No preview available
HomeMy WebLinkAboutC17-337 Colorado Department of Human ServicesMEMORANDUM OF UNDERSTANDING The State of Colorado Department of Human Services And The Board of County Commissioners or other elected governing body of Eagle County(ies), Colorado This Memorandum of Understanding (or "MDU") is made this 09/26/2017 between the State of Colorado Department of Human Services (the "CDHS") and the Board of County Commissioners or other elected governing body of Eagle County(ies), Colorado (the "County"). CDHS is the sole state agency with the responsibility to administer or supervise the administration of the human services programs listed in CRS 25-1-201. The Colorado General Assembly enacted SB 13-231 in response to the CDHS being granted waiver authority by the United States Department of Health and Human Services, Administration for Children and Families, under Section 1130 of the Social Security Act, which authorizes states to conduct demonstration projects which are determined to promote the objectives of parts B or E of Title IV of the Social Security Act. A copy of the waiver terms and conditions are attached to this MDU as Exhibit A. CRS 25-5-105.4 requires CDHS and the County to enter into a Memorandum of Understanding that explains the County's duties and responsibilities in implementing the Title IV -E Waiver Demonstration Projects. CDHS and the County understand and agree that the services outlined in this MDU are subject to available appropriations by the General Assembly, and neither party will be obligated to provide services or assistance if adequate appropriations have not been made. C17-337 The following terms are agreed to by CDHS and the County: 1. MOU MEETS PERFORMANCE AGREEMENT REQUIREMENT The parties agree that the provisions of this MOU constitute compliance with CRS 26-5-105.4. 2. TERM The term of this MOU will be from July 1, 2017 to and including June 30, 2018. 3. DEFINITIONS The parties agree to provide the following minimum services to the identified populations as denoted below (check all that apply): V Family Engagement — Meetings will be provided to families with a newly opened child welfare case during the demonstration period: • Within seven business days of case opening; o (in FAR cases, within seven business days after the 60"' day (69 days by including weekends); • Within seven business days of initial placement; • Every 90 days when in out -of -home care (DHS/DSS custody); • Every six months in in-home (case open). Permanency Roundtables — Meeting will be held quarterly for: [(All open cases involving a child/youth with a goal of Other Planned Permanent Living Arrangement; and/or S(All open cases involving a child/youth who has been in out of home care for 12+ months; and/or ❑ Other: ❑ Kinship Supports — Support services and goods will be provided to kinship families who are: ❑ Licensed kinship foster caregivers; ❑ Non -licensed kinship foster caregivers. 2 Trauma Informed Screening, Assessment, and Treatment to the following target population: FM All children with open child welfare cases 4. REQUIRED DUTIES OF THE COUNTY a) During the term of the agreement, the County agrees to implement the intervention(s) in accordance with the rules adopted by the State Board of Human Services, and as described in Exhibit B, "County IV -E Waiver Demonstration Application," modified as necessary in accordance with Section 6 of this Memorandum of Understanding. b) The County will maintain sufficient records, will submit reports, and will accurately record Colorado Trails (Trails) and CFMS actions as may be required to document all cost and case activities supporting the implementation of the Waiver, and will permit CDHS, its evaluators, duly designated agents and/or representatives of the federal government, to inspect the records and will make such records available to CDHS as specified in CRS 26-1-122. If the County complies with current record keeping requirements as outlined by current rules, such shall be considered to be "sufficient records" c) Counties shall report costs to provide an intervention service to an individual, as authorized through this MOU. The cost shall include the type of intervention service provided, the volume of such services provided, and costs of the intervention service, where applicable. The costs include intervention funds, staff and vendor costs as identified in Trails, County Financial Management System (CFMS) and/or 100% time reporting by individuals performing a waiver activity. There is a presumption that a cost is not a waiver cost unless affirmatively documented in CFMS, Trails, and/or a vendor's time detail report for 100% time reporting. d) The County agrees to participate in the evaluation of the Title IV -E Waiver Demonstration Project, as described under Section 3 of Exhibit A, and as established under CRS 26-5-105.4. e) In accordance with CRS 26-5-105.4, the County agrees to the State retaining 50%Q of the Child Welfare savings resulting from the IV -E Waiver activities. The remaining 50% 3 savings will be retained by the County for additional Child Welfare services, as defined in CRS 26-5-101.3. Cost savings are determined as follows: 1) The difference between i) the amount of Title N -E funds that were claimed for foster care maintenance, case planning and administration and eligibility determination in State Fiscal Year ("SFY") 2012-13, and ii) the amount of Title N -E funds that would have been claimed for foster care maintenance, case planning and administration and eligibility determination in SFY 2017-18, had the State of Colorado not been granted waiver authority by the United States Department of Health and Human Services under Section 1130 of the Social Security Act. 2) For the ten counties with the largest caseload size, the methodology for distributing cost savings between counties that have entered into a Title N -E Waiver Demonstration Project MCU shall be based on the reduction in the number of foster care bed days between SFY 2012-13 and SFY 2017-18; 3) For all other counties that have entered into a Title N -E Waiver Demonstration MDU with CDHS, the methodology for distributing cost savings between counties that have entered into a Title IV -E Waiver Demonstration Project MCU shall be based on the reduction in the number of foster care bed days between either SFY 2011-12 or SFY 2012-13, and SFY 2017-18, as selected by the County. 4) "Cost savings" shall not include unspent Title N -E Waiver Demonstration Project funds provided to counties through the MCU for purposes of implementing Waiver Interventions. Any such unspent funds remaining at the end of SFY 2017-18 shall revert to the Title N -E Waiver cash fund and rolled into the SFY 2018-19 child welfare block allocation, unless the CDHS is granted a Waiver extension. If an extension is granted, the reverted funds shall be included in the total amount of available funds for counties' SFY 2018-19 IV -E Waiver Demonstration extension interventions. 5) The County insures any county employee funded with Title N -E Waiver Intervention funds participates in 100% time reporting. County employees with 100% of time devoted to Title N -E Waiver intervention(s) may utilize the six Month Certification form in lieu of 100% time reporting. El f) No later than June 30, 2019, the County agrees to use 50% of the underspent county Title IV -E Wainer funds for child welfare services that can include: 1) IV -E Waiver intervention services to eligible and non -eligible Title IV -E children 2) Conventional title IV -E program services that are maintained for those Title IV -E eligible children in out of home placement 3) Other child welfare services to eligible and non -eligible Title IV -E children and their families 4) The County plan to expend either allocated Title IV -E Waiver funds, or underspent county Title IV -E Waiver funds as outlined in Exhibit B. 5. DUTIES OF CDHS a) CDHS will oversee the implementation of the Title IV -E Waiver Demonstration Project, and will develop standardized forms and reporting processes for the tracking of participants, in consultation with the Counties. b) CDHS will monitor the County's provision of Title IV -E Waiver intervention services as outlined in the Exhibit B and Exhibit C. CDHS will pull any necessary records or data for monitoring purposes from existing TRAILS and other current recording/data keeping systems. CDHS will not request the County to compile records/data that CDHS may compile or access through the use of TRAILS or other record/data keeping systems. c) CDHS will exercise oversight of and responsibility for the development, implementation, maintenance, and enhancement of Trails and its application relative to Child Welfare Services. d) For SFY 2017-18, CDHS agrees to allocate to counties any Title IV -E funds transmitted to the Title IV -E Waiver cash fund and appropriated by the general assembly to either implement the Title IV -E Waiver Demonstration Project, or to fund out of home placement and case planning for Title IV -E eligible children, in accordance with CRS 25-5-105.4. 6. BUDGET In the preparing of Exhibit B, "Title IV -E Waiver Demonstration Project Year 5 (SFY2017-18) Application," the County shall develop a detailed budget that identifies all direct costs associated 5 with the implementation of the Waiver interventions, as defined in Section 3 of this Memorandum, for which the County has applied for IV -E Waiver Demonstration funds, a) Based on the results of negotiations with CDHS, should the level of funding awarded through the MOU differ from the funding requested through the Application, the County shall prepare and submit a revised Budget and any other changes to service delivery that will differ from the County's original Application submission. The revisions to the Application, once accepted by CDHS, shall constitute the Exhibit B. and shall become part of this MDU. b) With the written approval of CDHS, the County may request a revision to its accepted budget during the term of the agreement: 1) The County may transfer budgeted funds between expenditure line items within a specific intervention, provided that the transferred amounts do not constitute a significant modification to the services as described within the Application. 2) A written statement of impact to the services as described in the Application shall be prepared by the County and accompany any requested budget revisions that exceed the thresholds as identified in Sections 6.8.1 above, and may be required by CDHS for any requested budget revision falling within the thresholds identified in Sections 6.8.1 above. 7. SEVERABILITY To the extent that this MDU is executed, and performance of the obligations of the parties may be accomplished, the terms of the MOU are severable. Should any singular term in this MDU be declared invalid or become inoperative for any reason, it will not invalidate the MDU itself, or any of the terms included therein. S INTEGRATION OF UNDERSTANDING The parties recognize the nature of the relationship between the County and the State. This relationship is governed more broadly by pertinent provisions of the Colorado Constitution and of state statutes and rules, including lawful rules promulgated by the State Board of Human Services. The parties further recognize that this MOU is not intended to supersede or change the relationship between the County and the State as established by any legal authority. 0 9. NO THIRD PARTY BENEFICIARY This MDU is binding to CDHS and the County, as well as their respective successors and assigns. It is agreed that the enforcement of the terms and conditions of this MDU are reserved for CDHS and the County, to the extent permitted by law. Nothing contained in this MDU allows a claim or right of action by a third party. Any third party receiving services or benefits under the provisions of this MCU is deemed an incidental beneficiary. 10. DISPUTE RESOLUTION Prior to the execution of this document, if the parties are unable to reach agreement concerning the inclusion of, or wording of, provisions of the MDU, either party may refer the dispute to the Title IV -E Waiver Demonstration Project Oversight Committee. The Committee's decision will be made by a majority vote of its members, and is non-binding. If dissatisfied with the decision of the oversight committee, either party may seek review by the Office Director of Children Youth and Families or designee. Nothing in these provisions limits a party's ability to pursue other remedies available under the law. 11. TERMINATION The parties acknowledge that withdrawal from this MDU will result in the termination of this Agreement and termination of funding and services associated with this Agreement. The County shall assure as little disruption as possible in the delivery of services provided to Recipients. a) Withdrawal/Termination. Any party may withdraw from this Agreement at any time by providing 30 days written notice to all other Parties. b) For Loss of Funds. Any party may withdraw from this Agreement, in the event of loss or reduction of resources from its funding sources and shall provide notice of withdrawal, in writing within 30 days. c) Lack of Compliance. CDHS may terminate the agreement if it is found the County is not complying with the terms of this memorandum. In the event the memorandum is terminated for failure to perform, interventions funds may be reduced at the discretion of CDHS. 7 IN WITNESS WHEREOF, the Parties hereto, through their authorized representatives have executed this Memorandum of Understanding effective for the dates written above. Ann Rosales, Director, Division of Child Welfare COUNTY(ies) OF Eagle COLORADO, by and through the BOARD OF COUNTY COMMISSIONERS Chairman ATTEST: DATE: 09/27/2017 County Clerk to the Board F-9 10/02/2017 Date DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION FOR CHILDREN AND FAMILIES ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES CHILDREN'S BUREAU DEMONSTRATION PROJECT AUTHORITY STATE: COLORADO Waivers of the following provisions of the Social Security Act and Program Regulations are provided to the State to operate a demonstration project: Section 471 (a)(10): Licensing Standards: To allow the State to waive categorically specific non -safety standards (as determined by the State) in relative foster family homes for specific children in care. Section 472 (a): Expanded Eligibility: To allow the State to expend title IV -E funds for children and families who are not normally eligible under Part E of title IV of the Act as described in the Terms and Conditions. Section 474(a)(1): Expanded Claiming: To allow the State to claim at the Federal medical assistance percentage any allowable expenditures of foster care maintenance payment cost savings. Section 474(a)(3)(E) and 45 CFR 1356.60(c)(3): Expanded Services: To allow the Skate to make payments for services that will be provided that are not normally covered under Part E of title IV of the Act; and to allow the State to use title IV -E funds for these costs and services as described in the Terms and Conditions, Section 2.0. All waivers are granted only to the extent necessary to accomplish the project as described in these Terms and Conditions. Colorado Terms and Conditions — FINAL DEMONSTRATION PROJECT TERMS AND CONDITIONS COLORADO SECTION 1: GENERAL 1.0 The Department of Health and Human Services (hereinafter referred to as "the Department") will grant waivers to the State of Colorado (hereinafter referred to as "the State") under Section 1130 of the Social Security Act (hereinafter referred to as "the Act") to operate a demonstration project (hereinafter referred to as "the demonstration") as set forth in these Demonstration Project Terms and Conditions. The Department reserves the right, in its sole discretion, to withdraw approval of this demonstration project, including withdrawal of any and all waivers granted by the Department at such time(s) that the Department determines that the State has materially failed to meet the requirements as set forth in these Demonstration Project Terms and Conditions. The State also retains the right to terminate the demonstration. 1.1 Failure to operate the demonstration as approved and according to Federal and State statutes and regulations will result in withdrawal of approval of this demonstration project. The Federal statutes and regulations with which the State must comply in the operation of the demonstration include civil rights statutes and regulations that prohibit discrimination on the basis of race, color, national origin, disability, sex, age, and religion, including title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, title II of the Americans with Disabilities Act, the nondiscrimination provisions of the Omnibus Budget Reconciliation Act of 1981, and the Multiethnic Placement Act as amended. After the demonstration is approved, the Department reserves the right to withdraw approval if agreement cannot be reached on any item(s) cited in this document as needing approval by the Department. The State also has the same right. 