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Home My WebLink About20192264.tiffPRIVILEGED AND CONFIDENTIAL MEMORANDUM 17+rotC+ =!7 #e-1-131 DATE: May 4, 2021 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment with Perklen Center for Psychotherapy 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 with Perklen Center for Psychotherapy. The Department entered into a Child Protection Agreement for Services with Perklen Center for Psychotherapy, identified as Tyler ID 2019-2264 on June 17, 2019. The Agreement was amended on April 27, 2020 to extend the term date through May 31, 2021 and to amend the Scope of Services and Rate Schedule. The Agreement is now being amended to renew for a third and final year, for the period of June 1, 2021 through May 31, 2022 and to make changes to the Scope of Services and Rate Schedule as noted below. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Scope of Services Changes: • The provider bid in this year's Request for Proposal to add two additional services to their current Agreement: Mental Health Therapy and Mental Health Evaluations. These new services are now reflected in the provider's Scope of Services. Rate Schedule Changes: • The following rates were added for the new Mental Health Therapy and Mental Health Evaluation services: Mental Health Treatment Rate Type Service Name $ 85.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM) Meeting, Professional Staffing $800.00 Episode Mental Health Evaluation $ 85.00 Hour Mental Health Therapy $100.00 Episode No Show -Mental Health Evaluation $ 43.00 Hour No Show -Therapy $ 85.00 Hour Trauma Informed Therapy Services Pass -Around Memorandum; May 4, 2021 — ID 4731 eOnSex-) 4- A 05/ lorDI Page 1 ©l - aa�� HRooq 0 PRIVILEGED AND CONFIDENTIAL. I do not recommend a Work Session. I recommend approval of this Agreement Amendment. Perry L. Buck Mike Freeman Scott K. James, Pro-Tem Steve Moreno, Chair Lori Saine Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; May 4, 2021 — ID 4731 Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PERKLEN CENTER FOR PSYCOTHERAPY +h This Agreement Amendment, made and entered into I O day of 2021 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 Perklen Center for Psychotherapy, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Anger Management/Domestic Violence and Sexual Abuse Treatment, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2264, approved on June 17, 2019. 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, 2020. • The Original Agreement was amended on: April 27, 2020 to extend the term date through May 31, 2021 and to amend the Scope of Services and Rate Schedule. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2264. • 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: 1. Term This agreement is being renewed for a third and final year, for the period of June 1, 2021 through May 31 2022. 2. Exhibit C, Scope of Services, is hereby amended as attached. 3. Exhibit D, Rate Schedule, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST• ) *le/1 ;0k BOARD OF COUNTY COMMISSIONERS Weld •oun Clerk to the Bo WELD COUNTY, COLORADO By: Deputy Clerk, the : yard%il j; . // �� Steve Moreno, Chair MAY 1 0 2021 Perklen Center for Psychotherapy 2619 West l lth Street Road, Suite 33 Greeley, Colorado 80634 By: Date: ,7a#Q Goiet Jodie corer (Apr P, 2021110D Mon Jodie Goter, MA. LPC Executive Director and Co -Owner Apr 27, 2021 020/9--a2zS- EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management/Domestic Violence (Impact of Domestic Violence on Children and Victims), Trauma -Informed Therapy Services, Sexual Abuse Treatment (Offense Specific), Mental Health Therapy and Mental Health Evaluation as referred by the Department. 2. Anger Management/Domestic Violence (Impact of Domestic Violence on Children and Victims) a. Capacity for Services: Two (2) 120 -minute sessions for a total of four (4) hours b. Goals of Service: Educate individual, family members, and concerned parties about the impact of domestic violence on children and victims who have been impacted by being in a home where domestic violence is prevalent. Curriculum includes: i. Cycle of violence ii. Types of violence iii. How children and victims are traumatized by witnessing domestic violence iv. Misconceptions about domestic violence v. Trauma signs and symptoms c. Outcomes of Service: i. Client will be able to identify how children, victims and secondary victims are impacted by domestic violence. ii. Client will be able to discuss trauma symptoms, each stage of the cycle of abuse, and cognitive distortions around the concept of domestic violence. Client will develop strategies for the prevention of trauma to children. d. Target Population: i. Male and female youth, 12 to 18 years of age. ii. Male and female adults, 19 and older. e. Service Access: i. 2619 West 11`h Street Road, Suite 23, Greeley, CO 80634. ii. Crisis and after hours, (970) 237-1134. f. Language: English 3. Sexual Abuse Treatment (Offense Specific): All services will be provided in compliance with Sex Offender Management Board (SOMB) guidelines. a. Sexual Abuse Evaluations i. Contractor requires a psychosexual evaluation to determine if a client is appropriate for an outpatient treatment program. Evaluations will examine seven (7) areas: 1. Potential to re -offend 2. Amenability for treatment 3. Recommended treatment setting 4. Type of treatment needed 5. Risk factors/monitoring/potential new victims 6. Psychiatric/substance abuse/individual/family needs 7. Mental health concerns ii. Evaluations will include: 1. Structured clinical interview 2. Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctor, courts, police reports and other relevant sources 3. Assessments, which may include (dependent on age of offender and circumstances of case): a. Hare Psychopathy Checklist -Revised b. Minnesota Multiphasic Personality Inventory -II c. Jessness Inventory d. SASSI Drug and Alcohol Inventory e. Millon Clinical Multiaxial Inventory f. Shipley -2 g. State Trait Anger Expression Inventory h. Vermont Assessment of Sex Offender Risk -2 i. Sex Offender Treatment Intervention and Progress Scale j. Abel Assessment for Sexual Interest k. Juvenile Sex Offender Assessment Protocol iii. Capacity for Services: 1. Clinical interview (minimum 3 hours) 2. Administration of psychometric instruments (3 hours) a. Abel Assessment for Sexual Interest (2 hours) iv. Goals of Services: 1. Access the type of treatment needed for the client 2. Assess risk for recidivism 3. Define additional treatment needed, which may include: a. Medication evaluation b. Psychiatric evaluation c. Monitoring for substance abuse d. Trauma assessment and treatment e. Substance abuse treatment 4. Development of measurable treatment goals 5. Monthly monitoring of goals v. Outcomes of Service: Written evaluation outlining the clinical interview, social history, results of psychometric testing, risk for recidivism, and recommended treatment options. Interventions will address child welfare specific needs. vi. Target Population: 1. Male and female youth, ages 12 to 18 years, who require a Juvenile Mental Health Sex Offense -specific Evaluation. 2. Male and female adults, ages 19 and older, who require an Adult Mental Health Sex Offense -Specific Evaluation. 3. Developmentally/intellectually delayed offenders who require a Mental Health Sex Offense -specific Evaluation for Developmentally/Intellectually Delayed Offenders. vii. Service Access: 1. 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. 2. Crisis and after hours, (970) 237-1134. viii. Language: English b. Sexual Abuse Treatment: i. Services under this agreement include: 1. Offense -specific group therapy 2. Individual, couples and/or family therapy 3. Informed Supervision groups — youth (1 hour/month or six intensive sessions) 4. Community Support Group/Approved Supervisor Group -adults (1 hour/month ongoing) ii. All services are provided in a non -medical, cognitive behavioral model that emphasizes a strengths -based approach, and will incorporate: 1. Relationship and interpersonal social skills 2. Sex education 3. Victim empathy and awareness 4. Anger management/impulse control skills 5. Cognitive behavioral modification 6. Self-esteem building 7. Values clarification and examination 8. Prosocial living 9. Relapse prevention 10. Aftercare services 11. Types of abuse a. Deviant sexual behavior b. Physical c. Emotional d. Verbal e. Psychological iii. Capacity for Services: 1. Adults: Two (2) times per week for 90 minutes each session (3 hours weekly) 2. Juveniles: One (1) time per week for 90 minutes each session (1-1/2 hours weekly) 3. All clients will attend a 60 -minute session one (1) time per month 4. Crisis Intervention sessions are 60 minutes and will be scheduled as needed iv. Goals of Service: 1. Provide a structured treatment environment for the safety of the client, family, victim, and community in order to prevent recidivism. 2. Increased awareness and empathy for the victim and the impact of the offense on the victims and family members. 3. Foster a safe environment to effect positive change by developing the use of appropriate social/sexual skills and expressions through recognition of situations and stimuli that trigger sexually aggressive behavior. 4. Assist family members to develop the skills necessary to recognize and understand the sexual behavior of their family member for the purpose of providing support while the client progresses through treatment. v. Outcomes of Service: 1. Client will: a. Consistently define all sexually abuse behavior b. Acknowledge risk by demonstrating foresight and using safety planning c. Consistently recognize/interrupt sexual abuse cycle d. Demonstrate new coping skills and develop stress management techniques e. Demonstrate victim empathy and understand how behavior affects the victim, family and community f. Display accurate attribution of responsibility for offending behavior g. Be able to manage frustration and unfavorable events h. Reject sexually abusive thoughts as dissonant with self-image i. Demonstrate pro -social relationship skills j. Project positive self-image k. Demonstrate the ability to resolve conflict and make decisions 1. Celebrate appropriate behavior and experience pro -social pleasure m. Delay gratification n. Communicate assertively o. Develop family and/or community support systems p. Develop an adaptive sense of purpose and future 2. Contractor will track progress through the program, as follows: a. Through an individualized treatment plan that will outline what the client will accomplish in order to complete treatment b. By assessing client progress made toward treatment plan, and changes and updates will be made to the plan as needed c. By evaluating whether the client is understanding the concepts presented during groups using a Group Note and homework d. By providing feedback to the client at the start of the next group to help the client obtain maximum benefit from groups vi. Target Population: 1. Male and female youth, 12 to 18 years of age 2. Youth with current sexual offense adjudications or youth who have admitted guilt and will provide a letter from a parent or attorney stating they plan to plead guilty 3. Youth with both average intelligence and those who are developmentally delayed 4. Male and female adults, age 19 or older 5. Adults who have been found guilty of a sexual offense or have a written letter from an attorney stating they plan to plead guilty 6. Adults with both average intelligence and those who are developmentally delayed vii. Service Access: 1. 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. 