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HomeMy WebLinkAbout2003-253O. . U3 Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street, Vero Beach FL , 32960 ("County") and Community Child Care Resources (" Recipient") ; of: (Address ) Community Child Care Resources P . O . Box 3451 Vero Beach , Florida 32964 Psychological Services Program Background Recitals A. The County has determined that it is in the public interest to promote healthy children in a healthy community. B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance") and established the Children 's Services Advisory Committee to promote healthy children in a healthy community and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose . D . The proposals submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals The background recitals are true and correct and form a material part of this Contract. 2 . Purpose of Grant The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes") . 3 . Term The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2003/2004 ("Grant Period" ) . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Eight Thousand , Five Hundred Dollars ($8 , 500 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly . Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit " B" attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County . In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligations of Recipient . 5 . 1 Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant . In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period , The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense , upon five ( 5) days prior written notice . 5 . 2 Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws , rules , and regulations . 5 . 3 Quarterly Performance Reports . The Recipient shall submit Quarterly Performance Reports to the Human Services Department of the County within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 , and September 30 . 5 .4 Audit Requirements . If Recipient receives $25 , 000 or more in the aggregate from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year , the Recipient shall submit the audit to the Indian River County Office of Management and Budget . The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for a prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate this Contract . 5 .4 . 2 The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 Insurance Requirements . Recipient shall , no later than September 23 , 2003 , provide to the Indian River County Risk Management Division a certificate or certificates issued by an insurer or insurers authorized to conduct business in Florida 2 - that is rated not less than category A- : VII by A. M . Best, subject to approval by Indian River County's risk manager, of the following types and amounts of insurance : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , products/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non-owned autos and other vehicles ; and ( iii ) Workers ' Compensation and Employer's Liability (current Florida statutory limit) 5 . 6 Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given to the County. In addition , the County may request such other proofs and assurances as it may reasonably require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract . The County shall be listed as an additional insured on all insurance coverage required by this Contract , except Workers' Compensation insurance . The Recipient shall , upon ten ( 10 ) days ' prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract , then the County may, at its sole option , terminate this Contract . 5 . 7 Indemnification , The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct , negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract. 5 . 8 Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract . 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party . In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this Contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. - 3 - 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIO ERS By: 'd ..40 11 //7 ' ae� nneth . Mac t, Chairman Attest : J . K . Barton , Clerk Deputy Clerk Approved : O ' &I't C/ & pec J es C andler, County Admin trator Ap ved s to form and legal suffici�nc . ian , Assistant CoLrntyAtf6fnry RECIPIENT : Community Child Care Resources P . O . Box 3451 Vero Beach , Florida 32964 By: � a&,L J , Name Title 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - Community Child Care Resorces Inc. " Psychological Service " Children 's Services Advisory Committee PROGRAM COVER PAGE • Organization Name : Communi1y Child Care Resources Inc . Executive Director: Barbara Patten Email : cccrbp(a ,aol . com Address : P . O . Box 3451 Telephone : 567 — 3202 Vero Beach, Florida 32964 Fax : 567 - 1136 Program Director: Same as above Email : Address : Telephone : Fax : Program Title : Psychological Services Priority Need Area Addressed: MENTAL WELLNESS ISSUES : 1 . Increasing programs that promote enhanced emotional-social skills . 2 . Increasing early intervention services for "border line" children- physical/emotional . Brief Description of the Program : This program provides parent counseling; (RP-450 . 650) and in-person crisis intervention (RP450 . 330) services to CCCR families and contracting centers . Families receive individual and/or family theraR from various contracting_CCCR mental health professionals . Centers receive classroom Support in the form of site visits by therapists specializingin n early childhood. • Amount Requested from Funder for 2003 /04 : $ 8 , 500 Total Proposed Program Budget for 2003 /04 : $ 49 , 258 Percent of Total Program Budget: 17 . 3 % Current Funding (2002/03 ) : $ 79000 Dollar increase/(decrease ) in request : $ 11500 Percent increase/(decrease) in request : 21 . 4 % Unduplicated Number of Families to be served Individually 25 Unduplicated Number of Adults to be served Individually , - Unduplicated Number to be served via Group settings : 75 Total Program Cost per Client : 492 . 58 Will these funds be used to match another source ? yes If yes , name the source : United Way fo I . R . C . Amount : $ 59100 . 00 The Organization 's Board of Directors has approved this application on (date). wAA -, e� � � ]--a l �S Name of President/Chair of the Board Signature • Name of Executive Director/CEO Signature 3 Community Child Care Resorces Inc. " Psychological Service " Children's Services Advisory Committee PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question you are addressing. Type using 12 pt. Font on 8 '/2 X 11 paper and number each page . These directions and the graphic boxes may be deleted if space is needed . A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Community Child Care Resources ' mission is to ensure the availability and affordability of high quality early childhood development programs and family support programs to lower income, working families of Indian River. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments and population served. Community Child Care Resources (CCCR) contracts with six local childcare centers located on eight sites that meet CCCR Standards of Quality for the purpose of delivering quality childcare programs birth to kindergarten for working families who meet income eligibility guidelines . Centers receive weekly monitoring visits ; staff receives training and support, and center directors meet bi-monthly with CCCR staff to discuss mutual issues that affect the delivery of a quality program. The specific criteria for contracting include : a program that is both age and individually appropriate ; specifically trained and adequately compensated • teachers ; low adult to child ratios ( 1 : 10 for preschool) ( 1 : 8 for 2 yr. olds) ( 1 : 6 for toddlers) ( 1 : 4 for infants) ; close ties with families and meaningful parental involvement; and access to comprehensive services . The process for choosing centers involves a team of early childhood professionals . Once accepted as a new provider, a center remains at provisional status for a period of at least one year. Centers are reimbursed at an equitable rate that will support the required standards . CCCR' s overall program contains a strong family support and education component that includes parenting workshops, parent/child interactive Saturday programs, parent support groups, mentoring, resource and referral, and professional psychological clinical support. Children' s progress is monitored and documented. There is parental choice among centers. Parents sign a contract committing to a sliding fee scale, and mandatory participations in orientations, parent/teacher conferences and parent education programs throughout the year. Key elements to CCCR' s program are public awareness and fundraising, both vital to the support and delivery of the program . 4 Community Child Care Resorces Inc. " Psychological Service " Children 's Services Advisory Committee B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) a) What is the unacceptable condition requiring change? b) Who has the need ? c) Where do they live? d) Provide local, state or national trend data, with reference source, that corroborates that this is an area of need. a. A certain percentage of all families face problems and stresses that require or could benefit from professional psychological intervention. CCCR' s targeted population is more economically needy. CCCR families historically face other life challenges to a larger extent than the general population . Consequently, they exhibit a greater need for psychological support. There is a lack of psychological services in this community to serve low-income families with mental health needs . There is difficulty in identifying families with such needs . There is difficulty in encouraging those families with needs to take advantage of resources when they are available . Contracting CCCR centers do not have the clinical expertise on staff, or the financial resources to independently contract with mental health professionals . Problems arising in the classroom that cannot be handled within the capabilities of the staff, unfortunately often result in the expulsion of the child in crisis . Teacher requests for professional intervention generally center on the number of children (total class, not just CCCR) exhibiting inappropriate anger towards both fellow students and teachers . CCCR notes that this been an escalating concern in classrooms over the last few years . b. The targeted population are those families enrolled in CCCR who have demonstrated a need for psychological services in one or more of the following areas : a. ) Children exhibiting behavioral, developmental, and/or emotional difficulties that seriously impact their chances for school and life success . b .) Parents dealing with such issues as : abuse , divorce, depression, anxiety, custody, substance abuse , or significant health problems . Parents dealing with "special needs" children in the family. ) CCCR centers have the opportunity to receive on site professional psychological/behavioral support . c. The targeted population appears to be spread evenly throughout the county. d. In the 2001 -2002 funding year 17 . 5 % of CCCR families received psychological services . It should be noted that funding for these services ran out in April . Therefore no referrals were made during the last quarter of the year. This was due to the need for therapist time in the classrooms . 14 visits were made to classrooms , representing 42 hours of therapist time. Mid-year 2002-2003 , 19% of CCCR families were referred for counseling and five classroom visits representing 11 hours of therapist time were made. The Devereux Early Childhood Assessment Program (DECA) is a social/emotional screening instrument used in all CCCR centers. In 2001 -2002 , 29% of CCCR children scored outside the normal range . Fall 2002 DECA results showed 12% of CCCR children tested outside the norm. 2 . a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program. a.) To our knowledge, CCCR and the School Readiness Coalition are the only programs within the county that tie psychological services, including direct intervention to the funding of childcare . b.) The School Readiness Coalition has $ 5 ,000 . in enhancement money to be used exclusively for direct services to individual children. 62 . 5 therapy hours would be available to service 587 coalition children. s 5 Community Child Care Resorces Inc. " Psychological Service " Children's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed . MENTAL HEALTH WELLNESS : 1 . Increasing programs that promote enhanced emotional- social skills . 2 . Increasing early intervention services for "border line" children- physical/emotional . 2 . Briefly describe program activities including location of services . Psychological Support to Children and Families : a. ) All referrals start with the CCCR Family Resource Coordinator (FRC) , who conferences with the parent to assess the problem along with the need for intervention. Strategies and resources tried to date will be reviewed and recorded . b .) Once need is established, the FRC secures from the Executive Director (E .D . ) authorization for the referral . C . ) Parents select a therapist from a list of CCCR providers appropriate to address the problem, and give written consent for information sharing. d. ) The E .D . indicates in writing to the selected provider, CCCR' s funding criteria and reporting requirements . e .) Families with medical insurance will use those benefits first. Families pay a $ 5 . 