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Home My WebLink About20192020.tiff0.e.,,n+-nAc+ TQ #9-75G -75G PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: May 11, 2021 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment with Maple Star Colorado 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 Maple Star Colorado. The Department entered into a Child Protection Agreement for services with Maple Star Colorado, identified as Tyler ID 2019-2020 on May 29, 2019. The Agreement was amended on December 9, 2019 to amend the Scope of Services, and Rate Schedule, May 11, 2020 to extend the term date through May 31, 2021, and July 13, 2020 to amend the 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 Mental Health Services to their current Agreement. This new service is now reflected in the provider's Scope of Services. • Provider also added virtual options to their Scope of Services. Rate Schedule Changes: • The following rates were added for the new Mental Health Services Mental Health Services Rate Unit Tyne Service Name $130.00 Hour Family Team Meeting (FTM), Team Decision Making (TDM), Professional Staffing $130.00 Hour Mental Health Services, In-OfficeNideo $130.00 Each No Show Pass -Around Memorandum; May 11, 2021 — ID 4756 atnscrl+ o swi rg i ce-IGLAtdeXi.[-so *7/,1-1 Page 1 00 - DoQo H FR009 a 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 Recommendation ilvt Schedule Work Session Other/Comments: em Pass -Around Memorandum; May l 1, 2021 — ID 4756 Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MAPLE STAR COLORADO +h This Agreement Amendment, made and entered into l i day of MOCe 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 Maple Star Colorado, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Life Skills, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2020, approved on May 29 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: December 9, 2019 to amend the Scope of Services and Rate Schedule. May 11, 2020 to extend the term date through May 31, 2021. July 13, 2020 to amend the Rate Schedule. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2020. • 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 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: ATTES „deAtA -` a0;l1 BOARD OF COUNTY COMMISSIONERS Weld ' ou ty Clerk to the Board WELD COUNTY, COLORADO By: Deputy Cl . iii.--.,,d,,,,i,,,,,,onva. AK ,, :i to the : oard / 0 o� " .1, t i t 1 Steve Moreno, Chair MAY 1 7 2021 NTRACTOR: aple Star Colorado 2250 South Oneida Street, Suite 200 Denver, Colorado 80124 By: Date: 'fee-ha/Wm? Heather Mortis (Play, 2021 20.03 MOT, Heather Morris, Executive Director May 6, 2021 oeo 02O02O EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Life Skills, Home Studies, and Mental Health services, as referred by the Department. 2. Life Skills: Contractor utilizes a self -assessment scale based on the Parent Assessment Scale at intake and again after four (4) visits to develop goals for services and transition to lower levels of supervision and structure. a. Services available under this agreement include: i. Supervised Visitation at Department or a secured facility: Clients appropriate for this level are assessed, in collaboration with the Department, to have high risk behaviors that would necessitate the presence of security or law enforcement to ensure the safety of the child(ren) and/or Contractor's Facilitator. ii. Supervised Visitation at Contractor's facility or other agreed upon semi -contained location or office: Clients appropriate for this level can receive services in a less restrictive setting where the risk level has been determined to not require the presence of law enforcement on the premises. Contractor facility does allow for structure and containment for the visit, reducing the anxiety and additional distractions or external stimuli that may be present in community -based visitation. iii. Community Based Visitation: Moderate or lower levels of parent coaching and role modeling are required. Contractor's Facilitator will remain within line of sight and earshot at all times but will intervene less frequently. Clients appropriate for this level will demonstrate an ability to engage the child with the additional exterior stimuli and maintain the safety of the child in an open and less restrictive setting. This level is appropriate when the client is engaged in treatment services for substance abuse and/or mental health and/or is working on systemic issues in relation to their environment. iv. Intermittent Visitation: Least direct observation of the parent and child and may decrease from presence in the same area where sight lines may be maintained. Client is interacting independent of the Contractor's Facilitator and is out of earshot most times. Contractor's Facilitator will conduct "drop in" visits with the client during extended unsupervised time to check on child safety and ensure continued compliance with case plan expectations. This level only available for short periods of time of less than one month and is intended as a final step down to unsupervised visitation. b. Capacity for Services: i. Frequency is dependent on the individual needs of the client. ii. Contractor will provide a minimum of two per visit. iii. For visitations in duration of one (1) hour, Contractor will establish an office -based schedule to support services will require little or no transportation or travel time between visit locations in order to maximize the number of hours available to provide family contact supportive coaching. iv. Services will initially be scheduled for 45 to 90 days dependent on the level of service authorized. c. Goals of Service: To support parents in connecting with their child, learning and implementing positive parenting skills and decreasing the level of service. d. Outcomes of Service: Clients will progress on the Parent Assessment Scale ratings and progress from higher to lower level of visitation with the goal being unmonitored and reunification. e. Target Population: Children, ages 0 to 18, and their visiting parent/family member. f. Service Access: i. Office Locations: 1. 2250 South Oneida, Suite 200, Denver, Colorado 80224 2. 1465 North Union Boulevard, Suite 102, Colorado Springs, Colorado 80909 3. 635 West Corona Avenue, Suite 209, Pueblo, Colorado 81004 4. 565 North Cleveland Avenue, Loveland, Colorado 80537 ii. Contractor will utilize virtual services as needed to ensure that parent and child contact can be maintained during times that in person services are unable to be provided, such as in the case of illness or inclement weather, as well as on a case by case basis as is appropriate and in consultation with the Department. iii. Contractor will utilize virtual services for Client Intake/Orientation in addition to in person Intake/Orientation to increase access to orientation services during times that in person orientation is not able to be provided, or as an alternative for individuals encountering obstacles such as transportation or scheduling, in an effort to decrease the time from initial referral to first parent/child visitation session. g• Medicaid Eligibility: Services are not Medicaid eligible. h. Transportation: Contractor may provide transportation for children to and from visits when necessary and authorized by the Department. 3. Home Studies: Contractor will conduct the SAFE Home Study assessments per those items as listed in Volume VII of the Policies and Procedures for Child Welfare Services, Colorado Department of Human Services: for Foster Homes and Adoptive Homes: 7.500.2 A. 1-8; C. 1-9, D.; for Kinship Care Homes: 7.500.31 A. 1., and 2. a -m., and the Study Outline. These guidelines also apply to ICPC home studies. a. Contractor will conduct Home Studies, for the areas noted below, as referred by the Department. i. Kinship Care ii. Foster Care iii. Kinship Foster Care iv. Parent Care v. Foster -Adoption vi. Adoption vii. Interstate Compact on the Placement of Children (ICPC) b. Contractor is certified in Structured Analysis Family Evaluation (SAFE) and is on the State's approved home study vendor list. Contractor also is certified as a SAFE Supervisor. c. Contractor will utilize the most current Structured Analysis Family Evaluation (SAFE) forms and templates. Contractor will ensure all home studies completed for the Department include, at a minimum, all the following: i. SAFE Home Study template. ii. Compatibility Inventory. iii. References and documented direct follow-up with references (phone call or meeting). iv. Psychosocial Inventory for all applicants. v. Questionnaire I and II for all applicants. vi. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. vii. All additional collateral information collected from the applicants. viii. Urinalysis (UA) result from a certified testing facility, if requested by the Department. A UA will be required for any individual 18 or older residing in the home, when requested by the Department, if substance abuse concerns are noted. The cost of the UA will be responsibility of the applicant. d. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staff as follows: i. Following completion of individual applicant meetings. ii. Three (3) weeks after the completion of individual applicant meetings. iii. Prior to the final review with the applicant(s). e. Contractor will complete home studies within 60 days of receiving documents required to schedule and conduct first interview. At a minimum the Application and Questionnaire I must be received at the time of assignment and the applicants must be scheduled for fingerprinting. The remainder of the documents may be forwarded as they are completed. References will be sent by the Home Study Evaluator but will be returned to the Department. The Department will be responsible for forwarding these references to the Home Study Evaluator. f. Contractor understands that reimbursement for partial home studies will only occur after the following: i. At least one (1) face-to-face meeting and two (2) phone contacts, and ii. A letter has been submitted to the Department documenting why the study cannot move forward. g• Goals of Service: i. Determine if family is a viable and safe placement for children ii. Meet statutory and regulation requirements iii. Approve or deny a family for placement iv. Find families for children, not children for families v. Strengthen family functioning by addressing of concern and promote change vi. Prepare families for successful parenting caregiving experience vii. Placement matching h. Outcome of Service: High quality, comprehensive home studies completed by a SAFE certified home study evaluator and approved by certified home study supervisor. i. Target Population: i. Kinship Care ii. Foster Care iii. Kinship Foster Care iv. Parent Care v. Foster -Adoption vi. Adoption vii. Interstate Compact on the Placement of Children (ICPC) Service Access: i. Fort Collins along the Front Range to Pueblo and Alamosa counties. Contractor can travel to other areas in Colorado including the Western Slope, San Luis Valley and southwestern Colorado. ii. Contractor will utilize virtual services as needed to ensure that parent and child contact can be maintained during times that in person services are unable to be provided, such as in the case of illness or inclement weather, as well as on a case by case basis as is appropriate and in consultation with the Department. Contractor will utilize virtual services for Client Intake/Orientation in addition to in person Intake/Orientation to increase access to orientation services during times that in person orientation is not able to be provided, or as an alternative for individuals encountering obstacles such as transportation or scheduling, in an effort to decrease the time from initial referral to first parent/child visitation session. k. Language: English only. 1. Medicaid: Services are not Medicaid eligible. m. Transportation: Contractor does not provide transportation. 4. Mental Health Services a. Modalities, curriculum, and tools used in deliver of service: i. All services will be provided by licensed clinicians or Department of Regulatory Agencies (DORA) registered master's level psychotherapists supervised by licensed clinicians. ii. Trauma Based Relational Intervention (TBRI) — Family First Prevention Services Act (FFPSA) clearinghouse recognized Evidence Based Practice. Maple Star Colorado employs a TBRI practitioner to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Maple Star Colorado team members are trained. iii. Motivational Interviewing (M1)- FFPSA clearinghouse recognized Evidence Based Practice. Maple Star Colorado employs five (5) Ml trainers to ensure model fidelity, as well as providing on -going training to all incoming staff to ensure 100% of Maple Star Colorado team members are trained. iv. Diagnosis and Treatment Planning. v. Patient Health Questionnaire (PHQ)-9 depression scale. vi. Columbia Suicide Severity Rating Scale. vii. Trauma Informed Parenting by National Traumatic Stress Network (www.nctsn.com). viii. Culturally responsive and holistic interventions. ix. Traditional as well as non-traditional clinical expertise (mindfulness, mind -body, rhythmic movement, experiential therapy, art therapy, & dance/movement therapy). b. Anticipated frequency of service: i. One (1) or two (2) fifty (50) minute sessions per week as clinically indicated. More sessions may be arranged when approved by treatment team. c. Anticipated duration of service: i. Average length of service is 90-180 days. ii. Services will continue as long as clinically indicated and until treatment goals are met. iii. Treatment goals and progress will be evaluated every 30 days and treatment plans will be revised every 90 days, or as needed. d. Goals of the service: i. Provide stabilization, trauma informed interventions, diagnosis and treatment planning to address trauma and identified mental health issues. ii. Increase understanding of the impact of trauma on mental health and support to caregiver with regards to hands on techniques and approaches they may apply in their home. iii. Support parents and clients with communication, intervention, and teaching coping skills. iv. Support the family with potential crisis situations through 24/7 phone support. v. Serve as an advocate to families as appropriate, i.e., school, probation, or other needed services. vi. Transition cases to lower level intervention as indicated. e. Outcomes of the service: i. Increase caregiver's understanding of mental health diagnoses, the impact of trauma and increase their ability to practice client -centered, relationship -based interactions with the child/ adolescent. ii. Increase positive parent child interactions. iii. Achievement of clients' individualized treatment goals. f. Target population: i. Children and adolescents in conjunction with family therapy. g. Language: i. English only. h. Medicaid eligibility: i. Some services are Medicaid eligible. i. Transportation: i. Contractor does not provide transportation. Terms 1. Contractor will respond to the Quality Assurance Team (HS-CWQualitvAssurance(a�weldgov.com within three (3) business days regarding the ability to accept the received referral. 2. Upon acceptance of a referral, Contractor will offer an initial appointment within seven (7) days of receiving the referral. The first attempt to contact the client will occur within 24 hours of receiving the referral (excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If the client does not respond after three (3) attempts in the first seven (7) days of the referral period, the Contractor will notify the caseworker and the Quality Assurance Team HS- CW QualitvAssurance(a,weldgov.com. 3. Contractor understands that "no shows" are defined as unexcused and unplanned/uncommunicated absences for services. If a rate for "no shows" is not specifically stated in Exhibit D, Rate Schedule, then Contractor understands that the Department will not reimburse for "no shows". Contractor understands that the Department will only reimburse Contractor for up to two (2) "no-shows", or up to two (2) hours, on the part of case participants who cancel without 24 hour notice. After three (3) "no-shows", Contractor will place client on a behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team HS-CWQualitvAssuranceAweldgov.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-CWQualitvAssurance(aweldgov.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-CWQualitpAssurance(aweldgov.com of new staff who will manage and/or administer the services with the following information: a. Staff member name and contact information b. Education level/degree (if applicable) c. Licensure/credentials (if applicable) d. Department of Regulatory Authority (DORA) number (if applicable) e. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 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, 2022. Expenses incurred by the Contractor prior to the term of this Agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services Home Studies Rate Unit Type Service Name $1,425.00 Episode Full SAFE Home Study $1,625.00 Episode Full SAFE Home Study, EXPEDITED $52.00 Hour Incomplete SAFE Home Study $0.56 Mile Mileage for Home Study $725.00 Episode SAFE Home Study Update Life Skills Rate Unit Type Service Name $91.00 Hour Family Engagement Meetings $60.00 Hour Intake for all services $75.00 Hour No Show $50.00 Hour Parent Assessment Scale $90.00 Hour Parent Coaching, One -on -One $50.00 Hour Professional Staffing, In -Person or Telephonic $75.00 Hour Supervised Facilitated Visitation $115.00 Hour Supervised Facilitated Visitation, In-Home/Community $75.00 Hour Supervised Facilitated Visitation, In -Office or Telehealth $115.00 Hour Supervised Facilitated Visitation, In -Office with Transportation $107.00 Hour Therapeutic Visitation $160.00 Hour Therapeutic Visitation, In-Home/Community $107.00 Hour Therapeutic Visitation, In -Office or Telehealth $160.00 Hour Therapeutic Visitation, In -Office with Transportation $0.56 Mile Transportation for All Visitation for all mileage more than a 30 mile radius from Contractor's closest office. Mental Health Services Rate Unit Type Service Name $130.00 Hour FTM, TDM, Prof. Staffing $130.00 Hour Mental Health Services, In-OfficeNideo $130.00 Each No Show 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. onti"act Farm . New Contract Request Entity information Entity Name* MAPLE STAR COLORADO ❑ New Entity? Entity ID* 0002 tr042 Contract. Name MAPLE STAR COLORADO AGREEMENT AMENDMENT Contract Status CFO REVIEW Contract Description* &IL1-BI900025 .E.RM 6/1/21- x'22. Contract ID 4756 Contract Lead APEC:G Parent Contract ID 20192020 Requires Board Approval YES Contract Lead Email Department Project # apeace rweldoov.com;cobl x xikcgrwOdgov.com Contract Description 2 CONSENT. PA IS BEJ,NG ROUTED THROUGH THE. NORMAL PROCESS. ETA TO CTB: 5 ,13 21. Contract Type* ANIENDMENT Amount. * 50.0 Renewable* NO Automatic Renewal Grant ICA Department HUMAN SER'V'ICES Department Email HurnanSeavi`es' °veklgov.co rn Department Head Email CM -Hu rna'nSer'vltes- ©eptHead Aveldgov.corn County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CN1..•. COUNTY'ATTORNEY inV'ELDC, OV CC)ti4 Requested BOCC Agenda Date* Clue Date 05/22 /2021 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 Nste: tree Freer©us C=ar tract Number and Master Se€vrces Agreement Norther should be left blank if those_ contracts are not it OnBase Contract Dates Effective Date. Review Date 04 +71 2022 Renewal Date: Termination Notice Period Contact Information Contact Info Contact Marne Purchasing Committed Delivery Date Contact Type Contact Email Expiration Date 05 31 2022 Contact Phone 1 Contact Phone 2 Purchasing Approver Purchasing Approved Date CONSENT 05 11 :2021 Approval Process Department Head JAMIE ULRICH Finance Approver CONSENT DH Approved Date Finance Approved Date 05 11 2021 Final Approval BUCC Approved BOCC Signed Date SDCC Agenda Date 05 17 2021 Originator A EGG Legal Counsel CONSENT Legal Counsel Approved Date 05 ]1,2021 05 11,'2021 Tyler Ref It AL 051721 • Coyt-i-flot_ef 363 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: June 30, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Agreement Amendment with Maple Star Colorado 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 Maple Star Colorado. The Department entered into a Child Protection Agreement for Services, identified as Tyler ID 2019-2020, on May 29, 2019 for the term June 1, 2019 through May 31, 2020. The agreement was amended on December 9, 2019 to add Home Study Services and update the mileage language. In addition, the agreement was amended on May 11, 2020 to extend the term from June 1, 2020 through May 31, 2021. The Department is now requesting to revise the current rates to reflect an "all inclusive" rate structure. The new rates are inclusive of the service as well as any administrative functions, that were previously billed as a separate items. This rate structure will bring the provider in alignment with other contractors providing similar services for the Department. The following is the current rate structure with the requested rate changes for the provider: $91.00 $50.00/Hour (Family Engagement Meetings) $60.00/Hour (Intake for all services) $90.00 $55.00/Hour (One-on-one Parent Coaching) $50.00/Hour (Parent Assessment Scale) $50.00/Hour (Professional Staffing — in -person or telephonic) $75.00 $60.00/Hour (Supervised Facilitated Visitation) $115.00 $90.00/Hour (Supervised Facilitated Visitation In- Home/Community) $107.00 $$6,00/Hour (Therapeutic Visitation) $160.00 $129.00/Hour (Therapeutic Visitation In-home/Community) $ .56/Mile (All mileage more than a 30- mile radius from Contractor's closest office.) Visitation including transportation will be billed at a rate of 1.5 times the rate based on the authorized service Early check -in as authorized by the Department to ensure visiting parent presence prior to child's arrive same as rate based on level of visitation. Pass -Around Memorandum; June 30, 2020 — CMS 3763 Bid No. B1900025 o7//3j2o 6)7( At,.