HomeMy WebLinkAboutbocc.res.111.2016 CONTRACT l 3 D��
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS
OF PITKIN COUNTY, COLORADO
TO APPROVE THE THREE YEAR CORE SERVICES PLAN
(SFY 2016-2019)
(RESOLUTION NO. /7/ -2016
1. In 1991, Article 5.5 was enacted to create the Colorado Family Preservation Act.
Although the program is defined in State statutes as Family Preservation,the program is
referenced in Colorado Department of Human Services (CDHS) Section 7.303 (12 CCR
2509-4)as Core Services.
2. The Board of County Commissioners desires to continue preserving safe and stable
families by utilizing Core Services funding for the provision of life skills support
services,home based services,interpretation services and therapeutic services.
NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Pitkin
County,Colorado to approve the Three Year Core Services Plan(SFY 2016-2019)and
authorizes the Chair or the Director of Health and Human services to sign the agreement on
behalf of the County and further, authorization for the Director of Health and Human services to
sign all future amendments to the Core Services PIan with approval of such by the county
manager.
INTRODUCED,READ AND ADOPTED ON THE /y DAY „ _ „
2016. /
A S : BOARD OF COUNTY COMMISSIONERS
By .41 Lt B : C
Je. E-tte Jones / Rachel E. Richards, hair
De ty County Cle
Date: O —aVI jo
APPROVED AS TO FORM: MANAGER APPROVAL
John gly,Coun orney J acock, County Manager
CONTRACT#-3C -5-26((-
ATI AC H ME IVT-
CORE
VrCORE SERVICES PROGRAM
FIRST OF A THREE-YEAR PL *vicar COLOR AD (
CO Office of Children
SFY 2016 - 2017 Youths Families
DiChild Welfare
S FY 2017 - 2018
SFY 2018 - 2019
FOR
Pitkin COUNTY(IES)
Please complete signature page, all corresponding Core Services
Plan and budget pages, and then submit the original hard copy
for approval.
RECEIVE 1
C61-15 COLORADO OCT 17 2016
CO i Office of Children,
Youth Et Families BY: -_.,.
Division of Child Walrate
Ann M. Rosales,MSW, Director
October 7, 2016
Nan Sundeen, Director
Pitkin County Health and Human Services
0405 Castle Creek Road, Suite#204
Aspen, CO 81611
RE: SFY 2016-2017 Core Services Program Allocation
Dear Ms. Sundeen,
This tetter is sent to advise you of your SFY 2016-2017 Core Services Program funding approval. In addition, the
letter will identify changes, if applicable, that need to be made to the Core Services Annual Plan in order for the
plan to gain full approval.
Core Services Program funds are to be used for the prevention of out-of-home placement of children, to reunite
children in out-of-home placement with their permanent families, and/or to prevent further involvement in child
welfare. The Core Services Program allocation may not be used to fund the costs of out-of-home placement.
The funds allocated among the Core Services 80/20 and 100%programs can be shifted across services throughout
the year at the discretion of the county, as long as the shift remains below 20%of the total plan amount. If the
amount meets or exceeds 20%of the total plan amount, the county must notify the State in writing of the intent to
shift funds. Core Services Program funding is the payer of last resort. Counties will not be reimbursed if other
funding sources are available per COHS Volume 7, 7.414(8)(3).
Funds allocated to Special Economic Assistance, Mental Health Services, and Substance Abuse Treatment may be
directed to other Core Services Programs.
The Core Services Program Plan is for SFY'S 2017-2019, a three-year plan; however, a Communication will be sent
each fiscal year indicating any Core Services Program funding changes. Additionally, each Core Service County
Design Program needs to be submitted annually per CDHS Volume 7, 7.401.12(E).
There are no additional Core Services Program funds for any submitted Core II Plan at this time.
