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Home My WebLink About971042.tiffRESOLUTION RE: APPROVE NINETEEN NOTIFICATION OF FINANCIAL ASSISTANCE AWARDS FOR PLACEMENT ALTERNATIVE COMMISSION FUNDS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with nineteen Notification of Financial Assistance Awards for Placement Alternative Commission Funds between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and various agencies as listed on the Department of Social Services memorandum attached hereto and incorporated herein by reference, commencing June 1, 1997, and ending May 31, 1998, with further terms and conditions being as stated in said awards, and WHEREAS, after review, the Board deems it advisable to approve said awards, copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, ex -officio Board of Social Services, that the nineteen Notification of Financial Assistance Awards for Placement Alternative Commission Funds between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Social Services, and various agencies as listed on the Department of Social Services memorandum attached hereto, be, and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said awards. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 28th day of May, A.D., 1997. BOARD OF COUNTY COMMISSIONERS eputy Clerk the Board APPD AS I FORM: SS W. H. Webster WELD COUNTY, COL DO nstance L. Har Barbara J. Kirkmeye Wdv 521 971042 SS0023 Weld County Department of Social Services Notification of Financial Assistance Award for Placement Alternatives Commission (PAC) Funds Type of Action contract Award No. FY97-PAC-9000 (RFP-PAC-97006) X Initial Award Revision Name and Address of Contractor Contract Award Period Alternative Homes For Youth Greeley Day Treatment 3000 Youngfield, Suite -#157 Lakewood, CO 80215 Beginning 06/01/97 and 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 a -ward is based is an integral part of the action. Special conditions Unit of Service Program provides a comprehensive, therapeutic alternative to placement that addresses behavioral, psychological, family issues and academic enrichment, with a strong emphasis on vocational exploration. A maximum of 14 youths (age 12-18), eight hours of site -based services per day, 40 hours per week for 26 weeks. cost Per Unit of Service 1) Reimbursement for the Unit of Services will be based on an monthly rate per child or per family. 2) The monthly rate will be paid for only direct face to face = contact with the child and/or family, as evidencedbyclient- signed verification -form, and as specified in the unit of cost computation. 3) Unit of service costs cannot exceed the monthly 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 Monthly Rate Per $1 365.00 Unit of Service Based on Approved Plan Enclosures: igned RFP; Exhibit A � ✓Addendum RFP Information; Exhibit B Condition(s) of Approval Program Official: By Approval - By i Ju We Date: . Gri o, Dire Coun Depa s/3/i7 t r nt of Social Services eorge . Baxter Board of Weld Count �t Date: 9% _ 971012 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. 971012 INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97006 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-97006) for: Family Preservation Program --Day Treatment 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 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 Day Treatment Program Category must provide a comprehensive, highly structured program alternative to placement that provides therapy and education for children. 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 Alternative Homes For Youth PART D...Bidder Response Format PART E...Bid Evaluation Process BID MUST BE SIGNED IN INK ELDON R. HOLLAND TYPED OR PRINTED SIGNATUR c andwritten Signature (Name) g ture By Authorized Officer or Agent of Vendor ADDRESS 9201 West 44th Avenue Wheat Ridge, CO 80033 PHONE k (303) 940-5540 TITLE Executive Director DATE March 17, 1997 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 971042 RFP-PAC-97006 Attached A DAY TREATMENT PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97005 NAME OF AGENCY: Alternative Homes For Youth ADDRESS: 1110 M Street PHONE: (970) 353-6010 CONTACT PERSON: Paulette Tamasky Greeley, CO 80631 TITLE: Program Director DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Day Treatment Program Category must provide a comprehensive, highly structured program alternative to placement that provides therapy and education for children. 12 -Month approximate Project Dates: Start June 1, 1997 End May 31, 1998 12 -Month contract with actual time lines of: Start June 1, 1997 End May 31, 1998 TITLE OF PROJECT: Alternative Homes For Youth - Greeley Day Treatment Program AMOUNT REQUESTED: Eldon R. Holland Name and Signature of Person Preparing I%cument Date Eldon R. Holland ' Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS Please initial to indicate that the following required sections are included in this proposal: $1,365 &.e., $65 per day of enrollment — 21 days of service per month on average') March 17, 1997 March 17, 1997 X Project Description X Measurable Outcomes X Staff Qualifications X Target/Eligibility Populations X Types of services Provided X Certificate of Insurance X Service Objectives X Unit of Service Rate Computation X Workload Standards X Program Capacity Per Month Date of Meeting (s) with Social Services Division Supervisor: L 4 (36 lino r Comments by SSD Supervisor: is n � ,-� � r_cL ci__ /S0O —02-2—tit ----ire c--,— . I6s-,.-.1 U ), 2 1.,i r—.,—_ Al,, fZY-i✓4- tw. I `� ( K� Iti cJi -----)41-^-t-f u\-• - (Al "tip,p,e-,--/1A--t--L eL & L---/- ThC'Th-t•-•---/-1,-CK Name and Signature of SSD Supervis fI/ A -n e/ESS' c 2. Date 971042 I. PROGRAM DESCRIPTION The Greeley Day Treatment Program utilizes a non -medical model of treatment. It is one of eight programs under the Alternative Homes For Youth umbrella. The Day Treatment Program has been successfully providing services to youth and families within the Greeley community since 1994. The program is geared towards providing services that meet the needs of male and female youth between ages of 12 and 18. The program provides a comprehensive, highly structured program alternative to placement that addresses behavioral, psychological, family issues and academic enrichment. There is also a strong emphasis placed on vocational exploration. Services are available from 8:00 a.m. - 5:00 p.m. with extended evening and weekend hours for family therapy and for tracking and support services. Evaluation criteria measure recidivism, school and/or work attendance and parent satisfaction. The survey is conducted 6 and 12 months after discharge. MISSION The Mission of the Greeley Day Program is to reduce the likelihood of placement outside the home. • By providing individual and family opportunities for the development of effective problem solving skills and constructive communication. • To help youth in rediscovering how to learn and succeed in school. • To increase responsibility on part of the youth. • To develop self respect through challenging experiences. • To empower the youth and their families to achieve future goals. 971042 II. TARGET/ELIGIBILITY POPULATION Youth to be Served A. An average of 14 youth, ages 12 to 18 years, will receive services within a 12 -month period. B. IQ of 60 or Above Non -Psychotic Male and Female Ages 12 - 18 years old (average age has been 15.3). Court ordered to the program Condition of bond, probation or deferred judgment. C. An average of 14 family units will be served, involving parents and siblings. D. 33% of youth served will receive bicultural/bilingual services. E. The total number of individuals who receive services in south Weld County will be determined by referral and transportation. F. Monthly maximum program capacity is 14 youth. G. Monthly average capacity is 7 youth. H. Average stay in program is 24 weeks. I. Average hours in program per week is 40 hours. J. Program Availability - 40 hours. III. TYPES OF SERVICES A. The Greeley Day Treatment Program provides a maximum of 8 hours of site -based services per day, for ages 12 to 18 years. PROGRAM SERVICES * Individual, Group and Family Therapy * Psychological assessments * Structured level system * Positive Peer Milieu * Regular staffings and communication with appropriate agencies, (i.e., social services probation and public schools) * Educational services * Relationship skill building increasing/enhancing self-esteem. 971042 PROGRAM SERVICES (continued) * Basic living skills * Vocational services * Drug/Alcohol monitoring and counseling * Parent and mental health education and support groups * Transportation within 10 miles B. Community Collaboration Efforts 1. Weld County Department of Human Services Referrals and Case Management Services which include staffings, treatment planning and discharge. 2. Weld County Department of Mental Health Case Management/coordination of therapeutic services and testing. 3. Colorado Department of Education Department of Education: staff certification, training and inservices. Weld County School District 6: case management, staffings, and testing (IEP). 4. Island Grove Case Management Services Group Therapy Services Drug and Alcohol Assessment and Urinalysis Testing 5. Individual Group Therapy Service (IGTS) Individual and Family Therapy C. Program Components 1. Educational Approved School Program by the Colorado Department of Education 2 - Certified Teachers Vocational/Independent Living Skills Physical health needs (nutrition, medical, sex education, HIV, contraception, etc.) Reintegration into public schools Educational Testing and assessment 2. Therapeutic Individual counseling services (average 1 hour per week) Group counseling services (average 10 hours per week) Family counseling services (average 1 hour per week) Island Grove -Substance Abuse Group (average 1 hour per week) Psychiatric Consultation Psychological Testing Dcurrie\michael\pac 3/97 042 3. Behavioral Utilization of Therapeutic Crisis Intervention Daily life supervision and interaction Peer Dynamics Behavioral modification Refusal Skills Life Skills 4. Recreational Wilderness Program (minimum of 2 trips offered per youth) Therapeutic Initiatives and Team Building activities Team Sports D. Parental/Caretaker Involvement 1. Day Treatment includes parental involvement in all program components as indicated in the Treatment Plan and as required. 2. Day Treatment advocates family therapy and encourages parents/guardians to participate in all phases of treatment. E. Assessment and Plan 1. Educational services are provided by 2 certified teachers. Pre -and Post -testing will be provided using the Woodcock Johnson Assessment Tool. 2. Vocational and Independent living skills are provided by certified teachers and counselors for age appropriate youth. Experiential activities and job coaching are also provided. 3. A contract for therapeutic services is established for every youth and family that outlines the frequency and level of services needed. This information is documented in the treatment plan and reviewed on a monthly basis. Individual and Family Therapy will occur weekly. 4. Physical health needs, i.e., sex education, HIV, contraception, nutrition, etc., are covered within the program's curriculum. Medical and dental appointments need to be scheduled prior to placement or will be scheduled within 30 days of placement. 5. Mental health needs such as psychotropic medications and testing are monitored through the treatment plan and recommendations for these additional services will be coordinated during case reviews and treatment staffings. The program is capable of administrating medications and coordinating mental health services. Dcurrie\michael\pac9798.doc 3/97 971.01, f F. ProActive Planning (transition) 1. The reintegration plan will be outlined and discussed 30 days prior to discharge. The program will maintain on -going communication with the school district to ensure continuity of care. 2. Monthly staffing will occur between the Greeley Day Treatment staff and the IGTS therapists to monitor treatment progress. The program will also schedule two follow- up sessions with the youth and family to further insure family stability. 3. Within 10 days of being discharged from Day Treatment, program staff will follow- up with telephone contact to the youth and family to check on progress and offer support. 4. A 6 and 12 month follow-up evaluation will be conducted on all youth and families who have been discharged from the program. The evaluation will measure client satisfaction, and progress in school, employment, family dynamics, recidivism and stability within the community. 5. A collaborative effort in utilizing community resources will be established to insure that personal and family growth is sustained, (i.e., Vocational Rehabilitation Summer Youth Employment, etc.). IV. MEASURABLE OUTCOMES A. 70% of the youth who complete the Day Treatment Program will be residing in their homes 6 months after being discharged from the program. B. 70% of the youth, will enter public school upon graduation from the program. Proiect Monitoring and Evaluation Internal monitoring/evaluation of the program will include a quarterly review of the program by Alternative Homes For Youth's Quarterly Assurance Review Team. The team will ensure compliance with the AHFY Quality Assurance Manual. Program evaluation will be coordinated at six-month and one-year intervals to reevaluate youths successful reintegration into the community. Areas that will be tracked will be employment, school, illegal activities, and any commitments or new offenses with the judicial system. The data will be compiled to evaluate the outcome of the program to prevent imminent placement of children and to reunify children in placement with their families. DcurrieAmicfiaelApac9798.d91 j7()4Z The program will monitor daily, weekly, and monthly services by utilizing the ECHO Client Record Management System. This computerized data collection system will provide the project up-to-date information about delivery of services and the utilization of these services. Each service is documented in quarter hour increments. The program will also fill out quarterly client progress reports as prescribed by Weld County Department of Social Services. V. SERVICE OBJECTIVES A. Fewer than 30% of the youth will be placed within six months of Day Treatment graduation/discharge. B. 70% of the youth discharged from Day Treatment will be enrolled in public school. C. The Day Treatment Program will assist families in the awareness and identification of community resources that can be utilized regarding family management issues (i.e., human services, vocation, housing, medical/health, mental health, education, and legal resources.). The evaluation methods that will be utilized include the computerized ECHO Client Record Management System that allows for client follow-up 6 months and 1 year after discharge. The follow-up procedure is able to quantify service objectives. The ECHO System will also track client and parental involvement in community and state sponsored services on a weekly basis. VI. WORKLOAD STANDARDS A. An average of 14 youth and families will receive services within a 12 month period. B. The duration and length of time within the program is an average 24 weeks. C. Total number of hours per day/week/month. Day - 8 hours per day Week - 40 hours per week (40 hours service) Month - 173 hours per month. D. We anticipate no more than 14 youth total in Greeley Day Treatment Program. The Program is staffed with, 1 Tracker/Counselor, 1 Treatment Leader, 1 Counselor/Wilderness Experience Coordinator and 1 Teacher. Dcurrie\michael\pac9798.doc 3/97 971042, VII. STAFF QUALIFICATIONS Day Treatment staff will meet or exceed the minimum Merit System qualifications in education and experience. A. Counselors will have a minimum of a Bachelor's degree in Social Work, Psychology, Sociology or closely related field. Treatment Leader will have a minimum of a Master's degree of Social Work and three years of clinical supervision experience. B. The number of staff at Day Treatment. 1 - Counselor/Wilderness Experience Coordinator 1 - Tracker/Counselor 1 - Treatment Leader 1 - Certified Teacher C. Staff to youth ratio for youth 12 to 18 years of age. 1 - Counselor to 12 youth l - Treatment Leader to 20 youth VIII. COMPUTATION OF DIRECT SERVICE RATE Direct Time (Per Month) l Direct client contact Indirect Time 2 3 4 5 6 7 8 9 10 11 Completion of Paperwork Travel Court Appointments Vacation Sick Leave Case Management Other Subtotal Total Time Available Per Month Ratio of Direct to Total Time Hours 394 26 4 2 32 13 22 52 151 545 (Sum of 1-8) .72 (1/10 = 11) 971042 IX. BUDGET DESCRIPTION Direct Costs* Salary Benefits Subtotal Indirect Costso Supervision Salary Benefits Clerical Salary Benefits Monthly Service Costs Total Hourly Rate Total Direct Hourly Rate of Time Direct Time Charge $5,269 1,236 6,505 (450 hours) (394 hours) $11.71 $13.37 2.75 3.14 14.46 16.51 (95 hours) (394 hours) $2,000 $21.05 $5.07 380 4.00 .96 511 5.38 .96 97 1.02 .25 Subtotal 2,988 Agency Overhead Rent (Program/Admin. $1.00 per sq. ft) Utilities Supplies Postage Travel Telephone Equipment Data Processing Other Total # of Employees Overhead Per Employee Overhead Per Total Hours Direct Service Rate * Direct Cost calculated by 2.6 staff at 173 hours. 0 Indirect Cost calculated by .55 staff at 173 hours. 31.45 7.58 Monthly $1,000 50 250 12 133 67 333 75 0 1,920 3.15 FTE $610 $3.52 100 100 100 $13.37 3.14 16.51 $5.07 .96 .96 .25 7.58 Direct Time Charge Most of these costs are direct program costs that are not administrative in nature. $ 4.87 $28.96 • Total Cost of Program is $1,365 i.e., $65 per day of enrollment - 21 days of service per month on average. 971042 CERTIFICATE OF INSURANCE issued by the COLORADO COMPENSATIONINSURANCE 82 4000 720 South Colorado Blvd., Denver, CO 80222, (303) CERTIFICATE HOLDF1t: - .... .......... WELD COUNTY DEPT SOCIAL SERVICES P OsBOX 758:91510TH ST G1iEELEY,CO 80632 TO WHOM IT MAY CONCERN: This is to certify that this company has issued a Standard Workers' Compensation and Employers' Liability Policy as descnTxdbelow covering the liability imposed upon subject employers by the Workers'. Compensation Act of Colorado, said policy being ingood standing as of this date. . - POLICY NUNtBER. 1453282 MARCH 18, 1997 POLICY PERIOD: 07/01/96 TO 07/01/97 INSURED: ALTERNATIVE HOMES FOR YOUTH 9201 W44THAVE WHEATRIDOE,CO 80033 ORIGINAL EFFECi1VE DATE: "-. 01/27/83 . _ . -ANNUAL ADJUSTED IMPORTANT: THE COVERAGE DESCRIBED ABOVE IS It'1 EE£ECT'AS OF THE ISSUE DATE OF THIS CERTIFICATE IT IS SUBJECT TO CHANGE AT ANY TIME IN THE FUTURE. All policies are subject to the following provhsion of the Workers' Compensation Act with respect to cancellation: The issuance of this certificate ofinsurance is subject to section 844-110 C.R.S., which requires that a thirty (30) day notice of cancellation be given unless cancellation is based on fraud; material misrepresentation, nonpayment of premium or any other reason approved by the Commissioner of Insurance: in such instances, CCIA will provide a ten day notice of cancellation. Alteration of this document is a criminal offense pursuant to Colorado Criminal Code 18-S-102: "A person commits forgery, if, with intent to defraud, such person falsely makes, completes, alters, or utters a written instrument which is or purports to be, or which is calculated to become or to represent H compieted:. - . a commercial instrument -1' SM/bem Adrianne Noble Customer Service Representative CLASS CODES COVERED ON THIS POLICY: 08810/05,08833/05,08868/051 Z0/Z0'd ZLAA Tv:80 8T-£0'L66T 971042 motnaas aawoisnot WO6A ro^ m��_;:: `h sr°?tl 3/14/1997 I..mm,:.. �RTIPICATI; OF INS 25-S �w,;s,:::w`::�.::<:::�.<s.:: :.:. :`. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS RCOVERAGE CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER AFFORDED BY THE POLICIES BELOW. g ,sFE I COMPANIES AFFORDING COVERAGE latggem COMPANY A: RELIANCE INSURANCE COMPANY COMPANY B: COMPANY C:• COMPANY D: DUCER imam Corporation 0 Permsylv;snia St ver, CO 80::03-1390 3) 831-171/ URED =NATIVE HOMES FOR YOUTH N: BILL LD:!TIG 1 11. 44TH AVENUE NT RIDGE CO 80033 rw,nwsm..�m�m..'?;=?^:4:^iF:a%b`. ",'C:..� :_^...,,.,,..N n...s...-- ._.....Wrxo mw :'S�u:5 �1 " 'w_.: - '`n„'� . ' ;w is l COVERAGES "=� s 3. -• p li es at i insurance xis" lic rs to certify chi: policies of listed below bare been issued to the insured nosed above for the po try period ated, notwitheta'ling any requirement, term or condition of any contract or other docunent with respect to which this ficate tay is:iad or may pertain, the insurance afforded by the policies described herein is sub]ect to all the tens, sins and condit.rns of such policies. Lisits shown may nave been reduced by, paid claims. g, a,, „ ^�,.;,. Q.: LIMITS 3)I : "" `na,'.o:::.� ,�-� INSURANCE �� POLICY NUMBER & DATES �:...............al � . General Agg Pro/Co Ops Agg Pers/Adv Inj Ea Occurrence Fire Damage Medical Exp 3ENERAL LIABILITY [E] Cams Con Liab [ ] CM [E Occur [ I OCP IX) PROF I CAB %UTO LIABI:;ITY [ ]Any I ],011 Own [X]Schd 12 Hired [X] Non-Own'xd [l [I "MIRAGE LIA:3ILITY [ ]Any Auto [1 (1 EXCESS LIA:3ILITY [ IUmbrell.r Form [ ]Other T: ian Umb NC/EMP LIA3ILITY [ lIncl [ Excl Prop/Part/execs JE2827622 Eff 07/01/96 Exp 07/01/97 Elf $1,000 000/S2,000 0 / / 00 Eff / / Exp / / JR2827622 Eff 07/01/96 Exp 07/01/97 $500 DED COMP t COLLISION Elf / Eff / / Exp / / Eff / / Exp / / Eff / / Exp / / $2,000,000 $2,000,000 $1,000,000 $1,000,000 $ 50,000 $ 5,000 $1,000,000 CSL BI (person) $ BI (accident) $ Property Dam Auto -Each Acc Other -Ea Ace -Aggregate Occurrence Aggregate Stat Lmts I ]Other — EL Each Acc EL Dis-POI Lmt EL Dis-Ea Emp Eff / / Exp / / :ription c` operations/locations/vehicles/special items DITIONAL IaSURED: SOCIAL FECVICRSAAND WELD COure£Y DEPARTMENT OF _ I CERTIFICATE HOLDER IF725sIg :D COUNTY . LW:"PAT. PE ).BOX 758 3ELEY CO 8 )EPT_ OF SOCIAL SRVCS 2SICHINO, DIR GEN SRVC )632 — CANCRIJ,ATION Should any of the above described policies be cancelled before the expiration date thereof, the issuing companyendeavor will to mail 60 days written notice to the certificate holder named to the left, but failure to mail such notice shall pose no obligation or liabilityofany kind upon the eom y, itta��or reps. esentative TOTAL P.02 971012 05-1997,1;_44PM FROM ALTERNATIVE HOMES 3039405542 - P.2 111�� Alternative Homes for Youth Residential Care and Treatment for Troubled Youth and Families. May 5, 1997 Judy A. Griego Weld County Department of Social Services P.O. Box A Greeley, Colorado 80632 Re: RFP-PAC Bid 97006 Dear Ms. Griego: I am writing this letter per your request regarding additional information regarding the Alternative Homes For Youth, Day Treatment proposal. The information should provide you the clarification that will assist you and Placement Alternatives Commission in awarding proposals. I. The program has been in full operation for the past three years and we do not expect a problem in the delivery of services within five working days of formal announcement. 2. Alternative Homes For Youth has proposed offering day treatment services to the southern communities of Weld County since these area's have been identified with limited resources and services. Alternative Homes For Youth has also agreed to provide transportation for youth within ten miles of the facility. 3. 70% of the youth will complete the program and return to their home school for formal graduation. The program is approved and can formally graduate students. However, the goal of the program is to return students back to their home schools. 4. Within the past year the average length of stay has been 144 days. It is reasonable to anticipate that students would return back to public school after completing the program or at semester break. Maa&r Asesry NIA National Anocirim nnnq ur AAA.. A - aen...-.4 D:A.... rt1 0/11112 • FY12\ cmn.CC.n . FAY iranAl oan.ccn 971012 5-05-1997 1:44PM M ALTERNATIVE HOMES 3039405542 P.3 5. The program is responsible for the coordination and dissemination of all education information between the program and the home school. This is done by the close relationship that have been established between the teachers and representative from Weld County District 6. All youth will have two formal staffings who are admitted into the program. The first occurs within in 30 days of admission and 30 days prior to discharge. Students who have Individualised Education Plans (MP) are reviewed formally with representatives from the home school to ensure a successful transition. In addition the program has coordinated its curriculum to reflect the current curriculum of the home school. This collaboration has created a learning environment that promotes active learning with minimal disruptions to the student. 6. All youth will participate in initial psycho/social and educational assessments to determine the range of services. All youth will have an educational plan and will participate in individual, group and family therapy. In addition students will also participate in wilderness, life skills, health, recreation, job coaching, drug and alcohol services. These services are provided by internal and external resources. 7. Counselor qualifications are as follows: • Counselors have a minimum of a bachelor's degree of Social Work, Psychology or closely related field with at least one year prior experience working with youth. In addition counseling staff are also certified in First Aid/CPR. Wilderness Counselors have also successfully participated in Alternative Homes For Youth Wilderness Training Program. The counselor to youth ratio is 1:10. If you need additional information, please call me at (303) 940-5540 EXT. 106. Sincerely, Michael A. Gal egos, M.S.CAC HI Program Coordinator 97.3-042 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. 971942 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 Contract Award No. FY97-PAC-11000 (RFP-PAC-97006) Name and Address of Contractor Weld County Department of Social Services Generic Day Treatment 315 North 11th Avenue, P.O. Box A Greeley, CO 80631 Computation of Awards Unit of Service The ability to purchase day treatment for children who are placed in their own homes, family foster homes, foster -adoptive, adoptive homes, group homes, and CPA's. Up to a maximum of six children (ages 5-18 yrs) annually, an average of five hours per day for 52 weeks will preserve placement and allows at -risk children to remain in their own homes or the least restrictive, most family -like setting; and this service prevents or reduces placement failures and multiple moves for these vulnerable children. Monthly Rate Per $ 1 300.00 Unit of Service Based on Approved Plan Enclosures: Signed RFP; Exhibit A �Addendtun RFP Information ✓ Condition(s) of Approval Approvals) t3eorge Fa!Baxter Board of Web County Comm'' one Date: i ern Y V 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 monthly rate per child or per family. 2) The monthly 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 monthly 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 Program • fficial: By ' its.4P 1I �41a1LW Jury . Grieg•, I irecto / Welt ounty •epartmen of Social Services Date: 2 971042 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. , INVITATION TO BID DATE: February 5, 1997 BID NO: RAP -PAC -97006 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 SUMMARY Request for Proposal (RAP -PAC -97006) for: Deadline: March 25, 1997, Tuesday, 10:00 a.m. Family Preservation Program --Day Treatment 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 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 Day Treatment Program Category must provide a comprehensive, highly structured program alternative to placement or more restrictive placement that provides therapy and education for children. 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) PART D. .Bidder Response Format PART E...Bid Evaluation Process VENDOR Weld County Department of Social Services (Name) Handature B Offrc4r r Ageirt of Ven p(e�// BID MUST B SIGNED IN INK Vii(/ (57bP</ci72 C TYPED OR PRINTED SIGNATURE ADDRESS 315 N 11 Avenue Greeley CO 80631 PHONE # 970.352.1551 TITLE Child Protection Supervisor III DATE 370N(9 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 971342 RFP-PAC-97006 Attached A DAY TREATMENT PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97005 NAME OF AGENCY: Weld County Department of Social Services ADDRESS: 315 N 11 Avenue P. O Box A. Greeley CO 80631 PHONE: (970) 352.1551 CONTACT PERSON: Chris Karl TITLE: Child Protection Supervisor III DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The ay Treatment Program Category must provide a comprehensive. highly structured program alternative to placement that provides therapy and education for children. 12 -Month approximate Project Dates: Start June I. 1997 End May 31 1998 TITLE OF PROJECT: Generic Day Treatment X 12 -month contract with actual time lines of: Start June I. 1997 End M •y 31. 