1.2 The Department may terminate the State's authority to conduct a demonstration project if, after the three-year period following approval of these Terms and Conditions, the State has not made significant progress in implementing the child welfare program improvement policies proposed by the State in its application to conduct a demonstration, and as described in section 1130(a)(3)(C) of the Act (see also Section 2.3). 1.3 If Federal or State statutes or regulations that would have a major effect on the design and impacts of this demonstration are enacted, or if any deficiencies or serious problems in implementation of these Terms and Conditions are noted by the Department, the Department and the State will reassess the overall demonstration and develop a mutually agreed-upon strategy for dealing with the demonstration in the context of such changes. If such a mutually agreed-upon strategy cannot be developed, the Department reserves the right, in its sole discretion, to withdraw approval at such time(s) as the Department determines. Colorado Terms and Conditions — F17VAL 2 1.4 All provisions of the Act not waived remain in effect. 1.5 The demonstration provisions will be implemented no earlier than April 1, 2013, and no later than October 1, 2013. The implementation date of the demonstration shall be the first day on which the State offers services, subsidies, or other supports under the provisions of these Demonstration Project Terms and Conditions to participating children, caregivers, or other targeted individuals. For cost -neutrality purposes, the demonstration shall be deemed to begin on the first day of the calendar quarter (hereinafter "quarter"), which includes the implementation date, but for the purpose of calculating costs for the initial quarter of the demonstration, only costs incurred beginning with the month that includes the implementation date will be counted. The demonstration shall end no later than the last day of the 201h quarter ending after the deemed beginning date. The demonstration provisions shall be as specified in Sections 2 and 3. Waivers necessary for the demonstration are approved upon acceptance by the Department and the State of these Demonstration Project Terms and Conditions. They will become effective as of the implementation date and will remain in effect until the last day of the 20'11 quarter ending after the deemed beginning date, unless the demonstration is terminated earlier. The State's project demonstration period may not exceed a maximum of five total years under the provisions of the Act, unless in the judgment of the Secretary, the demonstration project shall be allowed to continue. 1.6 Federal approval of these Demonstration Project Terms and Conditions shall not be construed to establish any precedent that the Department will follow in the approval of any subsequent request for Terms and Conditions. 1.7 Nothing in these Terms and Conditions shall create eligibility for any child or family for any Federal program or entitlement for which that child or family would not otherwise be entitled, except that title IV -E funds may be expended, according to the provisions of these Terms and Conditions, for persons who would not be eligible for title IV -E funds in the absence of the demonstration. Receipt of services reimbursable under title XIX but provided under these Terms and Conditions for children and families who are not eligible under title IV -E does not constitute eligibility for Medicaid. Children under this demonstration who are determined to be eligible under title IV -E will retain that eligibility through the duration of the demonstration project, so that such children will remain eligible for Medicaid, title IV -E Adoption Assistance, title IV -E Foster Care, and title IV -E Guardianship Assistance Program, if applicable. Colorado Terms and Conditions - FIN14L 3 SECTION 2: IMPLEMENTATION 2.0 Under these Demonstration Project Terms and Conditions, the State is authorized to implement a demonstration project that seeks to integrate current systemic child welfare reforms and innovative practices through the use of strategies to increase family engagement and address the assessment and treatment of childhood trauma. The State's demonstration will focus on accomplishing the following goals): ■ Increase permanency for all infants, children, and youth by reducing the time in foster placements when possible and promoting a successful transition to adulthood for older youth. ■ Increase positive outcomes for infants, children, youth, and families in their homes and communities, including tribal communities, and improve the safety and well- being of infants, children, and youth. • Prevent child abuse and neglect and the re-entry of infants, children, and youth into foster care. The demonstration will be implemented in up to 64 counties in the State; however, each county will implement some or all service interventions in varying stages during the demonstration time period. The demonstration's target population will include all title IV -E eligible and non -IV -E eligible children with screened -in reports of abuse or neglect and those already receiving services through an open child welfare case during the demonstration period regardless of custody status. Once the demonstration is fully implemented, the State estimates that it may serve up to 101,104 cases (duplicated count) through the six service interventions described in Section 2.1 below. The state may choose to implement the demonstration project either by individual county performance agreements or by a change in State regulation. . 2.1 The State's demonstration will include the following three primary service interventions to be implemented statewide: • Family Engagement: The State will introduce family engagement precepts and processes through a combination of training, coaching, and peer mentoring. Additionally, the State will modify non -safety certification regulations of relative foster family homes to facilitate the placement of children with relatives when out -of -home placement is necessary. ■ Trauma -Informed Child Assessment: The State will supplement existing assessment processes and instruments with standardized tools that are geared specifically toward children who have experienced trauma. The following assessment tools will be evaluated to determine the best tool for use by Colorado's county departments and behavioral health organizations and may Colorado Terms and Conditions — FINAL 4 include but are not limited to: ■ Child Observation Record ■ Battelle Development Inventory ■ Ages and Stages Questionnaire ■ Child Development Inventory ■ BehavioraI and Emotional Rating Scale ■ Clinical Assessment Package for Assessing Clients' Risk and Strengths Social Skills Rating System ■ Child and Adolescent Adaptive Functioning Scale ■ 4-D Strengths -Based Assessment Tools for Youth in Care Family, Friends, and Self Form Colorado Behavioral Health Organizations (BHOs) and/or local child welfare service agencies may be engaged to conduct the trauma -informed assessments. The final selection of trauma -informed assessment tools, and the timeline for implementing them, will be specified in the State's Final Design and Implementation Report (Section 2.4). Trauma -Focused Behavioral Health Treatments: Counties and behavioral health organizations will increase the use of behavioral health treatments that have been shown to be effective with children who have experienced trauma through contracts with local human service providers and/or through their expanded utilization by BHOs. The treatment interventions (organized by category below) will be evaluated to determine the best tool to meet local need and may include, but are not limited, to: ■ General Case Management: Family Connections and Solution -Based Casework ■ Trauma and Anxiety: Eye Movement Desensitization & Reprocessing, Trauma -Focused Cognitive BehavioraI Therapy, and Coping Cat ■ Therapeutic Interventions: Multidimensional Family Therapy, Multi- systemic Therapy, and Multidimensional Treatment Foster Care ■ Substance Abuse (adults): Motivational Interviewing ■ Depression (adults): Cognitive Therapy and Interpersonal Psychotherapy ■ Parent Training: The Incredible Years, Parent Management Training, Parent -Child Interaction Therapy, and Positive Parent Program (Triple P) The final selection of trauma -focused behavioral health treatments, and the timeline for implementing them, will be specified in the State's Final Design and Implementation Report (Section 2.4). In addition to the three primary service interventions noted above, the State will assist individual counties in identifying additional interventions to be implemented Colorado Terra and Conditions — FINAL 5 based on the specific needs and circumstances of the county. Additional service interventions that may be implemented by counties include: ■ Permanency Roundtables: Expansion of Casey Family Program's existing Permanency Roundtable initiative to counties that do not directly participate in the initiative, and that make substantial use of congregate care and other planned permanent living arrangements for children in out -of -home placement. ■ Kinship Supports: Establishment of support groups and referral networks, combined with the provision of discretionary funds for time-limited supports and services, to assist non -licensed kin foster caregivers. • Market Segmentation: Development of a tool to assist in the identification and recruitment of foster and adoptive parents. The specific counties that will implement each of these supplemental service interventions, and the timeline for implementing them, will be based upon counties' readiness to implement, driven by local need, and specified in the State's Final Design and Implementation Report (Section 2.4). 2.2 The State shall comply with the following general provisions over the full term of the demonstration project. The State will, or where appropriate, will ensure that caseworkers, supervisors, and contracted service providers: a. Work closely with the evaluator to maintain the integrity of the evaluation. b. Develop and deliver services to meet the individual needs of each child and family. C. Ensure that any services being provided to a child or family member at the time the demonstration ends will be completed. d. Ensure the confidentiality of the information collected on the children and families under the demonstration. e. Ensure that the rights of children and their families are protected, and that the safety of the children is a paramount concern of the demonstration project. f. Ensure that title IV -E eligibility determinations are made for all children who are involved in the demonstration project, throughout the life of the demonstration project, to ensure that eligible children retain their eligibility after the demonstration ends. g. s Bear any costs that exceed the amount of Federal funds provided for the demonstration. Colorado Terms and Conditions — FINAL 6 h. Ensure that the State is organizationally and legally prepared for all aspects of demonstration project implementation. L Ensure that a conventional title IV -E program is maintained for those children and families that are not designated to receive demonstration services, and that these children and families continue to receive services that are consistent with the "traditional services" available to such children and families in the State at the time the demonstration begins. Ensure that all applicable provisions of the Act apply to all demonstration components except for those provisions that are explicitly waived above. k. Ensure that children who are eligible for the Medicaid program will retain their eligibility for a full range of Medicaid services under the demonstration. Ensure that any "savings" resulting from the demonstration, whether they are savings to the Federal government, to the State, or to a county or to another jurisdiction within the State, will be used for the further provision of child welfare services. For the purposes of this provision, "savings" means any amount that would have been expended for conventional title IV -E purposes in the absence of this demonstration, or that could have been expended under title IV -B of the Act. In. Ensure that the State annually will provide an accounting of any additional Federal, State, tribal, and local investments made, as well, as any private investments made in coordination with the State, to provide the service intervention(s) that the applicant intends to undertake through the demonstration (see Section 5.6). n. Ensure that in each year throughout the duration of this demonstration the appropriate State official(s) and evaluators will attend and participate in an annual meeting of the Child Welfare Demonstration States in the Washington, D.C. area. o. For the duration of the demonstration project, assure that the State shall provide health insurance coverage to any child with special needs (as determined under Sec. 473(0) of the Act) for whom there is in effect an adoption assistance agreement between the State and an adoptive parent or parents. 2.3 The State shall provide assurance of how the State has implemented, or plans to implement within three years of the date on which it submits its application the following child welfare program improvement policies: • Address Health and Mental Health Needs of Children in Foster Care: The development and implementation of a plan for meeting the physical and mental health needs of infants, children, and youth in foster care that ensures that the provision of such care is child -specific, comprehensive, appropriate, and consistent (through such means as ensuring that the child has a medical home, Colorado Terms and Conditions — FINAL 7 regular wellness medical visits, and addressing the issue of trauma, when appropriate). ■ Limiting the Use of Congregate Care: The development and implementation of a plan that ensures congregate care is used appropriately and reduces the placement of children and youth in such care. 2.4 Within 90 days following acceptance of these Terms and Conditions, the State will Submit a Preliminary Design and Implementation Report to the Department for approval; and a Final Design and Implementation Report will be submitted to the Department for approval within ] 80 days following acceptance of these Terms and Conditions (see Section 5.2). These reports will include information about program design and implementation. Report sections regarding implementation will include: • A Final Work Plan, outlining the key tasks, reporting requirements, and timelines throughout the course of the demonstration; • A phase -down plan for the demonstration so that case plans for children and their families can be adjusted, if necessary, for the post -demonstration portion of their placement (See Section 6.1); • The detailed protocol or set of policies.that will guide decisions about which families or children are to be selected to participate in the demonstration, how the selection will be made, and how the suitability of services will be determined; ■ Standards of quality and safety and practice requirements identified by the State to be incorporated into any agreements with public and private providers that are expected to provide support and services; and ■ The status of evaluation activities, including efforts to engage a third -party evaluator. The demonstration project will be reviewed periodically by the Department to ensure that the demonstration activities are consistent with the purposes of titles IV -13 and IV -E of the Act and these Terms and Conditions in providing child welfare services, including an assurance of the safety of the children and families involved. The review is intended to ensure that benefit eligibility will not be impaired and that improved outcomes for the children and families will result. Any proposed amendment to these Terms and Conditions is subject to prior approval by the Department. Colorado Terns and Conditions - FINAL 8 SECTION 3: EVALUATION 3.0 The State will conduct an evaluation of the use of title ]V -E funds to test the hypothesis that the flexible use of title 1(V -E funds to provide family engagement services, trauma -informed child assessments, and trauma -focused behavioral health treatments, as appropriate, will result in improved safety, permanency, and well- being for children. The evaluation will consist of three components: A process evaluation, an outcome evaluation, and a cost analysis. The State is required to engage a third party to conduct an evaluation of the demonstration program. The evaluator shall be an independent organization that is not affiliated with state or local government, except that state universities may be engaged to conduct the evaluation. The evaluator shall be responsible for the development of the final evaluation design within the basic evaluation parameters outlined below. The evaluator shall develop a research design and sampling plan; develop and execute the data collection and analysis plans; and prepare interim and final reports. 