Memorandum of Understanding for Buying Property - DOC by sge21080

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									                          MEMORANDUM OF UNDERSTANDING
                           PURSUANT TO HOUSE BILL 04-1451

This Agreement is made by and between:
   Alamosa County Department of Social Services, 610 State, Alamosa CO 81101
   12th Judicial District Probation Department, is 702 4th Street, Alamosa, CO 81101
   Alamosa County Nursing, 8900 Independence Way, Alamosa CO 81101
   Alamosa School District, 209 Victoria, Alamosa, CO 81101
   San Luis Valley Comprehensive Community Mental Health Center, 8945 County Rd 9
    South, Alamosa CO 81101
   SLV Boys & Girls Club a non-profit corporation whose principal place of business is 1115
    10th St., Alamosa, CO 81101
   Colorado Behavioral Health Partnership (“MHASA”), a limited liability company whose
    principal place of business is located at 7150 Campus Dr, Ste 300, Colorado Springs, CO
    809203
   Signal Behavioral Health Network (MSO for Substance Abuse Service), 1391 Speer
    Boulevard Suite 300 Denver, CO 80204;
   Division of Youth Corrections (“DYC), Southern Region, located at 321 S. Tejon Street,
    Colorado Springs, CO 80903
   Alamosa Police Department, 2431 Main Street # 22, Alamosa, CO 81101
   SLV Prevention Coalition, 8745 County Rd 9 South Alamosa, CO 81101


Each signatory to this agreement is referred to as a “Party”, and collectively as “Parties”.

WHEREAS, the Colorado General Assembly has determined that a collaborative approach to the
delivery of services to children and families may lead to the provision of more appropriate and
effective delivery of services; and

WHEREAS, the Colorado General Assembly has determined that such collaboration may
ultimately allow the agencies providing treatment and services to provide appropriate services to
children and families within existing consolidated resources; and

WHEREAS, the Colorado General Assembly has determined that it is in the best interests of the
State of Colorado to establish a collaborative management of multi-agency services provided to
children and families; and

WHEREAS, Colorado revised statutes, Section 24-1.9-101, et.seq. authorizes the county
department of social services to enter memorandums of understanding with specific agencies for
the purpose of promoting a collaborative system of local-level interagency oversight groups and


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individualized service and support teams to coordinate and manage the provision of services to
children and families who would benefit from integrated multi-agency services; and

WHEREAS, the undersigned desire to enter into an agreement for the collaboration of services
to families and children who would benefit from integrated multi-agency services; and

WHEREAS, the undersigned agencies include all of the agencies required by statute;

NOW THEREFORE, in consideration of the premises and mutual promises and covenants herein
contained, the Parties agree as follows:

The Agreement. This Memorandum of Understanding (“MOU” or “Agreement”) is contained
in this writing, which consists of 25 pages and #1 Attachment.

Term of the Agreement. This MOU shall be effective beginning July 1 2008 and shall expire
June 30, 2009.

I. Renewal of MOU. The Parties may renew this MOU annually subject to mutual agreement.
Each Party reserves the right to elect not to renew the MOU after expiration of the current term.
If any Party intends not to renew the MOU, it should give notice of such intent at least thirty (30)
days prior to expiration of the Agreement.

II. Population to be Served. The persons who will be recipients of services under this MOU
shall be “children and families who would benefit from integrated multi-agency services”,
(“Recipients”). This population of persons is defined as follows:

Children and Families of children with complex needs. Complex needs are defined as needing or
having involvement with multiple systems or agencies, and requiring supports or services in
areas that limit a child’s independence and functioning and may impede a child’s ability to
participate in daily activities at home, school or in the community. Complex needs include, but
are not limited to, the need for substantial services and supports to address the areas of:
developmental, physical and mental health; substance abuse; risk and/or criminal behaviors;
homelessness; domestic violence; and abuse/neglect. May want to also include the region to be
served.

Alamosa County estimates they will see 50-75 children between the ages of 0-21.




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III. Services and Funding Sources. The Parties agree to provide the following specific services
and subject to available funds, hereby identify the following funding sources for the provision of
such services.