1998 Date Date MANDATORY PROPOSAL REOUIREMENTS Please initial to indicate that the following required sections are included in this proposal: Project Description 1 Yes Measurable Outcomes Target/Eligibility Populations Service Objectives Types of services Provided Yes Workload Standards Certificate of Insurance 7 Yes Staff Qualifications Unit of Service Rate Computation Program Capacity per Month Date of Meeting (s) with Social Services Division Supervisor: Comments by SSD Supervisor: Not Applicable Name and Signature of SSD Supervisor 24 Date 971012 Attached A RFP-PAC-97006- Program Category Day Treatment Pr • am Bi. at - • . Project Title Vendor I. PROJECT DESCRIPTION The project allows the Weld County Department of Social Services the ability to purchase day treatment for children who are placed in their own homes, family foster homes, foster -adoptive and adoptive homes. This service may not otherwise be available to these children (5 years of age through 18 years of age) and families. This service preserves their placements and allows these at -risk children to remain in their own homes or the least restrictive, most family -like setting. This service prevents or reduces placement failures and multiple moves for these vulnerable children. The project is imperative for the Weld County Department of Social Services to maintain and meet its compliance requirements under the Child Welfare Settlement Agreement which requires country -wide day treatment services for children and limiting the number of placements for children. The project augments other potential day treatment projects to be offered by the Carson Day Treatment Program for school aged children (School District 6 and Weld Mental Health) and Youth Passages' Day Treatment Program for adolescents (North Colorado Medical Center). II. TARGET/ELIGIBILITY POPULATIONS The proposed target/eligibility population will be identified through social caseworker files and referral by caseworkers and is described as follows: A. Total number of clients to be served in the 12 -month program: 6 children B. Total individual clients and the children's ages. 5 years of age through 18 years of age. C. Total family units. 5 family units. D. Sub -total of individuals who will receive bicultural/bilingual services. Translator services provided as needed for parents. E. Sub -total of individuals who will receive services in South Weld County. For those referrals made in South Weld County with the approval of school districts with placement and excess costs. F. The monthly maximum program capacity. 5 children. G. The monthly average capacity. 5 children. H. Average stay in the program (weeks). 52 weeks. I. Average hours per week in the program. 5 hours. 911,912 75 Attached A RFP-PAC-97006- III. TYPE OF SERVICES TO BE PROVIDED A. $ite based services The program shall provide site -based services for at least 5 hours per day. The site -based hours will be monitored through monthly reports from vendors and through required caseworker site visits on a monthly basis. B. Community collaboration efforts. The program shall collaborate by: t Documenting case records, monitoring the services of vendors through staff of the Weld County Department of Social Services. 2 Consulting for therapeutic needs with the Weld Mental Health, Inc., or other mental health providers, as required and nerrccary with vendors. 3 Gaining approval of the appropriate school districts for required educational costs (IEP approval) and academic standards. C. Program components. Each child or adolescent will be provided an individualind plan which coordinates and documents educational, therapeutic, behavioral, and recreational services with each day treatment provider (vendor). D. Parental/Caretaker Involvement: The case plan will outline the level of parental/caretaker involvement for each child or adolescent. The caseworker, through home and site visits, will report such involvement through monthly provider reports. 911042 '.F RFP-PAC-97006 Assessment and Plan of Child and Family: Each vendor of day treatment, which is required by State licensing standards, must provide education through a certified teacher and individual/family therapy for the child, and, as appropriate, for all family members. The Weld County Department of Social Services will provide vocationallmdependent living for age appropriate adolescents and care for the physical health needs of children though other Department resources. Proactive planning for transition to public school setting or independent living Day Treatment compliments and facilitates all of the goals as follows: 1. Reintegration into public schools 2. Follow-up for individual and family therapy 3. Completion of day treatment 4. Identifies progress/outcomes 5. Reinforces gains These goals are monitored by State staff who are assigned to monitor these goals through case files for compliance with the Child Welfare Settlement Agreement. All five children or adolescents will have each service component described in III A though F. E. F. Attached A IV. MEASURABLE OUTCOMES The measurable outcomes are very simple. One goal is to maintain the child in the placement or home they are in at the time they receive day treatment. The other goal is to transition the child back to the public school system upon graduation from the day treatment program. Children completing the day treatment program will be residing in their own homes six months after discharge from the program. The methods to monitor the outcomes, include the following: - open case files will be kept and monitored on each child and family - monthly reports from the Day Treatment Program vendor will be monitored - school records will be used - discharge records from the Day Treatment Program vendor will be required - staffing of the case will also be required The measurable outcomes are: A. 2 children will be placed within six months of Day Treatment graduation/discharge. 97 971012 RFP-PAC-97006 B. 3 children will be enrolled in public school from graduation/discharge from the Day Treatment Program. C. 5 families will be able to improve their ability to access resources through support services which will be provided by the Department of Social Services and the vendors of Day Treatment Programs. Attached A V. SERVICE OBJECTIVES The service objective of this fund is to be able to provide intensive services needed to preserve a placement or to prevent the need for more restrictive care. The individual provider of day care will have all the practical clinical goals of reducing inappropriate behavior, improving parental competency, increasing self-control, etc. Quantitatively, the service objectives are the same as the measurable outcomes. Two children will graduate within six months of the beginning of day treatment, to be transitioned into public school. Three children will be able to attend public school after day treatment services, and all families will increase their ability to access services. VI. WORKLOAD STANDARDS The Day Treatment Program will utilize State -licensed vendors which must comply with ratio standards of pupil/therapist and the duration of the program. A. 5 children and families will be served. B. 52 weeks will be the duration/length of the program C. 5 hours per day will be per workload by staff members. VII. STAFF QUALIFICATIONS All vendors of day treatment are licensed by the State and requiredto meet appropriate licensing requirements for Residential Child Care Facilities (RCCFs) and other private facilities. RFP-PAC-97006 Attached A VIII. COMPUTATION OF DIRECT SERVICE RATE Since this program will purchase services instead of providing them, rates will be determined by the State for State licensed programs and are governed by State rules and regulations. Educational costs are the responsibility of the school district for which the child is of residence. Average Annual Rate per Child/Family: $15,600 Average Monthly Rate per Child/Family: $1,300 Further rate computations/cost breakdown will not be possible until individual providers are engaged. 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 Hours 9. Subtotal 10. Total Time Available Per Month (Sum of 1-8) 11. Ratio of Direct to Total Time (1/10 = 11) 29 97.1912 Attached A 'P -PAC -97006 IX. RATE COMPUTATION Direct Costs Salary Benefits Subtotal Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal Agency Overhead Rent Utilities Supplies Postage Travel Telephone Ecmipment Data Processing Other Total # of Employees Overhead Per Employee Overhead Per Total Hours Service Costs Total Total Direct Direct Time Monthly Hourly Rate Hourly Rate % of Time Charge Direct Service Rate (Hourly) (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 sfor staffdirect services. Agency Overhead - Monthly cost for rent, supplies, postage, etc. If the agency uis or clerical ed estimatedupportproviding t building is owned use market rent for the building. # of Employees - Total number of employees in the agency building. Overh 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. 111 9710/72 lk COLORADO April 28, 1997 Judy Griego, Director Weld County Department of Social Services Post Office Box A Greeley, CO 80632 DEPARTMENT OF SOCIAL SERVICES P.O. BOX A GREELEY, COLORADO 80632 Administration and Public Assistance (970) 352-1551 Child Support (970) 352-6933 Protective and Youth Services (970) 352-1923 Food Stamps (970) 356-3850 Fax (970) 353-5215 Dear Ms. Griego: Re: RFP-PAC Bid 97006 (Generic Day Treatment) At the request of the Evaluation Commitee, I submit the following on the generic day treatment account. 1. Further explain the proposed program evaluation. The purpose of day treatment will be to keep a high need child in the least restrictive setting. The fact that we can keep identified children from requiring residential care will be one measure. Caseworkers will also attend staffings and use their clinical judgement as to the effectiveness of day treatment to meet the treatment goals of their child and family. We will also keep track of how many clients accessing this service will successfully return to public school. 2. Interventions within five working days. The availability of day treatment will be known by the referring caseworker prior to approval of funding. The five day rule will not present an obstacle. 3. Services provided to South County. South County clients may benefit from the use of The Cleo Wallace Center in Broomfield. This reputable program is closer to Brighton and Ft. Lupton than Greeley, and they have a more extensive program than the Carson Center. The generic account allows for more geographic flexibility. 4. Provision for transportation. This will be determined on a case -by -case basis. Most school districts provide transportation for children in day treatment, and parents can also transport their own children. The department would not provide daily transportation to day treatment. This would apply to South County as well. 5. Estimated percentage of children to complete graduation from day treatment. As this account is expected to have only a few children whose location and level of need would qualify them for the account, a percentage may be an inaccurate measure. It would be hoped that one hundred percent would graduate and be transitional to public school. However, some children with extreme mental health issues may require residential placement. An estimate of seventy- five percent or better is realistic. 6. Estimate the time frame for the child to return to school. This estimate would again be contingent on how extensive the presenting problems are for the child. As day treatment is expensive, a one or two month stay in day treatment would be desired to stabilize a child under situational duress. For a more chronic case, a six month stay would not be unreasonable. Any stay over six months would require the caseworker to document to the supervisor why day treatment was still needed, and what progress had been made on the treatment goals. 7. Describe transitional strategies to accomplish the child's return to public school. Again, these would depend on the client's needs and circumstance. Staffings with the receiving school district would be used to develop the strategy. The day treatment providers would also be expected to participate in a sound transition plan. Please contact me if you need further information. Sincerely, Christopher Karl Child Protection Supervisor Weld County DSS 97 1.7x2 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. 9710 '12 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 Adolescent Partial Hospitalization Program designed to address the multifaceted needs of adolescents experiencing significant emotional, behavioral, educational, interpersonal, familial problems, and adolescents suffering from a wide range of psychiatric disorders and chemical dependency, up to a maximum of 144 adolescents (agesl0-18 yrs) per year, 40 hours per week for twelve -twenty weeks. Cost Per Unit of Service Monthly Rate Per Unit of Service $ 3.120.00 Based on Approved Plan (Day -Treatment) Monthly Rate Per Unit of Service Based on Approved Plan (Int-Outpatient) $ 936.00 Enc iw,pies: Signed RFP; Exhibit A Addendum RFP Information; Exhibit B Condition(s) of Approval Approval By Geo ! E. Baxter Board of el i County Col Date: Os 3 % contract Award No. FY97-PAC-10000 (RFP-PAC-97006) Name and Address of Contractor North Colorado PsychCare - Youth Passages Day Treatment Program 928 12th Street 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 monthly rate per child or per family. 2) The monthly 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 monthly 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 o, Direct Departm t of Social Services X3/47 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. 971042 INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97006 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-97006) for: Family Preservation Program--D.y Treatment 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 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 Day Treatment Program Category must provide a comprehensive, highly structured program alternative to placement that provides therapy and education for children. 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 North Colorado PsyncCare PART D...Bidder Response Format PART E...Bid Evaluation Process BID MUST BE SIGNED IN INK Karl Gills TYPED OR PRINTED SIGNATURE (Name) Handwritten Signature By Authorized Officer or Agent of Vender ADDRESS 928 12th Street Greeley, CO 80631 PHONE # 970-352-1056 TITLE DATE Administrator 4Zkzca 3 j, /S7 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 971042 RFP-PAC-97006 Attached A DAY TREATMENT PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97005 NAME OF AGENCY: North Colorado PsychCare ADDRESS: 928 12th Street Greeley, CO 80631 PHONE: ( 970 1352-1056 CONTACT PERSON: Jeff DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Day Treatment Program Category must provide a comprehensive. highly structured program alternative to placement that provides therapy and education for children. J. Hauser TITLE: Manager - Behavioral Services 12 -Month approximate Project Dates: Start June 1. 1997 End May 31 1998 TITLE OF PROJECT: Youth Passages AMOUNT REQUESTED: N/A Jeff J. Hauser Name and Signature of Karl Gills Name and Signature Cirief Administrative Officer Applicant Agency 12 -month contract with actual time lines of: Start June 1, 1997 End May 31, 1998 Document Date 12_`s)i1 3/3/c7 Date MANDATORY PROPOSAL REQUIREMENTS Please initial to indicate that the following required sections are included in this proposal: 4 Project Description X Target/Eligibility Populations )('" Types of services Provided X Certificate of Insurance X Measurable Outcomes Service Objectives i)(' Workload Standards LX/ Staff Qualifications Unit of Service Rate Computation ,5C Program Capacity per Month Date of Meeting (s) with Social Services ce/Division Supervisor: -O2-- I f- J 7 Co ennts by SSD( Supervisor: CY.cR S ----f '4- '`Lt Th- O a [{i.: • (-4,1-4,.. yi, Pavia 5, cc -Q 11 a-4-5 7 Name and Signature of SSD Supervisor Date AZ AR le /mss% ' S Vim.., sfle- 24 971042 PAC PROPOSAL I. PROJECT DESCRIPTION Youth Passages Adolescent Partial Hospitalization Program has been designed to address the multifaceted needs of adolescents experiencing significant emotional, behavioral, educational, interpersonal, and familial problems. As such, it serves adolescents suffering from a wide range of psychiatric disorders and chemical dependency. As a partial hospitalization program, Youth Passages can intensively treat these adolescents while simultaneously minimizing the disruption and stigma often associated with inpatient treatment or other restrictive settings. Youth Passages offers programming options of day treatment (Monday through Friday 8:00 am - 4:00 p.m.), intensive outpatient (Monday, Wednesday and Friday 4:00 p.m. to 7:30 p.m.) and outpatient services (individual, group and family therapy). Treatment modalities include milieu, individual, group, experiential, behavioral and family therapy including parenting classes and multifamily group. When indicated, psychotropic medications are also administered. In addition, an accredited BOCES classroom staffed by an affective needs teacher addresses academic and behavioral issues in the classroom. Until the opening of Youth Passages, adolescents needing a more intensive treatment modality than outpatient therapy were necessarily treated outside of our community and/or separated from family. Indeed, in order to assure the adolescent's safety they were often hospitalized because there were no intermediate levels of care available. Youth Passages is currently the sole community provider of medical model adolescent partial hospitalization services. Given the level of utilization of our PAC program since June '93, Youth Passages appears to be meeting a vital need within our community. We believe that the therapeutic scope and intensity of our program is well suited to successfully intervene with children that are at risk for being placed outside of their homes. By utilizing a partial or day hospitalization model specific therapeutic interventions can be implemented with the family system or with the child's problem behavior while they continue to reside at home. 9'71042 X 12 Mo. Program North Colorado PsvchCare .0 N Nmae of Day Treatment Project: Youth Passages 0 N 5 kids/month for 12 months All Youth Passages participants are from 10 to 18 years old cn s .E ' a" y 0 O >> o .D .[ C O • V N U • o 3 0 .Y c —„ • 00 a 0 • •4ticcl .341.-i .C t O w • 0 0 0 O ¢ N .Q C N Y y O �3 a O .' 4-0° on av o C O •> .r 0 -0 H N > 0 O 0 C 0 0 C > Cd ❑. '.:+ a N~ w .L-) N C _ O y C S N O 'C N � H C E c 3 7 01. .° cys ea O C N N 0 C .>. Cd 4 0 O T N 0 H £ co o �. C1. H cd 4 Cho. U V 0 b0 � y N .c .C. C CND ed 0 p ti '0 U 0 Y 0 ncd' C • C .� C O E .c 0 .1 .7 Ct N O O Q_ .0 > a y o ' •}' 0 N • cd N O O $3." y y O O O c • .� N 0. " w,_ 'o c. 3,V 7 y 0 • * U ON* 003 iat catW 0 C Q 0 N N N 0 N1 O '. y Q N C a) U 00 O O C- . O C 7 0 C r m oa c 0 0 tO 0 L ti y V OI V) T N W r td C 7 0 0 3 Ln .N . 0 00 U td 7 .D I- • C .c 00- 0 O 3 o> W en W a o N N d U 0 0 O Cd CCd N C C 7 d T 0 N E C w a) • E H E OI Cd El N O 4-. 0• 0_ N 0 T ≥ > 0 .O U 70 O. C 3 • 3 Cd O 0 W 3 3 a a N N ?„ a 7 a 7 7 'O -0 0 a '> N> U .X -0 a C <.., N o3 >, o N .c C y o o a 0 o e c ' v • P .c v) cn • 0 C ' OI ca NI Q W w G. 7 The monthly average capacity Cd L .�e • ° 0 0 3 I- 0 I. [131)E o o I a* to r O .L+ 4 •Q. C C N.4 o4 y y O 5 3 3 n. Jl , y y • 7. 0 G) N II., to 7 it ti n' '7d 0 * 7 7 > 0 0 0 0 d * �E t.N *O Q t .0 0 0 d c VI I xi •-i 971042 (Be Specific) Explain How This Item Will Be Met / .■ r.0 @ §6 / §- \ «] ^ ,. 2g2 \ // §k ) ?/%g «§ i 37/ El i EfI]!a» 6@§§ #§ $ 7}7\!§tE \\\\ \\ ( o84'A id \(/ r4 4 t0 �� k)/\�j °r= )•EM{ 'ft..a9.5 oo_oil o t2.a1j. 2\/0 JJ aoa�)cn�t &yIe =R A =R f & /■ ! \ /2 to z G, ] a \\ \ \\ k\f2 ) f >( )I)j \\ &e§ N / \j \� "\ \ 04 m /f§/k} \a .kf\$! § .. <\;--®- }/ }i2)7G®/ Rm© =Rp m — Yes/No 3. TYPE OF SERVICE TO BE PROVIDED: Will your project provide services as follows: A. Site based services with a minimum of site based services of 5 hrs. per day? B. Community collaboration efforts among: I) The Department of Social Services? 2) The Department of Mental Health? 3) The Department of Education? 4) Others (Please Describe)? C. Program components of: 1) Educational? 2) Therapeutic? 3) Behavioral? 4) Recreational? 5) Substance Abuse Programming D. Parental/Caretaker involvement in all program components as indicated in the case plan and as required? E. Assessment and plan to meet the needs of child and family including: 1) Education through a certified teacher? 2) Vocational/Independent living for age appropriate children? 3) Individual and family therapy which includes all family members? 4) Physical health needs, i.e., nutrition, medical, dental, sex education, HIV, contraception, etc.? 5) Mental health needs such as psychotropic medications, etc? Yes/No (Be Specific) Explain How This Item Will Be Met �\ ?a ®VC / &§ \2 )§ — 8 k / ) /\ ] 2\ Ca § «) k)a§/ G e� .;(e] ) �/ tJ.ii. ){ } & (�f|�6 2Fl : \ „�- «| nj!:I k }} `§if#) « 7(!//6 )�\\)\\f/«a °§=5el�IO) /®/02\��}/I / / > // 3. TYPE OF SERVICE TO BE PROVIDED: (Continued) F. Proactive planning for transition to public school setting or independent living: 1) Reintegration into public school? 2) Follow-up for individual and family therapy? 3) Completion of Day Treatment? 4) Identifies progress/outcomes? 5) Reinforce gains? QUANTITATIVE MEASURES (Relate to previous described services) Total Number to be served up to 12 continuous months plus completion of partial semester the child is enrolled in 2a. 60 2b. 2c. 2d. 2e. 2f. " 97104? 971.042 (Be Specific) Explain How This Item Will Be Met 20% of Youth Passages graduates may be placed in out -of -home placement by DSS within 6 months of graduation from Youth Passages. 100% of children are enrolled in public school or other education (ie: Homebound, workstudy, Aims). 100% of parents, guardians, foster parents or residential treatment center staff members will be invited to multi- disciplinary case conferences involving treating physician, PsychCare staff, and home school personnel. Private therapists, WCDSS case workers and WMHC counselors will be invited per client circumstance. Utilization of PAC follow-up questionnaire. Refer to 94-95 PAC grant, page 5, dated 1/7/94. Yes/No al r E r V 5. SERVICE OBJECTIVES Will your project provide the service objectives as follows: a. The number of children placed within six months of Day Treatment graduation/ discharge. b. The number of children that were enrolled in public school from graduation/ discharge from the Day Treatment Program. c. Improve parents' ability to access full range of community services. QUANTITATIVE MEASURES (Relate to previously described service objectives) Total Number How will these services be measured? 4a. 12 971042 (Be Specific) Explain How This Item Will Be Met 60 kids per year and their families. Anticipated average length of stay in treatment is 6-10 weeks in each level of care. Youth Passages: 8 hours per day, 40 hours per week; 160 hours per month. Intensive Outpatient Program: 4 hours per day M,W,F and 2 hours on Saturday; 14 hours per week; 56 hours per month. Outpatient Program: Individual and family therapy scheduled in one -hour increments as needed. Group therapy scheduled in two-hour increments as needed. Four full-time staff members dedicated solely to adolescent services with perdiem therapists and staff available as needed. See attached certificate of insurance. Yes/No 6. WORKLOAD STANDARDS Will your project be measured by: a. Total number of children and families served. b. Duration/length of time in program. c. Total number of hours per day/week/month d. Total number of individuals providing these services. e. Insurance . n -rte i (Be Specific) Explain How This Item Will Be Met Personnel staffing at Youth Passages meets or exceeds standards enumerated in Vol. VII(7.706). Teacher -Masters Degree in Affective Needs Therapists - Masters Degree in psychology, counseling, social work or related field Medical Director -Board Certified Child and Adolescent Psychiatrist 1 Teacher 2 Mental Health Therapists 1 Psych Tech Assistant 1 Medical Doctor All participants of Youth Passages are between 10 and 18 years old (exceptions may be discussed) A full census is 18 and the number of kids at each age varies week to week. We will increase our staffing pattern per guidelines outlined in sections a and b when census is greater than 11. O z 4 r E r 7. STAFF QUALIFICATIONS a. Will your staff who are providing direct services have the minimum qualifications as enumerated in Volume VII(7.706)? b. 5 Total number of staff (4 fulltime, MD part time available for project based on projected average daily census of 10. (per diem therapists and team assistants in census dictates) c . 2 staff member to 5 children ages 5 years to 13 years (minimum is 1 staff member to 8 children)? d. 2 staff member to 6 children ages 16 years and over (minimum is 1 staff member to 10 children)? CO 971.042 RFP-PAC-97006 Attached A Program Category Project Title Vendor ay Treatment Program Bid Category Youth Passages North Colorado Medical Center 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. 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. Site based services (The Bidder must state that a minimum of site based services of 5 hours per day, ages eight through twenty-one (21) and two and one-fourth hours minimum per day for children ages three to seven) will be provided. B. Community collaboration efforts. The Bidder must describe its community collaborative efforts with: 1. The Department of Social Services. 2. The Department of Mental Health. 3. The Department of Education. 4. Others (Please Describe). C. Program components. The Bidder must describe the program components of 1. Educational 2. Therapeutic 3. Behavioral 4. Recreational D. Parental/Caretaker involvement in all program components as indicated in the case plan and as required. 25 97942 RFP-PAC-97006 Attached A E. Assessment and plan to meet the needs of child and family including: 1. Education through a certified teacher. 2. VocationalIndependent living for age appropriate children. 3. Individual and family therapy which includes all family members. 4. Physical health needs, i.e., nutrition, medical, dental, sex education, HIV, contraception, etc. 5. Mental health needs such as psychotropic medications, etc. F. Proactive planning for transition to public school setting or independent living: 1. Reintegration into public school. 2. Follow-up for individual and family therapy. 3. Completion of Day Treatment. 4. Identifies progress/outcomes. 5. Reinforces gains. 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. MEASURABLE OUTCOMES Please provide a two page description of your expected measurable outcomes of the project. Please address the following measurable outcomes: A. The children completing the Day Treatment Program will be residing in their own homes 6 months after discharge from the program. B. The children will enter public school upon graduation from Day Treatment. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. 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. The number of children placed within six months of Day Treatment graduation/discharge. B. The number of children that were enrolled in public school from graduation/discharge from the Day Treatment Program. 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. 26 971042 RFP-PAC-97006 WORKLOAD STANDARDS Attached A 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 Total number of children and families served. B. Duration/length of time in program. C. Total number of hours per day/week/month. D Total number of individuals providing these services. E. Insurance. VII. STAFF QUALIFICATIONS Please provide a one page description of staff qualifications and address, at a minimum, the following: A. Will your staff who are providing direct services have the minimum qualifications in education and experience. Describe. B. Total number of staff available for the project. C- Total number of counselor and/or treatment leader(s) to the number of children ages 5 years to 13 years. (Minimum expectation is I staff member to 8 children.) D. Total number of counselor and/or treatment leader(s) to the number of children ages 16 years and over. (Minimum expectation is 1 staff member to 10 children.) 