The URL can be used to link to this page

Browse Search

Home My WebLink About20221535.tiffCbhkVa t A k 815 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND BARRY R. LINDSTROM, PHD, LLC This Agreement Amendment made and entered into t `J'' day of M1 , 2024 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 Barry R. Lindstrom, PhD., LLC, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Mental Health Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-1535, approved on June 6, 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, and 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 2022-1535. • 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. C6' aw8s,(4s--0) Conwvl+ I09ev,ds. 5//07,74- 20Z2-1535 5Asi24 HV-oogy IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: '-�' "° `id'‘A BOARD OF COUNTY COMMISSIONERS lerk to the Boar WELD CO O BY: Deputy Kevin D. Ross, Chair MAY 1 5 2024 ONTRACTOR: Barry R. Lindstrom, Ph.D., LLC 8217 West 20th Street, Suite A Greeley, Colorado 80634 (970) 356-3100 E;i-i- �' Lrno�ftnot�t By: BA,R Lin trom(May 1, 202413:56 MDT) Barry R. Lindstrom, Ph.D., Licensed Psychologist May 1, 2024 Date: 2022-IS35 SIGNATURE REQUESTED: Weld/Lindstrom, Barry R. PhD, LLC Amendment #2 Final Audit Report 2024-05-01 Created: 2024-05-01 By: Windy Luna (wluna@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAAoXpC6PfO09Yuhwb2XRLF001 mXGuai1 Wt "SIGNATURE REQUESTED: Weld/Lindstrom, Barry R. PhD, LL C Amendment #2" History 5 Document created by Windy Luna (wluna@weld.gov) 2024-05-01 - 5:14:33 PM GMT- IP address: 204.133.39.9 El Document emailed to barry.Iindstrom@pathways-wellness.com for signature 2024-05-01 - 5:15:12 PM GMT ,5 Email viewed by barry.lindstrom@pathways-wellness.com 2024-05-01 - 7:56:04 PM GMT- IP address: 104.47.58.126 4 Signer barry.lindstrom@pathways-wellness.com entered name at signing as BArry R Lindstrom 2024-05-01 - 7:56:49 PM GMT- IP address: 71.218.39.191 4 Document e -signed by BArry R Lindstrom (barry.lindstrom@pathways-wellness.com) Signature Date: 2024-05-01 - 7:56:51 PM GMT - Time Source: server- IP address: 71.218.39.191 0 Agreement completed. 2024-05-01 - 7:56:51 PM GMT Powered by Adobe Acrobat Sign Contract Form Entity Information Entity Name * LINDSTROM, BARRY Entity ID* @00000891 Contract Name * LINDSTROM, BARRY (PROFESSIONAL SERVICES AGREEMENT AMENDMENT #2. RELATED TO BID #B2200040) Contract Status CTB REVIEW Contract ID 8145 Contract Lead * WLUNA Q New Entity? Parent Contract ID 20221535 Requires Board Approval YES Contract Lead Email Department Project # wluna@weldgov.com;cob bxxlk@weldgov.com Contract Description* (CONSENT) LINDSTROM, BARRY (PROFESSIONAL SERVICES AGREEMENT AMENDMENT #2. RELATED TO BID #B2200040). TERM: 6/1/24 THROUGH 5/31 /25. Contract Description 2 PROVIDER WAS LISTED ON APPROVED VENDOR LIST PRESENTED TO THE BOCC ON ORIGINALLY ON 04/6/22, AND AMENDED 6/13/22. Contract Type* AMENDMENT Amount* $0.00 Renewable* NO Automatic Renewal Grant IGA Department Requested BOCC Agenda Due Date HUMAN SERVICES Date* 05/11/2024 05/15/2024 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 EY@WEL DGOV.COM 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 05/09/2024 Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 05/09/2024 05/09/2024 05/09/2024 Final Approval BOCC Approved Tyler Ref # AG 051524 BOCC Signed Date Originator WLUNA BOCC Agenda Date 05/15/2024 Conkvac Ite(oR20 Con da-- 5/SI 23 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 Barry R. Lindstrom, Ph.D., LLC. 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 Barry, R. Lindstrom, Ph.D., LLC. The Department has art Agreement with Barry R. Lindstrom, Ph.D., LLC for Mental Health Services. This Agreement is known to the Board as Tyler 1D# 2022-1535. The agreement is now being amended to renew for a second year, for the period June I, 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 (IISAC) 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. Program Ores Mental Health Ralc i sunny 1:nc , $425 00 Hour Evaluation Services: In -Home or Communi $425.00 Hour Evaluation Services: In-Office/Video $200.00 Hour Evaluation Services: Team Meeting (FTM), Team Decision Making (TDM) Meeting. Professional Staffing $100.00 Each Evaluation Services: No Show (Man of 2 no shows or 2 hours/month/client) $0.50 Mile Evaluation Services: Milgge* $250.00 Hour Case Consultation for Caseworkers and Foster Parents: In -Home or Community $250.00 Hour Case Consultation for Caseworkers and Foster Parents: In-Office/Video $200.00 Hour Case Consultation for Caseworkers & Foster Parents: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each Case Consultation for Caseworkers and Foster Parents: No Show (Max of 2 no shows or 2 hours/month/clientL_ $0.50 Mile Case Consultation for Caseworkers and Foster Parents: Mileage* I $250.00 Hour Inservice Training for Caseworkers and Foster Parents: in or Community Pass -Around Memorandum; May 2, 2023 CMS ID 6920 6C Ofi,80-42-0$9 4iS/25 Page I 2622-155 PRIVILEGED AND CONFIDENTIAL I do not recommend a Work Session. I recommend approval of this Agreement Amendment # I and authorize the Chair to sign. rove Recommendation Perry L. Buck, Fro-Tem Mike Freeman, Chair Scott K. James Kevin Ross Lori Saine Schedule Work Session Other/Comments: Pass -Around Memorandum; May 2, 2023 - CMS ID 6920 Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND BARRY R. LINDSTROM, PHD, LLC n This Agreement Amendment, made and entered into U day of 1" 1 p , 2023, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereiilzfter referred to as the "Department", and Barry R. Lindstrom, Ph.D., LLC, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Mental Health Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2022-1535, approved on June 6, 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 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 Child Protection 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. BY: COUNTY: BOARD OF COUNTY COMMISSIONERS to the Boar WELD COUNTY, COLORADO Mike Freeman, Chair MAY 0 8 2323 NTRACTOR: arry R. Lindstrom, Ph.D., LLC 217 West 20`h Street, Suite A Greeley, Colorado 80634 (970) 356-3100 By: Barry RLi dslrom, PhD (Apr 24, 202311 01 MDT) Barry R. Lindstrom, Ph.D., Licensed Psychologist Apr 24, 2023 Date: c20024,2 EXHIBIT A SCOPE OF SERVICES Contractor wil provide Mental Health Services, as referred by the Department. I. Evaluation Services a Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Individual Psychological Evaluations provide intellectual and diagnostic assessment and treatment recommendations. Specific referrals for intellectual and adaptive behavior assessment for disability determination are also accepted. Individual Psychological Evaluations will address referral questions regarding client's diagnoses and their impact on attachment and parenting, placement and visitation needs, and treatment recommendations. Services do not include Psychosexual or Sexual Offender evaluations. ii. Evaluations will include Interviews to obtain relevant psychosocial history and mental status evaluation, and Psychological Testing: I. Adults: Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function, Adult Version (BRIEF -A; Self -Report and Informant forms as indicated); Minnesota Multiphasic Personality Inventory -3 (MMPI-3); Millon Clinical Multiaxial Inventory -IV (MCMI-IV); Personality Assessment Inventory (PAI); Vineland Adaptive Behavior Scales - Third Edition (Vineland -3) or Adaptive Behavior Assessment System (Second Edition, ABAS-II) if needed for determination of intellectual or developmental disability; *Beck Depression Inventory, Beck Anxiety Inventory, Penn Inventory for PTSD, Adult Self -Report Scale (for ADHD), Stressful Life Events Questionnaire, Mood Disorder Questionnaire, Rotter Incomplete Sentences. 2. Children and Adolescents: Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function (BRIEF, Self -Report, Parent and Teacher forms as indicated); Minnesota Multiphasic Personality Inventory for Adolescents -Restructured Format (MMPI-A-RF); Millon Adolescent or Pre- Adolescent Clinical Inventory, (MACI, M- PACI); Behavioral Assessment System for Children -3rd Edition (BASC-3) completed by the child, parents, foster parents, and teachers; Conners Rating scales, developmental history forms and other non -standardized behavioral assessments completed by parents, foster parents, and teachers; Vineland Adaptive Behavior Scales -Third Edition (Vineland - 3; Caregiver and Educator forms). iii. Mental Health Assessments are a brief assessment of an individual's mental health functioning to answer diagnostic questions outlined by the Department and to provide treatment recommendations. Mental Health Assessments will include a review of Weld County Department of Human Services (WCDHS) social history and family service plans, but limited outside collateral information. Psychological screening instruments (listed above) will be completed, but no formal psychological testing. If psychological testing is indicated, further Psychological Evaluation will be recommended and completed if approved. iv. Family (Interactional) evaluations are provided as Parent -Child Interactional (PCI) or Sibling Interactional evaluations. PCI evaluations can include birth, adoptive and foster parents, and kinship providers as referred. Interactional evaluations will address referral questions regarding clients' diagnoses; attachment and interaction patterns; placement and visitation needs; and treatment recommendations. Family Evaluations can also assess level and intensity of visitation, including issues related to visitation between children and their incarcerated parents. v. Interactional evaluations will address the relative contribution of the multiple factors related to the child(ren), the parent(s), and their interaction and attachment patterns that led to the Department's involvement, and identify any systemic factors that may contribute or need further assessment (e.g., criminal or domestic relations cases, secondary gain, multigenerational factors). 