The Parties agree that the service delivery package in Alamosa County will include key
components as follows:

1. Develop and implement an integrated services system. This system can be characterized by
   development of an infrastructure with an integrated management information system,
   blended funding and flexible programming, policies and programs that emphasizes
   prevention, result-based accountability that includes performance and outcome measures,
   statutory and other policy frameworks that support systemic change and reliance on
   evidence-based practices. It includes improved communication between partners, shared
   caseloads and programs or procedures targeted to specific points in the case process to
   improve care management and outcomes.

   Alamosa County will research and discuss the implementation of the nationally recognized
   core values and principles of a System of Care.

   The core values of this system are: child-centered and family-focused, community-based and
   culturally competent.

   The ten Guiding Principles are:
      a. Access to a comprehensive array of services that address physical, emotional, social,
          and educational needs.
      b. Individualized services which address the unique needs and potential of a child;
          guided by an individualized service plan.
      c. Least restrictive, most normative environment.
      d. Families are full participants in planning and service delivery.
      e. Services are integrated & coordinated across agencies and programs.
      f. Case management ensures services are coordinated and responsive to changing needs.
      g. Early identification and intervention is promoted.
      h. Transitions to the adult service system are smooth.
      i. Rights of children are protected and effective advocacy efforts are promoted.
      j. Non-discrimination; sensitive & responsive to culture & special needs.

2. Streamline the system for accessing quality, evidenced-based services and/or programs.

3. Pool/blend resources for effective and integrated care management to increase the buying
   power of funding sources.

4. Understand the mandates and resources of the Parties to create a safety net for children by
   mapping the Parties organizational capabilities.

5. Build capacity and increase expertise.



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6. Use natural and community based supports and services, which include but are not limited to:
   faith communities, neighborhoods, informal family supports.

7. Be open to doing things differently than current practice – creatively thinking of solutions
   while anticipating potential problems and learning from success elsewhere – within the
   confines of organizational mandates.

8. Engage the support of other organizations/coalitions in the implementation of supports and
   services.

Specifically each party agrees to the following:

A.       Social Services.

ACDSS will provide services and programs to support the safety, permanency and well being of
children and their families, thus enabling children and families to remain together and to avoid
out of home placement and to facilitate reunification when possible. Services include the
following:

        Life Skills
        Special Circumstance Day Care
        Special Economic Assistance
        Home Based Service
        Independent Living Skills
        Intensive Case Management
        Casework Services
        Out of home placement - foster care, kinship care, adoption, CHRP, TRCCF,
        PRTF
        Mentoring Program
        Intensive In-home Therapy
        Family Decision Making Conferencing


In-kind Staff Contributions: Caseworkers, director/supervisor                 $12,000

Other In-kind Contributions: Office space starting in December, 2008

Funding Sources: Funding for these programs and services include: DHS Child Welfare Block
funding, CORE Services and TANF funds.




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B.       Probation.

The 12th Judicial District Probation Department will be responsible for the following:

        Actively participate in the IOG as a voting member.
        Refer Youth on Probation for substance abuse, sex offender and mental health
         treatment/evaluations, which will be funded from the following: Judicial Branch Budget.
        Provide staff to participate in individual staffings conducted for the target population.

Estimated Amount Available:

        Adolescent sex offender assessment/treatment:                       $13,000
        Adolescent substance abuse/mental health assessment services        $ 5,000

Estimated In-Kind Contribution:
     Probation Officer Time                                                 $ 5,000

C.       Health.

Alamosa County Nursing Service will be responsible for the following:

     1. Participating with the Alamosa County Interagency Oversight Group (IOG) as a voting
        member.
     2. Providing information and referral to programs in the community and at ACNS
        (Alamosa County Nursing Service). Based on the requirements of the target population
        and referral for service, ACNS services may include:
      Health Care Program for Children with Special Needs (HCP) including traumatic brain
        injury
      Referral for Health care access assistance for CHP+, Medicaid and EPSDT (early
        periodic screening, diagnosis and treatment
      Immunizations
      Referral to Women, Infant and Children Federal Nutrition Program
      Nurse home visits, may include Nurse/Family Partnership, breast feeding assistance and
        post partum visits

         Estimated In-Kind Contribution:
              Baby and Me Tobacco Free                             $500
              Tobacco Cessation                                    $3,000
              HCP                                                  $1,500
              Nurse time for Child Protection Team                 $700
              IOG staff time                                       $1,000
              Nurse visitor time                                   $5,000
              Immunizations                                        $400
              Staff time for IOG mtgs

I:CPP:1451Health Agreement
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D.       School District.