(7L.A5-O) 7- i3 -moo Page 1 2c, - 20 0 P gooqo PRIVILEGED AND CONFIDENTIAL Home Studies: $1,425.00/Episode (Full Completed SAFE Home Study — Including evaluation by SAFE Evaluator and supervision by SAFE Supervisor) $1,625.00/Episode (Expedited Full Completed SAFE Home Study submitted within 30 days — Including evaluation by SAFE Evaluator and supervision by SAFE Supervisor) $725.00/Episode (Completed SAFE Home Study Update) $52.00/Hour (Incomplete SAFE Home Study) $ .56/Mile (All mileage more than a 30 mile radius from Contractor's closest office or the evaluator's home, whichever is closest.) 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 -Tern Kevin Ross Approve Schedule Recommendation Work Session rnf' Pass -Around Memorandum; June 30, 2020 — CMS 3763 Bid No. B1900025 Other/Comments: Page 2 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MAPLE STAR COLORADO This Agreement Amendment, made and entered into ��J day of , 2020 by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Hum $ii Serves, hereinafter referred to as the "Department", and Maple Star Colorado, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Life Skills, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2020, approved on May 29, 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. • The Original Agreement was amended on December 9, 2019 and May 11, 2020. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2020. • 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. 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. ATTEST: Weld C By: lerk to Deputy Clerk to COUNTY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair 'JUL 13 2020 CONTRACTOR: Maple Star Colorado 2250 South Oneida Street, Suite 200 Denver, CO 80124 By: Date: h`eathe`No` :r Heather Morris (Jun 25, 2020 09:04 MDT) Heather Morris, Executive Director Jun 25, 2020 .Q / q- 020020 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 3 I, 2021. Expenses incurred by the Contractor prior to the tern 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 Life Skills: $91.00/Hour (Family Engagement Meetings) $60.00/Hour (Intake for all services) $90.00/Hour (One-on-one Parent Coaching) $50.00/Hour (Parent Assessment Scale) $50.00/Hour (Professional Staffing — in -person or telephonic) $75.00/Hour (Supervised Facilitated Visitation) $1 15.00/Hour (Supervised Facilitated Visitation In-home/Community) $107.00/Hour (Therapeutic Visitation) $160.00/Hour (Therapeutic Visitation In-home/Community) $ .56/Mile (All mileage more than a 30 mile radius from Contractor's closest office.) Visitation including transportation will be billed at a rate of 1.5 times the rate based on the authorized service Early check -in, as authorized by the Department, to ensure visiting parent presence prior to child's arrival will be billed at the same rate as the level of visitation. Home Studies: $1,425.00/Episode (Full Completed SAFE Home Study — Including evaluation by SAFE Evaluator and supervision by SAFE Supervisor) $1,625.00/Episode (Expedited Full Completed SAFE Home Study submitted within 30 days— Including evaluation by SAFE Evaluator and supervision by SAFE Supervisor) $725.00/Episode (Completed SAFE Home Study Update) $52.00/Hour (Incomplete SAFE Home Study) $ .56/Mile (All mileage more than a 30 mile radius from Contractor's closest office or the evaluator's home, whichever is closest.) 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. Entity Information Entity Name* MAPLE STAR COLORADO Contract Name* MAPLE STAR COLORADO Contract Status CTB REVIEW Entity ID* @00027042 ❑ New Entity? Contract ID 3763 Contract Lead* CULLINTA Contract Lead Email cullinta@co_weld.co.us,cobbxxl k@co.weld.co.us Parent Contract ID 20192020 Requires Board Approval YES Department Project # Contract Description* AGREEMENT AMENDMENT NO. 3 FOR NEW RA I ES CHILD WELFARE RFP BID NO. B2000037. CONSENT TERM: JUNE 1, 2020 THROUGH MAY 31, 2021. FUNDING: CORE/OTHER Contract Description 2 Contract Type* AGREEMENT Amount* 50 00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN SERVICES Department Email C M- HumanServices@weldgov.r_om Department Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WELD GOV.COM Requested BOCC Agenda Date* 07/0812020 Due Date 07/04/2020 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 NISA 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* Renewal Date OS/03/2021 Termination Notice Period Committed Delivery Date Expiration Date* 05/3112021 Contact Information Conta In o Contact Narne Contact Type Contact Email Contact Phone 1 Contact Phone 2 `1Ca:5i APPr€ val P%ces: Department Head JAMIE ULRICH DH Approved Date 06f2912020 Final,ApprovaJ BO CC Approved ROCC Signed Date BUCC Agenda Date 07/0612020 Originator SNYDERKL Fi a Approver BARB CONN©LLY Purchasing Approved Date Finance Approved Date 06/30/2020 Legal Counsel GABE KAL©USEK Legal Counsel Approved Date 06130/2020 Tyler Ref #? V � rA 87{400C20AG �0 �G. 4:ft 5561 PRIVILEGED AND CONFIDENTIAL MEMORANDUM DATE: April 2, 2020 TO: Board of County Commissioners — Pass -Around FR: Jamie Ulrich, Director, Human Services RE: Child Welfare 2020-21 Service Provider Agreement Amendments 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 Child Welfare 2020-21 Service Provider Agreement Amendments. The Department entered into agreements with various Child Welfare service providers through the 2019-20 Request for Proposal (RFP), identified as Tyler ID 2019-0707). These agreements were issued for a period of three years with the option to renew annually. The attached list reflects the providers, services and rates, including minor rate changes, the Department wishes to enter into for the period of June 1, 2020 through May 31, 2021. The Human Services Advisory Commission (HSAC) has reviewed and approved this information. Upon Board approval of this pass -around, signed agreement amendments will be obtained from providers and submitted to the Board for approval and Chair signature. I do not recommend a Work Session. I recommend approval of these Agreement Amendments. Mike Freeman, Chair Scott James Barbara Kirkmeyer Steve Moreno, Pro-Tem Kevin Ross Approve Schedule Recommendation Work Session Other/Comments: Pass -Around Memorandum; April 2, 2020 — Not in CMS Gon Seli T- o5/li/zm kiSV 054A/A0 Page I 1�ool© VENDOR RENEWALS Vendor Program Area Mediation Service Name Y ation Services Funding Core Rate $ 250.00 Unit Type Hour Julie A. Scroggins, Attorney at Law, P.C. Knipscheer and Associates, Inc. Polygraph Services Polygraph CW Block/Child Welfare Services $ 250.00 Episode Lutheran FamilyServices' Rocky Mountains Life'Skills Supervised Visitation ' Core i' $ 85,00 Hour Team Decision Meetings, Staffing Core $ 90.00 Hour Therapeutic Parenting Time Core $ 95.00 Hour Parent Education Nurturing Parent: Drop -In Session CW Block $ 135.00 Class Nurturing Parent: English CW Block $ 197:00 Glass Nurturing Parent: Spanish CW Block $ 213.00 Class Nurturing. Parent: Teen Parents Class CW Block $ 97.50 Class Parenting Your Teen Class CW Block $ 120.00 Class RETHINK: Anger Management for Parents Class CW Block $ 105,00 Class Maple Star Colorado Home Studies Full SAFE Home Study CW Block/Child Welfare Services $ 1,425.00 Episode Full SAFE Home Study, EXPEDITED CV/ Block/Child Welfare Services $ 1,625.00 Episode Incomplete SAFE Home Study CW Block/Child Welfare Services $ 52.00 Hour Mileage far Home Study= CW Block/Child Welfare Services $ 0.56 Mile SAFE Home Study Update CW Block/Child Welfare Services $ 725.00 Episode Life Skills Family Engagement Meetings Core S 50.00 Hour Intake Core $ 60.00 Hour Parent Assessment Scale Gore $ 50.90 Hour Parent Coaching, One -on -One Core $ 55.00 Hour Professional Staffing, In -Person or Telephonic Core $ 50.90 Hour Supervised Facilitated Visitation Core $ 60.00 Hour Supervised Facilitated Visitation, In- home/Community Core $ 90.00 Hour Therapeutic Visitation Core $ 86.00 Hour Therapeutic. Visitation, In-home/Community Core $ 129.00 Hour Transportation for All Visitation Core $ 0.56 Mile Martinez, Tim Sexual Abuse Treatment - Cognitive Behavioral Therapy Core '. $ 75:00 : Hour EMDR Therapy Core $ 75.00 Hour Family Therapy Core : , $ 75.00 Hour Healthy Sexuality Core $ 75.00 Hour Offense Specific Juvenile Evaluation with Abel Assessment_ Core $ 1,200:00 Episode Offense Specific Juvenile Evaluation Without Abel Assessment Core $ 900.00 Episode Offense Specific' Treatment Family Therapy Core $ 75.00 Hour Offense Specific Treatment Individual Therapy Core $ 75.00 Hour Trauma Informed Care Core $ 75.00 Hour Treatment Team Meeting Participation Core $ 75.00 Hour Milestones Counseling Services Foster Care/Adoption Support Family Team Meeting (FTM), Team Decision Making Meeting (TDM), etc. Core $ 80.00 Hour Foster Parent Consultation Core $ 110.00 Hour Mileage Reimbursement Core $ 0.56 Mile Mount Saint Vincent Home Day Treatment Services Day Treatment Services Core $ 135.00 Day Mental Health Services Follow-up NMI Consultation After 3 Months Core $ 150.00 Hour Mileage Core $ 0.54 Mite WELD COUNTY DEPT. OF HUMAN SERVICES - CHILD WELFARE DIVISION 2020-21 SERVICE VENDORS (CORE/NON-CORE) BID NO.: 82000037 �'p -* 3361 AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MAPLE STAR COLORADO L 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 Depaent of Human Services, hereinafter referred to as the "Department", and Maple Star Colorado, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Life Skills, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2020, approved on May 29, 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. • The Original Agreement was amended on December 9, 2019. The Amendments are identified by the Weld County Clerk to the Board of County Commissioners as document number 2019-2020. • 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 of June 1, 2020 through May 31, 2021. • All other terms and conditions of the Original Agreement remain unchanged. C.on4erfi- *464_ © 54 t /AO cc : Oniae►re- HeO cal cal ;,40 ,U' 19'- 43,20 µRo©90 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY ATTEST: dir444) CI • Weld County Clerk to the Board By: a uty Clerk to the Board BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Tf14,t,R,, •e Mike Freeman, Chair MAY 1 12020 CONTRACTOR: Maple Star Colorado 2250 South Oneida Street, Suite 200 Denver, CO 80124 By: Date: 1/eatlhetNot`if Heather Morris (Apr 20, 2020) Heather Morris, Executive Director Apr 20, 2020 O2.0)g- olo,1-0' Contract Form New Contract Request Entity Information Entity Name* MAPLE STAR COLORADO Entity ID* @00027042 ❑ New Entity? Contract Name* Contract ID MAPLE STAR COLORADO (AGREEMENT AMENDMENT) 3551 Contract Status CTB REVIEW Contract Lead* CULLINTA Contract Lead Email cullinta@co weld co.us Parent Contract ID Requires Board Approval YES Department Project # Contract Description* CONSENT_ BID NO. 2000037. BOCC APPROVAL 04 15.20 CHILD PROTECTION AGREEMENT AMENDMENT. TERM: 06101!24 THROUGH 05131/20 FUNDING: CORE/OTHER Contract Description 2 Contract Type* AGREEMENT Amount* $0.00 Renewable* NO Automatic Renewal Gant I GA Department HUMAN SERVICES Department Email CM- HumanServices@3i weldgov.com Department Head Email CM-HumanServices- DeptHead@weldgovcom County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WELD GOV.COM Requested BOCC Agenda Date* 04/15/2020 Due Date 04/11/2020 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 !NSA 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* Renewal Date 04/01/2021 Termination Notice Period Committed Delivery Date Expiration Date* 05/3112021 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JAMIE ULRICH DH Approved Date 05/05/2020 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05/11/2020 Originator SNYDERKL Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Contact Phone 2 Purchasing Approved Date Finance Approved Date 05/06/2020 Tyler Ref # AG 051120 Legal Counsel GABE KALOUSEK Legal Counsel Approved Date 05/06/2020 Subrnit Con f rOtct PRIVILEGED AND CONFIDENTIAL sD 36 co3 MEMORANDUM DATE: November 20, 2019 TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Agreement Amendment with Maple Star Colorado 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 Maple Star Colorado. The Department entered into an agreement with Maple Star Colorado with a term of June 1, 2019 through May 31, 2020, for Life Skills. This agreement is identified as 2019-2020, approved on May 29, 2019. At this time the Department would like to add Home Study Services and update the mileage language. The associated rates and updated language are as follows: • $1,425.00/Episode (Full Completed SAFE Home Study — Including evaluation by SAFE Evaluator and supervision by SAFE Supervisor) • $1,625.00/Episode (Expedited Full Completed Home Study submitted within 30 days — Including evaluation by SAFE Evaluator and supervision by SAFE Supervisor) • $725.00/Episode (Completed SAFE Home Study Update) • $52.00/Hour (Incomplete SAFE Home Study) • $ .56/Mile (All mileage more than a 30 -mile radius from Contractor's closest office or the evaluator's home, whichever is closest.) I do not recommend a Work Session. I recommend approval of this Amendment and authorize the Chair to sign. Sean P. Conway Mike Freeman, Pro-Tem Scott James Barbara Kirkmeyer, Chair Steve Moreno Approve Schedule Recommendation Work Session Pass -Around Memorandum; November 20, 2019 - CMS 3063 /O2., g- l 9 Other/Comments: Page 1 0Zoi 9 020 /7 -7e -W AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MAPLE STAR COLORADO This Agreement Amendment made and entered into day of 2019 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 Maple Star Colorado hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Life Skills ("Original Agreement') identified by the Weld County Clerk to the Board of County Commissioners as document No. 2019-2020, approved on May 29, 2019. WHEREAS the parties hereby agree to amend the tern 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. Exhibit C, Rate Schedule, is hereby amended as attached. 2. 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. ATTEST: Weld C By: COUNTY: BOARD OF COUNTY COMMISSIONERS Clerk to t e Board WELD COUNTY, COLODO Deputy Clerk j t e Band �l ; j ` C'�,��,�� ,�: arbara Kirkmeyer, Chas DEC 0 9 2019 Maple Star Colorado 2250 South Oneida Street, Suite 200 Denver, CO 80124 (303)433-1975 171e& -het Ottif By: Heather Morris (Sep 15, 2019) Date: Heather Morris, Executive Director Sep 15, 2019 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Life Skills and Home Studies, as referred by the Department. 2. Life Skills: Contractor utilizes a self -assessment scale based on the Parent Assessment Scale at intake and again after four (4) visits to develop goals for services and transition to lower levels of supervision and structure. a. Services available under this agreement include: i. Supervised Visitation at Department or a secured facility: Clients appropriate for this level are assessed, in collaboration with the Department, to have high risk behaviors that would necessitate the presence of security or law enforcement to ensure the safety of the child(ren) and/or Contractor's Facilitator. ii. Supervised Visitation at Contractor's facility or other agreed upon semi -contained location or office: Clients appropriate for this level can receive services in a less restrictive setting where the risk level has been determined to not require the presence of law enforcement on the premises. Contractor facility does allow for structure and containment for the visit, reducing the anxiety and additional distractions or external stimuli that may be present in community -based visitation. Community Based Visitation: Moderate or lower levels of parent coaching and role modeling are required. Contractor's Facilitator will remain within line of sight and earshot at all times but will intervene less frequently. Clients appropriate for this level will demonstrate an ability to engage the child with the additional exterior stimuli and maintain the safety of the child in an open and less restrictive setting. This level is appropriate when the client is engaged in treatment services for substance abuse and/or mental health and/or is working on systemic issues in relation to their environment. iv. Intermittent Visitation: Least direct observation of the parent and child and may decrease from presence in the same area where sight lines may be maintained. Client is interacting independent of the Contractor's Facilitator and is out of earshot most times. Contractor's Facilitator will conduct "drop in" visits with the client during extended unsupervised time to check on child safety and ensure continued compliance with case plan expectations. This level only available for short periods of time of less than one month and is intended as a final step down to unsupervised visitation. b. Capacity for Services: i. Frequency is dependent on the individual needs of the client. ii. Contractor will provide a minimum of two per visit. For visitations in duration of one (1) hour, Contractor will establish an office -based schedule to support services will require little or no transportation or travel time between visit locations in order to maximize the number of hours available to provide family contact supportive coaching. iv. Services will initially be scheduled for 45 to 90 days dependent on the level of service authorized. c. Goals of Service: To support parents in connection with their child, learning and implementing positive parenting skills and decreasing the level of service. d. Outcomes of Service: Clients will progress on the Parent Assessment Scale ratings and progress from higher to lower level of visitation with the goal being unmonitored and reunification. e. Target Population: Children, ages 0 to 18, and their visiting parent/family member. 1 f Service Access: i. Office Locations: 1. 2250 South Oneida, Suite 200, Denver, CO 80224 2. 1465 North Union Boulevard, Suite 102, Colorado Springs, CO 80909 3. 635 West Corona Avenue, Suite 209, Pueblo, CO 81004 4. 565 North Cleveland Avenue, Loveland, CO 80537 g• Community Based Facilitated Visitation Services h. Medicaid Eligibility: Services are not Medicaid eligible. i. Transportation: Contractor may provide transportation for children to and from visits when necessary and authorized by the Department. 3. Home Studies: Contractor will conduct the SAFE Home Study assessments per those items as listed in Volume VII of the Policies and Procedures for Child Welfare Services, Colorado Department of Human Services: for Foster Homes and Adoptive Homes: 7.500.2 A. 1-8; C. 1-9, D.; for Kinship Care Homes: 7.500.31 A. 1., and 2. a -m., and the Study Outline. These guidelines also apply to ICPC home studies. a. Contractor will conduct Home Studies, for the areas noted below, as referred by the Department. i. Kinship Care ii. Foster Care Kinship Foster Care iv. Parent Care v. Foster -Adoption vi. Adoption vii. Interstate Compact on the Placement of Children (ICPC) b. Contractor is certified in Structured Analysis Family Evaluation (SAFE) and is on the State's approved home study vendor list. Contractor also is certified as a SAFE Supervisor. c. Contractor will utilize the most current Structured Analysis Family Evaluation (SAFE) forms and templates. Contractor will ensure all home studies completed for the Department include, at a minimum, all the following: i. SAFE Home Study template. ii. Compatibility Inventory. References and documented direct follow-up with references (phone call or meeting). iv. Psychosocial Inventory for all applicants. v. Questionnaire I and II for all applicants. vi. Indian Child Welfare Act (ICWA)/Indian heritage discovery and documentation. vii. All additional collateral information collected from the applicants. viii. Urinalysis (UA) result from a certified testing facility, if requested by the Department. A UA will be required for any individual 18 or older residing in the home, when requested by the Department, if substance abuse concerns are noted. The cost of the UA will be responsibility of the applicant. d. Contractor will meet regularly with Department staff during the home study process. At a minimum, Contractor will meet with Department staff as follows: i. Following completion of individual applicant meetings. ii. Three (3) weeks after the completion of individual applicant meetings. 2 iii. Prior to the final review with the applicant(s). e. Contractor will complete home studies within 60 days of receiving documents required to schedule and conduct first interview. At a minimum the Application and Questionnaire I must be received at the time of assignment and the applicants must be scheduled for fingerprinting. The remainder of the documents may be forwarded as they are completed. References will be sent by the Home Study Evaluator but will be returned to the Department. The Department will be responsible for forwarding these references to the Home Study Evaluator. f Contractor understands that reimbursement for partial home studies will only occur after the following: i. At least one (1) face-to-face meeting and two (2) phone contacts, and ii. A letter has been submitted to the Department documenting why the study cannot move forward. g. Goals of Service: i. Determine if family is a viable and safe placement for children ii. Meet statutory and regulation requirements Approve or deny a family for placement iv. Find families for children, not children for families v. Strengthen family functioning by addressing of concern and promote change vi. Prepare families for successful parenting caregiving experience vii. Placement matching h. Outcome of Service: High quality, comprehensive home studies completed by a SAFE certified home study evaluator and approved by certified home study supervisor. i. Target Population: i. Kinship Care ii. Foster Care Kinship Foster Care iv. Parent Care v. Foster -Adoption vi. Adoption vii. Interstate Compact on the Placement of Children (ICPC) J - Service Access: Fort Collins along the Front Range to Pueblo and Alamosa counties. Contractor can travel to other areas in Colorado including the Western Slope, San Luis Valley and southwestern Colorado. k. Language: English only. 1. Medicaid: Services are not Medicaid eligible. m. Transportation: Contractor does not provide transportation. 