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Home My WebLink About20194388.tiff RESOLUTION RE: APPROVE STANDARD FORM OF PROVISIONAL AGREEMENT FOR PROFESSIONAL SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND VARIOUS PROVIDERS AND DELEGATE AUTHORITY TO DIRECTOR OF HUMAN SERVICES TO SIGN AGREEMENTS CONSISTENT WITH SAID FORM WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board, sitting as the Weld County Board of Human Services, has been presented with the Standard Form of Provisional Agreement for Professional Services between the Weld County Department of Human Services and various providers, and WHEREAS, after review, the Board deems it advisable to approve the form of said agreement, a copy of which is attached hereto and incorporated herein by reference, and delegate standing authority to the Director of the Department of Human Services to execute individual agreements between the Department of Human Services and various providers. NOW,THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Weld County, Colorado, sitting as the Weld County Board of Human Services, that the Standard Form of Provisional Agreement for Professional Services between the Weld County Department of Human Services and various providers, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the authority to sign as the Agent for the Weld County Board of Commissioners, Weld County, Colorado, be, and hereby is, delegated to the Weld County Director of the Department of Human Services, for any agreements consistent with said form. HSI),cexc KM) t O r as/19 2019-4388 H R0090 STANDARD FORM OF PROVISIONAL AGREEMENT FOR PROFESSIONAL SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND VARIOUS PROVIDERS AND DELEGATE AUTHORITY TO DIRECTOR OF HUMAN SERVICES TO SIGN AGREEMENTS CONSISTENT WITH SAID FORM PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 2nd day of October, A.D., 2019. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COL ADO ATTEST: dith,,O jeL;ok. arbara Kirkmeyer, C it Weld County Clerk to the Board Mike Freeman, P o-Tem BY: Q — Deputy Clerk to the Board % L® Sean P. Conway C APP V AS TO F c t . ames o ty At orney _ fie �`' 11TY1' Steve Moreno Date of signature: la/O5O i°( 2019-4388 HR0090 PRIVILEGED AND CONFIDEN'T'IAL MEMORANDUM DATE: September 20,2019 1861 TO: Board of County Commissioners—Pass-Around FR: Judy A. Griego, Director, Human Services c o UN T Y RE: Provisional Agreement for Professional Services Template and Scopes for Temporary or Provisional Services Please review an d d 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 Provisional Agreement for Professional Services Template and Scopes for Temporary or Provisional Services. The Department, in conjunction with County Legal(Karin McDougal), has developed a Provisional Agreement for Professional Services template to allow access,on a temporary or provisional basis, to services that are needed immediately. This agreement will only be used in situations in which a specified service has been identified and is not currently available under an approved agreement. These agreements will be for no more than 90 days and may not be renewed,may not exceed$25,000.00 in reimbursement,and must fall within one of the attached pre-defined scopes of services, which include: - Mental Health Evaluation Services - Behavioral Coaching Services - Mentoring Services Karin McDougal has approved the final template and scopes and has further stipulated that the Department may only request this type of agreement up to two(2)times for the same vendor. The Department is requesting authorization to utilize the developed template and scopes(attached), and requests authorization for the Director to sign these agreements. I do not recommend a Work Session. I recommend approval to use this template and associated scopes and authorize the 1 Director to sign. Approve Schedule Other/Comments: Recommendation Work Session Sean P.Conway _ Mike Freeman,Pro-Tern Scott K. James Barbara Kirkmeyer, Chair Steve Moreno thl i Pass-Around Memorandum; September 20,2019—(Not in CMS) Page 1 �i 2019-4388 (--IRoo90 WELD COUNTY PROVISIONAL AGREEMENT FOR PROFESSIONAL SERVICES BETWEEN WELD COUNTY & [OTHER PARTY NAME] [PROJECT DESCRIPTION]. THIS AGREEMENT is made and entered into this [DATE] day of JMONTHl,'YEAR],by and between the County of Weld, a body corporate and politic of the State of Colorado, by and through the Weld County Department of Human Services as designee for the Board of County Commissioners pursuant to Weld County Code Section 5-4-60(B), whose address is 315 North 11th Avenue, Greeley, Colorado 80631 hereinafter referred to as "County," and [OTHER PARTY NAME], fan individual], [a limited liability partnership] [a limited liability company] [a corporation], who whose address is LADDRESS1, hereinafter referred to as "Contractor". WHEREAS, County desires to retain Contractor as an independent Contract Professional to perform certain services on a temporary or provisional basis because of an immediate need for the identified service; and WHEREAS, Contractor has the ability, qualifications, and time available to timely perform the services, and is willing to perform the services according to the terms of this Agreement. WHEREAS, Contractor is authorized to do business in the State of Colorado and has the time, skill, expertise, and experience necessary to provide the services as set forth below; NOW,THEREFORE, in consideration of the mutual promises and covenants contained herein,the parties hereto agree as follows: 1. Introduction. The terms of this Agreement are contained in the terms recited in this document and in Exhibits A and B which form an integral part of this Agreement. Exhibits A and B are specifically incorporated herein by this reference. This Agreement is a provisional agreement only and is to be used in situations where an urgent need for a specific service has been identified by the County prior to completion of a full contract. 