The following are approved Core Services Program funds for your county:
Approved Funds Available/Source
$21,103- 80/20
S38,988-- 100%
$906- 100%SEA
Regional- 100%Mental Health
Regional- 100%Substance Abuse
Any available Core Services Program funds for the delivery of Program Area Three(PA3)services
�"',�'pF C�tO 1
;575 Sherman Street,2-id Floor,Denver,CO 80203 F 303.866.5932 F 3003.866.5563 www.cotoraeo.gov/cdhs "ucfarj
John W.Nickentooper,,Governor Regg'e Bicha,Executive Director +��'+ %)*,
.+/g8
4 • ,,p,_+ 4
Plan Approvals
Ho Core Services Program Plan correction needed, Your SFY 2016-2017 Core Services Program Plan is
approved.
Please accept our approval of your intent to implement Program Area Three(PA3)for Core Services Program
funding. Information will be provided as the Trails Automated System changes and enhancements for Program Area
Three (PA3) evolve.
Technical Assistance
For questions regarding billing throug i the Traits or CFMS systems, please contact the Help Desk at 303.866.5204
or 1.877.487.4871,
For questions regarding allocations, Core Services Program plan amendments or extensions, please contact Melinda
Cox at 303.866.5962.
Sincerely.
7X•ka
Ann M. Rosales, MSVI, Director
Division of Child Welfare
Cc: County Core Services Coordinator
Sandy Eckerman
1575 Sherman Street,2nd Floor, Denver,CO 80203 P 303.8665932 F 303.8665563 www.coiorado.govtcdhs Nz:
John W, Nickenlooper,Governor i Reggie 8icha, Executive Director *
'18764
REQUEST FOR STATE APPROVAL OF PLAN
Since this is the second of a the three-year Core Services Plan, this page needs to be signed by a Core
Service Program county representative.
This Core Services Plan is hereby submitted for Pitkin
[Indicate county name(s) and lead county if this is a multi-county plan], for the period contract years
June 1, 2016, through May 31, 2017, fiscal years July 1, 2016, through June 30, 2017. The Plan includes
the following:
• Completed "Statement of Assurances";
• Completed Statement of the eight (8) required Core services to be provided or
purchased; a list of county optional services, County Designed Program Services
(indicate Evidenced Based Services to Adolescents Awarded County Designed
Programs), to be provided or purchased;
• Completed program description of each proposed"County Designed Service";
• Completed'Information on Fees"form;
• Completed "Reunification Issues"form;
• Completed"Direct Service Delivery"form;
• Completed"Purchase of Service Delivery"form;
• Completed"Projected Outcomes"form;
• Completed"Overhead Cost"form;
• Completed"Final Budget Page"form;
• Completed"State Board Summary"; and,
• Completed "100%Funding Summary"form.
This Core Services Program Plan has been developed in accordance with State Department of Human
Services rules and is hereby submitted to the Colorado Department of Human Services, Division of Child
Welfare for approval. If the enclosed proposed Core Services Program Plan is approved, the Plan will be
administered in conformity with its provisions and the provisions of State Department rules.
The person who wilt act as primary contact person for the Core Services Plan is, Kim DuBois,Manager
Adult and Family Services, Pitkin County and can be reached at telephone number(970)429-2043,
and e-mail at kim.duboisrPoitkincounty.com. If two or more counties propose this plan, the required
signatures below are to be completed by each county, as appropriate. Please attach an additional
signature page as needed.
6/1 h U- /pc r /-1q7aoito
Signature, DIRECTOR,COUNTY DEPARTMEtfr OF HUMAN/SOCIAL SERVICES DATE
Signature, CHAIR, PLACEMENT ALTERNATIVES COMMISSION DATE
Sig ature, CHAIR, BOAR of COUNTY COMMJSSION.E5s DATE
4•C G Sr n a✓ ,c.� uef
,G1✓
Please check here if your county does not have a Placement Alternative Commission: Eg
2
CORE SERVICES
STATEMENT OF ASSURANCES
Pitkin County(ies) assures that, upon approval of the Core Services Program Plan the following will be
adhered to in the implementation of the Plan:
Core Services Assurances:
• Operation will conform to the provisions of the Plan;
• Operation will conform to State rules;
• Core Services Program Services, provided or purchased, will be accessible to
children and their families who meet the eligibility criteria set forth in Rule
Manual Volume 7, at 7.303.13;
• Operation will not discriminate against any individual on the basis of race, sex,
national origin, religion, age or mental/physical disability who applies for or
receives services through the Core Services program;
• Services will recognize and support cultural and religious background and
customs of children and their families;
• Out-of-state travel wilt not be paid for with Core Services funds;
• All forms used in the completion of the Core Services Plan will be State
prescribed or State approved forms;
• Core FTE/Personal Services costs authorized for reimbursement by the State
Department will be used only to provide Core Services authorized in the
county(les)'approved Core Services Plan;
• The purchase of services will be in conformity with State purchase of service
rules including contract form,content,and monitoring requirements; and
• Information regarding services purchased or provided will be reported to the
State Department for program, statistical and financial purposes.