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 Subtotal 27 Hours 104, 14 0 0 12 4 24 54 971042 RFP-PAC-97006 10. Total Time Available Per Month 158 11. Ratio of Direct to Total Time .66 Attached A (Sum of 1-8) (I/10= I1) 971042 RPF-PAC-97006 VIII. RATE COMPUTATION SERVICE COSTS Monthly Total Total Direct Hourly Rate Hourly Rate Direct Costs Salary* $2629.60 Benefits 736.29 Subtotal 3365.89 Salary** 1484.00 Salary*** 3349.92 Indirect Costs Supervision Salary 3285.27 Benefits 919.88 Clerical Salary 1581.22 Benefits 442.74 Subtotal 6229.11 Sub total Agency Overhead Rent Utilities Supplies Postage Travel Telephone Equipment Data Processing Other Total It of Employees Overhead Per Employee Overhead per Total Hours 15.20 4.26 19.46 8.58 69.79 18.99 5.32 9.14 2.56 36.01 NA $31363.50 1754.00 572.00 200.00 NA NA NA 1623.00 $35512.50 5 $ 7102.50 $ 3.41 Direct Service Rate (Hourly) (Daily if appropriate) 25.23 7.07 32.30 14.24 69.79 28.49 7.98 13.71 3.84 54.02 Direct Time % of Time Charge NA 25.23 NA 7.07 NA 32.30 NA 14.24 NA 69.79 50% 14.24 50% 3.99 50% 50% 50% 3.41 6.86 1.92 27.01 143.34 143.34 146.75 as calculated by the formula ****$18.00/hr will be actual rate charged to PAC *Salary is average of Masters Level Therapists who work in Youth Services at NCMC **NCMC portion of salary paid to Masters Level Affective Needs Teacher ***Youth Passages portion of salary for Medical Director ****As a community service provider, NCMC has decided to use the same rates as in the 96006 grant 971.042 IX. PROGRAM CAPACITY BY MONTH: As outlined in Section #2 the monthly maximum program capacity for Youth Passages is 12. There is no minimum number of patients necessary to support our programs. However, we hope to carry at least 3 or 4 youths and their families at all times in our various levels of care. 971042 North Colorado Medical Center 1801 16th Street Greeley, CO 80631-5199 (970) 352-4121 March 3, 1997 Pat Persichino Director of General Services 915 10th Street P. O. Box 758 Greeley, CO 80632 Ref RFP-PAC-97006 TO WHOM IT MAY CONCERN: RE: LUTHERAN HEALTH SYSTEMS Lutheran Hospitals and Homes Society of America Western Health Network, Inc. Country Health, L.L.C. North Colorado Medical Center (dba North Colorado Psychcare/North Colorado Family Recovery Center) This is to advise that Lutheran Health Systems, along with its subsidiary operations, are self - insured through the LHS Self -Insured Liability Trust. The effective date of this coverage is January 1, 1997. This coverage extends to all corporate entities as well as any employee working within the scope of their employment. The limits provided by the LHS Self -Insured Liability Trust are at least $1,000,000 per occurrence/$ 15,000,000 in the aggregate. Excess liability limits of $25,000,000 are provided through the American Healthcare Systems Risk Retention Group. If additional information is necessary, please contact Philip Holt, Insurance Manager at Lutheran Health Systems, Post Office Box 6200, Fargo, North Dakota 58106-6200 (701/277-7577) (FAX 701/277-7636). Sincerely, � lti John Miller Assistant Administrator A member of Western Plains Health Network 971.042 i, 13 6, 1997 acement Alternative luation Committee artment of:Social Box A eley, CO 80632 Commission Services 'Whom It May Concern: following document your April 17, 1997 contains responses to letter to Karl Gills. 1. iii f I' _I1I ' Noah Colt dip des are/ Family Reccivery(tenter The menta1 heaiandd add+ctton'tinit of ' North (Colorado car Center i' stated concbrns'address I Further explain the the proposed program evaluation used,c the effectiveness of your program. Program:. effectiveness is addressed via the f methods: llowi�ig j a. Administration of the Brief Symptom Inlventorylpee Attachment A) upon admission andjat discharge:to.' • evaluate the increase or decrease of symptomology during treatment; I b .Weekly administration of client s'atisfactioil� and progress surveys (see Attachment Bi'. Neg&tive comments are addressed via a one On one sessiois with- -'. client to address concerns. �' r c. Patient feedback forms completed iat discharge 1 sr.e Attachment C) ; I I j d. Family feedback forms completed at dis6hatg@Dee I Attachment D); I { II] I e Living situation (i.e. home versus placement)'(, and school enrollment status is gathered . 6'''nop hub post, discharge through contact with DSS casewotkdr'nd/o',r.� family of youth. This data is communicatedito,the.(PAC; Committee via quarterly reports. I We compile all of this data as well as feedback from referring professionals in the community to evaluate our lev}:,1 ofI.I; performance. This data is examined on a monthly basis our;, continuous Quality Improvement Committee. �!I y I H1 Willyou initiate service delivery within five working days of referral? i i Yes. Further clarify services provided to South Clunty H clients. I Youth Passages is open to accepting clillents from the South County region and has served families fcocc Ftj.. Lupton, Hudson, Dacono and Keenesburg Over the pasty ew years. Our service delivery base will continue to kb* located in Greeley at the Psychcare/Family Recovery genter at 428 12t" Street. 928 -12c - St i H Greeley CO 8Q 3li j/1O422 (9711) 352-705fi E80b1I887(829,; {gpp),$ X673 " w b0'd 1H101 transitioning to the above mentionedlschool a chejdule., Youth Passages is willing to be flexibleandi icreative in setting up transitional planning.!! It the Conmtittee requires any additional claritcatlon please n'o'tify me at your convenience. Thank You. I irIL spectfully submitted, e ser,' MSW/MAEd nager .7)1: klan I 9 1942 4. 7 • I rurther clarify proposed provision for transportation,;., 1nloludiag -_ South :'County. , H !i! ,j Youth Passages does not have the ability to transport youth on a regular basis. In the past we have worked'io ip conjunction with Weld BOCES to provide transportation in ' special circumstances. I {' '.'I': We are open to working in collaborationiwith' other. genpies ' (e.g. local and regional school districts) anal £arlif es., to increase attendance from outlying communities: Wherl feasible, we will assist with transportationq : Estimate the percentage: of children expected to com'p' graduation from day treatment. i ! '. We will strive to graduate 75% of youthlifromieur,layii treatment program. Our statistics on discharge siege January 1995 reflect the following breakdown;.:I 'Il' 1. Successfully Ended Program -•67.9%; 2. Transferred to a more restrictive 'setting 3. Unable to locate - 11.3% i, 4, Transferred to less restrictive setting,.- 5, Unable to work with client - 1.9% Estimate the time frame for child to return 4 puhiio eahOMl.:. I The estimated average length of stay iniour day-,treataent component is 6 to 10 weeks. Longer or shorter lengths of, stay will be determined on a case by case bans.! Ve4iables examined to determine this decision include 1: - I Ill H. 1 severity of:presenting problem;. I' 2, chronicity of presenting problem;:; 3; family situation and level of program particRipation4H;' 4., input from referral sources including DsS„sachidl and; primary care provider. ! I, I Youths in our evening program wily expetlence 4n4rma1, if any, school disruption. Describe the transitional strategies to accomplish khedKilfd's.- return do public school. thef.l7awimgs rain?cc Transition to the. public school is aide by strategies: i �{ a. discharge case conference attended by ybuth,i tami'ly,, DSS worker, school personnel, thrapist andlYo*th • 1 Passages' staff; b. gradual transition to the public school set lupion a case by case basis (e.g. attending Youth 2ass4eson, '. M,W,F and school T and Th the firj'st week and -Mouth Passages T and Th and school M,W,'IF theli:eegtjweek Another option is attending school in bhe , morning and', Youth Passages in the afternoon for a ;week and i n I 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. 971042 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-2004 (RFP-PAC-97006) Revision Contract Award Period Beginning 06/01/97 and Ending 05/31/98 Computation of Awards Unit of Service A comprehensive, highly structured service alternative to the out -of -home placement or the more intensive placement of a child (age 5-12 yrs) already in placement that provides mental health therapy and education to its student clients, up to a maximum of 20 children, 27.5 hours weekly for 36-52 weeks. Cost Per Unit of Service Monthly Rate Per $ 1.435.OQ Unit of Service Based on Approved Plan Enclosures: V Signed RFP; Exhibit A ✓//7ddendum RFP Information 1/ Condition(s) of Approval Approval By eorge . axter Board of Weld County Co ssio, Date:/' yy NeC Name and Address of Contractor Weld Mental Health Center, Inc. Carson Children's Center Day Treatment Program 1306 11th Avenue 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. Soecial conditions 1) Reimbursement for the Unit of Services will be based on an monthly rate per child or per family. 2) The monthly 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 monthly 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 Program Official: By l.t, lu Wel Date: y ri Direct o vi rt of Social Services 971142 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. 971042 INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97006 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-97006) for: Deadline: March 25, 1997, Tuesday, 10:00 a.m. Family Preservation Program --Day Treatment 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 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 Day Treatment Program Category must provide a comprehensive, highly structured program alternative to placement or more restrictive placement that provides therapy and education for children. 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 Weld Mental Health Center, Inc. PART D...Bidder Response Format PART E. Bid Evaluation Process BID MUST BE SIGNED IN INK Dale F Peterson TYPED OR PRINTED SIGNATURE (Name) Handwritten Signature By Authorized Officer or Agent of Vender ADDRESS 1306 11th Avenue PHONE # 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. 1 971042 RFP-PAC-97006 Attached A DAY TREATMENT PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97005 NAME OF AGENCY: Weld Mental Health Center, Inc. ADDRESS: 1306 11th Avenue Greeley, CO 80631 PHONE: ( 970) 353-3686 CONTACT PERSON: Dan Dailey TITLE: Program Director DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Day Treatment Program Category must provide a comprehensive. highly structured program alternative to placement that provides therapy and education for children. 12 -Month approximate Project Dates: Start June 1. 1997 End M•y31 1998 TITLE OF PROJECT: Carson Children's Center AMOUNT REQUESTED: Dan E. Dailey Name and Signature of Person PrepanJrtg Document 1 Date I2 -month contract with actual time lines of: Start End 3/12/97 Dale F. Peterson nip 3/12/97 Name and Signature Chief Administrative Officer Applicant Agency Date MANDATORY PROPOSAL REQUIREMENTS 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 Staff Qualifications Unit of Service Rate Computation Program Capacity per Month Date of Meeting (s) with Social Services Division Supervisor: 2/27/97 Comments by SSD Supervisor: Name and Signature of SSD Supervisor 24 Date 7(y 7 971042 I. PROJECT DESCRIPTION In August, 1995, Weld County School District Six (District 6), the University of Northern Colorado (UNC), and the Weld Mental Health Center (WMHC) jointly opened the Carson Children's Center (CCC) at 3807 Carson Street in Evans, Colorado. The CCC is a year around day treatment program for children aged five through 12 years. Licensed since October, 1995, to provide services for up to 25 children, it currently has a capacity of 12 students due to space limitations at its present site. It is anticipated that up to nine of those 12 students will be eligible for funding through monies available through the Weld County Placement Alternatives Commission. Day treatment is a comprehensive, highly structured alternative to the out -of -home placement or the more intensive placement of a child already in placement that provides mental health therapy and education to its student clients. Treatment services for each student client's family are an integral part of the program. As practiced.. at the CCC,day treatment provides highly integrated and coordinated educational and treatment services to its students. The affective needs of each child are responded to not only by the treatment staff but by the educational and supportive services staffs as well. Similarly, the students' educations are not solely the responsibility of the teaching staff but are shared by all on -site personnel. Because all CCC students are staffed as special needs children, additional services called for in each child's individualized education plans (IEP) such as occupational therapy, speech and language services, and physical therapy are also provided on -site. The CCC begins its day with a welcoming group to greet the children and to help them make the transition from life at home to a day in school and in treatment. Information from each student's parents, guardians, or foster parents is obtained to keep the staff up-to-date and to encourage open communication. In the group room is a large bulletin board with each student's name and a set of goals on which she or he is working. The goals and each child's progress towards them are updated daily before the children move on to other aspects of the day. Educational and affective curricula are simultaneously in place as much as is feasible in the various daily activities of the CCC. The students progress through a series of treatment and educational offerings each day. There are ongoing, scheduled therapy groups that address new themes as well as themes from earlier sessions. While some children are in the classroom for group and individual instruction, others are seen in individual therapy, while others still are in a treatment group. The CCC daily schedule is similar from day to day promoting the consistent milieu essential to the success of the project. Recess, lunch, and all other activities are similarly integrated. The CCC day ends back in the room where welcomes occurred. Now, the focus is to review the day with the children and prepare them for the transition back to their homes. Goals and successes of the day are the focus of this departure activity. One or more of the children may remain for a family therapy session. Family therapy typically is scheduled after the end of the school day to allow for parents' work schedules but the schedule is sufficiently flexible to allow for family sessions as needed during the school day. 971042 II. TARGET/ELIGIBILITY POPULATIONS A total of 12 children aged five through 12 years and their families will be served at any given time in the six to 24 month program of the CCC. Of these, it is anticipated that up to nine will have the financial aspect of their care covered under the services proposed herein. Up to 20 children and their families will be served annually of whom 15 will be eligible for PAC funded services. Approximately 25% of the students will receive bilingual/bicultural services. Based on current utilization rates, it is estimated that about 25% of the CCC students will be from southern Weld County. For the purposes of this grant, the monthly maximum program capacity is defined as nine children with a monthly average program capacity of seven. The average length of stay in the program is estimated to be in the range of 36 to 52 weeks. Full-time students of the CCC spend a minimum of 27.5 hours weekly in the total program. In order for a child to be considered as a potential student of the CCC, she or he must be staffed into special education services in her or his home school district and must have demonstrated the capacity to return to her or his home school upon successful completion of the CCC program. Children referred to the project will have met, 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." 97101? III. TYPE OF SERVICES TO BE PROVIDED Site -based services to the students of the CCC and their familieswill be held each day District 6 schools are regularly in session plus through the summer. An academic year at the CCC will consist of 48 total weeks with an average of not less than 27.5 hours of programming weekly. The planning and implementation of the CCC has been a collaborative and cooperative effort from its inception. The Weld County Department of Social Services (WCDSS), involved early on in the planning process, has agreed to utilize the services of this day treatment program for those of its clients demonstrating the need for it. The collaborative role of District 6 has been exemplary from the planning stage forward as it obtained and furnished the CCC site, recruited and hired professional and paraprofessional staff, and provided administrative guidance. Early on in the planning process, the District 6 Board of Education expressed its eagerness to lead the way in this endeavor. District 6 has provided excellent staff to aid in the planning and implementation of the CCC primarily in the person of Mike Hoover, EdD. Similarly, the WMHC, with the strong support of its Board of Directors and management team, offered administrative assistance in planning and implementing the treatment program of the CCC primarily through Anne Mitchell, RN, LCSW and Dan Dailey, BA. The WMHC hired additional staff to cover the treatment needs of the children and their families. The UNC has continued to provide initial and ongoing technical assistance through Teresa Bunsen, PhD from its Special Education Department. The UNC also provides two doctoral students as part-time staff for the program. Extensive effort has been invested into planning the milieu and overall program of the CCC so that educational, therapeutic, behavioral, and recreational components are closely integrated. By design, each of these four components contains aspects of the other three. Concerted efforts helped to achieve and now help to maintain this high level of integration. The educational component is primarily the responsibility of the District 6 teaching staff plus other instructional staff as may be required. The therapeutic component is primarily the responsibility of the WMHC on -site staff. The behavioral component of the CCC is present across all activities of the program and is the responsibility of all on -site personnel. Each student has an individualized education plan and a mental health services plan that spell out behavioral concerns and details how those concerns will be addressed in the daily activities of the student. Similarly, the recreational component of the CCC includes educational, therapeutic, and behavioral programming to meet each student's needs. All components of the program are typically carried out on -site. Exceptions to this occur primarily during times when a student is in a transitional stage in returning to her or his home school and when off -site services, such as involvement in a particular therapy group, are indicated. Parents, guardians, or other caretakers are actively encouraged to be engaged in their children's education and treatment whenever appropriate. Educational and support groups are offered to parents. At least two family therapy sessions are held weekly for each student. In most instances, parental or guardian involvement is mandatory. This stems from a core belief that not just the child but his or her family must actively involve themselves in the treatment/education process for it to 971042 III. TYPE OF SERVICES TO BE PROVIDED, continued be effective and for the positive results to be longstanding. The mental health services plan dictates the specific nature of the family work that is required for each child. The lead teacher at the CCC is a certified special education teacher for significantly identifiable emotionally disturbed children. She is assisted by two full-time para-professionals in carrying out each student's individualized educational plan. Due to age of the CCC's students, there is no need for vocational or independent living assessment or training. The mental health needs of the children are responded to by the WMHC on - site staff as described above. Each student weekly receives up to two hours of individual therapy, five hours of group therapy, and two hours of family therapy. Those students with psychotropic medication needs are the responsibility of the CCC staff psychiatrist. For new students of the CCC who are not clients of the WMHC at the time of enrollment, an initial mental health assessment and service plan is formulated. There is simultaneous development or updating of the individualized education plan when a child is staffed into the CCC. The physical health needs of CCC students including, but not limited to nutrition, medical, and dental, are primarily the responsibility of District 6 nursing staff. These are shared as appropriate by the staff of the CCC. Proactive planning for reintegrating a student into her or his home school begins during the initial screening of the child for consideration of admission to the CCC. The capacity to return to one's home school, i.e. the school referring the child or the school to which the child will attend upon promotion to her or his next higher grade, must be established before a child will be accepted into the CCC program as must be the referring school's willingness to have the student return there. Similarly, the graduation requirements for students admitted to the CCC are formulated in a preliminary manner during the screening and planning sessions held with each child and her or his family. The requirements are largely expressed in terms of outcomes the child will achieve. The program is constructed to emphasize the positive outcomes and gains each student will make. Whenever possible, the strengths of the child will be used as the primary tools for progress. Follow-up mental health care for students graduating from the CCC will be arranged by the CCC mental health staff with either the WMHC or a private practitioner of the graduate's family's choosing. The transition plan that guides the student's return to her or his own school also provides for a stepped, systematic introduction to the new therapist to ensure continuity from day treatment to more traditional outpatient services. 9%1O42 IV. MEASURABLE OUTCOMES At the time of admission to the CCC, each student will be evaluated using, in part, the Assessment and Discharge Form developed by the Colorado Office of Mental Health. Every six months thereafter and at discharge from the CCC, the Assessment and Discharge Form will again be administered. The two page form covers a wide range of variables and assessments. Also to be used are the Family Preservation Program Admission and Termination Evaluation Forms. These look specifically at the effects of the CCC program. Copies of these forms are attached at the end of this proposal. Also attached are samples (not of data from CCC 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 the CCC in the upcoming fiscal year by the WMHC Program Evaluation Office. It is anticipated that 90% of the children successfully completing the program of the CCC will reside in their own homes, or remain in placement at a similar level of care as they were at the time of their referral, for the first six months after their discharge. The criteria for success will be that each child returns to or remains in her or his home or foster home and is able to safely and constructively do so for at least the first six months they are no longer attending the CCC. This information will be gathered by each student's WCDSS caseworker and mental health therapist upon direct observation of and interaction with the child and her or his family. Additionally, all successful graduates will enter, remain in, and make satisfactory progress in public school after their discharge from the CCC. More specifically, each graduate of the CCC will maintain or enhance the progress she or he made academically, socially, behaviorally, and emotionally during her or his time in the program. This will be monitored by the child's family, their WCDSS caseworker, their mental health therapist, and by the school/community facilitator (or the equivalent) from their home school. The criteria for success will be maintenance of or improvement upon her or his levels of functioning in the four areas mentioned above as stated in their individualized educational plan and their mental health services plan. The families of 90% of the children successfully completing the CCC program will report a more relaxed, nurturing, and competent relationship with their children than existed prior to enrollment. Families will be surveyed by their WCDSS caseworker and by their mental health therapist at discharge and six months thereafter. Ninety percent of the children completing the CCC program will report and demonstrate an improved sense of self worth, self confidence, and pride in themselves to their families, the CCC educational and mental health staff, and to their WCDSS caseworker. Appropriate improvements will be revealed when pre-CCC Assessment and Discharge Form ratings are compared with similar ratings done at the time of completed transition back to the home school. 971042 V. SERVICE OBJECTIVES The primary goal of the CCC is to successfully intervene in the lives of its students and their families to minimize the future need for similar intensive services, to enhance each child's ability to be educated and to benefit from that education in her or his home school, to enhance each child's ability and capacity to respond appropriately and healthfully to her or his family, and to improve each child's family's abilities to adequately and appropriately respond to and provide for the child's needs in a competent, safe, nurturing, and growth enhancing manner. In working with families to achieve the goal of improving their abilities to manage family conflict in a safe, constructive manner, the CCC staff will work toward the objective of resolving conflicts between 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 will be measured by family, caseworker, and therapist reports that the objective was met. Each family will also be asked to report on its subjective improvements in this area. To meet the CCC goal of improving overall parental competency, an objective of increasing the parents' abilities to develop and maintain sound, caring, effective relationships with each other and with their children is established. An additional objective will be to enhance the abilities of the parents to provide with as much proficiency as possible for their family's care, nutrition, hygiene, discipline, protection, education, and supervision. All parents are encouraged to develop appropriate support systems designed to last beyond their child's involvement with the CCC. Again, the parents and children will be polled concerning their subjective opinions about the improvements they have made as will the therapist and caseworker. The CCC will work with each client family to achieve the goal of improving its household management competency. The objective is to enhance the capacity of the parents to provide a safe household environment for the children through competently managing the home to include cleaning, repairing, and maintaining the home, as well as via effective budgeting and purchasing. The family, therapist, and caseworker will document the improvements made in this area. The CCC will work to improve each family's ability to find and use appropriate resources. Treatment and case management services will assist each family to learn more effective means to obtain needed help from other sources in the community and from local, state, and federal governments. This will be modeled in each of the families' relationships with the CCC staff. The families will report, and their caseworker and therapist will confirm, all gains made in this area. 9%1012 VI. WORKLOAD STANDARDS The CCC will provide, at any given time, day treatment services to 12 children aged five through 12 years, nine of whom will meet the PAC funding criteria. A year round academic/treatment schedule is in place. It is anticipated that approximately 20 children will be enrolled in the course of a year. The average length of stay in the program will range from 36 to 52 school weeks. Full-time CCC students will attend an average of at least 5.5 hours of programming daily on all days the school is in session. The total staff of the CCC numbers more than 10 individuals and is slightly more than the equivalent of six full-time employees. This staffing level exceeds all State licensing rules. Said rules specify a student to total staff ratio of not more than eight to one which is the case at the CCC. Even the ratio of on -site mental health staff to students (2.30 to 12) exceeds the total staff ratio requirement. If there is a time when only one staff member is present, a second staff member is on call and immediately available to be summoned to an emergency. 