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					                   OFFER FROM NON-PROFIT ORGANIZATIONS
                            FOR 2010/2011 BUDGET

                                            MESA COUNTY

What is Budgeting for Outcomes?


Budgeting for Outcomes is a budget process which “buys” results based on the Board of County
Commissioners priorities. The Board has defined a set of critical issue and desired outcomes from their
strategic plan that will be the basis for the 2010/2011 budget. It emphasizes accountability, innovation, and
partnerships. Information on the Critical Issue Areas and the Offer for Results is available at:
http://www.mesacounty.us/finance/budget2010-2011.aspx


Critical Issues and Outcomes


The Board of County Commissioners defined six critical issue areas allocated funding to each critical issue.


1. Continue to promote and protect public safety through an effective and efficient criminal justice
system and emergency preparedness:
“I want to feel safe anytime, anywhere in Mesa County.”

2. Promote public health.
"I want a healthy Mesa County."

3. Promote economic vitality.
"I want Mesa County to have a variety of industries that will promote a healthy and sustainable economy."


4. Create well-planned and developed communities.
"I want plans and infrastructure that maintain the quality of life."

5. Continue to efficiently and effectively protect and manage all public resources
"I want Mesa County to have well-managed public resources."

6. Promote self-sufficient individuals and families.
"I want a community where citizens have opportunities to be self-sufficient."
Offers for Results

Request for Results (RFR’s) have been developed for each desired outcome. RFR’s will identify the outcome,
the factors that contribute to an outcome, the strategies that will influence the outcome and three “indicators”
that will determine if the County is making progress toward the desired outcome. The RFR is similar to a
Request for Proposal (RFP) in that any County Department or not-for-profit agency may submit an offer to
provide the services that have been outlined in the Request for Results. Requests for Results are available at
http://www.mesacounty.us/finance/budget2010-2011.aspx


Preparing Your offer

• Review the Results Team’s Request for Results (RFR). Results teams have developed RFR’s
describing what kinds of offers they are looking for from sellers. They have crafted these RFR’s based
on their Result Maps and evidence of what they think will most likely achieve the outcome they have
been assigned. Offers are not about process – they are about outcomes.
• Align your Offer with the appropriate RFR - Make sure you have fully read the Results Team RFR's
for each outcome. Design your offer to maximize results that respond to the critical issue, and describe
and justify fully in your offer how the offer responds to that RFR. If your offer also fits within another
RFR, identify and explain that in your justification. Agencies are encouraged to document the logic and
evidence that show how the offer responds to the RFR.
• Focus each Description and Justification. In your description and justification, you can assist the
results teams by being concise and clear. It is critical that your descriptions and justifications are
complete. Do not assume program understanding by those who must read and evaluate the offer. The
offer must be simple, accurate, succinct and complete.
Completing Your Offer

Click on the Offer Form at the bottom of the screen and fill out all of the boxes highlighted in yellow:

Agency or Non-profit Organization Name - Enter the name of your organization.
Offer or Program Name - Enter the name of your offer or program.
Critical Issue Area - Enter the Critical Issue Area (see above for a list)

Is this Offer related to another Offer? - If yes, name the other offer and describe how they are related.

Does your organization have other grants or contracts with Mesa County? - Enter any funding your
organization receives from Mesa County and the type (contract, grant, etc.)

Executive Summary - Briefly describe your offer/program.
Offer Description - Describe your offer/program in detail.

Offer Contribution - Describe how the offer/program will contribute to the Critical Issue/Outcome.
Expected Performance Results - Describe the results you anticipate if your offer is funded
Performance Measures - Each offer must include a way to measure the performance of the offer. If your
offer is approved, you will be asked to report on the progress achieved toward the result using the performance
measures identified. These performance measures with a targeted level of service delivery should relate to the
indicators in the RFR. Sometimes, the performance measure and the indicator will be the same. You may use
more than one performance measure if you wish. Do not use more than three. Your performance measure
should reflect the outcome your offer produces, not the inputs used. Measure results, not activities. Keep in
mind that we are looking for measures that support the results we are seeking.
If you received funding from Mesa County in 2009, please enter the results of your 2009 Performance
Measures here.