2. Crisis and after hours, (970) 237-1134. viii. Language: English 4. Trauma -Informed Therapy Services: Contractor will provide evaluation and treatment of individuals with post -traumatic stress symptoms, dissociative behaviors, and heightened anxiety, as well as depressive symptoms as a result of traumatic life events. This modality of treatment has been beneficial to service members who struggle with the impact of deployment. In most cases, a Trauma -Focused Mental Health Evaluation will be completed with the client to determine the scope of services needed. The evaluation will consist of a social history interview, review of collateral data, and the administration of psychometric instruments. The psychometric instruments used may include the following: The Hare Psychopathy Checklist -Revised, Minnesota Multiphasic Personality Inventory -II, Jessness Inventory, Milton Clinical Multiaxial Inventory, Shipley -2, Dissociative Experiences Scale, and the Multidimensional Dissociation Instrument. Eye Movement Desensitization and Reprocessing (EMDR) may be added as part of the treatment plan. a. Capacity for Services: Weekly or biweekly for 50 minutes. EMDR will begin with 90 -minute sessions and gradually decrease to 60 -minute sessions as symptom management is increased. b. Duration of Service: Four (4) to six (6) months. c. Goals of Service: i. Decrease symptoms present at intake. ii. Development of self -management tools. iii. Client will be able to manage life symptom free. d. Outcomes of Service: i. Individuals will be able to identify traumatic events and manage symptoms that disrupt their day-to-day activities. ii. Individuals will be able to develop and utilize strategies to cope with symptoms and upsetting triggers, such as memories. e. Target Population: i. Male, female, lesbian, gay, bisexual, transgender, and queer (LGBTQ), and any gender identified with, ages 12 to 18, male, female, LGBTQ, and any gender identified with, over the age of 19, veteran and active service members, victims of abuse and/or neglect; history of incarceration and imprisonment, gang members, cult survivors, and those with unidentified trauma. f. Service Access: i. 2619 West 1 lth Street Road, Suite 23, 25, and 13 Greeley, CO 80634. g. Language: English 5. Mental Health Therapy: a. Modalities, curriculum, and tools used in deliver of service: i. Services are provided by a Licensed Professional Counselor, a Licensed Professional Counselor Candidate, or a registered psychotherapist with oversight from a Licensed Professional Counselor. ii. Client's available mental health records will be reviewed. iii. The psychometric instruments used may include the following: 1. The Hare Psychopathy Checklist -Revised 2. Minnesota Multiphasic Personality Inventory -II 3. Jesness Inventory 4. Millon Clinical Multiaxial Inventory 5. Shipley -2 6. Beck Depression Inventory 7. Beck Anxiety Inventory 8. Dissociative Experiences Scale 9. Multidimensional Dissociation Instrument. b. Anticipated frequency of service: i. Weekly or biweekly 50 -minute sessions until treatment goals are met. c. Anticipated duration of service: i. Four (4) to six (6) months, treatment will by adjusted as needed. d. Goals of the service: i. To assist the client in decreasing symptoms presented at intake. ii. The client will develop self -management tools. iii. The client will be able to manage life symptom free. e. Outcomes of the service: i. Management of symptoms that previously disrupted a client's day-to-day activities. ii. The development and utilization of strategies to cope with symptoms and upsetting triggers. iii. Utilizing techniques such as journaling, mindfulness exercises, and stress management. f. Target population: i. Any gender ages twelve (12) and up. ii. LGBTQ iii. Veterans and active service members iv. Victims of abuse or neglect v. Individuals with a history of incarceration and imprisonment vi. Gang members vii. Cult survivors viii. Those with general mental health needs Language: i. English only. g• h. Medicaid eligibility: i. This service is not Medicaid eligible. 6. Mental Health Evaluation a. Modalities, curriculum, and tools used in deliver of service: i. Services are provided by a Licensed Professional Counselor, a Licensed Professional Counselor Candidate, or a registered psychotherapist with oversight from a Licensed Professional Counselor. ii. Social history interview. iii. Review of collateral data. iv. Administration of psychometric instruments. 1. The Hare Psychopathy Checklist -Revised 2. Minnesota Multiphasic Personality Inventory -II 3. Jesness Inventory 4. Millon Clinical Multiaxial Inventory 5. Shipley -2 6. Beck Depression Inventory 7. Beck Anxiety Inventory 8. Dissociative Experiences Scale 9. Multidimensional Dissociation Instrument. b. Anticipated frequency of service: i. Two (2) sessions with will last for two (2) hours each. In some cases, additional sessions may be needed. c. Anticipated duration of service: i. The full evaluation will be completed within a two (2) month period. d. Goals of the service: i. Determine treatment needs. ii. Determine unhealthy psychological, social, and developmental patterns. iii. Determine recommendations for treatment. e. Outcomes of the service: i. Determine symptoms that have disrupted a client's day-to-day activities. ii. Recommendation for treatment or adjunct services. iii. Weekly or biweekly treatment recommendations. f. Target population: i. Any gender ages twelve (12) and up. ii. LGBTQ iii. Veterans and active service members iv. Victims of abuse or neglect v. Individuals with a history of incarceration and imprisonment vi. Gang members vii. Cult survivors viii. Those with general mental health needs g. Language: i. English only. h. Medicaid eligibility: i. This service is not Medicaid eligible. Terms 1. Contractor will respond to the Quality Assurance Team (HS-CWQualityAssurance(&,,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 - C W QualityAssu rance(aweldgov.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 discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team HS-CWQualityAssurance(a,weldgov.com. 4. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team HS-CWQualityAssurance(a)weldgov.com immediately via email, to discuss service continuation. 5. Contractor will identify in detail areas of continued concern and make recommendations to the Department 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 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 the caseworker, their supervisor, or the Family Support and Visitation Center. 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 Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and 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 Client Verification Form. 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, if approved by the Department. 10. Contractor will notify the Quality Assurance Team HS-CWOualitvAssurance(&,weld2ov.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. EXHIBIT D 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. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2021. 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 Anger Management/Domestic Violence: Rate Type Service Name $340.00 Episode Impact of Domestic Violence on Children and Victims (Episode) $ 85.00 Hour Impact of Domestic Violence on Children and Victims (HR) Sexual Abuse Treatment: Rate Type Service Name $ 300.00 Episode ABEL Assessment for Sexual Interests (Episode) $ 150.00 Hour ABEL Assessment for Sexual Interests (HR) $ 45.00 Episode Adult Education Group $ 100.00 Episode Adult Intake $ 45.00 Episode Adult Phase 1 Group $ 45.00 Episode Adult Phase 2 Group $ 45.00 Episode Adult Phase 3 Group $ 45.00 Episode Adult Phase 4 Group $ 50.00 Episode Adult Sex Offender Evaluation in Correctional Facility Additional Fee $1,000.00 Episode Adult Sex Offender Evaluation with ABEL (Episode) $ 167.00 Hour Adult Sex Offender Evaluation with ABEL (HR) $ 820.00 Episode Adult Sex Offender Evaluation with no ABEL (Episode) $ 182.00 Hour Adult Sex Offender Evaluation with no ABEL (HR) $1,000.00 Episode Adult Sex Offender Updated Evaluation (Episode) $ 167.00 Hour Adult Sex Offender Updated Evaluation (HR) $ 20.00 Episode Aftercare Group $1,000.00 Episode Child Contact Assessment $ 45.00 Episode Community Support/Approved Supervisor Group, 2 People $ 125.00 Episode Deniers Treatment $ 95.00 Episode Family Therapy $ 85.00 Episode Individual Therapy $ 45.00 Episode Informed Supervision Group, 2 people $ 85.00 Hour Informed Supervision, Individual $ 50.00 Episode Juvenile Sex Offender Evaluation in Correctional Facility Additional Fee $1,000.00 Episode Juvenile Sex Offender Evaluation, with Testing and ABEL (Episode) $ 164.00 Hour Juvenile Sex Offender Evaluation, with Testing and ABEL (HR) $ 800.00 Episode Juvenile Sex Offender Evaluation, with Testing and No ABEL, 14 Years and Older (Episode) $ 164.00 Hour Juvenile Sex Offender Evaluation, with Testing and No ABEL, 14 Years and Older (HR) $ 700.00 Episode Juvenile Sex Offender Evaluation, Without Testing (Episode) $ 200.00 Hour Juvenile Sex Offender Evaluation, Without Testing (HR) $ 45.00 Episode Juvenile Sex Offender Group $ 100.00 Episode Juvenile Sex Offender Intake Mental Health Treatment Rate Type Service Name $ 85.00 Hour FTM, TDM, Professional Staffing $ 800.00 Episode Mental Health Evaluation $ 85.00 Hour Mental Health Therapy $ 100.00 Episode No Show-MH Evaluation $ 43.00 Hour No Show -Therapy $ 85.00 Hour Trauma Informed Therapy Services 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report 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 and Exhibit A. 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 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. New Contract Request Entity :Information Entity Name* PERKLEN INCORPORATED Entity ID* `000246817 Contract Name* PERKLEN CENTER FOR PSYCOTHERAf Y (AGREEMENT AME:NDMENT) Contract Status C;Tg REVIEW Contract Description' 61D ;411900025, TERM: 6 l 21-5 31 22 ❑ New Entity? Contract ID 473? Contract Lead* APEGG Contract Lead Email apegtl,l?weldgov.com:cobbx xIk:17(I �eldgov.cone Contract Description. 2 CONSENT. PA IS BEING ROUTED THROUGH THE NORMAL PROCESS. ETA TO CITP. 5/6;21. Contract Type* AMENDMENT Amount* S x:00 Renewable* NO AUtomatic. Renewal Grant IGA Department HUMAN SERVICES Department Email CM- HLtmarlServicesgweiddov'.co ;m Department Head Email CM-HurnanServices- DeptHeadn Wveldgov.com County Attorney GENERAL COUNTY AI I _ ORNEY EMAIL County Attorney Email Ch1.... COlrNTYATTORNEY,I WELDC OV.COM Requested B€)CC Agenda Date* 05 26x'2021 Parent Contract ID 20192264 Requires Board Approval YES Department Project If Due Date 05_'22 2023 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 these contracts are not in OnBase Contract Dates Effective Date Review Date 04;r01:2027 Renewal Date Termination Notice Period Contact Information Contact Info Contact Name Purchasing Committed Delivery Date Contact Type Contact Email Expiration Date's 05 31 2022 Contact Phone 1Contact Phone 2 Purchasing Approver Purchasing Approved Date CONSENT 04 28 2021 Approval Process Department Head JAMIE ULRIC;H DH Approved Date 04.' 28 2021 Final Approval BOCC Approved 8OCC Signed Date ROCC Agenda Date 05;'10'20+21 Originator AFE.GC Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date 04/28;2021 L��egal Counsel Approved Bate 04/28'2021 .t%L°' 28; 202 1 Tyler Ref # AC: 041021 PRIVILEGED AND CONFIDENTIAL 46.337 MEMORANDUM DATE: April 7, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment with Perklen Center for Psychotherapy 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 with Perklen Center for Psychotherapy. The Department entered into a Child Protection Agreement for Services, identified as Tyler ID 2019-2264, on June 17, 2019, for the term June 1, 2019 through May 31, 2020, with the option to extend annually upon written agreement for a total period not to exceed three years. The Department wishes to extend the agreement for the term of June 1, 2020 through May 31, 2021 and, the vendor has requested to add the following rates for the following services: $85.00/Hour (In -Office - Trauma -Informed Therapy Services) - $85.00/Hour (FTM, TDM, Prof. Staffing — Trauma Informed Therapy Services) $42.50/Hour (No Show — Trauma Informed Therapy) I do not recommend a Work Session. I recommend approval of this Amendment and authorize the Chair to sign. Mike Freeman, Chair Scott James Barbara Kirkmeyer Steve Moreno, Pro-Tem Kevin Ross Approve Schedule Recommendation Work Session (NAP - r vt, Other/Comments: Pass -Around Memorandum; April 7, 2020 — CMS 3516 Page 1 of --I Tl� 2a/9 -A201 p-zoa90 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PERKLEN CENTER FOR PSYCOTHERAPY This Agreement Amendment, made and entered into day of 2020 by and between the Board of Weld County Commissioners, on behalf of the Weld County D artment of Human Services, hereinafter referred to as the "Department", and Perklen Center for Psychotherapy, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Anger Management/Domestic Violence, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2264, approved on June 17, 2019. 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, 2020. • 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: 1. Term This agreement is being renewed for a second full year term, for the period June 1, 2020 through May 31, 2021. 2. Exhibit C, Scope of Services, is hereby amended as attached. 3. Exhibit D, Rate Schedule, is hereby amended as attached. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST. didet) `�' �� BOARD OF COUNTY COMMISSIONERS Weld C rk to the Bo. �`}�.� f�f WELD COUNTY, COLORADO ke Freeman, Chair APR 2 7 2020 CONTRACTOR: Perklen Center for Psychotherapy 2619 West 11`h Street Road, Ste. 33 Greeley, CO 80634 By: Kim Draughon Date: Apr 2, 2020 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management/Domestic Violence (Impact of Domestic Violence on Children and Victims), Trauma -Informed Therapy Services and Sexual Abuse Treatment (Offense Specific), as referred by the Department. 