The URL can be used to link to this page

Browse Search

Home My WebLink About20143107.tiff RESOLUTION RE: APPROVE TWO (2) CHILD PROTECTION AGREEMENTS FOR SERVICES AND AUTHORIZE CHAIR TO SIGN - NORTH RANGE BEHAVIORAL HEALTH 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 has been presented with two (2) Child Protection Agreements for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services and North Range Behavioral Health, commencing June 1, 2014, and ending May 31, 2015, with further terms and conditions being as stated in said agreements, and WHEREAS, after review, the Board deems it advisable to approve said agreements and copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the two (2) Child Protection Agreements for Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services and North Range Behavioral Health, be and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreements. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 13th day of October, A.D., 2014, nunc pro tune June 1, 2014 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: dv SIC ,, ; EXCUSED Douglas Rademacher, hair Weld County Clerk to the Boar Els • bara Kirkmeyer, ro-Tem 1161 BY:'� I .tl�. u,' ♦ 1 D pRy Clerk t the Boa ., 70,f ,® n no, ean P. Conway (— �UN-\\ AP ORM: p n:494:Ans Mike Freeman unty Attorney EXCUSED a William F. Garcia Date of signature 11a� 2014-3107 HR0085 CC: Nib1°fail 1861 MEMORANDUM --�ELDATE: October 2, 2014 j_2 C N T� TO: Douglas Rademacher, Chair, Bo rd of County Co issioners td FROM: Judy A. Griego, Director, H mu ar�Servic�s DepaThn�� SUBJECT: Child Protection Agreements for Services between the Weld County Department of Human Services and Various Providers Enclosed for Board approval are Child Protection Agreements for Services between the Department and Various Providers. These Agreements were reviewed under the Board's Pass-Around Memorandum dated May 22, 2014, and approved for placement on the Board's Agenda. There are a total of 45 agreements with various providers; the following represent the next 2 agreements received leaving 3 agreements needing to be signed by the Board Chair. The major provisions of these Agreements are as follows: Program Area/ No. Provider Funding Source PY14-15 Rate(s) 1 North Range Functional Family $700.00/Month (Pro-rated for partial month of Behavioral Health Therapy service) 06/01/14-05/31/15 Mental Health Services $70.00/Hour(Treatment—TraumaInformed for Children) $200.00/Episode (Mental Health Assessment— Trauma Informed for Children) $250.00/Episode(Level 1 - Behavioral Health Evaluation) $800.00/Episode(Level 2 - Partial Psychologica Evaluation) $1,200.00/Episode(Level 3 - Full Psychological Evaluation) $1,800.00/Episode(Level 4 - Extended Psychological Evaluation) $120.00/Hour(Hourly rate for partial evaluation, not to exceed full cost of evaluation. Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting. Case consultation.) Multisystemic Therapy $1,800.00/Month (Pro-rated for partial month of service) Core 2 North Range Anger Management/ $200.00/Episode (Anger Management or Domestic Behavioral Health Domestic Violence Violence Evaluation) Evaluation and $25.00/Hour(Group Session) 2014-3107 06/01/14-05/31/15 Treatment $17.50/15 Minutes (Individual Session) Monitored Sobriety $20.00/Episode(UA - 5 Panel. UA-7 Panel. UA— Multi-Panel Instant. Instant Swab. CW Admin $35.00/Episode (GCMS - Confirmation of Positive Result) $5.00/Episode(BA) $100.00/Episode (Hair Testing) $50.00/Episode(Patch Monitoring. UA-Expanded Designer Stimulants.) $35.00/Episode(EtG Test Only. UA -3 Panel. UA— "Spice". Oral Swab - "Spice".) $2.00/Episode(UA - Single Panel EtG Add-on Test with UA - 5 or 7 Panel. UA -Add-on Panel, Oxycodone or Buprenorphrine— 5 or 7 Panel If you have any questions, give me a call at extension 6510. PY-14-15-CORE-0120 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH This Agreement, made and entered into the L day of Dot2014 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 North Range Behavioral Health, 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 the Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. 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 funding to the Department for Functional Family Therapy, Mental Health Services,and Multisystemic Therapy. NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1,2014 upon proper execution of this Agreement and shall expire May 31, 2015, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the Contractor to any person(s)eligible for services in compliance with Exhibit A,Weld County's 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 Department's Resource Manager,Child Welfare Contract and Services Coordinator,or 1 -3/01 PY-14-15-CORE-O12O through a Team Decision Making(TDM)meeting or Family Team Meeting(FTM). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product(ex. psychological evaluation,substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. 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. Monthly reports will be submitted through the Department's online reporting system,unless otherwise directed or agreed to by the Department. 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. b. Payment shall be made in accordance with Exhibit A,Weld County's Request for Proposal, Exhibit B, Contractor's Response to the Request for Proposal,Exhibit C,Scope of Services,and Exhibit D, Payment 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. 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 2 PV-14-15-CORE-0120 expended under this Agreement must conform to the Single Audit Act of 1984 and 0MG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A,Weld County's Request for Proposal,Exhibit B,Contractor's Response to the Request for Proposal,Exhibit B,Scope of Services,and Exhibit D, Payment 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 ACH Form for Colorado Providers,which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement,Contractor will strictly adhere to all applicable Federal and State laws,order,and applicable standards, regulations,interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records, papers,documents,tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations, including, but not limited to the following: - Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et.seq. and its implementing regulation,45 C.F.R. Part 80 et.es;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.ss and its implementation regulations,45 C.F.R.Part 91;and - Title VII of the Civil Rights Act of 1964;and - the Age Discrimination in Employment Act of 1967;and 3 r) PY-14-15-CORE-0120 - the Equal Pay Act of 1963;and - the Education Amendments of 1972;and - Immigration Reform and Control Act of 1986, P.L.99-603,42 C.F.R. Part 2;and - all regulations applicable to these laws prohibiting discrimination because of race,color, national origin,sex, religion,and handicap, including Acquired Immune Deficiency Syndrome (AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R.Part 2. 45 C.F.R.Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,contractors and sub-contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services,Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Core Services. d. Contractor assures and certifies that it and its principals: - Are not presently debarred,suspended, proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not,within a three-year period preceding this Agreement,been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining,attempting to obtain,or performing a public(Federal,State or Local)transaction or contract under public transaction;violation of federal or state antitrust statutes or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements,or receiving stolen property;and - are not presently indicted for or otherwise criminally or civilly charged by a government entity(federal,state or local)with commission of any of the offenses enumerated in this certification; and - have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,or local)terminated for cause or default. 4 PV-14-15-CORE-O12O e. Contractor certifies that it shall comply with the provision of the Colorado Revised Statutes(C.R.S.)8- 17.5-101,et.seq. 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 to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor represents,warrants,and agrees that it(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b) otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). Contractor shall comply with all reasonable requires made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If Contractors fails to comply with any requirement of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and Contractor shall be liable for actual and consequential damages to the Department. 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 this Agreement,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 this Agreement. If Contractor operates as a sole proprietor,it hereby affirms under penalty of perjury that s/he(a)is a citizen of the United States or is otherwise lawfully present in the United State 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 this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety,Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan (PIP)will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review(CFSR),and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d)of this Agreement. 9. Insurance Requirements Contractor and 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. 5 PY-14-15-CORE-0120 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/Contract Professionals 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/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement,or any extension thereof,during any warranty period,and for three(3)years after termination of the Agreement.The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as"A"VIII or better. Each policy shall contain a valid provision or endorsement stating"Should any of the above-described policies by canceled or should any coverage be reduced before the expiration date thereof,the issuing company shall send written notice to the Weld County Director of General Services by certified mail,return receipt requested.Such written notice shall be sent thirty(30)days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten(10)days prior. If any policy is in excess of a deductible or self-insured retention,County must be notified by the Contractor/Contract Professional.Contractor/Contract Professional shall be responsible for the payment of any deductible or self-insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond,at no cost to County,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/Contract Professional. Contractor/Contract Professional 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/Contract Professional 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 Contract Professional's employees acting within the course and scope of their employment. If Contractor is an Independent Contractor, as defined by the Colorado Worker's Compensation Act,this requirement shall not apply. Contractor must submit to the Department a Declaration of Independent Contractor Status Form prior to the start of this agreement. ii. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent,covering premises operations,fire damage,independent Contractors, products and completed operations, blanket contractual liability,personal injury,and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; - $50,000 any one fire;and - $500,000 errors and omissions. 6 PY-14-15-CORE-0120 iii. Automobile Liability: Contractor/Contract Professional 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 reduce by twenty-five percent(25%)or more by paid or reserved claims,Contractor shall notify County 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 County. v. For all general liability,excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims-made policy,the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County,whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator")at or before the time of execution of this Agreement,and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided,a commercial general liability insurance policy,including public liability and property damage,in form and company acceptable to and approved by said Administrator,covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker,and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance. County reserves the right to require Contractor/Contract Professional 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/Contract Professional's insurer shall name County as an additional insured as follows f. Waiver of Subrogation: For all coverages,Contractor/Contract Professional's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors,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/Contract Professional.Contractor/Contract Professional 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/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors,sub-vendors suppliers or other entities upon request by the County. 7 PY-14-15-CORE-0120 A provider of Professional Services(as defined in the Bid or RFP)shall provide the following coverage: Professional Liability: Contract Professional 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 that 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 970-352-1551,x6503,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 shall permit the Department,and any other duly authorized agent or governmental agency,to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. 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. 8 PY-14-15-CORE-0120 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker,Administrator Larry D.Pottorff, 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: For Contractor: Judy A.Griego, Director Larry D. Pottorff, Executive Director P.O. Box A 1300 North 17th Avenue, Greeley,CO 80632 Greeley,CO 80631 (970)352-1551 j970)347-2120 18. Litigation Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. 9 PY-14-15-CORE-0120 Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation" includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department,or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental Immunity Act of§§24-10-101 et. seq. as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer, member or employee of weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in 10 PY-14-15-CORE-O12O opposition. In order to create the appearance of a conflict of interest,it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement,Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation,Contractor shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid, by or on behalf of Contractor,to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any cooperative agreement,and the extension,continuation, renewal, amendment,or modification of an Federal contract, loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records Contractor agrees that authorized local, Federal,and State auditors and representatives shall,during business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the 'Federal and/or State government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven(7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of,all such information,in any form, including social networks. Contractor shall advise its employees,agents, and subcontractor,if any,that they are subject to these confidentiality requirements. 11 PY-14-15-CORE-0120 Contractor shall provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets, business affairs, internal operations and management procedures and those of its customers,clients or affiliates, but does not include information(1) lawfully obtained from third parties, (2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary Information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by the Contractor for similar information in the course of its own business. 27. Independence of Contractor: Not an Employee of Weld County Contractor agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner ,consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B,C,and D. 12 PY-14-15-CORE-0120 31. Acceptance of Services Not a Waiver Upon completion of the work,the Contractor shall submit to Department originals of all tests and results, reports,etc.,generated during completion of this work.Acceptance by 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.4424-18-201 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 conflict 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 Contract Professional'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, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 13 PY-14-15-CORE-0120 35. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional,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. 14 PV-14-15-CORE-O12O IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, onth,and year first above written. S ATTEST: BOARD OF COUNTY COMMISS ONERS W LD COUNTY,COLORA 0 Weld County Clerk to the Board , arbara Kirkmeyer, Pro—Tem Elsa By: ,.>•,l l /1 _ CT 13 2014 De•uty Clerk to the Board t(1tt.61 • AP �►rr� t torney WELD COUNTY DEPARTMENT NORTH RANGE BEHAVIORAL EALTH OF HUMAN SERVICES By: By: J A.Griego, Director Larry D. ttorff,Exe utive Directo 15 2014-3/07 WELD COUNTY'S REQUEST FOR PROPOSAL Bid No. 81400069 BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF WELD, STATE OF COLORADO, BY AND THROUGH THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES DATE: 03/05/2014 PAGES .-4 OF THIS REQUEST FOR PROPOSAL CONTAIN GENERAL INFORMATION. NOT ALL OF THE INFORMATION CONTAINED IN PAGES 1-4 MAY BE APPLICABLE. SPECIFICATIONS UNIQUE TO THIS REQUEST FOR PROPOSAL FOLLOW PAGE 4. NOTICE TO BIDDERS A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the Board of Weld County Commissioners, wishes to purchase the following: VARIOUS SERVICES(AS DESCRIBED ON PAGES 12-14) B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter at vegterta@weldgov.com or P.O. Box A, 315 A North 11th Avenue, Greeley, CO 80631, through: WEDNESDAY, MARCH 21. AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNIT TIME CLOCK). II. INVITATION TO BID A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various Services (as described on pages 12-14). B. Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if awarded the bid. C. Emailed Bids Are Preferred. Emailed (fully typed) bids are preferred. However, if the bidder is unable to submit an emailed bid, the bidder must comply with the requirements set forth in Paragraph II D below. An emailed bid must contain the following statement: "I hereby waive my right to a sealed bid." D. Unless the Bid is emalled, one original and one corn/ of the Bid must be submitted. One complete bid document, which will be the only official copy of the bid, shall be filed at the Weld County Department of Human Services, Service Utilization Unit. After certification of the bid, the other copy will be routed for applicable review. An e-mail confirmation will be sent when we receive your bid/proposal. Page 1 Bid No. B1400069 III. INSTRUCTIONS TO BIDDERS A. Bids shall be typewritten. Each bid must give the full business address of the bidder and be signed by him with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the partners of the partnership or by an authorized representative, followed by the signature and title of the person signing. Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in this matter. Bids submitted by limited liability companies must furnish the full names of all members and managers and must be signed by a manager or by an authorized representative, followed by the signature and title of the person signing. The name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing. When requested, satisfactory evidence of the authority of the officer signing in behalf of a corporation shall be furnished. All corrections or erasures shall be initialed by the person signing the bid. All bidders shall agree to comply with all of the conditions, requirements, specifications, and/or instructions of this bid as stated or implied herein. All designations and prices shall be fully and clearly set forth. B. Bids may be withdrawn upon written request to the Weld County Department of Human Services received from bidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened. C. Bidders are expected to examine the conditions, specifications, and all instructions contained herein. Failure to do so will be at the bidder's risk. D. Bidders shall not stipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto. Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected. E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the time indicated in Section I., entitled "Notice to Bidders." F. When approximate quantities are stated, Weld County reserves the right to increase or decrease quantity as best fits its needs. G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Page 2 Bid No. B1400069 Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County. All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance. J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of Families, Youth and Children's Commission. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for royalties, for patents or suit for infringement thereon, which may be involved in the manufacture or use of the material to be furnished. L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. 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 this 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 this Contract. Page 3 Bid No. B1400069 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 a Contract. M. All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado. N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified. O. In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract. The Board of County Commissioners of Weld County, Colorado, reserves the right to reject any and 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. P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your cooperation is invited. Q. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV. General Specifications. A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. Page 4 Bid No. B1400069 B. Governmental Immunity: No term or condition of the 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. C. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee. He or she shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The successful bidder 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 (b) provide proof thereof when requested to do so by Weld County. D. Compliance with Law: The successful bidder 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. E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra-judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental Page 5 Bid No. B1400069 beneficiary only. H. Attorneys Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. Insurance Requirements. i. General Requirements: Contractors/Contract Professionals 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/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above-described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self-insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self-insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, 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/Contract Professional. Contractor/Contract Professional 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. ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: (a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. (b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: Page 6 Bid No. B1400069 * $1,000,000 each occurrence; * $2,000,000 general aggregate; * $2,000,000 products and completed operations aggregate; * $50,000 any one fire; and * $500,000 errors and omissions. (c). Automobile Liability: Contractor/Contract Professional 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. (d). Additional Provisions: * Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: * If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County 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 * h r A provision that coverage is non-contributory with of coverage or e self- insurance provided by County. (e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims-made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance on Page 7 Bid No. B1400069 www.lns-Cert.com and link the information to County. County reserves the right to require Contractor/Contract Professional 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. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. vii. Subcontractors: All subcontractors, 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/Contract Professional. Contractor/Contract Professional 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/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub-vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. V. Warranty. The successful bidder shall warrant that: A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended; B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein. Page 8 Bid No. B1400069 Project Overview: The Weld County Department of Human Services (WCDHS) is seeking various services. Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi-Systemic Therapy, Home Based Intensive Services, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services. Refer to pages 12-14 for specific definitions related to the above-mentioned service areas. Qualifications: To be considered, a bidder must meet the following minimum qualifications: 1) A bidder must submit a completed Provider Information Form. 2) A bidder must submit a one page or less cover letter that introduces the bidder,the bidder's location(s) of practice and target area, his or her experience and qualifications, and staff. 1) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications"for all bidders. Each service must be submitted as its own proposal. inclusive of scope of services and rate information. 3) Bidders should avoid elaborate artwork,graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Proposal. 4) A bidder must demonstrate the knowledge,training and expertise to conduct the proposed service(s). 5) A bidder must provide a current resume, as well as proof of licensure, for self and staff members. Additionally, a bidder must include proof of inclusion on State vendor lists if applicable to the proposed service (ex. Home Study Providers, Sex Offender Management Board Providers). 6) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal. Page 9 Bid No. B1400069 7) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services as requested. 8) A bidder must agree to enter into a contract, attached as Exhibit A, with the Weld County Department of Human Services and comply with all requirements of the contract. Contract Period and Pricing: 1) The initial contract period shall commence on June 1, 2014, through May 31, 2015, so long as both parties are satisfied. The selected vendor(s) will have the opportunity to resubmit annually. 2) The initial contract will be funded through Core Services Program or Child Welfare Administration funding, so long as funding is made available. 3) The selected vendor will bill the Weld County Department of Human Services monthly according to billing requirements set forth by the Weld County Department of Human Services. Submittal Requirements for All Proposals: A bidder must submit according to requirements set forth in this Request for Proposal. All proposals must contain the following specific information: 2) Completed Provider Information Form with original signature of authorized representative. 3) One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his or her experience and qualifications, and staff. 4) Sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications" for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate Information. 5) Bidders should avoid elaborate artwork,graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Proposal. Page 10 Bid No. B1400069 6) Current resume, proof of licensure and copies of applicable training certificates for all staff members who will manage and/or administer services under this proposal. 7) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and comply with the specific requirements set forth by the Weld County Department of Human Services. 8) All proposals must include a clear and concise rate schedule that accurately correlates to the proposed services and is inclusive of all possible charges related to the proposed service(s). The rate schedule must demonstrate an exact fee for the described service (s). Approximate rates or a range of rates for a service will not be accepted. 9) Each bidder must submit a Standard Certificate of Insurance, or letter of intent from an insurance company authorized to do business in the State of Colorado stating its willingness to insure the bidder pursuant to the terms of this Request for Proposal. Evaluation of Proposals: All proposals that meet the basic proposal, service and qualification requirements will be reviewed by the Families, Youth and Children (FYC) Commission. The FYC Commission will make recommendations to the Board of Weld County Commissioners by and through the Weld County Department of Human Services. The Weld County Department of Human Services will make its award of contract to the successful bidders upon final approval of the Board of Weld County Commissioners. Page 11 Bid No. B1400069 SERVICE AREA DEFINITIONS Aftercare Services Services provided to prepare a child for reunification with his/her family or other permanent placement and to prevent future out- of-home placement of the child. Anger Management/Domestic Violence Diagnostic and/or therapeutic services to assist in the development of the family services plan,to assess and/or improve family communication, functioning and relationships, and to prevent further domestic violence. Day Treatment Comprehensive, highly structured services that provide education to children and therapy to children and their families. Foster Parent Consultation Services provided to foster and group home families caring for WCDSS children and youth in their homes to enhance and improve the quality of care being provided. Foster Parent Training Core training for new Weld County foster parents. Functional Family Therapy Intensive family-based treatment that addresses the pervasive patterns of relational dysfunction known to be determinants of conduct disorder, violent acting out, and substance abuse among youth 10-18 years old. Home-Based Intervention Services provided primarily in the home of the client that include a variety of services which can include therapeutic services, concrete services, collateral services and *crisis intervention directed to meet the needs of the child and family. *Crisis Intervention is defined as 24/7 phone access and in-home counseling. Page 12 Bid No. 81400069 Homes Studies/Relinquishment Counseling Home studies and home study updates per the standardized SAFE home study tool for the purpose of adoption,foster care, and expedited permanency planning. Relinquishment counseling for parents considering relinquishment of their children. Life Skills Visitation (both in-home and in-office) and services provided primarily in the home that teach household management, effective access to community resources, parenting techniques and family conflict management. Mediation/Intensive Family Therapy Therapeutic intervention typically with all family members to improve family communication, functioning and relationships. Mental Health Services Diagnostic and/or therapeutic services to assist in the development of family services plan,to assess and/or improve family communication, functioning and relationships. Multisystemic Therapy Intensive family- and community-based treatment program designed to make positive changes in the various social systems (home, school, community, peer relations)that contribute to the serious antisocial behaviors of children and adolescents who are at risk for out-of-home placement. Sex Abuse Treatment Therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetrations, and to prevent further sexual abuse and victimization. Page 13 Bid No. 81400069 Substance Abuse Treatment Services Diagnostic and/or therapeutic services to assist in the development of the Family Service Plan (FSP), to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol. Page 14 Bid No. 81400069 EXHIBIT A CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND «CONTRACTORI» This Agreement, made and entered into the_day of ,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 «Contractor»,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 Department's Request for Proposal, Exhibit B,Scope of Services,Exhibit C, Contractor's Response to the Request for Proposal, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. 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«funding»to the Department for «Services»;and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on «TermStart», upon proper execution of this Agreement and shall expire«TermEnd»,unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the Contractor to any person(s)eligible for services in compliance with Exhibit A,Weld County's Request for Proposal,and Exhibit B,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 1 Bid No. B1400069 through the Department's Resource Manager,Child Welfare Contract and Services Coordinator,or through a Team Decision Making(TDM)meeting or Family Team Meeting(FTM). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. d. Contractor agrees to submit a monthly report with the billing statement by the 7`h of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product(ex. psychological evaluation,substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. Contractor will document in detail any and all observed or ve'r'balized 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. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 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. b. Payment shall be made in accordance with Exhibit A, Department's Request for Proposal, Exhibit B, Scope of Services,, Exhibit C,Contractor's Response to the Request for Proposal,and Exhibit D, Payment 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. 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 2 Bid No. B1400069 expended under this Agreement must conform to the Single Audit Act of 1984 and 0MG Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A, Department's Request for Proposal, Exhibit B,Scope of Services,, Exhibit C,Contractor's Response to the Request for Proposal,and Exhibit D,Payment 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 ACH Form for Colorado Providers,which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement,Contractor will strictly adhere to all applicable Federal and State laws,order,and applicable standards,regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all applicant/recipient records,papers,documents,tapes and any other materials that have been or may hereafter be established which relate to the Agreement. Contractor shall abide by all applicable laws and regulations,including,but not limited to the following: - Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-1 et seq. and its implementing regulation,45 C.F.R. Part 80 et.sea.: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.sec and its implementation regulations,45 C.F.R. Part 91;and - Title VII of the Civil Rights Act of 1964; and - the Age Discrimination in Employment Act of 1967;and 3 Bid No. B1400069 - 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 dient records except as permitted by 42 C.F.R.Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute(C.R.S.)26-6-104, requiring criminal background record checks for all employees,contractors and sub-contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services,Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is«funding». d. Contractor assures and certifies that it and its principals: - Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not,within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining,attempting to obtain,or performing a public(Federal,State or Local)transaction or contract under public transaction;violation of federal or state antitrust statutes or commission of embezzlement,theft,forgery,bribery,falsification or destruction of records,making false statements,or receiving stolen property;and - are not presently indicted for or otherwise criminally or civilly charged by a government entity(federal, state or local)with commission of any of the offenses enumerated in this certification;and - have not,within a three-year period preceding this Agreement, had one or more public transactions(federal,state,or local)terminated for cause or default. 4 Bid No. 81400069 e. Contractor certifies that it shall comply with the provision of the Colorado Revised Statutes(C.R.S.)8- 17.5-101,et.leg. 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 to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor represents,warrants,and agrees that it(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and (b)otherwise will comply with the requirements of C.R.S.8.17.5-102(2)(b). Contractor shall comply with all reasonable requires made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If Contractors fails to comply with any requirement of this provision or C.R.S.8-17,5-101,et.seq.,the Department may terminate this Agreement for breach and Contractor shall be liablefor actual and consequential damages to the Department. 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 this Agreement,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 this Agreement. If Contractor operates as a sole proprietor, it hereby affirms under penalty of perjury that s/he(a)is a citizen of the United States or is otherwise lawfully present in the United State 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 this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. `Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety,Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review(CFSR),and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d)of this Agreement. 9. Insurance 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 5 Bid No. B1400069 Commissioners of Weld County, its employees,volunteers and agents. Contractor shall provided the liability(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. with the acceptable evidence that such coverage is in effect Contractor shall provide the Department g P 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. - Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at the work site. - General Liability(PL and PD)(Minimum) o Combined single limit-$500,000.00 written on an occurrence basis. o Additional insurance required if claims reduce the annual aggregate below$500,000.00. o Weld County,State of Colorado,to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. - Automobile Liability(Minimum)for any Contractor transporting children or any party to whom Department services are being provided. - Additional coverage may be required in specific program areas. For any insurance that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 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. Trainin Contractor may be required to attend training that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in 6 Bid No. B1400069 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 970-352-1551,x6503,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 shall permit the Department,and any other duly authorized agent or governmental agency,to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. 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. 7 Bid No. B1400069 - Incorrect payment to the Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker,Administrator «RepFName»aRepLName»,«RepTitle» 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: For Contractor: Judy A.Grieco, Director «NoticeFName»uNoticeLName», P.O. Box A «Addressl», «Address2» Greeley.CO 80632 «City»,«State»«Zip» j970)352-1551 «Phone» 18. Litigation Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director Of Human Services. The term"litigation" includes an assignment for the benefit of creditors,and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. 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. 8 Bid No. B1400069 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities, rights, benefits, protections or other provisions,of the Colorado Governmental Immunity Act of§§24-10-101 et.seq.,as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section,subsection,paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer,member or employee of weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationship 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 two4relationships are in opposition. During the term of the Agreement,Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation,Contractor shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with the Contractor. 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, 9 Bid No. B1400069 amendment,or modification of an Federal contract,loan,grant,or cooperative agreement. 24. Storage.Availability and Retention of Records Contractor agrees that authorized local, Federal,and State auditors and representatives shall,during business hours,have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents,communications,and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of,all such information,in any form, including social networks. Contractor !shall advise its employees,agents,and subcontractor, if any,that they are subject to these confidentiality requirements. Contractor shall provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 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 10 Bid No. B1400069 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 it is an independent contractor and that its officers and employees do not become employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as the result of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty. The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that ,perform services of a similar nature to those described in this Agreement including Exhibits A,B,C, and D. 31. Acceptance of Services Not a Waiver. Upon completion of the work, the Contractor shall submit to Department originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by 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. 11 Bid No. B1400069 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et sea. 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 conflict 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 Contract Professional'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, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Attorneys Fees/Legal Costs. In the event of a dispute between County and Contract Professional, 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. 12 Bid No. B1400069 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO Weld County Clerk to the Board Douglas Rademacher,Chair By: Deputy Clerk to the Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT «CONTRACTOR1» OF HUMAN SERVICES By: By: Judy A.Griego, Director «SigFName» «SigLName»,«Title» 13 Bid No. B1400069 EXHIBIT A REQUEST FOR PROPOSAL Bid No. B1400069 BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF WELD,STATE OF COLORADO, BY AND THROUGH THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES DATE: 03/05/2014 PAGES 1-4 OF THIS REQUEST FOR PROPOSAL CONTAIN GENERAL INFORMATION. NOT ALL OF THE INFORMATION CONTAINED IN PAGES 1-4 MAY BE APPLICABLE. SPECIFICATIONS UNIQUE TO THIS REQUEST FOR PROPOSAL FOLLOW PAGE 4. NOTICE TO BIDDERS A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the Board of Weld County Commissioners, wishes to purchase the following: VARIOUS SERVICES(AS DESCRIBED ON PAGES 12-14) B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter at vegterta@weldgov.com or P.O. Box A, 315 A North 11th Avenue, Greeley, CO 80631, through: WEDNESDAY, MARCH 21, AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNIT TIME CLOCKI. II. {INVITATION TO BID A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various Services (as described on pages 12-14). B. Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if awarded the bid. C. Emailed Bids Are Preferred. Emailed (fully typed) bids are preferred. However, if the bidder is unable to submit an emailed bid,the bidder must comply with the requirements set forth in Paragraph II D below. An emailed bid must contain the following statement: "I hereby waive my right to a sealed bid." D. Unless the Bid is emailed, one original and one copy of the Bid must be submitted. One complete bid document, which will be the only official copy of the bid, shall be filed at the Weld County Department of Human Services, Service 14 Bid No. B1400069 Utilization Unit. After certification of the bid, the other copy will be routed for applicable review. An e-mail confirmation will be sent when we receive your bid/proposal. III. INSTRUCTIONS TO BIDDERS A. Bids shall be typewritten. Each bid must give the full business address of the bidder and be signed by him with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the partners of the partnership or by an authorized representative, followed by the signature and title of the person signing. Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in this matter. Bids submitted by limited liability companies must furnish the full names of all members and managers and must be signed by a manager or by an authorized representative, followed by the signature and title of the person signing. The name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing. When requested, satisfactory evidence of the authority of the officer signing in behalf of a corporation shall be furnished. All corrections or erasures shall be initialed by the person signing the bid. All bidders shall agree to comply with all of the conditions, requirements, specifications, and/or instructions of this bid as stated or implied herein. All designations and prices shall be fully and clearly set forth. B. Bids may be withdrawn upon written request to the Weld County Department of Human Services received from bidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened. C. Bidders are expected to examine the conditions, specifications, and all instructions contained herein. Failure to do so will be at the bidder's risk. D. Bidders shall not stipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto. Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected. E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the time indicated in Section I., entitled "Notice to Bidders." F. When approximate quantities are stated, Weld County reserves the right to increase or decrease quantity as best fits its needs. 15 Bid No. B1400069 G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County. All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance. J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of Families, Youth and Children's Commission. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for royalties, for patents or suit for infringement thereon, which may be Involved in the manufacture or use of the material to be furnished. L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. 16 Bid No. B1400069 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 this 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 this 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 a Contract. M. All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado. N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified. 0. In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract. The Board of County Commissioners of Weld County, Colorado, reserves the right to reject any and 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. P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your cooperation is invited. O. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV. General Specifications. 17 Bid No. B1400069 A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. B. Governmental Immunity: No term or condition of the 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. C. Independent Contractor:The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee. He or she shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have authorization, express or implied,to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The successful bidder 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 (b) provide proof thereof when requested to do so by Weld County. D. Compliance with Law: The successful bidder 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. E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra-judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of 18 Bid No. B1400069 action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental beneficiary only. H. Attorneys Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. Insurance Requirements. i. General Requirements: Contractors/Contract Professionals 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/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement; or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above-described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified,mail, return receipt requested. Such written notite 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, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self-insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, 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/Contract Professional. Contractor/Contract Professional 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. ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: (a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. 19 Bid No. B1400069 (b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: * $1,000,000 each occurrence; * $2,000,000 general aggregate; * $2,000,000 products and completed operations aggregate; * $50,000 any one fire; and * $500,000 errors and omissions. (c). Automobile Liability: Contractor/Contract Professional 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. (d). Additional Provisions: * Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must'provide the following: * If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County 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 County. (e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims-made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and 20 Bid No. B1400069 company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance on www.lns-Cert.com and link the information to County. County reserves the right to require Contractor/Contract Professional 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. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. vii. Subcontractors: All subcontractors, 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/Contract Professional. Contractor/Contract Professional 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/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub-vendors suppliers or other entities upon request by the County. A provider offaProfessional Services (as defined in the Bid or RFP) shall provide the folloviijng coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. V. Warranty. The successful bidder shall warrant that: A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended; B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein. 21 Bid No. B1400069 Prolect Overview: The Weld County Department of Human Services(WCDHS) is seeking various services. Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi-Systemic Therapy, Home Based Intensive Services, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services. Refer to pages 12-14 for specific definitions related to the above-mentioned service areas. Qualifications: To be considered, a bidder must meet the following minimum qualifications: 1) A bidder must submit a completed Provider Information Form. 2) A bidder must submit a one page or less cover letter that introduces the bidder, the bidder's location(s) of practice and target area, his or her experience and qualifications, and staff. 1) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets"minimum qualifications"for all bidders. Each service must be submitted as its own proposal. inclusive of scope of services and rata information. 3) Bidders should avoid elaborate artwork,graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Proposal. 4) A bidder must demonstrate the knowledge, training and expertise to conduct the proposed service(s). 5) A bidder must provide a current resume, as well as proof of licensure, for self and staff members. Additionally, a bidder must include proof of inclusion on State vendor lists if applicable to the proposed service (ex. Home Study Providers, Sex Offender Management Board Providers). 6) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal. 22 Bid No. B1400069 7) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services as requested. 8) A bidder must agree to enter into a contract, attached as Exhibit A, with the Weld County Department of Human Services and comply with all requirements of the contract. Contract Period and Pricine: 1) The initial contract period shall commence on June 1, 2014,through May 31, 2015, so long as both parties are satisfied. The selected vendor(s)will have the opportunity to resubmit annually. 2) The initial contract will be funded through Core Services Program or Child Welfare Administration funding, so long as funding is made available. 3) The selected vendor will bill the Weld County Department of Human Services monthly according to billing requirements set forth by the Weld County Department of Human Services. Submittal Requirements for All Proposals: A bidder must submit according to requirements set forth in this Request for Proposal. All proposals must contain the following specific information: 2) Completed Provider Information Form with original signature of authorized representative. 3) One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his or her experience and qualifications, and staff. 4) Sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications" for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. 5) Bidders should avoid elaborate artwork,graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Proposal. 23 Bid No. B1400069 6) Current resume, proof of licensure and copies of applicable training certificates for all staff members who will manage and/or administer services under this proposal. 7) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and comply with the specific requirements set forth by the Weld County Department of Human Services. 8) All proposals must include a clear and concise rate schedule that accurately correlates to the proposed services and is inclusive of all possible charges related to the proposed service(s). The rate schedule must demonstrate an exact fee for the described service (s). Approximate rates or a range of rates for a service will not be accepted. 9) Each bidder must submit a Standard Certificate of Insurance, or letter of intent from an insurance company authorized to do business in the State of Colorado stating its willingness to insure the bidder pursuant to the terms of this Request for Proposal. Evaluation of Proposals: All proposals that meet the basic proposal,service and qualification requirements will be reviewed by the Families, Youth and Children(FYC) Commission. The FYC Commission will make recommendations to the Board of Weld County Commissioners by and through the Weld County Department of Human Services. The Weld County Department of Human Services will make its award of contract to the successful bidders upon final approval of the Board of Weld County Commissioners. 24 Bid No. B1400069 SERVICE AREA DEFINITIONS Aftercare Services Services provided to prepare a child for reunification with his/her family or other permanent placement and to prevent future out- of-home placement of the child. Anger Management/Domestic Violence Diagnostic and/or therapeutic services to assist in the development of the family services plan,to assess and/or improve family communication, functioning and relationships, and to prevent further domestic violence. Day Treatment Comprehensive, highly structured services that provide education to children and therapy to children and their families. Foster Parent Consultation Services provided to foster and group home families caring for WCDSS children and you th in their homes to enhance and improve the quality of care being provided. Foster Parent Training s, Core training for new Weld County foster parents. e. . Functional Family Therapy Intensive family-based treatment that addresses the pervasive patterns of relational dysfunction known to be determinants of conduct disorder, violent acting out, and substance abuse among youth 10-18 years old. Home-Based Intervention? Services provided primarily in the home of the client that include a variety of services which can include therapeutic services, concrete services, collateral services and *crisis intervention directed to meet the needs of the child and family. *Crisis Intervention is defined as 24/7 phone access and in-home counseling. 25 Bid No. B1400069 Homes Studies/Relinquishment Counseling Home studies and home study updates per the standardized SAFE home study tool for the purpose of adoption,foster care, and expedited permanency planning. Relinquishment counseling for parents considering relinquishment of their children. Life Skills Visitation (both in-home and in-office) and services provided primarily in the home that teach household management, effective access to community resources, parenting techniques and family conflict management. Mediation/Intensive Family Therapy Therapeutic intervention typically with all family members to improve family communication, functioning and relationships. Mental Health Services Diagnostic and/or therapeutic services to assist in the development of family services plan, to assess and/or improve family communication, functioning and relationships. Multisystemic Therapy Intensive family- and community-based treatment program designed to make positive changes in the various social systems (home, school, community, peer relations)that contribute to the serious antisocial behaviors of children and adolescents who are at risk for out-of-home placement. Sex Abuse Treatment Therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetrations, and to prevent further sexual abuse and victimization. 26 Bid No. 81400069 Substance Abuse Treatment Services Diagnostic and/or therapeutic services to assist in the development of the Family Service Plan (FSP), to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol. 27 Bid No. B1400069 EXHIBIT B SCOPE OF SERVICE 1. Contractor understands that the Department will not reimburse Contractor for"no shows"or cancelled appointments,either on the part of the client or the Contractor. 2. 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. Upon receipt of an invitation from the Department,Contractor must contact the Child Welfare Contract and Services Coordinator to request approval to bill for participation if Contractor wishes to be reimbursed. 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 requests approval to bill in advance 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. 3. Contractor will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the Contractor will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately'. ttk _w= ,rt 28 Bid No. B1400069 EXHIBIT C CONTRACTOR'S RESPONSE TO THE REQUEST FOR PROPOSAL 29 Bid No. 81400069 EXHBIT D PAYMENT 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 specified 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 in Trails after May 31, 2015. 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 «Rate Schedule» Contractor may not attempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. Contractor will collect ate, applicable sliding scale co-pays and credit the Department for any payment received-on the monthly Oling: 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher,and signed monthly report if applicable,certifying that services authorized were provided on the date(s)indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. 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. b. For one-time services,proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 30 CONTRACTORS RESPONSE TO THE REQUEST FOR PROPOSAL 97A NOBEHAVIORAL HEALTH RTH RANGE March 19, 2014 Tobi Vegter Core and Service Contract Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11t Avenue Greeley, CO 80632 Re: Bid No. B1400069 Dear Tobi: Attached are North Range's Core and Contracted Services Bid proposals for the following program areas and a Certificate of Insurance demonstrating the required limits of coverage: 1. Anger Management/ Domestic Violence; 2. Functional Family Therapy; 3. Mental Health Services— Psychological Evaluation; 4. Monitored Sobriety Only; and 5. Multisystemic Therapy. If awarded, North Range agrees to enter into a contract with the Weld County Department of Human Services and comply with all requirements of the contract. Sincerely, tr. /V Larry D. ttorff Executive irector Enclosures ,. • 4x. Y' t Where hope begins. ft NORTHoRAL HEALTH RANGE March 18, 2014 Tobi Vegter Core&Contracted Services Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Anger Management/Domestic Violence services program area. We propose to provide these services to male and female adults age 18 and older at North Range's adult outpatient site, 1260 H Street, Greeley. All services will be provided by academically qualified and/or licensed/ DV approved staff as evidenced by the attached resumes and certification /licensure information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions,please do not hesitate to contact me. Sincerely, Laura ays, LPC, N , Program Director-Adult Outpatient- 970-347-2357 Laura.hays@northrange.org Enclosures Where hope begins. 974 NORTHoRAL HEALTH RANGE March 19,2014 Tobi Vegter Core&Contracted Services Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Functional Family Therapy services program area, We propose to provide these services to male and female youth ages 11-17 at North Range's youth and family site, 1300 N. re Avenue, Greeley. All services will be provided by academically qualified and/or licensed staff as evidenced by the attached resumes and certification / licensure information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincerely, Rebecca Wyperd, LP 1 (l Program Director—Youth and Family Services 970-381-3578 rebecca.wyperd@northrange.org Enclosures :` - 5 ' Where hope begins. NORTH RANGE gu BEHAVIORAL HEALTH March 19, 2014 Tobi Vegter Core Et Contracted Services Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Dear Tobi: North Range Behavioral Health (NRBH) is submitting this contract proposal for the mental health services option, to provide diagnostic/therapeutic services to assist the Department of Human Services, Child Welfare, in developing the family services plan, and to assist the families that are serviced to improve family communication, functioning, and relationships. NRBH is proposing to provide psychological/behavioral health evaluations that involve an integrated assessment of mental health and substance abuse issues. Evaluation results can be useful in the development of treatment plans, placement options, and decisions regarding reunification of families through quality and cost effective behavioral health evaluations. Services to be provided under the terms of this contract by North Range will be provided, at a minimum, by an academically qualified, doctorate candidate under the direct supervision of a licensed clinical psychologist. Evaluators will also be competent in the evaluation of substance abuse issues and supervised by a CAC III or LAC supervisor. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and service time frames. Costs of services are proposed under a four-tier flat rate option to assist in meeting the varied needs of the Department. If desired, NRBH is also available to meet with the Department of Human Services staff to explain the program, time lines of response to referrals, and answer questions to enhance the program. Sincerely, Maureen f, Ph.D., Licen chologist, CAC III Program Director 970-313-1186 e NORTH RANGE 1 BEHAVIORAL HEALTH March 18,2014 Weld County Department of Human Services 315B N.11th Avenue PO Box A Greeley,CO 80631 Dear Ms.Vegter, North Range Behavioral Health Is respectfully submitting a bid for consideration as a monitoring services provider. North Range is able to provide services on a 24 hour a day,7 day a week basis at our facility located at 1140 M street and in addition,we have a fairly broad range of times at our South County facility located at 145 l'Street. The staff members who work at these two sites come from various backgrounds and education levels; many have a Certification in Addiction Counseling and have been working in the field for a number of years. North Range Behavioral Health takes pride in the services that we are able to provide to clients of all ages and we will continue to strive to meet the needs of the community. If you have further questions or concerns,please do not hesitate to contact me at 970-347-2352. Thank you for your consideration of our bid. Sincerely, — Amanda Springer, LPC,CACIII North Range Behavioral Health Program Director of Crisis Stabilization Services 1140 M Street Greeley,CO 80631 970-347-2352 a tom,., Where hope begins. , m , r u 11nn Alnrth 171, [Wan.te• . Crnnlm, inn ➢rtC21 • b7/1_ad7_717n . au...AInrN.bsnnn nrn ; °.v g4NORTH oRAL HEALTH RANGE March 19, 2014 Tobi Vegter Core &Contracted Services Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Multi-Systemic Therapy services program area. We propose to provide these services to male and female youth ages 12-17 at North Range's youth and family site, 1300 N. 17th Avenue, Greeley. All services will be provided by academically qualified and/or licensed staff as evidenced by the attached resumes and certification / licensure information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincerely,(th , rre_AJZ UPC—i Rebecca Wyperd, C Program Director—Youth and Family Services 970-381-3578 te �"'� rebecca.wype rd @ no rth ra nAe.o rR Enclosures .' Nye¢. Where hope begins. North Range Behavioral Health 2014-15 Anger Management/Domestic Violence Attachment to Provider Information Form(Proposal Cover Sheet) Weld County Department of Human Services Contracted Services—Program Year 2014 - 15 PROPOSED SCOPE OF SERVICES and FEES SCOPE OF SERVICES 1. CON 1_RACTOR will provide Anger Management and Domestic Violence services to males and females, 18 years and older,in Greeley. 2. CONTRACTOR will provide the following services under this contract: Anger Management • Group Process and Skills (Minimum 20 Weeks of Treatment) • Cognitive-Behavioral Skills • Passive,Aggressive and Assertive Domestic Violence (Length of treatment will comply with Behaviors Domestic Violence Offender Management Board • Victim Empathy [DVOMB] regulations based on placement criteria for • Treatment Goals treatment levels A,B or C.) Track(level)is determined by assessment with DV approved screening tools: • Substance Abuse • Track A—one group session a week: duration— • Stages of Change minimum of 2 treatment plan reviews taking place • Parenting every 2-3 months - depending on progress on the • Men's Issues /Women's Issues (as required*Core Competencies applicable) • Track B—one group session a week/one • Effects on Children(DV only) additional contact a month: duration—minimum • Steps to Problem Solving of 3 treatment plan reviews taking place every 2-3 • Steps to Conflict Resolution months -depending on progress on the*Core • Characteristics of Assaultive Adults Competencies • Attitudes Toward the Opposite Sex • Track C—one group session a week/one • Sex Role Training additional contact per week: duration—minimum of 3 treatment plan reviews taking place every 2-3 • Socio-cultural Basis for Violence months -depending on progress on the*Core • Provocation Competencies • Appropriate Containment and Additional contacts will be in a group or individual setting Expressions of Anger depending on the clinical need. • Experiencing Emotions and Feelings Beyond Anger Monitoring UAs/BAs: When assessed to be appropriate • Grief and loss • Depression and Anxiety *CORE COMPETENCIES—per DVOMB Regulations • Stress Management A. Commitment to eliminate abusive Behavior • Relapse / Recidivism Prevention B. Personal Change Plan work—Demonstrate change • Healthy Relationships C. Complete the Personal Change Plan Worksheet • Sexuality D. Recognize and demonstrate Empathy • Spirituality E. Accept full responsibility for the offense and abusive • Resources history F. Identify and reduce pattern of power&control behaviors,beliefs and attitudes of entitlement G. Accountable for abusive behaviors,acce t 1 North Range Behavioral Health 2014-15 Anger Management/Domestic Violence Attachment to Provider Information Form (Proposal Cover Sheet) consequence, take steps to reconciliation to prevent future abusive behaviors H. Accept that abusive behavior should have and has consequences I. Participate and cooperate in treatment J. Ability to define types of DV K. Understand,identify,&manage own pattern of violence L. Understand intergenerational effects of violence M. Understand&use of healthy communication skills N. Understand&use time outs O. Recognizes financial responsibilities as required P. No new violence or abusive offenses Q. Prohibited from purchasing,possessing,or using firearms&ammunition 3. Anger Management and Domestic Violence intakes will be completed with recommendations before the client is placed into treatment. The intake will determine the best placement for the client in regards to treatment,which may include group sessions and/or individual sessions. Individual sessions will only be utilized under one or more of the following circumstances: a. The referred client's individual treatment needs cannot be adequately addressed in a group setting. b. The client is not currently appropriate for a group setting and requires a limited number of individual sessions to prepare for a group setting. c. The client's job requirements make it impossible to attend regularly scheduled group sessions and individual sessions are the only option for the client to comply with their treatment plan. d. When assessed for a DV track in which an additional contact is required. If the client is assessed at a higher level of care than this agency offers, the client will be recommended to enroll into Domestic Violence treatment at an agency in the community that provides that level of care,i.e. Perklin. 4. CONTRACTOR will comply with the Colorado Domestic Violence Offender Management Board's Standards and Guidelines. 5. All therapists providing services will receive Trauma Informed Care training within 90 days of acceptance of this contract,and will provide the Department of Human Services with training certificates for proof of attendance. FEES Fees for Services $200.00/Episode (Anger Management or Domestic Violence Evaluation) $25.00/hour(Group Session) $17.50/15 Minutes (Individual Session) $17.50/15 minutes (Court Testimony including travel,wait,&prep time) 2 NRBH-CORE SERVICES CONTRACT 2014.2015 North Range Behavioral Health Scope of Service—Functional Family Therapy (FFT) 1. General Description of Contractor,including target population, area served,and program being proposed. Contractor has offices in Greeley, CO and in Fort Lupton, CO, and provides in-home, evidence-based,therapeutic services in accordance with National Functional Family Therapy(FFT) standards to male and female youth approximate ages 10-17, within Weld County. 2. Type of service, brief description and rate for each proposed service. Description of service should include any assessment tools or specific practices used in the provision of that service. All services are overseen/supervised by a licensed professional and FFT National Consultant Functional Family Therapy Age Range: --10— 17 years Gender Criteria: Both Male and Female clients served Goals: Empower families with the skills and resources needed to independently address the difficulties they are having raising their children;Empower youth to cope with family,peer, school, and neighborhood problems;Build community and natural support systems; Decrease negativity and blame among family members;Decrease anti-social behavior to include legal contacts,truancy and substance abuse issues. Length of Treatment: 2—6 months, I -2 hours per week Primary Intervention Type: As clinically appropriate: Family Interventions, Cognitive/Behavioral,Family Therapy, School and Community based interventions,and substance abuse intervention. Special Services: Bi-lingual therapist;Case Management, School Interventions, Advocacy,Court/Staffing Participation; Sustainability Planning; Booster services after discharge. Monthly Cost: $700.00 per month/per family,pro-rated for partial month NRBH-CORE SERVICES CONTRACT 2014-2015 Inclusionary Criteria: Child must be at risk of out of home placement or transitioning back from placement within 30 days; Child is displaying moderate to severe behavioral problems in the home/school/community; Child is involved in criminal behaviors to include substance abuse;Child demonstrates verbal and/or physical aggression at home/school/community; Child is engaged with deviant peer group;Child is struggling with school behaviors to include failing grades,truancy and anti-social behaviors;Family has persist conflict and negative child-parent relationship;Caregiver is abusing substances; Family has limited resources and would benefit from psychoeducation and parenting skill development. -Maximum Program Capacity: 40 45 youth Referral Process/Timelines: Referrals must be made to program supervisor for review on approved FFT referral form. Each referral is considered within one week and clients are accepted based on problem severity/risk and therapist availability. Special Assessments/Practices: Use of FFT approved assessments as indicated by licensing agreements and FFT consultant directives including pre,post,and intermittent assessments(provided upon request). Trauma Focused Training: Integrative Treatment of Complex Trauma for Adolescents(ITCT-A)-February 2014 Trauma-Focused Cognitive Behavioral Therapy(TF-CBT)-July 2014 Dialectical Behavioral Training for Adolescents(DBT)-March 2014 3. Fees for Services Monthly cost is$700.00 per client/family,pro-rated for partial month services. 4. FFT Outcomes in Weld County Impact to the County Prior to Treatment • All youth receiving FFT services had at least one risk factor of:At risk of out of home placement, returning from out of home placement, legal involvement,and/or school problems prior to admission Current Year of FFT in Weld County(3/1/2013 -3/1/2014) Outcomes after completing FFT Treatment(N=76 cases completed) • 94%of youth living in the home • 97%in school or working • 91%with no new arrest or legal involvement Past years of FFT in Weld County(1/1/2010—3/1/2014) Outcomes after completing FFT Treatment(N=267) • 96%of youth living in the home • 94% in school or working • 86%with no new arrest or legal involvement NRBH CONTRACT PROPOSAL NORTH RANGE BEHAVIORAL HEALTH MENTAL HEALTH SERVICES: PSYCHOLOGICAL/BEHAVIORAL HEALTH EVALUATIONS SCOPE OF SERVICES Contractor Description: North Range Behavioral Health (NRBH) is the community behavioral health center serving Weld County, Colorado. We are a private, non-profit corporation dedicated to providing professional, culturally competent behavioral health services to the residents of our area. Target/Eligible Population The target/eligible population includes child welfare family members referred by the Department of Human Services due to risks of out-of-home placement and who are in need of possible behavioral health services. Services to be provided under the terms of this contract by North Range will be provided, at a minimum, by an academically qualified, doctorate candidate under the direct supervision of a licensed clinical psychologist. Evaluators will also be competent in the evaluation of substance abuse issues and supervised by a CAC III or LAC supervisor. NRBH can assist the Weld County Department of Human Services by delivering psychological/behavioral health evaluation services for children, adolescents, and families involved with the Child Welfare system. Evaluation results can be useful in the development of treatment plans, placement options, and decisions regarding reunification of families through quality and cost effective behavioral health evaluations. Type of Services. Description of Services, & Rates: FOUR-TIER FLAT RATE PSYCHOLOGICAL EVALUATION OPTIONS Level 1: Behavioral Health Evaluation Cost: $250.00 Est. Time: 3-6 hours Example: 1. Review of DSS case records,and if applicable NRBH records. 2. Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). 3. Possible administration of brief screening inventories (e.g., Beck Inventories, State-Trait Inventories, Personality Assessment Screener). DHS Contract-2014-2015.doc Page 1 of 4 NRBH 4. Feedback given to the client. 