Ranking of offers
All offers for funding are evaluated by the Results Teams against other offers from Mesa County Departments
and compete for the dollars allocated to that particular outcome.


Your offers are due August 21. Please submit these electronically to eleanor.thomas@mesacounty.us or
jennifer.schmalz@mesacounty.us. Each offer will be sent to the appropriate Results Team.
                                                     MESA COUNTY
                                          OFFER FROM NON-PROFIT ORGANIZATIONS
                                                  FOR 2010/2011 BUDGET

Instructions: Complete all fields highlighted in yellow. If you wish to copy text from a Word document, highlight the text in Word,
and click on the Copy button. On this page click on the appropriate yellow field, hit the F2 key, click on the paste button on the tool
bar and hit Enter. The Offer Description is in 3 different rows to get around the size limitation in Excel.
Instructions for completing this application are provided in the tab "Instructions".




AGENCY OR NON-PROFIT ORGANIZATION NAME:
                                Mesa Developmental Services
OFFER OR PROGRAM NAME:
                                Services for People in Mesa County with Developmental Disabilities and Infants/Toddlers with Developmental Delays


Critical Issue Area                        # 6 - Promote Public Health and the success of all citizens/ Self Sufficiency for Individualsand Families
Contact Person & Phone #:                  Jeff Nichols, 256-8601
Contact Email:                             jnichols@mesadev.org
Alternate Contact:                         Marilee Langfitt (preparor of offer) or Ed Wieland (VP of Finance)
Is this offer related to another offer?
                                           No
 If so, please enter the other offer name and how it is related.



Does your organization have other grants or contracts with Mesa County?
                                          No
 If Yes, please enter the other Mesa County Department name and the service being provided in the grant or contract.




2. Executive Summary (50 words or less)
                                           A private, nonprofit under contract since 1966 with the Colorado Department of Human Services to provide total care or
                                           support services in Mesa County to: adults with developmental disabilities (cognitive and physical); families raising a child
                                           with a disability; and infants/toddlers with disabilities or developmental delays.


Offer Description:
                                             The mission, vision and values of Mesa Developmental Services (MDS) is centered on support services and opportunities
                                             for personal growth that promote self sufficiency for people with disabilities. We serve approximately 600 Mesa County
                                             residents and their families from 44 residential sites and eight program sites. The majority are adults (350) with
                                             developmental disabilities (DD). These individuals require life long care of varying degrees ranging from intensive round-
                                             the-clock care, to a few hours of support services weekly to assist people with a milder form of DD to live independently.
                                             The majority of this latter group are employed in the competitive job market in our community. In spite of their ability to
                                             hold jobs, they still need support services from MDS because they have minimal problem solving and safety skills. Only a
                                             small percentage can read or do math so they need help with budgeting, bill paying, medications, and the higher level skills
                                             necessary to live completely independent.

                                             Most of the people we support were born with a disability but some acquired their disabilities through head trauma or
                                             other types of brain damage that occurred during childhood. Some live at home with their families, who gladly care for
                                             them but need help to do so. Others require so much care it is difficult, if not impossible, for them to receive the level of
                                             round-the-clock care they need in the family home so they live in a staffed group home. We provide total care for 75
                                             people in twelve group homes, 37 in host homes and apartments, and oversee care for an additional 67 individuals
                                             receiving residential services through other approved service providers. Host homes are similar to adult foster care and are
                                             a growing service model we promote because it offers a more natural home environment and is the most cost effective
                                             option.