1 As such, interactional evaluations include a brief mental health assessment of each individual in addition to an assessment of family interaction patterns and attachment behaviors. vi. Interactional evaluations will typically include: 1. Individual interviews with each referred family member to obtain relevant psychosocial history and mental status; Conjoint interviews with all family members (including marital, parent -child, and sibling subsystems); and 2. Conjoint interview / consultation with child and current caregivers (e.g., foster parent, kinship, relative) if child is in out of home placement at the time of evaluation. And, 3. Psychological Screening/Testing: 4. Adults: Millon Clinical Multiaxial Inventory -IV (MCMI-IV) and/or Minnesota Multiphasic Personality Inventory -3- (MMPI-3) as indicated and screening instruments*. 5. Children and Adolescents: BASC-3 completed by the child, parents, foster parents, and teachers; Conners Rating scales; developmental history forms and other non - standardized behavioral assessments. vii. NOTE: Family (interactional) evaluations can be provided for families with both Dependency and Neglect and Domestic Relations (divorce) cases. Referrals for such evaluations that include an Interactional Assessment (PCI) with each parent and psychological testing, would allow for findings and recommendations to the Department regarding the additional factors that typically present with these "cross -over" or hybrid cases (e.g., allegations of alienation vs abuse). viii. b. Anticipated Frequency of Services: i. Direct service time is per evaluation. ii. Individual Psychological Evaluations will typically include: 1. Interviews to obtain relevant psychosocial history and mental status evaluation one (1) to three (3) hours. 2. Psychological Testing four (4) to six (6) hours. iii. Mental Health Assessments will typically include: 1. Two (2), one (1) hour interviews approximately two (2) weeks apart. iv. Family (Interactional) Evaluations will typically include: 1. Interviews (4-10 hours). 2. Individual interviews to obtain relevant psychosocial history and mental status evaluation with each family member. 3. Conjoint interviews a minimum of two (2) with all family members (including marital, parent -child, and sibling subsystems). 4. Conjoint interview/consultation with child and current caregivers (e.g., foster parent, kinship, relative) if child is in out of home placement at the time of evaluation. v. Psychological Screening/Testing: 1. Adults one (I) to two (2) hours for each party. 2. Children and Adolescents (1 hour) for each child. c. Anticipated Duration of Services: i. Evaluations are typically completed within two (2) to four (4) months. d. Goals of Services: i. Provide individual and family diagnostic evaluations to assess individual functioning, family structure, communication, and attachment relationships to assist in the development of family services plans. ii. Address referral questions regarding clients' diagnoses and their impact on attachment and parenting, placement and visitation needs, and treatment recommendations. iii. Family Evaluations can also assess and make recommendations regarding level and intensity of visitation, including issues related to visitation between children and their incarcerated parents. iv. Provide treatment recommendations in support the permanency goals established by the Court and in the child(ren)'s best interests for safety, permanence and well-being. 2 v. Offer a prognosis for change within a developmentally meaningful timeframe. vi. Provide consultation to caseworker. Outcomes of Services: i. A final diagnostic feedback session is offered to the client as part of each evaluation to discuss psychological test results, and the observations, findings, and recommendations of the evaluation. ii. A written report will be provided for all evaluations summarizing the CORE Services referral questions; brief case and social history; evaluation course, methods and procedures; assessment findings; collateral contacts; limitations; analysis; and conclusions and recommendations for visitation, treatment, medication evaluations or further psychological evaluation. Evaluations will include a review of WCDHS social history, family services plans and case records; consultation with collateral sources; previous evaluations and treatment records. Evaluation reports will address strengths and protective factors as well as risk factors or problems related to the child's Safety, Permanence, and Well Being. Incomplete evaluations will be documented in writing to the extent possible, outlining the limitations and impact of any missing information. iii. Case management will include regular email or telephone communication with caseworkers at the time of referral and after each appointment to update on the progress of the evaluation, discuss concerns and meet deadlines. Communication with Guardians ad Litem and treating professionals to obtain collateral information as needed. iv. All evaluations will be completed following the Guidelines for Psychological Evaluations in Child Protection Matters as published by the American Psychological Association (2013, APA -currently being revised) and the Ethical Principles of the American Psychological Association (APA). v. All evaluations will be completed in such as manner as to be able to provide consultation and expert testimony as requested. Target Population: i. All ages and gender identifications. ii. Includes child and parents, foster parents or caregivers such as kin, special respondents, intervenors, and/or siblings. Language: i. English. a. Medicaid Eligibility: i. This service is not Medicaid eligible. Service Access and Transportation: i. At Contractor's office located at the office of Pathways at 217 West 20th Street, Suite A, Greeley, Colorado 80634. Virtual appointments can also be arranged if needed. ii. Psychological evaluations can be completed with locally incarcerated clients as needed. iii. Family interviews can be coordinated for time and location with any family visitation services already in place (e.g., Family Support and Visitation Center in Greeley, or Del Camino, or with other providers) as needed to complete interactional interviews and observations for Interactional Assessments. 3 2. Case Consultation for Caseworkers and Foster Parents a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Consultation regarding specifically referred cases will be provided to caseworkers regarding assessment and treatment planning questions, case management or other questions or concerns as needed. ii. Consultation to caseworkers and foster parents in order to help foster children preserve or maintain placement in a clinically appropriate level of care, to minimize the number of changes or transitions, and to meet permanency goals. This is a brief consultation and not intended to replace formal evaluation of an individual or family. b. Anticipated Frequency of Services: i. As requested by the Department. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Address caseworkers' questions regarding a specific case or issue. ii. Review case history and records as needed. iii. Provide a letter or brief report as requested. e. Outcomes of Services: i. Answer caseworkers' questions regarding a specific case or issue. ii. Consultation can also include attendance at Clinical, Psychiatric or Educational such as Individualized Education Program (IEP) Stuffings as approved. iii. If requested, a letter or brief report can be prepared summarizing recommendations. f. Target Population: i. Any case referred by the Department. g• Language: i. English. h. Medicaid Eligibility: i. Not Medicaid eligible. i. Service Access and Transportation: i. Virtually. ii. Contractor's office located at the office of Pathways at 217 West 20th Street, Suite A, Greeley, Colorado 80634. iii. At the Department. iv. In the Foster home as needed. 