual surveys will be conducted thereafter. The surveys will be supplemented by ongoing informal assessments based on feedback from medical providers. 5. COORDINATION WITH OTHER HUMAN SERVICE PROVIDERS WHAT TO MEASURE - KEY ISSUES What are the perceptions of the staff of other community agencies of the accessibility, quality and coordination of services? What concerns do providers have about the capitation piayram? How well is the MHASA doing in meeting the needs of clients referred by other agencies? METHODS OF ASSESSMENT - Specific Measures and Indicators A survey will be conducted of human service providers in the community who are involved in the provision of services to Medicaid recipients. REVIEW PROCESS A survey is planned for 1996. Annual surveys will be conducted thereafter. The surveys will be supplemented by ongoing informal assessments based on feedback from medical providers. 6. ACCESS TO SERVICES WHAT TO MEASURE - KEY ISSUES How accessible have the services to Medicaid recipients been? Has the MHASA identified barriers to clients obtaining services? If so, what are they? To what degree is the MHASA providing services to all of the residential areas in the service area? To what degree is the MHASA providing a wide array of services throughout the service area? What are the trends in service after the start of capitation? Is there a decrease, increase, no -change in the numbers and amounts of services provided during capitation. What are the perceptions of access to services by consumers, family members, community agencies, and medical practitioners? METHODS OF ASSESSMENT - Specific Measures and Indicators Surveys of consumers, family members, community agencies, and health providers will be conducted and will address issues related to accessibility. Waiting times for appointments for admission to MHASA services and for all programs and services will be examined. 971083 Trends and patterns in utilization rates of services during the first year will be reviewed. REVIEW PROCESS Summary data for patterns of service utilization during the first year will be collected. This data will be updated quarterly. There will be continuous monitoring of waiting list data. Surveys will be conducted annually. 7. CONSUMER CHOICE OF PROVIDERS WHAT TO MEASURE - KEY ISSUES To what degree has the MHASA provided consumers with a choice of providers? Has this been sufficient? Have problems arisen and if so what are they? Has the MHASA facilitated those consumers who choose to be served by a member of the EPN? METHODS OF ASSESSMENT - Review of procedures and policies and the degree to which they were implemented. A survey will be conducted of consumers who chose to utilize a member of the MHASA's EPN. REVIEW PROCESS An initial formal review of procedures and policies will be conducted. Thereafter, data and other information pertaining to consumer choice will be monitored continuously. Consumers choosing to use the EPN will be surveyed on an ongoing basis. There will be a formal annual survey of members of the EPN. Input from the EPN will be monitored on an ongoing basis. 8. PRIOR AUTHORIZATION (PA) SYSTEM WHAT TO MEASURE - KEY ISSUES How effectively was the prior authorization system implemented? Is it meeting its goal? What types of problems have been encountered? Are there changes that need to be made in the PA process? METHODS OF ASSESSMENT - Review of policies and procedures and actual implementation of prior authorization process will be conducted. Modifications made and reasons for modifications will be reviewed. Input on the prior authorization process will be obtained from program directors and practitioners within the MHASA and from members of the External Provider Network. Patterns of service utilization will be analyzed with comparisons made with available data on pre -capitation practices. REVIEW PROCESS Input from the first year's experience will be summarized retrospectively. Problems, trends, and issues in the prior authorization process will be monitored continuously using appropriate sources of input. 9. CLIENT RIGHTS AND ADVOCACY WHAT TO MEASURE - KEY ISSUES Are clients informed of their rights and do they understand them? To what degree was the complaint and grievance process implemented on a timely basis? It there evidence the complaint process is working as it should? 971083 Are consumers satisfied and treated with courtesy and respect during the complaint process? Are clients aware there is a customer representative? METHODS OF ASSESSMENT - Specific Measures and Indicators Consumer surveys of open clients and terminated clients will be conducted to determine if clients were informed of their rights and the degree to which they understood this process. A review will be conducted of the implementation and documentation of the complaint and grievance process policies and procedures. REVIEW PROCESS A formal review will be performed retrospectively for the first year and formally updated annually. There will be ongoing monitoring of the complaint and grievance process. Applicable surveys will be conducted at least annually. 10. EVALUATION OF THE EXTERNAL PROVIDER NETWORK (EPN) PAYMENT SYSTEM TO NON-MHASA PROVIDERS WHAT TO MEASURE - KEY ISSUES Has the payment to non-MHASA providers been accomplished on a timely basis? If not, what steps have been taken to correct this matter? What issues need to be addressed from the perspectives of the members of the EPN and the MHASA? METHODS OF ASSESSMENT - A survey of the External Provider Network will be conducted in 1996. The payment history to the EPN during the first year will be reviewed. REVIEW PROCESS Data and input for the first year will be reviewed. Ongoing monitoring of the system will take place thereafter. 11. APPROACH TO MANAGED CARE — INTEGRATED SERVICE ACCESS SYSTEM (ISAS) WHAT TO MEASURE - KEY ISSUES What are the perceptions of the effectiveness of the ISAS from the perspective of consumers, family members, community agencies, external providers, and MHASA staff? METHODS OF ASSESSMENT - Specific Measures and Indicators Consumers, community agency staff members, members of the External Provider Network, and MHASA staff will be surveyed to assess their perceptions of ISAS services. Data will be analyzed as it relates to service issues such as length of time between initial contact and intake. REVIEW PROCESS Surveys will be conducted at least annually, with the data being incorporated into the agency's planning process. Monitoring of trends and issues will occur continuously. 12. ROLE OF CONSUMERS AND FAMILY MEMBERS WHAT TO MEASURE - KEY ISSUES To what degree have consumers and family members been able to have input into the development and implementation of the capitation project? Have they been kept informed? Has their input been solicited? Have there been 971083 complaints and if so what are their nature? To what degree is the MHASA meeting the needs of family members? METHODS OF ASSESSMENT - Specific Measures and Indicators Surveys of family members will be conducted to obtain their perspectives on the development and implementation of the Capitation project. Informal feedback from family members and consumers will also be utilized. REVIEW PROCESS In addition to the surveys the Local Area Advisory Council meets during the year and is a source of input for the planning process. The Program Director of the Community Support Program attends meetings of the Greeley Alliance for the Mentally Ill. 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) for Placement Alternatives Commission (PAC) Funds Type of Action Contract Award No FY97-PAC-5000 (RFP-PAC-97005) X Initial Award _ Revision Contract Award Period Name and Address of Contractor Beginning 06/01/97 and A Woman's Place, Inc. Ending 05/31/98 Life Skills for Battered Women P.O. Box 71 Greeley, CO 80631 Computation of Awards Description Unit of Service The project will take an intensive and multi- faceted approach including 12 weeks of 7-8 hours of contact per week for up to a maximum of 15 total family units. Each week the client will receive 1-2 hours of individual counseling, and two group sessions. Cost Per Unit of Service The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal (RFP) and the Addendum RFP Information. The RFP specifies the scope of services and conditions of award. Except where it is in conflict with this NOFAA in which case the NOFAA governs, the RFP upon which this award is based is an integral part of the action. Special conditions Hourly Rate Per $ 35.71. 1) Reimbursement for the Unit of Services will be based Unit of Service Based on Approved Plan Enclosures: on an hourly rate per child or per family. 2) The hourly be for / ✓ ,Signed RFP; Exhibit A rate will paid only direct face to face contact with the child and/or family, as evidenced by client -signed verification form, and in iv/Addendum RFP Information; Exhibit B as specified the unit of cost computation. t/ Condition(s) of Approval 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. 4) Payment will only be remitted on cases open with, and referrals made by the Weld County Department of Social Services. 5) Requests for payment must be submitted to the Weld County Department of Social Services by the end of the third business day following the end of the month of service. Approvals: Program Official: E Bylieor By A S e . Baxter Board of Weld minty Date: Co • ` �i Co iss' � _ ��r'•�, �. ,t. Judy Weld Date: rteg ounty S 13 , Direct i r epartme 3/47 7 of Social Services 971053 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilingual/bicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 A Woman s Place, Inc. March 24, 1997 Pat Persichino, Director of General Services 915 10th Street March 27 & 28 P.O. Box 758 Greeley, Colorado, 80632 Bid Number: RFP-PAC-97005 through 97011 Dear Ms. Persichino: Information/Donations 351-0476 Executive Director 351-6950 Ft. Lupton Office 857-2642 Crisis Calls 356-4226 Domestic violence agency for Weld County I have enclosed our bid packet with six copies for The Life Skills Category. I based this year's bid proposal on our second year's experience. We have had a consist flow of PAC referrals in this second funding year, and we believe the groups are functioning well. Our staff and clients that have participated in this process believe that it is an effective and needed service. Our unit of service rate is higher than last year's based on the budget formula and some additional indirect costs. It looks more accurate for direct and indirect costs. I adjusted our number of family units to be served based on last year's clients who actually attended and completed the 12 week groups. Twelve women attended our groups in this funding period. We are receiving the Social Services referrals, but not all mothers are following through. We are calling all new referrals within a five day period to encourage their participation, and we are following up with pending cases. Sincerely, c.nJ /Y Sharon A. Mitchell Executive Director P.O. Box 71, Greeley, Colorado 80632 YfLl1W1 A United Way Agency P.O. Box 312, Ft. Lupton, l,Olora. o .21 INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97005 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 25, 1996, Tuesday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out -of -Home Placement (C.R.S. 26- 5.3-101). The Placement Alternatives Commission wishes to approve twelve month programs targeted to run from June 1, 1997, through May 31, 1998, at specific rates for different types of service, the county will authorize approved vendors and rates for services only. The Life Skills Program must provide services that focus on teaching life skills which are designed to improve household management competency, parental competency, family conflict management and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART B...Background, Overview and Goals PART C...Statement of Work Delivery Date (After receipt of order) VENDOR A Woman's Place, Inc. (Name) Handwritten Signature By Authorized Officer or Agent of Vender ADDRESS P.O. Box 71 TITLE Executive Director DATE PART D...Bidder Response Format PART E.. Bid Evaluation Process BID MUST BE SIGNED IN INK Sharon A. Mitchell TYPED OR PRINTED SIGNATURE PHONE # Greeley, CO 80632 (970) 351-6950 March 24, 1997 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 971083 RFP-PAC-97005 Attached A LIFE SKILLS PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97005 NAME OF AGENCY: ADDRESS: A Woman's Place, Inc. P.O. Box 71, Greeley, CO 80632 PHONE:( 974 351-6950 CONTACT PERSON: Sharon A. Mitchell TITLE: Executive Director DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills Program Category must provide services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household management competency. parental competency. family conflict management and effectively accessing community resources 12 -Month approximate Project Dates: Start June 1, 1997 End May 31. 1998 12 -month contract with actual time lines of: Start End TITLE OF PROJECT: Life Skills for Battered Women AMOUNT REQUESTED: 15 Families at $35.71/Hr. Name and Signature of Person Preparing Document Date 42.1-t_._r,-.J A tltO.Al w c_37,1 y/9 7 Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REOUIREMENTS Please initial to indicate that the following required sections are included in this proposal: Project Description >Ann Measurable Outcomes Staff Qualifications o Target/Eligibility Populations ,4r -' Service Objectives Unit of Service Rate Computation S4ri Types of services Provided Workload Standards Program Capacity per Month \tw Certificate of Insurance Date of Meeting(s) with Social Se ices Din, Supe isor: t — Comments by SSD Supervisor: Jt/ C1 C'��" Name and Signature of SSD Supervisor 24 3 ��-97 Date 971083 I. PROJECT DESCRIPTION: The LIFE SKILLS PROGRAM FOR BATTERED WOMEN is a project to empower battered women to escape the cycle of violence in their lives. The project will be available to women referred by the Weld County Department of Social Services due to the removal or imminent removal of their children from their care. Only women who are victims of domestic violence will be referred to this project. The project will take an intensive and multi -faceted approach including 12 weeks of 7-8 hours of contact per week for referred clients. Each week the client will receive 1-2 hours of individual counseling, attend two group sessions, including one two-hour BASIC LIFE SKILLS GROUP, one two-hour DOMESTIC VIOLENCE EDUCATION AND SUPPORT GROUP and the option of a one or two-hour scheduled ACTIVITY SESSION FOR MOTHERS AND CHILDREN as needed or requested by group counselor and/or children's counselor. There will be an ACTIVITY/COUNSELING GROUP FOR CHILDREN while their moms are in the two above groups. Women and their children who require safe housing could be housed at the safehouse during the first four weeks of this program (subject to availability of rooms). 1. BASIC LIFE SKILLS GROUP is based on LIFE SCHOOL CURRICULUM plus AFFECTIVE SKILLS CURRICULUM which addresses four key areas: interacting with others, enhancing self- awareness, realizing goals, and recognizing emotions. The group facilitator will assess and evaluate the clients needs and in what areas she feels inadequate. The program will then be structured to address those particular areas of needed and desired improvement. Skills enhancement could occur in such widely diverse areas of day-to-day life as how to prepare a workable budget on a limited income, how to shop for and prepare nutritious meals, how to fill out a job application, etc. This group will include both a formal (pencil and paper) and an informal assessment (interview) to frame needed topics.(SEE ATTACHED GROUP CURRICULUM) 2. DOMESTIC VIOLENCE EDUCATION AND SUPPORT GROUP is based on a social work curriculum, IN OUR BEST INTEREST and an other empowerment program model. This group will allow battered women to understand the dynamics of domestic violence and how it affects both the victims/survivors and their observing children. The group will a provide a supportive (and sometimes confrontational) venue for a battered women to begin the arduous task of extricating herself from the cycle of violence. A combination of groups and individual counseling has been shown to be the most effective approach to moving a battered women out of her victimization.(SEE ATTACHED GROUP CURRICULUM) 3. ACTIVITY/COUNSELING GROUP FOR CHILDREN will provide the children an opportunity to participate in creative activities, learn non-violent behavior and play, and express feelings in an appropriate way. The activities will be designed to reinforce the parenting skills and new non- violent behavior that their moms are learning in their groups.. The desired outcome from this group would be to work with the children, so they can deal with their reactions and issues due to abuse or observation of domestic violence and to strengthened the family unit. Additional scheduled child/mother sessions can provide an opportunity for mothers to utilize the parenting, communication, assertiveness, and other skills that they learn in individual / group counseling. (SEE ATTACHED GROUP CURRICULUM) 4. INDIVIDUAL COUNSELING will focus on both the emotional and practical skills required to maintain a healthy relationship with the rest of the family. These sessions will also offer women a time to process the impact of their two groups. Many issues arise in groups that can be handled in more depth in individual counseling. Issues that might be discussed could be the cycle of violence, effects of family violence on children, non-violent communication skills, assertiveness, loss issues, anger management or any other issues that could enable the client to become more personally balanced and more effective as a mother. 971083 DV Support Group - Ellenor/ Sharon B. Life Skills Group - Betsy or Maggie All mothers All mothers Listening skills Home safety Personal Health Dealing with emergencies Budgeting Nutrition Child and adult C a Cl) CO co C13 a E U a) a) 0) .0 Na N a) w < O OO a O C � a ,- t E ° a 0 CT L O) C C a) a a) a L O) C C a) a What is abuse - types/cycle/effects characteristics of male batterer and battered woman/why women stay Anger and anger management conflict resolution/ problem solving/ stress management "Family portraits/childhoods/tapes from childhood/drawings of childhood "Our Children"/issues/ affect of abuse How child views abuse/ meeting dream of motherhood Grief and loss/experiences of grief stages of grieving Feelings and how to deal with appropriately/guilt, anger, depression Learning about abuse through Positive thinking/irrational story telling, creative activities, beliefs/distorted thinking/RET/ and sharing experiences assertiveness vs. aggression Parent/Child Groups - Erin/Interns All Children/moms as scheduled a elf -esteem building activities/age appropriate and nurturing for 0+ ages. Conflict Resolution/non-violent play, problem solving, and discipline techniques/ based on age. Family and home drawings/role playing. Grief issues/anger issues with older children. Hygiene age appropriate Taking Care of Me/verbally illicit & reflect needs/fellings through play/activities/observation. Safety/ 911, appropriate touch, who to tell,/ what is safe? for appropriate age. Observation of inappropriate touch or play for all ages. Communication/model non- violent caring methods of interaction. Boundaries/Body Awareness a) r N CO V LL) (O I- 00 971053 Responsibility - needs, taking care of Setting goalsfinterpersonal self and children/boundaries relationships Self-esteem/Stress Management self-esteem/conflict manage- ment Wholeness/wellness iz run in me Kitchen/finger food, Healthy relationships/what is love? appropriate tasks and social Red flags -what to look and listen for interaction Discipline Methods/demonstrate non-violent approaches/redirect aggressive behavior to positive behavior. Observe and record inappropriate behavior. Anger management/ time out, talking it out, appropriate physical outlets O 1- < Y O L a W N U) (0 L a E a) a) N (6 i d C 4) O) L 4) L O D C (6 O) C C m Ca m a V) a) J O 0 C C O) O a) R) a C J O a U) C O O C 7 E E O O O) C_ D 3 E a) 4) N N 00. O U) O) 971083 II. TARGET/ELIGIBILITY POPULATIONS A. A Woman's Place staff will provide a combination of group and individual counseling services to 15 families which are headed by mothers who are victims of domestic violence and are identified and referred by Social Services at high risk for losing their children or have already lost their children. B. 15 total family units will consist of a mother and at least one child, birth to 16 years of age and all siblings. C. Same as B A sub -total of 2-3 clients will receive bi-cultural/bi-lingual services. Our bi-lingual / Mastered level Lead Counselor and Program Coordinator will supervise this program and provide counseling services. Our Case manager is also bi-lingual and has 12 years of case management experience. A sub -total of 1- 2 clients will receive services in South Weld County by our South Weld Coordinator who has an MA in Counseling, plus by our Lead Counselor/Program Coordinator and our Children's Coordinator who are in Fort Lupton one day a week. F. The monthly maximum program capacity will be 8 Family units. G. The monthly average capacity will be 3 Family Units. H. Average stay in the program will be 12 -18 weeks. Both groups are scheduled for 12 weeks and will be conducted in the same 12 weeks but on different days. The Children's groups will be conducted at the same time as the above two groups. I. The average hours per week in the program will be 8 hours. Mothers and their children, if in the home, will spend 4 hours in their 2 respective groups weekly, plus up to 4 hours individual counseling, family sessions, or case management. 