4. Contractor will respond to the Quality Assurance Team Supervisor (hainlejd(a)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 3 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 (hainlejd@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 requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor (hainlejd(h)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 (hainlejd(cr)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 (hainlejd@weldgov.com, 970-400-6210) of new staff who will manage and/or administer the services with the following information: 4 b. Staff member name and contact information c. Education level/degree (if applicable) d. Licensure/credentials (if applicable) e. Department of Regulatory Authority (DORA) number (if applicable) f. Supervisor name and contact information The Department reserves the right to decline the new staff members managing and/or administering services to Department clients. 5 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 Life Skills: $50.00/Hour (Family Engagement Meetings) $60.00/Hour (Intake for all services) $55.00/Hour (One-on-one Parent Coaching) $50.00/Hour (Parent Assessment Scale) $50.00/Hour (Professional Staffing — in -person or telephonic) $60.00/Hour (Supervised Facilitated Visitation) $90.00/Hour (Supervised Facilitated Visitation In-home/Community) $86.00/Hour (Therapeutic Visitation) $129.00/Hour (Therapeutic Visitation In-home/Community) $ .56/Mile (All mileage more than a 30 mile radius from Contractor's closest office.) - Visitation including transportation will be billed at a rate of 1.5 times the rate based on the authorized service Early check -in as authorized by the Department to ensure visiting parent presence prior to child's arrive same as rate based on level of visitation. Home Studies: $1,425.00/Episode (Full Completed SAFE Home Study — Including evaluation by SAFE Evaluator and supervision by SAFE Supervisor) $1,625.00/Episode (Expedited Full Completed SAFE Home Study submitted within 30 days — Including evaluation by SAFE Evaluator and supervision by SAFE Supervisor) $725.00/Episode (Completed SAFE Home Study Update) $52.00/Hour (Incomplete SAFE Home Study) $ .56/Mile (All mileage more than a 30 mile radius from Contractor's closest office or the evaluator's home, whichever is closest.) 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 Th 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 Form ew Contract Request Entity Information Entity Name* MAPLE STAR COLORADO Contract Name* MAPLE STAR COLORADO (AMENDMENT) Contract Status CTB REVIEW Entity ID* @0©027942 ❑ New Entity? Contract ID 3©53 Contract Lead* CULLINTA Contract Lead Email culliMa@co.weld.co us Parent Contract ID 20192029 Requires Board Approval YES Department Project Contract Description* AMENDMENT TO EXISITNG CHILD PROTECTION AGREEMENT FOR SERVICES (ADD HOME STUDY SERVICES AND UPDATE MILEAGE GUAGE). Contract Description 2 Contract Type* AGREEMENT Amount k $0 DO Renewable* NO Automatic Renewal Grant Department HUMAN SERVICES Department Email CM- HumanServlces(a)weldgov corn Derfirns*nt Head Email CM-HumanServices- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYA I I ORNEY@WELD GOV.COM Requested Date 09/25/2019 C kr nda Due Date DK12019 Will a work session with R()CC be required?* NO Does Contract > +wire Purchasing Dept. to be included? If this is a renewal enter previous Contract ID If this is part of a F SA 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 Bates Effective Date Termination Notice Period Review Date* 04/01./2020 Committed Dave Renewal Date Expiration Date* 05t'31:2020 Contact Information Contact Info Contact Narrte Purchasing Approval Process Department Head JUDY GR1EG© DH Apprct 3/2019 Final Approval �e BOCC Signed Date MCC Agenda Date 121'09/2019 Originator CULLINTA Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone 1 Purchasing Approved Date Fnance Approved Date 11'13/2019 Tyler Ref AG 120919 Legal Counsel KARIN MCDOUGAL Legal Counsel Approved Date 11/21/2019 e2 //JW-07(o90 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MAPLE STAR COLORADO / This Agreement, made and entered into tF day of / 2019by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of an Services, hereinafter referred to as the "Department' and Maple Star Colorado, hereinafter referred to as the "Contractor". The parties to this Agreement understand and agree that the provisions of this Agreement specifically include the following documents: Exhibit A, 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 81900025, which is incorporated into this agreement by reference and will be provided upon request to the Department. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies and WHEREAS, the Colorado Department of Human Services has provided Core Services or other funding to the Department for Life Skills. 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 7'h of the month, following the month of service, utilizing billing forms required by the ej/ciii,64,4(d5-0 2019-2020 11-(Zoo'7:0 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 7"' 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 indudes 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. S 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 govem 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 govemment 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 iri 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. § 2476.5-103(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 CR.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 "X VIII or. better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, the Department must be notified by the Contractor. Contractor shall be responsible for the payment of any deductible or self -insured retention. The Department reserves the right to require Contractor to provide a bond, at no cost to the Department, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverages specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Contractor. Contractor shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. b. Types of Insurance: Contractor shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: i.Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act, this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii.Commercial General liability Insurance written on ISO occurrence form CG 00 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 daims-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, induding 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. Training Contractor may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas Contractor will, on behalf of its employees and/or officers, accept any subpoena for testimony from the 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 970-000-6503 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 govemmental 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 inay from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker, Child Welfare Division Head Heather Morris, Executive Director 17. Notice All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley. CO 80632 (970)400-6510 9 For Contractor: Heather Morris, Executive Director 2250 South Oneida Street, Suite 200 Denver. CO 80124 (303) 433-1975 18. Litigation Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a parry defendant in a case that involves services provided under this Agreement. Contractor, within five (S) 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 foredosure. 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 Thin! -Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act of §§24-10-101 et. seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Imaroorieties/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 dient 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 govemment 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 Contractorshall 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 prof 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 pre, 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, induding but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Govemmental actions. 39. Severability If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. 14 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: ddeAS/1) Kf+4+; 11 Weld C• ty Clerk to the Board WELD COUNTY, COLORADO BOARD OF COUNTY COMMISSIONERS By: Deputy Clerk to t e B • : r 15 arbara Kirkmeyer, Cha CONTRACTOR: MAY 21,,2019 Maple Star Colorado 2250 South Oneida Street, Suite 200 Denver, CO 80124 (303)433-1975 1/m6i2-0/lr.'r By: Heather Morris (May 9, 2019) Date: Heather Morris, Executive Director May 9, 2019 .2019-ozP02-' 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. MaIllgStgr EXHIBIT B CONTRACTOR'S RESPONSE TO REQUEST FOR PROPOSAL 2250 S. Oneida, Ste. 200, Denver, CO 80224 I T: (303) 433-1975 F: (303) 433 1980 1465 N. Union Blvd., Suite 102, Colorado Springs, CO 80909 I T: (719) 694-8037 F: (719) 445-0841 565 W. Corona Ave, Suite 209, Pueblo, CO 81004 565N. Cleveland Ave, Loveland CO 80537 To Whom it may Concern: Maple Star Colorado (MSCO) was incorporated in 1994 as a non-profit child placement agency by the state of Colorado Department of Human Services. Since then MSCO has developed multiple community services to meet the need of the children and families of many communities throughout Colorado. Services include Facilitated Visitation and Parent Coaching, SAFE Home Studies, KEEP Removal Prevention and Reunification Services, KEEP Kinship, KEEP Teen, Domestic Violence Reduction, and Intensive Family Finding. Additionally, Maple Star provides Clinical Services such as the Virtual Residential Program in -home intensive child and family therapy, STAND adoption disruption prevention program, and Autism Services. Maple Star provides individualized client care that is creative, flexible, adaptive, and timely. MSCO actively provides services throughout the Front Range from Larimer to Pueblo Counties, but also contracts with multiple other Counties and States to provide our Community, Clinical and Foster Care services within Colorado. Maple Star has provided Foster Care to Weld County since licensed to 1994 and an array of services including Supervised and Therapeutic visitation, Home Study and KEEP services to Weld County since 2016. Mission and Service Philosophy: Maple Star's trauma -specific approach provides individualized and holistic services that promote wellness, durability, and healing through the context of relationship. Service Philosophy: Maple Star believes in enhancing the self-determination of each client through a model that encourages healing, growth, and progress through a relationship -based model. This model is developed from current research (Karyn Purvis, Daniel Seigel, Heather Forbes, Bryan Post, and Bruce Perry) and incorporates an understanding of trauma and the brain. In 2014 Maple Star became a trauma -informed workplace participating in a yearlong process through the National Council of Behavioral Health. Through conducting organizational assessments developed with a trauma lens, Maple Star was able to evaluate agency -wide trauma competency and implement new, or Improve current, practices to best meet the needs of clients, staff and community partners with a holistic trauma informed approach. Maple Star Colorado has a demonstrated ability to provide highly trauma competent and resourceful services cross discipline throughout multiple communities in Colorado. MSCO understands the unique needs of counties served and strives to contextualize our services to best serve the related population. Maple Star recruits and employs staff to meet the needs of County contracts. MSCO and Weld County have developed a positive working relationship including reporting, regular contract utilization and compliance meetings and developing protocols to meet the Department's needs. The Facilitated Visitation and KEEP programs currently operates under Pat Pisan°, Northern Colorado Visitation Supervisor with support from Director of Visitation Services, Patrice Brown, LCSW and Director of Community Programs, Barbara Murphy -Toros, MSW. The Home Study program has multiple SAFE Supervisor trained Supervisors and is overseen by Executive Director, Heather Morris, MSW. Agency Directors manage the contracts. They are responsible to oversee Quality Assurance compliance, billing, and program development. Following are proposals for Visitation, Home Study, and KEEP Removal Prevention and Reunification and Kinship services. Also attached are our insurance certificate and other documents to support the individual proposals. Please direct any questions or communication to Heather Morris (information below). Maple Star Colorado appreciates your careful consideration of these proposals for Various Services to Weld County as described above and looks forward to your response. Respectfully Sut?mitted, Heather Morris, MS Executive Director Maple Star Colorado Heather. MorrisCo?Pathways.com 303-564-2595 (cell) EXHIBIT B PROVIDER INFORMATION FORM Weld County Department of Human Services Maple Star Colorado AGENCY OR PRIVATE PRACTICE }feather Morris. MSW PRIMARY CONTACT— FULL NAME 1303)433-1975 PHONE NUMBER Heather.Morris@pathways.com PRIMARY CONTACT — E-MAIL ADDRESS 2250 S. Onelda St, Suite 200 AGENCY MAILING ADDRESS Denver CITY 90967 TRAILS PROVIDER ID (If Known) Executive Director PRIMARY CONTACT- TITLE 303 )433-1980 FAX NUMBER www.MaoleStaratet AGENCY/PRACTICE WEB ADDRESS (IF APPLICABLE) 80124 aP REFERRAL CONTACT HOME STUDY Nikova Marsh REFFERAL CONTACT — FULL NAME 720-209-1634 REFERRAL CONTACT — PHONE NUMBER Pat Pisano REFFERAL CONTACT — FULL NAME 9704133296 REFERRAL CONTACT — PHONE NUMBER EXT. Home Study Program Administrative Assistant REFERRAL CONTACT —TITLE CO Homestudv@pathways.com REFERRAL CONTACT— E-MAIL ADDRESS FACIUTATED VISITATION SERVICES & KEEP EXT. Supervisor of Visitation Services- Northern Colorado REFERRAL CONTACT -TITLE patricia.Pisano@Pathways.com REFERRAL CONTACT— E-MAIL ADDRESS BRUNG CONTACT Heather Childs BI W NG CONTACT — FULL NAME LS40)710-5140 BI W NG CONTACT — PHONE NUMBER EXT. Revenue Cede Management Specialist BILLING CONTACT — TITLE Heather.Childsi0 Pathways.corR BI W NG 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: _1/28/19 B1800 EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: Maple Star Colorado Bid No. B1900025 Child Welfare- Various Services- Life Skills 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Maple Star believes strongly in its mission to provide individualized and holistic services that promote wellness, durability, and healing through the context of relationship and a trauma specific approach. Maple Star believes in keeping services consistent across counties and across clients, to the extent that is appropriate without negating necessary regional contextualization. Particular to visitation services, the families served necessitate significant consistency in their visit times and facilitator. Through the trauma informed lens ;that Maple Star views our clients and services, we identify the need of the children served to see the involved parents at predictable, consistent times. It is also ideal to keep the structure and expectations of visitation consistent, as we know that these factors remaining stable minimize the trauma that begins at time of removal and often prior. Facilitators may employ a variety of interventions including: coaching and teaching skills; psycho -education around the role of trauma on behavior and understanding behaviors through a trauma informed lens, modeling positive parenting interventions, self - regulation, safety planning, and support In areas such as nutrition, and connection activities. After all referrals to Maple Star, an intake meeting is scheduled with the parent(s) prior to visitations occurring. This first step is key in developing a relationship with parent(s) in a culturally responsive manner. During this intake appointment, Maple Star utilizes a seff- assessment scale based on the Parent Assessment Scale (described below) with the related parent. After 4 visits between the parent(s) and child(ren) the Parent Assessment Scale is then implemented in its full form, considering observations related to interactions with the children involved, during the first visit. The self -assessment completed during the intake appointment and this initial Parent Assessment Scale are reviewed with the parent(s) so the Facilitator may identify and address any discrepancies. These tools are used to develop goals for the Facilitated Visitation Services provided by Maple Star. Maple Star believes that strengths -based language and empowerment will assist the client in moving forward successfully. The use of this concrete, consistent tool helps to avoid the negative associations that may be present for the client in regards to the reasons they necessitate visitation services. By doing so; Facilitators may overcome a potential barrier to success at the onset of services through engagement of the parent(s) In visitation services. Regular intervention, coaching and in some cases therapeutic level intervention will be provided to all families with the goal of developing their skills, maintaining connection and increasing bonds in order to support successful reunification whenever possible. Offering the continuum of Facilitated Visitation Services allows a smooth and supervised transition to lower levels of supervision and structure by Maple Star with the targeted goal of reunification. Conversely, if a family is struggling at a lower level of structure and supervision, higher level visitation services may be indicated and can be accessed Immediately upon authorization by appropriate Department personnel. Maple Star's Parent Assessment Scale Recommendations to the Department regarding the level of visitation will be based on the safety and needs of the child. Maple Star's Fadlitated Visitation Services will be used only until it is safe for children to be in a monitored or unsupervised visiting situation. The following factors will be considered in determining the length of time and level of supervision for visitation time services: Safety of child/children, Progress of parents In treatment towards resolution of abusive/neglectful behavior, Progress of parents in demonstrating skills necessary to keep their children safe, Progress of parents in demonstrating an Increase in their parental protective capacities Maple Star utilizes an assessment tool, combined with the factors listed above, to determine the needs and concerns to be addressed during the visitations. The assessment tool was based on the North Carolina Family Assessment Scale (NCFAS), an evidence based tool developed to assess safety. Maple Star modified this tool to target areas of the scale specific to the delivery of visitation services. This targeted tool delineates visitation services into specific categories. It does so by allowing facilitators to rate participants in several concrete domains. This gives all professionals and Involved family members a common language from whicdt to build goals and interventions. This tool is administered at the onset of services and at 30 day increments following. It is used Bid No.: 31900025- Life Skills EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) collaboratively with the family in efforts to enhance understanding of challenges and successes for the family as well as increase engagement in visitation services and time with their children. Maple Star utilizes a Parent Coaching curriculum based on Daniel Siegel's Whole Brain Child (2012), Karyn Purvis's The Connected Child (2007), and John Medina's Brain Rules (2014). Visitation Facilitators use approaches outlined in these writings, as well as dynamic approaches that emerge though other evidence based approaches such as Trust Base Relational Intervention In educating parents on brain science, child development, and behavioral intervention strategies during their visits and during the debriefing time before and/or after the visit. Level of Services in MSCO FVS program • Supervised Visitation at Department or a secured facility- Thls level of visitation would be determined in collaboration with the County Case Worker if the family is assessed to have high risk behaviors that would necessitate the presence of security or law enforcement to ensure the safety of the child(ren) and/or Facilitator. • Supervised Visitations at Maple Star or other agreed upon semi -contained locations or offices- This level of visitation allows for a less restrictive setting where the risk level has been determined to not require the presence of law enforcement on the premises. The Maple Star offices do allow for structure and containment for the visit, reducing the anxiety and additional distractions or external stimuli that may be present in community based visitation. • Community Based Visitation- In this level moderate or lower levels of parent coaching and role modeling are required. While Facilitators still remain within line of sight and earshot of visitor and child at all times, fewer interventions are required. The level of visitation requires that the parent demonstrate an ability to engage the child with the additional exterior stimuli and maintain the safety of the child in an open and less restrictive setting. This level is appropriate when Parent Assessment Scale Indicates parent is engaged in treatment services for SA/MH challenges and/ or is working on systemic issues in relation to their environment. • Intermittent Visitation- This levels of visitation require the least direct observation of the parent and child and may decrease from presence In the same area where sight lines may be maintained but the family is interacting independent of the Facilitator and is most times out of ear shot down to "drop in" visits with a family during extended unsupervised time to chedc on child safety and ensure family's continued compliance with case plan expectations. This Is not a primary service of Maple Star and would be provided for only short time periods of less than one month and serve to provide a final step down to unsupervised visitation. Preferred qualifications for Facilitators are a Bachelor's Degree and child welfare experience. All therapeutic visits will be completed by a Master's level professional. Additional details regarding staff qualifications, badcground check and training may be found in supplemental document #1: 4. Anticipated frequency of the service (ex. 4 hours/week). Frequency Is dependent on the individual needs of the family. Maple Star's community based Facilitated Visitation Services are provided for 2 hours minimum per encounter. No maximum per family weekly is established. However, scheduling/ availability must take in to account Colorado Labor laws requiring a 30 minute lunch/rest period after 5 hours of work. Should Weld County request visitations In duration of 1 hour, Maple Star would endeavor to establish an office based schedule to support such services which require little or no transportation or travel time between visit locations in order to maximize the amount of hours available to provide family contact and supportive coaching. 