971042 VII. STAFF QUALIFICATIONS Licensing requirements mandate that day treatment programs have a treatment leader who is responsible for the overall mental health services to each child. This person must hold a masters degree in the behavioral sciences and have not less than five years of clinical experience. Counselors in day treatment programs are mandated by the State of Colorado to have completed a bachelor's degree in the behavioral sciences or to have at least four years of experience with appropriate aged children, and must be at least 21 years of age. Ginger Meyette, LCSW and Marjorie Wallbank, MSW are the CCC treatment leaders/counselors. Each fulfills the above requirements and has extensive experience in the field of working with children and families. Ms. Meyette is a former classroom teacher who brings her expertise in teaching and in mental health work to the CCC. Ms. Wallbank brings more than 15 years experience in operating her own group home for children and adolescents. Anne Mitchell, RN, LCSW is the clinical supervisor for the staff of the CCC and is its project director. She is responsible for attending screenings and staffings of all children referred to the CCC. Once a child is accepted into the CCC, she develops the day treatment services plan for him or her and for the child's family. Dan Dailey, BA is the administrative supervisor for the CCC's mental health component. He is the program director of the Children and Family Services Program of the WMHC. He brings more than 25 years experience in the mental health field to this task. Russ Johnson, MD, staff psychiatrist for the CCC, is a board certified child psychiatrist. He is also on the psychiatric staff of the WMHC which enables him to follow-up with children after they graduate from the CCC and enter more traditional outpatient care. Mike Hoover, EdD is the administrative supervisor for the CCC's educational component. Since 1992, he has been a Special Education Coordinator for District 6. Currently certified as a School Psychologist and Special Education Administrator, he has worked in the field for more than 20 years. The CCC's lead teacher, Robin Haskett, MA, is a certified special education teacher for significantly identifiable emotionally disturbed children. She is assisted by two full-time para-professionals, Chris Basley and Kit Lynch, in carrying out each student's individualized educational plan. Cindy von Tersch, RN is the school nurse and health consultant to the CCC. She regularly checks in with the staff and students of the CCC and is also available as needed. Providing additional services to the CCC students are two UNC Special Education Department doctoral students. They assist in the classroom, therapy settings and also are working in the evaluation aspect of the project. 971.042 VIII. COMPUTATION OF DIRECT SERVICE RATE Direct Time (Per Month Per FTE) Hours 1. Direct client contact 122.00 Indirect Time 2. Completion of Paperwork 12.00 3. Travel 1.00 4. Court Appointments 2.00 5. Vacation 14,00 6. Sick Leave 8.00 7. Case Management 10.00 8. Other 4.33 9. Subtotal 10. Total Time Available Per Month 11. Ratio of Direct to Total Time 51.33 173.33 (Sum of 1-8) 0.70 (1/10 = 11) This high ratio of direct to total time is accomplished to facilitate the marked emphasis on the treatment needs of the children. In order to accommodate this, the staff have developed effective ways to ensure that they document their services and perform all other indirect tasks in a highly efficient manner. Computers are used extensively to minimize and automate as many record keeping tasks as possible. The above computation reflects this. Every effort is 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 two hours per month per client family. Travel is a minimal expense in this project and is based on our experience to date at the CCC. Time spent in court works out to an average of only 10 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 less than two years accrue 1.25 days, or 10 hours, of vacation and 1.00 days, or eight hours, of sick leave monthly. Those staff with more than two years service 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. 971.942 RFP-PAC-97006 Attached A IX. 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 $ 5390.00 1294.00 6684.00 $ 7200.00 1728.00 1700.00 408.00 $11036.00 $17727 5100 4781 1850 4200 3217 3100 4000 20049 $64024 141.9 $ 451.19 2.61 Service Costs Total Total Direct Hourly Rate Hourly Rate $ 15.57 $ 22.09 3.73 5.30 19.30 27.39 $ 20.80 $ 29.50 4.99 7.08 4.91 6.96 ].17 1.67 $ 31.87 $ 45.21 Direct Service Rate (Hourly) (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 m 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. Direct Time % of Time Charge 100.00 $ 22.09 100.00 5.30 100.00 27.39 30.00 $ 8.85 30.00 2.12 50.00 3.48 50.00 .84 $ 15.29 S 2.61 $ 45.29 29 971012 IX. RATE COMPUTATION: BUDGET DESCRIPTION Personnel costs are predominant in this budget. Day treatment is one of the most labor intensive types of mental health service, second only to inpatient and residential services. The figures represent the equivalent of 2.00 full-time clinical staff of the WMHC working on -site at the CCC, supported by psychiatric, psychological, support, and supervisory services. Direct services personnel costs $27.39 per direct service hour, or 60% of the total of $45.29. Day treatment services require higher than usual levels of supervision due to the marked difficulties the children clients and their families bring to treatment. Supervisory costs, thus, are $10.97, or 24%, of the total direct time cost. The clerical support services cost $4.32, or 10%, of the total. The agency overhead of $2.61 amounts to only 6% of the total cost per hour. Rather than use the formula suggested in the RFP, the WMHC is requesting a set rate of $1325 monthly per child for CCC services. This requested rate (the equivalent of $66.25 daily per student based on a 20 day per month schedule) covers the care in the CCC for each of the children and their families placed into the CCC at any given time throughout a 12 month academic year. This compares favorably with the current rates per child per month for similar day treatment services at other facilities in Colorado and represents only a 6% increase over the monthly charge of $1250 ($62.50 daily) levied last fiscal year. All PAC funds will be accounted for separately within the overall budget of the WMHC. Each project is regarded as a distinct cost center. The WMHC is independently audited annually, including its use of PAC funds. PROGRAM CAPACITY BY MONTH The CCC is designed to function with a minimum clinical staff contingent of 2.00FTE, serving an average of 12 children and their families at any given time throughout the upcoming fiscal year. At the present time, we are limited by our current site to not accepting more than 12 children. If a need for additional day treatment placements for children aged five through 14 years can be demonstrated, we will gladly seek out the means to meet this need. 971042 ASSESSMENT/DISCHARGE Sheet 7 AGENCY GAF SCORE CLIENT ID MEDICAID II) ADMISSION DATE. mm/dd/yy 1 1 VICTIM PROBLEMS Check ALL that Apply Ever Sexual Abuse Victim Ever Physical Abuse Victim Ever Verbal Abuse Victim Neglect PROBLEM SEVERITY RATE the CURRENT P-SEV (PROBLEM SEVERITY) for each area using the following scale: None Slight Moderate Severe Extreme 6 - 7 - S - 9 CURRENT P-SEV Check ALL Problems that Apply 1 Blunted Affect Reticent Distant EMOTIONAL WITHDRAWAL DEPRESSION Depressed Bored Sad ANXIETY Anxious Tense Obsessive Underactive Passive Reserved Worthless Hopeless Desolate Fearful Panic Restless HYPER AFFECT Mania Agitated _ _Sleep Deficit Mood Swings _ Pressured Speech _Accelerated Speech SUICIDE / DANGER TO SELF Suicide Ideation Suicide Plan Past Suicide Attempt Self Injury Danger to Self (4`2$:.37;i t)_ Vacant - Subdued Detached Lonely - Defected - Sleep Problem Nervous Phobic Guilt Overactive Elevated Mood Suicide Attempt Self Mutilation THOUGHT PROCESSES Bizarre Suspicious Disorganized Illogical COGNITIVE PROBLEMS Memory Concrete Attention Span Delusions Paranoid Derailed Magical Thought _Confused Impaired Judgment Lacks Self -Awareness Hallucinations Repeated Thought Loose Associations Unwanted Thought Intellect Disoriented 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 (CRS 2740) RESISTIVENESS Uncooperative Guarded Antagonistic 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 Parole VIOLENCE / DANGER TO OTHERS (Client to Others) Dishonest Offenses / Prop. Destroy Properly Angry "Notorious" Uses/Cons Others Offenses/Persons Pending Charges Violent - Sexual Abuser Homicide Attempt Danger to Others Assaultive Homicidal Idea (CRS 27=-f0)'._ Physical Abuser Homicidal Threats ROLE PERFORMANCE (Work / School) Absenteeism Performance - Terminations Learning Disabilities Behavior Not Employable Doesn't Read/Write Doesn't Earn Unstable Work/School Hiss FAMILY PROBLEMS (Client Problems in Family) No Family w/Relative w/Parenting No Contact w/Farruly w/Child Acting Out w/Partner —w/Parent 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 _Addi_ cted Interferes with Responsibilities _ DUI/DUID Family History of Substance Abuse MEDICAL/PHYSICAL _Acute Illness _Chronic Illness CNS Disorder Nutrition Eating Disorder _Physical Handicap Enuretic Encopretic Medical Care Needed _Developmental Disability Penn. Disability Attention Deficit Disorder Injury by Abuse/Assault SECURITY / MANAGEMENT ISSUES Restraint Seclusion Security Walkaway/Ecrape Surveillance _ Locked Unit Time Out Medication Compliance Close Supervision Behavior Management Suicide Watch OVERALL DEGREE OF PROBLEM SEVERITY CHANGE IN OVERALL, PROBLEM SEVERITY 1=Much Worse 5=Somewhat Better 6 -Better 7- Much Better 9 7. 0 ,* n 2=Worse 3=Somewhat Worse 4 -No Change 7/95 WMtaC rr1NM am CLIENT I.D. # DATE OF ADMISSION ASSESSMENT/DISCHARGE Sheet 2 Very Low Function 1 Very Low Function Tolerance STRENGTHS / RESOURCES Check ALL CURRENT STRENGTHS / RESOURCES individual has. ECONOMIC RESOURCES Employment Transportation Medicaid/Medicare EDUCATION / SKILL RESOURCES Education Job Skills PERSON RESOURCES Spouse Parent (s) Other Family Friend (s) PERSONAL STRENGTHS Housing SSI/SSDI Intelligence Interpersonal Skills Insight Judgment Emotional Stability Adaptability Appearance Thought Clarity Empathy 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 Very Low Moder Low Function Function Very Low Function Average Function Moder High Very High Function Function 2 3 4 5 6 7 8 9 INTERPERSONAL FUNCTIONING Moder Low Average Moder High Very High Function Function Function Function 1 2 3 0 5 6 7 8 9 Very Low Function DAILY LIVING / PERSONAL CARE FUNCTIONING Moder Low Average Moder High Very High Function Function Function Function 1 2 3 4 5 6 7 8 9 PHYSICAL FUNCTIONING Moder Low Average Moder High Very High Function Function Function Function 2 3 4 5 6 7 6 COGNITIVE / INTELLECTUAL FUNCTIONING 2 Moder Low Function 9 Average Moder High Very High Function Function Function 3 4 5 6 7 8 9 Very Low Function 1 2 OVERALL LEVEL OF FUNCTIONING Moder Low Function Average Function Moder High Very High Function Function 3 4 5 6 7 e 9 CHANGE IN LEVEL OF FUNCTIONING 1 -Much Worse 2 -Worse 3 -Somewhat Worse 4=No Change 5 -Somewhat Better 6=Better 7=Much Better PROGRAM I- ACf10N TYPE 01=Admission 02-- Activate 03=Update 04=Inactivate 05=Discharge (Manual Input Only) 1.1 Correction to Admission 12 Correction to Activation 13 —Correction to Update 14=Correction to Inactivation 15=Correction to Discharge EFFECTIVE DATE- nuNdd/yy DATE FORM COMPLETED.mm/dd/y LAST CONTACT DATE: mm/dd/yy CURRENT DIAGNOSIS CURRENT / EXPECTED RESIDENCE: 1=Corrections/Jail 2 -Inpatient 3 =Nursing Home 4=Residential - Mental l lealth 5 -Residential Non- Mental 6 -Boarding Home 7 -Homeless -in Shelter B=Homeless-on Street 9=Other Independent Living Arrangements CURRENT / EXPECTED LIVING ARRANGEMENT-. I=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 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 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/Client Died 7-Patient/Client Terminated TERMINATION REFERRAL: NOTE: Use 61 "Self' if no Referral This field wi11 contain one of dic (Moving codes d .i.uon type = 05 or II. Personal referrals - 61 - Self, 62-Family/relative, 63 - Fnend/Employer/Clergy; MedicauPaycblanie referrals - 68 - Outpatient psychiatric; 69 - Private psychiatrist; 10 - Other private MH practitioner; 71- Ch69?, lJ - Colorado Mental Health Centers/Clinics. 74 - Nursing home, 75- Community residential organization; 16 - Alcohol/Drug u atment facility; 77 - Medical practitioner; 78 - General hospital inpatient psychiatric program. 79 - Other inpatient psychiatric program, SodJ server/Education referrals - STAFF ID/ STAFF SIGNATURE DISCIPLINE: 1 -none 2 -nth worker 3 -nursing 4 -social work DEGREE: Drone 2- associate 3 -bachelors 4=masters 5lxychology 6=psychiatry 7 other 5=PhD/PsyD/Edl) 6 -MI) 7=other 81 - Social servbe agency; 82 - Agency for the Developmental disabled 83 - Vocational rehabilitation facility, 84 - Educational system/school: 85 - Shelter for homeless/abused; legal referrals - 91- Law enforcement, 92 -Coco (including juvenile), 93 - Correctional facility; 94- Probation/parole. All other referral sources - 98 - Other. JIX - Referral sauce not known. 971042 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) ScCIETAL 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 971042 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 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 971_.042 ATU - Data for non -Medicaid clients Weld Mental Health Center Adult Acute Treatment Unit Client Admission and Termination Data August 1, 1995 - June 30, 1996 Global Assessment Functioning Scores ATU - Data for all clients Mean 20 Mean 20 ATU - Data for all Medicaid clients 0 20 Admissions: n = 247 SM Terminations: n = 245 40 60 40 Mean 40 L_J Admissions: n = 131 ® Terminations: n = 131 60 mim Admissions: n = 116 ® Terminations: n = 114 Weld Mental Health Center Adult Acute Treatment Unit Client Admission and Termination Data August 1, 1995 - June 30, 1996 LATU - Data for all clients Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intollectial Functioning Overall Level of Functioning Problem Severity Score 0 Mean 4 6 8 ATU - Data for non -Medicaid clients Admissions = 247 Terminations = 245 Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Functioning Overall Level of Functioning Problem Severity Score Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Font.tlJX Overall Level of Functioning Problem Severity Score 0 Mean 2 4 6 8 A ATU - Data for Medicaid clients Mean 0 2 4 6 8 I n Admissions = 131 gal Terminations= 131 Admissions = 116 �(( ® Terminations = 114 971142 Mental Health Center co 4- Co 0 C O Co C E V a) H V C co C O Cl). N E Q C a) O C 4- C a) ca a) H a) U Q V Q August 1, 1995 - June 30, 1996 Medicaid Clients Non -Medicaid Clients N C N U Admission Termination Admission Termination Admission Termination ▪ O 7- O r co 'co r r M r co. M M M r N 4 CO OD m - CO r M r CO O O r CO r O r N CO r Lt) N. V CO N M CO r M r CO in V N CO N- CO v Cj N V r r N r O r r V N Nr N � � N V O) r M CO r • r r CO V r N • N 0)r CO .4- 05 N CO R M co (or c") r O O (t7 r M r r V N 00 O r r M • r N r r M r r • 7 CO N C C c8) a) E a) E e ccj E o f a) E o cu f w E a) E 2z 2z MD 2z 2z 2z 2z 2z Global Assessment Functioning Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectual Functioning Overall Level of Functioning Problem Severity Score 971142 S --I2-1997 8 34AM FROM Atom, CERTIFICATE OF INSURANCE mooucEa - - Flood & Peterson Ins. Inc P. 0. Box 578 4687 W. 18th Street Greeley, CO 80632 INSURED Weld Mental Health Center 1306 11th Avenue Greeley, CO 80631 COVERAG✓eS. LAIR A THE PROPRIETOR/ PARTNERSTEXECUTIVE OFFICERS ARE: A OTHER Prof. Claims Made THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT HOLDER. THIS CF-RTIFICATE S UPON THE ,CERTIFICATEXNO ALTER THE COVERAGE AFFORDEED BYS O THE POLICIES EBELOW COMPANIES AFFORDING COVERAGE DATEIMMMT +IT1 03/12/6; COMPANY ASt. Paul Ins. Co. COMPANY B COMPANY COMPAN\ D THIS IS TO CERTFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD *MATED. NOTWRHSTANono ANY REQUIREMENT. TERM OR CONDIT:IN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEWTFICA1E MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS. OCCLUSIONS AND CONOTTIONS OF SUCH POLICIES. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POUCY NUMBER GENERALUABILT ' FK06002791 X MMERCIAL GENERAL LIA BARN (CLAIMS MADE( XI OCCUR W NERS L CONTRACTORS PROT? AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY POLICY EFFECTIVE POLICY EXPIRATION; GATE(MMIPDFYT) I DATE(MM/DDITT) 01/01/97'01/01/98 '.OENERALAOOREUATE sl 000, 000 LIMITS ' PROOUOTS-COMP/OP AGO sl 000 000 AT Rso AAL ACV INJURY 131, 000, 000 EACHOCCURRENCE 31, 000, 000 Gm)$100,000 MEOEXP(Rey ono person) 3.5, 000 COMBINED SINGLE LIMIT I BODILY INJURY (Pa Pon) 3 Amon) I BODILY INJURY :IPr ScclOen;) 3 PROPER TT DAMAGE T UMBRELLA FORM OTHER THAN UMBRELLA fORm WEARERS COMPENSATION AND EMPLDTERfW LIABILITYi INCL I EXCL' Liab.JFK06002791 DESCRIPTION OF OPERATIONCILOCATIQNGNENICLECISPECNL ITEMS Retro date 7/1/86 CERTIFICATE HOLDER'.: AUTO ONL Y. EA ACCIDENT I OTHER THAN AUTO ONLY. EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE $ $ STATUTORY l ion's .3 EACHACCIDENT it DISEASE -POLICY L MIT 01/01/97 01/01/88 181,000,000 EMPLOYEE 1 IS 1S1,000,000 ea. pers. $3,000,000 total lim. Weld County Placement Alternatives Committee c/o Weld County Department of Social Security 800 8th Avenue Greeley, CO 80631 lAcoas25-slaci41 W1 #S81049/M81047 eAHCEuapOa. .:.... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E��)B(YArRTR TICN DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL y_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BLITFAIL\IRE TO OH N•• > L IMPOSE NO. BLIGATION OR LIABILITY ANT NTHE MPANT IT: 't. OR REIZREGENTATNES. AI�HORI I N7 P o AGORD T)oN TYss 971042 1: T 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 WMHC 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, Dikctor Children and Family Services enc. Robert R Merz President Carla Lujan Vice -President Alvina Derrera Secretary Sharon McCon ' 1 • Q,c? 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 9'7.1'_742 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 971042 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-ehgibilitycriteria-established 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. 97.1012 WMHC response to PAC concerns Page 5of15 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 971042 WMHC 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 971042 WMI-IC 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 97101? 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 (MMP1-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 971942 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 971012 WMHC response to PAC concerns Page 10of15 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. 971042 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 1FT clients, these services are available at the Ft. Lupton office of the WMHC or at other sites as may be needed. Psychiatric 971912 WMHC 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 WM] IC. 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 IFT 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. 971.012 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 be 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 971942 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 WMHC'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. 971:112 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. 971042 APPENDIX A 971.142 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 Problem 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 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 SOCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING 971E 42 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 fran 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 971042 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 971012 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 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 971042 ASSESSMENT /DISCHARGE Sheet I AGENCY GAF SCORE I 1 I 1 1 I I I I I CLIENT ID MEDICAID ID ADMISSION DATE: mm/dd/vy 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 Problems that Apply EMOTIONAL WITHDRAWAL Blunted Affect Reticent Distant DEPRESSION Depressed Bored - Sad ANXIETY _Anxious Tense - Obsessive 1 HYPER AFFECT Mania Sleep Deficit Pressured Speech 1 Underactive Passive Reserved Worthless Hopeless Desolate Fearful Panic Restless Agitated Mood Swings Accelerated Speech SUICIDE / DANGER TO SELF Vacant Subdued Detached Lonely Dejected Sleep Problem Nervous Phobic Guilt Overactive Elevated Mood Suicide Ideation Suicide Plan _Suicide Attempt _Past Suicide Attempt ..._ . _^Self Injury _Self Mutilation _Danger to Self tfatri THOUGHT PROCESSES Bizarre Suspicious Disorganized Illogical COGNITIVE 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 (CRS 2, 7.1Q): rJRESISTIVENESS Uncooperative Guarded Antagonistic 7/95 Evasive _Wary Denies Problems Resistive Oppositional Refuses Treatment CURRENT P-SEV AGGRESSIVENESS Aggressive Belligerent Defiant Cheek 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 (CRS 27..10)'::. Physical Abuser Homicidal Threats ROLE PERFORMANCE (Work / School) _Absenteeism _Performance _Behavior _Temtinations Learning Disabilities Not Employable _Doesn't Read/Write _Doesn't Earn _Unstable Work/School Hist 1 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 Physical Assault INTERPERSONAL PROBLEMS w/Friend Social Skills _Establishing Relationships Maintaining Relationships SUBSTANCE ABUSE PROBLEMS Alcohol Addicted DUI/DUID MEDICAIJPHYSICAL 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 Penn. 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=Worse 3 -Somewhat Worse 4=No Change 5=Somewhat Better 6=Better 7=Much Better 971.0/12 WMHC FORM 260 - CLIENT I.D. # DATE OF ADMISSION ASSESSMENT/DISCHARGE Sheet 2 Very Low 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 Parent (s) Other Family Friend (s) PERSONAL STRENGTHS Insight Emotional Stability Tolerance Thought Clarity Housing SSI/SSDI Financial Medical Insurance Intelligence Language Skills Int.ipsisonal Skills Judgment Adaptability Appearance Empathy Child (ren) Others Responsibility Resourcefulness Health LEVEL -OF -FUNCTIONING (LOF) Check ONE Response for Each LOF Area SOCIETAL / ROLE FUNCTIONING Very Low Moder Low Function Function 1 2 <4oa'Very Low Function Average Moder High Very High Function Function Function 3 4 5 6 7 8 INTERPERSONAL FUNCTIONING Moder Low Average Moder High Function Function Function 9 Very High Function 1 2 3 4 5 6 7 8 9 DAILY LIVING / PERSONAL CARE FUNCTIONING Very Low Moder Low Function Function Average Function Moder High Very High Function Function 1 2 3 4 5 6 7 8 9 PHYSICAL FUNCTIONING Moder Low Average Moder High Very High Function Function Function Function 2 3 4 5 6 7 8 9 COGNITIVE / INTELLECTUAL FUNCTIONING Very Low Moder Low Function Function 1 2 3 Average Function Moder High Very High Function Function 4 5 6 7 8 9 OVERALL LEVEL OF FUNCTIONING Very Low Moder Low Function Function 2 3 Average Function Moder High Very High Function Function 4 5 6 7 8 9 CHANGE IN LEVEL OF FUNCTIONING l=Much Worse 2=Worse 5=Somewhat Better 6=Better I PROGRAM 3=Somewhat Worse 4 --No Change 7 -Much Better l -- ----1 A, I ION _1 YPI[ (Manual Input Only) 01 Admix ion I I Correction to Admission 02=Activate 12 -Correction to Activation 03 -Update 13 -Correction to Update 04 -Inactivate 14 -Correction to Inactivation 05 -Discharge 5=Correction to Discharge 1 EFFECTIVE DATE mm/ddhv DATE FORM COMPLETED-mm/dd/v LAST CONTACT DATE: mm/dd/yy CURRENT DIAGNOSIS CURRENT / EXPECTEI) RESIDENCE I= Corrections/Jail 2=Inpatient 3=Nursing Home 4 -Residential - Mental Health 5 -Residential Non- Mental 6 -Boarding Ilome 7 -Homeless -in Shelter 8 -Homeless -on Street 9=Other Independent Living Arrangements CURRENT / EXPECTEI) LIVING ARRANGEMENT I =Lives w/Both Parents 2 -Lives w/One Parent 3=Lives w/Spouse and/or Other Relative(s) CURRENT / EXPECTED EMPLOYMENT: I=Employed-Full Time 2=Employed-Part Time 3=Homemaker not Otherwise Employed 4=Sheltered Employment 4=Lives Alone 5 -Lives w/Unrclated Person(s) 5 -Not in Labor Force 6=Unemployed less than 3 Months 7=Unemployed 3 Months or More S=Armed Forces Active Military Duty INACTIVE / DISCHARGE TYPE OF TERMINATION: STAFF/AGENCY INITIATED CLIENT INITIATED 1= Discharged/Fransferred 2=TX Completed/No Referral 3=TX Completed/Follow-up 4 -Evaluation Only 5=Inactive for 1 Year 6-Patient/Client Died 7=Patient/Client Terminated TERMINATION REFERRAL: NOTE: Use 61 "Self' if no Referral This field will custom one Mite follmdng codes if .11211011 type = 05 or 15: Personal referrals - 62 - Family/relative; 63- Friend/Employer/Clergy; Medical/Psychiatric referrals - 68 - Outpatient psychiatric; 69 -Private psychiatrist; 70 - Other private MH practitioner; 71-GA8/P; 72- CMFWFL: 73- Colorado Mental Health Centers/Clinics: 71- Nursing home; 75 - Community residential organization, 76 - AlcehoVDmg treatment facility, 77 - Medical ptutitioncr; 78 - General hospital inpatient psychiatric program, 79- Other inpatient psychiatric program; Social service/Education referrals - 81- Social service agency; 83 - Agency for the Developmental disabled; 83 - Vocational rehabilitation facility; 84 -Educational system/school; 85 - Shelter for homeless/abused; Legal referrals - 91 - Law enforoenent; 92 - Court (including 1 ovcnile), 93 Correctional facility; 94 - Probation/parole; All other referral sources - 98 - Other. XX - Referral source not known. STAFF ID / STAFF SIGNATURE DISCIPLINE: I=nwne 2 snh worker 3=nursing 4=social work 5 psychology 6 --psychiatry 7 —other DEGREE: I —none 2=associate 3=bachelors 4=masters S=1'hD/1'syt)/Fidl) 6 —MD 7 -other 971042 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. 971942 A. TREATMENT OUTCOME APPROACHES AND MEASURES Treatment outcane is an essential part of the MHASA's approach to program evaluation because it directly addresses the effects of clinical services, the major indicator of service quality. Treatment outcane 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 canbination of clinical issues, client satisfaction, general mental health status, system -wide access and service issues, mental health treatment and outcanes, and cost effectiveness. Treatment outcome 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 outcome 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-IASA 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 MiASA 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 97 042 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 AJD 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 971012 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. 971/42 g. 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. 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. 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 97104-2 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. 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. 971042 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 MHASAs in cooperative efforts that will ultimately enhance statewide service provision. 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 ate 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 weatnesses 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 andtypes of services provided during the first eleven months of capitation will be conducted. The distribution of services by aid category, age group, ethnicity, and gender 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 971.012 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? 971012 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 SIRENS 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 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 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. 9;? 01'2 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 MAASA 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? 9'71142 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. w 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 conductedat 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 9 7 7.0': 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. 971012 Weld MHASA Children's Acute Treatment Unit Outcome Report January 12, 1996 - December 31, 1 April 30, 1997 971042 TABLE ONE CATU SUMMARY DATA JANUARY 1996 THROUGH DECEMBER 1996 FROM JANUARY 12, 1996, THROUGH DECEMBER 31, 1996 THERE WERE A TOTAL OF 38 ADMISSIONS. nr AT ADMISSION 7 - 9 YEARS 10 - 12 YEARS 13 - 15 YEARS OF AGE =11 OFAGE =15 OF AGE =12 MEAN AGE = 11.5 YEARS MEDIAN AGE = 12.0 YEARS MEDICAID STATUS MEDICAID NON- MEDICAID SEX ETHNIC CUSTODY AT ADMISSION = 24 (63.2%) = 14 (36.8%) BOYS = 16 (42.1%) GIRLS = 22 (57.9%) ANGLO = 29 (76.3%) HISPANIC = 9 (23.7%) PARENTS =18 (47.4%) SOCIAL SERVICES =20 (52.6%) AVERAGE LENGTH OF STAY (ALL 38 DISCHARGES) MEAN = 52.8 DAYS MEDIAN = 28.0 DAYS RANGE 1 DAY TO 251 DAYS AVERAGE LENGTH OF STAY BY SELECTED VARIABLES MEDICAID STATUS MEDICAID = 60.3 DAYS NON -MEDICAID = 39.9 DAYS CUSTODY AT TIME CF ADMISSION PARENTS = 54.7 DAYS SOCIAL SERVICES = 51.1 DAYS SEX ACE ACE AGE MALE = 55.9 DAYS FEMALE = 50.5 DAYS 7 THROUGH 9 YEARS 10 THROUGH 12 YEARS 13 THROUGH 15 YEARS = 63.4 = 57.7 = 31.8 DAYS DAYS DAYS 971112 Weld Mental Health Center Children's Acute Treatment Unit January 12, 1996 - December 31, 1996 Client Residential Status (All Client Admissions) Chart 2 Was Living Parents ® Other Familt Member Foster Home C3 Alternative Home for Youth • Jeffereson Hills • Other RCCF St Fort Logan Cl PsychCare Cleo Wallace Moved To 22 (57.9%) 1 (2.6%) 7 (18.4%) 2 (5.3%) 2 (5.3%) 1 (2.6%) 2 (5.3%) 1 (2.6%) Total = 38 - Parents Other Familt Member EN Foster Home LEE Jeffereson Hills • Other RCCF ri Fort Logan PsychCare • AWOL 971.312 WELD MENTAL HEALTH CENTER CHILDREN'S ACUTE TREATMENT UNIT JANUARY 12, 1996 THROUGH DECEMBER 31, 1996 TABLE THREE CLIENT RESIDENTIAL STATUS AT ADMISSION AND TERMINATION MEDICAID ONLY ADMISSIONS MOVED TO Parents Foster Jeff. Other Fort Psych- AWOL ROW Home Hills ROOF Logan Care TOTAL WAS LIVING Parents N 5 % 100.0 20.9 5 Foster N 6 1 1 8 Home % 75.0 12.5 12.5 33.3 Alt. Home N For Youth % 1 1 100.0 4.2 Jefferson N Hills 100.0 4.2 Other N 2 ROOF % 66.7 1 3 33.3 12.5 Fort N 1 1 Logan % 100.0 4.2 PsychCare N 2 1 % 50.0 25.0 1 4 25.0 16.7 Cleo N 1 1 Wallace IP % 100.0 4.2 Column N 11 6 1 2 1 2 1 24 Total % 45.8 25.0 4.2 8.3 4.2 8.3 4.2 100.0 There were 5 youths living with their parents prior admission to the CATU. At the time of discharge all 5 were returned to their parents. Of the 8 youths living in foster homes prior to admission, 6 were returned to foster homes, 1 went to a Residential Child Care Facility (RCCF), and 1 was sent to PsychCare. The one youth residing at Alternative Homes for Youths prior to admission, ran away (AWOL). The one youth residing at Jefferson Hills prior to admission was returned to that facility. member at the time of discharge. Of the 3 youths living at other RCCF's prior to their admission, 2 went home to their parents homes and 1 was sent to the Colorado Mental Health Institute at Fort Logan. The one youth residing at Fort Logan prior to admission went to parents home at the time of discharge. Of the 4 youths living at PsychCare prior to their admission, 2 went home to their parents, 1 went to another RCCF, and 1 was sent to PsychCare. The one youth residing at Cleo Wallace Inpatient prior to admission went home to the parents. at the time of discharge. 