00 "out of pocket" charge for each visit, directly to the therapist. f. ) The FRC monitors the treatment plan through regular conferences with families, and will informally consult with providers as appropriate . e .) The FRC facilitates any recommended changes in the child' s individual school program, and with the classroom teacher monitors progress . • f.) Services are usually provided at the office of the selected therapist. Psychological Support to Centers : a.) Contracting CCCR therapist makes available 2-3 hour time blocks to those CCCR centers with documented need, for the purpose of working with classroom teachers on specific behavioral issues that may be interfering with social and/or cognitive learning in the classroom. b .) Teacher completes pre-observation form prior to visit, therapist records observation, conferences with teacher, gives written strategies and sets date for follow-up . C.) The FRC follows-up in helping the classroom teacher implement and evaluate program changes. 3 . Briefly describe how your program intends to address the stated need/problem. Include reference to any studies or evidence that indicate proposed strategies are effective with target population. CCCR recognizes that research indicates parent support and education are vital to a child' s successful preschool experience. A child' s development does not end when he leaves the classroom. The child that goes home to a dysfunctional family will not thrive . CCCR' s Psychological Support Services component often times is the only access families have to professional intervention. Dollars are best spent on childcare, when the child is able to return home to a functional family, capable of positively reinforcing, nurturing and appreciating the child. 22 individuals within 17 families completed treatment last year. 77% showed improvement in their Global Assessment of Function Scores . Families attending more than two sessions showed a 100% increase in scores. • 6 Community Child Care Resorces Inc. " Psychological Service " Children's Services Advisory Committee The Children' s Center in Titusville, Florida, the Space Coast Early Intervention Center, and The Walden Preschool in Maryland are three model early intervention childcare facilities . Although these centers provide programs for special needs children, they each also enroll a "typically developing" population of students . All three are recognized as models of excellence, and all three have a strong mental health counseling component to their overall program . Last year CCCR initiated a component to the Psychological Support Program that provided every CCCR classroom the opportunity for site visits by contracting therapists . The therapist worked with the classroom as a whole, and did not counsel individual children. In an end-of-year survey, all center directors indicated that the positive impact on classroom behavior was significant. They indicated that their teachers were less frustrated and seemed more willing to try new strategies . The percent of children exhibiting behavior/emotional concerns in the classroom dropped from 29% fall of 2001 to 12% fall of 2002 as evidenced by Devereux Early Childhood Assessment screenings . Although it is impossible to weigh all the factors, it does seem reasonable to conclude that this type of classroom intervention has a positive impact. 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (This section should conform with the information in the Position Listing on the Budget Narrative Worksheet). Professional Staff: Executive Director_ ( 1 ) On average 8 hours per week are devoted to program. Experience/expertise in: securing and distributing funding for the program, monitoring compliance regarding reporting and billing procedures, maintaining a varied "bank" of quality therapists, available to • serve families at a reduced hourly billing rate . Family Resource Coordinator: _( 1 ) On average 10 hours per week are devoted to program. Experience/ Expertise in: assessing referrals, monitoring treatment plans , implementing program changes in the classroom serving as a liaison among parents, therapists, and centers . Support staff Secretary/Bookkeeper: ( 1 ) On average 4 hours per week is devoted to the program. Experience/expertise in: processing invoices from providers, monitoring parent compliance regarding "out of pocket" payments, checking family health insurance benefits . 5. How will the target population be made aware of the program? CCCR families are made aware of the psychological support program during intake, at the CCCR orientation, and individually through the Family Resource Coordinator. In addition, all center staffs are aware of the availability of the program, and can refer families as needed to the Family Resource Coordinator. 6. How will the program be accessible to target population (i. e. location, transportation, hours of operation) ? Within the parameters of therapist specialty, there is parental choice. This enables a parent to choose a therapist convenient to home or work. Some contracting therapists have evening and weekend appointments available for CCCR families . Some contracting therapists are willing to hold individual therapy sessions at the child' s center. Parents unable to pay the $ 5 . 00 "out of pocket" charge may have it waved through CCCR' s program committee i Community Child Care Resorces Inc. " Psychological Service " Children's Services Advisory Committee D4 . FY03-04 MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) • FY03-04 OUTCOMES ACTIVITIES Add all the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . To increase ; the number of active treatment 1 . All referrals start with the CCCR Family cases ; compared to the number of families Resource Coordinator (FRC), who referred for psychological services ; by 10% ; conferences with the parent to assess the during the 2003 -2004 school year; as problem along with the need for intervention measured by the number of completed 2 . Once need is established, the FRC secures Mental Health Provider Forms . from the Executive Director (E .D . ) Baseline : Family Resource Coordinator' s authorization for the referral . Psychological Referrals log. 3 . Parents select a therapist from a list of CCCR providers appropriate to address the problem, and give written consent for sharing of information. 4 . The E.D . indicates in writing to the selected provider, CCCR' s funding criteria and reporting requirements . 