5. Anticipated duration of the service (ex. 3-4 months). Upon referral, families will participate in an initial intake meeting with Maple Star staff. In accordance with the Maple Star staff intake evaluation and the required referral information provided by Weld County at the time of referral, the appropriate duration of service will be determined Services will initially be scheduled for 45- 90 days dependent on the level of service authorized. Weld County will coordinate staffing required to reauthorize per this contract. All Authorizations will remain In effect and subject to billing until formal notification of service termination is received by Weld County. Maple Star will monitor service authorization periods and document these In communications with the Department. Based on the referral information provided by the Department, a visitation format and plan will be discussed with the family including but not limited to: Individuals participating in visits and anyone restricted from attending visits; the level of structure/supervision to be provided by Maple Star; explanation of the reporting function the agency has as facilitator; Bid No.: 81900025- Life Skills EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) expectations for parents in terms of preparation for visits and Items they need to bring; possible learning/skill-building goals and activities to be integrated into the visitation time and some general guidelines in relation to attendance and behavior. Visitation and coaching may be provided at Weld County, in the community, or at the family home. Once reunification has occurred, the services may extend to the family home In the form of Parent Coaching. For additional Information regarding Maple Star's Intake procedure, please refer to Supplemental attachment #2. 6. Goais of the service. As stated above, the goals of service are to support parents in connection with their child, learning and implementing positive parenting skills and decreasing the level of service. 7. Outcomes of service. Maple Star would like to see progress by visiting parents on Parent Assessment Scale ratings and progress by families from higher to lower level of visitation with the goal being unmonitored and reunification. 8. Target population for service. Maple Star Facilitated Visitation Services work with,children ages 0-18 and their visiting parent/ family member. Our area of expertise is trauma informed care, but additional training/ consultation for visitation personnel may be provided by Maple Star's Domestic Violence program's DVOMB certified supervisor. 9. Service access. Maple Star office locations available for Weld County children and families are located in Loveland, Denver Colorado Springs and Pueblo. A complete listing of addresses may be found in Supplemental attachment #3. For Community Based Facilitated Visitation Services, Maple Star may provide a wide range of options which includes parenting time 7 days a week, between the hours of 8:00 am to 7:00 pm, depending on the scope of the contract. The length and frequency of parenting time will be dependent on the needs of the case and schedules of the parents and children. Every attempt will be made to provide timely and flexible scheduling in the child's home community. 10. Medicaid eligibility of service. Visitation services are not Medicaid billable Maple Star is able to bill Medicaid for medically necessary therapy services. 11. Transportation of clients. Maple Star may provide transportation for children to/ from visits when necessary and authorized by the Case Worker. 12. Rates of service. Maple Star's Facilitated Visitation and Parent Coaching Rates: Intake for all services: $60/ hour Therapeutic Visitation: $86/ hour. Therapeutic Visitation with transportation: $106/ hour. Supervised Facilitated Visitation: $60/ hour Supervised Facilitated Visitation with transportation: $80/ hour Family Engagement Meetings: $50/ hour Professional staffings (in -person or telephonic): $50/ hour Parent Assessment Scale- completion and supervision- $50/ hour Court testimony- court preparation up to 3 hours and testimony- $80/ hour One on one Parenting Coaching: $55/ hour in 15 minute Increments including WsRation coaching/ debrief before and after visits. Group Parenting Coaching: $80/ hour Early check -in as requested by Case Worker and team to ensure visiting parent presence prior to child's arrival- same as rate based on level of visitation. Formal authorizations for this servlcebut by County Case Worker are required but the service may commence immediately with written (email) request from the Case Worker in order to ensure seamless service to the family. Mileage for visits outside of Weld County will be charged at the IRS rate for all mileage more than a 20 mile radius form the closest Map Star office or the Facilitators home, whichever is closer. Service authorizations cancelled or modified by Weld Department personnel without documented communication to Maple Star are subject to payment, including those which extend past authorization dates. Maple Star will communicate with Case Workers, then supervisors in efforts to ensure service gaps do not occur. Should Weld County not communicate any service change, Maple Star will support the best interest of children and parents to continue connection through visitation. If services are terminated, payment standards are outlined above will apply. Bid No.: B1900025- Life Skills Supplemental Document #1 Staff qualifications and background checks: Prior to an offer of employment, 3 telephone references checks are completed, Social Security number screen, a criminal history search by SSN in States where the applicant has lived in the last 10 years is completed, and a Driving Records Check is conducted. All of the following are searched for exclusionary criteria: General Service Administration- Excluded Parties List System, Office of Inspector General- List of Excluded Individuals/ Entities, Office of Inspector General- Most Wanted Fugitives, Office of Foreign Asset Control - Specially Designated Nationals, Department of Health Care Services Once Maple Star applicants are offered a position, the following background checks occur: Fingerprinting for Colorado Bureau of Investigation, Federal Bureau of investigation, and signed forms to complete Background Investigation Unit checks and E -Verify is completed within 3 days of employment. Mandatory training for all employees includes: Crisis management, HIPPA Requirements, Confidentiality, Ethics, Mandatory Reporting, Child and Adolescent Development, Trauma and the Brain, Family dynamics, Strengths -Based Family Theory, Parenting, which includes signs of abuse and neglect, Awareness related to alcohol and substance abuse Issues, Safety protocols. Maple Star Colorado provides a new hire academy to all new employees. This 4 day foundational training includes an agency overview, an introduction to Motivational Interviewing, HIPAA protocols, Community and Home Visit Safety, Trauma Informed Care Basics, Informed Supervision, Culturally Competent Practice and Professional Boundaries/ Self Care. Maple Star's Staff Qualifications Maple Star's Visitation staff meet the following regulations: • Maple Star's visitation workers all have Bachelor's Degrees; however, a worker may have obtained a high school diploma or General Equivalency Diploma (GED) and six months full time public contact in human services or a related field in some instances; however, the majority of the staff in this position will be Bachelor's level with experience. Substitution for public contact is successful completion of a certificate program and/or college course equivalent to public contact in human services or a related field. • The current Director of Visitation Services meets the equivalent of the minimum qualifications, as defined Volume 7, with a Master's Degree and Licensure in Social Work. • All visitation workers providing therapeutic visitation hold Master's degrees in the human services field. • Visitation reports will be emailed to the Department Case Worker and/or entered in to the required database based on individual Department requirements. • All Maple Star employees, including visitation workers, are background -searched to Include finger prints and child welfare checks. • Mandatory training for all employees includes: • Crisis management • CPR/First Aid • H1PPA Requirements • Confidentiality • Ethics • Mandatory Reporting • Child and Adolescent Development • Trauma and the Brain • Beyond Consequences • Family dynamics • Strengths -Based Family Theory • Parenting which includes signs of abuse and neglect • Awareness related to alcohol and substance abuse issues • Safety protocols • Additional trainings for Parenting Time workers includes: • Intervention to promote change • Parenting skills • Behaviors that facilitate positive attachment, separation and reconnection • Training for therapeutic visitation includes: • Any person providing therapeutic supervised visitation services must be a licensed mental health professional or supervised by a licensed mental health professional • The use of therapeutic modalities to address parent -child Interactions with a focus on improving the relationship and bonding between the parent and child. In collaboration with Maple Star, the county may request levels of experience or education for particular levels of service. Supervisory structure of staff members and/or contractors of the bidder. This should include the ratio of supervisor to staff and/or contractors, frequency and duration of supervision, credentials of supervisor and length of time as a supervisor. • Ratio of staff to supervisor does not exceed 10:1. • Supervision is generaily bi-monthly but may be more or less frequently based on staff case load and client need, equivalent of two hours of supervision per month per employee; however, additional supervision may be provided during times of crises or when employees are new or experiencing a difficult case. • Most supervisors have master's degrees plus two years or more experience; while supervisors without master's degrees generally demonstrate two years or more work experience. • Supervisors receive additional training on how to be a supervisor though regular group supervision with cross Program Directors. Maple Star strives to sustain consistency across counties in the services we provide. In alignment with thls goal, the agency conducts monthly supervisor meetings across the agency as well as monthly program supervisors meetings. Supplemental Document #2 Referral acceptance and assignment Referral Maple Star will accept referrals via their designated referral email or via phone in case of emergencies. Maple Star will endeavor to advise re: their ability to accept the referral within 24 hours. This ability will be affected by the detail of information included in the referral. In order to review and advise re: acceptance of referral, Maple Star will require the following Information: Child(ren)'s name(s) Duration, frequency and location of visit Current contact information and all known availability for all parties (including visiting parent, child and caretaker of child who will be transporting) Failure to provide this information will impact Maple Star's ability to assess immediate availability of staff to coordinate and commence visitation. All parties must be contacted and schedules confirmed for Maple Star to be able to guarantee acceptance. Intake For all referrals made to Maple Star for visitation, an intake meeting will be scheduled with the parent(s) prior to visitations occurring. This first step is a key in developing a relationship with the parent(s) in a culturally responsive manner. Based on the referral information provided by the referring county, a visitation format and plan will be discussed with the family and indude a variety of possible issues including but not limited to: scheduling/duration of visits; individuals participating in visits and anyone restricted from attending visits; the level of structure/supervision to be provided by Maple Star; explanation of the reporting function the agency has as facilitator; expectations for parents in terms of preparation for visits and items they need to bring; possible learning/skill-building goals and activities to be integrated into the visitation time and some general guidelines in relation to attendance and behavior. Maple Star will also take the first session to explain Maple Star's, the courts', the parents' and the county's roles with an emphasis on the importance of child safety. Ample time will be given to respond to any questions posed. During this intake appointment, Maple Star utilizes a self- assessment scale based on the Parent Assessment Scale (described below) with the related parent. This allows the parent the opportunity to self -report on their perceived skills and abilities to provide a safe and protective environment for children without requiring the parent to recount the entire history of their child protection services involvement. At the initial visit between the parent(s) and children) the Parent Assessment Scale is then implemented in its full form, taking into account observations related to interactions with the children involved, during the first visit. The self -assessment completed during the intake appointment and this initial Parent Assessment Scale are reviewed with the parent(s) so the Facilitator may identify and address any discrepancies. These tools are used to develop goals for the Facilitated Visitation Services provided by Maple Star. Maple Star believes that strengths -based language and empowerment will assist the client in moving forward successfully. The use of this concrete, consistent tool helps to avoid the negative associations that may be present for the client in regards to the reasons they necessitate visitation services. By doing so, Facilitators may overcome a potential barrier to success at the onset of services through engagement of the parent(s) in visitation services. Offering the continuum of Facilitated Visitation Services allows a smooth and supervised transition to lower levels of supervision and structure by Maple Star with the targeted goal of reunification. Conversely, if a family is struggling at a lower level of structure and supervision, higher level visitation services may be indicated and can be accessed immediately upon authorization by authorized Department personnel. If reunification is the outcome of the case Parent Coaching services may follow the children in to the home and provide support in applying skills learned during visitation services as well as assistance with other areas such as household management, and access to community resources. Cancellation Maple Star currently provides visitation services in Weld County as well as the adjacent communities of Larimer, Boulder, Adams and Broomfield counties. Additionally, Maple Star is currently contracted to provide Home Study and KEEP services in Weld County. Maple Star will be able to meet the need of Weld County through office hubs located in Loveland, Denver, Colorado Springs or Pueblo in a timely and effective manner. Maple Star will be able to take referrals within 30-45 days of the initiation of the contract or upon formal notification of intent to award the contract. Maple Star would use the FVSC for the purposes of Safe Exchange, should that be a contracted service. Maple Star does not currently occupy a physical space in South Weld County, but may explore based on contract. The Program Supervisor's phone number is available where interested referring Department Case Workers may call and staff cases for appropriateness of service, discuss dynamics of the case and determine ways the Maple Star Visitation and Parent Coaching program may be of service to the family. If an appropriate match is determined, the Case Worker will make a referral via email and FIDOS, and get approval through internal Department procedures. Once an approved referral has been received from the Department, Maple Star Northern Colorado Supervisor will reach out to the referring caseworker to gather any additional information. The supervisor will then staff the case with available workers and make assignments based on caseload and family location. The staff will reach out to the family to schedule an initial visit. The staff or supervisor will then email the referring caseworker regarding contact information for those that are assigned as well as details about the initial visit. Maple Star's established track record is evident in their ability to provide accurate, detailed and timely written reports for referral sources as well as maintaining productive working relationships with counties with which we collaborate. Maple Star will communicate progress and challenges to the caseworker on at least a weekly basis in the form of progress notes. Additionally, visitation workers are trained in issues related to working with families, crisis, abuse, reunification, and observation. The visitation workers' documentation will reflect their observations in multiple domains that include interpersonal dynamics, parenting techniques, behavioral appropriateness, and logistical responsibility (arriving on time and consistently or notifying Maple Star when delays or cancellations occur). The Program Supervisor also will track statistics and report to the County Department monthly. Visitation plans are based on court orders, children's safety, parents' progress, and status of the court case and are developed in collaboration with the parent during their intake visit. These goals in these plans are regularly reviewed and updated. Consistent communication between caseworkers and Maple Star's visitation workers will ensure compliance to the family's visitation plans. Case Worker and referral worker feedback surveys may be utilized at the time of case closure or termination of services. Maple Star endeavors to schedule a minimum of quarterly face-to-face meetings between Maple Star program supervisors and designated Department personnel to elicit feedback, discuss progress and concerns, and modify to fulfill Department expectations and ensure contract compliance. Quality Assurance calls are made randomly to clients to ensure client contacts are made and to ensure clients are receiving services and to determine if they are satisfied and are subsequently are given a forum to provide feedback. Supplemental documentation #3 Maple Star Office Locations: 2250 S. Oneida, Ste. 200, Denver, CO 80224 I T: (303) 433-1975 F: (303) 433 1980 1465 N. Union Blvd., Suite 102, Colorado Springs, CO 80909 I T: (719) 694-8037 F: (719) 445-0841 635 W. Corona Ave, Suite 209, Pueblo, CO 81004 565 N Cleveland Ave, Loveland CO 8-537 STAFF DATA SHEET EXHIBIT D (Bidder must Ilst all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: South County Visitation Services- Weld County DHS BIDDER LEGAL ENTITY NAME: (Maple Star Colorado No. 2 Maria (970) 825-4583 Maria.HannamtDothw, aT.com Aleena (970) 373-7489 /een.... to iii�wa •m 4 Breann (970)400-7025 Brooke (970)391-2500 Janet (970) 617-0778 Sabrina (970) 213-7308 Suzanne (970) 294-9540 S�enne.y ite eNa thwa om Yaricza (970) 443-1923 Yariaa�Sg{�nouNoathways com Patrice (720) 298-8936 Patiice.erowntiPpathways.com First Mahe Workll 10 13 14 15 16 17 18 19 21 22 23 24 25 26 27 Last Name Pisano Hannam Soto Williams Hawley Um beck Slagowski-Tipton Walters Serrano Brown APPLICABLE STAFF MEMBER OR CONTRACTOR INFORMATION. Education Level Work Email Patrda (970) 413-3296 P�tricia.PjsanFL@Qp hways corer Brooke. gli mgyoogthways,,om Ja�etLimbec itg�hways com ° BA BS BA Bachelor's Masters EWA Masters MSW . Measure, Degree;Focus Credentials Psychology N/A Early Childhoo • N/A Sodology N/A Human Servi• N/A N/A Social work Reg. Psycho Communicatio Fine Arts Sodology Sodla Work N/A N/A N/A Law 28 ' 9U PERVI R .ap S O I N FO r :�rke.B RM AT I O N IaVodtFinaO .t,-., .I row nLla°athwaNI N/A Brown Patrice N/A Pisano Patricia' ' : PaMPi da.sano�IDpath N/A Pisano ' •N/A ys.comvfd M! N/A Pisano Pisano Patrida Patricia (970) 413-32' : P Aatisanot®oathways.fom : NLC.0108125 Pisan° Patricia (970) 413-329: (970) 413-3 • : c pgtrida.pisanot3O • athWays. . patri4la.eisano@pathwa .coal N/A Psano Patricia (970)413-329: N/A N/A Pisano Patricia (970) 413-329: (970)413-32•:p (303) 960-743: patr cip,Pisano@oath a s. . Ida.pisano ll thwayl•com Kim.VanAukentiaoathways corm Pisano Kim Patricia VanAuken A4,,,�-- CERTIFICATE OF LIABILITY INSURANCE GATE ° THIS CERTIFICATE IS ISSUED AB A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCA TE HOLDER. '�'°S R"'� THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF =GRANGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERD3). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder la an ADDITIONAL INSURED, the POIlsKeso) must haw ADDITIONAL INSURED If SUBROGATION IS WAIVED, outyaot to the terms and cond[tions of the policy. certain policies may m ures:nerdion* A be erT ent tort We csrlifles a does net confer eights to the certificate holder In Ilea of such an 41Nre an ortdorsnmerH A statamaM on use dareslesrr!(o). PRoo ENO R INI 6 hem= Snnmp ar CA lb= 10437t83 177 Bath Rpm Street lm MQdee, C1 90017 C N 109049 328 PROD CA SUMIS 19 Hinstuf 7960 6oidh Orolds West SnEa T0Q Demsr.CO 80221 :rr e+auanalss AnyleoIRG covathea wort essuRERA: UnIngion hum= ComQory 19497 DOWER a:Mew s's4drmetlyC4 25168 PORN=a : 7rm04:foxyCsouaAY L rme, OfAmorles 26814 emus==,; NIA N8% COVERAGES CERTIFICATE NUMBER: MEURER E ; 9ffiU! ER PI LOS-00Z7M12 REVISION )(BRIBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUETO THE INSURED NAMED 3IDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN. THE, INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, �� bICONDITIONS CLUSIONS AND OF SUCH POLICIES, Leers Shows! REDUCED MAY HAVE BEEN BY PAID CLAIMS. 19 1 TYPE Of aIaWNRC6 ASSIL.SLUE % C gancAL6EXERS4.minus D� Wins. Pa11C7rnAOHt �&.emtl� 5797581 03.01/1119 a>,,o 9 ____f I � a OCCUR GENL AGGREGATE LMT APPLIES PER: A 1 POLICY n n LOC I Orly AVTOYOSILEUASMY X ANY AUTO AUTONOMY REED AUTOS ONLY E OOULED AUTOS AUTnNG i Doa.Y TC7JGR426i8955.1A 0101(7019 09101;2118 i BODILY GAJURY per paa,) � s BODILY SALARY (Ptir oddest) i USaTS EADHoocisusENCE DARIAGETO RENTED PREMISES fEA MEG EXP (Au, m. prom) PERSONAL i ADV INJURY Gawps'. AGGREGATE PRODUCTS • COMP1OP AGO i i 1,000.900 9.000,000 s 1,0231000 s etaf i;N uasuNrc A UMIRELLAQUI Incase LAS DID I IAETERLTORs CLAIPASIAADE WORKERS CONP61aATION AND EMPLOYER, mount Y IN ANfPItRNEUOR ESCUSIRlET�CLRnfe I 1 lrcwGeDT oEit:PJ OP OOPERATIONSbe11p HEALTHCARE PROFEWICHAL lIA6 CLANS MADE HC2.1442511f39Sfl 111AHDO17 10A1V219 memoCCtRRErCE AGGREGATE I ErATLRE Pk EJ_ EACH ACC )ENT El INSEAM - EA EEHPLOYefi o EL. D E ME-PDLILY war s EACH VEDEAL ecroE IT AGGREGATE osacseprtow OF OPERATWYe f LOCATTSNe f YEHICLED - fAcaTra 101, Aden. nd Re PER eardols, m0.' . ddalrod 7nrer. oPu Is geub>dt tNdd Caubr fuse 6rd<dsd a eddBbed Insured There reQu4ad b1 TnA1sn oorascl wIN LesPed b Qerrerd latdiy. CERTIFICATE HOLDER i 1,004000 1,033.008 1,))04000 SIAM, Weld County Weld County Dissamerd of Ham &Mom 11500 SI PO &is 169 Greeley, CO 50832 ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WON THE POLICY PROVISIONS. AUTHGROS5D NIPREBENTATIVa of Iltrsk Risk S Issuraee swim* Charles Shin 01168-2016 ACORD CORPORATION. All rights reserved Tho ACORD name and logo ere registered medal of ACORD EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidders legal entity name: L Program name or service type being proposed: Maple Star Colorado Child Welfare- Various Services- Home Study Bid No.: 81900025 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Maple Star Colorado (MSCO) is proposing to continue utilization our comprehensive Home Study Program being administered for multiple Counties including: Douglas, Arapahoe, Jefferson, Adams, Denver, Clear Creek and Weld counties to meet the needs of the families and children served by Weld County Department of Human Services. Maple Star has also completed studies for Gilpin and Larimer counties. Maple Star Colorado utilizes the SAFE (Structured Analysis Family Evaluation) Home Study format to evaluate applicants' suitability and preparedness to provide care to children Involved with the Child Welfare System. MSCO believes that a thorough psychosocial evaluation and mitigation of current and historical concerns is vital to providing the highest quality of matching and placements to children in need of kinship (certified or non -certified), foster, adoptive and/or ICPC homes. Through the use the of SAFE, MSCO supports the need for qualified, safe and stable homes for children. MSCO also ensures strict adherence to SAFE protocols and CDHS Volume VII requirements resulting in fully vetted SAFE studies being provided to the Department that are in compliance with all, SAFE, State and audit requirements. Maple Star Colorado's Home Study Program has been providing contracted home studies including evaluation and supervision by SAFE trained/ certified persons to multiple counties throughout Colorado, since May 2012. Since the inception of the Home Study Program over 2,300 SAFE Home Studies have been completed by the Maple Star team. Maple Star also has experience in writing and supervising SAFE studies since Colorado implemented SAFE in support of our Foster Care program. Maple Star has been providing SAFE Home Studies to Weld County since 2016. The specific processes which have been developed for the delivery of qualified SAFE Home Study and SAFE Supervision to Weld County may be found in Attachment #1. These processes were developed to support all Volume VII and SAFE protocols. Required documents and outlined communications are required to complete SAFE Home Studies accordingly. Maple Star's team of approximately 40 SAFE Evaluators and 6 SAFE Supervisors provides comprehensive SAFE evaluations and updates of foster, adoptive, interstate compact for the placement of children (ICPC) or kinship homes. Maple Star also completes Safety, Stability and Permanency Assessments (SSPA) for Adams County. Maple Star Colorado's Home Study Program is set apart from other contractors in that they provide both Home Study evaluation from 2 day SAFE trained evaluators as well as review and approval according to SAFE and Volume VII regulations by a SAFE Supervisor who has attended the above referenced 2 day training as well as the additional 8 hour SAFE Supervisor training. SAFE required Consistency and Compliance trainings are all completed. Qualified SAFE evaluators are assigned to SAFE certified Supervisors. The Maple Star Home Study Supervisor is responsible for staffing cases with providers, reviewing all documentation and questionnaires, reviewing and approving the SAFE and Psychosocial Inventory according to SAFE standards. Maple. Stars Home Study Supervisors ensure that all SAFE guidelines are followed with regards to interviews, evaluation and mitigation, that the home study documentation is completed correctly and signed off on by all necessary parties, and that the final SAFE home study is submitted to the Department of Human Services. A certification with regards to each of these areas is completed, signed and submitted by the Home Study Supervisor with the final report in accordance with SAFE Home Study guidelines. Content of the SAFE Home Study assessments include those items as listed in Volume VII of the Policies and Procedures for Child Welfare Services, Colorado Department of Human Services: for Foster Homes and Adoptive Homes: 7.500.2 A. 1-8; C. 1-9, D.; for Kinship Care Homes: 7.500.31 A. 1., and 2. a -m., and the Study Outline. These guidelines also apply to ICPC home studies. SAFE home studies / updates include structured questionnaires, interviews, assessment guides, SAFE compatibility inventory, structured family references, and the pre -formatted home study report. Maple Star's staff use the most current SAFE home study format / SAFE home study desk guide, Psychosocial Inventory which is required by the Colorado Department of Human Services. The site is checked regularly and all SAFE updates are distributed to the team by the program administrator. Maple Star's staff will also: (1) discuss with the family any and ail concerns that arise during the study process as they relate to EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) recommendations; (2) verbally inform the family of the recommendation being made to Weld County Department of Human Services regarding certification, kinship care or adoption; and (3) inform family members they will be active participants in the development of the SAFE home studyy report and they will be able to read a copy of their SAFE home study report, arranged by Maple Star's staff. Weld County Department of Human Services may request to participate in a face-to-face meeting with the applicant family, should the study conclude with a recommendation against placement of a child in the applicant family home. Maple Star's staff will be available by telephone or in person for Certification Review Team meetings. Maple Star's staff will communicate directly with Weld County Case Workers for child specific home studies to ensure that the family is evaluated to meet any special needs of that child. Maple Star also remains in constant communication with certification workers and supervisors regarding the progress on studies and notify the Department immediately of any situation which may result in a delay of the submission of the finalized report. All SAFE Home Study Providers and Supervisors are listed on the Colorado Department of Human Services Vendors list as Maple Star Colorado staff and appropriate records of qualifications are maintained by Maple Star Colorado Human Resources personnel. See Attachment #2 for a job description for SAFE evaluators and the background check processes for Maple Star Colorado. The Vendor List is currently under revision so the version currently available does not reflect all evaluators and supervisors. However, MSCO can provide documentation of submission of all requirements to CDHS can be provided upon request. Designated County Department of Human Services staff complete a home study referral and submit to Maple Star via email at designated program email: CO Homestudy(wPathways.com The program administrator checks for and assigns referrals dally. The program administrator will notify the referring Weld County staff member of the assigned writer and supervisor. Weld County Department of Human Services will complete initial background checks including fingerprinting, CBI, FBI, and National and Colorado Sex Offender registries, CDHS application, completed Questionnaire 1 and all required Department certification paperwork. This documentation will be provided to MSCO evaluator and supervisor as outlined in Attachment #1. All referrals for home studies or home study updates will be completed, unless the applicant family voluntarily withdraws their application, or unless Weld County staff recommend closure of the home study process. In these situations, Weld County staff and Contractor's staff will be in dose communication regarding a final decision about completing a study or update. All completed home studies, home study updates, partial home studies or home study updates will be electronically forwarded to designated Weld County Department of Human Services personnel using password protected/ encrypted emails. Original documents including Questionnaire Its administered by the Home Study Provider, signature pages, signed psychosocial inventory and Supervisor Home Study Certification check list will be delivered in person or via U.S. mail to the designated Weld County staff member per processes outlined in attachment #1 "process document". All documentation and the SAFE Home Study report will be submitted to Weld County Human Services and will. become the Department's property. Future requests for release or review of a completed home study must be directed to Weld County Human Services. Maple Star SAFE Home Study evaluations are completed using trauma informed interviewing techniques to avoid retraumatization of applicants when discussing sensitive historical events. Maple Star Home Study Evaluators treat all applicants with respect and treat every applicant's information with the highest level of confidentiality and maintain records in accordance with HiPPA requirements. 4. Antidpated frequency of the servke (ex. 4 hours/week). Per State Volume VII regulations, after the first SAFE interview, the second interview and any subsequent interviews of the adults shall not be until at least 3 calendar days after the previous interview. A minimum of 2 in person interviews will be conducted with a minimum of one face to face contact In the applicants home. interviews will be completed and subsequent contacts made with references, collateral contacts and the applicant(S) to gather additional information needed to fully evaluate the home per SAFE standards and State Volume VII regulations. 5. Anticipated duration of the service (ex. 3-4 months). Maple Star will complete SAFE Home Studies, including supervision by a certified SAFE Supervisor within 60 days of receiving documents, required to schedule and conduct first interview. The documents required are listed in Attachment g 3. The documents contained in this attachment must be collected by the Department and provided to the Home Study Evaluator. Per SAFE requirements certain documents are required to be reviewed by the SAFE evaluator prior to their first home visit, Including but not limited to SAFE Questionnaire I and the application (please refer to SAFE process document copied from the SAFE Supervisors manual which outlines these requirements- also in Attachment #3) At a minimum the Application and Questionnaire I EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) must be received at the time of assignment and the applicants must be scheduled for fingerprinting. The remainder of the documents may be forwarded as they are completed. References will be sent by the Home Study Evaluator but will be returned to the Department. The Department will be responsible for forwarding these references to the Home Study Evaluator. Home Studies may not be completed/ approved without the SAFE Evaluator and their Maple Star SAFE Supervisor receiving and reviewing all documents listed in Attachment #3. 6. Goals of the service. The purpose of a SAFE Home Study is to determine if family is a viable and safe placement resources for children, meet statutory and regulation requirements, approve or deny a family for placement, find families for children, not children for families, strengthen family functioning: Address issues if concern, promote change, Family preparation: Prepare the family for a successful parenting caregiving experience, and Placement matching. (Consortium for Children) Maple Star's SAFE Home Study Program is to provide high quality SAFE home studies which comply with all SAFE guidelines and requirements, all Volume VII requirements and are fully supervised and approved by a SAFE certified Supervisor. A sample SAFE Home Study evaluation written and supervised by Maple Star is available upon request. 7. Outcomes of service. High quality, comprehensive SAFE Home Study completed by a SAFE certified Home Study Evaluator and approved by a SAFE certified Home Study Supervisor. 8. Target population for servke. Maple Star Home Study Evaluators and Supervisors have experience with multiple types of evaluations. As a private, non-profit CPA Maple Star has conducted and supervised SAFE Home Studies for certified foster and adoptive families, including certified kinship, since SAFE was introduced in Colorado. In May 2012, Maple Star began contracting with multiple counties to complete SAFE evaluations for Foster, Fost-Adopt, Certified Kin, Non -certified Kin and ICPC studies. The team of Supervisors within Maple Star have multiple years (between 3 and 10+) of Supervising the full gamut of SAFE Studies. 9. Service access. Maple Star's Home Study Program is currently staffed to provide SAFE to various Departments of Human Services and families with whom they are working from Ft. Collins along the front range to Pueblo and Alamosa counties. Maple Star also employs evaluators residing in or willing to travel to other areas of Colorado including the Western slope, San Luis Valley and southwestern Colorado. 10. language Service is available in. Maple Star endeavors to recruit and train staff members within the communities served by the Departments of Human Services with whom they contract and additional Home Study Providers may be hired if a need is identified. Maple Star currently employs two Home Study Providers that speak both English and Spanish with the goal of administering the SAFE Home Study in the language in which the applicant is most comfortable communicating. Evaluators fluent in other languages may be recruited as needed. Home Study evaluators are trained and supervised to view the family in a strengths -based manner, taking in to consideration the family's cultural identity and practices. 11. Medicaid eligibility of service. SAFE Home Study services are not Medicaid billable. 12. Transportation of clients. SAFE Home Studies occur primarily in the applicants home or rarely at an agreed upon community setting. There are no transportation needs associated with Home Studies. 13. Rates of service. $1425 for a full completed SAFE Home Study- including evaluation by SAFE evaluator and supervision SAFE Supervisor $1625 for an expedited full SAFE Home Study (submitted within 30 days) $725 for a completed Home Study update $52/ hour for incomplete SAFE home studies. Mileage will be billed at the IRS rate, according to Maple Star's mileage policy of all miles over 20 miles each way from the dosest office or the evaluator's home, whichever is closest. Studies over 120 miles each way from evaluator may require overnight accommodations and will may require additional remuneration to be negotiated on a case by case basis. Home Study Process All below requirements apply unless otherwise agreed upon between the HSP and their supervisor Home Study Assignment 1. Request for Home Study forms, will be scanned and e -mailed to Maple Star (Co Homestudy@maplestar.net). These requests will come from: Sharon Abuso [mailto:abusoxslaweldgov.com] a. Weld County Home Study staff 2. Maple Star will review the referral and assign a home study provider (HSP) and their MS supervisor. 3. Maple Star will forward the Request for Home Study Form to the HSP, their MS supervisor, county caseworker and Department Administrative Support staff to communicate the assignment to all parties. 4. All documentation necessary to begin the home study will be forwarded to the home study provider and home study supervisor by County personnel via email. 5. Maple Star program administrator will record the date these documents were received as this is when the 60 time line begins. 6. Communications from Maple Star to the County Departments will be via encrypted email which will require County Department personnel to register with MSCO's system. Home Study Process- 60 day deadline 1. Home Study provider will review all documentation sent by the County excluding references and Questionnaire I when the information is forwarded (via secure email). The information will be submitted to the HSP and their supervisor directly from the County. 2. References will need to be completed by the Maple Star HSP.. The Home Study Provider is responsible for reviewing all documents and ensuring that they are complete. If documents are not complete, the HSP must immediately notify the CW and cc CO Homestudy@maplestar.net. The 60 day time line begins when all necessary documentation has been received. All Communication with Department which includes any PHI or identifying client information should include [encrypt] in the subject line of the email. The County recipient will need to set up an encrypted email password for Maple Star emails. 3. After reviewing all documentation, Home Study Provider will contact the family to set up initial meeting as soon as possible (within 72 hours). 4. Home Study provider will have applicants sign a Signature Sheet (provided in new hire documents) at each meeting. 5. For Certified Home Studies, please contact Tim Nava at 970-352-1551 ext 6292 to report on how initial home study contact went. 6. Home study provider will contact the county caseworker, if child -specific, to inquire about the needs of the child, etc. For certified -kinship, foster, foster -adopt or adoption home studies, contact the certification worker to discuss the applicants participation in training and any observations. The date of this contact should be listed on the Home Study under interview dates. Do not use specific quotes regarding concerns or identified areas of weakness without the permission of the case or certification worker. 7. Home Study evaluator and Supervisor will remain in communication with Department certification, kinship, or adoption worker and immediately notify them of: **any new persons found living in the home that were not disclosed on the original application so that they may obtain fingerprints, **any criminal background which was disclosed by applicant but not reflected on the background clearances, **and/or any concerns the evaluator has which may result in a denial. 