2. Anger Management/Domestic Violence (Impact of Domestic Violence on Children and Victims) a. Capacity for Services: Two (2) 120 -minute sessions for a total of four (4) hours b. Goals of Service: Educate individual, family members, and concerned parties about the impact of domestic violence on children and victims who have been impacted by being in a home where domestic violence is prevalent. Curriculum includes: i. Cycle of violence ii. Types of violence iii. How children and victims are traumatized by witnessing domestic violence iv. Misconceptions about domestic violence v. Trauma signs and symptoms c. Outcomes of Service: i. Client will be able to identify how children, victims and secondary victims are impacted by domestic violence. ii. Client will be able to discuss trauma symptoms, each stage of the cycle of abuse, and cognitive distortions around the concept of domestic violence. iii. Client will develop strategies for the prevention of trauma to children. d. Target Population: i. Male and female youth, 12 to 18 years of age. ii. Male and female adults, 19 and older. e. Service Access: i. 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. ii. Crisis and after hours, (970) 237-1134. f. Language: English 3. Sexual Abuse Treatment (Offense Specific): All services will be provided in compliance with Sex Offender Management Board (SOMB) guidelines. a. Sexual Abuse Evaluations i. Contractor requires a psychosexual evaluation to determine if a client is appropriate for an outpatient treatment program. Evaluations will examine seven (7) areas: 1. Potential to re -offend 2. Amenability for treatment 3. Recommended treatment setting 4. Type of treatment needed 5. Risk factors/monitoring/potential new victims 6. Psychiatric/substance abuse/individual/family needs 7. Mental health concerns ii. Evaluations will include: 1. Structured clinical interview 2. Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctor, courts, police reports and other relevant sources 1 3. Assessments, which may include (dependent on age of offender and circumstances of case): a. Hare Psychopathy Checklist -Revised b. Minnesota Multiphasic Personality Inventory -II c. Jessness Inventory d. SASSI Drug and Alcohol Inventory e. Milton Clinical Multiaxial Inventory f. Shipley -2 g. State Trait Anger Expression Inventory h. Vermont Assessment of Sex Offender Risk -2 i. Sex Offender Treatment Intervention and Progress Scale j. Abel Assessment for Sexual Interest k. Juvenile Sex Offender Assessment Protocol iii. Capacity for Services: 1. Clinical interview (minimum 3 hours) 2. Administration of psychometric instruments (3 hours) a. Abel Assessment for Sexual Interest (2 hours) iv. Goals of Services: 1. Access the type of treatment needed for the client 2. Assess risk for recidivism 3. Define additional treatment needed, which may include: a. Medication evaluation b. Psychiatric evaluation c. Monitoring for substance abuse d. Trauma assessment and treatment e. Substance abuse treatment 4. Development of measurable treatment goals 5. Monthly monitoring of goals v. Outcomes of Service: Written evaluation outlining the clinical interview, social history, results of psychometric testing, risk for recidivism, and recommended treatment options. Interventions will address child welfare specific needs. vi. Target Population: 1. Male and female youth, ages 12 to 18 years, who require a Juvenile Mental Health Sex Offense -specific Evaluation. 2. Male and female adults, ages 19 and older, who require an Adult Mental Health Sex Offense -Specific Evaluation. 3. Developmentally/intellectually delayed offenders who require a Mental Health Sex Offense -specific Evaluation for Developmentally/Intellectually Delayed Offenders. vii. Service Access: 1. 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. 2. Crisis and after hours, (970) 237-1134. viii. Language: English b. Sexual Abuse Treatment: i. Services under this agreement include: 1. Offense -specific group therapy 2. Individual, couples and/or family therapy 3. Informed Supervision groups — youth (1 hour/month or six intensive sessions) 2 4. Community Support Group/Approved Supervisor Group -adults (1 hour/month ongoing) ii. All services are provided in a non -medical, cognitive behavioral model that emphasizes a strengths -based approach, and will incorporate: 1. Relationship and interpersonal social skills 2. Sex education 3. Victim empathy and awareness 4. Anger management/impulse control skills 5. Cognitive behavioral modification 6. Self-esteem building 7. Values clarification and examination 8. Prosocial living 9. Relapse prevention 10. Aftercare services 11. Types of abuse a. Deviant sexual behavior b. Physical c. Emotional d. Verbal e. Psychological iii. Capacity for Services: 1. Adults: Two (2) times per week for 90 minutes each session (3 hours weekly) 2. Juveniles: One (1) time per week for 90 minutes each session (1-1/2 hours weekly) 3. All clients will attend a 60 -minute session one (1) time per month 4. Crisis Intervention sessions are 60 minutes and will be scheduled as needed iv. Goals of Service: 1. Provide a structured treatment environment for the safety of the client, family, victim, and community in order to prevent recidivism. 2. Increased awareness and empathy for the victim and the impact of the offense on the victims and family members. 3. Foster a safe environment to effect positive change by developing the use of appropriate social/sexual skills and expressions through recognition of situations and stimuli that trigger sexually aggressive behavior. 4. Assist family members to develop the skills necessary to recognize and understand the sexual behavior of their family member for the purpose of providing support while the client progresses through treatment. v. Outcomes of Service: 1. Client will: a. Consistently define all sexually abuse behavior b. Acknowledge risk by demonstrating foresight and using safety planning c. Consistently recognize/interrupt sexual abuse cycle d. Demonstrate new coping skills and develop stress management techniques e. Demonstrate victim empathy and understand how behavior affects the victim, family and community f. Display accurate attribution of responsibility for offending behavior g. Be able to manage frustration and unfavorable events h. Reject sexually abusive thoughts as dissonant with self-image i. Demonstrate pro -social relationship skills j. Project positive self-image k. Demonstrate the ability to resolve conflict and make decisions I. Celebrate appropriate behavior and experience pro -social pleasure m. Delay gratification n. Communicate assertively o. Develop family and/or community support systems p. Develop an adaptive sense of purpose and future 2. Contractor will track progress through the program, as follows: a. Through an individualized treatment plan that will outline what the client will accomplish in order to complete treatment b. By assessing client progress made toward treatment plan, and changes and updates will be made to the plan as needed c. By evaluating whether the client is understanding the concepts presented during groups using a Group Note and homework d. By providing feedback to the client at the start of the next group to help the client obtain maximum benefit from groups vi. Target Population: 1. Male and female youth, 12 to 18 years of age 2. Youth with current sexual offense adjudications or youth who have admitted guilt and will provide a letter from a parent or attorney stating they plan to plead guilty 3. Youth with both average intelligence and those who are developmentally delayed 4. Male and female adults, age 19 or older 5. Adults who have been found guilty of a sexual offense or have a written letter from an attorney stating they plan to plead guilty 6. Adults with both average intelligence and those who are developmentally delayed vii. Service Access: 1. 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. 2. Crisis and after hours, (970) 237-1134. viii. Language: English 4. Trauma -Informed Therapy Services: Contractor will provide evaluation and treatment of individuals with post -traumatic stress symptoms, dissociative behaviors, and heightened anxiety, as well as depressive symptoms as a result of traumatic life events. This modality of treatment has been beneficial to service members who struggle with the impact of deployment. In most cases, a Trauma -Focused Mental Health Evaluation will be completed with the client to determine the scope of services needed. The evaluation will consist of a social history interview, review of collateral data, and the administration of psychometric instruments. The psychometric instruments used may include the following: The Hare Psychopathy Checklist -Revised, Minnesota Multiphasic Personality Inventory -II, Jessness Inventory, Millon Clinical Multiaxial Inventory, Shipley -2, Dissociative Experiences Scale, and the Multidimensional Dissociation Instrument. Eye Movement Desensitization and Reprocessing (EMDR) may be added as part of the treatment plan. a. Capacity for Services: Weekly or biweekly for 50 minutes. EMDR will begin with 90 -minute sessions and gradually decrease to 60 -minute sessions as symptom management is increased. b. Duration of Service: Four (4) to six (6) months. 4 c. Goals of Service: i. Decrease symptoms present at intake. ii. Development of self -management tools. iii. Client will be able to manage life symptom free. d. Outcomes of Service: i. Individuals will be able to identify traumatic events and manage symptoms that disrupt their day-to-day activities. ii. Individuals will be able to develop and utilize strategies to cope with symptoms and upsetting triggers, such as memories. e. Target Population: i. Male, female, lesbian, gay, bisexual, transgender, and queer (LGBTQ), and any gender identified with, ages 12 to 18, male, female, LGBTQ, and any gender identified with, over the age of 19, veteran and active service members, victims of abuse and/or neglect; history of incarceration and imprisonment, gang members, cult survivors, and those with unidentified trauma. f. Service Access: i. 2619 West 11`h Street Road, Suite 23, 25, and 13 Greeley, CO 80634. g. Language: English 5. Contractor will respond to the Quality Assurance Team Supervisor (hainleld@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 6. 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 Supervisor (hainleid@weldgov.com, 970-400-6210). 7. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understand that the Department will no reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. After three (3) "no-shows, " Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). 8. Contractor understands that the Department will not reimburse Contractor for cancelled appointments either on the part of the client or the Contractor. If the cancellation is generated from the Contractor, a "makeup" session/episode, to occur within 30 days of the cancellation, will be offered to the client (excluding session/episodes that fall on holidays). If the cancellation is generated from the client, the Contractor must request a makeup session from the Department prior to the makeup session occurring (excluding session/episodes that fall on holidays). After three (3) cancellations, Contractor will inform the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com) immediately via email, to discuss service continuation. 9. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 5 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 immediately AND on the required monthly report. 11. 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. 12. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. 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. 13. Contractor agrees to attend meetings when available and as requested by the Department. Such meetings include Court Facilitations, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, the Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. 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, if approved by the Department. 14. Contractor will notify the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210) 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 D 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. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2021. 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 Anger Management/Domestic Violence: $85.00/Hour (Impact of Domestic Violence on Children and Victims) $340.00/Episode (Impact of Domestic Violence on Children and Victims, minimum of 4 hours) Sexual Abuse Treatment: $150.00/Hour (ABEL Assessment for Sexual Interests) $300.00/Episode (ABEL Assessment for Sexual Interests) $45.00/Episode (Adult Education Group) $100.00/Episode (Adult Intake) $45.00/Episode (Adult Phase 1 Group) $45.00/Episode (Adult Phase 2 Group) $45.00/Episode (Adult Phase 3 Group) $45.00/Episode (Adult Phase 4 Group) $50.00/Episode (Adult Sex Offender Evaluation in Correctional Facility Additional Fee) $167.00/Hour (Adult Sex Offender Evaluation with ABEL) $1,000.00/Episode (Adult Sex Offender Evaluation with ABEL) $182.00/Hour (Adult Sex Offender Evaluation with no ABEL) $820.00/Episode (Adult Sex Offender Evaluation with no ABEL) $167.00/Hour (Adult Sex Offender Updated Evaluation) $1,000.00/Episode (Adult Sex Offender Updated Evaluation) $20.00/Episode (Aftercare Group) $1,000.00/Episode (Child Contact Assessment) $45.00/Episode (Community Support/Approved Supervisor Group, 2 People) $125.00/Episode (Deniers Treatment) $95.00/Episode (Family Therapy, 50 -minute Session) $85.00/Episode (Individual Therapy, 50 -minute Session) $45.00/Episode (Informed Supervision Group, 2 People) $85.00/Hour (Informed Supervision, Individual) $50.00/Episode (Juvenile Sex Offender Evaluation in Correctional Facility Additional Fee) $164.00/Hour (Juvenile Sex Offender Evaluation, with testing and ABEL) $1,000.00/Episode (Juvenile Sex Offender Evaluation, with testing and ABEL) $164.00/Hour (Juvenile Sex Offender Evaluation, with testing and no ABEL, 14 years and older) $800.00/Episode (Juvenile Sex Offender Evaluation, with testing and no ABEL, 14 years and older) $200.00/Hour (Juvenile Sex Offender Evaluation, without testing) $700.00/Episode (Juvenile Sex Offender Evaluation, without testing) $45.00/Episode (Juvenile Sex Offender Group) $100.00/Episode (Juvenile Sex Offender Intake) Mental Health Treatment: $85.00/Hour (In -Office - Trauma -Informed Therapy Services) $85.00/Hour (FTM, TDM, Prof. Staffing — Trauma Informed Therapy Services) $42.50/Hour (No Show —Trauma Informed Therapy) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report 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 and Exhibit A. 