The Alamosa School District has the legal responsibility to provide free public education to all
residents of the state between the ages of six and twenty-one years.

Alamosa School District will be responsible for:

            Actively participate in the IOG as a voting member.
            Provide staff to participate in ISST and other staffings conducted for the target
             population.
            Consultation and collaboration with community agencies during risk assessments and
             student transitions
            Coordination and implementation of Individual Education Plans for Special
             Education students.
            Participation on the Alamosa County Child Protection Team, SLV Prevention
             Coalition and other workgroups and subcommittees as appropriate.

Management of the following continuum of services:

        Summer School
        After school tutoring
        Family Liaison
        Parent Education Computer Courses
        Integrated Nutrition Education Program
        House School Resource Officer


Funding from the following sources is anticipated: Funding for school districts services comes
from a combination of sources including: local, state and federal education funds, including
property taxes, specific ownership revenue, grants, entitlements, bond revenues, TSJC, Migrant
Education, Department of Social Services, Alamosa Education Foundation, Immigration
Resource Center, USDA, and the City of Alamosa.


Estimated Staff time: $5,000




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E.       Mental Health.

 The San Luis Valley Comprehensive Community Mental Health Center has legal responsibility
to provide medically necessary mental health services. Services include a full range of inpatient
and outpatient mental health treatment services.

The San Luis Valley Comprehensive Community Mental Health Center will be responsible for
the following:

        Actively participate in the IOG as a voting member.
        Provide staff to participate in ISST and other staffings conducted for the target
         population.
        Provide space for the IOG meetings and ISST Meetings

Management of the following continuum of services for eligible families and youth within the
target population, in accordance with its compliance needs:

        Assessment, psychiatric evaluation and medication management, in conjunction with
         individual and family counseling
        Trauma Focused Cognitive Behavioral Therapy for children and adolescents
        Services to Support At-Risk children and Their Families
        Early Childhood Intervention
        Family Advocacy
        Service Coordination
        Intensive Mentoring Program
        Juvenile substance abuse assessments

Funding from the following sources is anticipated: Funding for SLVMHC services and
involvement comes from a combination of Medicaid, State General Fund, Core Services,
contracts, department of social services, grants and fees.



Estimated In-Kind Contribution:                                               $10,000

In-kind services including staff time for IOG, ISST, coordination of mtgs, space for meetings
related to 1451.      This does not include the time therapist will be spending with
families/youth providing the above mental health services.




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F.     BHO


Colorado Health Networks, the Behavioral Health Organization will be responsible for all
medically necessary covered mental health treatment services for Medicaid eligible children and
adults with covered diagnoses. Services must come from a credentialed provider.

Estimated In-Kind Contribution:

The BHO contribution comes through San Luis Valley Comprehensive Community Mental
Health who is the BHO contractor that provides medically necessary services and plans for
Medicaid members. As the provider SLVMHC also represents the BHO at 1451 meetings to
serve as a member of the Alamosa County Interagency Oversight Group to participate actively in
the planning and monitoring of the integrated service system.

Estimated staff time                                                     $3,000

The services will be funded from the following sources: Colorado Medicaid Community Mental
Health Program.




G.     Division of Youth Corrections (DYC)/Southern Region

The southern Region/Division of Youth Corrections (DYC) will provide expertise and
consultation in the development of the youth assessment process within the integrated service
system. DYC will provide ongoing supervision of the clinical staff responsible for the
implementation of the assessment process and continue to support training and program fidelity.