2. Service or Work. Contractor agrees to procure the materials, equipment and/or products necessary for the Project and agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the Project described in Exhibit A. 3.Term.This Agreement shall become effective on(date),upon proper execution of this Agreement and shall expire(date), unless sooner terminated as provided herein. This Agreement is for a period of no more than ninety (90) days and may not be renewed. . 3a. Limitations on Agreement. This agreement may only be for ninety (90) days and for services under twenty-five thousand ($25,000) dollars. It is not meant to allow Contractor to avoid the formal bidding process required by Colorado Revised Statutes and Colorado Rules. Therefore,a vendor may only be accessed through this provisional agreement process twice before having to formally respond to the County's bid for services, if the Contractor wishes to continue to provide services to the County. 4. Termination. County has the right to terminate this Agreement, with or without cause on ten (10) days written notice. Furthermore, this Agreement may be terminated at any time without notice upon a material breach of the terms of the Agreement. 5. Extension or Modification. Any amendments or modifications to this agreement shall be in writing signed by both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by County for such additional services. 6. Compensation/Contract Amount. Upon Contractor's successful completion of the Project, and County's acceptance of the same, County agrees to pay an amount no greater than $25,000 for the services as set forth in Exhibit A. County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. 7. Independent Contractor. 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. 8. Subcontractors. Contractor acknowledges that County 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 County's prior written consent, which may be withheld in County's sole discretion. 9. Ownership. All work and information obtained by Contractor under this Agreement or individual work order shall become or remain (as applicable),the property of County. 10. Confidentiality. Contractor agrees to keep confidential all of County's confidential information. Contractor agrees not to sell, assign, distribute, or disclose any such confidential information to any other person or entity without seeking written permission from the County. Contractor agrees to advise its employees, agents, and consultants, of the confidential and proprietary nature of this confidential information and of the restrictions imposed by this agreement. 11. Warranty_ Contractor warrants that the services performed under this Agreement will be performed in a manner consistent with the standards governing such services and the provisions of this Agreement. Contractor further represents and warrants that all services shall be performed by qualified personnel in a professional and workmanlike manner, consistent with industry standards, and that all services will conform to applicable specifications. 12. Acceptance of Services Not a Waiver. In no event shall any action by County hereunder constitute or be construed to be a waiver by County of any breach of this Agreement or default which may then exist on the part of Contractor. Acceptance by the County of, or payment for, the services completed under this Agreement shall not be construed as a waiver of any of the County's rights under this Agreement or under the law generally. 13. Insurance and Indemnification. Contractor shall procure at least the minimum amount of automobile liability insurance required by the State of Colorado for the use of any personal vehicle. Proof of said automobile liability insurance shall be provided to County prior to the performance of any services under this Agreement. Professional Liability(Errors and Omissions Liability) The policy shall cover professional misconduct or lack of ordinary skill for those positions defined in the Scope of Services of this contract. Contract Professional shall maintain limits for all claims covering wrongful acts, errors and/or omissions, including design errors, if applicable, for damage sustained by reason of or in the course of operations under this Contract resulting from professional services. In the event that the professional liability insurance required by this Contract is written on a claims-made basis, Contract Professional warrants that any retroactive date under the policy shall precede the effective date of this Contract; and that either continuous coverage will be maintained or an extended discovery period will be exercised for a period of two(2)years beginning at the time work under this Contract is completed. Minimum Limits: Per Loss $ 1,000,000 Aggregate $ 2,000,000 14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its officers, agents, and employees, from and against injury, loss damage, liability, suits,actions, or claims of any type or character arising out of the work done in fulfillment of the terms of this Contract or on account of any act, claim or amount arising or recovered under workers' compensation law or arising out of the failure of the Contractor to conform to any statutes, ordinances, regulation, law or court decree. 