• All providers of Core Services (through purchase of service contracts and county
staff providing direct delivery of services) must be registered with the Colorado
Department of Regulatory Agencies (DORA). The provision of Life Skills is the
only exception to this mandate.
3
CORE SERVICES TO BE PROVIDED/PURCHASED
Place an "X" to indicate which of the following Core Services Program Services will be
provided/purchased:
X Home Based Intervention
X Intensive Family Therapy
Sexual Abuse Treatment Services
_ Day Treatment
X Life Skills
Spedat Economic Assistance
X Mental Health Services (Regional Contract, Garfield County Adminstrator)
X Substance Abuse Treatment Services (Regional Contract, Garfield County Administrator)
List below "County Designed Service" that will be provided/purchase. Please indicate which, if any, of
the County Designed Service are provided through the Evidenced Based Services to Adolescents
earmarked funding:
Trauma Informed Care/Services
Child Mentoring,Family Support,Coaching
Funding for Evidenced Based Services to Adolescents
If the county received funding for evidenced based services to adolescents, and is requesting the
funding to continue to receive the same funding for the same expansion or created of the evidenced
based county designed program to adolescents, please indicate that above, as well as on the Core Plan under
County Designed.
4
CORE SERVICES COUNTY DESIGNED SERVICE
Service Name: Purchase of Service: Trauma Informed Practices/Non-traditional Therapies
Optional services approved as a part of the county's Core Services Plan are approved on an annual basis.
For a County Designed Service to be extended beyond one year, this portion of the plan must be
submitted and approved annually by the State Department.
Given that County Designed programs are not standardized across counties, it is important to provide
detailed information as outlined below. The information listed below is to be completed for each County
Designed Service and included in the County(les)' Core Services Program Plan.
County Designed Service, Purchase of Service-Trauma Informed Care/Services:
We provide options for specialized approaches/therapies utilizing integrative/non-traditional healing
therapeutic approaches to address grief, loss and trauma experienced by children and families in the child
welfare system. (Some listed below but we plan to expand our provider network).
Music therapy
Yoga therapy
Mindfulness therapy
Art Therapy
Dance Therapy
Equine Therapy
Children, parents and families in our community have been limited by traditional "talk therapy"
that often occurs in an office setting. While this approach is effective for some,we do not believe that this
is not the most effective approach for children and families who experience significant grief, loss and
trauma. Our goal is to broaden options for them. Pitkin and Eagle County would like to contract with
various service providers who employ a non-traditional therapeutic approach to work with children and
families. This is available for all ages and the time frame of the service is anywhere between 8-12 sessions
depending on recommendations made in Family Meetings, Support Planning Meetings, or through Program
Area 3 coordination and/or ISST meetings. We prioritize the highest risk families so that we can maximize
benefits of these non-traditional therapies. This is listed under "Trauma informed Care/Services in Trails.
We have several purchase of service, contracted providers. All service providers are listed and costs are
anywhere between 50-100/per session/episode.
County Designed Purchase of Service-Child Mentoring,Family Support,Coaching
This program serves families and children ages 0-18 and is designed to be a flexible service to meet the
individual needs of a family with the goal to keep children with their family of origin or in a family setting.