                                             Other Services Provided by MDS Include:
                                                    • Infant and toddler developmental screening and early intervention therapy services for children birth to
                                                     three identified as having a developmental delay or disability. The goal is to correct developmental delays
                                                     or minimize disability. These services are delivered in the family home, which has the benefit of being a more
                                                    natural environment, less costly than a clinical setting and allows staff to teach parents how to enhance their
                                                    child’s development in the course of their daily activities. These strategies are all preventative in nature. Last year
                                                    we served 242 children 0-36 months old with developmental delays and the majority will reach age appropriate



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                                       we served 242 children 0-36 months old with developmental delays and the majority will reach age appropriate
                                       development because of early intervention. It is estimated that only 10 – 11% will need life long services for
                                       developmental disability.

                                       • For children age three to adult with significant disabilities, our role is to provide customized assistance to
                                        help the family care for their child in the family home. Assistance is in the form of equipment purchase
                                        or loan, home modifications, respite, training, counseling, etc. - services that ease the strain and expense
                                       of each families’ intensive care regimen. We serve about 90 Mesa County families in this program and have 43
                                       families waiting for services.

                                       • Support services to enable adults with developmental disabilities to live as independently as possible or remain
                                       in their family home.

                                       • Vocational training and employment services for individuals working in the community or on one of MDS’ crews
                                       doing contract work (janitorial, grounds maintenance, assembly work, bulk mailing). Last year we assisted 114
                                       individuals in gaining and maintaining employment.

                                       • Various day programs for non-workers based on level of disability. Some programs improve skills of
                                       independence and social skills. Others are therapy based for those with significant physical and/or cognitive
                                       disabilities.

                                       • Other Support Services - Transportation, Case Management, Health and Wellness Services (nursing, therapy
                                       and behavioral health services).

                               The people we serve are a vulnerable, at risk population. Our main responsibility is to ensure their health and safety, and
                               to provide opportunities for personal growth. Our continuum of services provides for: basic personal needs; safe housing;
                               health; safety; life skills training; vocational/self sufficiency education; protection from mistreatment, abuse, neglect and
                               exploitation; community inclusion; self determination; and mobility.

                               Our services reduce the need for county services in a variety of areas:
                               • State institutions are no longer a service option for adults with developmental disabilities. If we can’t afford to serve
                               individuals with developmental disabilities, especially people with the most significant disabilities who are the most costly
                               to serve, it will be up to the Mesa County Department of Human Services.
                               • Our services cost 60-70% less than the same services delivered through state institutions.
                               • Our services prevent homelessness and keep people out of the judicial system.
                               • We help reduce system reliance by increasing self sufficiency.
                               • Early intervention programs reduce the need for life long services.
                               • Our support to families raising a child with a significant disability helps the family stay together, thereby preventing the
                               need for foster care and other emergency services.
                               • Our transportation services reduce the pressure on GVT to provide wheelchair transportation.

                               Need for Funding:
                               • Of our approximately $15 million budget, 88% comes from the State of Colorado, primarily Medicaid dollars. Only 9%
                               of our budget is administrative. Our rates are controlled by the state and the number of people we serve is controlled by
                               the state. There are not enough appropriated state funds and federal grant funding to cover all the mandated services.
                               We operate in a funding and regulatory environment over which we have little control. Federal and state agencies
                               determine how services are to be provided, and how much will be paid for the services. We face a constantly shifting
                               environment that is requiring more record keeping, more financial details on all transactions, and more time spent on
                               issues other than providing services to individuals with developmental disabilities. There were numerous changes to rate
                               levels (down) and processes initiated for this current fiscal year, which began July 1.