971012 Weld Mental Health Center Children's Acute Treatment Unit January 12, 1996 - December 31, 1996 Client Residential Status (Medicaid Only Admissions) Chart 3 Was Living 8 (33.3%) 1 (4.2%) 1 (4.2%) 3 (12.5%) 4 (16.7%) 1 (4.2%) Total = 24 - Parents - Foster Home C� Alternative Home for Youth Jeffereson Hills ® Other RCCF Fort Logan n PsychCare Ell Cleo Wallace Moved To 6 (25.0%) 1 (4.2%) 11 (45.8%) 1 (4.2%) 2 (8.3%) 1 (4.2%) 2 (8.3%) Total = 24 III Parents NI Foster Home Jeffereson Hills ® Other RCCF - Fort Logan I I PsychCare - AWOL WELD MENTAL HEALTH CENTER CHILDREN'S ACUTE TREATMENT UNIT JANUARY 12, 1996 THROUGH DECEMBER 31, 1996 TABLE FOUR CLIENT RESIDENTIAL STATUS AT ADMISSION AND TERMINATION NON -MEDICAID CLIENT ADMISSIONS MOVED TO Parents Other Foster AWOL ROW Family Home TOTAL WAS LIVING Parents N 9 % 90.0 1 10 10.0 71.4 Other Family N 1 Member % 100.0 1 7.1 PsychCare N 1 1 % 33.3 33.3 1 3 33.3 21.4 Column N 11 1 1 1 14 Total % 78.6 7.1 7.1 7.1 100.0 There were 10 youths living with their parents prior admission to the CATU. At the time of discharge 9 were returned to their parents and 1 was sent to a foster home. The one youth living with another family member prior to admission was returned to that family member at the time of discharge.. Of the 3 youths living at PsychCare prior to their admission, 1 went home to their parents, 1 went to another family member, and 1 ran away (AWOL). 97104?, Weld Mental Health Center Children's Acute Treatment Unit January 12, 1996 - December 31, 1996 Client Residential Status (Non -Medicaid Admissions) Chart 4 Was Living 1 (7.1%) a Parents EU Other Familt Member I IPsychCare Moved To 11 (78.6%) 1 (7.1%) 1 (7.1%) 1 (7.1%) Total = 14 MI Parents tiffl Other Familt Member Foster Home MI AWOL Weld Mental Health Center Co Co C C 0 Sd Co C LC) V C Co C 0 Sd C a v C C a) Co a) w a) Sd U) c 0 L U January 12, 1996 - December 31, 1996 Medicaid Clients Non -Medicaid Clients N c m Admission Termination Admission Termination Admission Termination CO O V �. N V CO Cr co to M O) et V V CD • OD (rj CO O CO on N N O V to N r N CD CV O1 0.4' a)d' Net (0 el- 01 e .4N 4N 4N c, j N Lei N co N co CO co r LO N N M co 'I- to CO CD 01 N V COCD CNt Ln n 0 n O) 'rt O V O) ' Mr Mr V r L) cr V r V. -- CO 01 O7 V O d' CO a O et 1- n C vt O) d' N Mr .4: Or 4 r Mr tri O M CO in CO O) CO LOCO N. CO CO CO CD NCO CID et NCO cpCO MCO CD OD ▪ et ei a n a a 9 a w E w E w E w E w E IX - c9 w E cow E 2' 2z 2z 2Z 2z 2' 2' 2z zzz Global Assessment Functioning Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectual Functioning Overall Level of Functioning 22 it a) E m a 0 a 9710,12 Weld Mental Health Center Children's Acute Treatment Unit Client Admission and Termination Data January 12, 1996 - December 31, 1996 Global Assessment Functioning Scores 40, CATU - Data for non -Medicaid clients I I Mean 40 NM Admissions: n = 38 ® Terminations: n = 38 t I Admissions: n = 14 Terminations: n = 14 60 CATU - Data for all Medicaid clients 20 Mean 40 simii Admissions: n = 24 Terminations: n = 24 60 971142 Weld Mental Health Center CATU - Data for non- Medicaid clients i I Admissions: n = 14 ® Terminations: n = 14 Children's Acute Treatment Unit Client Admission and Termination Data January 12, 1996 - December 31, 1996 Overall Level of Functioning ME Admissions: n = 38 EBIN Terminations: n = 38 Mean 3 3.64 J I � CATU - Data for all Medicaid clients Fa Admissions: n = 24 NM Terminations: n = 24 971312 312 Weld Mental Health Center CATU - Data for non -Medicaid clients i I Admissions: n = 14 ® Terminations: n = 14 Children's Acute Treatment Unit Client Admission and Termination Data January 12, 1996 - December 31, 1996 Problem Severity Score CATU - Data for all clients 2 Mean 3 4 5 WM Admissions: n = 38 INEN Terminations: n = 38 6 7 Mean 2 5 6 5.93 CATU - Data for all Medicaid clients EMI Admissions: n = 24 ® Terminations: n = 24 971312 Weld Mental Health Center Children's Acute Treatment Unit Client Admission and Termination Data January 12, 1996 - December 31, 1996 CATU - Data for all clients [CATU - Data for all clients =II Admissions = 38 Eli Terminations = 38 0 Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectual Functioning Overall Level of Functioning Problem Severity Score Mean 2 3 4 ECM . �----a- ■ Admissions = 38 II Terminations = 38 5 6 7 97374,2 Weld Mental Health Center Children's Acute Treatment Unit Client Admission and Termination Data January 12, 1996 - December 31, 1996 CATU - Data for Medicaid Clients Mean 20 40 60 IEEM Admissions = 24 Ibba Terminations = 24 Global Assessment Functioning CATU - Data for Medicaid Clients Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Functioning Overall Level of Functioning Problem Severity Score Mean 0 1 2 3 4 5 f 7 - --r ® Admissions = 24 ■ Terminations = 24 6 7 _J 971.112 ? Weld Mental Health Center Children's Acute Treatment Unit Client Admission and Termination Data January 12, 1996 - December 31, 1996 CATU - Data for Non -Medicaid Clients Global Assessment Functioning Mean Admissions = 14 awl Terminations= 14 CATU - Data for Non -Medicaid Clients Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Functioning Overall Level of Functioning Problem Severity Score ❑ Admissions = 14 is Terminations= 14 971212 Weld Mental Health Center Children's Acute Treatment Unit Client Admission and Termination Data January 12, 1996 - December 31, 1996 0 Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Functioning Overall Level of Functioning Problem Severity Score CATU - Data for all clients Mean 2 3 4 5 8 CATU - Data for non -Medicaid clients 0 Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Inalleclel Functioning Overall Level of Functioning Problem Severity Score Mean 3 4 — Admissions = 38 a Terminations = 38 CATU - Data for Medicaid clients C Admissions = 14 a Terminations= 14 0 Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellacteal Functioning Overall Level of Functioning Problem Severity Score Mean 2 3 4 5 6 7 IBM Admissions = 24 ® Terminations = 24 Planning For Transition A Collaborative Process Carson Center School 3807 Cars Greeley, Co. 80620 (970) 304-0372 971042 Dear Fellow Educator, Welcome to Carson. The mission of the Carson Center School is provide a nurturing, accepting, and learning environment that delivers therapeutic, emotional and behavioral support in order to assist students in becoming a credit to themselves and society. As with most day treatment centers, this is not a permanent placement, reintegrating the student back into their home school is our primary goal. However, we need the home school's support throughout the entire process to obtain this goal. This is an informational packet explaining what the home school can expect from Carson Center and what Carson Center needs from the home school during this transition process. Please remember the key person in this transition is the student and we need to provide support to the student throughout the entire process. This is a collaborative effort. The Carson Center is looking forward to working with the home school to provide a supportive and successful transition for the student. Sincerely, The Carson Center Staff 971012 Carson -Home School Agenda What Carson Needs To Facilitate A Successful Reintegration From the Home School 1. The name of the student's primary teacher. 2. The names of school personnel who will have contact with the student. 3. The student's class schedule. 4. A list of extra -curricular activities the student could be involved in at the school. 5. A positive attitude concerning the reintegration process. This is a process and there will be both high and low points. What The Home School Can Expect From Carson Center 1. You will receive an evaluative summary from the teacher and the mental health therapist at the Carson Center. Included in this summary will be a culmination of effective interventions, what the student does well, and what the student needs for continued support to enhance further academic and emotional development. 2. A current list of medications the student is taking at time of transition including dosage and administration times. 3. How the Carson Center has interacted with the family. 4. Results from any formal and informal academic testing. 5. Time line of the transition. 6. Support throughout the. process. This will be designed at the initial Carson -home school reintegration meeting. 971012 Transition Time Line Each student's transition will be individually scheduled. However, these are the general guidelines. Transitions can be difficult for anyone and often produce anxiety for the student and their family during the process. Therefore, the transition needs to take place in a manner which is the least anxiety provoking for the student. If a transition takes too long the "window of opportunity" can be missed. Carson's transition process for reintegration is four weeks. Week One: 1. Initial Carson Center -Home School Reintegration Meeting. This meeting will provide a forum to design an individual transition plan for the student (see page 3 for Carson -home school meeting agenda). 2. Home School Teacher and Community School Facilitator visit Carson Center to observe student in class. Week Two: 1. The student will visit the home school classroom with a Carson Center staff member. 2. The student will visit the home school independently for at least one hour. 3. The student will attempt to follow home school class schedule at Carson to learn the routine. Week Three: 1. Each day the student will attend a half -day at the home school and half day at Carson. 2. The student will have lunch at least two days at the home school. Week Four: 1. The student will attend three full days at home school and two full days at Carson. Preferably MWF at home school and TTH at Carson. 2. A meeting is scheduled to discuss the transition for the following week. Week Five: Student is fully reintegrated back into the home school. 971012 Top 10 Key Elements to support individuals through the change process 1. Learn the recess of change. 2. Remember that change is a gradual process. 30 4 0 Commit to becoming a change agent. Provide proper support to individuals making hangee 5. Realize that the decision to c individual act. hangs is an 6. Accept that each group goes trough a necessary developmental process to function effectively. 7. Plan for and accept conflict B. Embrace conflict as an opportunity to be creative and productive. 9. Celebrate every accomplishment no matter how small. 10. °Just Do iitr9 'Taken from: Colorado Department of Education (1993). Colorado Transitions. Colorado Department of Education: Denver, CO. p. 223 971,92 Transition Information For Educators Improving outcomes for youth with disabilities and supporting the transition process requires all of us to change. Society must change it's perceptions of persons with disabilities and must expect them to be productive citizens rather than a burden on the "system". Students and families must take risks, access new systems, and break new ground. As educators, we must change the curriculum and programming so students can have experiences that promote self- determination and transition. Finally all individuals in every system must change the way they think about persons with disabilities. We must see their abilities and provide opportunities for success (McAlonan, p. 214). 'Adapted from Colorado Department of Education (1993). Colorado Transitions. Colorado Department of Education: Denver, Colorado 971.(1-1, 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. 971042 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-18000 (RFP-PAC-97010) Revision contract Award Period Name and Address of Contractor Beginning 06/01/97 and Ackerman and Associates, P.C. Option B - Home Based Services 1750 25 Avenue, Suite 101 Greeley, CO 80631 Ending 05/31/98 computation of Awards Description Unit of Service Service to a maximum of 24 families. The service offers a range, on average, of three hours per week of in -home services for a 20 -week period, plus follow-up at six and twelve months. 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, or 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 $ 54.17 Unit of Service Based on Approved Plan Enn.J6sures: Signed RFP Addendum RFP Information Condition(s) of Approval Approval : By led „i� Program By Official: eorge E. Baxter Jud Wel Date: . Gri ount l7123 o, Dire r Depa nt of . Social Services Board of WeldCCunty Co .\` /�% Date: 1 \, 1C� ` I 9710-12 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. 974'hlfl INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97010 RETURN BID TO: Pat Persichino, Director of General Services 915 10th Street, P.O. Box 758, Greeley, CO 80632 Request for Proposal (RFP-PAC-96010) for: SUMMARY Family Preservation Program --Option B - Home Based Intensive Family Intervention 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 Option B - Home Based Intensive Family Intervention Program is a family strength focused home -based services to families in crisis which are time limited, phased in intensity, and produce positive change which protects children, prevents or ends placement, and preserves families. 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 VENDOR ADDRESS PHONE # (After receipt of order) (Name) Avel 7 c0 p-3 i A Swi i-C 101 6ree- Gj g'04 3 I 17O Sr 3 - 3373 BID MUST BE SIGNED IN INK to yct_ Sktk r &AP r•, EA 4 TYPED OR PRINTED SIGNATURE ca— ritlen Signature By Authorized O cer or Agent of Vender frejrbet^-c / l(syCholtif TITLE DATE The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 971012 RFP-PAC-97010 Attached A TITLE OF PROJECT: OPTION B - HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97010 NAME OF AGENCY: A G rM °-n ADDRESS: 17 5Th Pr r1 A VC^ ` �t PHONE: i 9t) 3s- 3 - 3 3 7 3 CONTACT PERSON: \FO /- X Acsoct eJ P. C. TITLE: tree Co ?oc3/ DESCRIPTION OF FAMILY PRESERVATION PROGRAM CATEGORY: The Option B - Home Based Intensive Family Intervention Program is a family strength focused home -based services to families in crisis which are time limited. phased intensity. and produce positive change which protects children prevents or ends placement and preserves families I2 -Month approximate Project Dates: jr Start June I. 1997 VEnd May 31. 1998 ram. i It AgervaX con am\ and Signature of Person Preparing Document A )v A . Name atfd ,igniture Chief Administrative Officer Applicant Agency 12 -month contract with actual time lines of: Start End Date Date MANDATORY PROPOSAL REOUIREMENTS Please initial to indicate that the following required sections are included in this proposal Project Description ✓ Measurable Outcomes V Target/Eligibility Populations ✓ Service Objectives V Types of services Provided ,/Workload Standards r/ Certificate of Insurance /Staff Qualifications /Unit of Service Rate Computation _VProgram Capacity by Month Date of Meeting(s) with Social Services Division Supervisor: Comments by SSD Supervisor: J L(14 f ( , • }� e••)--)/i: Z.)')i l r tN b1 E Name and Signature of SSD Supervisor, 24 Date 4 RFP-PAC-97010 Program Category _Option B - Home Based Intensive Famil Intery n i n Pr r Bi Project Title Fn�.r' ry %�rese.,..-�,o.; chit ro rm ..-, Vendor /QcAerc ,rn ter. oC 4ss o ,—ra A 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 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 service. 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. Therapeutic Services - includes re -parenting, family therapy, support groups, problem solving, communication skills, parent -child conflict management, etc. B. Concrete Services - means concentrated assistance in the development and enhancement of parenting skills, stress reduction, problem solving, hands-on parenting, budget management, recreational activities, etc. C. Collateral Services - teaching families to work with other community agencies such as drug and alcohol, health care, job training, information and referral, advocacy, etc. D. Crisis Intervention Services - including in -home counseling and other interventions available on a 24 hour basis. 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. 25 9711 0.4 RFP-PAC-97010 Attached A IV. MEASURABLE OUTCOMES Please provide a two page description of your expected measurable outcomes of the project. Please address the following measurable outcomes: A. Child remains in home at time ease is closed. B. Improvements in parental competency, parent/child conflict management and household management competency as measured by pre and post placement functional tests. C. Children who currently in their own home will remain in their own home 12 months after the completion of Home Based Intensive Family Intervention family preservation services. D. Children currently in long-term placement who are provided reunification Home Based Intensive Family Intervention services will return to their own home and not reenter out -of - home placement 12 months after completion of Home Based Intensive Family Intervention services. E. Families who receive either family preservation or reunification services will not have a substantiated abuse or neglect 12 months after completion of Home Based Intensive Family Intervention services. F. Cases which receive either family preservation or reunification services by Home Based Intensive Family Intervention will measure "LOW" on the risk assessment devise at service closure. Describe your quantitative measures: Also, describe the methods you will use to measure, evaluate, and monitor each quantitative measure. 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 disagreements between parents and their children contributing to child maltreatment, running away and other status 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 Household Management Competency - capacity of parents to provide safe household environment for their children through competent household cleaning and maintenance, budgeting and purchasing. D. Improve Ability to Access Resources - services shall assist parents in learning to obtain help from other sources in the community and within the local, state, and federal governments. Describe the methods you will use to measure, evaluate, and monitor each service objective. 26 9710"2 RFP-PAC-97010 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. (Minimum intensity of 3 hours per week per family.) B. Number of individuals providing the services. C. Maximum caseload per worker. (Minimum family caseload of 8-10.) 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. 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 your staff have received mandated new caseworker training. D. Will your staff have knowledge in risk assessment. E. Will your staff have completed the required State Home Based Intensive Family Services training component. 27 971042 RFP-PAC-97010 Attached A 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 9. Subtotal 10. Total Time Available Per Month 11. Ratio of Direct to Total Time 28 Hours /69-42 ,k'tn (s/m o"ncb 15Row c is Rawl, 02. - a O O gg 0.17sy (Sum of 1-8) (1110= 11) v1 )S9 > ol're t Sec- ci • 9'11 4 RFP-PAC-97008 Attached A � IX R A'I I COMPUTATION �� °" �c R (?? I Service Costs Direct Costs Salary Benefits Subtotal Indirect Costs Supervision Salary Benefits Clerical Salary Benefits Subtotal Total Total Direct Direct Time Monthly Hourly Rate Hourly Rate 9%% of Time Charge P. 3s-h,P 6/"s, vk 1289-S Sy. 23 5'1.23 /op ✓fr-P.3 12,8622 C'/ 2 3 y" 4. 23 /OJ 0 0 O o O O a 689_ rr— .2689 _--13, IN, IYXSAer/M..Tt 13. 84 -I 3,XL Agency Overhead Rent / 6 y% Utilities / i l Supplies 9 `(Z Postage Sf 0 C. Travel 5 - Telephone (p 1' 1 Equipment 38 Data Processing _�_� Other 8 r/ d Total 4./? '0' a # of Employees Overhead Per Employee ?%L. tip cr.> 1 P 5%.23 13.16 10,7 ' _! 3. et ti,,•t- Y rl(V...-QD, -C. S1 r '�?rota Pie— se Overhead Per Total Flours 9,57 70 a_.r , t Direct Service Rate (Hourly) 99..99 (Daily if appropriate) Service Cost Definitions •v GOB,`: '. i Direct Costs - Salary and benefits for employees providing direct services to clients. Indirect Costs - Salary and benefits for employees ppiovrdm supervision or clerical support for staff providing direct services. Agency Overhead - Monthly cost for rent, supplies, postage, etc Ifth bageni, building is owned use estimated market rent for the building. # of Employees -Total number of employees in the agency building! Overrhead Per Employee - Divide the total agency overhead by the total number by 173 hours. ft tree Service Rate - The rate is the hoarly'chirge to provide service taking into consideration compensation and overhead. It can he used as a rough measure to compare services that are uniform in uaturei- It should not be used to compare services that are different with more expensive components of labor such as psychiatrio consultation Teti! Hourly Rate - Cost divided by total hours available. Total Direct I louttly Rate - Cost divided by total direct hours. SeQ b r0,1.k.st-tr«OLkeo-r- Se- c -t/ 9:101,2 Project Description Home Based Family Preservation Services Overview: Ackerman and Associates, PC. proposes to deliver a home -based intensive Family Preservation program. Lori Kochevar, an associate with us, has conducted a similar program in the San Luis Valley region, treating approximately one hundred and twenty five cases over a six year period using this model of services. The model presented here is adapted from that experience. Target families are either facing imminent out of home placement or the family has a member who has returned from foster placement and these services are designed to help reunification succeed. Purpose: We propose to provide home -based services in Weld county that is: 1. Strongly based in the principles of bilingual/ bicultural treatment, 2. Based upon a nationally recognized model for home -based family preservation called the home builders model, 3. Promptly responsive to the needs of social services for feedback on the enrollment of families and the progress of families in the home -based treatment process, 4. Effective at preventing placement of referred children. Our target for prevention of placement is 85% which means of the projected twenty four families in our program, no more than three families should have to ultimately receive placement during the program period. Design: Our program is designed on the Home Builders model which Lori Kochevar used in delivery of services in the San Luis Valley. Lori is trained as a supervisor in this method of home -based intervention. Other Considerations: The strength of our staff in this project in experience in bilingual/ bicultural service delivery and in the delivery of home -based services to over one hundred of client families in another rural Colorado County are considerations we considered important for the reviewers of this proposal. Lori Kochevar has extensive experience in home -based placement prevention/ family preservation programs. As well she has extensive training in cultural competency issues. She was the chair of the multicultural committee of a group called the Youth Coalition that successfully implemented multicultural trainings throughout the San Luis Valley. Carmen Jimenez is a fluent bilingual provider from rural northeastern Colorado with a master's degree in social work. She also self identifies as Hispanic. She has worked 1 9 in Mental health Centers and in home health care delivery as well as in private practice. They both work within the business structure of Ackerman and Associates PC., a group now in its third year of providing successful services to PAC eligible families. Another major consideration is the change in the mode of funding projects in this fiscal cycle. We seek to be on the list of approved vendors for the provision of these services. This means that we are not specifically seeking to be the sole provider of these services for Weld County. Rather, we believe that we are qualified to provide these services and that the introduction of competition for the privilege to serve the needs of referred families will benefit all home -based family services in the county. 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. If we assume a family size of six, two adults and four children, then the total client pool to be served is 144 individuals. That number includes at least 24 individuals who face either imminent out of home placement or who need reunification services. B. Distribution of clients. Total number of clients we will serve is approximately 144 as calculated above. Our experience suggests we would expect approximately 48 of these would be adult members of the family and approximately 96 would be minors. The age distribution of the index case children would tend toward the younger children based on our experience with home -based intensive therapy. We estimate that about one third of the index children would be older than ten with an average age of about 14 and about two thirds would be under ten. The older group would most likely be teenagers in conflict with their family. 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. C. Families Served. We would anticipate serving twenty-four family units. D. Sub total who will receive bicultural/bilingual services. As stated above, Carmen Jimenez is a licensed social worker fully fluent in Spanish who is also Hispanic. Carmen will serve one fourth of the projected caseload. This represents six families or approximately one case ever other month. Thus one fourth of the projected total will be able to be conducted bilingually. All of the services provided will be done in a manner which is sensitive to the culture of origin of the family. Both Lori and Carmen have extensive experience in bicultural settings. E. We can provide services in South County . We anticipate that up to one third of the projected case load or eight families may reside in the South County Area. 2 9710,12 F. Accessibility. On weekdays all providers of Ackerman and Associates are accessible through a 24 hour answering service and pager system and this would be true for clients in this program who need to reach Carmen or Lori. On weekends, this 24 hour access reaches the provider on call who is always a licensed Mental Health Provider. In this program, four additional providers, all licensed psychologists, will share weekend call, and will be able to reach Lori or Carmen. Those psychologists are Laurence Kerrigan, Susan Bromley, Steven Patrick and Joyce Ackerman, all of Ackerman and Associates P.C. G. Maximum per month. The program maximum is two families accepted into the program per month. H. The monthly average capacity is two families per month. I. The average stay in the program is three hours per week over an average of a twenty week period, (sixty hours) and a follow up at six and twelve months. For some families the sixty hours of treatment may be delivered over a longer or shorter period with more services delivered early in the program and less per week toward the end of the treatment. This is a design where services are more intense during a crisis and decrease gradually as clinically appropriate. The average length of stay will be sixty hours. Types of Services Provided We will provide the following services to all families in the program. Specific details which further define these services are in the section of this bid called service objectives. We will measure the effect of these services on the family units using several pre and post assessment formats with both adults and children as described in the section on measurable outcomes. Our proposal is based on the Home Builders model summarized below: The Home Builders model of Family Preservation Services uses the following strategies to increase effectiveness with families: 1. An immediate initial response to the crisis is made because people who are in crisis are often more motivated to change. This is an excellent opportunity for client therapist bonding. 2. The therapist focuses on the family's presenting problem. This increases the clients motivation to work on that problem. Clients are perceived in this model as having the best information about themselves and their lives. Everyone has strengths, skills and unique cultural experiences. Recognition of these experiences and respect for the family usually lead to positive working relationships. 