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Home My WebLink About20221472.tiffCo►"kt'GC-l- IbiRZl3 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SAVIO HOUSE This Agreement Amendment made and entered into ZZn day of 2024 by and between the Board of Weld County Commissioners, on behalf of the Wel County Department of Human Services, hereinafter referred to as the "Department", and Savio House, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Home -Based Intervention, Life Skills, Mental Health Services, Multisystemic Therapy, Sexual Abuse Treatment, Functional Family Therapy and Substance Abuse Treatment, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-1472, approved on May 25, 2022. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and any previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement was set to end on May 31, 2023. • The Original Agreement was amended on: • May 8, 2023 to extend the term date through May 31, 2024, to amend Exhibit A, Scope of Services, and Exhibit B, Rate Schedule. • The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2022-1472. • These Amendments, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement as of June 1, 2024: 1. Term This agreement is being renewed for the third and final year, for the period June 1, 2024 through May 31, 2025. • All other terms and conditions of the Original Agreement remain unchanged. 0,4- 0-k) ZOO Cohw)+Rr6-c. .5frtaia s� 0Ve--009A 5/22/Zy IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: � ATTEST: �/ J rt, BOARD OF COUNTY COMMISSIONERS lerk to the Boar. WELD COUNTY, COLORADO BY: Deputy'I'-rk t• the Q Kevin D. Ross, Chair ONTRACTOR: avio House 325 King Street Denver, Colorado 80219 (303) 225-4040 MAY 22224 By: Norma Aguilar -Dave, Executive Director """'2°24 Date: SIGNATURE REQUESTED: Weld/Savio House Amendment #2 Final Audit Report 2024-05-10 Created: 2024-05-01 By: Windy Luna (wluna@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAA4VH0h7P6tDpy8oHkDrb4A43k8dCjC6D9 "SIGNATURE REQUESTED: Weld/Savio House Amendment #2 " History ,n Document created by Windy Luna (wluna@weld.gov) 2024-05-01 - 5:42:35 PM GMT- IP address: 204.133.39.9 Cl Document emailed to Norma Aguilar -Dave (naguilar-dave@saviohouse.org) for signature 2024-05-01 - 5:43:10 PM GMT t Email viewed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) 2024-05-02 - 5:17:27 AM GMT- IP address: 104.28.48.215 t Email viewed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) 2024-05-07 - 9:12:26 PM GMT- IP address: 172.226.137.13 ,n Email viewed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) 2024-05-08 - 3:53:28 AM GMT- IP address: 104.28.48.213 t Email viewed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) 2024-05-10 - 8:14:18 PM GMT- IP address: 104.28.55.234 6© Document e -signed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) Signature Date: 2024-05-10 - 8:28:12 PM GMT - Time Source: server- IP address: 174.216.213.6 O Agreement completed. 2024-05-10 - 8:28:12 PM GMT Powered by Adobe Acrobat Sign Contract Form Entity Information Entity Name* SAVIO HOUSE Entity ID* @00035730 Contract Name* SAVIO HOUSE (PROFESSIONAL SERVICES AGREEMENT AMENDMENT #2) Contract Status CTB REVIEW Q New Entity? Contract ID 8213 Contract Lead WLUNA Contract Lead Email wluna@weldgov.com;cob bxxlk@weldgov.com Parent Contract ID 20221472 Requires Board Approval YES Department Project # Contract Description* (CONSENT) SAVIO HOUSE - PROFESSIONAL SERVICES AGREEMENT AMENDMENT #2. RELATED TO BID #B2200040. TERM: 06/01 /2024 THROUGH 05/31 /2025. Contract Description 2 PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON 06/13/2022. Contract Type AMENDMENT Amount* $ 0.00 Renewable" NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices@weldgov. com Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WEL DGOV.COM Requested BOCC Agenda Date 05/22/2024 Due Date 05/18/2024 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Termination Notice Period Contact Information Review Date * 03/31/2025 Committed Delivery Date Renewal Date Expiration Date* 05/31/2025 Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 05/15/2024 Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 05/15/2024 05/15/2024 05/15/2024 Final Approval BOCC Approved Tyler Ref # AG 052224 BOCC Signed Date Originator WLUNA BOCC Agenda Date 05/22/2024 Conkvad- 1,1)4 Vci 7-4 C6nw-}-f-Yeck, PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: May 2, 2023 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment #1 with Savio House Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Department's Agreement Amendment #1 with Savio House. The Department has an Agreement with Savio House. for Home -Based Intervention, Life Skills, Mental Health, Multisystemic Therapy, Sexual Abuse Treatment, Functional Family Therapy, and Substance Abuse Treatment Services. This Agreement is known to the Board as Tyler ID# 2022-1472. The agreement is now being amended to renew for a second year, for the period June 1, 2023 through May 31, 2024, and to make changes to the Scope of Services and Rate Schedule as noted below. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Scope of Services Changes: • Updates to the terms as requested by the Department. Rate Schedule Changes: • Updates to the terms as requested by the Department. • Updates to the rates as requested by the Contractor. Rate changes are noted below. Home Based Intervention $1,170.00 Month Therapeutic Community Based Services for Adolescents or Family Wellness: Low (1-2 contact hours per week) $1,850.00 Month Therapeutic Community Based Services for Adolescents or Family Wellness: Moderate (3-4 contact hours per week) $2,476.00 Month Therapeutic Community Based Services for Adolescents or Family Wellness: Intensive (5-6 contact hours per week) $1,170.00 Month Therapeutic Kinship Services for Adolescents or Family Wellness: Low (1-2 contact hoursper week) $1,850.00 Month Therapeutic Kinship Services for Adolescents or Family Wellness: Moderate (3-4 contact hours per week) $2,476.00 Month Therapeutic Kinship Services for Adolescents or Family Wellness: Intensive (5-6 contact hours per week) Life Skills $1,015.00 Month Family Coaching: Low (1-2 contact hours _per week) Pass -Around Memorandum; May 2, 2023 — CMS ID 6924 C&) rA2.3 Page 1 PRIVILEGED AND CONFIDENTIAL Life kills $1,650.00 Month Family Coaching: Moderate (3-4 contact hours per week) $2,250.00 Month Family Coaching: Intensive (5-6 contact hours per week) $1,015.00 Month Adolescent Skills Coaching: Low (1-2 contact hours per week) $1,650.00 Month Adolescent Skills Coaching: Moderate (3-4 contact hours per week) $2,250.00 Month Adolescent Skills Coaching: Intensive (5-6 contact hours per week) $1,015.00 Month SafeCare (1 session per week) $100.00 Hour Supervised Visitation: Bachelor (RA) level $100.00 Each Supervised Visitation: BA level No Show (Max of 2 no shows or 2 hours/month/client) $110.00 Hour Supervised Visitation: BA level Spanish Speaking $110.00 Each Supervised Visitation: BA level Spanish Speaking No Show (Max of 2 no shows or 2 hours/month/client) $140.00 Hour Supervised Visitation: Masters level $140.00 Each Supervised Visitation: Masters level No Show (Max of 2 no shows or 2 hours/month/client) Supervised Visitation: Masters level Spanish Speaking $ 154.00 Hour $154.00 Each Supervised Visitation: Masters level Spanish Speaking No Show (Max of 2 no shows or 2 hours/month/client) Mental Health Services $1,128.00 Month Trauma Focused Cognitive Behavioral Therapy (IT Cn►) $1,819.00 Month Trauma Systems Therapy (TOT) - Flat Rate $1,128.00 Month Eye Movement Desensitization and Reprocessing Therapy (EMDR) Multisystemic Therapy $2,254.00 Month Multisystemic Therapy (MST) Sexual Abuse Treatment $2,796.00 Month Multisystemic Therapy -Problem Sexual Behavior (MST PSB) $1,170.00 Month Sexual Abuse Intervention (SAO: Low Level (1-2 contact hours per week) $1,712.00 Month Sexual Abuse Intervention (SAO: Moderate Level (3-4 contact hours per week) $2,177.00 Month Sexual Abuse Intervention (SAI): Intensive Level (5-6 contact hours per week) $1,170.00 Month Sexual Abuse Intervention Family Wellness: Low Level (1-2 contact hours per week) $1,712.00 Month Sexual Abuse Intervention Family Wellness: Moderate Level (3-4 contact hours per week) $2,177.00 Month Sexual Abuse Intervention Family Wellness: Intensive Level (5-6 contact hours per week) $300.00 Each Informed Supervision Substance Abuse Treatment $2,554.00 Month Multisystemic Therapy- Contingency Management (MST CM) Pass -Around Memorandum; May 2, 2023 — CMS ID 6924 Page 2 PRIVILEGED AND CONFIDENTIAL Piti,,itti \rri Rd, l lilt ticn irc N.,.i)i Substance Abuse Treatment $1,350.00 Month Functional Family Therapy- Contingency Ma. amen, (FFT CM) Functional Family TherapY $1,250.00 Month Functional Family Therapy _ $1,400.00 Month Functional Family Therapy Gang (FFT GL. All Prog ram Areas $100.00 Month Spanish Interpreter for Monthly Rates $500.00 Month Outside Catchment Service Areas (For distances greater than thirty (30) miles. Starting point is the home office of the assigned staff) I do not recommend a Work Session. I recommend approval of this Agreement Amendment # 1 and authorize the Chair to sign. Perry L. Buck, Pro-Tem Mike Freeman, Chair Scott K. James Kevin Ross Lori Saine Anprove %,4 Schedule -Work Session Other/Comments; Pass -Around Memorandum; May 2, 2023 — CMS ID 6924 Page 3 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SAVIO HOUSE This Agreement Amendment, made and entered into O ' day of M 1 , 2023, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department", and Savio House, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Home -Based Intervention, Life Skills, Mental Health Services, Multisystemic Therapy, Sexual Abuse Treatment, Functional Family Therapy, and Substance Abuse Treatment Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-1472, approved on May 25, 2022. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement and my previously adopted amendment, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on May 31, 2023. • This Amendment, together with the Original Agreement, constitutes the entire understanding between the parties. The following additional changes are hereby made to the current Agreement as of June 1, 2023: 1. Term This Agreement is being renewed for the second year, for the period of June 1, 2023 through May 31, 2024. 2. Exhibit A, Scope of Services, is hereby amended as attached. 3. Exhibit B, Rate Schedule, is hereby amended as attached. All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ike Freeman, Chair MAY 0 8 2323 vio House 25 King Street Denver, Colorado 80219 (303) 225-4040 4./eu AGzc a� —mac By: Norma Aguilar -Dave, Executive Director Apr 6, ZI123 Date: 0.20°202- /411,2- EXHIBIT A SCOPE OF SERVICES Contractor will provide Home -Based Intervention, Life Skills, Mental Health Services, Multisystemic Therapy, Sexual Abuse Treatment, Functional Family Therapy, and Substance Abuse Treatment Services, as referred by the Department. Home -Based In-.ervention 1. Therapeutic Community Based Services for Adolescents i Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Designed to focus on prevention and treatment of delinquent behavior with a Master's level clinician. This is accomplished through school interventions, family interventions, mentoring and youth advocacy. ii. Designed to provide flexibility to address needs of the child and/or family (e.g., individual therapy and mentoring). The principles of Multisystemic Therapy (MST) regarding sustainability and to do "whatever it takes" are adopted in CBS -Adolescent through the clinicians' efforts to be a role model who solves problems, motivates clients, and locates sustainable resources that address identified needs b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. a. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Improve overall family functioning. ii. Prevent out -of -home placement. iii. Stabilize placement. e. Outcomes of Services: i. Stabilized home environment. ii. Improved parenting. iii. Connection to community resources. iv. Decrease of negative or delinquent behaviors. E Target Population: i. Families with youth ages twelve (12) to eighteen (18) who are risk for out -of -home placement or ready to transition home. Language: i. English. ii. Spanish may be available. h. Medicaid Eligibility: i. This service is not typically Medicaid eligible. Contractor will assess each case for Medicaid eligibility. Service Access and Transportation: i. In client's home. 1 2. Therapeutic Community Based Services Family Wellness a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Intensive in -home service for families with children age birth to twelve (12) years to prevent placement, transition children from out -of -home care, or stabilize placements with a Master's Level clinician. ii. Contractor will build parental protective capacity to remove safety concerns and mitigate. Signs of Safety, Solution Focused Brief Therapy and trauma -informed practice are the clinical foundation for understanding the problems and developing interventions. iii. Extensive effort is made to involve extended family/kin and the community for long term support and sustainability. b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Increase protective capacity of parent/caregiver. ii. Improve family functioning. iii. Eliminate safety concerns within the family system. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Assist with establishing permanency for children. iii. Reduce or eliminate future incidents of child maltreatment. f. Target Population: i. High risk families struggling with severe neglect or abuse, unstable mental health (parent or child), and problematic child behaviors (parenting skills) are a good fit for this program. g. Language: i. English. ii. Spanish may be available. h. Medicaid Eligibility: i. This service is not typically Medicaid eligible. Contractor will assess each case for Medicaid eligibility. i. Service Access and Transportation: i. In client's home. 3. Therapeutic Kinship Services for Adolescents a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Therapeutic Community Based Services for Adolescents (CBS -Adolescent) is designed to focus on prevention and treatment of delinquent behavior with a Master's level clinician. This is accomplished through school interventions, family interventions, mentoring and youth advocacy. This service is designed to provide flexibility to address 2 needs of the child and/or family (e.g., individual therapy and mentoring). The principles of Multisystemic Therapy (MST) regarding sustainability and to do "whatever it takes" are adopted in CBS -Adolescent through the clinicians' efforts to be a role model who solves problems, motivates clients and locates sustainable resources that address identified needs Iv. Anticipated Frequency of Services: i. Low: one (l) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. al. Goals of Services: i. Improve overall family functioning. ii. Prevent out -of -home placement. iii. Stabilize placement. e. Outcomes of Services: i. Stabilized home environment. ii. Improved parenting. iii. Connection to community resources. iv. Decrease of negative or delinquent behaviors. I Target Population: i. Families with youth ages twelve (12) to eighteen (18) who are risk for out -of -home placement or ready to transition home. g. Language: i. English. ii. Spanish may be available. h. Medicaid Eligibility: i. This service is not typically Medicaid eligible. Contractor will assess each case for Medicaid eligibility. Service Access and Transportation: i. In client's home. 4. Therapeutic Kinship Services Family Wellness a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Therapeutic Community Based Family Wellness is an intensive in -home service for families with children age birth to twelve (12) years to prevent placement, transition children from out -of -home care, or stabilize placements with a Master's Level clinician. ii. Contractor will build parental protective capacity to remove safety concerns and mitigate. Signs of Safety, Solution Focused Brief Therapy and trauma -informed practice are the clinical foundation for understanding the problems and developing interventions. iii. Extensive effort is made to involve extended family/kin and the community for long term support and sustainability. h. Anticipated Frequency of Services: 3 i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Increase protective capacity of parent/caregiver. ii. Improve family functioning. iii. Eliminate safety concerns within the family system. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Assist with establishing permanency for children. iii. Reduce or eliminate future incidents of child maltreatment. f. Target Population: i. High risk families struggling with severe neglect or abuse, unstable mental health (parent or child), and problematic child behaviors (parenting skills) area good fit for this program. g. Language: i. English. ii. Spanish may be available. h. Medicaid Eligibility: i. This service is not typically Medicaid eligible. Contractor will assess each case for Medicaid eligibility. i. Service Access and Transportation: i. In client's home. Life Skills 1. Family Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement i. In-home/community-based program designed as an early -intervention service that helps stabilize families struggling with issues with school, mental health and other matters that place the family at risk of becoming further involved with the child welfare system. ii. The service is provided by Bachelor level staff. b. Anticipated Frequency of Services: iv. Low: one (1) to two (2) hours per week. v. Moderate: three (3) to four (4) hours per week. vi. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: ii. One (1) to four (4) months. d. Goals of Services: i. Connect family to needed community resources. ii. Stabilize family system. 4 iii. Provide coaching and support for parenting. iv. Build caregiver protective factors. Outcomes of Services: i. Reduce or eliminate the need for child welfare involvement. ii. Reduce or eliminate future incidents of child maltreatment. iii. Increase family functioning. f. Target Population: i. Families with children of all ages. ii. This service works well with prevention cases prior to court involvement. g. Language: i. English. ii. Spanish. 1<. Medicaid Eligibility: i. This service is not Medicaid eligible. i_ Service Access and Transportation: i. Client's home. 2. Adolescent Skills Coaching Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Short term skills coaching for adolescents and their families to support them in making connections with natural supports in their environment to help meet the family's needs. This model builds on the family's strengths, encourages the development of supportive and sustainable relationships that promote long term resilience. ii. This program can also be an intervention that evaluates the youth's environment and aligns with the parents to establish household structure and supervision. iii. This service is offered by a Bachelor Level Staff. iv. Specialized services such as mental health treatment is provided either by the Contractor's Community Based Services (CBS) Worker or through linkages with community resources. CBS services begin with the Contractor's staff being the support system for the youth and their family. b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. e. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Assist family to identify and successfully access community resources. ii. Assist youth in building independent living skills. iii. Align with family and youth as an advocate. iv. Support caregiver in establishing household structure. v. Support caregiver in developing rules and consequences. vi. Assist family in establishing support network for long term assistance. e. Outcomes of Services: 5 i. Increase the youth and their family's ability to access ecological networks of support beyond the Contractor. ii. Establishing a strong network of support enables the youth and their family to maintain the skills teamed and increases the likelihood of success after discharge. f. Target Population: i. Youth with treatment needs in the following program areas: drug and alcohol services; tracking; mentoring; family intervention; educational support; employment/vocational support; restorative justice; independent living skills; crisis intervention; and aftercare. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. 3. SafeCare for Court Involved Families a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. SafeCare is an evidence -based parenting skills intervention that reduces future incidents of child maltreatment. ii. The four modules are outlined below. iii. Each module involves baseline assessment, intervention (training) and follow-up assessments to monitor change. iv. Staff members conduct observations of parental knowledge and skills for each module by using a set of observation checklists. v. The SafeCare training format is based on well -established social learning theory and evidence from previous research. Service providers and parents are trained using a general seven step format: b. Anticipated Frequency of Services: i. One (1) to two (2) hours. c. Anticipated Duration of Services: i. Sixteen (16) to eighteen (18) weeks. d. Goals of Services: i. Increase parental protective capacity in the following areas: a. Health. b. Home Safety. c. Parent-Child/Parent-Infant Interactions. d. Problem Solving and Communication. e. Outcomes of Services: i. Increase parental protective capacity in the following areas: a. Health. b. Home Safety. c. Parent-Child/Parent-Infant Interactions. d. Problem Solving and Communication. f. Target Population: 6 i. Families with children ages zero (0) to five (5) with an open dependency and neglect case. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. 4. Supervised Visitation (Bachelor Level Staff) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Providing supervised visitation services with Bachelor level staff that includes family coaching and intervention during the session. b. Anticipated Frequency of Services: i. Based on the client and family's need. c. Anticipated Duration of Services: i. Based on the client and family's need. d. Goals of Services: i. Improve parent -child relationship. ii. Increase parenting skills. iii. Provide important parent -child contact. e. Outcomes of Services: i. Based on identified case goals. f. Target Population: i. Families with court ordered parenting time in need of basic coaching during visitation time. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i Service Access and Transportation: i. To be determined by case need. 5. Therapeutic Supervised Visitation (Master's Level Clinician) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Providing supervised visitation services with master's level clinician that includes family therapeutic/trauma informed intervention during the session. b. Anticipated Frequency of Services: 7 i. Frequency is dependent on the client/family's need. c. Anticipated Duration of Services: i. Duration is dependent on the client/family's need. d. Goals of Services: i. Improve parent -child relationship. ii. Increase parenting skills. iii. Provide important parent -child contact. e. Outcomes of Services: i. Based on identified case goals. f. Target Population: i. Families with court ordered parenting time in need of therapeutic interventions during parenting time. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. To be determined by case need. Mental Health Services 1. Trauma Focused Cognitive Behavioral Therapy (TF CBT) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidenced -Based Treatment for children ages three (3) to eighteen (18) years experiencing trauma -related difficulties as the result of one or multiple traumatic events and their non -offending parent/caretaker. A brief age -specific trauma assessment is completed at the point of intake to determine if the referred child has clinically significant Post Traumatic Stress Disorder (PTSD) or depression symptoms that indicate trauma treatment is needed. The age -appropriate trauma assessment is completed during the intake meeting and includes input from the child and their caretakers. These assessments are brief and used as a tool to determine the need for TF CBT. If it is determined that the child does not have clinically significant symptoms, Savio will make a recommendation for other services. ii. Contractor can conduct a brief trauma assessment as a standalone service if there is question with regard to the need TF CBT. b. Anticipated Frequency of Services: i. One (l) session per week. c. Anticipated Duration of Services: i. Twelve (12) to twenty (20) sessions. d. Goals of Services: i. Reduce or eliminate PTSD symptoms. ii. Increase parental ability to be tuned into the needs of the child/youth. iii. Increase child/youth regulation skills. 