971083 III. TYPE OF SERVICES TO BE PROVIDED A. Teaching, modeling, demonstrating, and coaching as an interactive process with the clients. Life Skills For Battered Women will be taught in three types of interactive groups: 1) Basic Skills Group, 2) Domestic Violence Education and Support Group, and 3) Activity/Counseling Group For Children. The Basic Skills Group will teach the following skills: listening, home safety, personal health, dealing with emergencies, setting goals, establishing healthy relationships, conflict resolution, and stress management. Activities will include role playing, problem solving, demonstrating new behaviors and concepts, practicing skills in the group setting, and coaching each other in mastering newly learned skills. The Domestic Education and Support Group will focus on teaching what domestic violence is, the types of abuse, the abuse cycle, characteristics of victims and batterers, red flags of unhealthy relationships, why women stay, assertiveness, positive thinking, anger management, responsibility, how to deal with grief issues, how to establish good boundaries and good relationships. Group activities will also include role playing, demonstrating new behaviors and concepts, modeling appropriate behavior, problem solving, and coaching each other in applying newly learned skills. The Activity/Counseling Group For Children will be reinforcing and modeling the parenting and disciplinary skills as well as teaching and modeling good communication skills, appropriate behavior, and boundaries. They will be coached on their newly learned skills. Children will be observed for behavioral, mental, and physical symptoms in all age groups. Training in household management, including budgeting, cleaning, maintenance, purchasing, menu planning, food preparation, etc. Basic Skills Group will focus on budgeting, shopping wisely, menu planning, preparing nutritious food, cleaning, household safety, and time management. The clients will get hands on training and will have group time to practice and illustrate newly learned or enhanced skills. C. Teaching child rearing and discipline; parenting. The Basic Skills Group will focus on parenting skills and discipline using the STEP and Nurturing Programs' tools of natural and logical consequences, identifying the goal of misbehavior, disciplining with love, age appropriate boundaries and behavior, good family communication skills, etc. The Activities/Counseling Group For Children will also be modeling and reinforcing parenting skills and discipline. There will be family sessions available to practice new skills in parenting, communication, non-violent behavior, and conflict resolution to strengthen the family unit. D. Teaching how to establish community linkages/advocacy, and making use of services. Basic Skills Group will teach, demonstrate, and role play how to use the phone book and access community and government services. In the Domestic Violence Education and Support Group, the facilitator will reinforce taking responsibility and following through on goals for self-sufficiency. In the Activity/Counseling Group For Children, the children's coordinator will teach and role play children accessing 911 and other needed resources for their safety. Our case manager will also assist clients to access appropriate resources and to follow up. Individual counseling sessions will 971083 include support, encouragement, and coaching for doing these activities as well. E. Demonstrating nurturing/esteem role -modeling. The group facilitators, children's coordinator, case manager, counselors, and other staff will emphasize and model nurturing, non-violent, and esteem building behavior in all group and individual sessions as well as in case management and in other services. QUANTITATIVE MEASURES (as they directly relate to each service) Total Number to be served up to 12 mos. w/ children in their home 2a. 9 2b. 9 2c. 9 2d. 9 2e. 9 and/or Total Number to be served up to 12 mos. w/children in out -of -home 2a. 6 2b. 6 2c. 6 2d. 6 2e. 6 971083 1V MEASURABLE OUTCOMES A. Improvement of household management competency as measured by pre and post assessment instruments. Pre-test based on the the Life School Curriculum in the areas of Consumer Economics/Household Management. The Pre-test will ask open ended questions to access the client's current knowledge on budget, shopping, menu planning, nutrition, cleaning, home safety, time management, etc. An essay/problem solving Post-test will be administered at the end of the 12 week group to assess skills/competencies mastered. On going ranking of skills mastered will be done by a facilitator at each session. On going role playing and problem solving in groups will help assess mastered skills. Pre and Post needs and competency assessment interview with group facilitators or individual counselor as assigned. B. Improvement of parental competency as measured by pre and post assessment instruments. Pre-test based on the Affective Skills Curriculum, STEP and Nurturing Parent Programs. The Pre-test will ask open ended questions on the above programs to assess client's skill level. These skills will also be ranked each session by a facilitator. Role playing and problem solving activities will also be on going in the groups to assess skills mastered and ability to apply. An essay or open ended Post-test will be administered at the end of the 12 week group to assess knowledge learned and to assess ability to apply newly learned knowledge and tools. Pre and Post needs and competencies assessment interview with group facilitators or individual counselor as assigned C. Parents can independently work with other sources in the community and within the local, state, and federal governments. Pre-test based on Life School Curriculum in the area of Community Resources/Government and law. Problem solving and role playing in groups to apply skills to access resources and to assess what skills are mastered. An essay and open ended Post-test will be administered after the completion of 12 week group to assess competencies mastered. Pre and Post needs and competency assessment interview with facilitator of Basic Life Skills Group and/or individual counselor assigned. D. Families receiving life skills services will remain intact six months after discharge of services. At least 80% of families(12) will show measurable progress in all areas (3a. -d) and will remain intact six months after completing the 12 week program. E. Families/participants who complete the Life Skills Services will have improved competency level or reduced risk on standardized assessment, such as the risk assessment tool. A mid -point evaluation with clients and facilitators to assess if curriculums are meeting 971083 the needs of the clients. If not, staff will adjust the curriculum to meet the needs. A final written assessment at the end of 12 weeks of group participation to assess skills mastered and what coping skills were learned to lower risk factors. (NEW) A client satisfaction survey will also be administered at the end of the 12 week group on services delivered and professionalism of staff. QUANTITATIVE MEASURES ( as they relate to the described measurable outcomes) Total Numbers 3a. 15 ( pre and post testing, ongoing activities and ranking in groups to assess application and progress) 3b. 15 ( pre and post tests, problem solving, role playing etc. to assess mastered skills and to assess application of new tools.) 3c. 15 ( pre and post tests, hands on activities to practice assessing needed resources) 3d. 15 ( must be a minimum of 80% of total individual/family services) 3e. 15 ( final written assessment of what coping skills have been mastered to lower risk factors) All measurable outcomes are recorded in the progress notes and case management notes of each client. 971083 SERVICE OBJECTIVES A. Improve Household Management Competency -capacity of parents to provide safe household environment for their children through competent household cleaning, maintenance, budgeting, and purchasing. Combining two curriculums for a multi faceted approach to household management techniques and practical applications to foster competency in the area of safety, household cleaning and maintenance, nutritious food planning and purchasing, budgeting etc. B. Improve Parental Competency -capacity of parents to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision. Combining three parenting curriculums for structured instructional and interactive activities such as problem solving, role playing, demonstrating, modeling, coaching, practicing, etc. to enhance parenting skills and mother/child relationship skills. C. Improve Ability to Access Resources -services shall assist parents to work with other sources in the community and the local, state, and federal governments Educate on available and appropriate resources, coach and encourage clients to to access and follow up on community resources, including local, state, and federal governments. In groups, role play, model, demonstrate, problem solve, etc. QUANTITATIVE MEASURES ( as they relate to the described objectives) Total Number 4A. 12 franking of skills mastered in each group, role playing and problem solving to assess application of new skills/tools, and open ended/essay post test to assess skills mastered) 4B. 12 (ranking on parental skills/tools progress, role playing, problem solving ability, and an open ended or essay post test to assess learned skills mprovement) 4C. 12 (ranking on accessing community and government resources, problem solving and follow through abilities, an essay post- test to assess learned knowledge and application of skills/tools) 971083 VI. WORKLOAD STANDARDS A. Number of hours per day, week, or month. A client can receive 8 hours of group and individual services a week and up to 32 hours of service per month. The services include 4 hours in the 2 groups weekly plus up to 4 hours a week for individual counseling, family sessions, and case management. B. Number of individuals providing services. Five staff members will provide direct services: 3 Group Facilitators for the two groups( there are co -facilitators for the Domestic Violence Education/Support Group), 1 Children's Coordinator for the Children's Counseling/Activity Group, and one Case Management person. One co -facilitator is bi-lingual and the case management person is bi-lingual. If we have South Weld County clients, our Mastered level Coordinator/Counselor in South Weld County will fill in for one of the above co -facilitators. These staff members also provide indirect services by doing advocacy, referral and follow up, progress notes and other paper work that is directly related to the client Four additional staff members provide indirect services in supervision, paper work, evaluation, curriculum revision to meet the needs of the clients, etc. This staff involves the Director and Administrative Assistant from A Woman's Place and two staff people from Right To Read, the Director and the Curriculum Coordinator. Total Staff Providing Services 9 (5 direct /indirect and 4 indirect only) C. Maximum caseload per worker. A maximum caseload of 8 family units per staff member with as many as 4 to 5 different staff members working collaboratively with an individual family. D. Modality of treatment. Provide agency based education / support groups, individual counseling, advocacy, and case management to empower, educate, model, and support healthy and appropriate behaviors, and monitor and evaluate a family's progress. E. Total number of hours per day/week/month. A client may receive 1 to 2 hours of services a day if needed, 8 hours weekly with 2 groups, family sessions, individual counseling, advocacy, and case management services, and a total of 32 hours a month. Total number of individuals providing these services. Refer to B above. A total of 9 staff persons. 971083 G. Maximum caseload per supervisor. Supervisor will oversee the maximum of 8 caseloads, but only have the responsibility of a caseload of 4 for individual services. H. Insurance. Please refer to our Certificate of Insurance that outlines our coverage for general liability that is attached. 971083 ACOJED. CERTIFICATE OF INSURANCE " CSR RM ,: .. DATE IMM/DDm „WOMATF.1, .. 03/24/97 rRGDucER Boulder Insurance Assoc., Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND on ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1601 28th Street CO 80301 COMPANIES AFFORDING COVERAGE , Boulder p3-444-4443 urea. — COMPANY A Nonprofits Mutual Risk rnmeue_ _ INSURED COMPANY B Executive Risk Specialty, Inc. Inc. COMPANY C A Woman,. Placa, PO Box 71 Greeley Co 80632 COMPANY D COVERAGES "" ,.. 7. .:i .i:.' , THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE INDICATED, NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EXCLUSIONS AND CONDITIONS. OF SUCH POLICIES. LIMITS SHOWN MAY HAVE I. >: , ,. ':,: ' ......-.: BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BEEN REDUCED 9Y PAID CLAIMS. ._ CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY V ICED/a DATE Pima:NNW( POUCT EXPRATION DATE IMM/DOMI OMIT! -171. GENERAL. AGGREGATE 7 e 1, 000, 000 GENERAL LIABILITY MGL97 C01355 03/01/97 03/01/95 PRODUCTS• COMPIOPAGO 11,000,000 A X COMMERCIAL GENERAL LIABILITY PERSONAL& AOV INJURY 01,000,000 (CLAIMS MADE )C OCCUR 01,000. 000 PROT EACH OCCURRENCE OWNER'S & CONTRACTOR'S RAE DAMAGE Any one MR $ S 0 , 0 00 MED CM (Any one (Aoon) 4 5,000 AUTOMOBILE LIABILITY MOL97C01355 03/01/97 03/01/98 COMBINED SINGLE LIMN 0 $1,000 a 000 A _ -^- ANY AUTO ALL OWNED AUTOS - BODILY INJURY (Per w,wnl X SCHEDULED AUTOS HIRED AUTOS AUTOS BODILY INJURY IPc, eecldontl $ NON -OWNED - PACKET,/ DAMAGE e AUTO ONLY • EA ACCIDENT 0 GARAGE UABIUTY : OTHER THAN AUTO ONLY: .... �. ANY AUTO EACH ACCIDENT 0 —•' AGGREGATE $ MAMMY EACH OCCURRENCE 0 EXCESS FORM AGGREGATE I UMBRELLA OTHER THAN UMBRELLA FORM I WORANIR COMPENSATION AND 7 STATUTORY LIMITS EMPLOYERS' LIABRITY EACH ACCIDENT 0 THE PROPRIETOR/ I INCL DISEASE • POLICY LIMIT 0 PARTNERS/EXECUTIVE OFFICERS ME: I EXCL _ DISEASE • EACH EMPLOYEE I A OTHER Property 234T770 03/18/97 _ 03/01/98 DESCRIPTION OF OPERAIIONAOCATIONS/VEHICLES/SPECIAL IIEYRS B) Directors A Officers 7510003456 03/01/97-98 $1,000,000 Rae Placement Alternative Commioion Grant CERTIFICATE HOLDER , >r ,'? ' :';CANCELEAtlOH WEI.13C01 '.::':'.1 ;:° ` ;? SHOULD ANY OF THE ABOVE (*SCAMPI POLICIES SE CANCELLED !MORE THE EXPIRATION HATE THSRSOF. THE rctOINO COMPANY WEL ENDEAVOR TO MAR 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Weld County Social Services P 0 BOX A RUT FAMINE TO MALSUICII NOTICE SHALL IMPOSE NO OPERATION OR LIASIUTY OF ANT RIND UPON THE COMPANY, ITS AGENTS OR ?IVES. Greeley, Co 80632 . AUT O RFS ( T If (\�/l '... ••e. . p CORPORATION 1993 97.1082 VII. STAFF QUALIFICATIONS A. The 5 staff members who are providing direct/indirect services exceed the experience qualification. A bi-lingual, mastered level staff person will supervise the program and staff. She has a Masters in Rehabilitation Psychology and has worked at the Safehouse for a total of 5 years, and she will be one of the co -facilitators of the Domestic Violence Group. The Basic Skills Group Facilitator has a Masters in Education/Gifted and Talented. The Children's Coordinator who will conduct the Children's Activity/Counseling Group has a BA in Psychology, and she has had experience with A Woman's Place, as a crisis line volunteer. The other group facilitator for the Domestic Violence Group has a Masters in Agency Counseling and has had years of experience in private practice with abuse issues. Our Case Management person has 2 years of college and 12 years experience in case management plus 3 years experience at A Woman's Place. Coordinator/Counselor in South Weld County who has a Masters in Counseling and 17 years experience will fill in for one of the above Domestic Violence Group Facilitators when we have a South Weld client. Our bi-lingual staff is also available to South County clients. The 4 staff involved in providing indirect services have a B.A. in Administration of Community Programs, a B.S. in Business Administration, a B.S.W./CSU, and a person with more than 2 years of accounting/non-profit experience. B. TOTAL STAFF 9 Program Capacity per Month A combination of group and individual counseling services will be provided to a total of fifteen families. We have the capacity to serve 8 families monthly up to 32 hours of service per family. Our actual monthly capacity has been 3 to 4 families a month for 6-8 hours of service weekly per family (24-32 hours a month). For more detail on this, please refer to II. Target/Eligibility Populations section of this grant. 971083 RFP-PAC-97005 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. For different services the provider can request different direct service rates. An average rate can be used or a separate rate can be used for each type of service. Service rates may also be stated as a fixed amount for an assessment, court appearance, etc. If so completing this section would not be necessary. Service rates can be stated on a daily basis, as opposed to an hourly amount. Direct Time (Per Month) 1. Direct client contact Indirect Time 2. Completion of Paperwork 3. Travel 4. Court Appointments 5. Vacation 6. Sick Leave 7. Case management 8. Other Supervision 9. Subtotal 10. Total Time Available Per Month 11. Ratio of Direct to Total Time 27 Hours 43.33 17.33 9.75 27.08 70.41 (Sum of 1-8) 61 .54% (1/10= 11) 971083 RFP-PAC-97005 Attached A IX. RATE COMPUTATION Service Costs Direct Costs Salary Benefits Subtotal Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal Agency Overhead Rent Utilities Supplies Postage Travel Telephone Equipment Data Processing Other Total #ofEs Overhead Per Employee Overhead Per Total Hours 4,835.43 790.38 5,625.81 Total Total Direct Monthly Hourly Rate Hourly Rate 9.30 21.46 1.52 3.51 10.82 24.97 Direct Time % of Time Charge 1.0 21.46 1.0 1.0 3.51 24.97 4,617.54 13.20 30.46 .0975 2.97 457.84 9,088.07 1,209.51 15,372.96 1,000. 