Coaches provide intensive services to children and families in their homes, providing families with strategies
to improve the current level of functioning and decrease negative behaviors.They serve as a positive rote
model for families to observe and learn socially effective values, attitudes and behaviors. The focus of the
Coaching program is to provide parents with the skills to draw on strengths in an effort to improve parenting
and family functioning.Coaches provide one on one teaching and advocacy to youth and families in order to
avoid placement disruptions and address issues being presented by the identified client. Coaches are
responsible for helping families establish links with viable community resources. This service interfaces with
social workers,juvenile probation officers,school counselors,and various community based agencies.
5
INFORMATION ON CORE SERVICE FEES
Please check all that apply:
X Fees will not be assessed for Core Services Program Services.
If above tine is checked, STOP. Remainder of information does not need to be completed.
Fees will be assessed for the following services:Check those that apply:
Home Based Intervention
Intensive Family Therapy
Life Skills
Day Treatment
Sexual Abuse Treatment
County Designed Service(List Services Below)
Special Economic Assistance
Mental Health Services
Substance Abuse Treatment Services
Fee assessment formula is the same for all services. State the formula here (attach additional
sheets as needed).
Fee assessment formula varies with service. State formula used for each service (attach
additional sheets as needed).
6
HOME BASED INTERVENTION SERVICES
DIRECT SERVICE DELIVERY- CORE SERVICES PROGRAM
CFMS - Function Code 1700, 1800
Definition
7.303.1 D Home Based Intervention: Services provided primarily in the home of the client and includes 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.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in
part. Include only amounts that are to be charged to Core Services. Staff positions to be included are County Core Services employee positions
and employee contract positions. Core Services Providers must be registered with DORA.
1 2 3 4 5 6 7 8 9 10 11 12 13 I
Position Job Title Gross Monthly Monthly Monthly Percent Percent Percent of Percent Total Number Total
Number Monthly Fringe Travel Operate of of Salary Salary of Salary Monthly of Direct
Salary Salary Funded Funded by Funded Direct Months Service
Funded by TANF, FSS, by Service of Cost Cost
by 100% Other County Cost
80/20 1800 (Circle alt Block (3+4+5+6)
1700 that apply)
Caseworker 4900 900 300 5% 6% .89% 6100 12 8052
i
TOTAL 8052
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,8).
7
INTENSIVE FAMILY THERAPY
DIRECT SERVICE DELIVERY- CORE SERVICES PROGRAM
CFMS- Function Codes 1710, 1810
Definition
7.303.1 E Intensive Family Therapy: Therapeutic intervention typically with all family members to improve family communication,
functioning, and relationships.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or In
part. Include only amounts that are to be charged to Core Services. Staff positions to be included are County Core Services employee positions
and employee contract positions. Core Services Providers must be registered with DORA.
1 23 4 5 6 7 9 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent Percent Percent of Percent of Total Number of Total
Number Monthly Fringe Travel Operate of Salary of Salary Salary Salary Monthly Months Direct
Salary Funded Funded Funded by Funded by Direct of Cost Service
by 80/20 by 100x6 TAMP, County Service Cost
1700 1800 FSS, Other Block Cost
(Circle all (3+4+5+6)
that
aPPly)
TOTAL
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,B).
8
LIFE SKILLS
DIRECT SERVICE DELIVERY-CORE SERVICES PROGRAM
CFMS- Function Codes 1720, 1820
Definition
7.303.1 F Life Skills: Services provided primarily In the home that teach household management, effectively accessing community
resources, parenting techniques, and family conflict management.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in
part. Include only amounts that are to be charged to Core Services. Staff positions to be included are County Core Services employee positions
and employee contract positions.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent Percent Percent of Percent of Total Number of Total
Number Monthly Fringe Travel Operate of Salary of Salary Salary Salary Monthly Months of Direct
Salary Funded Funded Funded by Funded by Direct Cost Service
by 80/20 by 100% TANF, County Service Cost
1700 1800 F55,Other Block Cost
(Circle all (3+4+5+6)
that
apply)
Case Aide 3,750 900 200 300 10% 10% 80% 5,150 12 12,380
Supervisor 5,800 900 1% 1% 98% 6,700 12 1,608
TOTAL 13,968
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7,at 7.414,B).