3 971042 3. Services are provided in the client's natural environment to increase accurate assessment, therapist credibility with the client, and the probability the client will incorporate the material they learn into daily family activities. 4. The therapist is available on a 24 hour basis to address client concerns. Such access increases the ability to monitor for potentially dangerous situations and provide immediate assistance in crisis situations. 5. Family Preservation Services uses skills based intervention to empower the client to handle life situations without the help of others. This also lessens the need for ongoing long term intervention. 6. Provision of concrete services for meeting basic needs is a cornerstone of this model. Delivery of concrete services is a powerful way to build relationships with the family. It also helps meet basic need such as food, clothing, housing and transportation so the family is better able to focus on new skill acquisition and address emotional difficulties. The Home builders model follows established standards for Family Preservation Services. A copy of the topic outline for these standards is in the appendix to this document. Our internal process so that these funds will not duplicate or supplant otherwise funded services available in the community will be through the referral mechanism we use. If services are available at a subsidized rate and the client can afford those services, they will be referred to such a service for treatment. A. Therapeutic Services: We will provide the following services and document the delivery of these services using an individualized treatment plan for each family. The family treatment plan will be developed by combining the concerns identified by the WCDSS caseworker who fills out the family referral form with a clinical assessment of the family by the either Lori or Carmen. Clinically appropriate intervention strategies will be chosen by the therapist working with the family from the Family Intervention Modalities Treatment Inventory. In most families serves by this program the following modalities will be utilized based on the individualized list of identified family needs: 1. Reparenting including emotional support to address those issues related to the parents' family of origin, and parenting role models. 2. Family therapy to address structural and issue related difficulties the family is experiencing. 3. Support Groups to address couples' communication, alcohol and drug issues and other issues as identified. 4 • 97104? 4. Problem solving and negotiation skills to enhance the clients' interpersonal effectiveness in implementing change. 5. Communications skills to enhance general aspects of interpersonal effectiveness. 6. Parent child conflict management skills to enhance the parents' ability to set effective limits for the child in a nurturing manner. B. Concrete Services: In addition to the therapeutic interventions described above client families must be able to apply those concepts and skills to their own specific needs and experiences. They must be able to put these ideals into practice in their own family. Their ability to do so is what we term concrete skills acquisition. We use the term concrete skills acquisition to describe the incorporation of behavioral management practices into the daily life of the family. This is distinct from the functional aspects of concrete services which are described later. Progress in this area and in other aspects of treatment will be documented in the family treatment chart. Behavioral Components of Concrete Services: Specific aspects of the family behavior where concrete skill acquisition is documentable and necessary for family success to either prevent placement or retain a child who has been returned to the home include: 1. Development/enhancement and maintenance of parenting skills including nurturing, limit setting and appropriate child management. 2. Stress Reduction and Anger Management Skills. 3. Communications, problem solving and negotiation skills to enhance interpersonal effectiveness. 4. Practice in hands on parenting skills using a coaching model to provide feedback, reinforcement and clarification as to appropriate child management skills. 5. Money management including budgeting and resource acquisition. 6. Other activities of daily living including recreational activities related to enhancing family development, spiritual support, community involvement and maintenance of physical and emotional well being. 5 9711 ,1,2 Functional Aspects of Concrete Services In addition to helping clients learn and use concrete behavioral skills as described above, many client families need what we term functional concrete skills. These are skills at meeting the physical needs of daily living. By providing improved access to the basic needs of daily living the therapist helps provide basic support for the family. When a family's basic needs for food, shelter and safety are met they better able to focus on acquisition of skills and on emotional recovery. We will make a $100.00 "grant" available for each of the families in our program. The funds will come from the fees generated by this contract. Each Family Preservation Specialist will be able to spend $100 on each family to meet needs in the following categories: Transportation ___ Housework/cleaning - Financial assistance _ Childcare/babysitting - Clothing Legal aid _ Housing Utility benefits or services Food ___ Medical/dental services Client employment ___ Furniture/household goods Toys/recreational equipment C. Collateral Services: Collateral services involve connecting the family with the services they need in the community. Such services may include • Drug and Alcohol Services. Such services are available on an intensive outpatient basis through Ackerman and Associates PC. within the services we propose here for mild to moderate levels of problems with addictions. A copy of our brochure in regard to adult and adolescent alcohol treatment is attached. Referrals to other alcohol and drug treatment programs including Island Grove and Family Recovery Center are available for more severe cases. • Health Care Referrals are also routinely available in our practice. General psychiatric services are provided at our location by James Medelman M.D. PC. Medical treatment referrals are provided trough Sunrise Health Center, the Children's Clinic, the Greeley Clinic and other providers. • Job training referrals are available through the Job services and through Vocational Rehabilitation. • WIRS will be a major resource for information and referral for clients. Lori has directed an agency similar to United Way in Alamosa and is currently part time on the staff of Weld County United Way as Volunteer Resource Coordinator. Advocacy and case management are roles for the providers of the home -based services in that our providers will help the family access services they need and 6 971..7'2, advocate with them for access to such services. D. Crisis intervention: Twenty four hour access is assured for the families to reach the providers. We have secretarial and office staff support at Ackerman and Associates 9-5 Monday through Friday at Ackerman and Associates P.C. We maintain a twenty four hour 365 day a year access system through our answering service. All providers can be reached through pagers by the answering service. In home services for crisis intervention are available through this on call system. The Family Preservation specialists are on call during the week nights and on weekends we have a rotating call system within the six providers of Ackerman and Associates. 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 accept the referral from their caseworker? 2. Did we accept the family to our program? 3. Is the family making progress with the treatment plan for each component as outlined in the service objectives? 4. Has the family completed the pre test/ post test assessment instruments ( the AAPI and the PCRI) in a manner which is valid. 5. Has the family followed through with recommendations and referrals during the course of treatment? 6. Has the family completed a Family Satisfaction Questionnaire to provide the Family Preservation Specialist feedback on the clients perceptions of improvement and change and to monitor the perceived effectiveness of treatment. Summative outcomes: At six months and at twelve months after completion of the case we determine the following information. Is the child still in the home? How well are the changes from treatment persisting? This measures if family behavior is different compared to their behavior before treatment. Specific summative outcomes are listed below. A. The child receiving services does not go into placement and remains at home at the time the case is closed. This will be measured by recording the status of the child at the time the case is closed 7 971012 B. Improvement in Parental competency and parent child conflict management and Household management will be measured by pre and post testing. We will use two instruments that are established and validated tools for measuring family relationships and the role of the parents in the dynamics of the family. The Parent Child Relationship Inventory ( PCRI) and the Adult Adolescent Parenting Inventory (AAPI) will be used as pre and post measurements for the family. The PCRI is an excellent general instrument for families with children of any age and the AAPI is focused on adolescents. In homes with no adolescents only the PCRI will be used. In homes with adolescents the PCRI and the AAPI will be used. In addition where it is clinically appropriate, the House Tree Person and the Draw A Family tests will be used to ascertain the perspectives of children in the family on a pre and post basis. As well a narrative which we term the discharge summary of pre and post treatment family conditions will be constructed based on a review of the treatment when the case is closed. C. Children will remain in the home twelve months after the case is closed. This criterion will be measured at the twelve month followup contact. D. Children who were reunified will still be in the home twelve months after the case is closed . This criterion will be measured at the twelve month follow up contact. E. Treated families will not have a substantiated abuse or neglect twelve months after the case is closed. This information will be obtained by checking with the referring caseworker at Social Services after the twelve month follow up is completed. F. Families will be rated "low" on the risk assessment device at closure of the case. The providers will rate the family at the time of case closure on 1. adherence and success with the treatment plan, 2. Pre post changes on the PCRI /AAPI and 3. clinical impression of future success. As well, other rating instruments in use by social services for monitoring home -based programs will be completed. Service objectives We have the following service objectives: A. Improvement of family conflict management. The 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. The initial goal of FPS services is to assist the family in finding behavioral solutions to the existing 8 conflict. Both providers are skilled in family systems work through their participation in our intensive family mediation program. Other aspects of conflict management include the following areas: Family Therapy Parent child conflict clarification Problem solving skills Negotiation Skills Communication Skills Re -parenting / emotional support Multifamily Communications Group Intensive Adult Drug and Alcohol Treatment Group Intensive Adolescent Drug and Alcohol Treatment Group 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 treatment gives the parents the opportunity in their own home to practice and to clarify the roles each parent expects of the other and what is expected of the child. Relative to expectations concerning child rearing practices and in age appropriate expectations they can have for the child, the Home Builders model of home -based care is able to improve parental performance based on the experience that this staff brings to this proposal. Specific aspects of these service objective include delivery of services in the following areas Parenting: Schedule of reinforcement _ Active listening skills Charting behaviors "I" statements Natural/logical consequences _ Problem -solving strategies Time out ____ Coaching Nurturing Emotional Issues: _ Anger management _ Depression management _ Anxiety/confusion management Self-criticism reduction Building self-esteem Handling frustration Impulse management Interpersonal Skills Training _ Social skills ___ Problem -solving ___ Negotiation skills _ Giving/accepting feedback 9 __ Use of crisis card _ Rational Emotive Therapy concepts _ Rational Emotive Therapy techniques ___ Recreation _ Relaxation _ Tracking emotions ___ Defusing anger Appropriate sexual behavior Accepting "No" Other 9710 /`:2 Assertiveness: ___ Aggressive v. assertive ____ Fair fighting Other Intervention Topics: ___ Use of a journal ___ Encouraging/building hope _ Monitoring client ___ Developing academic skills ___ Relationship building _ Clarifying family roles Coping with change Child/adolescent development _ Clarifying problem behaviors - Defusing crises Ref raming _ Managing money - Managing time _ Identify client strengths ___ Other Coordinating treatment plans _ Setting treatment goals/objectives - Providing reinforcers Counseling _ Deescalating - Values clarification _ Providing support/understanding Establishing structure/routine Establishing family rules Role playing Providing literature Pursuing leisure activities Job hunting/interviewing Teach parenting skills C. Improve household safety. One aspect of the treatment plan is associated with maintaining a safe household environment, adequately cleaned and maintained and stocked with food and supplies. Service objectives assisting in the acquisition of the following areas as appropriate to the needs of a family. Transportation Financial assistance Clothing Housing _ Food _ Client employment _ Toys/recreational equipment ___ Housework/cleaning C h i I do a re /b ab ys i tti n g Legal aid Utility benefits or services Medical/dental services Furniture/household goods Brokering services D. The program will provide access to needed services as documented in the treatment plan for each family. Specific types of referrals may include the following ___ Referral to counseling Working with schools ___ Referral to drug/alcohol program Referral to social services ___ Using support groups Implementing court orders Negotiating with utility companies Coordinating with diversion/probation 10 9 Recognizing potential suicide Coping with domestic violence Risk assessment Workload Standards A. The program has a capacity of two families per month with an average of two families per month. The families will receive an average of three hours per week for twenty weeks with a maximum length of service being five months and a maximum number of hours per family being sixty. All families will be treated within this framework regardless of the family composition. B. We have two providers for this program who will be family preservation specialists. They are Lori Kochevar and Carmen Jimenez. Lori and Carmen's experience are described in the body of the document and are summarized here. Their resumes' are attached to this proposal. Lori Kochevar has a B.A. from the University of Northern Colorado and an M.S. in counseling psychology from the University of Southern Mississippi. She is a Licensed Professional Counselor in Colorado. She has extensive experience in Family Preservation Services as documented in her reference and her resume which are attached. She is a supervisor in the Family Preservation Service System. Carmen Jimenez received her bachelors of Social Work and her masters of Social Work degrees from Colorado State University. She has been a licensed clinical social worker since 1995. She has had employment with community development with low income families, rural mental health and in fostering family development. Prior to joining Ackerman and Associates, she had a wide range of work in mental health center settings. She is fully fluent in Spanish. Her resume is appended to this application. The four psychologists who complete the Staff of Ackerman and Associates serve as back up and support for the Family Preservation Specialists and are available on call to assist them as well as to consult on intervention strategies on an anonymous case presentation basis. as well they can assist in interpretation of the AAPI/ PCRI instruments as needed. The psychologists are Joyce Ackerman Ed.D., Laurence Kerrigan Ph.D., Steven Patrick Ph.D. and Susan Bromley Psy.D.. Dr. Patrick manages our alcohol and drug intensive outpatient programs, Dr. Bromley and Lori Kochevar co-facillitate a couples communication group. Other aspects of the group practice are described in the newsletter Volume 1, #1 appended to this proposal. C. Of the twenty four families the caseload is projected at eighteen families for Lori and six families for Carmen. D. The modality of treatment is home -based care using the home builders model. 11 9i?.012 As well referral and group treatment and support will be offered as described above. E. Hours /weeks The total number of therapist hours is 60 per family over twenty weeks or a total for the budget calculation of 1440 per year based on our projected average. Maximum capacity is the same as this level. The hourly fee is requested at $80.83 as documented in the rate calculation section. F. Staff There are two individual providers supported by two secretaries in the practice, and there are four psychologist who provide on call support and back up services. G. Supervisor - This contract would be supervised by Joyce Shohet Ackerman Ed.D. who would monitor the project for compliance. Clinical supervision would be by Lori Kochevar who is trained as a Family Preservation Services supervisor. The maximum caseload for each type of supervisor is two families per month. H. Insurance - Ackerman and associates PC. carries one million three million liability coverage for professional liability on the corporation and its associates and each associate also carries the same level of coverage individually. In addition, Ackerman and Associates PC. carries a general liability policy related to accident or injury on our premises through Farmer's insurance. Both General and Group liability coverages are attached. Staff Qualifications A. Both staff members who will be Family Preservation Specialists exceed the minimum qualifications needed for this project in both education and experience as described above. B. Staff available for the project consist of the two Family Preservation specialists and Four licensed psychologists C. Current Mandated Training: Lori Kochevar is a supervisor in family preservation programs. Carmen Jimenez will need to take the mandated training prior to beginning the delivery of services. Lori may need to refresh her training if new components have been added since her work in southern Colorado last year. D. Both Family preservation specialists and all the psychologists have knowledge of risk assessment and are skilled in the application of that knowledge especially in relation to the assessment of risk of harm to self or others. E. Will staff have required state home based training? The exact and current requirements of this training need to be fully ascertained, but Lori Kochevar should be up to date or nearly so. Carmen Jimenez will complete these training activities prior to the delivery of services. If needed, Lori will update her training as well prior to onset of 12 9 ' a2 service delivery. 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. However, this value overestimates the cost of these services. The level of the involvement of the psychologists will be lower than our usual experience in our general practice. Therefore we suggest the following cost adjustments. The base rate for the Master's level providers in this practice is $75 per hour. Using this rate for the projected 1440 hours of service generates a figure of $108,000. If we add to this the 100 dollar per family amount to help meet basic needs ($2400 for 24 families) and provide a 250 dollar per family travel support for the Family Preservation Specialists ($6000 per 24 families) we come to a total of $116,400 for 1440 hours of direct service. This translates to a direct rate of $80.83 per hour . This is the rate we are applying under for the Home based intervention program. Budget Justification 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 manner. No special issues are present related to project audit to our knowledge. Ackerman and Associates completed an random audit (by the County conducted by Anderson and Whitney) of our mediation program after its first year of operation with no deficiencies. Ackerman and Associates P.C. is a type S professional for profit corporation and not a 501.c.3. Our direct service rate based on 1996 fiscal year figures is $93.99 Our Rate based on 1995 figures was $94.33 and our rate based on 1994 figures was $89.27 . Nevertheless, we propose the rate of $80.83 described above. 13 9 i ?.C''') Appendix Problem list for Family Referred by Weld County Department of Social Services to Ackerman and Associates P.C. Family Preservation Services Family Name Address Phone Caseworker filling out this form Extension # Date The family presents the following concerns or needs check all appropriate items optional space for brief keywords/ description [ 1 Family conflict [ 1 Parenting issue [ 1 Child abuse [ ] Child neglect [ 1 Sexual abuse/incest [ 1 Alcohol abuse [ 1 Drug abuse [ 1 Criminal/Police records [ ] Physical/domestic violence [ 1 Divorce/separation issues [ 1 Financial hardship [ ] Concrete/direct service needs [ 1 Home management issues [ 1 Medical illnesses/disabilities [ 1 Developmental disabilities [ 1 Mental health issues [ ] Suicidal tendencies _ [ ] Past suicides/attempts [ 1 Child behavior problems [ 1 Delinquency _ [ 1 Truancy/School problems [ ] Teen pregnancy [ 1 Runaway history [ 1 Other Thank you for this referral. Please fax this completed form to Lori Kochevar, M.S., L.P.C. Ackerman and Associates P.C. Fax # 353-3374 14 9710112 Ackerman and Associates P.C. Family Preservation Services Treatment Modality Inventory Therapeutic services Home based Family Therapy Parent child conflict Problem solving skills Negotiation Skills Communication Skills Re -parenting / emotional support Intensive group services ( with Ackerman and Associates RC.) multifamily communications group Intensive adult drug and alcohol treatment group intensive adolescent drug and alcohol treatment group Concrete intervention services Behavior Management Approaches: Parenting: ___ Schedule of reinforcement Charting behaviors NaturalAogical consequences Time out Nurturing Emotional Issues: ___ Active listening skills "I" statements _ Problem -solving strategies coaching Anger management Use of crisis card Depression management R.E.T. concepts Anxiety/confusion management ___ R.E.T. techniques Self-criticism reduction Recreation ____ Building self-esteem - Relaxation Handling frustration - Tracking emotions Impulse management Defusing anger Interpersonal Skills Training Social skills Problem -solving Negotiation skills Giving/accepting feedback 15 ____ Appropriate sexual behavior Accepting "No" Other 9i1O Assertiveness: Aggressive v. assertive _ Fair fighting Other Intervention Topics: Use of journal Encouraging/building hope Monitoring client Developing academic skills Relationship building Clarifying family roles Coping with change Child/adolescent development Clarifying problem behaviors Defusing crises Reframing Managing money Managing time Identify client strengths Concrete Services - Functional Transportation Financial assistance Clothing Housing _ Food Client employment Toys/recreational equipment Access to Community Services Referrals / Case Management Referral to counseling Referral to drug/alcohol program Using support groups Negotiating with utility companies Recognizing potential suicide Risk assessment _ Other _ Coordinating treatment plans _ Setting treatment goals/objectives _ Providing reinforcers - _ Counseling Deescalating ___ Values clarification _ Providing support/understanding ___ Establishing structure/routine Establishing family rules _ Role playing ___ Providing literature _ Pursuing leisure activities - _ Job hunting/interviewing _ Teach parenting skills aspects of services: 16 _ Housework/cleaning ___ Childcare/babysitting ___ Legal aid _ Utility benefits or services ___ Medical/dental services ___ Furniture/household goods ___ Brokering services _ Working with schools Referral to social services ___ Implementing court orders ___ Coordinating with diversion/probation _ Coping with domestic violence LORI KOCIIEVAR, M.S., L.P.C. 713 2nd Street Alamosa, CO 81101 (719) 589-3479 EDUCATION: University of Southern Mississippi, M.S. Counseling Psychology, Cumulative GPA 3.8. University of Northern Colorado, B.A. Pre -Professional Psychology, Cumulative GPA 3.5. PROFESSIONAL EXPERIENCE: 5/95 - PRIVATE PRACTICE THERAPIST, STRETCHING OUR STRENGTH'S Serve others through a creative process, that stretches participants strengths and provides an environment for authentic healing. Facilitate opportunity for individuals, families and groups to participate in an interpersonal dynamic and skills based creative process. Skills based facilitation for community development, team building, stress reduction, anger management, parenting, and personal effectiveness available. 5/95 - DIRECTOR, VALLEY COMMUNITY FUND Serve and manage Board of Directors to strengthen the internal structure of the agency to increase fundraising capabilities. Responsibilities include: Access state, government, and businesses to participate in payroll deduction, grant writing, marketing, coordination of special events and community training's, and disbursement of funds. 5/92 - 5/95 FAMILY PRESERVATION SPECIALIST, SAN LUIS VALLEY MENTAL HEALTH CENTER Provide intensive home -based treatment for families that are at risk of having youth removed from the home. Intervention emphasizing strength -based approaches, including psychotherapy, skill building (parenting, communication, anger control, problem -solving, etc.), educational support, and assistance in obtaining support for concrete needs. Management duties: public relation, supervise students, hire staff, and provide training for staff and community. 9.1.0 1,2 3/92 - 5/95 WILDERNESS THERAPIST, SAN LUIS VALLEY MENTAL HEALTH CENTER Provide intensive tent -based treatment for youth ages 8-17. Provide an opportunity for young people to learn skills in leader -ship, team work, decision making, dealing with stress, facing fears, and accepting responsibility. Used outdoor challenge course experiences such as rafting, backpacking, mountaineering, and rock climbing to facilitate skills based learning. 5/89 - 5/91 CONSULTANT, GRADUATE ASSISTANT, UNIVERSITY AFFILIATED PROGRAM, UNIVERSITY OF SOUTHERN MISSISSIPPI Participation in an interdisciplinary team that provides assistance for community - based child care centers who serve children with disabilities and their families. Responsibilities included: Grant writing, development and presentation of awareness training and assessment of learning environment and handicapping condition. Provided consultation for teachers and parents using a coaching model, skills -based training, and evaluation of change using a concerns -based model. 5/89 - 8/90 TEACHING ASSISTANT, THE WASHINGTON CENTER: WOMEN AS LEADERS Served as general resource counselor and support person for students. Responsible for leading workshops, facilitating small group discussions, reviewing papers, and evaluations of student's overall performance during seminars. 1/89 - 5/89 TEACHING ASSISTANT, UNIVERSITY OF NORTHERN COLORADO Teaching basic skills for report writing and use of computer programs; PC Write and Labstat. Taught weekly labs and graded lab reports . 4/86 - 9/89 RECREATION SUPERVISION, BOYS AND GIRLS CLUB OF GREELEY Providing guidance and support for at -risk youth, fundraising, program planning, facilitate teenage drug and pregnancy prevention program and family and community involvement, organization and supervision of field trips, and participation in local and national staff development training. INVOLVEMENT: FOUNDER, BOARD MEMBER, BOYS AND GIRLS CLUB OF ALAMOSA. Spearheaded community organization to obtain Boys and Girls Club. Organized fundraising, board development, marketing, and regional and national networking efforts. MEMBER , SAN LUIS VALLEY COALITION FOR YOUTH SERVICES: member of the steering committee and chairperson of the multicultural task force. 