8. Throughout the home study process, Home Study evaluator will communicate with the applicant regarding any concerns which may result in a denial and attempt to obtain additional information through interview, references or other collateral contacts. 9. If the applicant is currently engaged in mental health treatment, a release of information must be signed by the applicant so that the Home Study Evaluator may contact the mental health professional. The Department may provide a release for communication between Maple Star and identified professionals. If this release is not provided, MSCO HS Evaluators will obtain a release of information directly from the client. 10. Home Study evaluator will submit draft study to supervisor along with scanned copied of Quesdonnaire Hs and any other documents obtained by the evaluator during the, interview/ assessment process for review within 45 days. 11. Home Study Supervisor will review all documentation submitted by the Department and by the Home Study evaluator and return home studies to Home Study Providers within 10 days of receipt with questions highlighted. 12. Home Study Providers will return copy with additional information added to address any questions highlighted by supervisor to supervisor for final review. If CBUFBI and National and Colorado Sex Offender Registry clearances for all adults living in the home have not been received, the home study may not be finalized. Please see below for finalization of home studies where there is a delay in the CBI/FBI results. 13. The Home Study Supervisor will send the electronic finalised "draft" without family signatures to Weld County for review. Once Weld County has reviewed the Home Study at CRT and given approval, the Home Study Provider will take home study to family for review and signature. IS THIS TRUE FOR ALL HOME STUDIES OR ONLY CERTIFIED STUDIES? 14. The final electronic version of the final home study with all edits requested by the supervisor and any changes needed after meeting with the family for review will be e -mailed to your Home Study Supervisor within 60 days of receipt of study documentation from the Department. 15. Home Study Supervisors will email an electronic copy of the final report to the appropriate County [encrypt]. WHO ARE WE TO ADDRESS THE FINAL ELECTRONIC VERSION TO? AND TO WHOM DO THE FINAL DOCUMENTS GO? SHARON? all home studies should be submitted to Bereniz Hernandez at hernanbx@weldgov.com. Bereniz will route studies to the appropriate Child Welfare staff for review and designee signature, and track them as 1upetvisorlkirtiship workerIndrked appropriate. Please be sure to copy, the caseworker when submitting the home study for review as this will assist Bereniz and other staff. The final electronic copy should include scanned copies of the signature pages collected during the interview meetings, the QI s and the signature & psychosocial inventory pages. 16. *** Home Study Supervisors Please CC: CO Homestudy@maplestar.net AND Heather when you email the final version to the County Supervisor. Indicate in the subject line the name of the study and if it is "approved" or "denied". That is the day that CO Homestudv@maplestar.net maplestar.net will log the study as "Finalized"*** 17. Home study provider will mail ONLY the signature/ psychosocial inventory pages of the Home Study to Home Study Supervisor. Alternatively, the Home Study Provider can arrange to meet the Maple Star Home Study Supervisor to obtain their signature. i. Home Study Supervisor will sign and return to the Home Study Provider along with the completed and signed Supervisor Home Study Certification foam. 18. The Home Study Provider will mail or hand deliver the "final packet" to the appropriate County supervisor. This packet should include: 1. Original Signature pages (approval/ denial page and. the psychosocial inventory) 2. Original Questionnaire II document (s) for all adults in the home 3. Home Study Supervisor's certification 4. Any other original documents such as a Questionnaire I or reference document you might have administered, phone references which you may have conducted, documents the Applicant might have given to you rather than mail to the Department, or if there were incomplete or unsigned pages from Questionnaire I that you asked Applicants to complete. 19. Any documentation scanned and sent to Home Study Provider must be deleted from computer and/or all additional copies must be appropriately shredded. 20. Home Study Providers must notify County CW, Maple Star supervisor and CO Homestudy@maplestar.net of any issues which may result in non -completion of a home study within 60 days as soon as they become aware of the situation. Finalization of reports with no CBUFBI/ National and Colorado Sex Offender Registries A home study may not be completed without CBUFBI and National and Colorado Sex Offender Registry results for all adults living in the home. The Home Study Provider may contact the Department or complete both Sex Offender Registry checks themselves. If the Home Study Provider completes checks, these documents must be included in the final file. The Home Study Provider should complete all interviews and writing of the report while waiting for the CBI/FBI results. The draft version may be reviewed by the Home Study Supervisor and all corrections may be made to the report. Home Study Providers should remain in contact with the County to obtain results. The Home Study Provider will need to wait for the results to come in, verify the information contained in these background checks is consistent with the information contained in the report and enter the dates the reports were received in the SAFE report. Only after the CBI/FBI results have been received may a Home Study Provider review the report with the applicants and obtain the signature(s). The "final" electronic version of the home study should not be sent to the County prior to review by the family. The County Supervisors are aware that we may not release incomplete home studies to them prior to review with the applicants and are aware that due to the backlog of fingerprints with CBUFBI, there may be a delay in them receiving our final reports. If a home study is completed, the Home Study Supervisor has reviewed and all corrections have been made and only the CBI/FBI results are missing, the Home Study Provider may include that study on their time sheet. The "Date completed" column should indicate -"No CBUFBI". Once the fingerprint clearances are received and the report is finalized, the Home Study Provider will submit the electronic version to their Maple Star Home Study Supervisor, who will forward to the appropriate County Supervisor and cc: CO Homestudy@,maplestar.net as described in #12 above. REMEMBER: **60 day.deadlines requre.drafts to be sent to the supervisor forapproval by.day 45 and finalized by day'60: ICPC. studies are-onFa shorter deadline. These studies int*1 have draft's sent to the supervisor in 30 days: and finalized on day 45:*!:- **Home Study Evaluator is responsible for checking SAFE website for updates and using most current - forms. ALL Home Studies are to be completed using the FULL SAFE Home Study Template- no matter what type of study it is (do NOT use the Non -certified kinship template). ** Desk Guide must be used to evaluate each area on the PsychoSocial Inventory for every study ** Recommendations should cover all ages, gender and level of need which the Evaluator feels the family may be appropriately suited. Even if the family only wants a certain age/ gender- the study should evaluate their ability to care for any age/ gender. Evaluator may note their agreement with the applicants "preference" but should make broader recommendations. ** Evaluators should obtain a Release of Information, signed by the applicant, to discuss with outside contacts any information that is reported as "mitigation" for significant historical events and for which no other documentation has been provided (I.e.-current medication management, psychiatric care, counseling). ** Should an evaluator fail to completely discuss/ mitigate significant historical issues which were known at the time of the original home study, the Department may request that the evaluator complete an addendum to fully address these issues. The evaluator must use the SAFE Home Study Update/ Addendum form to do so. The evaluator may not bill for information missed in original study. If new information or circumstances arise after the completion of the home study, the Department may request an update. This update will be completed and billed separately by the evaluator. MapleStar SAFE Home Study Provider PAGE 1 MAPLE STAR COLORADO JOB DESCRIPTION POSITION TITLE: SAFE HOME STUDY PROVIDER REPORTS TO: DIRECTOR OF COMMUNITY OPERATIONS OR EXECUTIVE DIRECTOR POSITIONS SUPERVISED: NONE LOCATION OF JOB: COMMUNITY -BASED POSITION STATUS: Part -Time, Non -Exempt, Pay per Project Brief Job Summary: The SAFE Home Study Provider will complete Home Studies for County prospective foster, adoptive, kinship and ICPC families as assigned by Regional Director. Outline of Essential Job Duties: 1 Complete SAFE Home Studies for prospective County foster, foster to Adopt, Kinship and ICPC families utilizing the SAFE format. All SAFE home studies will include structured questionnaires, interviews, assessment guides, structured family references, and the pre -formatted home study report. Provider will use the most current SAFE home study format / SAFE home study desk guide which are required by the Colorado Department of Human Services. 2. Respond to emails and/or phone calls from Regional Director regarding assignment of Home Study within 24 business hours. Failure to reply in a timely fashion may result in the home study being referred to another provider. 3. Review all information provided by Regional Director related to assigned home study and notify of any deficiencies or questions. 4. Communicate directly with county caseworkers for child specific home studies, with the exception of ICPC Home Studies (discussed in #12). 5. Provide completed home study to Regional Director or designated Home Study supervisor for review within required timeframes prior to presenting to family for final review and signature. All Home Studies are to be submitted electronically. 6. Participate as requested with a County representative in a face-to-face meeting with the applicant family, should the study conclude with a recommendation against placement of a child in the applicant family home. 7. Discuss with the family any and all concerns that arise during the study process as they relate to recommendations. 8. Verbally inform the family of the recommendation being made to the Department regarding certification, kinship care or adoption. 9. Inform family members they will be active participants in the development of the SAFE home study report and they will be able to read a copy of their SAFE home study report, arranged by the home study provider. 10. Be available by telephone or in person for Certification Review Team. 11. Participate in supervision in person or by phone at least one time per month. SAFE Home Study Provider PAGE 2 12. Home study updates for 1CPC cases shall be completed uponrequest of the County. For expedited ICPC home studies, completed studies are due to the County within thirty (30) days of assignment and the receipts of a completed documentation packet presented to the home study provider. Timeline for submission to Regional Director for review and approval to be determined at time of assignment. 13. Complete all referred home studies unless the prospective family voluntarily withdraws their application or the County requests closure of the home study process. 14. Immediately notify Regional Director if any circumstance arises which may prevent the Home Study Provider from completing the assigned home study within the time frames outlined above. 15. Maintain complete account of hours on Maple Star time sheet, to be submitted to Regional Director on a monthly basis according to payroll schedule. Payment will be made on the first of the month for all Home Studies completed and approved in the previous month. 16. Notify Regional Director if hours that are scheduled to be worked in a week will be in excess of 35 hours. All hours in excess of 35 hours must be approved in advance by the Regional Director. Knowledge, Skills, and Abilities Required: 1. Completed 2 day SAFE Home Study Training and is in possession of SAFE certificate 2. Knowledge of Volume 7 Regulations related to completion of home studies for foster, foster to adopt, kinship and ICPC homes. 3. Bachelo 4. Knowledge and use of Microsoft applications and basic computer skills. 5. Knowledge and use of fax machine, phone, copier, and other office equipment. Other Requirements: 1. Must be willing to submit for fingerprinting and a background criminal check. 2. Background criminal check must meet the Colorado State Department of Social Services requirements for personnel working in the child welfare system. 3. Valid Colorado Driver's License and a clean motor vehicle record. 4. Experience working with children and families 5. Bachelor's degree in human services, social work, or related field Material or Equipment Used: 1. General office supplies (ie: pens, paper, stapler etc...) 2. Office equipment including: telephone, copy machine, computer, and fax machine. Working Environment/Physical Activities: Time is spent in the community and in the local office as needed. Rev 03/30/12 Employee signature: Supplemental Document Staff qualifications and background checks: Prior to an offer of employment, 3 telephone references checks are completed, Social Security a criminal history search by SSN in States where the applicant has fired In the last 10 years is coma et mber screen, Driving Records Check Is conducted. All of the following are searched for exclusiona completed, and a General Service Administration- Excluded Parties List ry criteria: Individuals,/ Entitles, Office of hem, Office of inspector General- List of Excluded �� Desi Inspector General- Most Wanted Fugitives, Office of Foreign AssetControl- �+ated Nationals, Department of Health Care Services Once Maple Star applicants are offered a position, the following background chedks occur: F1nge►Prtnting for Colorado Bureau of Investigation, Federal Bureau of investigation, and signed forms to complete Badgpound investigation Unit checks and E -Verify Is completed within 3 days of employment. Mandatory training for all employees includes: Crisis Ethic, Mandatomanagement, HIPPA Requirements, Confidentiality,ry, �o'�e. Child and Adolescent Development, Trauma and the Brain, Family dynamics, Strengths -Based Family Theory, Parenting, which includes signs of abuse and alcohol and substance abuse issues, Safety protocols. Awareness related to Maple Star Colorado provides a new hire academy to ail new employees. This 4 clay foundational training Indudes an agency oveMew, an introduction to Motivational interviewing, HIPAA protocols, Community and Home Visit Safety, Trauma Informed Care Basics, Informed Supervision, Culturally Competent Practice and Professional Boundaries/ Self Care. BEFORE FIRST HOME STUDY INTERVIEW Administer Questionnaire I* (include /n Packet with Application, etic) Review Questionnaire I and Application — highlight what "makes you curious." Develop Questionnaire Harvesting Sheet l Review with Supervisor prior to First Home Study interview. Prepare Interview Work Sheet. l . First Home Study Interview with Applicants. *If applicable, provide Applicants with the/SAFE Compatibility Inventory Structured Analysis — Assign Desk Guide Ratings using "/" rnarking *Reminder: You must rate according to the Desk Guide. ) Submit Psychosocial Inventory to Supervisor for Review. 1 . Second Home Study Interview with Applicants (This can be the Questionnaire Ii Interview.) REMEMBER Questionnaire II* never leaves your "Sight or Control" and you must interview the Applicants individually IMMEDIATELY after you administer the Questionnaire. I Structure Analysis — Assign Desk Guide Ratings using "\" marking *Reminder; You must rate according to the Desk Guide. I Submit Psychosocial Inventory to Supervisor for Review. I Continue this process of Interview and Structured Analysis until interviews are complete. After the final Interview mark the Psychosocial Inventory using the Desk Guide with "High Confidence" ratings. 'If applicable, collect completed SAFE Compatibility inventory f Put the Desk Guide aside and begin the Mitigation Process. f Return to all Ratings of 3, 4 or 5 and determine whether you should sustain, reduce or erase the rating. I Meet with Supervisor to Review your Mitigation Ratings and your Mitigation Theories. Write the Home Study using the Home Study Report. `Questionnaire J and B MUST be administered to all applicants. You MAY administer the Questionnaires to others hi the home or the individual Study Practitioner and/or their Super). up to (it Is 8 I PAGE Consortium for Children, O 2076 all rlghb reserved — Structured Analysis Family Evaluation Supervisor Manual FORMS CHEKCLIST FOR HOME STUDY APPLICANTS- TO. BE SENT TO MAPLE STAR Home: Address: # of other adults in foster home: DATE SENT TO MAPLE STAR FORM: LIST SIGNATURE DATES Provider #1 Provider #2 N/A Section 1 Application **** at time of referral SAFE Questionnaire #1 ****at time of referral Financial Statement Fingerprints -CBI - Must have been submitted by the time of refeerral FBI- Must have been submitted by the time of refeerral Dispositions for any arrests Colorado Courts Out of State check if in CO less than 5 years Central Registry (background inquiry) **** National Sex Offender Registry **** Colorado Sex Offender Registry- name and address **** TRAILS check **** ` DMV Record ( if required by Department) Reference Letters (3 per applicant- no more than one family 1 1 member) ** NOTE: NOT ALL 3 REFERENCES ARE NOT NEEDED 2 2 TO BE RECEIVED TO START A HOME STUDY BUT THEY ARE 3 3 REQUIRED BEFORE FINALIZATION. D & N/ Summary of Reason for Removal Original Home Study- if requesting an update FOR CERTIFIED HOMES CORE Training (NOTE:. CORE TRAINING DOES NOT HAVE TO BE 100% COMPLETE AT THE TIME OF REFERRAL BUT MOST BE DONE WITHIN TWO WEEKS OF REFERRAL FOR THE EVALUATOR TO DISCUSS DURNG HOME STUDY EVALUATION MEETINGS WITH THE APPLICANT. Health evaluations School Reports (if available) Physical examination for children in home (# ) Driver's License Automobile Insurance Automobile Registration Home Insurance Pet Immunizations (# ) CPR (or date class is scheduled) First Aid (or date class is scheduled) STAFF DATA SHEET EXHIBIT D (Bidder must list all applicable staff who will manage and/or administer the proposed service, One Staff Data Sheet per proposed service, Bidd PROPOSED SERVICE OR SERVIC g I' St1PERVt50R iNF,ORMA710Hr_`r:t, Work N Home Study BIDDER LEGAL ENTITY NAME: Maple Star Colorado APPLICABLE STAFF MEMBER -OR CONTRACTOR INFORMATION No. Last Name; Firit Name ` MlorkA Work Email - • Education, Level: ... Degree Focus Licensing/ Credentials Do" RAYI- -- (H-applkiible) ,..---„,.p. Last Name i' Fir st Na (Tie F sR + 1 WOrli-Errtait •,.. -- , `? , �-- . 1 Alicea,. RileyeY 720-505-1148 AUce.Riley cJ�i j�a cpm See attached Julie Berland r _ _ _- 720-922-3516 2 Am(ta Chugh 303-475-6783 1rmlta.ohughtiiluathways.cont JuUe.berland®JuaRhway�cgd_i 3 Allison Rodasta 303-717-7273 a(Uson.nodastaf loattlways,com AshIle._Hoviarathways.cOrrl _See attached Kristy Briggs 720-849-0437 krlstv.brlgaseopthwrays.corn 4 5 Ashlie Hovland Barb D'Albey 720-217-2176 See attached Julie Berland 720-922-3516 lulie.berlendailpathways.com See attached Beth Risdon 720-352-5237 6 Brandi Haws 303-421-0443 719-200-6336 I —_ippothways•Qom See attached See attached _ Beth Risdon 720-352 5237 be�h,iisdon(dloattrways,co[tt beth.rts5lonneathways,com 7 Beth Risdon 720-352-5237 _brandlhawsgloathways,coM beth.risdonatipathways,com Julie Berland 720-922-3516 Aill ejmdoxfitositylscui See attached _ Barb D'Albey 303-421-0443 garb.d'glbey(d)pathways.cotn 8 Betsy Chanthapaseuth 303-994-5293 littik&liotiyomum See attached Beth Risdon 720-352-5237 bethsisdonRboa 9 any Cornelius 720-427-2688. antanv.Cornellus(Eilaatthttum491 Martha,Smallacathways. cQrR Ched.SlauabteaDoathways.corn See attached - See attached See attached Julie Berland � 720-922-3516 '°° Julle.bertandaloatitways 10 Caroline Small 979-220-8129 11 Cheri Slaughter (720) 365-1068 � Julie Berland Julie Berland 720-922-3516 ,Wlie.bertarld(dlpa rxml ��rcon3 12 Christi Beach 720-891-2625 Ch •BeathititoattIwaye•con, 720-922-3516 Julie.berland(dtoathvvafvs,corn bart?.d'aiboyfteathways,pont See attached See attached Barb D'Albey 303-421-0443 _ 13 Elizabeth Sterling_ Emily 765-918-7203 EIZzebeth,Sterlinotfilnatltways.com Beth Risdon 720-352-5237 be rlado lloa a1• D t�ys•com 14 Tracy 970-389-7574 Er i ,Tracv(dlna ly tttvgays.com See attached 15 Erica Cohen 303-478-5079 Kristy Briggs 720-849-0437 lSngy.briagstlInathr(ava.com Erica.Coh9n2@oatwravk,com See attached See attached 17 Jean Davis 720-810-5071 kan.daviseoathways.eom Julie Berland Beth Risdon 720-922-3516 720-352-5237 ulie,berlandaoathwevs.com 18 Jennifer Kemp 303-563-9886 jennIfer.kemp taathwava.eom J2E4h.risdonfteattoyetialm See attached Barb D'Albey 303-421-0443 barb.d'al 19 Joan Oldenberg 303-746-9971 Joan.OldenburoWathways.eorrt See attached Julie Berland 720-922-3516 ylkathwa Julie,berland i �m ��rattra l _ 20 Josh Aevum 719-425-5026 j�pshuatsevurniijoathvoivs, corJJ 21 Julie Berland 720-922-3516 Jaw berland@oathvrpvs.com` See attached See attached See attached Julie Berland Beth Risdon 720-922-3516 22 Karen Murphy 720-499-7025 karen.murohvierratMKays.corn 720-352-5237 23 Kathleen Maybury 970-456-2420 Kathleen, Ma yjxav(rbDathways,corR Josh Aevum 719-425-5026 Josh � �I?a See attached 24 Kristy Briggs 720-849-0437 krlsty.b►Igpseloatttways,cpm See attached Beth Risdon 720-352-5237 beth,risdop(�pagfyvavg,corrt corn 25 Laura Graber 303-870-9855 FJaure.praberdboathways.cortt Beth Risdon 720-352-5237 beth.risdon(ppathwave.eotrt See attached Beth Risdon 720-352-5237 DAtia„tistmapathway$,com 26 Leanne Figueroa 720-244-6347 Leanne. FioeuroaMeathways.com l IndedySchmidtaijoathways,corn Quinbe.L.orsttaahsethways.corn See attached 27 Lindsay Schmidt 319-231-1423 Kristy Briggs 720-849-0437 tII 28 Lori Loretta 720-203-0855 See attached Beth Risdon 720-352-5237 bath. on ft athways oom See attached Julie Berland 720-922-3516 Julie,bertandlaoathways.corn 29 30 31 32 33 34 Maria Bangs 970-232-4286 Ma.r(9.,.