9
DAY TREATMENT
DIRECT SERVICE DELIVERY- CORE SERVICES PROGRAM
CFMS- Function Codes 1730, 1830
Definition
7.303.1 C Day Treatment: Comprehensive, highly structured services that provide therapy and education for children.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in
part. Include only amounts that are to be charged to Core Services. Staff positions to be included are County Core Services employee positions
and employee contract positions. Core Services Providers must be registered with DORA.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent Percent Percent of Percent of Total Number of Total
Number Monthly Fringe Travel Operate of Salary of Salary Salary Salary Monthly Months of Direct
Salary Funded Funded Funded by Funded by Direct Cost Service
by 80/20 by 100% TANF, County Service Cost
1700 1800 FSS, Other Block Cost
(Circle all (3+4+5+6)
that
apply/
TOTAL
Core Services Program expenditures wilt not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,13).
10
SEXUAL ABUSE TREATMENT SERVICES
DIRECT SERVICE DELIVERY -CORE SERVICES PROGRAM
CFMS - Function Codes 1740, 1840
Definition
7.303.1 H Sexual Abuse Treatment: Therapeutic intervention designed to address issues and behaviors related to sexual abuse
victimization sexual dysfunction, sexual abuse perpetration,and to prevent further sexual abuse and victimization.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in
part. Include only amounts that are to be charged to Core Services. Staff positions to be included are County Core Services employee
equivalent positions and employee contract positions. Core Services Providers must be registered with DORA.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent Percent Percent of Percent of Total Number of Total
Number Monthly Fringe Travel Operate of Salary of Salary Salary Salary Monthly Months of Direct
Salary Funded Funded Funded by Funded by Direct Cost Service
by 80/20 by 100% TANF, County Service Cost
1700 1800 F55, Other Block Cost
(Circle all (3+4+5+6)
that
apply)
TOTAL
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,B).
II
COUNTY DESIGNED SERVICE
DIRECT SERVICE DELIVERY - CORE SERVICES PROGRAM
CFMS - Function Codes 17 , 18_
Definition
7.3011 B County Designed Services: innovative and/or otherwise unavailable service proposed by a county that meets the goals of the
Core Services Program.
Indicate information for each line service worker and his/her immediate supervisor for whom Core Services funding is proposed in whole or in
part. Include only amounts that are to be charged to Core Services. Staff positions to be included are County Core Services employee positions
and employee contract positions. Core Services Providers must be registered with DORA.
1 2 3 4 5 6 7 8 9 10 11 12 13
Position Job Title Gross Monthly Monthly Monthly Percent Percent Percent of Percent of Total Number of Total
Number Monthly Fringe Travel Operate of Salary of Salary Salary Salary Monthly Months of Direct
Salary Funded Funded Funded by Funded by Direct Cost Service
by 80/20 by 100% TANF, County Service Cost
1700 1800 FSS, Other Block Cost
(Circle all (3+4+5+6)
that apply
I
TOTAL
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,B).
12
HOME BASED INTERVENTION SERVICE
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS - Function Code 1700, 1800
Indicate information for each Trails provider from whom Core services are proposed to be purchased. Core Services Providers must be
registered with DORA.
1 2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract Contract of Units Rate per Month of Per Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
80/20 100% TANF, FSS, Service/ Service of Cost
Other Month
(Circle all
that apply)
Family Visitor's Program 71441 2,000 1,840 4/Daily 120 480 8 3.840
1
TOTAL 3,840
Identification of unit is: II- Hourly, D it Daily, W=Weekly, M o Monthly, E=Episode
Core Services Program expenditures wilt not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,8).
13
INTENSIVE FAMILY THERAPY
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS- Function Code 1710, 1810
Indicate information for each Trails provider from whom Core services are proposed to be purchased.Core Services Providers must be
registered with DORA.