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 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Contract Farm New Contract Request Entity Information Entity Name* PERKLEN INCORPORATED Entity ID* aW0028680 Contract Name* PERKLEN CENTER FOR PSYCHOTHERAPY CHILD PROTECTION AGREEMENT AMENDMENT FOR SERVICES Contract Status CTB REVIEW ❑ New Entity? Contract ID 3516 Contract Lead* CULLINTA Contract Lead Email cullinta@co.weld.co.us Parent Contract ID 20102264 Requires Board Approval YES Department Project # Contract Description* PERKLEN CENTER FOR PSYCHOTHERAPY CONSENT. AGREEMENT AMENDMENT FOR SERVICES. FUNDING CORE/OTHER. TERM 061O1r2 THROUGH 05/31/21 Contract Description 2 BID NO. B2000037 Contract Type* AGREEMENT Amount* $0.00 Renewable* YES Automatic Renewal Department HUMAN SERVICES Department Email CM- HumanServices@weldgcw.com Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY A I I ORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WELD GOV.COM Requested BOCC Agenda Date* 04/08/2020 Due Date 04104/2020 Will a work session with BOCC be required?* NO Does Contract require Purchasing Dept. to be induded? 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 Review Date* 04/01/2021 Termination Notice Period Committed Delivery Date Renewal Date* 06101;2021 Expiration Date Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 04/21/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 04/27/2020 Originator SNYDERKL Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Fnance Approved Date 04/22/2020 Tyler Ref # AG 042720 Legal Counsel GABE KALOUSEK Legal Counsel Approved Date 04/22/2020 Submit eAr\hokA,1- ID*Vzikq CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PERKLEN CENTER FOR PSYCHOTHERAPY h This Agreement, made and entered into the/ day of 019, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departme of Human Services, hereinafter referred to as the "Department' and Perklen Center for Psychotherapy, hereina er 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, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule. Exhibit B, C, and D are attached hereto and incorporated herein by this reference. Exhibit A is Weld County's Request for Proposal Number B1900025which is incorporated into this agreement by reference and will be provided upon request to the Department. W ITN ESSETH 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 Anger Management/Domestic Violence and Sexual Abuse Treatment. 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, 2019, upon proper execution of this Agreement and shall expire May 31, 2020, unless sooner terminated as provided herein. The agreement is for a period of three years. However, the agreement must be renewed by both parties, in writing, on an annual basis. 2. Scope of Services Services shall be provided by the Contractor to any person(s) eligible for services in compliance with Exhibit B, Contractor's Response to Request for Proposal and Exhibit C, Scope of Services. 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 Supervisor (hainleid@weldgov.com, 970-400-6210). 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 Ni\s_zAA 17.\ Lsz-Vt—t9 0.1 -s -v) 2019-2264 Department. Contractor agrees to utilize the Client Verification Form for all scheduled and unscheduled face-to-face services with the exception of home studies and monitored sobriety testing. Contractor agrees that original complete Client Verification Forms are to be submitted with the Request for Reimbursement. Requests for Reimbursement and Client Verification Forms received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet 60 -day deadline may result in 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 of service b. Where the service took place 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, Weld County's Request for Proposal, Exhibit B, Contractor's Response to Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule, 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. 2 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 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 OMG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit B, Contractor's Proposal, Exhibit C, Scope of Services, and Exhibit D, Rate Schedule: 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 an, 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 3 - 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 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 4 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 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. 5 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 within seven (7) days of the date 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, the following insurance coverage. Weld County, State of Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible the insurance provider. 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. Tvoes 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 0110/93 or equivalent, covering premises operations, fire damage, independent Contractors, 6 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 as follows 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 (as defined in the Bid or RFP) 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. Trng 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 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 970-400-6503 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 8 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). For Department: Heather Walker, Child Welfare Division Head 17. Notice For Contractor: Jodie Goter, LPC 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: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 400-6510 9 For Contractor: Jodie Goter, Executive Director and Vice President 2619 West 11th Street Road, Suite 23 Greeley, CO 80634 (970)353-8171 18. Litigation 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. seo., 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 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 10 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 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. 11 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 A 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 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. 12 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, etc., 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. §§24-18-201 et seq. and §24-50-507 The signatories to this Agreement aver that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. The Contractor has no interest and shall not acquire any interest direct or indirect, which would in any manner or degree with the performance of the Contractor's services and the Contractor, shall not employ any person having such known interests. During the term of this Agreement, the Contractor shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the Contractor to ensure compliance with this provision may result, in the Department's sole discretion, in immediate termination of this Agreement. No employee of the Contractor nor any member of the Contractor's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises Contractor's operations, or authorizes funding to the Contractor. 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. 13 36. Attorney's Fees/Legal Costs 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. Severabilit 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. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST:j.41(afet) ap/� BOARD OF COUNTY COMMISSIONERS Weld Co Clerk to the Board WELD COUNTY, COLORAgO By: Deputy Clerk to the }.ard ,�� rbara Kirkmeyer,hair 31,1 17 2419 AltkS.R, i CONTRACTOR: Perklen Center for Psychotherapy 2619 West 11th Street Road, Suite 23 Greeley, CO 80634 (970) 353-0371 Jadie tit Gotet Jodie M. Goter (May 6, 2019) By: Date: 15 Jodie Goter, Executive Director and Vice President May 6, 2019 EXHIBIT A 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 intentionally left blank. EXHIBIT B CONTRACTOR'S RESPONSE TO REQUEST FOR PROPOSAL Perklen Center for Psychotherapy A Journey to Integrity Through Self-awareness 2619 West 11th Street Road, Suite 23, Greeley, Co. 80634 P: 970.353.8171 F: 970.353.0371 January 21, 2019 Weld County Department of Human Services 915 10th Street Greeley, CO 80632 RE: Services Bid for Program year 2019-2020 To whom it may concern: The Perklen Center for Psychotherapy dba Perklen Inc. was first established as a private practice, single owner, for-profit agency in Greeley, Colorado on February 1, 2001. Currently, Kim R. Ruybal, MA, LPC and Jodie M. Goter, MA, LPC co-own the company. From its inception, this agency has been dedicated to reducing violence in the Weld County community by providing services to those who are on community supervision. We work closely with professionals within the legal system to include the Department of Human Services, Parole, Probation, Community Corrections, the Judicial Bench, and the District Attorney's Office. We provide State approved (SOMB) sex offender evaluations, Abel Assessment for Sexual Interests, and group and individual treatment. Our programs include mental health, anger management, and impact of domestic violence on children and victims. Many of the staff of the Perklen Center are approved providers with Parole and the Sex Offender Management Board; the governing agencies that provide standards of care for this specific clientele. The individuals we serve include males, females, youth, those with marital discord, families, couples, individuals with developmentally disabilities, and the LGBTQ+ community. We offer mental health, cognitive behavioral group intervention and short-term, intensive, individual treatment. We are contracted with the Department of Youth Corrections to provide offense -specific treatment for youth who have sexually abused. We work closely with Intervention Community Corrections (ICCS) and Foothills Gateway, Inc., a program that supports people with developmental disabilities. We are providers for clients who have Crime Victim Compensation funding. As a part of a Community Supervision Team (CST), Multi -treatment Team (MTT), and a Multi -discipline Team (MDT), we coordinate the containment of our clients with probation, parole, community corrections, mental health agencies, and polygraphers. The Perklen Center for Psychotherapy is a protected entity under the provisions of HIPAA and the Regulations. Every measure is taken to ensure that the clients Protected Health Information (PHI) is secure and confidential. Perklen Center can deliver the services as proposed and will comply with the specific requirements set forth in the provisions as stated in Exhibit A. Attached are the RFPs proposed, Exhibit B, Exhibit C, Exhibit D, and proof of professional liability insurance. Respectfully submitted, 6114' Kim R. Ruybal, LPC, President, Perklen Center for Psychotherapy dba Perklen Inc., State of Colorado EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services Perklen Center for Psychotherapy AGENCY OR PRIVATE PRACTICE Jodie Goter, LPC PRIMARY CONTACT -FULL NAME ( 970 1353-8171 PHONE NUMBER jgoter@perklen.org PRIMARY CONTACT -E-MAIL ADDRESS 2619 West 11th Street Road, Suite 23 AGENCY MAILING ADDRESS TRAILS PROVIDER ID (If Known) Executive Directer and Vice President PRIMARY CONTACT - TITLE l 970 1 353-0371 EXT. FAX NUMBER NA AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) Greeley, CO CITY 80634 ZIP REFERRAL CONTACT Jennifer Wuthrich REFFERAL CONTACT- FULL NAME ( 970 1353-8171 REFERRAL CONTACT -PHONE NUMBER EXT. Office Manager REFERRAL CONTACT - TITLE office@perklen.org REFERRAL CONTACT- E-MAILADDRESS BILLING CONTACT Jennifer Wuthrich BILLING CONTACT- FULL NAME ( 970 ) 353-8171 BILLING CONTACT -PHONE NUMBER EXT. Office Manager BILLING CONTACT - TITLE office@perklen.org BILLING CONTACT- E-MAIL ADDRESS I certify that the services proposed for intended