15. Non-Assignment. Contractor may not assign or transfer this Agreement or any interest therein or claim thereunder, without the prior written approval of County. 16. Interruptions.Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 17. Compliance with Law. Contractor shall strictly comply with all applicable federal and State laws,rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices. 18. Non-Exclusive Agreement. This Agreement is nonexclusive and County may engage or use other Contractors or persons to perform services of the same or similar nature. 19. Entire Agreement/Modifications. This Agreement including the Exhibits attached hereto and incorporated herein, contains the entire agreement between the parties with respect to the subject matter contained in this Agreement. This instrument supersedes all prior negotiations, representations, and understandings or agreements with respect to the subject matter contained in this Agreement. This Agreement may be changed or supplemented only by a written instrument signed by both parties. 20. Fund Availability. Financial obligations of the County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. Execution of this Agreement by County does not create an obligation on the part of County to expend funds not otherwise appropriated in each succeeding year. 21. Employee Financial Interest/Conflict of Interest—C.R.S. §§24-18-201 et seq. and §24-50-507. The signatories to this Agreement state 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. 22. 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. 23. 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 §§24-10-101 et seq., as applicable now or hereafter amended. 24. No Third Party Beneficiary. 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. 25. 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 or its designee. 26. 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. 27. Public Employment Retirement Program. Contractor is responsible for notifying Weld County of any previous participation in the Colorado Public Employee Retirement Program. Contractor must notify Weld county of the most recent employment for a PERA contributing employer. 28. Public Contracts for Services C.R.S. §8-17.5-101. Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Contractor will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E-Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor shall not use E- Verify Program or State of Colorado program procedures to undertake pre-employment screening or job applicants while this Agreement is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Contractor shall notify the subcontractor and County 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. Contractor 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 an 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 County, 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., County, may terminate this Agreement for breach, and if so terminated, Contractor shall be liable for actual and consequential damages. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Contractor receives federal or state funds under the contract,Contractor must confirm that any individual natural person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Contractor operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 29. Acknowledgment. County and Contractor acknowledge that each has read this Agreement, understands it and agrees to be bound by its terms. Both parties further agree that this Agreement, with the attached Exhibits [*] and [*], is the complete and exclusive statement of agreement between the parties and supersedes all proposals or prior agreements, oral or written, and any other communications between the parties relating to the subject matter of this Agreement. IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month, and year first above written. CONTRACTOR: By: Date Name: Title: COUNTY: By: Date Name: Title: EXHIBIT <<letter>> SCOPE OF SERVICES 1. Contractor will provide Mental Health Evaluation Services, as referred by the Department. The following services are available under this Agreement: a. Individual Psychological Evaluation: A thorough intellectual and diagnostic assessment, to include formal psychological testing and a review of social history, Family Service Plans and collateral information. Individual Psychol '��II o i.c Evaluations will address referral questions regarding diagnoses and pact on attachment and parenting, placement and visitation needs, ands er tr tment recommendations. b. Mental Health Assessment (MHA): A brief assessment 7 health functioning to answer diagnostic questionsthe ,apartm nt and to provi nt�de treatment recommendations. Me �alAssessments will include a review of WCDHS social history and family se s b limited outside collateral information. Psychological sc� be completed, but no formal psychological testing. If o,,,f tcal testing is indicated, a Psychological Evaluation may be re o n ed: or approval by the Department. 