1 2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract Contract of Units Rate per Month of Per Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
80/20 100% TANF,FSS, Service Service of Cost
Other /Month
(Circle all
that apply)
Joel Karr 30658 1,200 2,000 8/Hourly 100 800 4 3,200
TOTAL 3,200
Identification of unit is: H=Hourly, D-Daily,W=Weekly, M=Monthly, E= Episode
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,B).
14
LIFE SKILLS
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS- Function Code 1720, 1820
Indicate information for each Trails provider from whom Core services are proposed to be purchased.
1 2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost Per
Resource/Provider Contract Contract Contract of Units Rate per Month of Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
80/20 100% TANF, FSS, Service Service of Cost
Other /Month
(Circle all
that apply)
David Perez 1681805 659.23 4,371.98 988.10 12.5 40 500.00 12 5,031.90
(Hourly)
TOTAL 5.0391.90
Identification of unit is: H=Hourly, D=Daily,W-Weekly,M a Monthly,E=Episode
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,8).
15
DAY TREATMENT
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS - Function Code 1730, 1830
Indicate information for each Trails provider from whom Core services are proposed to be purchased. Core Services Providers must be
registered with DORA.
2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost Per
Resource/Provider Contract Contract Contract of Units Rate per Month of Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
80/20 100% TANF, FSS, Service Service of Cost
Other /Month
(Circle alt
that apply)
TOTAL
Identification of unit is: H=Hourly, D=Daily, W=Weekly,M R Monthly, E= Episode
Core Services Program expenditures wilt not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,B).
16
SEXUAL ABUSE TREATMENT
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS - Function Code 1740, 1840
Indicate information for each Traits provider from whom Core services are proposed to be purchased. Core Services Providers must be
registered with DORA.
2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost Per
Resource/Provid&r Contract Contract Contract of Units Rate per Month of Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
80/20 100% TANF, FSS, Service/ Service of Cost
Other Month
(Circle all
that apply)
TOTAL
Identification of unit is: H=Hourly, 0=Daily,W=Weekly,M=Monthly, E- Episode
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,B).
17
SPECIAL ECONOMIC ASSISTANCE
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS - Function Code 1754, 1755, 1854, 1855
Indicate information for each Trails provider from whom Core services are proposed to be purchased. Core Services Providers must be
registered with DORA.
2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost Per
Resource/Provider Contract Contract Contract of Units Rate per Month of Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
80/20 100% TANF, FSS, Service Service of Cost
Other /Month
(Circle all
that apply)
L
TOTAL
Identification of unit is: H= Hourly, D=Daily, W=Weekly, M=Monthly, E= Episode
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,8).
18
MENTAL HEALTH SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS - Function Code 1745, 1845
Indicate information for each Trails provider from whom Core services are proposed to be purchased. Core Services Providers must be
registered with DORA.
2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract Contract of Units Rate per Month of Per Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
80/20 100% TANF, FSS, Service/ Service of Cost
Other Month
• (Circle all
that apply)
Garfield County, 45023
Administrator
Regional Contract
TOTAL
Identification of unit is: H a Hourly, 0 m Daily,W=Weekly,M Monthly, E=Episode
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,8).
19
SUBSTANCE ABUSE TREATMENT SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
CFMS - Function Code 1750, 1850
Indicate information for each Traits provider from whom Core services are proposed to be purchased. Core Services Providers must be
registered with DORA.
2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract Contract of Units Rate per Month of Per Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
{ 80/20 100% TANF, FSS, Service Service of Cost
Other /Month
(Circle all
that apply)
Garfield County, 45023
Administrator
Regional Contract
I _
TOTAL
Identification of unit is: H= Hourly, D- Daily,W=Weekly,M e Monthly, E=Episode
Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,8).
20
COUNTY DESIGNED SERVICES
PURCHASE OF SERVICE
CORE SERVICES PROGRAM
Indicate information for each Trails provider from whom Core services are proposed to be purchased. Core Services Providers must be
registered with DORA.