3. Inservice Training for Caseworkers and Foster Parents a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. In person or virtual training or workshops for caseworkers, foster parents, Court Appointed Special Advocates (CASAs), therapists, attorneys and judicial officers as requested. b. Anticipated Frequency of Services: i. As requested by the Department. c. Anticipated Duration of Services: 4 i. Each training is one session. c. Goals of Services: i. To provide training and support for: 1. Caseworkers, supervisors, managers; 2. Foster parent; 3. CASAs, therapists, and other providers 4. Attorneys and judicial officers. Outcomes of Services: i. To provide training as requested, including the following or other topics as arranged: 1. Assessment and diagnosis; 2. Trauma, Post Traumatic Stress Disorder (PTSD), Vicarious Trauma and Compassion Fatigue; 3. Specific behavioral health diagnoses or interventions. Target Population: i. Any Department employee or provider. g. Language: i. English. Medicaid Eligibility: i. This service is not Medicaid eligible. . Service Access and Transportation: i. At the Department. ii. Virtually. iii. Other pre -determined location. Terms 1. Contractor understands and will comply with all aspects of the referral authorization, billing and tracking requ cements as set forth by the Department. Failure to comply with all aspects may result in a forfeiture of paytoert. 2. 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 Cot -tractor has received an authorized referral form from the Department. Contractor further acknowedges 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. 3. Contractor will respond to the Mental Health and Support Services Team as, CW 3erviceReferral(a,weldeov.com within three (3) business days regarding the ability to accept the rece ved referral. 4. Upoz ar ceptance of a referral, Contractor will offer an initial appointment within seven (7) days of rece ving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referat (excluding weekends and holidays). Contractor will document efforts to engage client in referred sery ce;. 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 Mental Health and Support Services Team (HS- CW ServiceReferral(a,weldgov.com). 5 5. Contractor acknowledges that any and all modifications to an existing referral must be approved through the Mental Health and Support Services Team (HS-CWServiceReferral(&,weldgov.com). No other Department staff or other party to the case may authorize services or modifications to services. 6. 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 Mental Health and Support Services Team (HS- CWServiceReferral(a,weldeov.com) within three (3) days of when the client is placed on a behavioral plan or discharged 7. 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 Mental Health and Support Services Team(HS-CWServiceReferral(a�weldeov.com) immediately via email, to discuss service continuation. 8. 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. 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. 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)weldeov.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. 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. 6 13. On a monthly basis, the Contractor will notify the Mental Health and Support Services Team HS- CWberviceReferral(b/weldgov.com) of new staff who will manage and/or administer the services with the following information: 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 -he Department reserves the right to decline the new staff members managing and/or administering Cervices to Department clients. 14. Compliance with Child and Family Services Review The Chid 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. Follcwing the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Contactor 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. Certlication Contactor 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. 16. Traiaina 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. 17. Subpoenas Contactor 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 iris purpose, Contractor will designate an e-mail address prior to the start of this Agreement. If the Contactor receives a subpoena via e-mail but will only accept personal service, the Contractor will contact the \i/ell County Attorney's Office immediately at (970) 336-7235 and advise that the subpoena must be personally served. 18. Motitoring and Evaluation Contactor 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 7 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 to 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. 8 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 tlis 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 expendiures 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 depcsit, 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 sordces not funded through Core Services; Contractor agrees to accept payment through County Wanton when funding source does not allow for direct deposit. Paymeri pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the contiru ng 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 Prog-am .area Ivvntlal Health Services Rate $425.00 l Mt i pe Hour Service Name Evaluation Services: In -Home or Community $425.00 Hour Evaluation Services: In-OfficeNideo $200.00 Hour Evaluation Services: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each Evaluation Services: No Show (Max of 2 no shows or 2 hours/month/client) $0.50 Mile Evaluation Services: Mileage* $250.00 Hour Case Consultation for Caseworkers and Foster Parents: In -Home or Community $250.00 Hour Case Consultation for Caseworkers and Foster Parents: In-OfficeNideo $200.00 Hour Case Consultation for Caseworkers & Foster Parents: Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each Case Consultation for Caseworkers and Foster Parents: No Show (Max of 2 no shows or 2 hours/month/client) $0.50 Mile Case Consultation for Caseworkers and Foster Parents: Mileage* $250.00 Hour Inservice Training for Caseworkers and Foster Parents: In -Home or Community $250.00 Hour Inservice Training for Caseworkers and Foster Parents: In-Office/Video $0.50 Mite Inservice Training for Caseworkers and Foster Parents: Mileage* * For distances exceeding 60 roundtrip miles from 8217 West 20th Street, Greeley, Colorado 80634 3. Request for Reimbursement and Supporting Documentation Contractor shall submit all Requests for Reimbursement and supporting documentation to the Department by the 7. 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 7. 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 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. 5. Rembdies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contactor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to saisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contmctor. These remedial actions are as follows: 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. Incoreci 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. 6. Finakcial Management At of 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 Finaicial Management Manual adopted by the State of Colorado. The required annual audit of all funds expeidad under this Agreement must conform to the Single Audit Act of 1984 and OMB Circular A-133. SIGNATURE REQUESTED: Weld/Lindstrom Amendment #1 - 2023-24 Final Audit Report 2023-04-24 Created: 2023-04-21 By: Lesley Cobb (cobbxxlk@co.weld.co.us) Status: Signed Transaction ID: CBJCHBCAABAA0K-ZxmLBY7CLOLsN6aV11Ar7PQFQvbP9 "SIGNATURE REQUESTED: Weld/Lindstrom Amendment #1 - 2023-24" History t Document created by Lesley Cobb (cobbxxlk@co.weld.co.us) 2023-04-21 - 5:59:16 PM GMT- IP address: 204.133.39.9 P. Document emailed to barry.lindstrom@pathways-wellness.com for signature 2023-04-21 - 5:59:54 PM GMT .5 Email viewed by barry.lindstrom@pathways-wellness.com 2023-04-24 - 5:00:26 PM GMT- IP address: 73.78.130.11 4, Signer barry.lindstrom@pathways-wellness.com entered name at signing as Barry R Lindstrom, PhD 2023-04-24 - 5:01:26 PM GMT- IP address: 73.78.130.11 4, Document e -signed by Barry R Lindstrom, PhD (barry.lindstrom@pathways-wellness.com) Signature Date: 2023-04-24 - 5:01:28 PM GMT - Time Source: server- IP address: 73.78.130.11 0 Agreement completed. 2023-04-24 - 5:01:28 PM GMT Names and email addresses are entered into the Acrobat Sign service by Acrobat Sign users and are unverified unless otherwise noted. Powered by Adobe Acrobat Sign Contract Form New Contract Request Entity information Entity Name" LINDSTROM, BARRY Entity ID* g.00000891 Contract Name" Contract ID LINDSTROM, BARRY PHD., LLC (AGREEMENT AMENDMENT 6920 #1 PY 2023-24) Contract Lead" Contract Status COBBXXLK CTB REVIEW ❑ New Entity? Parent Contract ID 20221535 Requires Board Approval YES Contract Lead Email Department Project t cobbxxlk@co.weld.co.us 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 Grant IGA Department HUMAN SERVICES Department Email CM- HumanServices 2weldgov.co Department Head Email CM -Hu manServices- DeptHead=wveldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTOR N EYTT W ELDG OV.COM If this is a renewal enter previous Contract ID If this is part of a MSA enter NSA Contract ID Requested BCCC Agenda Date 05 10 2021 Due Date 05 '06 2023 Will a work session with BCCC 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 On Base Contract Dates Effective Date Review Date" 03,`29 2024 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 04 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 , 28 2023 04 28 2023 Tyler Ref # AG 050823 Coyvc+ ID-4ss10g CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND BARRY R. LINDSTROM, PHD, LLC This Agreement, made and entered into the �t'hday of Jam, , 2022, 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 Barry R. Lindstrom, PhD, LLC, 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 Mental Health 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. 