                               • We have a history of managing our resources well. Despite our frugality, it’s a continual struggle to provide quality
                               services and compensate our staff adequately. We have made progress by raising our base salaries this past year for
                               direct support professional starting pay from $8 per hour to $10. This has had a positive impact on our recruitment and
                               retention, yet most of our employees still do not make at or above what is considered a living wage in Mesa County
                               according to the Mesa County DHS “Bridges Out of Poverty” self sufficiency report from last year.
                               • We experienced more funding cuts for this fiscal year:
                                           o Supported Living Services Program - reduced support staff by 5.7 FTE - $350,000 revenue loss
                                           o United Way and other renwewable funding reduced
                                           o A significant County DHS grant assisting three programs was rescinded
                                           o Experienced cutback in funding from Division of Vocational Rehabilitation
                               • We are serving more people with severe, multiple disabilities that need more supports than in the past. An aging
                               population also creates new needs and new expenses
                               • New demands on staff time because of numerous unfunded or underfunded state and federal mandates and system
                               changes are substantial and climbing.
                               • Infant & Toddler Early Intervention (therapeutic prevention services for age 0-3) -MDS is funded to serve fewer children
                               than we actually serve. We are mandated to serve all eligible children in Mesa County for free with inadequate resources.
                               However, last year we were able to bill private insurance for the first time in this program. We anticipated approxiamely
                               $25,000 of new revenue as a result. The actual figure was $35,760 for a partial year (since January).
                               • Through CAPTA (Child Abuse Protection and Treatment Act), we have an interagency agreement with Mesa County
                               Department of Human Services to refer all children 0-3 to MDS who are victims of a substantiated case of abuse or neglect,
                               and children who are identified as affected by illegal substance abuse or symptoms resulting from prenatal drug exposure.
                               MDS will evaluate their development and eligibility for services. Ages and Stages screenings and The Childhood Autism
                               checklist now used by physicians at well baby checks have also contributed to an increase in referrals.
                               • We have 90+ local families waiting for services that we do not have resources for.
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                                            • We have 90+ local families waiting for services that we do not have resources for.
3. Expected Performance results: What will be the results of the offer?
                                        Desired Outcomes are: restructuring operations and finding additional resources:
                                         We are developing more collaborations and partnerships which have the potential to shift some of our service provision
                                        and/or create additional efficiencies:

                                           o We are currently moving forward with plans to conduct joint trainings with our provider agencies to share costs, strengthen
                                           our partnerships and assure all of our employees and theirs have the best possible training in direct care services.

                                           o Developing more host home residential service options, which are the most cost effective service model.

                                           o We have opened a dialogue with our service provider partners and the Colorado Division of Developmental Disabilities to
                                           increase community capacity.

                                           o We continually seek out additional private grant funding to supplement services, equipment and capital needs.

                                           
                                           self sufficient individuals and families, and vulnerable populations:

                                           o o We provide shelter for 179 people, and oversee/support shelter for an additional 50.

                                           o We meet the transportation needs of all of our clients who are not in walking distance of their destination or not able to use
                                           other means of transportation (GVT) independently.

                                           o We offer self-sufficiency and a hand-up through vocational training, skills of independence training, and employment support
                                           services. We also provide support to people who can live independently as long as they have a little help to do so, such as help
                                           with budgeting, medications, etc.

                                           o We have a zero tolerance policy for abuse, neglect, mistreatment and exploitation of the vulnerable population we serve
                                                                                                                                                     .
                                           o Behavioral Health intervention is one of our services. We have a professional staff of three to design and implement
                                           behavior plans, and one day a week services from a psychiatrist at Colorado West Mental Health.


Performance Measures 2010-2011 Offer: How will you measure the performance of the offer? (These may be the same as previous year.)



               Performance Measure #1        MDS will have a staffing vacancy rate of less than 10%.


                                             Technology efficiencies will result in a minimum of 4 FTE reductions in non direct service provision positions (clerical,
               Performance Measure #2
                                             reception, scheduling, etc.)
                                             Expand the number of people currently being served by MDS by at least 5%. (This takes into account expanding programs to
                                             serve individuals projected to leave institutional services at the Grand Junction Regional Center for community based
               Performance Measure #3        services in the coming year and to be able to expand services and the level of care for this population requiring a higher level
                                             of service and supports.)