3.1 Evaluation Design: The State's evaluation will involve a matched case comparison design and a time -series analysis. The matched case comparison design will examine changes in outcomes for children receiving one or more interventions implemented at the beginning of or early in the demonstration period compared to similar children in counties that implemented these interventions later in the demonstration period. The time series analysis will examine changes over time in key measures of child safety and permanency. To the extent possible, the State's analysis of process and outcome findings will be based on case -level data from the State's child welfare information systems, case records, and other data sources as appropriate. Additionally, the State's process and outcome evaluation will include an analysis of the modification of State non -safety certification regulations for relative foster family homes on child safety outcomes which will include, but are not limited to, allegations of abuse in relative foster family homes. The State will also examine the differences in outcomes for children placed in relative foster family homes as they compare to those in traditional foster family homes. These outcomes will be regularly monitored by the State's Administrative Review Division and reported in the State's progress reports (Section 5.3) and interim and final evaluation reports (Sections 5.7 and 5.8). Additional details of the final evaluation design will be determined in consultation with the Department and the State's third -party evaluation contractor and described in the State's evaluation plan (Section 3.5). Throughout the evaluation, the State will apprise the Department of any difficulties encountered in achieving the estimated sample sizes for the project, and in consultation with the outside evaluator will determine if such difficulties will affect the State's ability to identify statistically significant differences in key demonstration outcomes. The State Colorado Terms and Conditions — FINAL 9 will notify the Department as soon as any serious problems are noted. Semi-annual progress reports (see Section 5.4) will include an update on the sample sizes and progress toward meeting the targeted sizes. Cases will maintain their assigned status for the full period of the demonstration. Modifications to the sampling plan may be proposed to the Department for approval if the sample sizes for the experimental and control groups are such that the number of clients in each group will provide adequate statistical power to detect differences in outcomes of interest between the two groups. 3.2 Process Evaluation: The evaluation will include interim and final process analyses that describe how the demonstration was implemented and that identify how demonstration services differ from services available prior to implementation of the demonstration, or from services available to children and families that are not designated to receive demonstration services. The analysis will include a logic model that describes the demonstration's objectives, the services or other interventions provided, and the way the intervention is linked to measurable outcomes. In addition, the process analysis will examine, at a minimum, the following: • The planning process for the demonstration including whether any formal needs assessment, asset mapping, or assessment of community readiness was conducted; • The organizational aspects of the demonstration, such as staff structure, funding committed, administrative structures, and project implementation, including ongoing monitoring, oversight, and problem resolution at various organization levels; • The number and type of staff involved in implementation, including the training they received, as well as their experience, education and characteristics; • The service delivery system, including procedures for determining eligibility, referring subjects for services, the array of services available, the number of children/families served and the type and duration of services provided; • The role of the courts in the demonstration and the relationship between the child welfare agency and court system, including any efforts to jointly plan and implement the demonstration; • Contextual factors, such as the social, economic and political forces that may have a bearing on the replicability of the intervention or influence the implementation or effectiveness of the demonstration. This discussion will note any possible confounding effects of changes in these systems, or changes resulting from other demonstrations or reforms that were implemented during the title IV -E demonstration; Colorado Terms and Conditions — FINAL 10 • The degree to which demonstration programs and services are implemented with fidelity to their intended service models; and ■ The barriers encountered during implementation, the steps taken to address these barriers, and any lessons learned during implementation. For each of the factors described above, the process analysis will note any differences, as appropriate for the State's evaluation design, in implementation before and after the start of the demonstration, among participating counties or other administrative units, or between the experimental and control/comparison groups. 3.3 Outcome Evaluation: The State's outcome evaluation will address, at a minimum, changes in the following outcomes: • Caregiver knowledge and capacity. • Child emotional/behavioral and social functioning. ■ Out -of -home placement and re-entry rates (placement avoidance). • Placement with kin caregivers (both licensed and unlicensed). ■ New and repeat allegations of abuse (in relative and non -relative foster family homes). • Length of stay in out -of -home care. • Frequency of changes in placement setting (placement stability). ■ Exits to permanency through reunification, guardianship, and adoption. ■ Foster care re-entry rates. • Use of congregate care. The State is free to propose additional research questions and outcome measures for inclusion in the evaluation. The State will collect data to address these questions from the State's automated child welfare information systems, child welfare agency case records, and additional information sources as appropriate. The State will work with its evaluation contractor to identify other appropriate data sources to address the process and outcome measures described above. 3.4 Cost Study: The cost analysis will examine, at a minimum, the costs of the key elements of services received by children and families designated to receive demonstration services and will compare these costs with those of services available prior to the start of the demonstration, or that were received by the children and families that were not designated to receive demonstration services. The cost analysis will also include an examination of the use of key funding sources, including all relevant Federal sources such as titles IV -A, IV -I3, IV -E and XIX of the Act, as well as State and local funds. The purpose of the analysis will be to compare the costs of services available through the demonstration with those of services traditionally provided to children and their families. Where feasible, a cost-effectiveness analysis will be conducted to estimate the costs of Colorado Terms and Conditions -- FINAL 11 each successful outcome achieved through the demonstration. This analysis will be conducted using one or more of the key outcome measures for which a statistically significant difference is identified. 3.5 Evaluation Reporting Requirements: The following reports and documents shall be provided to the Department for review and approval (also noted in Section 5): The State will submit to the Department for review a draft of the specifications or Request for Proposals (RFP) for the agreement to conduct an evaluation of the demonstration within 60 days after acceptance of these Terms and Conditions. The draft specifications must detail the objectives of the project, the evaluation design, the specific tasks to be conducted, the time frames for conducting those tasks, and a schedule and list of deliverables. The research questions, key variables, data collection methods, sample sizes and other aspects of the evaluation noted in these Terms and Conditions will be clearly described. • The State will submit an evaluation plan to the Department for approval within 120 days after the evaluation contract is awarded. The evaluation plan must present the underlying logic linking interventions to expected outcomes, the research questions to be studied, the major variables to be measured, the final sampling plan, the data sources (including an assessment of the reliability and validity of each source), data collection procedures, and the major data analyses to be performed. The plan will describe the comparability of selected time periods and groups on key variables. ■ Not later than 60 days after the conclusion of the 10th quarter following the demonstration's implementation date, the State will submit an interim evaluation report (see Section 5). The report will include a process analysis of the evaluation to date and any outcome data available at that time. The report will also include a brief description of the outcome and cost components of the evaluation planned and note any issues or problems anticipated in completion of these components. if the findings are unclear or incomplete, the Department may request revisions and resubmission of the report. • Not later than six months after the conclusion of the demonstration (20'' quarter), a final report integrating the process, outcome and cost components of the evaluation will be submitted. If the findings are unclear or incomplete, the Department may request revisions and resubmission of the report. • The State will post copies of the interim and final evaluation reports on the State's child welfare agency Website (see Section 5.10). • Not later than six months after the conclusion of the demonstration (2e quarter), the State will have the evaluation contractor produce and make available public -use data tapes, including documentation necessary to permit re -analysis of the data gathered during the course of the evaluation. Colorado Terms and Conditions — FINAL 12 Public release of any evaluation or monitoring reports required under this agreement will be made only by the Department or the State. Prior to public release of such reports, the Department and the State will have at least a 30 -day period for review and approval. 3.6 Program Changes: Additional program changes that are not applied equally to experimental and control/comparison groups, or that would substantially affect the evaluation of the demonstration, must be approved by the Department as an amendment to these Demonstration Project Terms and Conditions. Colorado Terms and Conditions — FINAL 13 SECTION 4: COST NEUTRALITY 4.0 As required by section 1130(h) of the Act, the amount of Federal funds expended for this project may not exceed the amount of such funds that would be expended by the State under the State plans approved under parts B and E of title FV if the demonstration project were not conducted. Therefore, except for costs of evaluating and developing this project (as specified in Sections 4.4 and 4.5 below), starting with the deemed beginning date (see Section 1.5) the operation of this demonstration is to be cost -neutral to the Federal government with respect to maintenance and administrative costs for titles IV -B and lV-E of the Act. 4.1 Section 4 Terms: Costs. All references made to costs (unless otherwise specifically noted) consist of total computable (gross) costs. The Federal share of demonstration project costs will be computed using the matching rate applicable to the funding category. Maintenance Costs. All references made to maintenance costs include title IV -E allowable foster care maintenance assistance payments (per Section 475(4)(A) of the Act), and such other costs for cases deemed as title IV -E allowable through a waiver granted for this demonstration project. Administrative Costs. All references made to administrative costs include title IV -E allowable administrative costs (per Federal regulations at 45 CFR 1356.60(c)) and other costs deemed as title IV -E allowable through a waiver granted for this demonstration project. Cumulative. All references made to cumulative in the context of costs will indicate that costs are to be summed for all quarters from the deemed beginning date through the quarter in question. 4.2 The total costs of foster care payments, including maintenance and administrative costs, shall be an amount determined by a base allocation as determined in Section 4.2.1 below plus any annual change factor or exclusions as specified in Section 4.2.2. The results of this calculation are shown in Section 4.3, Table 1. The aggregate five- year sum of Federal share payments shall be the cumulative fixed payment that shall be made to the State. Receipt by the State of payments not greater that the cumulative fixed payment shall be considered cost neutral to the Federal government. At least 90 days prior to implementation, the State shall provide the Department with a document showing a fixed schedule of payments for the five-year demonstration period. The State may receive quarterly payments in accordance with a schedule of quarterly payments the sum of which do not exceed the total cumulative payments under the demonstration. Colorado ferns and Conditions — FINAL 14 4.2.1 The foster care base allocation amount to be used for purposes of establishing a cap to reflect cost neutrality to the Federal government for demonstration project operations has been determined for each of the funding categories impacted by the demonstration project through the following processes: Source of claims: The base amount is the calculated State Fiscal Year (SFY) total computable (gross) title IV -E Foster Care claims (including current and prior quarter adjustments) submitted by Colorado on quarterly reports of expenditures and estimates (i.e. form ACF -IV -E-1 or CB -496, as applicable) during the specified time periods for the following cost categories and adjusted for baseline increases as specified below: • Foster care maintenance costs: Total computable costs of $35,943,219. This total is calculated from the average of maintenance payments claims for SFY 2008-2010. • Foster care administrative costs(excluding SACWIS non-SACWIS child welfare information systems, and training):: Total computable costs of $54,251,490. This total is calculated from the average of administration claims for SFY 2008-2010 in the following specific categories of administration: eligibility determinations and case management. Application of base allocation: The base amount will be applied separately in determining annual allocations for maintenance assistance payments and administration. 4.2.2 The payments for each full FFY during the 5 -year operational period of the demonstration project shall consist of the base amount adjusted each FFY by the change factor(s) and the exclusions described in the subsections below. Thus, payments in the second and subsequent full FFYs of demonstration operations will equal the amount calculated for the prior FFY plus any further applicable changes. Payments for demonstration operations during any partial FFY will be pro -rated proportionally by quarter to reflect the portion of the FFY when the demonstration project is operational. 