3. Referrals, Billing and Tracking a. 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. b. 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-CWQualitvAssurance(aweldgov.com). No other Department staff or other party to the case may authorize services or modifications to services. c. 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 result in delay or forfeiture of payment. Consistent failure to meet 45 -day deadline may result in cc� at.P,4C1-152) 2022-1535 (.0 (An/ore /2Z termination of the Agreement. d. 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. 4. 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. 5. Financial Management 2 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. 6. 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. 7. 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 - 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 3 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 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 4 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. 8. 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. 9. 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 listed in this agreement. The Board of County Commissioners of Weld County and its Officers/Employees shall be named as additional insured. 5 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; - 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. 10. 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. 11. 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. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the 7 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. 13. 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. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. 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. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). 8 For Department: For Contractor: Heather Walker, Child Welfare Division Head Barry R. Lindstrom, PhD, Licensed Psychologist 17. 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 18. Litigation For Contractor: Barry R. Lindstrom, PhD, Licensed Psychologist 8217 West 20th Street, Suite A Greeley, Colorado 80634 (970) 356-3100 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. 19. 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. 20. 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. 21. 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. 22. 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 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 9 sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. 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. 24. 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. 25. 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 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 10 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. 26. 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. 27. 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. 28. 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. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner 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 11 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. 31. 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. 32. Employee Financial Interest/Conflict of Interest. C.R.S. x$24-18-201 et seq. and F124-50-507 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. 33. 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. 34. 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. 35. 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. 36. 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. 37. 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. 38. 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. 39. 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: '.�r.7./ '�' `';ei BOARD OF COUNTY COMMISSIONERS Id County Clerk to th - : oard WELD COUNTY, COLORADO puty Clerk 13 ames, Chair JUN 0 6 2022 CONTRACTOR: Barry R. Lindstrom, PhD, LLC 8217 West 20th Street, Suite A Greeley, Colorado 80634 (970) 356-3100 By: Barry l , H ma -t0, PhD (May 0,z2 13:3/ /G l(/ Barry R. Lindstrom, PhD, Licensed Psychologist Date: May 24, 2022 aoaa - /535 EXHIBIT A SCOPE OF SERVICES Contractor will provide Mental Health Services, as referred by the Department. 1. Evaluation Services a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Individual Psychological Evaluations provide intellectual and diagnostic assessment and treatment recommendations. Specific referrals for intellectual and adaptive behavior assessment for disability determination are also accepted. Individual Psychological Evaluations will address referral questions regarding client's diagnoses and their impact on attachment and parenting, placement and visitation needs, and treatment recommendations. Services do not include Psychosexual or Sexual Offender evaluations. ii. Evaluations will include Interviews to obtain relevant psychosocial history and mental status evaluation, and Psychological Testing: 1. Adults: Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function, Adult Version (BRIEF -A; Self -Report and Informant forms as indicated); Minnesota Multiphasic Personality Inventory -3 (MMPI-3); Millon Clinical Multiaxial Inventory -IV (MCMI-IV); Personality Assessment Inventory (PAI); Vineland Adaptive Behavior Scales - Third Edition (Vineland -3) or Adaptive Behavior Assessment System (Second Edition, ABAS-II) if needed for determination of intellectual or developmental disability; *Beck Depression Inventory, Beck Anxiety Inventory, Penn Inventory for PTSD, Adult Self -Report Scale (for ADHD), Stressful Life Events Questionnaire, Mood Disorder Questionnaire, Rotter Incomplete Sentences. 2. Children and Adolescents: Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function (BRIEF, Self -Report, Parent and Teacher forms as indicated); Minnesota Multiphasic Personality Inventory for Adolescents -Restructured Format (MMPI-A-RF); Millon Adolescent or Pre- Adolescent Clinical Inventory, (MACI, M- PACI); Behavioral Assessment System for Children -3rd Edition (BASC-3) completed by the child, parents, foster parents, and teachers; Conners Rating scales, developmental history forms and other non -standardized behavioral assessments completed by parents, foster parents, and teachers; Vineland Adaptive Behavior Scales -Third Edition (Vineland - 3; Caregiver and Educator forms). iii. Mental Health Assessments are a brief assessment of an individual's mental health functioning to answer diagnostic questions outlined by the Department and to provide treatment recommendations. Mental Health Assessments will include a review of Weld County Department of Human Services (WCDHS) social history and family service plans, but limited outside collateral information. Psychological screening instruments (*listed above) will be completed, but no formal psychological testing. If psychological testing is indicated, further Psychological Evaluation will be recommended and completed if approved. iv. Family (Interactional) evaluations are provided as Parent -Child Interactional (PCI) or Sibling Interactional evaluations. PCI evaluations can include birth, adoptive and foster parents, and kinship providers as referred. Interactional evaluations will address referral questions regarding clients' diagnoses; attachment and interaction patterns; placement and visitation needs; and treatment recommendations. Family Evaluations can also assess level and intensity of visitation, including issues related to visitation between children and their incarcerated parents. v. Interactional evaluations will address the relative contribution of the multiple factors related to the child(ren), the parent(s), and their interaction and attachment patterns that led to the Department's involvement, and identify any systemic factors that may contribute or need further assessment (e.g., criminal or domestic relations cases, secondary gain, multigenerational factors). 