5 . Families with medical insurance will use those benefits first. Families pay a $ 5 . 00 "out of pocket" charge directly to the therapist. If the family can' t afford the co-pay, the FRC • will refer the case to the Program Committee who may waive the fee . 6 . Families directly schedule an initial appointment with the therapist. 7. The FRC will remain in weekly contact with the parent to help encourage the parent to call for an appointment. 2 . 85 % of individuals attending more than two 1 . The therapist designs a treatment plan, and therapy sessions will raise their Global the family takes responsibility for the Assessment of Functioning (GAF) ; within the scheduling of all appointments. 2003 -2004 school year; as measured by the 2 . The FRC monitors the treatment plan through Discharge GAF score . regular conferences with the family, and Baseline : Admission GAF score . consults informally with therapists as appropriate. 3 . The FRC facilitates any recommended changes in the child' s individual school program, and with the classroom teacher monitors progress. • 8 Community Child Care Resorces Inc. " Psychological Service " Children's Services Advisory Committee FY03-04 OUTCOMES ACTIVITIES • Add all the elements or your Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 3 . To decrease the level of anger and 1 . The contracting CCCR therapist schedules inappropriate behavior in classrooms two-hour time blocks with classrooms receiving clinical intervention during 2003 - having documented behavioral concerns . 2004 by 10% as measured by spring DECA 2 . During the first visit, the Psychological assessments . Services Classroom Report is completed . Baseline : Fall DECA assessments 3 . The therapist works with the classroom teacher on enhancing the classroom environment, and targets with the teacher specific behavioral concerns . 4 . The therapist helps the teacher put a behavior management plan in place, and conferences with the Center Director, regarding the plan. 5 . The CCCR Family Resource Coordinator (FRC) follows-up on a regular basis, with the classroom teacher to help implement, adjust and evaluate the plan. 6 . If needed the therapist makes additional visits and/or suggestions for individual child referrals . • • 9 Community Child Care Resorces Inc. " Psychological Service " Children' s Services Advisory Committee • E . COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. [NOTE : Collaborative agreement letters are not required by United Way of Indian River County.] Collaborative Agency Resources provided to the program CCCR Contracting Therapists : All CCCR therapists discount their hourly rate Randy Arms, LCSW approximately 29% . Linda Asher, Ph.D . Some provide evening and weekend hours Robert Brugnoli , Ph.D . Some provide service at the child ' s center Madeleine Laplante, M.A. , LMHC All Complete Mental Health Provider Forms Marcy Purdy, A. T. R. -B . C . or Psychological Support Classroom Report Forms, as Thane Trujillo, M.A. , NCAC II appropriate. Charlotte Kay, M. S . , L .M. H . C . Community Church Partner' s Program The Partner' s program can transport CCCR families that they are working with to and from therapy appointments . The mentor will go with the parent to an initial appointment, if so desired. The Partner' s Program will pay for any medication that may be prescribed, if the parent cannot afford it. The Partner' s program will provide babysitting so a parent may go to a therapy appointment. Indian River Public Schools & Does diagnostic screening on CCCR children who have Florida Diagnostic & Learning learning and behavioral concerns. The data is then used Resources System (FDLRS) by the CCCR therapist to design a treatment plan. Indian River School Readiness Coalition CCCR manages psychological enhancement dollars for the School Readiness Coalition. CCCR coordinates referrals and therapist placements. The CCCR Mental Health provider Form, the Initial Classroom Observation Report, and the Psychological Services Survey are used by the Coalition. The collaboration provides direct psychological services for subsidized families and increased revenue for CCCR therapists willing to reduce rates for both programs , 10 Community Child Care Resorces Inc. " Psychological Service " Children's Services Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender and ethnic background) required by the funder in Section H ? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Data Elements Describinz "Services to Families " Target Population: a. ) Source of referral — (center, parent, CCCR, outside agency) b . ) Form of treatment plan — (child, parent, couple, family) C .) Diagnostic code (DX) number d. ) Admission Global Assessment of Functioning (GAF) number e .) Anticipated number of service units that will be needed Data Elements Describing "Services to Classrooms " target Population: a.) Number of children exhibiting behavioral concerns b . ) Number of children scoring below standard norms on DECA assessment C .) Type and number of unsuccessful teacher interventions prior to requesting services d .) Type and number of teacher requests for service in individual centers e . ) Number of service units used per classroom f.) Number of children referred for individual therapy. 2. MEASURES : What data elements will you need to collect to show that you have • achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades , survey scores, attendance, absences, skill levels) for your program ? Are you getting baseline information from a source on your Collaboration List in Section E? Are there results from your Activities in Section D that need to be documented? How often do you need to collect or follow-up on this data ? "Services to Families " Measurement Elements a.) The number of referrals made for psychological services will be collected by the Family Resource Coordinator (FRC) and compiled in the Psychological Services Log b .) Mental Health Provider Forms completed by the therapist will be collected quarterly and compiled in the Psychological Services Log. The form documents admission and discharge GAF ' s, Diagnosis Codes and descriptions, # of appointments made, kept, cancelled and "no Show", anticipated length of treatment, and other outside resources being used. "Services to Classrooms " Measurement Elements a.) Fall and spring DECA assessment scores will be collected in October and May and compiled in the Psychological Services Log. b .) The numbers and types of classroom concerns are collected through the completion of the Teacher Pre-Observation Forms . They are submitted along with the Psychological Support Classroom Report Form to the FRC who compiles them in the psychological Services log. c.) The Psychological Support Classroom Report Form, upon completion by the 11 Community Child Care Resorces Inc. " Psychological Service " Children' s Services Advisory Committee therapist is submitted to the FRC and compiled in the psychological Services Log. • This form documents type and severity of behavioral concerns observed, description of strategies to be implemented, and the expected need for follow-up by the therapist to the classroom. 