4.2.2.1 The annual allocation change factors applied have been determined by the following process: a. Maintenance assistance payments: Three year average annual rate of change in the ratio of total computable maintenance payment claims to average monthly number of children. b. Administration: Three year average annual rate of change in total computable administration claims for the specified categories. Colorado Terms and Conditions —FINAL 15 4.2.2.2 The foster care costs excluded from the cost neutrality calculation and thus subject to payment outside of the capped allocation are as follows: a. Any allowable foster care administrative costs not previously identified in Section 4.2.1 will be excluded from the calculation of the demonstration's capped allocation (see Section 4.3), and will be reimbursable separately in addition to the amount of the capped allocation. b. Any allowable SACWIS or non-SACWIS child welfare information system development or operational costs will be excluded from the calculation of the demonstration's capped allocation (see Section 4.3), and will be reimbursable separately in addition to the amount of the capped allocation. Costs associated with the development, maintenance and operation of the State's SACWIS project will be subject to applicable advance planning document and approval processes. c. Any allowable stafflprovider or professional partner training costs will be excluded from -the calculation of the demonstration's capped allocation (see Section 4.3), and will be reimbursable separately in addition to the amount of the capped allocation. 4.3 Federal title IV -E payments to the State for this demonstration, including expenditures of any realized savings, will be made for amounts in accordance with Table 1 (shown below) quarterly based on State estimates of demonstration expenditures for the next quarter in accordance with the payment schedule (as determined in Section 4.2 above). Table 1- Colorado Title IV -E foster Care Total Computable Demonstration Project CaaPed Allocation Payments Demonstration . Base SFY SFY 2013 SFY 2014 SFY 2015 SFY 2016 SFY 2017 SFY 2018 Project Funding Allocation Allocation Allocation Allocation Allocation Allocation Category Amount Cap Cap Cap Cap Cap Cap Maintenance Payments 35,943,219 36,593,888 37,212,120 38,486,500 39,353,687 40,323,825 41,414,040 Administration 54,251,490 55,651,178 56,669,595 57,383,632 58,468,183 59,438,754 60,389,774 All Capped Categories 90,194,709 92,245,066 93,881,715 95,870,132 97,821,870 99,762,579 101,803,814 Federal title IV -E payments for demonstration operational expenditures will be made for any quarter beginning in accordance with the dates specified in section 1.5 of these terms and conditions when the demonstration is in operation and for a total period of no longer than five years (20 quarters) thereafter. Colorado Terms and Conditions — FINAL 16 Actual expenditures claimed for the demonstration project, including expenditures of any realized savings, along with estimates in advance of each quarter, will be identified separately on the ACF quarterly claim form, CB -496. Summary fiscal information on the results of the project must be reported in Part 3 as well as other applicable parts of form CB -496. These estimates and claims relating to the demonstration will be subject to review and deferral or adjustment according to the normal procedures for reviewing title IV -E estimates and paying title IV -E claims. All other title IV -E claims that are not related to this demonstration will continue to be filed in accordance with current quarterly claiming requirements for payments for allowable cost. The State must examine its cost allocation plan to determine whether any of the components will affect the calculation of or claiming for any administrative costs under title IV -E, and if so the State must submit an amendment to the cost allocation plan prior to the implementation date to address any such effects appropriately. 4.4 Developmental Costs. Developmental costs are the expenses the State incurs to establish the demonstration prior to the project's implementation. These costs are excluded from the cost -neutrality calculation. For activities undertaken prior to the implementation date specified in Section 1.5 above, the Federal government will match the approved administrative costs related to development of the demonstration project (otherwise called developmental costs) at the applicable matching rate without application of cost allocation. Such costs can begin with the preparation of the State's proposal and may also include automated systems development and changes, policy or procedures development, and staff training. Developmental costs do not include costs for activities performed on or after the deemed start date of project operations. No later than 30 days after the State formally accepts these Terms and Conditions, the State will submit a plan, for approval by the Department, designating which administrative costs will be treated as developmental costs for purposes of this section (see Section 5.0). This section is not intended to supersede other requirements for Federal approval for administrative costs of the programs involved in the demonstration, 4.5 Evaluation Costs. Evaluation costs are expenses incurred by the external evaluator as well as those incurred by the State that are directly related to the evaluation effort. These costs are excluded from cost -neutrality calculation. Evaluation costs begin with the first evaluation planning activities and continue until the final evaluation report is submitted. Such costs will encompass all costs necessary to carry out the approved evaluation plan, including costs for evaluation activities carried out by State and local agencies as well as those carried out by the evaluation contractor. The costs of approved evaluation activities may be charged to title IV -E administrative costs without cost allocation so that the State may claim a full 50 percent of these costs as title IV -E administrative costs. The State shall address any changes needed to implement this provision through submission of appropriate amendments to its approved State cost allocation plans. Costs of evaluation that arise from the demonstration project(s) approved under these Terms and Conditions may be claimed for a reasonable period of time after the expiration of the period of this demonstration (Section 1.5) so long as the costs are for activities required by the evaluation plan(s) approved by the Department and are otherwise allowable and Colorado Terms and Conditions — FINAL 17 reasonable. Evaluation components not approved by the Department will not qualify for Federal matching funds. Colorado Terms and Conditions -- FINAL 18 SECTION 5: MONITORING The State will send all reports required in this section to the Children's Bureau, the Regional ACF Office, and the evaluation technical assistance contractor for this initiative. 5.0 The State must submit a plan, for approval by the Department, designating which administrative costs will be treated as developmental costs (see Section 4.4) no later than 30 days after accepting these Terms and Conditions. 5.1 Within 60 days of acceptance of these Terms and Conditions, the State will submit to the Department a draft of the specifications or Request for Proposal (RFP) and evaluation specifications for review. 5.2 Within 90 days following acceptance of these Terms and Conditions, the State will submit a Preliminary Design and Implementation Report to the Department for approval; and a Final Design and Implementation Report will be submitted to the Department for approval within 180 days following acceptance of these Terms and Conditions (see Section 2.4 for detailed elements of the reports). 5.3 The State shall submit quarterly progress reports beginning 90 days after the acceptance of these Terms and Conditions and continuing until implementation. The Preliminary Design and Implementation Report will serve as the first quarterly report. All subsequent reports are due no later than 30 days after the conclusion of each quarterly period and will include a basic update on the status of each activity or task identified in the Implementation Report. The report will also identify any problems encountered that may have an impact on the design or anticipated implementation schedule. Suggestions for resolving these problems will be provided for the Department's review and approval. 5.4 Once implementation has begun, serni-annual progress reports will be required throughout the project period summarizing project and evaluation activities and accomplishments during the reporting period as well as interim findings from the evaluation, if available. The semi-annual monitoring reports shall indicate issues or problems and resolutions regarding the implementation of the demonstration or evaluation as approved, including updates on the resolution of any significant problems identified in the implementation report. The State will address its progress toward implementing the Child Welfare Program Improvement Policies as described in Section 2.3. These reports are due no later than 30 days after the conclusion of each reporting period. 5.5 The State will submit an evaluation plan to the Department for approval within 90 days after the evaluation contract is awarded (Section 3.5). The evaluation plan must be approved by the Department prior to implementation. 5.6 The State will submit an annual accounting during the demonstration project period of all investments, public or private, made in coordination with the State to provide services under the proposed demonstration project. Colorado Terms and Conditions — FINAL 19 5.7 The State will submit an Interim Evaluation Report 60 days after the conclusion of the 101 quarter following the demonstration's implementation date (Section 3.5). Additional reports may be proposed by the State and, subject to approval by the Department, may be considered allowable components of the evaluation of the demonstration. 5.8 The State will submit a Final Evaluation Report six months after the project ends, integrating the process study, the outcomes study, and the cost analysis (Section 3.5). 5.9 The State will post copies of the interim and final evaluation reports on the State's child welfare agency Website (see Section 3.5). 5.10 The State will submit, or have the evaluation contractor produce and make available, public -use data tapes, including documentation necessary to permit re -analysis of the data gathered during the course of the evaluation, six months after the project ends (Section 3.5). Colorado Terms and Conditions — FINAL 20 SECTION 6: TERMINATION PROCEDURES 6.0 Federal financial participation in demonstration activities requiring waivers will not be provided beyond the period approved by the Department. 6.1 As part of the Preliminary Design and Implementation Report and the Final Design and Implementation Report (Section 2.4), the State will submit for the Department's approval a plan to phase down and end the demonstration to ensure that there are no demonstration -related Federal costs incurred beyond the period approved by the Department. All activities requiring Department approval must cease on the date decided by the Department if the project is terminated prior to the end of the 20'h quarter after the deemed beginning date of the demonstration. Approval: and Families q/agli�Date Colorado Terms and Conditions — FINAL 21 Acceptance: Reggie Bicha Executive Director Colorado Department of Human Services Date EXHIBIT B I�ti�Cy `- -L£ COUN 7 County E N V E P Child Welfar Resiliency Project APAHOE COON' ❑AA:� 5 Ra• N L' Title IV -E Waiver Demonstration Project Application SFY 2017 — 2018 Submitted: April 14, 2017 Resubmitted: August 8, 2417 • • COLORADO DEPARTMENT OF HUMAN SERVICES [Type text] Title IV -E Waiver Demonstration Project Regional Collaboration 5FY2016-2017 Intervention Expansion Application Colorado Department of Human Services welcomes you to propose an expansion of existing Title IV -E Waiver Demonstration Project interventions. Research your county's Title IV -E Waiver child welfare needs and gaps in service delivery and request this funding to improve services to children, youth and families in need. Use data to support needed FTE's and funding for hard goods. Please contact Tyler Allen, Administrator of the Title IV -E Waiver Demonstration Project at tyler.allen@state.co.us, 303.866.2154, with questions related to this application. Name of County/Region/Project: Child Welfare 7 County Resiliency Project Primary Contact: Jim Drendel County: Larimer : Address 2555 Midpoint Drive, #E Phone: 970-498-6584 Waiver Interventions Date: Agency: Children, Youth and Families Division City, State Zip Fort Collins, CO 80525 Email: jdrendel@co.larimer.co.us W hat Title IV -E Waiver Intervention(s) are you applying for funding to expand? ❑ Family Engagement Total Funding Amount Requested: ❑ Permanency Roundtables ❑ Kinship Supports ® Trauma -Informed Screening, Assessment, and Treatment 7 County Child Welfare Resiliency Center Total Funding Amount Requested: Total Funding Amount Requested: Total Funding Amount Requested: $1,360,288 TOTAL: $1,360,288 2 Management Plan for Waiver Intervention (s) Implementation Who will provide oversight, coaching, and supervision of the intervention(s)? Will your management team include the data analyst, financial manager, staff members throughout the hierarchy? If you are a region, include representation from each county. Name: Angela Lytle Title: Deputy Director Agency: Arapahoe County Department of Human Services Phone: 303-636-1966 Email: ALytle@arapahoegov.com Specific Intervention: Child Welfare 7 County Resiliency Project Name: Kit Thompson Title: Family and Children Services Division Director Agency: Boulder County Department of Housing and Human Services Phone: 303-441-1509 Email: kthompson@bouldercounty.org Specific Intervention: Child Welfare 7 County Resiliency Project Name: Ann Scheuermann Title: Director, Child Welfare Agency: Denver County Department of Human Services Phone: Email: Ann Scheuermann@denvereov.ore Specific Intervention: Child Welfare 7 County Resiliency Project Name: Ruby Richards Title: Child Welfare Administrator Agency: Douglas County Department of Human Services Phone: (303) 814-5389 Email: rarichar@douslas.co.us Specific Intervention: Child Welfare 7 County Resiliency Project Name: Agency: Kendra Schleff Director Eagle County Department of Health and Human Services Director Phone: 970-328-8852 Email: Jone.Bosworth@eaglecounty.us Specific Intervention: Child Welfare 7 County Resiliency Project Name: Mary Berg Title: Deputy Director, Department of Human Services Agency: Jefferson County Department of Human Services. Phone: VL -271-41-61 Email: mbere@ieffco.us Specific Intervention: Child Welfare 7 County Resiliency Project Name: Jim Drendel Title: Manager, Children, Youth and Families Agency: Larimer County Department of Human Services Phone: 970-498-6584 Email: drendeim@co.larimer.co.us Specific Intervention: Child Welfare 7 County Resiliency Project • Define Opportunity/Intended Practice Describe the structure of the oversight coaching, and supervision (for both: the overall project, and each county specifically). What agencies andlor community partners (e.g., BHO's, CMHCs, Community Resource Centers) are involved with this expansion? What is the identified targe t popula tion of the project (if different for each county, please identify each separately)? Is this building on existing county practice? If you are a region, which county will be the fiscal agent? A trauma success story illustrating positive transformation: A trauma provider received a referral for a 17 -year-old female. On the day of the assessment the youth arrived with her mother and presented as very anxious. She said she did not want to complete the assessment and was very upset to hear it was an all -day assessment. Despite the efforts of staff, she chooses to go home that day without completing any of the assessment. In the coming days, we called the youth directly and talked more about the purpose of the assessment and she agreed to come back. On the second date, her mom called and let us know she was refusing to attend. In talking with her again, the youth agreed that the 3 7 County Child Welfare Resiliency Center clinicians could come to her home for the assessment. A few days later Z clinicians drove to the youth's home and spent 3-4 hours with her completing the assessment. She taught the clinicians a great deal about herself. In addition, her testing revealed difficulties in language and verbal communication. She then attended the report review at CSU with her mother a few weeks later. During this meeting, she and her mother remarked that they were in therapy but were not making any progress - it was a stressful situation and we could tell they felt defeated. The clinician explained that the testing revealed a strength in non-verbal communication and processing, but a weakness in verbal and normalized how frustrating talk -therapy must be. "Lightbulbs" went off for both mom and daughter and they worked together with the clinician in building recommendations for therapy that would feel more useful to them, including more hands-on activities. In addition, mom