DYC/Southern Region will be responsible for the following:

              Active participation in the IOG
              Provide Data Collection Support
              Provide Financial supports requested and available

Estimated In-kind:

Staff time – DYC Southern Region Director & Parole Officer               $8,000




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H.     Signal Behavioral Health Network (MSO)
Signal will be responsible for the following:

Active participant as a voting member on the IOG

Support of the integrated recommendation staffings in the 2008-2009 year of the agreement by
contributing:
                          Assisting communities in accessing a network of substance abuse
       providers that have approved credentialing and participate in contract management for
       Core Service’s and AFS substance abuse treatment funds.
                          Signal will provide in-kind participation in meetings either in person
       or via teleconferencing to assist in integrated service coordination, referral, authorization
       and payment for substance abuse treatment services.
                          In the event that an absentee vote must be made Signal will wither
       email their vote and comments to an IOG member prior to the meeting in which the vote
       will be held. The vote and comments of the absentee part will be reported and recorded
       at the meeting or abstain from voting on the issue.
                          In-kind technical assistance on substance abuse trend data, legislative
       updates on issues impacting substance abuse, advocacy support to influence public policy
       related to substance abuse and information on treatment resources including available
       funding options.

I.     SLV Boys & Girls Club

Positive youth development services include the implementation of year-round age-specific
prevention programs and activities at the Boys & Girls Clubs. Programming features interactive,
small-group activities designed to increase participants’ peer support, enhance life skills, build
resiliency and strengthen leadership skills.

SLV Boys & Girls Club will be responsible for the following:

On-going, year-round prevention programming for youth ages 6-18 years of age and their
parents. Prevention and Unit Directors at each Unit, Alamosa – Monte Vista – La Jara, are
implementing weekly SMART Moves (Skills Mastery and Resistance Training) and Girls Circle
prevention programs and activities. Prevention modules are age-specific and designed to engage
Club Members, parents, community members and older teen members in a team approach to
prevention. Specific teen only initiatives and outreach are implemented on an on-going basis in
the Alamosa and Monte Vista Units. Activities include prevention programming every week
during “Teen Night” and teen only dances every quarter. Family Plus and SMART Parents
prevention programming is also provided once per quarter for parents of Club Members.
Prevention programming for 2008-2009 will be funded in part by TGYS, TGYS-TTI and the
Women’s Foundation of Colorado.
       Estimated In-kind:
            Staff time for IOG and ISST Meetings as appropriate                    $6,000



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J. Alamosa Police Department

The Alamosa Police Department serves all people within the City of Alamosa. The department
is committed to the prevention of crime and the protection of life and property, the preservation
of peace, order and safety, the enforcement of laws and ordinances, and the safeguarding of
constitutional guarantees. The Alamosa Police Department will be responsible for the following:


       Actively participate in the IOG.
       Provide staff to participate in ISST and other staffings conducted for the target
        population.
       Provide an officer for the school district (School Resource Officer)

    Services
              Enforcement of Underage Drinking Grant
              Citizen’s Police Academy
              School Resource Officer

Estimated In-kind Contribution for staff time to attend working groups               $5000



K. SLV Prevention Coalition

The San Luis Valley Prevention Coalition will be responsible for the following:

       Actively participate in the IOG
       Provide staff to participate in individual staffings conducted for the target population
        when appropriate.
       Provide support for the IOG meetings (set-up room, minutes, food)
       Coordination with schools to implement the Healthy Kids Youth Survey to students in
        middle and high school and present data on substance abuse to IOG members.

Funding comes from coalition funding: Drug Free Communities Federal Coalition Funding,
Alcohol and Drug Abuse Division (ADAD) Coalition Block Funding, ADAD Colorado
Prevention Partners Coalition Funding, State Tobacco Education Prevention Partnership.


Estimated In-Kind Contribution:

   Staff time for IOG mtg support (minutes, set-up,), food, related to 1451, and survey $3,000




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IV. Oversight group. The Parties agree that there is hereby created an Interagency Oversight
Group, “IOG”, whose membership shall be comprised of a local representative of each Party to
this MOU, each such Party having voting member status. Membership requirements are:

The Parties agree that there is hereby created an Interagency Oversight Group, “IOG”, whose
membership shall be comprised of a local representative of each Party to this MOU, each such
Party having voting member status. Membership requirements are:

      Designate a policy and decision-making representative or designee;
      Attend and actively participate in regularly scheduled meetings.
      Assume personal responsibility in oversight of the project by reading reports, making
       recommendations and managing conflict in a professional problem-solving manner.
      Assume solution focused responsibility for oversight of the financial status of the project.
      Participate in both short and long-term planning, goal setting
      Provide input and recommendations
      Assume personal responsibility to help assure the project remains mission driven

The oversight group shall elect a Chair, Vice-Chair, and a Secretary each year during the
business meeting after the signing of that fiscal year’s MOU.