1 As such, interactional evaluations include a brief mental health assessment of each individual in addition to an assessment of family interaction patterns and attachment behaviors. vi. Interactional evaluations will typically include: 1. Individual interviews with each referred family member to obtain relevant psychosocial history and mental status; Conjoint interviews with all family members (including marital, parent -child, and sibling subsystems); and 2. Conjoint interview / consultation with child and current caregivers (e.g., foster parent, kinship, relative) if child is in out of home placement at the time of evaluation. And, 3. Psychological Screening/Testing: 4. Adults: Millon Clinical Multiaxial Inventory -IV (MCMI-IV) and/or Minnesota Multiphasic Personality Inventory -3- (MMPI-3) as indicated and screening instruments*. 5. Children and Adolescents: BASC-3 completed by the child, parents, foster parents, and teachers; Conners Rating scales; developmental history forms and other non - standardized behavioral assessments. vii. NOTE: Family (interactional) evaluations can be provided for families with both Dependency and Neglect and Domestic Relations (divorce) cases. Referrals for such evaluations that include an Interactional Assessment (PCI) with each parent and psychological testing, would allow for findings and recommendations to the Department regarding the additional factors that typically present with these "cross -over" or hybrid cases (e.g., allegations of alienation vs abuse). viii. b. Anticipated Frequency of Services: i. Direct service time is per evaluation. ii. Individual Psychological Evaluations will typically include: 1. Interviews to obtain relevant psychosocial history and mental status evaluation one (1) to three (3) hours. 2. Psychological Testing four (4) to six (6) hours. iii. Mental Health Assessments will typically include: 1. Two (2), one (1) hour interviews approximately two (2) weeks apart. iv. Family (Interactional) Evaluations will typically include: 1. Interviews (4-10 hours). 2. Individual interviews to obtain relevant psychosocial history and mental status evaluation with each family member. 3. Conjoint interviews a minimum of two (2) with all family members (including marital, parent -child, and sibling subsystems). 4. Conjoint interview/consultation with child and current caregivers (e.g., foster parent, kinship, relative) if child is in out of home placement at the time of evaluation. v. Psychological Screening/Testing: 1. Adults one (1) to two (2) hours for each party. 2. Children and Adolescents (1 hour) for each child. c. Anticipated Duration of Services: i. Evaluations are typically completed within two (2) to four (4) months. d. Goals of Services: i. Provide individual and family diagnostic evaluations to assess individual functioning, family structure, communication, and attachment relationships to assist in the development of family services plans. ii. Address referral questions regarding clients' diagnoses and their impact on attachment and parenting, placement and visitation needs, and treatment recommendations. iii. Family Evaluations can also assess and make recommendations regarding level and intensity of visitation, including issues related to visitation between children and their incarcerated parents. iv. Provide treatment recommendations in support the permanency goals established by the Court and in the child(ren)'s best interests for safety, permanence and well-being. 2 v. Offer a prognosis for change within a developmentally meaningful timeframe. vi. Provide consultation to caseworker. e. Outcomes of Services: i. A final diagnostic feedback session is offered to the client as part of each evaluation to discuss psychological test results, and the observations, findings, and recommendations of the evaluation. ii. A written report will be provided for all evaluations summarizing the CORE Services referral questions; brief case and social history; evaluation course, methods and procedures; assessment findings; collateral contacts; limitations; analysis; and conclusions and recommendations for visitation, treatment, medication evaluations or further psychological evaluation. Evaluations will include a review of WCDHS social history, family services plans and case records; consultation with collateral sources; previous evaluations and treatment records. Evaluation reports will address strengths and protective factors as well as risk factors or problems related to the child's Safety, Permanence, and Well Being. Incomplete evaluations will be documented in writing to the extent possible, outlining the limitations and impact of any missing information. iii. Case management will include regular email or telephone communication with caseworkers at the time of referral and after each appointment to update on the progress of the evaluation, discuss concerns and meet deadlines. Communication with Guardians ad Litem and treating professionals to obtain collateral information as needed. iv. All evaluations will be completed following the Guidelines for Psychological Evaluations in Child Protection Matters as published by the American Psychological Association (2013, APA -currently being revised) and the Ethical Principles of the American Psychological Association (APA). v. All evaluations will be completed in such as manner as to be able to provide consultation and expert testimony as requested. f. Target Population: i. All ages and gender identifications. ii. Includes child and parents, foster parents or caregivers such as kin, special respondents, intervenors, and/or siblings. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. At Contractor's office located at the office of Pathways at 217 West 20th Street, Suite A, Greeley, Colorado 80634. Virtual appointments can also be arranged if needed. ii. Psychological evaluations can be completed with locally incarcerated clients as needed. iii. Family interviews can be coordinated for time and location with any family visitation services already in place (e.g., Family Support and Visitation Center in Greeley, or Del Camino, or with other providers) as needed to complete interactional interviews and observations for Interactional Assessments. 2. Case Consultation for Caseworkers and Foster Parents 3 a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. Consultation regarding specifically referred cases will be provided to caseworkers regarding assessment and treatment planning questions, case management or other questions or concerns as needed. ii. Consultation to caseworkers and foster parents in order to help foster children preserve or maintain placement in a clinically appropriate level of care, to minimize the number of changes or transitions, and to meet permanency goals. This is a brief consultation and not intended to replace formal evaluation of an individual or family. b. Anticipated Frequency of Services: i. As requested by the Department. c. Anticipated Duration of Services: i. One (1) to three (3) months. d. Goals of Services: i. Address caseworkers questions regarding a specific case or issue. ii. Review case history and records as needed. iii. Provide a letter or brief report as requested. e. Outcomes of Services: i. Answer caseworkers' questions regarding a specific case or issue. ii. Consultation can also include attendance at Clinical, Psychiatric or Educational such as Individualized Education Program (IEP) Staffings as approved. iii. If requested, a letter or brief report can be prepared summarizing recommendations. f. Target Population: i. Any case referred by the Department. g. Language: i. English. h. Medicaid Eligibility: i. Not Medicaid eligible. Service Access and Transportation: i. Virtually. ii. Contractor's office located at the office of Pathways at 217 West 20th Street, Suite A, Greeley, Colorado 80634. iii. At the Department. iv. In the Foster home as needed. 3. Inservice Training for Caseworkers and Foster Parents a. Contractor will utilize the following modalities, curriculum, and tools in the delivery of services under this agreement: i. In person or virtual training or workshops for caseworkers, foster parents, Court Appointed Special Advocates (CASAs), therapists, attorneys and judicial officers as requested. b. Anticipated Frequency of Services: i. As requested by the Department. c. Anticipated Duration of Services: i. Each training is one session. 4 d. Goals of Services: i. To provide training and support for: 1. Caseworkers, supervisors, managers; 2. Foster parent; 3. CASAs, therapists, and other providers 4. Attorneys and judicial officers. e. Outcomes of Services: i. To provide training as requested, including the following or other topics as arranged: 1. Assessment and diagnosis; 2. Trauma, Post Traumatic Stress Disorder (PTSD), Vicarious Trauma and Compassion Fatigue; 3. Specific behavioral health diagnoses or interventions. f. Target Population: i. Any Department employee or provider. g. Language: i. English. h. Medicaid Eligibility: i. This service is not Medicaid eligible. i. Service Access and Transportation: i. At the Department. ii. Virtually. iii. Other pre -determined location. Terms 1. Contractor will respond to the Quality Assurance Team (HS-CWQualityAssurance(a)weldgov.