5. Written report addressing relevant psychosocial history, diagnostic formulation, and treatment recommendations. The Behavioral Health Evaluation can be useful for ruling in/out basic mental health and substance abuse issues, advising on provisional diagnoses, and making recommendations for treatment when appropriate. Level 2: Partial Psychological Evaluation Cost: $800.00 Est. Time: 8-14 hours Example: 1. Review of DSS case records, and if applicable NRBH records. 2. Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). 3. Administration of a partial test battery, such as administration of just cognitive or just personality testing (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, test results, diagnostic formulation, and treatment recommendations. This evaluation can be useful for ruling in/out mental health, substance abuse, cognitive, and/or personality issues, advising on diagnoses, and making treatment recommendations. Level 3: Full Psychological Evaluation Cost: $1200.00 Est. Time: 16-20 hours Example: 1. Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports, medical records, and records from other agencies involved in the case. 2. Extensive integrated clinical evaluation(multiple sessions). 3. Administration of a formal battery of tests (multiple tests) to assess personality, emotional, and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, substance abuse, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant behavioral health issues and diagnoses, as well as addressing personality issues, intellectual DHS Contract-2014-2015.doc Page 2 of 4 NRBH functioning, the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues, and treatment recommendations. Level 4: Extended Psychological Evaluation Cost: $1800.00 Est. Time: 20- hours Example: • This level is intended to be utilized when impairment in cognitive functioning is suspected/known, when the client is unable to read or write, when there are major memory deficits, when resistance leads to invalid measures and instruments need to be re-administered, and/or when other significant barriers to testing are present. • Preauthorization is required by WC DSS Administrative Directors prior to requesting or proceeding with this level of evaluation 1. Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports, medical records, and records from other agencies involved in the case. 2. Extensive integrated clinical evaluation (multiple sessions). 3. Administration of a formal battery of tests (multiple tests) to assess personality, emotional, and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant mental health and substance abuse issues and diagnoses, as well as addressing personality issues, intellectual functioning,the ability to manage emotions,parenting issues and potential safety of the children in the home,placement issues, and treatment recommendations. Partially Completed Evaluations When an evaluation is only partially completed,the charge will be the lower of the following: • $120.00 per hour • The cost of the next lower level of evaluation Partially completed evaluations will come with a written report of any finding that can be appropriately offered based upon the information that was gathered. Other Services: $120.00 per hour • Court Facilitation Meetings • Court Testimony DHS Contract-2014-2015.doc Page 3 of 4 NRBH • Case Conferences All services will be provided by an NRBH provider at an NRBH location or another suitable location(e.g.,client's home, school, detention center), depending on circumstances. All services will be referred via email by the Core Services Specialist. The referral authorization level will be clearly stated on the referral. Any supporting documentation available via email will be sent with the referral. The initial referral will be for either: a Behavioral Health Evaluation; a Partial Psychological Evaluation; or a Full Psychological Evaluation. If the caseworker wishes to refer for a Behavioral Health Evaluation, and authorizes a full evaluation if necessary, a notation approving this will be provided in the"narrative" section. Otherwise,prior to North Range continuing with a full evaluation, a one-page summary of the reasons why this recommendation is being made must be sent to the Core Services Specialist, and an authorization to continue from the Core Services Specialist will be needed to continue further. The Core Services Specialist will consult with the Child Protection caseworker and/or their supervisor regarding authorization. Referrals will contain start and end dates for payment authorization. Only services provided within those authorization dates will be paid by the Department. Any services provided outside those dates will be denied for payment. Service Time Frames 1. Evaluations, through a written report,will be completed within forty-five(45) days from the point of first contact with the client, provided that the client can be reached for appointments and the client attends appointments as scheduled. 2. Deadlines may be extended by the Department of Human Services on behalf of North Range when clients cannot be found or reached. 3. If a client partially complies with appointments,North Range will write the evaluation based on information obtained up to that date and prorated based on hours performed by North Range. If no appointments have been made, the evaluation referral may be dropped by North Range due to the client's failure to follow through and North Range will not bill the Department of Human Services. North Range agrees to: 1. Be available to meet with the Department of Human Services staff to explain the program, time lines of response to referrals, and answer questions to enhance the program. 2. Be available for the Families, Youth and Children Commission review and attendance at the FYC meeting, if requested. Termination This Agreement may be terminated at any time by either party given sixty(60)days written notice. DHS Contract-2014-2015.doc Page 4 of 4 North Range Behavioral Health 2014-15 Monitored Sobriety Services Attachment to Provider Information Form(Proposal Cover Sheet) Weld County Department of Human Services Contracted Services— Program Year 2014-15 PROPOSED SCOPE OF SERVICES and FEES SCOPE OF SERVICES Contractor (North Range Behavioral Health) will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: a. Services will be provided at the North Range Behavioral Health - Crisis Stabilization Services facility at 1140 M Street in Greeley, Colorado, and at 145 1't Street in Fort Lupton, Colorado. b. Contractor will provide a qualified monitored sobriety collector 24 hours a day/seven days a week at the Greeley site. At the Fort Lupton site, the Contractor will provide a qualified monitored sobriety collector Monday through Thursday from 9a.m. to 12:00 noon and 1p.m. to 4:30P.m. for UAs; 8a.m. to 12:00 noon and 1p.m. to 7p.m. for BAs; and on Friday from 9a.m,to 12:00 noon for UAs, and 8a.m. to 12:00 noon and 1p.m. to 5p.m. for BAs, with no services at this site on Saturday and Sunday. c. Contractor will confirm all positive and negative monitored sobriety results for a BA within 24 hours through a phone call, test result, e-mail, and/or fax to the referring caseworker. Contractor will confirm all positive and negative monitored sobriety results for lab UA's once processing has been completed through Redwood, typically within 3 days. Instant UA results will be reported within 24 hours. If the'result is positive, the result will be sent to Redwood for final confirmation. d. Contractor will submit a copy of the valid Authorization for Services form, result, and client sign in sheet (if applicable) with each monthly billing. e. All processed test results, will be available online 24 hours a day, seven (7) days per week at Redwood Toxicology (www.webtoxicoloov.com). FED $20.00/Episode (Urinalysis Test— 5 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates) $20.00/Episode (Urinalysis Test—7 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates, Barbiturates, Alcohol) $20.00/Episode (Multi-panel Instant UA) $20.00/Episode (Instant Swab) $35.00/Episode (GCMS—Confirmation of Positive Result) $5.00/Episode (Breathalyzer) $100.00/Episode(Hair Testing) $50.00/Episode (Patch Monitoring) $35.00/Episode (Ethyl Glucuronide/EtG Test) $50.00/Episode (UA— Expanded Designer Stimulants— 14 Panel) $35.00/Episode (UA— MDPV, Mephedrone, Methylone—3 Panel) $35.00/Episode (UA— Synthetic Cannabinoids—"Spice") $35.00/Episode (Oral Swab—Synthetic Cannabinoids—"Spice") $2.00/Episode (UA - Single Panel EtG Add-on Test—Only When Added to a 5 or 7 Panel UA) $2.00/Episode (UA - Optional Add-on Panel (Oxycodone or Buprenorphine) —Only When Added to a 5 or 7 Panel UA) NRBH-CORE SERVICES CONTRACT 2014-2015 North Range Behavioral Health Scope of Service—Multisystemic Therapy (MST) 1. General Description of Contractor, including target population, area served, and program being proposed. Contractor has offices in Greeley, CO and in Fort Lupton, CO, and provides in-home, evidence-based, therapeutic services in accordance with National Multisystemic Therapy (MST) standards to male and female youth approximate ages 12-17, within Weld County. 2. Type of service,brief description and rate for each proposed service. Description of service should include any assessment tools or specific practices used in the provision of that service. All services are overseen/supervised by a licensed professional and MST National Consultant Multisystemic Therapy: Age Range: —12— 17 years Gender Criteria: Both Male and Female clients served Goals: Empower caregivers with the skills and resources needed to independently address the difficulties they are having managing their children; Empower youth to cope with family, peer,school,and neighborhood problems;Build community and natural support systems;Decrease anti-social behavior. Length of Treatment: 2—5 months, 3—5 hours per week Primary Intervention Type: As clinically appropriate: In-home Caregiver Interventions, Cognitive/Behavioral, Family Therapy, Individual therapy, School and Community based interventions. Special Services: 24/7 on-call services,Case Management, School Interventions, Advocacy,Court/Staffing Participation, Sustainability Planning. Monthly Cost: $1800.00 per month/per family, pro-rated for partial month Inclusionary Criteria: Child must be at risk of out of home placement;Child returning from placement;Child involved in criminal behavior; Persistent family conflict; Child and or Caregiver is abusing substances; Behavior is chronic; Child is engaged with deviant peers; Child is struggling at school; Family has few resources; Parents would benefit from psycho-education and skill development; NRBII-CORE SERVICES CONTRACT 2014-2015 Child is displaying moderate—severe behavior problems. Maximum Program Capacity: 20-30 youth Referral Process/Timelines: Referrals must be made to program supervisor for review. Each referral is considered within one week and clients are accepted based on problem severity and therapist availability. Special Assessments/Practices: Use of MST approved assessments as indicated by licensing agreements and MST consultant directives (provided upon request). Trauma Focused Training: Integrative Treatment of Complex Trauma for Adolescents(ITCT-A)-February 2014 Trauma-Focused Cognitive Behavioral Therapy(TF-CBT)-July 2014 Dialectical Behavioral Training for Adolescents(DBT)-March 2014 3. Fees for Services $1800 per month/per client/family, pro-rated for partial month services. 4. MST Outcomes in Weld County (2005-2013) Impact to the County Prior to Treatment(N=231) • 60%with out of home experience before admission • 34%with juvenile detention before admission • 80%with multiple/chronic disciplinary problems in school; 12%passed most classes • 69%with legal involvement; 56%with more than one type • 31%arrested for crimes against a person • 100%with mental health problems; 87%with more than one • 47%with problems resulting from drug use; 37%with problems related to alcohol use Outcomes after receiving MST Treatment (N=231) • 93%decrease in the most common out of home situations, including residential treatment, inpatient psychiatric care, and detention • Significant improvement in school functioning • Significant reductions in legal issues • Significant reductions in mental health and substance abuse symptoms and problems • Significantly improved ratings of youth and family functioning NRBH MST Program Implementation Data Report(Report Period: 3/1/2013 -2/28/2014) Ultimate Outcomes after receiving MST Treatment(N=45) • 93.3%of youth living at home • 95.6%of youth in school/working • 95.6%of youth with no new arrests NRBII-CORE SERVICES CONTRACT 2014-2015 Instrumental Outcomes after receiving MST Treatment(N=451 • 95.6%of caregivers with parenting skills necessary to handle future problems • 100%of families with improved family relations • 97.8%of families with improved network of supports • 93.3%of youth with success in educational/vocational setting • 91.1%of youth involved with prosocial peers/activities • 93.3%of cases where changes have been sustained gird 7 NORTH RANGE rd BEHAVIORAL HEALTH July 11, 2014 Heather Walker Child Welfare Division Director Weld County Department of Human Services 315 A. North 11th Ave. Greeley, CO 80631 Dear Heather NRBH is committed to supporting Weld County's implementation of the Colorado IV-E Waiver Demonstration Project. The provision of trauma assessment and focused,evidence-based treatment services to children and youth who have screened positive for trauma exposure and reactivity are critical to the project and NRBH is pleased to partner with Weld County Department of Human Services to ensure these are available in our community. We recognize that many of the children and youth who are referred for trauma services related to the IV-E Waiver will have Medicaid benefits to fund medically necessary services. Others may have commercially available health insurance plans which may fund their care. In some cases,there will not be readily available resources and it is on behalf of those children/youth and their families that North Range Behavior Health is submitting this request to expand its CORE contract with Weld County Department of Human Services. Please feel free to contact me with any questions related to this request or for more information. My direct phone line is:970-347-2413. Sincerely, Susan E. R. Stone Administrative Director:Children,Youth, Family& Prevention Where hope tic t r71NORTHoRANGE BEHAVIRAL HEALTH Request to Amend CORE Contract with Weld County DHS Pursuant to IV-E Waiver Demonstration Project Related Mental Health Services Pursuant to the trauma-focused provisions of the Colorado IV-E Waiver Demonstration Project Implementation Plan, North Range Behavioral Health(NRBH) proposes to provide mental health and trauma assessment, trauma-informed/focused treatment, and required outcomes feedback to Weld County OHS. Funding for the provision of services to children and youth who do not have Medicaid benefits or other appropriate health insurance benefits are the focus of this request to amend NRBH's current CORE Contract. Scope of Service • Target Population: Children and youth, aged 0—18,with open DHS cases and who have screened positive for trauma on the Southwest Michigan Children's Trauma Assessment Center Screening Checklist. CORE funded cases must be referred by Weld County DHS. • Location and Hours of Service: Services will available at all child and youth serving NRBH offices. These include 1300 N. 17" Avenue (Main), 2350 3rd Street Road (The Littler Prevention Campus), 515 13`"Avenue in Greeley (The Tom Roche Center, aka Intensive Adolescent Services), and at 145 1"Street, in Fort Lupton. In certain cases, assessments might be conducted in-home,a community-based setting,or in another setting due to the needs and dynamics of the family. Assessments will be conducted by appointment,8:00—5:00, Monday through Friday and as arranged in limited specific cases requiring special scheduling. • Capacity: Up to 60 cases annually. This is based on historic Weld County demographic assumptions. However,with the implementation of health care funding reform, this can only be an estimate of the number of cases who may present without Medicaid or other funding resources. • Service Description o Assessment 1. The Trauma Symptom Checklist for Young Children, applicable to children ages 3-7, will be administered to children ages 3—6 by early childhood mental health trained clinicians. 2. The Child PTSD Checklist,applicable to children and youth ages 7—18,will be administered to children/youth ages 7— 18. 3. A Trauma/Loss Exposure History, developed by NCTSN,will be completed for all children and youth. o Treatment Treatment will be recommended based on the child/youth's clinical presentation. Evidence-informed and Evidence-based Trauma-informed/focused interventions which are consistent with the IV-E Waiver Demonstration Project Implementation Plan will include: 1. TF-PCIT(Trauma Focused Parent Child Interaction Therapy): Interactive dyadic therapy, with parental couching regarding interaction and development. Evidence- based therapy;weekly sessions, approximately 12 months. Ages 2—7. 2. TF-CBT(Trauma-Focused Cognitive Behavioral Therapy): Intervention includes desensitization,coping skills building, family communication skills building, and safety enhancing interventions. Ancillary services are often used to bolster treatment,with maintained fidelity. Evidence-based therapy;approximately 16 weekly sessions(excluding ancillary services). Ages 3—18. 3. DBT(Dialectical Behavior Therapy)for Adolescents: Works to identify and treat depression,at risk behaviors, suicidal ideation and attempts, substance use, aggression,and other issues. Evidence-based therapy. Once weekly and open ended. Ages 12—18. 4. Psychotherapy to ready the child/family for trauma specific services: Individual, family and/or group psychotherapy and ancillary services (e.g. medication)to stabilize high acuity or complex cases via the provision of coping skills and safety enhancing treatment. The recommendation for such treatment would be discussed with DHS prior to service provision. Rate Schedule • Mental Health Assessment, Including Age-appropriate Trauma Assessment $200.00 each • Treatment $ 70.00 hour • Feedback to DHS, per IV-E Waiver Demonstration Project Implementation Plan Included Contact for this funding request: Susan Stone,Administrative Director:Children,Youth and Family Services 970-347-2413 Susa n.sto ne(t north ra nge,org Authorized Signatory: 7// La Pottorff, SW t1 Date Executive Dir r Laura L. Hays, M.A., CAC III, LPC Current Clinical Position: North Range Behavioral Health—Adult Outpatient/BASIC Program Director—Greeley, Colorado July, 2008 - Present Island Grove Treatment Center—Outpatient Program Manager- Greeley,Colorado November, 2005 -July, 2008 ************* Island Grove Treatment Center—Clinical Coordinator- Greeley, Colorado May, 2003 —November,2005 Island Grove Treatment Center—Outpatient Bilingual Counselor- Greeley, Colorado May, 2000—May, 2003 Professional Certifications: Colorado State: *Chemical Addiction Counselor, Level I - January, 2001 *Chemical Addiction Counselor, Level II - December,2001 *Chemical Addiction Counselor, Level HI - May, 2003 *Approved Domestic Violence Provider -April, 2004 *Licensed Professional Counselor -June, 2007 *EMDR Trained Counselor - September,2007 The Wellness Institute,Washington (1995-98) *Certified Clinical Hypnotherapist *Certified Advanced Clinical Hypnotherapist *Certified Release Therapist Education: Master in Community Counseline/Marriage & Family - University of Northern Colorado, Greeley,Colorado - 2003 Bachelor in Human Services/Counseling- Western Washington University; Bellingham, Washington- 1994 Associate in Arts & Science Degree-Bellevue Community College; Bellevue, Washington- 1992 Associate/Legal Secretary Degree- Lewis-Clark State College; Lewiston, Idaho— 1977 Frperience/Internships: Youth & Family Services Counselor -Island Grove Community Counseling Center, Colorado (May, 2002 -May, 2003) Duties: Facilitate counseling sessions with families and individual adolescents. Crisis intervention,charting, case management, treatment plans Private Counseling Practice-offices in Lewiston,Grangeville, &Kooskia, Idaho(1998 99) Duties: Crisis intervention, charting, case management,treatment plans, correspondence, discharge summaries, &day-to-day operations of practice Clinical Counselor Assistant- Jodi Cook's Counseling, Washington (1993-94) Duties: Case management, charting,&assisting in day-to-day operations of practice Educational/Counselor Assistant-Maple Hills Elementary, Washington(1992-93) Duties: Attended staff meetings,crisis intervention, & individual counseling as needed BoliviaSantaCruz Mission(Span2n°lang)—ChurchofJesusChristofLatter-DaySaints (1978-79)Duties:Taught day-to-day skills to improve the native people's lives • STATE OF COLORADO Department of Regulatory Agencies Division of Professions and Occupations Active PRINTED ON SECURE PAPE ACC ACC.0005513 0901/1013 08(3111015 Number Issue Date Expire Date Laura L Hays Greeley CO 80631 I i,. . I Division Director Signature STATE OF COLORADO Department of Regulatory Agencies Division of Professions and Occupations PRINTED ON SECURE PAPE Active IPC Number 0004561 I 08012013 09/3112015 {I Issue Date Expire Date Laura L Hays Gree(�yyj� �y.�,/i.w..C�OO 80631 Divisions Director I Signature Abbey Keeney LPC CAC II EDUCATION& LICENSURE Master of Science in Counseling Psychology,Northeastern University, Boston MA 2003 Bachelor of Arts in General Psychology, University of Colorado, Boulder CO 2000 ** Licensed Addiction Counselor—pending MAC Exam only,all classes complete EXPERIENTIAL HIGHLIGHTS • Administrative and leadership skills • Familiar with CAQH database&joining insurance panels • Comfortable with insurance process for authorizations&online billing • Strong communication skills with collaterals from all professional levels • Organized, efficient, determined, knowledgeable,capable • Timely, clear,professional documentation • Supervision of staff administratively& clinically • Extensive individual, family and group clinical experience • Thorough and timely assessments, evaluations, and diagnostic skills • Compassion and education around cultural issues • Crisis centered interventions • Emergency room, inpatient, residential,outpatient experience • Electronic Faxing, email encryption, HIPAA compliance • Employee Engagement& Staff Satisfaction Committee PROFESSIONAL CLINICAL EXPERIENCE Compass Counseling Services, LLC (Loveland,CO) Independent Private Practice&Business owner 02/2010—Present • Profitable independent private practice • Conduct all insurance authorizations&billing • Self management of paperwork, client issues, scheduling • Private office management, decoration,and facility maintenance North Range Behavioral Health(Greeley,CO) Program Coordinator for the Adult Outpatient Program 04/2012—Present • Program enhancement(Same Day Access, Feather Awards, Mail Merge, New Hire Training Manual (in process)) • Supervision of LPC candidates as well as graduate level internship students • Report management for clinicians • Regular chart auditing, familiar with state requirements • Responsible for individual client caseload,treatment planning,and productivity • Created efficient new mail merge system for monthly letters and evaluations Licensed Behavioral Health Specialist for Adult Outpatient Program 11/2006-04/2012 • Licensed therapist responsible for full caseload,range of clients • Timely&accurate documentation in electronic medical record • Exceeded productivity requirement every year • Group, Individual,and Couples Therapy • Multiple electronic system reporting;CMHC, Signal, TMS,CWise • Collateral communication with multiple community agencies Intensive Care Coordinator 08/2005 - I 1/2006 • Monitored all Weld County Medicaid Hospital Admissions in State ofCO • Managed disposition of each patient as well as connection to services • Communicated efficiently with current provider • Facilitated interagency meetings for high risk clients • Close work with State Hospital • Residential Assessments for youth Poudre Valley Health Systems (Fort Collins,CO) Care Coordinator at Mountain Crest Hospital 03/2008- 12/2009 • Coordination of care for inpatient unit • Discharge planning and family meetings • Communication with external agencies and insurance companies • Therapy on inpatient unit,crisis driven, solution focused • Collaboration& communication with staff psychiatrists and inpatient staff Crisis Assessment Center Behavioral Health Specialist 03/2006- 12/2009 • Emergency room evaluations • Insurance authorizations if admission needed • Disposition planning with hospitals, family, community resources • Mental Health and Substance Abuse Holds • Collateral communication with emergency department staff Health and Education Services (Beverly, MA) Emergency Services Pre-Screener 02/2004-07/2005 • On call team member for 4 Hospital Emergency Rooms • Emergency room evaluations • Disposition planning&communication with collaterals Riverview Program Diagnostic Therapist 09/2003 -08/2005 • Residential program for Adolescent Females • Individual,group&family therapist • Diagnostic Evaluations for clients Consulting Therapist Homeward Bound Program 09/2003 -03/2004 • Residential program for Adolescent Males • Short term support during staffing problems • Individual and family therapy McLean Hospital(Brighton, MA) Internship at Franciscan Children's Hospital Kennedy Hope Academy 02/2002 -06/2003 • Behavioral support for clients on unit • Unit reserved only for Autism Spectrum Clients • Group Therapy and social skills development Print Lookup Details Page 1 of 1 /� r r � j ��I� Barbara J.Keller t Executive Director ` leto / Departmem or Regutaxy*geodes Lookup Detail View Licensee Information This serves as primary source verifkation`of the license. *Primary source verification:License information provided by the Colorado Division of Profess!ons and Occupations,established by 24-34.102 C.R.S. Name Public Address Abbey George Keeney 1260 H Street Greeley, CO 80631 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date LPC.0004161 Endorsement Licensed Professional Active 11/09/2005 09/01/2013 08/31/2015 Counselor Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/13/2014 9:56:52 AM Print Lookup Details Page 1 of 1 e r , Drikra Barbera J.Kelley �^Executive Directors. �' . Department ofxegulatoryAgencies Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24.34-102 C.R.S. Name Public Address Abbey George Keeney 1260 H Street Greeley, CO 80631 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACB.0007294 Original Certified Addiction Active 11/08/2010 09/01/2013 08/31/2015 Counselor Ii Board/Progam Actions Discipline There is no Discipline or Board Actions on rile for this credential. Generated on: 3/13/2014 9:56:40 AM Fazio, I of 3 Annie Fazio, M.A. 2647 12th Avenue Ct Greeley, CO 80631 anniefazio@gmail.com 515-208-4489 EDUCATION M.A. University of Northern Colorado Graduated: August, 2012 Concentration: Clinical Counseling Degree(M.A.) B.A. Metropolitan State College of Denver Graduated: May, 2009 Major: Honors in Psychology (B.A.) PROFESSIONAL WORK EXPERIENCE August 2013-Present Therapist,Adult Outpatient Program North Range Behavioral Health 1260 Fl Street Greeley,CO 80631 • Responsibilities: Provided integrated mental health and substance abuse services to a wide range of voluntary and criminally involved clients using a number of different evidence based therapeutic interventions and skills. July 2012-August 2013 Therapist,Behavioral Alternative Services in Community (BASIC) North Range Behavioral Health 1260 H Street Greeley, CO 80631 • Responsibilities: Provided integrated mental health and substance abuse services to a wide range of mandated and criminally involved clients using a number of different evidence based therapeutic interventions and skills. September 2011- August 2012 Intern,Adult Outpatient Therapist North Range Behavioral Health, Adult Outpatient Program 1260 H Street Greeley, CO 80631 • Responsibilities: Worked with a diverse group of adult clients administering intakes, individual therapy sessions, co-facilitating and facilitating group therapy sessions. Fazio,2 of 3 July 2008- September 2010 Research Assistant Metropolitan State College of Denver Worked under Dr. Aaron Richmond, Ph.D. Plaza 220 Speer Blvd. and Colfax Ave. Denver, CO 80217 • Responsibilities: Engaged in a full spectrum of research, from inception to presentation of results. Took part in the research process through writing, submitting, and presenting research. Also worked a s a leader in presenting the research at a regional and national psychology conference. May, 2007-August 2009 Psychology Department, Work Study Metropolitan State College of Denver Plaza 220 Speer Blvd. and Colfax Ave. Denver, CO 80217 • Responsibilities: Assisted faculty in educational, research, and administrative tasks. Provided information and guidance to MSCD students and employees. Also maintained and assisted in organizational tasks within an academic setting. CLINICAL TRAININGS Eye Movement Desensitization and Reprocessing(EMDR, Part 1), November 2013 Dialectical Behavioral Therapy(DBT), May 24th 2013 Trauma Focused Cognitive Behavioral Therapy (TF-CBT), June 2013 Strategies for Self-Improvement& Change(SSC), February 8a'2013 Certified Addiction Counselor(CAC) Credits Professional Ethics II Group Counseling Skills RESEARCH EXPERIENCE Fazio,A. K. (2009). Correlations between religiosity and resiliency within a college population. Independent research project,presented in Research Methods course. Richmond, A. S., Camey, R.,Fazio, A. K., Carter, V.,Hasen,N., & Conrad,L.(2009). Motivational & metacognitive predictors of mnemonic learning. Poster presentation at Rocky Mountain Psychological Association conference and MSCD Annual Undergraduate Conference(2009). Richmond, A. S., Carney, R., & Fazio,A. K. (2009). Can mnemonic training alter r • Fazio,3 of 3 metacognative and self-efficacy for memory beliefs? Poster presentation at Rocky Mountian Psychological Association conference and MSCD Annual Undergraduate Conference (2009 & 2010). Oakman, S., Fazio,A. K.,Donisi, K.,& Richmond, A. (2009). Cheating behaviors: Peer conformity, influences, and reasoning. Poster presentation at Rocky Mountain Psychological Association conference and MSCD Annual Undergraduate Conference. Richmond, A., Fazio,A.K.,Oakman, S. (2009). Can mnemonic training change need for cognition, memory for self-efficacy, and state metacognition beliefs? Richmond, A., Carney, R., Fazio,A. K.,&Oakman, S. (2009). The mnemonic keyword method applied to neuroscience: A focus on retention and higher-order thinking. Research Presentation at American Educational Research Association (AERA, 2010). PROFESSIONAL ORGANIZATIONS & GROUP MEMBERSHIP American Counseling Association 2010-Present Golden Key National Honor Society,2008 to Present Psi Chi National Honor Society, 2008 to Present Research Club, 2008 to Present Rocky Mountain Psychology Association member,2008 to Present DANIELLE SOLANO Greeley, CO 80634 720-301-9449 Dsolano901@aol.com EDUCATION Walden University Masters in Mental Health Counseling 2012- Present Westwood College 2009 Bachelor of Science,Criminal Justice Skills Communication and collaboration with agencies Resource Specialist Crisis Intervention Specialist Computer Proficient Experience North Range Behavioral Health,Greeley,CO Case Manager 2012-Present Case Management for individual's who are engaged in mental health or substance abuse treatment.Responsibilities include resources and referrals that assist and support individuals in achieving self sufficiency and stability. Youth and Family Connections/Weld County JAC,Greeley,CO 2011-2012 Case Manager Case management for at-risk youth and their families. Responsibilities included assessments with youth and parents to identify the factors influencing family functioning and academic progression. Complete referrals to community services and agencies to access additional support and services. Catholic Charities,Guadalupe Center,Greeley,CO 2011-2012 Shelter Staff Responsibilities included assisting clients and conducting the day to day operation of a 24 hour emergency shelter. As a shelter staff member I would open the facility,conduct sign-in and complete records and reports as needed. When appropriate, I would supervise the preparation and clean up of meals, chores, and facility maintenance. Gateway Battered Women's Shelter,Aurora, CO 2009-2010 Court Victim Advocate Responsibilities included advocating for victims of domestic violence in a court setting which included providing community resources for men,women and children. I also prepared children who are subpoenaed to court to testify in domestic violence trials. Initial contact with clients included interviewing and documenting physical injuries.explanation of the court process, victim rights, crisis and non-crisis counseling. 1 DANIELLE SOLANO Greeley, CO 80634 720-301-9449 Dsolano901@aol.com RELATED EXPERIENCE Colorado Organization for Victims Assistance 2007.2008 Victim Advocate Internship with the Denver City Attorney's Office Denver City Attorney's Office 2007-2008 Contract Juvenile Victim Advocate Attitude Development Services 2009 Office Manager REFERENCES Aletta Ce De Baca Personal 970.381.2653 Reference Michelle Brown Personal 303-817-7594 Reference Michael Guthrie Professional 970-351-5460 Reference Al Arriessecq Professional 970-351-7414 Reference 2 516 54^Avenue Greeley (b7O 4 05--3)< 3630 Email rnslvaCman.con Elizabeth L. Silva Education 1995-1997 University of Northern Colorado Greeley, Co. Bachelor Of Arts In Sociology,Emphasis Criminal Justice Minor Legal Studies 1993-1995 Aims Community College Greeley,Co. Associate Of Arts Liberal Arts,Criminal Justice pal 03/01-Present Adams County/17th Judicial District Probation Department, experienceBrighton,CO/FTA Position. Adult Probation Officer: Domestic Violence Offender Case Load • Supervise(Max-Med)domestic violence probationers. • Provide referrals to community resources on a case by case basis. • Maintain probation notes as established by department policy. • Compose reports and memorandum as established by department policy. • Formulate case plans for probation through a continuum of sanctions. • Conduct assessments and recommendations for sentencing to the court. • Present information verbally and in writing before the court. • Conduct home/absconder visits, work visits, &treatment agency staffings. • Provide assistance to Spanish speaking victims as needed. • Have supervised the following case loads: Sex Offenders, Drug/Alcohol Offenders, Property/Theft Offenders. 04/99-Present North Range,Greeley,CO , Part-Time Bilingual Outpatient Counselor • Screening, Intakes and Assessment of clients with required instruments in required format within appropriate time lines. • Facilitate Counseling Groups as assigned-Primarily Domestic Violence • Perform Individual Counseling as assigned • Develop written treatment plans/updates and continuing care plans and make appropriate referrals • Monitor Antabuse, Breathalyzers, and other medication as required • Case management as indicated • Complete written discharge summaries and correspondence within established time lines • Supervise a Case Load of up to 24 clients 08/99-2101 Boulder County/20t Judicial District Probation Department, Boulder Co./Contract Position. Probation Officer/Bilingual ual Case Load Adult g • Supervised (Max)probationers, Drug, Theft, Domestic Violence, & Phase III I.S.P • Provide referrals to community resources on a case by case basis. • Maintain probation notes as established by department policy. • Compose reports and memorandum as established by department policy. • Formulate case plans for administrative compliance strategies and recommend extensions or terminations of probation through a continuum of sanctions. • Conduct investigations and provide recommendations for sentencing to the court based on findings. Present information verbally and in writing before the court. • Provide victim assistance to Spanish speaking and some English. Supervised a Case Load of 140 clients, 85%Spanish speaking. 06/98-03199 Denver County Probation Denver, Co. Adult Probation Officer/Bilingual Case Load • Interviewing: Utilize knowledge of communication skills and effective interviewing techniques to elicit relevant information on individuals referred by the Court. • Research, Investigation and Recommendations: Through use of computer record systems and records provided by NCIC, CCIC and local agencies to obtain data that is pertinent to the evaluation of the individual referred. • Report Writing and Meeting Deadlines: Compile and organize data collected during the pre-sentence interview and investigation and present that information in a concise, complete and well-organized fashion as directed by department policy. • Referral to Treatment: Clients will be referred to appropriate treatment agencies considering the following elements: Court orders; treatment agencies with appropriate licensure/certification for the type of treatment needed; client treatment needs; geographical and financial accessibility for the client, greatest opportunity for client success; other unique elements related to the client or offense. • Supervised a Case Load: 350 clients/Alcohol/Drug/D.V., Spanish speaking only Bilingual Volunteer Probation Officer l9"'Judicial District 8/95-4198 Volunteer • Interviewing: Utilize knowledge of communication skills and effective interviewing experience techniques to elicit relevant information from individuals referred by the Court. • Referral to Treatment: Clients referred to appropriate treatment agencies, related to the client or offense. • Report Writing and Meeting Deadlines: Court revocation and non-compliant complaints in a complete and well organized and reviewed by Volunteer Coordinator. • Hours per week: minimum of 11 and no less. • Supervised a Case Load of 56 clients/90% Spanish Speaking Bilingual Volunteer Programs Counselor Weld County Sheriffs Department, Greeley, Co. 10/97-2/98 • Interviewing: Utilize knowledge of communication skills and effective interviewing techniques to elicit relevant information from individuals arrested and detained with in 24 hours of their arrival in to the sheriffs department. • Assessment: Determine the severity of the arrest and classify_defendants by their criminal history repot from NCIC/CCIC. • Other duties: Co-Facilitate activities, such as gym, or learning activities involving the defendants in custody. • CAC III and an Approved Domestic Violence Treatment Provider Certifications Languages Fluent in Spanish: read, write and speak References Upon Request Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com Obiective: To provide every client with empathic counseling services and advocate on their behalf. This will be accomplished by considering each client's unique circumstances and goals, and working with other professionals for the benefit of the client. Education: 2010-2013 University of Northern Colorado (Greeley, CO) Master of Arts program for Clinical Counseling Master of Arts program for School Counseling 2005-2009 University of Northern Colorado(Greeley, CO) Bachelor of Arts Degree with a GPA 3.97 Graduated Suma Cum Laude. Majored in Psychology, Minored in Sociology 2001-2005 Grandview High School (Aurora, CO) Graduated with honors Master's Level Practicum and Internship Experience: January 2013-May 2013 Internship Student at Mead Elementary School (Mead, CO) • Help individual students by meeting on a weekly basis • Lead weekly groups on issues such as divorce and social skills • Responsive services August 2012-December 2012 Internship Student at John Evans Middle School (Greeley, CO) • Help individual students by meeting on a weekly basis • Lead weekly grief and loss group • General school support and responsive services May 2012 -December 2012 Internship Student at Alternatives To Violence (Loveland, CO) • Work with clients through conducting intake appointments and individual therapy • Lead weekly DV 101 group • Help clients by consulting with other personnel about resources in the community • continued to volunteer by running group and conducting individual counseling sessions through May 2013 Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com November 2011-May 2012 Practicum II Student at Action Counseling (Denver, CO) • Work with court mandated clients in individual and group contexts • Conduct intake appointments for DUI and domestic violence clients • General office work • Helped with intake and release of patients Bachelor's Level Field Experience: Jan 2009-May 2009 (Greeley, CO) Intern at Children's Advocacy, Resource, and Education Center • Monitored children for signs of physical and mental abuse • Maintained facilities to insure the safety of the children • Lead parents and children in bonding activities May 2008-August 2008 (Greeley, CO) Intern at North Range Behavioral Health: Acute Treatment Unit • Helped direct patient's activities in groups • Monitored the status of patient's mental health • Conducted one-on-ones with individual patients Work Experience: Dec 2013- Present Mental Health Therapist at North Range Behavioral Health (Greeley, ggi • Conduct Intake appointments for substance abuse and mental health clients • Conduct substance abuse and mental health group counseling • Conduct individual counseling appointments May 2009-May 2010 Assistant to Robin Garvisch, Apartment Blue Book (Denver, CO) • Data entry • Brochure packaging • Developing brief descriptions of apartment communities for use online and in print Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com Sept 2009-Oct 2010 Sales Associate at Waloreens (Denver, CO) • Assuring customers have the experience they expect • Aided in re-stocking and inventory management • Constructed new displays and kept the department organized • Daily money and cash register reconciling Professional Memberships: Chi Si Spring 2011 Present Sigma Iota Member g Licenses and Credentials: Registered Psychotherapist in the state of Colorado Substitute authorization #69804 from Colorado Department of Education Special services provider license#82434, to serve as a school counselor, from Colorado Department of Education Nationally Certified Counselor References: Available Upon Request - M Cynthia K. Gibbens 505 33rd Street Evans,CO 80620 WORK EXPERIENCE: North Range Behavioral Health, Greeley, CO(970)347-2120 November 4, 2013 Supervisor: Laura Hays I provide assessment, treatment planning, education, individual/group therapy, case management with family members, employers, and community agencies, and discharge planning. I served clientele with mental health and substance abuse and clients with co- occurring disorders. Michaels Arts and Craft Stores, Greeley, CO(970) 353-9780 April 22, 2013 Supervisor: Pearl Smith, Cuprea Lange; Store Manager: Dino Rivera I work as a picture framer in the store frame shop and assist with customer service throughout the store. Advantage Sales and Marketing/In Marketing April 15, 2013 —October 20, 2013 Supervisor: Laci Cummings (970)212-6685 I prepared, presented,and distributed a variety of food products to store shoppers. Bass Pro Shops, Denver, CO (720) 385-3600 October, 17. 2012 —Christmas 2012 Supervisor:Nicole I was working in the Santa's Wonderland at Bass Pro Shops as a seasonal employee. Peak Wellness Center,Cheyenne, Wyoming(307) 632-9362 February 2007-April 2012 Supervisors:Natalie Milligan, Elaine Renfro, Linda Goodman I began working at PWC after taking time off following completion of my master's degree. I provide assessment with the ASI,treatment planning,education, individual/group therapy with the Matrix System, case management with family members, employers, and community agencies, and discharge planning. I served clientele with substance abuse and clients with co occurring disorders. I completed course training in Seeking Safety by Lisa Najavits and have developed a group therapy for treatment for PTSD and substance abuse following the plan described in this manual. I have also completed trainings including Traumatic/Acquired Brain Injury, Wounded Warrior, Prolonged Exposure Therapy, and EMDR basic training. Turning Point, Ft. Collins, Colorado (970) 232-3660 November 2005—February 2007 Supervisors: Colleen Timpe, Eddie Russell I completed a master's internship at Turning Point—Birch. I provided individual/group/family therapy, case management with referring agencies and family members,treatment planning, education,and discharge planning. The clientele served was adolescents with substance abuse and co occurring disorders. I also provided clinical supervision for counselors accumulating credits and hours for Certified Addiction Counselor (CAC). Harmony Foundation, Inc., Estes Park, Colorado(970) 586-4491 June 2000-July 2006 Supervisors: Roger Kirby, Debra Foster, Gary Wise, Sandi Kohtz I was a primary counselor at the Harmony Foundation,residential treatment. I managed a case load and provided assessments with the Addiction Severity Instrument (ASI), treatment planning, case management with family members, referring agencies and continuing care facilities,education lectures, individual therapy, group therapy, and discharge planning. Island Grove Regional Treatment Center, Greeley, Colorado(970) 356-6664 March 1995 —May 2000 Supervisors: BJ Dean, Bill Wendt, Frank Cohoon, Rhonda Fraser I began IGRTC as a Detox Aide and my duties were to admit,monitor withdrawal symptoms and discharge clients with appropriate referrals for treatment and recovery. I also facilitated individual and group therapy/education as well as family groups. I obtained CAC in June 1996. I began co facilitating the Intensive Outpatient Program in 1997 and administering Addiction Severity Index (ASI)to make appropriate treatment referrals for IGTC, Dept. of Social Services, and Probation Dept. I provided individual/group/family therapy and for a time was the solo IOP counselor. My duties also included treatment planning, discharge planning, and case management with referral sources, and other community agencies. Beginning in 1998 I received CAC II and had a small caseload of clients in the Transitional Residential Treatment program. I completed assessments,treatment planning,case management, education, discharge planning, and individual/group/family therapy ..r .. Cynthia K. Gibbens 505 33rd Street Evans,Colorado 80620 EDUCATION: Paris Junior College, Paris, Texas 1991 — 1993 Aims Community College, Greeley, Colorado 1994— 1995 University of Northern Colorado, Greeley, Colorado 1993 — 1998 (BA in Psychology) University of Phoenix, Westminster, Colorado 2004-2006 (Master of Community Counseling) CERTIFICATION: Licensed Addictions Counselor 2007 Colorado Certified Addictions Counselor III 2000 National Certified Addictions Counselor II 2002 - 2006 Master Addictions Counselor(NAADAC) 2007 LICENSURE: Licensed Professional Counselor(Wyoming) 2010-2012 Licensed Professional Counselor (Colorado) 10/2012 i STATE OF COLORADO • , ` Department of Regulatory Agencies STATE OF COLORADO Division of Professions and Occupations Department of Regulatory Agencies PRINTED ON SECURE PAPER Division of Professions and Occupations Active PRINTED ON SECURE PAPER Active rACD LPC I ACD.0000145 09/01/2013 09/31/2015 ! Number Issue Date Expire Date u=c.0011729 o91o1rzo13 08/3512015 Number 1 Issue Date I Expire Date Cynthia Kaye Gibbens Cynthia Kaye Gibbens Evans CO 80620 Evans CO 80620 3ce.%, Mature ijitieL S Division Director 19 i Division Director Sign ure I ._ CURRICULUM VITAE Duane F. Barone,MA Caledonia Counseling PO Box 1989,Parker,Co 80134 Tel: 303-478-7311 Fax: 303-841-3068 caledoniacounsel i ng uhotmail.com www.caledonia-counseling.com EDUCATION Post graduate(MA)studies Capella University • Addictions June 2003—Dec 2005 • Group work professional development • Family systems • Marital therapy • Career counseling Master of Arts Univ.of Colorado at Denver Clinical Psychology May 2003 Post Graduate(BSc)Diploma Open University, England • Child development Jan 2000 • Social systems Bachelor of Science Texas A&M University Psychology May 1989 PROFESSIONAL Approved Domestic Violence Treatment Provider DEVELOPMENT March 2004-present DVOMB Research Committee Jan 2011 —Dec 2012 Participating DV Therapist in the DVRNA validation study DVOMB Sub-committee member February 2011 -2012 To assess the safety,needs,and appropriateness of couples counseling for DV offenders and their partners. DVOMB Research Committee member 2004-2006 Data collection form development,data analysis,and report review Metro Denver Domestic Violence Alliance Aug 2003—present Current Chairman&Active member; previously Vice Chairman,Treasurer,Secretary 18th Judicial District Domestic Violence Task Force Attending member Aug 2007—present PROFESSIONAL American Counseling Association ASSOCIATIONS Professional member June 2003—present American Psychological Association Graduate Student member Aug 2001-June 2003 British Association for Counseling&British Psychological Society Mar 1995—July 2001 CURRENT THERAPEUTIC ENVIRONMENT • Facilitating group and individual therapy for court-ordered adults(domestic violence offenders) and court-ordered adolescents. Treatment planning, service coordination and monthly reporting to probation officers. • Integrated therapy approach to treatment provision, combining CBT and psychodynamic modalities; family of origin and interpersonal factors are primary foci. • Intake interviews providing treatment recommendations and diagnosis using DSM- IV-TR criteria. Administration and interpretation of assessment instruments for adults and children,e.g.,MCMI-3, MMPI-2, WAIS-III,and WISC-III. • Pre-sentence Domestic Violence Evaluations June 03—present Psychotherapist/Independent contractor Domestic Violence counselor,male and female offender groups and individual therapy. Adolescent therapy:individual,family,and group;voluntary and court referred clients. Treatment planning,service coordination,monthly reporting to probation officers. April 06-Aug 06 Rite of Passage Watkins,Co Therapeutic Manager Responsible for coordinating therapy and case management needs for 10 adjudicated(DYC)adolescent females at the Betty Marler Youth Service Center on the Mont View campus. Facilitated domestic violence psychoeducation group Aug 02—May 03 Action! Counseling Denver,Co. Student Intern Provided individual psychotherapy to private clients and anger management counseling to court-ordered clients. Co-facilitate group therapy with domestic violence offenders. Conducted intake interviews and processed paperwork. Review clinical data for monthly probation reporting. EXPERIENCE PRIOR TO MASTERS DEGREE Twelve years experience providing direct care support, case management, staff and program oversight for adults with chronic mental illness and adults with developmental disabilities in residential support services, day programs, and vocational training services. Duties included group and individual counseling, case management, liaison with external and internal agents within a multidisciplinary team format, program evaluation, managing day-to-day operations, budget management,facilitating team meetings,etc. Oct 99—July 01 Scottish Association for Mental Health Drumchapel,Scotland Depute Project Manager Aug 96—Sept 00 Dykebar Psychiatric Hospital Paisley,Scotland Psychology Assistant(volunteer) Oct 97-June 99 Fair Deal for 1 in 100 Glasgow,Scotland Project Manager May 96-Nov 97 Key Housing Association Gourock,Scotland Depute Project Manager Dumbarton Adult Training Center Dumbarton,Scotland Sept 95-May 96 Senior Day Center Officer(temporary post) Adams Community Mental Health Center Commerce City,Colorado Mar 92-Feb 95 Team Leader/Mental Health Clinician Laradon Hall Denver,Colorado Dec 89-Feb 92 Quality Assurance Manager & Vocational Program Coordinator KATHERINE GODWIN, MA, LPCC 820 22^1 Street, Greeley, CO 80631 970.381.8043 kgodwin6583C4gmail.com EDUCATION Master of Arts, Clinical Counseling University of Northern Colorado, 2013 Bachelor of Science, Art and Philosophy University of Wisconsin, 2005 COUNSELING EXPERIENCE Mental Health Therapist October 2013-Present North Range Behavioral Health, Adult Outpatient, Greeley,CO le Counseling 20-25 individual and couples weekly + Working from an integrative theoretical perspective of interpersonal, person-centered and attachment based therapy. •? Working primarily with co-occurring mental health and substance use clients • Facilitating groups: Men's and Women's Relapse Prevention, Men's Depression, and DUI Group • Coordinate intakes, develop and implement treatment plans with clients Mental Health Therapist(Internship) May 2013-October 2013 North Range Behavioral Health, Greeley,CO w Counseled 7-12 client's on a weekly basis • Co-facilitate substance abuse and trauma groups • Develop and implement treatment plans/Coordinate intakes Counselor in Training(Practicum I Sr II) September 2012-May 2013 North Range Behavioral Health&University of Northern Colorado, Greeley, CO C' Counseled 3-7 individual client's on a weekly basis • Co-facilitated substance abuse groups • Developed and implemented treatment plans/Coordinated intakes Licenses and Memberships Licensed Professional Counselor Candidate Working towards CAC II License, estimated date January 2015 Member of ACA since 2011 Member of CSI Counseling Honors Society since 2011 REFERENCES Fred Hanna, PhD Professor, UNC, Counselor Education 970.351.2788 Jennifer Murdock, PhD Professor, UNC,Counselor Education 970.351.2544 David Gonzalez.PhD Professor, UNC, Counseling Psychology 970.351.2731 Nathan Kyle Swisher CURRICULUM VITAE 218 47"'Avenue Court Phone:(970)381-6093 Greeley,CO 80634 E-mail:nkswisher@yahoo.com LICENSURE Licensed Psychologist, Colorado - PSY.0003840 Issue Date: 01/02/2013 Expire Date: 08/31/2015 EDUCATION 05/2008-08/2011 Doctorate of Psychology in Clinical Psychology Rosemead School of Psychology, Biola University, La Mirada, CA Psy.D. conferred August 31, 2011 08/2006- 05/2008 Master's of Arts in Clinical Psychology Rosemead School of Psychology, Biola University 08/2002- 05/2006 Bachelor of Arts in Biblical Studies,Concentration in Psychology Trinity Western University, Langley, British Columbia,CAN CLINICAL EXPERIENCE North Range Behavioral Health Sept 2011-Present Adult Outpatient Therapist(Full Time Employment) Setting: Community mental health network, Greeley, CO - adult outpatient program. Duties: • Implement clinical assessment,psychological testing (cognitive,personality), and culturally-sensitive individual/group/family/couples psychotherapy for an ongoing caseload of 45-55 individuals(in addition to therapy groups). Caseload consists of both mental health and substance abuse referrals, voluntary and court-mandated. • Engage in regular faculty meetings and trainings,case consultation, individual and group supervision [qualifying for psychologist licensure and CAC (Certified Addiction Counselor)requirements], and external clinical seminars(including training for CAC II, Gottman Couples Therapy, and others). • Participated in weekly child therapy seminar/training (spring, 2009),weekly clinic in-service meetings (including case conceptualization and presentation),HIPAA training, and other clinically-related training; • Participated in two Gestalt Therapy seminars (as presented by David Gorton, Ph.D., Director of the Gestalt Therapy and Training Center, Woodland Hills,CA), and participated in Sand Tray and Psychotherapy workshop (as presented by Meredith Phanco, Ph.D., Biola Counseling Center, La Mirada, CA). Measurement and Assessment Practica: Various Settings Fall 2007-Spring 2008 Setting: La Habra City School District; Arbolita Elementary School (grades K-2), El Cerrito Elementary School (grades K-2) and Walnut Elementary School (grades 3-5), La Habra, CA. Population represented age range from 5-10 years-old, various ethnic backgrounds (predominantly Latino) and levels of socio-economic status. Duties: • 300-hour school assessment practicum: assessed special education and general education students for learning and behavioral problems,consisting of neuropsychological and psycho-diagnostic tests,student interviews, in-class observation, case conceptualization,report writing, and Individualized Education Programs(IEP); participated in weekly individual supervision and presented in weekly consultation group with practicum supervisor and other practicum students. Setting: Rosemead School of Psychology, La Mirada, CA; comprehensive testing batteries administered to recruited child clients from the community and Biola University undergraduate students. Duties: • Completion of 3-semester sequence of measurement and assessment courses involving the administration and report writing of 6 comprehensive testing batteries; courses consisted of Measurement and Assessment I (trained to administer, score, and interpret the WAIS-III, WISC-IV, Woodcock-Johnson III, ADSA, Conner's (CPRS-R:L), and PPVT-III),Measurement and Assessment II (trained to administer and score the MMPI-II,MCMI-III, Folstein Mini Mental Status Exam,Thematic Apperception Test, House Tree Person Projective Drawings, Kinetic Family Drawing, and the Forer Structured Sentence Completion Test),and Measurement and Assessment III (trained to administer, score, and interpret the Rorschach). AspenPointe Health Services Sept 2010-Sept 2011 2,000-hour APPIC Pre-Doctoral Internship Setting: Community mental health network, Colorado Springs, CO. Major internship rotation located at Adult and Rural Services(adult outpatient); minor internship rotations included: Lighthouse (adult acute inpatient), Peak Vista Community Health Center(primary care), AspenPointe—Fountain, CO(rural outpatient). Duties: • Implemented clinical assessment, psychological testing(cognitive,personality),and culturally-sensitive individual/group/family/couples psychotherapy(EBP) for an ongoing caseload of 25-35 severely and persistently mentally ill adult consumers. • Provided crisis assessment, individual/group/family/couples psychotherapy for an adult population in an acute crisis setting(inpatient). • Coordinated clinical assessment and brief individual psychotherapy in a primary care setting, participating in brief behavioral health consultations for patients. • Implemented supervision with master's level psychology intern, including weekly clinical observation. • Engaged in regular faculty meetings,case consultation, internship training seminars (including presentation of doctoral paper), individual supervision,and external clinical seminars. Harbor UCLA Medical Center—South Bav TIES for Families Sept 2009-Aug 2010 830-hour Advanced Practicum Setting: Los Angeles County Department of Mental Health outpatient clinic;a Multidisciplinary treatment approach promoting the successful adoption of foster children and adolescents. Duties: • Provided direct clinical assessment,psychological testing(cognitive, academic achievement, personality, socioemotional,neuropsychological), consultation, and individual/family/group psychotherapy for children, adolescents, and families. • Coordinated care with the court system and Department of Child and Family Services as needed. • Engaged in internal and external training for infant mental health(e.g.,the Bayley Scales of Infant Development),Narrative Therapy,Reflective Parenting, Mindful Parenting, Incredible Years, and other clinically-relevant seminars and didactic training made available at the Harbor-UCLA Medical Center. Rosemead School of Psychology.Biota University Fall 2009—Spring 2010 Setting: Biola University campus, La Mirada, CA. Duties: • 32-hour Clinical Supervision Practicum(provided weekly, individual supervision for graduate student providing services to adults in an outpatient setting; engaged in weekly supervision and tape review of supervisory sessions; presented audio tapes and progress notes for peer consultation and critique) • 32-hour Child and Adolescent Practicum(engaged in live peer supervision with teaching assistant using bug-in-the-ear technology; provided individual psychotherapy and parental feedback/consultation to an adolescent client recruited from the community). • 32-hour Group Therapy Practicum(provided process-oriented group therapy for a group of 10 college students for 10 weeks; consulted and worked successfully with co-therapist; maintained individual client files consistent with group conceptualization; engaged in weekly supervision). Biola Counseling Center August 2007—June 2009 1,090-hour University Counseling Center Practicum Setting: Outpatient university and community counseling center, La Mirada, CA. Clientele worked with consisted of an age range of 18-55,from various ethnic backgrounds, and presenting with various forms of mood-, anxiety-, relational-, adjustment/phase of life-,and disorder of thought-related problems. Duties: • Provided short- and long-term psychotherapy for adult individuals and couples,using Cognitive-Behavioral Therapy,Rogerian techniques, Emotion-Focused Therapy for Couples and Individuals,and Psychodynamic Psychotherapy. • Completed biweekly floor duty and structured intake interviews including MMPI-2 interpretation(written reports); provided MMPI-2 feedback sessions to graduate students. OTHER WORK EXPERIENCE CLINICALLY-RELEVANT EMPLOYMENT : • Intensive Support Services (ISS) Jun 2007-Sep 2007 Setting: Institute for Applied Behavior Analysis, Santa Ana, CA Hours: 30 per week Duties: Received training in Competency Based Training and provided support to children and adolescents with developmental disabilities. • Hontecare Provider Jul 2005-Jul 2006 Setting: Visiting Angels Living Assistance Services, Bellingham, WA Hours: 20 per week Duties: Provided living assistance services, including various behavioral interventions, for adolescents with autism in home and community settings. TEACHING ASSISTANT EXPERIENCE : • Teacher Assistant: Psychology of Marriage Fall 2009 Keith Edwards, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 3 per week Duties: Facilitate the discussion in and processing of areas such as family of origin issues, and lead skill building exercises in areas such as conflict resolution and empathic listening with undergraduate students. • Teacher Assistant: variety of courses covering the Fall 2007-Spring 2008 integration of theological topics and psychological theory Steve Porter, Ph.D.; Rosemead School of Psychology, La Mirada. CA Hours: 7 per week Duties: Provided assistance to Dr. Porter for grading of graduate-level coursework. • Teacher Assistant: Psychology of Christian Thought Spring 2008 Elizabeth Hall, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hill for grading of undergraduate-level psychology coursework. • Teacher Assistant: Psychology of Christian Thought Fall 2007 Pete Hill, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hall for grading of undergraduate-level psychology coursework. PRESENTATIONS • Presentation of Gottman Couples Therapy In-clinic presentation to adult outpatient staff,North Range Behavioral Health, Greeley, CO April 24, 2013 • Presentation of Bipolar Disorder: Diagnosis and Treatment In-clinic presentation to adult outpatient staff, North Range Behavioral Health, Greeley, CO June 6, 27, 2012 • Presentation of Schema Therapy In-clinic presentation to adult outpatient staff, North Range Behavioral Health, Greeley, CO January 18, 2012 • "Reflective Functioning in Couples Therapy" 1-Hour In-clinic presentation to all clinical staff,AspenPointe Health Services, Colorado Springs, CO August 18, 2011 • Presentation of Doctoral Paper: "The Enhancement of Reflective Functioning in Couples Therapy: Integrative Literature Review and Theoretical Development" 2-Hour Intern Seminar, AspenPointe Health Services, Colorado Springs, CO June 23, 2011 • "Forming Attachment Bonds in Marriage: Can You Hear Me Now?" "The Risks and Treasures of Love"relationship conference; hosted by Living Hope Church,Colorado Springs, CO April 2, 2011 PROFESSIONAL MEMBERSHIPS • American Psychological Association Current Membership# 95673434 --- STAT OF COLORADO Department of Regulatory Agencies Division of Professions and Occupations Active PRINTED ON SECURE PAPE PSY PSY.000t384O OQ/e11Q613 0e13120t8 Number Issue Date Expire Date • Nathan Kyle Swlsher Greeley CO 80634 Division Director Si9r ah�s 1260 H Street,Greeley,CO 80631.970-313-1169 Nikki Tolle Objective To work with people effectively and efficiently using well-established therapeutic skills in domestic violence,anger management, substance abuse,and individual therapy. Professional Accomplishments Licensed Professional Counselor • Licensed August 2007 • License number-4735 Certified Addictions Counselor • Licensed June 2008 • License number—ACC 6658 Domestic Violence Approval, Colorado • Approved to work with male offenders,female offenders,LGBT offenders DBT approved • Formally trained by Marsha Linehan Associates November 2010 Employment History January 2013 —present Adult Outpatient Therapist North Range Behavioral Health June 2011 —January 2013 Private Practice San Juan House/SLV Therapeutic Services March 2005—June 2011 Clinical Supervisor San Luis Valley Mental Health Center,Alamosa,CO April 2003 —March 2005 Academic Counselor University of Phoenix, Colorado Springs,CO March 2005 —January 1996 Quality Control Supervisor American Express, Phoenix, AZ Education August 2013 PhD in Clinical Psychology Walden University, Minneapolis, MN 1260 H Street,Greeley,CO 80631.970-313-1169 Nikki Tolle June 2005 Master of Arts in Community University of Phoenix,Colorado Counseling Springs,CO Bachelor of Science in University of Phoenix, Denver, June 2001 Human Services CO STATE OF COLORADO DeparbneM of Regulatory Agencies Division of Professions end Occupations PRINTED ON SECURE PAPER Active • LPC LPCDmess I 00101/2013 comma Number Issue Date I Expire Date Nicole Michelle Tolle Fort Collins CO 50521 ,4J' 4t,",Cvf./it.'"r`t, • Division Director Signature • • STATE OF COLORADO Depannient Division of P of Regulatory roMssdans and Occu Active PRINTED ON SECURE PAPER ACC ACG000N51 I owc oso 08/51107015 Number 1 testis Date Expire Date Nicole Michele Tolls Fat Collins CO 1 ' DMslon J Signature Rachael Moe (970)-573-8055 moerachaelAtmail.com Areas of training • Sexual Abuse/Domestic • Marriage and Family Counseling and Certifications Violence Advocacy • Non-Custodial Parental Visitation Rights • ACA(American • CPI Training Counseling Association)& • QMAP Certification CCA • GLBTQ Safe Zone Training • First Aid/CPR • Emotionally Focused Therapy Externship • CAC II course work • Level 1 Gottman Training • ASIST-suicide first aid • EMDR Education Master of Clinical and Family/Marriage Counseling August, 2010-Present University of Northern Colorado. Greeley Colorado August, 2005-May 2010 Bachelor's in Psychology and Sociology (Minor: Community Health)Minnesota State University Moorhead, Moorhead Minnesota Experience North Range Behavioral Health,Adult Outpatient August '13-present • Provide substance abuse, individual,EMDR,group and couples counseling. • Models used are client centered, motivational interviewing, EFT, DBT and EMDR. North Range Behavioral Health-Maxwell Center August '11-August '13 • Behavioral Health Worker II,Residential Treatment for Chronic Mentally Ill Adults. Activities Coordinator as of May 2012. NRBH Child & Family,Youth Day Reporting Center and Adult Outpatient August '12-May'13 • Interned working with children age 5-16 and Adults age 19-60 • Provided individual therapy,family and couple services through a systemic lens. • Models used were Emotion Focused Therapy,Gottman,CBT, REBT, motivational interviewing, and play therapy. • Assisted in Substance Abuse Groups for DUI and Relapse Prevention. Volunteer Experience Sexual Assault Victim Advocacy Greeley Colorado May 2012-Present • Provide educational advice post assault for callers in crises. • Mandatory Reporter and advocate for sexual assault victims • Provide emotional support for victims through phone contact,refer for continuity of care, and assist in emotional support during SANE examination. Student Academic Conference,MSUM 2009 and UNC 2010 • Presented on the issues on Sexual Assault; myths about victims and perpetrators • PTSD and Marital Satisfaction,comparing Male and Female Soldiers Rainbow Bridge of Fargo/Moorhead 2006-2010 Provided mediated visitation services to children,adolescents, and adults using individual, family,and group treatment through court orders.Included were adult and teen survivors and perpetrators of sexual abuse and incest.Qualified as expert in documenting visits to be used in court for custodial privileges. Rape and Abuse Crisis Center of Fargo,North Dakota 24 hour crisis hotline 2008-2010 • Educated on the area of victims in rape and abuse through a 1 month course on legal and ethical standards of North Dakota/Minnesota. • Advocate, Support, Educate and provide Referral Information. Angela M. White 3532 E. Prospect Rd. Ft. Collins,CO 80525 Cell: (970)481-0835(preferred) Work: (970)347-2316 Personal E-mail:TheShadowLandsFarm@gmail.com Work E-mail: angela.white@northrange.org Objective To obtain a counseling position working with adults that will allow me to effectively utilize my intellect,talent, training,and experience. If possible,I desire to obtain my CAC II over a period of three years while working in this position. Education & Credentials • Bachelor of Ads, May 2002, Asbury University, Wilmore, KY Major: English Literature • Masters of Arts, August 2011, Asbury Theological Seminary, Wilmore, KY Concentration: Counseling • Licensed Professional Counselor,Awarded March 2014 *Note: 1 am in the process of completing CAC classes and accruing hours for this certification. Employment & Experience Bilingual Mental Health Therapist(September 2011-present), Full Time North Range Behavioral Health, Integrated Care team, Greeley, CO • Provide assessment,consultation,advocacy, psycho-education,and therapy to new and returning clients in a competent and culturally sensitive manner. • Conduct individual,group,and family therapy sessions to help clients reach their mental and behavioral health goals and increase healthy functioning. • Serve all people of all backgrounds, diagnoses,and co-morbid conditions including addiction. • Develop and update treatment plans to address client's present condition and work collaboratively to set specific,realistic goals for therapy. • Coordinate,consult, and refer(where appropriate)in order to provide clients with the highest quality of care possible. • Maintain close symbiotic relationships with community agencies to reduce waste by not duplicating services. • Uphold the highest standards of ethical behavior in all interactions with clients, co-workers,and supervisors. Primary Therapist--Internship (January 2011-July 2011), Full Time Chrysalis House,Lexington, KY *Left position because my internship ended and our family relocated to Ft.Collins for my husband to pursue further education. • Conducted individual weekly counseling sessions with clients who met criteria for chemical dependence. • Co-facilitated group therapy focusing on skill building and psychological processing for clients. • Developed, maintained,and reviewed treatment plans to address clients' areas of concern including,but not limited to,chemical dependence, mental health issues,physical health,employment difficulties, financial challenges,and social/family problems. • Coordinated and consulted with other staff members to deliver the most appropriate service to clients. • Upheld the highest standards of ethical behavior in all interactions with clients and staff. Barista and Shift Supervisor Starbucks Coffee,Lexington, KY(May 2007—May 2010), Part Time 'Left position because I needed to focus on my Masters' work. Starbucks Coffee, Gulf Breeze, FL(March 2005—November 2005), Full Time *Left position because I got a job as a schoolteacher. Starbucks Coffee, Orlando, FL (August 2004—March 2005), Full Time *Left position because I relocated to Gulf Breeze where my fiancé was. Starbucks Coffee,Jacksonville, FL (February 2003—January 2004), Full Time *Left position because I moved to Honduras to teach English for an internship. • Managed employees on shift as acting manager. • Communicated concerns with general and regional manager. • Delivered top-notch customer service to each person,every day. • Respectfully resolved customer complaints in a timely manner to promote repeat business. • Listened to employees concerns and acted as mediator when appropriate. • Followed all directives received by management staff. • Consistently went above and beyond job expectations. High School Reading Teacher(November 2005-May 2007), Full Time Navarre High School,Navarre, FL 'Left position because I relocated to Kentucky to begin Masters program. • Selected,evaluated,and taught pertinent curriculum to high school students ages 14-18 who had failed Florida's standardized test(FCAT)and were in danger of failing high school. • Maintained a balance of classroom discipline and individual student growth. • Initiated and facilitated parent-teacher conferences in order to cooperatively formulate a plan to address critical problems present with individual students. • Tailored educational approach to individual students' needs including,but not limited to,academic accommodations for physical and learning disabilities. • Effectively communicated concerns with other teachers, parents,and administration. Youth Volunteer(March 2005-November 2008) St. Paul United Methodist Church, Gulf Breeze, FL (March 2005-May 2007), Part Time Versailles United Methodist Church, Versailles, KY(May 2007-November 2008),Part Time *Stopped volunteering when my husband resigned as youth minister. • Conducted informal counseling with girls ages 12-18 and their families. • Facilitated small group study for junior high girls. • Served as a positive role model for youth. Intern Teacher(January 2004-August 2004) Loma de Luz Hospital, Cornerstone Foundation,Balfate, Honduras *Left position when my internship was finished. • Taught Spanish-speaking children English,reading,and math. • Co-taught Spanish-speaking and English-speaking children geography and history. t. • Maintained classroom discipline when main teacher was not present. • Navigated cultural customs, language,currency,and transportation without assistance in order to obtain supplies. • Became fluent in Spanish. • Assisted work and travel teams who used Loma de Luz facilities. References: Paulette Tarnasky, LCSW, Program Director, Integrated Care,North Range Behavioral Health (970)395-1104 Mendy Daniels, LCSW,Clinical Supervisor,Chrysalis House,(859)619-0644 Dr.Virginia Holeman, Department Head and Professor,Asbury Theological Seminary,(859) 858-3581 Licensed Professional Counselor Bored:Licensed PhaM1Weal Counwor®Type:LPC Number.it$4S STATE OF COLORADO Mall Conespondence to: Home Business Department of ReQUIrOly Agendas (Circe one) Division of Professions and Occupations Active Pnimeo ON SECURE PAPEP Home Phone: Business Phone: Licensed Professional Counselor LPCea1101e WIWM14 1 aselaois Name: Number Issue On FCa Date • Street Address: Angela Michelle White Fort Collins CO 80525 City,Side and Zip Code: I i I I ♦Use the Area above for any ADORFSS Change• Division Director • Signature -4 THIS IS YOUR WALLET CARD Maribel Favela 126O H Street,Greeley,Colorado 8O631 97O-347-2393 Maribelfavela@northrange.org CURRENT EMPLOYMENT STATUS North Range Behavioral Health at Greeley(11/98• North Range Behavioral Health at present) Ft.Lupton(11/98-5/09) 1260 H Street 145 First Street Greeley,Colorado 80631 Ft. Lupton,Colorado 80621 970-347-2393 303-857-6365 EDUCATION Masters of Social Work Colorado State University,Fort Calins,Colorado Graduated: May 2012 Bachelor of Arts:Spanish & Bachelor of Arts:Hispanic Studies Emphasis:Liberal Arts Emphasis:Mexican-American Studies University of Northern Colorado,Greeley,Colorado Graduated:December 1997 CERTIFICATION • Colorado Alcohol and Drug Counselor III-received 2-12-02 • Colorado Alcohol and Drug Counselor ll-received-11-30-00 C. Approved Domestic Violence Treatment Provider-received 5.4-04 S Approved Spanish Speaking Domestic Violence Treatment Provider-received 5.4-04 le Approved Female Domestic Violence Treatment Provider received 3.18-08 PROFESSIONAL EXPERIENCE Bilingual Outpatient Therapist(7/09-present) North Range Behavioral Health(11/98-present) 'r Therapist for the Adult Outpatient Program servicing the Social Services,Domestic Violence,Mental Health and Substance Abuse populations in English and Spanish. oe Provide direct services for clientele with substance abuse,anger management,mental health and domestic violence issues via assessments,intakes,treatment planning,psycho-educational sessions, group and individual therapy utilizing conceptual understanding of group dynamics,clinical supervision,activities,psycho-education,using various therapeutic models and factors,and process therapy to facilitate clients'therapeutic progress in a group setting. 4 Traditional therapeutic models include Motivational Interviewing,Cognitive Behavioral Therapy, Client-Centered Therapy,Psychoanalytical and Psychodynamic Therapies. 4 Assist clients with specialized case management in engaging with external services,such as medical screens,case management services,family services,Medicaid services,food stamps and other pertinent services. • Advocate for clients at state and local level. • Collaborate with Probation,Intervention,Rocky Mountain Offender Management Systems,Social Services and other community agencies to provide clientele with external services. • Community Collaboration to provide quality,culturally competent therapeutic services to clients in routine and crisis situations in order to ensure clients successful outcomes. • Supervision,translation,and upgrading of Spanish Adult Outpatient Program curriculum and forms. Lead Bilingual Outpatient Counselor II (8/02-7/09) Island Grove at North Range Behavioral Health + Lead counselor for the Adult Outpatient Program servicing the Social Services,Domestic violence and Substance Abuse populations with emphasis on the Spanish-Speaking and Social Services population. 