2. Capacity: As needed. Contractor g ill,Gcomplyt , Mental Health Assessments (MHA) within in one (1) month or less and Individu Psychological Evaluations will be completed within two (2) monthsi r'�Ie �� t 3. Goals of Service a. Provide i i a o t e luations to assess individual functioning to assist in th ' p ent f { •yService Plans and provide treatment reco mendat b. Supstablished by the Court and in the child(ren)'s best interests for : O - and well-being. - vice: a`tagnostic feedback session will be offered to the client to discuss psychological test results, findings and recommendations of the evaluation. A, written report will be provided for all evaluations summarizing the referral questions, brief case and social history, evaluation course, methods and procedures, assessment findings, collateral contacts, limitations, analysis, and conclusions and recommendations for visitation, treatment, medication evaluation or future psychological evaluation. i. Incomplete evaluations will be documented to the extent possible and will outline the limitations and impact of any missing information. 5. Target Population: a. Children, ages birth to 12 years. b. Adolescents, ages 13 to 18 years. c. Adults, over the age of 18 years. d. All genders. 6. Service Access: <<address>> 7. Language: <<language(s)>> ,O 0 r,u0ion 8. Contractor will respond to the Quality Assurance Team Supervisor Am, uo,golim,,,,,' (hainlejd@weldgov.com, 970-400-6210) within three (3) business"days= ` t the ability to accept the received referral. i� y�i� eiloto 9. Upon acceptance of a referral, Contractor will offer an in:OT n *ent within seven (7) days of receiving the referral. The first attempt to cont . t thy- t will occur within 24 hours of receiving the referral (excluding weekended ,., Contractor will document efforts to engage client in referred sere' s. ` -„e'''+cient does not respond after three (3) attempts in the first seven (7) days oft referral period, the Contractor will notify the caseworker and the Quality Ass ° �el �' l�`� e� ;upervisor (hainlejd@weldgov.com, 970-40,�� °s 10. Contractor understands that "no shows"atfined as unexcused and unplanned/uncommunicated absences f r visitation services. If a rate for "no shows" is not specifically stated in„Exh,'i DR ` t ;Schedule, then Contractor understand that the Department will no reimbur e for"no shows". Contractor understands that the x T i r O�a� Department @q Contractor for up to two (2) "no-shows" on the part of the client per th e ee 3) "no-shows, "Contractor will place client on a behavioral plan requ ri ,attendance or discharged client from services. Contractor must inform the cas _ the Quality Assurance Team Supervisor r ovcom, 970-400-6210). r x stands that the Department will not reimburse Contractor for cancelled , ts either on the part of the client or the Contractor. If the cancellation is nerrom the Contractor, a"makeup" session/episode, to occur within 30 days of ° fiction, 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@weldgov.com) immediately via email, to discuss service continuation. 12. 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. 13. 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 o the required monthly report. h ipa H PP' 14. Contractor will submit reports on a monthly basis for each active referral refertojifOppgping services. Reports will be submitted per the online format required bay the Deent, unless otherwise directed by the Department. g @j" ''N0R0 ,10 ,, � ��au 4i ,, t1 k ro ' s gany change existing :pr _Owed through the 15. Contractor agrees to an referral mush Child Welfare Contract and Services Coordinator, aR,:,,,,:a.,g0t#V4ated Team Decision Making (TDM) or Family Team Meeting ��o b �; , order. A change is defined as anything outside of the approved dock} n deice on the initial authorized referral form. This may include an increase r decrease in services hours, change in frequency, change in location ofl' er ',r 4@ortation needs, or any change to the initial referral or subsequent uiza '7,..6.2„0"0" 16. Contractor agrees to attend meetings when av ilable and as requested by the Department. Such meetings include Court ili ,Court Staffings, Family Team Meetings and/or Team Decision Maki TheDepartmen.t will reimburse for actual participation in theeetn only s on as the meeting is at least one hour in length, the fi Contractor obti; �i �� ` �� ture on the Client Verification Form (if in person) at the ti and participation in the meeting is deemed appropriate and necessa y� Department. Staffings and/or meetings other than those listed above 4,474 are not consi ?re( reimnursable unless otherwise approved by the Child Welfare Contract a d Servi es Coordinator. Contractor may participate by phone, if approved by t will notify the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 10) of new staff who will manage and/or administer the services with the 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. . rolltitoptipol INKL �tia�i�^a p-, WNIGSb dui wl tft O�i7 �i94r; iF m4,�6t9i 0r, 4 a"i is t ^aci iti�iil'�''+� offerrt II itge--6,,mwa AFL ,la�w_' NR Atw YiNN oA ((�`k t !clog, ".} :1914A-Orpipairtgas t : s EXHIBIT «letter>> SCOPE OF SERVICES 1. Contractor will provide Behavior Coaching to children and youth, as referred by the Department. 