458. 146. 100. 167. 733. 83. 2,400. 5,087. 10.76 473. 2.73 1.31 3.02 .0975 .29 10.47 24.16 1.39 3.21 26.37 60.85 Direct Service Rate (Hourly) (Daily if appropriate) .1733 .1733 4.19 .56 8.01 2.73 35.71 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. ft 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. 28 971083 AOIMO. CERTIFICATE OF INSURANCE CSR RM WOMAP-1 DATEIMM/DDNYI 03/24/97 PRODUCER Boulder Insurance Assoc., Inc. 1601 28th Street THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE*ELOW. Boulder CO 80301 COMPANIES AFFORDING COVERAGE,: T..) Phone No. 303-444-4443 Fax No. s -: COMPANY P A Nonprofits Mutual Risk N r1 1 T, INSURED ('J G��+`��-' 1.J7 COMPANY B Executive Risk Specialty, -.We.< A Woman's Place, Inc. RT% 4 4(J (J 199 I MI 2 I T: COMPANY t>.) C PO Box 71 Greeley CO 80632 #Pages COMPANY — - J7 CO COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DONT) POLICY EXPIRATION DATE IMM/DONYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL lCLAIMS MADE LIABILITY X OCCUR MGL97C01355 03/01/97 03/01/98 GENERAL AGGREGATE $ 1,000,000 PRODUCTS-COMP/OP AGO 81,000,000 PERSONAL & ADV INJURY $ 1,000,000 EACH OCCURRENCE 81,000,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) 8 50,000 MED EXP (Any one person) 6 5,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS MGL97CO1355 03/01/97 03/01/98 COMBINED SINGLE LIMIT S $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident)X 8 PROPERTY DAMAGE S GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT 8 OTHER THAN AUTO ONLY: EACH ACCIDENT 8 AGGREGATE 8 EXCESS UABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE 8 AGGREGATE $ 6 WORKERS COMPENSATION EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE: AND INCL EXCL 1 STATUTORY LIMITS EACH ACCIDENT S DISEASE - POLICY LIMIT S DISEASE - EACH EMPLOYEE 8 A OTHER Property 234T770 03/18/97 03/01/98 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS B) Directors & Officers 7510003456 03/01/97-98 $1,000,000 Re: Placement Alternative Commision Grant CERTIFICATE HOLDER WELDC01 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Weld County Social Services BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR RE TIVES. P O Box A Greeley, CO 80632 ACORD 25-S (3/931 AUT O C6R PRESET T S RD CORPORATION 1993 in 4 (10 A Woman's Place, Inc. May 2, 1997 Judy Griego, Director Weld County Department of Social Services P.O. Box A Greeley, CO 80632 Dear Ms Griego: Information/Donations 351-0476 Executive Director 351-6950 Ft. Lupton Office 857-2642 Crisis Calls 356-4776 Domestic violence agency for Weld County In response to your letter that I received on April 28, 1997 regarding our PAC bid, I have added the following information that hopefully will clarify your concerns, and I have enclosed copies of the tools we use for assessment, progress, and evaluation. Proposed program evaluation: Each client takes a pre-test for the Basic Life Skills Group and a pre-test for the Domestic Violence Group as part of their initial interview with a counselor. After a client completes each twelve week group, she takes a post test to measure her total progress. In each group session, mastery of skills and ability to apply newly learned skills are assessed by role playing and other problem solving activities. Also a group progress sheet is completed on each client for every group attended. In individual counseling sessions, progress notes are written and placed in the client's file. A new client satisfaction survey has been developed to assess the client's perspective of the program content, process, and if her goals were met in the twelve week groups. In the Children's groups, the Children's Coordinator assesses the child's behavior, writes progress notes on each group session, and works with the mother and her child/children to strengthen family skills. After each twelve week cycle, all staff involved in this program evaluates the curriculum, process, and tools for revision. See attached tools. Initiate service interventions within five working days: Our staff is committed to the PAC program, and they have been responding to the P.O. Box 71, Greeley, Colorado 80632 A United Way Agency P.O. Box 312, Ft. Lupton, Colo 971083 caseworker or client within five working days to begin direct services. Periodically, a client does not respond or cannot be reached within the five working days. If this is the case, our staff contacts the caseworker by the end of the five working days. Our philosophy is that the client has to be motivated and follow through for program success; therefore, we do allow time for the client to contact us first within the five working days' period. South Weld Services: If a South Weld PAC referral cannot attend the twelve week groups in Greeley, she can meet with our South Weld Coordinator/Counselor in Fort Lupton and meet the program goals of both groups as well as receive individual counseling. The South Weld Outreach Office is open from Monday -Thursday weekly, and there is a domestic violence support group on Wednesday evenings. Children can receive the services they need on Wednesdays when our Children's Coordinator is in Fort Lupton conducting child individual sessions and the children's group. South Weld clients will receive services from both South Weld and Greeley staff as needed for program requirements. One South Weld client was successfully served in Fort Lupton in this past funding year. Sessions were set up when she had available transportation. Proposed provision for transportation, including South Weld County: The two twelve week groups are conducted when public transportation is available, and staff has assisted a client occasionally with a transportation need. Normally, we do not transport women to our services or other agencies; yet we will work with them on their schedules and transportation needs. As stated above South Weld sessions are set up for clients when they have available transportation. Daycare for children is not an issue because we provide the children's groups while the mothers are in their groups. If you need more information or have any questions, please call me at 351-6950. Thank you! Sincerely, Sharon A. Mitchell Executive Director 971083 NAME DATE FAMILY PRESERVATION PROGRAM LIFE SKILLS - RRWC REVISED PRE/POST TEST -- DRAFT -- 3/1/96 Use the ads attached to answer the next two questions. Circle the letter by the best answer. l Which store has the better buy on apples? a. U -Save Food Store b. Red Flower Foods c. Apples cost the same at both stores Good as Gold is a name brand sou buy? p Red Flower soup is a store grand. Which is the better a. Red Flower, because store brands cost less b. Good as Gold c. Both soups cost the same 3. You are buying something. with a shelf date. Which should you buy? a. one with today's date b. one with the date farthest in the future c. one with the date farthest in the past jThe label on a can of juice drink lists these ingredients in this order: water, sugar. orange uice. What is the main ingredient? 5. How much sales tax do you pay where you live? percent Read Anna's medicine label to answer the next three questions. 6. How often should Anna take this medicine? How long should Anna take this medicine? 8. When will this medicine be too old to take? 19 Park Pine_ DOW/WOW/1, OR CHOICE DRUGSTORE 555— 6422 Nc. - C-= tall=: Take entire Pc_.;riliir VK 7--t ES Use Eercre: 9/84 971083! ***** it NAVE MO N ***;; Dairy VVay BUTTER .81 Frozen CARROTS 530 :n butter 10 oz. Good as Gold n9 0 Noodle AC Soup. U -SAVE COOKING OIL 1 G ti*a Red Flower Foods i _ Specials! Red Flower Noodle Soup 2 cans`cr 59°I fresh CARROTS one pound 5-_ i REVISED PRE/POST TEST -DRAFT-- pg2 9. List some of the basic needs of children. 10. List ways you can help your child succeed in school. I1. What do you do when your child misbehaves at home? 12. List ways you communicate with your children in a positive way. Read the label for COLD -AWAY TABS. Fill in the blanks with numbers. COLD -A 33: TABS DOSAGE: ADULTS -2 tablets every 4 hours as needed. Do net exceed 8 tablets in 24 hours. CHILDREN 6-12 — 1 tablet every 4 hours as needed. Do not exceed 4 tablets in 24 hours. Unless directed by a physician, do not give to children under 6. 13. Maria is 14. She may take tablet(s) at a time. 14. Children 6 to 12 should not take more than tablets in 24 hours. 15. Children under should not take this medicine unless a doctor says so. 971083 REVISED PRE/POST TEST —D RAFT-- pg3 16. Fill out this check completely. Pay $25.73 to Cheryl's Hardware for a stepladder. I W. I. R. S. RIGHT -TO -READ 1211 A STREET 352-9477 CREELEY, COLORADO 80631 1080 19 Pay to the order or Greele a IFor "Do 2E51i' 1:10700035EI: 12191E100to KER61IT C. HUCKABAY - TREAS. 1226 82-35 1070 Dollars 1". List three qualities ofa good listener. 18. What are three ways to chiidproof your kitchen? 19. For how long should you leave your baby unattended? 20. What is aerobic exercise? 21. How often do you do a breast self-examination? 22. What phone number do you call in an emergency? 23. What is a balanced household budget? 24. List the five basic food groups. 25. How do you know how large a serving of cereal to give to your child? 26. List two ways you can save money at the grocery store. 27 Where are the emergency phone numbers .listed in the telephone book? 971083 REVISED PRE/POST TEST -DRAFT-- pg4 28 What information is in the blue pages of the telephone book? 29. What are two of your short-term goals? 30. What are two of your long-term goals? 31. Write one example of each of the following types of behavior Submissive behavior Aggressive behavior Assertive behavior 32 List three signals you get when you are feeling angry. 33. List three ways you control your anger. 34. What is self-esteem? 35. List two ways you show your self-concept to others. 36. Give an example of an "I" message. 37. List four ways to deal with stress. 971083 FAMILY PRESERVATION PROGRAM DOMESTIC VIOLENCE SUPPORT GROUP PRE/POST TEST Please complete each question. 1. What is physical abuse? 2. What should you do when you become angry with someone? 3. How does abuse (domestic violence) affect children? 4. Explain how any loss produces a grief situation. 5. Name three feelings. 6. Give your definition of asstertiveness. 7. Give your definition of aggressiveness. 8. What is your definition of a boundry? 9. Name three ways of taking care of yourself. 10. Which of the following is true? a. lower class women get battered more than upper class. b. If you are a minority you get battered more. c. Battered women are uneducated and have few skills. d. Battered women are found in all levels of race, education, and income. 971083 re, - 11. Is love an emotion? Please explain your answer 12. How do you feel when you say goodbye? 13. What is love? your own definition. 14. Which of the following is true? a. Marriage is forever. b. Women need to keep the family together. c. Women should obey their husbands. d. Drinking causes men to batter. e. all of the above f. none of the above 971083 GROUP PARTICIPATION PROGRESS NOTES Name Session Date Group Type Topic I. Participation I 2 3 4 5 N/A 2. Interest I 2 3 4 5 N/A 3. Homework I 2 3 4 5 N/A 4. Grasp of Topic I 2 3 4 5 N/A 5. Conscious Raising I 2 3 4 5 N/A 6. Proactivity I 2 3 4 5 N/A 7. Growth I 2 3 4 5 N/A 8. Support of Others I 2 3 4 5 N/A 9. Crisis Level I 2 3 4 5 N/A NOTES: 971083 CLIENT # CLIENT NAME COUNSELOR CAP FORMAT: C: Client issue (what the client says the problem or situation is) A: Assessment (what you observe about client's appearance and/or affect) P: Plan of action (next steps client plans to take) DATE NOTES COUNSELING NOTES 971083 Child Intake Form Date: Name of Counselor: Name of Child: Age: Date of Birth: Name of parent/guardian: Preinterview Counselor Checklist [ ] The child understands intake procedures. [ ] Issues of confidentiality and mandatory reporting were discussed with the child. Introduction I. How do you feel about coming here today? School 2. Which school do you go to? _ 3. What is your teacher's name? 4. What do you like best about school? 5. Is there anything you don't like about school? Interpersonal Relationships (Friends) 6. Do you have friends at school? 7. Do you have friends that you can play with at home? 8. Do you have a best friend? What do you like to do with your best friend? 9. What do you do when you get mad at your best friend or one of your other friends? 10. Do you ever play by yourself? What do you like to do? Interpersonal Relationships (Family) 11. Tell me the names of everyone in your family: 971083 12. Who lives at home with you? 13. Where does everyone sleep? 14. What do you like to do with your family? 15. Who in your family do you like to be with a lot? Why? 16. When you feel worried, sad, or scared, who in your family do you tell it to? Do they help you? 17. Is there anyone in your family you don't like to be with sometimes? (explore who and why) Self -Concept 18. Name two things you like about yourself or that you are good at: 19. If you could be any age at all, what age would it be and why? Feeling States 20. What is the happiest time you remember? 21. What is the scariest thing that happened to you? 22. What did you do when you got scared? 23. What is the saddest thing that ever happened to you? 24. What sorts of things do you get mad about? 25. What do you do when you get really mad? 971082_ Child Abuse 26. When you break something at home or don't do what your mom tells you to do, what happens? 27. Sometimes children tell me that they get hurt by people who care about them? Has this ever happened to you? (explore carefully) Violence Witnessed by the Child 28. We know that fighting happens in a lot of families. All of the children who come here have heard or seen their parents ( or mom and her partner) fight. Can you tell me what you remember about the fighting in your house? 29. What do you do when they fight? 30. How do you feel when they fight? 31. Why do you think they fight? 32. Some children tell me that they think fighting is their fault. Have you ever thought this before? (explore) 33. Do your brothers and sisters ever get hurt? (Explore who, how , when was the last time) We are almost finished. I have a few fun questions to ask you, and then you can ask me any questions you want. Fantasy 34. Sometimes it's fun to pretend we're an animal. If you could be an animal, what would you be? Why? 35. Let's pretend that you could have three wishes. What would you wish for? 1. 2. 3. 971063 Conclusion 36. Do you have any questions for me, or is there anything that you are wondering about? Interviewer Comments/ Observations 971083 Parent Interview Form Date: Name of Parent/Guardian: Name of Child: Name of Counselor: Preinterview Counselor Checklist [ ] The parent is informed on the agency's philosophy and programs. [ ] The parent understands intake procedures. [ ] Issues of confidentiality and mandatory reporting were discussed, and the parent has signed a Permission to Treat Minors Form. Family Relationships 1.. Who is in your family (name, age, gender)? 2. What is your current relationship status (legal, living, and custody arrangements) from the child's other parent? 3. Are you divorced or separated from the child's other parent? yes no When did you separate/divorce? How old was your child at the time? 4. Does your partner/ex-partner have visitation and does he/she consistently use this privilege? Are these arrangements suitable for your child? 5. Describe your child's relationship with your ex -partner: 6. Describe your relationship with your child: 7. Describe your child's relationships with his/her siblings: 8. How is affection shown in your family? 971083 9. How is anger shown in your family? Child Behavior and Relationships 10. How would you describe your child's main characteristics (include strengths and weaknesses)? 11. Regarding the following, how do you know when your child is: afraid: angry: physically hurt: sad: feels fine: 12. How does your child resolve conflicts with other family members? 13. How would you describe your child's relationship with friends/peers? 14. How does your child resolve conflict with peers (negotiates, withdraws, yells, hits)? 15. Tell me about the way your child plays (what type of activities, plays alone, with others): 16. Tell me about your child's school performance (academic achievements and problems): Parenting 17. How do you/did you discipline your child? 18. How did your ex -partner discipline your child? 971083 19. What would you like to change about the way that you parent? Violence Directed at Child 20. Do you have any suspicions or concerns that your child has been sexually touched or abused? • yes no Why? 21. Do you have any suspicions or concerns that your child has been physically abused? yes no Why? 22. Do you have any suspicions/concerns that your child has been emotionally abused? yes no Why? 23. Has Child Protection Services intervened with your child? yes no Explain: What requirements has CPS imposed on the parents? 24. Has your child been involved in a counseling or family violence program before? 25. Do you have any worries that your child is self -injurious? Violence Witnessed by Child 26. Describe abusive behavior that has occurred between you and your partner since your child's birth: 971083 27. What is your most memorable incident of abuse, between your partner and yourself, that you believe that your child heard or witnessed? 28. Have you talked with your child about the violence/abuse in your family? 29.. How do you think that your child has been affected by the violence/abuse in your family? 30. Has your child witnessed any other violent and/or abusive events inside or outside the family? 31. Beyond violence, has your child experienced any traumatic events throughout his/her life? Summary 32. What do you think will be most helpful in dealing with the concerns that you raised about your child? 33. Is there anything else about your child that you would like us to know? Interviewer Comments/Observations 971083 PAC/FAMILY PRESERVATION CLIENT SATISFACTION SURVEY 1. What session/sessions helped you the most in the Basic Life Skills group? Please give examples. 2. What session/sessions helped you the most in the Domestic Violence Group? Please give examples. 3. What needs were not met for you in the Basic Life Skills Group? Please be clear or give examples. 4. What needs were not met for you in the Domestic Violence Group? Please be clear or give examples. 5. What changes would you like to see in either group? 6. Did the staff help you meet your needs? 7. Any other comments that you would like to add? 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilingual/bicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) for Placement Alternatives Commission (PAC) Funds Type of Action contract Award No X Initial Award FY97-PAC-6000 (RFP-PAC-97005) Revision Contract Award Period Name and Address of Contractor Beginning 06/01/97 and Child Advocacy Resource & Education Life Skills - Family Advocate Program 814 9th Street Greeley, CO 80631 Ending 05/31/98 Computation of Awards Description Unit of Service The program is a very intensive home -based intervention program. Each family would be provided with 2 to 50 hours per month of Life Skills Training. Approximately 154 clients in the 12 month program, up to a maximum of 50 total family units, (for approximately 38 weeks). cost Per Unit of Service The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal (RFP) and Addendum RFP Information. The RFP specifies the scope of services and conditions of award. Except where it is in conflict with this NOFAA in which case the NOFAA governs, the RFP upon which this award is based is an integral part of the action. Special conditions 1) Reimbursement for the Unit of Services will be based on an hourly rate per child or per family. 