Decisions of the oversight group (hereafter referred to as “partners”) shall be made by consensus
whenever possible. Efforts will be made in good faith to reach consensus on all matters affecting
the partners.

In the event that at a consensus cannot be reached on a necessary decision, then a two-thirds
majority shall prevail. Each partner shall have one vote. In the event that a partner is not present
at the time of the original vote, that partner shall be polled by phone or email so that all partners’
votes will be counted.

In the event that two or more individual partners are in dispute over a matter not affecting the
other partners, then those in dispute shall be expected to resolve the disputed matter informally,
outside of the partnership if possible.

Other voting members may be added to the IOG membership by a majority vote of the members
authorized to vote.

In the event that the IOG identifies a need for a subcommittee group, the following process shall
be followed for creation of such subcommittee:

1) IOG members will be asked to voluntarily participate on sub-committees.

2) Non-voting members will be included in the IOG including, but not limited to, representatives
of local private sector entities and family members or caregivers of children. Such members will
be included to provide input, evaluation, and recommendations to the IOG.




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V. Collaborative Management Processes. The IOG shall establish a collaborative
management process to be utilized by individualized service and support teams described below.
The collaborative management process shall address risk-sharing, resource-pooling, performance
expectations, outcome-monitoring, and staff training in order to do the following:

A.     Reduce duplication and eliminate fragmentation of services provided to Recipients;
B.     Increase the quality, appropriateness, and effectiveness of services delivered to
       Recipients, to achieve better outcomes; and
C.     Encourage cost sharing among service providers.

VI. Individualized Service and Support Teams. The IOG is authorized to create
individualized service and support teams, (hereinafter “ISST”) within the context of an
integrated service system. The teams will work with difficult families and youth identified and
served by multiple partners with complex needs. The creation of the ISST will occur following
appropriate training of required facilitators to develop a service and support plan and provide
services to families and youth. See attached protocol.

VII. Authorization to Contribute Resources and Funding.                 Each Party to this MOU
represents that it has the authority to approve the contribution of time, resources, and funding to
solve problems identified by the IOG in order to create a seamless, collaborative system of
delivering services to Recipients. The resources and funding to be contributed are identified
above. Protocol will be established early spring 2009.

VIII. Reinvestment of Moneys Saved. Reinvestment of Moneys Saved. The IOG will create
a procedure, subject to the approval of the head or director of each Party agency, to allow any
monies distributed by the Colorado Department of Human Services as a result of achieving the
identified goals through interagency collaboration, or resulting from waivers granted by the
federal government and any state general fund savings realized as a result of the implementation
of services provided to Recipients pursuant to this MOU to be reinvested by the Parties to this
agreement. This money will be used to provide appropriate services to Recipients. Alamosa
County Department of Social Services elects to participate in Surplus Distribution for State
Fiscal Year 2008-2009.


IX. Performance-Based Measures. The Parties hereby determine that they will attempt to meet
performance measures specified by the Department of Human Services (“DHS”) and elements of
collaborative management as defined by rule of the State Board of Human Services, (“State
Board). The IOG will create a procedure, subject to the approval of the head or director of each
Party agency, to allow incentive moneys received by the DHS, and allocated pursuant to Section
24-1.9-104, C.R.S. to be reinvested by the Parties to provide appropriate services to Recipients

X. Confidentiality Compliance. Parties agree that State and Federal law concerning
confidentiality shall be followed by the Parties and IOG. Any records used or developed by the
IOG or its members or by the ISST that relate to a particular person are to be kept confidential
and may not be released to any other person or agency, except as provided by law



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XI. Termination of MOU. The Parties acknowledge that withdrawal from this MOU of any
statutorily required Party will result in the automatic termination of this Agreement and
termination of the collaborative system of delivery of services developed hereunder. The
withdrawing Party shall assist the other Parties to achieve an orderly dissolution of the
collaborative system with as little disruption as possible in the delivery of services provided to
Recipients.
        A. Withdrawal/Termination Any Party may withdraw from this Agreement at
        any time by providing 30 days written notice to all other Parties.
        B. For Loss of Funds. Any Party may withdraw from this Agreement, or modify the
        level of its commitment of services and resources hereunder, effective immediately, in
        the event of loss or reduction of resources from its funding source identified herein. Any
        Party withdrawing due to loss of funds will provide notice of withdrawal, in writing
        within 30 days.