4 Lead counselor for services provided at Ft Lupton branch,which includes clinical supervision of other counselors. :• Primary auditor of counselor work via chart audits. 4 Assist Adult Outpatient Program Manager with counselor supervision,and the development and implementation of new programming. • Assist Adult Outpatient Program Manager with screening,interviewing,and recruitment of staff. ✓ Supervision,translation,and upgrading of Spanish Adult Outpatient Program curriculum and forms. + Responsible for organization and upkeep of the Counselor Training Manual. • Provide direct services for clientele with substance abuse,anger management,and domestic violence issues via assessments,intakes,treatment planning,educational sessions,group and individual therapy,as well as specialized case management. •. Assist clients in engaging with external services,such as medical screens,mental health services, family services,Medicaid services,food stamps and other pertinent services. Advocate for clients at state and local level. 4 Community Collaboration to provide quality,culturally competent therapeutic services to clients in routine and crisis situations in order to ensure clients successful outcomes. •. Participated in Clinical Trials Network—Motivational Enhancement Treatment to Improve Treatment Engagement and Outcome for Spanish-Speaking Individuals Seeking Treatment for Substance Abuse(METS)protocol at Island Grove from 2004 to 2005. Lead Bilingual Outpatient Counselor 1(12/01-8/02) c• All regular counselor duties listed above,including some administrative tasks,but excluding staff supervision. Bilingual Outpatient Counselor 11 (11/98-12/01) :• All counselor duties listed above excluding administrative tasks. REFERENCES Work and character references available upon request Maribel Favela 1260 II Street,Greeley,Colorado 80631 970-347-2393 CERTIFICATIONS Required Hours for certification Approved Domestic Violence Provider Assessments— 1134hours -received 5-4-04/Recertified 2/13 Co-facilitated Groups—818 hours Approved Spanish Speaking Domestic Violence Provider Supervision Pre-Approval-476 hours -received 5-4-04/Recertified 2/13 Supervision Post-Approval-2 hours per month Approved Female Domestic Violence Provider -received 3-18-08/Recertified 2/13 Tr mints Towards Approval Domestic Violence:Female Offenders with Lotte Muster,LAC,LPC,NCC Domestic Violence:Female Offenders II with Lotte Muster,LAC,LPC,NCC Victim Issues With Ms.Shelley Larson Of Greeley Police Dept.Victim's Services Susan's Story II With Kathleen Bird DV:Impact Of Violence On Children With Darlene Chavez Vicarious Trauma With Lotte Muster Domestic Violence&Multi-Disciplinary Response Training With Domestic Violence Enhanced Response Team&The Center For Prevention Of Domestic Violence Victims Awareness Training with Nancy Kroll of 19th Judicial Probation Dept. Learning Styles With Scott Demuro Gender Specific Issues In The Delivery Of Treatment With Nancy Lantz Hispanic Cultures In US At University Of Northern Colorado-Fall Sem. 1997 Basic Addiction Counseling Skills With Linda Dawson Cocaine Treatment:Use&Abuse With Carol Atkinson Motivational Interviewing With Stephen Bentley Resistant Client With Marjorie Lewis Clinical Utility&Interpretation Of The Milton Clinical Multiaxial Inventories-III With Paul Retzlaff,PhD Personality Disorders With Lotte Muster Group Counseling Skills With Michael Connelly Advanced Group Counseling Skills With Judy Moor Domestic Violence Training With Nancy Lewis Of COVA Victim Rights Act Compliance Training With Nancy Lewis&Cynthia Geissinger Of COVA Sexual Harassment With Colorado Judicial Branch Human Resources Training Susan's Story 11 With Kathleen Bird Intergenerational Violence With Doris Kruse Post Traumatic Stress Disorder&Anger Management With Charles Allen Differential Assessment And Treatment Planning With Michael Connelly DV:Evaluation Of Perpetrators&Risk Assessment With Nancy Lantz Social Stratification Of The Mexican-American Community At University Of Northern Colorado-Spring Sem. 1996 Deviance&Criminal Behavior With Rand Kannenberg Sexual Abuse As A Control Technique With Doris Krus Community Resources With Lotte Muster 2002 Standards For Tx W/Court Ordered Offenders With Cheryl Milliken Domestic Violence And Legal Issues With Lotte Muster CERTIFICATIONS Experiential Hours for certification s Colorado Alcohol and Drug Counselor III-received-2-12-02 5000 Experiential hours •Colorado Alcohol and Drug Counselor Il-received-11-30-00 3000 Experiential hours Specified Training Towards CAC Certifications Addiction Counseling Skills Ethical Issues Jurisprudence Exam Client Records Management Infectious Diseases Ethical Issues-Social Stratifications of the Mexican-American Community Differential Assessment&Treatment Planning Motivational Interviewing Group Counseling Pharmacology I&II Cocaine Use&Abuse Domestic Violence:Profiles&Treatment of Addicted Batterers Clinical Supervision Advanced Counseling Skills SASSI-Administration and Scoring SASSI-Clinical Interpretation Driving With Can:Alcohol or Other Drug Safety Education&Treatment Conflict Management Deviance&Criminal Behavior Post Traumatic Stress Disorder&Anger Management Susan's Story-victim's issues Sexual Harassment Sexual Abuse as a Control Technique Clinical Utility&Interpretation of the Millon Clinical Multiaxial Inventories-Ill Print Lookup Details Page 1 of 1 ,diyr-, Dora+„,��•„ Executive Director ' f Department of Regu4tonAgent4s' e1S� Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License Information provMed by the Colorado Division of Professions and Occupations,established by 24-34.102 CRS. Name Public Address Maribel Faveia %North Range Behavioral Health 1260 H Street Greeley, CO 80631 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACC.0005484 Original Certified Addiction Active 02/12/2002 09/01/2013 08/31/2015 Counselor III Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/14/2014 2:44:26 PM Pr 4 REBECCA J. WYPERD . (970)339-8266 rebecca.wyperd@northrange.org EDUCATION Licensed Professional Counselor State of Colorado licensure#5240 Master of Arts Degree University of Northern Colorado Greeley,Colorado August 2005 • Emphasis in Community Counseling:Marriage and Family Therapy Bachelor of Arts Degree University of Northern Colorado Greeley, Colorado May 2002 • Emphasis in Psychology EXPERIENCE Program Director: Youth and Family Services,North Range Behavioral Health • Provide clinical and administrative oversight of all programming within the Youth and Family Team totaling 25 staff: o MST&FFT o 180 o MYAT o Substance abuse programming o School Based services o Platte Valley Youth Services Center services o Outpatient mental health services o Youth and Family Connections clinicians ➢ June 2011 to present Program Coordinator: Child and Family Services,North Range Behavioral Health • Provided clinical and administrative supervision of multiple programs within the Child and Family Team totaling 15 staff. • Initiated constant collaboration between NRBI-I and partnering agencies to ensure continued program success and development • Tracked program grants,perform audits,billing,formal reporting,and data collection for program sustainability ➢ November 2010 to June 2011 MST Supervisor,North Range Behavioral Health • Supervised four Multisystemic Therapy clinicians • Held weekly supervision and consultation to maintain model fidelity • Provided oversight of program operations bridging agency directors and team • Maintained link with community stakeholders and ensure sufficient referral flow and program collaboration • Generated billing,perform chart audits and approve reports for court monthly • Collaborated in the development of 180 including programming,policy and procedure,data collection, and agency partnerships ➢ April 2007 to June 2011 Bereavement Counselor,Chrysalis Grief Center,Greeley,Colorado • Held an individual and family counseling case load of up to forty • Facilitated bereavement groups and day trips • Responded to organizations in the community after a death • Received supervision in art,sand tray and play therapy • Maintained client records appropriate with agency policy and ethics • Participated in daily running of the center, planning,and fundraising > September 2005 to March 2007 Mental Health Therapist,Acute Treatment Unit,North Range Behavioral Health • Worked with up to sixteen,persistently mentally ill,inpatients at a time • Initiated intake,case management,counseling,monitoring,and discharge • Collaborated with nurse and psychiatrist on treatment planning • Maintained daily treatment records for multiple clients • Responded to the after hours emergency phone line for three counties > August 2004 to May 2005 Victim Advocate,Greeley Police Department,Greeley,Colorado • Volunteered a minimum of forty eight hours a month to victims of crime • Responded first to the scene and initiated crisis and trauma debriefing • Assisted victims with restraining orders,court,counseling,and resources • Attended group meetings and seminars for further training > July 2003 to September 2006 Enrichment Director,Frontier Academy,Greeley,Colorado • Directed enrichment program for fifty school-aged students • Assisted kids with academic,social,and emotional issues • Initiated licensure for the program • Monitored two employees during tutoring • Assembled financial books and updated them weekly > August 1998 to May 2004 Professional references available upon request Print Lookup Details Page 1 of 1 1 Diva Barbara J.Kelley •• r, 211 Executive Dkeclor, et5! Department ofR[g Mwcy Agencies Lookup Detail View Ucensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupation,established by 24-34-102 C.R.S. Name Public Address Rebecca lean Wyperd Greeley, CO 80634 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date LPC.0005240 Examination Licensed Professional Active 04/29/2009 09/01/2013 08/31/2015 Counselor Board/Progam Actions Disdpline There is no Discipline or Board Actions on file for this credential. Generated on: 3/14/2014 12:38:55 PM r .. a ,. f ,. I n. . .. ...... .. .. . .. . ...... . • Address: Contact Information: 1300 N. It"Avenue Jennifer K. Wallace, LCSW (970) 397-5331 Greeley,CO 80631 Jennifer.wallace@northrange.org EDUCATION/LICENSURE August 2008 Department Of Regulatory Agencies Colorado Licensed Clinical Social Worker • Supervise clinicians working towards LCSW • Supervise Interns working towards their master's degree • Supervise FFT therapists 2003-2006 Illinois State University Normal, IL Masters of Social Work with Emphasis on Child and Family Practice • GPA: 3.93/4.0 1999-2003 Saint Louis University St. Louis, MO Bachelor of Arts with majors in Spanish and Communication • Graduated Magna Cum Laude • Varsity Soccer Player/Division I-NCAA Academic All-American 2002 LANGUAGES • Provide services for Spanish speaking families at NRBH from January 2006-Present • Studied the Spanish language and Spanish speaking cultures through college and High school. • Studied abroad in Madrid,Spain during Spring of 2001 • Participated in a 3 week Spanish emersion program in Costa Rica in April of 2008 PROFESSIONAL EXPERIENCE December 2011-Present North Range Behavioral Health Weld County,CO Functional Family Therapy Coordinator • Supervise therapists using FFT Model with families with an at-risk adolescent • Maintain referrals for program,perform screens with families,and complete monthly billing. • Maintain small caseload(8-10) September 2008-Present North Range Behavioral Health Weld County,CO Functional Family Therapist • Practice therapy in a three phase,evidenced based model for families with an at-risk adolescent • Maintain contact with numerous stakeholders including Department of Social Services, Probation, the court, District Attorneys,Youth and Family Connections, and the schools. January 2010-2012 North Range Behavioral Health Weld County,CO Intern Supervisor • Provided Individual supervision for Interns working towards their Master's Degree • Coordinated services with University of Northern Colorado,Colorado State University • Created and implemented an intern training binder including: Intake,treatment planning,crisis management and supervision April 2006-September 2008 North Range Behavioral Health Weld County, CO Multisystemic Therapist • Provided intensive in-home therapy for families with an at-risk adolescent • Coordinated meetings with stakeholders including Department of Human Services,Probation, the court,District Attorneys,Department of Youth Corrections,and the schools. January 06-April 06 North Range Behavioral Health Weld County,CO Bilingual Therapist for Multicultural services • Completed concentration practicum by working with Spanish speaking adolescents and adults Summer 2005 Chestnut Health,Systems Bloomington, IL Primary Therapist • Completed foundation practicum at residential facility for adolescents that used substances • Lead skills groups,community groups,counseling groups and family groups Page 1 of 2 • Address: Contact Information: 1300 N.17th Avenue Jennifer K. Wallace, LCSW (970)397-5331 Greeley,CO 80631 Jennifer.waliace@northrange.org POST-DEGREE TRAININGS February 2014 Integrative Treatment of Complex Trauma for Adolescents(ITCT-A)Denver CO May 2011 Dialectical Behavioral Therapy Greeley,CO August 2010-2012 Have completed all courses for CACTI Greeley,CO September 2008 Functional Family therapist Replacement Training Lima,OH March 2008 ASIST: Applied Suicide Intervention Skills Training Greeley, CO April 2006 Multisystemic Therapy Five Day Training Denver, CO WORK EXPERIENCE 2003-2006 Illinois State University Athletic Department Normal, IL Support staff to Director of Operations and Director of Facilities • Performed event management and public relations tasks for university and private functions • Designed/maintained excel documents to monitor athletic maintenance budget and timecards • Became fluent in Microsoft Excel,Word, Publisher,and Access. 2003-2006 Illinois State University Athletic Department Normal, IL Graduate Assistant Soccer Coach • Created/maintained Access and Excel documents to track recruiting,fundraising and player performance • Assisted in preparing practices and tactical decisions • Organized and ran camps,clinics and training sessions for players age 5-18 1999-2003 Fort Collins Soccer Club Ft. Collins, CO Summer Soccer Camp Coach • Coached week long soccer camps for kids age 5-10 • Taught skills,supervised other coaches and encouraged kids through play PARAPROFESSIONAL EXPERIENCE Spring 2003 La Clinica St. Louis,MO Tutor • Tutored Latino children with limited profigienwy in English to improve communication skills • Participated in activities to boost self-esteem,knowledge and interest in the Latino culture Spring 2003 Ralph Bunche International Studies Middle School St. Louis,MO Teacher Assistant • Assisted Teaching English to Speakers of Other Languages (TESOL)teacher work with students from more than 10 different countries of all levels of English speaking ability • Worked with the Spanish teacher in an inner-city public school 2000-2002 SPENSA (Special Needs Soccer Association) St Louis, MO Helper for Clinics • Helped children with disabilities(Ages 4-18)play soccer and participate in physical activities • Boosted morale and self-esteem of children through games and activities 2001-2002 Karen House St. Louis, MO Tutor • Volunteered as a tutor at shelter for women and children • Designed and supervised activities to develop interest in education for the children of residents REFERENCES Personal/professional references and/or academic credentials will be submitted upon request Page 4 of 2,,, Print Lookup Details Page 1 of 1 fib.,., d Dora BakberaJ.Kelle>r _,. .4 1. • I Executive Director •.laid / Department of Rego4tory Merbt es �� Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24.34.102 C.R.S. Name Public Address Jennifer Kehl Wallace Windsor, CO 80550-5463 Credential Information License License License Original Issue Effective Expiration Number Method Ucense Type Status Date Date Date CSW.00001141 Examination Licensed Clinical Active 08/28/2008 09/01/2013 08/31/2015 Social Worker Board/Progam Actions Disdpllne There Is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:01:16 PM Sara Dillon LPC 2517 14th Avenue Ct Greeley CO 80631 (619) 820-2953 saradillon@hotmail.com Work History Functional Family Therapist September 2011-present North Range Behavioral Health, Greeley, CO • Provide in-home family therapy for at-risk adolescents • Collaborate on cases with stakeholders such as schools, probation, courts,DHS, Guardians Ad Letim and Youth and Family Connections • Perform intakes including diagnosis, create and monitor treatment plans and provide case management • Work as part of both FFT and Youth and Family team Paraprofessional August 2007- October 2007 Collaborative Education Program (CEP), Behavioral Adjustment Class 3 (BAC 3)John Evans Middle School, Greeley, CO • Assisted teacher in construction of daily lesson plans • Helped to write behavior goals and establish discipline for students Educational Assistant February 2006- June 2007 Keystone Schools Steele Canyon, El Cajon, CA • Led groups of three to five students in academic instruction • Wrote and implemented Individual Education Plans (lEP) • Monitored students and assuring their safety during behavioral outbursts • Documented Incident Reports as necessary • Trained in Pro-Act physical restraint methods Educational Work Experience Child and Family Team Intern January 2011- August 5 2011 North Range Behavioral Health, Greeley, CO • Maintained a case load of children and adolescents, working both individually and with families • Facilitated co-therapy group counseling for process, DBT, art and multi-family substance abuse groups • Performed case management, developed and monitored of treatment plans • Processed intakes for new clients including diagnosis Clinical Care Coordinator Intern January 2011- August 5 2011 Mountain Crest Behavioral Health, Poudre Valley Health System, Fort Collins, CO • Counseled individual adolescents in crisis • Did family therapy with adolescents in crisis • Created safety plans with suicidal & homicidal adolescents • Addressed case management with stakeholders • Participated in daily treatment team with psychiatrist, psychologist, nurses and mental health counselors School Counseling Intern August 2010- December 2010 Ivy Stockwell Elementary School, Berthoud, CO • Ran small groups for students of various ages including topics such as self-confidence, friendship skills, social skills and appropriate playground behavior. • Taught classroom guidance lessons • Met with students individually and facilitated conflict management • Consulted with teachers and parents • Served on the Problem Solving Intervention Team School Counseling Intern January 2010- May 2010 Franklin Middle School, Greeley, CO • Developed and facilitated sixth grade girls relational aggression groups • Advised students in career development using College in Colorado • Mentored students individually and performed conflict management with groups • Held consultations with teachers and parents Counselor in Training Spring 2009 & Fall 2010 UNC Psychological Services Clinic, Greeley, CO • Work with individuals • Work with couples and families Education Master of Arts, Clinical Counseling, Emphasis: Couples and Family Therapy Master of Arts, School Counseling • ' "• University of Northern Colorado (UNC); Greeley, CO Graduation Date: August 2011 Bachelor of.4rts, Psychology San Diego Christian College(SDCC), El Cajon, CA Graduation Date: December 2005 Honors,Awards and Activities Leadership Fellow, Awarded by the School of Applied Psychology and Counselor Education at the University of Northern Colorado (2010) Executive for Chi Sigma Iota counseling honors society (2009-2011) Awarded NAIA Volleyball All-American (2004,2005) Professional Affiliations and Certifications Licensed Professional Counselor#0011790, Colorado National Certified Counselor#274952, National Board of Certified Counselors § § a k! ■1:41 ; |7 ! ! ° Im ! , $ ao S S 0 !! |a ° B C( as k II . O2 - $ ( §` $ • ) ! 2k tu tu . § - !] ■ ) E •-,co * 0 gg at \ C6 ! 0 Oa 0 an O7 \ y 2 } ) |! a \ �2 Is I \ \ • I Chan"Nina"Lu,MA,NCC 1640 37th Ave.,Greeley,CO 80634 . (970)313-8950 . Ichan.lu®northrange.org EDUCATION Denver Family Institute,Marriage and Family Training Program, Denver,CO August 2013 • COAMFTE accredited program University of Northern Colorado,Graduate School of Clinical Counseling,Greeley,CO May 20 • Masters in Clinical Counseling,Area of Focus: Couple and Family Therapy. • CACREP accredited program • Member of Chi Sigma Iota(CSI)Honor Society National Hsin-Chu University of Education,Hsin-Chu,Taiwan August 2008 • Bachelor of Arts in Elementary Education,Area of Focus: Language and Literacy Studies. WORK EXPERIENCE Functional Family Therapy and Child and Family Therapist, October 2013 to present • Provides and facilitates home-based family therapy and case management activates to achieve treatment goals • Offers on-going evaluation and prevents deterioration and/or hospitalization/out of home placement • Assists families in routine and crisis situations and connects them with proper referral resources • Maintains time-limited duration of treatment(2-6 months per family depending on the seriousness of the case) • Advocates for consumers in various forums including(federal, state and local court systems,school,etc.) • Collaborates and cooperates with community agencies and other public agencies in carrying out service plans • Participates in all training and supervision required by FFT, LLC to facilitate high fidelity replication of the model Psychotherapist--Denver Family Institute, Denver,CO,September 201 Ito September 2013 • Worked with individuals,couples and families in therapy using family systemic framework • Interviewed clients and evaluated both routine and crisis situations • Implemented therapeutic interventions with an integrated,solution-focused,and strength-based approach • Consulted and collaborated with probation officers, schools.doctors,social services, and other related agencies • Referred clients to appropriate services and coordinated integrated care • Counseled with diverse clientele including:court-ordered,at-risk teens,DV,sexual assault,abuse and neglect, adoption,homeless,addictions,disorders,disabilities,grief and loss, immigrants, culturally diverse populations • Training completed: Relational Treatment of Substance Abuse,40 hours ASSECT certification,30 hours EFT Extemship Equivalent,and 20 hours Registered Play Therapist Practicum psychotherapist---UNC Psychological Services Clinic,Greeley,Co,August 2010 to May 2011 • Provided individual, family,and couple counseling for diverse populations • Conceptualized cases through systemic lens and implemented culturally appropriate treatment plans VOLUNTEER EXPERIENCE • Child care provider---Global Refugee Center,Greeley,CO. July 2013 to Sep 2013 • Couple and Family Counselor---Cafe 180, Englewood,CO,June 2013 to Sep 2013 • International Ambassador---UNC Center for International Education,Greeley,CO, January 2009 to August 2011 • Senior Assistance---Senior Resource Center,Greeley,CO,January 2010 to May 2010 • Respite Child Care Provider---24/7 Kids Support for Families,Greeley,CO,January 2010 to May 2010 I Chan "Nina" Lu, MA,NCC 1640 37th Ave.,Greeley,CO 80634 . (970)313-8950 . Ichan.Iu@northrange.org References • Robert Kelsall, LCSW RKelsall®denverfamilytherapycenter.com Denver Family Therapy Center 4891 Independence St#165, Wheat ridge,CO 80033 (303)456-0600 • Misti Klarenbeek-McKenna, LCSW,LMFT mistilonckenna@msn.com Thriving Connections, LLC 7651 W 41st Ave.Suite#200,Wheat Ridge,CO 80033 (303)900-7008 • Rita S. Lewis,LCSW,RN Ritadfi@gmail.com Denver Family Institute 7200 East Hampden Avenue,Suite 301,Denver,CO 80224 (719)357-7772;(720)341-2874 Jessica E. Leiby 317 E. Olive Street Fort Collins, CO 80524 Jessica.Leibv@northrange.org (847)338-6648 EDUCATION The Chicago School of Professional Psychology Chicago, IL Master of Arts in Clinical Psychology, Counseling Specialization 08/10-08/12 Western Illinois University Macomb, IL Bachelor of Arts, Psychology 08/05-05/09 PROFESSIONAL EXPERIENCE North Range Behavioral Health, Functional Family Therapy FFT Therapist 03/14-Present Rosecrance Health Network, Crisis Residential Unit Rockford, IL Mental Health Clinician 02/13-09/13 Truman & Harold Washington City Colleges, Wellness Center Chicago, IL Intern Counselor 06/11-06/12 PROFESSIONAL DEVELOPMENT TRAINING FFT LLC Replacement Training; New London, CT; March 12-14, 2014 VOLUNTEER EXPERIENCE Interfaith House Chicago, IL Volunteer Group Facilitator 01/13-03/14 The Women's Treatment Center Chicago, IL � 1 Clothing Donation Room Volunteer 10/13-03/14 LICENSES/CERTIFICATIONS CPR AED Certified, 2013 974 NORT ORAL HEALTH RANGE March 18, 2014 Tobi Vegter Core and Service Contract Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Re: Bid No. B1400069 Functional Family Therapy proposal Multisystemic Therapy proposal Dear Ms. Vegter: The intent of this letter is to address the qualification requirement set forth in the above- referenced bid of familiarity with Trauma Informed Care. The following Youth and Family Services program staff attended the Integrative Treatment of Complex Trauma for Adolescents presented by John Briere, Ph.D. and Cheryl Lanktree, Ph.D. on February 18 and 19, 2014: Susan Stone Jennifer Wallace Rachel Yearous Chad Reznicek Maggie Vandenberg Danielle Critten Sarah Hansen As of this writing, attendees have not received the requested documentation of participation in the training as evidenced by the attached correspondence. If you have any questions, please feel free to contact me. Sincerely, Susan E. R. Stone, M.A., LMFT Administrative Director I Children, Youth, Family & Prevention 4A. tC , Enclosure . t N_ T* .�. i.. rr Where hope begins. ° ' MAUREEN E. HUFF, Ph.D., CAC III Licensed Psychologist,State of Colorado North Range Behavioral Health, 1306 11th Avenue,Greeley,CO 80631 Office: (970)313-1186 Cell Phone: (970)219-5031 LICENSURE AND EDUCATION CAC III 2010 Certified Addictions Counselor III,State of Colorado License 2000 Licensed Psychologist,State of Colorado Ph.D. 1998 Counseling Psychology,Colorado State University(4.0 GPA) APA Accredited Internship: Denver VA Medical Center,Colorado. M.S. 1995 Counseling Psychology,Colorado State University(4.0 GPA) B.A. 1992 Psychology Major&Sociology Minor, St.Cloud State University, MN.(4.0 GPA) PROFESSIONAL HONORS AND AWARDS • CSU Alumni Association"Best Teacher Award of the Year"nomination. • CSU Undergraduate"Favorite Faculty of the Year Award." • PHI KAPPA PHI Outstanding Graduate Award for Highest GPA in Social Sciences. • PHI KAPPA PHI National Fellowship Outstanding Applicant Award. • Sociology Department Research Paper Competition, First Place. • PSI CHI Certificate of Recognition for Excellence in Research. • All Colleges and Universities Award,and Letter of Commendation from SCSU's President. • Outstanding College Students of America Recognition. • PHI KAPPA PHI Recognition of High Scholastic Achievement. • SCSU Certificate of Scholastic Achievement and Dean's List(1987-1992). EDUCATIONAL FELLOWSHIPS AND SCHOLARSHIPS: 1995-1997 Teaching Fellowship,Department of Psychology,CSU,Colorado 1995-1996 Women's Forum of Colorado,Graduate Scholarship Grant,Colorado 1994-1995 Working Woman's Scholarship,Working Women's Fair, Inc.,Colorado 1992-1993 Graduate Fellowship,Colorado State University,Colorado 1990-1992 PSI CHI Scholarship Award, SCSU Chapter,Minnesota 1990-1991 Ward's SCSU Bookstore Scholarship Award,Minnesota 1989-1992 Nontraditional Student Scholarship Award, SCSU,Minnesota 1989-1992 Allis SCSU Scholarship Award,Minnesota 1988-1992 Phillip Halenbeck Scholarship Award,SCSU,Minnesota PROFESSIONAL INVOLVEMENT,ACTIVITIES.AND COMMITTEES 2004—pres. Management Team,North Range Behavioral Health,Colorado 2004-2008 Mental Health Disaster Response Coordinator,North Range Behavioral Health,Colorado. 2004-2008 Emergency Services Committee, Weld County Community Collaborative Efforts 2004-2006 Thriving Organizational Practices(TOP)Committee,North Range Behavioral Health 2003-2004 Barriers to Productivity Committee,North Range Behavioral Health,Colorado. 2002-2004 Training Committee,North Range Behavioral Health,Colorado. 2001 -2003 Alternatives In Management Committee,North Range Behavioral Health,CO. 2000-2012 Quality Assurance Committee,North Range Behavioral Health,Colorado 2000-2012 Credentialing Committee,External Provider Network,Northeast Behavioral Heath 1998-2000 Curriculum Committee,Counseling psychology Program,University of Oregon 1998-2000 Doctoral Competency Examination Committee, University of Oregon 1998-2000 Dissertation Committee Chair,Doctoral Projects, University of Oregon 1998-2000 Program Selection Committee,Doctoral Applicants,University of Oregon 1995-1996 Curriculum Committee-Counseling Psychology Program,CSU,CO. 1993-1996 Graduate Student Representative,Counseling Psychology Program,CSU,CO. 1993-1994 Admissions Committee-Counseling Psychology Program,CSU,CO. 1990-1991 Council of Organizations Representative,St.Cloud State University,MN. 1989-1992 President,PSI CHI,National Honor Society in Psychology,St.Cloud State University Chapter,MN. M. E.Huff,p.2 of 9 CLINICAL AND SUPERVISORY EXPERIENCE 2000-pres. North Range Behavioral Health Program Director,Adult Recovery Program, 10/2012—pres. Interim Director,Integrated Care,4/2012-10/2012 Director of Training and Utilization Management,2008-10/2012 Program Director,Assessment and Brief Therapy Program. 2004-2008. Clinical Director,Intensive Child,Youth,and Family Services Team. 2000-2004 Licensed Psychologist,North Range Behavioral Health,Greeley,Colorado Responsibilities: Provide oversight of clinical programs, utilization management, and training program. Involved in clinical services provided to children,adolescents,adults,couples,and families through the years. Conduct psychological evaluations with high-risk populations referred through human services agencies, County Courts, and/or the Department of Corrections. Administration of full and abbreviated psychological batteries, including cognitive, intellectual, personality, emotional, psychosocial,and family functioning. 2000 Contracted Psychologist: Larimer Center for Mental Health,Fort Collins,Colorado. Responsibilities: Full-time (32 hours per week), Conducted psychological evaluations in a community mental health setting with high-risk populations referred through human services agencies, County Courts, and/or the Department of Corrections. Administration of full and abbreviated assessments, including cognitive, intellectual, personality, emotional, psychosocial, and family functioning. 1998-2000 Clinical Supervisor: DeBusk Memorial Clinic,University of Oregon. Responsibilities: Part-time (20 hours per week). Oversight of clinical services in a community mental health setting. Individual and group supervision of therapists,as well as supervision of clinical supervisors. Clinic provides intake, crisis intervention, therapy, and psychological assessment services to the local community. 1997-1998 Psychology Resident: Denver Veterans Administration Medical Center,CO. Clinical Rotations: Psychological Consultation&Assessment, Inpatient Psychiatric Units(locked& unlocked), Inpatient PTSD Unit,Alcohol&Domestic Violence Unit,&Outpatient Clinic. Responsibilities: Full-time (40 hours per week). Consultation services provided to medical and psychiatric units, psychiatric admissions, and inpatient and outpatient services. Psychological assessments and individual, group, and family therapy, as well as psychoeducational groups, case management,treatment planning,and crisis intervention. 1994-1997 Clinical Supervisor/Staff Therapist:Psychological Services Center,Colorado State University. Responsibilities: Part-time (20 hours per week). Adult, adolescent, child, couples, and family services provided to the Fort Collins community. Intakes, individual and group therapy, psychological evaluations, crisis intervention and mediation, and consultation with human service professionals, school personnel, and medical and legal professionals. Supervision of doctoral students: Monitored client progress, assisted in the development of case conceptualization and treatment planning, advised on assessment matters, processed professional and developmental issues, and encouraged skill building. 1995-1996 Emergency Services Provider: Larimer County Mental Health,Ft.Collins,CO. Responsibilities: Part-time (16-24 hours per week). Emergency services provider serving the Larimer County community. Case management,crisis intervention,mental status exams,consultation with medical staff,and voluntary/involuntary hospitalizations. 1994-1995 Emergency Services Provider: University Counseling Center&Psychological Services Center Responsibilities: Part-time (72 hours per month). Emergency services provider serving the CSU campus and Fort Collins community. Case management, crisis intervention, mental status exams, consultation with medical staff,and voluntary/involuntary hospitalizations. 1994-1995 Group Therapist, Anger Management and Anxiety Reduction: Tri-Ethnic Center for Prevention Research,Colorado State University. M. E.Huff,p.3 of 9 Responsibilities: Part-time (8 hours per week). Application of cognitive-behavioral interventions, social skills and mediation training, and relaxation techniques for anger management and anxiety reduction. 1993-1998 Training Team Member:Victims Assistance Team,Colorado State University. Responsibilities: Response and prevention training to victim advocates, campus administration, residence hall directors, student assistants, campus organizations, and community organizations. Focus on recognition of trauma symptoms,response to trauma,support&advocacy,and prevention. 1993-1994 Staff Therapist: University Counseling Center,Colorado State University. Responsibilities: Part-time (10 hours per week). Intakes, evaluations, crisis intervention, & individual,couples,&group therapy. 1992-1998 Group Therapist,Sexual Assault Survivors: Victims Assistance Team,CSU. Responsibilities: Part-time (10 hours per week). Group facilitator serving campus and community population. Intake assessments, consultation and referrals, group and individual services, and crisis management. 1992-1997 Emergency Services Provider: Victim Assistance Team,CSU. Responsibilities: Emergency services provider to primary and secondary victims of sexual assault, serving the campus population and Fort Collins community. Crisis intervention, support, advocacy (medical, legal,and academic),and referral. 1989-1991 Advocate/Support Person(volunteer): Women's Center,SCSU,Minnesota. Responsibilities: Serving the campus and St. Cloud community. Intake assessment, support, advocacy,and referral. COMMUNITY OUTREACH. CONSULTATION. WORKSHOPS & PRESENTATIONS 2009—pres. Mental Health First Ai& Twelve-hour certificate training presentations for members of the community addressing mental health first aid crises, how to respond and give assistance, and how/when to get appropriate professional help. 2009—pres. Lunch & Learn Series. Series of one hour presentations for clinical staff addressing clinical issues, such as mood disorders, anxiety disorders, psychotic disorders, disruptive behavior disorders, pervasive developmental disorders,etc. 2008-2009 Diagnoses& GAF. Four hour presentations for clinical staff addressing issues associated with diagnoses and determination of global assessment of functioning(GAF). Feb.2005 Utilization of Beck Inventories to Screen for Mental Health Issues. Two-hour training presentation for community mental health center clinical staff on the administration and utility of Beck's Depression, Anxiety,Hopelessness,and Suicidal ideation scales for adolescent and adult populations. Jan.2005 Organizational/Team Conununication Based on MBTI Personality Types Two-hour interactive workshop for Children's Residential Facility staff focused on understanding and enhancing communication among staff. Jan.2005 Utilization of Beck's Youth Inventories to Screen for Mental Health Issues. Two-hour training presentation for community mental health center children's residential staff on the administration and utility of Beck's Depression, Anxiety,Anger, Obsessive, and Disruptive Behavior scales for children and young adolescents. June 2004 Clinical Documentation,Assessment, and Diagnosis. Seven-hour training presentation for community mental health center staff on state and agency standards for clinical documentation of services, methods of clinical assessment,and differential diagnoses. M. E.Huff,p.4 of 9 May 2004 Brief Screening Instruments for the Assessment of Mental Health Issues. Two-hour training presentation for community mental health center clinical staff on numerous brief and rapid screening instruments to be used in assessing mental health issues (e.g., suicide, cognitive confusion, depression,anxiety,anger). April 2004 Legal Workshop:Responding to Subpoenas. Four-hour presentation for community mental health center staff on responding to subpoenas, confidentiality and protecting privileged communication, negotiating releases,and testifying as an expert witness. Feb.2000 Assessment of Posttrauntatic Stress Disorder in Combat Veterans. Eight-hour training workshop for Veterans Administration clinical staff on the formal assessment of PTSD in combat Veterans. Oct. 1999 Intelligence Testing with the WAIS-IH and WISC-Ill. Eight-hour training workshop presented to University of Oregon Clinical and Counseling Psychology Doctorate Students. 1994-1996 PTSD and Rape Trauma Syndrome. Educational presentations (3 per semester) given to students enrolled in Abnormal Psychology and Human Sexuality courses at Colorado State University. Aug. 1995 Rough Rapids: Sexual Assault in Residence Halls. Three-day workshop presented to CSU residence hall administrators, directors, student assistants, and support staff. Included large group education presentations and 1'/-hour small-group interactive presentations focused on prevention, recognition, support,response procedures,state laws,and university regulations. 1994-1997 Rape Trauma Syndrome:Support and Advocacy. Training workshops for new Victim Assistance Team members. Presentation on the aftermath of sexual assault, recognizing symptoms, identifying concerns,crisis intervention,and provision of support services. Nov. 1994 Sexual Assault: Victims and Perpetrators. Educational presentations given to students enrolled in Human Sexuality courses at CSU. Sept. 1994 Sexual Assault: Prevalence, Prevention, Recognition, and Support. Two-week training workshop presented to CSU residence hall administrators, directors, student assistants, and support staff. Offered through the Victims Assistance Team. ACADEMIC/TEACHING EXPERIENCE 1998-2000 Assistant Professor, Counseling Psychology Doctorate Program; Department of Counseling, Family, and Human Services;University of Oregon. Responsibilities: Teaching, supervision of fellowships, clinical practicums, and psychological assessments,and dissertation and competency exam committee chair/member,and student advising. Teaching Responsibilities: Graduate Courses(counseling,clinical,&school psychology doctorate students) • CPSY644: Group Counseling and Psychotherapy • CPSY622: Advanced Psychological Assessment II—Personality&Emotional • CPSY62I: Advanced Psychological Assessment I—Cognitive&Intellectual • CPSY612: Professional Ethics • CPSY607: Doctoral Seminar—Assessment Undergraduate Courses(Family&Human Services Program) • EDST430: Advanced Individual and Group Interventions • EDST330: Individual and Group Interventions M. E. Huff,p.5 of 9 1996-1997 Teaching Fellow,Department of Psychology,Colorado State University. Responsibilities: PY320: Abnormal Psychology (2 sections, 180 students per section) and PY100: General Psychology(2 sections,215 students per section). Supervision of teaching assistants. 1996-1997 Instructor,Department of Continuing Education,Colorado State University. Responsibilities:PY100:General Psychology(2 sections,25 students per section). 1995-1996 Teaching Fellow,Department of Psychology,Colorado State University. Responsibilities: PY100: General Psychology(4 sections, 215 students per section). Supervision of graduate and undergraduate teaching assistants. 1995 Instructor,Department of Psychology,Colorado State University. Responsibilities: PY496: Professions In Psychology(adv-seminar,60 students). 1993 Instructor,Department of Psychology,Colorado State University. Responsibilities:PY325:Personality Psychology(35 students). 1993 Teaching Assistant/Mentor,CSU Teaching Assistant Workshop. University-wide training workshop for new graduate teaching assistants from across disciplines. 1990-1992 Lab Instructor: Department of Psychology,St. Cloud State University,MN. Responsibilities: PY260: Descriptive and Inferential Statistics Lab (2 sections per quarter, 40 students per section). Provided supplementary lectures/labs three times a week,graded and recorded daily assignments and exams. 1989-1990 Teaching Assistant:Department of Psychology,St. Cloud State University,MN. Responsibilities: PY100: Introductory Psychology. Graded and recorded lab reports, essays, and exams. Led weekly groups supplementing course material. RESEARCH PUBLICATIONS AND PRESENTATIONS Martin, V. A. & Huff, M. E. (2005). Relationships Between Attributions] Bias, Child Abuse History, and PTSD Symptom Severity in Adult Populations. Cognitive Therapy and Research. Martin, V. A. & Huff, M. E. (2003). A Diathesis-Stress Model of Posttraumatic Stress Disorder: Ecological, biological,and residual-stress pathways. Review of General Psychology, 7(3), 237-250. Martin, V. A., McWhirter, B. & Huff, M. E. (2001, August). Relationships Between Learned Helplessness Factors, Child Abuse, and Combat-Related PTSD. Paper presented at the American Psychological Association Convention, San Francisco, CA. Deffenbacher, J. L., Huff, M. E., Lynch, R. S., Getting, E. it., & Salvatore, N. F. (2000). Characteristics and treatment of high anger drivers. Journal of Counseling Psychology, 47, 5- 17. Huff, M. E. (1998). Attributions and locus of control as related to anger and anger expression styles. Doctoral dissertation,Colorado State University,Fort Collins, Colorado. Deffenbacher, J. L., Huff, M. E., Salvatore, N. F., & Lynch, R. S. (1998). Stress inoculation and applied relaxation in the reduction of driving anger. Paper presented at the Rocky Mountain Psychological and Western Psychological Associations'Convention,Albuquerque,NM. Lynch, R. S., Deffenbacher, J. L., & Huff, M. E. (1998). Reactions of high and low driving anger individuals. Paper presented at the Rocky Mountain Psychological and Western Psychological Associations' Convention, Albuquerque, NM. M. E.Huff,p.6 of 9 Powell, K. M., Rosen, L. A., & Huff, M. E. (1997). Disruptive behavior disorders and the avoidance of responsibility. Personality and Individual Differences, 23, 549-557. Deffenbacher, J. L., Getting, E. R., Huff, M. E., Cornell, G. R., & Dallager, C. J. (1996). Evaluation of two cognitive-behavioral approaches to general anger reduction. Cognitive Therapy and Research. 20, 551-573. Huff, M. E. (1995). Therapists'perceptions, preferences, comfort, and confidence with different client types. Unpublished master's thesis,Colorado State University,Fort Collins,Colorado. Deffenbacher, J. L., Getting, E. R., Huff, M. E., & Thwaites, G. A. (1995). A fifteen-month follow-up of social skills and cognitive-relaxation approaches to general anger reduction. Journal of Counseling Psychology, 42, 400-405. Deffenbacher, J. L., Huff, M. E., Cornell, G. & Dallager, C. (1995). A social skills approach to the reduction of anger. Paper presented at Rocky Mountain Psychological Association,Boulder,CO. Huff, M. E. (1991). The effects of motivation and failure on problem solving performance: Reactance vs. helplessness. Paper presented at the Red River Psychology Conference, APA Midwestern Region,Moorhead,MN. OTHER RESEARCH EXPERIENCE 1995-1998 Collaborative Research:Tri-Ethnic Center for Prevention Research,CSU. Description: Work on various NIMH grant funded research projects. Development of Anger- expression scales, including measurement of cognitive factors and associated personal and social consequences. Treatment outcome studies involving group therapy for individuals with anger problems. 1995-1996 Collaborative Research,Department of Psychology,CSU. Description: Scale development and statistical analyses of avoidance of responsibility symptoms in disruptive behavior disorder subtypes. 1994 Research Assistant: Department of Human Development and Family Studies,CSU. Responsibilities: Content analysis and data coding to determine the prevalence of aging issues and later family life concerns in marriage and family therapy literature. 1993-1995 Graduate Research Assistant: Tri-Ethnic Center for Prevention Research,CSU. Responsibilities: Work on various NIMH grant funded research projects. Organization and implementation of data collection procedures (pre, post, and follow-up surveys). Data input, statistical programming, and data analyses. Group therapist for treatment groups using cognitive behavioral,social skills training,and/or relaxation techniques to reduce anger and anxiety. 1992-1993 Graduate Research Assistant:Women's Programs and Studies,CSU. Responsibilities: Academic programming, research, publication of program newsletter, and facilitation of Sexual Assault Support Group. 1990-1992 Member of the Experimental Psychology Research Group(EPRG),SCSU,MN. Responsibilities: Collaboration, design, and implementation of research projects for presentation at professional conferences. Critical analyses of existing research and the feasibility of future projects. 1990 Non-Response Enumerator,US Dept.of Commerce Bureau of the Census. Responsibilities: Interviews with"refusal to respond" and difficult cases for the 1990 United States Census. Aided individuals in filling out census forms, due to inability to read or understand questionnaires. Mapped and routed areas in which inaccurate or incomplete records existed. 1989-1991 Research Assistant: Women's Center,SCSU,MN. Responsibilities: Initiated development of the Women's Center resource/referral manual. Surveyed state,community,and campus resources. M.E. Huff,p.7 of 9 SPECIALIZED TRAINING, CONTINUING ED,& PROFESSIONAL DEVELOPMENT 1/2005 Invisible Child Conference: Conference focused on children with"invisible"challenges stemming from brain differences, such as Bipolar Disorder, ADHD, OCD, Anxiety Disorders, and Pervasive Developmental Disorders. 12/2004 Changes in CRS 27-10 Regulations in the State of Colorado, provided by the Division of Mental health. Focus on changes in"involuntary hold and treat"regulations. 10/2004 The Biosocial Effects of Methamphetamine Abuse. Workshop presented by Nicolas Taylor, Ph.D., CAC III. Sponsored by the Colorado Trust/Rural Solutions in partnership with Island Grove Treatment Center. 10/2004 CMHDRS Disaster Response Training—Level II Certification. Training workshop sponsored by the Colorado Mental Health Disaster Response System. 8/2004 CMHDRS Disaster Response Training—Level I Certification. Training workshop sponsored by the Colorado Mental Health Disaster Response System. 8/2004 Developing the Most Effective Systems of Care for People with Co-Occuring Mental Health and Substance Use Disorders: Working Together for Change. Workshop presented by Kenneth Minkoff, MD 7/2004 Summer Leadership Institute for Nonprofit Executives. Two day workshop sponsored by the Kenneth W. Monfort College of Business at the University of Northern Colorado. 4/2004 The 4`" Annual Mental Health Performance Indicator and Outcomes (PIO) Conference: The r President's New Freedon Commission on Mental Health, Evidence Based Practices & Recovery. Sponsored by SAMHSA's Center for Mental Health Services Data Infrastructure Grant. 4/2003 Wolves at the Door: Responding to the Demands for Evidence by the Legal System. Workshop presented by Stromberg,Cleveland,Crawford,&Schmidt. 3/2003 Brief and Solution Focused Treatment Approaches. Workshop presented by Michael Kucera,Ph.D. 11/2002 Collaborate: A Call to Action. Weld County Juvenile Collaborative Conference. 11/2001 Disaster Psychology and mental Health Response. Eight-hour training resulting in certification as a Type II Mental Health Disaster Responder. 9/1999 Multicultural Counseling: Working with differences in Race, Ethnicity, and Sexual Orientation. 32 hour advanced training workshop presented by Derald Wing Sue,Ph.D. 3/1998 Personality Assessment Inventory (PAY) Training Workshop. Presentation by Leslie Morey, Ph.D. (creator of the PAI),Vanderbilt University. 10/1997 Wechsler Adult Intelligence Scale - III (WAIS-III) and Wechsler Memory Scale - Ill (WMS-III) Training Seminar. Telecommunications seminar presented by the Psychological Corporation (Psych-Cop)Harcort Brace&Company. 9/97-8/98 Psychological Assessment and Evaluation. 100 hours of advanced training in the use of Wechsler Intelligence Scales, MMPI-2, PAI, MCMI-11, Rorschach, TAT, Incomplete Sentences Blank, Hand Test, Object Sorting Test, Behavioral Dyscontrol Scale, and the Self-Administered Interview. Coordinated by the Denver VA Medical Center,Psychology Services. M. E. Huff,p. 8 of 9 9/97-8/98 Neuropsychological Assessment. 100 hours of advanced training in symptom recognition, assessment of, and diagnosis of neurological disorders (e.g., dementia, Alzheimer's Disease, Parkinson's Disease, Huntington's Chorea, Korsakoffs, and Traumatic-Brain Injuries and Syndromes). Coordinated by the Denver VA Medical Center, Psychology Services. 9/97-8/97 Treatment of Culturally Diverse Populations. 100 hours of advanced training involving clinical case presentations using various theoretical perspectives,treatment models,and approaches. Presentations by a variety of expert clinicians with emphasis on different cultural groups. Coordinated by the Colorado Health Sciences Center,Psychology Services. 9/1997 PTSD in Vietnam Veterans of Native American and Asian Descent. Presentation provided through the collaborated research efforts of the Department of Veteran Affairs Medical Centers and the University of Colorado Health Sciences Center. 4/1996 Supervision Issues Workshop. Presentation by John Morse, M.S., LMFT, Rocky Mountain Marriage and Family Center. Sponsored by the Colorado Association for Marriage and Family Therapy. 4/1996 Advancing Brief Therapy: Attitudes and Techniques. Presentation by Tracy Todd, Ph.D., Brief Therapy Institute of Denver,Incorporated. 4/1996 Private Practice Sanity. Presentation by Janet Pipal, Ph.D. Workshop sponsored by the Department of Psychology and the Psychological Services Center at CSU. 3/1996 Dealing with Under-Motivated Adolescents. Presentation by Bill Parks, LMFT, Jim Campion, L.S.C.W., and Lisa Barnes, L.C.S.W. Seminar for professionals offered by Mountain Crest Behavioral Healthcare System. 3/1996 Depression in Childhood and Adolescence. Presentation by Mark Fallon-Cyr, M.D. Mountain Crest Behavioral Healthcare System's Grand Rounds Lecture Series. Sum 1995 Child and Adolescent Assessment and Treatment. Five-day training workshop on the assessment and treatment of disruptive behavior disorders and ADHD. Offered by the Department of Psychology, Colorado State University. Sum 1995 Neuropsychological Assessment. Semester of specialized training in administration of neurological test batteries, including the Halstead-Reitan battery. Offered by the Department of Psychology,CSU,and Thomas Bennett, Ph.D., Director of the Brain Injury Recovery Program. Spring 1995 Group Counseling and Psychotherapy. Semester of specialized training in theories and techniques of group therapy. Offered by the Department of Psychology,CSU. 3/1995 Foundations of Multicultural Communication Training. Presentation by Alma Vigo Morales, Director of Fort Collins Human Rights Office,and Barb Kissler,Director of Activities,CSU. Fall 1994 Marriage and Family Therapy. Semester of specialized training in dominant marriage and family therapy theories and techniques. Offered by the Department of Human Development and Family Studies,Colorado State University. Fall 1994 Emergency Services Training, Larimer County Mental Health Center, Fort Collins, CO. 4 hours initial training and 14 hours of in-service training. Fall 1994 Group Treatment and Implementation of Cognitive-Behavioral, Social Skills, and Relaxation Techniques for Anger and Anxiety Management. 24 hours of training and supervision with experiential components involving the group treatment of individuals with high levels of trait anger. 4/1994 Attention Deficit Hyperactivity Disorders. Presentation by Dr. Sam Goldstein. Seminar offered by the McKee Conference and Wellness Center,CO. M.E. Huff,p. 9 of 9 4/1994 Marriages From Hell: Trouble in Marriages, Turning Points in Marriages, Sick Marriages, and Treating Marriages. Presentation by Frank S. Pittman, Ill,MD. Mountain Crest Hospital, Master's Lecture Series,Fort Collins,CO. 11/1993 Male Survivors of Sexual Abuse. Presented by Mark Brosal,Ph.D. Sponsored by the Women at Noon Forum and the Dept.of Women's Programs and Studies at CSU. 8/1993 Multicultural Training Workshop. Presentations by the McKinley Group, Inc., Washington D. C.; Pima Prevention Partnership;and Team Fort Collins,Colorado. Three-day therapist training. 4/1993 Treating Adult Survivors of Incest. Case presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. 3/1993 Multicultural Communication. Presentation by Lillian Robal-Rose. Full day seminar offered through Colorado State University Programs Office. Spring 1993 Emergency Services and Crisis Intervention Training, Victim Assistance Team, Colorado State University,CO. 16 hours initial training and 16 hours of in-service. Spring 1993 Advanced Seminar on College Teaching. Training in various presentation styles, learning styles, and effective teaching techniques. Offered by the Department of Graduate Studies,CSU. 11/1992 Treating Childhood Trauma and PTSD. Case presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. 10/1992 The Famine Within. Training on eating disorders presented by Dr. Susan MacQuiddy. Sponsored by the Women at Noon Forum and the Department of Women's Programs and Studies,CSU, 9/1992 Psychic Trauma. Presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. Spring 1991 SPSS-X in the Social Sciences. Training in computer analysis using the SPSS and SPSS-X data analysis systems. Offered by the Department of Social Sciences, SCSU. Winter 1991 Research Topics in Psychology. Seminar involving critical analysis and implementation of research designs, Department of Psychology,SCSU. Winter 1991 Psychology of Teaching Practicum. Seminar involving supervised training and practical experience, Department of Psychology,SCSU. Congratulations, • • • The wallet card provided below Ai your Official authcrtiatlon to pradlce,.Photpcopiesare net mniidered official documents:but may be used to verify a Colorado license for credentialing or insurance purposes:You may now order a professionally designed was`canniiestel To place an order,go to www.dora.colorado.gov/professions/wallcertlRcalas or1-888-025.5237. - - • As a condition of licensing,you have a continuing obligation to comply with the statutes,rules and regulations governing your license in Colorado. Our website is a good source for this information.It is your responsibility to keep our office advised of your current address.You are responsible for keeping your license current and renewing it before the expiration date. • To Remove Document Fold and Tear Along This Peroration -- -- • • Certified Addiction Counselor III - Board:Ackacndouuakrnoa/n Type:Ace Number sacs STATE OF COLORADO Mail Correspondence to: Home Business Department of Regulatory Agendes (Circle one) Division of Professions and Occupations Active PRINTED ON SECURE PAPER Home Phone: Business Phone: ACC ACO.WWi7s osalabla wNSIR01s Name: Number Issue Date Expire Date Street Address: Maureen Edith Huff Greeley CO 60631 City,State and Zip Code: , �S. . `iF�'' I4te ♦Use the Area above for any ADDRESS Change Division Director Signature THIS IS YOUR WALLET CARD Congratulations, The wallet card provided below is your official authorization to practice.Photocopies are not considered 9rcoal documents,but may be used Iavedly a Colorado license for c edentialing or insurance purposes.You may now order a professionally designed wall certificatef To place an order,90 to www.dora coloredo goviprofessionslwallcertiflcates or 1.888-925- 237. As a condition of licensing,you have a continuing obligation to comply with the statutes,rules and regulations governing your license in Colorado. Our website is a good source for this information.It is your responsibildy to keep our office advised of your current address.You are responsible for keeping your license current and renewing it before the expiration date. Colorado has a medical and public health volunteer system for persons who are interested in assisting during an emergency Of disaster.To participate.register al httpc:rlcovolunteers.state-co us. • -- To Remove Document Fold and Tear Along This Perforation • -• • Licensed Psychologist - Board:Pie Ct'C sl E.arnrwrs Board Type:r rr Number:2458 STATE OF COLORADO Mail Correspondence Icy Home Business Department of Regulatory Agencies (Circle one) Division of Professions and Occupations Active Pn1NTEo ON SECURE P&PFR Home Phone: Business Phone: PSY P5Y000249n o0101:2o17 I 08/31/2015-----1 , Name: Number _ L Issue Date i Expire Date Street Address: Maureen Edith Huff Greeley CO 0631 City,Stale and Zip Code: • (Cf` - A Use the Area above for any ADDRESS Change • Division Director Signe ure r THIS IS YOUR WALLET CARD Nathan Kyle Swisher CURRICULUM VITAE 218 47'h Avenue Court Phone:(970)381-6093 Greeley,CO 80634 E-mail:nkswisher@yahoo.com LICENSURE Licensed Psychologist, Colorado - PSY.0003840 Issue Date: 01/02/2013 Expire Date: 08/31/2015 EDUCATION 05/2008-08/2011 Doctorate of Psychology in Clinical Psychology Rosemead School of Psychology, Biola University, La Mirada, CA Psy.D. conferred August 31, 2011 08/2006- 05/2008 Master's of Arts in Clinical Psychology Rosemead School of Psychology, Biola University 08/2002- 05/2006 Bachelor of Arts in Biblical Studies, Concentration in Psychology Trinity Western University, Langley, British Columbia, CAN CLINICAL EXPERIENCE North Range Behavioral Health Sept 2011-Present Adult Outpatient Therapist (Full Time Employment) Setting: Community mental health network, Greeley, CO - adult outpatient program. Duties: • Implement clinical assessment,psychological testing (cognitive,personality), and culturally-sensitive individual/group/family/couples psychotherapy for an ongoing caseload of 45-55 individuals(in addition to therapy groups). Caseload consists of both mental health and substance abuse referrals, voluntary and court-mandated. • Engage in regular faculty meetings and trainings, case consultation, individual and group supervision [qualifying for psychologist licensure and CAC (Certified Addiction Counselor) requirements],and external clinical seminars(including training for CAC II, Gottman Couples Therapy, and others). AspenPointe Health Services Sept 2010-Sept 2011 2,000-hour APPIC Pre-Doctoral Internship Setting: Community mental health network, Colorado Springs, CO. Major internship rotation located at Adult and Rural Services (adult outpatient); minor internship rotations included: Lighthouse (adult acute inpatient), Peak Vista Community Health Center(primary care), AspenPointe—Fountain, CO (rural outpatient). Duties: • Implemented clinical assessment,psychological testing (cognitive,personality), and culturally-sensitive individual/group/family/couples psychotherapy(EBP) for an ongoing caseload of 25-35 severely and persistently mentally ill adult consumers. • Provided crisis assessment, individual/group/family/couples psychotherapy for an adult population in an acute crisis setting(inpatient). • Coordinated clinical assessment and brief individual psychotherapy in a primary care setting,participating in brief behavioral health consultations for patients. • Implemented supervision with master's level psychology intern, including weekly clinical observation. • Engaged in regular faculty meetings, case consultation, internship training seminars (including presentation of doctoral paper), individual supervision, and external clinical seminars. Harbor UCLA Medical Center—South Bay TIES for Families Sept 2009-Aug 2010 830-hour Advanced Practicum Setting: Los Angeles County Department of Mental Health outpatient clinic; a multidisciplinary treatment approach promoting the successful adoption of foster children and adolescents. Duties: • Provided direct clinical assessment,psychological testing (cognitive, academic achievement,personality, socioemotional, neuropsychological), consultation, and individual/family/group psychotherapy for children,adolescents, and families. • Coordinated care with the court system and Department of Child and Family Services as needed. • Engaged in internal and external training for infant mental health(e.g.,the Bayley Scales of Infant Development),Narrative Therapy, Reflective Parenting, Mindful Parenting, Incredible Years, and other clinically-relevant seminars and didactic training made available at the Harbor-UCLA Medical Center. Rosemead School of Psychology,Biola University Fall 2009—Spring 2010 Setting: Biola University campus, La Mirada, CA. Duties: • 32-hour Clinical Supervision Practicum (provided weekly, individual supervision for graduate student providing services to adults in an outpatient setting; engaged in weekly supervision and tape review of supervisory sessions; presented audio tapes and progress notes for peer consultation and critique) • 32-hour Child and Adolescent Practicum (engaged in live peer supervision with teaching assistant using bug-in-the-ear technology; provided individual psychotherapy and parental feedback/consultation to an adolescent client recruited from the community). • 32-hour Group Therapy Practicum(provided process-oriented group therapy for a group of 10 college students for 10 weeks; consulted and worked successfully with co-therapist; maintained individual client files consistent with group conceptualization; engaged in weekly supervision). Biola Counseling Center August 2007—June 2009 1,090-hour University Counseling Center Practicum Setting: Outpatient university and community counseling center, La Mirada, CA. Clientele worked with consisted of an age range of 18-55, from various ethnic backgrounds, and presenting with various forms of mood-, anxiety-, relational-, adjustment/phase of life-, and disorder of thought-related problems. Duties: • Provided short- and long-term psychotherapy for adult individuals and couples, using Cognitive-Behavioral Therapy, Rogerian techniques, Emotion-Focused Therapy for Couples and Individuals, and Psychodynamic Psychotherapy. • Completed biweekly floor duty and structured intake interviews including MMPI-2 interpretation(written reports); provided MMPI-2 feedback sessions to graduate students. • Participated in weekly child therapy seminar/training(spring, 2009), weekly clinic in-service meetings (including case conceptualization and presentation), HIPAA training, and other clinically-related training; • Participated in two Gestalt Therapy seminars(as presented by David Gorton, Ph.D., Director of the Gestalt Therapy and Training Center, Woodland Hills, CA), and participated in Sand Tray and Psychotherapy workshop (as presented by Meredith Phanco, Ph.D.,Biola Counseling Center, La Mirada, CA). Measurement and Assessment Practica: Various Settings Fall 2007— Spring 2008 Setting: La Habra City School District; Arbolita Elementary School (grades K-2), El Cerrito Elementary School (grades K-2) and Walnut Elementary School (grades 3-5), La Habra, CA. Population represented age range from 5-10 years-old, various ethnic backgrounds (predominantly Latino) and levels of socio-economic status. Duties: • 300-hour school assessment practicum: assessed special education and general education students for learning and behavioral problems, consisting of neuropsychological and psycho-diagnostic tests, student interviews,in-class observation, case conceptualization,report writing, and Individualized Education Programs (IEP); participated in weekly individual supervision and presented in weekly consultation group with practicum supervisor and other practicum students. Setting: Rosemead School of Psychology, La Mirada, CA; comprehensive testing batteries administered to recruited child clients from the community and Biola University undergraduate students. Duties: • Completion of 3-semester sequence of measurement and assessment courses involving the administration and report writing of 6 comprehensive testing batteries; courses consisted of Measurement and Assessment I(trained to administer, score, and interpret the WAIS-III, WISC-IV, Woodcock-Johnson III, ADSA,Conner's (CPRS-R:L), and PPVT-III), Measurement and Assessment II (trained to administer and score the MMPI-II, MCMI-III, Folstein Mini Mental Status Exam,Thematic Apperception Test, House Tree Person Projective Drawings, Kinetic Family Drawing, and the Forer Structured Sentence Completion Test), and Measurement and Assessment III (trained to administer, score, and interpret the Rorschach). OTHER WORK EXPERIENCE CLINICALLY-RELEVANT EMPLOYMENT : • Intensive Support Services (ISS) Jun 2007-Sep 2007 Setting: Institute for Applied Behavior Analysis, Santa Ana, CA Hours: 30 per week Duties: Received training in Competency Based Training and provided support to children and adolescents with developmental disabilities. • Homecare Provider Jul 2005-Jul 2006 Setting: Visiting Angels Living Assistance Services, Bellingham, WA Hours: 20 per week Duties: Provided living assistance services, including various behavioral interventions, for adolescents with autism in home and community settings. TEACHING ASSISTANT EXPERIENCE : • Teacher Assistant: Psychology of Marriage Fall 2009 Keith Edwards,Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 3 per week Duties: Facilitate the discussion in and processing of areas such as family of origin issues, and lead skill building exercises in areas such as conflict resolution and empathic listening with undergraduate students. • Teacher Assistant: variety of courses covering the Fall 2007-Spring 2008 integration of theological topics and psychological theory Steve Porter, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 7 per week Duties: Provided assistance to Dr. Porter for grading of graduate-level coursework. • Teacher Assistant: Psychology of Christian Thought Spring 2008 Elizabeth Hall, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hill for grading of undergraduate-level psychology coursework. • Teacher Assistant: Psychology of Christian Thought Fall 2007 Pete Hill, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hall for grading of undergraduate-level psychology coursework. PRESENTATIONS • Presentation of Gottman Couples Therapy In-clinic presentation to adult outpatient staff,North Range Behavioral Health, Greeley, CO April 24, 2013 • Presentation of Bipolar Disorder: Diagnosis and Treatment In-clinic presentation to adult outpatient staff,North Range Behavioral Health, Greeley, CO June 6,27, 2012 • Presentation of Schema Therapy In-clinic presentation to adult outpatient staff,North Range Behavioral Health, Greeley, CO January 18, 2012 • "Reflective Functioning in Couples Therapy" 1-Hour In-clinic presentation to all clinical staff,AspenPointe Health Services, Colorado Springs, CO August 18, 2011 • Presentation of Doctoral Paper: "The Enhancement of Reflective Functioning in Couples Therapy: Integrative Literature Review and Theoretical Development" 2-Hour Intern Seminar, AspenPointe Health Services, Colorado Springs, CO June 23, 2011 • "Forming Attachment Bonds in Marriage: Can You Hear Me Now?" "The Risks and Treasures of Love"relationship conference; hosted by Living Hope Church, Colorado Springs, CO April 2, 2011 PROFESSIONAL MEMBERSHIPS • American Psychological Association Current Membership#95673434 -- ---- . .r OF COLORA Department of RegWatay Agencies Division of Profasalale anti Occupations Active HUNTED ON SECURE PAPE PSY PSY.00a1810 Uao12Dfa Wrii2018 Numger Issue Date Enquire Date • Nathan Kyle Swisher Greeley CO 80834 iDivision Director Signature Alan Ulibarri 815 Coffman St.#8 Longmont, Co 80501 970-534-5811 Alan.ulibarri@northrange.org Objective To continue my education and growth through my professional experiences so I can expand my ability of helping others Education Bachelors Degree in Psychology and Sociology University of Northern Colorado Greeley, Colorado August 2003-May 2007 Experience Mental Health Worker II Acute Treatment Unit of North Range Behavioral Health Greeley, Colorado 970-347-2120 May 2007-December 2008 In patient services for the severe and chronically mentally ill, Crisis phone line counseling for North East Colorado, administering medication, milieu management Behavioral Health Specialist II Crisis Stabilization Services of North Range Behavioral Health Greeley, Colorado 970-347-2120 December 2008-Present All duties performed at the ATU were continued with the addition of substance abuse specific duties: client admission assessment and coordination, admissions and discharges, withdrawal assessment, case management, and substance abuse monitoring Trainings Colorado Qualified Medication Administration Person A variety of Certified Addictions Counselor courses Crisis Prevention Institute's training in Nonviolent Interventions Multiple trainings in cultural diversity, de-escalation techniques, workplace safety,first aid,and seclusion/restraints References Please see Resume on file or contact me for updated contact information Amber Frazier 4408 John F Kennedy Pkwy Apt D303 (970) 218-0945 Ft Collins, Co 80525 amber.frazier@northrange.org Education Bachelor of Science, Psychology University of Northern Colorado, Greeley, CO May 2010 GPA: 3.2/4.0 Certifications Certified Addiction Counselor II, Expiration: August 2015, ACB.0007633 CPR, Expiration: January 2015 Experience Behavioral Health Worker: Monitoring, Crisis Stabilization Services,NRBH, Greeley, CO 8/2010-Present • Perform sample collections for drug and alcohol testing; urinalysis, oral swabs, patches, hair follicle, and breathalyzers • Maintain client records related to drug and alcohol testing • Monitor clients taking Antabuse • Collect payments for detox and monitoring services • Reporting monitoring results to requesting agencies Behavioral Health Worker, Crisis Stabilization Services,NRBH, Greeley, CO 8/2010-Present • Complete Detox intakes and discharges • Diagnose Detox charts • Perform one-on-ones for Detox and ATU clients • Check vital signs on Detox clients • Observe clients for fifteen minute checks on the Detox and ATU floors Certified Nurse Assistant,Prospect Park Living Center, EPMC, Estes Park, CO 4/2006-11/2009 • Assisted residence in activities of daily living; patient ratio average of 1:12 • Provided residence with stimulating activities • Documented relevant physical, cognitive and social changes in residence Trainings QMAP-Qualified Medication Administration Person, Expiration: 9/2015 Detox Program Training 4/7-8/2011 CPI Training-Nonviolent Crisis Intervention Training 3/13/2013 Activities Alpha Kappa Psi- international,professional business fraternity Psi Chi- international honor society in psychology • Professional development • Community service • Print Lookup Details Page 1 of 1 C±) Dora Barbera J.Kelley • • U1{ ' Executive Director r.1'f.2� Department d newton Agencies Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:license information provided by the Colorado Division of Professions and Occupations,established by 24.34-102 C.R.S. Name Public Address Amber Alyse Frazier Fort Collins, CO 80525-3457 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACB.0007633 Original Certified Addiction Active 10/03/2012 09/01/2013 08/31/2015 Counselor II Board/Progam Actions Disdpline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:29:49 PM +... ^.':,'. .f• „ Y�K:r. r..ad, ,.a, , , i _nay'-, + y.�, ;e.... ».,. , ,. ,q ,». x �..