2. Under this agreement, Contractor will: a. Connect child or youth, and their families, to community resources. b. Advocate for child youth's rights within the various systems, while teaching, accountability and responsibility for behaviors. ��au�„��u c. Teach skills which foster independence such as job skills, independent ing goal setting and development. w eso1 �i�yi identifying d. Mediate during conflicts, to assist in strengthening conflicli ; � alternative outlets for self-destructive behavior, as we l as ss ss g risks and developing plans to make positive choices in difficult "� �4 "'� e. Engage child or youth in activities, interests,� d p � ote positive self_ 'u' a ip "' h� a ��'� �xa�ro•image, participation in pro-social activities, ositive experiences as well as increase positive peer association. * f. Assist with compliance of system expect a�lud g probation, community service, electronic home monitor, cud. `ces, school attendance, and other professional meetings ' �i, g. Educate and encourage re t m ziended o ms, such as therapy, as well as rocessin barriers to overc " d � �'�n�� vem2 p g �i� n meet goals. h. Provide opportunitiesR n � � on o strengthen self-esteem, communication skills, and coping strategies i building hope and intermediary steps towards long-term goals i. Guide child n out 1An increase communication with parents and adult supports, Vin; n� a .,°g utilizl " i �� , �ql 3. Capacity for Services: A minimum of one (1) hour per week per referred child or youth. ,waGoal X fi M V� ',.., t2,11,,,„;:..„,„,,, iii,�"OSR«rvM �9# ;U��' Tk ma jor role in guiding and teaching child or youth to make positive �� hoi y supporting referral goals identified by the Department, Preventing � � ��, � � cement into detention or out-of--home placement. � port referral goals and collaborate for linkage to resources, initially identified by the Department, to maximize desired outcomes. c. Promote independence and empowerment for both child or youth, and family, so they may successfully function within the home, school, and community. d. Provide an environment conducive to healthy role-modeling, by showing mutual respect, open communication, and a positive attitude. 1 5. Outcomes of Services: a. Increase stability in the home and community, demonstrated through pro-social behaviors and skills. b. Increased positive coping outlets, supportive resources, increased communication and problem-solving skills. c. Improved relationships overall. d. Generalization of skills obtained and applied to other areas of life. 6. Target Population: Children or youth, ages eight (8) to 18 years of age. A, ,,;g nders3 �y�ili��{i r�retit� 3 �. l�9;�a, 7. Services Access: Services will be provided in the community or in the referred child'or youth's home. 8. Language: <<language(s)>> ��Pi� i rt#4, 6411 9. Contractor will respond to the Quality Assurance Tees » , � y, t�o�hti hainle d@weld ov.com, 970-400-6210) within, usiness days regarding the ability to accept the received referral. 10. Upon acceptance of a referral, C©- � ` � �eran initial appointment within seven � pp (7) days of receiving the referral `pie fir t p"to contact the client will occur within 24 hours of receiving the referral ding weekends and holidays). Contractor will document efforts to engage client e 1 ervices. If the client does not respond after <,k three (3) attempts in the first e �"-�n ys of the referral period, the Contractor will rr n notify the casewo, p� Quality A surance Team Supervisor (hainlejd(a�w �l � `rt20). ua 11. Contractor "no shows" are defined as unexcused and unplanned/ d absences for visitation services. If a rate for "no shows" is d in Exhibit D, Rate Schedule, then Contractor understand that the ,1 "reimburse for"no shows". Contractor understands that the hntmu, only reimburse Contractor for up to two (2) "no-shows" on the part of a� per month. After three (3) "no-shows, "Contractor will place client on a plan requiring attendance or discharged client from services. Contractor must caseworker and the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400-6210). 12. 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 2 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@weldgov.com) immediately via email, to discuss service continuation. 13. 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. 14. Contractor will document in detail any and all observed or verbalized concerns regarding any child whom the Contractor is working with under an active referral4 ' ", as if concern may include, but are not limited to, any physical, emotional ,41onal.;.or behavioral issues. Areas of concern should be reported immediately AID on the required monthly report. 15. Contractor will submit reports on a monthly basis f ach tiver f rral for ongoing services. Reports will be submitted per the online formatr qu the Department, unless otherwise directed by the Department. 16. Contractor agrees any change to an existm x" l m be pre-approved through the Child Welfare Contract and Servicesl 'o nator, Department-facilitated Team Decision Making (TDM) or Family` FTM), or by court order. A change is defined as anything outside of the p.p o documented service on the initial authorized referral form. Thi o increase or decrease in services hours, change in frequency, change�Iocation of services, transportation needs, or any change to the initial referral-ors so rizations. Co 17. Contractor agreesto tngs when available and as requested by the Department. Such meetin,t , Cou t Facilitations, Court Staffings, Family Team Meetings and/or Tea e tsronMaking meetings. The Department will reimburse for actual the meeting only so long as the meeting is at least one hour in length, the 7 ac orgobb ns the Facilitator's signature on the Client Verification Form (if in of the meeting and participation in the meeting is deemed appropriate trfnecessary by the Department. Staffings and/or meetings other than those listed above sidered reimbursable unless otherwise approved by the Child Welfare tradand Services Coordinator. Contractor may participate by phone, if approved by the Department. 