971042 CONFERENCES/ 1'RAININGS: 12/05/89 Play Assessment 05/12-26/89 Women as Leaders 05/30/90-06/01/90 Gulf Coast Conference on Early Intervention 09/20-21/90 Parents and Professionals United 10/11-13/90 CH.A.D.D. Conference on Attention Deficit Disorders 02/16-17/91 Adolescence in the Family: Strategic Therapy 03/01-07/92 International Women's Week: Diverse Perspectives Within Unified Voices: Career Exploration - Organizer & Presenter 03/16-19/92 Family Preservation Training 04/23-24/92 Domestic Violence Conference 07/07-08/92 Active Parenting 08/11-14/92 Multicultural Training: CSAP 09/17-19/92 Annual Mental Health Conference 1993 - 1995 Creative Process 02/06/93 Increasing Meaningful Communication in the Family Spring 1993 Play Therapy Class Spring 1993 Redirecting Children's Behavior 03/11-14/93 Child Adolescent Conference 04/26-27/93 Family Sculpting 06/09/93 Empowering Resistive Clients 09/26/93 Traumatic Stress Reactions in Children 10/05-08/93 Baseline TOT: Drug Prevention - Presenter 10/13/93 Conflict Mediation Training 11/30/93 Exploring Multiculturalism Within 02/01-04/94 Multicultural Conference 04/14/94 Empowering Resistive Client II 05/06/94 CPR and First Aid Certification 05/13-14/94 CEASE - Impact of Sexual Addiction on Families; Presenter - Family Sculpting - Presenter 05/16-17/94 FPS - Motivational Interviewing - Jill Kenney 05/20-22/94 Organizational Conflict Management: CSAP 07/08-09/94 Play Therapy 07/13/94 Family Sculpting 07/13/94 TOT Multicultural - Presenter 07/20/94 Jim Fay Parenting 08/15-16/94 Teen Baseline TOF: Drug Prevention - Presenter 09/15-16/94 Family Preservation - Supervision 07/13-15/95 Philanthropy Days - Organized 09/14-16/95 Annual Hospice Conference 02/09-13/95 Challenge by Choice: Ropes Course Facilitation Fall 1995 Leading Edge/Business 03/29/95 Fundsaving Workshop 04/02-05/95 Center for Creative Leadership 04/19/95 Building a Strong Non -Profit Board - Presenter 9710, `? August 6, 1996 San Luis Valley Comprehensive Community Mental Health Center ADMIN AND CLINIC OFFICE 522 ALAMOSA AVENUE ALAMOSA, CO 81101 719-589-3673 FAX 719-589-1521 CONIC OFFICE 1015 FOURTH STREET ALAMOSA, CO 81101 TDD 719-589-3671 719-589-3671 FAX 719-589-9136 CLINIC OFFICE 402 FOURTH STREET MONTE VISTA, CO 81144 719-852-5186 FAX 719-852-3043 26041 Woodland Ave. Esparto, CA 95627 Dear Colleagues: I have worked very closely with Lori in the Family Preservation program. Lori has been a wonderful asset to this program and to all her colleagues at Mental Health. More importantly, her dedicated and skillful service to our clients has greatly benefitted many SLV families. Lori's skills are numerous. She is well organized and very conscientious. She has excellent speaking and writing skills. Her forte is her ability to work with all kinds of people, and work through difficult interpersonal situations. Lori has consistently impressed me with her resilience and problem solving skills in dealing with some of the most chaotic and resistive families. In working with these families, Lori has also come to know the needs of SLV families and has become an expert in resources that are available throughout the Valley. She has worked in every county in the Valley. Despite carrying a full caseload of challenging cases, Lori took "time off' for herself by making solid contributions to other programs. I was amazed to see Lori doing good work for such things as the Mental Health Center's Wilderness Program, the Boys and Girls Club of Alamosa, the Multicultural Awareness Committee and the Drug and Alcohol Baseline program. She attended trainings in all of these programs and then consistently returned to share her expertise and take responsible roles in each, and handling the mix of responsibilities effectively. Lori has a strong philosophical commitment to the empowerment of the oppressed. Lori will direct people toward healthy, fun relationships. Lori will earn the confidence of the people with whom she works: staff, clients, and community leaders. I highly recommend her. Sincerely, Offering Comprehensive Mental Health Care For The Entire San Luis Valley Ji ..0��-'x2 Carmen M. Jimenez 226 Lake St. Ft. Morgan, CO 80701 (970) 867-3326 Employment History 11/95 to Present Mental Health Therapist Weld Mental Health Greeley, Colorado Provide individual and group therapy, and case management services to young children, adolescents, and families in the Children's Program. Individual psychotherapy to Spanish -speaking -only adults. 6/93 to 11/95 Mental Health Therapist Centennial Mental Health Center Ft. Morgan, Colorado 1) Outpatient clinician working with families, couples, young children and adolescents, and Spanish -speaking -only clients.g2 2) OBRA Program Specialist providing individual psychotherapy to the rric population in nursing home facilities. 3) Community Program Specialist working with the chronically mentally ill population offering individual and group psychotherapy, and case management services. On -call, emergency and crisis intervention position. 9/91 - 5/93 Graduate Research Positions while attending - Colorado State University Fostering Famil - Centennial Mental Health Center, Inc. - Colorado Division of Mental Health, Rural Colo. State Univ. ies Program Crisis Grant 7/81 - 8/92 Administrative Assistant Community Development Block Grant (CDBG) U.S. Dept. of HUD City of Fort Collins, Colorado Administrative duties including grant -writing and work with non-profit agencies. Direct work with low-income families involving community development and housing programs. Administrative assistant to the City of Fort Collins CDBG Commission and the Commission on Disability. 1/81 - 7/81 Secretary City Manager's Office City of Fort Collins, Colorado Education/Qualifications Licensed Clinical Social Worker, June, Master of Social Work Degree, Colorado BSW Degree, Colorado State University, Fluent in Spanish. Extensive work with the elderly population in nursing facilities. Experience in grant -writing. Work with non-profit organizations and HUD programs. Organizational Affiliations League of Women Voters Membership, Sterling, Co. Rose Arbor Nursing Home Volunteer Services, Sterling, Co. Fort Collins Commission on Disabilities Assistant Neighbor -to -Neighbor, Inc. Comprehensive Housing Counselor United Day Care, Inc. Board Member 1995 1993 State University, May, 1987 r) fli Ackerman and Associates P.C, Mental Health Newsletter Volume 1 Number 1, February 15, 1 997 mimmstisamnane Purpose This newsletter is to let you know about the psychological services of Ackerman and Associates and the psychiatric services of Dr. James Medelman. Ackerman and Associates, P. C. We offer a wide variety of mental health services to meet the needs of our clients of any age. Since the early 1980's we have built a multiple discipline practice of professional licensed providers representing many specialty areas. With this diversity we have developed what we refer to as a "lifespan oriented" practice philosophy. We provide services for: • CHILDREN • TEENAGERS • ADULTS • COUPLES • FAMILIES • SENIORS Our Services Our diagnostic techniques center on interviews, and when appropriate on more formal evaluations. Our treatment techniques are determined by the needs of the client at the time. Individuals who seek services in Spanish are welcome. We also provide psychiatric referrals and coordinate care with your physician as needed. Recently we have been named a center of excellence in the treatment of depression, family issues and mental health concerns related to physical rehabilitation.Other treatment specialties include short term therapy, anxiety management, play therapy and medical hypnosis. Mediation is used to help families and couples resolve disputes. Your confidentiality is strictly protected under Colorado law. Our Therapists Joyce Shohet Ackerman, Ed.D Licensed Psychologist Joyce provides treatment and evaluation of adults, children and families. Psychological concerns related to rehabilitation and illness and family mediation are some specialty areas for Dr. Ackerman. Susan Pluck Bromley,Psy. D. Licensed Psychologist Susan provides treatment for young, middle age and older adults. She specializes in adjustment to physical illness and injury, women's issues and hypnosis for medical problems. Carmen Jimenez M.S.W. Licensed Clinical Social Worker Carmen is a licensed clinical social worker who works with children, adults and families. She also provides services in Spanish. asematananame Laurence P. Kerrigan, Ph.D. Licensed Psychologist Larry counsels teens, adults couples and families. Areas of focus include treatment of depression, stress reduction, pain management, habit control and short term solution focused therapy. Lori Kochevar, M.S., L.P.C. Licensed Professional Counselor Lori's expertise is in the areas of family therapy, grief counseling and relationship issues. She specializes in play therapy with children, and in treatment of adolescents and their families. Steven Patrick, Ph.D. Licensed psychologist Steven has extensive background in crisis management and brief therapy. He counsels clients with substance abuse, depression anxiety, trauma or family relations issues. Special programs Intensive outpatient alcohol treatment program. We run an eight week alcohol group program for adults. Patients attend one or two group sessions per week depending on their level of need. Several HMO and Managed Care Companies support this service. We also run an adolescent alcohol and drug abuse treatment group. Ackerman and Associates P.C, Mental Health Newsletter Volume 1 Number 1, February 15, 1997 Marriage Support Group We provide an ongoing group for the enhancement and support of the marriage relationship. This group is designed to help each spouse identify methods to strengthen and improve their relationship. Family Mediation Ackennan and Associates has been under contract to Weld County for a program of intensive mediation to help families resolve serious disputes since 1994. This program has been very successful in reducing the intensity of those conflicts. We arc now pleased to provide mediation for families on a private basis. Families attempting to resolve an ongoing conflict or in need of establishing a way of solving a dispute are appropriate for mediation. Conflicts with teens in the family structure are particularly responsive to mediation techniques. Divorce Mediation Ifamarriage does not succeed, mediation is often used in divorce to help settle child custody issues and in the financial division of property. We conduct such financial mediations with the assistance of Mr. Phil Neville Certified Public Accountant with Anderson & Whitney Business Mediations.When business relationships end, mediation is often a useful tool for the closure of that enterprise. When interventions are conducted earlier, mediation may be able to help restructure the business relationship. Business mediations are conducted by our office with tic assistance of Mr. Neville We arc pleased to provide mediation services in any of these areas. Psychological Evaluations. We provide diagnostic services for children and adults. These include intelligence and personality assessment, drug and alcohol evaluations, custody evaluations, testing for attention deficit disorder and other evaluations. Workshops in the workplace Ackerman and Associates provides workshops on site at business locations on sensitivity training for staff in regard to cross cultural sensitivity in the workplace and on techniques for dispute management in the workplace. Workshops in Human Services We also provide staff oriented workshops related to helping families and individuals for human service agencies. Appointments Please feel free to call our twenty four hour number at any time to request an appointment. During regular business hours, your call will be answered at our offices and after hours by our answering service. One of our staff will answer your questions. Appointments are available workdays, evenings and Saturdays Our providers are covered by most insurance and managed care companies. We will be glad to assist you in verifying your insurance information and helping you with insurance concerns. Our office is fully accessible to the handicapped. Please call 353-3373 to set up an appointment. Questions about Workshops or Programs Please contact our office with any questions about our workshops ,or treatment programs. Please ask Madra or Maureen to direct your call to one of our providers. Psychiatric Services of James K Medelman M.D., I.C. Dr. James Medelman is a physician who practices psychiatry in his own business within our office suite. He has been in practice since 1967 and has extensive experience in general psychiatry in both inpatient and outpatient settings. His specialty areas include psychopharmacology (treatment of mood and sleep disorders with medication) as well as psychotherapy. He is pleased to coordinate care with your primary physician and with your therapist. To make an appointment with Dr. Medelman's office please call 352-6600 Ackerman and Associates P.C. and James K. Medelman M.D., P.C. are separate business entities Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80631 (970) 353-3373 fax: (970) 353-3374 ADOLESCENT DRUG AND ALCOHOL EDUCATION PROGRAM Ackerman and Associates announces an Adolescent Drug and Alcohol Education and Treatment Program. Using a group therapy format, we can help you: Conduct a self -education of your level of use. Be motivated to change. - Guide you through treatment and recovery. Understand biological contributions to drug/alcohol problems - Identify high risk situations for relapse. - Resist social and peer pressure. - Manage your emotions and deal with anger, anxiety and depression. Prepare your plans for life after treatment. The program will be conducted by Dr. Steven Patrick, Ph.D., Licensed Psychologist, who directs our alcohol treatment program and by Lori Kochevar, M.S., Licensed Professional Counselor, who has extensive background in adolescent treatment and family systems. A two hour group will be held twice a week (Monday and Wednesday afternoons). The program also includes family support services. Please contact our office to set-up an appointment with Dr. Patrick for participation in the group. The cost for the complete eight week program is $850.00. Several major insurance companies (including FHP) will cover the cost of these services. 971O42 Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80631 (970) 353-3373 fax: (970) 353-3374 ALCOHOL AND DRUG OUTPATIENT TREATMENT PROGRAM Ackerman and Associates has designed an Intensive Outpatient Treatment Education Group for adults who have problems with alcohol in their lives. People who find that they have any of these problems with alcohol or drugs are appropriate for the group. Friends tell you they are concerned Your use is creating problems in your life Drinking is an issue in your relationship An evaluation will be conducted when you start the group to be sure this is the correct level of treatment for you. The process is based on group and individual therapy over an eight week period and is usually insurance reimbursable for managed care and traditional insurance plans. Two hour groups, two meetings per week are involved in the program. Dr. Steven Patrick, Ph.D., Licensed Psychologist is the clinician who coordinates our alcohol and drug treatment activities. Please contact our office to set-up an appointment with Dr. Patrick for participation in the group. The cost for the complete eight week program is $850.00. Several major insurance companies (including FHP) will cover the cost of these services. 971012 PECLARATIONS ❑ TRUCK INSURANCE EXCHANGE SPECIAL FARMERS INSURANCE EXCHANGE E FIRE INSURANCE EXCHANGE 4. Mortgage Holders SENTINEL PACKAGE SUPER MEMBERS of FARMERS INSURANCE GROUP OF COMPANIES HOME OFFICE: 4680 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90010 1. Named . DR JOYCE SHOHET ACKERMAN PC Insured . Mailing ' . 1750 25TH AVE SUITE 101 Address . GREELEY CO 80631 Prematic Acc't No. 07-04-362 04576-38-07 Agent Policy Number Prod. Count The named insured is an individual unless otherwise stated: Type of ❑ Partnershi ® Corp. Business OFFICE ❑ Joint Venture Organization (Other than Partnership or Joint Venture) 2. Policy Period from 07/01 /96 to 07/01/97 (not prior to time applied for) If this policy replaces other coverages that end at noon standard lime on the same day this policy begins, this policy will not take effect until the other 12:01 a.m. Standard Time. 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 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 coverages indicated by a specific limit or by an COVERAGES SECTION 1 Property and Loss of Income SECTION II Liability and Medicals SECTION III Crime A -Building B -Business Personal Property C -Loss of Income (Not exceeding 12 consecutive months) OPTIONAL COVERAGES Swimming Pool/Fences and Walkways Building Glass(Blanket) Outdoor Sign Coverage Valuable Papers (In addition to $1000 included.) 0 Earthquake Damage D -Business Liability - Including Products and Completed Operations. (Annual aggregate applies for all occurrences during the policy period.) X LIMITS OF INSURANCE DEDUCTIBLE $ 50,000 $250 applies unless other cation indicatedb-y�' an® $iooDssoo L Is ACTUAL LOSS SUSTAINED NONE Above deduc- REPLACEMENT COST tibia applies $ 100 unless other $ option indi- See Coverages A.B. & C LIMITS OF LIABILITY (Annual Aggregate) $ 1,000,000 E -Fire Legal Liability $75,000 included unless other option indicated by an Q 0 $100,000 ❑ $150,000 each occurrence (Subject to the annual aggreagate shown for Cov. 0) F -Medical P (yments to Others (Subject to the annual aggregate $5,000 each person shown fer Coverage D. ) ❑ Profession.;) Liability (see attached endorsement) ® I - V COVERED Agreement I Employee Dishonesty Agreement II -Broad Form Money and Securities -Inside Agreement III -Broad Form Money and Securities -Outside Agreement IV -Medical Payments Agreement V -Forgery or Alterations 56-5308 2-92 2ND EDITION Countersigned Limit of Liability (Annual Aggregate) cated. 100 9u of the applicable ins. limit. $5,000 $1,000 $1,000 $500 each person NONE J$2,500 NONE DEDUCTIBLE NONE $250 $250 Authorized Representative Branch 32 13/A A Producer # Issue Date Renewal/Replacement No. 0002360 '`15.00 05%14/96 RENEWAL PSyCIIOLOGIS"IS PROFESSIONAL LIABILITY CLAIMS -MADE INSURANCE POLICY PURCHASING GROUP POLICY NUMBER: 452-0002000 NOTICE: THIS IS A CLAIMS -MADE POLICY -,PI FACE READ THE POI Icy CAREFULLY Item DECLARATIONS CERTIFICATE NUMBER: 45P- 2032570 NAMED INSURED: ACKERMAN AND ASSOCIATES PC ADDRESS 1750 25111 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 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. NIONROE STREET, CHICAGO, ILLINOIS 60603 REPRESENTATIVE: Agent or Broker: Kirke -Van Orsdel, Incorporated Office Address: 1776 West Lakes Parkway Town and State: West Des Moines, IA. 50398 Toll -free Number: 1-800-852-9987 INTERSTATE. INSURANCE GROUP PLP-2012 (06/93) (Elec.) Oil 8003 nl9.n lea- L ^-"!• - L.A i M : Ackerman and Associates PHONE NO. : 9703533374 May. 05 1997 04:32PM P6 May 2, 1997 Ackerman and Associates, P.C. 1750 25th Avenue, Suite 101 Greeley, Colorado 80631 (970) 353-3373 (ax: (970) 353-3374 Judy A. Griego, Director Weld County Department of Social Services P.O. BoxA Greeley, Colorado 80632 In response to your letter concerning our bid on RFP PAC bid #97010. 1. Program evaluation is detailed under the measurable outcomes section of the proposed. Each family will have evaluation sheets incorporating our proposed evaluation criteria that will be completed 1) at the end of their treatment and 2) at the twelve month follow up. Pre and post measures will be based on the form related to the parents' description of family interactions called the Parent Child Relationship Inventory, a fully validated psychological instrument. Adolescent dynamics within a family will be addressed using the Adult - Adolescent Parenting Inventory. Both inventories give perceptible rank on a variety of scales. By using these instruments, pre and post treatment changes in that percentile rank will be measured. Improvement in the percentile rank on each scale will reflect improvement in parenting style. 2. We anticipate being able to contact the family and schedule with -in five working days, assuming a phone is available to the family. We will also provide notification that the family has been contacted within this time period to the caseworker who made the referral. In most cases, we will be able to see the family for the first appointment within the five day period if the family accepts the first offered appointment time. 3. In general, clients will be served in their homes whether in South County or else- where in Weld County. 4. Transportation is only for our specialists to travel to the families. We have budgeted a $250.00 per family allowance for our specialists to support their travel costs- We will not transport the family for reason of liability. 5. We understand that the $100 per family stipend for emergency needs we proposed will not be approved. We will assist clients in applying for FROM : Ackerman and Associates PHONE NO. : 9703533374 May. 05 1997 04:32PM P7 IV A/EA Special Economic Assistance funds. 6. We wish to offer a re -calculated fee for our services. As a private agency, we have no subsidy of any type from any tax base in providing these services. Never the less, in hopes of not only being vendors of the service, but also in having the services used extensively, we offer a discounted rate of $50 per hour rather than $75 per hour originally proposed. This leads to the following recalculation: $50 per hour X 1440 hrs = 72,000 $250 travel X 24 families = 6,000 $78,000 Cost per hour of service = $54.17 Our original proposed cost per hour was $80.83. The new figure represents a thirty three percent reduction in the cost of services for this proposed cycle. Sincerely, 4t..1-u�� Joyce Shohet Ackerman, Ed.D Licensed Psychologist IC 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. 9"1 2 _:.^j Casa 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-2001 (RFP-PAC-97010) Revision Contract Award Period Name and Address of Contractor Beginning 06/01/97 and Weld Mental Health Center, Inc. Option B - Mobile Mental Health Team 1306 I lth Avenue Greeley, CO 80631 Ending 05/31/98 Computation of Awards Description Unit of Service Service to a maximum of four families needing moderately high level of care. The service offers a range, on average, of three to five hours of weekly in -home mental health services for up to nine months to each family in crisis. 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, or 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 $ 41.69 Unit of Service Based on Approved Plan Enclosures: ✓Signed RFP; Exhibit A ✓Addendum RFP Information Condition(s) of Approval Approvals: Byk�i(? �, �� y��"/" Program/ By ' Official: eorge E. axter Judy Weld Date: Grigi , Dire or ounr Depa /ent of Social Services 23/f 7 Board of Weld County Comm'erE Date: r.5 _Yiq �' �� 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. INVITATION TO BID DATE: February 5, 1997 BID NO: RFP-PAC-97010 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-96010) for: Deadline: March 25, 1997, Tuesday, 10:00 a.m. Family Preservation Program --Option B - Home Based Intensive Family Intervention 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 Option B - Home Based Intensive Family Intervention Program is a family strength focused home -based services to families in crisis which are time limited, phased in intensity, and produce positive change which protects children, prevents or ends placement, and preserves families. This program announcement consists of five parts, as follows: PART A.. Administrative Information PART B...Background, Overview and Goals PART C. Statement of Work PART D...Bidder Response Format PART E.. Bid Evaluation Process Delivery Date (After receipt of order) BID MUST BE SIGNED IN INK VENDOR ADDRESS PHONE# Weld Mental Health Center, Inc. (Name) 1306 11th Avenue Greeley, CO 80631 (970) 353-3686 Dale F. Peterson TYPED OR PRINTED SIGNATURE Handwritten Signature By Authorized Officer or Agent of Vender TITLE DATE Executive Director 3/12/97 The above bid is subject to Terms and Conditions as attached hereto and incorporated. 1 RFP-PAC-97010 Attached A OPTION B - HOME BASED INTENSIVE FAMILY INTERVENTION PROGRAM BID PROPOSAL FAMILY PRESERVATION PROGRAM 1997/1998 BID PROPOSAL APPLICATION PROGRAM FUNDS YEAR 1997-1998 BID #RFP-PAC-97010 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 Option B - Home Based Intensive Family Intervention Program is a family strength focused home -based services to families in crisis which are time limited, phased intensity, and produce positive change which nrotects children. prevents or ends placement, and preserves families 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: Mobile Mental Health Services Option B Dan E. Dailey Name and Signature of Person Prep g Document Dale F. Peterson c,2, a ►...o 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(s) with Social Services Division Supervisor: Staff Qualifications Unit of Service Rate Computation Program Capacity by Month Comments by SSD Supervisor: Name and Signature of SSD Supervisor 24 07_0? )-917 Date I. PROJECT DESCRIPTION The Mobile Mental Health Services (MMHS) project of the Weld Mental Health Center (WMHC) has been serving client families for the past five years. It meets all requirements of the state defined Option B - Home Based Intensive Family Intervention Program. It is the second most intensive offering of the WMHC's Family Preservation Team's (FPT) continuum of treatment projects that includes Homebuilders (Option A), the Intensive Family Therapy Service, 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 not less than four families at any given time who need, in the assessment of their Weld County Department of Social Services (WCDSS) caseworker, this moderately high level of care. The service offers a range, on average, of three to five hours of weekly in -home mental health services for up to nine months to each client family. Due to this design, MMHS is established for families in crisis who are at risk of having a child placed out of the family home but who do not present with the severity of crisis present in Homebuilders Option A referrals but with more severity than those referred to the Intensive Family Therapy Service. Another factor is considering MMHS as a treatment alternative is the client family should be seen as in need of extensive mental health intervention over a relatively prolonged period of time. Four primary types of treatment services are provided to recipients of MMHS Option B services: therapeutic, concrete, collateral, and crisis intervention. Each family admitted to the project will have a service plan developed for them that spells out 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 MMHS will concentrate on four service objectives in its 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. The services of the MMHS Option B are designed to respond to the needs of families with moderate to severe levels of dysfunction. They provide a clear middle treatment ground between Homebuilders Option A and Intensive Family Therapy. II. TARGET/ELIGIBILITY POPULATIONS The MRS Option B project will serve at least four Weld County families at any given time. At this level, not less than eight families may be served annually. Referred children may range in age from birth through 17 years. Whenever feasible and appropriate, all available nuclear family members of the referred child will be incorporated into the treatment plan as well as those members of her or his extended family deemed necessary to the treatment process. At least one parent must consent to work with the project, to protect the child from further harm with the goal of maintaining or reunifying the family. It is anticipated that not fewer than 25% of the client families will receive bicultural/bilingual services. Services will be available throughout Weld County with at least 25% being delivered to families residing in the southern portion of the county. All families served will have access to 24 hour care. In accordance with the RFP requirements, the monthly maximum capacity of the project is four families with an average monthly capacity of not less than three families. The average length of stay in the project will be six to nine months. Families will be provided an average of five hours of care weekly for at least the first three months of the intervention, followed by the provision of an average of three hours of weekly care for the remaining six months. A manageable level of risk of harm to each referred child must exist. Children referred to MMHS Option B will have met 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 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." III. TYPE OF SERVICES TO BE PROVIDED All families referred and accepted into the MMHS Option B project will receive home -based services for approximately five hours weekly for the first three months of care and three hours weekly for the remaining six months of care. Service offerings consist of therapeutic, concrete, collateral, and crisis intervention services. 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. Therapeutic services will include (when appropriate), but not be limited to re -parenting, individual and family therapy, support groups, education in problem solving, lessons in communication skills, and training in parent -child and parent -parent conflict management. Concrete services will include, again when appropriate and not limited to, training in the following areas: 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. 