2 3 4 5 6 7 8 9 10
PROVIDER NAME Trails Amount of Amount of Amount of Number Payment Cost Per Number Total Cost
Resource/Provider Contract Contract Contract of Units Rate per Month of Per Provider
Number Funded by Funded by Funded by of Unit of (6 x7) Months (8 x 9)
80/20 100% TANF, FSS, Service/ Service of Cost
Other Month
(Circle alt
that apply)
Mack Bailey 1659384 1000 5000 4/Hourly 125 500 12 6000
Kym Allison New Contract 1600 4/Hourly 100 400 4 1600
Max Mancini New Contract 1400 3400 4/Hourly 100 400 12 4800
Jennifer Shumacher New Contract 1400 3400 4/Hourly 100 400 12 4800
Susan Mount 1668411 1200 2/Hourly 100 200 6 1200
Daniel Panzarella 1886819 4000 4/Hourly 100 400 10 4000
Soaring Spirits New Contract 800 4/Hourly 50 200 4 800
Windwalkers 1553905 800 4/Hourly 50 200 4 800
Visiting Angels 1651490 2000 10/Hourly 50 500 4 2000
TOTAL 27.600
Identification of unit is: H=Hourly, D=Daily,W=Weekly,M e Monthly, E= Episode
Core Services Program expenditures wilt not be reimbursed when the expenditures may be reimbursed by some other source. (Set forth in Rule Manual
Volume 7, at 7.414,8).
21
CORE SERVICES PROGRAM
OVERHEAD COST for CORE SERVICES STAFF
**"OPTIONAL PAGE•ONLY USE IF YOUR COUNTY WISHES TO CLAIM OVERHEAD COSTS'*`
1. DIRECT SERVICE
A. Total Core Services salary/Fringe/Travel/Operating Costs of Line
Core Service Workers and their Immediate Supervisors
B. Formula Percentage Allowed for Overhead Costs 15%
C. Provided Service Overhead Costs(A X B)
2. PURCHASED SERVICE
A. Purchased Service Dollar Amount
B. Formula Percentage Allowed for Overhead Costs
SO-50,000 =5% $50,001 -100,000=4.9%
For each$50,000(in total expenditure)increase the overhead
decreases by.1 %.
C. Allowed Amount for Overhead Costs(A X B)
D. Base Overhead Cost Allowed $500.00
E. Purchased Service Overhead Costs(C+D)
3. TOTAL OVERHEAD COSTS(1C+2E1
DISTRIBUTION OF OVERHEAD COSTS AMONG SERVICES"
SERVICE Provided Service Purchased Service Total Overhead
Overhead Costs Overhead Costs Costs
1. Home Based Intervention
2. Intensive Family Therapy
3.Sexual Abuse Treatment
4. Day Treatment
5. Life Skills
b. County Designed Service
COLUMN TOTALS
•Formula to determine overhead cost by service:
Step 1: total provided service cost (by service)x 15%is provided service overhead cost
Step 2: total purchased service cost(by service)x%listed in 2B=Y
$500 divided by the number of purchased service=2, then Y+ Z=overhead cost
Step 3: Provided service overhead cost plus purchased service overhead cost equals total overhead cost.