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 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- CWQualityAssurance(&,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 5 (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-CWQualitvAssurance(a,weld2ov.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-CWQualitvAssurance(& 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. 10. On a monthly basis, the Contractor will notify the Quality Assurance Team HS- CWQualityAssurance(a)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. 6 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 Evaluation Services Rate Unit Type Service Name $400.00 Hour In-officeNideo $400.00 Hour In -Home or Community $200.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No Show $0.50 Mile For distances exceeding 60 roundtrip miles from 8217 West 20th Street, Greeley, Colorado 80634 Case Consultation for Caseworkers & Foster Parents Rate Unit Type Service Name $200.00 Hour In-officeNideo $200.00 Hour In -Home or Community $200.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $100.00 Each No Show $0.50 Mile For distances exceeding 60 roundtrip miles from 8217 West 20th Street, Greeley, Colorado 80634 Inservice Training for Caseworkers & Foster Parents Rate Unit Type Service Name $200.00 Hour In-officeNideo $200.00 Hour In -Home or Community $0.50 Mile For distances exceeding 60 roundtrip miles from 8217 West 20th Street, Greeley, Colorado 80634 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 7th 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: Barry R Lindstrom,PhD, LLC (billings as Pathways Management, LLC) Barry R Lindstrom Provider Contact Full Name: 970.356.3100 Primary Phone Number (10 -digit): Primary Contact Email: Ext.: barry.lindstrom@pathways-wellness.com Trails Provider ID (if known): Licensed Psychologist Title: Agency Location Address (Street, city, state, zip): 970.356.4827 Fax Number (10 -digit): Web Address: pathwaysgreeley.com 8217 W 20th St, Suite A, Greeley, CO 80634 Agency Mailing Address (Street, city, state, zip): 8217 W 20th St, Suite A, Greeley, CO 80634 Agency Type (pick one): { 1 Public Company [] Private Non -Profit Private for Profit Send Referrals for Service to: Referral Contact Name: Bary R Lindstrom Psychologist Title: 970.356.3100 Referral Phone Number (10 -digit): Ext.: Email: barry.lindstrom@pathways-wellness.com Billing Contact Jolene Johnson Billing Contact Name: 970.356.3100 Billing Phone Number (10 -digit): Title: Business Manager Ext.: Email: jolene.johnson@pathways-wellness.com r ------------------------------------CERTIFICATION -----------.. ...--------....---•----i I I I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it j 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 iDepartment 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. I WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000. Barry R Lindstrom j Authorized Rep. Full Name: barry.lindstrom@pathways-wellness.com Authorized Rep. Email: Authorized Rep. Address (Street, city, state, iSignature of Authorized Rep.: Title: Psychologist 970.356.3100 Phone (10 -digit): Ext.: 8217 W 2,gih St, Suite A, Greeley, CO 80634 % v tr' �� `—�--•� -----• Date---- -� 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 for Proposal starting on page 13. Barry R Lindstrom, PhD, LLC [billing by Pathways Management,. Lid] Mental Health Services Number of services offered on this Attachment C (max 5): 5 You may complete another Attachment Cif you have more than 5. SECTION 2 - Service Name(s) and Information If the service is a monthly package, please offer different levels. All monthly packages must state a specific minimum number of direct service hours. Service #1 Name: Evaluation Services 2.1a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Individual Psychological Evaluations provide intellectual and diagnostic assessment and treatment recommendations. Specific referrals for intellectual and adaptive behavior assessment for disability determination are also accepted. Individual Psychological Evaluations will address referral questions regarding client's diagnoses and their impact on attachment and parenting, placement and visitation needs, and treatment recommendations. This proposal does not. include Psychosexual or Sexual Offender evaluations. Evaluations will include Interviews to obtain relevant psychosocial history and mental status evaluation, and Psychological Testing: Adults: Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function, Adult Version (BRIEF -A; Self -Report and Informant forms as indicated); Minnesota Multiphasic Personality Inventory -3 (MMPI-3); Millon Clinical Multiaxial Inventory -IV (MCMI-IV); Personality Assessment Inventory (PAI); Vineland Adaptive Behavior Scales - Third Edition (Vineland -3) or Adaptive Behavior Assessment System (Second Edition, ABAS-II) if needed for determination of intellectual or developmental disability; *Beck Depression Inventory, Beck Anxiety Inventory, Penn Inventory for PTSD, Adult Self -Report Scale (for ADHD), Stressful Life Events Questionnaire, Mood Disorder Questionnaire, Rotter Incomplete Sentences. Children and Adolescents: Wechsler Abbreviated Scale of Intelligence (WASI); Wide Range Achievement Test -Fourth Edition (WRAT-5); Behavior Rating Inventory of Executive Function (BRIEF, Self -Report, Parent and Teacher forms as indicated); Minnesota Multiphasic Personality Inventory for Adolescents -Restructured Format (MMPI-A-RF); Millon Adolescent or Pre - Adolescent Clinical Inventory, (MACI, M-PACI); Behavioral Assessment System for Children -3`d Edition (BASC-3) completed by the child, parents, foster parents, and teachers; Conners Rating scales, developmental history forms and other non -standardized behavioral assessments completed by parents, foster parents, and teachers; Vineland Adaptive Behavior Scales -Third Edition (Vineland -3; Caregiver and Educator forms). Mental Health Assessments are a brief assessment of an individual's mental health functioning to answer diagnostic questions outlined by the Department and to provide treatment recommendations. Mental Health Assessments will include a review of WCDHS social history and family services plans; but limited outside collateral information. Psychological screening instruments (*listed above) will be completed, but no formal Psychological testing. If psychological testing is indicated, further Psychological Evaluation will be recommended and completed if approved. Family (Interactional) evaluations are provided as Parent -Child Interactional (PCI) or Sibling Interactional evaluations. PCI evaluations can include birth, adoptive and foster parents, and kinship providers as referred. Interactional evaluations will address referral questions regarding clients' diagnoses; attachment and interaction patterns; placement and visitation needs; and treatment recommendations. Family Evaluations can also assess level and intensity of visitation, including issues related to visitation between children and their incarcerated parents. Interactional evaluations will address the relative contribution of the multiple factors related to the child(ren), the parent(s), and their interaction and attachment patterns that led to the Department's involvement, and identify any systemic factors that may contribute or need further assessment (e.g., criminal or domestic relations cases, secondary gain, REV. OCT 2021 1 ATTACHMENT C - PROPOSAL multigenerational factors). As such, interactional evaluations include a brief mental health assessment of each individual in addition to an assessment of family interaction patterns and attachment behaviors. Interactional evaluations, will typically include: Individual interviews with each referred family member to obtain relevant psychosocial history and mental status; Conjoint interviews with all family members (including marital, parent -child, and sibling subsystems); and Conjoint interview / consultation with child and current caregivers (e.g., foster parent, kinship, relative) if child is in out of home placement at the time of evaluation. And, Psychological Screening/Testing: Adults: Millon Clinical Multiaxial Inventory -IV (MCMI-IV) and/or Minnesota Multiphasic Personality Inventory-3- (MMPI-3) as indicated and screening instruments*. Children and Adolescents: BASC-3 completed by the child, parents, foster parents, and teachers; Conners Rating scales; developmental history forms and other non -standardized behavioral assessments: NOTE: Family (interactional) evaluations can be provided for families with both Dependency and Neglect and Domestic Relations (divorce) cases. Referrals for such evaluations that include an Interactional Assessrrlent (PCI) with each parent and psychological testing, would allow for findings and recommendations to the Department regarding the additional factors that typically present with these "cross -over" or hybrid cases (e.g., allegations of alienation vs abuse). 