�'*�5 ._ Bradley J.Crookston 3300 Rio Grande Avenue Evans, CO 80620 (970)673-5640 "To Exceed Expectations" Work History (past to present): ➢ Coldstone Creamery 1431 N. Denver Avenue Loveland, CO 80538 Direct Supervisor: Paul Schofield • Date(s) employed: June 2003 —May 2006 • Job Title at Time of Hiring: Crew Member/Wage at Time of Hiring: $6.00/hr. • • Job Title at Time of Resignation: Supervisor/Wage at Time of Resignation: $9.50/hr. • Reason for Resignation: Accepted Job Offer at Universal Mechanical Inc. • Description of Duties: Service of customers, opening the store, closing the store, balancing cash register at open and closing times, general cleaning duties, supervision of up to five crew members at one time, as well as the making of ice cream. > Universal Mechanical Inc. 328 S. Link Lane#12 Fort Collins, CO 80524 Direct Supervisor: Heath Morby • Date(s) employed: May 2006—August 2006 • Job Title at Time of Hiring: Crew/Wage at Time of Hiring: $12.00/hr. • Job Title at Time of Resignation: Crew/Wage at Time of Resignation: $12.00/hr. • Reason for Resignation: Traveled to Mexico to serve a mission for The Church of Jesus Christ of Latter-Day Saints • Description of Duties: Assist in the installation of new HVAC units as well as the removal of old HVAC units. This included, but was not limited to: electrical wiring, making of ventilation duct, & installation of new ventilation duct. > The Church of Jesus Christ of Latter-Day Saints Mexico Southeast Mission Apartado#103 (lo. De Mayo#1319) Veracruz, Veracruz Mexico • Date(s) served: August 2006—June 2007 • Title: Missionary/Wage: n/a(volunteer) • Description of Duties: Learn the Spanish language,proselyte door to door, develop friendships, engage in community service opportunities,baptize and confirm new members. > Whelan Security 6501 South Fiddlers Green Circle#117 Denver, CO 80111 (303)221-4518 Direct Supervisor: Mehdi El Hafiane • Date(s) employed: June 2008—September 2012 • Job Title at Time of Hiring: Security Officer/Wage at Time of Hiring: $11.00/hr. • Job Title at Time of Resignation: Security Officer Hybrid/Wage at Time of Resignation: $13.50/hr. • Description of Duties: Perform building patrols,report suspicious activity,emergency response, escort janitorial staff, & perform lobby post duties. Perform SCC Operator duties when required, including monitoring of cameras, notification of proper personnel regarding abnormal and emergency situations, coordination of security officers in order to perform required daily shift duties, writing as well as submission of incident reports, issuance of keys to contracted personnel, &coordination of security emergency response.Special Note: In December of 2008 I was promoted to the station of Security Supervisor which I held until December of 2010. I willfully resigned from the position in order to focus on my education at the University of Northern Colorado. During this time I performed the following additional duties: assist the Site Account Manager in the scheduling of the SRO (flex) officer as well as the scheduling of time off requests and the arranging of appropriate coverage. Also, I Supervised a staff of five individuals, this included the recommendation of individuals for awards as well as the disciplinary action of individuals when authorized by the Account Manager. In addition, I led two separate Task Teams of three to four individuals each. These Task Teams included the evaluation and streamlining of forms and documents utilized by the department as well as an evaluation of the current technology deployed by the department. > North Range Behavioral Health CSS 1140 M Street Greeley, CO 80631 (970) 313-1173 Direct Supervisor: Michelle Aragon • Date(s) employed May 2012-July 2012 • Job Title: Student Intern/Wage: n/a(volunteer) • Description of Duties: Client Supervision, Group Counseling assistance and observation, One-on-One interviews with clients, intake/discharge observation, accompany staff on client transports, supervise clients for urine analysis, measuring client's vitals and assist staff as directed. > North Range Behavioral Health CSS 1140 M Street Greeley, CO 80631 (970)313-1173 Direct Supervisor: Stephanie Nielsen • Date(s) Employed: September 2012—Present Day • Job Title at Time of Hiring: Behavioral Health Worker Current Job Title: Behavioral Health Worker • Description of Duties: Perform monitoring duties, including BA's, UA's, hair follicle samples, sweat patch samples, and corresponding documentation. Facilitate client participation in respective individual treatment plan, by providing emotional support, advocating for the client, and assisting the client in problem solving. Perform on-on-one interviews with clients, intake/discharge of clients from facility, group counseling sessions, transport clients to and from hospitals and other medical or mental health facilities, measure client vitals, assess client withdrawal symptoms, supervise clients for urine analysis, inventory client belongings, ensure client safety, and document client progress during client stay at facility. Education (past to present): > Loveland High School 920 West 29th Street Loveland, CO 80538 • Date(s)Attended: August 2001 —May 2005 • Degree Awarded: High School Diploma > University of Northern Colorado 501 20th Street Greeley, CO 80631 • Date(s)Attended: August 2005—May 2006 &August 2009—December 2012 • Degree Obtained: Bachelor's Degree of Psychology • Date(s) Attended: May 2013 —Current • Pursuing Master's Degree in Clinical Mental Health Counseling: Couples and Family Therapy Additional Skills & Abilities: > Proficient in the Spanish Language (read,write, and speak) > Goal Oriented > Strong Work Ethic > Skilled in Microsoft Office software programs > Detail Oriented > Punctual > Motivated > Strong Social Skills > Excellent Customer Service Skills > Team Player > Leadership Ability > Tactful > Ability to Learn New Things Quickly&Efficiently Personal& Professional References: Sam Morris—Manager from 2009 to 2012 Contact Information: (970) 691-9169 Braden Price—Childhood Friend since 1990 Contact Information: (970) 581-8693 Mehdi El Hafiane—Co-worker& Supervisor from 2008 to 2012 Contact Information: (720)472-0413 Stephen Schoon—Childhood Friend since 1991 Contact Information: (970) 310-7283 Sean Ronan—Friend from School & Church since 2006 Contact Information: (970) 590-7582 Ben Dennis—Childhood Friend since 1992 Contact Information: (970) 685-2994 *Letters of Recommendation Can Be Provided Upon Request* 1217 11`h Ave. Greeley, Colorado 80631 970-347-0068 daniel.ferris@northrange.org Daniel J. Ferris-Shaw PROFESSIONAL SUMMARY: Behavioral Health Worker with a Bachelors Degree in Psychology/CACII and shift supervisor for North Range Behavioral Health Crisis Stabilization Services for clients for Substance Abuse (Detox) and the mentally Ill (Acute Treatment Unit"ATU.) Monitoring of vital signs,withdrawals from alcohol and other known mind/mood altering substances,counseling,and informing clients of further treatment resources and programs. Handling crisis calls from those who are in crisis or are in need of telephone therapy and knowing when to request a welfare check to be done on those who are a danger to themselves or others. Monitoring the safety of all clients on the unit. Administering drug testing for those in need of breathalyzer, urinalysis testing, alcohol swabs,hair follicle testing,and drug patches. QUALIFCATIONS and CERTIFICATIONS: • Certified in first Aide & CPR • Qualified Medication Assistant Personnel (QMAP) • CPI Seclusion and Restraint certified • Certified Addiction Counselor Level II (CAC II) • Administering medications covered under the QMAP certification • Checking vital signs of clients • Understanding the CIWA/COWS scales for withdrawals for detox clients • Crisis Assessment practice and application • Understanding HIPPA laws and confidentiality • Diagnosing Substance Abuse client charts (Covered under CAC II licensure) • Providing clients with knowledge of available resources and treatment opportunities EDUCATION: University of Northern Colorado Greeley, CO. May 2009 • Bachelors Degree in Psychology AIMS Community College Greeley, CO. December 2005 • Associates in Liberal Arts North Range Behavioral Health Greeley, CO. March 2011 • Certified Addictions Counseling(CAC)Level II • 135 Internship Hours EXPERIENCE • North Range Behavioral Health CSS January 2009-current -Shift Supervisor Promotion: Sept 2010-current • Smoker Friendly Windsor/Greeley/Loveland stores March 2003-April 2009 -Assistant Manager a)Book keeping b)Auditing(inventory counting and calculation) c) Cashier d) Putting in orders e)Calling in orders • Perkins Family Restaurant Greeley,CO. May 2000-July 2001 Print Lookup Details Page 1 of 1 11?' ' Barbara J.Kelley to rt +� / Dora Exeegtive Director Jetta zvnt '.Dean mdRewkmrr +o '. +" e.. LoakuD Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:Lkense Information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Daniel John Ferris-Shaw Greeley, CO 80631-3827 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACB.0007379 Original Certified Addiction Active 03/30/2011 09/01/2013 08/31/2015 Counselor II Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:31:54 PM .... n I I •I n• , n . ,.. • .. • . Melissa Blatnik 1140 M.Street Greeley,CO 80631 Phone:970-313-1173 Cell:970-590-4280 Melissa.blatnikPnorthranae.org OBJECTIVE • To provide a quality service for our clients and other service providers. SKILLS • Effectively communicate with staff and clients for a successful outcome in treatment • Supervise staff and delegate tasks sufficiently EXPERIENCE July 2006 until present, North Range Behavioral Health Greeley,CO Behavioral Health Worker • Safety checks every 15 minutes on each client. • Checking clients blood pressure every two hours • Individual counseling • Group counseling Supervisor From February 2006 until present • Administering medications to the clients • Coordinating admissions and discharges of clients • Coordinate placement and transportation with the local hospital staff • Work with the staff to ensure quality of care to the clients EDUCATION • Northern Colorado University,Greeley,CO Bachelor's Degree in Psychology August 2011 • Certified Addictions Counselor III October 2009 REFERENCES Available upon request 3604 I S•Ave k cell(970)405-6906 Evans Col 80620 Rachel Watson Experience Dec 2009-Current North Range Behavioral Health Greeley,Co Program Coordinator • Collaborate with internal and external agencies for client care. • Develop trainings and facilitate training with staff members. • Supervision of staff. • Updating Medicaid authorization to Value Options. 2005-Dec 2009 North Range Behavioral Health/Island Grove Greeley,Co Shift Supervisor • Supervise day shift employees. • Monitor clients by taking vitals and administering medication. • Intakes and discharging of clients. • Responsible of ordering and monitoring services. 2000-2005 Theresa's Tall Giraffe Day Camp Evans,Co Teachers Aid • Responsible for care and wellbeing of children from 2 K to 14 years old. • Coordinate and Implement daily actives within the weekly themes. • Coordinate all three centers in the transport of school age children to and from school. 1996-2000 Montgomery Ward Greeley,Co Lead Associate For Men and Children Department • Supervised 5 to 15 employees on cash register and department regulations. • Help insure customer satisfaction while keeping co-worker motivated and on task. • Train and educate all department employees of new policies and procedures concerning our zone of the floor and merchandise inventory. Education 2003-2005 University of Northern Colorado Greeley,Co • Associates of Science through Aims Community College • B.A.,Criminal Justice. • Minor Rehabilitative Services. 12008 July • CAC H certification 2009 October • CACIII QMAP 2013 January • CPR Trained 2013 March • CPI Trained References Will obtain upon request. Print Lookup Details Page 1 of 1 .� '%'1 Dora tA B�bare J.l(eFlep . , r, • I:{ A, . Executive Director ` ..i b-Department ofRegutatory Agencies -....-t, , 4;'‘ ink, Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24.34-102 C.R.S. Name Public Address Rachel Maria Watson Evans, CO 80620-2027 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACC.0006837 Original Certified Addiction Active 10/13/2009 09/01/2013 08/31/2015 Counselor III Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:33:02 PM .., . . ,. ............ . Troy Melcher 3333 35st Greeley, CO 80631 (970)903-8477 melcher.troy@yahoo.com Objective To adequately assist clients through the detoxification process and provide adjacent staff with the assistance necessary for a functional and successful team as a behavioral health worker at North Range Behavioral Health Crisis Stabilization Services Qualification Highlights • Well-developed verbal and written communication skills • High degree of organization • Promotes and adheres to efficiency,professionalism, and accuracy in the workplace • Proficient in Microsoft Word,Microsoft Excel,and Microsoft PowerPoint • Very capable of working alone or with others Education Bachelor of Arts, Psychology Minor: Criminal Justice University of Northern Colorado(UNC),Greeley,CO Graduation Date: December 2012, GPA 3.83/4.0 Master's of Arts, Clinical Counseling University of Northern Colorado Anticipated graduation date: May 2015,GPA 3.73/4.0 Work Experience Bank Teller,Citizens State Bank of Ouray, Silverton,CO(summers of 2009 and 2010) • Managed the debiting and crediting of accounts • Informed customers about bank products and handled phone enquires • Assisted out-of-town customers with banking affairs • Maintained accuracy of cash flow using a double entry bookkeeping format Behavioral Health Worker,North Range Behavioral Health—Crisis Stabilization Services,Greeley, CO(May 2012-present) • Assist callers using the crisis phone line with de-escalation • Aid detoxification and mental health clients with living in the facility • Conduct one-on-on and group sessions to promote the stabilization process Honors Member,Psi Chi Honor Society(April 2011 - December 2012) Recipient,Dean's List(UNC)(2011 - December 2012) President,Golden Key Honor Society(September 2011 -December 2012) AMANDA SPRINGER 1715 30 Ave Ct Residence: 970-353-0340 Greeley, CO 80634 alpenglocreations@comcast.net OBJECTIVE Obtain a challenging role in a behavioral health facility where my strengths in evaluation, communication, relationship development, organization, and use of counseling skills can support the staff in an effort to provide quality care to their clientele. SUMMARY Accomplished professional with experience in evaluation,case management, group facilitation, and counseling in the human services field. Core competencies include diagnostics, intake interviewing, problem solving,treatment planning, and management of crisis situations. Strong team player with the ability to work under intense pressure, completing projects in a timely fashion. Decisive and energetic in nature. SKILLS *Leading People *Problem Solving *Communications *Intake Interviewing *Diagnostics *Rapport Development *Group Facilitation *Organization *Crisis Management SELECTED ACHIEVEMENTS Supervising staff and clients for a combined 16 bed locked facility for the mentally ill and a 23 bed locked facility for those withdrawing from substances. Enhanced the programs by improving one-on-one contact with the clients and developing an assortment of therapeutic group activities. Result: Increased success in the duration of time that numerous clients remained outside of the facility, increased client awareness of symptoms and resources available to them, as well as higher client satisfaction reports. Responded to emergency crisis calls for a 12 county area. Result: Determined where individuals in crisis needed to be placed for appropriate treatment and assisted crisis workers in arranging these placements. Completed assessments for the PASRR-MI and reported to Dual Diagnosis Management in regards to individuals needing placement in a nursing facility. Result: Advocated on the behalf of individuals with mental illnesses in regards to obtaining the best and most appropriate care to meet their present needs. model to address the behavioral issues of youth Modified and implemented a behavioral/teaching at risk. Result: Youth learned acceptable and unacceptable behavior and were unable to manipulate staff as easily when everyone was working under the same model. Taught life skills to individuals with disabilities. Result: Advocated on behalf of individuals and assisted them in finding employment, in addition to teaching skills to assist them in functioning more independently within their communities. PROFESSIONAL EXPERIENCE North Range Behavioral Health, Greeley, CO August 1999-present Program Director September 2006--present Supervise staff in the care of the inpatient population we serve. Review charts and maintenance of records. Problem solve for difficult cases and situations on the unit. Mental Health Therapist October 2004—September 2006 Maintain a brief and chronic therapy model caseload. Responsible for crisis evaluations. Responsible for case management. Responsible for intake evaluations and assignment to appropriate therapy. Mental Health Therapist September 2001- October 2004 Responsible for 16 bed inpatient facility. Supervision of various staff members. Responsible for crisis evaluations. Responsible for treatment and case management. Facilitated group activities. Clinical Care Assistant August 1999—September 2001 Milieu manager responsible for treatment and case management. Responsible for preparation and organization of routine services on the unit. Windsor Middle School,Windsor, CO. January 2003-May 2003 Internship-Middle School Counselor Provided personal and academic counseling to students with diverse needs. Planned and implemented a variety of groups to meet the needs of students. Performed organizational functions in maintaining student records. Assessed reports, surveys, and research. Office of Human Development, Sidney,NE. February 1999-August 1999 Life Skills Assistant Supervised the living environment/behaviors of mentally disabled individuals. Taught useful skills for daily living. Provided one-on-one counseling. LICENSURE State of Colorado-Licensed Professional Counselor License Number 4263 2006. State of Colorado-Certified Addiction Counselor III License Number 7416 2011. EDUCATION M.A. School/Community Counseling. University of Northern Colorado, Greeley, CO. 2003. B.A. Psychology and English. Chadron State College, Chadron,NE. 1998. Print Lookup Details Page 1 of 1�CtfDOr&mt : * AS •.fHs' DeparM1neM dRequYtory agencies wtr-. LOOkLID Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Amanda Kay Springer Greeley, CO 80634-6826 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACC.0007214 Original Certified Addiction Active 05/25/2011 09/01/2013 08/31/2015 Counselor III Board/Proqam Actions Disdpilne There is no Discipline or Board Actions on file for this credential. i Generated on: 3/17/2014 5:28:16 PM ,r n. . ,. , m • .. • t., . n . q..nn. n n,.—,nn. . • Print Lookup Details Page 1 of 1 • / � Barbara J.Kelley •• ,t r& Dora • � , ,,.;, Executive Director .riff.! Department of RegubtoryAgendes Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License lnfomreton provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Amanda Kay Springer Greeley,CO 80634-6826 Credential Information License License License Original Issue Effective Expiration Number Method License Typo Status Date Date Date LPC.0004263 Examination Licensed Professional Active 03/29/2006 09/01/2013 08/31/2015 Counselor Board/Proeam Actions Discipline There Is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:28:37 PM I _ 1 .f /I• • II . .. . n . n . 497 E.20th Street Phone(970)324-3873 Greeley,CO 80831 E-mall amc1451lyahoo-com Anna M. Strobridge Education Greeley Central High School August 1984—May 1987 1515 14th Street Greeley, Colorado 80631 (970)348-5000 • Graduated with a 3.0 GPA in May of 1987 AIMS Community College September 1999—May 2006 5401 West 20"Street Greeley,Colorado 80634 (970)330-8008 • Graduated in May of 2008 with an Associates of Science in Surgical Technology. • Graduated May 2012 with a Liberal Arts Associates in Criminal Justice. Professional June 1988—June 1990 experience Hardees Downtown 720 10"Street Greeley, Colorado 80631 (970) 352-9522 Crew Leader • Line Cook • Prepare food • Customer Service • Deposits • Open Store June 1990—August 2005 Eastman Kodak Colorado Windsor,Colorado 80551 (970)686-7611 Production Operator in C-13 • Spooled and packaged movie film • Chopped, inspected, heat sealed, packaged, and palletized X-Ray film products • Shipped product to distribution,and fork truck certified Production Operator in C-29 • Chemical mixing of dye solutions • Shipped and received bulk chemicals • Assisted coating machine in changeovers • Prepared special solutions for experiments • Tested all chemicals and dry products in analytical lab • Looked for defects in the chemical and finished products • Slit finished product into smaller customer usable spools • Prepared all paperwork, labels,and order that rolls should run • Packaged and shipped finished product • Data entry and extraction Kodak Operating Systems Lead • Lead special events with production operators,engineers, management,and outside consultants to create more efficient production lines. • Analyzing data from normal operations, make appropriate changes, and produce matrixes to track progression of changes Focus Person • Lead person for 15 operators in the finishing area • Managed and set daily production goals per daily schedules • Delegated work and handled vacations, personal time, sick leave and,time cards • Facilitated production meetings for management • Handled operator,inventory, and product problems • Evaluated operators for promotions, code changes,and raises September 2005—May 2006 Walgreens 1480 Main Street Windsor, Colorado 80550 (970)6745091 Customer Service Representative • Cashiered • Stocked store and front end caps • Counted tills • Assisted customers with finding,and pricing products May 2006—August 2006 Platte County Memorial Hospital 201 14th Street Wheatland,Wyoming 82201 (307)322-3636 Surgical Technologist • Set up and maintained sterile field before, during and after surgical procedures • Passed instrumentation to surgeons during surgical procedures • Assisted surgeons with retracting • Organized all equipment,instrument trays, and specialty supplies • Oversaw inventory,and ordering supplies for entire operating room September 2006—November 2006 Mckee Medical Center 2000 Boise Avenue Loveland,Colorado 80538 (970)669-4640 Surgical Technologist • Set up and maintained sterile field before, during and after surgical procedures • Passed instrumentation to surgeons during surgical procedures • Assisted surgeons with retracting February 2007—Present North Range Behavioral Health Crisis Stabilization Services 1140 M Street Greeley,Colorado 80634 (970)313-1173 Certified Addictions Counselor III/Supervisor • Assess and admit clients who are under the influence of alcohol or illegal drugs • Monitor clients for withdraws from alcohol or illegal drugs • Administer Urine Analysis, Breath Analysis, Patches, and Swab tests on clients • Counsel clients on their addictions and offer options for treatment. • Hold therapeutic groups for detox and mental health clients. • Transport clients to and from facility. • Work with Weld County Law Enforcement Weld County Dispatch, and Hospitals in Northern Colorado assisting in bed availability for detox and mental heath clients. • High volume of calls from public needing assistance, answering questions pertaining to clients, facilities, different treatments, bed availability,and crisis calls. • Assist clients with follow up appointments, filling out various types of paperwork for treatment and different assistance programs. • Assisting clients with making calls to various locations for different services • Mediate between clients,and families. • Supervise 6 staff,delegate work load, conduct supervisions with staff, and assist staff with problems. Additional • Microsoft Office Applications professional • Outlook activities • Filing, Faxing, and Multi-line Phones • Type 45 Words Per Minute • Data Entry • CPR Certified Languages • Spanish(Conversation) References Gary Pegg Josie Cano 407 Mapleton Ct. 1917 31°Street Ft Collins, Colorado 80526 Greeley,Colorado 80631 (970)223-4906 (970)371-0829 Known 15 Years Known 4 Years Melissa Bladnik Stephanie Nielson 2815 Longboat Way 3618 Stampede Dr. Ft Collins, Colorado 80524 Evans, Colorado 80620 (970)590-4280 (719)216-7004 Known 7 Years Known 3 Years Regina Rickman 4901 E. Kelton Lane Unit 10197 Scottsdale Arizona 85254 (602)663.8583 Known 3 Years Print Lookup Details Page 1 of 1 t) DOraz Department of Regu40ocyAgenflef LookuD Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Anna Martinez Cruz Greeley, CO 80631 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACC.0006911 Original Certified Addiction Active 03/05/2010 09/01/2013 08/31/2015 Counselor III Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:42:38 PM u...._.tI_______ __,___ �_ . ..,a. __ n•. n , m .r .� •. a I a ••,• . 3405 16th street #32 Greeley Colorado PHONE 970 515-2551 BRIDGET REYEZ OBJRCTIVE:To utilize my clinical skills and knowledge of the substance abuse field in order to facilitate recovery and better the lives of others. EMPOLYMENT HISTORY: 6 2006—Current North Range Behavioral He alth-Mental Health Worker / 5/1997 Current Community Advantage-Direct Care Staff 5/2002 Mosaic—Direct Care Staff EDUCATION: 1994 Aims Community Advantage Associate of Arts 1994 University Of Northern Colorado,Greeley,CO 2013 CAC II Certified Alcohol Counselor JOB RELATED SKILLS: SUBSTANCE ABUSE MONITORING MENTAL HEALTH SERVICES CPR TRAINED SPECAIL NEEDS PEOPLE COMPUTER SKILLS Print Lookup Details Page 1 of 1 i Barbara J.Kelley N, \: Dora Executive Director •-4o•te41--.- Department Department dnegot troy Agencies 'IF:. �. s. Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Bridget Rene Reyez Greeley, CO 80634-1040 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACB.0007750 Original Certified Addiction Active 12/18/2013 12/18/2013 08/31/2015 Counselor II Board/Progam Actions Disdpline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:43:59 PM L.a�...11._�...-. _ i ..J_ ii__�Il.____.___n' __l ,n_•_a !____.r_..a_ _J—nnnnefl e_ "ll^Il"A4A RESUME Josephine E. Cano December 1978-May 1984: Weld County Sheriff's Office,918 10th Street, Greeley, Co 80631 Supervisor: Edward Jordan, David Shelton 970-356-4010 Duties: Booking area. December 1984-February 2001: Colorado Rural Legal Services, now Colorado Legal Services, 800 8th Avenue,#202, Greeley, CO 80631 Supervisor: Joel Hayes, Mario Rivera. 970-353-7554 Duties: Legal Secretary/Receptionist/Office Manager for a legal aide office. February 2001-July 2003: The Law Office of Miguel Martinez, 1102 5th Street, Greeley, CO 80631 Supervisor: Angela Saucedo, 970-470-4810 Law firm-w worker's compensation, personal injury, some criminal, immigration,bankruptcy and small portion of civil law cases. I was legal assistant, receptionist,filer, scheduled appointment for attorneys and I ordered supplies. August 2003 to August 2005: Working PT with The Law Office of Dan Trevino, 1122 9th Street, Greeley, Co 80631. Supervisor: Daniel Trevino Temporary Part time Receptionist,answer phone, filing and typing. Computer program use, Word and Best bankruptcy. 2006-to 2008 Island Grove Center, Substance Abuse Adolescent-Adult Outpatient facility. Assist clients,answer phones, put chart together, Collect monies,reconciliation,typing of correspondence,administered BA/UA's.. 2008-to North Range Behavioral Health, Child and family both SA and MH team until 01/01/11. Support staff for 17 staff, filing, answer phones, registrations, collect monies, reconciliation. 01/03/11 to preset North Range Behavioral CSS SA and MH facility, Detoxing of clients and Acute Treatment Center,put charts together, put info on a roster, sent over to billing at Main, verify Medicaid through the state, collect monies, reconciliation. Filing of documents for charts, ordering supplies(pass this info on to Sarah), transport log documentation(mileage/calls) reporting.Redwood reporting. Trained/Supervised. Monitoring sobriety through UA and BA,Enter daily referral's from outside agencies for monitoring services. Trained and supervised several work study students,and interns since 2008 to present. Bi-lingual Nick White 621 Scotch Pine Dr. • Severance,CO 80550• (970)301-2263 • Nickwco85@yahoo.com EDUCATION: Bachelor of Arts, Psychology 2004-2008 Minor: Sociology Overall GPA 3.0 University of Northern Colorado Greeley, CO 80631 RELEVENT WORK EXPERIENCE: North Range Behavioral Health Crisis Stabilization Services, Greeley, CO 04/2011—Present, Behavioral Health Worker • Responsible for taking vitals every 2 hours and doing 15-minute checks on clients. • Admits clients by gaining all pertinent information, writing it down, placing it in the client's chart and entering into computer system. • Answers the phone, including emergency calls,and responding appropriately. • Transports clients to and from CSS, hospitals, and Weld County Jail. • Talks to clients and makes sure needs are met. • Registers shift notes in the computer system for each client. • Administers UA's and BA's to monitoring clients North Range Behavioral Health,Acute Treatment Unit, Greeley, CO Spring 2008, Intern • Assisted in counseling in one-on-one and group settings. • Helped in the day to day activities such as talking to clients, serving them food and answering any needs the clients had. • Answered phones, including emergency line. Spoke to troubled clients over the phone and helped them work through stressful issues they were experiencing. OTHER WORK EXPERIENCE: Wal-mart, Greeley, CO 04/2010-04/2011, Sales Associate 07/2009-04/2010, Cashier Alamo Liquor, Greeley, CO 03/2008-07/2009, Sales Clerk UNC Holmes Dining Hall,Greeley, CO 04/2005-02/2008,Student Supervisor Rafferty's, Greeley, CO 04/2001-02/2004, Busser SARAH A. VALLEJOS Objective To work within the Crisis Stabilization Services and Monitoring services helping clients through every step of their sobriety and stabilization. Work experience 07-01-08 to present North Range Behavioral Health Greeley CO Behavioral Health Worker I • Intakes of clients who are detoxing or withdrawling from substances. • Participating as a member of the program team to implement an individual care plan for clients in accordance to applicable policies, rules and regulations. • Monitoring of vitals and clients withdrawals while detoxing. • Helping with a treatment plan, and helping write and edit plans as necessary, offering emotional support, resource problem solving and advocate while having interaction with clients as well as referral source. • Looking for treatment facilities for clients with their needs in mind and helping facilitate the necessary communication to get clients into appropriate treatment • Documentation of every step of the process for each client • Doing monitoring services for Outpatient clients,with all documentation and faxing to appropriate agencies. • Communicate with outside agencies and give reports of monitoring goals • Back-up of emergency lines to include answering the phone and general office duties. • Transport current clients to appointments as requested by Primary Counselor or Case Manger. • Assist Case managers and program directors as needed. 04-16-06 to 6-31-08 Island Grove Regional Treatment Greeley CO Substance Abuse Specialist I Same as above.Companies merged 7/01/2008 Education 1999-2005 Aims Community College Greeley, CO AAS in Early Childhood Education • State Certification of Director in Child Care. Group Lead; Infant/ Toddler; and Preschool; emphasis Certification. Emphasis in Children with disabilities Certification. • CAC I and II level classes complete. • State of Colorado Notary • CPI,CPR, and Q MAP Reference: Available upon request. REBECCA J. WYPERD (970)339-8266 rebecca.wyperd©northrange.org EDUCATION Licensed Professional Counselor State of Colorado licensure#5240 Master of Arts Degree University of Northern Colorado Greeley,Colorado August 2005 • Emphasis in Community Counseling:Marriage and Family Therapy Bachelor of Arts Degree University of Northern Colorado Greeley,Colorado May 2002 • Emphasis in Psychology EXPERIENCE Program Director:Youth and Family Services,North Range Behavioral Health • Provide clinical and administrative oversight of all programming within the Youth and Family Team totaling 25 staff o MST&FFT o 180 o MYAT o Substance abuse programming o School Based services o Platte Valley Youth Services Center services o Outpatient mental health services o Youth and Family Connections clinicians ➢ June 2011 to present Program Coordinator: Child and Family Services,North Range Behavioral Health • Provided clinical and administrative supervision of multiple programs within the Child and Family Team totaling 15 staff. • Initiated constant collaboration between NRBH and partnering agencies to ensure continued program success and development • Tracked program grants,perform audits,billing,formal reporting,and data collection for program sustainability ➢ November 2010 to June 2011 MST Supervisor,North Range Behavioral Health • Supervised four Multisystemic Therapy clinicians • Held weekly supervision and consultation to maintain model fidelity • Provided oversight of program operations bridging agency directors and team • Maintained link with community stakeholders and ensure sufficient referral flow and program collaboration • Generated billing,perform chart audits and approve reports for court monthly • Collaborated in the development of 180 including programming,policy and procedure,data collection, and agency partnerships ➢ April 2007 to June 2011 • Bereavement Counselor,Chrysalis Grief Center,Greeley,Colorado • Held an individual and family counseling case load of up to forty • Facilitated bereavement groups and day trips • Responded to organizations in the community after a death • Received supervision in art,sand tray and play therapy • Maintained client records appropriate with agency policy and ethics • Participated in daily running of the center,planning,and fundraising ➢ September 2005 to March 2007 Mental Health Therapist,Acute Treatment Unit,North Range Behavioral Health • Worked with up to sixteen,persistently mentally ill,inpatients at a time • Initiated intake,case management,counseling,monitoring,and discharge • Collaborated with nurse and psychiatrist on treatment planning • Maintained daily treatment records for multiple clients • Responded to the after hours emergency phone line for three counties > August 2004 to May 2005 Victim Advocate,Greeley Police Department,Greeley,Colorado • Volunteered a minimum of forty eight hours a month to victims of crime • Responded first to the scene and initiated crisis and trauma debriefing • Assisted victims with restraining orders,court,counseling,and resources • Attended group meetings and seminars for further training ➢ July 2003 to September 2006 Enrichment Director,Frontier Academy,Greeley,Colorado • Directed enrichment program for fifty school-aged students • Assisted kids with academic,social,and emotional issues • Initiated licensure for the program • Monitored two employees during tutoring • Assembled financial books and updated them weekly > August 1998 to May 2004 • Professional references available upon request Print Lookup Details Page 1 of I Dora Barbara J.Kelley h r\ EaeculiVe Director. w , \'Atilt, Department of Regulator,Agrees A„ Lookup Detail View Licensee Information This serves as primary source verification*of the license. 'Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24-34.102 C.R.S. Name Public Address Rebecca lean Wyperd Greeley, CO 80634 Credential Information License license License Original Issue Effective Expiration Number Method License Types Status Date Date Date LPC.0005240 I Examination Licensed Professional I Active 04/29/2009 09/01/2013 08/31/2015 Counselor Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/14/2014 12:38:55 PM Rachel G. Yearous 1094 Mahogany Way (970)580-2990 Severance,CO 80550 rgracep@hounail.com EDUCATION Masters of Social Work June 2008 University of Denver,Denver,CO Bachelor of Arts May 2005 Colorado State University,Fort Collins,CO Major: Sociology,Concentration: Criminal Justice,Second Major: Psychology EXPERIENCE IN HUMAN SERVICES FIELD Multi-systemic Supervisor August 2011-Present North Range Behavioral Health,Greeley,CO Provide clinical supervision to MST therapists related to their caseloads and the MST model. Coordinate with internal and external supportive services to assist families in obtaining services. Multi-systemic Therapist August 2008—August 2011 North Range Behavioral Health,Greeley,CO Provided in home family therapy and case management for families who have youth that are at risk of being removed from their homes related to delinquent behaviors. Clinical Care Coordinator Intern September 2007-May 2008 Mountain Crest Behavioral Healthcare Center,Fort Collins,CO Provided brief supportive therapy and case management,as part of an interdisciplinary team,for adolescents and adults hospitalized on inpatient units. Counselor I,Step Wise May 2007-November 2007 Arapahoe House,Inc.,Thornton,CO Provided milieu management, group facilitation,and crisis intervention for co-ed adolescents in a residential substance abuse treatment program. Residential Counselor December 2006-March 2007 Namaqua Center,Loveland,CO Provided milieu management and crisis intervention in a residential program for children 3-12 dealing with abuse,trauma,and severe emotional disturbances. Intern,Step Wise September 2006-May 2007 Arapahoe House,Inc.,Thornton,CO Provided individual counseling,group facilitation,and crisis intervention for co-ed adolescents in a residential substance abuse treatment program. Correctional Service Worker March 2005-August 2006 Larimer County Community Corrections,Fort Collins,CO Supervised and monitored clients placed under a court ordered custody in a residential halfway house and the community. CERTIFICATIONS Currently obtaining hours for Licensed Clinical Social Worker credentials . , Chad Reznicek,MA, LPC 3918 Heatherwood Circle Johnstown, CO 90534 Home 970-667-7045 chadrez@yahoo.com Education Master of Arts in Art Therapy,November, 2000 Southwestern College, Santa Fe,NM Bachelor of Arts in Psychology, May 1997 Bachelor of Fine Arts in Studio Art, May 1997 Hastings College, Hastings,NE Professional Work Experience North Range Behavioral Health; Greeley CO,July 2012 to Present Multi-Systemic Therapist • Conduct MST assessment including review of referral information, identifying and engaging key participants,identifying systemic strengths and weaknesses, and developing an analysis of the fit of problem behaviors within the ecological context. • Engage primary caregiver and other key participants in active change- oriented treatment by identifying and overcoming barriers to engagement. • Implement a problem conceptualization,treatment planning, intervention implementation, outcome review and strategy revision procedure using the MST Analytic Process. • Maintain clear and concise documentation of treatment efforts that promote peer and supervisory review and feedback,and that demonstrate compliance with the nine MST Principles and the MST Analytic Process. • Collaborate with all relevant systems and key participants within each system to ensure their buy-in and cooperation throughout MST treatment. • Provide direct clinical treatment using methods compatible with MST principles and practices. • Participate in all MST training, supervision and consultation activities. TeamBuilders Counseling Services; Las Vegas,NM September 2009 to June 2012 Multi-Systemic Therapy Supervisor • Responsible for starting up and providing clinical oversight for two MST teams in Las Vegas and Taos,NM. • Worked with community stakeholders including probation,judiciary, schools,and mental health providers to secure and maintain referral sources and collaborative relationships. • Provided weekly supervision on each case. • Worked closely with MST consultant to ensure fidelity to clinical model. • Developed and maintained clinician development plans for each therapist. • Conducted referral screening and assessments • Monitored and evaluated employee and programs workflow using knowledge of business/administrative functions,program requirements and mandated performance standards. • Directed work activities of employee's ensuring a high level of performance and compliance with County, State and Federal rules and regulations. Juvenile Community Corrections Supervisor • Responsible for starting up a life skills program to serve adjudicated adolescents. • Provided staff training and development in model implementation • Conducted assessment, service plan development and oversight of interventions. • Provided ongoing collaboration with a multi-disciplinary team and community stakeholders. • Presented training topics at annual conference Staff Developer • Provided twice monthly trainings to paraprofessionals and clinical staff on state from crisis intervention to communication skills. required topics ranging cns s P g g Rancho Valmora; 81 Bed Adolescent Residential Treatment Program; Valmora,NM Assistant Administrator Aug,2003 to Aug,2009 • Responsible for clinical oversight and programmatic application of the therapeutic model. • Developed and continued to refine programmatic training protocols for crisis intervention and sexual abuse awareness and prevention. • Provided on-going staff development training and supervision for all departments responsible for child care including licensed professionals,paraprofessionals and education staff Authored a wide range of training material related to clinical interventions,parental skill development,treatment planning,and aftercare contracts. • Responsible for all aspects of recruitment, hiring,disciplinary actions,and terminations. Implemented and monitored staff disciplinary actions to promote adherence to policy or to best ensure minimized unemployment claims for terminations. • Initiated, led,and supervised internal investigations including a high profile physical abuse situation involving agency staff. Coordinated with community agencies for external investigations. Worked with referral sources and community agencies to ensure absolute credibility in the investigation while maintaining overall agency reputation. • Provided public relations services,crisis management,and mediation during conflicted relationships with families or referral sources; attended national networking conferences;and assisted in student recruitment involving touring/educating potential families. • Actively participated in program evaluation and planning,proactive and positively preparing for program changes,changes in funding projections and improve operational efficiencies by learning and understanding best practices. • Was contracted to visit and consult with a sister facility to provide guidance on risk management and immediately address and provide direct training to reduce aggression and safety concerns. Group Leader/Therapist Aug,2001 to 2009 • Provided group,individual and family therapy for student caseload. • Provided weekly parental updates and training. • Maintained collaborative relationships with educational consultants(referral sources). • Developed and coordinated treatment strategies to be implemented across a multidisciplinary team. • Responsible for upkeep and timely completion of all relevant clinical documentation. • Worked closely with educators to align treatment and academic goals as a cross over between treatment plans and IEPs. • Aftercare planning involving coordination of community resources across the United States. The Recovery of Alcoholics Program,Santa Fe,NM T e g Inpatient Therapist March, 2001 to Aug 2001 • Primary therapist for adults in residential substance abuse treatment. • Provided individualized therapeutic interventions related to co-occuring mental health, legal problems,and substance abuse issues. • Conducted assessments: Addiction Severity Index, Substance Abuse Subtle Screening Inventory,Beck Inventory,and numerous projective drawing assessments. • Facilitated individual,group,family therapy; along with individual,group, family,and multi-family art therapy. • Additional responsibilities included:treatment planning,case management, coordination of services with referral agencies,aftercare planning and follow up assessment. Intensive Outpatient Coordinator May 2000-Mar 2001 • Developed an IOP program to serve the needs of adjudicated incarcerated adults with substance abuse problems. • Coordinated all services for an average caseload of 20 clients attending the outpatient day program. • Conducted intakes,assessments,placement analysis,case management,and treatment planning. • Facilitated individual,group, and family therapy sessions. • Worked collaboratively with community agencies including: criminal justice, public defenders,district attorneys,judges,and community corrections. STATE OF COLORADO Department of Regulatory Agencies Division of Professions and Occupations Active PRINTED ON SECURE PIPE LPC • LPC.00085a1 MAD 8013 080112015 Number Issue Date Expire Date Chad Edward Reznicek Las Vegas NM 87701.103E Division Director nature Danielle R. Critten, MA 2214 Owens Avenue#202 I Fort Collins,Colorado 80528 1660-663-7083 crit2005@bears.unco.edu Objective: Currently seeking a full-time position in a clinical setting where my experience in behavioral health, psychological research,and problem-solving skills can be used to their full potential. EDUCATION: Certification: Certified Rehabilitation Counselor,valid until May 2018 Eligible for LPC licensure pending required supervision. University of Northern Colorado,Greeley,Colorado Major: Rehabilitation Counseling Master of Arts in Rehabilitation Counseling:May 2013 Major GPA: 4.00/4.00 University of Missouri,Columbia,Missouri Major:Psychology Bachelor of Arts in Psychology:December 2010 Major GPA:3.73/4.00 Major:Sociology Bachelor of Arts in Sociology:December 2010 Major GPA: 3.47/4.00 Total Cumulative: 3.36/4.00 CLINICAL EXPERIENCE: Spirit Crossing Clubhouse,Touchstone Health Partners,Fort Collins,Colorado Jan 2013-May 2013 Clinical Graduate Internship • Assist adults with serious mental illness with employment through vocational counseling and supported employment services. • Provide emotional and social support. • Create case notes for client goals,action plans,and vocational counseling sessions. • Develop wellness activities and lead wellness groups. • Develop and organize a client reach-out program,record data,and correlate reach-out data with client statistics(average daily attendance,etc.) Mark T.Starr Adult Day Care and Respite Center,Lakewood,Colorado Volunteer Oct 2011-Dec 2012 • Instruct adults with developmental disabilities in reading skills and other academic tasks. • Record each participant's progress in the reading program. • Collaborate with other team members and parents about participants' progress. • Fulton State Hospital(FSH),Fulton,Missouri May 2010-June 2011 Intern at Forensic Psychiatric Facility • Close observation in nationally-recognized Social Learning Program including: o Client-staff interactions in order to improve communication skills with a population whose primary diagnosis is schizophrenia. o Clinical staff delivering various group therapies such as: Illness Management&Recovery,Social Skills,Goal Setting,Relationships Effectiveness,Stress Management,Conversation Skills,and Continued Recovery Substance Abuse Program. • Interact with clients promote the development of social skills during informal interaction and other activity sessions. • Attend weekly team/case management meetings which involve evaluation of client progress and discussion of client goals. Mid-Missouri Crisis Hotline and Deafline,Columbia,Missouri Jan 2010-Jul 2010 Volunteer • Attend crisis line and deaf line in order to counsel those in immediate crisis in the surrounding community. • Provide counseling and referral service to the deaf community. RESEARCH: TACE Region 8,University of Northern Colorado,Greeley,Colorado Jan 2011 -Dec 2012 Graduate Research Assistant, Paid • Conduct research and develop curriculum and materials for continuing education credits for rehabilitation counselors in the participating six-state region. • Provide training and assist continuing education specialists with projects as assigned. Fulton State Hospital (FSH),Fulton,Missouri Nov 2009-Jan 2011 Research Assistant,Paid • Assist with project conducted by the University Of Missouri's Department Of Psychiatry focusing on client's aggressive and self-harm behaviors associated with restraint and seclusion use in mental health institutions. • Code data from clients'institutional reports and assecsments. • Collaborate with other research assistants and supervisors regarding research progress,inter-rater reliability reports,and future research-related topics. University of Missouri,Columbia,Missouri Jan 2008-Jan 2011 Research Assistant, Volunteer • Investigate cognitive and emotional control in schizophrenia. • ,. • Analyze data using SPSS software and independently graph and interpret results. • Code disorganized speech of individuals with schizophrenia using the Communication Disturbances Index. • Transcribe therapy sessions of clients from Fulton State Hospital. P PUBLICATIONS: In Press: Critten, D.,Bezyak,J.,&Fried,J.The importance of positive client-staff interactions in inpatient psychiatric rehabilitation programs. Journal of Applied Rehabilitation Counseling. RELEVANT TRAINING: Supervised Counseling Practicum,December 2012 Social Learning Program Training,2011 Suicide Prevention Training,2010 ACADEMIC AWARDS: University of Missouri Dean's List:Fall 2008-December 2010 UNCO Graduate School Universal Scholarship recipient: 2011-present OTHER SKILLS: Excel in:interpersonal communications,case management,professional development,collaboration with other professionals,and quick adaptation to any professional environment Computer:SPSS,Excel,Access,PowerPoint,Windows 98/XP/Vista,Photoshop,any agency-specific case-management programs,file system,etc. Maggie VanDenBerg,M.S. PHONE:303.668.6588 EMAIL:'invite vaodrnberg;alvahoo.corn OBJECTIVE I have many years of unique experience working with youth and families,and have recently completed my Masters degree in Marriage and Family Therapy.My primary goal is to work for a vibrant,innovative agency where I can take my skills to the next level. PROFILE Interpersonal Skills • Friendly and outgoing personality that allows people to feel appreciated,comfortable and welcome • Clinical experience with diverse populations,including adults and children experiencing physical and/or mental disabilities • Excellent communication skills with children,youth,and adults(both written and verbal) Work Attitudes • Strong clinical skills with adolescents,families,couples and individuals,emphasizing a compassionate and strength based approach • Strong work ethic • Able to work independently,multi-task,and manage time effectively • Able to accurately assess needs,design solutions and resolve problems • Flexible,quick learning and efficient at crisis intervention and problem solving y.XPERIENCE Marriage and Family Therapist Intern,Boardwalk Therapy Center and Center for Family and Couple Therapy,Fort Collins,CO January,2011-July,2012 Intern at private practice office and community based psychotherapy clinic.Provided psychotherapy,family therapy and play therapy to children,youth,adults,and families.Primarily clinical issues included trauma recovery,marriage and family conflict,abuse and neglect,and transgender and sexual orientation.Duties included clinical assessment,coordination of care,and developing and completing required paperwork and documentation. Campus Corps Course Instructor Colorado State University,Fort Collins,CO January,2011 —May,2012 Primary instructor for undergraduate service learning course where approximately 30 students individually mentored at-risk youth.Duties included training and supervising students while participants engaged in pro-social activities and academic tutoring.Involved clinical assessment of substance use,health and safety concerns and crisis intervention,including mandatory reporting when applicable.Communicated with families and referral sources.Gained training in motivational interviewing and supervised undergraduate students in the method. Research and Teaching Assistant Colorado State University, Fort Collins,CO August,2010—May,2012 Worked as research assistant on teen sex education intervention project doing data management and entry.Served as a teaching assistant for several undergraduate courses.Duties included grading papers,teaching for instructor when needed,and meeting with students regarding course related issues.Received specialized training as a Writing Graduate Assistant,and provided students with support regarding the development of their writing in a Psychology 100 level course. Program Coordinator Carmel Community Living Corp., Boulder,CO January,2008-August,2009 Coordinate the residential living situations for adults with developmental disabilities.Duties include developing programs with clients and providers that foster learning opportunities and facilitate independence,supervising approximately 16 providers,and ensuring all aspects of client care is individualized and executed with a high quality of care. Interviewer Project Bloom,Aurora,CO May,2007-August,2008 Evaluation position involving interviewing participants in Project Bloom about the quality of care their child and family is receiving through a federally funded initiative. Required home visitation and ability to adapt and conduct interviews in chaotic home environments. Our Whole Lives Facilitator First Unitarian Society of Denver, Denver,CO August,2006—June,2007 Volunteer position of teaching a research-based,comprehensive sex education curriculum to youth ages 12 thru 14. Worked as part of the education team with three other facilitators.Trained and certified to teach the 8-month curriculum. Consultant National Technical Assistance Partnership. Pittsburgh,PA and Sarasota,Fl January,2006-June,2006 Served as a youth-involvement specialist to two emerging System of Care sites funded by SAMHSA.Provided information and consultation on developing and implementing youth involvement in their System of Care sites. Office Manager Federation ofFamilies for Children's Mental Health, CO Chapter, Denver,CO Oct 2004—Sept 2006 Duties included managing/assisting accounting and financial procedures,maintaining database,maintaining office space,and assisting supervisor with various duties and responsibilities. Youth Coordinator,Federation of Families for Children's Mental Health, CO Chapter,Denver February 2003—March,2004 Organizing,educating,and advocating for youth involvement within the Federation of Families and Project BLOOM, an early childhood initiative within four counties of Colorado.Job duties included supervising youth(ages 11 to 18),providing training opportunities for both youth and adults on the topic of youth involvement within System of Care and enabling youth to have their voice heard about their involvement and opinion within the mental health system. Paraprofessional,Prairie Crossing Elementary School, Parker,CO September 2002—May 2003 Supervising on the playground and in the lunchroom;clerical work;working individually with children to assist in reading development,mathematics,etc.;assisting and substituting in the Special Ed Department working with special needs children. Child Care Worker/Respite Provider, Various individual families 1995-Present Cared for the children(infant to 14 years)of more than twelve families in the states of Pennsylvania and Colorado. Specialized in providing care for special needs children,including developmentally disabled,mental health issues,and at-risk. EDUCATION • MS in Human Development and Family Studies,Marriage and Family Therapy at Colorado State University, Graduated August,2012 with a 3.8 GPA • BA in Human Development with a Minor and Certification in Non-Profit Management at Metropolitan State College of Denver,Graduated December,2007 with a 3.4 GPA • Chaparral High School,Graduated May,2002 • Extensive training in multiple modalities of therapy including but not limited to motivational interviewing,trauma and the neurobiological effects of childhood trauma,play therapy with families and children,and issues in sexuality. • Certified to teach Our Whole Lives,a comprehensive research-based sexuality curriculum for grades 7-12. • Proficient in Microsoft Office Programs PUBLICATIONS AND PRESENTATIONS • VanDenBerg,M,2012.Protective Factors for Teen Mothers:Relations among Social Support,Psychological Resources,and Child-Rearing Practices.Masters Thesis Defense and Publication. • Hurst,D,VanDenBerg M,2006.Predictors of Adolescent Sexuality.Presented at the Tenth Annual Undergraduate Psychology Conference,Metropolitan State College of Denver,May 3. • Hurst,D,VanDenBerg,M,2006.Predictors of Adolescent Sexuality.Presented at the Conference on Human Development,Louisville Kentucky,April 30. • Hagan,L,VanDenBerg M,2006.Portraits of Human Sexuality.Video Handbook.Metropolitan State College of Denver. • VanDenBerg,M 2004.News'mental illness series appreciated.Editorial.Rocky Mountain News,January 29. • Lane S,Matarese M,Payton O,VanDenBerg M,2004.Youth Involvement:Understanding the Revolution.Presented at the San Antonio Systems of Care Conference,January 12. • Davidon S,Hill R,VanDenBerg M,2004.What do Youth Think of This?Presented at San Antonio Systems of Care Conference,January 15. • Davidon S,Grimsley M,VanDenBerg M,2003.Youth Involvement in Project BLOOM.Presented at the Federation of Families for Children's Mental Health National Conference,Washington D.C.November 23. PERSONAL INFORMATION • Unmarried and no children • Interests include hiking,camping,kayaking,animals,reading,knitting,and traveling • Colorado resident for over 12 years Sarah Hansen 6612 Avondale Rd. D3 Fort Collins,CO 80525 303-330-2606 sarjrun@gmail.com North Range Behavioral Health Greeley, CO 2007-2009 Multisystemic Therapist • Provided in home therapy to youth age 11-17 at risk of out of home placement and their caregivers. • Worked intensively with caregivers to put them in control and supported the child in decreasing behaviors that are putting them at risk. • Collaborated with community stakeholders in supporting youth and family. • Available for on call crisis management to families 24 hours a day,seven days a week. • Developed and monitored service plans with continued assessment of crisis intervention. • Attended court,school meetings and probation meetings to provide feedback on case progress. The University of Chicago Office of Undergraduate Student Housing, Chicago, IL 2003-2006 Resident Head • Lived in a co-ed residential hall and was responsible for fostering a community atmosphere by organizing trips, hosting study breaks, facilitating committee meetings among students and dining with students. • Implemented housing system policies,completed administrative paper work and was expected to be present and on call throughout the academic year. • Counseled students through emotional, educational and psychological challenges. • Supervised up to 6 student workers and 1 assistant resident head. Baby Ph. D Daycare Chicago IL 2002-2005 Childcare Professional • Worked collaboratively with staff and teachers in a home based daycare setting to provide a safe and stimulating learning environment for children ages 4 months-7 years. • Planned and led art,music and educational activities. • Responsible for the safety, care and wellbeing of up to 8 children at a time. Volunteers of America Chicago,IL 2001-2002 Child Welfare Worker • Responsible for providing services and managing caseload of 20 children and adolescents in the inner city foster care system. • Performed monthly visits to child's home and school as well as coordinated sibling visits. • Worked intensely with foster parents to ensure child was getting all his/her needs met and also offered support to the foster parents in any difficulties they were experiencing. • Identified and set up resources to fit the child's needs. • Attended court on a regular basis to represent child and express my thoughts as to what would be in the child's best interests. • Participated in weekly meetings with supervisor to discuss difficult cases. Sekyerman High School Mampang, Ghana 2000-2001 Volunteer Teacher • Developed and studied innovative and stimulating teaching techniques to teach youth age 13-17 English and Geography in an environment with limited resources. • Encouraged students to understand the importance of their education and where it could take them. • Designed and presented an HIV/AIDS presentation to help educate students and also traveled nearby villages to present. St. Cloud Hospital Adolescent Mental Health Unit,St Cloud, MN 2000-2001 Behavioral Health Associate • Worked with a team to provide patient care for children and adolescents age 8-17 on a locked unit. • Performed 1:1 observations on high risk patients and acquired intervention skills essential in crisis situations. • Offered crisis counseling for youth experiencing mental illness and/or addictions. • Planned and facilitated small group discussions and activities. • Offered input in meetings with psychiatrists,social workers, nurses and other staff in patient's care. Also received daily supervision with supervisor who was the charge nurse. • Responsible for daily charting and reports to provide ongoing patient progress. IBANORTH oRAL HEALTH RANGE March 18, 2014 Tobi Vegter Core and Service Contract Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 111°Avenue Greeley, CO 80632 Re: Bid No. B1400069 Functional Family Therapy proposal Multisystemic Therapy proposal Dear Ms.Vegter: The intent of this letter is to address the qualification requirement set forth in the above- referenced bid of familiarity with Trauma Informed Care. The following Youth and Family Services program staff attended the Integrative Treatment of Complex Trauma for Adolescents presented by John Briere, Ph.D. and Cheryl Lanktree, Ph.D. on February 18 and 19, 2014: Susan Stone Jennifer Wallace Rachel Yearous Chad Reznicek Maggie Vandenberg Danielle Critten Sarah Hansen As of this writing, attendees have not received the requested documentation of participation in the training as evidenced by the attached correspondence. If you have any questions, please feel free to contact me. Sincerely, G/ Susan E. R. Stone, M.A., LMFT Administrative Director I Children, Youth, Family & Prevention Enclosure Where hope begins. PY-14-15-CORE-0120 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Functional Family Therapy(FFT), Mental Health Services,and Multisystemic Therapy(MST)to individuals and families,as referred by the Department. 2. Functional Family Therapy(FFT):Contractor will provide Functional Family Therapy(FFT)services to male and female youth within the approximate age range of 10-17 years of age,and their families, residing in Weld County,as referred by the Department. a. Contractor has offices in both Greeley and Fort Lupton,CO. b. Services are provided in-home in accordance with the National Functional Family Therapy(FFT) model,and its standards and guidelines. All services are overseen/supervised by a FFT National Consultant. c. Youth and family are deemed eligible for services based on one or more of the following inclusionary criteria: • Child must be at risk of out-of-home placement or transitioning back from placement within 30 days. • Child is displaying moderate to severe behavioral problems in the home/school/community. • Child is involved in criminal behaviors to include substance abuse. • Child demonstrates verbal and/or physical aggressions at home/school/community. • Child is engaged with deviant peer group. • Child is struggling with school behaviors to include failing grades,truancy and anti-social behaviors. • Family has persistent conflict and negative child-parent relationship. • Caregiver is abusing substances. • Family has limited resources and would benefit from psycho-education and parenting skill development. d. FFT utilizes Family Interventions,Cognitive Behavioral Therapy,Family Therapy,school and community interventions,and substance abuse intervention,as clinically appropriate. e. The goal of services is to: • Empower families with the skills and resources need to independently address the difficulties they are having raising their children. • Empower youth to cope with family, peer, school and neighborhood problems. • Build community and natural support systems. • Decrease negativity and blame among family members. • Decrease anti-social behavior to include legal contacts,truancy and substance abuse issues f. Service duration is two(2)to six(6) months for one(1)to two(2) hours per week. g. Services include: • Case Management • School Interventions • Advocacy • Court/Staffing Participation • Sustainability Planning • Booster Services After Discharge 1 PY-14-15-CORE-0120 h. CONTRACTOR has the ability to provide bilingual services(Spanish). 3. Mental Health Services: Contractor is the community mental health center serving Weld County. a. Contractor will provide the following services under this contract: i. Level 1—Behavioral Health Evaluation: Useful for ruling in/out basic mental health and substance abuse issues,advising on provisional diagnoses,and making recommendations for treatment when appropriate. Approximate completion time is three(3)to six(6)hours. • Review of Department records,and if applicable,NRBH records. • Clinical interview and integrated diagnostic evaluation(assessment of mental health and substance abuse issues). • Possible administration of brief screening inventories(e.g., Beck Inventories,State- Trait Inventories,Personality Assessment Screener). • Feedback to client. • Written report addressing relevant psychosocial history,diagnostic formulation, and treatment recommendations. ii. Level 2- Partial Psychological Evaluation: Useful for ruling in/out mental health, substance abuse,cognitive,and/or personality issues,advising on diagnoses,and making treatment recommendations. Approximate complete time is eight(8)to 14 hours. • Review of Department records,and if applicable, NRBH records. • Clinical interview and integrated diagnostic evaluation(assessment of mental health and substance abuse issues). • Administration of a partial test battery,such as administration of just cognitive or just personality testing(e.g.,Wechsler IQ tests, MMPI,MCMI, PAI,etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing relevant psychosocial history,diagnostic formulation, and treatment recommendations. iii. Level 3—Full Psychological Evaluation: Useful in identifying more significant behavioral health issues and diagnoses,as well as addressing personality issues,intellectual functioning,the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues,and treatment recommendations. Approximate completion time is 16 to 20 hours. • Review of all available records including Department records,prior evaluation and behavioral health treatment records, police records,medical records, records from other agencies involved in the case,and if applicable, NRBH records. • Extensive integrated clinical evaluation(multiple sessions). • Administration of a formal battery of tests(multiple tests)to assess personality, emotional and/or cognitive functioning,and/or parenting issues(e.g.,Wechsler IQ tests, MMPI, MCMI, PAI,STAXI,STAI, Beck screens,TSI, PSI,etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing psychosocial history, personality issues,emotional 2 PY-14-15-CORE-0120 functioning and regulation abilities,and/or intellectual functioning and/or parenting/family issues,substance abuse,and diagnostic formulation,as well as treatment recommendations and prognosis. iv. Level 4—Extended Psychological Evaluation: Useful in identifying more significant mental health and substance abuse issues and diagnoses,as well as addressing personality issues,intellectual functioning,the ability to manage emotions,parenting issues and potential safety of the child(ren)in the home,placement issues,and treatment recommendations. To be utilized when impairment in cognitive functioning is suspected/known,when the client is unable to read or write,when there are major memory deficits,when resistance leads to invalid measures and instruments need to be re-administered,and/or when other significant barriers to testing are present. • Review of all available records including Department records,prior evaluation and behavioral health treatment records,police records,medical records, records from other agencies involved in the case,and if applicable, NRBH records. • Extensive integrated clinical evaluation (multiple sessions). • Administration of a formal battery of tests(multiple tests)to assess personality, emotional and/or cognitive functioning,and/or parenting issues(e.g.,Wechsler IQ tests,MMPI, MCMI,PAI,STAXI,STAI, Beck screens,T51, PSI, etc.). • Consultation with collateral sources. • Feedback to client. • Written report addressing psychosocial history, personality issues,emotional functioning and regulation abilities,and/or intellectual functioning and/or parenting/family issues,substance abuse,and diagnostic formulation,as well as treatment recommendations and prognosis. For partially completed evaluations,Contractor will submit a written report of any finding that can be appropriately offered based upon the information gathered. Evaluations will be conducted at an NRBH location or another suitable location (e.g., client's home,school,detention center,etc.),depending upon the circumstances. Evaluations will be conducted by a qualified NRBH provider. CONTRACTOR will submit the written report,following completion of the evaluation, within forty-five(45)days from the point of initial contact with the client,provided the client can be reached for appointments and the client attends appointments as scheduled. The Department may choose to extend the referral as deemed appropriate or the referral may be closed if the client fails to follow through. CONTRACTOR will communicate with the referring caseworker and the Child Welfare Contract and Services Coordinator regarding any issues contacting the client,missed appointments,or other issues that arise that prevent the completion of the referred evaluation. v. Mental Health Assessment with Age-appropriate Trauma Assessment: Contractor will conduct a Mental Health Assessment with age-appropriate trauma assessment for children,age birth to 18 years,as part of the IV-E Waiver Demonstration Project Implementation Plan. 3 I _ PY-14-15-CORE-0120 For purposes of trauma assessment,Contractor will utilize the Trauma Symptom Checklist for Young Children for children age 3-6 years,and the Child PTSD Checklist for children,age 7-18 years. Additionally,a Trauma/Loss Exposure History will be completed for all children. vi. Trauma Informed Treatment: Contractor will provide treatment based on the referred child or youth's presentation. Evidence-informed and Evidence-based Trauma- informed/focused interventions,consistent with the IV-E Waiver Demonstration Project Implementation Plan,will be utilized. These include: • Trauma-Focused Parent Child Interaction Therapy(TF-PCIT): Interactive dyadic therapy,with parental coaching regarding interactions and development. Weekly sessions for approximately 12 months. Appropriate for children age 2-7 years. • Trauma-Focused Cognitive Behavioral Therapy(TF-CBT): Intervention includes desensitization,coping skills building,family communication skills building,and safety enhancing interventions. Approximately 16 weekly sessions. Appropriate for children age 3-18 years. • Dialectical Behavior Therapy(DBT)for Adolescents. Works to identify and treat depression,at-risk behaviors,suicidal ideation and attempts,substance use, aggression,and other issues. Weekly sessions(timeframe dependent on adolescent). Appropriate for age 12-18 years. • Psychotherapy: Utilized to ready the child/family for trauma specific services and to stabilize high acuity or complex cases via the provision of coping skills and safety enhancing treatment. Determined on a case-by-case basis with Department approval. 4. Multisystemic Therapy(MST): Contractor will provide Multisystemic Therapy services to male and female youth within the approximate age range of 12-17 years of age,and their families, residing in Weld County, as referred by the Department. a. CONTRACTOR has offices in both Greeley and Fort Lupton,CO. b. Services are provided in-home in accordance with the National Multisystemic Therapy(MST) model,and its standards and guidelines. All services are overseen/supervised by a MST National Consultant. c. Youth and family are deemed eligible for services based on one or more of the following inclusionary criteria: • Child must be at risk of out-of-home placement or transitioning back from placement within 30 days. • Child is involved in criminal behaviors. • Persistent family conflict. • Child and/or caregiver is abusing substances. • Behavior is chronic. • Child is engaged with deviant peers. • Child is struggling at school. • Family has few resources. • Parents would benefit from psycho-education and skill development. 4 f PY-14-15-CORE-0120 • Child is displaying moderate to severe behavior problems. d. MST utilizes In-home Caregiver Interventions,Cognitive Behavioral Therapy, Family Therapy, Individual Therapy,as well as school and community interventions. e. The goal of services is to: • Empower caregivers with the skills and resources needed to independently address the difficulties related to managing their children. • Empower youth to cope with family,peer, school and neighborhood problems. • Build community and natural support systems. • Decrease anti-social behavior. f. Service duration is two(2)to five(5)months for three(3)to five(5)hours per week. g. Services include: • 24/7 On-call Services • Case Management • School Interventions • Advocacy • Court/Staffing Participation • Sustainability Planning h. Contractor has the ability to provide bilingual services(Spanish). 5. Contractor will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the Contractor will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 6. 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. 7. 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. 8. 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. 9. 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. 10. Contractor understands that the Department will not reimburse Contractor for"no shows"or cancelled appointments,either on the part of the client or the Contractor. 5 PY-14-15-CORE-0120 11. 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. FFT and MST services are inclusive of attendance at staffings. For Mental Health Services only,upon receipt of an invitation from the Department,Contractor must contact the Child Welfare Contract and Services Coordinator to request approval to bill for participation if Contractor wishes to be reimbursed. 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 requests approval to bill in advance 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. 6 PY-14-15-CORE-0120 EXHIBIT D PAYMENT 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 specified 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 in Trails after May 31, 2015. 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. this Agreement,whether in whole or inpart,is subject to and contingent upon the Payment pursuant to g 1 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 Functional Family Therapy(FFT): $700.00/Month (Pro-rated for partial month of service) Mental Health Services: $70.00/Hour(Treatment—Trauma Informed for Children) $200.00/Episode(Mental Health Assessment—Trauma Informed for Children) $250.00/Episode(Level 1—Behavioral Health Evaluation) $800.00/Episode(Level 2—Partial Psychological Evaluation) $1,200.00/Episode(Level 3—Full Psychological Evaluation) $1,800.00/Episode(Level 4—Extended Psychological Evaluation) $120.00/Hour(Hourly rate for partial evaluation, not to exceed cost of full evaluation) Multisystemic Therapy(MST): $1,800.00/Month (Pro-rated for partial month of service) Contractor may not attempt to collect co-pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers signed shall prepare and submit monthly an itemized voucher, and g ned monthly report if applicable,certifying that services authorized were provided on the date(s)indicated and the charges 1 PY-14-15-CORE-0120 made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. 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. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services,proof of services rendered shall be the test result. 2 1 i -1 NUK I N12 Urlu: LW ACORO CERTIFICATE OF LIABILITY INSURANCE D07/01/201ATE YY) onovzola THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: M the certificate holder is an ADDITIONAL. INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the teens and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER C EDT Michael J Schmitt CIC Rich&Carbnill Ins of CO �WPHCONE -356$030 rat/Loot of Colorado LLC (AiV 119.Exll:970 970 358$032 8213 W.20th Street ADDRESS: Greeley, 80634 INSURERS)AFFORDING COVERAGE NAIC a Michael S J Schmitt CIC -- --- INSURERA:Philadelphla Insurance Co 23850 INSURED North Range Behavioral Health INSURER B:PInnaCOl Assurance 1300 N 17th Avenue —.--- _ INSURER C:Lloyds of London Greeley,CO 80631 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR SUM TYPE OFINSURANCE ML YYVD POLICY NUMBER (M IO lTR S11Dg1YYY1 mINDOITYYYI LIMITS GENERAL UABIUTY EACH OCCURRENCE __ $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X PHPK1200226 07/01/2014 07/0112016 PREMISE IE 1 :__- 1,000,000 CLAIAS-MADE X OCCUR MED EXP(Any w person)._ -.-__ 20,000 X Professional Llab PERSONAL a ACV INJURY a 1,000,000 X HIPAA Intl GENERAL AGGREGATE S 3,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ -__ 3,000,000 I POLICY PF a X LOC Emp Ben. S 1,000,000 AUTOMOBILE LIABILITY COLA RED SINGLE LIMIT $ 1,000,006 A X ANY AUTO PHPK1200226 0710112014 07/01/2015 BODLYINA ./(riaperson) $ LLOWNED SCHEDULED BODILY INJURY(Per scCid,X) $ AUTOS HIRED AUTOS _ NON-OWNED jTOµ S�� (PER ARTY CCIDENT) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAO CLAIMS-MADE PHUB466313 OT/01/2014 07/01/2015 AGGREGATE __- $ 2,000,000 DED DED I X I RETENTIONS 10,000 ( f -- WORKERS COMPENSATOR X I TO STAN B 1 %R AND EMPLOYERS*IJABILITY B ANY PROPRIETORIPARTIERIEXECUTNE Y(� NIA 4044331 07/01/2014 01/01/2015 EL.EACH ACCIDENT $ �— 100,000 OFFICERAIEMBER EXCLUDED? I I Mandator/In NH) E.L.DISEASE-EA EMPLOYEE $ _ 100,000 n DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 C Privacy UCS2669560.14 07/01/2014 07/01/2015 Each 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATORS I VEHICLES (Attach ACORD 101,Alnlen&Renele scloduN,N mom apace M ngWnd) State of Colorado is listed as additional insured as pertains to the general Liability policy, per written contract. CERTIFICATE HOLDER CANCELLATION WEL-HUM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Weld County Department of ACCORDANCE WITH THE POLICY PROVISIONS. Human Services 315 N 11th Ave AUTHORIZED REPRESENTATIVE Greeley, CO 80631 Michael J Schmitt CIC ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I PY-14-15-CPS-0094 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH lh //1yn� This Agreement, made and entered into thef3 day of 1( 2014, 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 North Range Behavioral Health,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 the Request for Proposal, Exhibit C, Scope of Services, and Exhibit D, Payment Schedule. Each of these documents is attached hereto and incorporated herein by this reference. 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 Child Welfare Administration funding 'o the Department for Anger Management Evaluation and Treatment,Domestic Violence Evaluation and Treatment,and Monitored Sobriety Services. NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on June 1,2014,upon proper execution of this Agreement and shall expire May 31,2015 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the Contractor to any person(s)eligible for services in compliance with Exhibit A,Weld County's 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 Department's Resource Manager,Child Welfare Contract and Services Coordinator,or 1 t aI'1-3/07 PY-14-15-CPS-0094 through a Team Decision Making(TDM)meeting or Family Team Meeting(FM). No other Department staff or other party to the case may authorize services or modifications to services. F. Contractor agrees to submit an itemized complete billing statement by the 7th of the month, following the month of service, utilizing billing forms required by the Department. d. Contractor agrees to submit a monthly report with the billing statement by the 7th of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product(ex. psychological evaluation,substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. 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. Monthly reports will be submitted through the Department's online reporting system,unless otherwise directed or agreed to by the Department. 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. b. Payment shall be made in accordance with Exhibit A,Weld County's Request for Proposal, Exhibit B, Contractor's Response to the Request for Proposal, Exhibit C,Scope of Services,and Exhibit D, Payment 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. 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 2 PV-14-15-CPS-0094 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 A,Weld County's Request for Proposal, Exhibit B,Contractor's Response to the Request for Proposal, Exhibit B,Scope of Services,and Exhibit D, Payment Schedule: 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 ACH Form for Colorado Providers,which will be provided by the Department. Contractor is solely responsible to submit the ACH Form to the State of Colorado per the directions on the form. Failure to complete and submit this form in a timely and accurate manner may result in a delay of payment. c. Contractor agrees to accept payment through county warrant when funding source does not allow for direct deposit. 