18. Contractor will notify the Quality Assurance Team Supervisor (hainlejd(cweldgov.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 3 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. OPPRORPI motagoz000mir —Tool •womotiuj aai nr =w�v Pi�.� mna�unyr� . umth lu�NE y titig-a et¢ �v Pa �gym. s Way 4 wrpowirroptit EXHIBIT <<letter>> SCOPE OF SERVICES 1. Contractor will provide Mentoring Services to children and youth, as referred by the Department. 2. Contractor will provide individual mentoring services to at-risk child or youth to improve the well-being of the referred child or youth by providing a role model that can support them academically, socially and/or personally, and help them develop skills and knowledge that will enhance their growth. 3. Capacity for Services: A minimum of one (1) hour per week per referred .4,111!youth. 11E1, —1Y-111 4. Goals of Service: 1:%1',:::042'h"-strengthening P �^�' a. Promote the resilience and life success of at-risk a :::O h s engthening social bonds, increasing academic engageme rfo ee. decreasing substance use and delinquent behaviors, and €1 rov 1of self. b. Prepare youth to become positive and eta � munibers. 5. Outcomes of Service: a. Significantly improved behavioral b. Reduced substance use. ��1,4G�!1 II q c. Increased school attendance d. Reduced recidivism. b� e,�a�° e. Lower interactions w` P al justice systems. f. Increased efficac ��' c� r��eer anal College placement. , 6. Target Population: Children' �� '' th, ages eight (8) to 18 years of age. All genders. 1 7. Service Access:` ; thee` ommunity or the referred child or youth's home or school F setting.%91b1'; . _ anguage(s)>> will respond to the Quality Assurance Team Supervisor weldgov.com, 970-400-6210) within three (3) business days regarding the 111'''''''11 a b flay to accept the received referral. 10. 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 1 notify the caseworker and the Quality Assurance Team Supervisor (hainlejd@weldgov.com, 970-400-6210). 11. 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 ' behavioral plan requiring attendance or discharged client from services. Contractor must inform the caseworker and the Quality Assurance Team Supervisor ^ ft < (hainlejd@weldgov.com, 970-400-6210). 0 i`ttntiWitAts 12. Contractor understands that the Department will not reimburse ,r a for cancelled appointments either on the part of the client or theCohtr4t4pttr 44iOncellation is generated from the Contractor, a"makeup" session/ soe t oocu within 30 days of the cancellation, will be offered to the client (excluding se i ties that fall on holidays). If the cancellation is generated from the client,rho Contractor must request a makeup session from the Department prior„itoFl��th ma p s ' ion occurring (excluding session/episodes that fall on holida iittl)iCancellations, Contractor will inform the caseworker and the Q 41 A'e ' 7 yam Supervisor (hainlejd@weldgov.com) immed �! -ml discuss service continuation. 13. Contractor will identify in d a� g aitt.1f continued concern and make recommendations to the Department regardmt of services and/or the need for additional services. . �ti ire ,flumolatilWoh 01 14. Contractor will ."34,14g l any and all observed or verbalized concerns regarding any child w �� ' , ��,�� tor is working with under an active referral. Areas of concer re not limited to, any physical, emotional, educational behavinma� . ll�AA re as Of concern should be reported or ed immediately AND on the i re i t " eport. t will submit reports on a monthly basis for each active referral for ongoing t r cy Reports will be submitted per the online format required by the Department, unless herwise directed by the Department. 16. 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, 2 change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 17. 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 deemedppropriate and necessary by the Department. Staffings and/or meetings other than those, sted above ppby ld T +�`, are not considered reimbursable unless otherwise approved the Chi ' �' � ' Contract and Services Coordinator. Contractor may participate by 09#0;0,61515tbved by the Department. 18. Contractor will notify the Quality Assurance Team Supervisor(hainle d' 'weld ov.com, 970-400-6210) of new staff who will manage and/or administer th services with the following information: fx a. Staff member name and contact informat on b. Education level/degree (if appbl �c. Licensure/credentials (if applicable)Z" " Autha d. Department of Regulatory rity1(DC ) number (if applicable) e. Supervisor name and contact information The Department reserves the is " " decline the new staff members managing and/or administering services sent clients. 3 EXHIBIT(letter) 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, (Year). 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 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(Number)and Exhibit(Letter). 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(Number)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