2) The hourly rate will be paid for only direct face to face contact with the child and/or family, as evidenced by client -signed verification form, and as specified in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. 4) Payment will only be remitted on cases open with, and referrals made by the Weld County Department of Social Services. 5) Requests for payment must be submitted to the Weld County Department of Social Services by the end of the third business day following the end of the month of service. Hourly Rate Per $ 28.19 Unit of Service Based on Approved Plan Enclosures: Signed RFP; Exhibit A Addendum RFP Information; Exhibit B i..7--Condition(s) of Approval Approvals: By i- l Program By Official: eorge . Baxter Board of W IdCounty — Date: 0�o?g�°}7 sm t.;" II� FN�1l Judy Wel Date: Gri , Direct ount epartme t of Social Services 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilingual/bicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 INVITATION TO BID DATE: February 5, 1997 RETURN BID TO BID NO: RFP-PAC-97005 Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 Request for Proposal (RFP-PAC-96005) for: SUMMARY Family Preservation Program --Life Skills Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 25, 1996, Tuesday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out -of -Home Placement (C.R.S. 26- 5.3-101). The Placement Alternatives Commission wishes to approve twelve month programs targeted to run from June 1, 1997, through May 31, 1998, at specific rates for different types of service, the county will authorize approved vendors and rates for services only. The Life Skills Program must provide services that focus on teaching life skills which are designed to improve household management competency, parental competency, family conflict management and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART B...Background, Overview and Goals PART C...Statement of Work Delivery Date (After receipt of order) VENDOR Child Advocacy Resource and Education Inc. (Name) PART D...Bidder Response Format PART E...Bid Evaluation Process ADDRESS 814 9th St. Greeley CO 80631 PHONE # 970 - 356 - 6751 BID MUST BE SIGNED IN INK Gwen m. Schooley, MA TYPED OR PRINTED SIGNATURE D Mil Han tten Signature By Authori Officer or Agent of Vender TITLE Coordinator of Advocate Programs DATE March 94, 1g97 The above bid is subject to Terms and Conditions as attached hereto and incorporated. I 971083 REP -PAC -97005 Attached A LIFE SKILLS PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97005 NAME OF AGENCY: Child Advocacy Resource and Fduratinn 1Nr ADDRESS: 814 9th St. Greeley, CO 806312 PHONE: f 9701 356- 6751 CONTACT PERSON: Gwen Schooley TITLE: Coordinator of DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skvhhs rogrann at gory must provide services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household management competency_ parental competency family conflict management and effectively accessing community resources 12 -Month approximate Project Dates: Start June 1. 1997 End May 31. 1998 TITLE OF PROJECT: Family Advocate Program AMOUNT REQUESTED: 4 of a . (o Name d Signature of Person Preparing Docibhent e and Signa �. Chief Administrative Officer Applicant Agency 12 -month contract with actual time lines of: Start June I, )497 End Hay 31, 1998 .3 r=21-92 Date Date MANDATORY PROPOSAL REOUIREMENTS Please initial to indicate that the following required sections are included in this proposal: &S Project Description 65 Measurable Outcomes &S Target/Eligibility Populations Z:3 Service Objectives C75Types of services Provided G5 Workload Standards 6-5 Certificate of Insurance 65 Staff Qualifications Unit of Service Rate Computation 65 Program Capacity per Month Date of Meeting(s) with Social Services Division Supervisor: ti/c2 (a/ 97 Comments by SSD Supervisor /4-eLde-,-ga ag'-.>)-496-71-8- -7-4 Vi/d-ti - (ti,,.utd ,fir (--endu (c, n ss 4hr and Signature SSD Supervisor Date ?-5 7 24 971083 Child advocacy resource and education, Inc. 814 9th Street — P.O. Box 945 — Greeley, Colorado 80632 — (970) 356-6751 I. Project Description The Family Advocate Program was developed with the primary purpose of strengthening and preserving families while protecting children from (re) abuse or neglect, thereby preventing out -of -home placement or expediating the return to the home from children living in foster care. The program is an intensive home -based intervention program utilizing trained paid employees. There are two components of the program: A. The Family Advocate Program Each family that meets the Family Preservation criteria that is referred into the program would be provided with from 2-50 hours per month of Parenting and Life Skills Training which would enhance and strengthen the parents' ability to create and maintain stable and nurturing home environments. The services that will be outlined in greater detail below are designed to promote healthy child development, assist children and families to resolve crisis, connect with appropriate and necessary services, and remain safely together in their homes, avoiding unnecessary out -of -home placement of children and helping children already in out -of -home care to be returned to and maintained with their families. B. The Family Advocate Program Plus This addition to the basic Family Advocate Program includes supervised visits for those families that are in the process of reuniting and / or needing supervision services. During supervision, the Family Advocate will continue to use that time for parent and life skills education, increasing positive and appropriate interactions among family members. The c.a.r.e. Coordinator of Advocate Programs will administer the program including the hiring, training and supervising of Family Advocates, as well as the initial and ongoing assessment of families. Referrals into the program will be initiated through the Weld County Department of Social Services. A UNITED WAY AGENCY 083 II. Target / Eligibility Populations A. Total number of clients to be served: This depends on the amount of referrals into the program, however, as stated below, the program has the capacity to serve approximately 30 families per month, or an approximate total of 154 clients per year. B. Total individual clients and the children's ages: As stated above, there is a total capacity of 154 clients; this includes parents, plus children aged birth through teens. Families eligible for this program can vary in age from pregnant / parenting teens through grandparents or other specific caregivers. C. Total family units: 40-50 total family units per year. D. Sub -total of individuals who will receive bicultural/bilingual services: 2-3 families per year. E. Sub -total of individuals who will receive services in South Weld County: 10-12 families per year. F. The monthly maximum program capacity: 30 -35 families G. The monthly average capacity: 30 families H. Average stay in the program: 38 weeks I. Average hours per week in the program: 6-7 hours per week. The figures above are approximate. Each family in the program has an individual service plan depending on the needs of the family and recommendation of the caseworker. Therefore not every family utilizes the program for a uniform amount of hours. The program has the capacity to expand as needed. The above figures are based on the past year. 971083 III. TYPE OF SERVICE TO BE PROVIDED Each of the following services could be provided to any family enrolled in the program; however all families do not need all services. Services provided would be determined by the program coordinator, family advocate and caseworker. A. Teaching, modeling, demonstrating, and coaching as an interactive process with the clients: Homebased parenting and life skills education by a trained family advocate including role modeling, homework, teaching and coaching of appropriate interactions in the family. B. Training in household management, including budgeting, cleaning, maintenance, purchasing, menu planning, food preparation, etc.: Intensive homebased training in household management , especially as it pertains to safe and nurturing child rearing. The goal is to help parents establish better household environments. C. Teaching child rearing and discipline; parenting: Provide homebased parent education, including but not limited to Parenting with c.a.r.e., Baby Talk, Parents of Teens, and the 48 session Nurturing Parenting Program, as well as other parenting topics, based on the needs of the family. The focus is on problem solving, conflict resolution, protection, supervision and attaining appropriate parenting skills with ongoing support and encouragement. D. Teaching how to establish community linkages / advocacy / and making use of services: Provide information, training, and role modeling in accessing appropriate community resources, as well as follow- through in using resources. E. Demonstrating nurturing / esteem role modeling: The advocate will model and teach a nurturing parent role with a focus on parent / child self esteem. The goal is to improve family relationships. 971083 Family Advocate Program Plus: Components of in -home supervision include all of the above activities when appropriate to the needs of the family as well as supervised visitation and contact with parent and child. This includes exchange of information with the parent, support and / or guidance as needed, help with the use of community resources and ongoing communication and feedback about parenting progress and goals. Activities of The Family Advocate Program and The Family Advocate Program Plus will be recorded by the advocate . The WCDSS will be provided with a monthly contact sheet as well as a quarterly progress sheet and / or court progress report. Ongoing contact with the WCDSS caseworker is crucial. Quantitative Measures: Each service can be offered to each family enrolled in the program, depending on need. Therefore , there is a potential for up to 45 families per year to receive any or all services. Supervised visitation as part of the Family Advocate Program will be offered to fewer families, because there is less need for these services. These figures are estimates, based on the previous year. The program can be expanded when needed, depending on the number of referrals. The Family Advocate Program is the only home -based program of its' kind in Weld County, working with this population of families that are at risk of children's placement . We do not provide mental health services, substance abuse treatment or other professional services that are funded by another source. 971083 IV. MEASURABLE OUTCOMES All families in the program will be evaluated using the following measures. In some instances, availability and ability of the clients might affect the program's success in obtaining outcomes. The average nuymber of families available for measurement of outcomes is 45. A. Improvement of household management competency as measured by pre and post test instruments. This is measured by advocate report and observation. B. Improvement of Parental Competency as measured by pre and post assessment instruments. This will be measured by advocate report and observation , and pre and post test scores on the Adult - Adolescent Parenting Inventory and The Nurturing Quiz. C. Parents can independently work with other sources in the community and within the local, state and federal governments. This will be measured by advocate report and observation of the family's progress, with information obtained through family and community linkages. D. Families receiving Life Skills services will remain intact six months after discharge of the services. Parents will sign a consent to allow c.a.r.e. to do a follow-up contact with WCDSS six months after completion of the program. E. Families / Participants who complete the Life Skills Services will have improved competency level or reduced risk on standardized assessment , such as the Risk Assessment Tool. Utilizing the Family Risk Scale, pre and post test, there will be documentation of improved competency and / or reduced risk. This will also be measured ongoing by advocate report and observation. 971083 V. Service Objectives A. Improve Household Management Competency: Intensive homebased household management techniques taught by trained family advocates to improve the capacity of parents to provide a safe, nurturing environment. This will include but not be limited to cleaning, budgeting, purchasing, safety and maintenance. This will be measured through the pre and post Household Management Performance Tool, as well as advocate report and observation. B. Improve Parental Competency: The program will provide homebased parent education including coaching, instructing, problem -solving, role modeling and supervision that will help improve the parent's ability to provide sound relationships within the family. This will include but not be limited to nutrition, hygiene, discipline and protection. This will be measured by advocate record and observation; as well as pre and post scores on the Nurturing Quiz which tests knowledge of parenting, the Adult / Adolescent Parenting Inventory which provides information about attitudes toward parenting and the _ Family Risking Scale which documents changes for families. C. Improve Ability to Access Resources Adovocate will provide information, training, and follow-through to families to enable them to effectively learn to access appropriate community resources, including those on the the local, state and federal level. Outcomes will be measured by advocate record and observation as well as improved scores on the Family Risking Scale. 971083 VI. Workload Standards A. Number of hours per day, week or month. From 1-50 hours per month for each family unit. This number changes depending upon start-up or closure date during the month, contracted hours with the family and any periodic changes due to the progress and needs of the family. B. Number of individuals providing services: 12-15 part-time Family Advocates, 1 Coordinator, and 1 Agency Director, working with from 40-45 families per year. C. Maximum caseload per worker: Each part-time Family Advocate could work with from 1-4 families, depending upon skill level, amount of contracted hours per family and personal work preference. D. Modality of treatment: Home -based instruction and / or supervision, coaching, role - modeling, practicing and support. E. Total number of hours per day / week / month: From 1-50 hours per month, depending upon needs of the family. On the average, each family works 23 hours per month in the program. F. Total number of individuals providing this service: 12-15 part-time Family Advocates, 1 full-time Program Coordinator, 1 Agency Director G. The maximum caseload per supervisor: 25-30 families per month. H. Insurance: Child Advocacy Resource and Eduction, Inc carries a commercial general liability policy with Non -Profit Mutual Risk Retention Group, Inc. 971083 VII. Staff Qualifications: A. Yes, the staff that is providing direct services will have the minimum qualifications in education and experience. The 12 - 15 Family Advocates will meet the minimum qualifications of a Case Services Aide II, which includes graduation from High School or GED equivalent and six months full time public contact experience. In addition, an advocate will have had experiences with parenting and / or working with children and families in environments such as a day care or preschool. Currently, one staff member has a master's degree, two have high school degrees and eight have bachelor's degrees in related fields. The coordinator of the Family Advocate Program holds a Master's Degree in Agency Counseling with an emphasis in Marriage and Family Therapy. She has 6 years of experience as a Family Advocate and three years as Program Coordinator. The Executive Director has a Ph.D. in school psychology and 9 years of experience in the field of human resources and child psychology. B. Total number of staff available for the project: 14-17. 971083 RFP-PAC-97005 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. For different services the provider can request different direct service rates. An average rate can be used or a separate rate can be used for each type of service. Service rates may also be stated as a fixed amount for an assessment, court appearance, etc. If so completing this section would not be necessary. Service rates can be stated on a daily basis, as opposed to an hourly amount. Direct Time (Per Month) 1. Direct client contact Indirect Time 2. Completion of Paperwork 3. Travel 4. Court Appointments 5. Vacation 6. Sick Leave 7. Case management Other (Training, supervision) 9. Subtotal 10. Total Time Available Per Month 11. Ratio of Direct to Total Time 27 Hours 22 3 3 3 6 15 37 (Sum of 1-8) 59.45 (60k1/10=11) 971053 REP -PAC -97005 Attached A IX. RATE COMPUTATION Service Costs Total Total Direct Direct Time Monthly Hourly Rate Hourly Rate % of Time Charge Direct Costs Salary Benefits Subtotal Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal 3748.62 9.50 5.65 5.65 412.35 1.05 .62 .62 4160.97 10.55 6.2/ 6.27 4110.33 12.00 12.00 502.13 34 95 1.32 1.32 4646.71 13.32 13.32 13.32 Agency Overhead (Family Advocate Program portion) Rent 209.75 Utilities Supplies 401.58 Postage 15.00 Travel / 50.00 Telephone 2 7 .0 0 Equipment 75.00 Data Processing Other (Conferences, 500.00 Total Training) 1978.33 #of Employees FTF 4 ( Advocates work part-time, this is the full- time equivalent) Overhead Per 2.85 Employee Overhead Per Total Hours 2.85 Direct Service Rate (Hourly) 22.64 (Daily if appropriate) 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. 