use by the Weld County Department of Human Services will meet all the specifications it has so indicated in this bid form. I further affirm intention to enter into an agreement with Weld County, on behalf of the Weld County Department of Human Services, and comply with all requirements of the contract, if awarded. The Board of Weld County Commissioners reserve the right to reject any or all bids, to waive any informality in the bids, and to accept the 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. Signature of Authorized Representative: Date of Signature: 01/10/2019 N'wV Bid No.: B1900025 RFP-FYC-2019-20 D1900025 1. Perklen Incorporated dba Perklen Center for Psychotherapy 2. Anger Management Services Bid Proposal 3. The following modalities, curriculum and tools will be utilized in the delivery of services. Perklen Center for Psychotherapy can evaluate and treat individuals with high levels of antisocial traits, as well as, anger management concerns. Services may initially include an anger management evaluation to determine the scope of services needed. In that case, a clinical interview, social history, and psychometric testing will be utilized to determine recommendations for treatment. Instruments administered may include the Hare Psychopathy Checklist -Revised, Minnesota Multiphasic Personality Inventory -II, Jessness Inventory, SASSI Drug and Alcohol Inventory, Milton Clinical Multiaxial Inventory, Shipley -2, and the State Trait Anger Expression Inventory. In most cases individual and group counseling is best practice. Primarily a cognitive behavioral modality will be used. Therapy for anger management is psycho -educational and consists of a non- medical, cognitive behavioral model. Studies have shown that caring confrontation (pointing out client errors in thinking and behavior while treating the client with respect) is the most effective way of motivating the client to make changes. This model also focuses on the various types of abuse that clients may have exhibited while angry; this may include physical, emotional, verbal and psychological trauma. 4. Capacity to provide services. Clients in the anger management program will meet weekly until treatment goals are met. Each session is 60 -minutes. Crisis intervention sessions are 60 -minutes and are scheduled on an as needed basis. 5. The goals of treatment are to assist the client in understanding how their lack of anger management impacts their functioning. Sessions may address grief and loss, abuse and neglect, and trauma, as well as, other issues that may surface during their time in treatment. Interventions will address child welfare specific needs. 6. The outcomes of services. Sessions will help the client identify triggers and stressors that impact their anger issues and help the client develop and utilize strategies for anger management. In addition to an educational format, homework is given with passing grades expected in order to finish the program. 7. Target population for services. Male and female youth 12 to 18 years of age. Male and female adults age 19 and older, youth in conflict, and therapy for those involved in dependency and neglect cases. 8. Services will be accessed by face-to-face meetings at 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. The phone number is 970-353-8171 and for crisis and after hour contact a therapist can be reached at 970-237-1134. 9. English is the only language services are available in. 10. Rates of services are as follows: Anger Management Evaluation (per episode) $225.00 Hourly rate $75.00 Evaluations conducted while incarcerated (per episode) $275.00 Individual Sessions (per episode) $85.00 Group Sessions (per episode) $45.00 No Show/No Call (hourly rate for up to two sessions only) for Group $45.00 For individual sessions $85.00 RFP-FYC-2019-20 D1900025 1. Perklen Incorporated dba Perklen Center for Psychotherapy 2. The Impact of Domestic Violence on Children and Victims Bid Proposal 3. The following modalities, curriculum and tools will be utilized in the delivery of services. 4. Capacity to provide services. Clients will meet for four hours total. The sessions will be two 120 minutes appointments. 5. The goals of treatment are to educate individuals, family members, and concerned parties about the impact of domestic violence on children and victims who have been impacted by being in a home where domestic violence is prevalent. Sessions may address grief and loss, abuse and neglect, and trauma, as well as, other issues that may surface during their time in treatment. Interventions will address child welfare specific needs. The cycle of violence, types of violence, how children and victims are traumatized by witnessing domestic violence, misconceptions about domestic violence, and trauma signs and symptoms are a part of the curriculum. 6. The outcomes of services. The client will be able to identify how children, victims, and secondary victims are impacted by domestic violence. They will be able to discuss trauma symptoms, each stage of the cycle of abuse, cognitive distortions around the concept of domestic violence, and be able to develop strategies for the prevention of trauma to children. Interventions will address child welfare specific needs. 7. Target population for services. Male and female youth 12 to 18 years of age. Male and female adults age 19 and older. 8. Services will be accessed by face-to-face meetings at 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. The phone number is 970-353-8171 and for crisis and after hour contact a therapist can be reached at 970-237-1134. 9. English is the only language services are available in. 10. Rates of services are as follows: Four hour program $340.00 Hourly rate $85.00 No Show/No Call (hourly rate for up to two sessions only) for Group $85.00 RFP-FYC-2019-20 D1900025 1. Perklen Incorporated dba Perklen Center for Psychotherapy 2. Sexual Abuse Evaluations for Adults and Juveniles Services Bid Proposal 3. The following modalities, curriculum and tools will be utilized in the delivery of service. Before clients can be accepted into the outpatient program, a psychosexual evaluation is required to determine whether an outpatient program will be appropriate. Evaluations will examine seven areas: The client's potential to re -offend, Amenability for treatment, Recommended treatment setting, Type of treatment needed, Risk factors/monitoring/potential new victims, Psychiatric/substance abuse/individual/family needs, Mental health concerns. Evaluations will include: A structured clinical interview, Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctors, courts, police reports, or other relevant sources. Other assessment tools may include (depending on the age of the offender and circumstances of the case): Hare Psychopathy Checklist -Revised, Minnesota Multiphasic Personality Inventory -II, Jessness Inventory, SASSI Drug and Alcohol Inventory, Milton Clinical Multiaxial Inventory, Shipley -2, State Trait Anger Expression Inventory, Vermont Assessment of Sex Offender Risk -2, Sex Offender Treatment Intervention and Progress Scale, Abel Assessment for Sexual Interest, and the Juvenile Sex Offender Assessment Protocol. 4. Capacity to provide services. Once a referral has been received a minimum of three sessions will be scheduled for a clinical interview (3 hours), administration of psychometric instruments (3 hours), and an Abel Assessment for Sexual Interest (2 hours). 5. The goal of the evaluation is to assess the type of treatment needed for the client, risk for recidivism, and define additional treatment needed. Additional treatment may include a medication evaluation, psychiatric evaluation, monitoring of substance abuse, trauma assessment and treatment, and/or substance abuse treatment. Evaluations will determine a client's risk, needs, and responsivity factors, which will be incorporated into treatment goals. Measurable treatment goals will be developed and monitored on a monthly basis. 6. The outcomes of services. A written evaluation will be submitted to the referring source outlining the clinical interview, social history, results of psychometric instruments, risk for recidivism, and recommended treatment options. Interventions will address child welfare specific needs. 7. Target population for services. Male and female youth 12 to 18 years of age will complete a Juvenile Mental Health Sex Offense -specific Evaluation. Male and female adults age 19 and older will complete an Adult Mental Health Sex Offense -specific Evaluation. A client who is developmentally/intellectually delayed will complete a Mental Health Sex Offense -specific Evaluation for Developmentally/intellectually Delayed Offenders. 8. Services will be accessed by face-to-face meetings at 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. The phone number is 970-353-8171 and for crisis and after hour contact a therapist can be reached at 970-237-1134. 9. English is the only language services are available in. 10. Rates of services are as follows: JSO Evaluation w/o Testing (per episode) $700.00 Hourly rate $200.00 JSO Evaluation with Testing and no Abel 14 year's old and older (per episode) $800.00 Hourly rate $160.00 JSO Evaluation with Testing and Abel (per episode) $1000.00 Hourly rate $164.00 JSO Evaluation in a Correctional Facility (one episode), Add $50.00 Adult Evaluation with Abel (per episode) $1000.00 Hourly Rate $167.00 Adult Evaluation with no Abel (per episode) $ 820.00 Hourly Rate $182.00 Adult Updated Evaluation (per episode) $1000.00 Hourly Rate $167.00 Jail Evaluation in a Correctional Facility, Add (per episode) $50.00 RFP-FYC-2019-20 D1900025 1. Perklen Incorporated dba Perklen Center for Psychotherapy 2. Sexual Abuse Treatment Program for Adults and Juveniles Services Bid Proposal 3. The following modalities, curriculum and tools will be utilized in the delivery of services. Psychosexual testing and evaluation using standardized psychometric assessments approved by the Sex Offender Management Board. Offense -specific group therapy, individual, couples, and/or family therapy. Informed Supervision groups - youth (1 hour/month or six intensive sessions). Community Support Group/Approved Supervisor Group- adults (1 hour/month ongoing). Sessions will incorporate the following: Relationship and interpersonal social skills, Sex education, Victim empathy and awareness, Anger management/impulse control skills, Cognitive behavioral modification, Self-esteem building, Values clarification and examination, Prosocial living, Relapse prevention, and aftercare services. Interdisciplinary team meetings will be attended monthly and more often if needed. Therapy for adolescents and adult sexual abusers consists of a non -medical, cognitive behavioral model, which emphasizes a strengths -based approach. Studies have shown that caring confrontation (pointing out client errors in thinking and behavior while treating the client with respect) is the most effective way of motivating the client to make changes. This model also focuses on the various types of abuse that clients have committed in addition to their deviant sexual behavior, including physical, emotional, verbal and psychological. Understanding when sexual behavior is abusive will be taught by helping clients understand the concept of consent, victim empathy, responsibility, and relapse prevention. An integral part of treatment will include a polygraph during portions of the program, as well as shortly before discharge from the program. The purpose of the polygraph includes encouragement of more disclosure of additional victims or other deviant sexual behavior and monitoring for honesty to assess progress in treatment and increase containment. 4. Capacity to provide services. Clients in the adult program will meet twice weekly for 90 minutes each session (3 hours weekly). Juveniles will meet once weekly for 90 -minutes (1.5 hours weekly). In addition, each client will attend a 60 -minute session once monthly. Crisis intervention sessions are 60 - minutes and are scheduled on an as needed basis. Treatment is open ended; only when the requirements for discharge as mandated by the SOMB are met will treatment end. 5. The goals of treatment are to provide a structured environment for the safety of the client, family, victim, and community in order to prevent recidivism. The program is designed to increasing awareness and empathy for the victim and the impact of the offense on the victims and family members. Treatment will foster a safe environment to effect positive change by developing the use of appropriate social/sexual skills and expressions through recognition of situations and stimuli that trigger sexually aggressive behavior. Treatment will assist family members to develop the skills necessary to recognize and understand the sexual behavior of their family member for the purpose of providing support while the client progresses through treatment. 