7. Compliance with Applicable Laws a. At all times during the performance of this Agreement,Contractor will strictly adhere to all applicable Federal and State laws,order,and applicable standards,regulations, interpretations and/or guidelines issued pursuant thereto. This includes protection of the confidentiality of all I 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.mg,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.m,and its implementation regulations,45 C.F.R.Part 91;and - Title VII of the Civil Rights Act of 1964;and - the Age Discrimination in Employment Act of 1967;and 3 PY-14-15-CPS-0094 - 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.5.)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 I discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services,Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is Child Welfare Administration. d. Contractor assures and certifies that it and its principals: - Are not presently debarred,suspended, proposed for debarment,declared ineligible,or voluntarily excluded from covered transaction by a Federal or State department or agency; and - have not,within a three-year period preceding this Agreement,been convicted of or had a civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining,attempting to obtain,or performing a public(Federal,State or Local)transaction or contract under public transaction;violation of federal or state antitrust statutes or commission of embezzlement,theft,forgery, bribery,falsification or destruction of records,making false statements,or receiving stolen property;and - are not presently indicted for or otherwise criminally or civilly charged by a government entity(federal, state or local)with commission of any of the offenses enumerated in this certification;and 4 PV-14-15-CPS-0094 - 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. Contractor certifies that it shall comply with the provision of the Colorado Revised Statutes(C.R.S.)8- 17.5-101,et.s g 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 to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor represents,warrants,and agrees that it(a) has II verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). Contractor shall comply with all reasonable requires made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If Contractors fails to comply with any requirement of this provision or C.R.S.8-17.5-101,et.sea..the Department may terminate this Agreement for breach and Contractor shall be liable for actual and consequential damages to the Department. 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 this Agreement,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 this Agreement. If Contractor operates as a sole proprietor,it hereby affirms under penalty of perjury that s/he(a)is a citizen of the United States or is otherwise lawfully present in the United State 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 this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review(CFSR)examines child welfare service outcomes in three areas; Safety,Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan (PIP)will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review(CFSR),and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d)of this Agreement. 9. Insurance Requirements Contractor and 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 5 PY-14-15-CPS-0094 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/Contract Professionals 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/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement,or any extension thereof,during any warranty period,and for three(3)years after termination of the Agreement.The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as"A"VIII or better. Each policy shall contain a valid provision or endorsement stating""Should any of the above-described policies by canceled or should any coverage be reduced before the expiration date thereof,the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested.Such written notice shall be sent thirty(30)days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten(10)days prior. If any policy is in excess of a deductible or self-insured retention,County must be notified by the Contractor/Contract Professional.Contractor/Contract Professional shall be responsible for the payment of any deductible or self-insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond,at no cost to County,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/Contract Professional.Contractor/Contract Professional 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/Contract Professional 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 Contract Professional'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. H. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent,covering premises operations,fire damage,independent Contractors, products and completed operations,blanket contractual liability,personal injury,and advertising liability with minimum limits as follows: - $1,000,000 each occurrence; - $2,000,000 general aggregate; 6 PY-14-15-CPS-0094 - $50,000 any one fire;and - $500,000 errors and omissions. iii. Automobile Liability: Contractor/Contract Professional 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 reduce by twenty-five percent(25%)or more by paid or reserved claims,Contractor shall notify County 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 County. v. For all general liability,excess/umbrella liability, liquor liability, pollution liability and professional liability policies,if the policy is a claims-made policy,the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County,whichever is earlier. c. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator")at or before the time of execution of this Agreement,and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided,a commercial general liability insurance policy,including public liability and property damage,in form and company acceptable to and approved by said Administrator,covering all operations hereunder set forth in the related Bid or Request for Proposal. d. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker,and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance.County reserves the right to require Contractor/Contract Professional 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/Contract Professional's insurer shall name County as an additional insured as follows f. Waiver of Subrogation: For all coverages,Contractor/Contract Professional's insurer shall waive subrogation rights against County. g. Subcontractors: All subcontractors,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/Contract Professional.Contractor/Contract Professional 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/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors,sub-vendors suppliers or other entities upon request by the County. 7 PY-14-15-CPS-0094 A provider of Professional Services(as defined in the Bid or REP)shall provide the following coverage: Professional Liability: Contract Professional 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 that 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 970-352-1551,x6503,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 shall permit the Department,and any other duly authorized agent or governmental agency,to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. 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 8 PY-14-15-CPS-0094 All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find the Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions are as follows: - Withhold payment to the Contractor until the necessary services or corrections in performance are satisfactorily completed. - Deny payment or recover reimbursement for those services or deliverables,which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. - Incorrect payment to the Contractor due to omission,error,fraud,and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor,or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement,the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker,Administrator Larry D. Pottorff, 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: For Contractor: Judy A.Griego, Director Larry D.Pottorff, Executive Director P.O.Box A 1300 North 17th Avenue, I Greeley,CO 80632 Greeley,CO 80631 (970)352-1551 (970-347-2120 18. Litigation 9 PY-14-15-CPS-0094 Contractor shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term "litigation"includes an assignment for the benefit of creditors,and filings of bankruptcy,reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld,State of Colorado,to expend funds not otherwise appropriated in each succeeding year,as this Agreement is subject to the availability of funding. Therefore,the Department may terminate this Agreement at any time if the source of funding for the services made available to the Contractor is no longer available to the Department,or for any other reason. Contractor reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action I 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. Improprieties/Conflict of Interest No officer, member or employee of weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof. 10 PV-14-15-CPS-0094 The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement,Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation,Contractor shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with the Contractor. Contractor certifies that Federal appropriated funds have not been paid or will be paid,by or on behalf of Contractor,to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any cooperative agreement,and the extension,continuation,renewal, amendment,or modification of an Federal contract,loan,grant,or cooperative agreement. 24. Storage,Availability and Retention of Records Contractor agrees that authorized local, Federal,and State auditors and representatives shall,during 'business hours, have access to inspect and copy records,and shall be allowed to monitor and review through on-site visits,all activities related to this Agreement,supported with funds under this Agreement, to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records,documents, communications,and other materials created pursuant or related to this Agreement shall be maintained by the Contractor in a central location and shall be made available to the Department upon its request,for a period of seven(7)years from the date of final payment under this Agreement,or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the seven (7)year period, or if audit findings have not been resolved after a seven (7) period,the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection. No information about or obtained from any applicant/recipient in possession of Contractor shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with the Contractor's written policy governing access to, duplication and dissemination of,all such information,in any form,including social networks. Contractor shall advise its employees,agents,and subcontractor,if any,that they are subject to these confidentiality 11 PY-14-15-CPS-0094 requirements. Contractor shall provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Sroprietary 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 arties, (2)that which is in the public domain,or(3)that which is developed independently. Neither arty 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 nformation removed from the Department's site by the Contractor in the course of providing services nder 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 it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees,as the result of this Agreement. 28. Entire Agreement This Agreement,together with all attachments hereto,constitutes the entire understanding between the ct to the matter hereof,and may not be changed or modified except as state in parties with respect subject g P Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors,heirs, legal representatives,and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B,C,and D. 12 PY-14-15-CPS-0094 31. Acceptance of Services Not a Waiver Upon completion of the work,the Contractor shall submit to Department originals of all tests and results, reports,etc.,generated during completion of this work.Acceptance by 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 n The signatories to this Agreement aver that to their knowledge,no employee of Weld County has any subject matter of thisj personal or beneficial interest whatsoever in the service or property which is the sub� 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 conflict 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 Contract Professional's operations,or authorizes funding to the Contractor. 33. Board of County Commissioners of Weld County Approval I 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, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 13 PV-14-15-CPS-0094 35. Attorneys Fees/Legal Costs In the event of a dispute between County and Contract Professional,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. • • 14 PY-14-15-CPS-0094 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: /C��,(�,� � sic BOARD OF COUNTY COMMI TONERS ! 1H/ uires WELD COUNTY,COLORADO n , Weld County Clerk to the Board '—� arbara Kirkm yer, Pro em By: • L L'_ d�11 / ��,Slab�� U T 1 3 2014 D •uty Clerk to the Board t .;,.S RO D :- +' �" ' � { • ttorney WELD COUNTY DEPARTMENT NORTH RANGE BEHAVIORAL EALTH OF HUMAN S RVICES By: �ft .I i I � % By: Ju•y .Griego Director Larry Pottorff,Exe ut Dire r 15 i I WELD COUNTY'S REQUEST FOR PROPOSAL Bid No. B1400069 BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF WELD,STATE OF COLORADO, BY AND THROUGH THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES DATE: 03/05/2014 PAGES-4 OF THIS REQUEST FOR PROPOSAL CONTAIN GENERAL INFORMATION. NOT ALL OF THE IN ORMATION CONTAINED IN PAGES 1-4 MAY BE APPLICABLE. SPECIFICATIONS UNIQUE TO THIS REQUEST FOR PROPOSAL FOLLOW PAGE 4. I. NOTICE TO BIDDERS A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the Board of Weld County Commissioners, wishes to purchase the following: VARIOUS SERVICES (AS DESCRIBED ON PAGES 12-14) B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter at vegterta@weldgov.com or P.O. Box A, 315 A North 11th Avenue, Greeley, CO 80631, through: WEDNESDAY. MARCH 21. AT 5:00 P.M. (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNIT TIME CLOCK). II. INVITATION TO BID IA. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various Services (as described on pages 12-14). B. Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if awarded the bid. I C. Emailed Bids Are Preferred. Emailed (fully typed) bids are preferred. However, if the bidder is unable to submit an emailed bid,the bidder must comply with the requirements set forth in Paragraph II D below. An emailed bid must contain the following statement: "I hereby waive my right to a sealed bid." D. Unless the Bid is emailed, one original and one coin( of the Bid must be submitted. One complete bid document, which will be the only official copy of the bid, shall be filed at the Weld County Department of Human Services, Service Utilization Unit. After certification of the bid, the other copy will be routed for applicable review. An e-mail confirmation will be sent when we receive your bid/proposal. Page 1 Bid No. 91400069 III. NSTRUCTIONS TO BIDDERS • Bids shall be tvaewritten. Each bid must give the full business address of the bidder and be signed by him with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the partners of the partnership or by an authorized representative, followed by the signature and title of the person signing. Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in this matter. Bids submitted by limited liability companies must furnish the full names of all members and managers and must be signed by a manager or by an authorized representative, followed by the signature and title of the person signing. The name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing. When requested, satisfactory evidence of the authority of the officer signing in behalf of a corporation shall be furnished. All corrections or erasures shall be initialed by the person signing the bid. All bidders shall agree to comply with all of the conditions, requirements, specifications, and/or instructions of this bid as stated or implied herein. All designations and prices shall be fully and clearly set forth. B. Bids may be withdrawn upon written request to the Weld County Department of Human Services received from bidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened. C. Bidders are expected to examine the conditions, specifications, and all instructions contained herein. Failure to do so will be at the bidder's risk. D. Bidders shall not stipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto. Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected. E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the time indicated in Section I., entitled "Notice to Bidders." F. When approximate quantities are stated, Weld County reserves the right to increase or decrease quantity as best fits its needs. G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Page 2 ' I Bid No. B1400069 Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County. All discounts shall be figured from the date of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance. J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of Families, Youth and Children's Commission. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims for royalties, for patents or suit for infringement thereon, which may be involved in the manufacture or use of the material to be furnished. L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. 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 this 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 this Contract. Page 3 Bid No. B1400069 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 a Contract. M. All goods shall remain the property of the seller until delivered to and accepted by Weld County, Colorado. N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will attach to the Families, Youth and Children Commission, the Weld County Department of Human Services, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified. O. In submitting the bid, the bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract. The Board of County Commissioners of Weld County, Colorado, reserves the right to reject any and 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. P. These instructions, the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transactions will be mutually satisfactory. Your cooperation is invited. IQ. Substitutions or modifications to any of the terms, conditions, or specifications of this which are made by Weld County after the bids have been distributed to prospective bidders and prior to the date and time of bid opening, will be made in writing. No employee of Weld County is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV. General Specifications. A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. Page 4 Bid No. B1400069 Governmental Immunity: No term or condition of the 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. C. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee. He or she shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The successful bidder 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 (b) provide proof thereof when requested to do so by Weld County. D. Compliance with Law: The successful bidder 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. E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra-judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental Page 5 Bid No. B1400069 beneficiary only. H. Attorneys Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. Insurance Requirements. i. General Requirements: Contractors/Contract Professionals must secure, at or before , followingthe insurancetimeof coveringexecution allof operationsanyagreement, goodsor or servicescommencement providedofany pursuantworkthe to this request. Contractors/Contract Professionals shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above-described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self-insured retention, County must be notified by the Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self-insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, 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/Contract Professional. Contractor/Contract Professional 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. ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: (a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. (b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: Page 6 Bid No. B1400069 * $1,000,000 each occurrence; * $2,000,000 general aggregate; * $2,000,000 products and completed operations aggregate; * $50,000 any one fire; and * $500,000 errors and omissions. :c). Automobile Liability: Contractor/Contract Professional shall maintain limits of $1,000,000 for bodily injury pe person, $1,000,000 for bodily injury for each accident, and $1,000,000 for pr erty damage applicable to all vehicles operating both on County property and els where. (d). Additional Provisions: * Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: * If any aggregate limit is reduce by twenty-five percent (25%) or more by paid or reserved claims, Contractor shall notify County 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 County. (e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims-made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance on Page 7 Bid No. B1400069 www.lns-Cert.com and link the information to County. County reserves the right to require Contractor/Contract Professional 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. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. Contract Professional's vi. Waiver of Subrogation: For all coverages, Contractor/Contract insurer shall waive subrogation rights against County. vii. Subcontractors: All subcontractors, 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/Contract Professional. Contractor/Contract Professional 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/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub-vendors suppliers or other entities upon request by the County. 'A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. V. Warranty. The successful bidder shall warrant that: A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended; B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein. Page 8 Bid No. B1400069 Project Overview: The Weld County Department of Human Services (WCDHS) is seeking various services. Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi-Systemic Therapy, Home Based Intensive Services, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services. Refer to pages 12-14 for specific definitions related to the above-mentioned service areas. Qualifications: To be considered, a bidder must meet the following minimum qualifications: 1) A bidder must submit a completed Provider Information Form. 2) A bidder must submit a one page or less cover letter that introduces the bidder,the bidder's location(s) of practice and target area, his or her experience and qualifications, and staff. 1) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications"for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. 3) 'Bidders should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Proposal. 4) A bidder must demonstrate the knowledge, training and expertise to conduct the ' proposed service(s). 5) A bidder must provide a current resume, as well as proof of licensure, for self and staff members. Additionally, a bidder must include proof of inclusion on State vendor lists if applicable to the proposed service (ex. Home Study Providers, Sex Offender Management Board Providers). 6) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal. Page 9 Bid No. B1400069 7) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services as requested. I 8) W bidder must agree to enter into a contract, attached as Exhibit A, with the Weld County Department of Human Services and comply with all requirements of the contract. Contract Period and Pricing: 1) The initial contract period shall commence on June 1, 2014, through May 31, 2015, so (long as both parties are satisfied. The selected vendor(s) will have the opportunity to resubmit annually. 2) The initial contract will be funded through Core Services Program or Child Welfare 'Administration funding, so long as funding is made available. 3) 'The selected vendor will bill the Weld County Department of Human Services monthly according to billing requirements set forth by the Weld County Department of Human Services. Submiral Reauirements for All Proposals: A bidd r must submit according to requirements set forth in this Request for Proposal. All proposals must contain the following specific information: 2) I Completed Provider Information Form with original signature of authorized representative. 3) I One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his or her experience and qualifications, and staff. 4) Sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications"for all bidders. Each service must be submitted as its own proposal, inclusive of scope of services and rate information. 5) Bidders should avoid elaborate artwork,graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Proposal. Page 10 f I I Bid No. B1400069 6) Current resume, proof of licensure and copies of applicable training certificates for all staff members who will manage and/or administer services under this proposal. 7) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and comply with the specific requirements set forth by the Weld County Department of Human Services. 8) All proposals must include a clear and concise rate schedule that accurately correlates to the proposed services and is inclusive of all possible charges related to the proposed service(s). The rate schedule must demonstrate an exact fee for the described service l(s). Approximate rates or a range of rates for a service will not be accepted. 9) Each bidder must submit a Standard Certificate of Insurance, or letter of intent from an insurance company authorized to do business in the State of Colorado stating its (willingness to insure the bidder pursuant to the terms of this Request for Proposal. Evaluaron of Proposals: All proposals that meet the basic proposal, service and qualification requirements will be reviewed by the Families, Youth and Children (FYC) Commission. The FYC Commission will make recommendations to the Board of Weld County Commissioners by and through the Weld County Department of Human Services. The Weld County Department of Human Services will make its award of contract to the successful bidders upon final approval of the Board of Weld County Commissioners. Page 11 Bid No. B1400069 SERVICE AREA DEFINITIONS Aftercare Services Services provided to prepare a child for reunification with his/her family or other permanent placement and to prevent future out- of-home placement of the child. Anger Management/Domestic Violence Diagnostic and/or therapeutic services to assist in the development of the family services plan,to assess and/or improve family communication, functioning and relationships, and to prevent further domestic violence. Day Treatment Comprehensive, highly structured services that provide education to children and therapy to children and their families. Foster barent Consultation Services provided to foster and group home families caring for WCDSS children and youth in their homes to enhance and improve the quality of care being provided. Foster Parent Training Core training for new Weld County foster parents. Functional Family Therapy Intensive family-based treatment that addresses the pervasive patterns of relational dysfunction known to be determinants of conduct disorder, violent acting out, and substance abuse among youth 10-18 years old. Home-Based Intervention Services provided primarily in the home of the client that include a variety of services which can include therapeutic services, concrete services, collateral services and *crisis intervention directed to meet the needs of the child and family. *Crisis Intervention is defined as 24/7 phone access and in-home counseling. Page 1P Bid No. B1400069 Homes Studies/Relinquishment Counseling Home studies and home study updates per the standardized SAFE home study tool for the purpose of adoption, foster care, and expedited permanency planning. Relinquishment counseling for parents considering relinquishment of their children. Visitation (bot h in-home and in-office) and services Life Skills provided primarily in the home that teach household management, effective access to community resources, parenting techniques and family conflict management. Mediation/Intensive Family Therapy Therapeutic intervention typically with all family members to improve family communication, functioning and relationships. Mental Health Services Diagnostic and/or therapeutic services to assist in the development of family services plan,to assess and/or improve family communication, functioning and relationships. Multisystemic Therapy Intensive family- and community-based ased treatment program designed to make positive changes in the various social systems (home, school, community, peer relations)that contribute to the serious antisocial behaviors of children and adolescents who are at risk for out-of-home placement. Sex Abuse Treatment Therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetrations, and to prevent further sexual abuse and victimization. Page 14 Bid No. 81400069 Substance Abuse Treatment Services Diagnostic and/or therapeutic services to assist in the development of the Family Service Plan (FSP), to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol. Page 14 Bid No. B1400069 EXHIBIT A CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND«CONTRACTOR1» This Agreement, made and entered into the_day of ,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 «Contractor»,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 Department's Request for Proposal,Exhibit B,Scope of Services,Exhibit C, Conti ctor's Response to the Request for Proposal, and Exhibit D,P$pent Schedule. Each of these documents is attachgd hereto and incorporated herein by this reference. WITNESSETH WHEREAS,required approval,clearance,and coordination have been accomplished from and with appropriiate agencies;and WHEREAS,the Colorado Department of Human Services has provided«funding»to the Department for «Services»;and NOW THEREFORE, in consideration of the premise the parties hereto covenant and agree as follows: 1. Term This agreement shall become effective on «TermStart», upon proper execution of this Agreement and shall expire«TermEnd»,unless sooner terminated as provided herein. 2. Score of Services Services shall be provided by the Contractor to any person(s)eligible for services in compliance with Exhibit A,Weld County's Request for Proposal,and Exhibit B,Scope of Services. 3. I 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 1 Bid No. B1400069 through the Department's Resource Manager,Child Welfare Contract and Services Coordinator,or through a Team Decision Making(TDM)meeting or Family Team Meeting(FTM). No other Department staff or other party to the case may authorize services or modifications to services. c. Contractor agrees to submit an itemized complete billing statement by the 7Th of the month, following the month of service,utilizing billing forms required by the Department. d. Contractor agrees to submit a monthly report with the billing statement by the 7`h of the month following the month of service for each client receiving ongoing services. One-time services will be verified through receipt of the completed product(ex. psychological evaluation,substance abuse evaluation). Verification of Monitored Sobriety Services will be the test result. I 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. Monthly reports will be submitted through the Department's online reporting system, unless otherwise directed or agreed to by the Department. 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. b. Payment shall be made in accordance with EXhibit A, Department's Request for Proposal, Exhibit B, Scope of Services,, Exhibit C,Contractor's Response to the Request for Proposal,and Exhibit D, Payment 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. 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 2 Bid No. B1400069 expended under this Agreement must conform to the Single Audit Act of 1984 and 0MG Circular A-133. 6. payment Method Unless otherwise provided in Exhibit A, Department's Request for Proposal, Exhibit B,Scope of Services,, Exhibit C,Contractor's Response to the Request for Proposal,and Exhibit D,Payment Schedule: If services are funded through Core Services, Contractor agrees to accept reimbursement through ACH direct deposit one time per month. Contractor I set up with the State of Colorado to accept direct deposit, b. If Contractor is not currently P agrees to complete and submit an ACH Form for Colorado Providers,which will be provided by the I Department. Contractor is solely responsible to submit the ,; Form to the State of Colorado per the directions on the form. Failure to complete and submit this form 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 Ia. At all times during the performance of this Agreement,Contractor will strictly adhere to all applicable Federal and State laws,order,and applicable standards, regulations,interpretations and/or guidelines issued pursuant thereto. This Includes protection of the confidentiality of all applicant/recipient records;papers,documents,tapes and any other materials that have been or may hereafter be established which relate to therAgreement. 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:sea.: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.ss and its implementation regulations,45 C.F.R. Part 91;and - Title VII of the Civil Rights Act of 1964;and - the Age Discrimination in Employment Act of 1967;and 3 Bid No. B1400069 - the Equal Pay Act of 1963;and - the Education Amendments of 1972;and - Immigration Reform and Control Act of 1986, P.L.99-603,42 C.F.R. Part 2;and - all regulations applicable to these laws prohibiting discrimination because of race,color, national origin,sex,religion,and handicap, including Acquired Immune Deficiency Syndrome (AIDS)or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited above. If necessary,Contractor and the Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74,Appendix G 9,which requires that affirmative steps be taken to assure that small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction and services. This assurance is given in consideration of and for the purpose of obtaining any all Federal and/or State financial assistance. - Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal background record checks for all employees,contractors and sub-contractors. b. Contractor is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the United States Department of Health and Human Services,Office for Civil Rights. c. Contractor assures that it will fully comply with all other applicable Federal and State laws which may govern the ability of the Department to comply with the relevant funding requirements. Contractor understands the source of funds to be accessed under the Agreement is«funding». 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 civi* {Igment rendered against them for commission of fraud or criminal offense in connection with obtaining,attempting to obtain,or performing a public(Federal,State or Local)transaction or contract under public transaction;violation of federal or state antitrust statutes or commission of embezzlement,theft,forgery,bribery,falsification or destruction of records, making false statements,or receiving stolen property;and - are not presently indicted for or otherwise criminally or civilly charged by a government entity(federal, state or local)with commission of any of the offenses enumerated in this certification;and - have not,within a three-year period preceding this Agreement,had one or more public transactions(federal,state,or local)terminated for cause or default. 4 Bid No. 81400069 e. Contractor certifies that it shall comply with the provision of the Colorado Revised Statutes(C.R.S.)8- 17.5-101,et.seq. 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 to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Contractor represents,warrants,and agrees that it(a)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security,and(b) otherwise will comply with the requirements of C.R.S.8-17.5-102(2)(b). Contractor shall comply with all reasonable requires made in the course of an investigation under C.R.S.8-17.5-102 by the Colorado Department of Labor and Employment. If Contractors fails to comply with any requirement of this provision or C.R.S.8-17.5-101,et.seq.,the Department may terminate this Agreement for breach and Contractor shallbeliable for actual and consequential damages to the Department. 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 this Agreement,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 this Agreement. If Contractor operates as a sole proprietor, it hereby affirms under penalty of perjury that s/he(a)is a citizen of the United States or is otherwise lawfully present in the United State 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 this Agreement. 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 4,measure each state's perforrnance according to national standards and monitor progress over time. Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance services to families. Contractor agrees to continually strive for positive outcomes in the areas of Safety,Permanency and Well Being. Contractor will ensure that any employee or subcontractor of Contractor providing services under this Agreement will work towards positive outcomes in the aforementioned three areas as outlined under the Child and Family Services Review(CFSR),and will address the aforementioned three areas when completing monthly reports as required by Paragraph 3(d)of this Agreement. 9. ( Insurance 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 5 Bid No. B1400069 Commissioners of Weld County,its employees,volunteers and agents. Contractor shall provided the liability(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. 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. t 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. - Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease,covering all employees at the work site. - General Liability(PL and PD)(Minimum) o Combined single limit-$500,000.00 written on an occurrence basis. o Additional insurance required if claims reduce the annual aggregate below$500,000.00. o Weld County,State of Colorado,to be named a 'additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. Automobile Uability(Minimum)for any Contractor transporting children or any party to whom Department services are being provided. Additional coverage may be required in specific program areas. For any insurance that are required by this Agreement,a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 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 that the request of the Department specific to services provided under this Agreement. The Department will not compensate the Contractor for said training in 6 Bid No. B1400069 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 970-352-1551,x6503,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,thEDepartment and the 'Contractor. Contractor shall permit the Department,and any other duly authorized agent or governmental agency,to monitor all activities conducted by the Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deeti necessary or appropriate,such program data,special analyses,on-site checking,formal audit examinations,or any other reasonable procedures. 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 I the Contractorsubstantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfytfe,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. 7 Bid No. B1400069 - 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 ipf the respective parties. Either party may from time to time designate in writing a new or substitute representative(s). For Department: For Contractor: Heather Walker,Administrator «RepFNamit»`«RepLName», «RepTitle» 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: .,;, For Contractor: ,Judy A.Griego,Director «NoticeFName»«NoticeLName», P.O. Box A «Addressl»,«Address2» Greeley.CO 80632 «Gtv»,«State» «Zip» (970)352-1551 «Phone» 18. Litigation Contractor shall promptly notify,the Department in the event that Contractor learns of any actual litigation in which it'fga party defendant in a case that involves services provided under this Agreement. Contractor,within five(5)calendar days after being served with a summons,complaint,or other pleading which has been filed in any Federal or State court or administrative agency,shall deliver copies of such document(s)to the Director of Human Services. The term"litigation"includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty(30)days written notice to the individuals identified in paragraph 18. 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. 8 Bid No. B1400069 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement,and all rights of action relating to such enforcement,shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver,express or implied,of any of the immunities, rights, benefits,protections or other provisions,of the Colorado Governmental Immunity Act of§§24-10-101 et. sea.,as applicable now or hereafter amended. 22. !Partial Invalidity of Agreement If any section, subsection, paragraph,sentence,clause,or phrase of this Agreement is for any reason held or decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or invalid. 23. Improprieties/Conflict of Interest No officer,member or employee of weld County and no member of their governing bodies shall have any pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a Contractor with the Department when the Contractor also maintains a relationship with a third party and the two relationship are in opposition. In order to create the appearance of a conflict of interest,it is not necessary for the Contractor to gain from knowledge of these opposing interests. It is only necessary that the Contractor know that the two relationships are in opposition. During the term of the Agreement,Contractor shall not enter into any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation,Contractor shall submit to the Department,a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination,for cause,of its Agreement with the Contractor. 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, 9 Bid No. B1400069 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. IAII 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, Ior until an audit has been completed with the following qualifications: If an audit by or on behalf of the Federal and/or State government has begun but is not completed at the end of the:seven(7)year period, or if audit findings have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the audit finding. 25. I Confidentiality of Records Contractor shall protect the confidentiality of all applicant records and other materials that are maintained in aced ante with this Agreement except for purposes directly connected with the administration of C 1 Protection."No information about or obtained from any applicant/recipient in possession of Contractor shall be'rlisclosed 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,agentsf and subcontractor, if any,that they are subject to these confidentiality requirements. Contractor shall provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. Contractor shall have its employees,agents,and subcontractors, if any,sign a written confidentiality agreement and shall provide a copy of such agreement to the Department,if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development,trade secrets,business affairs, internal operations and management procedures and those of its customers,clients or affiliates,but does not include information (1)lawfully obtained from third parties, (2)that which is in the public domain,or(3)that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by the Contractor in the course of providing services 10 Bid No. B1400069 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 it is an independent contractor and that its officers and employees do not become employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as the result of this Agreement. 28. Entire Agreement (This Agreement,together with all attachments hereto,constitutes the entire understanding between the parties with respect to the subject matter hereof,and may not be changed or modified except as state in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto,their successors, heirs, legal representatives,and assigns. The Contractor and the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 29. (Agreement Nonexclusive This Agreement does not guarantee any work nor does it create an exclusive agreement for services. 30. Warranty. The Contractor warrants that services performed under this Agreement will be performed in a manner consistent with the professional standards governing such services and the provisions of this Agreement. The Contractor shall faithfully perform the work in accordance with the standards of care, skill, training, diligence and judgment provided by highly competent individuals and entities that perform services of a similar nature to those described in this Agreement including Exhibits A, B,C, and D. 31.IAcceotance of Services Not a Waiver. Upon completion of the work, the Contractor shall submit to Departinent originals of all tests and results, reports, etc., generated during completion of this work. Acceptance by 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 I 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. 11 Bid No. 81400069 32. Employee Financial Interest/Conflict of Interest. C.R.S. §§24-18-201 et sea. and 124-50-507. 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 conflict 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 Contract Professional'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. Colbradop: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, Contract Professional agrees that the Weld County District Court shall have exclusive jurisdiction to resolve said dispute. 35. Attorneys Fees/Legal Costs. In the a of a dispute between County and Contract Professional,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. 12 Bid No. B1400069 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO Weld County Clerk to the Board Douglas Rademacher,Chair By: Deputy Clerk to the Board APPROVED AS TO FORM: County Attorney WELD COUNTY DEPARTMENT ecONTRACTOR1» OF HUMAN SERVICES By: By: Judy A.Griego,Director «SigFName»«SigLName»,«Title» 13 Bid No. 81400069 EXHIBIT A REQUEST FOR PROPOSAL Bid No. 81400069 BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF WELD,STATE OF COLORADO, BY AND THROUGH THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES DATE: 03/05/2014 PAGESI1-4 OF THIS REQUEST FOR PROPOSAL CONTAIN GENERAL INFORMATION. NOT ALL OF THE INFORMATION CONTAINED IN PAGES 1-4 MAY BE APPLICABLE. SPECIFICATIONS UNIOUE TO THI REQUEST FOR PROPOSAL FOLLOW PAGE 4. I. NOTICE TO BIDDERS A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the Board of Weld County Commissioners, wishes to pUt-chase the following: VARIOUS SERVICES (AS DESCRIBED ON PAGES 12-14) B. Bids for the stated services will be received by the Weld County Department of Human Services, Resource Unit, Attn: Tobi Vegter at vegterta@weldgov.com or P.O. Box Aj315 A North 11th Avenue, Greeley, CO 80631, through: WEDNESDAY. MARCH 21,-AT S:00 IlMA, (WELD COUNTY DEPARTMENT OF HUMAN SERVICES, RESOURCE UNITTIIVIE CLOCKI. II. I INVITATION TOyBID A. The Families, Youth and Children's Commission, on behalf of the Weld County Department of Human Services, by and through the board of Weld County Commissioners requests bids for the purchase of Various Services (as described on pages 12-14). B. Bids shall include any and all charges for service(s) applied for by the bidder, and shall, in every way, be the total net price which the bidder will expect the Board of County Commissioners of Weld County to pay if awarded the bid. C. Emailed Bids Are Preferred. Emailed (fully typed) bids are preferred. However, if the bidder is unable to submit an emailed bid,the bidder must comply with the requirements set forth in Paragraph II D below. An emailed bid must contain the following statement: "I hereby waive my right to a sealed bid." D. Unless the Bid is emailed. one original and one cony of the Bid must be submitted. One complete bid document, which will be the only official copy of the bid, shall be filed at the Weld County Department of Human Services, Service 14 Bid No. B1400069 Utilization Unit. After certification of the bid, the other copy will be routed for applicable review. An e-mail confirmation will be sent when we receive your bid/proposal. III. INSTRUCTIONS TO BIDDERS A. Bids shall be typewritten. Each bid must give the full business address of the bidder and be signed by him with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the partners of the partnership or by an authorized representative, followed by the signature and title of the person signing. Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in this matter. Bids submitted by limited liability companies must furnish the full names of all members and managers and must be signed ky a manage$or by an authorized representative, followed by the signature and title of the person signing. The name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing. When requested, satisfactory evidence of the authority of the officer signing in behalf of a corporation shall be furnished. All corrections or erasures shall be initialed by the person signing the bid. All bidders shall agree to comply aft all of the conditions, requirements, specifications, and/or instructions of this?* as stated or implied herein. All designations and prices shall be fully and clSatly set forth. B. Bids may be withdrawn upon written request to the Weld County Department of Human Services feceived frombidders prior to the submission deadline. Negligence on the part of bidder in preparing the bid confers no right for the withdrawal of the bid after it has been opened. C. Bidders are expected to examine the conditions, specifications, and all instructions contaned herein. Failure to do so will be at the bidder's risk. D. Bidders shall ndtMtipulate in their proposals any conditions not contained in the instructions and specifications herein unless specifically requested by the special instructions attached hereto. Any proposal which fails to comply with the letter of the instructions and specifications herein may be rejected. E. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Department of Human Services, Service Utilization Unit, on or prior to the time indicated in Section I., entitled "Notice to Bidders." F. When approximate quantities are stated, Weld County reserves the right to increase or decrease quantity as best fits its needs. 15 Bid No. B1400069 G. Whenever requested, samples or descriptive matter shall be filed prior to the opening of bids. H. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, the Board of County Commissioners of Weld County will give preference to resident Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that the Board of County Commissioners of Weld County will give preference to suppliers from the State of Colorado, in accordance with Section 30-11-110, CRS, when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County. All discounts shall be figured from the date,of delivery and acceptance of the articles, or in the case of an incorrect invoice, from the date of receipt of corrected invoice, if this be subsequent to delivery and acceptance. J. Substitutions or modifications to any of the terms, conditions, or specifications of this bid package which are made by Weld County, Colorado, after the bids have been distributed to prospective bidders, and prior to the date and time of bid opening, will be made in writing and signed by the Families, Youth and Children's Commission. No employee of Weld County, Colorado, is authorized in any way to modify any of the terms, conditions, or specifications of this bid without written approv; I of Families, Youthrand Children's Commission. This is not to imply that bids ill not be acceptetror considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. K. The successful bidder shall indemnify and hold harmless Weld County, Colorado, against all claims fb1 royalties, for patents or suit for infringement thereon, which- may be involved in the manufacture or use of the material to be furnished. t„ L. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Weld County may terminate this Contract for breach and Contractor shall be liable for actual and consequential damages to Contractor. 16 Bid No. B1400069 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 this 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 this 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 a Contract. is M. All goods shall remain the property of the°seller until delivered to and accepted by Weld County, Colorado. N. Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will,,attach to the Families, Youth and Children Commission, the Weld County Department of Human SetVices, or the Board of Weld County Commissioners, for the premature opening of a bid not properly addressed and identified. O. In submitting the bid, Ile bidder agrees that the acceptance of any and all bids by the Board of County Commissioners of Weld County within a reasonable time or period does not constitute a contract, The Board of County Commissioners of Weld County,Colorado, reserves the right to reject any and 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 a best intaitts of the Board and of the County of Weld, State of Colorado P. These instructions,the proposal forms, and specifications have been developed with the hope of raising the standard of purchasing negotiations to a level wherein all transacts ns will be mutually satisfactory. Your cooperation is invited. Q. Substitutions or modifications to any of the terms, conditions, or specifications of this,which are made by Weld County after the bids have been distributed to prospe't$.'ve biddej4 and prior to the date and time of bid opening, will be made in writing. o emplikee of Weld County is authorized in any way to modify any of the terms,conditions, or specifications of this bid without written approval of said Director of the Weld County Department of Human Services. This is not to imply that bids will not be accepted or considered with specifications which are different from those herein. Any item which does not meet all the terms, conditions, or specifications of this bid, must be clearly indicated on a separate sheet of paper, attached to the bid specification and proposal sheets and returned with the bid. IV. General Specifications. 17 Bid No. B1400069 A. Fund Availability: Financial obligations of the Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. B. Governmental Immunity: No term or condition of the 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. C. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent contractor and not as an zgmployee. He or she shall be solely responsible for its acts and those of its a is and employees for all acts performed pursuant to the contract.Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if suck coverage is made available by the successful bidder or a third party. The successful bidder shall pay wasp due all applicable employment taxes and income taxes and local head taxes (If applicable) incurred pursuant to the contract.-The successful bidder shall not have authorization, express or implied,to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The'successful bidder 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 (b) provide proof thereof when requested to do so by Weld County. D. Compliance with Law: The successful bidder 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. E. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. F. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of 18 Bid No. B1400069 action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental beneficiary only. H. Attorneys Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. Insurance Requirements. i. General Requirements: Contractors/Contract Professionals must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all ope tions, goods or services provided pursuant to this request. Contractors/Contract t�rofessionalst'Shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, during any warranty period, and for three (3) years after termination of the Agreement. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above-described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall balaent thirty (30) days prior to such cancellation or reduction unless due to non-paythent of premiums for which notice shall be sent ten (10) days prior. If any policyjs in excess of a deductible or self-insured retention, County must be notified by the. Contractor/Contract Professional. Contractor/Contract Professional shall be responsible for the payment of any deductible or self-insured retention. County reserves the right to require Contractor/Contract Professional to provide a bond, at no cost to County, 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/Contract Professional. Contractor/Contract Professional 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. ii. Types of Insurance: Contractor/Contract Professional shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: (a). Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of Contractor's Contract Professional's employees acting within the course and scope of their employment. 19 Bid No. B1400069 (b). Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: * $1,000,000 each occurrence; * $2,000,000 general aggregate; * $2,000,000 products and completed operations aggregate; * $50,000 any one fire; and * $500,000 errors and omissions. (c). Automobile Liability: Contractor/Contract ofessional 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. (d). Additional Provisions: * Policies for all general liability, excess/umbrella liability, liquor liability and pollution liability must provide the following: • * If any aggregate limit it'reduce by twe ty,five percent (25%) or more by paid or reserved claims, Contractor shall notify'County 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,provisionthat coverage is non-contributory with other coverage or self- insurance provided by County. (e). For all general liability, excess/umbrella liability, liquor liability, pollution liability and professional liability policies, if the policy is a claims-made policy, the retroactive date must be on or before the contract date or the first date when any goods or services were provided to County, whichever is earlier. iii. Contractors/Contract Professionals shall secure and deliver to County's Risk Administrator ("Administrator") at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and 20 f I Bid No. 61400069 company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the related Bid or Request for Proposal. iv. Proof of Insurance: Contractor/Contract Professional shall provide a copy of this information to its insurance agent or broker, and shall have its agent or broker provide proof of Contractor/Contract Professional's required insurance on www.Ins-Cert.com and link the information to County. County reserves the right to require Contractor/Contract Professional 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. v. Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Contractor/Contract Professional's insurer shall name County as an additional insured. vi. Waiver of Subrogation: For all coverages, Contractor/Contract Professional's insurer shall waive subrogation rights against County. Ivii. Subcontractors: All subcontractors, 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/Contract Professional. Contractor/Contract Professional 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/Contract Professional agrees to provide proof of insurance for all such subcontractors, independent contractors, sub-vendors suppliers or other entities upon request by the County. A provider of Professional Services (as defined in the Bid or RFP) shall provide the following coverage: Professional Liability: Contract Professional shall maintain limits of $1,000,000 for each claim, and $2,000,000 aggregate limit for all claims. V. I Warranty. The successful bidder shall warrant that: A. The services to be supplied pursuant to this bid are fit and sufficient for the purpose intended; B. The services sold to Weld County, Colorado pursuant to this bid conform to the minimum Weld County specifications as established herein. 21 Bid No. 81400069 Protect Overview: The Weld County Department of Human Services (WCDHS) is seeking various services. Service areas include, but are not limited to, Anger Management/Domestic Violence, Day Treatment, Foster Parent Consultation, Foster Parent Training, Functional Family Therapy, Home Studies/Relinquishment Counseling, Life Skills, Mediation, Mental Health, Monitored Sobriety, Multi-Systemic Therapy, Home Based Intensive Services, Sexual Abuse Treatment, and Substance Abuse Treatment Services and Aftercare Services. Refer to pages 12-14 for specific definitions related to the above-mentioned service areas. Qualifications: To be considered, a bidder must meet the following minimum qualifications: 1) A bidder must submit a completed Provider Information Form. 2) A bidder must submit a one page or less cover letter that introduces the bidder,the bidder's location(s) of practice and target area, his or her experience and qualifications, and staff. 1) A bidder must submit sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets"minimum qualifications"for all bidders. Eachstirvice must be submitted as its own proposal. inclusive of scope of services and rate information. 3) Bidders should avoid elaborate artwork,graphics, binding, presentation or other artifice that does not directly address;the requirements set forth in this Request for Proposal. 4) . A bidder must demonstrate the knowledge,training and expertise to conduct the proposed service(s). 5) A bidder must provide a current resume, as well as proof of licensure, for self and staff members. Additionally, a bidder must include proof of inclusion on State vendor lists if applicable to the proposed service (ex. Home Study Providers, Sex Offender I Management Board Providers). 6) A bidder must demonstrate familiarity with Trauma Informed Care. Bidder must provide copies of applicable training certificates, or proof of registration for training, for all staff members who manage and/or administer services under this proposal. 22 Bid No. B1400069 7) A bidder must demonstrate prior and current capacity to be organized, responsive and to quickly and successfully schedule services as requested. 8) A bidder must agree to enter into a contract, attached as Exhibit A, with the Weld County Department of Human Services and comply with all requirements of the contract. Contract Period and Pricing: 1) The initial contract period shall commence on June 1,2014,through May 31, 2015, so long as both parties are satisfied. The selected vendor(s)awill have the opportunity to resubmit annually. 2) The initial contract will be funded through Core Services Program or Child Welfare Administration funding, so long as funding is made available. 3) The selected vendor will bill the Weld County Department of Human Services monthly according to billing requirements set forth by the Weld County Department of Human y, Services. Submittal Requirements for All Proposals: A bidd r must submit according to requirements set forth in this Request for Proposal. All propo als must contain the following specific information: 2) Completed Provider Information Form with original signature of authorized representative. 3) I One page or less cover letter that introduces the bidder, the bidder's location(s) of practice, his orjher experience and qualifications, and staff. 4) Sufficient information concerning each proposed service for Weld County to evaluate whether or not the bidder meets "minimum qualifications"for all bidders. Each service must be submitted as its own proposal.inclusive of scope of services and rate information. 5) Bidders should avoid elaborate artwork, graphics, binding, presentation or other artifice that does not directly address the requirements set forth in this Request for Proposal. 23 Bid No. 81400069 6) Current resume, proof of licensure and copies of applicable training certificates for all staff members who will manage and/or administer services under this proposal. 7) All proposals must demonstrate the bidder has the ability to deliver the services as proposed, and comply with the specific requirements set forth by the Weld County Department of Human Services. 8) 'All proposals must include a clear and concise rate schedule that accurately correlates to the proposed services and is inclusive of all possible charges related to the proposed service(s). The rate schedule must demonstrate an exact fee for the described service I(s). Approximate rates or a range of rates for a service''will not be accepted. 9) Each bidder must submit a Standard Certificate of Insurance, or letter of intent from an insurance company authorized to do business in the State of Colorado stating its 'willingness to insure the bidder pursuant to the terms of this Request for Proposal. Evalualtion of Proposals: All proposals p that meet the basic proposal,service and qualification requirements will be reviewed by the Families,Youth and Children (FYC) Commission. The FYC Commission will make recommendations to the Board of Weld County Commissioners by and through the Weld Count Department of Human Servtes. The Weld County Department of Human Services will make its award of contract to the successful bidders upon final approval of the Board of Weld County Commissioners. 24 Bid No. B1400069 SERVICE AREA DEFINITIONS Aftercare Services Services provided to prepare a child for reunification with his/her family or other permanent placement and to prevent future out- of-home placement of the child. Anger Management/Domestic Violence Diagnostic and/or therapeutic services to assist in the development of the family services plan,to assess and/or iitove family communication, functioning and relationships, and to prevent further domestic violence. Day Treatment Cth prehensive,highly structured services that provide education to children and therapy to children and their families. Foster Parent Consultation Services provided to foster and group home families caring for WCDSS children and youth in their homes to enhance and improve the quality of fF care being provided. I x�ti Foster Parent Training Core training for new Weld County foster parents. FunctiQ nal.FamilY Therapy Intensive family-based treatment that addresses the pervasive patterns of relational dysfunction known to be determinants of conduct disorder, violent acting out, and substance abuse among youth 10-18 years old. Home-Based Intervention Services provided primarily in the home of the client that include a variety of services which can include therapeutic services, concrete services, collateral services and *crisis intervention directed to meet the needs of the child and family. *Crisis Intervention is defined as 24/7 phone access and in-home counseling. 25 Bid No. 81400069 Homes Studies/Relinquishment Counseling Home studies and home study updates per the standardized SAFE home study tool for the purpose of adoption,foster care, and expedited permanency planning. Relinquishment counseling for parents considering relinquishment of their children. Life Skills Visitation (both in-home and in-office) and services provided primarily in the home that teach household management, effective access to community resources, parenting techniques and family conflict management. Mediation/Intensive Family Therapy Therapeutic intervention typically with all family members to improve family communication, functioning and;elationships. Mental Health Services Diagnostic and/or therapeutic services to assist in the development of family services plan,to assess and/or improve family communication, functioning and relationships. Multisystemic Therapy Intensive family- and community-based treatment program designed to make positive changes in the various social systems (home, school, community, peer relations)that contribute to the serious antisocial behaviors of children and adolescents who are at risk for out-of-home placement. Sex Abuse Treatment Therapeutic intervention designed to address issues and behaviors related to sexual abuse victimization, sexual dysfunction, sexual abuse perpetrations, and to prevent further sexual abuse and victimization. 26 Bid No. B1400069 Substance Abuse Treatment Services Diagnostic and/or therapeutic services to assist in the development of the Family Service Plan (FSP), to assess and/or improve family communication, functioning and relationships, and to prevent further abuse of drugs or alcohol. 27 Bid No. 81400069 EXHIBIT B SCOPE OF SERVICE 1. Contractor understands that the Department will not reimburse Contractor for"no shows"or cancelled appointments,either on the part of the client or the Contractor. 2. 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. Upon receipt of an invitation from the Department,Contractor must contact the Child Welfare Contract and Services Coordinator to request approval to bill for participation if Contractor wishes to be reimbursed. 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 requests approval to bill in advance 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. 3. Contractor will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the Contractor will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 28 Bid No. 81400069 EXHIBIT C CONTRACTOR'S RESPONSE TO THE REQUEST FOR PROPOSAL 29 Bid No. B1400069 EXHBIT D PAYMENT 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 specified 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 in Trails after May 31, 2015. 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 «Rate Schedule» Contractor may notettempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthlybllling. ' 3. {Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher,and signed monthly report if applicable,certifying that services authorized were provided on the date(s)indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all Monthly billings and applicable reports to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. 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. b. For one-time services,proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services,proof of services rendered shall be the test result. 30 CONTRACTORS RESPONSE TO THE REQUEST FOR PROPOSAL ,t NDRT ORAL HEALTH RANGE March 19, 2014 Tobi Vegter Core and Service Contract Coordinator Servi a Utilization Unit Weld County Department of Human Services P.O. Box A 315AN 11 th Avenue Greeley, CO 80632 Re: Bid No. B1400069 Dear Tobi: Attached are North Range's Core and Contracted Services Bid proposals for the following program areas and a Certificate of Insurance demonstrating the required limits of coverage: 1. Anger Management/ Domestic Violence; 2.1 Functional Family Therapy; 3. Mental Health Services — Psychological Evaluation; 4. Monitored Sobriety Only; and 5. Multisystemic Therapy. If awarded, North Range agrees to enter into a contract with the Weld County Department of Human Services and comply with all requirements of the contract. Since ely, Larry D. orff Executive irector Enclolsures : y w; M r t; - •' yyW Where hope begins. g4NORTH oRAL HEALTH RANGE March 18,2014 Tobi Vegter Core&Contracted Services Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Anger Management/Domestic Violence services program area. We propose to provide these services to male and female adults age 18 and older at North Range's adult outpatient site, 1260 H Street, Greeley. All services will be provided by academically qualified and/or licensed / DV approved staff as evidenced by the attached resumes and certification/licensure information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions,please do not hesitate to contact me. Si{werely, II Laura ays, LPC, N , III Program Director—Adult Outpatien 970-347-2357 La ura.hays@northranee.org Enclosures Where hope begins. RNORTH oRAL HEALTH RANGE March 19, 2014 Tobi Vegter Core &contracted Services Coordinator Service.Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Dear Tab': Attached is North Range's Core and Contracted Services Bid proposal for the Functional Family Therapy services program area. We propose to provide these services to male and female youth ages 11-17 at North Range's youth and family site, 1300 N. 17th Avenue, Greeley. All services will be provided by acade icaliy qualified and/or licensed staff as evidenced by the attached resumes and certification / licensu�e information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you have any questions, please do not hesitate to contact me. Sincer ly, OThn ae-- (PO Rebecca Wyperd, LP Progra Director—Youth and Family Services 970-38 -3578 rebecc .wvperd@northrange.org 4.4 ,. Enclosures . ;,.' r 0, g. ; Where hope begins. NORTH RANGE frill BEHAVIORAL HEALTH March 19, 2014 Tobi Vegter Core 8: Contracted Services Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Dear Tobi: North Range Behavioral Health (NRBH) is submitting this contract proposal for the mental health services option, to provide diagnostic/therapeutic services to assist the Department of Human Services, Child Welfare, in developing the family services plan, and to assist the families that are serviced to improve family communication, functioning, and relationships. NRBH is proposing to provide psychological/behavioral health evaluations that involve an integrated assessment of mental health and substance abuse issues. Evaluation results can be usefu in the development of treatment plans, placement options, and decisions regarding reuni cation of families through quality and cost effective behavioral health evaluations. Servic to be provided under the terms of this contract by North Range will be provided, at a mini m, by an academically qualified, doctorate candidate under the direct supervision of a licensed clinical psychologist. Evaluators will also be competent in the evaluation of substance abuse issues and supervised by a CAC III or LAC supervisor. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and service time frames. Costs of services are proposed under a four-tier flat rate option to assist in meeting the varied needs of the Department. If desired, NRBH is also available to meet with the Department of Human Services gaff to explain the program, time lines of response to referrals, and answer questions to enhance the program. Sinceiely, Maureen f, Ph.D., Lic chologist, CAC III Progr m Director 970-3 3-1186 ? NORTH RANGE fSt BEHAVIORAL HEALTH March 18, 2014 Weld County Department artment of Human Services 3158 N.11th Avenue i PO Box A Greeley,CO 80631 Dear Ms.Vegter, North Range Behavioral Health is respectfully submitting a bid for consideration as a monitoring services i provider. North Range is able to provide services on a 24 hour a day,7 day a week basis at our facility locat d at 1140 M street and in addition,we have a fairly broad range of times at our South County faclli y located at 145 rt Street. The staff members who work at these two sites come from various i back rounds and education levels; many have a Certification in Addiction Counseling and have been working in the field for a number of years. North Range Behavioral Health takes pride in the services that we are able to provide to clients of all ages and we will continue to strive to meet the needs of the community. If yoq have further questions or concerns, please do not hesitate to contact me at 970-347-2352. Thank you fbr your consideration of our bid. Sincerely, ....., LP C cnc Ur- i Amanda Springer, LPC,CACIII North Range Behavioral Health Program Director of Crisis Stabilization Services 1140 M Street Greeley,CO 80631 970-347-2352 ,.- ;tt Jj r=te fir Where hope begins. >,t,i .mu AIne+I bannn n•n 1111(1AInrt6 '17N• Avnnnn • Gnanlmr r(1 CrIG3'1 • b7l1_7d7_717r1 w "a �y a4NORTHoRAL HEALTH RANGE March 19, 2014 Tobi Vegter Core &Contracted Services Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Dear Tobi: Attached is North Range's Core and Contracted Services Bid proposal for the Multi-Systemic Therapy services program area. We propose to provide these services to male and female youth ages 12-17 at North. Range's youth and family site, 1300 N. 17th Avenue, Greeley. All services will be provided by academically qualified and/or licensed staff as evidenced by the attached resumes and certification / licensure information. Included in the attached proposal are details on the types of services, description of services, and rates for services, as well as details about target populations and projected outcomes. If you ihave any questions, please do not hesitate to contact me. Sincerely, ,--,//0., rifeuck2, L.PC. Rebec�ca Wyperd, C Progrm Director—Youth and Family Services 970-3 1-3578 rebecca.wyperd@northrange.org Enclosures 1 tiv y i, 4. X p'4r. Where hope begins. t North Range Behavioral Health 2014-15 Anger Management/Domestic Violence Attachment to Provider Information Form(Proposal Cover Sheet) Weld County Department of Human Services Contracted Services—Program Year 2014 - 15 PROPOSED SCOPE OF SERVICES and FEES SCOPE OF SERVICES 1. CONTRACTOR will provide Anger Management and Domestic Violence services to males and females, 18 years and older,in Greeley. 