971053 MEMO Page 1 Boulder Insurance Assoc., Inc. 1601 28th Street Boulder CO 80301 303-444-4443 C.A.R.E., Inc. Jennifer Penner, PhD P O Box 945 Greeley CO 80632 Jennifer ACCOUNT NO. CAREC-1 OP MG DATE 08/08/96 POLICY INFORMATION POLICY I/ MGL96CO33743 TYPE GL -N EFFECTIVE EXPIRATION 06/01/96 06/01/97 We are enclosing the 6/1/96 renewal policies written with Nonprofits' Mutual Risk Retention Group. We encourage you to review the policies and if you have any questions, do not hesitate to contact me. If you need certificates of insurance at any time for funding purposes, call me. Your continued business with our agency is appreciated. Madelyn K. Gehr1ngi CIC, AAI 971083 PRODUCER: NONPROFITS' MUTUAL RISK RETENTION GROUP, INC. P.O. Box 306, Montpelier, VT 05601 (800)533.3097 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Boulder Insurance Associates, Inc. 1601 28th Street Boulder, CO 80301 NAMED INSURED AND MAILING ADDRESS: POLICY NUMBER: MGL96CO3374-3 RENEWAL OF NUMBER: MGL95CO3374-2 LOCATION OF PREMISES OF DIFFERENT THAN MAILING ADDRESS): SEE ENDORSEMENT G Child Advocacy Resource & Education, Inc. (C.A.R.E.) P.O. Box 945 Greeley, CO 80632 POLICY PERIOD: FROM 06/01/96 TD 06/01/97 AT 1201 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE. BUSINESS DESCRIPTION: Health Care Facility IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. LIMITS OF COVERAGE GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS -COMPLETED OPERATIONS) PRODUCTS -COMPLETED OPERATIONS AGGREGATE LIMIT lq liSONAL AND ADVERTISING INJURY LIMIT Ilr•-..ACH OCCURRENCE LIMIT FIRE DAMAGE LIABILITY LIMIT MEDICAL EXPENSE LIMIT PROFESSIONAL LIABILITY AGGREGATE LIMIT ADDITIONAL COVERAGE • (LIMITS ARE INCLUDED IN GENERAL AGGREGATE LIMITS LISTED ABOVE) NON•OWNED AUTO HIRED AUTO $ 2,000,000 1,000,000 1,000,000 1,000,000 50,000 ANY ONE FIRE 5,000 ANY ONE PERSON 2,000,000 Included Included CLASSIFICATION(S): SEE ATTACHED SUPPLEMENTAL DECLARATIONS ENDORSEMENT G PREMIUM: $ 2,175.00 FORMS AND ENDORSEMENTS MADE A PART OF THIS POLICY AT TIME OF ISSUE: ENDORSEMENT G,CG0001/1 I-88,IL0021 /I 1-85,CG2231/ 11-85,CG2021/11-85,CO2407/ 11-85,CG2116/I I-85,CG2146/ I-87 NMRRG-E3/4-92,NMRRG-X1/4-92,NMRRG-E7/4-92,NMRRG-EB/4-92,NMRRG-C 1 /1-94, CO0419/11-85,NMRRG-El/1-95(2nd Edition),NMRRG-E13/6-94,NMRRG-E14/1-96, COUNTERSIGNED w// 2 / �/ (- BY D E IAUTFiORI ENTATIVE) THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORMISI AND ENDORSEMENTS. IF ANY, ISSUED TO FORM A PART THEREOF. COMPLETE THE ABOVE NUMBERED POLICY. e This policy is issued by your risk retention group. Your risk retention group may not be subject to all of the insurance laws and regulations of your state. State insurance insolvency guaranty funds are not available for your risk retention group. NMRRG - GL (1194) 971083 • ala ;ii f11 ANPNOFITS' MUTUAL MIM MLTL]IO%GROUP ENDORSEMENT G Policy Number Named Insured Lac # Build # Address Class Code/Description Exposure MGL96CO3374-3 Child Advocacy Resource 1 & Education, Inc. (C.A.R.E.) 1 t Date: 06/12/96 Signed: 814 9th Street, Greeley, 44438/Health Care 1,976 CO Facilities -Mental NFP (A) 814 9th Street, Greeley, 48558/Social Gatherings and 1 CO Meetings-NFP (T) 9'7108.3 c•a•r•e lip(* /? Child advocacy resource and 814 9th Street — P.O. May 2, 1997 1 education, Inc. Box 945 — Greeley, Colorado 80632 - (970) 356-6751 Placement Alternatives Commission Dep't. of Social Services P.O.Box A Greeley, CO 80632 Dear PAC Committee members: Enclosed please find the additional information which you requested for the Evaluation Committee. I have included copies of all current instruments. Please note however, that the Household Management Tool and an instrument which will be used to record details of supervised visits are both still in the planning stages but will be ready to use at the beginning of the grant year, June i, 1997. I will be happy to make them available at a future date. Please let me know if there is anything else needed. Sincerely, Gwe'rfM. Schooley Coordinator of Advocate Programs A UNITED WAVM I c•a•r•e Child advocacy resource and education, Inc. 814 9th Street — P.O. Box 945 — Greeley, Colorado 80632 - (970) 356-6751 c.a.r.e. Family Advocate Program Item 1. Program Evaluation: (Copies of the following instruments are enclosed.) Each family in the program is evaluated with pre and post instruments that measure the following: Adult -Adolescent Parenting Inventory- This instrument measures the parent's attitudes about parenting, as reflected in scores along four constructs: appropriate expectations, empathy, belief in corporal punishment and appropriate family roles. The Nurturing Quiz- This is an instrument that measures parenting knowledge regarding behavior management techniques and nurturing parent techniques. The Family Risking Scale- This is a simple instrument which documents basic information about families, and identifies family's level of risk in certain areas. The Scale of Family Functioning- This instrument helps determine how well the parent is functioning in certain areas; social supports, family. conflict/stress/ coping, self esteem, confidence as a parent, stability and meeting basic needs, expectations, affective relationship and sensitivity to caregiving functions. It is scored by advocate observation of the parent within the family. (* Please note- I am currently in the process of getting purchasing and use information for this instrument.) The Household Management Performance Tool- This instrument , being developed by the Family Advocate Program will show ability in areas of household skills. Currently, this skill is measured through advocate report and observation. This will be in place by June 1, 1997. Data Collection: Information regarding each family is collected by the advocate or the Coordinator of Advocates. It is kept in a file, with monthly information sent to the caseworker. A quarterly progress report is also prepared and sent to the caseworker. A UNITED WAVff1 FAMILY ADVOCATE PLUS PROGRAM: This program will utilize all of the above testing instruments but will also include a form which will detail the supervised visit. This form is not available at this time, it is in the planning stages. The plan is for this document to give detailed information to the caseworker regarding each supervised visit that occurs with the family. Item 2: Initiation of Service Interventions: It is the intention of the Family Advocate Program to initiate direct service interventions to families within five working days. This is not always possible, depending upon the availability of the family and the advocate. It is also dependant upon the flow of referrals, if there is a numerous amount that come in all within the week, even under the best of circumstances it would be difficult to get everything in place as quickly as during a slower time. The program works very hard to get referrals matched as quickly as it can, and will speak to the caseworker when there is a problem so that they know what to expect. Item 3: South County Clients Currently, there are two advocates that reside in South Weld County and three other advocate staff that travel to South Weld County to provide services to families when needed. We provided The Family Advocate Program to 18 families in South Weld County during the 96-97 grant year. I anticipate that this will at least remain the same. If there is a greater need in this area, I feel we could meet this need, even with the addition of the Family Advocate PlusProgram which includes in -home supervision. Item 4: Transportation: There is currently no provision for transportation included in our PAC grant. Our program does not provide transportation; however, we will problem -solve with clients any transportation barriers that they might have. 971083 Nurturing Program For Parents and Children 4-12 Years Nurturing Quiz Name: Date: Circle the response you feel best completes the statement. There is only one. 1. Behavior management is a general term used to describe: a. Techniques to help children learn desirable behaviors. b. A way to get children to behave perfectly. c. A way of punishing children. d. A way to help parents control the feelings of their children. e. I'm not sure. 2. Which of the following statements best defines the concept of discipline? a. Spanking children. b. Rewarding children. c. Ignoring children. d. Establishing family rules. e. I'm not sure. 3. How does punishment differ from discipline? a. Punishment is establishing rules for a child: discipline is what a child receives after breaking the rules. b. Discipline is establishing rules for a child; punishment is what a child receives after breaking the rules. c. They don't differ --they're the same. d. Punishment is what a child gets for following the rules. There is no discipline. e. I'm not sure. 4. Which of the following statements is the correct way to praise a child? a. Sally, you washed the dishes. What a great kid you are. b. You washed the dishes, but I only wish you could have put them away. c. You sure did a great job in washing those dirty dishes. d. Washing dishes is a tough job. Mommy real- ly loves you. e. I'm not sure. S. Parents should praise themselves in front of their children when the parents do something good. a. True b. False c. I'm not sure. 6. Family rules are rules mainly for. a. Parents b. Grandparents c. Children d. All family members 7. Spanki: s a good way to let children knowyou are angry. a. True b. False c. I'm not sure. ©1986 Family Development Resources. Inc. 971083 3. Personal power is: a. How physically strong we are. b. Forcing children to behave. c. How emotionally strong we arc to meet our needs. d. A way to punish children. e. I'm not sure. 9. Telling your child he or she has to sit in a chair for three minutes is an example of which be- havior management technique? a. b. c. d. e. Time-out Ignoring Isolation Discipline I'm not sure. 10. Which of the following is a necessary step for using time-out? a. Make sure the child knows what time-out is. b. Establish rules that will warrant a time-out. c. Pick a time-out place. d. Establish beforehand how long the time-out will last. e. All of the above are ner-csary steps. t. I'm not sure. 11. If you tell a child to take a time-out and he or she ref uses to go: a. Drag the child to the chair. b. Tell the child you don't love him anymore. c. Give the child choices and consequences. d. Give up this time. Try again later. e. I'm not sure. L. Children should be told the amount of time they have to spend in time-out. a. True b. False c. I'm not sure. 13. Making appropriate expectations of children helps them: a. To feel good about themselves. b. To do what they're suppose to. c. To Quit making mistakes. d. To quit getting into trouble. e. I'm not sure. 14. Choices and consequences is a behavior management techniques used to help children learn: a. b. c. d. e. Self-control. To make wise choices. To accept responsibilities. All of the above. I'm not sure. 15. How are natural and logical consequences dif- ferent? a. Natural consequences arc planned; logical consequences happen without planning b. Natural consequences happen without plan- ning; logical consequences arc planned. c. Natural consequences happen only to children; logical consequences happen only to parents. d. There really is no difference between natural and logical consequences. e. I'm not sure. 16. Which of the following is never a good conse- quence for misbehavior? a. Physical threats. b. Loss of privileges. c. Tune -out. d. Having to pay back or replace a broken ob- ject. c. I'm not sure. 971083 Form A or B ADULT-ADOLESCEN I PARENTING PROFILE Parenting Profile for: (circle one) • Abusive Adults • Non -Abusive Adults • Abused Adolescents • Non -Abused Adolescents W U a a) co di U Z W D O C9 5- 0 C a) 0 • O 0 L U h HIGH SCORE DESCRIPTION APPROPRIATE EXPECTATIONS Understands child growth and development Children are allowed to exhibit normal developmental behaviors Self-concept as a caregiver and provider Is positive Tends to be supportive of children APPROPRIATE EMPATHY Understands and values children's needs Children are allowed to display normal developmental behaviors Nurtures children and encourages positive growth Communicates with children Recognizes feelings of children VALUE ALTERNATIVES TO CORPORAL PUNISHMENT Understands alternatives to physical force Utilizes alternatives to corporal puNstment Tends to be democratic ti rue making Rules for family, not lust for children Tends to have respect for children and their needs Values mutual parent -child relationship APPROPRIATE FAMILY ROLES Tends to have needs met appropriately Finds comfort, support. companionshp from peers Children are allowed to express devebprnental needs Takes ownership of behavior Tends to feel woithwhlle as a person good awareness of sell STANDARD TEN SCORE (STEN) Average 1 2 3 4 5 6 7 8 9 10 i . D v Low Score Description INAPPROPRIATE EXPECTATIONS Expectations exceed developmental capabilities of children Lacks understanding of normal chid growth and development Self-concept as a parent is weak and easily threatened Tends to be demanding and controlling LACKS EMPATHY Fears spoiling cNldren Children's normal developmental needs not understood or valued Children must act right and be good Lacks nurturing skills May be unable to handle parenting stresses STRONG BELIEF IN VALUE OF CORPORAL PUNISHMENT Hitting, spanking, slapping children Is appropriate and required Lacks knowledge of alternatives to corporal Punishment acks ability to use alternatives to corporal nishment Strong discplinariars rigid Tends to be controlling, authoritarian REVERSES FAMILY ROLES Tends to use children to meet self needs Children perceived as objects for adult gratiflcaion D Tends to treat children as confidant, peer Expects children to make life better by providing love. assurance, comfort Tends to exhibit low self esteem, poor self awareness, poor social life STANDARD SCORE Form A I Form B RAW SCORE Form A I Form B Z R Wut, <oow Q 0 U m C 0 .0 N C m E 0 71083 of population 2.3 % 4.4 9.2 % 15.0 % 19.1 % 19.1 % 15.0 9.2 % 4.4 We 2.3 % /zJ O 0 .0 c E 0 W U, n a n d o ° o N C N 2 L - v� E _ w < a Li 'So E C ✓ 3 o E o `o o_ N T Qr C C E a a v O 0 > o m p n T 6- E n m .. LL O C D >, N m' g m - o O d L L OI y, U • o N N L I- Form A Strongly Strongly Age Agee Uncertain Disagree Disagree 1. Young children should be expected to comfort SA A U D SD their mother when she is feeling blue. 2. Parents should teach their children right from SA A U D SD wrong by sometimes using physical punishment. 3. Children should be the main source of comfort SA A U D SD and care for their parents. 4. Young children should be expected to hug their SA A U D SD mother when she is sad. 5. Parents will spoil their children by picking them SA A U D SD up and comforting them when they cry. 6. Children should be expected to verbally express , SA A U D SD themselves before the age of one year. 7. A good child will comfort both of his/her parents SA A U D SD : after the parents have argued. 8. Children learn good behavior through the use of SA A U D SD physical punishment. 9. Children develop good, strong characters through SA A U D SD very strict discipline. 10. Parents should expect their children who are SA A U D SD under three years to begin taking care of them- selves. 11. Young children should be aware of ways to com- SA A U D SD fort their parents after a hard day's work. 12. Parents should slap their child when s/he has done SA A U D SD something wrong. 13. Children should always be spanked when they SA A U D SD misbehave. 14. Young children should be responsible for much of SA A U D SD the happiness of their parents. 15. Parents have a responsibility to spank their SA A U D SD children when they misbehaver : • Please go to next page. • 01%4 Family Development Remounts. Inc All Rights Resented This test or pans thereof may not be 'reproduced in any form without permission of the publisher. 971083 Attacnment B FAMILY RISKING SCALE _^mi'y Name ".EDICAL/PHYSICAL FACTORS (check those which apply) Known genetic abnormality Known metabolic abnormality Birthweight under 1500 grams/prematurity Congenital condition/syndrome associated with developmental delay Known physical trauma Severe asphyxia History of seizures Suspected sensory impairments Suspected gross or fine motor impairment Feeding difficulties Little or no prenatal care SOCIAL/ENVIRONMENTAL FACTORS (check those which apply) Developmentally delayed parents Parent with clinically diagnosed psychiatric disorder History of spousal abuse in home History of child emotional/physical/medical neglect Parental substance abuse (type: Parent with a sensory impairment Age of mother less than fourteen years Age of mother fourteen to eighteen years (age: Suspected difficulty in parental/infant bonding (please comment) Lack of support network for parent Lack of permanent housing 971083 aue 4 ;ttacnment B (continued) Maternal education less than 12th grade (highest grade completed: More than four children in home Mother chronically Recent high stress in family Recent financial crisis in family Low income (S per month, ? in household Parent(s) unemployed No public assistance for child care ADDITIONAL COMMENTS: SIGNATURE: TITLE: DATE: •Adapted from Mesa County Infant/Toddler Program and Ms. Lisa Hoy(PCLC) 971083 ,SCALE OF FAMILY FUNCTIONING Family Case No. Date The following are a list of factors which represent possible life circumstances in families being evaluated for our program. This is to be used in conjunction with the scale of family functioning in order to help determine the need level of a family. Items are to be checked if present in family history or present situation. Check if Score Present (2) (1) (2) (2) (2) (1) (1) (1) (1) (1) Total Score Major psychiatric disorder/significant retardation. Abuse or neglect in parent's own background. Past abuse or neglect of own children/history of abuse of other children. History of suicidal attempts. History of spouse abuse. Past criminal record or involvement; current criminal proceedings. Expressed desire to abort or relinquish during pregnancy. Medical/health complications during pregnancy/birth. Premature, SGA or handicapped infant. Parent loss prior to age 5. © 1984 Janet Dean, L.C.S.W. ; JoAnn Robinson, Ph.D. (Not for use without written permission by first author.) Reprint Requests: Janet Dean 502 Hapgood St. Boulder, Colorado 80302 971083 c c C ❑ E c ti E c a v > v, v 9 n L J. � Y C y 1 -H q n _> Q C Z. o ?' J ≥ � 2- a. - w ,≥ n E E .0 v G.° O 'u' - - C> q n > a o n n- n n 3 v r n V a >.C n, `. E= 2 N c En C iia d 5 c o c a.- E ..e. —n•>- -,: in -- :---C c2 "c— S2 c °--O o o c 28b 3a.UC C=o Ea tjvo- unay Cu.Cq •oc Se rt usly Impaired > -0 Y V -6 N .0 a>. n n E 0 ‘20 - LA 0 i taa v E 1-. - N E -C n .0 N dyn 0 YC a3 n� cm ° 0'0.5 0 , E 3eiL N c`oa 5 o> o o _ Y -E v 3 3 >i� �c �0- v CJ�YO n0 2 -- o o- u 2.S n�q c.5 E d o E 0_ c Moderately Adequate Marginally Adequate N C > d i- Y „a� c` 1 5 E C o > c J E.; c _ a E E T3.' v c v .0 c..L45C =EEn? r v G a%iDVL Ou =u-9.�n 0 ❑ To d _E- C _ q 18.E _ Y d J o o` g. o 'J 2 d n c `o_E O E C 12-..E.-1 J 1 C 0 H v'd ?-16 vEE-v0-aa a L . J L C v J • 2 >, `o a 2.ec w c E n C D O d J ≥ n L to D a -a m n C - q 3 C' n c -E ro '. 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C C 2 9 L V Autueg 971083 • highly unrealistic expectations, distorte view of infant • may experience delusional thoughts u relation to infant L d- n G G. V m o� o s G N -O — co -.N E s c O ... m...2 J O S O 3 3 m n C CD.. d O n d O m C CL q d d L V C ac co o ao 3 E- E O "(a N OV • unrealistic ❑ expectations; too high or too low • rigid thinking n a ` a ° ' c w E G1:5 5 0) : O _- _ -5 ✓ A 5 v° bj a E _ o ° fd`a 4_V E 3- C 2t¢, O'= � m a m y n -al ca o r h c a m co.. �` QX d o v >, E c; a E _E 2. o S_ w,... t,y a .Eq y ryE d A w 5qgs >o mo .5& Ea L. s° SS3 o` n ° c w J c- O �L pp>. ° d O 6. 5 '° '� en CO C d ` -t1d 0 E m 0� A .. d m G LS� ° -CI t d:G t c .5 0 o d 9 .5 eeo , c in 5 0 � >. c -o c a in m N .5 d t'o .- .47. v.5 q. g.a o u, g= t" E 9S�°!.5 `ovS3 AEL 9i o_A L. m c • expectations for infant ❑ are inappropriate for age; somewhat high or too low • has somewhat rigid image of what infant will be like • parents demonstrate some flexibility in thinking about infant O C C Cu O d ° ."' c > .S „ OA) `o c� d m ca c =s >A ga §E L> r' -A .5'n a- 3 N a E N �c c o u v dC g..5 E �' 3 O` Fi 7 ° O -e' c d L0 L. .C w 3 C >- A3 0 OE v_ of o 5C dC ,� u 'cc 0No G LC O 0 9S .., o _C ad trl a in a c v v q.5 �� .J-°° ° � N .. .5 3 °'.v`o ° a0 3t w • unsure of age 0 appropriate expectations • flexibility in thinking O 0 E aJ c o v d .? 8 �`omq �u -5 0 .a) E, gn G.a -0v ° L T c -S c'^ —O °i E a)D adodgE E.d CoC 5-5 as c �° St [[ go E�� J S -5 3._.- J� O ' >, d N No o E E S. O 2 o A d.5 -° 5>.�A - E.. d So c� r'.- C..c'°. k`C0� CL O y'G o C s!.. "Sc ONNT q� C>` q $�"0E aE,' cg 9 N "0 3 S N • • parents demonstrate a y ❑ appropriate expectations • demonstrate flexible thinking in relation to infant 0 v >, no D d o -s .a.• Li d ° O G. q uea o E G, a c o y 3 `.. >. �O `� 5t,F �.y y .vca' o:o' 5t `ma -5> S„c >n5 �d d9 la d O °� E d N °.: a... V N O in N no r E L d a O '° >, V d a.. •p o q ✓! C C ° c O m O c .�uC ca Taa a �-0 d 5 0 E° E .. A A C ° •-,t j � d:E o u. iia yq'°� do�m5 may, c° `c o'oa a,C,- v now � d �.E N N • EXPECTATIONS _ tZ ix O �ZZ f zz SVcyE r.� Z WV area oN asej Allured 971083 rc•a•r•e `_\ Child advocacy resource and education. Inc. 814 9th Street — P.O. Box 945 — Greeley. Coloroco 80632 - (970) 356-6751 FAMILY ADVOCATE MONTHLY REPORT CLIENT'S NAME ADVOCATE CASEWORKER MONTH AND YEAR TIME SHEET Face to Face Contact Travel Time Paperwork Supervision/Training Case Management Total Mileage Other Comments: • UNITED WAY AGENCY c•a•r•e tJ V^v (J 1 I` UU Child advocacy resource and education, Inc. 814 9th Street — P.O. Box 945 — Greeley, Colorado 80632 - (970) 356-6751 MONTHLY CONTACT SHEET CLIENT MONTH / YEAR TOTAL APPOINTMENTS KEPT CANCELLED MISSED DATE / TIME SPENT GOAL CLIENT SIGNATURE 971083 CLIENT'S NAME MONTHLY GOALS 1 What activities did you do that supported your case goals and action plans? 2. Any additional activities curing the month? 3. Did you experience any frustrations or problems? 