3. REPORTING : What will you do with this information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program ? "Services to Families ". Reporting Chan a.) The number of referrals for service will be compared with the number of Mental Health b . ) Provider Forms completed. This will document the percent of families following through on referral . b . ) Data collected from the Mental Health Provider Form is used to compare the patient ' s level of functioning before and after treatment. This will document the percent of patients who raised their GAF scores. "Services to Classrooms "- Reporting Change a. ) The Teacher Pre-Observation Form serves as a baseline in determining change . b . ) The Psychological Services Classroom Report Form documents areas to be addressed and strategies to be implemented. c .) Fall and spring DECA results are compared to document the percent of children • exhibiting behavioral concerns in the classroom setting before and after psychological service intervention. This measures the degree of change in the classroom after psychological service intervention. Sharing Results With the Consumer: CCCR uses past percentages of CCCR families utilizing psychological services, as a "marketing tool" to help present CCCR families feel comfortable in asking for help. Individually, therapists can show patients in a concrete way what they have accomplished. DECA results are interpreted for parents during conferences to better show how the child functions in a group and where the child is in terms of social/emotional development With the Funder: Results are used to show progress and measure outcome success. Generally presented in chart form, they document that the program is satisfactorily delivering the services for which it is being funded. With the Program: Results are used by Board and staff to validate that the mission is being carried forward. Evaluative information helps target areas for improvement and/or growth. With the Community: Sharing measurable results about your program leads to community awareness that in turn may lead to new sources of funding. Outcome success also results in attracting quality people to your organization. • 12 Community Child Care Resorces Inc. " Psychological Service " Children's Services Advisory Committee G. [NOT REQUIRED FOR UNITED WAY OF INDIAN RIVER COUNTY 1 • TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections. Month/Period Activities Psychological Support to Children and Families 1 . On-going 1 . Referral and authorization process 2 . On-going 2 . Treatment 3 . On-going 3 . Family Resource Coordinator monitors treatment plan with therapist and shares as appropriate with center 4 . Dec . and April 4 . Mental Health Provider Forms completed by therapists . 5 . Jan . and May 5 . Mental Health Provider Forms reviewed by Program Committee 6 . At discharge 6 . Client Satisfaction Survey completed by parent Psychological Support to Centers 1 . On-going 1 . Documentation of need for clinical classroom support 2 . Prior to Visit 2 . Teacher completes Pre-Observation of Psychological Services Classroom Report 3 . Day of visit 3 . Therapist completes Psychological Services Classroom Report 4 . Day of visit 4 . Behavior Management Plan in place 5 . On-going 5 . Family Resource Coordinator does classroom follow-up 6 . Dec . and May 6 . Psychological Services Classroom Report reviewed by Program Committee 13 Community Child Care Resorces Inc. " Psychological Service " Children's Services Advisory Committee H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2001/2002 Budget 2002/03 Projections 2003/04 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 60 48 49 S . Indian River County 63 49 51 Indian River Co. Total 123 97 100 Greater Stuart - - - Hobe Sound - - - Indiantown - - - Jensen Beach - - - Palm City - - - Martin County Total - - - Fort Pierce - - Port Saint Lucie - St. Lucie Co. Total - - - Okeechobee County - - - Palm Beach County - - - TOTAL SERVED 123 97 100 Number of Unduplicated Clients by Age L"tS.-Fiscal Year Current Fiscal Year Next Fiseal� Year .: ,R.�s+Fk'� . . .. G , 'S ,+ 3 . : • 3. ;3x, ..•`ilk. iT9. 1 = . i .; Location :Actua1200t/2002 , Budget 2002/03 1.rolec, 200310* Lidividaals : Groep' r ; Individuals Group Indivmdda ��;Group 0 to 4 (Families) - - 22 75 25 75 5 to 10 - (Elementary) - - - - - 11 to 14 - (Middle) - - - - - - 15 to 18 - (High School) - - - - - - 19 to 59 - (Adults) - - - - - - 60 + ( Seniors) - - - - - - TOTAL SERVED - - 22 75 25 75 14 DA, w . D . < as �K e � ; r � ti rir ;�• t3 .<{ � SC � � r.+ ,A iru , '� p �tl ^, J' '� ,.r , t• ul ti ' Proposed • I • Funder • I Agency Budget. BudgetBudget 164111 R. • M6 •I T-TR • / - • • - • • 1 • 11 11 11 11 1 : 11 1 / - • Ost"M Z= • 1 1 / / 1 1 1 • • ' • • • / ContributionswCash • • • 111 1 • • • 111 1 / . : 111 1 / Fun • Raising EventsmNet1 11 11 11 1 / to-Public Net r • 11 11 laTro I - • e1i • • 1 1 1 1 1 1 , � 1 - . ' 1 • • I I • 1 111 11 TOTAL REVENUES include line '1 . _. ®— 1111 • • • • 1 . 11 • EXPENDITURES • • . • Total Program • • - TotalAgencyAGENCY USE ONLY Budget • 1Budget , Salaries - (must complete on - • _ • - 1 1 11 IG no FICA - Total salaries0.0765 • 1 11 Retirement - Annual pension for qualitied staff 1 11 Disab. 1 11 144orkers Compensatio—n - employees x ra • • ' - _ - ® 1 11 • 11 Florida Inemploymen - #-p-ro—jectia-d-- i, employees111 • rate 1 1 / Community Child Care Resources Inc, "Psychological Service" SALARIES A D POSITION LISTING Gross Annual Portion of Salary on Proposed C % of Gross Annual Salary Program Funder Specific Budget Salary Position Title / Total Hrs/wk (Agency) Requested(CIA) Example: Executive Dfrector/ 40 hrs 70,000.00 100000. 00 51000.00 7, 14% Executive Director / 40 hrs 40 , 847. 33 81169 .47 0 .00 0 .00% Family Res . Corr. 35, 535. 96 81883 . 99 0. 00 0 . 00°/ Book Keeper 27,270 . 96 61817.74 0. 00 0 . 00% #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! Remaining positions throughout the agency Total Salaries 1 $ 103 ,654.251 $23 , 871 .20 $0 . 00 0 . 000/ FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B c D E F G Pension Workers Unemp/oyme Total Fringes Funder Column C only, from line 22 to 27) Specific FICA 7,65% (A x /) Health Ins, Compens. nit Compens. Specific Position Tide / Total Hrs/wk Budget Example: Case Manager/ 40 hrs 51000.00 382,50 200.00 500.00 300.00 200.00 1,582,50 Executive Director 140 hrs 0. 