&_agoaiNglmotelscgin See attached Kristy Briggs 720-849-0437 Maria Hernandez 719-580-4108 jyhi ty,J ,a_fttoa corn ffarta.Hemandezteiaathweys.eam See attached Beth Risdon Maureen Foley 720-352-5237 ! h ri@�n(�8wvm 303-910-7435 maura_en,d corn ��' See Sattached Julie Berland Patricia Chase 970-768-7665 Patrieia,ChAS.F.eogghways.,wrn 720-922-3516 ,lulie.berland t(bnatftwvnl,sa See attached Heather Morris River Holmes -Miller 303-564-2595 heather, m 970-889-7029 Rlver,Holmets-Mil thwa �� ys.00rn See attached Julie Berland Ronalea Alleman 720-837-5020 720-922-3516 iande oRthwa s.cor ,julieJr4rlandt�jhways,cgril ,cwin Egnejm.,Atomnangbytamcvm See attached Josh Aevum 35 Rosemarie Fritz 719-025-5026 303-887-1076 ame__,,l�Rogmayg mn See attached Julie Berland 36 Sarah Cratty 720-922-3516 Julle.berlancl@ce,thways.com ce,thways. Julie.balbeXI 303-881-7746 �ph.creitkaaoathways com 5_._heny.tataiNgtptaiLegm See attached Barb D'Albey 37 S ham' �98s 720-329-0790 30321-0443 Dathwvays.corn parb.Q'albeyfdtpathyvaY3rcorrt 38 Stephanie Walker See attached Barb D'Albey 303-421-0443 barb.d ibe 1� �d R 970-581-2435 Steohanie.Welkert; pathways,ogm See attached Beth Risdon 39 Suzanne Millar 719-406-9207 Suzanne.m)Jlerl®oathways.corn 720-352-5237 bath.risdon®pathrvvays.com 40 Sylvia Priest See attached Josh Aevum 719-425 5026 oshua.aevum(r3loatltwava.com 303-091-3617 sylviaDriest@thways.com See attached - Julie Berland 720-922-3516 Julla.beriand aQoanwaiva,com 82800058 STAFF DATA SHEET EXHIBIT D (Bidder must list all appkable staff who will manage and/or administer the proposed service, One Staff Data Sheet per proposed service. Bidder should not combine services,) I 41 I 720-220-7676 limy. NaviauggoatAir cipmm [See attached Tracy Naviaux 81800058 1 tulle Berland 1 I 720-922-3516 Pulle.ber pnd@pathrvgvs.COM I V� CERTIFICATE OF LIABILITY INSURANCE DATE pliEDDffY'fil TIES CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. RN CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON T/TUTE A CONTRACT BETWEEN THE ISSUIN{I< REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE INSUREREL AUTHORIZED IMPORTANT: If the oerltthsate holder la an ADDMONAL *ABED. the Pollorne) must haw ADDMONAL INSURED proWs}orw�e endorsed I! SUBROGATION IS WAIVED, sweat to the tints and condltions of the policy. certain policies rney require an endorsement A dakenent on �ttthiusec�e�rtificate doss not confer rights to the t erXNJeam holder In Ileu Oasts sts enr�� darse AAA Rs 8 Imps= Sallee • • .. _��► CA thensej04.17Mil m 8w� ee Street !m k+ysA G 00017 "n CINDOGESPROVCARM-18-16 YEepb Sir Waldo 2200 Seal Omen Steel Sett 200 Denrw.CO 00224 WOOF 18137 20056 2S74 NSA COVERAGES CERTIFICATE NEMBER; USEZmiral2 REYRBION NUMBER: i I TH18 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN NEED TO ME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHBTANG010 ANY REOuptE ENT. TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE sIAY BE ISSUED oR MAY PERTAIN, THE INSURANCE AFFORDED SY HIE POLICIES DESCRIBED HEREIN I8 SUBJECT TO ALL THE TERITS. EXCLUSIONS AND COMMONS OF SUCH POUCIES. UP= BROM NAY HAW BEEN REDUCED BY PAID CLAIMS, MO OFIIen o= unw mna. COMME IXALRNBRALUABany 0 Ocala AWKIIKeILEUAMUTT ANY AUr0 otkreo BONkw= AGINow , M�prf��w ONLY AUTOll CPU � , CLA4teiaee cONPRAGATTOR A�SIIPU TERV LIAIMAYAlltYPECPXSTORWARTNEWEXECIRIVE TIN n N MR[P110N under OF OPHiAma Wow A REALINCARE PROFESSIONAL U AB CLAIMS GCE MIX Kean' mem= TC2lCAF42MB93i18 N/A 1634257B310S-tr 03,431/2616 ?31011016 occomance 001011018 c30trffi18 1W011181r 101 NNI TO Atli= FRED fre occumwa1 t i MED BXP ftr peacn1 e PENN:a&iAtNDRRiY 8 itt,ouraee$-PCUGy 111aT 03O1/2018 0201/1019 EACH PIEDICAL MCS ENT AGGREGATE INEIIc+avrroeOFaPeawnoseerLocAnorlsrveNCLEatACORDOH, Addend Rentals ses.dude.lAybwitched Ifn. ism la ragweed) Witkl Cooly Mate hdedod as edema, bowed Wm npobad by bei m c limet ei0 raped b 8erorel yEbb, CERTIFiCATIE HOIPER lix•zINO i 3.IIa1,t>00 t 1INq,800 L i L 0000 i Walt Coe* Wed CarerDapmfmard of Huron BIM= 1150OSt PO Bos RS 6taefey, CO RIES • CANCEUATION SHOULD ANY OPINE ABOVE DESCRIBED MX= BE CANCELLED BEFORB T11E EXPIRATION DATE THEREOF, ATOTICE WILL B8 DELIVERED IN ACCORDANC8NATHTHE POW, PRoinSIONa. o (Musk Risk ®R A 1a aorMaae OMAN Bids �� ACORD SO12010RM 01088.2018 ACORD CORPORATION. AB rights reserved. The ACORD name and logo era registered corals of ACCORD EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 1. Bidder's legal entity name: 2. Program name or service type being proposed: Maple Star Colorado Bid No. 81900025 Child Welfare- Various Services- Removal Prevention, Aftercare, Kinship, 3. Modalities, curriculum or tools that will be utilized in the delivery of the service. Maple Star Colorado (MSCO) believes strongly in its mission to provide individualized and holistic services that promote wellness, durability, and healing through the context of relationship and a trauma specific approach. MSCO believes in keeping services consistent across counties and across clients, to the extent that is appropriate without negating necessary regional contextualization. Particular to reunification, kinship and removal prevention support services the families served necessitate significant in their visit times and facilitator. Though the trauma informed lens that Maple Star views our clients and services, we identify the need of the children served to see the involved parents at predictable, consistent times. It is also ideal to keep the structure and expectations of home visits or community contacts consistent. The KEEP Program strives to assist in necessary ways to prevent removal of children from the home or to support the reunification process. The KEEP program also is specifically trained In the dynamics specific to kinship placement. KEEP can assist when a family. (biological parent, kin or foster) needs Intense support to maintain the stability and safety of the home or support the reintegration of children into the home after a removal. Whether we are attempting to keep the children in the home or reunify them with their family home, the KEEP program can help in multiple ways. Mission: Assist families in working toward a safe and stable home, equipped with the necessary tools for immediate and future use KEEP stands for Key Essential Elements of Permanency and Is a removal prevention and reunification program. Maple Star has provided these services under the umbrella the KEEP program since October 1, 2012. Maple Star created and implemented this program to assist families in achieving and maintaining stability in the home and/or creating permanency for the related children. Through an emphasis on family engagement, the KEEP program focuses on family strengths in an effort to identify their challenges, engage the families in the process, and work to create self-sufficiency. The success of the program rests on this premise and Is further enhanced by the availability of the KEEP staff as well as the creativity they provide in responding to a family's needs. A strength of the KEEP program is the ability to work with families in their home communities which defuses resistance and creates alignment and follow through on the part of the family. The KEEP program is not portrayed as part of the system trying to control the family's behaviors. It is a strengths -based program that works in collaboration with the family. KEEP case managers utilize an objective and holistic lens in working with families. This Is operationalized via training in motivational interviewing and trauma informed care. Employing motivational interviewing allows for the client to identify their goals and confidence in attaining these, while the KEEP case manager walks alongside the individual and actively builds their confidence and competence. Our utilization of trauma informed care allows us to effectively work with clients to achieve stability while providing' them with a concrete path towards resiliency. Its concepts remove the perceived judgment of a situation and provide evidence - based tools for success. The KEEP program's success is due to the following strategies that are included in all interventions: • Fiat rate contracts which guarantee specific availability and response time, two on -call workers are available 24 hours per day, seven days per week to take referrals for contracts, with a response time of up to two hours, depending on the family's needs. Case rate contracts ensure 24 hour business hour response to the family, provided all necessary information is received from the Department Case Worker at the time of referral. Accurate phone or physical address are required. • KEEP's prongs of service enable professionals and families involved to choose the level of service that is most beneficial to the client. Removal Prevention: this prong offers up to 50 hours over 30 days, which includes direct client contact, as well as indirect case management services such as resource development and support services for 30 days to help mitigate safety Bid No. B1900025 Child Welfare- Various Services- Removal Prevention, Aftercare, Kinship EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) concerns that may lead to removal of the children, and maintain stability In the home for the youth and their family. Reunification and Kinship services provide the same number of case hours over a period of 60-90 days with a focus on assisting children/ youth and the respective families with needs and concerns specific to maintaining the safety and stability in the home. Through each of these aspects of the KEEP program, KEEP offers services that indude but are not limited to the following: • Connecting with professionals, medical professionals, schools, and others to meet the needs of the family. • Connection with community resources to assist with familial needs to include: mortgage or financial assistance, household or concrete needs such as infant items, child care options and financial assistance. • Liaison and advocacy services for the family, as well as education around self -empowerment • Educating families In identifying and accessing community resources which include: family support lines, crisis lines, medical help lines, and others. • Crisis intervention • Assisting with household structure to include routine and safety. • Providing parenting education as well as child development information • Psycho -education around tools of self -regulation and coping. • Necessary transportation • Unscheduled and scheduled family visits • Detailed notes and prompt communication with caseworker . • Attendance of relevant appointments, staffings, and court dates • Anger management 4. Anticipated frequency of the service (ex. 4 hours/week). Up to 50 service hours are available to every KEEP case. Intensive removal prevention services will consist of 3-5 face to face contacts ( or documented attempts) as well as indirect case management services as outlined above for a period of 30 days. Reunification or Kinship cases may provide these 50 hours over a period of 60-90 days, with 1-3 face to face contacts per week. The duration of each contact is tailored to meet the needs of the family, the case goals and requirements of outside influences (ie: court, IEP meetings, drug court, etc.). 5. Antldpated duration of the service (ex. 3-4 months). As outlined above, intensive removal prevention services can be provided up to 50 hours over the course of 30 days. Reunification or Kinship services are available for up to 50 hours over a 60-90 day period. 6. Goals of the servke. Goals: Secure safety In the home Help families satisfy immediate needs of the household Provide psychosodal education and support in the areas of child development and appropriate care, needs and interactions, impact of trauma on children, trauma informed parenting Intervention's, accessing supports during times of crisis, and how to plan for and support children, youth and families during difficult periods. Link families to essential community resources Communicate with related counties in the interest of the families 7. Outcomes of service. For outcomes, see Appendix 1. In the outcomes, note the KEEP Program's acceptance into the Colorado Promising Practices based on the positive outcomes determined by an independent researcher. The details of this report are included in Attachment 1. Bid No. B1900025 Child Welfare- Various Services- Removal Prevention, Aftercare, Kinship EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) 8. Target population for service. KEEP focuses on any family referred by the Department who demonstrates a high risk of child removal due to abuse, neglect or. environmental safety concerns. Kinship and reunification services are focused on the support and education of families to most fully support the needs of children who have experienced trauma. 9. Service access. Maple Star can provide KEEP throughout Weld County: KEEP services are almost exclusively provided in the home of the referred family. Other contacts may be centered around court dates, meetings at the Department or the child(ren)'s school, specific service attendance, or locating/ accessing community resources. Maple Star office locations available for Weld County children and families are located in Loveland, Denver, Colorado Springs and Pueblo. 10. Medicaid eligibility of service. KEEP services are not Medicaid billable. KEEP does not require a treatment plan developed by a Medicaid diagnostician and allows a more nimble and holistic approach to the needs of families, with or without Medicaid eligibility. The foundation of the KEEP program is it's dynamic ability to adjust and adapt to the emergent needs of the children and families with whom they work. Maple Star has extensive experience with Medicaid billing and while the psychoeducational, case management, and resource connection elements of KEEP may appear similar to those of other programs billing Medicaid, KEEP services are not intrinsically tied to a clinical service plan and can provide more complete, wrap around services to all families, and not to those which are not Medicaid eligible. 11. Transportation of clients. Contact occurs primarily in the client home. If clients need to access outside services or contacts, KEEP personnel may assist with coaching re: how to find and access public transportation, in order that the client has the knowledge/skill/ confidence to do so Independently subsequently. 12. Rates of service. Maple Star's KEEP Removal Prevention and Reunification Services may be procured through two different rate schedules: • A single case rate is $3250 for the entire case; response time is within 24-08 business hours from referral. • OR • A fixed rate contract for removal prevention cases with an agreed upon number of referrals will be billed at a rate of $2750 per case ( 10 case minimum)= $27,500 per month or $330,000 annually. Response time for fixed rate contracts is within 2 hours, 24/7. Capacity at this price would be 120 referrals per year. Case Rate would apply in excess of this capacity. • The rates above are for services provided withinall of Weld County. Maple Star also provides services from their Denver metro, Colorado Springs and Pueblo offices. For the purposes of this proposal, Maple Star will provide services throughout Weld County at the above noted rates. Mileage will be billed at the IRS rate, according to Maple Star's mileage policy of all miles over 20 miles each way from the closest office or the KEEP Case Manager's home, whichever is closest. Studies over 120 miles each way from Case Manager's home that may require ovemight accommodations may require additional remuneration to be negotiated on a case by case basis. Service authorizations cancelled or modified by Weld Department personnel without documented communication to Maple Star are subject to payment, including those which extend past authorization dates. Maple Star will communicate with Case Workers, then supervisors In efforts to ensure service gaps do not occur. Should Weld County not communicate any service change, Maple Star will support the best interest of children and parents to continue connection through visitation. If services are terminated, payment standards are outlined above will apply. Bid No. B1900025 Child Welfare- Various Services- Removal Prevention, Aftercare, Kinship Attachment #1 . Summary of KEEP Promising Practices Submission compiled by Adams County As of November 30, 2013,110 families involving 215 children were referred to and received services from the program. The following is a description of the program and analysis of intended population and outcomes. There are two identified populations. The first are families with screened -In referrals/assessments or in open cases In which the children/youth are at imminent risk for out of home placement. The second population includes families of children/ youth being reunited with parents. The data suggests that children/youth experience re-entry after reunification at a higher rate early in the reunification process. The Maple Star KEEP program provided services to 110 families referred in the first eleven months from October 1, 2012 through October 31, 2013. Fourteen families were referred twice, each have two separate spans of service. There was a distinct count of 96 families. Services were provided to 215 children. % Within Age Group -KEEP 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 42.7% 34.0% 23.3% 0-4 5-12 13 and older Total:KEEP Population During Program Involvement Removal. Percent Without During. Program Removal Total Without During_ Program Removal After" Program Removal as. Of. 11=30=2013 Total Without After Program Removal Families Children 110 215 8 17 92.7% 92.1% 102 198 20 44 82 154 Percent Without. ..Removal -that Completed' Program as of 11-3x2013"• 80.4% 77.8% Overall Percent Without -Removal During or After • Program; 74.5% 71.6% Overall Removal Outcome Less than ten percent of families and children experience removal during KEEP involvement. There is an increase in removals subsequent to KEEP involvement. Seven families (15 children) experienced removal within 30 days of KEEP completion which may indicate a need for extended program involvement for certain families. Fourteen families (35 children) were referred twice. Seven of the families referred twice did not experience removal. Multiple referrals to KEEP for some families may be a good strategy for removal avoidance. Thirteen families experienced after program removal ranging from 36 to 211 days after KEEP involvement. It is likely that these families established an acceptable level of stability that could not be sustained over time. It must be reiterated that these are some of the most high risk cases within child welfare caseloads. Cost Benefit Analysis There was a marked decrease in placement costs when comparing a twelve month period prior to KEEP implementation and a twelve month period during KEEP. According to Monica Sorenson, Manger of Client Services for the Division, there were no other programs or initiatives in place during the most recent twelve month period that would account for a decrease in placement costs. It is likely that KEEP may have impacted placement costs. This may be best characterized as cost shifting. That is the savings in placement costs have been shifted to upfront intensive coordinated KEEP services provided to families and children. The contracted cost for the KEEP program is $302,120. The most significant long term benefits occur when effective social services case management employs resources such as KEEP and others to mitigate child abuse and neglect risk by providing parents the opportunity to gain the skills necessary to keep their children safe. r ' . t ' ; ' .; r - y 12 Montfi,Pgd t icomPariwn _ . Annual AueragOlaOinent,cost (easeiantrailsser�e tioru r, Vvichaii4ii )1, . —1777,:!-.`Fri, .- s ,,, . AverageiDai. -)tatO _. :,: c, ._ .- 10-1-2011 to 9-30-2012 $9,645,493 $67.95 10-1-2012 to 9-30-2013 $9,130,474 $73.61 Difference $515,019 Difference with Adjustment for 2% Increase $697,628 $67.95 STAFF DATA SHEET Exillsrr D (Bidder must list all applicable staff who will manage and/or administer the proposed service. One Staff Data Sheet per proposed service. Bidder should not combine services.) PROPOSED SERVICE OR SERVICE TYPE: KEEP 2019 BIDDER LEGAL ENTITY NAME: Maple Star Colorado No, Last Name 1 Pisan° 2 3 Soto Serrano RrsYName Patricia Aleena `ferias APPUCABLE STAFF MEMBER OR CONTRACTOR INFORMATION, World' (970)413-3296 (970)373-7489 170)443-1923 Work Email Patricla, Pisa noPpathways.com A na. o rw corer 7ariaa.§erra n9Opathwaygm 14 IS Education Level BA BA Bachelor's Degroe Focus PsYchdoBY Sociology Sociology 16 17 Uoensure/ Credentials N/A N/A N/A DORA0 (N appBceble). N/A N/A N/A •:�__.