remarked that she'd never understood her daughter's "bad behaviors" in this way before, or how they had both been impacted by trauma. Counties in this project use a wellbeing tool. Most counties use the Treatment Outcomes Package (TOP) which is a multi -rater tool that provides a child or youth's current functioning report mapping strengths and concerns in a variety of areas. The tool establishes a baseline, and then, with regular completion, will document improvement or lack of progress over time when compared to the baseline. An immediate picture of the child/youth is formed from the perceptions of the child/youth and those around them. The TOP includes questions to rate assertiveness, resilience, incontinence, sexual acting out and eating issues for children, as well as school functioning, mania, social conflict, and substance abuse for adolescents. The factors for both age groups include conduct, depression, psychosis, sleep problems, ADHD symptoms, conduct, suicidality, and violence, providing a comprehensive picture of functioning at both age levels. Strengths and well-being are indicated by the presence of assertiveness and resilience for children, and functioning well at school or socially for adolescents, as well as the absence of symptoms in any of the rated areas. Boulder County uses the Child and Adolescent Needs and Strengths (CANS) which is a multi-purpose tool developed to support care planning and level of care decision -making, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. The CANS was developed from a communication perspective in order to facilitate the linkage between the assessment process and the design of individualized service plans including the application of evidence -based practices. The CANS Comprehensive gathers information on youths and parents/caregivers' needs and strengths. Strengths are the youth's assets: areas life where he or she is doing well or has an interest or ability. Needs are areas where a youth requires help or serious intervention. Care providers use an assessment process to get to know the youth or youth and families with whom they work and to understand their strengths and needs. This IV -E Waiver application provides opportunities to test the effects of ameliorating trauma through both the child welfare and mental health systems to improve the child's resiliency and well-being 4 7 County Child Welfare Resiliency Center trajectory through specific services, strategies and supports. It also demonstrates that a greater number of children can be maintained in their own home, in foster homes or with kin if developmental, emotional, and cognitive needs are met as a result of a comprehensive assessment that includes assessment of the child/youth's trauma. We will demonstrate that children can be served safely in their own homes, in kin homes or in foster homes rather than congregate care. Improving the child's resilience and well being through addressing the child's trauma will increase the child's opportunity for safe permanence. The intended practice in the waiver is to screen, assess and treat trauma through the Colorado State University Resiliency Center, Community Mental Health Centers, and other endorsed and credentialed mental health provider(s) for children/youth. Additionally, the Treatment Outcome Package (TOP) tool or the CANS (Boulder) will be used to measure child wellbeing by using information involved with the child or youth to evaluate improvement over time. Structure of oversight, coaching and supervision (overall proiect and each county specifically): Overall: Representatives from each county department, their behavioral health organizations, community mental health centers, other providers, resiliency center staff and State staff meet monthly to oversee project implementation and to share implementation concerns or successes. Trauma Coordinators from each county also meet monthly to share information, discuss issues and potential resolutions. Monthly, Trauma Coordinators are reviewing assessments to identify and resolve any quality assurance. Following are county specific activities. Arapahoe County Department of Human Services (ACDNS): • Arapahoe County holds a Trauma Steering Committee with members from each area of Child and Adult Protection Services (CAPS) to ensure solid communication and input on how we are implementing the requirements of the IV -E grant as well as how we are working to achieve our CAPS goal of continuing to infuse trauma informed care into our overall practice. • Monthly meetings of the Secondary Traumatic Stress Committee which consists of ACDHS staff from all levels as well as staff from the two community mental health centers. This team has planned and continues to work on full implementation of the Resiliency Alliance mode and is implementing an Emergency Response model to respond to crises encountered by casework staff such as child fatality, child sexual and physical abuse, and violence or threatening behavior toward staff. • Resource Parent Curriculum training for foster parents/kin/adoptive parents. • Use of a Trauma Coordinator, staff hired to coordinate the intervention systemically will oversee the essential elements of trauma -informed child welfare practice for children and families. Boulder: • This project is overseen by Boulder's Child Welfare Managers and Director to ensure that the project is successful and that any barriers can be mitigated. • The Resiliency Project Core Implementation Team meets twice each month to oversee the 5 7 County Child Welfare Resiliency Center implementation activities and subcommittees. • A monthly meeting involves behavioral health representatives from Mental Health Partners and private providers to ensure that the assessments and treatment are consistent with best practices and the requirements of the IV -E waiver. • The supervision and coaching of the resiliency coordinator is provided by one of the CW Managers. • Routine training occurs with staff regarding the CANS assessment tool. nipnvipr• • A Trauma Coordinator oversees the implementation and use of the trauma evaluation and services in addition to coordinating and blending with pre-existing trauma informed practice efforts and training. • Monthly meetings of the Trauma Leadership Group which consists of the Clinical Services Administrator, Deputy Division Director, Placement Services Administrator and service navigation staff. • A pairing of the Trauma assessments with our current efforts to reduce congregate care. An inclusion of the assessments and their outcomes in our internal DDHS congregate care project and meetings. • Monitoring data reflecting: o Numbers of moderate and high-level trauma screens that have been referred for assessments o Numbers of assessments that have determined services are necessary. o Numbers of services arranged/delivered o Monitoring the TOPS that have been completed, and repeated at defined intervals o Monitoring of the number of family meetings that have been completed • Utilize family engagement meetings regarding decision making, service provision, and placement coordination. • Use of Utilization Management staff to assure service delivery, transition support and contract compliance. • Monitoring of the quality of the assessments completed. Douglas: • Monthly meetings of the Trauma Leadership Group which includes Child Welfare Administrator, Child Welfare Program Development Manager, Representatives from the BHI, AIIHealth Network, Medicaid, and other identified individuals as needed. • Monthly meetings of the Trauma Practice Committee, which includes caseworkers, supervisors, Program Development Managers, clinicians from Arapahoe -Douglas Mental Health Network, and other contracted trauma assessment and treatment providers. • Agency leadership meetings to trouble shoot potential practice, implementation, or philosophical concerns. • Resiliency training and regular phone conferences amongst therapists to share information, discuss complex cases, and provide support to therapists. • Use of Trauma Coordinators to assure services are arranged and to address potential barriers to a child/youth or family receiving necessary treatment. N. 7 County Child Welfare Resiliency Center • Monitoring data reflecting: o Numbers of moderate and high-level trauma screens that have been referred for assessments o Numbers of assessments that have determined services are necessary. o Numbers of services arranged/delivered o Monitoring the TOPS that have been completed, and repeated at defined intervals o Monitoring of the number of family meetings that have been completed • Monitoring of the quality of the assessments completed. • Use of Utilization Management staff to assure delivery on contractual agreements. • Trainings and consultation with expert ❑r. Jim Henry to: improve caseworker's engagement with children and their families related to building resilience; define standard expectations for trauma assessments; address foster parents and other treatment provider's anxieties so they are better able to support the child/youth's treatment; and, train clinicians to improve their assessments. Eagle: • Eagle uses a unique approach of incorporating trauma informed principals to existing collaborative teams such as The Collaborative Management Program's Interagency Oversight Group. The current resources and community partners are limited and therefore, creating an additional committee that involves the same partners is not an efficient use of resources for Eagle County. We will continue to internally strategize the best options for this approach, including cutting edge presentations. • Individual and group supervision will be used as an opportunity to check in on project specific assignments and coach caseworkers to utilize trauma informed practice techniques. • Use of Trauma Coordinator (if funded through this grant) to assure services are arranged and to address potential barriers to treatment. • Monthly meetings between Trauma Coordinator and Caseworkers to refine processes and coordinate trauma assessments. • Monthly meetings between Mind Springs Health and Eagle County DHS • Monthly meetings between Trauma Coordinator and the Samaritan Counseling Center's ❑r. Erik Marsh, Ph.D. primary local assessment provider. • Monitoring data reflecting: o Number of completed trauma screens o Number of referrals for trauma assessments o Number of children referred for trauma focused treatment o TOP work • Monitoring the quality of the assessments completed • Eagle County will also use recognition and awards to promote positive practice in TOP completion and other trauma informed practice work. • Trainings and consultation with expert ❑r. Jim Henry & the CSU Resiliency Center to: improve caseworker's engagement with children and their families related to building resilience; define standard expectations for trauma assessments; address foster parents and other treatment provider's anxieties so they are better able to support the child/youth's treatment; and, train clinicians to improve their assessments. 7 7 County Child Welfare Resiliency Center Jefferson: • Use of County Trauma Practice Collaboration to include county administration, BHO administration, Community Mental Health Center Administration, and Value Options. This occurs in coordination with Boulder County as we share the same BHO. o Monthly oversight meetings to address practice implementation and finances o Currently Jefferson County has three treatment providers fully endorsed to complete trauma assessments. Maple Star, Jefferson Center for Mental Health and Savio House. • Use of Trauma Practice Workgroup to include caseworkers, supervisors, management, and community mental health center. Monthly meetings to coordinate and implement practice, address implementation concerns and develop structure. • Use of practice support and consultation for practitioners providing trauma assessment and treatment • A Trauma Care Coordinator and supervisor coordinates implementation of trauma screening, assessment and services. These positions also ensure that assessment recommendations are implemented. • Use of Resource Parent Curriculum in training all prospective and current foster families with the Collaborative Foster Care Program which includes Jefferson, Arapahoe and Douglas Counties • Use of Treatment Outcome Package (TOP) o Youth in residential care receive a TOP every 30 days and every 90 days post discharge and until case closure o Monitor rater responsiveness and engagement for the TOP and engage collaborative partners in analyzation of multi rater reports for use in case planning o Train agency staff and collaborative partners in the use of TOP results in decision making regarding treatment services, case planning, level of need and permanency planning • Use of Utilization Management staff to assure delivery on contractual agreements. • Using recognition and awards to promote positive practices in TOP completion and trauma treatment activities. • Monitoring data reflecting: o Numbers of children screened for trauma exposure who meet criteria for assessment. o Number of recommended trauma services implemented o Monitoring the TOPS that have been completed, and repeated at defined intervals Larimer: • Monthly meetings of the Trauma Cabinet which includes Child Welfare Deputy Division Managers, representatives from the BHO, Touchstone, CSU Arch, Medicaid, and other identified individuals as needed. • Monthly meetings of the Trauma Practice Committee, which includes caseworkers, supervisors, Deputy Division Managers, clinicians from Touchstone, CSU Resiliency Center, and other contracted trauma assessment and treatment providers. • Quarterly Trauma Leadership meetings include community agency leadership to trouble shoot potential practice, implementation, or philosophical concerns. • Trauma assessment providers meet monthly to address barriers and concerns, to discuss complex F3 7 County Child Welfare Resiliency Center cases, to discuss how to write assessments that engage the family and child. • Use of Trauma Treatment Coordinators to assure services are arranged and to address potential barriers to a child/youth or family receiving necessary treatment. • Use of Coaches in home to support families 24/7 to manage child's behavior. • Monitoring data reflecting: o Numbers of trauma screens that have been referred for assessments o Numbers of assessments that have determined services are necessary. o Numbers of services arranged/delivered o Monitoring the TOPS that have been completed, and repeated at defined intervals o Monitoring of the number of family meetings that have been completed • Use of Utilization Management staff to assure delivery on contractual agreements. • Trainings and consultation to: improve caseworker's engagement with children and their families related to building resilience; define standard expectations for trauma assessments; address foster parents and other treatment providers anxieties so they are better able to support the child/youth's treatment; train clinicians to improve their assessments; • Trainings and consultation as needed with expert Dr. Krause in the use of the Treatment Outcomes Package (TOP) tool. • Sharing the good news of positive experiences of children and families to build the value of our day to day work accomplishing spectacular things with children and families. Community Agencies involved with the project: Arapahoe: Aurora Mental Health Center, AIIHealth Network, trauma assessment and treatment providers to include various Core providers, BHI, other community partners including our Courts, Gals, etc. New providers will be added to address the need for increased capacity for assessments and treatment. Boulder: Mental Health Partners, Impact partnership agencies, Local Treatment Providers (Core and Medicaid) Denver Juvenile Probation, Rocky Mountain Children's Law Center, Denver Collaborative Partnership, Access Behavioral Care, Kempe Center, Services and Savio House. Douglas: Arapahoe/Douglas Mental Health Network, BHI, Local Treatment Providers (Core and Medicaid), Our Best Practice Team, (Court, Probation, Diversion, Schools, Wraparound, Pretrial Release, Gals, DA) Eagle: Mind Springs Health (local community mental health center) and The Samaritan Counseling Center. Jefferson: Jefferson Center for Mental Health, Value Options, Foothills Behavioral Heath, Maple Star, Savio House, Excelsior Cares and Residential Child Care Facilities. Other community partners including our Courts, Gals, etc. New providers will be added to address the need for increased capacity for assessments and treatment. Larimer —CSU Resiliency Center staff, Summitstone (community mental health center), Behavioral Health Representatives and trauma assessment and treatment providers. Additional community partners are engaged as needed. 