6. The outcomes of services. Upon completion of the program, clients should be able to demonstrate the following: Consistently define all sexually abusive behavior, Acknowledge risk by demonstrating foresight and using safety planning, Consistently recognize/interrupt sexual abuse cycle, Demonstrate new coping skills and develop stress management techniques, Demonstrate victim empathy and understand how his/her behavior effects the victim, family, community, etc., Display accurate attribution of responsibility for offending behavior, Able to manage frustration and unfavorable events, Reject sexually abusive thoughts as dissonant with self image, Demonstrate pro -social relationship skills, Project positive self image, Demonstrate the ability to resolve conflict and make decisions, Celebrate appropriate behavior and experience pro -social pleasure, Delay gratification, Communicate assertively, and Develop family and/or community support systems. The client will have an adaptive sense of purpose and future. Interventions will address child welfare specific needs. Tracking progress through the program will take place in the following manner: Upon acceptance into group, clients will receive an individualized treatment plan that will outline what the client will accomplish in order to complete treatment. Therapists will be assessing the progress each client is making toward their treatment plan. Changes and updates will be made to the treatment plan as needed. The therapist will evaluate whether the client is understanding the concepts presented during groups using a Group Note and homework. Feedback will be provided at the start of the next group to help the client obtain maximum benefit from groups. Polygraphs will be conducted periodically to determine whether clients are being truthful regarding their referring offense; their current and continued safety in the community; compliance with their terms and conditions of probation, parole plan, or case management plan; and their sexual history. For adult offenders and juvenile offenders, the Abel Assessment for Sexual Interest, will be administered as needed to assist with arousal management and deviant sexual interests. The Multi -Disciplinary Team (MDT) and Community Supervision Team (CST) will meet monthly to discuss client's progress in the program. Any major concerns that arise prior to the monthly meeting will be discussed with the case worker, case manager, probation/parole officer within 48 hours. 7. Target population for services. Male and female youth 12 to 18 years of age. Youth with current sexual offense adjudications or youth who have admitted guilt and will provide a written letter from a parent or attorney stating they plan to plead guilty. Youth with both average intelligence and those who are developmentally delayed. Male and female adults age 19 and older. Clients who have been found guilty of a sexual offense or have a written letter from an attorney stating they plan to plead guilty. Adults with both average intelligence and those who are developmentally delayed. 8. Services will be accessed by face-to-face meetings at 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. The phone number is 970-353-8171 and for crisis and after hour contact a therapist can be reached at 970-237-1134. 9. English is the only language services are available in. 10. Rates of services are as follows: Individual sessions are 50 minutes Abel Assessment for Sexual Interests (per episode) $300.00 Hourly rate (2 hours) $150.00 Community Support/Approved Supervisor Group for two people $45.00 Child Contact Assessment (per episode) $1000.00 Family (per individual session) $95.00 Individual Sessions $85.00 Informed Supervision Group for two people $45.00 Individual sessions per hour $85.00 JSO Intake (per episode) $100.00 JSO Group (per episode) $45.00 Adult Intake (per episode) $100.00 Adult Education Group (per episode) $45.00 Deniers Treatment (per episode) $125.00 Adult Phase I, II, III, IV (per episode, group) $45.00 Aftercare Group (per episode) $20.00 No Show/No Call (hourly rate for up to two sessions only) for Group $45.00 For individual sessions $85.00 I..XI]e:r ty 1nternatiFfERa1 US5.(exwriter,. Healthcare Professional Liability _ LIBERTY I NSURANCE UNDERWRI TERS INC. (A Stock insurance Company, hereinafter the "Company") 55 Water Street, 18th Floor New York, NY 10018 PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY FOR PROFESSIONAL COUNSELOR AND HUMAN DEVELOPMENT PRACTITIONERS DECLARATIONS I'IBNI AHZ-103018007 AHZ-103018006 q POLICI NI7l11Ii klen Inc. RENEW AL O1,: Named Insured: 2. 1020 8th Street Mailing Address: Greeley, CO 80631 3. 04/01/2018 04/01/2019 Policy Period: F o 1TAEA.M. Standard Tiine At Location of Designated Premises 4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premitun charge or charges : COVERAGE PREMIUM X A. Professional Liability 1 J General Liability 1 J Terrorism Risk Insurance Act I. A C. Endorsements [ J Total: $2,337.00 $0.00 $258.00 $2,595.00 5• LIMITS OF LIABILITY $1,000,000 bccltt}}t(48nt or $3,000,000 Aggregate in the 6. The Named Insured is: ❑ Sole Proprietor (including Individual) ❑ Partnership U Corporation 7. ❑ O cher. Counselor 8 Business or Occupauon of the darned Insured. This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s): HCPL-2016 (1/14), HCPL-2038 (11/09), HCPL-8020 (Ed. 12/10), HCPL-8101A (04/14), HCPL-8189 (1/14), HCPL-8003 (01/14), HCPL-8003 (01/14), OFAC (08/09), HCPL-2016-9000-CO (11/09) HCPL-8321 (01/15), HCPL-8326 (02/15) HCPL-8328 (02/15) Representative Agent or Broker: Mercer Consumer, a service of Mercer Health & Benefits Administration LLC P.O. Box 14576 Des Moines, IA 50306-3576 1-800-503-9230 1 1 --- -1 HCPL-2016 D (11/09) Client # 9105743 MEMO RANDUM OF INSURANCE Date Issued 05/10/2018 Prod ucer Mercer Consumer, a service of Mercer Health & Benefits Administration LLC P.O. Box 14576 Des Moines, IA 50306-3576 1-800-503-9230 This memorandum is issued as a matter of information only and confers no rights upon the holder. This memorandum does not amend, extend or alter the coverages afforded by the Certificate listed below. Company Affording Coverage Liberty Insurance Underwriters Inc Insured Perklen Inc. 1020 8th Street Greeley CO 80631 This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicat ed, not withstanding any requirement, term or condition of any contract or other document with respect to which this nemorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Type of Insurance Certificate Number Effective Date Expiration Date Limits Professional Liability MentalHS Fm Counselor AHZ-103018007 04/01/2018 04/01/2019 Per Incident/ Occurrence Annual Aggregate $1,000,000 $3,000,000 Memorandum Holder is added as an Additional Insured but only as respects to claims arising out of the sole negligence of the named insured subject to the terms and provisions of the policy. Memorandum Holder: Weld County Dept of Human Services 915 10th Street PO Box 758 Greeley CO 80632 of Should the above describe Certificate be cancelled before the expiration date thereof, the issuing company will endev or to mail 30 days written notice to the Memorandum Holder named to the left, but failure to mail such notice shall impose no obligation or liability any kind upon the company, its agents or representatives. Authorized Representative MarkBro��stowitz �u,tir`a. i5tAos4÷ Mercer Consumer, a service of Mercer Health & Benefits Administration LLC. In CA d/b/a Mercer Health & Benefits Insurance Senrioes LLC. CA Ins Lic. #0G39709 Li be rty International Underwriters. Healthcare Professional Liability LIBERTY I NSURANCE UNDERWRI TERS INC. (A Stock Insurance Company, hereinafter the "CompanO 55 Water Street, 18th Hoot New York, NY 10018 PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY FOR PROFESSIONAL COUNSELOR AND HUMAN DEVELOPMENT PRACTITIONERS DECLARATIONS I ITM AHZ-103018007 AHZ-103018006 1 POLIO NUMBV4klen Inc. RENEWAL Ol,: Named Insured: 2. 1020 8th Street 'Mailing Address: Greeley, CO 80631 3. 04/01/2018 04/01/2019 Policy Period: F o To: 1 fL:(.A._.1. Standard Time .At Location of Designated Premises 4. The insurance afforded is only with respect to such of the following types of insurance as indicated by specific premium charge or charges : COVERAGE PREMIUM X A. Professional Liability I J General Liability ( J Terrorism Risk Insurance :pct [ A C. Endorsements ( J Total: $2,337.00 $0.00 $258.00 $2,595.00 5. LIMITS OF LIABILITY $1,000,000 ital{i}c Fit or $3,000,000 aggregate in the 6. The Named Insured is: ❑ Sole Proprietor (including Individual) ❑ Partnership U Corporation 7. ❑ Other: Counselor 8 Business of Oct upauon of the Manned Insured. This police= is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s): HCPL-2016 (1/14), HCPL-2038 (11/09), HCPL-8020 (Ed. 12/10), HCPL-8101A (04/14), HCPL-8189 (1/14), HCPL-8003 (01/14), HCPL-8003 (01/14), OFAC (08/09), HCPL-2016-9000-CO (11/09) HCPL-8321 (01/15), HCPL-8326 (02/15) HCPL-8328 (02/15) Representative Agent or Broker: Mercer Consumer, a service of Mercer Health & Benefits Administration LLC P.O. Box 14576 Des Moines, IA 50306-3576 1-800-503-9230 i 1 HCPL-2016 D (11/09) Client # 9105743 MEMO RANDUM OF INSURANCE Date Issued 05/10/2018 Prod ucer Mercer Consumer, a service of Mercer Health & Benefits Administration LLC P.O. Box 14576 Des Moines, IA 50306-3576 1-800-503-9230 This memorandum is issued as a matter of information only and confers no rights upon the holder. This memorandum does not amend, extend or alter the coverages afforded by the Certificate listed below. Company Affording Coverage Liberty Insurance Underwriters Inc Insured Perklen Inc. 1020 8th Street Greeley CO 80631 This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicat ed, not withstanding any requirement, term or condition of any contract or other document with respect to which this nemorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Type of Insurance Certificate Number Effective Date Expiration Date Limits Professional Liability MentalHS Fm Counselor AHZ-103018007 04/01/2018 04/01/2019 Per Incident/ Occurrence Annual Aggregate $1,000,000 $3,000,000 Memorandum Holder is added as an Additional Insured but only as respects to claims arising out of the sole negligence of the named insured subject to the terms and provisions of the policy. Memorandum Holder: Weld County Dept of Human Services 915 10th Street PO Box 758 Greeley CO 80632 before of Should the above describe Certificate be cancelled the expiration date thereof, the issuing company will endev or to mail 30 days written notice to the Vlemorandum Holder named to the left, but failure to mail such notice shall impose no obligation or liability any kind upon the company, its agents or representatives. Authorized Representative MarkBropstowitz Aar —et Mercer Consumer, a service of Mercer Health & Benefits Administration LLC. In CA d/b/a Mercer Health & Benefits Insurance Services LLC. CA Ins Lic. #0G39709 STAFF DATA SHEET (Bidder must list all applicable staff who will manage and/oEaklittlBti§t@r the proposed service. One Staff Data Sheet per proposed service. Bidder should not PROPOSED SERVICE OR SERVIC1 Anger Management BIDDER LEGAL ENTITY NAME: Perklen Center for Psychotherapy APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION „ SUPERVISOR INFORMATION No. Last Name First Name Work#., , Work Email Education, Level • • Degree Focus Licensure/ Credentials DORA (If applicable) Last Name First Name Work # Work Email 1 Goter Jodie (970)353-8171 jgoter@perklen.org MA Counseling Psychology LPC#2647 N/A N/A N/A N/A N/A 2 Nielsen Stephanie (970)353-8171 snielsen@perklen.org MA Clinical M H Counseling LPC#15137 N/A Goter Jodie (970)353-8171 jgoter@perklen.org 3 Hendryx Aubrie (970)353-8171 ahendryx@perklen.org MA Clinical MH Counseling Registered Psychotherapist LPCC.0015962 Goter Jodie (970)353-8171 jgoter@perklen.org 4 Sperling Holly (970)353-8171 hsperling@perklen.org BS Psychology Registered Psychotherapist NLC.0109403 Goter Jodie (970)353-8171 jgoter@perklen.org 5 Cline Jamie (970)353-8171 maintern@perklen.org BA Criminal Justice, Psychology Registered Psychotherapist NLC.0109372 Goter Jodie (970)353-8171 jgoter@perklen.org 6 7 8 9 10 11 12 13 14 "15 16 17 18 19 20 21 22 23 24 25 26 27 28 Bid No.: B1900025 STAFF DATA SHEET (Bidder must list all applicable staff who will manage and/oalcht1lBii§tir the proposed service. One Staff Data Sheet per proposed service. Bidder should not PROPOSED SERVICE OR SERVIC1 Impact of DV on children & victims BIDDER LEGAL ENTITY NAME: Perklen Center for Psychotherapy APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION No. Last Name, First Name Work# WorkEmail ' Education Level Degree Focus Ucensuref Credentials DORA # (If applicable). Last Name First Name Work # Work Email 1 Goter Jodie (970)353-8171 jgoter@perklen.org MA Counseling Psychology LPC#2647 N/A N/A N/A N/A N/A 2 Nielsen Stephanie (970)353-8171 snielsen@perklen.org MA Clinical M H Counseling LPC#15137 N/A Goter Jodie (970)353-8171 jgoter@perklen.org 3 Hendryx Aubrie (970)353-8171 ahendryx@perklen.org MA Clinical MH Counseling Registered Psychotherapist LPCC.0015962 Goter Jodie (970)353-8171 jgoter@perklen.org 4 Sperling Holly (970)353-8171 hsperling@perklen.org BS Psychology Registered