8 e. Outcomes of Services: i. Stabilize placement. ii. Eliminate the need for out -of -home placement. iii. Improved child wellbeing. iv. Improve family functioning. f. Target Population: i. Children and youth ages three (3) to eighteen (18) experiencing trauma related difficulties as a result of one (1) or multiple traumatic events and their non -offending caregiver(s). g. Language: i. English. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. Service Access and Transportation: i. In the client's home. 2. Trauma- Systems Therapy (TST) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidence -based treatment for children/adolescents who have experienced traumatic events and/or who live in environments where ongoing stress/traumatic reminders are present. ii. Methodology: a. A phase -based, comprehensive model designed to meet complicated needs of a trauma system defined as the combination of a traumatized child or adolescent, who when exposed to trauma reminders, has difficulty regulating emotions/behavior and a caregiver or system of care that is not able to protect the youth or help manager their dysregulation. Not all families begin at the Safety Focus phase; some begin at a later phase and do not require phase one (1). b. Anticipated Frequency of Services: i. Phase 1: Four (4) hours per week. ii. Phase 2: Three (3) hours per week. iii. Phase 3: One (1) to two (2) hours per week. c. Anticipated Duration of Services: i. Nine (9) to twelve (12) months. d. Goals of Services: i. Reduce or eliminate PTSD within the family system. ii. Improve family functioning. iii. Teach identified family members regulation skills. e. Outcomes of Services: i. Eliminate the need for out -of -home placement (stabilize permanent placement). ii. Improve caregivers' ability to be attuned to the needs of the child/youth. iii. Reduce or eliminate future incidents of child maltreatment. iv. Improve child well-being. f. Target Population: 9 i. Children, youth ages five (5) to twenty (20) and their caregivers who have a history of traumatic events. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. 3. Eye Movement Desensitization and Reprocessing (EMDR) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Therapy focuses directly on traumatic memories and is intended to change the way those memories are stored in the brain, thus reducing and eliminating the problematic symptoms. ii. During EMDR therapy, clinical observations suggest that an accelerated learning process is stimulated by EMDR's standardized procedures, which incorporate the use of eye movements and other forms of rhythmic left -right (bilateral) stimulation (e.g., tones or taps). iii. While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced. iv. Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client's own accelerated intellectual and emotional processes. b. Anticipated Frequency of Services: i. One (1) to two (2) times per week. c. Anticipated Duration of Services: i. Six (6) to twelve (12) sessions. d. Goals of Services: i. Reduce or eliminate PTSD symptoms. ii. Improve family functioning. iii. Improve youths' regulation skills. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Improve youth's wellbeing. iii. Reduce or eliminate the need for child welfare involvement. f. Target Population: i. Ages four (4) to eighteen (18). g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. Service Access and Transportation: 10 i. Client's home. Multisystemic Therapy 1. Multisystemic Therapy (MST) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidence -based intervention for youth who are chronic, violent or substance abusing juvenile offenders and their families. MST works with juveniles with a mental health diagnosis or who are emotionally disturbed. Youth served are at high risk of out -of -home placement or are transitioning home from residential treatment or correctional care. ii. Contractor has a twenty (20) plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. b. Anticipated Frequency of Services: i. Hours of services are based on what is clinically indicated for the family. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Increase youth's connection with positive peers. ii. Improve youth's performance in school. iii. Improve overall family functioning. iv. Develop clear rules and consequences within the family system. v. Improve caregivers' ability to parent youth. e. Outcomes of Services: i. Eliminate the need for out -of -home placement. ii. Reduce or eliminate delinquent activity by youth. iii. Successfully reunify youth placed in out -of -home placement. f. Target Population: i. Chronic, violent or substance abusing male and female juvenile offenders, ages eleven (11) to eighteen (18) and their families. ii. Youth ages eleven (11) to eighteen (18), and their families, demonstrating maladaptive behaviors including drug use, truancy, violence, parent -child conflict, youth who have had previous or current episodes of abuse or neglect and youth who are facing out of home placement or are reunifying home. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. 11 Sexual Abuse Treatment 1. Multisystemic Therapy Problem Sexual Behavior (MST PSB) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Intensive, comprehensive, community- and family -based treatment modality aimed at decreasing juvenile sex offending and effectively reintegrating youth into the home and community. MST-PSB incorporates evidence -based intervention techniques and utilizes an intensive quality assurance system to support treatment fidelity. The MST-PSB model does not support or utilize any group counseling. This modality views caregivers as the key to achieving favorable clinical outcomes for their youth. To ensure their participation, caregivers are highly involved in the development and implementation of interventions. The MST-PSB model is a total behavioral health care modality that addresses all the needs of each family member. ii. Contractor has a twenty (20) plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. b. Anticipated Frequency of Services: i. Hours of services are based on what is clinically indicated for the family. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Improve family functioning. ii. Improve relationships with peers, school, community. iii. Improve household structure. e. Outcomes of Services: i. Reduce problem sexual behavior. ii. Improve overall functioning of youth. iii. Reduce or eliminate the need for out -of -home placement. f. Target Population: i. Youth ages twelve (12) to eighteen (18) with problem sexual behaviors. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. 2. Sexual Abuse Intervention (SAI) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Works with youth demonstrating problem sexual behaviors and their families to stop sexually abusive behavior and prevent its recurrence through monitoring, education 12 and therapeutic intervention. The program utilizes a high level of supervision and involvement and emphasizes community safety and client accountability at all times. The program primarily serves adolescents who may or may not be adjudicated but are demonstrating problem sexual behaviors. ii. The SAI program can also work with youth who are demonstrating sexually reactive behavior related to trauma. iii. Clients receive services while living in the community at their homes or within out of home placement, depending on the needs of clients and their families. iv. The program utilizes this continuum of care to offer more or less restrictive services for clients, as changes in level of care are deemed appropriate to treatment needs. b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Six (6) to nine (9) months. d. Goals of Services: i. Address problem sexual behaviors within a family system. ii. Improve overall family functioning. iii. Increase safety for all children in the home. iv. Improve parental protective capacity. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Improve caregivers' ability to keep children safe. iii. Increase family's access to support system. f. Target Population: i. Youth ages eleven (11) to eighteen (18) with problem sexual behavior. ii. Families with histories of problematic sexual behaviors including Intrafamilial sexual abuse, adjudication as a result of sexual abuse, lack of impulse control, lack of supervision, poor social skills, minimizing/justifying abusive behavior (sexual or otherwise). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. 3. Sexual Abuse Intervention Family Wellness a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Works with children with problem sexual behaviors and their families to stop problem sexual behaviors and prevent its recurrence through monitoring, education and trauma - based cognitive behavioral interventions. By combining both Sexual Abuse Intervention and Family Wellness services we are able to address safety and protective issue while eliminating the sexually acting out behaviors. 13 b. Anticipated Frequency of Services: i. Low: one (l) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Six (6) to nine (9) months. d. Goals of Services: i. Address problem sexual behaviors within a family system. ii. Improve overall family functioning. iii. Increase safety for all children in the home. iv. Improve parental protective capacity. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Improve caregivers' ability to keep children safe. iii. Increase family's access to support system. f. Target Population: i. The program serves families with children four (4) to twelve years (12) of age. ii. The service helps families with young children who are sexually acting out inside or outside the family system. These families typically have a history of non -protective patterns that have led to the exposure of their children to abuse, neglect and in many cases, sexual victimization. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. 4. Informed Supervision a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Curriculum will be presented in a training format in which concepts are presented and participants have the opportunity to ask questions and receive guidance in supervising the youth under their care. ii. The curriculum follows Sex Offender Management Board (SOMB) guidelines and helps supervisors understand the expectations for supervision as identified in the Standards and Guideline. The training helps caregivers understand potential risks and how to prevent opportunities for risky behaviors through the use of alarms, cameras and planning. b. Anticipated Frequency of Services: i. One (1) hour. c. Anticipated Duration of Services: i. One (1) episode. d. Goals of Services: 14 i. Provide offense specific training to caregivers of children and youth with problem sexual behaviors. e. Outcomes of Services: i. Participants will be able to understand Informed supervision concepts. ii. Participants will be able to appropriately supervise youth with problem sexual behavior. f. Target Population: i. Families with children and youth who are expressing problematic sexualized behaviors. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home or office. Substance Abuse Treatment Services 1. Multisystemic Therapy Continency Management (MST CM) Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Is an adaptation of Multisystemic Therapy that was developed in order to offer a model specifically focused on addressing substance abuse problems. MST -CM builds upon the "standard" MST model, which is used to treat serious juvenile offenders, by including a contingency management protocol and focusing treatment more specifically on the youth's substance use in cases where such an approach is warranted. ii. Includes as standard certain treatment protocols to address youth substance use, such as functional analysis of the substance use, self -management plans to help the youth avoid substance use, teaching of drug refusal skills, providing incentives or rewards for not using drugs, and random drug screens. iii. Is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. iv. Contractor has twenty (20) plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model and is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. b. Anticipated Frequency of Services: i. Hours of services are based on what is clinically indicated each week for the family. c. Anticipated Duration of Services: i. Three (3) to five (5) months. d. Goals of Services: i. Decrease or eliminate youth's substance use. ii. Improve structure within the home. iii. Improve parental capacity to set limits. e. Outcomes of Services: 15 i. Eliminate the need for out -of -home placement. ii. Reduce or eliminate youth's involvement with juvenile justice. iii. Reduce youth's delinquency recidivism. f Target Population: i. Youth ages twelve (12) to seventeen (17) that present with chronic or severe delinquent behavior and are also abusing drugs and alcohol. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. Functional Family Therapy 1. Functional Family Therapy Contingency Management (FFT CM) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Is an enhancement of FFT aimed to specifically reduce substance use among adolescents and family members and to sustain sobriety. This model continues to focus on other risk factors or referring behaviors to the substance use. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) to twenty (20) sessions. d. Goals of Services: i. Decrease or eliminate youth's substance use. ii. Improve structure within the home. iii. Improve parental capacity to set limits. e. Outcomes of Services: i. Eliminate the need for out -of -home placement. ii. Reduce or eliminate youth's involvement with juvenile justice. iii. Reduce youth's delinquency recidivism. f Target Population: i. Adolescents between the ages of twelve (12) and eighteen (18), with negative behaviors that appear to be rooted in the relational dynamics of the family system. a. Substance abuse within family (caregiver or youth) in addition to the referral behaviors for FFT. b. Runaway behaviors. c. Defiance and verbal aggression. d. Physical aggression with people and property. e. Delinquency and truancy charges. f Substance use. g. Poor school performance. h. Self -harming behaviors. 16 i. Most mental health/behavioral disorder. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i Service Access and Transportation: i. Client's home. 2. Functional Family Therapy Contingency Management Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidenced -based family therapy model designed to reduce or eliminate problem behaviors by modifying the family relationships that support those behaviors. The three (3) phases of the model include: a. Engagement and Motivation. b. Behavior Change. c. Generalization. b. Anticipated Frequency of Services: i. One (1) to one and a half (1.5) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Establish household structure. ii. Increase monitoring and supervision. iii. Set clear rules and consequences for the youth. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Improve family functioning. iii. Reduce parent -child conflict. f. Target Population: i. Youth ages twelve (12) to eighteen (18) and their families demonstrating maladaptive behaviors including truancy, violence, parent -child conflict. ii. Youth who have had previous or current episodes of abuse or neglect and youth facing out -of -home placement or are reunifying home. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. 17 3. Functional Family Therapy Gang (FFT G) Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: Is a family intervention designed to help youth that are gang -involved or at risk for becoming gang involved. FFT-G® utilizes the core Functional Family Therapy model and has been shown to work with gang -involved or at -risk youth. Like FFT, FFT-G® is effective because it specifically targets risk factors relevant to gang -involved youth (conflictual family relationships, antisocial behaviors, impulsivity, substance use, lack of supervision). Treatment is intensive, and all sessions are conducted in the family home or at a location convenient to the youth and family. Family is defined broadly to include individuals that are important to the youth, which may include other members of the youth's gang. FFT-G® works closely with community partners to support the intervention and help youth and families meet their individual and family goals. FFT- G® has demonstrated significant recidivism reductions for drug charges, adjudicated delinquency, property charges, along with reductions in arrests (felony and crimes against persons). b. Anticipated Frequency of Services: ii. One (l) to one and a half (1.5) hours per week. c. Anticipated Duration of Services: ii. Three (3) to six (6) months. d. Goals of Services: i. Establish household structure. ii. Increase monitoring and supervision. iii. Set clear rules and consequences for the youth. e. Outcomes of Services: i. Reduce or eliminate substance use for the adolescent. ii. Reduce or eliminate the need for out -of -home placement. iii. Improve family functioning. iv. Reduce parent -child conflict. f Target Population: i. FFT-G Youth and adolescents ages eleven (11) to eighteen (18) who are currently gang involved, at risk of becoming involved, youth associated/affiliated with a gang, families with intergenerational gang involvement. must have at least one family member willing to participate. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. 18 Terms 1. Contracbr understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. 2. Contracbr agrees to receive referrals for services through e-mail and will provide an identified e-mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contactor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referal form will not be eligible for reimbursement. 3. Contractor will respond to the Mental Health and Support Services Team CWSer-iceReferral(a/weldeov.com within three (3) business days regarding the ability to accept the received referral. 4. Upon aweptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral 'excluding weekends and holidays). Contractor will document efforts to engage client in referred services If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, tine Contractor will notify the caseworker and the Mental Health and Support Services Team (HS - C W ServiceReferral(afweldgov.com). 5. Contracor acknowledges that any and all modifications to an existing referral must be approved through the Mental Health and Support Services Team (IS-CWServiceReferral(a,weldgov.com). No other Department staff or other party to the case may authorize services or modifications to services. 6. Contracor understands that "no shows" are defined as unexcused and unplanned/uncommunicated abseice: for services. Ha. rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contracor understands that the Department will not reimburse for "no-shows". Contractor understands that lie Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, on the partzf case participants who cancel without 24 -hour notice. After three (3) "no-shows", Contractor will place client on a behavioral plan requiring attendance or discharge the client from services. Contractor must inform the caseworker and the Mental Health and Support Services Team (HS- CWSerdiceReferral(afweldeov.com) within three (3) days of when the client is placed on a behavioral plan or discharged 7. Contracor understands that the Department will not reimburse Contractor for cancelled appointments either au the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contracor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the casewoicer and the Mental Health and Support Services Team(1S-CWServiceReferral(a,weldgov.com) imm diiitely via email, to discuss service continuation. 8. Contractor will identify, in detail, areas of continued concern and make recommendations to the casewoicer in a monthly report regarding continuation of services and/or the need for additional services. 9. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 19 10. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported to the caseworker and the Mental Health and Support Services Team (HS-CWServiceReferral(a,weldgov.com) immediately AND on the required monthly report. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Mental Health and Support Services Team. Any changes to visitation referrals will be approved by a new referral signed by the Child Welfare Supervisor. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Stuffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as there is written authorization from the Mental Health and Support Services Team, and the facilitator documents in the meeting notes the timeframe that the provider attended and when participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the meeting notes. Stuffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone or virtually, if approved by the Department. 13. On a monthly basis, the Contractor will notify the Mental Health and Support Services Team (HS- CWServiceReferral(&,weldgov.com) of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 14. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 9 of this Exhibit. 15. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary 20 licenses approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agcement. Copies of all necessary licenses shall be provided to the Department by the Contractor priorto :he start of any Agreement. 16. Trainin€ Coniracor may be required to attend training at the request of the Department specific to services provided under tlis Agreement. The Department will not compensate the Contractor for said training in the form of registraion fees, time spent traveling to and from training, attending the training or any other associated costs urless otherwise agreed to by the Department. 17. Subpoenas Contracor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For dris purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Wed County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be persenoly served. 18. Morritoing and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be: conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department, and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service deliver:, service quality, documentation, and invoicing during referral period and after services have conduced. The Contractor will require clients to sign releases of information. Contractor understands that the 1)eprtment will not reimburse for services rendered to Department clients until releases of information are cbt6ned. Con rador shall permit the Department, and any other duly authorized agent or governmental agency, to morito- all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere witlrth. work conducted under this Agreement. 21 EXHIBIT B RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate(s) specified below in Paragraph 2, Fees for Services. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. For services funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be provided by the Department, with a voided check, deposit slip or bank letter. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. For services not funded through Core Services; Contractor agrees to accept payment through County Warrant when funding source does not allow for direct deposit. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Program Area Home Based Intervention Kate $1,170.00 Unit I)pe Month Service Name Therapeutic Community Based Services for Adolescents or Family Wellness: Low (1-2 contact hours per week) $1,850.00 Month Therapeutic Community Based Services for Adolescents or Family Wellness: Moderate (3-4 contact hours per week) $2,476.00 Month Therapeutic Community Based Services for Adolescents or Family Wellness: Intensive (5-6 contact hours per week) $1,170.00 Month Therapeutic Kinship Services for Adolescents or Family Wellness: Low (1-2 contact hours per week) $1,850.00 Month Therapeutic Kinship Services for Adolescents or Family Wellness: Moderate (3-4 contact hours per week) $2,476.00 Month Therapeutic Kinship Services for Adolescents or Family Wellness: Intensive (5-6 contact hours per week) Life Skills $1,015.00 Month Family Coaching: Low (1-2 contact hours per week) $1,650.00 Month Family Coaching: Moderate (3-4 contact hours per week) $2,250.00 Month Family Coaching: Intensive (5-6 contact hours per week) $1,015.00 Month Adolescent Skills Coaching: Low (1-2 contact hours per week) Pr,g am .1rea Life Wills Rate $1,650.00 l'nit Type Month Service Name Adolescent Skills Coaching: Moderate (3-4 contact hours per week) $2,250.00 Month Adolescent Skills Coaching: Intensive (5-6 contact hours per week) $1,015.00 Month SafeCare (1 session per week) $100.00 Hour Supervised Visitation: Bachelor (BA) level $100.00 Each Supervised Visitation: BA level No Show (Max of 2 no shows or 2 hours/month/client) $110.00 Hour Supervised Visitation: BA level Spanish Speaking $110.00 Each Supervised Visitation: BA level Spanish Speaking No Show (Max of 2 no shows or 2 hours/month/client) $140.00 Hour Supervised Visitation: Masters level $140.00 Each Supervised Visitation: Masters level No Show (Max of 2 no shows or 2 hours/month/client) $154.00 Hour Supervised Visitation: Masters level Spanish Speaking $154.00 Each Supervised Visitation: Masters level Spanish Speaking No Show (Max of 2 no shows or 2 hours/month/client) Mrnhl Health Services $1,128.00 Month Trauma Focused Cognitive Behavioral Therapy (TF CBT) $1,819.00 Month Trauma Systems Therapy (TST) - Flat Rate $1,128.00 Month Eye Movement Desensitization and Reprocessing Therapy (EMDR) Multsystemc Therapy $2,254.00 Month Multisystemic Therapy (MST) Sexual Abuse Treatment $2,796.00 Month Multisystemic Therapy Problem Sexual Behavior (MST PSB) $1,170.00 Month Sexual Abuse Intervention (SAI): Low Level (1-2 contact hours per week) $1,712.00 Month Sexual Abuse Intervention (SAI): Moderate Level (3-4 contact hours per week) $2,177.00 Month Sexual Abuse Intervention (SAI): Intensive Level (5-6 contact hours per week) $1,170.00 Month Sexual Abuse Intervention Family Wellness: Low Level (1-2 contact hours per week) $1,712.00 Month Sexual Abuse Intervention Family Wellness: Moderate Level (3-4 contact hours per week) $2,177.00 Month Sexual Abuse Intervention Family Wellness: Intensive Level (5-6 contact hours per week) $300.00 Each Informed Supervision Subvance Abuse Treatment $2,554.00 Month Multisystemic Therapy Contingency Management (MST CM) $1,550.00 Month Functional Family, Therapy- Contingency Management (FFT CM) Program Area • Rate I. nit Type Ems Service Name $1,250.00 Functional Famil Thera. IIIIIIIIIIMIIIM $1 400.00 IMEGEMETEM All Pro:ram Areas $100.00 • S . anish Inter. reter for Monthl Rates $500.00 Month Outside Catchment Service Areas (For distances greater than thirty (30) miles. Starting point is the home office of the assi _ ed staff. 3. Request for Reimbursement and Supporting Documentation Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7th day of the month following the month of service, but no later than 45 days from the date of service for each client receiving ongoing services. Contractor shall prepare and submit monthly a Request for Reimbursement and monthly report including other supporting documentation, if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 of this Agreement. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Time(s) of service (i.e. 2-4pm) b. Location of where the service took place (i.e. clinician's office, client's home, in the community.) c. Clinician/therapist name d. What interventions were used, recommendations and/or goals discussed, progressions towards goals, and client engagement. e. For mileage reimbursement, if applicable, the mileage accumulated minus roundtrip mileage that is included in the rate, starting location, and ending location. f. Any and all safety concerns. When submitting a Request for Reimbursement for a one-time service, the contractor shall submit the first and last page of the evaluation/report to confirm proof of services rendered. The full evaluation/report should be submitted by the contractor to the caseworker. For Monitored Sobriety services, proof of services rendered shall be the test result. Requests for Reimbursement and/or supporting documentation received after the 7th day of the month may delay payment. Requests for Reimbursement and/or supporting documentation received after 45 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in termination of the Agreement. 4. Payment The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: The service being provided by the contractor is not a Medicaid eligible service; a. The service is not deemed medically necessary; b. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; c. A Medicaid provider is not available to provide the needed service; d. Medicaid is exhausted for the needed service; or e. Medicaid denied service. f The client is not eligible for Medicaid. The DeFartment may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumsance in writing to the Director of Human Services. The decision of the Director of Human Service: shall be final. 5. Renaedi:s The Director of Human Services or designee may exercise the following remedial actions should s/he find the Coriractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisf/i the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contrarror. These remedial actions are as follows: a. Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered front C.ntractor by deduction from subsequent payments under this Agreement or other agreements betweet the Department and Contractor, or by the Department as a debt due to the Department or otherwise as prov ded by law. 6. Financial Management At ail tines from the effective date of the Agreement until completion of the Agreement, Contractor shall comply -with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-133. SIGNATURE REQUESTED: Savio House Amendment #1 - 2023-24 Final Audit Report 2023-04-26 Created: 2023-04-21 By: Lesley Cobb (cobbxxlk@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAAmhNg2Uol_Yt5TtfSWnGhmY-n9B5fToD7 "SIGNATURE REQUESTED: Savio House Amendment #1 - 20 23-24" History e Document created by Lesley Cobb (cobbxxlk@co.weld.co.us) 2023-04-21 - 6:12:07 PM GMT- IP address: 204.133.39.9 El Document emailed to Norma Aguilar -Dave (naguilar-dave@saviohouse.org) for signature 2023-04-21 - 6:13:10 PM GMT n Email viewed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) 2023-04-21 - 6:25:33 PM GMT- IP address: 104.28.48.218 n Email viewed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) 2023-04-24 - 10:40:13 PM GMT- IP address: 104.28.48.215 ttlj Document e -signed by Norma Aguilar -Dave (naguilar-dave@saviohouse.org) Signature Date: 2023-04-26 - 10:49:20 PM GMT - Time Source: server- IP address: 143.244.115.154 0 Agreement completed. 2023-04-26 - 10:49:20 PM GMT Powered by Adobe Acrobat Sign New Contract Request Entity Information Entity Name* SAVIO HOUSE Entity ID OY10035730 Contract Name* SAVIO HOUSE (AGREEMENT AMENDMENT 01 PY 2023-24) Contract Status CTB REVIEW Contract ID 6924 Contract Lead* COBBXXLK ❑ New Entity? Parent Contract ID 20221472 Requires Board Approval YES Contract Lead Email Department Project cobbxxl kAAco.weld. co. u s Contract Description* BID# B2200040. MINOR SCOPE, RATE AND TERM CHANGES. TERM 6 1 :=23-5 31,'24. Contract Description 2 CONSENT: PA ROUTING THROUGH NORMAL APPROVAL PROCESS. ETA TO CTB 05.=04, 2023. Contract Type* AMENDMENT Amount* $0.00 Renewable* NO Automatic Renewal Department HUMAN SERVICES Department Email CM- HumanServices�weldgov.c Department Head Email CM-HumanServices- Oe ptHead<eldgov. co m County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTO RN EYAWELDG OV.COM Requested BOCC Agenda Date* 05,10,=2023 Due Date 05,06,2023 Will a work session with i1OCC be required?* NO Does Contract require Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a NSA enter MSA Contract ID Note- the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Effective Date Review Date* 03;`29x20.24 Renewal Date Termination Notice Period Committed Delivery Date Expiration Date* 05'31 2024 Contact Information Contact Info Contact Name Purchasing Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date CONSENT 04 28 2023 Approval Process Department Head JAMIE ULRICH DH Approved Date 04x'28,2023 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05 08,2023 Originator COBBXXLK Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 04.28'2023 04`28'2023 Tyler Ref AG 050823 Con*a Cf I t 5841 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SAVIO HOUSE This Agreement, made and entered into the 1, day of M CLAA , 2022, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departnaa it of Human Services, hereinafter referred to as the "Department" and Savio House, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, Scope of Services, Exhibit B, Rate Schedule, Exhibit C, Weld County's Request for Proposal, and Exhibit D, Contractor's Response to Request for Proposal. Exhibit A, B, and D are attached hereto and incorporated herein by this reference. Exhibit C is Weld County's Request for Proposal Number B220040 which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Home -Based Intervention, Kinship Services (Therapeutic), Life Skills, Mental Health Services, Multisystemic Therapy, Sexual Abuse Treatment, Substance Abuse Treatment Services,. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1, 2022, upon proper execution of this Agreement and shall expire May 31, 2023, unless sooner terminated as provided herein. This agreement may be renewed for 2 additional terms by written agreement of both parties. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit A Scope of Services, and Exhibit D, Contractor's Response to Request for Proposal. a. Referrals, Billing and Tracking b. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requirements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of payment. c. Contractor agrees to receive referrals for services through e-mail and will provide an identified e- mail address prior to the start of this Agreement. Contractor acknowledges that services are not authorized until the Contractor has received an authorized referral form from the Department. Contractor further acknowledges that services provided prior to the authorized start date or outside the scope of services on the referral form will not be eligible for reimbursement. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Quality Assurance Team(HS-CWOualitvAssurance(a,wetdgov.com). No other Department staff or other party to the case may authorize services or modifications to services. d. Contractor agrees to submit a complete Request for Reimbursement and supporting documentation by the 7th of the month, following the month of service, utilizing billing forms required by the Department. Requests for Reimbursement Forms received after 45 days from the date of service may Conte da- cc: oS/Z5/ZZ .5/02 6/02A 2022-1472 14 0094 result in delay or forfeiture of payment. Consistent failure to meet 45 -day deadline may result in termination of the Agreement. e. Contractor agrees to submit a monthly report by the 7th of the month, following the month of service, for each client receiving ongoing services. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. Monthly reports for ongoing services must include the following information, entered in the "Narrative" box for each date of service: a. Date and time(s) of service (i.e. two hours or 2-4pm) b. Location of where the service took place (i.e. clinician's office, client's home, in the community.) c. Clinician/therapist name d. Clients participating e. What interventions were used, recommendations and/or goals discussed f. Any and all safety concerns One-time services will be verified through receipt of the completed product (ex. psychological evaluation, substance abuse evaluation, home study). Verification of Monitored Sobriety Services will be the test result. A completed home study may be a full, partial or denied study, as determined by the Department. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under the Agreement. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately to the caseworker AND on the required monthly report. 3. Payment a. The Department and the Contractor agree that all benefits from private insurance and/or other funding sources such as Medicaid (if Contractor is a Medicaid eligible provider) or Victim's Compensation must be exhausted before Core Services or other Department funds can be accessed for services. Exceptions to this Paragraph may include, if approved by the Department, the following: i. The service being provided by the contractor is not a Medicaid eligible service; ii. The service is not deemed medically necessary; iii. The Court with jurisdiction over the case has ordered that a non -Medicaid provider or service be used; iv. A Medicaid provider is not available to provide the needed service; v. Medicaid is exhausted for the needed service; or vi. Medicaid denied service. vii. The client is not eligible for Medicaid. b. Payment shall be made in accordance with Exhibit A, Scope of Services , Exhibit B, Rate Schedule, Exhibit C, Weld County's Request for Proposal, and Exhibit D, Contractor's Response to Request for Proposal., attached hereto and incorporated herein by reference, so long as services are rendered satisfactorily and in accordance with the Agreement. c. Payment pursuant to this Agreement, whether in whole or in part, is subject to, and contingent upon, the continuing availability of said funds for the purposes hereof. d. The Department may withhold reimbursement if Contractor has failed to comply with any part of the Agreement, including the Financial Management requirements, program objectives, contractual terms, or reporting requirements. In the event of forfeiture of reimbursement, Contractor may appeal such circumstance in writing to the Director of Human Services. The decision of the Director of Human Services shall be final. 2 4. Financial Management At all times from the effective date of the Agreement until completion of the Agreement, Contractor shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-133. 5. Payment Method Unless otherwise provided in Exhibit A, Scope of Services, Exhibit B, Rate Schedule, and Exhibit D, Contractor's Proposal: a. If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. b. If Contractor is not currently set up with the State of Colorado to accept direct deposit, Contractor agrees to complete and submit a State of Colorado direct deposit enrollment form, which will be provided by the Department, with a voided check. Failure to complete and submit this form and voided check in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 6. Compliance with Applicable Laws a. At all times during the performance of this Agreement, Contractor will strictly adhere to all applicable Federal and State laws, order, and applicable standards, regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and - all provisions of the Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and - the Age Discrimination Act of 1975, 42 U.S.C. Section 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and - Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967; and - the Equal Pay Act of 1963; and - the Education Amendments of 1972; and - Immigration Reform and Control Act of 1986, P.L. 99-603, 42 C.F.R. Part 2; and 3 - all regulations applicable to these laws prohibiting discrimination because of race, color, national origin, sex, religion, and handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors and sub -contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services, Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is determined by the Department. d. Contractor assures and certifies that it and its principals: - Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and - are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in this certification; and - have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, or local) terminated for cause or default. e. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E - Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5- 102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and the Department within three (3) days that Contractor has actual knowledge that a subcontractor is 4 employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Contractor shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the State of Colorado program, Contractor shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Contractor has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Contractor shall deliver to the Department, a written notarized affirmation that it has examined the legal work status of such employee and shall comply with all of the other requirements of the State of Colorado program. If Contractor fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., the Department, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. f. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract, Contractor must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24- 76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5- 103 prior to the effective date of the contract. 7. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review (CFSR), and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d) of this Agreement. 8. Insurance Requirements Contractor and the Department agree that Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Contractor, it subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. Contractor shall indemnify, defend and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Contractor shall provide the liability insurances (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteers, and agents engaged in the performance of this Agreement which are required under Weld County's Request for Proposal, and required by the Colorado Worker's Compensation Act. Contractor shall provide the Department with the acceptable evidence that such coverage is in effect prior to execution of this Agreement. At a minimum, Contractor shall procure, either personally or through its employer as applicable to the Contractor's business, at its own expense, and maintain for the duration of the work, insurance coverage 5 listed in this agreement. The Board of County Commissioners of Weld County and its Officers/Employees shall be named as additional insured. a. General Requirements: Contractors must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Contractors shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; - $50,000 any one fire; and - $500,000 errors and omissions. iii.Automobile Liability: Contractor shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere. iv.Additional Provisions: Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: If any aggregate limit is reduced by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify the Department within ten (10) days and reinstate the aggregates required; - Unlimited defense costs in excess of policy limits; - Contractual liability covering the indemnification provisions of this Agreement; A severability of interests provision; Waiver of exclusion for lawsuits by one insured against another; 6 A provision that coverage is primary; and A provision that coverage is non-contributory with other coverage or self-insurance provided by the Department. v.For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims -made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to the Department, whichever is earlier. c. Contractors shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor shall provide a copy of this information to its insurance agent or broker and shall have its agent or broker provide proof of Contractor's required insurance. The Department reserves the right to require Contractor to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. e. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor's insurer shall name County as an additional insured. f. Waiver of Subrogation: For all coverages, Contractor's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverages required of Contractor. Contractor shall include all such subcontractors, independent contractors, sub -vendors, suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Contractor agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors, suppliers or other entities upon request by the Department. A provider of Professional Services shall provide the following coverage: Professional Liability: Contractor shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. 9. Certification Contractor certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Training Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 7 11. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by e-mail and will return a waiver of services within 72 business hours. For this purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contractor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 12. Monitoring and Evaluation Contractor and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. Contractor will collaborate in a timely manner with the Department to resolve issues pertaining to service delivery, service quality, documentation, and invoicing during referral period and after services have concluded. The Contractor will require clients sign releases of information. Contractor understands that the Department will not reimburse for services rendered to Department clients until releases of information are obtained. Contractor shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. The monitoring agency may, if in its sole discretion deems necessary or appropriate, have access to any program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures for purposes of monitoring. All such monitoring shall be performed in a manner that will not unduly interfere with the work conducted under this Agreement. 13. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 14. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 15. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives 8 of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Julia L. Roguski, Associate Executive Director 16. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Jamie Ulrich, Director P.O. Box A Greeley, CO 80632 (970)400-6510 17. Litigation For Contractor: Julia L. Roguski, Associate Executive Director 325 King Street Denver, Colorado 80219 (720) 530-6450 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 18. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department, or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 19. No Third -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 20. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 21. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The 9 parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 22. Improprieties/Conflict of Interest No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement, Contractor shall not enter into any third -party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, Contractor shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with the Contractor. A conflict of interest or appearance of a conflict of interest may also apply to personal relationships between providers and clients. If a provider has a personal relationship with a client to whom the Contractor may provide services for, the Contractor must disclose that relationship to the Department. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, loan, grant, or cooperative agreement. 23. Storage, Availability and Retention of Records Contractor agrees that authorized local, Federal, and State auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 24. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall 10 be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. Contractor shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. Contractor shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 25. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 26. Independence of Contractor: Not an Employee of Weld County Contractor agrees that it is an independent Contractor and that Contractor's officers, agents or employees will not become employees of County, nor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall perform its duties hereunder as an independent Contractor. Contractor shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to this Agreement. Contractor, its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through County and County shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees. Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party. Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to this Agreement. Contractor shall not have authorization, express or implied, to bind County to any agreement, liability or understanding, except as expressly set forth in this Agreement. Contractor shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and as set forth in Exhibit C, provide proof thereof when requested to do so by County. 27. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 28. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 29. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner 11 consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B, C, and D. 30. Acceptance of Services Not a Waiver Upon completion of the work, the Contractor shall submit to the Department originals of all tests and results, reports, and other similar items, generated during completion of this work. Acceptance by the Department of reports and incidental material(s) furnished under this Agreement shall not in any way relieve the Contractor of responsibility for the quality and accuracy of the services. In no event shall any action by the Department hereunder constitute or be construed to be a waiver by the Department of any breach of covenant or default which may then exist on the part of the Contractor, and the Department's action or inaction when any such breach or default shall exist shall not impair or prejudice any right or remedy available to the Department with respect to such breach or default; and no assent, expressed or implied, to any breach of any one or more covenants, provisions or conditions of the Agreement shall be deemed or taken to be a waiver of any other breach. Acceptance by the Department of, or payment for, any services performed under this Agreement shall not be construed as a waiver of any of the Department's rights under this Agreement or under the law generally. 31. Employee Financial Interest/Conflict of Interest. C.R.S. .$,S24-18-201 et seq. and &24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 32. Board of County Commissioners of Weld County Approval This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado. 33. Choice of Law/Jurisdiction Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. In the event of a legal dispute between the parties, Contractor agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 34. Subcontractors Contractor acknowledges that the Department has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the completion of this project without the Department's prior written consent, which may be withheld in the Department's sole discretion. 35. Attorney's Fees/Legal Costs 12 In the event of a dispute between the Department and Contractor, concerning this Agreement, the parties agree that each party shall be responsible for the payment of attorney fees and/or legal costs incurred by or on its own behalf. 36. Ownership All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable), the property of the Department. In addition, all reports, documents, data, plans, drawings, records and computer files generated by Contractor in relation to this Agreement and all reports, test results and all other tangible materials obtained and/or produced in connection with the performance of this Agreement, whether or not such materials are in completed form, shall at all times be considered the property of the Department. Contractor shall not make use of such material for purposes other than in connection with this Agreement without prior written approval of the Department. 37. Interruptions Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 38. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: . :; JC Ot By: 13 BOARD OF COUNTY COMMISSIONERS WELIj OUNTY, COLORADO Scott K. James, Chair CONTRACTOR;, Savio House 325 King Street Denver, Colorado 80219 (303) 225-4040 MAY 2 5 2022 if/euruz 4 a .-TJa.., a. By: Norma Aguliar-Dave, Executive Director Date: May 18, 2022 o2o 2 /J.7L7.2� EXHIBIT A SCOPE OF SERVICES Contractor will provide Home -Based Intervention, Kinship Services (Therapeutic), Life Skills, Mental Health Services, Multisystemic Therapy, Sexual Abuse Treatment, Substance Abuse Treatment Services, as referred by the Department. Home -Based Intervention 1. Therapeutic Community Based Services for Adolescents (CBS -Adolescent) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Designed to focus on prevention and treatment of delinquent behavior with a Master's level clinician. This is accomplished through school interventions, family interventions, mentoring and youth advocacy. ii. Designed to provide flexibility to address needs of the child and/or family (e.g., individual therapy and mentoring). The principles of Multisystemic Therapy (MST) regarding sustainability and to do "whatever it takes" are adopted in CBS -Adolescent through the clinicians' efforts to be a role model who solves problems, motivates clients and locates sustainable resources that address identified needs b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Improve overall family functioning. ii. Prevent out -of -home placement. iii. Stabilize placement. e. Outcomes of Services: i. Stabilized home environment. ii. Improved parenting. iii. Connection to community resources. iv. Decrease of negative or delinquent behaviors. f. Target Population: i. Families with youth ages twelve (12) to eighteen (18) who are risk for out -of -home placement or ready to transition home. g. Language: i. English. ii. Spanish may be available. h. Medicaid Eligibility: i. This service is not typically Medicaid eligible, Contractor will assess each case for Medicaid eligibility. i. Service Access and Transportation: i. In client's home. 1 2. Therapeutic Community Based Services Child Protection a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Intensive in -home service for families with children age birth to twelve (12) years to prevent placement, transition children from out -of -home care, or stabilize placements with a Master's Level clinician. ii. Contractor will build parental protective capacity to remove safety concerns and mitigate. Signs of Safety, Solution Focused Brief Therapy and trauma -informed practice are the clinical foundation for understanding the problems and developing interventions. iii. Extensive effort is made to involve extended family/kin and the community for long term support and sustainability. b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Increase protective capacity of parent/caregiver. ii. Improve family functioning. iii. Eliminate safety concerns within the family system. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Assist with establishing permanency for children. iii. Reduce or eliminate future incidents of child maltreatment. f. Target Population: i. High risk families struggling with severe neglect or abuse, unstable mental health (parent or child), and problematic child behaviors (parenting skills) are a good fit for this program. g. Language: i. English. ii. Spanish may be available. h. Medicaid Eligibility: i. This service is not typically Medicaid eligible, Contractor will assess each case for Medicaid eligibility. i. Service Access and Transportation: i. In client's home. Kinship Services (Therapeutic) 3. Therapeutic Kinship Services for Adolescents a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Therapeutic Community Based Services for Adolescents (CBS -Adolescent) is designed to focus on prevention and treatment of delinquent behavior with a Master's level clinician. This is accomplished through school interventions, family interventions, 2 mentoring and youth advocacy. This service is designed to provide flexibility to address needs of the child and/or family (e.g., individual therapy and mentoring). The principles of Multisystemic Therapy (MST) regarding sustainability and to do "whatever it takes" are adopted in CBS -Adolescent through the clinicians' efforts to be a role model who solves problems, motivates clients and locates sustainable resources that address identified needs b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Improve overall family functioning. ii. Prevent out -of -home placement. iii. Stabilize placement. e. Outcomes of Services: i. Stabilized home environment. ii. Improved parenting. iii. Connection to community resources. iv. Decrease of negative or delinquent behaviors. f. Target Population: i. Families with youth ages twelve (12) to eighteen (18) who are risk for out -of -home placement or ready to transition home. g. Language: i. English. ii. Spanish may be available. h. Medicaid Eligibility: i. This service is not typically Medicaid eligible, Contractor will assess each case for Medicaid eligibility. i. Service Access and Transportation: i. In client's home. 4. Therapeutic Kinship Services Child Protection a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Therapeutic Community Based Child Protection is an intensive in -home service for families with children age birth to twelve (12) years to prevent placement, transition children from out -of -home care, or stabilize placements with a Master's Level clinician. ii. Contractor will build parental protective capacity to remove safety concerns and mitigate. Signs of Safety, Solution Focused Brief Therapy and trauma -informed practice are the clinical foundation for understanding the problems and developing interventions. iii. Extensive effort is made to involve extended family/kin and the community for long term support and sustainability. 3 b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Increase protective capacity of parent/caregiver. ii. Improve family functioning. iii. Eliminate safety concerns within the family system. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Assist with establishing permanency for children. iii. Reduce or eliminate future incidents of child maltreatment. f. Target Population: i. High risk families struggling with severe neglect or abuse, unstable mental health (parent or child), and problematic child behaviors (parenting skills) are a good fit for this program. g. Language: i. English. ii. Spanish may be available. h. Medicaid Eligibility: i. This service is not typically Medicaid eligible, Contractor will assess each case for Medicaid eligibility. i. Service Access and Transportation: i. In client's home. Life Skills 5. Family Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. In-home/community-based program designed as an early -intervention service that helps stabilize families struggling with issues with school, mental health and other matters that place the family at risk of becoming further involved with the child welfare system. ii. The service is provided by Bachelor level staff. b. Anticipated Frequency of Services: iv. Low: one (1) to two (2) hours per week. v. Moderate: three (3) to four (4) hours per week. vi. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: ii. One (1) to four (4) months. d. Goals of Services: i. Connect family to needed community resources. 4 ii. Stabilize family system. iii. Provide coaching and support for parenting. iv. Build caregiver protective factors. e. Outcomes of Services: i. Reduce or eliminate the need for child welfare involvement. ii. Reduce or eliminate future incidents of child maltreatment. iii. Increase family functioning. f. Target Population: i. Families with children of all ages. ii. This service works well with prevention cases prior to court involvement. g. Language: i. English. ii. Spanish. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. 6. Adolescent Skill Coaching a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Short term skills coaching for adolescents and their families to support them in making connections with natural supports in their environment to help meet the family's needs. This model builds on the family's strengths, encourages the development of supportive and sustainable relationships that promote long term resilience. ii. This program can also be an intervention that evaluates the youth's environment and aligns with the parents to establish household structure and supervision. iii. This service is offered by a Bachelor Level Staff. iv. Specialized services such as mental health treatment is provided either by the Contractor's Community Based Services (CBS) Worker or through linkages with community resources. CBS services begin with the Contractor's staff being the support system for the youth and their family. J. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. k. Anticipated Duration of Services: i. Three (3) to six (6) months. b. Goals of Services: i. Assist family to identify and successfully access community resources. ii. Assist youth in building independent living skills. iii. Align with family and youth as an advocate. iv. Support caregiver in establishing household structure. v. Support caregiver in developing rules and consequences. vi. Assist family in establishing support network for long term assistance. c. Outcomes of Services: 5 i. Increase the youth and their family's ability to access ecological networks of support beyond the Contractor. ii. Establishing a strong network of support enables the youth and their family to maintain the skills learned and increases the likelihood of success after discharge. d. Target Population: i. Youth with treatment needs in the following program areas: drug and alcohol services; tracking; mentoring; family intervention; educational support; employment/vocational support; restorative justice; independent living skills; crisis intervention; and aftercare. e. Language: i. English. ii. Spanish if arranged ahead of time. f. Medicaid Eligibility: i. This service is not Medicaid eligible. g. Service Access and Transportation: i. Client's home. 7. SafeCare for Court Involved Families a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. SafeCare is an evidence -based parenting skills intervention that reduces future incidents of child maltreatment. ii. The four modules are outlined below. iii. Each module involves baseline assessment, intervention (training) and follow-up assessments to monitor change. iv. Staff members conduct observations of parental knowledge and skills for each module by using a set of observation checklists. v. The SafeCare training format is based on well -established social learning theory and evidence from previous research. Service providers and parents are trained using a general seven step format: b. Anticipated Frequency of Services: i. One (1) to two (2) hours. c. Anticipated Duration of Services: i. Sixteen (16) to eighteen (18) weeks. d. Goals of Services: i. Increase parental protective capacity in the following areas: a. Health. b. Home Safety. c. Parent-Child/Parent-Infant Interactions. d. Problem Solving and Communication. e. Outcomes of Services: i. Increase parental protective capacity in the following areas: a. Health. b. Home Safety. c. Parent-Child/Parent-Infant Interactions. d. Problem Solving and Communication. f. Target Population: 6 i. Families with children ages zero (0) to five (5) with an open dependency and neglect case. h. Language: i. English. ii. Spanish if arranged ahead of time. i. Medicaid Eligibility: i. This service is not Medicaid eligible. j. Service Access and Transportation: i. Client's home. 8. Supervised Visitation (Bachelor Level Staff) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Providing supervised visitation services with Bachelor level staff that includes family coaching and intervention during the session. b. Anticipated Frequency of Services: i. Based on the client and family's need. c. Anticipated Duration of Services: i. Based on the client and family's need. d. Goals of Services: i. Improve parent -child relationship. ii. Increase parenting skills. iii. Provide important parent -child contact. e. Outcomes of Services: i. Based on identified case goals. f. Target Population: i. Families with court ordered parenting time in need of basic coaching during visitation time. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. To be determined by case need. 9. Therapeutic Supervised Visitation (Master's Level Clinician) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Providing supervised visitation services with master's level clinician that includes family therapeutic/trauma informed intervention during the session. b. Anticipated Frequency of Services: i. Frequency is dependent on the client/family's need. 7 c. Anticipated Duration of Services: i. Duration is dependent on the client/family's need. d. Goals of Services: i. Improve parent -child relationship. ii. Increase parenting skills. iii. Provide important parent -child contact. e. Outcomes of Services: i. Based on identified case goals. f. Target Population: i. Families with court ordered parenting time in need of therapeutic interventions during parenting time. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. To be determined by case need. Mental Health Services 10. Trauma Focused Cognitive Behavioral Therapy (TF CBT) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidenced -Based Treatment for children ages three (3) to eighteen (18) years experiencing trauma -related difficulties as the result of one or multiple traumatic events and their non -offending parent/caretaker. A brief age -specific trauma assessment is completed at the point of intake to determine if the referred child has clinically significant Post Traumatic Stress Disorder (PTSD) or depression symptoms that indicate trauma treatment is needed. The age -appropriate trauma assessment is completed during the intake meeting and includes input from the child and their caretakers. These assessments are brief and used as a tool to determine the need for TF CBT. If it is determined that the child does not have clinically significant symptoms, Savio will make a recommendation for other services. ii. Contractor can conduct a brief trauma assessment as a standalone service if there is question with regard to the need TF CBT. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) to twenty (20) sessions. d. Goals of Services: i. Reduce or eliminate PTSD symptoms. ii. Increase parental ability to be tuned into the needs of the child/youth. iii. Increase child/youth regulation skills. 8 e. Outcomes of Services: i. Stabilize placement. ii. Eliminate the need for out -of -home placement. iii. Improved child wellbeing. iv. Improve family functioning. f. Target Population: i. Children and youth ages three (3) to eighteen (18) experiencing trauma related difficulties as a result of one (1) or multiple traumatic events and their non -offending caregiver(s). g. Language: i. English. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. In the client's home. 11. Trauma Systems Therapy (TST) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidence -based treatment for children/adolescents who have experienced traumatic events and/or who live in environments where ongoing stress/traumatic reminders are present. ii. Methodology: a. A phase -based, comprehensive model designed to meet complicated needs of a trauma system defined as the combination of a traumatized child or adolescent, who when exposed to trauma reminders, has difficulty regulating emotions/behavior and a caregiver or system of care that is not able to protect the youth or help manager their dysregulation. Not all families begin at the Safety Focus phase; some begin at a later phase and do not require phase one (1). b. Anticipated Frequency of Services: i. Phase 1: Four (4) hours per week. ii. Phase 2: Three (3) hours per week. iii. Phase 3: One (1) to two (2) hours per week. c. Anticipated Duration of Services: i. Nine (9) to twelve (12) months. d. Goals of Services: i. Reduce or eliminate PTSD within the family system. ii. Improve family functioning. iii. Teach identified family members regulation skills. e. Outcomes of Services: i. Eliminate the need for out -of -home placement (stabilize permanent placement). ii. Improve caregivers' ability to be attuned to the needs of the child/youth. iii. Reduce or eliminate future incidents of child maltreatment. iv. Improve child well-being. f. Target Population: 9 i. Children, youth ages five (5) to twenty (20) and their caregivers who have a history of traumatic events. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. 12. Eye Movement Desensitization and Reprocessing (EMDR) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Therapy focuses directly on traumatic memories and is intended to change the way those memories are stored in the brain, thus reducing and eliminating the problematic symptoms. ii. During EMDR therapy, clinical observations suggest that an accelerated learning process is stimulated by EMDR's standardized procedures, which incorporate the use of eye movements and other forms of rhythmic left -right (bilateral) stimulation (e.g., tones or taps). iii. While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced. iv. Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client's own accelerated intellectual and emotional processes. b. Anticipated Frequency of Services: i. One (1) to two (2) times per week. c. Anticipated Duration of Services: i. Six (6) to twelve (12) sessions. d. Goals of Services: i. Reduce or eliminate PTSD symptoms. ii. Improve family functioning. iii. Improve youths' regulation skills. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Improve youth's wellbeing. iii. Reduce or eliminate the need for child welfare involvement. f. Target Population: i. Ages four (4) to eighteen (18) g. Language: i. English. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: 10 i. Client's home. Multisystemic Therapy 13. Multisystemic Therapy (MST) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidence -based intervention for youth who are chronic, violent or substance abusing juvenile offenders and their families. MST works with juveniles with a mental health diagnosis or who are emotionally disturbed. Youth served are at high risk of out -of -home placement or are transitioning home from residential treatment or correctional care. ii. Contractor has a twenty (20) plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. b. Anticipated Frequency of Services: i. Hours of services are based on what is clinically indicated for the family. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Increase youth's connection with positive peers. ii. Improve youth's performance in school. iii. Improve overall family functioning. iv. Develop clear rules and consequences within the family system. v. Improve caregivers' ability to parent youth. e. Outcomes of Services: i. Eliminate the need for out -of -home placement. ii. Reduce or eliminate delinquent activity by youth. iii. Successfully reunify youth placed in out -of -home placement. f. Target Population: i. Chronic, violent or substance abusing male and female juvenile offenders, ages eleven (11) to eighteen (18) and their families. ii. Youth ages eleven (11) to eighteen (18), and their families, demonstrating maladaptive behaviors including drug use, truancy, violence, parent -child conflict, youth who have had previous or current episodes of abuse or neglect and youth who are facing out of home placement or are reunifying home. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. Sexual Abuse Treatment 11 14. Multisystemic Therapy Problem Sexual Behavior (MST PSB) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Intensive, comprehensive, community- and family -based treatment modality aimed at decreasing juvenile sex offending and effectively reintegrating youth into the home and community. MST-PSB incorporates evidence -based intervention techniques and utilizes an intensive quality assurance system to support treatment fidelity. The MST-PSB model does not support or utilize any group counseling. This modality views caregivers as the key to achieving favorable clinical outcomes for their youth. To ensure their participation, caregivers are highly involved in the development and implementation of interventions. The MST-PSB model is a total behavioral health care modality that addresses all the needs of each family member. ii. Contractor has a twenty (20) plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. b. Anticipated Frequency of Services: i. Hours of services are based on what is clinically indicated for the family. c. Anticipated Duration of Services: i. Four (4) to six (6) months. d. Goals of Services: i. Improve family functioning. ii. Improve relationships with peers, school, community. iii. Improve household structure. e. Outcomes of Services: i. Reduce problem sexual behavior. ii. Improve overall functioning of youth. iii. Reduce or eliminate the need for out -of -home placement. f. Target Population: i. Youth ages twelve (12) to eighteen (18) with problem sexual behaviors. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. 15. Sexual Abuse Intervention (SAI) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Works with youth demonstrating problem sexual behaviors and their families to stop sexually abusive behavior and prevent its recurrence through monitoring, education and therapeutic intervention. The program utilizes a high level of supervision and involvement and emphasizes community safety and client accountability at all times. 