2. CONTRACTOR will provide the following services under this contract: Anger Management • Group Process and Skills (Minimum 20 Weeks of Treatment) • Cognitive-Behavioral Skills • Passive,Aggressive and Assertive Domestic Violence (Length of treatment will comply with Behaviors Domestic Violence Offender Management Board • Victim Empathy [DVOMB] regulations based on placement criteria for • Treatment Goals treatment levels A,B or C.) Track (level) is determined by assessment with DV approved screening tools: • Substance Abuse • Track A—one group session a week: duration— • Stages of Change minimum of 2 treatment plan reviews taking place • Parenting every 2-3 months- depending on progress on the • Men's Issues/Women's Issues (as required*Core Competencies applicable) • Track B—one group session a week/one • Effects on Children(DV only) additional contact a month:duration—minimum • Steps to Problem Solving of 3 treatment plan reviews taking place every 2-3 • Steps to Conflict Resolution months - depending on progress on the*Core • Characteristics of Assaultive Adults Competencies • Attitudes Toward the Opposite Sex • Track C—one group session a week/one • Sex Role Training additional contact per week: duration—minimum of 3 treatment plan reviews taking place every 2-3 • Socio-cultural Basis for Violence months - depending on progress on the*Core • Provocation Competencies • Appropriate Containment and Additional contacts will be in a group or individual setting Expressions of Anger depending on the clinical need. • Experiencing Emotions and Feelings I Beyond Anger Monitoring UAs/BAs: When assessed to be appropriate • Grief and loss • Depression and Anxiety *CORE COMPETENCIES—per DVOMB Regulatinnq • Stress Management A. Commitment to eliminate abusive Behavior • Relapse / Recidivism Prevention Personal Change Plan work—Demonstrate change • Healthy Relationships . Complete the Personal Change Plan Worksheet • Sexuality D Recognize and demonstrate Empathy • Spirituality E. Accept full responsibility for the offense and abusive • Resources history F. Identify and reduce pattern of power&control behaviors,beliefs and attitudes of entitlement G. Accountable for abusive behaviors,accept , 1 North Range Behavioral Health 2014-15 Anger Management/Domestic Violence Attachment to Provider Information Form(Proposal Cover Sheet) consequence, take steps to reconciliation to prevent future abusive behaviors H. Accept that abusive behavior should have and has I consequences I. Participate and cooperate in treatment J. Ability to define types of DV K. Understand,identify,&manage own pattern of violence L. Understand intergenerational effects of violence M. Understand&use of healthy communication skills N. Understand&use time outs O. Recognizes financial responsibilities as required P. No new violence or abusive offenses Q. Prohibited from purchasing,possessing,or using firearms&ammunition 3. Anger Management and Domestic Violence intakes will be completed with recomme ndations before the client is placed into treatment. The intake will determine the best placement for the client in regards to treatment,which may include group sessions and/or individual sessions. Individual sessions will only be utilized under one or more of the following circumstances: a. The referred client's individual treatment needs cannot be adequately addressed in a group setting. b. The client is not currently appropriate for a group setting and requires a limited number of individual sessions to prepare for a group setting. c. The client's job requirements make it impossible to attend regularly scheduled group sessions and individual sessions are the only option for the client to comply with their treatment plan. d. When assessed for a DV track in which an additional contact is required. If the dient is assessed at a higher level of care than this agency offers, the client will be recommended to enroll into Domestic Violence treatment at an agency in the community that provides that level of care,i.e. Perklin. 4. CONTRACTOR will comply with the Colorado Domestic Violence Offender Management Board's Standards and Guidelines. 5. All therapists providing services will receive Trauma Informed Care training within 90 days of ac�jceptance of this contract,and will provide the Department of Human Services with training cetificates for proof of attendance. FEES Fees for Services I $200.00/Episode (Anger Management or Domestic Violence Evaluation) I $25.00/hour(Group Session) $17.50/15 Minutes (Individual Session) $17.50/15 minutes (Court Testimony including travel,wait,&prep time) 2 NRBH-CORE SERVICES CONTRACT 2014-2015 North Range Behavioral Health Scope of Service—Functional Family Therapy(FFT) I. General Description of Contractor, including target population, area served,and program being proposed. Contractor has offices in Greeley, CO and in Fort Lupton,CO, and provides in-home, evidence-based, therapeutic services in accordance with National Functional Family Therapy(FFT) standards to male and female youth approximate ages 10-17, within Weld County. 2. Type of service, brief description and rate for each proposed service. Description of service should include any assessment tools or specific practices used in the provision of that service. All services are overseen/supervised by a licensed professional and FFT National Consultant Functional Family Therapy Age Range: —I0— 17 years Gender Criteria: Both Male and Female clients served Goals: Empower families with the skills and resources needed to independently address the difficulties they are having raising their children;Empower youth to cope with family,peer,school, and neighborhood problems;Build community and natural support systems; Decrease negativity and blame among family members;Decrease anti-social behavior to include legal contacts,truancy and substance abuse issues. Length of Treatment: 2—6 months, 1 -2 hours per week Primary Intervention Type: As clinically appropriate: Family Interventions, Cognitive/Behavioral,Family Therapy, School and Community based interventions,and substance abuse intervention. Special Services: Bi-lingual therapist;Case Management, School Interventions, Advocacy,Court/Staffing Participation; Sustainability Planning; Booster services after discharge. Monthly Cost: $700.00 per month/per family,pro-rated for partial month NRBH-CORE SERVICES CONTRACT 20142015 Inclusionary Criteria: Child must be at risk of out of home placement or transitioning back from placement within 30 days; Child is displaying moderate to severe behavioral problems in the home/school/community;Child is involved in criminal behaviors to include substance abuse;Child demonstrates verbal and/or physical aggression at home/school/community; Child is engaged with deviant peer group;Child is struggling with school behaviors to include failing grades,truancy and anti-social behaviors;Family has persist conflict and negative child-parent relationship;Caregiver is abusing substances; Family has limited resources and would benefit from psychoeducation and parenting skill development. Maximum Program Capacity: 40-45 youth Referral Process/fimelines: Referrals must be made to program supervisor for review on approved FFT referral form. Each referral is considered within one week and clients are accepted based on problem severity/risk and therapist availability. Special Assessments/Practices: Use of FFT approved assessments as indicated by licensing agreements and FFT consultant directives including pre,post,and intermittent assessments(provided upon request). Trauma Focused Training: Integrative Treatment of Complex Trauma for Adolescents(ITCT-A)-February 2014 Trauma-Focused Cognitive Behavioral Therapy(TF-CBT)-July 2014 Dialectical Behavioral Training for Adolescents(DIM-March 2014 3. Fees for Services Monthly cost is$700.00 per client/family, pro-rated for partial month services. 4. FFT Outcomes in Weld County Impact to the County Prior to Treatment • All youth receiving FFT services had at least one risk factor of: At risk of out of home placement, returning from out of home placement, legal involvement,and/or school problems prior to admission Current Year of FFT in Weld County(3/1/2013-3/1/2014) Outcomes after completing FFT Treatment(N=76 cases completed) • 94%of youth living in the home • 97%in school or working • 91%with no new arrest or legal involvement Past years of FFT in Weld County(1/1/2010—3/1/2014) Outcomes after completing FFT Treatment(N=267) • 96%of youth living in the home • 94%in school or working • 86%with no new arrest or legal involvement NRBH CONTRACT PROPOSAL NORTH RANGE BEHAVIORAL HEALTH MENTAL HEALTH SERVICES: PSYCHOLOGICAL/BEHAVIORAL HEALTH EVALUATIONS SCOPE OF SERVICES Contractor Description: North Range Behavioral Health (NRBH) is the community behavioral health center serving Weld County, Colorado. We are a private, non-profit corporation dedicated to providing professional, culturally competent behavioral health services to the residents of our area. Target/Eligible Population The target/eligible population includes child welfare family members referred by the Department of Human Services due to risks of out-of-home placement and who are in need of possible behavioral health services. Services to be provided under the terms of this contract by North Range will be provided,at a minimum, by an academically qualified, doctorate candidate under the direct supervision of a licensed clinical psychologist. Evaluators will also be competent in the evaluation of substance abuse issues and supervised by a CAC III or LAC supervisor. NRBH can assist the Weld County Department of Human Services by delivering psychological/behavioral health evaluation services for children, adolescents,and families involved with the Child Welfare system. Evaluation results can be useful in the development of treatment plans, placement options, and decisions regarding reunification of families through quality and cost effective behavioral health evaluations. Type of Services, Description of Services, & Rates: FOUR-TIER FLAT RATE PSYCHOLOGICAL EVALUATION OPTIONS Level 1: Behavioral Health Evaluation Cost: $250.00 Est. Time: 3-6 hours Example: 1. Review of DSS case records,and if applicable NRBH records. 2. Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). 3. Possible administration of brief screening inventories (e.g., Beck Inventories, State-Trait Inventories, Personality Assessment Screener). DHS Contract-2014-2015.doc Page 1 of 4 NRBH 4. Feedback given to the client. 5. Written report addressing relevant psychosocial history, diagnostic formulation, and treatment recommendations. The Behavioral Health Evaluation can be useful for ruling in/out basic mental health and substance abuse issues, advising on provisional diagnoses, and making recommendations for treatment when appropriate. Level 2: Partial Psychological Evaluation Cost: $800.00 Est. Time: 8-14 hours Example: 1. Review of DSS case records, and if applicable NRBH records. 2. Clinical interview and integrated diagnostic evaluation (assessment of mental health and substance abuse issues). 3. Administration of a partial test battery, such as administration of just cognitive or just personality testing (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, test results, diagnostic formulation, and treatment recommendations. This evaluation can be useful for ruling in/out mental health, substance abuse, cognitive, and/or personality issues, advising on diagnoses, and making treatment recommendations. Level 3: Full Psychological Evaluation Cost: $1200.00 Est. Time: 16-20 hours Example: 1. Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports,medical records, and records from other agencies involved in the case. 2. Extensive integrated clinical evaluation (multiple sessions). 3. Administration of a formal battery of tests (multiple tests) to assess personality, emotional, and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, substance abuse, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant behavioral health issues and diagnoses, as well as addressing personality issues, intellectual DHS Contract-2014-2015.doc Page 2 of 4 NRBH functioning, the ability to manage emotions, parenting issues and potential safety of the children in the home, placement issues, and treatment recommendations. Level 4: Extended Psychological Evaluation Cost: $1800.00 Est. Time: 20- hours Example: • This level is intended to be utilized when impairment in cognitive functioning is suspected/known, when the client is unable to read or write, when there are major memory deficits, when resistance leads to invalid measures and instruments need to be re-administered, and/or when other significant barriers to testing are present. • Preauthorization is required by WC DSS Administrative Directors prior to requesting or proceeding with this level of evaluation I. Review of all available records, including DSS records, prior evaluation and behavioral health treatment records, NRBH records if applicable, police reports, medical records, and records from other agencies involved in the case. 2. Extensive integrated clinical evaluation (multiple sessions). 3. Administration of a formal battery of tests (multiple tests) to assess and/or cognitive functioning, and/or parenting issues personality, emotional, g g> (e.g., Wechsler IQ, MMPI, MCMI, PAI, STAXI, STAI, Beck screens, TSI, PSI, etc). 4. Consultation with collateral sources. 5. Feedback given to the client. 6. Write-up addressing psychosocial history, personality issues, emotional functioning and regulation abilities, and/or intellectual functioning and/or parenting/family issues, and diagnostic formulation, as well as treatment recommendations and prognosis. This evaluation can be useful in identifying more significant mental health and substance abuse issues and diagnoses, as well as addressing personality issues, intellectual functioning,the ability to manage emotions,parenting issues and potential safety of the children in the home,placement issues, and treatment recommendations. Partially Completed Evaluations When an evaluation is only partially completed,the charge will be the lower of the following: • $120.00 per hour • The cost of the next lower level of evaluation Partially completed evaluations will come with a written report of any finding that can be appropriately offered based upon the information that was gathered. Other Services: $120.00 per hour • Court Facilitation Meetings • Court Testimony DHS Contract-2014-2015.doc Page 3 of 4 NRBH • Case Conferences All services will be provided by an NRBH provider at an NRBH location or another suitable location(e.g., client's home, school, detention center), depending on circumstances. All services will be referred via email by the Core Services Specialist. The referral authorization level will be clearly stated on the referral. Any supporting documentation available via email will be sent with the referral. The initial referral will be for either: a Behavioral Health Evaluation; a Partial Psychological Evaluation; or a Full Psychological Evaluation. If the caseworker wishes to refer for a Behavioral Health Evaluation, and authorizes a full evaluation if necessary, a notation approving this will be provided in the"narrative" section. Otherwise,prior to North Range continuing with a full evaluation, a one-page summary of the reasons why this recommendation is being made must be sent to the Core Services Specialist, and an authorization to continue from the Core Services Specialist will be needed to continue further. The Core Services Specialist will consult with the Child Protection caseworker and/or their supervisor regarding authorization. Referrals will contain start and end dates for payment authorization. Only services provided within those authorization dates will be paid by the Department. Any services provided outside those dates will be denied for payment. Service Time Frames 1. Evaluations, through a written report,will be completed within forty-five(45) days from the point of first contact with the client, provided that the client can be reached for appointments and the client attends appointments as scheduled. 2. Deadlines may be extended by the Department of Human Services on behalf of North Range when clients cannot be found or reached. 3. If a client partially complies with appointments,North Range will write the evaluation based on information obtained up to that date and prorated based on hours performed by North Range. If no appointments have been made, the evaluation referral may be dropped by North Range due to the client's failure to follow through and North Range will not bill the Department of Human Services. North Ranee agrees to: 1. Be available to meet with the Department of Human Services staff to explain the program, time lines of response to referrals, and answer questions to enhance the program. 2. Be available for the Families, Youth and Children Commission review and attendance at the FYC meeting, if requested. Termination This Agreement may be terminated at any time by either party given sixty(60)days written notice. DHS�ontract-2014-2015.doc Page 4 of 4 North Range Behavioral Health 2014-15 Monitored Sobriety Services Attachment to Provider Information Form(Proposal Cover Sheet) Weld County Department of Human Services Contracted Services— Program Year 2014-15 PROPOSED SCOPE OF SERVICES and FEES SCOPE OF SERVICES Contractor (North Range Behavioral Health) will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: a. Services will be provided at the North Range Behavioral Health — Crisis Stabilization Services facility at 1140 M Street in Greeley, Colorado, and at 145 in Street in Fort Lupton, Colorado. b. Contractor will provide a qualified monitored sobriety collector 24 hours a day/seven days a week at the Greeley site. At the Fort Lupton site, the Contractor will provide a qualified monitored sobriety collector Monday through Thursday from 9a.m. to 12:00 noon and 1p.m. to 4:30p.m. for UAs; 8a.m. to 12:00 noon and 1p.m. to 7p.m. for BAs; and on Friday from 9a.m.to 12:00 noon for UAs, and 8a.m. to 12:00 noon and 1p.m. to 5p.m. for BAs, with no services at this site on Saturday and Sunday. c. Contractor will confirm all positive and negative monitored sobriety results for a BA within 24 hours through a phone call, test result, e-mail, and/or fax to the referring caseworker. Contractor will confirm all positive and negative monitored sobriety results for lab UA's once processing has been completed through Redwood, typically within 3 days. Instant UA results will be reported within 24 hours. If the result is positive, the result will be sent to Redwood for final confirmation. d. Contractor will copy submit a of the valid Authorization for Services form, result, and client sign in sheet (if applicable) with each monthly billing. e. All processed test results, will be available online 24 hours a day, seven (7) days per week at Redwood Toxicology (www.webtoxicoloov.com). FEE $20.00/Episode (Urinalysis Test—5 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates) $20.00/Episode (Urinalysis Test—7 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates, Barbiturates, Alcohol) $20.00/Episode (Multi-panel Instant UA) $20.00/Episode (Instant Swab) $35.00/Episode (GCMS— Confirmation of Positive Result) $5.00/Episode (Breathalyzer) $100.00/Episode (Hair Testing) $50.00/Episode (Patch Monitoring) $35.00/Episode (Ethyl Glucuronide/EtG Test) $50.00/Episode (UA— Expanded Designer Stimulants— 14 Panel) $35.00/Episode (UA— MDPV, Mephedrone, Methylone—3 Panel) $35.00/Episode (UA— Synthetic Cannabinoids—"Spice") $35.00/Episode (Oral Swab —Synthetic Cannabinoids —"Spice") $2.00/Episode (UA - Single Panel EtG Add-on Test— Only When Added to a 5 or 7 Panel UA) $2.00/Episode (UA - Optional Add-on Panel (Oxycodone or Buprenorphine) —Only When Added to a 5 or 7 Panel UA) NRBH-CORE SERVICES CONTRACT 2014-2015 North Range Behavioral Health Scope of Service—Multisystemic Therapy (MST) 1. General Description of Contractor, including target population,area served,and program being proposed. Contractor has offices in Greeley, CO and in Fort Lupton, CO, and provides in-home, evidence-based, therapeutic services in accordance with National Multisystemic Therapy (MST) standards to male and female youth approximate ages 12-17, within Weld County. 2. Type of service, brief description and rate for each proposed service. Description of service should include any assessment tools or specific practices used in the provision of that service. All services are overseen/supervised by a licensed professional and MST National Consultant Multisystemic Therapy: Age Range: —12— 17 years Grinder Criteria: Both Male and Female clients served Goals: Empower caregivers with the skills and resources needed to independently address the difficulties they are having managing their children; Empower youth to cope with family, peer,school,and neighborhood problems;Build community and natural support systems; Decrease anti-social behavior. Length of Treatment: 2—5 months, 3—5 hours per week Primary Intervention Type: As clinically appropriate: In-home Caregiver Interventions, Cognitive/Behavioral,Family Therapy, Individual therapy, School and Community based interventions. Special Services: 24/7 on-call services,Case Management, School Interventions, Advocacy,Court/Staffing Participation, Sustainability Planning. Monthly Cost: $1800.00 per month/per family,pro-rated for partial month In4lusionary Criteria: Child must be at risk of out of home placement;Child returning from placement;Child involved in criminal behavior;Persistent family conflict; Child and or Caregiver is abusing substances; Behavior is chronic; Child is engaged with deviant peers; Child is struggling at school; Family has few resources; Parents would benefit from psycho-education and skill development; NRBH-CORE SERVICES CONTRACT 2014-2015 Child is displaying moderate—severe behavior problems. Maximum Program Capacity: 20-30 youth Referral Process/Timelines: Referrals must be made to program supervisor for review. Each referral is considered within one week and clients are accepted based on problem severity and therapist availability. Special Assessments/Practices: Use of MST approved assessments as indicated by licensing agreements and MST consultant directives (provided upon request). Trauma Focused Training: Integrative Treatment of Complex Trauma for Adolescents(ITCT-A)-February 2014 Trauma-Focused Cognitive Behavioral Therapy(TF-CBT)-July 2014 Dialectical Behavioral Training for Adolescents(DBT)-March 2014 3. Fees for Services $1800 per month/per client/family,pro-rated for partial month services. 4. MST Outcomes in Weld County (2005-2013) Impact to the County Prior to Treatment(N=231) • 60%with out of home experience before admission • 34%with juvenile detention before admission • 80%with multiple/chronic disciplinary problems in school; 12%passed most classes • 69%with legal involvement; 56%with more than one type • 31%arrested for crimes against a person • 100%with mental health problems; 87%with more than one • 47%with problems resulting from drug use; 37%with problems related to alcohol use Outcomes after receiving MST Treatment (N=231) • 93%decrease in the most common out of home situations, including residential treatment, inpatient psychiatric care, and detention • Significant improvement in school functioning • Significant reductions in legal issues • Significant reductions in mental health and substance abuse symptoms and problems • Significantly improved ratings of youth and family functioning NRBH MST Program Implementation Data Report(Report Period: 3/1/2013 -2/28/2014) Ultimate Outcomes after receiving MST Treatment(N=45) • 93.3%of youth living at home • 95.6%of youth in school/working • 95.6%of youth with no new arrests NRBH-CORE SERVICES CONTRACT 2014-2015 Instrumental Outcomes after receiving MST Treatment(N=451 • 95.6%of caregivers with parenting skills necessary to handle future problems • 100%of families with improved family relations • 97.8%of families with improved network of supports • 93.3%of youth with success in educational/vocational setting • 91.1%of youth involved with prosocial peers/activities • 93.3%of cases where changes have been sustained Laura L. Hays, M.A., CAC III, LPC Current Clinical Position: North Range Behavioral Health—Adult Outpatient/BASIC Program Director—Greeley, Colorado July, 2008 -Present Island Grove Treatment Center—Outpatient Program Manager- Greeley,Colorado November, 2005 -July,2008 ************* Island Grove Treatment Center—Clinical Coordinator- Greeley, Colorado May,2003 —November,2005 Island Grove Treatment Center—Outpatient Bilingual Counselor- Greeley, Colorado May, 2000—May,2003 Professional Certifications: Colorado State: *Chemical Addiction Counselor, Level I - January, 2001 *Chemical Addiction Counselor,Level II -December, 2001 *Chemical Addiction Counselor, Level HI - May, 2003 *Approved Domestic Violence Provider - April, 2004 *Licensed Professional Counselor -June, 2007 *EMDR Trained Counselor - September, 2007 The Wellness Institute,Washington (1995-98) *Certified Clinical Hypnotherapist *Certified Advanced Clinical Hypnotherapist *Certified Release Therapist Education: Master in Community Counseling/Marriage & Family - University of Northern Colorado, Greeley, Colorado - 2003 Bachelor in Human Services/Counseling- Western Washington University; Bellingham, Washington- 1994 Associate in Arts& Science Degree- Bellevue Community College; Bellevue, Washington- 1992 Associate/Legal Secretary Degree- Lewis-Clark State College; Lewiston, Idaho— 1977 Experience/Internships: Youth &Family Services Counselor-Island Grove Community Counseling Center, Colorado (May, 2002 -May, 2003) Duties: Facilitate counseling sessions with families and individual adolescents. Crisis intervention,charting, case management,treatment plans Private Counseling Practice-offices in Lewiston, Grangeville, &Kooskia, Idaho(1998 99) Duties: Crisis intervention,charting, case management,treatment plans, correspondence,discharge summaries,& day-to-day operations of practice Clinical Counselor Assistant -Jodi Cook's Counseling, Washington(1993-94) Duties: Case management, charting, &assisting in day-to-day operations of practice Educational/Counselor Assistant- Maple Hills Elementary, Washington(1992-93) Duties: Attended staff meetings,crisis intervention, & individual counseling as needed BoliviaSantaCruz Mission(Span2n°lang)—ChurchofJesusChristofLatter-DaySaints (1978-79)Duties:Taught day-to-day skills to improve the native people's lives • STATE OF COLORADO • Department of Regulatory Agencies Division of Professions and Occupations Active PRINTED ON SECURE PAPE ACC ACC.106513 OSptr1013 08/31/2015 Number Issue Date Expire Date Laura L Hays Greeley CO 80631 Division Director Signature STATE OF COLORADO Department of Regulatory Agencies Division of Professions and Occupations PRINTED ON SECURE PAPE Active IPC LPC.00DIea1 I Oa01/L013 OYl1ltJ15 Number J Issue Date I Expire Date Laura L Hays Greeley CO 80631 I , A4444-0161 Division or Signature Abbey Keeney LPC CAC II EDUCATION & LICENSURE Master of Science in Counseling Psychology,Northeastern University, Boston MA 2003 Bachelor of Arts in General Psychology, University of Colorado,Boulder CO 2000 ** Licensed Addiction Counselor—pending MAC Exam only,all classes complete EXPERIENTIAL HIGHLIGHTS • Administrative and leadership skills • Familiar with CAQH database&joining insurance panels • Comfortable with insurance process for authorizations&online billing • Strong communication skills with collaterals from all professional levels • Organized,efficient, determined, knowledgeable,capable • Timely,clear, professional documentation • Supervision of staff administratively&clinically • Extensive individual, family and group clinical experience • Thorough and timely assessments,evaluations, and diagnostic skills • Compassion and education around cultural issues • Crisis centered interventions • Emergency room, inpatient,residential,outpatient experience • Electronic Faxing,email encryption, HIPAA compliance • Employee Engagement& Staff Satisfaction Committee PROFESSIONAL CLINICAL EXPERIENCE Compass Counseling Services, LLC (Loveland,CO) Independent Private Practice &Business owner 02/2010—Present • Profitable independent private practice • Conduct all insurance authorizations&billing • Self management of paperwork, client issues,scheduling • Private office management, decoration,and facility maintenance North Range Behavioral Health(Greeley,CO) Program Coordinator for the Adult Outpatient Program 04/2012—Present • Program enhancement(Same Day Access, Feather Awards, Mail Merge, New Hire Training Manual (in process)) • Supervision of LPC candidates as well as graduate level internship students • Report management for clinicians • Regular chart auditing,familiar with state requirements • Responsible for individual client caseload,treatment planning, and productivity • Created efficient new mail merge system for monthly letters and evaluations Licensed Behavioral Health Specialist for Adult Outpatient Program 11/2006-04/2012 • Licensed therapist responsible for full caseload,range of clients • Timely&accurate documentation in electronic medical record • Exceeded productivity requirement every year • Group,Individual,and Couples Therapy • Multiple electronic system reporting; CMHC, Signal, TMS,CWise • Collateral communication with multiple community agencies 'Intensive Care Coordinator 08/2005 - 11/2006 • Monitored all Weld County Medicaid Hospital Admissions in State of CO • Managed disposition of each patient as well as connection to services • Communicated efficiently with current provider • Facilitated interagency meetings for high risk clients • Close work with State Hospital • Residential Assessments for youth Poudre Valley Health Systems (Fort Collins,CO) Care Coordinator at Mountain Crest Hospital 03/2008- 12/2009 • Coordination of care for inpatient unit • Discharge planning and family meetings • Communication with external agencies and insurance companies • Therapy on inpatient unit,crisis driven, solution focused • Collaboration&communication with staff psychiatrists and inpatient staff Crisis Assessment Center Behavioral Health Specialist 03/2006- 12/2009 • Emergency room evaluations • Insurance authorizations if admission needed • Disposition planning with hospitals,family, community resources • Mental Health and Substance Abuse Holds • Collateral communication with emergency department staff Health and Education Services (Beverly, MA) Emergency Services Pre-Screener 02/2004-07/2005 • On call team member for 4 Hospital Emergency Rooms • Emergency room evaluations • Disposition planning&communication with collaterals Riverview Program Diagnostic Therapist 09/2003 -08/2005 • Residential program for Adolescent Females • Individual, group&family therapist • Diagnostic Evaluations for clients Consulting Therapist Homeward Bound Program 09/2003 -03/2004 • Residential program for Adolescent Males • term support during staffing problems Short s pp • Individual and family therapy McLean Hospital(Brighton, MA) Internship at Franciscan Children's Hospital Kennedy Hope Academy 02/2002 -06/2003 • Behavioral support for clients on unit • Unit reserved only for Autism Spectrum Clients • Group Therapy and social skills development Print Lookup Details Page 1 of 1 lop ant\ Y St Barbara J.Kelley � � •.;:rid DraExecutive Director <.. Department of Regvimay Mendes '- -- '� ` 0,4 Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License Information provided by the Colorado Division of Profess!ons end Occupations,established by 24-34.102 C.R.S. Name Public Address Abbey George Keeney 1260 H Street Greeley, CO 80631 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date LPC.0004161 Endorsement Licensed Professional Active 11/09/2005 09/01/2013 08/31/2015 Counselor Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/13/2014 9:56:52 AM Print Lookup Details Page 1 of 1(!pDora ==. ; .y, -e. . rs}i'' O. men bfeegulaloryA¢ncIes Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Profess!ons and Occupations,established by 24.34.102 C.R.S. Name Public Address Abbey George Keeney 1260 H Street Greeley, CO 80631 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACB.0007294 Original Certified Addiction Active 11/08/2010 09/01/2013 08/31/2015 Counselor II Board/Progam Actions Discipline There Is no Discipline or Board Actions on file for this credential. Generated on: 3/13/2014 9:56:40 AM Fazio, 1 of 3 Annie Fazio, M.A. 2647 12th Avenue Ct Greeley, CO 80631 anniefazio@gmail.com 515-208-4489 EDUCATION M.A. University of Northern Colorado Graduated: August, 2012 Concentration: Clinical Counseling Degree (MA.) B.A. Metropolitan State College of Denver Graduated: May, 2009 Major: Honors in Psychology (B.A.) PROFESSIONAL WORK EXPERIENCE August 2013-Present Therapist,Adult Outpatient Program North Range Behavioral Health 1260 H Street Greeley, CO 80631 • Responsibilities: Provided integrated mental health and substance abuse services to a wide range of voluntary and criminally involved clients using a number of different evidence based therapeutic interventions and skills. July 2012-August 2013 Therapist,Behavioral Alternative Services in Community (BASIC) Nord}Range Behavioral Health 1260 H Street Greeley, CO 80631 • Responsibilities: Provided integrated mental health and substance abuse services to a wide range of mandated and criminally involved clients using a number of different evidence based therapeutic interventions and skills. Sept�mber 2011- August 2012 Inte , Adult Outpatient Therapist North Range Behavioral Health, Adult Outpatient Program 1260 H Street Greeley, CO 80631 • Responsibilities: Worked with a diverse group of adult clients administering intakes, individual therapy sessions,co-facilitating and facilitating group therapy sessions. Fazio,2 of 3 July 2008- September 2010 Research Assistant Metropolitan State College of Denver Worked under Dr. Aaron Richmond, Ph.D. Plaza 220 Speer Blvd. and Colfax Ave. Denver,CO 80217 • Responsibilities: Engaged in a full spectrum of research, from inception to presentation of results. Took part in the research process through writing, submitting, and presenting research. Also worked a s a leader in presenting the research at a regional and national psychology conference. May,2007- August 2009 Psychology Department, Work Study Metropolitan State College of Denver Plaza 220 Speer Blvd. and Colfax Ave. Denver, CO 80217 • Responsibilities: Assisted faculty in educational,research,and administrative tasks. Provided information and guidance to MSCD students and employees. Also maintained and assisted in organizational tasks within an academic setting. CLINICAL TRAININGS Eye Movement Desensitization and Reprocessing(EMDR, Part 1),November 2013 Dialectical Behavioral Therapy(DBT), May 24th 2013 Trauma Focused Cognitive Behavioral Therapy (TF-CBT),June 2013 Strategies for Self-Improvement& Change (SSC), February 8th 2013 Certified Addiction Counselor (CAC) Credits Professional Ethics II Group Counseling Skills RESEARCH EXPERIENCE Fazio,A. K. (2009). Correlations between religiosity and resiliency within a college population. Independent research project,presented in Research Methods course. Richmond, A. S., Carney, R., Fazio, A. K., Carter, V.,Hasen,N., & Conrad, L. (2009). Motivational & metacognitive predictors of mnemonic learning. Poster presentation at Rocky Mountain Psychological Association conference and MSCD Annual Undergraduate Conference(2009). Richmond, A. S.,Carney, R., & Fazio,A. K. (2009). Can mnemonic training alter • Fazio,3 of 3 metacognative and self-efficacy for memory beliefs? Poster presentation at Rocky Mountian Psychological Association conference and MSCD Annual Undergraduate Conference (2009 & 2010). Oakman, S., Fazio,A. K.,Donisi, K., & Richmond, A. (2009). Cheating behaviors: Peer conformity, influences, and reasoning. Poster presentation at Rocky Mountain Psychological Association conference and MSCD Annual Undergraduate Conference. Richmond, A., Fazio, A.K.,Oakman, S. (2009). Can mnemonic training change need for cognition, memory for self-efficacy, and state metacognition beliefs? Richmond, A.,Carney, R., Fazio,A. K.,&Oakman, S. (2009). The mnemonic keyword method applied to neuroscience: A focus on retention and higher-order thinking. Research Presentation at American Educational Research Association(AERA, 2010). PROFESSIONAL ORGANIZATIONS & GROUP MEMBERSHIP American Counseling Association 2010-Present Golden Key National Honor Society, 2008 to Present Psi Chi National Honor Society, 2008 to Present Research Club, 2008 to Present Rocky Mountain Psychology Association member, 2008 to Present DANIELLE SOLANO Greeley, CO 80634 720-301-9449 Dsolano901@aol.com EDUCATION Walden University Masters in Mental Health Counseling 2012- Present Westwood College 2009 Bachelor of Science,Criminal Justice Skills Communication and collaboration with agencies Resource Specialist Crisis Intervention Specialist Computer Proficient Experience North Range Behavioral Health,Greeley,CO Case Manager 2012-Present Case Management for individual's who are engaged in mental health or substance abuse treatment. Responsibilities include resources and referrals that assist and support individuals in achieving self sufficiency and stability. Youth and Family Connections/Weld County JAC,Greeley,CO 2011-2012 Case Manager Case management for at-risk youth and their families. Responsibilities included assessments with youth and parents to identify the factors influencing family functioning and academic progression. Complete referrals to community services and agencies to access additional support and services. Catholic Charities,Guadalupe Center,Greeley,CO 2011-2012 Shelter Staff Responsibilities included assisting clients and conducting the day to day operation of a 24 hour emergency shelter. As a shelter staff member I would open the facility,conduct sign-in and complete records and reports as needed. When appropriate, I would supervise the preparation and clean up of meals, chores, and facility maintenance. Gateway Battered Women's Shelter,Aurora, CO 2009.2010 Court Victim Advocate Responsibilities included advocating for victims of domestic violence in a court setting which included providing community resources for men,women and children. I also prepared children who are subpoenaed to court to testify in domestic violence trials. Initial contact with clients included interviewing and documenting physical injuries,explanation of the court process, victim rights, crisis and non-crisis counseling. 1 DANIELLE SOLANO Greeley, CO 80634 720-301-9449 Dsolano901@aol.com RELATED EXPERIENCE Colorado Organization for Victims Assistance 2007-2008 Victim Advocate Internship with the Denver City Attorney's Office Denver City Attorney's Office 2007-2008 Contract Juvenile Victim Advocate Attitude Development Services 2009 Office Manager REFERENCES Aletta Ce De Baca Personal 970-381.2653 Reference Michelle Brown Personal 303-817-7594 Reference Michael Guthrie Professional 970-351-5460 Reference Al Arriessecq Professional 970-351-7414 Reference 2 .10 • 516 5,Avenue Greeley 70)CO 80834 Phone(i1 405-3830 E-mail IIzasilva©man.com Elizabeth L. Silva Education 1995—1997 University of Northern Colorado Greeley, Co. Bachelor Of Arts in Sociology,Emphasis Criminal Justice Minor Legal Studies 1993—1995 Aims Community College Greeley,Co. Associate Of Arts Liberal Arts,Criminal Justice professional 03/01-Present Adams County/17th Judicial District Probation Department, experienceBrighton,CO/ FTA Position. Adult Probation Officer: Domestic Violence Offender Case Load • Supervise (Max-Med)domestic violence probationers. • Provide referrals to community resources on a case by case basis. • Maintain probation notes as established by department policy. • Compose reports and memorandum as established by department policy. • Formulate case plans for probation through a continuum of sanctions. • Conduct assessments and recommendations for sentencing to the court. • Present information verbally and in writing before the court. • Conduct home/absconder visits, work visits, &treatment agency staffings. • Provide assistance to Spanish speaking victims as needed. • Have supervised the following case loads: Sex Offenders, Drug/Alcohol Offenders, Property/Theft Offenders. 04199-Present North Range,Greeley,CO, Part-Time Bilingual Outpatient Counselor • Screening, Intakes and Assessment of clients with required instruments in required format within appropriate time lines. • Facilitate Counseling Groups as assigned-Primarily Domestic Violence • Perform Individual Counseling as assigned • Develop written treatment plans/updates and continuing care plans and make appropriate referrals • Monitor Antabuse, Breathalyzers, and other medication as required • Case management as indicated • Complete written discharge summaries and correspondence within established time lines • Supervise a Case Load of up to 24 clients 08199-2101 Boulder County/20th Judicial District Probation Department,Boulder Co./Contract Position. Adult Probation Officer/Bilingual Case Load • Supervised (Max) probationers, Drug, Theft, Domestic Violence, & Phase Ill I.S.P • Provide referrals to community resources on a case by case basis. • Maintain probation notes as established by department policy. • Compose reports and memorandum as established by department policy. Ay • Formulate case plans for administrative compliance strategies and recommend extensions or terminations of probation through a continuum of sanctions. • Conduct investigations and provide recommendations for sentencing to the court based on findings. Present information verbally and in writing before the court. • Provide victim assistance to Spanish speaking and some English. Supervised a Case Load of 140 clients, 85%Spanish speaking. 06/98-03/99 Denver County Probation Denver, Co. Adult Probation Officer/Bilingual Case Load • Interviewing: Utilize knowledge of communication skills and effective interviewing techniques to elicit relevant information on individuals referred by the Court. • Research, Investigation and Recommendations: Through use of computer record systems and records provided by NCIC, CCIC and local agencies to obtain data that is pertinent to the evaluation of the individual referred. • Report Writing and Meeting Deadlines: Compile and organize data collected during the pre-sentence interview and investigation and present that information in a concise, complete and well-organized fashion as directed by department policy. • Referral to Treatment: Clients will be referred to appropriate treatment agencies considering the following elements: Court orders; treatment agencies with appropriate licensure/certification for the type of treatment needed; client treatment needs; geographical and financial accessibility for the client; greatest opportunity for client success; other unique elements related to the client or offense. • Supervised a Case Load: 350 clients/Alcohol/Drug/D.V., Spanish speaking only Bilingual Volunteer Probation Officer 19'"Judicial District 8/95-4/98 Volunteer • Interviewing: Utilize knowledge of communication skills and effective interviewing experience techniques to elicit relevant information from individuals referred by the Court. • Referral to Treatment Clients referred to appropriate treatment agencies, related to the client or offense. • Report Writing and Meeting Deadlines: Court revocation and non-compliant complaints in a complete and well organized and reviewed by Volunteer Coordinator. • Hours per week: minimum of 11 and no less. • Supervised a Case Load of 56 clients/90% Spanish Speaking Bilingual Volunteer Programs Counselor Weld County Sheriff's Department, Greeley,Co. 10/97-2/98 • Interviewing: Utilize knowledge of communication skills and effective interviewing techniques to elicit relevant information from individuals arrested and detained with in 24 hours of their arrival in to the sheriffs department. • Assessment: Determine the severity of the arrest and classify defendants by their criminal history repot from NCIC/CCIC. • Other duties: Co-Facilitate activities, such as gym, or learning activities involving the defendants in custody. Certifications • CAC III and an Approved Domestic Valence Treatment Provider Languages Fluent in Spanish: read, write and speak References Upon Request Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com Objective: To provide every client with empathic counseling services and advocate on their behalf. This will be accomplished by considering each client's unique circumstances and goals, and working with other professionals for the benefit of the client. Education: 2010- 2013 University of Northern Colorado (Greeley, CO) Master of Arts program for Clinical Counseling Master of Arts program for School Counseling 2005-2009 University of Northern Colorado(Greeley, CO) Bachelor of Arts Degree with a GPA 3.97 Graduated Suma Cum Laude. Majored in Psychology, Minored in Sociology 2001-2005 Grandview High School (Aurora, CO) Graduated with honors Master's Level Practicum and Internship Experience: January 2013-May 2013 Internship Student at Mead Elementary School (Mead, CO) • Help individual students by meeting on a weekly basis • Lead weekly groups on issues such as divorce and social skills • Responsive services August 2012-December 2012 Internship Student at John Evans Middle School (Greeley, CO) • Help individual students by meeting on a weekly basis • Lead weekly grief and loss group • General school support and responsive services May 2012 -December 2012 Internship Student at Alternatives To Violence (Loveland, CO) • Work with clients through conducting intake appointments and individual therapy • Lead weekly DV 101 group • Help clients by consulting with other personnel about resources in the community • continued to volunteer by running group and conducting individual counseling sessions through May 2013 Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com November 2011-May 2012 Practicum II Student at Action Counseling (Denver, CO) • Work with court mandated clients in individual and group contexts • Conduct intake appointments for DUI and domestic violence clients • General office work • Helped with intake and release of patients Bachelors Level Field Experience: Jan 2009-May 2009 (Greeley, CO) Intern at Children's Advocacy, Resource, and Education Center • Monitored children for signs of physical and mental abuse • Maintained facilities to insure the safety of the children • Lead parents and children in bonding activities May 2008-August 2008 (Greeley, CO) Intern at North Range Behavioral Health: Acute Treatment Unit • Helped direct patient's activities in groups • Monitored the status of patient's mental health • Conducted one-on-ones with individual patients Work Experience: Dec 2013- Present Mental Health Therapist at North Range Behavioral Health (Greelev, cal • Conduct Intake appointments for substance abuse and mental health clients • Conduct substance abuse and mental health group counseling • Conduct individual counseling appointments May 2009-May 2010 Assistant to Robin Garvisch, Apartment Blue Book (Denver, CO) • Data entry • Brochure packaging • Developing brief descriptions of apartment communities for use online and in print Sydney Koenig 7411 East Jamison Circle Centennial Co. 80112 303.917.6261 sydney.koenig@yahoo.com Sept 2009-Oct 2010 Sales Associate at Walgreens (Denver, CO) • Assuring customers have the experience they expect • Aided in re-stocking and inventory management • Constructed new displays and kept the department organized • Daily money and cash register reconciling Professional Memberships: Spring 2011 - Present Chi Sigma Iota Member Licenses and Credentials: Registered Psychotherapist in the state of Colorado Substitute authorization #69804 from Colorado Department of Education Special services provider license#82434, to serve as a school counselor, from Colorado Department of Education Nationally Certified Counselor References: Available Upon Request Cynthia K. Gibbens 505 33rd Street Evans, CO 80620 WORK EXPERIENCE: North Range Behavioral Health, Greeley, CO(970)347-2120 November 4, 2013 Supervisor: Laura Hays I provide assessment,treatment planning,education, individual/group therapy, case management with family members, employers, and community agencies, and discharge planning. I served clientele with mental health and substance abuse and clients with co- occurring disorders. Michaels Arts and Craft Stores, Greeley, CO (970) 353-9780 April 22,2013 Supervisor: Pearl Smith, Cuprea Lange; Store Manager: Dino Rivera I work as a picture framer in the store frame shop and assist with customer service throughout the store. Advantage Sales and Marketing/In Marketing April 15, 2013 —October 20, 2013 Supervisor: Laci Cummings(970)212-6685 I prepared, presented, and distributed a variety of food products to store shoppers. Bass Pro Shops, Denver, CO (720) 385-3600 October, 17. 2012—Christmas 2012 Supervisor:Nicole I was working in the Santa's Wonderland at Bass Pro Shops as a seasonal employee. Peak Wellness Center, Cheyenne, Wyoming(307) 632-9362 February 2007-April 2012 Supervisors:Natalie Milligan, Elaine Renfro, Linda Goodman I began working at PWC after taking time off following completion of my master's degree. I provide assessment with the ASI,treatment planning,education, individual/group therapy with the Matrix System, case management with family members,employers, and community agencies, and discharge planning. I served clientele with substance abuse and clients with co occurring disorders. I completed course training in Seeking Safety by Lisa Najavits and have developed a group therapy for treatment for PTSD and substance abuse following the plan described in this manual. I have also completed trainings including Traumatic/Acquired Brain Injury, Wounded Warrior, Prolonged Exposure Therapy, and EMDR basic training. Turning Point, Ft. Collins, Colorado (970) 232-3660 November 2005—February 2007 Supervisors: Colleen Timpe, Eddie Russell I completed a master's internship at Turning Point—Birch. I provided individual/group/family therapy, case management with referring agencies and family 1 members,treatment planning, education,and discharge planning. The clientele served was adolescents with substance abuse and co occurring disorders. I also provided clinical supervision for counselors accumulating credits and hours for Certified Addiction Counselor (CAC). Harmony Foundation, Inc., Estes Park, Colorado(970) 586-4491 June 2000 -July 2006 Supervisors: Roger Kirby, Debra Foster, Gary Wise, Sandi Kohtz I was a primary counselor at the Harmony Foundation,residential treatment. I managed a case load and provided assessments with the Addiction Severity Instrument (ASI),treatment planning, case management with family members, referring agencies and continuing care facilities,education lectures, individual therapy, group therapy, and discharge planning. Island Grove Regional Treatment Center, Greeley, Colorado (970) 356-6664 March 1995 —May 2000 Supervisors: BJ Dean, Bill Wendt,Frank Cohoon, Rhonda Fraser I began IGRTC as a Detox Aide and my duties were to admit,monitor withdrawal symptoms and discharge clients with appropriate referrals for treatment and recovery. I also facilitated individual and group therapy/education as well as family groups. I obtained CAC in June 1996. I began co facilitating the Intensive Outpatient Program in 1997 and administering Addiction Severity Index (ASI) to make appropriate treatment referrals for IGTC,Dept. of Social Services, and Probation Dept. I provided individual/group/family therapy and for a time was the solo IOP counselor. My duties also included treatment planning, discharge planning, and case management with referral sources, and other community agencies. Beginning in 1998 I received CAC II and had a small caseload of clients in the Transitional Residential Treatment program. I completed assessments,treatment planning, case management, education, discharge planning,and individual/group/family therapy ar Cynthia K. Gibbens 505 33rd Street Evans, Colorado 80620 EDUCATION: Paris Junior College, Paris, Texas 1991 — 1993 Aims Community College, Greeley,Colorado 1994— 1995 University of Northern Colorado, Greeley, Colorado 1993 — 1998 (BA in Psychology) University of Phoenix, Westminster, Colorado 2004-2006 (Master of Community Counseling) CERTIFICATION: Licensed Addictions Counselor 2007 Colorado Certified Addictions Counselor III 2000 National Certified Addictions Counselor II 2002 - 2006 Master Addictions Counselor(NAADAC) 2007 LICENSURE: Licensed Professional Counselor(Wyoming) 2010-2012 Licensed Professional Counselor (Colorado) 10/2012 ..� STATE OF COLORADO — STATE OF COLORADO • Department of Regulatory Agencies Division of Professions and Occupations Department of Regulatory Agencies Active PRINTED ON SECURE PAPER Division of Professions and Occupations Active PRINTED ON SECURE PAPER ACD LPC ACO.0000145 09101/2013 05/31/2015 Number Issue Date Expire Date LPC.0011228 09/01/2013 0W31/2015 Number Issue Date I Expire Date Cynthia Kaye Gibbens Cynthia Kaye Gibbons Evans CO 80620 Evans CO 80620 Iji--Ate iIi-rj Drvlslon DirectorSture Director 19 Division Director Sign ure CURRICULUM VITAE Duane F.Barone,MA Caledonia Counseling PO Box 1989,Parker,Co 80134 Tel: 303-478-7311 Fax: 303-841-3068 caledoniacounseling u,hotmail.com www.caledonia-counseling.com EDUCATION Post graduate(MA)studies Capella University • Addictions June 2003—Dec 2005 • Group work professional development • Family systems • Marital therapy • Career counseling Master of Arts Univ. of Colorado at Denver Clinical Psychology May 2003 Post Graduate(BSc)Diploma Open University,England • Child development Jan 2000 • Social systems Bachelor of Science Texas A&M University Psychology May 1989 PROFESSIONAL Approved Domestic Violence Treatment Provider DEVELOPMENT March 2004-present DVOMB Research Committee Jan 2011 —Dec 2012 Participating DV Therapist in the DVRNA validation study DVOMB Sub-committee member February 2011 -2012 To assess the safety,needs,and appropriateness of couples counseling for DV offenders and their partners. DVOMB Research Committee member 2004-2006 Data collection form development,data analysis,and report review Metro Denver Domestic Violence Alliance Aug 2003—present Current Chairman&Active member; previously Vice Chairman,Treasurer, Secretary 18th Judicial District Domestic Violence Task Force Attending member Aug 2007—present 4. PROFESSIONAL American Counseling Association ASSOCIATIONS Professional member June 2003—present American Psychological Association Graduate Student member Aug 2001-June 2003 British Association for Counseling&British Psychological Society Mar 1995—July 2001 CURRENT THERAPEUTIC ENVIRONMENT • Facilitating group and individual therapy for court-ordered adults(domestic violence offenders) and court-ordered adolescents. Treatment planning, service coordination and monthly reporting to probation officers. • Integrated therapy approach to treatment provision, combining CBT and psychodynamic modalities; family of origin and interpersonal factors are primary foci. • Intake interviews providing treatment recommendations and diagnosis using DSM- IV-TR criteria. Administration and interpretation of assessment instruments for adults and children,e.g., MCMI-3, MMPI-2,WAIS-Ill,and WISC-HI. • Pre-sentence Domestic Violence Evaluations June 03—present Psychotherapist/Independent contractor Domestic Violence counselor,male and female offender groups and individual therapy. Adolescent therapy:individual,family,and group;voluntary and court referred clients. Treatment planning,service coordination,monthly reporting to probation officers. April 06-Aug 06 Rite of Passage Watkins,Co Therapeutic Manager Responsible for coordinating therapy and case management needs for 10 adjudicated(DYC)adolescent females at the Betty Marler Youth Service Center on the Mont View campus. Facilitated domestic violence psychoeducation group Aug 02—May 03 Action! Counseling Denver,Co. Student Intern Provided individual psychotherapy to private clients and anger management counseling to court-ordered clients. Co-facilitate group therapy with domestic violence offenders. Conducted intake interviews and processed paperwork. Review clinical data for monthly probation reporting. EXPERIENCE PRIOR TO MASTERS DEGREE Twelve years experience providing direct care support, case management, staff and program oversight for adults with chronic mental illness and adults with developmental disabilities in residential support services, day programs, and vocational training services. Duties included group and individual counseling, case management, liaison with external and internal agents within a multidisciplinary team format, program evaluation, managing day-to-day operations, budget management, facilitating team meetings,etc. Oct 99—July 01 Scottish Association for Mental Health Drumchapel,Scotland Depute Project Manager Aug 96—Sept 00 Dykebar Psychiatric Hospital Paisley,Scotland Psychology Assistant(volunteer) Oct 97-June 99 Fair Deal for 1 in 100 Glasgow,Scotland Project Manager May 96-Nov 97 Key Housing Association Gourock,Scotland Depute Project Manager Dumbarton Adult Training Center Dumbarton,Scotland Sept 95-May 96 Senior Day Center Officer(temporary post) Adams Community Mental Health Center Commerce City,Colorado Mar 92-Feb 95 Team Leader/Mental Health Clinician Laradon Hall Denver,Colorado Dec 89-Feb 92 Quality Assurance Manager & Vocational Program Coordinator KATHERINE GODWIN, MA, LPCC 820 22^"Street, Greeley, CO 80631 970.381.8043 kgodwin6583@gmail.com EDUCATION Master of Arts,Clinical Counseling University of Northern Colorado, 2013 Bachelor of Science, Art and Philosophy University of Wisconsin, 2005 COUNSELING EXPERIENCE Mental Health Therapist October 2013-Present North Range Behavioral Health, Adult Outpatient, Greeley,CO • Counseling 20-25 individual and couples weekly • Working from an integrative theoretical perspective of interpersonal, person-centered and attachment based therapy. ❖ Working primarily with co-occurring mental health and substance use dients • Facilitating groups: Men's and Women's Relapse Prevention, Men's Depression, and DUI Group ❖ Coordinate intakes, develop and implement treatment plans with clients Mental Health Therapist(Internship) May 2013-October 2013 North Range Behavioral Health, Greeley, CO N Counseled 7-12 client's on a weekly basis + Co-facilitate substance abuse and trauma groups + Develop and implement treatment plans/Coordinate intakes Counselor in Training(Practicum I Sr II) September 2012-May 2013 North Range Behavioral Health&University of Northern Colorado, Greeley, CO + Counseled 3-7 individual client's on a weekly basis + Co-facilitated substance abuse groups • Developed and implemented treatment plans/Coordinated intakes Licenses and Memberships Licensed Professional Counselor Candidate Working towards CAC II License, estimated date January 2015 Member of ACA since 2011 Member of CSI Counseling Honors Society since 2011 REFERENCES Fred Hanna, PhD Professor, UNC, Counselor Education 970.351.2788 Jennifer Murdock, PhD Professor,UNC,Counselor Education 970.351.2544 David Gonzalez. PhD Professor, UNC, Counseling Psychology 970.351.2731 Nathan Kyle Swisher CURRICULUM VITAE 218 47'"Avenue Court Phone:(970)381-6093 Greeley,CO 80634 E-mail:nkswisher@yahoo.com LICENSURE Licensed Psychologist, Colorado - PSY.0003840 Issue Date: 01/02/2013 Expire Date: 08/31/2015 EDUCATION 05/2008-08/2011 Doctorate of Psychology in Clinical Psychology Rosemead School of Psychology,Biola University, La Mirada,CA Psy.D. conferred August 31, 2011 08/2006- 05/2008 Master's of Arts in Clinical Psychology Rosemead School of Psychology, Biola University 08/2002- 05/2006 Bachelor of Arts in Biblical Studies, Concentration in Psychology Trinity Western University, Langley, British Columbia, CAN CLINICAL EXPERIENCE North Range Behavioral Health Sept 2011-Present Adult Outpatient Therapist(Full Time Employment) Setting: Community mental health network, Greeley, CO - adult outpatient program. Duties: • Implement clinical assessment,psychological testing (cognitive,personality), and culturally-sensitive individual/group/family/couples psychotherapy for an ongoing caseload of 45-55 individuals(in addition to therapy groups). Caseload consists of both mental health and substance abuse referrals, voluntary and court-mandated. • Engage in regular faculty meetings and trainings,case consultation, individual and group supervision [qualifying for psychologist licensure and CAC (Certified Addiction Counselor)requirements],and external clinical seminars(including training for CAC II, Gottman Couples Therapy, and others). • Participated in weekly child therapy seminar/training (spring,2009), weekly clinic in-service meetings (including case conceptualization and presentation),HIPAA training, and other clinically-related training; • Participated in two Gestalt Therapy seminars (as presented by David Gorton, Ph.D., Director of the Gestalt Therapy and Training Center, Woodland Hills, CA), and participated in Sand Tray and Psychotherapy workshop (as presented by Meredith Phanco, Ph.D., Biola Counseling Center, La Mirada, CA). Measurement and Assessment Practica: Various Settings Fall 2007—Spring 2008 Setting: La Habra City School District; Arbolita Elementary School (grades K-2), El Cerrito Elementary School (grades K-2) and Walnut Elementary School (grades 3-5), La Habra, CA. Population represented age range from 5-10 years-old, various ethnic backgrounds (predominantly Latino) and levels of socio-economic status. Duties: • 300-hour school assessment practicum: assessed special education and general education students for learning and behavioral problems, consisting of neuropsychological and psycho-diagnostic tests, student interviews, in-class observation, case conceptualization,report writing, and Individualized Education Programs(IEP); participated in weekly individual supervision and presented in weekly consultation group with practicum supervisor and other practicum students. Setting: Rosemead School of Psychology, La Mirada, CA; comprehensive testing batteries administered to recruited child clients from the community and Biola University undergraduate students. Duties: • Completion of 3-semester sequence of measurement and assessment courses involving the administration and report writing of 6 comprehensive testing batteries; courses consisted of Measurement and Assessment I (trained to administer, score, and interpret the WAIS-III, WISC-IV, Woodcock-Johnson III, ADSA, Conner's (CPRS-R:L), and PPVT-III), Measurement and Assessment II (trained to administer and score the MMPI-II, MCMI-III, Folstein Mini Mental Status Exam,Thematic Apperception Test, House Tree Person Projective Drawings, Kinetic Family Drawing, and the Forer Structured Sentence Completion Test), and Measurement and Assessment III (trained to administer, score, and interpret the Rorschach). AspenPointe Health Services Sept 2010-Sept 2011 2,000-hour APPIC Pre-Doctoral Internship Setting: Community mental health network,Colorado Springs, CO. Major internship rotation located at Adult and Rural Services (adult outpatient); minor internship rotations included: Lighthouse (adult acute inpatient), Peak Vista Community Health Center (primary care),AspenPointe—Fountain, CO(rural outpatient). Duties: • Implemented clinical assessment,psychological testing(cognitive,personality),and culturally-sensitive individual/group/family/couples psychotherapy(EBP) for an ongoing caseload of 25-35 severely and persistently mentally ill adult consumers. • Provided crisis assessment, individual/group/family/couples psychotherapy for an adult population in an acute crisis setting(inpatient). • Coordinated clinical assessment and brief individual psychotherapy in a primary care setting, participating in brief behavioral health consultations for patients. • Implemented supervision with master's level psychology intern, including weekly clinical observation. • Engaged in regular faculty meetings, case consultation, internship training seminars (including presentation of doctoral paper), individual supervision, and external clinical seminars. Harbor UCLA Medical Center—South Bay TIES for Families Sept 2009-Aug 2010 830-hour Advanced Practicum Setting: Los Angeles County Department of Mental Health outpatient clinic;a multidisciplinary treatment approach promoting the successful adoption of foster children and adolescents. Duties: • Provided direct clinical assessment,psychological testing(cognitive, academic achievement, personality, socioemotional,neuropsychological),consultation, and individual/family/group psychotherapy for children,adolescents, and families. • Coordinated care with the court system and Department of Child and Family Services as needed. • Engaged in internal and external training for infant mental health(e.g.,the Bayley Scales of Infant Development),Narrative Therapy, Reflective Parenting, Mindful Parenting, Incredible Years, and other clinically-relevant seminars and didactic training made available at the Harbor-UCLA Medical Center. Rosemead School of Psychology.Biola University Fall 2009—Spring 2010 Setting: Biola University campus, La Mirada, CA. Duties: • 32-hour Clinical Supervision Practicum(provided weekly, individual supervision for graduate student providing services to adults in an outpatient setting; engaged in weekly supervision and tape review of supervisory sessions; presented audio tapes and progress notes for peer consultation and critique) • 32-hour Child and Adolescent Practicum (engaged in live peer supervision with teaching assistant using bug-in-the-ear technology; provided individual psychotherapy and parental feedback/consultation to an adolescent client recruited from the community). • 32-hour Group Therapy Practicum(provided process-oriented group therapy for a group of 10 college students for 10 weeks; consulted and worked successfully with co-therapist; maintained individual client files consistent with group conceptualization; engaged in weekly supervision). Biola Counseling Center August 2007—June 2009 1,090-hour University Counseling Center Practicum Setting: Outpatient university and community counseling center, La Mirada, CA. Clientele worked with consisted of an age range of 18-55,from various ethnic backgrounds, and presenting with various forms of mood-,anxiety-, relational-, adjustment/phase of life-,and disorder of thought-related problems. Duties: • Provided short- and long-term psychotherapy for adult individuals and couples,using Cognitive-Behavioral Therapy,Rogerian techniques, Emotion-Focused Therapy for Couples and Individuals,and Psychodynamic Psychotherapy. • Completed biweekly floor duty and structured intake interviews including MMPI-2 interpretation(written reports); provided MMPI-2 feedback sessions to graduate students. OTHER WORK EXPERIENCE CLINICALLY-RELEVANT EMPLOYMENT : • Intensive Support Services (ISS) Jun 2007-Sep 2007 Setting: Institute for Applied Behavior Analysis, Santa Ana, CA Hours: 30 per week Duties: Received training in Competency Based Training and provided support to children and adolescents with developmental disabilities. • Homecare Provider Jul 2005-Jul 2006 Setting: Visiting Angels Living Assistance Services, Bellingham, WA Hours: 20 per week Duties: Provided living assistance services, including various behavioral interventions, for adolescents with autism in home and community settings. TEACHING ASSISTANT EXPERIENCE : • Teacher Assistant: Psychology of Marriage Fall 2009 Keith Edwards, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 3 per week Duties: Facilitate the discussion in and processing of areas such as family of origin issues, and lead skill building exercises in areas such as conflict resolution and empathic listening with undergraduate students. • Teacher Assistant: variety of courses covering the Fall 2007-Spring 2008 integration of theological topics and psychological theory Steve Porter, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 7 per week Duties: Provided assistance to Dr. Porter for grading of graduate-level coursework. • Teacher Assistant: Psychology of Christian Thought Spring 2008 Elizabeth Hall, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hill for grading of undergraduate-level psychology coursework. • Teacher Assistant: Psychology of Christian Thought Fall 2007 Pete Hill, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hall for grading of undergraduate-level psychology coursework. PRESENTATIONS • Presentation of Gottman Couples Therapy In-clinic presentation to adult outpatient staff, North Range Behavioral Health, Greeley, CO April 24,2013 • Presentation of Bipolar Disorder: Diagnosis and Treatment In-clinic presentation to adult outpatient staff, North Range Behavioral Health, Greeley, CO June 6, 27, 2012 • Presentation of Schema Therapy In-clinic presentation to adult outpatient staff, North Range Behavioral Health, Greeley, CO January 18, 2012 • "Reflective Functioning in Couples Therapy" 1-Hour In-clinic presentation to all clinical staff,AspenPointe Health Services, Colorado Springs, CO August 18, 2011 • Presentation of Doctoral Paper: "The Enhancement of Reflective Functioning in Couples Therapy: Integrative Literature Review and Theoretical Development" 2-Hour Intern Seminar, AspenPointe Health Services, Colorado Springs, CO June 23,2011 • "Forming Attachment Bonds in Marriage: Can You Hear Me Now?" "The Risks and Treasures of Love"relationship conference; hosted by Living Hope Church, Colorado Springs, CO April 2, 2011 PROFESSIONAL MEMBERSHIPS • American Psychological Association Current Membership# 95673434 STATE OF COLORADO Department of Regulatory Agencies Division of Professiohe and Occupations Active PRINTEO ON SECURE PAPE PSY ! PSY.00A3840 044111/2013Br3 i/2013 O1 D 5 1 N Jm¢er issue Date Expire Date Nathan Kyle Swisher Greeley CO 80634 • Division Oirector Signature 1260 H Street,Greeley,CO 80631.970-313-1169 Nikki Tolle Objective To work with people effectively and efficiently using well-established therapeutic skills in domestic violence,anger management, substance abuse,and individual therapy. Professional Accomplishments Licensed Professional Counselor • Licensed August 2007 • License number-4735 Certified Addictions Counselor • Licensed June 2008 • License number—ACC 6658 Domestic Violence Approval, Colorado • Approved to work with male offenders,female offenders,LGBT offenders DBT approved • Formally trained by Marsha Linehan Associates November 2010 Employment History January 2013—present Adult Outpatient Therapist North Range Behavioral Health June 2011 —January 2013 Private Practice San Juan House/SLV Therapeutic Services March 2005—June 2011 Clinical Supervisor San Luis Valley Mental Health Center,Alamosa,CO April 2003 —March 2005 Academic Counselor University of Phoenix, Colorado Springs,CO March 2005—January 1996 Quality Control Supervisor American Express, Phoenix, AZ Education August 2013 PhD in Clinical Psychology Walden University, Minneapolis, MN 1260 H Street,Greeley,CO 80631.970-313-1169 Nikki Tolle June 2005 Master of Arts in Community University of Phoenix,Colorado Counseling Springs,CO Bachelor of Science in University of Phoenix, Denver, June 2001 Human Services CO STATE OF COLORADO Department of Regulatory Agencies Division of Professions and Occupations PRINTED ON SECURE PAPER Active • LPC LPC.000a735 ] 01141/2013 Deal/2015 Number 1 trios Data I Expire Date Nicole Michelle Tote Fort Cottins CO 5O`21 Division Director Signature • STATE OF COLORADO Department of Regulatory Agencies Division of Professions and Occupations Alive PRINTED ON SECURE PAPER ACC ' ACC,MOOSSES 00r0t/Q_ con1r2013 Number issue Date Expire Date Nicole Michelle Toile Fort Collins CO 1 1 Division Director Signature I __ Rachael Moe (970)-573-8055 moerachael(ai gmail.com Areas of training • Sexual Abuse/Domestic • Marriage and Family Counseling and Certifications Violence Advocacy • Non-Custodial Parental Visitation Rights • ACA (American • CPI Training Counseling Association)& • QMAP Certification CCA • GLBTQ Safe Zone Training • First Aid/CPR • Emotionally Focused Therapy Externship • CAC H course work • Level I Gottman Training • ASIST-suicide first aid • EMDR Education Master of Clinical and Family/Marriage Counseling August, 2010-Present University of Northern Colorado, Greeley Colorado August, 2005-May 2010 Bachelor's in Psychology and Sociology (Minor: Community Health)Minnesota State University Moorhead, Moorhead Minnesota Experience North Range Behavioral Health,Adult Outpatient August '13-present • Provide substance abuse, individual,EMDR, group and couples counseling. • Models used are client centered, motivational interviewing, EFT, DBT and EMDR. North Range Behavioral Health-Maxwell Center August '11-August '13 • Behavioral Health Worker II,Residential Treatment for Chronic Mentally Ill Adults. Activities Coordinator as of May 2012. NRBH Child& Family,Youth Day Reporting Center and Adult Outpatient August '12-May'13 • Interned working with children age 5-16 and Adults age 19-60 • Provided individual therapy,family and couple services through a systemic lens. • Models used were Emotion Focused Therapy,Gottman,CBT, REBT, motivational interviewing,and play therapy. • Assisted in Substance Abuse Groups for DUI and Relapse Prevention. Volunteer Experience Sexual Assault Victim Advocacy Greeley Colorado May 2012-Present • Provide educational advice post assault for callers in crises. • Mandatory Reporter and advocate for sexual assault victims • Provide emotional support for victims through phone contact,refer for continuity of care, and assist in emotional support during SANE examination. Student Academic Conference,MSUM 2009 and UNC 2010 • Presented on the issues on Sexual Assault;myths about victims and perpetrators • PTSD and Marital Satisfaction,comparing Male and Female Soldiers Rainbow Bridge of Fargo/Moorhead 2006-2010 Provided mediated visitation services to children,adolescents,and adults using individual, family,and group treatment through court orders. Included were adult and teen survivors and perpetrators of sexual abuse and incest. Qualified as expert in documenting visits to be used in court for custodial privileges. Rape and Abuse Crisis Center of Fargo,North Dakota 24 hour crisis hotline 2008-2010 • Educated on the area of victims in rape and abuse through a 1 month course on legal and ethical standards of North Dakota/Minnesota. • Advocate, Support, Educate and provide Referral Information. Angela M. White 3532 E. Prospect Rd. Ft. Collins,CO 80525 Cell: (970)481-0835 (preferred) Work: (970)347-2316 Personal E-mail: TheShadowLandsFarm@gmail.com Work E-mail: angela.white@northrange.org Objective To obtain a counseling position working with adults that will allow me to effectively utilize my intellect,talent, training,and experience. If possible,I desire to obtain my CAC II over a period of three years while working in this position. Education & Credentials • Bachelor of Arts,May 2002, Asbury University, Wilmore, KY Major: English Literature • Masters of Arts, August 2011, Asbury Theological Seminary, Wilmore, KY Concentration: Counseling • Licensed Professional Counselor,Awarded March 2014 *Note: 1 am in the process of completing CAC classes and accruing hours for this certification. Employment & Experience Bilingual Mental Health Therapist(September 2011-present), Full Time North Range Behavioral Health, Integrated Care team, Greeley, CO • Provide assessment,consultation,advocacy, psycho-education,and therapy to new and returning clients in a competent and culturally sensitive manner. • Conduct individual, group,and family therapy sessions to help clients reach their mental and behavioral health goals and increase healthy functioning. • Serve all people of all backgrounds, diagnoses,and co-morbid conditions including addiction. • Develop and update treatment plans to address client's present condition and work collaboratively to set specific,realistic goals for therapy. • Coordinate,consult, and refer(where appropriate)in order to provide clients with the highest quality of care possible. • Maintain close symbiotic relationships with community agencies to reduce waste by not duplicating services. • Uphold the highest standards of ethical behavior in all interactions with clients,co-workers,and supervisors. Primary Therapist--Internship (January 2011—July 2011), Full Time Chrysalis House,Lexington, KY *Left position because my internship ended and our family relocated to Ft. Collins for my husband to pursue further education. • Conducted individual weekly counseling sessions with clients who met criteria for chemical dependence. • Co-facilitated group therapy focusing on skill building and psychological processing for clients. • Developed, maintained,and reviewed treatment plans to address clients' areas of concern including, but not limited to,chemical dependence, mental health issues, physical health,employment difficulties, financial challenges,and social/family problems. • Coordinated and consulted with other staff members to deliver the most appropriate service to clients. • Upheld the highest standards of ethical behavior in all interactions with clients and staff. Barista and Shift Supervisor Starbucks Coffee, Lexington, KY(May 2007—May 2010), Part Time *Left position because I needed to focus on my Masters' work. Starbucks Coffee, Gulf Breeze, FL(March 2005—November 2005), Full Time *Left position because I got a job as a schoolteacher. Starbucks Coffee, Orlando, FL (August 2004—March 2005), Full Time *Left position because I relocated to Gulf Breeze where my fiancé was. Starbucks Coffee,Jacksonville, FL (February 2003—January 2004), Full Time *Left position because I moved to Honduras to teach English for an internship. • Managed employees on shift as acting manager. • Communicated concerns with general and regional manager. • Delivered top-notch customer service to each person,every day. • Respectfully resolved customer complaints in a timely manner to promote repeat business. • Listened to employees concerns and acted as mediator when appropriate. • Followed all directives received by management staff. • Consistently went above and beyond job expectations. High School Reading Teacher(November 2005-May 2007),Full Time Navarre High School,Navarre, FL *Left position because I relocated to Kentucky to begin Masters program. • Selected,evaluated,and taught pertinent curriculum to high school students ages 14-18 who had failed Florida's standardized test(FCAT)and were in danger of failing high school. • Maintained a balance of classroom discipline and individual student growth. • Initiated and facilitated parent-teacher conferences in order to cooperatively formulate a plan to address critical problems present with individual students. • Tailored educational approach to individual students' needs including,but not limited to, academic accommodations for physical and learning disabilities. • Effectively communicated concerns with other teachers, parents, and administration. Youth Volunteer(March 2005-November 2008) St. Paul United Methodist Church, Gulf Breeze, FL (March 2005-May 2007), Part Time Versailles United Methodist Church, Versailles, KY(May 2007-November 2008), Part Time *Stopped volunteering when my husband resigned as youth minister. • Conducted informal counseling with girls ages 12-18 and their families. • Facilitated small group study for junior high girls. • Served as a positive role model for youth. Intern Teacher(January 2004-August 2004) Loma de Luz Hospital, Cornerstone Foundation,Balfate, Honduras *Left position when my internship was finished. • Taught Spanish-speaking children English,reading,and math. • Co-taught Spanish-speaking and English-speaking children geography and history. • Maintained classroom discipline when main teacher was not present. • Navigated cultural customs, language,currency,and transportation without assistance in order to obtain supplies. • Became fluent in Spanish. • Assisted work and travel teams who used Loma de Luz facilities. References: Paulette Tarnasky, LCSW, Program Director, Integrated Care,North Range Behavioral Health (970)395-1104 Moldy Daniels, LCSW,Clinical Supervisor, Chrysalis House,(859)619-0644 Dr.Virginia Holeman,Department Head and Professor, Asbury Theological Seminary, (859) 858-3581 Licensed Professional Counselor Board: Li r,wvrorw,ioniCounselorE►Type:LPC Number 1tasa STATE OF COLORADO Mall Correspondence to: Home Business Department of Regulatory Agencies (Circle one) Division of Prvressions and Occupations Active PRINTED of SECURE RAPEP Home Phone: Business Phone: Licensed Professional Counselor - _ lPC.00,ie1a m�varzou oet coie Name: Number issue Date Fire Date Street Address: Angela Michelle Whtte Fort Collins CO 80525 City,State and Zip Code: . 