2.1b 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: Note; direct service time is per eval, not per week Individual Psychological Evaluations will typically include: Interviews to obtain relevant psychosocial history and mental status evaluation (1 to 3!hours) and Psychological Testing (4 to 6 hours). Mental Health Assessments will typically include two (2) , one -hour interviews approximately weeks apart. Family (Interactional) evaluations will typically include: Interviews (4-10 hours): Individual interviews to obtain relevant psychosocial history and mental status evaluation with each family member; Conjoint interviews (minimum 2) with all family members (including marital, parent -chid, and sibling subsystems) Conjoint interview / consultation with child and current caregivers (e.g., foster parent, kinship, relative) if child is in out of home placement at the time of evaluation. Psychological Screening/Testing: Adults (1 to 2 hours) for each party. Children and Adolescents (1 hour) for each child. 2.1c Anticipated duration of service (i.e. 3-4 months): Individual and family evaluations can typically be completed within 2 to 4 months depending on client's availability and cooperation. 2.1d Three (3), or more, specific goals of the service (DO use bullet points): 1 To provide individual and family diagnostic evaluations to assess individual functioning, family structure, communication, and attachment relationships to assist in the development of family services plans. 2. To address referral questions regarding clients' diagnoses and their impact on attachment and parenting, placement and visitation needs, and treatment recommendations. 3. Family Evaluations can also assess and make recommendations regarding level and intensity of visitation, including issues related to visitation between children and their incarcerated parents. 4. To provide treatment recommendations in support the permanency goals established by the Court and in the child(ren)'s best interests for safety, permanence and well-being. 5. To offer a prognosis for change within a developmentally meaningful timeframe. 6. To provide consultation to caseworker. REV. OCT 2021 2 ATTACHMENT C - PROPOSAL 2.1e Three (3), or more, specific outcomes of service: 1. A final diagnostic feedback session is offered to the client as part of each evaluation to discuss psychological test results, and the observations, findings, and recommendations of the evaluation. 2. A written report will be provided for all evaluations summarizing the CORE Services referral questions; brief case and social history; evaluation course, methods and procedures; assessment findings; collateral contacts; limitations; analysis; and conclusions and recommendations for visitation, treatment, medication evaluations or further psychological evaluation. Evaluations will include a review of WCDHS social history, family services plans and case records; consultation with collateral sources; previous evaluations and treatment records. Evaluation reports will address strengths and protective factors as well as risk factors or problems related to the child's Safety, Permanence, and Well Being. Incomplete evaluations will be documented in writing to the extent possible, outlining the limitations and impact of any missing information. 3. Case management will include regular email or telephone communication with caseworkers at the time of referral and after each appointment to update on the progress of theevaluation, discuss concerns and meet deadlines. Communication with Guardians ad Litem and treating professionals to obtain collateral information as needed. All evaluations will be completed following the Guidelines for Psychological Evaluations in Child Protection Matters as published by the. American Psychological Association (2013, APA -currently being revised) and the Ethical Principles of the American Psychological Association (APA). All evaluations will be completed in such as manner as to be able to provide consultation and expert testimony as requested. 2.1f Target population of the service, including age and gender: Psychological Evaluations and Mental Health Assessments are provided by Dr. Lindstrom for Children (Birth through 12 years), Adolescents (13 through 18 years), and Adults over 18 years for individuals of any gender or identification. Family / Interactional evaluations are provided by Dr. Lindstrom for clients of any age, including the child and parents, foster parents or caregivers (kin, special respondents, intervenors) and/or siblings. 2.1g Languages service is available in (please list proficiency and if interpreter services are available): English 2.1h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Forensic evaluations such as these are not eligible for Medicaid (or other insurance) reimbursement. 2.1i Service location — list where the service will take place (i.e., client's home, in -office, other) Unless otherwise indicated or arranged, evaluation services will be provided at the office of Pathways at 8217 W 20th St., Suite A, Greeley, CO 80634. Virtual appointments can be provided as needed/requested for portions or all of an assessment. Psychological evaluations can be completed with locally incarcerated clients as needed. Family interviews can be coordinated for time and location with any family visitation services already in place {e.g., Family Services and Visitation Center in Greeley, or Del Camino, or with other providers) as needed to complete interactional interviews and observations for Interactional Assessments. REV. OCT 2021 3 ATTACHMENT C - PROPOSAL Service #2 Name: Family Engagement Meetings (FTM & TDM,) Professional Staffings and Court Facilitation Staffings 2.2a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Family Engagement Meetings, Professional Staffings and Court facilitation staffings participation can be attended before, during or after evaluation or treatment as requested by the Caseworker, GAL, County Attorney or Court facilitator. 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: At the completion of each evaluation and/or as requested and authorized. 2.2c Anticipated duration of service (i.e. 3-4 months): As needed. 2.2d Three (3), or more, specific goals of the service (DO use bullet points): To provide information and input regarding: 1. The evaluation process; 2. Findings and recommendations; and 3. Case consultation regarding treatment, visitation and permanency planning. 2.2e Three (3), or more, specific outcomes of service: 1. To engage family in treatment plan. 2. To provide case consultation regarding treatment, visitation and permanency planning. 3. Multidisciplinary collaboration and treatment planning. 2.2f Target population of the service: Any case referred for assessment. 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: None 2.2i Service location — list where the service will take place (i.e. client's home, in -office, other) Dr. Lindstrom canattend staffings Virtually or at the Department, or Courthouse as requested. , REV. OCT 2021 4 ATTACHMENT C - PROPOSAL Service #3 Name: Case Consultation for Caseworkers & Foster Parents 2.3a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Consultation regarding specifically referred cases will be provided to caseworkers regarding assessment and treatment planning questions, case management or other questions or concerns as needed. Consultation to caseworkers and foster parents in order to help foster children preserve or maintain placement in a clinically appropriate level of care, to minimize the number of changes or transitions, and to meet permanency goals. This is a brief consultation and not intended to replace formal evaluation of an individual or family. 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: As requested. 2.3c Anticipated duration of service (i.e. 3-4 months): 1 to 3 months. 2.3d Three (3), or more, specific goals of the service (DO use bullet points): 1. To address caseworkers questions regarding a specific case or issue. 2. To review case history and records as needed. 3. To provide a letter or brief report as requested. 2.3e Three (3), or more, specific outcomes of service: 1. Answer caseworkers questions regarding a specific case or issue. 2. Consultation can also include attendance at Clinical, Psychiatric or Educational (IEP) Staffings as approved. 3. If requested, a letter or brief report can be prepared summarizing recommendations. 2.3f Target population of the service: Any referred case. 2.3g Languages service is available in (please list proficiency and if interpreter services are available): English. 2.3h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part: Forensic evaluations such as these are not eligible for Medicaid (or other insurance) reimbursement. 2.3i Service location — list where the service will take place (i.e. client's home, in -office, other) Virtually, at the office, Department, or foster home as needed. REV. OCT 2021 s ATTACHMENT C - PROPOSAL Service #4 Name: Inservice training for Caseworkers & Foster Parents 2.4a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): In person or virtual training or workshops for caseworkers, foster parents, CASAs, therapists, attorneys and judicial officers as requested. 