00 0.00 0 .0 Family Res. Corr. 0. 00 0.00 0 .0 Book Keeper 0.00 0 . 00 0 .0 Q 0. 00 0. 00 0.0 0 0.00 0 .00 1 0.0 0 0. 00 0 .00 0.0 0 0. 00 0.00 0.0 Q 0. 00 0.00 0.0 Q 0 .00 0. 00 0.0 0 0.00 0. 00 1 0 .0 0 0.00 0. 00 0.0 0 0.00 0.00 0.0 0 0.00 0. 00 0.0 0 0.00 0. 00 0.0 Q 0 .00 0. 00 0.0 0 0 .00 0.00 1 0. 0 0 0.00 0.00 0. 001 0 0.00 0.00 0. 0 0 0.00 0. 00 0.0 0 1 0.001 0.001 1 0.0 Total Funder Request Fringe Benefits 1 $0 .001 $0 . 001 $0.001 $0.001 $0.001 $0. 001 $0 .001 MMWWMJ A B C D EXPENDITURES (MY AREAS FOR Proposed Total Program Funder Specific Total Agency AMMY USE Budget Budget Budget 5123/03 16 Community Child Care Resources Inc. "Psychological Service" 28 Travel-Daily 600 .00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb. ravel/Conferences/Training 19500. 00 • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel , lodging , registration , food) 30 Office Supplies 11100. 00 3 , 750. 00 Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 31 Telephone 615 .00 21640.00 # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 32 Postage/Shipping 618 .70 21690. 00 • Quarterly Mailing of Newsletter • Special events , etc. • Bulk mailings - appeals 33 Utilities 19152 . 51 41610 .04 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 34 Occupancy (Building & Grounds) 21277. 00 91900. 00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes rinting & Publications 690.00 31000 .00 qW Quarterly Newsletter ($ x 4) • Letterheads, Envelopes, etc. • Fundraising materials • Other 36 Subscription/Dues/Memberships 750.00 • Dues • Subscriptions to Newspapers/magazines , etc. 37 Insurance 920. 18 4,000.00 • Directors/Officers Liab. • Commercial/General Insurance • Bond Ins. • Auto Insurance 38 Equipment: Rental & Maintenance 172.43 750 .00 • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 39 Advertising 200.00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 40 Equipment Purchases:Capital Expense • Computer/monitor (# x $) • Laser Printer Professional Fees (Legal, Consulting) 13,600.00 13,600.00 16,600 .FO Legal advice ( estimated #hrs x $) Consultant fees • Other 5/23/03 17 Community Child Care Resources Inc. 'Psychological Service" ;42ooks/Educational Materials 3 ,050. 00 Books/videos Materials ($ x staff) ood & Nutrition 900. 00 Meals ( # meals x clients x 5days x 50 wks) Snacks 44 Administrative Costs 907 . 72 49538. 59 Admin . Cost (% of total budget) 45 Audit Expense 11000 . 00 5 ,000.00 Independent Audit Review 46 Specific Assistance to Individuals 350 .00 21000 .00 Medical assistance Meals/Food Rent Assistance Other 47 Other/Miscellaneous 11500.00 • Background check/drug test • Other 48 Other/Contract 404 ,695.05 Sub-contract for program services 49 TOTAL EXPENSES $ 139600.00 $585 ,278 .68 • • 5/23/03 18 Cmwwft CNN Cr Remauwes. h o / 'P$y&"09CW SeHce UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Community Child Care Resources Inc. / "Ps cholo ical Services" FY 01/02 FY 02103 FY 03/04 % INCREASE July 1June 30 July 1 -June 30 July 1 -June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-col. aycol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/0! 2 Children's Services Council-Martin 0.00 #DIV/0 ! 3 Children's Services Council-Okeechobee 0.00 #DIV/0 ! 4 Advisory Committee-Indian River 167 134.93 167 000.00 208 500.00 24. 85%9 5 United Way-St Lucie County 0.00 #DIV/01 6 United Way-Martin County 0.00 #DIV/0 ! 7 United Way-Okeechobee County 0.00 #DIV/0! e United Way-Indian River County 162t644.75 184 922.96 185 054.00 0.07% 9 Department of Children & Families 0.00 #DIV/01 to County Funds 0.00 #DIV/01 11 Contributions-Cash 67t340.00 5800.00 76 000.00 31 .03% 12 Program Fees 60 857.00 68 000.00 68M0.00 0.00% 13 Fund Raisinq Events-Net 10 975.82 22 500.00 22 500.00 0.00% 14 Sales to Public-Net 0.00 #DIV/01 15 Membership Dues 0.00 #DIV/O! 16 Investment Income 4, 167.00 851 .04 851 .00 0.00% 17 Miscellaneous 0.00 #DIV/01 16 Legacies & Bequests 0.00 #DIV/0! 19 Funds from Other Sources 83 766.00 83 000.00 65 000.00 -21 .69% 20a Reserve Funds Used for Operating 0.00 0.00 #DIV/O! 20b In-Kind Donations (Not Included In total) 0.00 #DIV/0! 21 TOTAL 556 885.50 584 274.00 625 905.00 7. 13% EXPENDITURES 22 Salaries 102 954.40 103 654.25 103 654.25 0.00% • 23 FICA 91109,00 8 276.75 8276.75 0.00% 24 Retirement 0.00 #DIV/O! 25 Life/Health 0.00 #DIV/O! 26 Workers Compensation 612.00 674.00 674.00 0.00% 27 Florida Unemployment 0.00 #DIV/el 28 Travel-Dailv 400.00 600.00 600.00 0.00% 29 Travel/Conferen cesrTraining 891 . 14 11500.00 1 P500,00 0.00% 30 Office Supplies 31262.20 39750.00 3g750.00 0.00% 31 Telephone 2 640.00 29640.00 2640.00 0.00% 32 Postage/Shipping 2157.64 21690,00 21690,00 0.00% 33 Utilities 31917,29 49610,04 49610.04 0.00% 34 Occupancy (Building & Grounds 10 540.00 92900.00 9900.00 0.00% 35 Printinq & Publications 1 580.41 32000,00 39000,00 0.00% 36 Subscription/Dues/Memberships 1 014.00 750.00 750.00 0.00% 37 Insurance 2,717.08 41000.00 41000.00 0.00% 38 E ui ment:Rental & Maintenance 750.00 750.00 750.00 0.00% 39 Advertising 200.00 200.00 200.00 0.00% 4o Equipment Purchases:Ca ital Expense 0.00 #DIV/01 41 Professional Fees (Legal, Consulting) 14 668.00 14 969.00 16 600.00 10.90%9 42 Books/Educational Materials 49043.33 39060.00 3 050.00 0.00%9 43 Food & Nutrition 756.42 900.00 900.00 0.00% 44 Administrative Costs 4t538.59 49538,59 0.00% 45 Audit Expense 59000,00 59000,00 5 000.00 0.00% 46 Specific Assistance to individuals 131 .54 29000,00 M_____2*000.00 0.00% 47 Other/Miscellaneous 566.00 115W,00 19500.00 0.00% 48 Other/Contract 408 104.05 404 695.05 444 695.05 9.88%9 49 TOTAL 576t014.50 583A47.68 625 278.68 7. 13% 5o REVENUES OVER/ UNDER EXPENDITURES -19, 129.001 626.32 626.32 0.00% yry� 19 CamnNy UM Cee Reeuree, he. I 'Psydwk*CW Service UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME:Community Child Care Resources Inc. / " Psych loical Services" • FY 01/02 FY 02/03 FY 03104 % INCREASE July 1June 30 July 1June 30 July 1June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Gcoi. Bycol. B REVENUES BUDGETED BUDGETED 1 Children's Services Counc!ISt. Lucie 0.00 #DIV/0! 2 Children's Services Council-Martin 0.00 #DIV/O! 3 Children's Services Council-Okeechobee 0.00 #DIV/Ot 4 Advisory Committee-Indian River 6t984.93 79000.00 850000 21 .43% 5 United Way-St Lucie County 0.00 #DIV/0! 6 United Way-Martin County 0 .00 #DIV/01 7 United Way-Okeechobee County 0 .00 #DIV/0! 8 United Way-Indian River County 41968.96 42968.96 57100 .00 2.64% 9 Department of Children & Families 0.00 #DIV/01 10 County Funds 0.00 #DIV/0! 11 Contributions-Cash 23 840.00 14 500.00 19 915.13 37. 