4..4•4•4",j ♦Use the Area above for any ADDRESS Change phrision Director Signature 4 THIS ES YOUR WALLET CARD • • • • Maribel Favela 126O H Street,Greeley,Colorado 8O631 97O-347-2393 MaribeLFavela northrange.org CURRENT EMPLOYMENT STATUS North Range Behavioral Health at Greeley(11/98- North Range Behavioral Health at present) Ft.Lupton(11/98-5/09) 1260 H Street 145 First Street Greeley,Colorado 80631 Ft.Lupton,Colorado 80621 970-347-2393 303-857-6365 EDUCATION Masters of Social Work Colorado State University,Fort Collins,Colorado Graduated:May 2012 Bachelor of Arts:Spanish & Bachelor of Arts:Hispanic Studies Emphasis:Liberal Arts Emphasis:Mexican-American Studies University of Northern Colorado,Greeley,Colorado Graduated:December 1997 CERTIFICATION d• Colorado Alcohol and Drug Counselor III-received 2-12-02 4+ Colorado Alcohol and Drug Counselor ll-received-11-30-00 4. Approved Domestic Violence Treatment Provider-received 5.4-04 4. Approved Spanish Speaking Domestic Violence Treatment Provider-received 5.4-04 Approved Female Domestic Violence Treatment Provider received 3-18-08 PROFESSIONAL EXPERIENCE Bilingual Outpatient Therapist(7/09-present) North Range Behavioral Health(11/98-present) 4 Therapist for the Adult Outpatient Program servicing the Social Services,Domestic Violence,Mental Health and Substance Abuse populations in English and Spanish. +i Provide direct services for clientele with substance abuse,anger management,mental health and domestic violence issues via assessments,intakes,treatment planning,psycho-educational sessions, group and individual therapy utilizing conceptual understanding of group dynamics,clinical supervision,activities,psycho-education,using various therapeutic models and factors,and process therapy to facilitate clients'therapeutic progress in a group setting. 4 Traditional therapeutic models include Motivational Interviewing,Cognitive Behavioral Therapy, Client-Centered Therapy,Psychoanalytical and Psychodynamic Therapies. +f Assist clients with specialized case management in engaging with external services,such as medical screens,case management services,family services,Medicaid services,food stamps and other pertinent services. - Advocate for clients at state and local level. + Collaborate with Probation,Intervention,Rocky Mountain Offender Management Systems,Social Services and other community agencies to provide clientele with external services. 4- Community Collaboration to provide quality,culturally competent therapeutic services to clients in routine and crisis situations in order to ensure clients successful outcomes. •'r Supervision,translation,and upgrading of Spanish Adult Outpatient Program curriculum and forms. Lead Bilingual Outpatient Counselor 11(8/02-7/09) Island Grove at North Range Behavioral Health 4. Lead counselor for the Adult Outpatient Program servicing the Social Services,Domestic violence and Substance Abuse populations with emphasis on the Spanish-Speaking and Social Services population. t• Lead counselor for services provided at Ft.Lupton branch,which includes clinical supervision of other counselors. P Primary auditor of counselor work via chart audits. Assist Adult Outpatient Program Manager with counselor supervision,and the development and implementation of new programming. ✓ Assist Adult Outpatient Program Manager with screening,interviewing,and recruitment of staff. •S Supervision,translation,and upgrading of Spanish Adult Outpatient Program curriculum and forms. 4' Responsible for organization and upkeep of the Counselor Training Manual. .• Provide direct services for clientele with substance abuse,anger management,and domestic violence issues via assessments,intakes,treatment planning,educational sessions,group and individual therapy,as well as specialized case management. Assist clients in engaging with external services,such as medical screens,mental health services, family services,Medicaid services,food stamps and other pertinent services. 4. Advocate for clients at state and local level. 4 Community Collaboration to provide quality,culturally competent therapeutic services to clients in routine and crisis situations in order to ensure clients successful outcomes. 4. Participated in Clinical Trials Network—Motivational Enhancement Treatment to Improve Treatment Engagement and Outcome for Spanish-Speaking Individuals Seeking Treatment for Substance Abuse(METS)protocol at Island Grove from 2004 to 2005. Lead Bilingual Outpatient Counselor I(12/01-8/02) t- All regular counselor duties listed above,including some administrative tasks,but excluding staff supervision. Bilingual Outpatient Counselor 11 (11/98-12/01) All counselor duties listed above excluding administrative tasks. REFERENCES Work and character references available upon request. Maribel Favela 1260 H Street,Greeley,Colorado 80631 970-347-2393 CERTIFICATIONS Required Hours for certification I Approved Domestic Violence Provider Assessments- 1134hours -received 5-4-04/Recertified 2/13 Co-facilitated Groups-818 hours a Approved Spanish Speaking Domestic Violence Provider Supervision Pre-Approval-476 hours -received 5-4-04/Recertified 2/13 Supervision Post-Approval-2 hours per month a Approved Female Domestic Violence Provider -received 3-18-08/Recertified 2/13 Trainings Towards Approval Domestic Violence:Female Offenders with Lotte Muster,LAC,LPC,NCC Domestic Violence:Female Offenders II with Lotte Muster,LAC,LPC,NCC Victim Issues With Ms.Shelley Larson Of Greeley Police Dept.Victim's Services Susan's Story II With Kathleen Bird DV:Impact Of Violence On Children With Darlene Chavez Vicarious Trauma With Lotte Muster Domestic Violence&Multi-Disciplinary Response Training With Domestic Violence Enhanced Response Team&The Center For Prevention Of Domestic Violence Victims Awareness Training with Nancy Kroll of 19`h Judicial Probation Dept, Learning Styles With Scott Demuro Gender Specific Issues In The Delivery Of Treatment With Nancy Lantz Hispanic Cultures In US At University Of Northern Colorado-Fall Sem. 1997 Basic Addiction Counseling Skills With Linda Dawson Cocaine Treatment: Use&Abuse With Carol Atkinson Motivational Interviewing With Stephen Bentley Resistant Client With Marjorie Lewis Clinical Utility&Interpretation Of The Millon Clinical Multiaxial Inventories-III With Paul Retzlaff,PhD Personality Disorders With Lotte Muster Group Counseling Skills With Michael Connelly Advanced Group Counseling Skills With Judy Moor Domestic Violence Training With Nancy Lewis Of COVA Victim Rights Act Compliance Training With Nancy Lewis&Cynthia Geissinger Of COVA Sexual Harassment With Colorado Judicial Branch Human Resources Training Susan's Story II With Kathleen Bird Intergenerational Violence With Doris Kruse Post Traumatic Stress Disorder&Anger Management With Charles Allen Differential Assessment And Treatment Planning With Michael Connelly DV:Evaluation Of Perpetrators&Risk Assessment With Nancy Lantz Social Stratification Of The Mexican-American Community At University Of Northern Colorado-Spring Sem, 1996 Deviance&Criminal Behavior With Rand Kannenberg Sexual Abuse As A Control Technique With Doris Krus Community Resources With Lotte Muster 2002 Standards For Tx W/Court Ordered Offenders With Cheryl Milliken Domestic Violence And Legal Issues With Lotte Muster CERTIFICATIONS Experiential Hours for certification a Colorado Alcohol and Drug Counselor III-received-2-12-02 5000 Experiential hours a Colorado Alcohol and Drug Counselor II-received-11-30-00 3000 Experiential hours Specified Training Towards CAC Certifications o Addiction Counseling Skills o Ethical Issues o Jurisprudence Exam o Client Records Management o Infectious Diseases o Ethical Issues-Social Stratifications of the Mexican-American Community o Differential Assessment&Treatment Planning o Motivational Interviewing o Group Counseling o Pharmacology I&II o Cocaine Use&Abuse o Domestic Violence: Profiles&Treatment of Addicted Batterers o Clinical Supervision o Advanced Counseling Skills o SASSI-Administration and Scoring o SASSI-Clinical Interpretation o Driving With Care:Alcohol or Other Drug Safety Education&Treatment o Conflict Management o Deviance&Criminal Behavior o Post Traumatic Stress Disorder&Anger Management o Susan's Story-victim's issues o Sexual Harassment o Sexual Abuse as a Control Technique o Clinical Utility&Interpretation of the Millon Clinical Multiaxial Inventories-Ill Print Lookup Details Page 1 of 1 a (( D^ra Barbara J.Kelleyt • Executive Director :' re3ry� Deportment or eegultolyAgences Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License Information provided by the Colorado Division of Professions and Occupations,established by 24.34.102 C.R.S. Name Public Address Maribel Favela % North Range Behavioral Health 1260 H Street Greeley, CO 80631 Credential Information License license License Original Issue Effective Expiration Number Method License Typo Status Date Date Date ACC.0005484 Original Certified Addiction Active 02/12/2002 09/01/2013 08/31/2015 Counselor III Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/14/2014 2:44:26 PM REBECCA J. WYPERD (970)339-8266 rebecca.wyperd@northrange.org EDUCATION Licensed Professional Counselor State of Colorado licensure#5240 Master of Arts Degree University of Northern Colorado Greeley,Colorado August 2005 • Emphasis in Community Counseling:Marriage and Family Therapy Bachelor of Arts Degree University of Northern Colorado Greeley, Colorado May 2002 • Emphasis in Psychology • EXPERIENCE Program Director:Youth and Family Services,North Range Behavioral Health • Provide clinical and administrative oversight of all programming within the Youth and Family Team totaling 25 staff: o MST&FFT o 180 o MYAT o Substance abuse programming o School Based services o Platte Valley Youth Services Center services o Outpatient mental health services o Youth and Family Connections clinicians D June 2011 to present Program Coordinator: Child and Family Services,North Range Behavioral Health • Provided clinical and administrative supervision of multiple programs within the Child and Family Team totaling 15 staff. • Initiated constant collaboration between NRBI-1 and partnering agencies to ensure continued program success and development • Tracked program grants,perform audits,billing,formal reporting,and data collection for program sustainability ➢ November 2010 to June 2011 MST Supervisor,North Range Behavioral Health • Supervised four Multisystemic Therapy clinicians • Held weekly supervision and consultation to maintain model fidelity • Provided oversight of program operations bridging agency directors and team • Maintained link with community stakeholders and ensure sufficient referral flow and program collaboration • Generated billing,perform chart audits and approve reports for court monthly • Collaborated in the development of 180 including programming,policy and procedure,data collection, and agency partnerships D April 2007 to June 2011 • Bereavement Counselor,Chrysalis Grief Center;Greeley,Colorado • Held an individual and family counseling case load of up to forty • Facilitated bereavement groups and day trips • Responded to organizations in the community after a death • Received supervision in art,sand tray and play therapy • Maintained client records appropriate with agency policy and ethics • Participated in daily running of the center,planning,and fundraising ➢ September 2005 to March 2007 Mental Health Therapist,Acute Treatment Unit,North Range Behavioral Health • Worked with up to sixteen,persistently mentally ill,inpatients at a time • Initiated intake,case management,counseling,monitoring,and discharge • Collaborated with nurse and psychiatrist on treatment planning • Maintained daily treatment records for multiple clients • Responded to the after hours emergency phone line for three counties > August 2004 to May 2005 Victim Advocate,Greeley Police Department,Greeley,Colorado • Volunteered a minimum of forty eight hours a month to victims of crime • Responded first to the scene and initiated crisis and trauma debriefing • Assisted victims with restraining orders,court, counseling,and resources • Attended group meetings and seminars for further training > July 2003 to September 2006 Enrichment Director,Frontier Academy,Greeley,Colorado • Directed enrichment program for fifty school-aged students • Assisted kids with academic,social,and emotional issues • Initiated licensure for the program • Monitored two employees during tutoring • Assembled financial books and updated them weekly > August 1998 to May 2004 Professional references available upon request Print Lookup Details Page 1 of 1 IF . '�'•, DoraBarbaraJKely I. .,�.,/ Executive Director -,4 trnt.! Department d Regulatory Agencies Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Rebecca Jean Wyperd Greeley, CO 80634 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date LPC.0005240 Examination Licensed Professional Active 04/29/2009 09/01/2013 08/31/2015 Counselor Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/14/2014 12:38:55 PM i .. n 1 1 ,. „' . n . n. .. .-. .. .. . ...... .. .. .. •. . o.... . Address: Contact Information: 1300 N. 17`"Avenue Jennifer K. Wallace, LCSW (970) 397-5331 Greeley,CO 80631 Jennifer.wallace@northrange.org EDUCATION/LICENSURE August 2008 Department Of Regulatory Agencies Colorado Licensed Clinical Social Worker • Supervise clinicians working towards LCSW • Supervise Interns working towards their master's degree • Supervise FFT therapists 2003-2006 Illinois State University Normal, IL Masters of Social Work with Emphasis on Child and Family Practice • GPA:3.93/4.0 1999-2003 Saint Louis University St. Louis, MO Bachelor of Arts with majors in Spanish and Communication • Graduated Magna Cum Laude • Varsity Soccer Player/Division I-NCAA Academic All-American 2002 LANGUAGES • Provide services for Spanish speaking families at NRBH from January 2006-Present • Studied the Spanish language and Spanish speaking cultures through college and High school. • Studied abroad in Madrid,Spain during Spring of 2001 • Participated in a 3 week Spanish emersion program in Costa Rica in April of 2008 PROFESSIONAL EXPERIENCE December 2011-Present North Range Behavioral Health Weld County, CO Functional Family Therapy Coordinator • Supervise therapists using FFT Model with families with an at-risk adolescent • Maintain referrals for program,perform screens with families, and complete monthly billing. • Maintain small caseload(8-10) September 2008-Present North Range Behavioral Health Weld County, CO Functional Family Therapist • Practice therapy in a three phase,evidenced based model for families with an at-risk adolescent • Maintain contact with numerous stakeholders including Department of Social Services, Probation, the court, District Attorneys,Youth and Family Connections,and the schools. January 2010-2012 North Range Behavioral Health Weld County, CO Intern Supervisor • Provided Individual supervision for Interns working towards their Master's Degree • Coordinated services with University of Northern Colorado,Colorado State University • Created and implemented an intern training binder including: Intake,treatment planning,crisis management and supervision April 2006-September 2008 North Range Behavioral Health Weld County, CO Multisystemic Therapist • Provided intensive in-home therapy for families with an at-risk adolescent • Coordinated meetings with stakeholders including Department of Human Services,Probation, the court, District Attorneys, Department of Youth Corrections,and the schools. January 06-April 06 North Range Behavioral Health Weld County,CO Bilingual Therapist for Multicultural services • Completed concentration practicum by working with Spanish speaking adolescents and adults Summer 2005 Chestnut Heallth,Systems Bloomington, IL Primary Therapist • Completed foundation practicum at residential facility for adolescents that used substances • Lead skills groups,community groups,counseling groups and family groups Page I of 2 • Address: Contact Information: 1300 N.176 Avenue Jennifer K. Wallace, LCSW (970)397-5331 Greeley,CO 80631 Jennifer.wallace@northrange.org POST-DEGREE TRAININGS February 2014 Integrative Treatment of Complex Trauma for Adolescents(ITCT-A)Denver CO May 2011 Dialectical Behavioral Therapy Greeley,CO August 2010-2012 Have completed all courses for CACII Greeley,CO September 2008 Functional Family therapist Replacement Training Lima,OH March 2008 ASIST: Applied Suicide Intervention Skills Training Greeley, CO April 2006 Multisystemic Therapy Five Day Training Denver, CO WORK EXPERIENCE 2003-2006 Illinois State University Athletic Department Normal, IL Support staff to Director of Operations and Director of Facilities • Performed event management and public relations tasks for university and private functions • Designed/maintained excel documents to monitor athletic maintenance budget and timecards • Became fluent in Microsoft Excel,Word,Publisher,and Access. 2003-2006 Illinois State University Athletic Department Normal,IL Graduate Assistant Soccer Coach • Created/maintained Access and Excel documents to track recruiting,fundraising and player performance • Assisted in preparing practices and tactical decisions • Organized and ran camps,clinics and training sessions for players age 5-18 1999-2003 Fort Collins Soccer Club Ft. Collins,CO Summer Soccer Camp Coach • Coached week long soccer camps for kids age 5-10 • Taught skills,supervised other coaches and encouraged kids through play PARA-PROFESSIONAL EXPERIENCE Spring 2003 La Clinica St. Louis,MO Tutor • Tutored Latino children with limited proficiency in English to improve communication skills • Participated in activities to boost self-esteem,knowledge and interest in the Latino culture Spring 2003 Ralph Bunche International Studies Middle School St. Louis,MO Teacher Assistant • Assisted Teaching English to Speakers of Other Languages(TESOL) teacher work with students from more than 10 different countries of all levels of English speaking ability • Worked with the Spanish teacher in an inner-city public school 2000-2002 SPENSA (Special. Needs Soccer Association) St Louis, MO Helper for Clinics • Helped children with disabilities(Ages 4-18)play soccer and participate in physical activities • Boosted morale and self-esteem of children through games and activities 2001-2002 Karen House St. Louis, MO Tutor • Volunteered as a tutor at shelter for women and children • Designed and supervised activities to develop interest in education for the children of residents REFERENCES Personal/professional references and/or academic credentials will be submitted upon request Page?,:of 2,;., Print Lookup Details Page 1 of 1 Dora WNW/J.Kelley I•- Il .: Executive Director x ieifi oppvvn entolamatory/yencies 9 - :: t." PM t, Lookup Detail View Licensee Information This serves as primary source verification•of the license. *Primary source verification:license information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Jennifer Kehl Wallace Windsor, CO 80550-5463 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date CSW.00001141 Examination Licensed Clinical Active 08/28/2008 09/01/2013 08/31/2015 Social Worker Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:01:16 PM Sara Dillon LPC 2517 14`h Avenue Ct Greeley CO 80631 (619) 820-2953 saradillon@hotmail.com Work History Functional Family Therapist September 2011-present North Range Behavioral Health, Greeley,CO • Provide in-home family therapy for at-risk adolescents • Collaborate on cases with stakeholders such as schools, probation, courts, DHS, Guardians Ad Letim and Youth and Family Connections • Perform intakes including diagnosis, create and monitor treatment plans and provide case management • Work as part of both FFT and Youth and Family team Paraprofessional August 2007- October 2007 Collaborative Education Program (CEP), Behavioral Adjustment Class 3 (BAC 3) John Evans Middle School, Greeley, CO • Assisted teacher in construction of daily lesson plans • Helped to write behavior goals and establish discipline for students Educational Assistant February 2006- June 2007 Keystone Schools Steele Canyon, El Cajon, CA • Led groups of three to five students in academic instruction • Wrote and implemented Individual Education Plans (IEP) • Monitored students and assuring their safety during behavioral outbursts • Documented Incident Reports as necessary • Trained in Pro-Act physical restraint methods Educational Work Experience Child and Family Team Intern January 2011- August 5 2011 North Range Behavioral Health, Greeley, CO • Maintained a case load of children and adolescents, working both individually and with families • Facilitated co-therapy group counseling for process, DBT, art and multi-family substance abuse groups • Performed case management, developed and monitored of treatment plans • Processed intakes for new clients including diagnosis Clinical Care Coordinator Intern January 2011- August 5 2011 Mountain Crest Behavioral Health, Poudre Valley Health System, Fort Collins, CO • Counseled individual adolescents in crisis ; • Did family therapy with adolescents in crisis • Created safety plans with suicidal & homicidal adolescents • Addressed case management with stakeholders • Participated in daily treatment team with psychiatrist, psychologist, nurses and mental health counselors School Counseling Intern August 2010- December 2010 Ivy Stockwell Elementary School, Berthoud, CO • Ran small groups for students of various ages including topics such as self-confidence, friendship skills, social skills and appropriate playground behavior. • Taught classroom guidance lessons • Met with students individually and facilitated c'o'nflict management • Consulted with teachers and parents • Served on the Problem Solving Intervention Team School Counseling Intern January 2010- May 2010 Franklin Middle School, Greeley, CO • Developed and facilitated sixth grade girls relational aggression groups • Advised students in career development using College in Colorado • Mentored students individually and performed conflict management with groups • Held consultations with teachers and parents Counselor in Training Spring 2009 & Fall 2010 UNC Psychological Services Clinic, Greeley, CO • Work with individuals • Work with couples and families Education Master of Arts, Clinical Counseling, Emphasis: Couples and Family Therapy Master of Arts, School Counseling • , University of Northern Colorado (UNC), Greeley, CO Graduation Date: August 2011 Bachelor of Arts, Psychology San Diego Christian College(SDCC), El Cajon, CA Graduation Date: December 2005 Honors,Awards and Activities Leadership Fellow, Awarded by the School of Applied Psychology and Counselor Education at the University of Northern Colorado (2010) Executive for Chi Sigma Iota counseling honors society (2009-2011) Awarded NAIA Volleyball All-American (2004,2005) Professional Affiliations and Certifications Licensed Professional Counselor#0011790, Colorado National Certified Counselor#274952, National Board of Certified Counselors ! co co i) |± ! . .0 a . a ) vi A / ,J IF, 1 B � $ ! §� / \ §® • a § 5 § )�} �� U k �] 2. . Of C go \ C/ k\ ! §) E _ : k a k r! 3 - ! «$ ) •` / \ \ } • I Chan"Nina"Lu,MA,NCC 1640 37th Ave.,Greeley,CO 80634 . (970)313-8950 . Ichan.lu®northrange.org EDUCATION Denver Family Institute,Marriage and Family Training Program, Denver,CO August 2013 • COAMFTE accredited program University of Northern Colorado,Graduate School of Clinical Counseling,Greeley,CO May 20 • Masters in Clinical Counseling,Area of Focus: Couple and Family Therapy. • CACREP accredited program • Member of Chi Sigma Iota(CSI)Honor Society National Hsin-Chu University of Education,Hsin-Chu,Taiwan August 2008 • Bachelor of Arts in Elementary Education,Area of Focus: Language and Literacy Studies. WORK EXPERIENCE Functional Family Therapy and Child and Family Therapist, October 2013 to present • Provides and facilitates home-based family therapy and case management activates to achieve treatment goals • Offers on-going evaluation and prevents deterioration and/or hospitalization/out of home placement • Assists families in routine and crisis situations and connects them with proper referral resources • Maintains time-limited duration of treatment(2-6 months per family depending on the seriousness of the case) • Advocates for consumers in various forums including(federal, state and local court systems.school,etc.) • Collaborates and cooperates with community agencies and other public agencies in carrying out service plans • Participates in all training and supervision required by FFT, LLC to facilitate high fidelity replication of the model Psychotherapist--Denver Family Institute,Denver,CO,September 2011to September 2013 • Worked with individuals,couples and families in therapy using family systemic framework • Interviewed clients and evaluated both routine and crisis situations • Implemented therapeutic interventions with an integrated,solution-focused,and strength-based approach • Consulted and collaborated with probation officers, schools,doctors,social services, and other related agencies • Referred clients to appropriate services and coordinated integrated care • Counseled with diverse clientele including: court-ordered,at-risk teens, DV.sexual assault,abuse and neglect, adoption,homeless,addictions,disorders,disabilities,grief and loss,immigrants,culturally diverse populations • Training completed: Relational Treatment of Substance Abuse,40 hours ASSECT certification,30 hours EFT Extemship Equivalent,and 20 hours Registered Play Therapist Practicum psychotherapist---UNC Psychological Services Clinic,Greeley,Co,August 2010 to May 2011 • Provided individual, family,and couple counseling for diverse populations • Conceptualized cases through systemic lens and implemented culturally appropriate treatment plans VOLUNTEER EXPERIENCE • Child bare provider---Global Refugee Center,Greeley,CO. July 2013 to Sep 2013 • Couple and Family Counselor--Café 180, Englewood, CO,June 2013 to Sep 2013 • International Ambassador---UNC Center for International Education,Greeley,CO,January 2009 to August 2011 • Senior Assistance---Senior Resource Center,Greeley,CO,January 2010 to May 2010 • Respite Child Care Provider--24/7 Kids Support for Families,Greeley,CO,January 2010 to May 2010 I Chan"Nina" Lu,MA,NCC 1640 37th Ave.,Greeley,CO 80634 . (970)313-8950 . lchan.lu@northrange.org References • Robert Kelsall, LCSW RKelsall@denverfamilytherapycenter.com Denver Family Therapy Center 4891 Independence St#165, Wheat ridge,CO 80033 (303)456-0600 • Misti Klarenbeek-McKenna, LCSW,LMFT mistikmckenna@msn.com Thriving Connections, LLC 7651 W 41st Ave.Suite#200, Wheat Ridge,CO 80033 (303)900-7008 • Rita S. Lewis,LCSW,RN Ritadfi@gmail.com Denver Family Institute 7200 East Hampden Avenue,Suite 301,Denver,CO 80224 (719)357-7772;(720)341-2874 Jessica E. Leiby 317 E. Olive Street Fort Collins, CO 80524 Jessica.Leibv@northrange.org (847)338-6648 EDUCATION The Chicago School of Professional Psychology Chicago, IL Master of Arts in Clinical Psychology, Counseling Specialization 08/10-08/12 Western Illinois University Macomb, IL Bachelor of Arts, Psychology 08/05-05/09 PROFESSIONAL EXPERIENCE North Range Behavioral Health, Functional Family Therapy FFT Therapist 03/14-Present Rosecrance Health Network, Crisis Residential Unit Rockford, IL Mental Health Clinician 02/13-09/13 Truman & Harold Washington City Colleges, Wellness Center Chicago, IL Intern Counselor 06/11-06/12 PROFESSIONAL DEVELOPMENT TRAINING FFT LLC Replacement Training; New London,CT; March 12-14, 2014 VOLUNTEER EXPERIENCE Interfaith House Chicago, IL Volunteer Group Facilitator 01/13-03/14 The Women's Treatment Center Chicago, IL Clothing Donation Room Volunteer 10/13-03/14 LICENSES/CERTIFICATIONS CPR AED Certified, 2013 RNORTH oRAL HEALTH RANGE March 18, 2014 Tobi Vegter Core and Service Contract Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11"'Avenue Greeley, CO 80632 Re: Bid No. 81400069 Functional Family Therapy proposal Multisystemic Therapy proposal Dear Ms. Vegter: The intent of this letter is to address the qualification requirement set forth in the above- referenced bid of familiarity with Trauma Informed Care. The following Youth and Family Services program staff attended the Integrative Treatment of Complex Trauma for Adolescents presented by John Briere, Ph.D. and Cheryl Lanktree, Ph.D. on February 18 and 19, 2014: Susan Stone Jennifer Wallace Rachel Yearous Chad Reznicek Maggie Vandenberg Danielle Critten Sarah Hansen As of this writing, attendees have not received the requested documentation of participation in the training as evidenced by the attached correspondence. If you have any questions, please feel free to contact me. Sincerely, Vt/A„caa.,‘„,. eribtrw._ Susan E. R. Stone, M.A., LMFT m Administrative Director I Children, Youth, Family & Prevention At,. e t *- Enclosure S ;r ^R Where hope begins. MAUREEN E. HUFF,Ph.D., CAC III Licensed Psychologist,State of Colorado North Range Behavioral Health, 1306 11'"Avenue,Greeley,CO 80631 Office: (970)313-1186 Cell Phone: (970)219-5031 LICENSURE AND EDUCATION CAC III 2010 Certified Addictions Counselor III, State of Colorado License 2000 Licensed Psychologist,State of Colorado Ph.D. 1998 Counseling Psychology, Colorado State University(4.0 GPA) APA Accredited Internship: Denver VA Medical Center,Colorado. M.S. 1995 Counseling Psychology,Colorado State University(4.0 GPA) B.A. 1992 Psychology Major&Sociology Minor,St. Cloud State University,MN.(4.0 GPA) PROFESSIONAL HONORS AND AWARDS • CSU Alumni Association"Best Teacher Award of the Year"nomination. • CSU Undergraduate"Favorite Faculty of the Year Award." • PHI KAPPA PHI Outstanding Graduate Award for Highest GPA in Social Sciences. • PHI KAPPA PHI National Fellowship Outstanding Applicant Award. • Sociology Department Research Paper Competition,First Place. • PSI CHI Certificate of Recognition for Excellence in Research. • All Colleges and Universities Award,and Letter of Commendation from SCSU's President. • Outstanding College Students of America Recognition. • PHI KAPPA PHI Recognition of High Scholastic Achievement. • SCSU Certificate of Scholastic Achievement and Dean's List(1987-1992). EDUCATIONAL FELLOWSHIPS AND SCHOLARSHIPS: 1995-1997 Teaching Fellowship,Department of Psychology,CSU,Colorado 1995-1996 Women's Forum of Colorado,Graduate Scholarship Grant,Colorado 1994-1995 Working Woman's Scholarship, Working Women's Fair, Inc.,Colorado 1992-1993 Graduate Fellowship,Colorado State University,Colorado 1990-1992 PSI CHI Scholarship Award, SCSU Chapter,Minnesota 1990-1991 Ward's SCSU Bookstore Scholarship Award,Minnesota 1989-1992 Nontraditional Student Scholarship Award, SCSU,Minnesota 1989.1992 Allis SCSU Scholarship Award,Minnesota 1988-1992 Phillip Halenbeck Scholarship Award,SCSU,Minnesota PROFESSIONAL INVOLVEMENT,ACTIVITIES.AND COMMITTEES 2004—pres. Management Team,North Range Behavioral Health,Colorado 2004-2008 Mental Health Disaster Response Coordinator,North Range Behavioral Health,Colorado. 2004-2008 Emergency Services Committee,Weld County Community Collaborative Efforts 2004-2006 Thriving Organizational Practices(TOP)Committee,North Range Behavioral Health 2003-2004 Bathers to Productivity Committee,North Range Behavioral Health,Colorado. 2002-2004 Training Committee,North Range Behavioral Health,Colorado. 2001 -2003 Alternatives In Management Committee,North Range Behavioral Health,CO. 2000-2012 Quality Assurance Committee,North Range Behavioral Health,Colorado 2000-2012 Credentialing Committee,External Provider Network,Northeast Behavioral Heath 1998-2000 Curriculum Committee,Counseling psychology Program,University of Oregon 1998-2000 Doctoral Competency Examination Committee, University of Oregon 1998-2000 Dissertation Committee Chair,Doctoral Projects,University of Oregon 1998-2000 Program Selection Committee,Doctoral Applicants,University of Oregon 1995-1996 Curriculum Committee-Counseling Psychology Program,CSU,CO. 1993-1996 Graduate Student Representative,Counseling Psychology Program,CSU,CO. 1993-1994 Admissions Committee-Counseling Psychology Program,CSU,CO. 1990-1991 Council of Organizations Representative,St. Cloud State University,MN. 1989-1992 President, PSI CHI,National Honor Society in Psychology,St.Cloud State University Chapter,MN. E. Huff, , .2 of 9p CLINICAL AND SUPERVISORY EXPERIENCE 2000-pres. North Range Behavioral Health Program Director,Adult Recovery Program, 10/2012—pres. Interim Director,Integrated Care,4/2012-10/2012 Director of Training and Utilization Management,2008-10/2012 Program Director,Assessment and Brief Therapy Program. 2004-2008. Clinical Director,Intensive Child,Youth,and Family Services Team. 2000-2004 Licensed Psychologist,North Range Behavioral Health,Greeley,Colorado Responsibilities: Provide oversight of clinical programs, utilization management, and training program. Involved in clinical services provided to children,adolescents,adults,couples,and families through the years. Conduct psychological evaluations with high-risk populations referred through human services agencies, County Courts, and/or the Department of Corrections. Administration of full and abbreviated psychological batteries, including cognitive, intellectual, personality, emotional, psychosocial,and family functioning. 2000 Contracted Psychologist: Larimer Center for Mental Health,Fort Collins,Colorado. Responsibilities: Full-time (32 hours per week), Conducted psychological evaluations in a community mental health setting with high-risk populations referred through human services agencies, County Courts, and/or the Department of Corrections. Administration of full and abbreviated assessments, including cognitive, intellectual, personality, emotional, psychosocial, and family functioning. 1998-2000 Clinical Supervisor: DeBusk Memorial Clinic,University of Oregon. Responsibilities: Part-time (20 hours per week). Oversight of clinical services in a community mental health setting. Individual and group supervision of therapists,as well as supervision of clinical supervisors. Clinic provides intake, crisis intervention, therapy, and psychological assessment services to the local community. 1997-1998 Psychology Resident: Denver Veterans Administration Medical Center,CO. Clinical Rotations: Psychological Consultation&Assessment,Inpatient Psychiatric Units(locked& unlocked),Inpatient PTSD Unit,Alcohol&Domestic Violence Unit,&Outpatient Clinic. Responsibilities: Full-time (40 hours per week). Consultation services provided to medical and psychiatric units, psychiatric admissions, and inpatient and outpatient services. Psychological assessments and individual, group, and family therapy, as well as psychoeducational groups, case management,treatment planning,and crisis intervention. 1994-1997 Clinical Supervisor/Staff Therapist:Psychological Services Center,Colorado State University. Responsibilities: Part-time (20 hours per week). Adult, adolescent, child, couples, and family services provided to the Fort Collins community. Intakes, individual and group therapy, psychological evaluations, crisis intervention and mediation, and consultation with human service professionals, school personnel, and medical and legal professionals. Supervision of doctoral students: Monitored client progress, assisted in the development of case conceptualization and treatment planning, advised on assessment matters,processed professional and developmental issues, and encouraged skill building. 1995-1996 Emergency Services Provider: Larimer County Mental Health,Ft. Collins,CO. Responsibilities: Part-time (16-24 hours per week). Emergency services provider serving the Larimer County community. Case management,crisis intervention,mental status exams,consultation with medical staff,and voluntary/involuntary hospitalizations. 1994-1995 Emergency Services Provider:University Counseling Center&Psychological Services Center Responsibilities: Part-time (72 hours per month). Emergency services provider serving the CSU campus and Fort Collins community. Case management, crisis intervention, mental status exams, consultation with medical staff,and voluntary/involuntary hospitalizations. 1994-1995 Group Therapist, Anger Management and Anxiety Reduction: Tri-Ethnic Center for Prevention Research,Colorado State University. M.E.Huff,p.3 of 9 Responsibilities: Part-time (8 hours per week). Application of cognitive-behavioral interventions, social skills and mediation training, and relaxation techniques for anger management and anxiety reduction. 1993-1998 Training Team Member: Victims Assistance Team,Colorado State University. Responsibilities: Response and prevention training to victim advocates, campus administration, residence hall directors, student assistants, campus organizations, and community organizations. Focus on recognition of trauma symptoms,response to trauma,support&advocacy,and prevention. 1993-1994 Staff Therapist:University Counseling Center,Colorado State University. Responsibilities: Part-time (10 hours per week). Intakes, evaluations, crisis intervention, & individual,couples,&group therapy. 1992-1998 Group Therapist,Sexual Assault Survivors: Victims Assistance Team,CSU. Responsibilities: Part-time (10 hours per week). Group facilitator serving campus and community population. Intake assessments, consultation and referrals, group and individual services, and crisis management. 1992-1997 Emergency Services Provider: Victim Assistance Team,CSU. Responsibilities: Emergency services provider to primary and secondary victims of sexual assault, serving the campus population and Fort Collins community. Crisis intervention, support, advocacy (medical,legal,and academic),and referral. 1989-1991 Advocate/Support Person(volunteer): Women's Center, SCSU,Minnesota. Responsibilities: Serving the campus and St. Cloud community. Intake assessment, support, advocacy,and referral. COMMUNITY OUTREACH, CONSULTATION, WORKSHOPS & PRESENTATIONS 2009—pres. Mental Health First Aid. Twelve-hour certificate training presentations for members of the community addressing mental health first aid crises, how to respond and give assistance, and how/when to get appropriate professional help. 2009—pres. Lunch &Learn Series. Series of one hour presentations for clinical staff addressing clinical issues, such as mood disorders, anxiety disorders, psychotic disorders, disruptive behavior disorders, pervasive developmental disorders,etc. 2008-2009 Diagnoses& GAF. Four hour presentations for clinical staff addressing issues associated with diagnoses and determination of global assessment of functioning(GAF). Feb. 2005 Utilization of Beck Inventories to Screen for Mental Health Issues. Two-hour training presentation for community mental health center clinical staff on the administration and utility of Beck's Depression, Anxiety,Hopelessness,and Suicidal Ideation scales for adolescent and adult populations. Jan.2005 Organizational/Team Communication Based on MBTI Personality Types. Two-hour interactive workshop for Children's Residential Facility staff focused on understanding and enhancing communication among staff. Jan.2005 Utilization of Beck's Youth Inventories to Screen for Mental Health Issues. Two-hour training presentation for community mental health center children's residential staff on the administration and utility of Beck's Depression,Anxiety,Anger, Obsessive, and Disruptive Behavior scales for children and young adolescents. June 2004 Clinical Documentation, Assessment, and Diagnosis. Seven-hour training presentation for community mental health center staff on state and agency standards for clinical documentation of services, methods of clinical assessment,and differential diagnoses. M. E. Huff,p.4 of 9 May 2004 Brief Screening Instruments for the Assessment of Mental Health Issues. Two-hour training presentation for community mental health center clinical staff on numerous brief and rapid screening instruments to be used in assessing mental health issues (e.g., suicide, cognitive confusion, depression,anxiety,anger). April 2004 Legal Workshop:Responding to Subpoenas. Four-hour presentation for community mental health center staff on responding to subpoenas, confidentiality and protecting privileged communication, negotiating releases,and testifying as an expert witness. Feb.2000 Assessment of Posttraumatic Stress Disorder in Combat Veterans. Eight-hour training workshop for Veterans Administration clinical staff on the formal assessment of PTSD in combat Veterans. Oct. 1999 Intelligence Testing with the WAIS-IH and WISC-Ill. Eight-hour training workshop presented to University of Oregon Clinical and Counseling Psychology Doctorate Students. 1994-1996 PTSD and Rape Trauma Syndrome. Educational presentations (3 per semester) given to students enrolled in Abnormal Psychology and Human Sexuality courses at Colorado State University. Aug. 1995 Rough Rapids: Sexual Assault in Residence Halls. Three-day workshop presented to CSU residence hall administrators, directors, student assistants, and support staff. Included large group education presentations and 11/2-hour small-group interactive presentations focused on prevention, recognition, support,response procedures,state laws,and university regulations. 1994-1997 Rape Trauma Syndrome:Support and Advocacy. Training workshops for new Victim Assistance Team members. Presentation on the aftermath of sexual assault, recognizing symptoms, identifying concerns,crisis intervention,and provision of support services. Nov. 1994 Sexual Assault: Victims and Perpetrators. Educational presentations given to students enrolled in Human Sexuality courses at CSU. Sept. 1994 Sexual Assault: Prevalence, Prevention, Recognition, and Support. Two-week training workshop presented to CSU residence hall administrators, directors, student assistants, and support staff. Offered through the Victims Assistance Team. ACADEMIC/TEACHING EXPERIENCE 1998-2000 Assistant Professor, Counseling Psychology Doctorate Program; Department of Counseling, Family, and Human Services;University of Oregon. Responsibilities: Teaching, supervision of fellowships, clinical practicums, and psychological assessments,and dissertation and competency exam committee chair/member,and student advising. Teaching Responsibilities: Graduate Courses(counseling,clinical,&school psychology doctorate students) • CPSY644: Group Counseling and Psychotherapy • CPSY622: Advanced Psychological Assessment II—Personality&Emotional • CPSY621: Advanced Psychological Assessment I—Cognitive&Intellectual • CPSY612: Professional Ethics • CPSY607: Doctoral Seminar—Assessment Undergraduate Courses(Family&Human Services Program) • EDST430: Advanced Individual and Group Interventions • EDST330: Individual and Group Interventions M. E. Huff,p.5 of 9 1996-1997 Teaching Fellow,Department of Psychology,Colorado State University. Responsibilities: PY320: Abnormal Psychology (2 sections, 180 students per section) and PY100: General Psychology(2 sections,215 students per section). Supervision of teaching assistants. 1996-1997 Instructor,Department of Continuing Education,Colorado State University. Responsibilities: PY100:General Psychology(2 sections,25 students per section). 1995-1996 Teaching Fellow,Department of Psychology,Colorado State University. Responsibilities: PY100: General Psychology(4 sections, 215 students per section). Supervision of graduate and undergraduate teaching assistants. 1995 Instructor,Department of Psychology,Colorado State University. Responsibilities: PY496:Professions In Psychology(adv-seminar,60 students). 1993 Instructor,Department of Psychology,Colorado State University. Responsibilities:PY325:Personality Psychology(35 students). 1993 Teaching Assistant/Mentor,CSU Teaching Assistant Workshop. University-wide training workshop for new graduate teaching assistants from across disciplines. 1990-1992 Lab Instructor: Department of Psychology,St.Cloud State University,MN. Responsibilities: PY260; Descriptive and Inferential Statistics Lab (2 sections per quarter, 40 students per section). Provided supplementary lectures/labs three times a week,graded and recorded daily assignments and exams. 1989-1990 Teaching Assistant:Department of Psychology,St. Cloud State University,MN. Responsibilities: PY100: Introductory Psychology. Graded and recorded lab reports, essays, and exams. Led weekly groups supplementing course material. RESEARCH PUBLICATIONS AND PRESENTATIONS Martin, V. A. & Huff, M. E. (2005). Relationships Between Attributions' Bias, Child Abuse History, and PTSD Symptom Severity in Adult Populations. Cognitive Therapy and Research. Martin, V. A. & Huff, M. E. (2003). A Diathesis-Stress Model of Posttraumatic Stress Disorder: Ecological, biological, and residual-stress pathways. Review of General Psychology, 7(3), 237-250. Martin, V. A., McWhirter, B. & Huff, M. E. (2001, August). Relationships Between Learned Helplessness Factors, Child Abuse, and Combat-Related P7'SD. Paper presented at the American Psychological Association Convention, San Francisco, CA. Deffenbacher, J. L., Huff, M. E., Lynch, R. S., Getting, E. R., & Salvatore, N. F. (2000). Characteristics and treatment of high anger drivers. Journal of Counseling Psychology, 47, 5- 17. Huff, M. E. (1998). Attributions and locus of control as related to anger and anger expression styles. Doctoral dissertation,Colorado State University, Fort Collins, Colorado. Deffenbacher, J. L., Huff, M. E., Salvatore, N. F., & Lynch, R. S. (1998). Stress inoculation and applied relaxation in the reduction of driving anger. Paper presented at the Rocky Mountain Psychological and Western Psychological Associations' Convention,Albuquerque,NM. Lynch, R. S., Deffenbacher, J. L., & Huff, M. E. (1998). Reactions of high and low driving anger individuals. Paper presented at the Rocky Mountain Psychological and Western Psychological Associations' Convention,Albuquerque, NM. M. E.Huff,p.6 of 9 Powell, K. M., Rosen, L. A., & Huff, M. E. (1997). Disruptive behavior disorders and the avoidance of responsibility. Personality and Individual D fferences, 23, 549-557. Deffenbacher, J. L., Getting, E. R., Huff, M. E., Cornell, G. R., & Dallager, C. J. (1996). Evaluation of two cognitive-behavioral approaches to general anger reduction. Cognitive Therapy and Research, 20, 551-573. Huff, M. E. (1995). Therapists'perceptions, preferences, comfort, and confidence with different client types. Unpublished master's thesis,Colorado State University,Fort Collins,Colorado. Deffenbacher, J. L., Getting, E. R., Huff, M. E., & Thwaites, G. A. (1995). A fifteen-month follow-up of social skills and cognitive-relaxation approaches to general anger reduction. Journal of Counseling Psychology, 42, 400-405. Deffenbacher, J. L.,Huff, M. E., Cornell, G. & Dallager, C. (1995). A social skills approach to the reduction of anger. Paper presented at Rocky Mountain Psychological Association,Boulder, CO. Huff, M. E. (1991). The effects of motivation and failure on problem solving performance: Reactance vs. helplessness. Paper presented at the Red River Psychology Conference,APA Midwestern Region,Moorhead,MN. OTHER RESEARCH EXPERIENCE 1995-1998 Collaborative Research:Tri-Ethnic Center for Prevention Research,CSU. Description: Work on various NIMH grant funded research projects. Development of Anger- expression scales, including measurement of cognitive factors and associated personal and social consequences. Treatment outcome studies involving group therapy for individuals with anger problems. 1995-1996 Collaborative Research,Department of Psychology,CSU. Description: Scale development and statistical analyses of avoidance of responsibility symptoms in disruptive behavior disorder subtypes. 1994 Research Assistant:Department of Human Development and Family Studies,CSU. Responsibilities: Content analysis and data coding to determine the prevalence of aging issues and later family life concerns in marriage and family therapy literature. 1993-1995 Graduate Research Assistant:Tri-Ethnic Center for Prevention Research,CSU. Responsibilities: Work on various NIMH grant funded research projects. Organization and implementation of data collection procedures (pre, post, and follow-up surveys). Data input, statistical programming, and data analyses. Group therapist for treatment groups using cognitive behavioral,social skills training,and/or relaxation techniques to reduce anger and anxiety. 1992-1993 Graduate Research Assistant:Women's Programs and Studies,CSU. Responsibilities: Academic programming, research, publication of program newsletter, and facilitation of Sexual Assault Support Group. 1990-1992 Member of the Experimental Psychology Research Group(EPRG),SCSU,MN. Responsibilities: Collaboration, design, and implementation of research projects for presentation at professional conferences. Critical analyses of existing research and the feasibility of future projects. 1990 Non-Response Enumerator,US Dept.of Commerce Bureau of the Census. Responsibilities: Interviews with"refusal to respond" and difficult cases for the 1990 United States Census. Aided individuals in filling out census forms, due to inability to read or understand questionnaires. Mapped and routed areas in which inaccurate or incomplete records existed. 1989-1991 Research Assistant: Women's Center,SCSU,MN. Responsibilities: Initiated development of the Women's Center resource/referral manual. Surveyed state,community,and campus resources. M. E.Huff,p.7 of 9 SPECIALIZED TRAINING, CONTINUING ED.& PROFESSIONAL DEVELOPMENT 1/2005 Invisible Child Conference: Conference focused on children with"invisible"challenges stemming from brain differences, such as Bipolar Disorder, ADHD, OCD, Anxiety Disorders, and Pervasive Developmental Disorders. 12/2004 Changes in CRS 27-10 Regulations in the State of Colorado, provided by the Division of Mental health. Focus on changes in"involuntary hold and treat"regulations. 10/2004 The Biosocial Effects of Methamphetamine Abuse. Workshop presented by Nicolas Taylor, Ph.D., CAC III. Sponsored by the Colorado Trust/Rural Solutions in partnership with Island Grove Treatment Center. 10/2004 CMHDRS Disaster Response Training—Level II Certification. Training workshop sponsored by the Colorado Mental Health Disaster Response System. 8/2004 CMHDRS Disaster Response Training—Level I Certification. Training workshop sponsored by the Colorado Mental Health Disaster Response System. 8/2004 Developing the Most Effective Systems of Care for People with Co-Occuring Mental Health and Substance Use Disorders: Working Together for Change. Workshop presented by Kenneth Minkoff,MD 7/2004 Summer Leadership Institute for Nonprofit Executives. Two day workshop sponsored by the Kenneth W.Monfort College of Business at the University of Northern Colorado. 4/2004 The 4th Annual Mental Health Performance Indicator and Outcomes (PIO) Conference: The President's New Freedon Commission on Mental Health, Evidence-Based Practices & Recovery. Sponsored by SAMHSA's Center for Mental Health Services Data Infrastructure Grant. 4/2003 Wolves at the Door: Responding to the Demands for Evidence by the Legal System. Workshop presented by Stromberg,Cleveland,Crawford,&Schmidt. 3/2003 Brief and Solution Focused Treatment Approaches. Workshop presented by Michael Kucera,Ph.D. 11/2002 Collaborate:A Call to Action. Weld County Juvenile Collaborative Conference. 11/2001 Disaster Psychology and mental Health Response. Eight-hour training resulting in certification as a Type II Mental Health Disaster Responder. 9/1999 Multicultural Counseling: Working with differences in Race, Ethnicity, and Sexual Orientation. 32 hour advanced training workshop presented by Derald Wing Sue,Ph.D. 3/1998 Personality Assessment Inventory (PAI) Training Workshop. Presentation by Leslie Morey, Ph.D. (creator of the PAI),Vanderbilt University. 10/1997 Wechsler Adult Intelligence Scale - III (WAIS-III) and Wechsler Memory Scale - Ill (WMS-HI) Training Seminar. Telecommunications seminar presented by the Psychological Corporation (Psych-Corp)Harcort Brace&Company. 9/97-8/98 Psychological Assessment and Evaluation. 100 hours of advanced training in the use of Wechsler Intelligence Scales, MMPI-2, PAI, MCMI-II, Rorschach, TAT, Incomplete Sentences Blank, Hand Test, Object Sorting Test, Behavioral Dyscontrol Scale, and the Self-Administered Interview. Coordinated by the Denver VA Medical Center, Psychology Services. M. E.Huf,f P. 8 of 9 9/97-8/98 Neuropsychological Assessment. 100 hours of advanced training in symptom recognition, assessment of, and diagnosis of neurological disorders (e.g., dementia, Alzheimer's Disease, Parkinson's Disease, Huntington's Chorea, Korsakoffs, and Traumatic-Brain Injuries and Syndromes). Coordinated by the Denver VA Medical Center, Psychology Services. 9/97-8/97 Treatment of Culturally Diverse Populations. 100 hours of advanced training involving clinical case presentations using various theoretical perspectives,treatment models,and approaches. Presentations by a variety of expert clinicians with emphasis on different cultural groups. Coordinated by the Colorado Health Sciences Center,Psychology Services. 9/1997 PTSD in Vietnam Veterans of Native American and Asian Descent. Presentation provided through the collaborated research efforts of the Department of Veteran Affairs Medical Centers and the University of Colorado Health Sciences Center. 4/1996 Supervision Issues Workshop. Presentation by John Morse, M.S., LMFT, Rocky Mountain Marriage and Family Center. Sponsored by the Colorado Association for Marriage and Family Therapy. 4/1996 Advancing Brief Therapy: Attitudes and Techniques. Presentation by Tracy Todd, Ph.D., Brief Therapy Institute of Denver, Incorporated. 4/1996 Private Practice Sanity. Presentation by Janet Pipal, Ph.D. Workshop sponsored by the Department of Psychology and the Psychological Services Center at CSU. 3/1996 Dealing with Under-Motivated Adolescents. Presentation by Bill Parks, LMFT, Jim Campion, L.S.C.W., and Lisa Barnes, L.C.S.W. Seminar for professionals offered by Mountain Crest Behavioral Healthcare System. 3/1996 Depression in Childhood and Adolescence. Presentation by Mark Fallon-Cyr, M.D. Mountain Crest Behavioral Healthcare System's Grand Rounds Lecture Series. Sum 1995 Child and Adolescent Assessment and Treatment. Five-day training workshop on the assessment and treatment of disruptive behavior disorders and ADHD. Offered by the Department of Psychology, Colorado State University. Sum 1995 Neuropsychological Assessment. Semester of specialized training in administration of neurological test batteries, including the Halstead-Reitan battery. Offered by the Department of Psychology,CSU,and Thomas Bennett, Ph.D., Director of the Brain Injury Recovery Program. Spring 1995 Group Counseling and Psychotherapy. Semester of specialized training in theories and techniques of group therapy. Offered by the Department of Psychology,CSU. 3/1995 Foundations of Multicultural Communication Training. Presentation by Alma Vigo Morales, Director of Fort Collins Human Rights Office,and Barb Kissler,Director of Activities,CSU. Fall 1994 Marriage and Family Therapy. Semester of specialized training in dominant marriage and family therapy theories and techniques. Offered by the Department of Human Development and Family Studies,Colorado State University. Fall 1994 Emergency Services Training, Larimer County Mental Health Center, Fort Collins, CO. 4 hours initial training and 14 hours of in-service training. Fall 1994 Group Treatment and Implementation of Cognitive-Behavioral, Social Skills, and Relaxation Techniques for Anger and Anxiety Management. 24 hours of training and supervision with experiential components involving the group treatment of individuals with high levels of trait anger. 4/1994 Attention Deficit Hyperactivity Disorders. Presentation by Dr. Sam Goldstein. Seminar offered by the McKee Conference and Wellness Center,CO. M.E. Huff,p.9 of 9 4/1994 Marriages From Hell: Trouble in Marriages, Turning Points in Marriages, Sick Marriages, and Treating Marriages. Presentation by Frank S.Pittman, III,MD. Mountain Crest Hospital,Master's Lecture Series,Fort Collins,CO. 11/1993 Male Survivors of Sexual Abuse. Presented by Mark Brosal, Ph.D. Sponsored by the Women at Noon Forum and the Dept.of Women's Programs and Studies at CSU. 8/1993 Multicultural Training Workshop. Presentations by the McKinley Group, Inc., Washington D. C.; Pima Prevention Partnership;and Team Fort Collins,Colorado. Three-day therapist training. 4/1993 Treating Adult Survivors of Incest. Case presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. 3/1993 Multicultural Communication. Presentation by Lillian Robal-Rose. Full day seminar offered through Colorado State University Programs Office. Spring 1993 Emergency Services and Crisis Intervention Training, Victim Assistance Team, Colorado State University,CO. 16 hours initial training and 16 hours of in-service. Spring 1993 Advanced Seminar on College Teaching. Training in various presentation styles, learning styles, and effective teaching techniques. Offered by the Department of Graduate Studies,CSU. 11/1992 Treating Childhood Trauma and PTSD. Case presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. 10/1992 The Famine Within. Training on eating disorders presented by Dr. Susan MacQuiddy. Sponsored by the Women at Noon Forum and the Department of Women's Programs and Studies,CSU. 9/1992 Psychic Trauma. Presentation and discussion by Dr. Henry Coppolillo. Mountain Crest Hospital Grand Rounds Lecture Series. Spring 1991 SPSS-X in the Social Sciences. Training in computer analysis using the SPSS and SPSS-X data analysis systems. Offered by the Department of Social Sciences, SCSU. Winter 1991 Research Topics in Psychology. Seminar involving critical analysis and implementation of research designs, Department of Psychology,SCSU. Winter 1991 Psychology of Teaching Practicum. Seminar involving supervised training and practical experience, Department of Psychology,SCSU. Congratulations. K . t ,' • The wallet card provided below.is your official authorlfalion id practice.Photocopies are.notCon3idered oif-icial.documents:biR may be used tb verify a Colorado license for credentialing or insurance purposes.You may now order a professionally designed waif Certificate)To place an order,go to www.flora.colorado.govfprofession5 wallcertifcatea or1-888-925.5237. As a condition of licensing,you nave a continuing obllgalbn to comply with the statutes,rules and regulations governing your license in Colorado. Our websile is a good source for this Information.It is your responsibility to keep our office advised of your current address.You are responsible for keeping your License current and renewing it before the expiration date. • - To Remove Document Fold and Tear Along This Perforation — Certified Addiction Counselor III Hoard:Aticl•cionCoumeorcrofirarn Type:AGO Number: M975 STATE OF COLORADO Mail Correspondence to: Home Business Department of Regulatory Agencies (Circle one) fliusion of Professions and Occupations Active PRINTED ont SECURE PAPER Home Phone: Business Phone. ACC nCC.ttooC47s I ava,aow 06131/2915 Name: Number Issue Date Expire Date Street Address; • 5r Maureen Edith Huff Greeley CO 80531 City.State and Zip Code: • 1 y A Use the Area above for any ADDRESS Change Division Director Signature - THIS IS YOUR WALLET CARD - Congratulations, The wallet card provided below is year official authorization to practice.Pholocopiet antral considered-ptfiolal doapnente.but may be used to verify a Colorado license for credentialifp orinsurance purposes,You may now order a professionally designed wall dbrtifleatef To place an order,go to www.dora coloredo gov/professionsAvallcertilicates or 1.888-925.8237. As a condilion of licensing,you have a continuing obligation to comply with the statutes,rules and regulations governing your license In Colorado. Our website is a good source for this information. II is your responsibility to keep our office advised of your current address.You are responsible for keeping your license current and renewing it before the expiration date. Colorado has a medical and public health volunteer system for persons who are interested in assisting during an emergency or disaster.To G P r'9 htlps:llcovolunteers.state.co.us. ate register ister at ht1 s:Jlcovolunteers.state.co.us. r • --- To Remove Document Fold and Tear Along This Perforation --. Sz Licensed Psychologist Board.ParatUsl E■amne,s RCVS, Type: ps" Number: 2405 STATE OF COLORADO Mail Correspondence to. Home Business Department of Regulatory Agencies (Circle one) Division of Professions and Occupations Active PRINTED ON SECURE P&PFR Home Phone: Business Phone: PSY PSY 0O0249b 00/0112012 I oeralrtols_- _ 1 Name: Number 1 Issue Date Expire Date Street Address: Maureen Edith Huff Greeley CO 0631 City.State and Zip Code: --{f— \N '� QL.fCOW- • Use the Area above for any ADDRESS Change A Division Director— Srgne ure 4 THIS IS YOUR WALLET CARD Nathan Kyle Swisher CURRICULUM VITAE 218 47'"Avenue Court Phone:(970)381-6093 Greeley,CO 80634 E-mail: nkswisher@yahoo.com LICENSURE Licensed Psychologist, Colorado - PSY.0003840 Issue Date: 01/02/2013 Expire Date: 08/31/2015 EDUCATION 05/2008-08/2011 Doctorate of Psychology in Clinical Psychology Rosemead School of Psychology, Biola University, La Mirada, CA Psy.D. conferred August 31, 2011 08/2006- 05/2008 Master's of Arts in Clinical Psychology Rosemead School of Psychology, Biola University 08/2002- 05/2006 Bachelor of Arts in Biblical Studies,Concentration in Psychology Trinity Western University, Langley, British Columbia, CAN CLINICAL EXPERIENCE North Ranee Behavioral Health Sept 2011-Present Adult Outpatient Therapist (Full Time Employment) Setting: Community mental health network, Greeley, CO - adult outpatient program. Duties: • Implement clinical assessment, psychological testing (cognitive, personality), and culturally-sensitive individual/group/family/couples psychotherapy for an ongoing caseload of 45-55 individuals (in addition to therapy groups). Caseload consists of both mental health and substance abuse referrals, voluntary and court-mandated. • Engage in regular faculty meetings and trainings, case consultation, individual and group supervision [qualifying for psychologist licensure and CAC (Certified Addiction Counselor) requirements], and external clinical seminars (including training for CAC II, Gottman Couples Therapy, and others). AspenPointe Health Services Sept 2010-Sept 2011 2,000-hour APPIC Pre-Doctoral Internship Setting: Community mental health network, Colorado Springs, CO. Major internship rotation located at Adult and Rural Services (adult outpatient); minor internship rotations included: Lighthouse (adult acute inpatient), Peak Vista Community Health Center(primary care), AspenPointe —Fountain, CO (rural outpatient). Duties: • Implemented clinical assessment,psychological testing (cognitive,personality), and culturally-sensitive individual/group/family/couples psychotherapy (EBP) for an ongoing caseload of 25-35 severely and persistently mentally ill adult consumers. • Provided crisis assessment, individual/group/family/couples psychotherapy for an adult population in an acute crisis setting(inpatient). • Coordinated clinical assessment and brief individual psychotherapy in a primary care setting, participating in brief behavioral health consultations for patients. • Implemented supervision with master's level psychology intern, including weekly clinical observation. • Engaged in regular faculty meetings, case consultation, internship training seminars (including presentation of doctoral paper), individual supervision, and external clinical seminars. Harbor UCLA Medical Center—South Bay TIES for Families Sept 2009-Aug 2010 830-hour Advanced Practicum Setting: Los Angeles County Department of Mental Health outpatient clinic; a multidisciplinary treatment approach promoting the successful adoption of foster children and adolescents. Duties: • Provided direct clinical assessment,psychological testing(cognitive, academic achievement,personality, socioemotional, neuropsychological), consultation, and individual/family/group psychotherapy for children,adolescents, and families. • Coordinated care with the court system and Department of Child and Family Services as needed. • Engaged in internal and external training for infant mental health(e.g.,the Bayley Scales of Infant Development),Narrative Therapy, Reflective Parenting, Mindful Parenting, Incredible Years, and other clinically-relevant seminars and didactic training made available at the Harbor-UCLA Medical Center. Rosemead School of Psychology,Biola University Fall 2009—Spring 2010 Setting: Biola University campus, La Mirada, CA. Duties: • 32-hour Clinical Supervision Practicum (provided weekly, individual supervision for graduate student providing services to adults in an outpatient setting; engaged in weekly supervision and tape review of supervisory sessions; presented audio tapes and progress notes for peer consultation and critique) • 32-hour Child and Adolescent Practicum (engaged in live peer supervision with teaching assistant using bug-in-the-ear technology; provided individual psychotherapy and parental feedback/consultation to an adolescent client recruited from the community). • 32-hour Group Therapy Practicum (provided process-oriented group therapy for a group of 10 college students for 10 weeks; consulted and worked successfully with co-therapist; maintained individual client files consistent with group conceptualization; engaged in weekly supervision). Biola Counseling Center August 2007—June 2009 1,090-hour University Counseling Center Practicum Setting: Outpatient university and community counseling center, La Mirada, CA. Clientele worked with consisted of an age range of 18-55, from various ethnic backgrounds, and presenting with various forms of mood-, anxiety-, relational-, adjustment/phase of life-, and disorder of thought-related problems. Duties: • Provided short- and long-term psychotherapy for adult individuals and couples, using Cognitive-Behavioral Therapy, Rogerian techniques,Emotion-Focused Therapy for Couples and Individuals, and Psychodynamic Psychotherapy. • Completed biweekly floor duty and structured intake interviews including MMPI-2 interpretation(written reports); provided MMPI-2 feedback sessions to graduate students. • Participated in weekly child therapy seminar/training(spring, 2009), weekly clinic in-service meetings (including case conceptualization and presentation), HIPAA training, and other clinically-related training; • Participated in two Gestalt Therapy seminars (as presented by David Gorton, Ph.D., Director of the Gestalt Therapy and Training Center, Woodland Hills, CA), and participated in Sand Tray and Psychotherapy workshop (as presented by Meredith Phanco, Ph.D.,Biola Counseling Center, La Mirada, CA). Measurement and Assessment Practica: Various Settings Fall 2007— Spring 2008 Setting: La Habra City School District; Arbolita Elementary School (grades K-2), El Cerrito Elementary School (grades K-2) and Walnut Elementary School (grades 3-5), La Habra, CA. Population represented age range from 5-10 years-old, various ethnic backgrounds (predominantly Latino) and levels of socio-economic status. Duties: • 300-hour school assessment practicum: assessed special education and general education students for learning and behavioral problems, consisting of neuropsychological and psycho-diagnostic tests, student interviews, in-class observation, case conceptualization, report writing, and Individualized Education Programs (IEP); participated in weekly individual supervision and presented in weekly consultation group with practicum supervisor and other practicum students. Setting: Rosemead School of Psychology, La Mirada, CA; comprehensive testing batteries administered to recruited child clients from the community and Biola University undergraduate students. Duties: • Completion of 3-semester sequence of measurement and assessment courses involving the administration and report writing of 6 comprehensive testing batteries; courses consisted of Measurement and Assessment I (trained to administer, score, and interpret the WAIS-III, WISC-IV, Woodcock-Johnson III, ADSA, Conner's (CPRS-R:L), and PPVT-III), Measurement and Assessment II (trained to administer and score the MMPI-II, MCMI-III, Folstein Mini Mental Status Exam,Thematic Apperception Test, House Tree Person Projective Drawings, Kinetic Family Drawing, and the Forer Structured Sentence Completion Test), and Measurement and Assessment III (trained to administer, score, and interpret the Rorschach). OTHER WORK EXPERIENCE CLINICALLY-RELEVANT EMPLOYMENT : • Intensive Support Services (ISS) Jun 2007-Sep 2007 Setting: Institute for Applied Behavior Analysis, Santa Ana, CA Hours: 30 per week Duties: Received training in Competency Based Training and provided support to children and adolescents with developmental disabilities. • Homecare Provider Jul 2005-Jul 2006 Setting: Visiting Angels Living Assistance Services, Bellingham, WA Hours: 20 per week Duties: Provided living assistance services, including various behavioral interventions, for adolescents with autism in home and community settings. TEACHING ASSISTANT EXPERIENCE : • Teacher Assistant: Psychology of Marriage Fall 2009 Keith Edwards, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 3 per week Duties: Facilitate the discussion in and processing of areas such as family of origin issues, and lead skill building exercises in areas such as conflict resolution and empathic listening with undergraduate students. • Teacher Assistant: variety of courses covering the Fall 2007-Spring 2008 integration of theological topics and psychological theory Steve Porter, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 7 per week Duties: Provided assistance to Dr. Porter for grading of graduate-level coursework. • Teacher Assistant: Psychology of Christian Thought Spring 2008 Elizabeth Hall, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hill for grading of undergraduate-level psychology coursework. • Teacher Assistant: Psychology of Christian Thought Fall 2007 Pete Hill, Ph.D.; Rosemead School of Psychology, La Mirada, CA Hours: 14 per week Duties: Provided assistance to Dr. Hall for grading of undergraduate-level psychology coursework. PRESENTATIONS • Presentation of Gottman Couples Therapy In-clinic presentation to adult outpatient staff; North Range Behavioral Health, Greeley, CO April 24,2013 • Presentation of Bipolar Disorder Diagnosis and Treatment In-clinic presentation to adult outpatient staff,North Range Behavioral Health, Greeley, CO June 6, 27, 2012 • Presentation of Schema Therapy In-clinic presentation to adult outpatient staff,North Range Behavioral Health, Greeley, CO January 18, 2012 • "Reflective Functioning in Couples Therapy" 1-Hour In-clinic presentation to all clinical staff,AspenPointe Health Services, Colorado Springs, CO August 18, 2011 • Presentation of Doctoral Paper: "The Enhancement of Reflective Functioning in Couples Therapy: Integrative Literature Review and Theoretical Development" 2-Hour Intern Seminar, AspenPointe Health Services, Colorado Springs, CO June 23, 2011 • "Forming Attachment Bonds in Marriage: Can You Hear Me Now?" "The Risks and Treasures of Love"relationship conference; hosted by Living Hope Church, Colorado Springs, CO April 2, 2011 PROFESSIONAL MEMBERSHIPS • American Psychological Association Current Membership#95673434 _._ _ STAFE OF COLORADO Department of Regulatey Agencies Division of Prifassdari9 and Occupations Active PR1MTto ON SECURE RAPE PSY PSY.0001810 00101201] 00!61/7015 1111. Number issue Date Expire Date Nathan Kyle Swisher Greeley CO 80634 Dhvision Director Signature Alan Ulibarri 815 Coffman St.#8 Longmont, Co 80501 970-534-5811 Alan.ulibarri@northrange.org Objective To continue my education and growth through my professional experiences so I can expand my ability of helping others Education Bachelors Degree in Psychology and Sociology University of Northern Colorado Greeley, Colorado August 2003-May 2007 Experience Mental Health Worker II Acute Treatment Unit of North Range Behavioral Health Greeley, Colorado 970-347-2120 May 2007-December 2008 In patient services for the severe and chronically mentally ill, Crisis phone line counseling for North East Colorado, administering medication, milieu management Behavioral Health Specialist II Crisis Stabilization Services of North Range Behavioral Health Greeley, Colorado 970-347-2120 December 200 8-Present r All duties performed at the ATU were continued with the addition of substance abuse specific duties: client admission assessment and coordination, admissions and discharges, withdrawal assessment, case management, and substance abuse monitoring Tralnings Colorado Qualified Medication Administration Person A variety of Certified Addictions Counselor courses Crisis Prevention Institute's training in Nonviolent Interventions Multiple trainings in cultural diversity, de-escalation techniques, workplace safety,first aid, and seclusion/restraints References Please see Resume on file or contact me for updated contact information Amber Frazier 4408 John F Kennedy Pkwy Apt D303 (970) 218-0945 Ft Collins, Co 80525 amber.frazier@northrange.org Education Bachelor of Science, Psychology University of Northern Colorado, Greeley, CO May 2010 GPA: 3.2/4.0 Certifications Certified Addiction Counselor II, Expiration: August 2015,ACB.0007633 CPR, Expiration: January 2015 Experience Behavioral Health Worker: Monitoring, Crisis Stabilization Services,NRBH, Greeley, CO 8/2010-Present • Perform sample collections for drug and alcohol testing; urinalysis, oral swabs, patches, hair follicle, and breathalyzers • Maintain client records related to drug and alcohol testing • Monitor clients taking Antabuse • Collect payments for detox and monitoring services • Reporting monitoring results to requesting agencies Behavioral Health Worker, Crisis Stabilization Services,NRBH, Greeley, CO 8/2010-Present • Complete Detox intakes and discharges • Diagnose Detox charts • Perform one-on-ones for Detox and ATU clients • Check vital signs on Detox clients • Observe clients for fifteen minute checks on the Detox and ATU floors Certified Nurse Assistant, Prospect Park Living Center, EPMC, Estes Park, CO 4/2006-11/2009 • Assisted residence in activities of daily living;patient ratio average of 1:12 • Provided residence with stimulating activities • Documented relevant physical, cognitive and social changes in residence Trainings QMAP-Qualified Medication Administration Person, Expiration: 9/2015 Detox Program Training 4/7-8/2011 CPI Training-Nonviolent Crisis Intervention Training 3/13/2013 Activities Alpha Kappa Psi- international,professional business fraternity Psi Chi- international honor society in psychology • Professional development • Community service • Print Lookup Details Page 1 of 1 Barbera J.Kell Dlea� Executive Director tz ": ` �I .