Psychotherapist NLC.0109403 Goter Jodie (970)353-8171 jgoter@perklen.org 5 Cline Jamie (970)353-8171 maintern@perklen.org BA Criminal Justice, Psychology Registered Psychotherapist NLC.0109372 Goter Jodie (970)353-8171 jgoter@perklen.org 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Bid No.: B1900025 STAFF DATA SHEET (Bidder must list all applicable staff who will manage and/oaf:M 11M the proposed service. One Staff Data Sheet per proposed service. Bidder should not PROPOSED SERVICE OR SERVIC1 Mental Health BIDDER LEGAL ENTITY NAME: Perklen Center for Psychotherapy 'APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION SUPERVISOR INFORMATION No: Last Name First_ Name Work# Work Email Education Level ' Degree Focus Ucensure/• Credentials - DORA # (If applicable) Last Name First Name Work # ' Work Email "- 1 Goter Jodie (970)353-8171 jgoter@perklen.org MA Counseling Psychology LPC#2647 N/A N/A N/A N/A N/A 2 Nielsen Stephanie (970)353-8171 snielsen@perklen.org MA Clinical M H Counseling LPC#15137 N/A Goter Jodie (970)353-8171 jgoter@perklen.org 3 Hendryx Aubrie (970)353-8171 ahendryx@perklen.org MA Clinical MH Counseling Registered Psychotherapist LPCC.0015962 Goter Jodie (970)353-8171 jgoter@perklen.org 4 Sperling Holly (970)353-8171 hsperling@perklen.org BS Psychology Registered Psychotherapist NLC.0109403 Goter Jodie (970)353-8171 jgoter@perklen.org 5 Cline Jamie (970)353-8171 maintern@perklen.org BA Criminal Justice, Psychology Registered Psychotherapist NLC.0109372 Goter Jodie (970)353-8171 jgoter@perklen.org 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Bid No.: B1900025 STAFF DATA SHEET (Bidder must list all applicable staff who will manage and/oattriditat9r the proposed service. One Staff Data Sheet per proposed service. Bidder should not PROPOSED SERVICE OR SERVIC1 Sexual abuse evaluations for adults and juveniles BIDDER LEGAL ENTITY NAME: Perklen Center for Psychotherapy APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION _SUPERVISOR INFORMATION No. Last Name First Name. Work# Work Email Education . Level �' Degree Focus` Licensure/ Credentials , DORA # ,(If applicable) Last Name First Name: Work #, Work Email • 1 Goter Jodie (970)353-8171 jgoter@perklen.org MA Counseling Psychology LPC#2647 N/A N/A N/A N/A N/A 2 Nielsen Stephanie (970)353-8171 snielsen@perklen.org MA Clinical M H Counseling LPC#15137 N/A Goter Jodie (970)353-8171 jgoter@perklen.org 3 Hendryx Aubrie (970)353-8171 ahendryx@perklen.org MA Clinical MH Counseling Registered Psychotherapist LPCC.0015962 Goter Jodie (970)353-8171 jgoter@perklen.org 4 Sperling Holly (970)353-8171 hsperiing@perklen.org BS Psychology Registered Psychotherapist NLC.0109403 Goter Jodie (970)353-8171 jgoter@perklen.org 5 Cline Jamie (970)353-8171 maintern@perklen.org BA Criminal Justice, Psychology Registered Psychotherapist NLC.0309372 Goter Jodie (970)353-8171 jgoter@perklen.org 6 7 8 9 10 11 12 13 14 ,. 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Bid NO.: B1900025 STAFF DATA SHEET (Bidder must list all applicable staff who will manage and/off 31It@r the proposed service. One Staff Data Sheet per proposed service. Bidder should not PROPOSED SERVICE OR SERVIC1 Sexual Abuse Treatment Program for Adults & Juveniles Services BIDDER LEGAL ENTITY NAME: Perklen Center for Psychotherapy APPLICABLE STAFF MEMBER OR, CONTRACTOR INFORMATION SUPERVISOR INFORMATION No. Last Name , First Name ' Work# • - ' Work Email Education Level. - Degree Focus Licensure/ Credentials DORA # (If applicable) Last Name First Name Work # . Work Email 1 Goter Jodie (970)353-8171 jgoter@perklen.org MA Counseling Psychology LPC#2647 N/A N/A N/A N/A N/A 2 Nielsen Stephanie (970)353-8171 snielsen@perklen.org MA Clinical M H Counseling LPC#15137 N/A Goter Jodie (970)353-8171 jgoter@perklen.org 3 Hendryx Aubrie (970)353-8171 ahendryx@perklen.org MA Clinical MH Counseling Registered Psychotherapist LPCC.0015962 Goter Jodie (970)353-8171 jgoter@perklen.org 4 Sperling Holly (970)353-8171 hsperling@perklen.org BS Psychology Registered Psychotherapist NLC.0109403 Goter Jodie (970)353-8171 jgoter@perklen.org 5 Cline Jamie (970)353-8171 maintern@perklen.org BA Criminal Justice, Psychology Registered Psychotherapist NLC.0309372 Goter Jodie (970)353-8171 jgoter@perklen.org 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Bid No.: B1900025 RFP-FYC-2019-20 D1900025 1. Perklen Incorporated dba Perklen Center for Psychotherapy 2. The Impact of Domestic Violence on Children and Victims Bid Proposal 3. The following modalities, curriculum and tools will be utilized in the delivery of services. 4. Capacity to provide services. Clients will meet for four hours total. The sessions will be two 120 minutes appointments. 5. The goals of treatment are to educate individuals, family members, and concerned parties about the impact of domestic violence on children and victims who have been impacted by being in a home where domestic violence is prevalent. Sessions may address grief and loss, abuse and neglect, and trauma, as well as, other issues that may surface during their time in treatment. Interventions will address child welfare specific needs. The cycle of violence, types of violence, how children and victims are traumatized by witnessing domestic violence, misconceptions about domestic violence, and trauma signs and symptoms are a part of the curriculum. 6. The outcomes of services. The client will be able to identify how children, victims, and secondary victims are impacted by domestic violence. They will be able to discuss trauma symptoms, each stage of the cycle of abuse, cognitive distortions around the concept of domestic violence, and be able to develop strategies for the prevention of trauma to children. Interventions will address child welfare specific needs. 7. Target population for services. Male and female youth 12 to 18 years of age. Male and female adults age 19 and older. 8. Services will be accessed by face-to-face meetings at 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. The phone number is 970-353-8171 and for crisis and after hour contact a therapist can be reached at 970-237-1134. 9. English is the only language services are available in. 10. Rates of services are as follows: Four hour program $340.00 Hourly rate $85.00 Court Testimony Hourly Rate $100.00 No Show/No Call 1/2 of Service Fee Non -medical Absence 1/2 of Service Fee RFP-FYC-2019-20 D1900025 1. Perklen Incorporated dba Perklen Center for Psychotherapy 2. Mental Health Services Bid Proposal 3. The following modalities, curriculum and tools will be utilized in the delivery of services. Services may include a mental health evaluation initially to determine to determine the scope of services needed. In that case, a clinical interview, social history, and psychometric testing will be utilized to determine recommendations for treatment. Instruments administered may include the Hare Psychopathy Checklist -Revised, Minnesota Multiphasic Personality Inventory -II, Jessness Inventory, SASSI Drug and Alcohol Inventory, Millon Clinical Multiaxial Inventory, Shipley -2, and the State Trait Anger Expression Inventory. In most cases individual sessions are best practice for mental health clients. Primarily a cognitive behavioral modality will be used with a person -centered focus. Services will assist in the development of the family services plan, asses and/or improve family communications, functioning, and relationship development. 4. Capacity to provide services. Mental health clients will meet weekly until treatment goals are met. Each session is 60 -minutes. Crisis intervention sessions are 60 -minutes and are scheduled on an as needed basis. 5. The goals of treatment are to improve the clients' overall mental health. The focus will be to assist the client in understanding how their mental health impacts their functioning and help identify triggers and stressors that impact strategies for mental health management. Sessions may address grief and loss, abuse and neglect, and trauma, as well as, other issues that may surface during their time in treatment. Interventions will address child welfare specific needs. 6. The outcomes of services. Mental health clients will be able to identify triggers and stressors that impact their ability to manage their life. Strategies and coping skills for ongoing mental health management will be developed and use of those strategies will have been obvious in treatment. Overall life functioning shall be improved in multiple factions of the client's life. 7. Target population for services. Male and female youth 12 to 18 years of age. Male and female adults age 19 and older. 8. Services will be accessed by face-to-face meetings at 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. The phone number is 970-353-8171 and for crisis and after hour contact a therapist can be reached at 970-237-1134. 9. English is the only language services are available in. 10. Rates of services are as follows: Mental Health Evaluation $1000.00 Hourly rate $175.00 Evaluations conducted while incarcerated $850.00 Individual Sessions $85.00 Court Testimony Hourly Rate $100.00 No Show/No Call 1/2 of Service Fee Non -medical Absence 1/2 of Service Fee RFP-FYC-2019-20 D1900025 1. Perklen Incorporated dba Perklen Center for Psychotherapy 2. Sexual Abuse Evaluations for Adults and Juveniles Services Bid Proposal 3. The following modalities, curriculum and tools will be utilized in the delivery of service. Before clients can be accepted into the outpatient program, a psychosexual evaluation is required to determine whether an outpatient program will be appropriate. Evaluations will examine seven areas: The client's potential to re -offend, Amenability for treatment, Recommended treatment setting, Type of treatment needed, Risk factors/monitoring/potential new victims, Psychiatric/substance abuse/individual/family needs, Mental health concerns. Evaluations will include: A structured clinical interview, Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctors, courts, police reports, or other relevant sources. Other assessment tools may include (depending on the age of the offender and circumstances of the case): Hare Psychopathy Checklist -Revised, Minnesota Multiphasic Personality Inventory -II, Jessness Inventory, SASSI Drug and Alcohol Inventory, Millon Clinical Multiaxial Inventory, Shipley -2, State Trait Anger Expression Inventory, Vermont Assessment of Sex Offender Risk -2, Sex Offender Treatment Intervention and Progress Scale, Abel Assessment for Sexual Interest, and the Juvenile Sex Offender Assessment Protocol. 4. Capacity to provide services. Once a referral has been received a minimum of three sessions will be scheduled for a clinical interview (3 hours), administration of psychometric instruments (3 hours), and an Abel Assessment for Sexual Interest (2 hours). 5. The goal of the evaluation is to assess the type of treatment needed for the client, risk for recidivism, and define additional treatment needed. Additional treatment may include a medication evaluation, psychiatric evaluation, monitoring of substance abuse, trauma assessment and treatment, and/or substance abuse treatment. Evaluations will determine a client's risk, needs, and responsivity factors, which will be incorporated into treatment goals. Measurable treatment goals will be developed and monitored on a monthly basis. 6. The outcomes of services. A written evaluation will be submitted to the referring source outlining the clinical interview, social history, results of psychometric instruments, risk for recidivism, and recommended treatment options. Interventions will address child welfare specific needs. 7. Target population for services. Male and female youth 12 to 18 years of age will complete a Juvenile Mental Health Sex Offense -specific Evaluation. Male and female adults age 19 and older will complete an Adult Mental Health Sex Offense -specific Evaluation. A client who is developmentally/intellectually delayed will complete a Mental Health Sex Offense -specific Evaluation for Developmentally/intellectually Delayed Offenders. 8. Services will be accessed by face-to-face meetings at 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. The phone number is 970-353-8171 and for crisis and after hour contact a therapist can be reached at 970-237-1134. 9. English is the only language services are available in. 10. Rates of services are as follows: JSO Evaluation w/o Testing $700.00 Hourly rate $200.00 JSO Evaluation with Testing and no Abel 14 year's old and older $800.00 Hourly rate $175.00 JSO Evaluation with Testing and Abel $1000.00 Hourly rate $164.00 JSO Evaluation in a Correctional Facility, Add $50.00 Adult Evaluation with Abel $1000.00 Hourly Rate $164.00 Adult Evaluation with no Abel $1000.00 Hourly Rate $180.00 Adult Updated Evaluation $1000.00 Hourly Rate $164.00 Jail Evaluation in a Correctional Facility, Add $50.00 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management/Domestic Violence (Impact of Domestic Violence on Children and Victims) and Sexual Abuse Treatment (Offense Specific), as referred by the Department. 