17 7 County Child Welfare Resiliency Center Other county information Target Population: Overall: The overall target populations for the project differs by county and is as broad as all open cases of children served in their own homes and in out of home placements to a more narrow population of children/youth in out of home placement for more than two years; children/youth in congregate care; and, new open cases/involvements. Because of the potential volume of cases/ involvements this could include county specific narrowing of the target populations as identified below. This narrowing will support counties in their efforts to reduce the numbers of children/youth in congregate care or in out of home placement for 2 or more years, and allow for funds saved in these areas to be redirected to additional trauma/resiliency services and supports. Counties will begin piloting trauma screens, assessment and services for parents after October. Arapahoe will serve 30 children/youth in the coming year. 15 children/youth will be those who have waited the longest for permanency. It is anticipated that several of these children/youth will have been in out of home placement for more than two years. Some of these youth may be in congregate care. As Arapahoe experiences success is moving children/youth in this group to permanency, they will move to the next longest waiting children in out of home placement. Youth will be identified by area administrators. In addition, Arapahoe will continue the prevention component which will include 15 children/youth entering the system who have the highest scores on their trauma assessments. The goals will be to provide trauma assessments and trauma informed services as recommended to either prevent placement and/or further penetration into our system. It is anticipated that 25% of the screened in children/youth will need a moderate level of assessment and 75% will need a high-level assessment. Arapahoe staff will complete the TOPS for all 30 children/youth in the project. Arapahoe will also be completing the trauma process for a select number of parents after the tools, criteria and processes are further defined. Boulder will serve 150 children/youth, 50 youth will be in Congregate Care, 20 children/youth will have been in out of home placement more than two years and 20 children/youth will have experienced a disrupted adoption. The remaining 60 children/youth will be any case going to a FAR -SP. It is anticipated that 330 children/youth will be screened, 150 of those will require assessment and 75 of those will require a moderate level assessment and 75 will require a high-level assessment. Boulder will be completing the CANS for all children/youth in the project. Denver will screen 120 children/youth currently in congregate care. Denver anticipates completing Moderate Level Trauma assessments on 106 children/youth. Denver will complete the TOP on all children/youth who receive a trauma assessment (estimated at 106). Denver will explore completing the trauma assessments for parents; however, it is more likely to happen in FY 2019.Douglas will serve 96 children/youth. 38 children/youth are currently in congregate care, and may also have been in out of home placement for more than two years, or be diagnosed as developmentally disabled or have experienced an adoption disruption. Douglas County also anticipates serving any new case involvement that screen in need of a moderate or high level trauma assessment that they estimate at 50 children/youth through the course of the year. 10 7 County Child Welfare Resiliency Center Eagle will serve all current and new children/youth who have open child welfare cases (approximately 40 children). They will complete the initial trauma screen on all children with open child welfare cases. They project to serve approximately 10 children with trauma assessments. Eagle County will complete TO Ps for all children/youth who receive Trauma Assessments (approximately 10). Jefferson is planning to serve 100 of their highest need children/youth with an open child welfare case. All children/youth will receive moderate level assessments. Larimer will continue to target all current and new open involvements that screen in need of a moderate or high-level trauma assessment. Building on existingpractice: The 7 counties involved in the project are at various stages of trauma assessment and treatment implementation. Fiscal Agent: Larimer County will be the fiscal agent for: • the TOP contract with Outcome Referrals • CSU Evaluation • Financial FTE(s) to maximize revenue • Establish Baseline/ Performance Goals What is the projected number of clients to be served? 1,369 children/youth and certain parents are expected to be served across the 7 counties. What impact will this intervention have to outcomes: entry/exit/reentry to/from out -of -home placement by care type (RCCF/Group Home Care/Foster Home Care), subsequent maltreatment, length of stay, or open case duration? Impacts: Projected impacts for children/youth served in the project are shown below: 7 County Outcome 5FY2017* Outcome Base Year 5FY13 Change (+/-) Projected Maintain or reduce the number of children in placement for 12 to 24 457 609 +152 months Reduce the number of children in placement for more than 24 months by 530 366 -164 2 Maintain or reduce RCCF placements 287 245 -42 Decrease the number of months to 21.65 21 -.65 adoption Maintain or increase absence of 94 68% 92.67 -2.01 recurrence of abuse Maintain or reduce the percentage of children who are abused within 12 93.99°/ 94.29 .3 months of case closure Maintain or reduce the number of children who re-enter out -of -home care 256 283 27 Decrease the use of Group Care 175 144 -31 11 7 County Child Welfare Resiliency Center Remain Home - Report Card 86.3411/o 85.24% -1.10% Maintain or reduce the number of children entering out of home 2191 2090 -101 placement • Strategies to Employ Please include descriptions detailed enough for replication. How may this intervention contribute to the development of a standard of practice? Proposed Standard of Practice: The proposed standard of practice is similar or the same across the counties in the project. County specific differences are spelled out below. The process to determine needed treatment begins with scoring open cases on the trauma screening tool in the State's Automated Case Management System, Trails. This screening is completed to determine if the child/youth qualifies for an assessment (scoring 6 or above). All counties will be completing the state required risk assessment on Program Area 4 and 5 children and families. Other activities key to replicabiIity are: • Routine training and retraining of caseworkers, supervisors, school personnel, court personnel and other community partners about the purpose and focus of the trauma work. • Routine work with caseworkers and supervisors to explore biases, build competence in talking with clinicians and parents, gain buy -in so that support of parents and providers can be obtained; • Quality assurance activities by Trauma Coordinators focused on quality of assessments. Routine work with community providers, BHO and Community Mental Health Center to address worries and well-dones, establish consistency in evaluations completed, and raise the expectation for comprehensive evaluations and treatment. • Sharing data so that child and family improvement across the resiliency domains of the TOP can continue the momentum and support for multi raters to complete the tool and understand the importance of the information contained in the tool. • Reviewing and sharing data to assure the trauma system is operating as intended. • Sharing information about congregate care being avoided for children with high needs through being kept successfully in their home to foster the belief by staff and community partners that not only is this possible, it should be expected. • Monitoring the process to assure movement through the system of screens, assessments and treatment. • Assuring appropriate funding stream is accessed for service reimbursement including Medicaid, parent's insurance or other funding. • After initial screen, either quarterly rescreening or one post screen on case closure, according to he cou my project. Arapahoe: • Arapahoe Case Flow Process remains the same as last year. Continued routine training of caseworkers, supervisors, administrators on child welfare trauma -informed practice will occur as well as use of the trauma screen, assessment, TOP and trauma services. 12 7 County Child Welfare Resiliency Center • Training of community partners will continue .including the Courts, Gals, etc. around trauma - informed practice • Work will continue toward full implementation of trauma -informed practice and integration with our practice model along with working with caseworkers and supervisors on how to accomplish this. • Reviewing and sharing data will continue to ensure the trauma system is moving forward, identifying and addressing barriers as needed. • The movement of trauma screens through the system to the mental health providers through assessment and service delivery will be monitored using the Consortium's fidelity model. Denver: • Continued training of caseworkers, supervisors, administrators on child welfare trauma -informed practice as well as use of the trauma screen, assessment, services, etc. • Continued training of community partners including the Courts, Gals, etc. around trauma -informed practice. • Continue to work toward full implementation of trauma -informed practice and integration with our practice model, working with caseworkers and supervisors on how to accomplish this. • Reviewing and sharing data to ensure the trauma system is moving forward, identify and address barriers. • Complete trauma screens every 90 days for the identified population. • Oversee the movement of trauma screens through the system to the mental health providers through assessment and service delivery. Douglas: Trauma Screen will be completed at initial assessment and at closure. Jefferson: The case flow process will be the same as last year. • Evaluation- including: Tangible Results, Improved Outcomes Describe yourcountylregio 7's expertise and capacity for data management. How Opp you intend to demonstrate the effectiveness of the intervention? What tangible results or improved outcomes Opo you intend to show? How Will the evaluation efforts of this intervention relate to the existing evaluation of the IV -E Waiver Demonstration Project? Evaluation of the project continues to be led by Colorado State University's Social Work Research Center (CSU) which includes Graig Crawford, a Trails data and reports expert, as a valued member of the team. CSU assures alignment between this project's evaluation and the larger IV -E Waiver Evaluation conducted by Human Services Research Inc. The evaluation subcommittee, including state, county and CSU staff, meets monthly to oversee the evaluation. Monitoring of the project uses the Process Fidelity Report which shows, by county: • Number of trauma screens completed, and whether the screen resulted in screen out, screen in and screen -in referred for trauma assessment. • Number of eligible children for whom screens have not been completed • Number of trauma screens scored as Low (under 6), Moderate (G— 10) or High (11+) • Number of trauma screen -outs and the scoring of Low, Moderate or High • Children and Youth that are due for a TOP to be completed 13 7 County Child Welfare Resiliency Center • TOP utilization by county and by month A Lime Survey was also developed that captures the following data points not found in Trails. • 1) 30 Days from Screen In: o Has trauma assessment occurred? ■ If not, has it been scheduled and when. ■ If it has not been scheduled, why • Client parent refused to complete assessment {end process} • Case closed (end process) • Provider wait Iist/delays • Trauma assessment referral not yet submitted • Case circumstances (placement disruption, runaway, etc.) • Other—specify ■ If trauma assessment has occurred • When it occurred • Agency {other selection} • Clinician who completed • Type (High or Moderate) high level assessments are not currently available • Were Immediate recommendations given by phone to caseworker and caregiver • did debrief occur with the family and clinician prior to family meeting (Yes/No/Unsure) • did family meeting ❑ccur/or has been scheduled to discuss recommendations • Were the recommendations realistic {if not — comments for why} • Rate the quality of the recommendations in terms of service planning and next steps forthe child (4 or 5 point scale) • Zj 90 days after assessment completion date and Case Closure: o Resiliency services strategies were put in place as a result of the trauma assessment o List of services strategies (see La rimer county list) 0 Status (not recommended, recommended not in place, recommended referral, recommended receiving, recommended - completed) o If all services have not been implemented, why (check all that apply) ■ Runaway ■ delay in referral ■ Family refused ■ Lack of family engagement ■ Lack of service availability ■ Other (specify) • Trauma Assessment Coordinators will review assessments to determine whether quality is met. • Use of an Endorsement Process for Trauma Assessment Centers. • Sustainability- �escribe the sustainability of this practice, including: Re -leveraging dollars, maximization of other funding sources, systemic cast containment, regional or shared resources. 14 7 County Child Welfare Resiliency Center There are multiple components to the sustainability plan for the project. The sustainability plan includes a new component this year along with carryover components from last year: • The 7 County Child Welfare Resiliency Project received funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) for the Colorado Children's Congregate Care Resiliency Opportunity Project (CROP). The grant implements an innovative trauma -informed resiliency -based collaborative model designed to prevent and reduce congregate care placements for children/youth in child welfare/juvenile justice. The group is developing and employing new approaches to identify, assess, and intervene with children/youth in congregate care as these children/youth frequently have complex trauma and often have poor long-term outcomes including multiple disrupted placements, aggression, delinquency and ongoing relational and behavioral issues (Briggs, Greeson, Layne, Fairbank & Pynoos, 2012). An ecological approach premised on the recognition that traumatized children and their caregivers' interactions are reciprocal and therefore the needs of both must be identified and addressed, will undergird CROP's interventions. The Project is in year one of the 5 years and will assist in the sustainability of the 7 -county project. • Support of Judicial, collaterals, probation, Guardians ad Iitem and others are a crucial component of sustainability. As the courts can see the validity and the reliability of the TOP in child functioning and the positive change in children/youth and their families as a result of focused trauma treatment, it is likely that the court will more easily support plans for children/youth that involve remain in home or return home and to the community more quickly. • Reducing the number of children/youth in congregate care and moving those children to their own homes with services, to permanency with services or to foster homes. Funding saved from the congregate care reduction will be used to fund the in-home services for non -Medicaid eligible children/youth or for services that cannot be funded by Medicaid. Remaining funding will be redirected to services to children/youth on case opening to prevent their placement and to build resiliency in children/youth to support their success in school, in the community and in their homes. • Reducing the number of children/youth in out of home placements for Z years or more and returning those children to their own homes or to permanent homes with services. Funding saved from reducing lengths of stay will be used to fund the in-home services for non -Medicaid eligible children/youth or for services that cannot be funded by Medicaid. Remaining funding can be redirected to services to children/youth on case opening to prevent their placement and to build resiliency in children/youth to support their success in school, in the community and in their homes. • The Child Welfare Allocation (CWAC) has a crucial role in sustainability for the project. If the State were to support a change in the allocation formula that rewarded counties for serving children/youth in their own homes or in foster/kin homes, then