✓ Oeprtment of Regulatory Agenda ti 1P` p„ Lookup Detjil View Licensee Information This serves as primary source verification*of the license. "`Primary source verification:License Information provided by the Colorado Division of Professions and Occupations,established by 24.34.102 C.R.5. Name Public Address Amber Alyse Frazier Fort Collins, CO 80525-3457 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACB.0007633 Original Certified Addiction Active 10/03/2012 09/01/2013 08/31/2015 Counselor II Board/Progam Actions Disdpline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:29:49 PM 11 . . .. . •, .. . ,.. .n....n n,...,..... . • •._. r-si<<",t <tys, ,.,, sr taid1“. z-as.•_Nib t::., Me.. Bradley J. Crookston 3300 Rio Grande Avenue Evans, CO 80620 (970)673-5640 "To Exceed Expectations" Work History (past to present): ➢ Coldstone Creamery 1431 N. Denver Avenue Loveland, CO 80538 Direct Supervisor: Paul Schofield • Date(s) employed: June 2003 —May 2006 • Job Title at Time of Hiring: Crew Member/Wage at Time of Hiring: $6.00/hr. • Job Title at Time of Resignation: Supervisor/Wage at Time of Resignation: $9.50/hr. • Reason for Resignation: Accepted Job Offer at Universal Mechanical Inc. • Description of Duties: Service of customers, opening the store,closing the store, balancing cash register at open and closing times, general cleaning duties, supervision of up to five crew members at one time, as well as the making of ice cream. > Universal Mechanical Inc. 328 S. Link Lane#12 Fort Collins, CO 80524 Direct Supervisor: Heath Morby • Date(s) employed: May 2006—August 2006 • Job Title at Time of Hiring: Crew/Wage at Time of Hiring: $12.00/hr. • Job Title at Time of Resignation: Crew/Wage at Time of Resignation: $12.00/hr. • Reason for Resignation: Traveled to Mexico to serve a mission for The Church of Jesus Christ of Latter-Day Saints • Description of Duties: Assist in the installation of new HVAC units as well as the removal of old HVAC units. This included,but was not limited to: electrical wiring,malting of ventilation duct,& installation of new ventilation duct. > The Church of Jesus Christ of Latter-Day Saints Mexico Southeast Mission Apartado#103 (lo. De Mayo#1319) Veracruz, Veracruz Mexico • Date(s) served: August 2006—June 2007 • Title: Missionary/Wage: n/a(volunteer) • Description of Duties: Learn the Spanish language, proselyte door to door, develop friendships, engage in community service opportunities,baptize and confirm new members. > Whelan Security 6501 South Fiddlers Green Circle#117 Denver, CO 80111 (303)221-4518 Direct Supervisor: Mehdi El Hafiane • Date(s) employed: June 2008 —September 2012 • Job Title at Time of Hiring: Security Officer/Wage at Time of Hiring: $11.00/hr. • Job Title at Time of Resignation: Security Officer Hybrid/Wage at Time of Resignation: $13.50/hr. • Description of Duties: Perform building patrols, report suspicious activity,emergency response,escort janitorial staff, & perform lobby post duties. Perform SCC Operator duties when required, including monitoring of cameras, notification of proper personnel regarding abnormal and emergency situations, coordination of security officers in order to perform required daily shift duties, writing as well as submission of incident reports, issuance of keys to contracted personnel, &coordination of security emergency response.Special Note: In December of 2008 I was promoted to the station of Security Supervisor which I held until December of 2010. I willfully resigned from the position in order to focus on my education at the University of Northern Colorado. During this time I performed the following additional duties: assist the Site Account Manager in the scheduling of the SRO (flex) officer as well as the scheduling of time off requests and the arranging of appropriate coverage. Also, I Supervised a staff of five individuals,this included the recommendation of individuals for awards as well as the disciplinary action of individuals when authorized by the Account Manager. In addition, I led two separate Task Teams of three to four individuals each. These Task Teams included the evaluation and streamlining of forms and documents utilized by the department as well as an evaluation of the current technology deployed by the department. > North Range Behavioral Health CSS 1140 M Street Greeley, CO 80631 (970) 313-1173 Direct Supervisor: Michelle Aragon • Date(s) employed May 2012-July 2012 • Job Title: Student Intern/Wage: n/a(volunteer) • Description of Duties: Client Supervision, Group Counseling assistance and observation,One-on-One interviews with clients, intake/discharge observation, accompany staff on client transports, supervise clients for urine analysis, measuring client's vitals and assist staff as directed. > North Range Behavioral Health CSS 1140 M Street Greeley, CO 80631 (970)313-1173 Direct Supervisor: Stephanie Nielsen • Date(s) Employed: September 2012—Present Day • Job Tide at Time of Hiring: Behavioral Health Worker Current Job Title: Behavioral Health Worker • Description of Duties: Perform monitoring duties, including BA's, UA's,hair follicle samples, sweat patch samples, and corresponding documentation. Facilitate client participation in respective individual treatment plan, by providing emotional support, advocating for the client,and assisting the client in problem solving. Perform on-on-one interviews with clients, intake/discharge of clients from facility, group counseling sessions,transport clients to and from hospitals and other medical or mental health facilities,measure client vitals, assess client withdrawal symptoms, supervise clients for urine analysis, inventory client belongings, ensure client safety,and document client progress during client stay at facility. Education (vast to present): > Loveland High School 920 West 29th Street Loveland, CO 80538 • Date(s)Attended: August 2001 —May 2005 • Degree Awarded: High School Diploma > University of Northern Colorado 501 20th Street Greeley, CO 80631 • Date(s)Attended: August 2005—May 2006 &August 2009—December 2012 • Degree Obtained: Bachelor's Degree of Psychology • Date(s) Attended: May 2013 —Current • Pursuing Master's Degree in Clinical Mental Health Counseling: Couples and Family Therapy Additional Skills & Abilities: > Proficient in the Spanish Language (read, write, and speak) > Goal Oriented > Strong Work Ethic > Skilled in Microsoft Office software programs > Detail Oriented > Punctual > Motivated > Strong Social Skills > Excellent Customer Service Skills > Team Player > Leadership Ability > Tactful > Ability to Learn New Things Quickly & Efficiently Persona!& Professional References: Sam Morris—Manager from 2009 to 2012 Contact Information: (970) 691-9169 Braden Price—Childhood Friend since 1990 Contact Information: (970) 581-8693 Mehdi El Hallam—Co-worker& Supervisor from 2008 to 2012 Contact Information: (720)472-0413 Stephen Schoon—Childhood Friend since 1991 Contact Information: (970) 310-7283 Sean Ronan—Friend from School &Church since 2006 Contact Information: (970) 590-7582 Ben Dennis—Childhood Friend since 1992 Contact Information: (970) 685-2994 *Letters of Recommendation Can Be Provided Upon Request* 1217 11th Ave. Greeley, Colorado 80631 970-347-0068 daniel.ferris@northranae.ora Daniel J. Ferris-Shaw PROFESSIONAL SUMMARY: Behavioral Health Worker with a Bachelors Degree in Psychology/CACII and shift supervisor for North Range Behavioral Health Crisis Stabilization Services for clients for Substance Abuse (Detox)and the mentally Ill (Acute Treatment Unit "ATU.) Monitoring of vital signs,withdrawals from alcohol and other known mind/mood altering substances,counseling, and informing clients of further treatment resources and programs. Handling crisis calls from those who are in crisis or are in need of telephone therapy and knowing when to request a welfare check to be done on those who are a danger to themselves or others. Monitoring the safety of all clients on the unit. Administering drug testing for those in need of breathalyzer,urinalysis testing, alcohol swabs, hair follicle testing,and drug patches. QUALIFCATIONS and CERTIFICATIONS: • Certified in first Aide & CPR • Qualified Medication Assistant Personnel (QMAP) • CPI Seclusion and Restraint certified • Certified Addiction Counselor Level II (CAC II) • Administering medications covered under the QMAP certification • Checking vital signs of clients • Understanding the CIWA/COWS scales for withdrawals for detox clients • Crisis Assessment practice and application • Understanding HIPPA laws and confidentiality • Diagnosing Substance Abuse client charts (Covered under CAC II licensure) • Providing clients with knowledge of available resources and treatment opportunities EDUCATION: University of Northern Colorado Greeley, CO. May 2009 • Bachelors Degree in Psychology AIMS Community College Greeley, CO. December 2005 • Associates in Liberal Arts North Range Behavioral Health Greeley, CO. March 2011 • Certified Addictions Counseling(CAC)Level II • 135 Internship Hours EXPERIENCE • North Range Behavioral Health CSS January 2009-current -Shift Supervisor Promotion: Sept 2010-current • Smoker Friendly Windsor/Greeley/Loveland stores March 2003-April 2009 -Assistant Manager a)Book keeping b)Auditing(inventory counting and calculation) c) Cashier d) Putting in orders e) Calling in orders • Perkins Family Restaurant Greeley, CO. May 2000-July 2001 Print Lookup Details Page 1 of 1 • ,iVtA Barbara 1 Kelley < ; t Executive Director Depnnnentot Reguiatoir t, :, �'^ aa. `, Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License Information provided by the Colorado Division of Professbns and Occupations,established by 24-34-102 C.R.S. Name Public Address Daniel John Ferris-Shaw Greeley, CO 80631-3827 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACB.0007379 Original Certified Addiction Active 03/30/2011 09/01/2013 08/31/2015 Counselor II Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:31:54 PM t..... n . ,. n v . m . .. • •• . .. . ..-.....a ,...- ,.. . Melissa Blatnik 1140 M.Street Greeley,CO 80631 Phone:970-313-1173 Cell:970-590-4280 Melissa.blatnik@northrange.org OBJECTIVE • To provide a quality service for our clients and other service providers. SKILLS • Effectively communicate with staff and clients for a successful outcome In treatment • Supervise staff and delegate tasks sufficiently EXPERIENCE July 2006 until present, North Range Behavioral Health Greeley,CO Behavioral Health Worker • Safety checks every 15 minutes on each client. • Checking clients blood pressure every two hours • Individual counseling • Group counseling Supervisor From February 2006 until present • Administering medications to the clients • Coordinating admissions and discharges of clients • Coordinate placement and transportation with the local hospital staff • Work with the staff to ensure quality of care to the clients EDUCATION • Northern Colorado University,Greeley,CO Bachelor's Degree in Psychology August 2011. • Certified Addictions Counselor III October 2009 REFERENCES Available upon request 3604 l5°Ave F cell(970)405-6906 Evans Col 80620 Rachel Watson Experience Dec 2009-Current North Range Behavioral Health Greeley,Co Program Coordinator • Collaborate with internal and external agencies for client care. • Develop trainings and facilitate training with staff members. • Supervision of staff. • Updating Medicaid authorization to Value Options. 2005-Dec 2009 North Range Behavioral Health/Island Grove Greeley,Co Shift Supervisor • Supervise day shift employees. • Monitor clients by taking vitals and administering medication. • Intakes and discharging of clients. • Responsible of ordering and monitoring services. 2000-2005 Theresa's Tall Giraffe Day Camp Evans,Co Teachers Aid • Responsible for care and wellbeing of children from 2 V2 to 14 years old. • Coordinate and Implement daily actives within the weekly themes. • Coordinate all three centers in the transport of school age children to and from school. 1996-2000 Montgomery Ward Greeley,Co Lead Associate For Men and Children Department • Supervised 5 to 15 employees on cash register and department regulations. • Help insure customer satisfaction while keeping co-worker motivated and on task. • Train and educate all department employees of new policies and procedures concerning our zone of the floor and merchandise inventory. Education 2003-2005 University of Northern Colorado Greeley,Co • Associates of Science through Aims Community College • B.A.,Criminal Justice. • Minor Rehabilitative Services. /2008 July • CAC II certification 2009 October • CACIII QMAP 2013 January • CPR Trained 2013 March • CPI Trained References Will obtain upon request. Print Lookup Details Page 1 of 1 t Barbara J.KeFley # •� Dat ,41 e Executive Director -. , Department yes �Iw � es rw. Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License Information provided by the Colorado Division of Professions and Occupations,established by 24.34-102 C.R,5. Name Public Address Rachel Maria Watson Evans, CO 80620-2027 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACC.0006837 Original Certified Addiction Active 10/13/2009 09/01/2013 08/31/2015 Counselor III Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:33:02 PM Troy Melcher 3333 35st Greeley, CO 80631 (970) 903-8477 melcher.troy@yahoo.com Objective To adequately assist clients through the detoxification process and provide adjacent staff with the assistance necessary for a functional and successful team as a behavioral health worker at North Range Behavioral Health Crisis Stabilization Services Qualification Highlights • Well-developed verbal and written communication skills • High degree of organization • Promotes and adheres to efficiency,professionalism,and accuracy in the workplace • Proficient in Microsoft Word,Microsoft Excel,and Microsoft PowerPoint • Very capable of working alone or with others Education Bachelor of Arts, Psychology Minor: Criminal Justice University of Northern Colorado(UNC), Greeley,CO Graduation Date: December 2012, GPA 3.83/4.0 Master's of Arts,Clinical Counseling University of Northern Colorado Anticipated graduation date: May 2015,GPA 3.73/4.0 Work Experience Bank Teller,Citizens State Bank of Ouray,Silverton,CO(summers of 2009 and 2010) • Managed the debiting and crediting of accounts • Informed customers about bank products and handled phone enquires • Assisted out-of-town customers with banking affairs • Maintained accuracy of cash flow using a double entry bookkeeping format Behavioral Health Worker,North Range Behavioral Health—Crisis Stabilization Services,Greeley, CO(May 2012 -present) • Assist callers using the crisis phone line with de-escalation • Aid detoxification and mental health clients with living in the facility • Conduct one-on-on and group sessions to promote the stabilization process Honors Member,Psi Chi Honor Society(April2011 - December 2012) Recipient,Dean's List(UNC)(2011 -December 2012) President,Golden Key Honor Society(September 2011 -December 2012) AMANDA SPRINGER 1715 30 Ave Ct Residence: 970-353-0340 Greeley,CO 80634 alpenglocreations@comcast.net OBJECTIVE Obtain a challenging role in a behavioral health facility where my strengths in evaluation, communication,relationship development, organization, and use of counseling skills can support the staff in an effort to provide quality care to their clientele. SUMMARY Accomplished professional with experience in evaluation, case management, group facilitation, and counseling in the human services field. Core competencies include diagnostics, intake interviewing, problem solving,treatment planning, and management of crisis situations. Strong team player with the ability to work under intense pressure, completing projects in a timely fashion. Decisive and energetic in nature. SKILLS *Leading People *Problem Solving *Communications *Intake Interviewing *Diagnostics *Rapport Development *Group Facilitation *Organization *Crisis Management SELECTED ACHIEVEMENTS Supervising staff and clients for a combined 16 bed locked facility for the mentally ill and a 23 bed locked facility for those withdrawing from substances. Enhanced the programs by improving one-on-one contact with the clients and developing an assortment of therapeutic group activities. Result: Increased success in the duration of time that numerous clients remained outside of the facility, increased client awareness of symptoms and resources available to them, as well as higher client satisfaction reports. Responded to emergency crisis calls for a 12 county area. Result: Determined where individuals in crisis needed to be placed for appropriate treatment and assisted crisis workers in arranging these placements. Completed assessments for the PASRR-MI and reported to Dual Diagnosis Management in regards to individuals needing placement in a nursing facility. Result: Advocated on the behalf of individuals with mental illnesses in regards to obtaining the best and most appropriate care to meet their present needs. Modified and implemented a behavioral/teaching model to address the behavioral issues of youth at risk. Result: Youth learned acceptable and unacceptable behavior and were unable to manipulate staff as easily when everyone was working under the same model. Taught life skills to individuals with disabilities. Result: Advocated on behalf of individuals and assisted them in finding employment, in addition to teaching skills to assist them in functioning more independently within their communities. PROFESSIONAL EXPERIENCE North Range Behavioral Health, Greeley, CO August 1999-present Program Director September 2006--present Supervise staff in the care of the inpatient population we serve. Review charts and maintenance of records. Problem solve for difficult cases and situations on the unit. Mental Health Therapist October 2004 September 2006 Maintain a brief and chronic therapy model caseload. Responsible for crisis evaluations. Responsible for case management. Responsible for intake evaluations and assignment to appropriate therapy. Mental Health Therapist September 2001—October 2004 Responsible for 16 bed inpatient facility. Supervision of various staff members. Responsible for crisis evaluations. Responsible for treatment and case management. Facilitated group activities. Clinical Care Assistant August 1999—September 2001 Milieu manager responsible for treatment and case management. Responsible for preparation and organization of routine services on the unit. Windsor Middle School,Windsor, CO. January 2003-May 2003 Internship-Middle School Counselor Provided personal and academic counseling to students with diverse needs. Planned and implemented a variety of groups to meet the needs of students. Performed organizational functions in maintaining student records. Assessed reports, surveys, and research. Office of Human Development, Sidney,NE. February 1999-August 1999 Life Skills Assistant Supervised the living environment/behaviors of mentally disabled individuals. Taught useful skills for daily living. Provided one-on-one counseling. LICENSURE State of Colorado-Licensed Professional Counselor License Number 4263 2006. State of Colorado-Certified Addiction Counselor III License Number 7416 2011. EDUCATION M.A. School/Community Counseling. University of Northern Colorado, Greeley, CO. 2003. B.A. Psychology and English. Chadron State College, Chadron,NE. 1998. Print Lookup Details Page 1 of I Barbara J.Kelley t � ; Diva Executive Director -`11,111G_,/ DepartMent dRegl$ay Agencies Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Amanda Kay Springer Greeley, CO 80634-6826 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACC.0007214 Original Certified Addiction Active 05/25/2011 09/01/2013 08/31/2015 Counselor III Board/Proqam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:28:16 PM II n , m .r • n • ...nn. n n...•,n n. • Print Lookup Details Page 1 of 1 tTh i DoraDepartment of Regulatory Agencies - ;, f*-. Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License Information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Amanda Kay Springer Greeley, CO 80634-6826 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date LPC.0004263 Examination Licensed Professional Active 03/29/2006 09/01/2013 08/31/2015 Counselor Board/Progam Actions Discipline There Is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:28:37 PM I. „• • If "n • .. r .. n . fl- .•• n n . . 497 E.20'"Street Phone(970)324-3873 Greeley,CO 80631 Email amc1451cyahoo.com Anna M. Strobridge Education Greeley Central High School August 1984—May 1987 1515 14th Street Greeley, Colorado 80631 (970)348-5000 • Graduated with a 3.0 GM in May of 1987 AIMS Community College September 1999—May 2006 5401 West 20th Street Greeley, Colorado 80634 (970)330-8008 • Graduated in May of 2008 with an Associates of Science In Surgical Technology. • Graduated May 2012 with a Liberal Arts Associates in Criminal Justice. Professional June 1988—June 1990 experience Hardees Downtown 720 10th Street Greeley, Colorado 80631 (970) 352-9522 Crew Leader • Line Cook • Prepare food • Customer Service • Deposits • Open Store June 1990—August 2005 Eastman Kodak Cobrado Windsor, Colorado 80551 (970)686-7611 Production Operator in C-13 • Spooled and packaged movie film • Chopped, inspected, heat sealed, packaged, and palletized X-Ray film products • Shipped product to distribution,and fork truck certified Production Operator In C-29 • Chemical mixing of dye solutions • Shipped and received bulk chemicals • Assisted coating machine in changeovers • Prepared special solutions for experiments • Tested all chemicals and dry products in analytical lab • Looked for defects in the chemical and finished products • Slit finished product into smaller customer usable spools • Prepared all paperwork, labels,and order that rolls should run • Packaged and shipped finished product • Data entry and extraction Kodak Operating Systems Lead • Lead special events with production operators,engineers, management and outside consultants to create more efficient production lines. • Analyzing data from normal operations, make appropriate changes, and produce matrixes to track progression of changes Focus Person • Lead person for 15 operators in the finishing area • Managed and set daily production goals per daily schedules • Delegated work and handled vacations, personal time, sick leave and,time cards • Facilitated production meetings for management • Handled operator,inventory, and product problems • Evaluated operators for promotions,code changes, and raises September 2005—May 2006 Walgreens 1480 Main Street Windsor, Colorado 80550 (970)674-5091 Customer Service Representative • Cashiered • Stocked store and front end caps • Counted tills • Assisted customers with finding,and pricing products May 2006—August 2006 Platte County Memorial Hospital 201 14t Street Wheatland,Wyoming 82201 (307)322-3636 Surgical Technologist • Set up and maintained sterile field before, during and after surgical procedures • Passed instrumentation to surgeons during surgical procedures • Assisted surgeons with retracting • Organized all equipment, instrument trays, and specialty supplies • Oversaw inventory,and ordering supplies for entire operating room September 2006—November 2006 Mckee Medical Center 2000 Boise Avenue Loveland,Colorado 80538 (970)669-4640 Surgical Technologist • Set up and maintained sterile field before, during and after surgical procedures • Passed instrumentation to surgeons during surgical procedures • Assisted surgeons with retracting February 2007—Present North Range Behavioral Health Crisis Stabilization Services 1140 M Street Greeley,Colorado 80634 (970)313-1173 Certified Addictions Counselor 111/Supervisor • Assess and admit clients who are under the influence of alcohol or illegal drugs • Monitor clients for withdraws from alcohol or illegal drugs • Administer Urine Analysis, Breath Analysis, Patches, and Swab tests on clients • Counsel clients on their addictions and offer options for treatment • Hold therapeutic groups for detox and mental health clients. • Transport clients to and from facility. • Work with Weld County Law Enforcement, Weld County Dispatch, and Hospitals in Northern Colorado assisting in bed availability for detox and mental heath clients. • High volume of calls from public needing assistance, answering questions pertaining to clients, facilities, different treatments, bed availability,and crisis calls. • Assist clients with follow up appointments, filling out various types of paperwork for treatment and different assistance programs. • Assisting clients with making calls to various locations for different services • Mediate between clients,and families. • Supervise 6 staff,delegate work load, conduct supervisions with staff, and assist staff with problems. Additional • Microsoft Office Applications professional • Outlook activities • Filing, Faxing, and Multi-line Phones • Type 45 Words Per Minute • Data Entry • CPR Certified Languages • Spanish(Conversation) References Gary Pegg Josie Cano 407 Mapleton Ct. 1917 31°Street Ft Collins, Colorado 80526 Greeley,Colorado 80631 (970)223-4906 (970)371-0829 Known 15 Years Known 4 Years Melissa Bladnik Stephanie Nielson 2815 Longboat Way 3618 Stampede Dr. Ft Collins, Colorado 80524 Evans,Colorado 80620 (970)590-4280 (719)216-7004 Known 7 Years Known 3 Years Regina Rickman 4901 E. Kelton Lane Unit 10197 Scottsdale Arizona 95254 (602)663-8583 Known 3 Years ' Print Lookup Details Page 1 of 1 4• f l , .� Barbara J.KeBeY i: �; °s_ �, Dora Executive Director *�. �crint,�Department of Regulatory Agencies _ I Lookup Detail View Licensee Information This serves as primary source verifications of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address IAnna Martinez Cruz Greeley, CO 80631 Credential Information , License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACC.0006911 Original Certified Addiction Active 03/05/2010 09/01/2013 08/31/2015 Counselor III Board/Prooam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on; 3/17/2014 5:42:38 PM ,....-"fir------- --,_.._ I_ . ..,a. _. n• n , ,.. .Y . .l . •, a I n a..n.n .n..,,nII 3405 16°'street #32 Greeley Colorado PHONE 970 515-2551 BRIDGET REYEZ OBJRCTIVE:To utilize my clinical skills and knowledge of the substance abuse field in order to facilitate recovery and better the lives of others. EMPOLYMENT HISTORY: 6/2006—Current North Range Behavioral Health-Mental Health Worker 5/1997 Current Community Advantage-Direct Care Staff 5/2002 Mosaic—Direct Care Staff EDUCATION: 1994 Aims Community Advantage Associate of Arts 1994 University Of Northern Colorado,Greeley,CO 2013 CAC II Certified Alcohol Counselor JOB RELATED SKILLS: SUBSTANCE ABUSE MONITORING MENTAL HEALTH SERVICES CPR TRAINED SPECAIL NEEDS PEOPLE COMPUTER SKILLS II Print Lookup Details Page 1 of 1 _ r Barbara J.Kelley : Dara v Executive Director /erx.•/ Oepanment d Regmbtmry Agencies _ 'R' a1• xr:.. Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License Information provided by the Colorado Division of Professions and Occupations,established by 24-34.102 C.R.S. Name Public Address Bridget Rene Reyez Greeley, CO 80634-1040 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date ACB.0007750 Original Certified Addiction Active 12/18/2013 12/18/2013 08/31/2015 Counselor II Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/17/2014 5:43:59 PM ._]_f\11I1 C1 0. 9I1111M11 A RESUME Josephine E. Cano December 1978-May 1984: Weld County Sheriff's Office,918 10th Street, Greeley, Co 80631 Supervisor: Edward Jordan,David Shelton 970-356-4010 Duties: Booking area. December 1984-February 2001: Colorado Rural Legal Services, now Colorado Legal Services, 800 8`h Avenue,#202, Greeley, CO 80631 Supervisor: Joel Hayes, Mario Rivera. 970-353-7554 Duties: Legal Secretary/Receptionist/Office Manager for a legal aide office. February 2001-July 2003: The Law Office of Miguel Martinez, 1102 5th Street, Greeley, CO 80631 Supervisor: Angela Saucedo, 970-470-4810 Law firm-w worker's compensation, personal injury, some criminal, immigration,bankruptcy and small portion of civil law cases. I was legal assistant,receptionist,filer, scheduled appointment for attorneys and I ordered supplies. August 2003 to August 2005: Working PT with The Law Office of Dan Trevino, 1122 9th Street, Greeley,Co 80631. Supervisor: Daniel Trevino Temporary Part time Receptionist, answer phone, filing and typing. Computer program use, Word and Best bankruptcy. 2006-to 2008 Island Grove Center, Substance Abuse Adolescent-Adult Outpatient facility. Assist clients,answer phones, put chart together, Collect monies, reconciliation,typing of correspondence,administered BA/UA's.. 2008-to North Range Behavioral Health,Child and family both SA and Mil team until 01/01/11. Support staff for 17 staff, filing, answer phones, registrations, collect monies, reconciliation. 01/03/11 to preset North Range Behavioral CSS SA and MH facility, Detoxing of clients and Acute Treatment Center, put charts together, put info on a roster, sent over to billing at Main, verify Medicaid through the state,collect monies, reconciliation. Filing of documents for charts, ordering supplies @ass this info on to Sarah), transport log documentation(mileage/calls) reporting. Redwood reporting. Trained/Supervised. Monitoring sobriety through UA and BA,Enter daily referral's from outside agencies for monitoring services. Trained and supervised several work study students, and interns since 2008 to present. Bi-lingual Nick White 621 Scotch Pine Dr. • Severance,CO 80550• (970)301-2263 • Nickwco85@yahoo.com EDUCATION: Bachelor of Arts, Psychology 2004-2008 Minor: Sociology Overall GPA 3.0 University of Northern Colorado Greeley, CO 80631 RELEVENT WORK EXPERIENCE: North Range Behavioral Health Crisis Stabilization Services, Greeley, CO 04/2011—Present, Behavioral Health Worker • Responsible for taking vitals every 2 hours and doing 15-minute checks on clients. • Admits clients by gaining all pertinent information, writing it down, placing it in the client's chart and entering into computer system. • Answers the phone, including emergency calls, and responding appropriately. • Transports clients to and from CSS, hospitals, and Weld County Jail. • Talks to clients and makes sure needs are met. • Registers shift notes in the computer system for each client. • Administers UA's and BA's to monitoring clients North Range Behavioral Health, Acute Treatment Unit, Greeley, CO Spring 2008, Intern • Assisted in counseling in one-on-one and group settings. • Helped in the day to day activities such as talking to clients, serving them food and answering any needs the clients had. • Answered phones, including emergency line. Spoke to troubled clients over the phone and helped them work through stressful issues they were experiencing. OTHER WORK EXPERIENCE: Wal-mart, Greeley, CO 04/2010-04/2011, Sales Associate 07/2009-04/2010, Cashier Alamo Liquor, Greeley, CO 03/2008-07/2009, Sales Clerk UNC Holmes Dining Hall,Greeley, CO 04/2005-02/2008,Student Supervisor Rafferty's, Greeley, CO 04/2001-02/2004, Busser SARAH A. VALLEJOS Objective To work within the Crisis Stabilization Services and Monitoring services helping clients through every step of their sobriety and stabilization. Work experience 07-01-08 to present North Range Behavioral Health Greeley CO Behavioral Health Worker I • Intakes of clients who are detoxing or withdrawling from substances. • Participating as a member of the program team to implement an individual care plan for clients in accordance to applicable policies, rules and regulations. • Monitoring of vitals and clients withdrawals while detoxing. • Helping with a treatment plan, and helping write and edit plans as necessary, offering emotional support, resource problem solving and advocate while having interaction with clients as well as referral source. • Looking for treatment facilities for clients with their needs in mind and helping facilitate the necessary communication to get clients into appropriate treatment • Documentation of every step of the process for each client. • Doing monitoring services for Outpatient clients,with all documentation and faxing to appropriate agencies. • Communicate with outside agencies and give reports of monitoring goals • Back-up of emergency lines to include answering the phone and general office duties. • Transport current clients to appointments as requested by Primary Counselor or Case Manger. • Assist Case managers and program directors as needed. 04-16-06 to 6-31-08 Island Grove Regional Treatment Greeley CO Substance Abuse Specialist I Same as above.Companies merged 7/01/2008 Education 1999-2005 Aims Community College Greeley, CO AAS in Early Childhood Education • State Certification of Director in Child Care. Group Lead; Infant/ Toddler; and Preschool; emphasis Certification. Emphasis in Children with disabilities Certification. • CAC I and II level classes complete. • State of Colorado Notary • CPI,CPR, and Q MAP Reference: Available upon request. • • • REBECCA J. WYPERD (970)339-8266 rebecca.wyperd@northrange.org EDUCATION Licensed Professional Counselor State of Colorado licensure#5240 Master of Arts Degree University of Northern Colorado Greeley,Colorado August 2005 • Emphasis in Community Counseling:Marriage and Family Therapy Bachelor of Arts Degree University of Northern Colorado Greeley,Colorado May 2002 • Emphasis in Psychology • EXPERIENCE Program Director:Youth and Family Services,North Range Behavioral Health • Provide clinical and administrative oversight of all programming within the Youth and Family Team totaling 25 staff. o MST&FFT o 180 o MYAT o Substance abuse programming o School Based services o Platte Valley Youth Services Center services o Outpatient mental health services o Youth and Family Connections clinicians P. June 2011 to present Program Coordinator: Child and Family Services,North Range Behavioral Health • Provided clinical and administrative supervision of multiple programs within the Child and Family Team totaling 15 staff. • Initiated constant collaboration between NRBH and partnering agencies to ensure continued program success and development • Tracked program grants,perform audits,billing, formal reporting,and data collection for program sustainability P. November 2010 to June 2011 MST Supervisor,North Range Behavioral Health • Supervised four Multisystemic Therapy clinicians • Held weekly supervision and consultation to maintain model fidelity • Provided oversight of program operations bridging agency directors and team • Maintained link with community stakeholders and ensure sufficient referral flow and program collaboration • Generated billing,perform chart audits and approve reports for court monthly • Collaborated in the development of 180 including programming,policy and procedure,data collection, and agency partnerships P. April 2007 to June 2011 4 Bereavement Counselor,Chrysalis Grief Center;Greeley,Colorado • Held an individual and family counseling case load of up to forty • Facilitated bereavement groups and day trips • Responded to organizations in the community after a death • Received supervision in art,sand tray and play therapy • Maintained client records appropriate with agency policy and ethics • Participated in daily running of the center,planning,and fundraising > September 2005 to March 2007 Mental Health Therapist,Acute Treatment Unit,North Range Behavioral Health • Worked with up to sixteen,persistently mentally ill,inpatients at a time • Initiated intake,case management,counseling,monitoring,and discharge • Collaborated with nurse and psychiatrist on treatment planning • Maintained daily treatment records for multiple clients • Responded to the after hours emergency phone line for three counties > August 2004 to May 2005 Victim Advocate,Greeley Police Department,Greeley,Colorado • Volunteered a minimum of forty eight hours a month to victims of crime • Responded first to the scene and initiated crisis and trauma debriefing • Assisted victims with restraining orders,court,counseling,and resources • Attended group meetings and seminars for further training > July 2003 to September 2006 Enrichment Director,Frontier Academy,Greeley,Colorado • Directed enrichment program for fifty school-aged students • Assisted kids with academic,social,and emotional issues • Initiated licensure for the program • Monitored two employees during tutoring • Assembled financial books and updated them weekly > August 1998 to May 2004 • Professional references available upon request Print Lookup Details Page 1 of 1 eDoraBarbara J.I(elleya �t Executive Director b.\ tat ' Deperanent or Regulatory Agenda% �.•. '1r cow Lookup Detail View Licensee Information This serves as primary source verification*of the license. *Primary source verification:License information provided by the Colorado Division of Professions and Occupations,established by 24-34-102 C.R.S. Name Public Address Rebecca Jean Wyperd Greeley, CO 80634 Credential Information License License License Original Issue Effective Expiration Number Method License Type Status Date Date Date LPC.0005240 Examination Licensed Professional Active 04/29/2009 09/01/2013 08/31/2015 Counselor Board/Progam Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 3/14/2014 12:38:55 PM Rachel G. Yearous 1094 Mahogany Way (970)580-2990 Severance,CO 80550 r_grace_p@hotmail.com EDUCATION Masters of Social Work June 2008 University of Denver,Denver,CO Bachelor of Arts May 2005 Colorado State University,Fort Collins,CO Major: Sociology,Concentration:Criminal Justice,Second Major: Psychology EXPERIENCE IN HUMAN SERVICES FIELD Multi-systemic Supervisor August 2011-Present North Range Behavioral Health,Greeley,CO Provide clinical supervision to MST therapists related to their caseloads and the MST model. Coordinate with internal and external supportive services to assist families in obtaining services. Multi-systemic Therapist August 2008—August 2011 North Range Behavioral Health,Greeley,CO Provided in home family therapy and case management for families who have youth that are at risk of being removed from their homes related to delinquent behaviors. Clinical Care Coordinator Intern September 2007-May 2008 Mountain Crest Behavioral Healthcare Center,Fort Collins,CO Provided brief supportive therapy and case management,as part of an interdisciplinary team,for adolescents and adults hospitalized on inpatient units. Counselor I,Step Wise May 2007-November 2007 Arapahoe House,Inc.,Thornton,CO Provided milieu management,group facilitation,and crisis intervention for co-ed adolescents in a residential substance abuse treatment program. Residential Counselor December 2006-March 2007 Namaqua Center,Loveland,CO Provided milieu management and crisis intervention in a residential program for children 3-12 dealing with abuse,trauma,and severe emotional disturbances. Intern,Step Wise September 2006-May 2007 Arapahoe House,Inc.,Thornton,CO Provided individual counseling,group facilitation,and crisis intervention for co-ed adolescents in a residential substance abuse treatment program. Correctional Service Worker March 2005-August 2006 Larimer County Community Corrections,Fort Collins,CO Supervised and monitored clients placed under a court ordered custody in a residential halfway house and the community. CERTIFICATIONS Currently obtaining hours for Licensed Clinical Social Worker credentials I Chad Reznicek,MA, LPC 3918 Heatherwood Circle Johnstown, CO 90534 Home 970-667-7045 chadrez@yahoo.com Education Master of Arts in Art Therapy,November,2000 Southwestern College, Santa Fe,NM Bachelor of Arts in Psychology, May 1997 Bachelor of Fine Arts in Studio Art,May 1997 Hastings College, Hastings,NE Professional Work Experience North Range Behavioral Health; Greeley CO,July 2012 to Present Multi-Systemic Therapist • Conduct MST assessment including review of referral information, identifying and engaging key participants,identifying systemic strengths and weaknesses, and developing an analysis of the fit of problem behaviors within the ecological context. • Engage primary caregiver and other key participants in active change- oriented treatment by identifying and overcoming barriers to engagement. • Implement a problem conceptualization,treatment planning, intervention implementation, outcome review and strategy revision procedure using the MST Analytic Process. • Maintain clear and concise documentation of treatment efforts that promote peer and supervisory review and feedback,and that demonstrate compliance with the nine MST Principles and the MST Analytic Process. • Collaborate with all relevant systems and key participants within each system to ensure their buy-in and cooperation throughout MST treatment. • Provide direct clinical treatment using methods compatible with MST principles and practices. • Participate in all MST training,supervision and consultation activities. TeamBuilders Counseling Services; Las Vegas,NM September 2009 to June 2012 Multi-Systemic Therapy Supervisor • Responsible for starting up and providing clinical oversight for two MST teams in Las Vegas and Taos,NM. • Worked with community stakeholders including probation,judiciary, schools,and mental health providers to secure and maintain referral sources and collaborative relationships. • Provided weekly supervision on each case. • Worked closely with MST consultant to ensure fidelity to clinical model. • Developed and maintained clinician development plans for each therapist. • Conducted referral screening and assessments • Monitored and evaluated employee and programs workflow using knowledge of business/administrative functions,program requirements and mandated performance standards. • Directed work activities of employee's ensuring a high level of performance and compliance with County,State and Federal rules and regulations. Juvenile Community Corrections Supervisor • Responsible for starting up a life skills program to serve adjudicated adolescents. • Provided staff training and development in model implementation • Conducted assessment,service plan development and oversight of interventions. • Provided ongoing collaboration with a multi-disciplinary team and community stakeholders. • Presented training topics at annual conference Staff Developer • Provided twice monthly trainings to paraprofessionals and clinical staff on state required topics ranging from crisis intervention to communication skills. Rancho Valmora; 81 Bed Adolescent Residential Treatment Program; Valmora,NM Assistant Administrator Aug,2003 to Aug, 2009 • Responsible for clinical oversight andprogrammatic lication of the g application therapeutic model. • Developed and continued to refine programmatic training protocols for crisis intervention and sexual abuse awareness and prevention. • Provided on-going staff development training and supervision for all departments responsible for child care including licensed professionals,paraprofessionals and education staff. Authored a wide range of training material related to clinical interventions,parental skill development,treatment planning,and aftercare contracts. • Responsible for all aspects of recruitment, hiring,disciplinary actions,and terminations.Implemented and monitored staff disciplinary actions to promote adherence to policy or to best ensure minimized unemployment claims for terminations. • Initiated, led,and supervised internal investigations including a high profile physical abuse situation involving agency staff. Coordinated with community agencies for external investigations. Worked with referral sources and community agencies to ensure absolute credibility in the investigation while maintaining overall agency reputation. • Provided public relations services,crisis management,and mediation during conflicted relationships with families or referral sources; attended national networking conferences;and assisted in student recruitment involving touring/educating potential families. • Actively participated in program evaluation and planning, proactive and positively preparing for program changes,changes in funding projections and improve operational efficiencies by learning and understanding best practices. • Was contracted to visit and consult with a sister facility to provide guidance on risk management and immediately address and provide direct training to reduce aggression and safety concerns. Group Leader/Therapist Aug, 2001 to 2009 • Provided group,individual and family therapy for student caseload. • Provided weekly parental updates and training. • Maintained collaborative relationships with educational consultants(referral sources). • Developed and coordinated treatment strategies to be implemented across a multidisciplinary team. • Responsible for upkeep and timely completion of all relevant clinical documentation. • Worked closely with educators to align treatment and academic goals as a cross over between treatment plans and IEPs. • Aftercare planning involving coordination of community resources across the United States. The Recovery of Alcoholics Program,Santa Fe,NM Inpatient Therapist March, 2001 to Aug 2001 • Primary therapist for adults in residential substance abuse treatment. • Provided individualized therapeutic interventions related to co-occuring mental health, legal problems,and substance abuse issues. • Conducted assessments: Addiction Severity Index, Substance Abuse Subtle Screening Inventory,Beck Inventory,and numerous projective drawing assessments. • Facilitated individual,group,family therapy; along with individual,group, family,and multi-family art therapy. • Additional responsibilities included:treatment planning,case management, coordination of services with referral agencies,aftercare planning and follow up assessment. Intensive Outpatient Coordinator May 2000-Mar 2001 • Developed an TOP program to serve the needs of adjudicated incarcerated adults with substance abuse problems. • Coordinated all services for an average caseload of 20 clients attending the outpatient day program. • Conducted intakes,assessments,placement analysis,case management,and treatment planning. • Facilitated individual,group, and family therapy sessions. • Worked collaboratively with community agencies including:criminal justice, public defenders,district attorneys,judges,and community corrections. • STATE OF COLORADO Department of Regulatory Agencies Division of Professions and Occupations Active PRINTED ON SECURE PAPE LPC • LPC.0000624 09/01/2013 08/31)2015 Number Issue Date Expire Date Chad Edward Reznicek Las Vegas NM 87701-103e Division Director rgnaWre 7 Danielle R. Critten, MA 2214 Owens Avenue#202 I Fort Collins,Colorado 80528 1660-663-7083 crit2005@bears.unco.edu Objective: Currently seeking a full-time position in a clinical setting where my experience in behavioral health, psychological research,and problem-solving skills can be used to their full potential. EDUCATION: Certification: Certified Rehabilitation Counselor,valid until May 2018 Eligible for LPC licensure pending required supervision. University of Northern Colorado,Greeley,Colorado Major: Rehabilitation Counseling Master of Arts in Rehabilitation Counseling:May 2013 Major GPA: 4.00/4.00 University of Missouri,Columbia,Missouri Major:Psychology Bachelor of Arts in Psychology:December 2010 Major CFA:3.73/4.00 Major.Sociology Bachelor of Arts in Sociology:December 2010 Major GPA: 3.47/4.00 Total Cumulative: 3.36/4.00 CLINICAL EXPERIENCE: Spirit Crossing Clubhouse,Touchstone Health Partners,Fort Collins,Colorado Jan 2013-May 2013 Clinical raduate Internship • Assist adults with serious mental illness with employment through vocational counseling and supported employment services. • Provide emotional and social support. • Create case notes for client goals,action plans,and vocational counseling sessions. • Develop wellness activities and lead wellness groups. • Develop and organize a client reach-out program,record data,and correlate reach-out data with client statistics(average daily attendance,etc.) Mark T.I Starr Adult Day Care and Respite Center,Lakewood,Colorado Volunteer Oct 2011-Dec 2012 • Instruct adults with developmental disabilities in reading skills and other academic tasks. • Record each participant's progress in the reading program. • Collaborate with other team members and parents about participants' progress. 1 II • Fulton State Hospital(FSH),Fulton,Missouri May 2010-June 2011 Intern at Forensic Psychiatric Facility • Close observation in nationally-recognized Social Learning Program including: o Client-staff interactions in order to improve communication skills with a population whose primary diagnosis is schizophrenia. o Clinical staff delivering various group therapies such as: Illness Management Sr Recovery,Social Skills,Goal Setting,Relationships Effectiveness,Stress Management,Conversation Skills,and Continued Recovery Substance Abuse Program. • Interact with clients promote the development of social skills during informal interaction and other activity sessions. • Attend weekly team/case management meetings which involve evaluation of client progress and discussion of client goals. Mid-Missouri Crisis Hotline and Deafline,Columbia,Missouri Jan 2010-Jul 2010 Volunteer • Attend crisis line and deaf line in order to counsel those in immediate crisis in the surrounding community. • Provide counseling and referral service to the deaf community. RES : TALElegion 8,University of Northern Colorado,Greeley,Colorado Jan 2011 -Dec 2012 Graduate Research Assistant,Paid • Conduct research and develop curriculum and materials for continuing education credits for rehabilitation counselors in the participating six-state region. • Provide training and assist continuing education specialists with projects as assigned. Fulton State Hospital(FSH),Fulton,Missouri Nov 2009-Jan 2011 Research Assistant,Paid • Assist with project conducted by the University Of Missouri's Department Of Psychiatry focusing on client's aggressive and self-harm behaviors associated with restraint and seclusion use in mental health institutions. • Code data from clients'institutional reports and assessments. • Collaborate with other research assistants and supervisors regarding research progress,inter-rater reliability reports,and future research-related topics. University of Missouri,Columbia,Missouri Jan 2008-Jan 2011 ResearchLAssistant, Volunteer • Investigate cognitive and emotional control in schizophrenia. :•• b' • Analyze data using SPSS software and independently graph and interpret results. • Code disorganized speech of individuals with schizophrenia using the Communication Disturbances Index. • Transcribe therapy sessions of clients from Fulton State Hospital. PUBLICATIONS: In Press: Critten, D.,Bezyak,J., &Fried,J.The importance of positive client-staff interactions in inpatient psychiatric rehabilitation programs. Journal of Applied Rehabilitation Counseling. RELEVANT TRAINING: Supervised Counseling Practicum,December 2012 Social Learning Program Training, 2011 Suicide Prevention Training,2010 ACADEMIC AWARDS: University of Missouri Dean's List:Fall 2008-December 2010 UNCO Graduate School Universal Scholarship recipient: 2011-present OTHER SKILLS: Excel irk:interpersonal communications,case management, professional development,collaboration with other professionals,and quick adaptation to any professional environment Computer:Slab,Excel,Access,PowerPoint,Windows 98/XP/Vista,Photoshop,any agency-specific case-management programs,file system,etc. f Maggie VanDenBerg,M.S. PHONE:303.668.6588 EMAIL: maytiee van lcnbcrgid'vahtw.can OBJECTIVE I have many years of unique experience working with youth and families,and have recently completed my Masters degree in Marriage and Family Therapy.My primary goal is to work for a vibrant,innovative agency where I can take my skills to the next level. PROFILE Interpersonal Skills • Friendly and outgoing personality that allows people to feel appreciated,comfortable and welcome • Clinical experience with diverse populations,including adults and children experiencing physical and/or mental disabilities • Excellent communication skills with children,youth,and adults(both written and verbal) Work Attitudes • Strong clinical skills with adolescents,families,couples and individuals,emphasizing a compassionate and strength batted approach • Strong work ethic • Able to work independently,multi-task,and manage time effectively • Able to accurately assess needs,design solutions and resolve problems • Flexible,quick learning and efficient at crisis intervention and problem solving EXPERIENCE Marriage and Family Therapist Intern,Boardwalk Therapy Center and Center for Family and Couple Therapy,Fort Collins,COI January,2011 -July,2012 Intern at private practice office and community based psychotherapy clinic.Provided psychotherapy,family therapy and play therapy to children,youth,adults,and families.Primarily clinical issues included trauma recovery,marriage and family conflict,abuse and neglect,and transgender and sexual orientation.Duties included clinical assessment,coordination of care,and developing and completing required paperwork and documentation. Campus Corps Count Instructor Colorado State University, Fort Collins,CO January,2011 —May,2012 Primary instructor for undergraduate service learning course where approximately 30 students individually mentored at-risk youth.Duties included training and supervising students while participants engaged in pro-social activities and academic tutoring.Involved clinical assessment of substance use,health and safety concerns and crisis intervention,including mandatory reporting when applicable.Communicated with families and referral sources.Gained training in motivational interviewing and supervised undergraduate students in the method. Research and Teaching Assistant Colorado State University, Fort Collins,CO August,2010—May,2012 Worked as research assistant on teen sex education intervention project doing data management and entry.Served as a teaching assistant for several undergraduate courses.Duties included grading papers,teaching for instructor when needed,and meeting with students regarding course related issues.Received specialized training as a Writing Graduate Assistant,and provided students with support regarding the development of their writing in a Psychology 100 level course. Program Coordinator Cannel Community Living Corp., Boulder,CO January,2008-August,2009 Coordinate the residential living situations for adults with developmental disabilities.Duties include developing programs with clients and providers that foster learning opportunities and facilitate independence,supervising approximately 16 provider*,and ensuring all aspects of client care is individualized and executed with a high quality of care. Interviewer Project Bloom,Aurora,CO May,2007-August,2008 Ev !nation position involving interviewing participants in Project Bloom about the quality of care their child and family is re iving through a federally funded initiative. Required home visitation and ability to adapt and conduct interviews in chaotic home environments. Our WholelLives Facilitator First Unitarian Society of Denver, Denver,CO August,2006—June,2007 Volunteer position of teaching a research-based,comprehensive sex education curriculum to youth ages 12 thru 14. Worked as part of the education team with three other facilitators.Trained and certified to teach the 8-month curriculum. Consultant National Technical Assistance Partnership. Pittsburgh,PA and Sarasota,Fl January,2006-June,2006 Served as a youth-Involvement specialist to two emerging System of Care sites handed by SAMHSA.Provided information and consultation on developing and implementing youth involvement in their System of Care sites. Office Manager Federation of Families for Children's Mental Health, CO Chapter, Denver,CO Oct 2004-Sept 2006 Duties included managing/assisting accounting and financial procedures,maintaining database,maintaining office space,and assisting supervisor with various duties and responsibilities. Youth Coordinator,Federation of Families for Children's Mental Health, CO Chapter,Denver February 2003—March,2004 Organizing,educating,and advocating for youth involvement within the Federation of Families and Project BLOOM, an early childhood initiative within four counties of Colorado.Job duties included supervising youth(ages II to I8),providing training opitortunities for both youth and adults on the topic of youth involvement within System of Care and enabling youth to have their voice heard about their involvement and opinion within the mental health system. Paraprofepsional,Prairie Crossing Elementary School, Parker,CO September 2002—May 2003 Supervising on the playground and in the lunchroom;clerical work;working individually with children to assist in reading development,mathematics,etc.;assisting and substituting in the Special Ed Department working with special needs children. Child Care Worker/Respite Provider, Various individual families 1995-Present Cared for the children(infant to 14 years)of more than twelve families in the states of Pennsylvania and Colorado. Specialized in providing care for special needs children,including developmentally disabled,mental health issues,and at-risk. EDUCATION • MS in Human Development and Family Studies,Marriage and Family Therapy at Colorado State University, Graduated August,2012 with a 3.8 GPA • BA in Human Development with a Minor and Certification in Non-Profit Management at Metropolitan State College of Denver,Graduated December,2007 with a 3.4 GPA • Chaparral High School,Graduated May,2002 • Extensive training in multiple modalities of therapy including but not limited to motivational interviewing,trauma and the neurobiological effects of childhood trauma,play therapy with families and children,and issues in sexuality. • Certified to teach Our Whole Lives,a comprehensive research-based sexuality curriculum for grades 7-12. • Proficient in Microsoft Office Programs PUBLICATIONS AND PRESENTATIONS • VanDenBerg,M,2012.Protective Factors for Teen Mothers:Relations among Social Support,Psychological Resources,and Child-Rearing Practices.Masters Thesis Defense and Publication. • Hurst,D,VanDenBerg M,2006.Predictors of Adolescent Sexuality.Presented at the Tenth Annual Undergraduate Psychology Conference,Metropolitan State College of Denver,May 3. • Hurst,D,VanDenBerg,M,2006.Predictors of Adolescent Sexuality.Presented at the Conference on Human Development,Louisville Kentucky,April 30. • Hdgan,L,VanDenBerg M,2006.Portraits of Human Sexuality.Video Handbook.Metropolitan State College of Denver. • VanDenBerg,M 2004.News'mental illness series appreciated.Editorial.Rocky Mountain News,January 29. • Lape S,Matarese M,Payton O,VanDenBerg M,2004.Youth Involvement Understanding the Revolution.Presented at the San Antonio Systems of Care Conference,January 12. • Davidon S,Hill R,VanDenBerg M,2004.What do Youth Think of This?Presented at San Antonio Systems of Care Conference,January 15. • Dalvidon S,Grimsley M,VanDenBerg M,2003.Youth Involvement in Project BLOOM.Presented at the Federation of Families for Children's Mental Health National Conference,Washington D.C.November 23. PERSONAL INFORMATION • Unmarried and no children • interests include hiking,camping,kayaking,animals,reading,knitting,and traveling • Colorado resident for over 12 years II Sarah Hansen 6612 Avondale Rd. D3 Fort Collins,CO 80525 303-330-2606 sarjrun@gmail.com North Range Behavioral Health Greeley, CO 2007-2009 Multisystemic Therapist • Provided in home therapy to youth age 11-17 at risk of out of home placement and their caregivers. • Worked intensively with caregivers to put them in control and supported the child in decreasing behaviors that are putting them at risk. • Collaborated with community stakeholders in supporting youth and family. • Available for on call crisis management to families 24 hours a day,seven days a week. • Developed and monitored service plans with continued assessment of crisis intervention. • Attended court,school meetings and probation meetings to provide feedback on case progress. The University of Chicago Office of Undergraduate Student Housing, Chicago,IL 2003-2006 Resident Head • Lived in a co-ed residential hall and was responsible for fostering a community atmosphere by organizing trips, hosting study breaks, facilitating committee meetings among students and dining with students. • Implemented housing system policies,completed administrative paper work and was ebcpected to be present and on call throughout the academic year. • Counseled students through emotional, educational and psychological challenges. • Supervised up to 6 student workers and 1 assistant resident head. Baby Ph. D Daycare Chicago IL 2002-2005 Childcare Professional • Worked collaboratively with staff and teachers in a home based daycare setting to provide a safe and stimulating learning environment for children ages 4 months-7 years. • Planned and led art, music and educational activities. • Responsible for the safety,care and wellbeing of up to 8 children at a time. Volunteers of America Chicago,IL 2001-2002 Child Welfare Worker • Responsible for providing services and managing caseload of 20 children and adolescents in the inner city foster care system. • Performed monthly visits to child's home and school as well as coordinated sibling visits. • Worked intensely with foster parents to ensure child was getting all his/her needs met and also offered support to the foster parents in any difficulties they were experiencing. • Identified and set up resources to fit the child's needs. • Attended court on a regular basis to represent child and express my thoughts as to what would be in the child's best interests. • Participated in weekly meetings with supervisor to discuss difficult cases. - . .. Sekyernaan High School Mampang, Ghana 2000-2001 Volunteer Teacher • Developed and studied innovative and stimulating teaching techniques to teach youth age 13-17 English and Geography in an environment with limited resources. • Encouraged students to understand the importance of their education and where it could take them. • Designed and presented an HIV/AIDS presentation to help educate students and also traveled nearby villages to present. St. Cloud Hospital Adolescent Mental Health Unit.St. Cloud, MN 2000-2001 Behavioral Health Associate • Worked with a team to provide patient care for children and adolescents age 8-17 on a locked unit. • Performed 1:1 observations on high risk patients and acquired intervention skills essential in crisis situations. • Offered crisis counseling for youth experiencing mental illness and/or addictions. • Planned and facilitated small group discussions and activities. • Offered input in meetings with psychiatrists,social workers, nurses and other staff in patient's care. Also received daily supervision with supervisor who was the charge nurse. • Responsible for daily charting and reports to provide ongoing patient progress. aANORTHoRAL HEALTH RANGE March 18, 2014 Tobi Vegter Core and Service Contract Coordinator Service Utilization Unit Weld County Department of Human Services P.O. Box A 315 A N. 11th Avenue Greeley, CO 80632 Re: I Bid No. 81400069 Functional Family Therapy proposal Multisystemic Therapy proposal Dear Ms. Vegter: The intent of this letter is to address the qualification requirement set forth in the above- referenced bid of familiarity with Trauma Informed Care. The following Youth and Family Services program staff attended the Integrative Treatment of Complex Trauma for Adolescents presented by John Briere, Ph.D. and Cheryl Lanktree, Ph.D. on February 18 and 19, 2014: Susan Stone Jennifer Wallace Rachel Yearous Chad Reznicek Maggie Vandenberg Danielle Critten Sarah Hansen As of this writing, attendees have not received the requested documentation of participation in the training as evidenced by the attached correspondence. If you have any questions, please feel free to contact me. Sincer@ly, Susan E. R. Stone, M.A., LMFT Administrative Director I Children, Youth, Family & Prevention Enclosure Where hope begins. PY-14-15-CPS-0094 EXHIBIT C SCOPE OF SERVICES 1. Contractor will provide Anger Management and Domestic Violence Services and Monitored Sobriety Services to individuals,as referred by the Department. 2. Anger Management/Domestic Violence: Contractor will provide Anger Management and Domestic Violence services to males and females, 18 years and older,at 1260 H Street,in Greeley. ' a. Services will be provided at the North Range Behavioral Health Adult Outpatient facility, located at 1260 H Street, in Greeley,CO. b. All services will be provided by academically qualified and/or licensed Domestic Violence Offender Management Board(DVOMB)approved staff. c. Contractor will provide the following services under this contract: Anger Management • Group Process and Skills (Minimum 20 Weeks of Treatment) • Cognitive-Behavioral Skills • Passive,Aggressive and Assertive Domestic Violence Behaviors (Length of treatment will comply with • Victim Empathy Domestic Violence Offender management • Treatment Goals Board (DVOMB)regulations based on • Substance Abuse • Stages of Change placement criteria for treatment levels A,B or • Parenting C.) Track(level)is determined by assessment • Men's Issues/Women's Issues(as DVOMB approved screening tools. Tracks are applicable) as follows: • Effects on Children (DV only) • Steps to Problem Solving - Track A: One(1)group session per • Steps to Conflict Resolution week. Minimum of two(2) • Characteristics of Assaultive Adults treatment plan reviews taking place • Attitudes Toward the Opposite Sex every 2-3 months,depending on • Sex Role Training progress on the required Core • Socio-cultural Basis for Violence Competencies(see below). • Provocation - Track B: One(1)group session per • Appropriate Containment and Expressions of Anger week and one(1)additional contact • Experiencing Emotions and Feelings per month. Minimum of three(3) Beyond Anger treatment plan reviews taking place • Grief and Loss every 2-3 months,depending upon • Depression and Anxiety progress on the required Core • Stress Management Competencies(see below). • Relapse/Recidivism Prevention - Track C: One(1)group session per • Healthy Relationships week and one(1)additional contact • Sexuality per week. Minimum of three(3) • Spirituality treatment plan reviews taking place • Resources every 2-3 months,depending upon progress on the required Core 1 PY-14-15-CPS-0094 Competencies(see below). Additional contacts will be in a group or individual setting depending on the clinical need. Core Competencies(per DVOMB regulations): A. Commitment to eliminate abusive behavior. B. Personal Change Plan work. Demonstrate change. C. Complete the Personal Change Plan Worksheet. D. Recognize and demonstrate empathy. E. Accept full responsibility for the offense and abusive history. F. Identify and reduce pattern of power and control behaviors,beliefs and attitudes of entitlement. G. Accountable for abusive behaviors, accept consequences,take steps to reconciliation to prevent future abusive behaviors. H. Accept that abusive behavior should have and has consequences. I. Participate and cooperate in treatment. J. Ability to define types of DV. K. Understand, identify and manage own pattern of violence. L. Understand intergenerational effects of violence. M. Understand and use healthy communication skills. N. Understand and use time outs. O. Recognize financial responsibilities as required. P. No new violence or abusive offences. Q. Prohibited from purchasing, possessing,or using firearms and ammunition. 2 PY-14-15-CPS-0094 d. Anger Management and Domestic Violence Intakes will be completed with recommendations before the client is placed into treatment. The intake will determine the best placement for the client in regards to treatment,which may include group session and/or individual sessions. CONTRACTOR will provide a copy of the intake to the caseworker. e. Individual sessions may be determined necessary at intake but will only be utilized under one or more of the following circumstances: • The referred client's individual treatment needs cannot be adequately addressed in a group setting. • The client is not currently appropriate for a group setting and requires a limited number of individual sessions to prepare for a group setting. • The client's job requirements make it impossible to attend regularly scheduled group sessions and individual sessions are the only option for the client to comply with their treatment plan. • When assessed for a DV track in which an additional contact is required. f. If the client is assessed at a higher level of care than what is offered by CONTRACTOR,a recommendation to an agency that offers that level will be made. g. Contractor will comply with the Colorado Domestic Violence Offender Management Board's Standards and Guidelines. 3. Monitored Sobriety Services: Contractor will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: a. Contractor will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: b. Services will be provided at the North Range Behavioral Health Crisis Stabilization Services facility in Greeley,CO,at 1140 M Street,or in Fort Lupton,CO,at 145 ft Street. c. Contractor will provide a qualified monitored sobriety collector 24 hours a day/seven(7)days a week at the Greeley site. At the Fort Lupton site,the Contractor will provide a qualified monitored sobriety collector Monday thru Thursday,9:00 a.m.-12:00 p.m.and 1:00 p.m.to 4:30 p.m.for Urinalysis Testing;and 8:00 a.m.-12:00 p.m.and 1:00 p.m.-7:00 p.m.for Breathalyzer Testing. On Fridays, Urinalysis Testing will be available 9:00 a.m.-12:00 p.m.and Breathalyzer Testing will be available 8:00 a.m.-12:00 p.m.and 1:00 p.m.-S:00 p.m. Services are not available in Fort Lupton on Saturdays and Sundays. d. Contractor will confirm all positive and negative Breathalyzer monitored sobriety results within 24 hours through a phone call,test result,e-mail and/or fax to the referring caseworker. e. Contractor will confirm all positive and negative laboratory Urinalysis results will be confirmed once processing has occurred through Redwood Toxicology(usually within three days). Confirmation will occur through a phone call,test result,e-mail and/or fax to the referring caseworker. f. Contractor will report all positive and negative Instant Urinalysis results within 24 hours. If the result is positive,it will be sent to Redwood for final confirmation. Confirmation will occur through a phone call,test result,e-mail and/or fax to the referring caseworker. 3 PY-14-15-CPS-0094 g. Contractor will submit a copy of the valid Authorization for Services form, result and client sign-in sheet(if applicable)with each monthly billing. h. All processed(laboratory)test results will be available online 24 hours per day,seven (7) days per week online at Redwood Toxicology(www.webtoxicoloev.com). 4. Contractor will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). Contractor will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the Contractor will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 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 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. 9. Contractor understands that the Department will not reimburse Contractor for"no shows"or cancelled appointments,either on the part of the client or the Contractor. 10. 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. 4 PY-14-15-CPS-0094 EXHIBIT D PAYMENT 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 specified 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 31,2015. Expenses incurred by the Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement,whether in whole or in part,is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds,or any part thereof,become unavailable as determined by the Department,the Department may immediately terminate the Agreement or amend it accordingly. 2. fees for Services Anger Management/Domestic Violence Evaluation and Treatment: $200.00/Episode(Anger Management or Domestic Violence Evaluation) $25.00/Hour(Group Session) $17.50/15 Minutes(Individual Session) Monitored Sobriety: $20.00/Episode(Urinalysis 5 Panel:THC,Coacaine,Amphetamines,Benzodiazepines,Opiates) $20.00/Episode(Urinalysis 7 Panel: THC,Coacaine,Amphetamines, Benzodiazepines,Opiates, Barbiturates,Alcohol) $20.00/Episode(Urinalysis—Multi-Panel Instant) $20.00/Episode(Instant Swab) $35.00/Episode(GCMS—Confirmation of Positive Result) $5.00/Episode(Breathalyzer) $100.00/Episode(Hair Testing) $50.00/Episode(Patch Monitoring) $50.00/Episode(Urinalysis—Expanded Designer Stimulants 14-Panel) $35.00/Episode(Ethyl Glucuronide/EtG Test Only) $35.00/Episode(Urinalysis-3 Panel: MDPV,Mephedrone, Methylone) $35.00/Episode(Urinalysis—Synthetic Cannabinoids"Spice") $35.00/Episode(Oral Swab—Synthetic Cannabinoids"Spice") $2.00/Episode(Urinalysis—Single Panel EtG Add-on Test with Urinalysis 5-Panel or 7-Panel) $2.00/Episode(Urinalysis—Add-on Panel for Oxycodone or Buprenorphrine,with a Urinalysis 5-Panel or 7-Panel) 1 PV-14-15-CPS-0094 Contractor may not attempt to collect co-pays and/or fees for services for which a Department client is responsible,but which a particular client refuses or fails to pay. Contractor will collect any applicable sliding scale co-pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers Contractor shall prepare and submit monthly an itemized voucher,and signed monthly report if applicable,certifying that services authorized were provided on the date(s)indicated and the charges made were pursuant to the terms and conditions of Paragraph 3 and Exhibit A. Contractor shall submit all monthly billings and applicable reports to the Department by the 7`"day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. 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. b. For one-time services, proof of services rendered shall be receipt of the completed product. c. For Monitored Sobriety services, proof of services rendered shall be the test result. 2 -1 ligir 1 NUN I Ill UP ILA: UP A ORn CERTIFICATE OF LIABILITY INSURANCE D07/01/2014ATE Y) onovzola THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER MichaelMichael J Schmitt CIC Rich&Cartmlll Ins of CO PHONE 970-.•56$030 FAIT of Colorado LLC (A/C.No.ENU: __ (we,No 970.358-8032__ 8213 W.20th Street ENROL D R A Ess; --- Greeley,CO 80634 INSURER(SI AFFOROINO COVERAGE NAIL Y —_ Michael J Schmitt CIC INSURER A:Philadelphia Insurance Co 23850 INSURED North Range Behavioral Health INSURER B:Pinnace)Assurance 1300 N 17th Avenue INSURER e:Lloyds of London Greeley,CO 80631 INSURER O: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT.TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS. LTR TYPE OF INSURANCE (NIP WUD POLICY NUMBER Y) RAWDONYEXPM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -- DAMAGE TO RENTED A X,COMMERCIAL GENERAL LIABILITY X PHPK1200226 07/01/2014 07/01/2016 PResse smarm,) s 1,000,000 CUIMS-MADE X I OCCUR MED EXP(Any one person) S _— 20,000 X Professional Liab PERSONAL 8 ADV INJURY $ 1,000,000 X HIPAA Inc) GENERAL AGGREGATE s 3,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPAP AGO S 3.000,00q I POLicy 1-1 ?& DO LOc Emp A 1,000,000 AUTOMOBILE uAaILRY COMBED D SINGLE LIMIT S 1,000,000 A X ANY AUTO PHPK1200226 07/01/2014 07/01/2015 BODILY INJURY(P.r P«wr) $ ALL OWNED SCHEDULED BODILY INJURY(PA.ccld.M) $ AUTOS _ AUTOSNON-O PROPERTY DAMAGE HIRED AUTOS AUTOS (PER ACCIDENT] S S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 5 2,000,000 A EXCESSUAB CLASISMADE PHU8466313 07/01/2014 07/01/2015 AGGREGATE A 2,000,000 DED I X I RETENTIONS 10,000 $ -WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LAM& TORY!IMITS B ANY PROPRIETORPARTNERIEXECUTNE Yn 4044331 07/01/2014 07/01/2015 E.L.EACH ACCIDENT 5 _ 100,000 OFFICEWMEMBER EXCLUDED? ' I NIA (MAgalory In NH) EL.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION *Nato wider DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 600,000 C Privacy UCS2669550.14 07/01/2014 07/01/2015 Each 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES WWII ACORD 101,AdMSon.l Roma*,SCINdSt N more spay is required) State of Colorado is listed as additional insured as pertains to the general Liability policy, per written contract. CERTIFICATE HOLDER CANCELLATION WEL-HUM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN Weld Coun Department of ACCORDANCE WITH THE POLICY PROVISIONS. Human Se cos 315 N 11th ve AUTNORIZEOREPRESENTATNE Greeley,CO'80631 Michael J Schmitt CIC 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Hello