4. What positive experiences did you have? 5. Additional comments: 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilingual/bicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) for Placement Alternatives Commission (PAC) Funds Type of Action contract Award No X Initial Award FY97-PAC-7000 (RFP-PAC-97005) _ Revision Contract Award Period Name and Address of Contractor Beginning 06/01/97 and First Steps of Weld County, Inc. Life Skills - Teen Pregnancy Program 1024 9th Avenue, Suite 3 Greeley, CO 80631 Ending 05/31/98 Computation of Awards Description The issuance of the Notification of Financial Assistance Award is based upon your Request for Proposal (RFP), and Addendum RFP Information. The RFP specifies the scope of services and conditions of award. Except where it is in conflict with this NOFAA in which case the NOFAA governs, the RFP upon which this award is based is an integral part of the action. Special conditions Unit of Service Provide services for Pregnant Teens (ages 10-17) and their families and High Risk Mothers with babies (ages 0-3), will be served with the Parents As Teachers program up to a maximum of eight families per year, four families monthly capacity, three hours per week of face to face contact for approximately 26 weeks. cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based on an hourly rate per child or per family. 2) The hourly rate will be paid for only direct face to face contact with the child and/or family, as evidenced by client - signed verification form, and as specified in the unit of cost computation. 3) Unit of service costs cannot exceed the hourly and yearly cost per child and/or family. 4) Payment will only be remitted on cases open with, and referrals made by the Weld County Department of Social Services. 5) Requests for payment must be submitted to the Weld County Department of Social Services by the end of the third business day following the end of the month of service. Hourly Rate Per Unit of Service Hourly Rated Per Unit of Service Based on Approved Plan Greeley/Evans area $ 45.47 Outside Greeley/Evans $ 55.67 Signed RFP; Exhibit A RFP Information; Exhibit B AdAddendum Condition(s) of Approval ApByproval • 7 1 Program By Official: Judy Del Date: Grie o3i , Directo epartment of S ial Services 3 / (7 or . Baxter Board of We d C unty Comm i 11? Date: X 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilingual/bicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971083 INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-9 7005 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 Request for Proposal (RFP-PAC-96005) for: SUMMARY Fami y Preservation Program --Life Skills Program Family Issues Cash Fund or Family Preservation Program Funds Deadline: March 25, 199/ Tuesday, 10:00 a.m. The Placement Alternatives Commission, an advisory commission to the Weld County Department of Social Services, announces that applications will be accepted for approved vendors pursuant to the Board of Weld County Commissioners authority under the Statewide Family Preservation Program (C.R.S. 26-5.5-101) and Emergency Assistance for Families with Children at Imminent Risk of Out -of -Home Placement (C.R.S. 26- 5.3-101). The Placement Alternatives Commission wishes to approve twelve month programs targeted to run from June 1, 1997, through May 31, 1998, at specific rates for different types of service, the county will authorize approved vendors and rates for services only. The Life Skills Program must provide services that focus on teaching life skills which are designed to improve household management competency, parental competency, family conflict management and effectively accessing community resources. This program announcement consists of five parts, as follows: PART A...Administrative Information PART D...Bidder Response Format PART B.. Background, Overview and Goals PART E...Bid Evaluation Process PART C...Statement of Work �( Delivery Date Cj(4 ( L " r to (After receipt of order) BID MUST BE SIGNED IN INK VENDOR ADDRESS First Steps of Weld County (Name) 1024 9th Avenue, Suite 3 Greeley, CO 80631 PHONE# (970) 353-4192 Kris A. Howard TYPED OR PRINTED SIGNATURE Handwritten Signature By Authorized Officer or Agent of Vender TITLE DATE Executive Director March 1, 1997 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 971083 RFP-PAC-97005 LIFE SKILLS PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97005 NAME OF AGENCY: First Steps of Weld County, Inc. ADDRESS: 1024 9th Avenue, Suite 3; Greeley, CO 80631 PHONE:( 973 352-4192 CONTACT PERSON: Kris A. Howard Attached A TITLE: Executive Director DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Life Skills Program Category must provide services that focus on teaching life skills designed to facilitate implementation of the case plan by improving household management cnmoetencv parental competent fa ilv conflict management and effectively ac sing community resources 12 -Month approximate Project Dates: Start June 1. 1997 End May 31, 1998 12 -month contract with actual time lines of: Start End TITLE OF PROJECT: Teen e/Pregnancy/Patents as Teachers AMOUNT REQUESTED: t4 47 (Pyle 116767 pp,L Kris Howard Name and Signature of Person Preparing Document Kris Howard - March 1. 1997 Date Name and Signature Chief Administrative Officer Applicant Agency Date _zg MANDATORY PROPOSAL REQUIREMENTS Please initial to indicate that the following required sections are included in this proposal: e4 Project Description K* Target/Eligibility Populations i4I- Types of services Provided OA Certificate of Insurance Measurable Outcomes Plit Service Objectives eir Workload Standards March 1, 1997 f* Staff Qualifications KP- Unit of Service Rate Computation Ct f Program Capacity per Month Date of Meeting(s) with Social Services Division Supervisor: "a - % - 9 Comments by SSD Supervisor: £)d /ot,L5 ifood- 4/0 &Lionye }ter -/ CA' -a 2- y,7 Nan a and Signature of SSD Supervisor Date 24 971083 RFP-PAC-97005 Program Category Project Title Vendor Life Skills Program Bid Category Teen Pregnancy/Parents as Teachers First Steps of Weld County, Inc. I. PROJECT DESCRIPTION Please provide a one page brief description of the project. II. TARGET/ELIGIBILITY POPULATIONS Attached A Please provide a one page brief description of the proposed target/eligibility populations. At a minimum your description must address: A. Total number of clients to be served. B. Total individual clients and the children's ages. C. Total family units. D. Sub -total of individuals who will receive biculturaVbilingual services. E. Sub -total of individuals who will receive services in South Weld County. F. The monthly maximum program capacity. G. The monthly average capacity. H. Average stay in the program (weeks). I. Average hours per week in the program. III. TYPE OF SERVICES TO BE PROVIDED Please provide a two page description of the types of services to be provided. Please address if your project will provide the service minimums as follows: A. Teaching, modeling, demonstrating, and coaching as an interactive process with the clients. B. Training in household management, including budgeting, cleaning, maintenance, purchasing, menu planning, food preparation, etc. C. Teaching child rearing and discipline; parenting. D. Teaching how to establish community linkages/advocacy and making use of services. E. Demonstrating nurturing/esteem role -modeling. Also, provide your quantitative measures as they directly relate to each service. At a minimum, include a number to be served in each service component. Describe your internal process to assure that PAC resources will not supplant existing and available services in the community; e.g. mental health capitation services, ADAD and professional services otherwise funded. IV. MEASURABLE OUTCOMES Please provide a two page description of your expected measurable outcomes of the project. Please address the following measurable outcomes: 75 9%1083 RFP-PAC-97005 C. Parents can independently work with other sources in the community and within the local, state, and federal governments. D. Families receiving life skills services will remain intact six months after discharge of the services. E. Families/participants who complete the Life Skills Services will have improved competency level or reduced risk on standardized assessment, such as the risk assessment tool. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. Attached A A. Improvement of household management competency as measured by pre and post assessment instruments. B. Improvement of parental competency as measured by pre and post assessment instruments. V. SERVICE OBJECTIVES Please provide a one page description of your expected service objectives and quantitative measures. Please address, at a minimum, the following ways the project will: A. Improve Household Management Competency - capacity of parents to provide safe household environment for their children through competent household cleaning and maintenance, budgeting and purchasing. B. Improve Parental Competency - capacity of parents to maintain sound relationships with their children and provide care, nutrition, hygiene, discipline, protection, instructions, and supervision. C. Improve Ability to Access Resources - services shall assist parents to work with other sources in the community and ahead the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. WORKLOAD STANDARDS Please provide a one page description of the project's work load standards and quantitative measures. Please address, at a minimum, the following areas: A. Number of hours per day, week or month. B. Number of individuals providing the services. C. Maximum caseload per worker. D. Modality of treatment E. Total number of hours per day/week/month. F. Total number of individuals providing these services. G. The maximum caseload per supervisor. H. Insurance. VII. STAFF QUALIFICATIONS Please provide a one page description of staff qualifications and address, at a minimum, the following: 26 971083 I. PROJECT DESCRIPTION First Steps of Weld County, Inc., furnishes care coordination (case management) services and home visitation throughout the pregnancy and parenting continuum. The Life Skills project serves two separate groups who meet the Family Preservation Program eligibility criteria: 1) Pregnant teenagers, ages 10-17 and/or 2) Babies, ages 0-3 years of age. When a teen becomes pregnant, the girl and her family encounter stressors that often result in controversy, communication barriers, and typically strain family situations that may already be tenuous. The resulting situation is unique in that there are two generations that require coping skills. First Steps' care coordinators, who are either registered nurses and medical social workers, provide support services for pregnant teens and their families to alleviate the unique crises that can lead out -of -home placement. Care coordination dovetails both medical and social work models to include: • Assessment and screening for physical and psychosocial barriers to healthy births and contributors to child abuse and neglect of the teen and/or the new baby. • Enhancing the teen parent's ability to create a safe, stable and nurturing home environment that will promote healthy child development. • Prenatal, postpartum and parenting education. • Referrals to healthcare and existing county resources. • Training in Self Esteem, Self -Responsibility, Decision Making Skills and Communication Skills. Following physical and psychosocial assessment, care coordinators provide case management for the pregnant teen and her parents that is both individualized and interactive. Families are taught skills that allow them to adopt appropriate measures to decrease barriers, increase the probability of the teen mother delivering a healthy infant and remaining in the home, and increase the success of appropriate parenting of the new baby. Through counseling, mentoring and education, care coordinators help families understand the many options and resources that are available to them, both financially, emotionally and physically. In the second focus area including children from birth to 3 years of age, parents receive all of the aforementioned services with the addition of the Parents As Teachers (PAT) program. PAT is designed to promote positive family functioning by giving parents realistic expectations of their parenting abilities, as well as their child's competencies. PAT emphasizes prevention of child maltreatment through a multi -dimensional focus including: • Basic child development -- increasing the knowledge of appropriate parenting skills tied to child development. • Enhancing parents' ability to create a safe, stable, and nurturing home environment that promotes healthy child development. • Education and skill development of child care and discipline. • Coaching parents in alternative approaches to punitive techniques of child management. • Improving connections to community support and resources. • Supervised visitation of infants who are being considered for reintroduction into the home. First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers 971083 II. TARGET/ELIGIBILITY POPULATIONS A. Total number of clients to be served in the 12 -month program. First Steps will serve eight clients during the 12 month program. Clients may be from either age group, the pregnant teens or infants and meet the program requirements for out -of -home placement criteria as listed in page 17 including: abandonment by or incarceration of caretakers, abuse or neglect, domestic violence, conditions that exist that cause the caretaker to be unable to care for the child, infant or young child of teen parent in placement, relinquishment or termination of parental rights, or child returning home from out -of -home placement. First Steps assists the Department of Social Services with intervention strategies and advocacy to: assess and identify parent's abilities to protect children and assist them in accessing and utilizing services that address the presenting conditions. B. Total individual clients and the children's ages. Pregnant teens will be between the ages of 10 and 17. Infants will be between birth and 3 years of age. C. Total family units. First Steps will serve eight family units. The pregnant teen and her family are considered one family unit. The infant and his/her parents and siblings, if present, are considered one family unit. D. Sub -total of individuals who will receive bicultural/bilingual services. First Steps is able to provide bilingual services, since two of First Steps' care coordinators are bilingual. Each of the bilingual care coordinators is available to serve one individual per year, one every six months. Therefore, First Steps would be able to serve four Spanish speaking individuals per year, two every six months. E. Sub -total of individuals who will receive services in South Weld County. First Steps is available to serve south county residents and the rate of service is reflected separately in the budget. F. The monthly maximum program capacity. The monthly maximum program capacity is four individuals. G. The monthly average capacity. The monthly average capacity is also four individuals. H. Average stay in the program (weeks). Approximately twenty-six weeks, unless a longer time frame is requested by the case worker. I. Average hours per week in the program. Approximately 3 hours per week of face to face contact with the care coordinator. First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers 2 971083 III. TYPE OF SERVICE TO BE PROVIDED A vital portion of care coordination involves the establishment and growth of a relationship between the care coordinator and the client. This relationship is interactive and allows the care coordinator to teach, model, demonstrate and coach the client according to the client's goals and individual needs. Care coordination includes: Assessment -- determining, in a comprehensive manner, the client's medical, psychosocial, education and financial needs. Care planning -- developing an individualized care plan focusing on the services and resources required to address the individual needs of the client. Service Coordination and Referral -- establishing access to services by assisting the client as they arrange for and obtain appropriate care and services. Follow-up & Monitoring -- assuring that services are accessed and delivered, assessing barriers to services and making modifications in the care plan and care coordination process. Empowerment & Advocacy -- developing a supportive, nurturing relationship with the client to develop the client's self esteem and skills which empower them to problem -solve as well as access and utilize services. Education -- providing all aspects of education and training in self-esteem, self -responsibility, decision -making skills, communication, household management, childrearing and discipline. The Teen Pregnancy and PAT projects both include all of the types of service provision: A. Teaching, modeling, demonstrating, and coaching as an interactive process with the clients. B. Training in household management. C. Teaching child rearing, appropriate discipline and parenting skills. D. Teaching how to establish community linkages, advocacy and making use of services. E. Demonstrating nurturing/esteem role -modeling. The teen pregnancy portion of the project includes education and support services for pregnant teens and their families. Care coordinators provide assessment of teens and their parents to screen for physical and psychosocial barriers to healthy births and contributors to child abuse and neglect of the teen and/or the new baby. Physical barriers contributing to child abuse that are specifically evaluated during the assessment process include: • Complications of pregnancy • Language, income and education barriers • Lack of resources and physical necessities First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers • Drug and alcohol abuse • Nutritional deficiencies • Unsafe household maintenance 3 971083 Psychosocial factors contributing to child abuse or neglect that are evaluated include: • Emotional status of the teen and her parents • The family's support system and coping skills • Decision -making skills • Her relationship to the baby's father • Parenting skills and expectations • Stress levels in the family Following identification of specific barriers, care coordinators follow both the pregnant teen and her parents on a regular basis to provide case management that is both individualized and interactive. Care coordinators utilize a variety of instructional methods including interactive learning modules, individualized instruction, role playing, as well as actual modeling of appropriate behaviors in concrete and tangible learning situations. Families receive skills to assist them in adopting appropriate tools to decrease barriers, increase the probability of the teens delivering healthy infant and remaining in the home, and increase the success of appropriate parenting of the new baby. Care coordinators are nurturing mentors, healthy role models and provide instruction in: • Coping skills for unique stressors • Communication skills • Utilization of community resources • Decision -making and problem solving skills • Appropriate self -responsibility and goal setting • Parenting knowledge, skills and practice • Appropriate expectations of both teen and infant growth and development • Household management (as related to newborn care) All of the previously mentioned services are provided in the second portion of the project dealing with infants (0- 3 years) in danger of out -of -home placement. In addition, the PAT curriculum is used to enable parents to cope with parenting responsibilities and learn appropriate parenting skills. The PAT program offers timely information about child development and gives parents realistic expectations of their child's abilities