this would positively impact the counties ability to sustain funding to the project. • Providing information to the State to support policy changes to require the use of trauma screens and assessments including developmental components when indicated for all children/youth with open cases. The county partners are hopeful that the State will be able to use the data gathered from this project, coupling it with other evaluative reports to drive policy benefiting children and their families: • Fund services that are proven to work and disallow expenditure of funds on programs that have not 15 7 County Child Welfare Resiliency Center proven effective. For example, Trauma Focused Cognitive Behavioral Therapy or other non- traditional therapies should be a required treatment when indicated in Capitated Medicaid mental health contracts. • Modify the current medical necessity definition to include complex trauma, so that children traumatized because of child abuse or involvement with the child welfare system will have the same access to treatment as children determined to be mentally ill. Maximizing other funding sources: Maximizing revenue sources other than the Title IV -E Waiver demonstration funding is a crucial project activity to assure sustainability after the conclusion of the IV -Waiver. An FTE is being directed to working directly with providers to become certified/credentialed to provide Medicaid funded mental health services. Additionally, a contract expert has been and will be used to work with Behavioral Health Organizations and Health Care Policy and Financing to assist in transition to Medicaid funded services from the current IV -E Waiver funded services. As the providers can access Medicaid, focus will begin on assuring providers are credentialed by all major insurance companies that provide benefits for families being served in child welfare. Work has concluded that EPSDT Medicaid fee for service funding can rarely be accessed for the children in the project. The project will continue to pursue being self-sustaining with the goal of securing insurance and Medicaid revenues for services to off set the IV -E Waiver costs. Reinvestment Plan: Each county will have a specific reinvestment plan that will allow reinvestment of funds in the trauma project as congregate care or length of stay in out of home placement is reduced. This reinvestment plan may include increasing the numbers of children and families served or decreasing the usage of IV -E Waiver funds in the project, depending on each county's circumstance. Systemic Cost Containment Additionally, systemic cost containment will need to be addressed considering issues identified with: • The Capitated Mental Health System • Differing definitions for service eligibility (including Medical Necessity) across Behavioral Health Organizations and Community Mental Health Centers • Medical Necessity definitions that do not include complex trauma or child abuse • Children being determined not eligible for service when treatment gains are made. onal or Shared Resources: The project will share training, consultation and technical assistance resources among the participating counties. The Title IV --E Waiver funding is a rime -limited resource. What is your countylregion s plan to reinvest the savings and to sustain the intervention efforts beyond the Title IV -E Waiver? The SAM HSA Grant will assist in continuing the intervention beyond the IV -E Waiver. Additionally, counties may use savings or other Child Welfare Block or Core Services funding to continue services to the extent possible. • Practice Shift- Different, enhanced or expanded. Describe haw this intervention will impact practice in your countylregion? What will have changed, been enhanced or been expanded as a result of your successful implementation of this intervention? 16 7 County Child Welfare Resiliency Center The Trauma Model, used by the 7 Counties has been refined to better assure fidelity to the model. Arapahoe: Goals remain to increase the ability to function as a trauma informed child and family service system which is identified and evidenced as one in which all parties involved recognize and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers, and service providers. Programs and agencies would infuse and sustain trauma awareness, knowledge, and skills into our organizational culture, practices, and policies. Over the last year we have continued to gain excitement about responding to our families in a more trauma - informed manner. All staff now share in the goal of infusing trauma practice into our everyday work. They are recognizing the need for the trauma assessments and coming forward asking for them. Boulder: Implementing this intervention impacts practice by identifying needed services to address trauma and other child developmental needs. This in turn drives a more comprehensive service array. This practice impacts the service providers used for trauma intervention and treatment, based on the effectiveness or lack thereof of service providers. Another crucial impact will be the ability of the Child Welfare Bureaucracy to successfully and safely serve children in their own homes, with kin or in foster homes if no relatives or kin are available. Boulder will be holding additional trainings for the Schools and Court related staff in the coming year. Boulder will also be holding several community meetings with other agency partners in this work. Denver: Goals remain to increase the ability to function as a trauma informed child and family service system which is identified and evidenced as one in which all parties involved recognize and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers, and service providers. Programs and agencies would infuse and sustain trauma awareness, knowledge, and skills into our organizational culture, practices, and policies. We would in act in collaboration with all those who are involved with the child, using the best available science, to facilitate and support the recovery and resiliency of the child and family. Our practice would include routinely screening for trauma exposure and related symptoms, and making resources available to children, families and providers on trauma exposure, its impact and treatment. There are a handful of children and youth who have been so impacted by trauma that success at healing and permanency has been impossible. If our system can accomplish becoming trauma informed and effective, that handful of children and youth will be positively impacted by a different way of receiving and responding to intervention and will experience successful healing and permanency. Douglas: Potentially, this intervention can impact every aspect of our child welfare practice from assessment to service provision. By understanding the trauma history of our children, youth and parents, we can move away from a reactive system response to trauma behavior to a trauma informed supportive system of care. Douglas County can become a trauma informed community able to understand trauma behavior (that in the past would have resulted in institutionalized children and youth) and supporting community based effective trauma informed interventions. There will be greater quality assurance and accountability of service providers; we will hold our system to a higher standard for assessments and services. Eagle: This project will improve casework practices in Eagle County by reinforcing trauma informed principles. As a result, our child welfare children and families will receive more appropriate 17 7 County Child Welfare Resiliency Center interventions thus leading to the successful closures of DHS interventions. Our team members will gain knowledge about the ways in which childhood traumatic stress impact children and caregivers and better understand the resources available to overcome these issues (including trauma screening, assessment and treatment options). Our community members will also gain trauma informed knowledge through trainings. Clinicians will expand their practice to include trauma focused assessments and interventions. Practicing these trauma informed principals allows Eagle County to maintain the philosophy of keeping children/youth with their families whenever safely possible. Jefferson: Jefferson County continues to reduce the number of children/youth in congregate care. It continues to be an area of focus to engage and educate agency staff and system partners. It is imperative to work collaboratively. The Jefferson County Division of Children, Youth and Families believe children thrive in families. Working with our system partners to embrace a similar philosophy to ensure that children are afforded the opportunity to remain at home and in their communities whenever safely possible is a priority. The implementation of the TOP, although slow and steady, provides a unique look at children's progress in treatment and placement. It provides opportunities to discuss those interventions that are working well and those that are not in order to make changes to improve the outcomes for kids. The Division of Children, Youth and Families continues to work with our judicial partners and has the expressed support of the reduction of congregate care from the Chief Juvenile Judge. Larimer: Larimer has expanded its use of Resilience Alliance activities to address secondary traumatic stress (STS) of staff. Staff at all levels of the agency are invited and self-select into a group that is co - hosted by a mental health therapist and a resilient agency worker. Resilience Alliance is a free Curriculum developed by Claude Chemtob pf NYU, and supported by the National Child Traumatic Stress Network. There are 12 modules and 12 additional "open modules" modules for a total of 24 modules. The focus is building staff resiliency in: emotional regulation, collaboration, mastery, optimism through education, exercises and mindfulness. Education occurs on STS and reactions of survival mode, reactivity and "us vs. them" mentality. Larimer believes that this activity has had a positive and direct impact on caseworker turnover in the agency. All Counties: Following are the areas that will have changed, been enhanced or been expanded as a result of the successful implementation of the intervention. • A more comprehensive service array will be implemented. Arapahoe: The county's service arrange includes: o TF -CBT o EM DR o Parenting Children with Traumatic Stress o Child Parent Psychotherapy (0-5) o Trauma Focused Parent Child Interaction Therapy (2-7) o Trauma Focused Cognitive Behavioral Therapy o Adolescent Dialectical Behavioral Therapy o Skill therapist trained in the sensory integration and the Neurosequential Model of Therapeutics o The in-house TAPS (Together Achieving Permanency and Sustainability) team provides 18 7 County Child Welfare Resiliency Center intensive in-home trauma -informed services to parents, including adoptive and foster parents. This service is funded through Core Services. o Resource Parent Curriculum o Trauma Informed Yoga FERMr.nz o Animal Assisted Therapies o Play Therapy o Preventative Aftercare o Intensive Home -Based Services o Adoption Preservation Services o Intensive Mentoring o Youth Advocacy o Behavioral Coaching o Therapeutic Visitation o Parent -Child Interactional Therapy Denver: Denver will use its existing robust trauma specific services which includes CPP, AF -CBT, TF -CBT, animal assisted therapy, Intensive Home -Based Services, Mentoring Programs, Behavioral Coaching for parents and children/youth, MST, FFT and a multi-level visitation program. Denver will increase the number of alternative treatment modalities such as art and movement therapy. In addition, the county will explore increase their County Designed Core services to include alternatives to traditional therapy to focus on building resiliency and mastery in youth. Denver will look at funding activities and classes for youth to become enrolled in to foster their resiliency. • A greater percentage of children and youth will be served in their homes, with their relatives or kin and in their communities with fewer children experiencing the trauma of separation from siblings and parents because of out of home placement. Arapahoe: The county has made a concentrated effort to reduce the number of youth in congregate care and the number of youth in out of home placements. Overall there has been a decrease in the past year in both areas. Boulder: Since 2008 the county has seen a 44% reduction in out of home placement of children/youth. There has also been a 40% increase in kinship care since 2012. Denver: The county is continuing to focus efforts on children/youth in congregate care settings and are hopeful that there will be success in both reducing congregate care numbers as well as reducing the number of children and youth who enter placements. The inclusion of the Trauma assessments in our additional ongoing efforts in Denver to impact the use of congregate care with targeted Congregate Care reduction hearings by our Judicial System as well and internal workgroups evaluating Denver's trends in the use of congregate care began in December 2016 with the hope of impacting positive change. • There will be a greater partnership amongst community partners including schools, mental health, probation, the courts and others as more children and youth are able to be successfully served in their own homes and communities. 19 7 County Child Welfare Resiliency Center Arapahoe: Overall, there continues to be strong collaboration amongst community partners including school, mental health providers and the court system. We have also begun to have good discussions with our main Core service and out of home care providers on the infusion of trauma informed care into their practices and are better aligning our Core services program with providers that offer true trauma informed practice. AIIHealth Network continues to allocate one employee who works with the county to complete trauma assessments on the youth selected to be a part of this pilot group and is providing very solid moderate level assessments. ADMHS has attended many meetings for this project and offered insight and resources to the process. Boulder: Community members have been trained in Dr. Henry's Trauma 101 and some school staff have attended the 201 training. Boulder's partners are very excited about this work and in serving more children and youth in the community. Denver: Denver has been very successful in engaging the community partners in attending the trainings offered by the project. As a result there has been an increased focus on strengthening these relationships through the common language of building resiliency and looking at children and youth through a trauma lens. As the new Core contract season begins, the county is engaging community partners in identifying their use of evidence based trauma focused services as well as creating new service packages that focus on transitioning children and youth out of congregate care and the preventing their entry into care. There has been a tremendous increase in our collaboration with our BHO, Colorado Access over this past year to focus on aligning service provision for our clients with Medicaid funding to impact the realignment of our families with community resources once our case has closed Eagle: Implementation of this project has improved community partnerships. For example, trauma informed relationships with the judicial system and local school system have improved which directly impacts services for children/youth. These partners are open to receiving support and training from Eagle County DHS in regard to trauma. The trauma project is the perfect tool to enhance partnerships, as it is common for clients to interact with multiple organizations. 