35% 12 Program Fees 47857.00 52000.00 51000.00 0.00% 13 Fund Raising Events-Net 10 500.00 10 500.00 0.00% 14 Sales to Public-Net 0.00 #DIV/0! 15 Membership Dues 0.00 #DIV/O! 16 Investment Income 167.00 243.00 243.00 0.00% 17 Miscellaneous 0.00 E#DIV/01 is Legacies & Bequests 0.00 19 Funds from Other Sources 51415. 13 0.00 % 20a Reserve Funds Used for Operating 0.00 20b In-Kind Donations (No inauaad In total) 0.00 21 TOTAL 40 817.89 47 627.09 49 258. 13 3.42% EXPENDITURES 22 Salaries 19 520.00 23 871 .20 23 871 .20 0.00% • 23 FICA 12669,68 19826.15 1826. 15 0.00% 24 Retirement 0.00 #DIV/0! 25 Life/Health 0.00 #DIV/01 2s Workers Compensation 142.00 157.24 157.24 0.00% 27 Florida Unemployment 0.00 #DIV/01 28 Travel-Dai 0.00 #DIV/01 29 Travel/Conferences/Trainin 0.00 #DIV/01 30 Office Supplies 19025.00 119100.00 1 100.00 0.00% 31 Telephone 615.00 615.00 615.00 0.00% 32 PostagelShipping 618.00 618.70 618.70 0.00% 33 Utilities 11140.001 19152.51 1 152.51 0.00% 34 Occupancy (Building & Grounds 2t277.00 21277.00 21277.00 0.00% 35 Printing & Publication 80.00 690.00 690.00 0.00% 36 Subscription/Dues/Memberships 0.00 #DIV/0! 37 Insurance 700.00 920.18 920. 18 0.00% 38 E ui mentRentai & Maintenance 172.50 172.50 172.43 -0.040/6 39 Advertising 0.00 #DIV/01 4o Equipment Purchases:Ca ital Expense 0.00 #DIV/01 41 Professional Fees (Legal, ConuMn 11 F953189 11 968.89 1360000 13.63% 42 Books/Educational Materials 0.00 #DIV/01 43 Food & Nutrition 0.00 #DIVl01 44 Administrative Costs 907.72 907.72 0.00% 45 Audit Expense 19000.00 11000,00 100000 0.00% 4s Specific Assistance to Individuals 350.00 =49,258, 133.420% % 47 Other/Miscellaneous 4a Other/Contract 49 TOTAL 40 913.07 47 627.09 %5o REVENUES OVER/ UNDER EXPENDITURES -95.18 0.00 sruus 20 Communtiy Child Care Resources, Inc. / "Psychological Services" UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET i PROGRAM EXPENSES AGENCY/PROGRAM NAME : Psychological Services FUNDER : Children 's Services A B C FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS . PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col . A) EXPENDITURES 22 Salaries 23 , 871 . 20 0 . 00 0 . 00% 23 FICA 19826 . 15 0 . 00 0 . 00% 24 Retirement 0 . 00 0 .00 #DIV/0 ! 25 Life/Health 0 . 00 0 . 00 #DIV/0 ! 26 Workers Compensation 157 .24 0 . 00 0 . 00% 27 Florida Unemployment 0 . 00 0 . 00 #DIV/O ! 28 Travel-Dail 0 . 00 0 . 00 #DIV/0 ! 29 Travel/Conferences/Training 0 . 00 0 . 00 #DIV/01 30 Office Supplies 19100 .00 0 . 00 0 . 00% • 31 Telephone 615 .00 0 . 00 0 .00% 32 Postage/Shipping 618 .70 0 .00 0000% 33 Utilities 1 , 152 . 51 0800 0 .00% 34 Occupancy (Building & Grounds 29277 . 00 0 . 00 0 .00% 35 Printing & Publications 690 . 00 0 . 00 0 . 00% 36 Subscription/Dues/Memberships 0 . 00 0 .00 #DIV/01 37 Insurance 92018 0 . 00 0 . 00% 38 E ui ment: Rental & Maintenance 172 "43 0 .00 0 . 00% 39 Advertising 0 .00 0 .00 #DIV/01 40 Equipment Purchases : Ca ital Expense 0 .00 0 . 00 #DIV/0 ! 41 Professional Fees (Legal , Consulting) 13, 600 . 00 139600. 00 100 . 00% 42 Books/Educational Materials 0 .00 0 .00 #DIV/0 ! 43 Food & Nutrition 0 .00 0 .00 #DIV/01 44 Administrative Costs 907 .72 0 . 00 0 . 00% 45 Audit Expense 1 ,000.00 0 . 00 0 .00% 46 Specific Assistance to Individuals 350. 00 0 .00 0 .00% 47 Other/Miscellaneous 0.00 0 .00 #DIV/01 48 Other/Contract 0000 0 .00 #DIV/0 ! • 49 TOTAL $49 ,258 . 13 $ 139600 . 00 $0 .28 5MUM 21 Co UnUy Chid Care Resources, Im. / -P%ychobpaY Smicea UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET 104GENCYIPROGRAM NAME: Community Child Care Resources Inc. I " Psychological Services" FUNDER:Children's Services LINE ITEM EXPLANATION FOR VARIANCE #DN/01 #DN/0! #DNIO! Advisory Committee-Indian River Expected increase in number of clients to be served. #DNI01 #DNIOI #DN/01 #DNI01 #DNI01 Contributions-Cash Foundation money moved from Funds from Other Sources to Contributions-Cash #DN/O ! #DNI01 #DNI01 #DN/01 #DN/01 #DNI01 #DN/01 #DN/01 #DNI01 #DN/01 #DN/01 #DNI01 #DNI01 #DIV/01 #DNI01 #DNI01 #DNIOI #DN/01 Maw 22 Community CM Care Ree fcM Im / 'Pq/&m CW SWWOW UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15016 OR MORE FUNDER SPECIFIC BUDGET 0GENCYIPROGRAM NAME : Community Child Care Resources Inc. / " Psychological Services" FUNDER: Children's Services LINE ITEM EXPLANATION FOR VARIANCE #DN/OI #DN/01 #DN/OI #DN/01 #DNIOI #DNI01 #DN/OI #DN/OI Professional Fees (Legal, Consurdri Increase thearpy cost- Increase number of clients #DNIOI #DN/OI #DN/OI #DNIO! • n3003 23 Community Child Care Resources Inc. "Psychological Services" Children's Services Advisory Committee ORGANIZATION : Community Child Care Resources, Inc. • PROGRAM : "Psychological Services" TABLE OF CONTENTS Please "X" the parts of the grant application to indicate they are included. Also, please put the page number where the information can be located. EXT— Section of the Proposal Pa e # TABLE OF CONTENTS (Check list) X COVER PAGE (with signatures) . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . " , " . , . " , 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 Be PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6&7 X4 . Staffing . I I I I I I * 9 , , 1 9 1 , 1 1 1 1 1 * I I , * 9 1 o I a I 1 4 4 0 9 0 9 1 " 0 " 6 6 1 1 . I I I I I I I I I I I I I I I I I I I 1 7 X 5 . Awareness of program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program. , . . . . . . . . . . . . 0 , , X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . 8 &9 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 & 12 X 3 . Reporting . 12 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1 Community Child Care Resources Inc. "Psychological Services" Children's Services Advisory Committee . I. BUDGET FORMS X 1 . Budget Narrative Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 , 169 17 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 X 3 . Total Program Budget . . . . . . . , . , , . . . . . . . . 19 X 4 . Funder Specific Budget. . . . 20 X 5 . Explanation for Variances — Total Program Budget . . 21 X 6 . Explanation for Variances — Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 J. FUNDER SPECIFIC/ADDITIONAL SHEETS K. APPENDIX • • 2 EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on February 19 , 2002] " D . Nonprofit Agency Responsibilities After Award of Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally , this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 1St may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year end (September 30th) must be submitted on a timely basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expenses by type . These summaries should be broken down into salaries , benefits , supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below . a . Travel expenses for travel outside the County including but not limited to ; mileage reimbursement , hotel rooms , meals , meal allowances , per Diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c . Any expenses not associated with the provision of the program for which the County has awarded funding . d . Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " - 1 - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices : Any notice , request, demand , consent , approval or other communication required or permitted by this Contract shall be given or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other parry ; delivery by commercial overnight courier service ; or mailed by registered or certified mail ( postage prepaid ) , return receipt requested at the addresses of the parties shown below: County : Joyce Johnston-Carlson , Director Indian River County Human Services 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : Community Child Care Resources P . O . Box 3451 Vero Beach , Florida 32964 2 . Venue ; Choice of Law: The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida , only . The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract , or any breach hereof, as well as any litigation between the parties , shall be Indian River County, Florida for claims brought in state court , and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement : This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly , it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability: In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract , and every other term and provision of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent , this Contract is deemed severable . 5 . Captions and Interpretations : Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless the context indicates otherwise , words importing the singular number include the plural - 1 - number, and vice versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract . The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient' s sole direction , supervision , and control . 7 . Assignment. This Contract may not be assigned by the Recipient without the prior written consent of the County . - 2 - � 4G� e -- Resources , Inc. Port Office. Box 3451 Phone ( 772 ', 567- 32M2 Vero Beach , Florida 32964 For Working Families In Indian River County Fax ( 772) 507 - 1116 Soni of Dirt cloys l:nfln +nr iiiJ! President Helt't , M ,rr•ratf Vice President Slit, SrrtolillEc secretnn: November 12, 2003 Guru Kurt Treasure.' Joyce Johnston-Carlson Director Ftrrr,urh ,c Indian River County Human Services 1lan:,,; ,rrta Gtsarc' Children ' s Services Advisory Committee Arrtl:oml ). on,± oriit� 1840 25u' Street A�? inc�Ji Fn11. T± n , a ; t, Glaser Vero Beach. FL 32960- 3394 Nancy I101n000d � List ,l . '!c Dear Ms . Johnston-Carlson : J;riki, K. Lwp`C.Y �ctlt Lv! , Sfclrlra,ria mac 'Nfdwat Our letter is to verify that neither employees nor volunteers of Community Child Kafl{:, Marsha'/ Care Resources. Inc transport clients (children) in the course of their duties. Awit• Pallaick Ciatiu Re' ir Linda shiltlry If you have questions about the transportation issue, please let me k-low. h1t/J;:a titttrdP!' 11;•1111n•r born Duke.. 1 Sincerely, ltdri�4nr7/ P,T�tarJ slf.mll Hlaxilt- oen1 Ra-s Catf,t•r,±rnu :11artP P. Graves ivi!iiaw Holl Abby Viralter SW '+t !,ic Gtnza•s 11cov. Y Executive Director Samtj Kai,it' . Mary Knvaip( Gha )-'ty Rtsplo ;':i' ti/;ctrl! lVrtt/tfcl! I 0 , Ir .. J .. 11 / 12 / 2003 16 : 46 FA% 772 562 3466 SID BANACK INS : 001 / 001 ACORD E (arluOorYY) ,l TMGAT . CERTIFICATE OF LIABILITY INSURANCE DATE PRODVCER $ ID 1K INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 204$ 14TH 4TI4 AVE. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O BOX 130 HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR VERO BEACH FL 32961 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE : 7724624369 INSURERS AFFORDING COVERAGE NAIC # _ .. _ _ . _.. ... . — . . __ ._ .. ._ ._.. _ . ._. _ . ._. INSURED INSVRERA: HARTFORD CASUALTY INSURANCE CO_ COMMUNITY CHILD CARE RESOURCES , INC . Ciq CCCR, INC- INSURER e: MARTINS CO OF SOUTHEAST 1027120 — . . — - - ' - P. O, BOX 34 $1 ' INSURER C: —. — VERO BEACH , FL 32964 INSURER D; INSURER E : COVERAGES THE POLICIES OF INSURANCE LISTED EELOW HANE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TME POLICY PERIOD INDICATED, NOTWITHSTANDI ANY REQUIREMCNT , TERM OR CONCITION OF ANY CONTRACT OR OTHER OOCLWNT WITH RESPECT TO WHICH THIS CERTIFICATE MAY NG BE ISSUED AN MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SVBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 1N . .. —_.. .-.. . . LT TYPE OF INSURANCE POLICY NUMBER POLICY CPPECTN[�roucY E PfRATrT LlMlrs PATO N�WODIW DATE MMIDO ceuaRAl LlAalurY X 21 SBA FP5973 DV OCT 14 03 i OCT 14 04 EACH OCCURRENCE s 1 ,000, 000 COMMERCVIL GENERAL LIABILITY I j DAMAGE TO RENTED ' s 300 000 CLABAS MADE 17 OCCUR I MED. I MED. EXP IArn• One Person; IS 101000 A - - - - PERSONAL L ADV INJURY S � I .. _. _.._ 1 .0,000 -- -� - I GENERAL ACCREGATE -�S— I GEN•L AGGREGATE LIMIT APPLIES PER: j r • ---•• _ Z_OOOr000 i ._ - I PO .ICY - -� .I I i PRODUCTS-COMPlOP AGG. IS • •- 21000,000 P I AUTOMOBILE UAdLTTV ! 21 SBA FP6973 DV OCT 14 03 OCT1404 ANY AUTO I COM21NEO SINGLE LIMIT S 000 000 I i � I (Ee eccloerN) , All, OWNED AUTOS — I— I BODILY INJURY A - I SCHEDULED AUTOS I I (Parpar:on) Is I � i HIREDAVTOS I '— '- - - • - • --- - - •- - L_"I BODILY INJURY � S X NON- OWNED AUTOS I (Per accbenl) PROPERTY DAMAGE {S GARAGE LIABILITY I ALTO ONLY • EA ACCIDENT I $ ANY AUTO _ I OTHER THAN EA ACCs _ 1 I AUYO ONLY: A3Q S EXCESS UMeEFEL44 LIABILITY EACH OCCURRENCE{ E OCCUR CLAIMS MADE ' AGGREGATE I - - --- -- - S DEDUCTIBLE •--- -- RETENTION g _ — $ I : WORKERS COMPENSATION AND 21WECDQ6422 ��CaTAru ciHER Ek PLOYER9 uABn IrY Ij OCT 14 03 OCT 14 04 �pRy UMITS x _ $ IArty PRDPRIkfcwPARTNtWfAtCMTf" I El, EACH ACCIDENT S 500,000 DFFlCEIRINGH EA EXCLUDEW _ _ Y rw, dwcMc YOM' I E L. DISEASE-EA EMPLOYEE $ $QQ ,000 SPECIAL MIONbIOM ONew E.L. DISEASE -POLICY LIMIT S $OO ,000 ' OTHER DESCRIPTION OF OPERATIONSILOCATION/VEHICLES/EXCLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED UNDER THE GENERAL LIABIUTY POLICY SUBJECT TO POLICY PROVISIONS . 10 DAY NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: _ CANCELL.,TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL U DAYS WRITTEN NOTICE 70 THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INDIAN RIVER COUNTY FLORIDA INSIVER, rS AGENTS OR REPRESENTATIVES. 1840 25TH STREET VERO BEACH, FL 32960-3365 AUTHORIZED REPRESENrATtVE � 7 Attention : JOYCE JOHNSON - FAX #978-1798 ' f"� 7 ACORD 26 (2001108 ) Certificate # 70671 Sidney M. Eanaek , Jr.