                                           Restrict administrative costs to 9% or lower through streamlining reporting and data systems, greater internal operating and
               Performance Measure #4
                                           energy efficiencies and working towards decreasing unnecessary systems changes, audits and reviews.



If your organization was funded by Mesa County in 2009, please provide the Results of Performance Measures for 2009:

                                             75% of children receiving services more than 6 months will have documented progress towards 50% of their goals …. Over
                Results of Performance       50% of qualifying children whose data had been analyzed had met this goal at year end. Due to abnormal growth in this
                      Measure #1             program with no new staffing to accommodate the increase, data on close to 1/3 of the eligible children had not yet been
                                             analyzed and added to the total.

                Results of Performance
                                             Zero emergency out-of-home placements and maintain family satisfaction … this goal was met.
                      Measure #2

                Results of Performance       90% of clients will have attained at least one of their personal quality of life goals as stated in their individual service plan …
                      Measure #3             this goal was met and exceeded as the majority met more than one of their quality of life goals.

                                             Reduce the number of direct care open positions by 20%. … We went from a range of 20 -30 open positions at any given
                Results of Performance
                                             time to our current number of open positions – 3! Our goal was a reduction to 16 – 24 open positions so we FAR exceeded
                      Measure #4
                                             this goal.
                                             Reduce hospitalizations and overall falls by 10%. Implement Occupational Therapy mobility screening. Due to the loss of an
                Results of Performance
                                             OT staff person (a 50% reduction in the force and the difficulty in finding a replacement –demand greater than supply) we
                      Measure #5
                                             were not able to implement this program but will as soon as that department is fully staffed.

                                             Seventy-five percent of individuals seeking employment will be employed. We have met this goal but it necessitated a shift in
                                             programming. Our numbers for people working directly in local businesses declined because of the high unemployment rate.
                Results of Performance
                                             Our vocational department added more crew work so that those having a difficult time competing for scarce community jobs
                      Measure #6
                                             would have employment on a crew until the economy begins to improve. Therefore, most people able to work are employed,
                                             but not necessarily in their job of choice … a reality for workers of all types in today’s job market.




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                Results of Performance        Eighty percent of those in vocational training will show improvement in at least one skill development goal at their 2X a year
                      Measure #7              Service Plan review … goal met.

                                              Reduction (10%) in reportable incidences of 85% of those with behavioral health issues … data not available due to a change
                Results of Performance
                                              in staff and process in the behavioral health program. New assessments and measurements are currently being
                      Measure #8
                                              implemented.

4. Funding Request:

Expenditures
Staffing                                        Our funding request included the ability to improve efficiencies that would have multiple positive results, including
                                                the ability to raise our base pay for direct support professionals to a competitive level. We made good progress
                                                towards this goal in the past year and are now working to improve the process to a pay rate that is more inline with a
                                                living wage and to implelent a merit system, which will in turn assist us in improving retention and the quality of our
                                                workforce.
(If requesting funding for Staff, please include the number of full time equivalent positions and job titles in the Offer Description above.)

Operating

(Please include the description of the capital or one-time expenditure and justification for purchase in the Offer Description above.)
               Capital or One-Time             Our capital expenditures related to this request are technology upgrades designed to increase efficiencies and reduce
               Expenditure                     costs. Last year we spent $14,307 and were able to add computers and networking to all group homes. We also
                                               added Share Point intranet that is leading us to a paperless system and is used for information sharing, tracking of
                                               hours and payroll calculations, task lists, electronic scheduling, online forms, etc. We have budgeted $90,000 for
                                               2010/2011, primarily to add client tracking software which will replace several side systems while providng for data
                                               integrity and eliminating duplication.


   TOTAL EXPENDITURES - FUNDING
            REQUESTED
                                                                                                                                                                $681,675.00

5. Revenue - What are your sources of revenue?

                                            88% State of Colorado
                                            5% client residential income
                                            3% Mesa County
                                            4% comes from other sources such as grants and donations




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