STATE BOARD SUMMARY
CORE SERVICES PROGRAM
FY 2016-2017 80/20 FUNDING
COUNTY(IES)
Services Resource/Provider or #of b Children Cost per Child Cost per Year
Number of FTE Age of Child Families Served Per Per Month
Served Per Month
Month
Life skills, Direct 0-18 2 4 72.75 6,984
HBIS,Direct .11 FTE, Pitkin DSS 0-18 4 6 50.83 3,660
HBIS, POS Family Visitors Program 0-18 2 2 83.33 2,000
IFT, POS Joel Karr 0-18 1 2 50 1,200
County Design,POS Various 0-18 4 8 91.6 6,600
Life Skills, POS David Perez 0-18 3 6 9.15 659.23
TOTAL 80/20 CORE 21,103.23
26
100% FUNDING SUMMARY
CORE SERVICE PROGRAM
FY 2016-2017
COUNTY(IES) Pitkin
Services Resource/Provide It of Families II Children Cost per Child Cost per Year
r or Age of Served Per Served Per per Month
Number of FTE Child Month Month
Life Skills, Direct 0-18 2 4 145.5 6,984
11BIS, Direct 0-18 4 6 61 4392
I-IBIS, POS 0-18 2 2 76.6 1840
IFT, P05 0-18 1 2 83.33 2000
County Design, POS 0-18 4 8 202.08 19,400
Life skills, P05 0-18 3 6 60.70 4,371
SEA 0-18 1 3 301.83 905.52
TOTAL 100%CORE_60,966.70
27
FINAL BUDGET PAGE
FY 2016'-2017
CORE SERVICES PROGRAM
CFMS Service Name Other DSS Other Total Total Funds Total FSS TOTAL
Function Funds Source Funds 100%(Core, SEA, Funds FUNDS
Code (SpecifyA Funds 80/20 Substance Mental
fund (Specify 1700 Health)
source) Fund
source) 1800
1 1720/1820 Life Skills, Direct Service 6,984 6,984 13,968
1700/1800 IBIS, Direct Service 3660 4392 8052
HBIS, POS 2000 1840 3,840
IFT, POS 1,200 2,000 3,200
Life Skills, POS 659.23 4,371.96 5,031.19
County Designed, POS 6,600 19,400 26,000
SEA 905.51 905.51
TOTALS 21,103.23 38,987.96 60,996.70
CFMS Function Codes 17xx denotes 80/20 funded Core Service
CFMS Function Codes 18xx denotes 100%funded Core Service
CFMS Functions Codes for Family Stability Services will be determined by funding source. Please contact Melinda Cox at 303.866.5962 for more
information.
28
1_..,....__ COM,' COLORADO
COIN TO
e Office of Children,
Youth b Families
Dwtstcncf Chdd We lare
Program Area Three PA3 -
Prevention and Intervention
Services Plan
Please submit if applying for CDHS funding sources per
Volume 7.200.1, 7.200.11 and 7.200.12.
1
Pitkin COUNTY(IES)
Prevention Intervention Service Delivery using:
Please check all that apply:
❑ Child Welfare Block Funding
o Collaborative Management Funding
o Core Services Program Funding
❑ County Only Funds
o Promoting Safe and Stable Families Program
Funding (if your county is an approved PSSF site)
❑ Parental Fee Funding
o SSA/SSI Trust Funds
❑ TANF Block Grant Funding
For Core Services Funding Only:
Program Area Three (PA3): Prevention and Intervention Services TO BE PROVIDED/PURCHASED
Place an "X" to indicate which of the following Services will be provided/purchased in accordance with State Department
rules:
X Home Based Intervention
Intensive Family Therapy
Sexual Abuse Treatment Services
Day Treatment
X Life Skills
Special Economic Assistance
Mental Health Services
Substance Abuse Treatment Services
List below "County Designed Service" that will be provided/purchased in accordance with State Department rules.
Trauma Informed Care/Services
� 2
Program Area Three (PA3): Prevention and Intervention Services
COUNTY DIRECTLY PROVIDED SERVICES SUMMARY ,
SFY 2016-2017
COUNTY(iES) Pitkin
Services Position Number of FTE Number of Number of Cost per Child Cost per Year
Age Range Families Served Children Per Month
of Child/ Per Month Served Per
children Month
CD-Trauma Informed, POS 4 4 68.75 3,300.00
Homebased, POS and DS Various/.2 FTE QHS 0.18 3 2 _ 112.5 2,700.00
Ufe Skills, POS and DS Various/.1 FTE OHS 0-18 3 3 83.3 3,000.00
TOTAL 9,000.00
rd
1
).
1
1
Y.
Program Area Three (PA3): Prevention and Intervention Services
FINAL BUDGET PAGE - SFY2017
Service Name Service Provider PA3 PA3 PA3 Funding Total Funds Total Funds TOTAL
Funding Funding Source: 80/20 100% FUNDS
Source: Source:
CWB: CWB:�
Core:_XCore:_X_
Trauma Informed, CD Various 300.00 3000.00 3300.00
Life Skills, DS/POS Various 700.00 2000.00 2700.00
Home based, DS/POS Various 3000.00 3000.00 '
,:
TOTAL 9000.00
,