2. Anger Management/Domestic Violence (Impact of Domestic Violence on Children and Victims) a. Capacity for Services: Two (2) 120 -minute sessions for a total of four (4) hours b. Goals of Service: Educate individual, family members, and concerned parties about the impact of domestic violence on children and victims who have been impacted by being in a home where domestic violence is prevalent. Curriculum includes: i. Cycle of violence ii. Types of violence iii. How children and victims are traumatized by witnessing domestic violence iv. Misconceptions about domestic violence v. Trauma signs and symptoms c. Outcomes of Service: i. Client will be able to identify how children, victims and secondary victims are impacted by domestic violence. ii. Client will be able to discuss trauma symptoms, each stage of the cycle of abuse, and cognitive distortions around the concept of domestic violence. iii. Client will develop strategies for the prevention of trauma to children. d. Target Population: i. Male and female youth, 12 to 18 years of age. ii. Male and female adults, 19 and older. e. Service Access: i. 2619 West 11`h Street Road, Suite 23, Greeley, CO 80634. ii. Crisis and after hours, (970) 237-1134. f. Language: English 3. Sexual Abuse Treatment (Offense Specific): All services will be provided in compliance with Sex Offender Management Board (SOMB) guidelines. a. Sexual Abuse Evaluations i. Contractor requires a psychosexual evaluation to determine if a client is appropriate for an outpatient treatment program. Evaluations will examine seven (7) areas: 1. Potential to re -offend 2. Amenability for treatment 3. Recommended treatment setting 4. Type of treatment needed 5. Risk factors/monitoring/potential new victims 6. Psychiatric/substance abuse/individual/family needs 7. Mental health concerns ii. Evaluations will include: 1. Structured clinical interview 2. Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctor, courts, police reports and other relevant sources 3. Assessments, which may include (dependent on age of offender and circumstances of case): 1 a. Hare Psychopathy Checklist -Revised b. Minnesota Multiphasic Personality Inventory -II c. Jessness Inventory d. SASSI Drug and Alcohol Inventory e. Milton Clinical Multiaxial Inventory f. Shipley -2 g. State Trait Anger Expression Inventory h. Vermont Assessment of Sex Offender Risk -2 i. Sex Offender Treatment Intervention and Progress Scale j. Abel Assessment for Sexual Interest k. Juvenile Sex Offender Assessment Protocol iii. Capacity for Services: 1. Clinical interview (minimum 3 hours) 2. Administration of psychometric instruments (3 hours) a. Abel Assessment for Sexual Interest (2 hours) iv. Goals of Services: 1. Access the type of treatment needed for the client 2. Assess risk for recidivism 3. Define additional treatment needed, which may include: a. Medication evaluation b. Psychiatric evaluation c. Monitoring for substance abuse d. Trauma assessment and treatment e. Substance abuse treatment 4. Development of measurable treatment goals 5. Monthly monitoring of goals v. Outcomes of Service: Written evaluation outlining the clinical interview, social history, results of psychometric testing, risk for recidivism, and recommended treatment options. Interventions will address child welfare specific needs. vi. Target Population: 1. Male and female youth, ages 12 to 18 years, who require a Juvenile Mental Health Sex Offense -specific Evaluation. 2. Male and female adults, ages 19 and older, who require an Adult Mental Health Sex Offense -Specific Evaluation. 3. Developmentally/intellectually delayed offenders who require a Mental Health Sex Offense -specific Evaluation for Developmentally/Intellectually Delayed Offenders. vii. Service Access: 1. 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. 2. Crisis and after hours, (970) 237-1134. viii. Language: English b. Sexual Abuse Treatment: i. Services under this agreement include: 1. Offense -specific group therapy 2. Individual, couples and/or family therapy 3. Informed Supervision groups — youth (1 hour/month or six intensive sessions) 4. Community Support Group/Approved Supervisor Group -adults (1 hour/month ongoing) 2 ii. All services are provided in a non -medical, cognitive behavioral model that emphasizes a strengths -based approach, and will incorporate: 1. Relationship and interpersonal social skills 2. Sex education 3. Victim empathy and awareness 4. Anger management/impulse control skills 5. Cognitive behavioral modification 6. Self-esteem building 7. Values clarification and examination 8. Prosocial living 9. Relapse prevention 10. Aftercare services 11. Types of abuse a. Deviant sexual behavior b. Physical c. Emotional d. Verbal e. Psychological iii. Capacity for Services: 1. Adults: Two (2) times per week for 90 minutes each session (3 hours weekly) 2. Juveniles: One (1) time per week for 90 minutes each session (1-1/2 hours weekly) 3. All clients will attend a 60 -minute session one (1) time per month 4. Crisis Intervention sessions are 60 minutes and will be scheduled as needed iv. Goals of Service: 1. Provide a structured treatment environment for the safety of the client, family, victim, and community in order to prevent recidivism. 2. Increased awareness and empathy for the victim and the impact of the offense on the victims and family members. 3. Foster a safe environment to effect positive change by developing the use of appropriate social/sexual skills and expressions through recognition of situations and stimuli that trigger sexually aggressive behavior. 4. Assist family members to develop the skills necessary to recognize and understand the sexual behavior of their family member for the purpose of providing support while the client progresses through treatment. v. Outcomes of Service: 1. Client will: a. Consistently define all sexually abuse behavior b. Acknowledge risk by demonstrating foresight and using safety planning c. Consistently recognize/interrupt sexual abuse cycle d. Demonstrate new coping skills and develop stress management techniques e. Demonstrate victim empathy and understand how behavior affects the victim, family and community f. Display accurate attribution of responsibility for offending behavior g. Be able to manage frustration and unfavorable events h. Reject sexually abusive thoughts as dissonant with self-image i. Demonstrate pro -social relationship skills j. Project positive self-image k. Demonstrate the ability to resolve conflict and make decisions I. Celebrate appropriate behavior and experience pro -social pleasure m. Delay gratification n. Communicate assertively o. Develop family and/or community support systems p. Develop an adaptive sense of purpose and future 2. Contractor will track progress through the program, as follows: a. Through an individualized treatment plan that will outline what the client will accomplish in order to complete treatment b. By assessing client progress made toward treatment plan, and changes and updates will be made to the plan as needed c. By evaluating whether the client is understanding the concepts presented during groups using a Group Note and homework d. By providing feedback to the client at the start of the next group to help the client obtain maximum benefit from groups vi. Target Population: 1. Male and female youth, 12 to 18 years of age 2. Youth with current sexual offense adjudications or youth who have admitted guilt and will provide a letter from a parent or attorney stating they plan to plead guilty 3. Youth with both average intelligence and those who are developmentally delayed 4. Male and female adults, age 19 or older 5. Adults who have been found guilty of a sexual offense or have a written letter from an attorney stating they plan to plead guilty 6. Adults with both average intelligence and those who are developmentally delayed vii. Service Access: 1. 2619 West 11th Street Road, Suite 23, Greeley, CO 80634. 2. Crisis and after hours, (970) 237-1134. viii. Language: English 4. Contractor will respond to the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 5. 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 Supervisor (hainleid@weldgov.com, 970-400-6210). 6. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for visitation services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understand that the Department will no reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows" on the part of the client per month. After three (3) "no-shows, " Contractor will place client on a behavioral plan 4 requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210). 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 Quality Assurance Team Supervisor (hainleid@weldgov.com) immediately via email, to discuss service continuation. 8. Contractor will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. 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 immediately AND on the required monthly report. 10. 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. 11. Contractor agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. 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, Court Staffings, Family Team Meetings and/or Team Decision Making meetings. The Department will reimburse for actual participation in the meeting only so long as the meeting is at least one hour in length, the Contractor obtains the Facilitator's signature on the Client Verification Form (if in person) at the time of the meeting and participation in the meeting is deemed appropriate and necessary by the Department. 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, if approved by the Department. 13. Contractor will notify the Quality Assurance Team Supervisor (hainleid@weldgov.com, 970-400-6210) 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 5 The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 6 EXHIBIT D 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. The total amount to be paid to the Contractor during the term of this Agreement shall be reported by the Department after May 31, 2020. 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 Anger Management/Domestic Violence: $85.00/Hour (Impact of Domestic Violence on Children and Victims) $340.00/Episode (Impact of Domestic Violence on Children and Victims, minimum of 4 hours) Sexual Abuse Treatment: $150.00/Hour (ABEL Assessment for Sexual Interests) $300.00/Episode (ABEL Assessment for Sexual Interests) $45.00/Episode (Adult Education Group) $100.00/Episode (Adult Intake) $45.00/Episode (Adult Phase 1 Group) $45.00/Episode (Adult Phase 2 Group) $45.00/Episode (Adult Phase 3 Group) $45.00/Episode (Adult Phase 4 Group) $50.00/Episode (Adult Sex Offender Evaluation in Correctional Facility Additional Fee) $167.00/Hour (Adult Sex Offender Evaluation with ABEL) $1,000.00/Episode (Adult Sex Offender Evaluation with ABEL) $182.00/Hour (Adult Sex Offender Evaluation with no ABEL) $820.00/Episode (Adult Sex Offender Evaluation with no ABEL) $167.00/Hour (Adult Sex Offender Updated Evaluation) $1,000.00/Episode (Adult Sex Offender Updated Evaluation) $20.00/Episode (Aftercare Group) $1,000.00/Episode (Child Contact Assessment) $45.00/Episode (Community Support/Approved Supervisor Group, 2 People) $125.00/Episode (Deniers Treatment) $95.00/Episode (Family Therapy, 50 -minute Session) $85.00/Episode (Individual Therapy, 50 -minute Session) $45.00/Episode (Informed Supervision Group, 2 People) $85.00/Hour (Informed Supervision, Individual) $50.00/Episode (Juvenile Sex Offender Evaluation in Correctional Facility Additional Fee) $164.00/Hour (Juvenile Sex Offender Evaluation, with testing and ABEL) $1,000.00/Episode (Juvenile Sex Offender Evaluation, with testing and ABEL) $164.00/Hour (Juvenile Sex Offender Evaluation, with testing and no ABEL, 14 years and older) $800.00/Episode (Juvenile Sex Offender Evaluation, with testing and no ABEL, 14 years and older) $200.00/Hour (Juvenile Sex Offender Evaluation, without testing) $700.00/Episode (Juvenile Sex Offender Evaluation, without testing) $45.00/Episode (Juvenile Sex Offender Group) $100.00/Episode (Juvenile Sex Offender Intake) 3. Submittal of Vouchers Contractor shall prepare and submit monthly a Request for Reimbursement, Client Verification Form, other supporting documentation, and monthly report 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 and Exhibit A. 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 60 days from the date of service. Requests for Reimbursement and/or supporting documentation received after 60 days from the date of service may result in delay or forfeiture of payment. Consistent failure to meet the 60 -day deadline may result in termination of the Agreement. For ongoing services, proof of services rendered shall be a Client Verification Form signed by the client and a monthly report submitted in accordance with Paragraph 3(d) of this Agreement. For one-time services, proof of services rendered shall be receipt of a Client Verification Form and the completed product. For Monitored Sobriety services, proof of services rendered shall be the test result. Hello