20 7 County Child Welfare Resiliency Center Rate each of your major community partners and their knowledge and support of the Title IV -E Waiver in your county/region on a scale of 1-5 with 1 being the least knowledgeable, supportive, etc. Use additional columns to add other major partners specific to your county/region. Bolded numbers in the chart indicate an improvement in scoring over last year. 21 7 County Child Welfare Resiliency Center Behavioral School Domestic Substance County Information Court Health System Probation Violence Abuse Arapahoe Understanding of the proposed intervention 3 5 3 3 3 4 expansion Arapahoe Willingness to work with county/region re: 3 4 4 3 3 implementation Arapahoe Commitment of staff to 4 4 4 intervention implementation Boulder Understanding of the proposed intervention 4 4 4 4 3 4 expansion Boulder Willingness to work with county/region re: 4 4 4 4 3 4 implementation Boulder Commitment of staff to 3 4 4 4 3 4 intervention implementation Denver Understanding of the proposed intervention 4 5 2 3 2 2 expansion Denver Willingness to work with county/region re: 4 4 3 4 3 3 im lementation Denver Commitment of staff to 4 4 2 3 3 3 intervention implementation Douglas Understanding of the proposed intervention 4 5 4 4 3 3 ex ansion Douglas Willingness to work with county/region re: 4 5 4 4 3 3 im lementation Douglas Commitment of staff to 3 5 3 3 1 1 intervention implementation Eagle Understanding of the proposed intervention 3 4 3 3 3 3 expansion Eagle Willingness to work with county/region re: 4 4 3 3 3 3 implementation Eagle Commitment of staff to 2 2 2 2 2 2 intervention implementation Jefferson Understanding of the proposed intervention 2 4 2 2 3 3 expansion Jefferson Willingness to work with county/region re: 3 4 3 2 4 4 im lementation Jefferson Commitment of staff to 3 4 3 3 4 4 intervention implementation Larimer Understanding of the proposed intervention 5 5 5 5 5 5 expansion Larimer Willingness to work with county/region re: 5 5 5 5 5 5 im lementation Larimer Commitment of staff to 5 5 5 5 5 5 intervention implementation 21 7 County Child Welfare Resiliency Center Describe your countylregion's effort to increase community understanding and engagement of the proposed Title IV -E Waiver intervention expansion. Training and Consultation is being provided to increase community members' understanding and support for using a trauma lens to inform needed treatment to supportthe child and family living in the least restrictive level of care possible. Arapahoe: For the coming year, regarding training and community meetings that will be needed, Arapahoe County will continue to engage with various trauma trainings both for ACDHS employees and community partners. ACDHS will continue to send participants to Dr. Henry's regularly offered Trauma 101 training. It is intended for this training to be offered to all new staff members as well as community partners. Arapahoe County will also continue to send community partners to Dr. Henry's trainings for court systems and school systems as they are offered in the future. It is anticipated that there will continue to be a greater need for future Schools Trauma Training. We also anticipate a need for future Trauma Treatment Coordinator trainings which would target providers who offer in-home services or advocacy services as well as additional provider training on Trauma Assessments. Arapahoe's local community mental health centers have been trained in the Assessment Training. Additionally, ACDHS will likely need to train more providers as the need and capacity to complete trauma assessments grow. We have identified many community providers who are ready and willing to participate in this training. We anticipate a need for continued training for both staff and resource parents in NCTSN's Resource Parent Curriculum. Arapahoe would also like to send medical professionals to trauma training in 2017 including our Nurses from our Tri -County nursing program. Arapahoe County is interested in offering further, more in-depth, trauma trainings for staff members, asthis has been requested by manyACDHS employees. Boulder: In the coming year, Boulder plans to hold additional trainings for the Schools and Court related staff. Boulder will also be holding several community meetings with other agency partners in this work. Denver: The trainings that occurred have laid the foundation for the broad overview of Dr. Henry's philosophy in assessing and treating trauma. As we begin to operationalize the process of conducting assessments we have identified several barriers in our overall efforts to reduce congregate care including our Judicial system (Judges, Magistrates, District Attorneys, GAL's, RPC's) as well as the probation department when the perceived threat of community safety interferes with following the recommendations of the assessments that have been completed. We continue to work on engaging these community partners and believe that the focus on training with the SAMSHA grant will assist in some of the barriers we have encountered. Douglas: We will enhance community relationships that have been rated as a 2 or below through outreach activities. We will establish a contact person for those systems and schedule face to face meetings at Director level through the Caseworker level. We will invite these partners to the trauma 101 training with Dr. Henry and other educational opportunities about trauma informed practices. We will offer to train those community members on Mandated Reporting and our processes to build more understanding. Eagle: We will enhance community relationships that have been rated as a 2 or below through 22 7 County Child Welfare Resiliency Center outreach activities. We will invite these partners to the trauma 101 trainings and other educational opportunities about trauma informed practices. We will offer to present about this project and train those community members on Mandated Reporting and our processes to build more understanding. Jefferson: We will enhance community relationships that have been rated as a 3 or below through outreach activities. Jefferson will continue to engage system partners in awareness and trauma trainings. Jefferson has begun and will continue to engage the community mental health center and behavioral health organization for training and awareness, financial reimbursement discussions and resource development. Jefferson will continue to engage the school district, judicial partners and community providers for the same. Jefferson will need continued resources to develop providers' skills for trauma assessment and continued development of trauma related services. Jefferson will continue to train staff and system partners on the TOP, understanding both how to utilize it and how to develop treatment plans and decision making based on its results. Larimer: Larimer County has accomplished the "5" rating amongst its community partners as a result of hard work, transparency, commitment and dedication. Larimer County engages in numerous interagency forums and meetings to share information and programming; to hear about issues and concerns; and, support resolution of concerns. Some of the types of meetings a re: • Task forces, oversight groups and steering committees - During these meetings, Larimer County shares information about their various activities and initiatives and listens carefully to community partners concerns and challenges in the work they are doing. Examples of these meetings are the Larimer County Interagency Oversight Group and the Trauma Steering Committee. • Open, community forums where information sharing about initiatives occur. • Specific meetings and trainings of partners - For example, if the county were to have a new District Attorney, or Judicial Officer, the county hosts meetings to brief the individual and their key staff on Departmental programs, including the federal or state requirements supporting the program. This same activity occurs with promising or best practices that the Division plans to launch. • Individual meetings with a community partner such as mental health, school or probation, if there appear to be concerns or conflict about a particular practice. • Immediate connections are made by one of the Division's leadership to any of the community partners to address rumors, concerns with staff, or county practice. • Routine meetings occur with community partners and Division staff to shape and refine new county practices. For example, subcommittees were formed out of the "Trauma Practice Group" to address practice questions, coaching summary forms and how best to address trauma in Family Service Planning. Another strong component of Larimer's approach with the partners is to use every opportunity to educate about the complexity of child welfare Issues. This might differ slightly by the area being discussed; however typically includes: how the practice is best for 23 7 County Child Welfare Resiliency Center children and families; national and local research about the topic; data on Larimer County's performance compared to other counties or other states, issues arising in Larimer's performance that is leading to a selection of one type of practice over another; goals that the county hopes to achieve and county's desire to engage community partners in supporting the practice. Describe how (if) your county/region envisions connections between the proposed intervention expansion and the following initiatives: This initiative is a testing of a Trauma -Informed System of Care for the population identified. Collaborative Management Program: Differential Response: Permanency by Design: Trauma -Informed Systems of Care: Additional Comments: None Do you foresee barriers internally in implementing the Title IV -E Waiver intervention expansion? In engaging community partners? In participating in the statewide evaluation? In collaborating with CDHS to ensure the success of Title IV -E Waiver? The largest and most difficult barrier to the project has been accessing Medicaid funding for assessment and treatment of children. The difficulties are demonstrated in the following: • The lengthy and difficult process for providers to become Medicaid providers. The process does not seem to be articulated clearly by any of the state agencies involved. As of this writing, Larimer County has had a provider working for more than 27 months to become a Medicaid provider for trauma assessment and treatment services, approved bythe Department of Human Services' Behavioral Health Division, and then credentialed by the Behavioral Health Organization. Expectations are shared at each step of the process and without the rationale for the expectation; for example, the provider is expected to sign the contract for billing without being able to know the rate for services (until after signing). This provider was also requested to perform 10 assessments without accessing Medicaid funding for the provider rate to be determined. • Another barrier to accessing Medicaid funding is misperception that trauma from abuse and neglect is the primary responsibility of the child welfare agency to address; it is not mental health trauma eligible for funding through Medicaid. Arapahoe: No barriers or potential barriers noted. Boulder: We do not anticipate any barriers internally in implementing the initiative. We do anticipate some barriers with Medicaid covering what is truly needed by traumatized children and their families. We do not anticipate any barriers in participating in the evaluation or in collaborating with CDHS. 24 7 County Child Welfare Resiliency Center Douglas: We have made tremendous strides over this past year in eliminating any internal barriers to implementing and sustaining the initiative. We have experienced barriers with our judicial system in embracing our reduction of congregate care efforts and fully valuing the Trauma Assessments and the recommendations they offer. We are continuing to work with our contracted provider and BHO on attempting to get the trauma assessments or portions of the assessments covered by Medicaid but have been unsuccessful in achieving these goals to date. Eagle: A potential barrier continues to be the lack of availability of evidence -based trauma focused mental health services within Eagle County. There are a small number of mental health clinicians in the community who utilize these specific modalities. Eagle County BHO and Community Mental Health Provider continue to move on thisjou rneytogether and we anticipate they will be our identified partner in the future. How may CDHS assist with addressing any of these barriers? Arapahoe: Assistance when barriers are identified and our attempts to resolve or remove have been unsuccessful. Boulder: We would like CDHS' help in working with HCPF and BHOs to remove barriers to fund the kinds of assessments and treatment needed by this population. Denver: We would also like additional assistance from CDHS, HCPF and BHO's in removing existing barriers to approve and pay for these assessments. Additional comments, concerns, justifications: None. Please accept this signature as verification of the information in the application as correct and support of my county's participation in the Title IV -E Waiver Demonstration Project, SFY 2015/2016. Regional Models must include each county's Director's signature. Cheryl Ternes, Director Arapahoe County Department of Human Services Frank Alexander, Director Boulder County Department of Housing and Human Services Don Mares, Manager Denver County Department of Human Services 7 County Child Welfare Resiliency Center Signature Signature Signature Date Date Date 25 Daniel Makelky, Director Douglas County Department of Human Services Kendra Schleff, Director Eagle County Department of Health and Human Services Lynn Johnson, Director Jefferson County Department of Human Services Laura Walker, Director Larimer County Department of Human Services Prevention 7 County Child Welfare Resiliency Center Signature Signature Signature Signature Date Date Date Date 25 LnGgG(% @ § Ln o � 00 r� 00 o Ln 2 � & 2 k a_ u § maj 2 �®I n 2 C � o = § / $ aa� m � 0 � 2 2 m' § ) � J�7 � u ®a § 6 / §k�§\ 7 ] z) § 2 \ j \ } \ \ k k t 2§ q / ] g Q � § § » r_ k :3 0 u m o 00 o m 2 E % E n \ % 2 ¥ + w R / q ƒ 2 E E %f 7 4--j a-§ w n k a q 9 j % / 2 j k / E i m § ■ 2 u m > to ± § ¢ � / ¢ *A :11=1 Ill 11903 COLORADO Office of Children, „ Youth Fr Families Division of Child Vr04rk Ann M. Rosales, MSW, Director Ms. Cheryl Ternes Arapahoe County DHS 1498 East Alameda Drive Aurora, CO 80012 Mr. Frank Alexander Boulder County DHHS 3400 North Broadway Boulder, CO 803D4 Mr. Don Mares Denver County DHS 1200 Federal Blvd Denver, CO 80204 August 8, 2417 Mr. Dan Makelky Douglas County DHS 4404 Castleton Court Castle Rock, CO 80109 Ms. Kendra Kleinschmidt Eagle County DHH5 PO Box 664 551 Broadway Eagle, CO 81631 Ms. Lynn Johnson Jefferson County DH5 900 Jefferson Cty Pkwy Golden, CO 80401 Ms. Laura Walker Larimer County DHS 1501 Blue Spruce Drive Fort Collins, CO 80524 Dear Directors Ternes, Alexander, Mares, Makelky, Woods, Johnson, and Walker, We are pleased to inform you that Alamosa, Boulder, Denver, Douglas, Eagle, Jefferson, and Larimer County D(H)HSs (hereafter referred to as the Seven County Consortium) are being awarded Title IV -E Waiver Demonstration Project funding. On February 28, 2015, the IV -E Waiver Oversight Committee (OSC) approved funding for the Resiliency Center through expansion of the trauma services intervent(Dns. On May 13, 2016, the OSC voted to continue the project through SFY 2016.17. The SFY 2017.18 Resiliency Center funding was included in the total annual Waiver allocation, approved by the OSC on April 21, 2417. The finalized SFY 2017-18 budget was provided to the State on August 8, 2017. Based on the detailed budget provided, the Seven County Consortium is awarded 51,177,093.00, to be spent within SFY 2017-18. This funding shall be used as defined in the approved application, as summarized in the attached budget (extracted from the Resiliency Center application). 1575 Sherman Street, 2nd Ftow, Denver, CO 30203 P 303.866.5932 F 303.666.5563 www,colorado.gavlcdhs John W. Hickenlooper, Governor I Reggie Bicha. Executive Director *A:11=1his3 The funding awarded by this letter is regarded as an expansion of the funding awarded to your counties by the Year 5 Waiver application, and subject to the terms of the Year 5 Memorandum of Understanding signed by your county's commissioning body. Please direct any questions you have about this to Tyler Allen, Title IV•E Waiver Administrator, at tyler.allen@state.cous or at (303)•866-2154. We are encouraged by your ongoing participation in the Project and look forward to continued collaboration. Please contact us with any questions. Sincerely, Mary Alice Me iaffey, Associate Director of Operations, Division of Child Vie Ifare 1575 Sherman Street, 2nd Floor, Denver, CO 80207 P 303.866.5932 F 303.866.5563 vNrw.rotorado.govlcdhs John W. Hickenlooper, Governor i Reggie Bicha, Executive Director *:1:11.1hi01 ? re 3 U m M ,P 4n In o v7 � OO M5 V a` a 0 6�1Qj CL CL p W ry s d V_ l o L C) ° u -, � .a �r �a s+a ,•, D v� 0 O b v Co !,- m C J r Ln GO es +M a r V. Ln n 04 a M a n r N V► r qt r F- r c ao uC a m oa N W LL Ln '� Q1 v C Y 0 .0 m M Dpi! = N � W �, a L u— LL � 41 N V C o C d G c L Y- — m N Ln LLJ di ° ° E L? cEUM �] Z �aU � L IQ 4� �.+ m Ln m Ln Q O rry .G 0 a L` M p N Ln r l"�l Ti P. C3 W C _ N 1.(F RJT VT l.li n L N � a y C a �C tigrn Q 1 ? 00 Lrj 10 %0 r to iJ C ^y� L ►a. S a o r` M a o a n .fl M o a e-, r n v c in a •,7i a7 C c L L 0! Qi N O L Ln o > on E 4 m a °; a a° w � F- ? re 3 U m M ,P 4n In o v7 � OO M5 V a` a 0 6�1Qj CL CL p W ry s d V_ l o L C) ° u -,