and their own parenting skills. During the 3 hours per week that the care coordinator spends with the family, she also provides training in household management as it applies to the care of a baby. Budgeting, cleaning, maintenance, purchasing, menu planning, and food preparation are taught as they relate to an child from birth to 3 years of age. Age appropriate childrearing and discipline instruction are given as needed, through demonstration of nurturing behaviors as well as through oral and written instruction. First Steps has been providing information and referral to area resources since its inception, thus care coordinators are well versed in the availability of community resources open to families. Care coordinators are also able to provide supervised visitation of infants who are being considered for reintroduction into the home. Quantitatively, all services are provided to all clients, whether they are in the teen pregnancy portion of the project or the PAT portion of the project. However even though all services are available, acquisition of services is client First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers 4 971053 driven, individualized and is determined during the assessment process. First Steps assessment tools are labeled and are included as an attachment. In addition, First Steps utilizes many educational handouts related to all aspects of pregnancy and parenting. These printed materials are developed by the First Steps staff or are purchased from educational suppliers. Any of the above are available for viewing at the office, however they are too numerous to be included as part of the bid. As part of the teen pregnancy focus, care coordinators will also be using a set of four workbooks called "My Baby and Me." Due to their size, they are not included in the bid packet, nevertheless a brief synopsis is included in the attachments. The D.A.R.E. to be You curriculum is also utilized and incorporates instruction in decreasing stress, increasing goal setting and decision -making skills, and increasing self-esteem and self -responsibility. A brief synopsis is included in the attachments as well. First Steps is able to serve eight clients per year, as explained in the Target/Eligibility Populations Section. These eight clients can be served either in the teen pregnancy or the PAT portion of the project. First Steps prenatal care coordination and PAT parenting education services are well-known in the county and the organization is committed to non -duplication of services. There is no other agency in the area providing the unique combination of a single point of entry into healthcare, education, support and resource referral for pregnant women and families with young children. Funding for the organization is obtained through philanthropic giving, contracts for services with individual corporations, through state Medicaid dollars and PAC resources. Individual referrals are matched with a single funding source according to predetermined criteria. PAC dollars are utilized for PAC referrals from case workers and are never used for clients from other referral sources. The organization is not large, thus this determination is never a difficult or tedious one. First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers 971083 IV. MEASURABLE OUTCOMES All services will be offered to all clients, however since services are individualized, some families may not require or receive all service objectives. Teen Pregnancy Component: 80% of families involved with the teen pregnancy portion will show improvement of household management competency (as related to the newborn), parental competency and ability to work independently with area resources and services as measured by pre and post assessment instruments. Households will be assessed according to the capacity of the teen's parent to maintain sound relationships with their child and provide nutrition, hygiene, discipline, protection as related to teenage pregnancy. Pregnant teens will be assessed as to their ability to maintain a home that is stable, safe and habitable, for the infant. Parents and teens will be assessed as to their ability to adequately utilize community resources, healthcare and other services that relate to teen pregnancy and newborn infants. First Steps' assessment tools and The North Carolina Family Assessment Scale (NCFAS) will be used to assess families and are included for review in the attachments. Parents as Teachers Component: 80% of families involved with the PAT component will show improvement of household management competency, parental competency and ability to work independently with area resources and services as measured by pre and post assessment instruments. Households will be assessed according to their ability to maintain a home that is stable, safe and habitable, for a child from birth to 3 years of age. The capacity of the parent to maintain sound relationships with their children and provide nutrition, hygiene, discipline, protection as related to babies from birth to age 3. Parents will be assessed as to their ability to adequately utilize community resources, healthcare and other services that relate to babies from birth to age 3. First Steps' assessment tools and either the NCFAS is used to assess families, as well as the PAT evaluation tools currently used by First Steps. All are included for review in the attachments. 80% of families receiving either component of life skill services will remain intact, to the best of our knowledge, six months after discharge of the First Steps' program and will have improved competency levels and/or reduced risk. First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers 971083 V. SERVICE OBJECTIVES First Steps assists clients in improving the household management competency, improving parental competency and improving the ability to access community resources through the utilization of: Home, office and phone visitation. Individualized instruction, workbooks, educational handouts, and learning modules. Role modeling and mentoring. • Resource referral, empowerment, instruction and advocacy. Quantitatively, all services are offered to all clients in either portion of the program. However, services are individualized, therefore some families may not require all service objectives. Services are measured through the use of pre and post tests, as well as First Steps' physical and psychosocial assessment tools. Referrals, care plans, progress notes and risk assessments are compiled in individual charts. First Steps also utilizes a computer database to track the number of referrals given to community resources, as well as the number of services received. First Steps of Weld County, Inc., Teen Pregnancy/parents as Teachers 971.1083 VI. WORKLOAD STANDARDS A. Number of hours per day, week or month -- Care coordinators record the time spent in face-to-face contact with clients, on paperwork requirements, travel and case management. See E. below. B. Number of individuals providing the services — At the present time, First Steps employees three staff members who are either Registered Nurses or M.S.W.s. These three professionals provide the care coordination services. C. Maximum caseload per worker -- Since First Steps provides additional services to the families of Weld County that are above and beyond the services required by the PAC bid, each part-time care coordinator will serve one PAC client per six month period and each full-time staff member will serve two PAC clients per six month period. Should the PAC have need for additional services, First Steps' will consider hiring the additional staff. D. Modality of treatment -- Care coordinators utilize home, office and phone visitation to serve clients. In addition to these weekly visits, care coordinators are available to accompany clients to individual appointments with healthcare providers and area resources. E. Total number of hours per month Each client receives: Each client is allowed: Total time/month: 13.00 hours 6.50 hours 4.33 hours 0.13 hours 4.30 hours 28.26 hours of face-to-face contact for completion of paperwork for travel to the client's home within a 15 mile radius of Greeley for court appointments of case management. per client • F. Total number of individuals providing these services -- See item B. G. The maximum caseload per supervisor -- Not applicable. H. Proof of Insurance -- Proof of insurance and Workman's Compensation are provided in the attachments. First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers 8 971083 VII. STAFF QUALIFICATIONS All staff are either Registered Nurses with Bachelor degrees or M.S.W.'s and have college education in behavioral sciences. All staff have more than 2 years of public contact in service related fields. Employees are certified Parents as Teachers Educators and certified Childbirth Education Instructors. There are presently three staff members available for the project, two staff members are bilingual. Nancy Culbreath. M.S.W.. LC.C.E. Bachelor of Arts in Sociology and Personnel Administration, and Master of Social Work. Presently: Certified Parents as Teachers Educator, Certified Childbirth Education Instructor through the International Childbirth Education Association. Past Experience: Instructor in Sociology and Abnormal Psychology at Aims Community College; Child Welfare, Juvenile Corrections, Head Start, Mental Health and School Social Work. Lani Wickam. RN.. B.S.N. Registered Nurse with a Bachelor of Science in Nursing Presently: Bilingual; Certified Parents as Teachers Educator; Childbirth Education Instructor; Staff Nurse at Monfort Family Birth Center, North Colorado Medical Center. Past Experience: Counselor, Crisis Pregnancy Center; Adult Prenatal Education. Katharine Frey. R.N.. B.S.N.. I.C.C.E. Registered Nurse with a Bachelor of Science in Nursing, Certified Childbirth Education Instructor through International Childbirth Education Association, Certified Meyers -Briggs Type Indicator Test Consultant. Presently: Bilingual, Parents as Teachers Educator, Childbirth Education Instructor Past Experience: Family and Life Education Coordinator (North Colorado Medical Center and Poudre Valley Hospital), Obstetrics and Community Health Nursing; Adult Education. VIII. PROGRAM CAPACITIES As stated on page 2 of this bid, with the current staff available, First Steps is able to serve a maximum of four individuals per month. If there is a greater need for First Steps' services in the PAC program, then hiring of new staff members would be considered in order to accommodate the increase in referrals. Since First Steps provides additional services to the community, the organization does not require a minimum number of clients to be able to offer the services to PAC. It is more important to match the needs of the individual with the services offered by First Steps. Should there not be any referrals generated, then the need for this program would have to be reconsidered. First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers 9 97108E3 RFP-PAC-97005 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. For different services the provider can request different direct service rates. An average rate can be used or a separate rate can be used for each type of service. Service rates may also be stated as a fixed amount for an assessment, court appearance, etc. If so completing this section would not be necessary. Service rates can be stated on a daily basis, as opposed to an hourly amount. Direct Time (Per Month) (4.3 weeks per month) 1. Direct client contact Indirect Time 2. Completion of Paperwork 3. Travel 4. Court Appointments 5. Vacation 6. Sick Leave 7. Case management 8. Other 9. Subtotal 10. Total Time Available Per Month 11. Ratio of Direct to Total Time 27 GREELEY Hours 51.6 25.8 17.2 .5 4.3 2.6 17.2 67.6 OUTSIDE GREELEY/EVANS 119.2 (Sum of 1-8) 0.43 (1/10=11) 51.6 25.8 43.0 .5 4.3 2.6 17.2 93.4 145.0 0.35 971.083 REP -PAC -97005 IX. RATE COMPUTATION Direct Costs Salary 2,439.00 Benefits 414.50 Subtotal 2,853.50 16.60 Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal Agency Overhead Rent Utilities Supplies Postage Travel Telephone Equipment Data Processing Other Total GREELEY Service Costs Total Total Direct Monthly Hourly Rate Hourly Rate 14,18 _2.98 2.42 5. 3 3-.b1 2 883.32 211 3 .53 1,118.00 191.00 4,637.00 450.00 50.00 50.00 150.00 200.00 50.00 50.00 475.00 1,475.00 # of Employees 3 FTE Overhead Per Employee Overhead Per Total Hours 491.67 2.84 6.50 1.11 26.96 Direct Service Rate (Hourly) (Daily if appropriate) 15.12 2.58 62.70 % of Time Attached A Direct Time Charge 1.0 32.98 1.0 5.63 1.0 38.61 . 05 1.92 . 05 .33 . 10 .26 . 10 4.02 -- 42.63 2.84 45.47 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. 971083 RFP-PAC-97005 Attached A IX. RATE COMPUTATION Direct Costs Salary Benefits Subtotal Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal OUTSIDE GREELEY/EVANS AREA Service Costs Total Total Direct Direct Time Monthly Hourly Rate Hourly Rate % of Time Charge 2,439.00 14.18 40.51 1.0 40.51 414.50 2.242 6.92 1.0 6.92 2,853.50 1b.60 47.43 1.0 47.43 2,845.00 483.00 1,118.00 191.0 4,637.00 Agency Overhead Rent 1450.00 Utilities Supplies 5 0. 0 0 Postage 50.00 Travel 389.00 Telephone 200.00 Equipment 90 00 Data Processing 50.00 Other 475.00 Total 1,710.00 # of Employees 3 FTE Overhead Per Employee 570.00 Overhead Per Total Hours 3.30 4 2. 1 6.50 1.11 26.96 Direct Service Rate (Hourly) (Daily if appropriate) 47.26 8.03 .05 2.36 .05 .40 18.57 .10 1 86 3.17 .10 .32 77 03 1n 7.70 -- 52.37 3.30 55.67 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. 28 971.083 FIRST STEPS PROGRAM ASSESSMENT Date I. CLIENT INFORMATION Client's Name: BD: Address: Age: Phone: Ethnicity: MS: Education: Employment: Income (gross): vk/mo/yr Languages spoken/understood: Stated Needs of Client: Household Members: Name Age Relationship Work/School 06/91 Revised 10/91 19-4140-1204 1 971083 II. PREGNANCY HISTORY A. Gravida Para B. Maternal medical complications_ C. Fetal/Newborn outcome III. PRENATAL ASSESSMENT (CURRENT PREGNANCY) A. Pregnancy test done Yes No B. Estimated Due Date: C. First Prenatal Visit Date: D. Child Birth Education: E. Primary Care Physician: _ F. Care Preference, if any: G. Medical Insurance: _ Yes No H. I. Is pregnancy covered? Yes Medical/physical Problems: _ Exercise: Where: Weeks Pregnant: Medicaid Yes No Pending No _ Partial J. Use of alcohol/drugs/smoking (type and frequency): K . Nutritional Evaluation/Dietary Recall: L. Breast/Bottle Feeding: 06/91 Revised 11/91 Revised 3/92 2 971083 IV. FAMILY NEEDS ASSESSMENT A. Financial: B. Food: C. Housing (Utilities, Conditions): D. Baby Needs (Crib, Carseat, Layette): E. Clothing: F. Transportation: G. Child Care: H. Medical Care for Other Children: 06/91 Revised 10/91 Revised 3/92 3 19-4140-1205 971083 V. PSYCHOSOCIAL INFORMATION A. Feelings about pregnancy (planned and/or wanted): B. Family/Friends Support System: C. Relationship to baby's father: D. Client's appearance (physical, emotional): E. Any evidence of abuse: F. Plans after delivery: --Education: --Employment: G. Parenting Concerns: H. Stress and Coping Style: 06/91 Revised 11/91 Revised 3/92 4 971083 VI. POSTPARTUM ASSESSMENT A. Date of Delivery B. Physical Well -Being: --Lochia: --Breasts: C. Breast or bottle feeding/comfort: D. Emotional Status: E. Appointment for Post-Partum Check: F. Birth control preference/arrangement to obtain: Previous use/success: G. Mother/infant interaction: H. Update family needs, psychosocial assessment: 06/91 Revised 11/91 Revised 3/92 19-4140-1206 Date 5 971083 VII. NEWBORN ASSESSMENT A. Baby's Physician: Birth Weight: Preterm Term Postdates Complications: B. Second PKU: C. Appointment for two week check for baby: D. Physical Assessment: --Feeding Patterns - -Sleeping Habits - -Stooling/Urination --Crying E. Possesses/Uses Carseat: D. Food assistance: F. Clothing assistance: E. Child care arrangements if necessary: 06/91 Revised 11/91 Revised 3/92 6 971083 NCFAS: North Carolina Family Assessment Scale for Intensive Family Preservation Services Programs Verson 1.2 IFPS SystemlDit Date IntalceA tact Completed IFPS Worker Date Case Clarki ?Assessinert Completed. Other Agency IN: Family Name: Introchiction Exit cf the following factors may be important to the level of imuoinent risk of cut -of -home placement for this family in the context of family strengths and weaknesses. Cot each factor and the items listed order each factor in terns of its importance in divesting the outer -home placement of children in this family. For each factor, rate its importance on a continuum of suength/aealmrss by using a 6 -point sale of +2: Clear Strength, +1: Mid strength, 0: Baseline adequate, -1: Mild problem, -2: Moderate Program, and -3: Serious Problem. To do so, circle the appropriate factor. 'T' represents the rating given at intake, and "C' represeus the rating at service or case closure, Ma you have rated the facts }au may want to use the sub -factor scales. To do so, circle the appropriate sore far each sub -factor. Use the etrddist below each Lector to indicate the anchor points that assisted you in your wring of factors and sdrfactors; check those that apply and add others as applicable. Only items which can impact a factor or subfactor and are capable of change, are included. Items such as a parent's history of childhood abuse should be included only if it impacts that parent's ability to function. Further, some items, such as "domestic violence," are included as sub factors only with problem ratings. Strengths are not included with these types of items. Complete these ratings within 1-2 weeks of intake @ and again within 1-2 weelcs of service termination (C). Shaded areas are required items, all others am rational or for you own use. A Environment Clear S. Mild S. Racial nr A Mild P. Moderate P. Serious P. Overall Environment @ +2 +1 0 1 -2 -3 (C) +2 +1 0 _1 -2 -3 Clear S. 1. Housing Stability (n +2 (C) +2 m Mild S. Baseline +l +1 Has been in the same residence for more than three years Pays rat/mortgage on time Moved more than twice in the last 12 months Has been threatened with eviction Kirk, R.S., Reed, K, Lin, A. Version 1.2 1/26/95 0 0 Mild P. Moderate P. Saiau P. I -2 -3 I -2 -3 (C) 971083 Clear S. Mild S. Baseline A. Mad P. Moderate P. Serino P. 2. Safety in community (1) +2 +1 0 4 -2 -3 (C) +2 +1 0 4 -2 -3 (1) (C) Safe neighborhood for the children (no problem playing outside) Neighbors look out foe each other Occasional disnuba ce in the neighborhood (fights, cuttur9s, but controllable) Unsafe in the neighborhood (can't Id children play outside, evident violence) 3. Habitability of Mousing (1) +2 +1 (C) +2 +1 0 0 -1 -2 -3 -1 -2 -3 (I) (C) Good space and privary for children Good adequate furnishing in rooms House in disrepair Complaints from neighbors about housing condition 4. Ic rntlanploymat m (C) +2 +2 0 0 I -2 -3 -1 -2 -3 (1) (C) The family has had stable arrploya>ent in the last 12 months Has had sufficient income to meet basic needs (food, herring, clothing, etc.) The family has changed =playmate more than twice in the In 12 months Is receiving total public acasarce 5. Financial Managanat (I) +2 (C) +2 0 0 -1 -2 -3 -1 -2 -3 m (C) The family has clear spading priorities; no bade bills The family is usually strapped for cash before the non paycheck Has difficulty paying bills Chaotic budgeting, often in crisis ova honey 2 Kirk, R.S., Reed, K, Lin, A. Version 1.2 1/26/95 971083 Clear S. Mild S. Baseline A. hfild P. ModP. 6. Food and Nutrition erate Serious P. (1) +2 +1 0 _1 -2 -3 (C) +2 +1 0 -1 -2 -3 m Prepares balanced, nutritious meals Family eats together whatever possible Does not consider food preparation important Children after go hungry 7. Personal Hygiene (I) +2 +1 (C) +2 +1 Children lock clean and well groomed Adults look clean and well groomed General appearance unIcatqt Noticeable poor personal hygiene 8. Transponaion (I) @ +2 +1 (C) +2 +1 Has anxs to public transportation Has awes to private transportation Can call upon friend/relative fix transportation needs No transportation available 9. Learning Fminonme nt (I) +2 +1 (C) +2 +1 Provides age appropriate toys and games Family has routine for study and play Little anahton p to developmental needs of children No opportunity for learning at home Kirk, R.S., Reed, K, Lin, A. Version 1.2 1126/95 0 0 0 0 0 0 3 -1 -2 -3 -1 -2 -3 1 -2 -3 -1 -2 -3 -1 -2 -3 I -2 -3 (C) (C) (c) (C) 97'1.083 $. social Support Oman Social (1)(� +2 +1 l Support 1. Social Rdationships m m (C) Clear S. +2 +2 Mild S. Baseline A. Mild P. ModaateP. Serious P. +1 +1 Has frequent ions with ielaiives/lrien is Attends civil and religious activities Infitquent interactions with rdatives/friads Social isolatior(no contact cc little contact with others) 2. Regular Savicm m (C) +2 +2 0 0 0 0 Ability to access available savices(child care, community services, etc.) Willingness to ass services when needed Na knowledgeable abaci availability of services Unwilling to access services 3. Ecnagax.Y Services m (C) m +2 +2 0 0 -2 -2 -3 -3 _1 -2 -3 1 -2 -3 Has access to artaSe cy ► elp from relatives/ der ds when in reed Knowledgeable abort what to obtain ernagency services from the oorammity Na knowledgeable abort availability of =agency services Unwilling to axes anergacy services Kirk, R.S., Reed, K, Lin, A. Version 1.2 1/26/95 4 -1 -2 -3 -1 -2 -3 (C) (C) 971083 Clear S. Mild S. Baseline A_ Mild P. Moderate P. Serious P. 4. Motivation for Support m +2 +I 0 -1 -2 -3 (C) +2 +1 0 -1 -2 -3 m The family accepts support/ vices fmm agencies The family is willing to swept support 5om tdatices/hiands The family is not motivated to seek help The family has refused help in the last 12 months Mild S. Baseline A Mild P. Moderate P. Serious P. Clear S. I. Parenting SiciUc 0) +2 (C) +2 C. Family/Caregiver Note: This section refers to biological parents, if presnt, or current Viers +1 0 -1 +1 0 -1 -2 Can provide consistent discipline Can effectively comuumicate with the child Inability to discipline Inability to c mm mite with the child 2. Adult Supervision (1) +2 (C) +2 m 0 0 Provides age appropriate supervision Can adapt to the conditions in the neighborhood for adult supervision Cannot supervise child effectively Little evidence of any adult supervision Kirk, R.S., Reed, K, Lin, A. Vcrsion 1.2 1/26/95 5 -2 -3 -3 1 -2 -3 l -2 -3 (C) (C) (C) 971083 (Note: Check N/A if the item des not apply) Clear S. Mild S. Baseline A. Mild P. Moderate P. Serious P. 3. Personal Problems Affecting Panning (1) — — — -1 -2 -3 N/A (C) - - - -1 -2 -3 N/A m (C) Physierl/medical problans that affect patenting Mental health problems that affect parenting Alcohol/substance abuse problems that affect parenting Marital problems that affect parenting 4. Incidents of Neglect/Abuse m (C) (1) Incidents or complains of child neglect Incidents or complaints of physical abuse Inc& ats or complaints of sexual abuse Incidents or dints of emotional abuse 5. Domestic Violate (1) Incidents or complaints about domestic violence Valente between the carvers which affects parcving Kirk, R.S., Reed, K, Lin, A. Version 1.2 1/26/95 6 -2 -3 N/A -2 -3 N/A (C) -2 -2 -3 N/A -3 N/A (C) 971083 D. Family Interactions Note: This seaion refers to family mantes living in tic same or different housebolds; an overall assessment Mild S. Baseline A Clear S. 1. Bonding with child (1) +2 (C) +2 m +1 +1 Healthy closeness with child Ability to nurture the child Inability to form a dose relationship with child Inability to mane the child 2. Communication with child (I) +2 (C) +2 Can effectively communicate with child Can resolve conflict and dispute in the family No open, clear communication mitt Family is coos iamfy in conflict 3. Marital Relationship m +2 (C) +2 m Stable marital relationship in the family Affection and harmony in the family Divorce or separation in the family Evident discord in the family Kirk, R.S., Reed, K, Lin, A. Version 1.2 (/26/95 0 0 0 0 0 0 7 Mild P. -1 -1 Moderate P. Serious P. -2 -2 -3 -3 -1 -2 -3 -1 -2 -3 I -2 -3 I -2 -3 (C) (C) (C) 9'71083 4. Expxmtion of the child (1) +2 +I (C) +2 +1 m Agc appropriate expectation of the child Clear expectation of the child Unnalistic egtogation of the child Cannot tolerate mistakes in child $. Mutual Support m m (C) +2 +2 Good emotional support as a family Can lend support when needed No evident mutual support or help in the family Undermining of each other in the family Clear S. 1. Child's Physical Health (I) +2 (C) +2 m 0 0 0 0 1 -2 -3 -1 -2 -3 -1 -2 -3 -1 -2 -3 E Child Well -Being Note: This section pertains to the imminent risk child; optional for other children using a separate assessment form Good health Regular physical check-up Physical illness that affects fmctioning Devdopmaihal disability that affects functioning Baseline A Mild P. Moderate P. Serious P. o -1 0 -I -2 -3 Kirk, R.S., Reed, K, Lin, A. Version 1.2 1/26/95 8 -2 -3 (c) (C) (c) 971083 Clear S. Mild S. Baseline A. Mild P. 2. Mental Health Moderate P. Scrips P. (I) +2 +I (C) +2 +1 0 -1 -2 -3 -2 -3 m Emotional stability Ability to handle stress Has emotional difficulties Has diagnosed mental illness 3. Alcohol/ Substance Abuse m m (C) (C) — — _ -1 -2 -3 N/A -1 -2 -3 Has Occasional alcohol/substance abase per, nn Has suiours addiction Has been id -erred for treatment Is in treatment 4. Sexual Abuse m (C) Has had irridents of venial abuse by others Has had incidents of abusing others Has been referred for treatment Is in treatment 5. Emotional Abuse m (C) Has been emotionally abused members Has been referred r tubYfartuly Incidents of emotional abuse have inatased Incidents ofenaaanal abuse have decreased Kirk, R.S., Reed, K, Lin, A. Version 1.2 1/26/95 9 (C) -2 -3 N/A -2 -3 WA -2 -3 N/A -2 -3 N/A (C) :3/:79'? • Clear S. Mild S. Baseline A Mild P. Moderate P. Serious P. 6. Child's Behavior +1 0 -1 -2 3 (I) +2 4 -2 -3 (C) +2 +1 0 m well behaved, no discipline problems Management problem at home Management problem at school Ddinquart behaviors 7. Sdwul Performance (1) m (C) +2 +2 Good attendance Good aradanicrecord Poor attendance Has school phobia, or los of interest in school 8. Relationship with Caregivers (1) +2 +1 (C) +2 +1 Accepts discipline and supervision Good communication with the caregivers Littlproblan e orr no corrummicalion with the caregivers 9. Rdationship w/ Sablings (1) +2 +2 Gds along with the sblings Helps each cilia in need Frequent fights does not gel along No support to or fiorn siblings 0 0 0 0 0 0 Kirk,.R.S., Reed, K, Lin, A. Version 1.2 1/26/95 10 -2 -2 (C) -3 N/A -3 N/A -1 -2 -3 -1 -2 -3 1 -2 -3 -1 -2 -3 (C) (C) (C) 971083 Claw S. Mild S. Baseline A Mild P. Moderate P. Serious P. 10. Relationship w/ It (1) +2 +I (C) +2 +I 0 0 -1 -2 -3 1 -2 _3 (1) (C) Has peas as dose friends Generally gas along with Pons Does not get along with peas Cannot form friendship 11. Motivation/ Cooperation (1) +2 +I (C) +2 +1 (1) Is interested in staying with the family/caregivers Is motivated to change behaviors Is not motivated to change Is against any intervention or services Kirk, R.S., Reed, K, Lin, A. Version 1.2 126/95 0 0 1 -1 -2 -3 -1 -2 -3 (C) 971083 PARENT ENTRY/EXIT QUESTIONNAIRE Parent's Name: Child's Name: Child's Date of Birth: Date Completed: Please read each of the following statements about young children and parenting practices. Check the response that most nearly describes your agreement or disagreement with the statement. Strongly Strongly Don't Agree Agree Disagree Disagree Know (4) (3) (2) (1) (0) 1. Attending a baby whenever he cries during the first few weeks of life results in a spoiled child. 2. Colorful commercial mobiles are of great interest to babies during the first month of life. 3. "Crying it out" when an infant is unhappy or upset should be used only when nothing else works. 4. Babies can be left in their crib or playpen most of the day without being harmed. 5. It really doesn't make much sense to talk to babies before they understand the meaning of words. 6. Babies learn best when you talk to them about what they are interested in at the moment. 7. Practice can be provided in head control by placing the baby on its back an hour each day. 971083 Strongly Strongly Don't Agree Agree Disagree clang. Know (4) (3) (2) (1) (0) 9. For the sake of safety, babies should be discouraged from crawling in the home. 9. Accidents are the number one cause of death and injury to young children. 10. Discipline means punishment. 11. The time when it becomes most important for parents to talk to babies is when babies begin to talk. 12. To avoid accidents, a young child should have only limited opportuni- ties to explore. 13. Discipline involves set- ting limits as well as punishing a child for misbehavior. 14. Children begin to show pride in their achieve- ments at 12 months. 15. Children develop language naturally, so parents need not worry about finding ways to encourage it. 16. The child understands words before he is able to speak. 17. Encouraging a baby to hold his own bottle as early as possible is a good way to encourage independence and to get him to sleep in his crib. 971083 retest r, vaivation of Yartnts as .t eacne -s trogruat Please rate the following services provided by the PAT program. A. Personal visits. 1. How helpful have the personal visits been? 2. Hew easy has it been to keep appointments for these visits? 3. How easy was it to follow up on the topics discussed? 4. Have these discussions made being a parent easier? S. Have these visits increased your confidence• as a parent? Comments What was least helpful and why? Not At All 'Moderately Very 1 2 2 Z 2 1 2 3 3 3 3 3 What was cost helpful and why? B. Were you given any referrals to community resources? Yes (If "non, go to C,) No Were you referred to: Yes No Were they helpful? Yes No WIC Supplemental Foods Medicaid Food Stamps 7th Day Adventist Clothing C.S.U. Outreach Crisis Pregnancy Center Other 971083 C. Are there any ways to improve the PAT experience for you in the following areas?. Visits with the educator: Informational handouts: Referrals: Other: D. Comments: 9'71083 "MY BABY AND ME" WORKBOOK SUMMARY GOING HOME: 1) What Does a Child Cost? 2) Basic Needs 3) Parent/Daughter Situations 4) My Day and My Needs 5) Finances 6) Planning A Budget BASIC DECISION -MAKING: 1) Looking Ahead 2) Dreams 3) My Lifeline 4) Decision Basics 5) Values & Goal Setting 6) Is Parenting for Me Now? (Adoption -related) 7) Alternatives & Decisions (How they affect the mom and baby) D.A.R.E. TO BE YOU TOPICS: 1) Self-Concept/Self-Esteem -- Self -Concept Models, Creating a Secure Environments, Identifying Personal, Positive Parenting Practices, Positive Reflections, Acknowledging Negative Feelings, Valuing Differences. 2) Self -Responsibility -- Control Auction, Recognizing Feelings, Development of Internal Control, Stress management. 3) Social/Communication Skills -- Friendship Skills, Social Network Survey, Communication Breakdowns, Reflective Listening 4) Decision-Making/Reasoning Skills -- Levels of Reasoning, Needs, Personalized Decision -Making. First Steps of Weld County, Inc., Teen Pregnancy/Parents as Teachers 971083 06/10/96 09:03 228139573488 RISK RET MGMT 4++ BOULDER INS. 2001/003 RISK RETENTION MANAGEMENT, INC. Toll Free (8001533-3097 2033 WOOD STREET, SUITE 200 FAX (941)957-3488 SARASOTA, FL 34237 TO: JOE BOBICH Client Number: 93-1789 #15281 FAX: BOULDER INS FROM: Sheie Eskue, Underwriter DATE: 06/04196 COMPANY: Nonprofits' Mutual Risk Retention Group, Inc. AUTfOR7.ZATION TO BIND FOR: First Steps of Weld County, Inc. EFFECTIVE DATE: 06/07/96 COVERAGE DEDUCTIBLE LIMIT General Liability: 1,000,000/2,000,000 (Form NMRRG E-13 Lead Exclusion applies) Directors & Officers: 1,000 1,000,000/1,000,000 (Excludes Improper Sexual Contact) PREMIUM 600.00 900.00 TOTAL: 1,500.00 Capital Contribution: 4% 60.00 The attached invoice reflects the downpaytnent necessary to continue coverage. Capital Contribution is not included in the total premium. It is a separate membership fee. Comments: RENEWAL TERMS AND CONDITIONS AS EXPIRING, EXCEPT AS NOTED. COVERAGE CONTINGENT UPON RECEIPT OF (1) UPDATED NMRRG APPLICATION , THESE ARE REQUIRED EVERY THREE YEARS (2) CURRENT FINANCIAL STATEMENT OR 990 TAX FORM (3) CURRENT UST OF DIRECTORS AND OFFICERS COV This Authorization to Bind is valid up to 30 days from effective date. GE ✓ 0 LY BE BO WIT NOTIFICATION FROM RISK RETENTION MANAGEMENT. Authorized Signantre ` �r Date (Coverage is subject to receipt of capital contribution and 25% downpayment within ten days of the effective date of coverage.) 971083 Colorado Compensation Insurance Authority 720 S. Colo.Blvd. Suite 100-N, Denver, Colorado 80222 (303) 782-4000 FIRST STEPS OF WELD COUNTY INC 1024 9TH AVENUE STE. ##3 GREELEY CO 80631 POLICY NO. 3120655 BROKER OF RECORD: BOULDER INSURANCE ASSOCIATES 1601 28TH STREET BOULDER CO 80301 (303) 444 1143 ENDORSEMENT THIS ENDORSEMENT SHALL BE ATTACHED TO AND WILL FORM A PART OF POLICY NUMBER 3120655 , ISSUED BY THE COLORADO COMPENSATION INSURANCE AUTHORITY. Item 1 of the policy, is amended to SHOW Broker of Record: LOCKTON COMPANIES OF COLORADO, INC. 4500 CHERRY CREEK DR. SO. STE 400 DENVER CO 80222 EFFECTIVE DATE: OCTOBER 1, 1996 THE COLORADO COMPENSATION INSURANCE AUTHORITY OF COLORADO HAS CAUSED THIS ENDORSEMENT TO BE SIGNED BY ITS PRESIDENT THIS 13TH DAY OF AUGUST, 1 WC 05 03 32 rev 6/92 w""-4 enaw "LEADERSHIP IN COLORADO WORKERS' COMPENSATION SERVICES S 028958 1915" 971083 3 e s P - 01 1-1 -t 1_ 9 7 THU U Of WELD CO(4N7Y, INC.: `s,. PRENATAL, POST PARTUM g WELL_EAEY CAPE 14 e s t moor a C o I d s_ Ms ,JudyA Griego Wel aty Department of Social Services Gree1I CO 80632 Dear;l'udy, I received your correspondence regarding our PAC Bid 97005 and wish to address several of the concerns' mentioned. Many of the items were discussed in our bid, therefore I will refer to the pagealaa which the information can be found. Question #1 Further explain the proposed program evaluation. t. , In the attachments to the bid, following the proof of Colorado Compensation Insurance, are the evaluation forms as well as pre-test/poet-teat instruments utilized by First Steps' case managers One or more of these documents are utilized by case managers depending' on the. s' provided. Included are the: • Steps Program Assessment (a 3 page, double sided document] -used to assess each individual client to determine risks, needs and barriers to attainment of resourees,':skills and services. The assessment incorporates both the prenatal and postpartum periods, depending on the client's status. North Carolina Family Assessment Scale (a 6 page, double sided document) -- used to :assess family strengths and weaknesses within the context of the environment, social support, caregiver, family interaction and child well-being parameters. 3. Parents as Teachers (PAT) Parent Entry/Exit Questionnaire -- used to measure the parent's knowledge of child growth and development. 4. PAT Parent Evaluation used to allow parent feedback concerning the PAT program and evaluate the use of resources and referrals Post -it Fax Note 7671 baf°6///47I W w ► a (� ' Ipnpos From 1 j `SJ,, T,..It Totkttie. 1' tr1 { rr /� CoC/DD/opt./; y 76J ^ ita_ •Phon Ca. Fite ��'W,,,,,, ,,Q,,,7```4 er p 353-419.2 4367c-cit§00-6i+442b April 30,1997 uestion,#2 -- The expectation of the PAC is that First Steps will initiate service interventions within five working days • This expectation is reasonable and First Steps is able to meet this requirement. The inability, to meet this requirement would occur only if the client was unable to coordinate an. appoRent time with the case manager TRIM TY OFFICE PLAZA • 1O24 9TH AVE. • SUflE 3 • gREELEY • COLORADO 80631. • (970) 353-4992 971083 u w. es *E3 -- Further clarify services provided to South County clients.' • This question is addressed on page 2 of our bid. "First Steps is available to serve South County resident and the rate of services is reflected separately in the budget" uestion #4 -- Further clarify' proposed provision for transportation, including South County. 1'r. First Steps is not in the habit of transporting clients on a regular basis. However, during the provision of PAC services, case managers have accompanied clients to appointments with physicians, counselors, court appointments, etc, First Steps is unable to transport South • clients to appointments in the Greeley area, but would be able to accompany them to talent :in South County that aredetermined to be a part of the provision of client services. I hope that this response is sufficient to address the Committee's concerns. If there are additional questions that arise as a result of this correspondence, please do not hesitate to contact me. ICxis Howard, R.N. Execxe Director 971083 Weld County Department of Social Services Notification of Financial Assistance Award (NOFAA) For Placement Alternatives Commission (PAC) Funds Condition(s) of Approval Weld County Placement Alternatives Commission will monitor, on a priority basis, the Contractor, by family or individual served, as follows: 1. Response time by the Contractor to provide direct services to the family or individual in response to the referral by the Weld County Department of Social Services. 2. The level of bilinguaUbicultural services provided under this NOFAA. 3. The level of services to South Weld County families and individuals provided under this NOFAA. 971.083 hiDe COLORADO DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, COLORADO 80632 Administration and Public Assistance (970) 352-1551 Child 933 Protective and Youth SeryServices (970) 352-1923 2 Food Stamps (970) 356-3850 MEMORANDUM Fax (970) 353-5215 TO: George E. Baxter, Chair Board of Weld County Commissioners May 23, 1997 FR: Judy A. Griego, Director, Social Services Q RE: Nineteen Notifications of Financial Assistance Awards (NOFAAs) Under the Weld County Family Preservation Program Enclosed for Board approval are nineteen (19) Notifications of Financial Assistance Awards (NOFAAs) under the Weld County Family Preservation Program and the Board approved plan for the program. A Bid Evaluation Committee is recommending approval of bids submitted by Contractors. These NOFAAs complete the bid process authorized under the Board of Weld County Commissioners. The major provisions of the NOFAAs are as follows: 1. The performance period is June 1, 1997 through May 31, 1998. 2. NOFAAs authorize contractors as vendors for specific services and at hourly or monthly rates. We do not provide program funding for the year 3. Recommended approval of vendors is as follows: A. Day Treatment 1. Alternative Homes for Youth 2. Weld County Department of Social Services 3. NCMC PyschCare 4. NCMC PyschCare Outpatient 5. Weld Mental Health B. Home Based Option B 1. Ackerman and Associates 2. Weld Mental Health $54.17 $41.69 Hourly Monthly $1365 $1300 $3120 $ 936 $1435 971084 971083 971042 Page 2 Memorandum May 23, 1997 C. Intensive Family Therapy 1. Ackerman and Associates - Short Term 2. Ackerman and Associates - Mediation 3. Island Grover Regional Treatment Center 4. Weld Mental Health D. Life Skills E. 1. A Woman's Place 2. C.A.R.E. 3. First Steps - Greeley First Steps - Outside Greeley 4. Greeley Dream Team 5. Weld County Health Department 6. Partners, Inc. $93.99 $93.99 $90.00 $43.98 $35.71 $28.19 $45.47 $55.67 $29.64 $80.25 $15.39 Sexual Abuse Treatment Program 1. Weld Mental Health $42.25 2. Island Grove Regional Treatment Center See a tChart 3. Weld County Department of Social Services Provider Rates 4. Each vendor provided a maximum capacity number of families and/or individuals that they may serve during the year. We outline these maximum capacity numbers in each NOFAA; however, the Weld County Department of Social Services does not commit to funding at these maximum capacity numbers. If you have any questions, please telephone me at extension 6200. Hello