� _..:� PERVISOR INFORMATION' ' ,lsitttaine , krst Name. Wwic lP Work.Emai) ,:. ; - Brown Patrice (720) 298.893E Patrice.Browngoathways.co Pisan° Patricia (970) 413-329E Patr)da.Plsonottpathwa •com Pisan° Patricia (970) 4I3 -329E Patricla.Pisano(mgathways.c�m 18 19 20 21 22 23 24 '25 26 27 28 we assoorml THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO I omen CERTIFICATE DOH NOT AFFIRMATIVELY OR NBGA7A/ELY RIGHTS UPON THE CF3t'TTRCATB HOLDER. THIS BELOW. THIS CERTWICATE OF 0OURANCE DOES NOT CONSTITUTE CONTRACTBELOW.. ALTER THIS COVERAGE AFFORDED IRIS iPOLICES REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER B87rIEEIII THE ISSUING lN8UR6R{!i}, AUTHORIZED ANT: If the earti>3cats Is an . .. INSURED. Eta po U SUBROGATION IS WAIVED. subject to tea terms one �iksl must hero ADDITIONAL tA1 an en Prseme t. A st cement n this mutants does net confer el 1s to the certificate hotdet In Neu ens* endorsements). � � �� ant A stabmsnt on �relgl _ ... CERTIFICATE OF LIABILITY INSURANCE INEWIEWIR ARae¢elle covaaApa rouREeA; 4e:drKKA bane Ccmosey snot=s: finnan! Waver Co imam o r Mann PANandasualritszuv OfAmDIlMa nantaRol ItH lRastete: COVERAGES CERTWICATE NUMBER: P THIS B TO CEitTTFY THAT THE POLICIES OF LOS -0032797M12 REVISION NUMBER: 5 INDICATED. NO7wITHETANO@q ANY R MN OR C.ORDITI LOWN �� SUED TO THE WEER® NAMED ABOVE THE POLICY PERIOD cERTIRCATE NAY BE ISSUED OR. MAY PERTAK THE INSURANCE ANY OTHER DOCUMENT SU RESPECT TO WHICH THIS EcCIANDONSArty CONOITICKS °FETICH POLICIES. UNITS AFFORDED PIN EO POl.IC3EP ID CLAM O h EiN B SUBJECT TO ALL THE TERMS, raw or IaelaMmCa ...._ i� SHOWN MAY HAVE BEFJI REDUCED BY PAID CLApNB POLICY mom QcMENCLALOEN RALMIMISrY Icu amous MOON LOD TA RO 1,10.000 ITZUCAR42 Ie 0ominole 03,0,113+9 E.L amaIMama , Fa LESEAsu • EA = a o�9rssr 'POI Ev ulot CLAWS MADE SWAIN _ ZIDISD19 EACH MEDICAL UMW AGGREGATE neeceaFnoeororoaAttaa eeNnomaimicias mom no, Adeseassa n1Mnadrara4stayeraeitedgidfAstieMab'mpihrq WEN Owrb Ws WAN a iddlond ewnad ahem requital OT alms mess odor rerp a b merit Way. CERTIFICATE HOLDER 1 ACORD 26 (2010103) CANCELLATION YAM Coin Skid MemDameltmrd NNomsl scree TIMOMPOlkr7b8 Brod* CO 80352 SHOULD ANY OPTHE move DESCRIBED Poucats et CANCELLED BEFORE THE EXPIRATION DATE ntERHOP, NDTmE WILL ti6 DEUVEMM IN ACISDRDANCE WITH TSB MX,/ PROVISIONS. AYTRICI@seRinessi ime of vane ma a Names Conlon Chattel Shin [.. (21_- 0 1058,2003 ACORD CORPORATION. Au rights reserved The ACORD name and logo are registered marks of ACORD EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) L Bidder's legal entity name: 2. Program name or service type being proposed: Maple Star Colorado Bid No. 81900025 Child Welfare- Various Services- Life Skills 3. Modalities, curriculum or tools that will be utilized In the delivery of the service. Maple Star believes strongly in its mission to provide individualized and holistic services that promote wellness, durability, and healing through the context of relationship and a trauma specific approach. Maple Star believes in keeping services consistent across counties and across clients, to the extent that is appropriate without negating necessary regional contextualization. Particular to visitation services, the families served necessitate significant consistency in their visit times and facilitator. Through the trauma informed lens that Maple Star views our clients and services, we identify the need of the children served to see the involved parents at predictable, consistent times. It is also ideal to keep the structure and expectations of visitation consistent, as we know that these factors remaining stable minimize the trauma that begins at time of removal and often prior. Facilitators may employ a variety of interventions including: coaching and teaching skills; psycho -education around the role of trauma on behavior and understanding behaviors through a trauma informed lens, modeling positive parenting interventions, self - regulation, safety planning, and support in areas such as nutrition, and connection activities. After all referrals to Maple Star, an intake meeting is scheduled with the parent(s) prior to visitations occurring. This first step is key in developing a relationship with parent(s) in a culturally responsive manner. During this intake appointment, Maple Star utilizes a self- assessment scale based on the Parent Assessment Scale (described below) with the related parent. After 4 visits between the parent(s) and children) the Parent Amassment Scale Is then implemented in its full form, considering observations related to Interactions with the children involved, during the first visit. The self -assessment completed during the intake appointment and this initial Parent Assessment Scale are reviewed with the parent(s) so the Facilitator may identify and address any discrepancies. These tools are used to develop goals for the Facilitated Visitation Services provided by Maple Star. Maple Star believes that strengths -based language and empowerment will assist the client in moving forward successfully. The use of this concrete, consistent tool helps to avoid the negative associations that may be present for the client In regards to the reasons they necessitate visitation services. By doing so, Facilitators may overcome a potential barrier to success at the onset of services through engagement of the parent(s) in visitation services. Regular intervention, coaching and in some cases therapeutic level Intervention will be provided to all families with the goal of developing their skills, maintaining connection and increasing bonds in order to support successful reunification whenever possible. Offering the continuum of Facilitated Visitation Services allows a smooth and supervised transition to lower levels of supervision and structure by Maple Star with the targeted goal of reunification. Conversely, if a family is struggling at a lower level of structure and supervision, higher level visitation services may be indicated and can be accessed immediately upon authorization by appropriate Department personnel. Maple Star's Parent Assessment Scale Recommendations to the Department regarding the level of visitation will be based on the safety and needs of the child. Maple Star's Facilitated Visitation Services will be used only until it is safe for children to be in a monitored or unsupervised visiting situation. The following factors will be considered in determining the length of time and level of supervision for visitation time services: Safety of child/children, Progress of parents in treatment towards resolution of abusive/neglectful behavior, Progress of parents in demonstrating skills necessary to keep their children safe, Progress of parents in demonstrating an increase in their parental protective capacities Maple Star utilizes an assessment tool, combined with the factors listed above, to determine the needs and concerns to be addressed during the visitations. The assessment tool was based on the North Carolina Family Assessment Scale (NCFAS), an evidence based tool developed to assess safety. Maple Star modified this tool to target areas of the scale specific to the delivery of visitation services. This targeted tool delineates visitation services into specific categories. It does so by allowing facilitators to rate participants in several concrete domains. This gives all professionals and involved family members a common language from which to build goals and interventions. This tool is administered at the onset of services and at 30 day increments following. It is used Bid No.: 81900025- Life Skills EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) collaboratively with the family in efforts to enhance understanding of challenges and successes for the family as well as increase engagement In visitation services and time with their children. Maple Star utilizes a Parent Coaching curriculum based on Daniel Siegel's Whole Brain Child (2012), Karyn Purvis's The Connected Child (2007), and John Medina's Brain Rules (2014). Visitation Facilitators use approaches outlined in these writings, as well as dynamic approaches that emerge though other evidence based approaches such as Trust Base Relational Intervention in educating parents on brain science, child development, and behavioral intervention strategies during their visits and during the debriefing time before and/or after the visit. Level of Services in MSCO FVS program • Supervised Visitation at Department or a secured facility- This ievei of visitation wouid be determined in collaboration with the County Case Worker if the family is assessed to have high risk behaviors that would necessitate the presence of security or law enforcement to ensure the safety of the child(ren) and/or Facilitator. • Supervised Visitations at Maple Star or other agreed upon semi -contained locations or offices- This level of visitation allows for a less restrictive setting where the risk level has been determined to not require the presence of law enforcement on the premises. The Maple Star offices do allow for structure and containment for the visit, reducing the anxiety and additional distractions or external stimuli that may be present in community based visitation. • Community Based Visitation- In this level moderate or lower levels of parent coaching and role modeling are required. While Facilitators still remain within line of sight and earshot of visitor and child at all times, fewer interventions are required. The level of visitation requires that the parent demonstrate an ability to engage the child with the additional exterior stimuli and maintain the safety of the child in an open and less restrictive setting. This level is appropriate when Parent Assessment Scale indicates parent is engaged in treatment services for SA/MH challenges and/ or is working on systemic issues in relation to their environment. • Intermittent Visitation- This levels of visitation require the least direct observation of the parent and child and may decrease from presence in the same area where sight lines may be maintained but the family is interacting independent of the Facilitator and is most times out of ear shot down to "drop in" visits with a family during extended unsupervised time to check on child safety and ensure family's continued compliance with case plan expectations. This is not a primary service of Maple Star and would be provided for only short time periods of less than one month and serve to provide a final step down to unsupervised visitation. Preferred qualifications for Facilitators area Bachelor's Degree and child welfare experience. All therapeutic visits will be completed by a Master's level professional. Additional details regarding staff qualifications, background check and training may be found in supplemental document #1. 4. Antldpated frequency of the service (ex. 4 hours/week). Frequency is dependent on the individual needs of the family. Maple Star's community based Facilitated Visitation Services are provided for 2 hours minimum per encounter. No maximum per family weekly is established. However, scheduling/ availability must take in to account Colorado Labor laws requiring a 30 minute lunch/rest period after 5 hours of work. Should Weld County request visitations in duration of 1 hour, Maple Star would endeavor to establish an office based schedule to support such services which require little or no transportation or travel time between visit locations in order to maximize the amount of hours available to provide family contact and supportive coaching. 5. Anticipated duration of the service (ex. 3.4 months): Upon referral, families will participate In an initial intake meeting with Maple Star staff. In accordance with the Mapie Star staff intake evaluation and the required referral information provided by Weld County at the time of referral, the appropriate duration of service will be determined Services will initially be scheduled for 45- 90 days dependent on the level of service authorized. Weld County will coordinate staffing required to reauthorize per this contract. All Authorizations will remain in effect and subject to billing until formal notification of service termination is received by Weld County. Maple Star will monitor service authorization periods and document these in communications with the Department. Based on the referral information provided by the Department, a visitation format and plan will be discussed with the family including but not limited to: Individuals participating in visits and anyone restricted from attending visits; the level of structure/supervision to be provided by Maple Star; explanation of the reporting function the agency has as facilitator; Bid No.: 81900025- Life Skills EXHIBIT C PROPOSAL TEMPLATE (Bidder must use this template for each service proposed. Maximum of 3 pages per proposed service.) expectations for parents in terms of preparation for visits and items they need to bring; possible learning/skill-building goals and activities to be integrated into the visitation time and some general guidelines in relation to attendance and behavior. Visitation and coaching may be provided at Weld County, in the community, or at the family home. Once reunification has occurred, the services may extend to the family home in the form of Parent Coaching. For additional information regarding Maple Star's Intake procedure, please refer to Supplemental attachment #2. 6. Goals of the service. As stated above, the goals of service are to support parents in connection with their child, learning and implementing positive parenting skills and decreasing the level of service. 7. Outcomes of service. Maple Star would like to see progress by visiting parents on Parent Assessment Scale ratings and progress by families from higher to lower level of visitation with the goal being unmonitored and reunification. S. Target population for service. Maple Star Facilitated Visitation Services work with children ages 0-18 and their visiting parent/ family member. Our area of expertise is trauma informed care, but additional training/ consultation for visitation personnel may be provided by Maple Star's Domestic Violence program's DVOMB certified supervisor. 9. Service access. Maple Star office locations available for Weld County children and families are located in Loveland, Denver Colorado Springs and Pueblo. A complete listing of addresses may be found in Supplemental attachment #3. For Community Based Facilitated Visitation Services, Maple Star may provide a wide range of options which includes parenting time 7 days a week, between the hours of 8:00 am to 7:00 pm, depending on the scope of the contract. The length and frequency of parenting time will be dependent on the needs of the case and schedules of the parents and children. Every attempt will be made to provide timely and flexible scheduling in the child's home community. 10. Medicaid eligibility of service. Visitation services are not Medicaid billable Maple Star Is able to bill Medicaid for medically necessary therapy services. 31. RSTransportatlon of clients. Maple Star may provide transportation for children to/ from visits when necessary and authorized by the Case Worker. 12. Rates of service. Maple Star's Facilitated Visitation and Parent Coaching Rates: Intake for all services: $60/ hour Therapeutic Visitation: $86/ hour. Supervised Facilitated Visitation: $60/ hour Visitation including transportation will be billed at a rate of 1.5x the rate based on the authorized service. Family Engagement Meetings: $50/ hour Professional staffings (in -person or telephonic): $50/ hour Parent Assessment Scale- completion and supervision- $50/ hour One on one Parenting Coaching: $55/ hour in 15 minute increments including visitation coaching/ debrief before and after visits. Early chedc-in as authorized by the Utilization Management team to ensure visiting parent presence prior to child's arrival- same as rate based on level of visitation. Mileage will be charged at $0.56/ mile for all mileage more than a 30 mile radius form the dosest Maple Star office. All services provided will be done so only after appropriate authorization from the Utilization Management team. Service authorizations cancelled or modified by Weld Department personnel without documented communication to Maple Star are subject to payment. Maple Star will communicate with Case Workers, then supervisors and Utilization Management in efforts to ensure service gaps do not occur. Bid No.: 61900025- Life Skills EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Life Skills, as referred by the Department. 2. Contractor utilizes a self -assessment scale based on the Parent Assessment Scale at intake and again after four (4) visits to develop goals for services and transition to lower levels of supervision and structure. 3. Services available under this agreement include: a. Supervised Visitation at Department or a secured facility: Clients appropriate for this level are assessed, in collaboration with the Department, to have high risk behaviors that would necessitate the presence of security or law enforcement to ensure the safety of the child(ren) and/or Contractor's Facilitator. b. Supervised Visitation at Contractor's facility or other agreed upon semi -contained location or office: Clients appropriate for this level can receive services in a less restrictive setting where the risk level has been determined to not require the presence of law enforcement on the premises. Contractor facility does allow for structure and containment for the visit, reducing the anxiety and additional distractions or external stimuli that may be present in community -based visitation. c. Community Based Visitation: Moderate or lower levels of parent coaching and role modeling are required. Contractor's Facilitator will remain within line of sight and earshot at all times but will intervene less frequently. Clients appropriate for this level will demonstrate an ability to engage the child with the additional exterior stimuli and maintain the safety of the child in an open and less restrictive setting. This level is appropriate when the client is engaged in treatment services for substance abuse and/or mental health and/or is working on systemic issues in relation to their environment. d. Intermittent Visitation: Least direct observation of the parent and child and may decrease from presence in the same area where sight lines may be maintained. Client is interacting independent of the Contractor's Facilitator and is out of earshot most times. Contractor's Facilitator will conduct "drop in" visits with the client during extended unsupervised time to check on child safety and ensure continued compliance with case plan expectations. This level only available for short periods of time of less than one month and is intended as a final step down to unsupervised visitation. 4. Capacity for Services: a. Frequency is dependent on the individual needs of the client. b. Contractor will provide a minimum of two per visit. c. For visitations in duration of one (1) hour, Contractor will establish an office -based schedule to support services will require little or no transportation' or travel time between visit locations in order to maximize the number of hours available to provide family contact supportive coaching. d. , Services will initially be scheduled for 45 to 90 days dependent on the level of service authorized. 5. Goals of Service: To support parents in connection with their child, learning and implementing positive parenting skills and decreasing the level of service. 6. Outcomes of Service: Clients will progress on the Parent Assessment Scale ratings and progress from higher to lower level of visitation with the goal being unmonitored and reunification. 7. Target Population: Children, ages 0 to 18, and their visiting parent/family member. 1 8. Service Access: a. Office Locations: i. 2250 South Oneida, Suite 200, Denver, CO 80224 ii. 1465 North Union Boulevard, Suite 102, Colorado Springs, CO 80909 iii. 635 West Corona Avenue, Suite 209, Pueblo, CO 81004 iv. 565 North Cleveland Avenue, Loveland, CO 80537 b. Community Based Facilitated Visitation Services 9. Medicaid Eligibility: Services are not Medicaid eligible. 10. Transportation: Contract may provide transportation for children to and from visits when necessary and authorized by the -Department. 11. Contractor will respond to the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400- 6210) within three (3) business days regarding the ability to accept the received referral. 12. 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@weldsov.com, 970-400-6210). 13. 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 dient 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 (hainlejd@weldgov.com, 970-400-6210). 14. 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 dient (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. 15. 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. 16. 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. 2 17. 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. 18. 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. 19. 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. 20. Contractor will notify the Quality Assurance Team Supervisor (hainlejd@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 dients. 3 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 $50.00/Hour (Family Engagement Meetings) $60.00/Hour (Intake for all services) $55.00/Hour (One-on-one Parent Coaching) $50.00/Hour (Parent Assessment Scale) $50.00/Hour (Professional Staffing— in -person or telephonic) $60.00/Hour (Supervised Facilitated Visitation) $90.00/Hour (Supervised Facilitated Visitation In-home/Community) $86.00/Hour (Therapeutic Visitation) $129.00/Hour (Therapeutic Visitation In-home/Community) $ .56/Mile (Transportation for all visitation) 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 7"' 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