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: As requested. 2.4c Anticipated duration of service (i.e. 3-4 months): Per training. 2.4d Three (3), or more, specific goals of the service (DO use bullet points): To provide training and support for: 1. Caseworkers, supervisors, managers; 2. Foster parent; 3. CASAs, therapists, and other providers 4. Attorneys and judicial officers. 2.4e Three (3), or more, specific outcomes of service: To provide training as requested, including the following or other topics as arranged: 1. Assessment and diagnosis; 2. Trauma, PTSD, Vicarious Trauma and Compassion Fatigue; 3. Specific behavioral health diagnoses or interventions. 2.4f Target population of the service: Any Department employee or provider. 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: Inservice or training services are not eligible for Medicaid (or other insurance) reimbursement. 2.4i Service location — list where the service will take place (i.e., client's home, in -office, other) At the Department, virtually, or as arranged. REV. OCT 2021 6 ATTACHMENT C - PROPOSAL Service #5 Name: Expert Testimony 2.5a Modalities, curriculum, tools used in delivery of service (DO NOT list company history; DO use bullet points): Expert testimony at Court hearings in person or via Webex as requested. 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: As requested. 2.5c Anticipated duration of service (i.e. 3-4 months): Per Subpoena (typically one day). 2.5d Three (3), or more, specific goals of the service (DO use bullet points): To provide expert testimony as requested regarding: 1. The evaluation process, findings and recommendations; 2. Treatment progress and outcomes; 3. Treatment, visitation and permanency planning recommendations. 2.5e Three (3), or more, specific outcomes of service: 1. Expert testimony regarding the evaluation process, findings and recommendations; treatment progress and outcomes; and treatment, visitation and permanency planning. 2. Expert testimony to provide information to the Court regarding abuse, attachment or other psychological topics on cases not seen for evaluation or treatment can also be provided. 3. Consultation with County Attorney as needed. 2.5f Target population of the service: Any referred case. 2.5g Languages service is available in (please list proficiency and if interpreter services are available): English 2.5 h Medicaid eligibility — list whether the service is eligible for Medicaid in whole or in part Forensic services are not eligible for Medicaid (or other insurance) reimbursement. 2.6 i Service location — list where the service will take place (i.e., client's home, in -office, other) Dr. Lindstrom will provide expert testimony virtually or at the Court, as requested. Section 3 — Service Access and Transportation 3.1 Will you charge Weld County for transporting clients or mileage? Check one: 3.2 Will you conduct services in a client's home or in the community? Check one: 3.3 Will you transport clients to and/or from services? Check one: O YES 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? El YES ® YES ® NO 60 NO Miles NO 8217 W 20th St, Greeley, CO 80634 REV. OCT 2021 7 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: I Evaluation Services $ Amount Unit Type 4.1a In-Office/Video: $400 per Hour 4.1b In -Office with Transportation: n/a per Hour No. of roundtrip miles included in rate: miles In -Home or Community: $400 per Hour No. of roundtrip miles included in rate: 60 miles 4.1c FTM, TDM, Prof. Staffing: $200 per Hour 4.1d No show: $100 per No Show 4.1e Mileage rate: $0.50 per Mile This is paid after the miles listed above. 4.2 Hourly Service #2 Name: [ Family Engagement Meetings (FEM, FTM & TDM) and Court Facilitation Staffings $ 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: I miles 4.2c In -Home or Community: per Hour No. of roundtrip miles included in rate: miles 4.2d FTM, TDM, Prof. Staffing: $200 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: I Case Consultation for Caseworkers & Foster Parents $ Amount Unit Type 4.3a In-Office/Video: $200 per Hour 4.3b In -Office with Transportation: n/a per Hour No. of roundtrip miles included in rate: miles 4.3c In -Home or Community: $200 per Hour No. of roundtrip miles included in rate: 60 miles 4.3d FTM, TDM, Prof. Staffing: $200 per Hour 4.3e No show: $100 per No Show 4.3f Mileage rate: $0.50 per Mile This is paid after the miles listed above. 4.4 Hourly Service #4 Name: I Inservice training for Caseworkers & Foster Parents $ Amount Unit Type 4.4a In-Office/Video: $200 per Hour 4.4b In -Office with Transportation: n/a per Hour No. of roundtrip miles included in rate: miles In -Home or Community: $200 per Hour No. of roundtrip miles included in rate: 60 miles 4.4c FTM, TDM, Prof. Staffing: per Hour 4.4d No show: per No Show 4.4e Mileage rate: $0.50 per Mile This is paid after the miles listed above. 4.5 Hourly Service #5 Name: Expert Testimony $ 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 8 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 n/a 4.6b 4.6c 4.6d 4.6e 4.6f 4.6g 4.6h 4.6i 4.6j 4.7 Home Study Providers — List your rates in the box below. n/a 4.8 Monitored Sobriety Providers — List your rates in the box below. n/a Provider special notes: All services are provided directly by Dr. Lindstrom. I look forward to our continued work together. REV. OCT 2021 9 Lindstrom R 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: Barry Lindstrom Pathways Management, LLC PHONE NUMBER: 970,356.3100 EMAIL: barry.Iindstrom@pathways-wellness.cam PROPOSED SERVICE(S): MENTAL HEALTH Previous Legal Last Name (If applicable) Legal First Name Barry All sure/ Credentials 1303 Psychologist applicable) Lindstrom R Barry All Psychologist 1303. CHILD WELFARE REQUEST FOR PROPOSAL 2022-23 - VARIOUS SERVICES POLICY NUMBER: 680-390N4113-21-42 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 09/07/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of person or organization: STATE OF COLORADO, WELD COUNTY, COLORADO BY AND THROUGH THE BOARD OF PO BOX A CO 80632 WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your acts or omissions. CGT4911188 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 CPH 6 ASSOCIATES Certificate of Liability Insurance Date Issued: 08/10/2021 PHILADELPHIA I: Nil; RANCE Co+aPnN trs Underwritten by: Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 • Bala Cynwyd, PA 19004 • NAIC #: 18058 Administered by: CPH & Associates • 711 S. Dearborn St. Ste 205 • Chicago, IL 60605 P 800.875.1911 • F 312.987.0902 • info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. The Certificate of Insurance 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 Insured: Barry R. Lindstrom PhD, LLC Barry Lindstrom 8217 W 20th Street, Suite A Greeley, CO 80634 Policy Number: 072277 Policy Term: 10/04/2021 to 10/04/2022 Covered Locations Professional Liability: Portable coverage, not location specific Coverage Type (Occurrence Form) Professional Liability Supplemental Liability Licensing Board Defense Commercial General Liability Fire/Water Legal Liability Business Personal Property Per Incident (Per individual claim) $ 1,000,000 $ 1,000,000 $ 100,000 N/A N/A N/A Aggregate (Total amount per year) $ 3,000,000 $ 3,000,000 $ 100,000 N/A N/A N/A Comments/Special Descriptions: Certificate Holder PROOF OF COVERAGE If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. Pt' Authorized Representative C. Philip Hodson New Contract Request Entity Information Entity Name* LINDSTROM, BARRY Entity ID* 110000891 Contract Name* Contract ID LINDSTROM, BARRY (NEW CHILD PROTECTION AGREEMENT) 5868 Contract Status CTB REVIEW Contract Lead* APEGG Contract Lead Email apeggglweldgov.com:cobbx xlkweldgov.com Contract Description* CONSENT BID# B22©0040 TERM: JUNE 1, 2022 THROUGH MAY 31, 2023 Parent Contract ID 20220410 Requires Board 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 05110,'2022. Contract Type* AGREEMENT Amount' X0.00 Renewable* YES Automatic Renewal Grant Depar txnent HUMAN SERVICES nt Email CM- HurnanSery cesCweIdgov.co rn rtment Head Email CM-HumanServices- DeptHeadg weldgov.cam County Attorney GENERAL COUNTY Al I ORNEY EMAIL County Attorney Email CM- COUNTYA I I ORNEYINELDG OV.COM Requested BOCC Agenda Date * 06,08'2022 Due Date 06/04 '2022 Will a work session with 8OCC 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 On Base Contract Dates Effective Date Review Date* 03;'31:2023 Renewal Date* 05'31,2023 Termination Notice Period Contact Information ContactI Contact Name Purchasing Committed Delivery Date Expi Contact Type Contact Email Contact Phone I Contact Phone 2 Purchasing Approver Purchasing Approved Date CONSENT 05'25'2022 Approval Process Department H JAMIE ULRICH OH Approved Date 05/25;2022 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 06%06.2022 Originator APEGC Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 05,25,=2022 05'25,'2022 Tyler Ref # AG 060622 Hello