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 available on a continual, 24 hour basis. Up to two hours of case management services will also be provided weekly to each family. Upon receipt of a referral, the MMHS 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 establish a plan to introduce the assigned therapist to the family and ensure that the family understands the nature of the MMHS service and agrees to participate in the service. Family members will be advised of their rights in receiving mental health services, 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 MMHS 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. Delivery of the core services outlined above now begins, maintaining the emphasis on the strengths of the family while closely monitoring the safety of the at risk child(ren). Each member of the family is engaged at an appropriate level given her or his position in the family. 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. As the ability of the family to provide safety and security for its III. TYPE OF SERVICES TO BE PROVIDED, continued members is enhanced, the service plan is updated to secure the gains made to date, evaluate what is working and what is not working, and to generally improve the family's capacity to effectively handle the crisis that lead to the initial referral and to generalize that improvement in the family's general level of functioning. 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 MMHS Option B mental health worker that the services are necessary to fulfill the treatment plans that are in effect. Case management services consisting of referral, linkage, monitoring, advocacy, and service planning will be 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. MMHS Option B services are culturally sensitive and competent. They are designed 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. IV. MEASURABLE OUTCOMES Each family member admitted to outpatient services of the WMHC will be evaluated at admission and at discharge from MMHS Option B 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. Also 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 MMHS project, the WMHC will 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 to enable the family to care for the children in the home setting. Objective. 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 weeks of referral (family reunification services.) 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 MMHS project will measure significantly lower on the risk assessment scales at the 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 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. 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 MMHS worker will strive to accomplish 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 objective was met. The family will also be asked to report on its subjective improvements in this area. To meet the goal of improving overall parental competency, the objective of increasing the parents' abilities to develop and maintain sound, caring, effective relationships with each other and with their children. 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. A 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 a safe household environment for the children 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 assistance of the therapist. The family, therapist, and caseworker will document the improvements made in this area. The fourth service goal of the MMHS is to improve the family's ability, 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. VI. WORKLOAD STANDARDS A worker in the Family Preservation Team of the WMHC will have a caseload of not more than four MMHS families at any one time. He or she will provide an average minimum of five hours of direct family preservation services per family per week for the first three months of care and three hours of direct family preservation services per family per week for the remainder of the intervention. 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 hourly averages are the up to two hours per week of case management required to assist the family achieve its goals and objectives. Direct supervision of the MMHS project occurs within the larger FPT. This team is currently comprised of seven individuals: six mental health workers and one administrative supervisor. We will expand the team as much as is necessary to accommodate referrals from WCDSS. The ratio of mental health workers to administrative supervisors will never exceed six to one. The supervisor, Sonja Faris, MA, reports directly to the director, 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, and available for consultation with staff, 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 also 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 plans of the client families. VII. STAFF QUALIFICATIONS All staff of the WMHC's Family Preservation Team will, as a minimum, meet the qualifications necessary to be a Caseworker III within the state social services system. All members of the team will have either have masters degrees in the human services area from accredited universities and have at least two years experience working with children and families or will have bachelor's degrees in the human services area from accredited universities and have at least five 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 one full time employee will provide MMHS services at any given time. All the present staff of the team are trained in risk assessment as will be any new staff members hired. At present, all members of the Family Preservation Team have attended and completed the State Home Based Intensive Family Services training program or its equivalent. Any new members hired will be sent to this training, or again its equivalent, as soon as possible after they begin their employment with us. Psychiatric and psychological services will be delivered by licensed professionals in each of these respective fields. VIII. COMPUTATION OF DIRECT SERVICE RATE Direct Time (Per Month Per FTE) 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) Mobile Mental Health Services are heavily personnel intensive. The above computation based on one full-time staff member reflects this. Every effort is 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 just over four hours 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 only 15 minutes per client family per month. Families in the initial stages of treatment typically spend more time in court than do those who have progressed. 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. RFP-PAC-97010 Attached A IX. RATE COMPUTATION Monthly Direct Costs Salary $ 2500.00 Benefits 600.00 Subtotal $ 3100.00 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 Hourly Rate $ 14.45 3.47 $ 17.92 Service Costs Total Direct Direct Time Hourly Rate % of Time Charge $ 24.04 100.00 $ 24.00 5.77 100.00 5.77 $ 29.81 100.00 $ 29.81 $ 6500.00 $ 37.57 $ 62.50 1560.00 9.02 15.00 1700.00 9.83 16.35 408.00 2.36 3.92 $ 10168.00 $ 58.78 $ 97.77 $ 17727 5100 4781 1850 4200 3217 3100 4000 20049 64024 141.9 $ 451.19 2.61 Direct Service Rate (Hourly) (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. 10.00 $ 6.25 10.00 1.50 7.50 1.23 7.50 .29 $ 9.27 $ 2.61 $ 41.69 29 IX. RATE COMPUTATION: BUDGET DESCRIPTION Personnel costs are predominant in this budget. The figures represent the equivalent of one full-time clinical staff member of the WMHC working in the Mobile Mental Health Services to provide the necessary level of additional services called for by service plans and the requirements set forth in this proposal, including clinical, case management, support, and supervisory services. Direct services personnel costs $29.81 per direct service hour, or 71% of the total of $41.69. Supervisory costs are $7.75, or 18%, of the total direct time cost. The clerical support services cost $1.52, or 3%, of the total. The agency overhead of $2.61 amounts to only 6% of the total cost per hour. Psychiatric and psychological services to clients are available at an hourly rate of $76.00 to those clients needing them and will be billed separately from other clinical costs. 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 is independently audited annually, including its use of PAC funds. PROGRAM CAPACITY BY MONTH The MMHS Option B service is designed to function with a minimum staff contingent of 1.00FTE, serving a minimum of four 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 MMHS service. ASSESSMENT/DISCHARGE Sheet 1 L _ AGENCY GAF SCORE l CLIENT ID MEDICAID ID ADMISSION DATE mat/cid/yy VICTIM PROBLEMS Check ALL that Apply _Ever Sexual Abuse Victim Ever Verbal Abuse Victim Ever Physical Abuse Victim Neglect PROBLEM SEVERITY RATE the CURRENT P-SEV (PROBLEM SEVERITY) for each area using the following scale: None Slight Moderate 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 Agitated Mood Swings Accelerated Speech SUICIDE / DANGER TO SELF _Suicide -Ideation Suicide Plan _Past Suicide Attempt _.._ Self Injury _Danger to Self (t" l S27A0)- 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 COGNITIVE PROBLEMS Memory Concrete Attention Span 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 (CBS27.j )3 RESISTIVENESS Uncooperative Evasive Guarded Wary, Antagonistic 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 (CRS 27401 Physical Abuser Homicidal Threats ROLE PERFORMANCE (Work / School) _Absenteeism _Performance Behavior _Temunations learning Disabilities _Not Employable _Doesn't Read/Write _Doesn't Earn Unstable Work/School Hiss FAMILY PROBLEMS (Client Problems in Family) No Family w/Relative w/Parenting No Contact w/Fanuly w/Partner --w/Child w/Parent _ng 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 Addicted DUI/DUID MEDICAI/PHYSICAL Acute Illness Nutrition Enuretic _Developmental Disability _ _Injury by Abuse/Assault Drug(s) Dependent Interferes with Responsibilities Family History of Substance Abuse Chronic Illness CNS Disorder Eating Disorder _Physical Handicap Encopretic _Medical Care Needed Perm. Disability Attention Deficit Disorder SECURITY / MANAGEMENT ISSUES Restraint Seclusion _Security _ W alkaway/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=Worse 5=Somewhat Better 6 -Better 3 -Somewhat Worse 4=No Change 7 -Much Better 7/95 CLIENT LD. # DATE OF ADMISSION ASSESSMENT/DISCHARGE Sheet 2 STRENGTHS / RESOURCES Check ALL CURRENT STRENGTHS / RESOURCES individual has. ECONOMIC RESOURCES Employment Transportation Medicaid/Medicare EDUCATION / SKILL RESOURCES Education Job Skills PERSON RESOURCES Spouse Parent (s) Other Family Friend (s) PERSONAL STRENGTHS Insight Emotional Stability Tolerance Thought Clarity Housing SSVSSDI Intelligence Interpersonal Skills Judgment Adaptability Appearance Empathy 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 Very Low Moder Low Function Function Average Function Moder High Very High Function Function 2 3 4 5 6 7 INTERPERSONAL FUNCTIONING Very Low Moder Low Function Function 8 9 Average Moder High Very High Function Function Function I 2 3 4 5 6 7 8 DAILY LIVING / PERSONAL CARE FUNCTIONING Very Low Moder Low Function Function 8 Average Moder High Very High Function Function Function 1 2 3 4 5 6 7 PHYSICAL FUNCTIONING Very Low Moder Low Function Function Average Function 8 9 Moder High Very High Function Function 1 2 3 4 5 6 7 8 COGNITIVE / INTELLECTUAL FUNCTIONING Very Low Moder Low Function Function Average Function 9 Moder High Very High Function Function 2 3 4 5 6 7 8 9 OVERALL LEVEL OF FUNCTIONING Very Low Moder Low Function Function Average Function Moder High Very High Function Function 1 2 -- 4 5 6 7 8 9 CHANGE IN LEVEL OF FUNCTIONING 1=Much Worse 2=Worse 3 -Somewhat Worse 4=No Change 5 -Somewhat Better 6=Better 7=Much Better FROG AM ACTION TYPE (Manual Input Only) 01=Admission 1.1=Correction to Admission 02=Act ivate 12=Correction to Activation 03 =Update 13 -Correction to Update 04 =Inactivate 14 -Correction to Inactivation 05 =Discharge 15 -Correction to Discharge I L l EFFECTIVE DATE. rnm/dcUyy DATE FORM COMPLETED:mm/dd/y LAST CONTACT DATE. rrirri/dd/yy CURRENT DIAGNOSIS CURRENT / EXPECTED RESIDENCE. 1-Corrections/Jail 2=Inpatient 3=Nursing Home 4=Residential - Mental Health 5 -Residential Non- Mental 6=l3oarding Home 7 -Homeless -in Shelter 8=Homelesson 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 Relative(s) CURRENT / EXPECTED EMPLOYMENT. I =Employed -Full Time 2=Employed-Pan 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 8=Armed Forces Active Military Duty INACTIVE / DISCHARGE TYPE OF TERMINATION. STAFF/AGENCY INITIATED CLIENT INITIATED I=Discharged/Fransferred 2 --TX Completed/No Referral 3 -TX Completed/Follow-up 4 -Evaluation Only 5=Inactive for I Year f 6=Patient/Client Died 7=Patient/Client Terminated TERMINATION REFERRAL: NOTE: Use 61 "Self if no Referral This field will contain one of the following coda d sbnn type =05 or 15: Personal referrals - al - Self; 62 - Familyfrelative; 63- Friend/Employer/Clergy; Mediral/Psychiatric referrals 68 - Outpatimu psychiatric, 69 - Private psychiatrist, 70 - Other private MH practitioner: 7l -GAWP; 73 - Colorado Mental Health Centers/Clinics; 74 - Nursing home; 75 - Community residential organization, 76 - AlcohoVDng treatment facility; 77 - Medical paeitioner; 78 -Commit hospital inpatient psyclwuic program, 79 -Other inpatient psychiauic program; Social service/Education referrals - 81- Social service agency; 82 - Agency for the Developmental disabled. 83 - Vocational rehabilitation facility; Si - Educational system/school; 85 - Shelter for homeless/abused; legal referrals - 91 - Law enforcement; 92- Conn (including juvenile). 93- Correctional facility; 94 - Probation/parole; All other referral sources - 98 - Other. XX - Referral source not known. STAFF ID / STAFF SIGNATURE 1 DISCIPLINE: 1 =tone 2=mh worker 3 -nursing 4=social work 5 --psychology 6=psychiatry 7=other DEGREE: (Tone 2=associate 3=bachelors 4=masters 5-PhD/PsyD/EdD 6 -MD 7 -other 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 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 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 Weld Mental Health Center Adult Acute Treatment Unit Client Admission and Termination Data August 1, 1995 - June 30, 1996 Global Assessment Functioning Scores ATU - Data for non -Medicaid clients j 0 20 Mean ATU - Data for all Medicaid clients 0 40 Mean 20 40 I MB Admissions: n = 247 Terminations: n = 245 40 60 L.1 Admissions: n = 131 ® Terminations: n = 131 60 um Admissions: n = 116 — Terminations: n = 114 60 Weld Mental Health Center Adult Acute Treatment Unit Client Admission and Termination Data August 1, 1995 - June 30, 1996 l ATU - Data for all clients Mean Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Functioning Overall Level of Functioning Problem Severity Score ATU - Data for non -Medicaid clients it MS Admissions = 247 ME Terminations = 245 j S rietal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Functioning Overall Level of Functioning Problem Seventy Score Societal Role Functioning Interpersonal Functioning Daily Living/Personal Care Functioning Physical Functioning Cognitive Intellectial Functioning Overall Level of Functioning Problem Seventy Score 0 2 Mean 4 6 8 ATU - Data for Medicaid clients L__I Admissions = 131 hits Terminations= 131 Mil Admissions = 116 ® Terminations = 114 enog ftluanaS waigaid Overall Level of Functioning Cognitive Intellectual Functioning 6uluoRound leo!sAUd Daily Living/Personal Care Functioning Interpersonal Functioning Societal Role Functioning Global Assessment Functioning c K c K c K c K c K c M c K c K QC7 30 30 QC) 30 30 30 N Qd o r CD= m= m= m= m= m= m= � -• -, -1 -I 61 A _. V al W - N .a A CO A --I J - o) 0) - CO A W r - CO CO a -a W O- W J W A(A) co N.) N A N V � A W - A CO 0) - A _a W _ A 6- ) A 0) N a N V V N A A v cn - A Oo - cn - A - O 0) a - N) N N C.) a ix) CO N A C11 co bi - A W - cn - CO 0) Q) co � A A - COco N W a oi J cn N a a O N —t W CO W W A CO A W W N A A p W W - A W J co - CO cji co A N01 A G cm co co J CO Admission Termination Admission Termination Admission Termination D C) CD r stuallO pleolpaw-uoN swuell0 pleolpaw August 1, 1995 - June 30, 1996 a C C, C m -, m 0) 3 co C a _3 V)' N O' 0) a CD 1 3 Q) O' C 0) 0) aa}uao IalueW PIaM S-12-1997 8:3dAM FROM PRODUCER Flood & Peterson Ins. Inc. P- O. Box 578 4687 W. 18th Street Greeley, CO 80632 INSURED Weld Mental Health Center 1306 11th Avenue Greeley, CO 80631 COVERAGES::•. COMPANY ASt. COMPANY B ACORN. CERTIFICATE OF INSURANCE: DATE (MM/Coin1 03/12/97 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ALTER THE COVERAGE AFFORDED BY THE E%TEND ORPOLI BELOW. COMPANIES AFFORDING COVERAGE Paul Ins. Co. COMPANY C COMPANY 1_ D THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED INDICATED. NOTWITHSTANDING ANY REOUFIEIALNTT TERM OR CONDRpN OF ANY CONY ACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERnFrATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE ABOVE UFOR THE AU. THE E S OCCLUSIONS AND CONDMONS OF SUCH POLICIES. LIMITS SHOWN MAY ROOE BEEN R Du DE B PAID DESCRIBED NEREN IS SUBJECT TO THE TERMS. DUCED BY PAID CLAIMS TYPE OFINSURANCE GENERAL LIABILITY MMERCIAL GENERAL LIAOA:TY CLAIMS MADE 1 X I OCCUR WNEWS L CONTRACTOR'S PROD AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA PORm WORIERSCOMPENSATION AND 1 EMPLOYERS LIABILITY THE PROPRIETOR/ E POLICY NUMBER FK06002791 PARTNERS/EXECUTIV ■ OFFICERS ARE: I ExCL1 A 01wEs Prof. Liab., FK06002791 laims Made DEFJIBmoN OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Retro date 7/1/86 CERTIFICATE - HOLDER Weld County Placement Alternatives Committee c/o Weld County Department of Social Security 800 8th Avenue Greeley, CO 80631 IAC0R048-S(edail011 S: O POLICY EFFECTIVE pouCT EJBMRATION DATE (MM/DD/YT) l DATE (MWD°/1'Y) 01/01/97,01/01/98 of NERALAOGRE GATE LIMITS !PR000 C T5. COMP,OP AGO `ERSONAL L AOV INJURY ' EACH OCCURRENCE ARE DAMAGE - on. CPS MCP EXP Y On plum, COM BINEO SINGLE LIMIT 8001LINJURY (Per Pwion) I BODILY INJURY 1 (Pw ACC ppnl) 1PROPER TY DAMAGE `U TOONLY.EAACCIOENT OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE IEACH OCCURRENCE AGGREGATE ;1 000 000 ;1 000 000 ;1 000 000 Tl 000 000 ;100 000 s5 000 ; S S STATUTORY LIMITS EACH ACCIDENT DISEASE -POLICY LIMIT y DISEASE -EACH EMPLOYEE• 01/01 97 01/01/98'$1,000,000 ea. pers. •S3,000,000 total lim. S CATSCEL1ATION SHOULD ANT OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1p_ DAYS WRITTEN NOTICE TO THE CERT FICATE HOLDER NAMED TO THE LEFT, BUT FAIL - TO MALLS CHIN L IMPOSE NO BLIGATION OR LIABILITY' ... ESENTATIVES. •ANT I •\ . THE aft N A N OR P G ACORD INCL 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 WMHC 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 Dan E. Dailey, Dikctor Children and Family Services enc. Robert R Merz President Carla Lujan Vice -President Alvina Derrera Secretary Sharon McComb 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 (WMI-IC) 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 WMIIC 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 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 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; 1 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 _ etigibilitycriterraestablished- -- 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. WMHC 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 cf 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 WMHC 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 WMI IC 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 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 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 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 1GTS. 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. 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 WMHC 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 WMHC. 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 1FT 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. 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. • Ashas 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 be 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 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 WMHC'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. 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. 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 g SOCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING 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 Sc.liw1 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 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 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 SCCIETAL FUNCTIONING INTERPERSONAL FUNCTIONING DAILY LIVING PERSONAL CARE PHYSICAL FUNCTIONING COGNITIVE INTELLECTUAL OVERALL LEVEL OF FUNCTIONING 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 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) GAF SCORE AT DISCHARGE OVERALL PROBLEM SEVERITY SCORE PRESENT Yes No 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 ASSESSMENT/DISCHARGE Sheet I AGENCY GAF SCORE CURRENT P-SEV Cheek ALL that Apply F-1 I I I I I ADMISSION DATE: mm/dd/vv I I I CLIENT ID I MEDICAID ID 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 rove -'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 Past Suicide Attempt Self Injury ...............� Danger to Self jtfltl)> Vacant Subdued Detached Lonely - Dejected - Sleep Problem Nervous Phobic Guilt Overactive Elevated Mood Suicide Attempt Self Mutilation THOUGHT PROCESSES _Bizarre _Suspicions Disorganized Illogical NITIVE PROBLEMS Delusions Paranoid Derailed Magical Thought Memory Concrete Attention Attention Span Confused Impaired Judgment Lacks Self -Awareness SELF -CARE / BASIC NEEDS (Doesn't) Hallucinations Repeated Thought Loose Associations Unwanted Thought Intellect Disoriented _Care for Self _Manage Money _Provide Food Provide Housing Manage Personal Environment _ Make Use of Available Resources Hygiene _ Gravely Disabled (CRS22d0): r] RESISTIVENESS Uncooperative Guarded Antagonistic Evasive Wary Denies Problems Resistive Oppositional Refuses Treatment AGGRESSIVENESS Aggressive Belligerent Defiant Hostile Threatening Intimidating SOCIO-LEGAL PROBLEMS Disregards Rules Dishonest Legal Problems Offenses / Prop. Fire Setter Probation 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 (CRS 27.10); Physical Abuser Homicidal Threats ROLE PERFORMANCE (Work / School) _Absenteeism Performance _Behavior Terminations _ Doesn't eaLearning Disabilities Not Employable _ _Rd/Write _Doesn't Earn _Unstable Work/School Hist FAMILY PROBLEMS (Client Problems in Family) No Family w/Relative w/Parenting w/Child Acting Out No Contact w/Family —w/Partner w/Parent 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 Addicted DUI/DUID Drug(s) Dependent _Interferes with Responsibilities Family History of Substance Abuse MEDICAL/PHYSICAL Acute Illness Chronic Illness IllCNS Disorder __ Nutrition Eating Disorder Physical Handicap _ _Ei__ nuretc Encopretic _Medical Care Needed Developmental Disability Perm. Disability Attention Deficit Disorder _ Injury by Abuse/Assault SECURITY / MANAGEMENT ISSUES Restraint Surveillance _ _ Seclusion Locked Unit _ _ Security _Time Out _ _Walkaway/Escape _Medication Compliance Close Supervision Behavior Management Suicide Watch OVERALL DEGREE OF PROBLEM SEVERITY CHANGE M OVERALL PROBLEM SEVERITY I=Much Worse 7=Worse 3=Somewhat Worse 4 -No Change 5=Somewhat Better 6 -Bette, 7.-- Much Better 7/95 WMHC FORM 260 CLIENT I.D. # DATE OF ADMISSION ASSESSMENT/DISCHARGE Sheet 2 STRENGTHS / RESOURCES ACTION TYPE (Manual Input Only) Check ALL CURRENT STRENGTI IS / RESOURCES individual has. ECONOMIC RESOURCES Employment _Housing Transportation SSUSSDI Medicaid/Medicare EDUCATION / SKILL RESOURCES Education Intelligence Job Skills Interpersonal Skills PERSON RESOURCES Spouse _Parent (s) Other Family Friend (s) PERSONAL STRENGTHS Insight Judgment Emotional Stability Adaptability Appearance Empathy Tolerance Thought Clarity Financial Medical Insurance Language Skills Child (Fen) Others Responsibility Resourcefulness Health LEVEL -OF -FUNCTIONING (LOF) Check ONE Response for Each LOF Area SOCIETAL / ROLE FUNCTIONING Very Low Mode Low Function. Function -<99,s-Very Low Function Average Moder High Very High Function Function Function 2 INTERPERSONAL FUNCTIONING Moder Low Average Moder High Function Function Function 8 1 2 3 4 5 6 7 8 DAILY LIVING / PERSONAL CARE FUNCTIONING Very Low Mods Low Function Function Average Function 9 Very High Function 9 Moder High Very High Function Function 1 2 3 4 5 6 7 8 PHYSICAL FUNCTIONING Very Low Mode Low Function Function Average Function 9 Moder High Very High Function Function 2 3 4 5 6 7 8 COGNITIVE / INTELLECTUAL FUNCTIONING Very Low Moder Low Function Function Average Function 2 3 4 5 6 9 Moder High Very High Function Function 7 8 9 OVERALL LEVEL OF FUNCTIONING Very Low Moder Low Function Function Average Function 1 2 3 4 5 6 Moder High Vcry High Function Function 7 8 9 CHANGE IN LEVEL OF FUNCTIONING 1=Much Worse 2 -Worse 3=Somewhat Worse 4 -No Change 5 -Somewhat Better 6=Better 7=Much Better PROGRAM 01 =Admission I I - Correction to Admission 02 =Activate 12 -Correction to Activation 03=Update I3 -Correction to Update 04= Inactivate 14 Correction to Inactivation OS =Discharge 15 -Correction to Discharge EFFECTIVE DATE: mm/dd/yy DATE FORM COMPLETED:nun/defy LAST CONTACT DATE: nun/ddlyy CURRENT DIAGNOSIS CURRENT/ EXPECTED RESIDENCE. 1=Corrections/Jail 2 -Inpatient 3 -Nursing Home 4=Residential - Mental Health 5=Residential Non- Mental 6=Hoarding 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 Relative(s) CURRENT / EXPECTED EMPLOYMENT: 1=Employed-Full Time 2 -Employed -Part Timc 3=Homemaker not Otherwise Employed 4 --Sheltered Employment 4 -Lives Alone 5 -Lives w/Unrelatcd Person(s) 5 -Not in Labor Force 6 -Unemployed less than 3 Months 7=Unemployed 3 Months or More B=Armed Forces Active Military Duty INACTIVE / DISCHARGE TYPE OF TERMINATION: STAFF/AGENCY INITIATED CLIENT INITIATED I-Discharged/fransferred 2 -TX Completed/No Referral 3=TX Completed/Follow-up 4 -Evaluation Only 5=Inactive for 1 Year TERMINATION REFERRAL: NOTE: Use 61 "Self' if no Referral This field will contain one of the following codes if .meson type = 05 or 15: Personal referrals - 61 - Self; 62 - Family/relative; 63 - Fricrid/EMployer/Clergy; Medical/Psychiatric referrals - 68 - Ontpatimt psychiatric, 69 - Private psychiatrist; 70 - Other private MH pnctiuoner; 71-CMF6/P; 72 - CMH,VFt; 73 -Colorado Mental Health Centers/Climes, 74 -Nursing home; 75 - Community raidcntial organization, 76 - A1mhoufmg ueatment facility, 77 - Media practitioner; 78 -General hospital inpatient psychiatric program. 79 -Other inpatient psychiatric program; Social service/Education referrals - 6-Patient/Client Died 7-Patient/Client Terminated 21 - Social service agency; 82 - Agency for the Developmental disabled; 23 - Voational rehabilitation facility. 84 - Educational system/school; 85 - Shelter for homeless/abused; Legal referrals - 91 - Law enforcement; 92 - Cant (including juvenile); 93 - Cormaionat facility; 94 - Probation/omit; All other referral sources - 92 - Other. IC4 - Referral soma not known. STAFF II) / STAFF SIGNATURE IDISCIPLINE: I=none 2=snit worker 3=nursing 4=social work 5='psychology DEGREE: I =none 2=associate 3=bachelors 4=nasters 5=PhD/Psyl)/F I) 6 -psychiatry 7 -other 6=MD 7=other 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. 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, system -wide access and service issues, mental health treatment and outcomes, and cost effectiveness. Treatment outcome measures at the M-IASA 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 outcome 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-IASA 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 MHASA 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 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 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. 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 (GAMS). 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. �qyv 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 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. voOr 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 implpmPnted, 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. 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. I). 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 MHASAs in cooperative efforts that will ultimately enhance statewide service provision. E. EVALUATION OF MANAGEMENT AND OPERATION OF CAPITATION PROG/UNIM. 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 included. in 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 aidcategory, 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 MRASAs 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 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? 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 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 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. 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. CONSI:M R 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? 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-MRASA 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 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. Hello