XII. Amendment. This agreement may be amended from time to time to reflect
department/agency reorganizations or statutory changes affecting the departments/agencies that
are parties to this agreement. Said amendments must be in writing and by mutual agreement of
all mandatory parties.




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IN WITNESS WHEREOF, the Parties hereto, through their authorized representatives have
executed this Memorandum of Understanding effective for the dates written above.


                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451

THE Alamosa County Department of Social Services      - COUNTY DEPARTMENT OF
HUMAN/SOCIAL SERVICES

By: _______________________________________________Date_________________
Its:_______________________________________________

                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451

THE   12th Judicial Probation Department - PROBATION DEPARTMENT

By____________________________________________Date_________________
Its:____________________________________________


                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451

THE Alamosa County Nursing Service - HEALTH DEPARTMENT

By: _______________________________________________Date______________
Its:_______________________________________________

                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451

THE Alamosa School District - SCHOOL DISTRICT

By: _______________________________________________Date_______________
Its:_______________________________________________

                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451

THE San Luis Valley Comprehensive Community Mental Health Center - MENTAL HEALTH
CENTER

By: _______________________________________________Date_______________
Its:_______________________________________________

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                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451


THE   Colorado Health Network - (BHO)

By: _______________________________________________Date________________
Its:_______________________________________________


                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451

THE   Signal Behavioral Health Network - MSO (Substance Abuse Services)

By: _______________________________________________Date________________
Its:_______________________________________________


                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451

THE   Division of Youth Services - (DYC) Southern Region

By: _______________________________________________Date________________
Its:_______________________________________________


                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451

THE SLV Boys & Girls Club – a non-profit

By: _______________________________________________Date________________
Its:_______________________________________________

                      MEMORANDUM OF UNDERSTANDING
                       PURSUANT TO HOUSE BILL 04-1451


THE SLV Prevention Coalition Alamosa County

By: _______________________________________________Date________________
Its:_______________________________________________




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                     MEMORANDUM OF UNDERSTANDING
                      PURSUANT TO HOUSE BILL 04-1451

THE _______________Alamosa Police Department

By: _______________________________________________Date________________
Its:_______________________________________________




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                                                                          ATTACHMENT A

                                Alamosa County Outcomes
                              Pursuant To House Bill 04-1451


CHILD WELFARE                   Stability in Foster Care - The Alamosa County Department of
                                 Social Services will have a 5% reduction in children ages 0 to 21
                                 who have had 2 or more placements within 12 months of the latest
                                 removal from their home.

                          Data source: TRAILS
JUVENILE JUSTICE SYSTEM       53% success rate for JISP
                              75% success rate for Juveniles
                              Successful termination of their probation
                              Increase our success rates 5%
                          Data source: Eclipse, Probation and Judicial; TRAILS


EDUCATION
                                Improve student achievement by 5% per year as measured by
                                 Dibels, Star Math, NWEA and CSAP (or) improve student
                                 achievement by 2 months growth average as measured by pre and
                                 Post, TABE, Dibels, Star Math and QRI-IV for the summer of 2009
                                Secondary outcome: 32% of students at Polston missed 10 days of
                                 school 07-08. Improve by 5%
                                5% increase in parental participation

                          Data source: Education
HEALTH /MENTAL HEALTH         Improvement by 10 pts in the Level of Functioning and Problem
                                 Severity as determined by the CCAR and/or DACODS from intake
                                 to discharge.
                                Secondary outcome: 85 % of the targeted youth will have required
                                 immunizations.
                             Data source: CCAR/DMH and MHC




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