12 The program primarily serves adolescents who may or may not be adjudicated but are demonstrating problem sexual behaviors. ii. The SAI program can also work with youth who are demonstrating sexually reactive behavior related to trauma. iii. Clients receive services while living in the community at their homes or within out of home placement, depending on the needs of clients and their families. iv. The program utilizes this continuum of care to offer more or less restrictive services for clients, as changes in level of care are deemed appropriate to treatment needs. b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Six (6) to nine (9) months. d. Goals of Services: i. Address problem sexual behaviors within a family system. ii. Improve overall family functioning. iii. Increase safety for all children in the home. iv. Improve parental protective capacity. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Improve caregivers' ability to keep children safe. iii. Increase family's access to support system. f. Target Population: i. Youth ages eleven (11) to eighteen (18) with problem sexual behavior. ii. Families with histories of problematic sexual behaviors including Intrafamilial sexual abuse, adjudication as a result of sexual abuse, lack of impulse control, lack of supervision, poor social skills, minimizing/justifying abusive behavior (sexual or otherwise). g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. 16. Sexual Abuse Intervention with Child Protection a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Works with children with problem sexual behaviors and their families to stop problem sexual behaviors and prevent its recurrence through monitoring, education and trauma - based cognitive behavioral interventions. By combining both Sexual Abuse Intervention and Child Protection services we are able to address safety and protective issue while eliminating the sexually acting out behaviors. b. Anticipated Frequency of Services: i. Low: one (1) to two (2) hours per week. 13 ii. Moderate: three (3) to four (4) hours per week. iii. Intensive: five (5) to six (6) hours per week. c. Anticipated Duration of Services: i. Six (6) to nine (9) months. d. Goals of Services: i. Address problem sexual behaviors within a family system. ii. Improve overall family functioning. iii. Increase safety for all children in the home. iv. Improve parental protective capacity. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Improve caregivers' ability to keep children safe. iii. Increase family's access to support system. f. Target Population: i. The program serves families with children four (4) to twelve years (12) of age. ii. The service helps families with young children who are sexually acting out inside or outside the family system. These families typically have a history of non -protective patterns that have led to the exposure of their children to abuse, neglect and in many cases, sexual victimization. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. 17. Informed Supervision a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Curriculum will be presented in a training format in which concepts are presented and participants have the opportunity to ask questions and receive guidance in supervising the youth under their care. ii. The curriculum follows Sex Offender Management Board (SOMB) guidelines and helps supervisors understand the expectations for supervision as identified in the Standards and Guideline. The training helps caregivers understand potential risks and how to prevent opportunities for risky behaviors through the use of alarms, cameras and planning. b. Anticipated Frequency of Services: i. One (1) hour. c. Anticipated Duration of Services: i. One (1) episode. d. Goals of Services: i. Provide offense specific training to caregivers of children and youth with problem sexual behaviors. 14 e. Outcomes of Services: i. Participants will be able to understand Informed supervision concepts. ii. Participants will be able to appropriately supervise youth with problem sexual behavior. f. Target Population: i. Families with children and youth who are expressing problematic sexualized behaviors. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home or office. Substance Abuse Treatment Services 18. Multisystemic Therapy Continency Management (MST CM) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Is an adaptation of Multisystemic Therapy that was developed in order to offer a model specifically focused on addressing substance abuse problems. MST -CM builds upon the "standard" MST model, which is used to treat serious juvenile offenders, by including a contingency management protocol and focusing treatment more specifically on the youth's substance use in cases where such an approach is warranted. ii. Includes as standard certain treatment protocols to address youth substance use, such as functional analysis of the substance use, self -management plans to help the youth avoid substance use, teaching of drug refusal skills, providing incentives or rewards for not using drugs, and random drug screens. iii. Is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. iv. Contractor has twenty (20) plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model and is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. b. Anticipated Frequency of Services: i. Hours of services are based on what is clinically indicated each week for the family. c. Anticipated Duration of Services: i. Three (3) to five (5) months. d. Goals of Services: i. Decrease or eliminate youth's substance use. ii. Improve structure within the home. iii. Improve parental capacity to set limits. e. Outcomes of Services: i. Eliminate the need for out -of -home placement. ii. Reduce or eliminate youth's involvement with juvenile justice. 15 iii. Reduce youth's delinquency recidivism. f. Target Population: i. Youth ages twelve (12) to seventeen (17) that present with chronic or severe delinquent behavior and are also abusing drugs and alcohol. J. Language: i. English. ii. Spanish if arranged ahead of time. k. Medicaid Eligibility: i. This service is not Medicaid eligible. 1. Service Access and Transportation: i. Client's home. 19. Functional Family Therapy Contingency Management (FFT CM) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Is an enhancement of FFT aimed to specifically reduce substance use among adolescents and family members and to sustain sobriety. This model continues to focus on other risk factors or referring behaviors to the substance use. b. Anticipated Frequency of Services: i. One (1) session per week. c. Anticipated Duration of Services: i. Twelve (12) to twenty (20) sessions. d. Goals of Services: i. Decrease or eliminate youth's substance use. ii. Improve structure within the home. iii. Improve parental capacity to set limits. e. Outcomes of Services: i. Eliminate the need for out -of -home placement. ii. Reduce or eliminate youth's involvement with juvenile justice. iii. Reduce youth's delinquency recidivism. f. Target Population: i. Adolescents between the ages of twelve (12) and eighteen (18), with negative behaviors that appear to be rooted in the relational dynamics of the family system. a. Substance abuse within family (caregiver or youth) in addition to the referral behaviors for FFT. b. Runaway behaviors. c. Defiance and verbal aggression. d. Physical aggression with people and property. e. Delinquency and truancy charges. f. Substance use. g. Poor school performance. h. Self -harming behaviors. i. Most mental health/behavioral disorder. g. Language: i. English. ii. Spanish if arranged ahead of time. 16 h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. Client's home. Functional Family Therapy 20. Functional Family Therapy a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Evidenced -based family therapy model designed to reduce or eliminate problem behaviors by modifying the family relationships that support those behaviors. The three (3) phases of the model include: a. Engagement and Motivation. b. Behavior Change. c. Generalization. b. Anticipated Frequency of Services: i. One (1) to one and a half (1.5) hours per week. c. Anticipated Duration of Services: i. Three (3) to six (6) months. d. Goals of Services: i. Establish household structure. ii. Increase monitoring and supervision. iii. Set clear rules and consequences for the youth. e. Outcomes of Services: i. Reduce or eliminate the need for out -of -home placement. ii. Improve family functioning. iii. Reduce parent -child conflict. f. Target Population: i. Youth ages twelve (12) to eighteen (18) and their families demonstrating maladaptive behaviors including truancy, violence, parent -child conflict. ii. Youth who have had previous or current episodes of abuse or neglect and youth facing out -of -home placement or are reunifying home. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. 21. Functional Family Therapy Gang (FFT G) a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Is a family intervention designed to help youth that are gang -involved or at risk for becoming gang involved. FFT-G® utilizes the core Functional Family Therapy model 17 and has been shown to work with gang -involved or at -risk youth. Like FFT, FFT-G® is effective because it specifically targets risk factors relevant to gang -involved youth(conflictual family relationships, antisocial behaviors, impulsivity, substance use, lack of supervision). Treatment is intensive, and all sessions are conducted in the family home or at a location convenient to the youth and family. Family is defined broadly to include individuals that are important to the youth, which may include other members of the youth's gang. FFT-G® works closely with community partners to support the intervention and help youth and families meet their individual and family goals. FFT-G® has demonstrated significant recidivism reductions for drug charges, adjudicated delinquency, property charges, along with reductions in arrests (felony and crimes against persons). b. Anticipated Frequency of Services: ii. One (1) to one and a half (1.5) hours per week. c. Anticipated Duration of Services: ii. Three (3) to six (6) months. d. Goals of Services: i. Establish household structure. ii. Increase monitoring and supervision. iii. Set clear rules and consequences for the youth. e. Outcomes of Services: i. Reduce or eliminate substance use for the adolescent. ii. Reduce or eliminate the need for out -of -home placement. iii. Improve family functioning. iv. Reduce parent -child conflict. f. Target Population: i. FFT-G Youth and adolescents ages eleven (11) to eighteen (18) who are currently gang involved, at risk of becoming involved, youth associated/affiliated with a gang, families with intergenerational gang involvement. must have at least one family member willing to participate. g. Language: i. English. ii. Spanish if arranged ahead of time. h. Medicaid Eligibility: i. This service is Medicaid eligible. i. Service Access and Transportation: i. Client's home. Terms 1. Contractor will respond to the Quality Assurance Team(HS-CWQualityAssurance(&weldeov.com within three (3) business days regarding the ability to accept the received referral. 2. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred 18 services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team HS - C W Qua litvAss u rance(a�weldgov.com. 3. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understands that the Department will not reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, on the part of case participants who cancel without 24 hour notice. After three (3) "no-shows", Contractor will place client on a behavioral plan requiring attendance or discharge the client from services. Contractor must inform the caseworker and the Quality Assurance Team HS-CWQualityAssurance(a,weldgov.com within three (3) days of when the client is placed on a behavioral plan or discharged. 4. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team HS-CWQualityAssurance(&,weldgov.com immediately via email, to discuss service continuation. 5. Contractor will identify, in detail, areas of continued concern and make recommendations to the caseworker in a monthly report regarding continuation of services and/or the need for additional services. 6. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported to the caseworker and the Quality Assurance Team HS-CWQualityAssurance(�weldgov.com immediately AND on the required monthly report. 7. Contractor will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 8. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Core Service Coordinator or any member of the Quality Assurance Team. Any changes to visitation referrals will be approved by a new referral signed by the Child Welfare Supervisor. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 9. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Bid Meetings, Professional Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as there is written authorization from the Quality Assurance Team, and the facilitator documents in the meeting notes the timeframe that the provider attended and when participation in the meeting is deemed appropriate and necessary by the Department. The Facilitator will be responsible for filling out the time attended on the meeting notes. Staffings and/or meetings other than those listed above are not considered reimbursable unless otherwise approved by the Child Welfare Contract and Services Coordinator. Contractor may participate by phone or virtually, if approved by the Department. 19 10. On a monthly basis, the Contractor will notify the Quality Assurance Team HS- CWQualityAssurance(aweldgov.com of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 20 EXHIBIT B RATE SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse the Contractor in consideration of the work and services performed under this Agreement at the rate specific in Paragraph 2, below. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Home -Based Intervention Therapeutic Community Based Services for Adolescents Rate Unit Type Service Name $1,073.00 Month Low one (1) to two (2) hours per week. $1,850.00 Month Moderate three (3) to four (4) hours per week. $2,476.00 Month Intensive five (5) to six (6) hours per week. $100.00 Month Services for families in Spanish Modifier. $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Therapeutic Community Based Services Child Protection Rate Unit Type Service Name $1,073.00 Month Low one (1) to two (2) hours per week. $1,850.00 Month Moderate three (3) to four (4) hours per week. $2,476.00 Month Intensive five (5) to six (6) hours per week. $100.00 Month Services for families in Spanish Modifier. $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Kinship Services (Therapeutic) Therapeutic Kinship Services for Adolescents Rate Unit Type Service Name $1,073.00 Month Low one (1) to two (2) hours per week. $1,850.00 Month Moderate three (3) to four (4) hours per week. $2,476.00 Month Intensive five (5) to six (6) hours per week. $100.00 Month Services for families in Spanish Modifier. $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Therapeutic Kinship Services Child Protection Rate Unit Type Service Name $1,073.00 Month Low one (1) to two (2) hours per week. $1,850.00 Month Moderate three (3) to four (4) hours per week. $2,476.00 Month Intensive five (5) to six (6) hours per week. $100.00 Month Services for families in Spanish Modifier. $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff Life Skills Family Coaching Rate Unit Type Service Name $1,015.00 Month Low one (1) to two (2) hours per week. $1,650.00 Month Moderate three (3) to four (4) hours per week. $2,250.00 Month Intensive five (5) to six (6) hours per week. $100.00 Each Spanish interpretation $110.00 Each No Show $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff Adolescent Skills Coaching Rate Unit Type Service Name $1,015.00 Month Low one (1) to two (2) hours per week. $1,650.00 Month Moderate three (3) to four (4) hours per week. $2,250.00 Month Intensive five (5) to six (6) hours per week. $100.00 Each Spanish interpretation $110.00 Each No Show $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff SafeCare Rate Unit Type Service Name $1015.00 Month One (1) session per week. $110.00 Each No Show Supervised Visitation Rate Unit Type Service Name $100.00 Hour Bachelor Level - English $100.00 Each No Show - English $110.00 Hour Bachelor Level — Spanish $110.00 Each No Show — Spanish $120.00 Hour Master's Level — English $120.00 Each No Show — English $154.00 Hour Master's Level — Spanish $154.00 Each No Show — Spanish Mental Health Services Trauma Focused Cognitive Behavioral Therapy (TF CBT) Rate Unit Type Service Name $1,128.00 Month Trauma Focused Cognitive Behavioral Therapy (TF CBT) $100.00 Each Spanish Interpretation $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Trauma Systems Therapy (TST) Rate Unit Type Service Name $2,293.00 Month Trauma Systems Therapy Phase 1 $1,777.00 Month Trauma Systems Therapy Phase 2 $1,128.00 Month Trauma Systems Therapy Phase 3 $100.00 Each Spanish Interpretation $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Eye Movement Desensitization and Reprocessing (EMDR) Rate Unit Type Service Name $1,128.00 Month Eye Movement Desensitization and Reprocessing (EMDR) $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Multisystemic Therapy (MST) Multisystemic Therapy (MST) Rate Unit Type Service Name $2,254.00 Month Multisystemic Therapy $100.00 Each Spanish Interpretation $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Sexual Abuse Treatment Multisystemic Therapy Problem Sexual Behavior (MST PSB) Rate Unit Type Service Name $2,796.00 Month Multisystemic Therapy Problem Sexual Behavior (MST PSB) $100.00 Each Spanish Interpretation $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Sexual Abuse Intervention (SAI) Rate Unit Type Service Name $1,170.00 Month Low one (1) to two (2) hours per week. $1,712.00 Month Moderate three (3) to four (4) hours per week. $2,177.00 Month Intensive five (5) to six (6) hours per week. $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Sexual Abuse Intervention with Child Protection Rate Unit Type Service Name $1,170.00 Month Low one (1) to two (2) hours per week. $1,712.00 Month Moderate three (3) to four (4) hours per week. $2,177.00 Month Intensive five (5) to six (6) hours per week. $100.00 Each Spanish Interpretation $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Informed Supervision Rate Unit Type Service Name $300.00 Each Informed Supervision $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. Rate Unit Type Substance Abuse Treatment Services Service Name $2,554.00 Month Multisystemic Therapy -Contingency Management (MST -CM) $1,250.00 Month Functional Family Therapy Contingency Management (FFT CM) $100.00 Each Spanish Interpretation $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff Rate $1,250.00 $1,400.00 Functional Family Therapy Unit Type Service Name Month Month Functional Family Therapy (FFT) — one (1) session per week Functional Family Therapy Gang (FFT G) — one (1) session per week $100.00 Each Spanish Interpretation $500.00 Month Extended area modifier for distances greater than thirty (30) miles. Starting point is the home office of the assigned staff. 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement and monthly report including other supporting documentation, if applicable, certifying that services authorized were provided on the date(s) indicated and the charges were made pursuant to the terms and conditions of Paragraph 3 of this Agreement . Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7`h day of the month following the month of service, but no later than 45 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 45 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 45 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. When submitting a request for payment for a one-time service, the contractor shall submit the first and last page of the evaluation/report to confirm proof of services rendered. The full evaluation/report should be submitted by the contractor to the caseworker. For Monitored Sobriety services, proof of services rendered shall be the test result. Exhibit C WELD COUNTY'S REQUEST FOR PROPOSAL (Weld County's Request for Proposal is incorporated into this agreement by reference and will be provided upon request to the Department.) This page is intentionally left blank Exhibit D Contractor's response to the Request for Proposal Exhibit D contains the following documents: • Attachment B — Provider Information Form (PIF) • Attachment C — Proposal • Attachment D — Staff Data Sheet • Certificate of Insurance (COI) ATTACHMENT B WELD COUNTY DEPARTMENT OF HUMAN SERVICES - PROVIDER INFORMATION FORM (PIF) AGENCY INFORMATION Agency Name: Savio House Provider Contact Full Name: Julia L. Roguski Primary Phone Number (10 -digit): 720.530.6450 Ext.: Trails Provider ID (if known): Title: Associate Executive Director 303.935.1001 Fax Number (10 -digit): Primary Contact Email: jroguski@saviohouse.org Web Address: www.saviohouse.org 325 King Street Denver, CO 80219 Agency Location Address (Street, city, state, zip): Agency Mailing Address (Street, city, state, zip): 325 King Street Denver, CO 80219 Agency Type (pick one): Public Company I� ! Private Non -Profit Private for Profit Referral Contact Name: Send Referrals for Service to: Julia Roguski Referral Phone Number (10 -digit): 720.530.6450 Ext.: Title: Associate Executive Director Email: jroguski@saviohouse.org Billing Contact Name: Billing Contact Robin Maher Billing Phone Number (10 -digit): 303.225.4015 Ext.: Title: Office Manager Email: rmaher@saviohouse.org ------------------------------------------------------------------------------------------- CERTIFICATION I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept Ithe bid, or part of a bid, that, in the opinion of the Board, is in the best interests of the Board and of the County of Weld, State of Colorado. The Board of Weld County Commissioners shall give preference to resident Weld County bidders in all cases where the bids are competitive in price and quality. WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000. I Norma Aguliar-Dave Authorized Rep. Full Name: g Title: Authorized Rep. Email: naguilar-lave@Saviohouse.org phone (10 -digit): 303.225.4040 Ext.: Authorized Rep. Address (Street, city, state, zip): .�/BOMdeZ Signature of Authorized Rep.: 325 King Street Denver, CO 80219 Executive Director Date: January 19, 2022 I 1 REV. DECEMBER 2021 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. Savio House Home -Based Intervention Number of services offered on this Attachment C (max 5): 2 If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h 2.11 Service 2.2a SECTION 2 - Service Name(s) and Information the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. #1 Name: Therapeutic Community Based Services for Adolescents Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Therapeutic CBS -Adolescent is designed to focus on prevention and treatment of delinquent behavior with a Master's level clinician. This is accomplished through school interventions, family interventions, mentoring and youth advocacy. This service is designed to provide flexibility to address needs of the child and/or family (e.g., individual therapy and mentoring). The principles of MST regarding sustainability and to do "whatever it takes" are adopted in CBS -Adolescent through the clinicians' efforts to be a role model who solves problems, motivates clients and locates sustainable resources that address identified needs Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Low: 1— 2 hours per week Moderate: 3 —4 hours per week Intensive: 5 — 6 hours per week Anticipated duration of service (i.e. 3-4 months): 3 — 6 months Three (3), or more, specific goals of the service (DO use bullet points): 1. Improve overal family functioning 2. Prevent out -of -home placement 3. Stabilize placement Three (3), or more, specific outcomes of service: 1. Stabilized home environment 2. Improved parenting 3. Connection to community resources 4. Decrease of negative or delinquent behaviors Target population of the service, including age and gender: Families with youth ages 12 —18 years at risk for out -of -home placement or ready to transition home. Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (Call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Depends on the case and overall goals. This is typically not, but all cases are assessed for Medicaid eligibility Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home #2 Name: Therapeutic Community Based Services Child Protection Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Savio Therapeutic Community Based Child Protection is an intensive in -home service for families with children age birth to 12 years to prevent placement, transition children from out -of -home care, or stabilize placements with a Master's Level clinician. Savio will build parental protective capacity to remove safety concerns and mitigate. Signs of Safety, Solution Focused Brief Therapy and trauma -informed practice are the clinical foundation for understanding the problems and REV. OCT 2021 1 ATTACHMENT C - PROPOSAL developing interventions. Extensive effort is made to involve extended family/kin and the community for long term support and sustainability 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Low: 1— 2 hours per week Moderate: 3 — 4 hours per week Intensive: 5 — 6 hours per week 2.2c Anticipated duration of service (i.e. 3-4 months): 4 — 6 months 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Increase protective capacity of parent/caregiver 2. Improve family functioning 3. Eliminate safety concerns within the family system 2.2e Three (3), or more, specific outcomes of service: 1. Reduce or eliminate the need for out -of -home placement 2. Assist with establishing permanency for children 3. Reduce or eliminate future incidents of child maltreatment 2.2f Target population of the service: High risk families struggling with severe neglect or abuse, unstable mental health (parent or child), and problematic child behaviors (parenting skills) are a good fit for this program. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (Call for availability) 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Depends on the case and overall goals. This is typically not, but all cases are assessed for Medicaid eligibility 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 months): REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.4d 2.4e 2.4f 2.4g 2.4h 2.4i Service 2.5a 2.5b 2.5c 2.5d Three (3), or more, specific goals of the service (DO use bullet points): Three (3), or more, specific outcomes of service: Target population of the service: Languages service is available in (please list proficiency and if interpreter services are available): Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service location — list where the service will take place (i.e. client's home, in -office, other) #5 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Anticipated duration of service (i.e. 3-4 months): Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 3.2 3.3 3.4 3.5 Section 3 — Service Access and Will you charge Weld County for transporting clients or mileage? Check Will you conduct services in a client's home or in the community? Check Transportation YES only to cover mileage for Medicaid cases outside Savio's catchment area YES NO one: ►5 ■ NO one: C. • NO Miles Will you transport clients to and/or from services? Check one: ►I YES ■ How many miles are you willing to travel round trip? List a specific miles. When you calculate mileage, what is your starting point address? number of 30 Starting point is the home office of the assigned staff to the client's home or place of service (kinship, foster care) SECTION 4 - SERVICE RATES REV. OCT 2021 3 ATTACHMENT C - PROPOSAL All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: $ Amount Unit Type 4.1a In-Office/Video: per Hour 4.1b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: per Hour 4.1d No show: per No Show 4.1e Mileage rate: per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: per Hour 4.2b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a CBS Adolescent or Child Protection Low $1073 1— 2 4.6b CBS Adolescent or Child Protection Moderate $1850 3 — 4 4.6c CBS Adolescent or Child Protection Intensive $2476 5 - 6 4.6d Services for families in Spanish Modifier $100 NA 4.6e Extended area Modifier (31 or more miles) $500 NA 4.6f Drive time for Medicaid cases outside of Savio's catchment $50 Hour 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: Savio has updated the rates and minimum hours for levels; therefore comparing rates from last bid this bid are not equal. The goal is to have clearer levels of service. It is anticipated that families will move from higher levels of service to lower as the case progresses. These services are also provided by a Master's level clinician. For Bachelor level services, please see Life Skills Family Coaching and Skill Building. Savio is always willing to negotiate the levels with the county to ensure the program meets the needs of the county and families served. The modifiers will be added to the base rate authorizations by Weld County Department of Human Services based on family need. All rates are fee for service monthly rates, prorated for partial months. Travel time will be utilized to pay for transportation on Medicaid cases outside of Savio's catchment area. REV. OCT 2021 5 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. Savio House Kinship Services (Therapeutic) Number of services offered on this Attachment C (max 5): 2 If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h 2.1i Service 2.2a SECTION 2 - Service Name(s) and Information the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. #1 Name: Therapeutic Kinship Services for Adolescents Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Therapeutic CBS -Adolescent is designed to focus on prevention and treatment of delinquent behavior with a Master's level clinician. This is accomplished through school interventions, family interventions, mentoring and youth advocacy. This service is designed to provide flexibility to address needs of the child and/or family (e.g., individual therapy and mentoring). The principles of MST regarding sustainability and to do "whatever it takes" are adopted in CBS -Adolescent through the clinicians' efforts to be a role model who solves problems, motivates clients and locates sustainable resources that address identified needs Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Low: 1— 2 hours per week Moderate: 3 —4 hours per week Intensive: 5 — 6 hours per week Anticipated duration of service (i.e. 3-4 months): 3 — 6 months Three (3), or more, specific goals of the service (DO use bullet points): 1. Improve overall family functioning 2. Prevent out -of -home placement 3. Stabilize placement Three (3), or more, specific outcomes of service: 1. Stabilized home environment 2. Improved parenting 3. Connection to community resources 4. Decrease of negative or delinquent behaviors Target population of the service, including age and gender: Families with youth ages 12 —18 years at risk for out -of -home placement or ready to transition home. Languages service is available in (please list proficiency and if interpreter services are available): English Spanish Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Depends on the case and overall goals. This is typically not, but all cases are assessed for Medicaid eligibility Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home #2 Name: Therapeutic Kinship Services Child Protection Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Savio Therapeutic Community Based Child Protection is an intensive in -home service for families with children age birth to 12 years to prevent placement, transition children from out -of -home care, or stabilize placements with a Master's Level clinician. Savio will build parental protective capacity to remove safety concerns and mitigate. Signs of Safety, Solution Focused Brief Therapy and trauma -informed practice are the clinical foundation for understanding the problems and REV. OCT 2021 1 ATTACHMENT C - PROPOSAL developing interventions. Extensive effort is made to involve extended family/kin and the community for long term support and sustainability 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Low: 1— 2 hours per week Moderate: 3 — 4 hours per week Intensive: 5 - 6 hours per week 2.2c Anticipated duration of service (i.e. 3-4 months): 4 — 6 months 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Increase protective capacity of parent/caregiver 2. Improve family functioning 3. Eliminate safety concerns within the family system 2.2e Three (3), or more, specific outcomes of service: 1. Reduce or eliminate the need for out -of -home placement 2. Assist with establishing permanency for children 3. Reduce or eliminate future incidents of child maltreatment 2.2f Target population of the service: High risk families struggling with severe neglect or abuse, unstable mental health (parent or child), and problematic child behaviors (parenting skills) are a good fit for this program. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Depends on the case and overall goals. This is typically not, but all cases are assessed for Medicaid eligibility 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 months): REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.4d 2.4e 2.4f Three (3), or more, specific goals of the service (DO use bullet points): Three (3), or more, specific outcomes of service: Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service 2.5a Service location — list where the service will take place (i.e. client's home, in -office, other) #5 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 3.2 3.3 3.4 3.5 Section 3 — Service Access and Will you charge Weld County for transporting clients or mileage? Check Will you conduct services in a client's home or in the community? Check Transportation YES only to cover mileage for Medicaid cases outside Savio's catchment area YES NO one: 0 • NO one: 0 ■ NO Miles Will you transport clients to and/or from services? Check one: ►_0 YES ■ How many miles are you willing to travel round trip? List a specific miles. When you calculate mileage, what is your starting point address? number of 30 Starting point is the home office of the assigned staff to the client's home or place of service (kinship, foster care) SECTION 4 - SERVICE RATES REV. OCT 2021 3 ATTACHMENT C - PROPOSAL All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: $ Amount Unit Type 4.1a In-Office/Video: per Hour 4.1b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: per Hour 4.1d No show: per No Show 4.1e Mileage rate: per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: per Hour 4.2b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a Kinship Services Adolescent or Child Protection Low $1073 1= 2 4.6b Kinship Services Adolescent or Child Protection Moderate $1850 3 - 4 4.6c C Kinship Services BS Adolescent or Child Protection Intensive $2476 5 — 6 4.6d Services for families in Spanish Modifier $100 NA 4.6e Extended area Modifier (31 or more miles) $500 NA 4.6f Drive time for Medicaid cases outside of Savio's catchment $50 hour 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: Savio has updated the rates and minimum hours for levels; therefore comparing rates from last bid this bid are not equal. The goal is to have clearer levels of service. It is anticipated that families will move from higher levels of service to lower as the case progresses. These services are also provided by a Master's level clinician. For Bachelor level services, please see Life Skills Family Coaching and Skill Building. Savio is always willing to negotiate the levels with the county to ensure the program meets the needs of the county and families served. The modifiers will be added to the base rate authorizations by Weld County Department of Human Services based on family need. All rates are fee for service monthly rates, prorated for partial months. Travel time will be utilized to pay for transportation on Medicaid cases outside of Savio's catchment area. REV. OCT 2021 5 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: Savio House Life Skills Program Areas are listed in column 1 of the table located in Item XI of the Request for Proposal starting on page 13. Number of services offered on this Attachment C (max 5): You may complete another Attachment Cif you have more than 5. 5 If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.11 2.1g 2.1h 2.1i Service 2.2a SECTION 2 — Service Name(s) and Information the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. #1 Name: Family Coaching Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): This Savio Family Coaching Program is an in-home/community-based program designed as an early -intervention service that helps stabilize families struggling with issues with school, mental health and other matters that place the family at risk of becoming further involved with the child welfare system. The Savio Family Coaching Program is available to families with children of all ages. This service is provided by a Bachelor Level staff. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Low: 1-2 Moderate: 3 — 4 Intensive: 5 -6 Anticipated duration of service (i.e. 3-4 months): 1— 4 months Three (3), or more, specific goals of the service (DO use bullet points): 1. Connect family to needed community resources 2. Stabilize family system 3. Provide coaching and support for parenting 4. Build caregiver protective factors Three (3), or more, specific outcomes of service: 1. Reduce or eliminate the need for child welfare involvement 2. Reduce or eliminate future incidents of child maltreatment 3. Increase family functioning Target population of the service, including age and gender: This service works well with prevention cases prior to court involvement. Families with children of all ages are eligible for this service. This service is also great for kinship homes in need of additional support. Languages service is available in (please list proficiency and if interpreter services are available): English Spanish Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Typically not. All cases are evaluated for Medicaid eligibility. Service location — list where the service will take place (i.e. client's home, in -office, other) Families Home #2 Name: Adolescent Skill Coaching Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Short term skills coaching for adolescents and their families to support them in making connections with natural supports in their environment to help meet the family's needs. This service is offered by a Bachelor Level Staff. This model builds on the family's strengths, encourages the development of supportive and sustainable relationships that promote long term resilience. This program can also be an intervention that evaluates the youth's environment and aligns with the parents to establish household structure and supervision. REV. OCT 2021 1 ATTACHMENT C - PROPOSAL 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Low: 1-2 Moderate: 3 — 4 Intensive: 5 — 6 2.2c Anticipated duration of service (i.e. 3-4 months): 3 — 6 months 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Assist family to identify and successfully access community resources 2. Assist youth in building independent living skills 3. Align with family and youth as an advocate 4. Support caregiver in establishing household structure 5. Support caregiver in developing rules and consequences 6. Assist family in establishing support network for long term assistance 2.2e Three (3), or more, specific outcomes of service: 1. Increase the youth and their family's ability to access ecological networks of support outside of Savio. 2. Establishing a strong network of support enables the youth and their family to maintain the skills -learned and increases the likelihood of success after discharge. 2.2f Target population of the service: The youth served may have treatment needs in the following program areas: drug and alcohol services; tracking; mentoring; family intervention; educational support; employment/vocational support; restorative justice; independent living skills; crisis intervention; and aftercare. Specialized services such as mental health treatment is provided either by the Savio CBS Worker or through linkages with community resources. CBS services begin with the Savio staff being the support system for the youth and their family. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Typically not. All cases are evaluated for Medicaid eligibility 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home Service #3 Name: SafeCare for Court Involved Families 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): SafeCare is an evidence -based parenting skills intervention that reduces future incidents of child maltreatment. The four modules are outlined below. Each module involves baseline assessment, intervention (training) and follow-up assessments to monitor change. Staff members conduct observations of parental knowledge and skills for each module by using a set of observation checklists. The SafeCare training format is based on well -established social learning theory and evidence from previous research. Service providers and parents are trained using a general seven step format: 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1— 2 hours 2.3c Anticipated duration of service (i.e. 3-4 months): 16-18 weeks 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Increase parental protective capacity in the following areas: 1. Health 2. Home Safety 3. Parent-Child/Parent-Infant Interactions 4. Problem Solving and Communication Three (3), or more, specific outcomes of service: 2.3f Target population of the service: Families with children age 0 — 5 with an current dependency and neglect case. Families who are NOT court involved should be referred to a prevention providers. 2.3g Languages service is available in (please list proficiency and if interpreter services are available): English REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.3h 2.3i Service 2.4a 2.4b 2.4c 2.4d 2.4e 2.4f 2.4g 2.4h 2.4i Service 2.5a 2.5b 2.5c 2.5d 2.5e 2.5f 2.5g 2.5h 2.6i Spanish (call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home #4 Name: Supervised Visitation (Bachelor Level Staff) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Providing supervised visitation services that includes family coaching and intervention during the session. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Based on client/family need Anticipated duration of service (i.e. 3-4 months): Based on client/family need Three (3), or more, specific goals of the service (DO use bullet points): 1. Improve parent -child relationship 2. Increase parenting skills 3. Provide important parent -child contact Three (3), or more, specific outcomes of service: Based on identified case goals Target population of the service: Families with court ordered parenting time in need of basic coaching during visitation time. Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No Service location — list where the service will take place (i.e. client's home, in -office, other) To be determined by case need #5 Name: Therapeutic Supervised Visitation (Master's Level Clinician) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Providing supervised visitation services that includes family therapeutic/trauma informed intervention during the session. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Based on client/family need Anticipated duration of service (i.e. 3-4 months): Based on client/family need Three (3), or more, specific goals of the service (DO use bullet points): 1. Improve parent -child relationship 2. Increase parenting skills 3. Provide important parent -child contact Three (3), or more, specific outcomes of service: Based on identified case goals Target population of the service: Families with court ordered parenting time in need of therapeutic interventions during parenting time. Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part No Service location — list where the service will take place (i.e. client's home, in -office, other) To be determined by case need Section 3 — Service Access and Transportation REV. OCT 2021 3 ATTACHMENT C - PROPOSAL 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 3.3 Will you transport clients to and/or from services? Check one: 3.4 3.5 When you calculate mileage, what is your starting point address? YES only to cover mileage for Medicaid cases outside Savio's catchment area ❑ NO Will you conduct services in a client's home or in the community? Check one: Z YES ❑ NO Z YES ❑ NO How many miles are you willing to travel round trip? List a specific number of miles. 30 Miles Starting point is the home office of the assigned staff to the client's home or place of service (kinship, foster care) SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: Family Coaching 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount $110 Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: Adolescent Skills Coaching 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount $110 Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: SafeCare 4.3a In-Office/Video: $ Amount Unit Type per Hour REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: $110 per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: Visitation (Bachelor) $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: $100/110 (Sp) per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: Visitation Therapeutic $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: $120/$154(sp) per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a Family Coaching Low $1015 1— 2 4.6b Family Coaching Moderate $1650 3 — 4 4.6c Family Coaching Intensive $2250 5 — 6 4.6d Adolescent Skills Coaching Low $1015 1— 2 4.6e Adolescent Skills Coaching Moderate $1650 3 — 4 4.6f Adolescent Skills Coaching Intensive $2250 5 - 6 4.6g SafeCare for Court Involved Families $1015 1 session per week 4.6h Supervised Visitation (Bachelor Level)/Spanish $100 $110 (Sp) Per hour 4.6i Supervised Visitation (Master's Level)/Spanish $120 $154 (Sp) Per hour 4.6j Modifiers: Spanish, Outside Catchment and Travel Time for Medicaid $100, $500, $50 Per auth, per auth, per hour 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: Savio has updated the rates and minimum hours for levels; therefore comparing rates from last bid this bid are not equal. The goal is to have clearer levels of service. It is anticipated that families will move from higher levels of service to lower as the case progresses. These services are also provided by a Bachelor level coach. For Master's level services, please see Home Based Services. Savio is always willing to negotiate the levels with the county to ensure the best fit for families. REV. OCT 2021 s ATTACHMENT C - PROPOSAL The modifiers will be added to the base rate authorizations by Weld County Department of Human Services based on family need. All rates are fee for service monthly rates, prorated for partial months. Travel time will be utilized to pay for transportation on Medicaid cases outside of Savio's catchment area. REV. OCT 2021 6 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: Program Areas are listed in column 1 of the table located in Item Xl of the Request You may complete another Attachment C if you have more than S. for Proposal starting on page 13. Savio House Mental Health Services Number of services offered on this Attachment C (max 5): 3 If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h 2.1i Service 2.2a SECTION 2 - Service Name(s) and Information the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. #1 Name: Trauma Focused Cognitive Behavioral Therapy (TF CBT) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is an Evidenced -Based Treatment for children ages 3 —18 years experiencing trauma -related difficulties as the result of one or multiple traumatic events and their non -offending parent/caretaker. A brief age -specific trauma assessment is completed at the point of intake to determine if the referred child has clinically significant Post Traumatic Stress Disorder (PTSD) or depression symptoms that indicate trauma treatment is needed. The age -appropriate trauma assessment is completed during the intake meeting and includes input from the child and their caretakers. These assessments are brief and used as a tool to determine the need for TF CBT. If it is determined that the child does not have clinically significant symptoms, Savio will make a recommendation for other services. Savio can conduct this brief trauma assessment as a standalone service if there is question with regard to the need TF CBT. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 session per week Anticipated duration of service (i.e. 3-4 months): 12 — 20 Sessions Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce or eliminate PTSD symptoms 2. Increase parental ability to be tuned into the needs of the child/youth 3. Increase child/youth regulation skills Three (3), or more, specific outcomes of service: 1. Stabilize placement 2. Eliminate the need for out -of -home placement 3. Improved child well being 4. Improve family functioning Target population of the service, including age and gender: Children/youth age 3 —18 experiencing trauma related difficulties as a result of one or multiple traumatic events and their non -offending caregiver(s). Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes. Other funding sources are used when there is no Medicaid or Medicaid denies Service location — list where the service will take place (i.e. client's home, in -office, other) #2 Name: Trauma Systems Therapy (TST) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Trauma Systems Therapy (TST) is evidence -based treatment for children/adolescents who have experienced traumatic events and/or who live in environments where ongoing stress/traumatic reminders are present. Methodology: REV. OCT 2021 1 ATTACHMENT C - PROPOSAL A phase -based, comprehensive model designed to meet complicated needs of a trauma system defined as the combination of a traumatized child or adolescent, who when exposed to trauma reminders, has difficulty regulating emotions/behavior and a caregiver or system of care that is not able to protect the youth or help manager their dysregulation. Not all families begin at the Safety Focus phase; some begin at a later phase and do not require phase -one. 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Phase 1: 4 hours per week Phase 2: 3 hours per week Phase 3: 1— 2 hours per week 2.2c Anticipated duration of service (i.e. 3-4 months): 9 —12 months 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Reduce or eliminate PTSD within the family system 2. Improve family functioning 3. Teach identified family members regulation skills 2.2e Three (3), or more, specific outcomes of service: 1. Eliminate the need for out -of -home placement (stabilize permanent placement) 2. Improve caregivers' ability to be attuned to the needs of the child/youth 3. Reduce or eliminate future incidents of child maltreatment 4. - Improve child well being 2.2f Target population of the service: Children, youth age 5 — 20 and their caregivers who have a history of traumatic events. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes. 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home Service #3 Name: Eye Movement Desensitization and Reprocessing (EMDR) 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): EMDR therapy focuses directly on traumatic memories and is intended to change the way those memories are stored in the brain, thus reducing and eliminating the problematic symptoms. During EMDR therapy, clinical observations suggest that an accelerated learning process is stimulated by EMDR's standardized procedures, which incorporate the use of eye movements and other forms of rhythmic left -right (bilateral) stimulation (e.g., tones or taps). While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced. Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client's own accelerated intellectual and emotional processes. 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1— 2 time per week 2.3c Anticipated duration of service (i.e. 3-4 months): 6 —12 sessions 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e 1. Reduce or eliminate PTSD Symptoms 2. Improve family functioning 3. Improve youths regulation skills Three (3), or more, specific outcomes of service: 1. Reduce or eliminate the need for out -of -home placement 2. Improve youth's wellbeing 3. Reduce or eliminate the need for child welfare involvement 2.3f Target population of the service: Savio's EMDR services are targeted for clients ages 4-18. EMDR is a psychotherapy technique that addresses maladaptively stored memories that include the thoughts, emotions, and behavioral responses that were experiencedatthe time of the traumatic event. Treatment accesses the memories and reprocesses the events to a healthier resolution. 2.3g Languages service is available in (please list proficiency and if interpreter services are available): REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.3h 2.3i Service 2.4a 2:4b 2.4c 2.4d 2.4e 2.4f 2.4g 2.4h 2.4i Service 2.5a 2.5b 2.5c 2.5d 2.5e English Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home #4 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Anticipated duration of service (i.e. 3-4 months): Three (3), or more, specific goals of the service (DO use bullet points): Three (3), or more, specific outcomes of service: Target population of the service: Languages service is available in (please list proficiency and if interpreter services are available): Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Service location — list where the service will take place (i.e. client's home, in -office, other) #5 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Anticipated duration of service (i.e. 3-4 months): Three (3), or more, specific goals of the service (DO use bullet points): Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 Section 3 — Service Access and Transportation Will you charge Weld County for transporting clients or mileage? Check one: ►.� YES oiy • NO to cover mileage for Medicaid cases outside Savio's REV. OCT 2021 3 ATTACHMENT C - PROPOSAL catchment area 3.2 Will you conduct services in a client's home or in the community? Check one: ® YES ❑ NO 3.3 Will you transport clients to and/or from services? Check one: ® YES ❑ NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 3.5 When you calculate mileage, what is your starting point address? 30 Miles Starting point is the home office of the assigned staff to the client's home or place of service (kinship, foster care) SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: $ Amount Unit Type 4.1a In-Office/Video: per Hour 4.1b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: per Hour 4.1d No show: per No Show 4.1e Mileage rate: per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: per Hour 4.2b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a Trauma Focused CBT (TF CBT) $1128 4.6b TST Phase i $2293 4.6c TST Phase 2 $1777 4.6d TST Phase 3 $1128 4.6e EMDR $1128 4.6f Spanish Modifier $100 Per auth 4.6g Outside Catchment Modifier $500 Per auth 4.6h Travel Time for Medicaid cases outside Savio's catchment area $50 hour 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: The modifiers will be added to the base rate authorizations by Weld County Department of Human. Services based on family need. All rates are fee for service monthly rates, prorated for partial months. Travel time will be utilized to pay for transportation on Medicaid cases outside of Savio's catchment area. REV. OCT 2021 5 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: Program Areas are listed in column I of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. Savio House Multisystemic Therapy Number of services offered on this Attachment C (max 5): If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h 2.1i Service 2.2a SECTION 2 - Service Name(s) and Information the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. #1 Name: MultiSystemic Therapy (MST) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): MST is an evidence -based intervention for youth who are chronic, violent or substance abusing juvenile offenders and their families. MST works with juveniles with a mental health diagnosis or who are emotionally disturbed. Youth served are at high risk of out -of -home placement or are transitioning home from residential treatment or correctional care. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Hours of service are based on what is clinically indicated for the family. MST is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. Savio has a 20 plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model and is not based on set hours of service, rather thefamily is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. Anticipated duration of service (i.e. 3-4 months): 4 - 6 Months Three (3), or more, specific goals of the service (DO use bullet points): 1. Increase youth's connection with positive peers 2. Improve youth's performance in school 3. Improve overall family functioning 4. Develop clear rules and consequences within the family system 5. Improve caregivers ability to parent youth Three (3), or more, specific outcomes of service: 1. Eliminate the need for out -of -home placement 2. Reduce or eliminate delinquent activity by youth 3. Successfully reunify youth placed in out -of -home placement Target population of the service, including age and gender: The targeted population for MST is chronic, violent or substance abusing male and female juvenile offenders, ages 11-18 and their families. Youth ages 11-18, and their families, demonstrating maladaptive behaviors including drug use, truancy, violence, parent -child conflict, youth who have had previous or current episodes of abuse or neglect and youth who are facing out of home placement or are reunifying home Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes Service location — list where the service will take place (i.e. client's home, in -office, other) Family's home #2 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): REV. OCT 2021 1 ATTACHMENT C - PROPOSAL 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.2c Anticipated duration of service (i.e. 3-4 months): 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 2.2e Three (3), or more, specific outcomes of service: 2.2f Target population of the service: 2.2g Languages service is available in (please list proficiency and if interpreter services are available): 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.4i Service 2.5a Service location — list where the service will take place (i.e. client's home, in -office, other) #5 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 3.2 3.3 3.4 3.5 Section 3 — Service Access and Will you charge Weld County for transporting clients or mileage? Check Will you conduct services in a client's home or in the community? Check Transportation YES only to cover mileage for Medicaid cases outside Savio's catchment area YES NO one: * • NO one: ■ NO Miles Will you transport clients to and/or from services? Check one: 0 YES ■ How many miles are you willing to travel round trip? List a specific miles. When you calculate mileage, what is your starting point address? number of 30 Starting point is the home office of the assigned staff to the client's home or place of service (kinship, foster care) SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. REV. OCT 2021 3 ATTACHMENT C - PROPOSAL 4.1 Hourly Service #1 Name: $ Amount Unit Type 4.1a In-Office/Video: per Hour 4.1b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: per Hour 4.1d No show: per No Show 4.1e Mileage rate: per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: per Hour 4.2b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a MST $2254 MST is an evidence -based model that delivers the level of service clinically indicated for each family. Typically, intensive level of service at the beginning with low levels as the family begins to successfully use skills. 4.6b Spanish Modifier $100 Per month per auth 4.6c Outside of Catchment Modifier $500 Per month per auth REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.6d Drive time for Medicaid cases outside of Savio's catchment $50 Hour 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: The fee for service for MST is based on ensuring the family receives the clinically appropriate level of service. This is different than other services. MST is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes: Savio has a 20 plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The fee for services covers the delivery of the model and is not based on set hours of service. The modifiers will be added to the base rate authorizations by Weld County Department of Human Services based on family need. All rates are fee for service monthly rates, prorated for partial months. Travel time will be utilized to pay for transportation on Medicaid cases outside of Savio's catchment area. REV. OCT 2021 5 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. Savio House Sexual Abuse Treatment Number of services offered on this Attachment C (max 5): 4 If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h 2.1i Service 2.2a SECTION 2 — Service Name(s) and Information the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. #1 Name: MultiSystemic Therapy Problem Sexual Behavior (MST PSB) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): MST for Problem Sexual Behaviors (MST-PSB) is an intensive, comprehensive, community- and family -based treatment modality aimed at decreasing juvenile sex offending and effectively reintegrating youth into the home and community. MST-PSB incorporates evidence -based intervention techniques and utilizes an intensive quality assurance system to support treatment fidelity. The MST-PSB model does not support or utilize any group counseling. This modality views caregivers as the key to achieving favorable clinical outcomes for their youth. To ensure their participation, caregivers are highly involved in the development and implementation of interventions. The MST-PSB model is a total behavioral health care modality that addresses all the needs of each family member. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Hours of service are based on what is clinically indicated for the family. MST PSB is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. Savio has a 20 plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model and is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. Anticipated duration of service (i.e. 3-4 months): 4-6 Months Three (3), or more, specific goals of the service (DO use bullet points): 1. Improve family functioning 2. Improve relationships with peers, school, community 3. Improve household structure Three (3), or more, specific outcomes of service: 1. Reduce problem sexual behavior 2. Improve overall functioning of youth 3. Reduce or eliminate the need for out -of -home placement Target population of the service, including age and gender: Multisystemic therapy for youth age 12 -18 with problem sexual behaviors (MST-PSB) is a family -and community -based treatment approach that is designed to promote victim safety and reduce the likelihood of future problem behaviors and criminal activity. Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No Service location — list where the service will take place (i.e. client's home, in -office, other) Family's home #2 Name: Savio Sexual Abuse Intervention (SAI) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): REV. OCT 2021 1 ATTACHMENT C - PROPOSAL The Sexual Abuse Intervention Program works with youth demonstrating problem sexual behaviors and their families to stop sexually abusive behavior and prevent its recurrence through monitoring, education and therapeutic intervention. The program utilizes a high level of supervision and involvement and emphasizes community safety and client accountability at all times. The program primarily serves adolescents who may or may not be adjudicated but are demonstrating problem sexual behaviors: The SAI program can also work with youth who are demonstrating sexuallyreactive behavior related to trauma. Clients receive services while living in the community at their homes or within out of home placement, depending on the needs of clients and their families. The program utilizes this continuum of care to offer more or less restrictive services for clients, as changes in level of care are deemed appropriate to treatment needs. 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: SAI Low 1-2 hours per week SAI Moderate 3 — 4 hours per week SAI Intensive 5 — 6 hours per week 2.2c Anticipated duration of service (i.e. 3-4 months): 6-9 Months 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Address problem sexual behaviors within a family system 2. Improve overall family functioning 3. Increase safety for all children in the home 4. Improve parental protective capacity 2.2e Three (3), or more, specific outcomes of service: 1. Reduce or Eliminate the need for out -of -home placement 2. Improve caregivers' ability to keep children safe 3. Increase family's access to support system 2.2f Target population of the service: Families with histories of problematic sexual behaviors including Intrafamilial sexual abuse, adjudication as a result of sexual abuse, lack of impulse control, lack of supervision, poor social skills, minimizing/justifying abusive behavior (sexual or otherwise). Youth age 11-18 with problem sexual behavior 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home Service #3 Name: Savio Sexual Abuse Intervention with Child Protection 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): The Sexual Abuse Intervention with Child Protection Program works with children with problem sexual behaviors and their families to stop problem sexual behaviors and prevent its recurrence through monitoring, education and trauma -based cognitive behavioral. interventions. By combining both Sexual Abuse Intervention and Child Protection services we are able to address safety and protective issue while eliminating the sexually acting out behaviors. 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (Le. 4 hours/week). If the service has levels, be specific for each level: SAI Low 1— 2 hours per week SAI Moderate 3 — 4 hours per week SAI Intensive 5 — 6 hours per week 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d 6 — 9 Months Three (3), or more, specific goals of the service (DO use bullet points): 1. Address problem sexual behaviors within a family system 2. Improve overall family functioning 3. Increase safety for all children in the home 4. Improve parental protective capacity 2.3e Three (3), or more, specific outcomes of service: 1. Reduce or Eliminate the need for out -of -home placement 2. Improve caregivers' ability to keep children safe. REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 3. Increase family's access to support system 2.3f Target population of the service: The program serves families with children four to twelve years of age. The service helps families with young children who are sexually acting out inside or outside the family system. These families typically have a history of non -protective patterns that have led to the exposure of their children to abuse, neglect and in many cases, sexual victimization. 2.3g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Family's home Service #4 Name: Informed Supervision 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): The Informed Supervision curriculum will be presented in a training format in which concepts are presented and participants have the opportunity to ask questions and receive guidance in supervising the youth under their care. The curriculum follows SOMB guidelines and helps supervisors understand the expectations for supervision as identified in the Standards and Guideline. The training helps caregivers understand potential risks and how to prevent opportunities for risky behaviors through the use of alarms, cameras and planning. 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 Hour 2.4c Anticipated duration of service (i.e. 3-4 months): 1 Episode 2.4d Three (3), or more, specific goals of the service (DO use bullet points): Provide offense specific training to caregivers of children and youth with problem sexual behaviors 2.4e Three (3), or more, specific outcomes of service: Participants will be able to understand Informed supervision concepts Participants will be able to appropriately supervise youth with problem sexual behavior 2.4f Target population of the service: Families with children and youth who are expressing problematic sexualized behaviors. 2.4g Languages service is available in (please list proficiency and if interpreter services are available): English 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service location — list where the service will take place (i.e. client's home, in -office, other) Families' home or office Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part REV. OCT 2021 3 ATTACHMENT C - PROPOSAL 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 3.2 3.3 3.4 3.5 Section 3 — Service Access and Will you charge Weld County for transporting clients or mileage? Check Will you conduct services in a client's home or in the community? Check Transportation YES YES NO one: • ►I NO one: @ ■ NO Miles Will you transport clients to and/or from services? Check one: ►I YES ■ How many miles are you willing to travel round trip? List a specific miles. When you calculate mileage, what is your starting point address? number of 30 Starting point is the home office of the assigned staff to the client's home or place of service (kinship, foster care) SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: 4.1a In-Office/Video: 4.1b In -Office with Transportation: In -Home or Community: 4.1c FTM, TDM, Prof. Staffing: 4.1d No show: 4.1e Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.2 Hourly Service #2 Name: 4.2a In-Office/Video: 4.2b In -Office with Transportation: 4.2c In -Home or Community: 4.2d FTM, TDM, Prof. Staffing: 4.2e No show: 4.2f Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles 4.3 Hourly Service #3 Name: 4.3a In-Office/Video: 4.3b In -Office with Transportation: 4.3c In -Home or Community: 4.3d FTM, TDM, Prof. Staffing: 4.3e No show: 4.3f Mileage rate: $ Amount Unit Type per Hour per Hour per Hour per Hour per No Show per Mile No. of roundtrip miles included in rate: No. of roundtrip miles included in rate: This is paid after the miles listed above. miles miles REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a MST PSB $2796 MST PSB is an evidence -based model that delivers the level of service clinically indicated for each family. Typically, intensive level of service at the beginning with low levels as the family begins to successfully use skills. 4.6b SAI or SAI CP Low $1170 1- 2 4.6c SAI or SAI CP Moderate $1712 3 — 4 4.6d SAI or SAI CP Intensive $2177 5 — 6 4.6e Informed Supervision $300 Episode 4.6f Spanish Modifier $100 Per auth 4.6g Outside of catchment area $500 Per auth 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: The fee for service for MST PSB is based on ensuring the family receives the clinically appropriate level of service. This is different than other services. MST PSB is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. Savio has a 20 plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The fee for services covers the delivery of the model and is not based on set hours of service. Savio has updated the SAI rates and minimum hours for levels; therefore comparing rates from last bid this bid are not equal. The goal is to have clearer levels of service. It is anticipated that families will move from higher levels of service to lower as the case progresses. These services are also provided by a Master's level. clinician. For Bachelor level services, please see Life Skills Family Coaching and Skill Building. Savio is always willing to negotiate the levels with the county to ensure the best fit for families. REV. OCT 2021 5 ATTACHMENT C - PROPOSAL The modifiers will be added to the base rate authorizations by Weld County Department of Human Services based on family need. All rates are fee for service monthly rates, prorated for partial months. Travel time will be utilized to pay for transportation on Medicaid cases outside of Savio's catchment area. REV. OCT 2021 6 ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. Savio House Substance Abuse Treatment Services Number of services offered on this Attachment C (max 5): 2 If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h 2.1i Service 2.2a SECTION 2 - Service Name(s) and Information the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. #1 Name: MultiSystemic Therapy Contingency Management (MST CM) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Multisystemic Therapy -Contingency Management (MST -CM) is an adaptation of Multisystemic Therapy that was developed in order to offer a model specifically focused on addressing substance abuse problems. MST -CM builds upon the'"standard" MST model, which is used to treat serious juvenile offenders, by including a contingency management, protocol and focusing treatment more specifically on the youth's substance use in cases where such an approach is warranted. MST -CM includes as standard certain treatment protocols to address youth substance use, such as functional analysis of the substance use, self -management plans to help the youth avoid substance use, teaching of drug refusal skills, providing. incentives or rewards for not using drugs, and random drug screens. Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time., overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: Hours of service are based on what is clinically indicated for the family. MST CM is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. Savio has a 20 plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The model and is not based on set hours of service, rather the family is given the level of service clinically indicated each week. Typically, services are more intensive at the beginning and reduce to lower levels as the family works on generalization of skills. Anticipated duration of service (i.e. 3-4 months): 3 - 5 months Three (3), or more, specific goals of the service (DO use bullet points): 1. Decrease or eliminate youth's substance use 2. Improve structure within the home 3. Improve parental capacity to set limits Three (3), or more, specific outcomes of service: 1. Eliminate the need for out -of -home placement 2. Reduce or eliminate youth's involvement with juvenile justice 3. Reduce youth's delinquency recividism Target population of the service, including age and gender: MST -CM is intended for youth ages 12-17 that present with chronic or severe delinquent behavior and are also abusing drugs and alcohol. Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: No Service location — list where the service will take place (i.e. client's home, in -office, other) Family's home #2 Name: Functional Family Therapy Contingency Management (FFT CM) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): REV. OCT 2021 1 ATTACHMENT C - PROPOSAL FFT-CM is an enhancement of FFT aimed to specifically reduce substance use among adolescents and family members and to sustain sobriety. This model continues to focus on other risk factors or referring behaviors to the substance use. 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1 session per week 2.2c Anticipated duration of service (i.e. 3-4 months): 12— 20 sessions 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Decrease or eliminate youth's substance use 2. Improve structure within the home 3. Improve parental capacity to set limits 2.2e Three (3), or more, specific outcomes of service: 1. Eliminate the need for out -of -home placement 2. Reduce or eliminate youth's involvement with juvenile justice 3. Reduce youth's delinquency recidivism 2.2f Target population of the service: Adolescents between the ages of 12-18, with negative behaviors that appear to be rooted in the relational dynamics of the family system • Substance abuse within family (caregiver or youth) in addition to the referral behaviors for FFT • Runaway behaviors • Defiance and verbal aggression • Physical aggression with people and property • Delinquency and truancy charges • Substance use • Poor school performance • Self -harming behaviors • Most mental health/behavioral disorder 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish (Call for availability) 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Family's home Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) REV. OCT 2021 2 ATTACHMENT C - PROPOSAL Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #5 Name: 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) Section 3 — Service Access and 3.1 Will you charge Weld County for transporting clients or mileage? Check 3.2 Will you conduct services in a client's home or in the community? 3.3 Will you transport clients to and/or from services? Check one: Transportation one: Check one: 0 YES • 0 YES YES • NO e • NO NO 3.4 How many miles are you willing to travel round trip? List a specific number of miles. 30 Miles 3.5 When you calculate mileage, what is your starting point address? Starting point is the home office of the assigned staff to the client's home or place of service (kinship, foster care) REV. OCT 2021 3 ATTACHMENT C - PROPOSAL SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: $ Amount Unit Type 4.1a In-Office/Video: per Hour 4.1b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: per Hour 4.1d No show: per No Show 4.1e Mileage rate: per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: per Hour 4.2b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show 4.5f Mileage rate: per Mile This is paid after the miles listed above. REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a MST CM - $2554 MST CM is an evidence -based model that delivers the level of service clinically indicated for each family. Typically, intensive level of service at the beginning withlow levels as the family begins to successfully use skills. 4.6b FFT CM $1250 1 session per week 4.6c Spanish Modifier 100 Per auth 4.6d Outside of catchment modifier 500 Per auth. 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: The fee for service for MST CM is based on ensuring the family receives the clinically appropriate level of service. This is different than other services. MST CM is a highly supervised, evidence -based model with internal and external experts who direct service levels and treatment throughout to ensure the most effective, sustainable outcomes. Savio has a 20 plus year history of delivering MST with high fidelity that produces sustainable positive outcomes for families served. The fee for services covers the delivery of the model and is not based on set hours of service. The modifiers will be added to the base rate authorizations by Weld County Department of Human Services based on family need. All rates are fee for service monthly rates, prorated for partial months. REV. OCT 2021 s ATTACHMENT C - PROPOSAL Please type your answers in the boxes below or check the appropriate box. SECTION 1— Provider and Program Area Information Bidder's Legal Name: Program Area: Program Areas are listed in column 1 of the table located in Item XI of the Request You may complete another Attachment C if you have more than 5. for Proposal starting on page 13. Savio House Functional Family Therapy Number of services offered on this Attachment C (max 5): 2 If Service 2.1a 2.1b 2.1c 2.1d 2.1e 2.1f 2.1g 2.1h 2.1i Service 2.2a SECTION 2 — Service Name(s) and Information the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. #1 Name: Functional Family Therapy Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Functional Family Therapy is an evidenced -based family therapy model designed to reduce or eliminate problem behaviors by modifying the family relationships that support those behaviors. The three phases of the model include Engagement and Motivation, Behavior Change and Generalization Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1-1.5 Hours per week (1 family therapy session) Anticipated duration of service (i.e. 3-4 months): 3 — 6 months Three (3), or more, specific goals of the service (DO use bullet points): 1. Target chronic, violent or substance abusing juvenile offenders ages 12 —18 2. Establish household structure 3. Increase monitoring and supervision 4. Set clear rules and consequences for the youth Three (3), or more, specific outcomes of service: 1. Reduce or eliminate the need for out -of -home placement 2. Improve family functioning 3. Reduce parent -child conflict Target population of the service, including age and gender: Youth age 12 -18 and their families demonstrating maladaptive behaviors including truancy, violence, parent -child conflict Youth who have had previous or current episodes of abuse or neglect and youth facing out -of -home placement or are reunifying home. Languages service is available in (please list proficiency and if interpreter services are available): English, Spanish (call for availability) Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes Service location — list where the service will take place (i.e. client's home, in -office, other) Client's homes #2 Name: Functional Family Therapy Gang (FFT G) Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): FFT-G®is a family intervention designed to help youth that are gang -involved or at risk for becoming gang involved. FFT-G® utilizes the core Functional Family Therapy model and has been shown to work with gang -involved or, atrisk youth. Like FFT, FFT-G® is effective because it specifically targets risk factors relevant to gang -involved youth(conflictual family relationships, antisocial behaviors, impulsivity, substance use, lack of supervision). Treatment is intensive, and all sessions are conducted in the family home or at a location convenient to the youth and family. Family is defined broadly to include individuals that are important to the youth, which may include other members of the youth's gang. FFT-G® works closely with community partners to support the intervention REV. OCT 2021 1 ATTACHMENT C - PROPOSAL and help youth and families meet their individual and family goals. FFT-G® has demonstrated significant recidivism reductions for drug charges, adjudicated delinquency, property charges, along with reductions in arrests (felony and crimes against persons). 2.2b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 1— 1.5 Hours per week (1 family therapy session) 2.2c Anticipated duration of service (i.e. 3-4 months): 3 6 Months 2.2d Three (3), or more, specific goals of the service (DO use bullet points): 1. Target chronic, violent or substance abusing juvenile offenders ages 12 —18 2. Establish household structure 3. Increase monitoring and supervision 4. Set clear rules and consequences for the youth 2.2e Three (3), or more, specific outcomes of service: 1. Reduce or eliminate substance use for the adolescent 2. Reduce or eliminate the need for out -of -home placement 3. Improve family functioning 4. Reduce parent -child conflict 2.2f Target population of the service: Who is eligible for FFT-G Youth and adolescents age 11-18 who are: currently gang involved, at risk of becoming involved, youth associated/affiliated with a gang, families with intergenerational gang involvement. must have at least one family member willing to participate. 2.2g Languages service is available in (please list proficiency and if interpreter services are available): English Spanish 2.2h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Yes 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Client's home Service #3 Name: 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.3b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.3c Anticipated duration of service (i.e. 3-4 months): 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 2.3e Three (3), or more, specific outcomes of service: 2.3f Target population of the service: 2.3g Languages service is available in (please list proficiency and if interpreter services are available): 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Service #4 Name: 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.4b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.4c Anticipated duration of service (i.e. 3-4 months): 2.4d Three (3), or more, specific goals of the service (DO use bullet points): 2.4e Three (3), or more, specific outcomes of service: 2.4f Target population of the service: 2.4g Languages service is available in (please list proficiency and if interpreter services are available): 2.4h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: 2.4i Service 2.5a Service location — list where the service will take place (i.e. client's home, in -office, other) #5 Name: Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): 2.5b Anticipated frequency of direct service time with the client/family per week, not including professional staffing time, administrative time, overhead, or travel time (i.e. 4 hours/week). If the service has levels, be specific for each level: 2.5c Anticipated duration of service (i.e. 3-4 months): 2.5d Three (3), or more, specific goals of the service (DO use bullet points): 2.5e Three (3), or more, specific outcomes of service: 2.5f Target population of the service: 2.5g Languages service is available in (please list proficiency and if interpreter services are available): 2.5h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part 2.6i Service location — list where the service will take place (i.e. client's home, in -office, other) 3.1 3.2 3.3 3.4 3.5 Section 3 — Service Access and Will you charge Weld County for transporting clients or mileage? Check Will you conduct services in a client's home or in the community? Check Transportation YES only to cover mileage for Medicaid cases outside Savio's catchment area YES NO one: ►5 • NO one: 0 ■ NO Miles Will you transport clients to and/or from services? Check one: ►5 YES ■ How many miles are you willing to travel round trip? List a specific miles. When you calculate mileage, what is your starting point address? number of 30 Starting point is the home office of the assigned staff to the client's home or place of service (kinship, foster care) REV. OCT 2021 3 ATTACHMENT C - PROPOSAL SECTION 4 - SERVICE RATES All rates need to include administrative work (i.e. scheduling or report writing) and overhead. Rates cannot be per episode, except for home studies and monitored sobriety testing. Only hourly or monthly rates will be accepted for services, except for those listed above. • For hourly rates complete section(s) 4.1-4.5. • For monthly rates complete section 4.6. • For Home study providers complete section 4.7. • For monitored sobriety testing providers complete section 4.8. 4.1 Hourly Service #1 Name: $ Amount Unit Type 4.1a In-Office/Video: per Hour 4.1b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.1c FTM, TDM, Prof. Staffing: per Hour 4.1d No show: per No Show 4.1e Mileage rate: per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: $ Amount Unit Type 4.2a In-Office/Video: per Hour 4.2b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: per Hour 4.2e No show: per No Show 4.2f Mileage rate: per Mile This is paid after the miles listed above. 4.3 Hourly Service #3 Name: $ Amount Unit Type 4.3a In-Office/Video: per Hour 4.3b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.3d FTM, TDM, Prof. Staffing: per Hour 4.3e No show: per No Show 4.3f Mileage rate: per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: $ Amount Unit Type 4.4a In-Office/Video: per Hour 4.4b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: $ Amount Unit Type 4.5a In-Office/Video: per Hour 4.5b In -Office with Transportation: per Hour No. of roundtrip miles included in rate: miles 4.5c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.5d FTM, TDM, Prof. Staffing: per Hour 4.5e No show: per No Show REV. OCT 2021 4 ATTACHMENT C - PROPOSAL 4.5f Mileage rate: per Mile This is paid after the miles listed above. 4.6 Monthly Service Rates (each level must be listed): Service Name with Level Rate per Month No. of Direct Service Hours: 4.6a Functional family Therapy (FFT) $1250 1 session pre week 4.6b Functional Family Therapy Gang (FFT G) $1400 1 session pre week 4.6c Services for families in Spanish Modifier $100 Per auth 4.6d Extended area Modifier (31 or more miles) $500 Per auth 4.6e Drive time for Medicaid cases outside of Savio's catchment $50 Per hour 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. 4.8 Monitored Sobriety Providers — List your rates in the box below. Provider special notes: The modifiers will be added to the base rate authorizations by Weld County Department of Human Services based on family need. All rates are fee for service monthly rates, prorated for partial months. Travel time will be utilized to pay for transportation on Medicaid cases outside of Savio's catchment area. REV. OCT 2021 s ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Julia L. Roguski Savio House PHONE NUMBER: 303.225.4200 EMAIL:]roguski@saviohouse.org PROPOSED SERVICE(S): 1. Functional Family Therapy 2. Home -Based Interventions 3. Kinship (Therapeutic) 4. Life Skills 5. Mental Health Services 6. MultiSystemic Therapy 7. Sexual Abuse Treatment 8. Substance Abuse Treatment ega La tMarne Middle Initial`applicable) Pv Legal Last' Legal First Name Service Type L"censure/ Credentials D( RA # elf applicable) Pantaleo Michael Trauma Serivces LCSW 09924205 Roguski Julia Associate Executive Director LPC 2989 Chaparro Rucobo Judith Child First Clinician LPCC pending Joyer Jeanette Bi Lingual Trauma Therapist SWC 281 Avilez Ximena Child First FSP NA Deanda Martha Child First FSP NA Doner Elizabeth Coordinator LPC 11414 Martinez Kenneth Supervisor Register Psychotherapist 11670 Thorsen Taylore Child First Clinician LPCC 18917 Valez LaDaiju Child First Clinician CSWC 346 Aikoriegie Angelique Child First FSP NA Crowe Kevin Child First FSP NA Redwine Chari Child First Supervisor LPC 16714 Riley Lakeisha Coordinator PhD SW pending Rodrigues Desiree Supervisor LPC 13877 Hanson Kate Supervisor LPCC 17876 Stephens Molly Team Leader NA Bacca Matthew Family Coach NA Ball Christy Trauma Therapist LPCC 16789 Diltz Derez CP Therapist Provisional SW pending Ford Susan CP Therapist Registered Psychotherapist 105657 CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Julia L. Roguski Savio House PHONE NUMBER: 303.225.4200 EMAIL: jroguski@saviohouse.org PROPOSED SERVICE(S): 1. Functional Family Therapy 2. Home -Based Interventions 3. Kinship (Therapeutic) 4. Life Skills 5. Mental Health Services 6. MultiSystemic Therapy 7. Sexual Abuse Treatment 8. Substance Abuse Treatment Legal Last Name Middle * Initial : Previous Legal last Name (If applicable) Legal First Name Service Type Licensure/ Credentials DORA # (If applicable) Liguori Gabriella Trauma Therapist CSWC 179 Looby Amelia CP Therapist LSW 9923536 Lukosi Sarah CP Therapist CSWC 282 McCarter Owen Coach NA Naugle Rebecca CP Therapist CSWC 157 Stafford Carolina Trauma Therapist LCSW 9926976 Talkington Molly CP Therapist SWC 594 Wagnaar Jeffery CP Therapist SWC 556 Watt Cara CP Therapist CSWC 326 Deherrera Nicole Coordinator LCSW 326 Molinari Megan CBS Worker NA Uwudia Nneka CBS Worker NA Weinstein Lauren CBS Worker NA Bell Kirsten Coach NA Diaz Jennifer Coach NA Figueroa Monserat Coach NA Lacheta Shannon Coach NA Mason Stephen Coach NA Phillips Robert Coach NA Fitzpatrick Stacey FFT Supervisor LCSW 9926180 Colangelo Anastasia FFT Therapist MFT 1530 CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Julia Roguski Savio House PHONE NUMBER: 303.225.4200 EMAIL: jroguski@saviohouse.org PROPOSED SERVICE(S): 1. Functional Family Therapy 2. Home -Based Interventions 3. Kinship (Therapeutic) 4. Life Skills 5. Mental Health Services 6. MultiSystemic Therapy 7. Sexual Abuse Treatment 8. Substance Abuse Treatment Legal Last Name Middle Initial Previous Legal Last Name (If applicable) Legal First Name , Service Type . Licensure/ Credentials ` DORA # If applicable) Wickstrom Kaitlin FFT Therapist LPCC 17968 Boffa-Schmidt Cynthia FFT Therapist SWC 530 Bush Tanya FFT Therapist LSW 9922849 Clough Gait FFT Therapist LSW 9923829 Maldonado Julie FFT Therapist Provisional SW pending Morris Kelly FFT Therapist Registered Psychotherapist 11735 Copelin Jauqueline FFT G therapist SWC 114 Daise Vanissa FFT G Therapist SWC pending Fiedler Courtney Coordinator LPC 6320 Brettell Holly MST PSB Therapist SWC pending Cadena Gabriella MST PSB Therapist LSW 9923715 Brown Julie Supervisor LCSW 2118 Denson Emma MST Supervisor LPCC 18717 Lay Kristy MST Supervisor MFTC 13952 Twiehaus Erin MST Supervisor LCSW 9926872 Ornelas Melissa Team Leader Registered Psychotherapist 11648 Savoy Michelle MST Team Leader Registered Psychotherapist 109815 Woods Rachel MST Team Leader LSW 9922698 Able Alex MST Therapist LSW 9923457 Brooks Holly MST Therapist SWC pending Gutowski Amiee MST therapist LSW 992338 CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Julia L. Roguski Savio House PHONE NUMBER: 303.225.4200 EMAIL: jroguski@saviohouse.org PROPOSED SERVICE(S): 1. Functional Family Therapy 2. Home -Based Interventions 3. Kinship (Therapeutic) 4. Life Skills 5. Mental Health Services 6. MultiSystemic Therapy 7. Sexual Abuse Treatment 8. Substance Abuse Treatment e al Last Name ' Middle Initial Previous Legai Last. Name (If applicable) ; Legal Filrst Name Serki a T�tp i:icensut<e/ Cred ntiais DQttA # (If`api li ble Lamure Dana MST Therapist LPCC 19190 McNulla Allison MST Therapist SWC 428 Morales Jeremy MST Therapist LSW 9922422 Newton Sue MST Therapist Registered Psychotherapist pending Paul Caren MST Therapist MFTC 14219 Sheridan Chelsea MST Therapist LCSW 9927827 Surratt Cameron MST Therapist SWC 491 Uilk Madion MST Therapist LPCC pending Wayant Steve MST Therapist SWC 523 West Brook MST Therapist SWC pending White Vicki MST Therapist ADDC 184 Anguiano Pimental Elizabeth MST Therapist Registered Psychotherapist 105109 Cline Whitney MST Therapist MFTC 13986 Ross Olivai MST Therapist Registered Psychotherapist 109573 Calkins Haley Supervisor LSW 9923925 Smartt Cassie MST PSB SWC 524 Abercrombie Pat SAI SWC pending Spinello Jamie SAI Team Leader LSCW 9926711 Baydush David SAI SWC 9927603 Ebertz Michelle SAI LPCC 389 Hacker Jennifer SAI LPCC 18794 CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES ATTACHMENT D - STAFF DATA SHEET Bidder Must List All Staff Who Will Administer the Proposed Service(s) BIDDER'S LEGAL NAME (As it appears on the W-9): AGENCY CONTACT: Julia L. Roguski Savio House PHONE NUMBER: 303.225.4200 EMAIL: jroguski@saviohouse.org PROPOSED SERVICE(S): 1. Functional Family Therapy 2. Home -Based Interventions 3. Kinship (Therapeutic) 4. Life Skills 5. Mental Health Services 6. MultiSystemic Therapy 7. Sexual Abuse Treatment 8. Substance Abuse Treatment Previo Name (If applicable)' Lane Colin SAI LCSW 9924088 Lidstrom Jordan SAI' LPCC 1559 Picht Alexandra SAI SWC 605 Reasons Roni SAI LCSW 9927569 Yarian Brenna SAI LSW 9923989 Rubens Lindsey SAI LPC 14657 CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES PINNIACOL ASSURANCE 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com Savio House Inc dba Savio House 325 King St Attn: Accounting Dept Denver, CO 80219-1326 ENDORSEMENT: Waiver Of Subrogation NCCI #: WC000313 Policy #: 984642 Associates Insurance Group 7395 E. Orchard Rd. Greenwood Village, CO 80111 (303) 793-3388 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Weld County 1150O St Greeley, CO 80631-9596 Effective Date: January 19, 2022 Pinnacol Assurance has issued this endorsement January 19, 2022 Page 1 of 3 P egille@workcompnow.com - 7501 E. Lowry Blvd Denver, CO 80230-7006 01/19/2022 16:48:10 984642 59232086 UW137 i 1 ® ACc Ro CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYW) 01/19/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Pinnacol Assurance 7501 E. Lowry Blvd. Denver, CO 80230-7006 CONTACT NAME: PHONE I FAX A/ c.ILo, Ext): (A/C, No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Pinnacol Assurance 41190 INSURED Savio House Inc dba Savio House 325 King St Attn: Accounting Dept Denver, CO 80219-1326 INSURER B : INSURER C : INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE $ TO PREMISES (Ea occu RENTED $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ $ $ GENERAL AGGREGATE PRODUCTS - COMP/OP AGG GEN'L AGGREGATE LIMIT APPLIES PER: LOC $ AUTOMOBILE 'I LIABIUTY ANY AUTO OWNED SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED J RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ECUTIVE A OFF CEO/MEMBER EXCLUDED?N (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below Y / N / A 984642 05/01/2021 05/01/2022 X STATUTE 0TH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Unless otherwise stated in the policy provisions, coverage in Colorado only. CERTIFICATE HOLDER CANCELLATION 2227045 Weld County 1150O St Greeley, CO 80631-9596 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Associates Insurance Group ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORDs provided by Forms Boss. www.FormsBoss.com; (c) Impressive Publishing 800-208-1977 CERTIFICATE HOLDER COPY Weld County 1150 O St Greeley, CO 80631-9596 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT (CONT) Contract Form New Contract Request Entity Information Entity Name* SAVIO HOUSE Contract Name* Entity ID* gO0035730 LI New Entity? Contract ID SAVIO HOUSE (NEW CHILD PROTECTION AGREEMENT) 5847 Contract Status CTB REVIEW Contract Lead'* APEGG Contract Lead Email apegg iweldgov.com;cobbx xlk' weldgov.com Contract Description* CONSENT BID# B2200040 TERM: JUNE 1, 2022 THROUGH MAY 31, 2023 Parent Contract ID 20220410 Requires Board Approval YES Department Project # Contract Description 2 PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESNETED TO THE BOCC ON 04.06 22 AND AS A COMMUNICATION ITEM/PA SENT TO CTB ON 05:10 2022. Contract Type* AGREEMENT Amount* $0.00 Renewable* YES Automatic Renewal Grant !GA Department HUMAN SERVICES Department Email CM- HurnanServices@weldgov.co m Department Head Email CM-HumanServices- DeptHead''wveldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTORN EY.TWELDG OV.COM If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Requested BOCC Agenda Date* 05 08 2022 Due Date 06 .' 04 : 2022 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Purchasing Approver CONSENT Approval Process Department Head JAMIE ULRICH DH Approved Date 05?20,'2022 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05 25 2022 Originator APEGG Review Date* 03 31 2023 Committed Delivery Date Contact Type Contact Email Finance Approver CONSENT Renewal Date* 05 31 2022 Expiration Date Contact Phone 1 Purchasing Approved Date 05/20'2022 Finance Approved Date 05120 2022 Tyler Ref # AG 052522 Legal Counsel CONSENT Contact Phone 2 Legal Counsel Approved Date 05 20,, 2022 Hello