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					                              Request
                                for
                            Applications
                                            for
                 Kentucky’s System to Enhance Early Development (KY SEED)
                                         Cohort 2




                           A Cooperative Agreement between the
Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID)
                                           and the
           Substance Abuse and Mental Health Services Administration (SAMHSA)




                                              1
                    Kentucky’s System to Enhance Early Development (KY SEED)
                                    Documentation Information

This Request for Applications (RFA) is a funding opportunity targeted for Kentucky Regional Interagency
Councils (RIACs) that are interested in improving and expanding their system of care for children ages birth
to five with severe emotional disabilities and their families.

Funding requests will be awarded to selected RIACs per federal fiscal year in the following manner.
 Federal      Year 0ne        Year Two        Year Three        Year Four        Year Five Year Six TOTAL
 Fiscal        2008-09         2009-10          2010-11          2011-12          2012-13         2013-14
 Year
 Cohort 2 Not               $100,000*        $100,000*        $75,000*           $10,000** $10,000** $295,000
             Applicable July 1, 2010 July 1, 2011             July 1, 2012
 *The monetary amount will decrease over subsequent years. There will be a coordinated effort to include
                          strategies for ensuring project sustainability after the final year of regional funding.
** $10,000 in the last two years of regional funding is provided to support continuation of evaluation efforts.

The RFA is categorized in two main domains:
   1) System infrastructure (100 points)
       Governance (25 points)
       Management and Operations (25 points)
       Service Array (25 points)
       Quality Monitoring (25 points)
   2) Service Delivery (100 points)
       Entry into Service System (30 points)
       Service Planning (30 points)
       Service Provision (20 points)
       Child and Family Progress Review Structure (20 points)

The RFAs will be scored and reviewed with a scoring rubric by the KY SEED RFA Review and Selection
Committee which is comprised of a representation from a variety of agencies.

As you begin developing the RFA, please use the following checklist to ensure you are meeting the
documentation requirements.

____ Is the RFA double-spaced with 12 point Times New Roman font and 1-inch margins?
____ Did you provide a cover letter that includes a name, address, phone number, and e-mail address for
     the regional contact person?
____ Was Attachment 1 reviewed to understand the values and principles that guide the system of care?
____ Does the RFA answer EACH question within the identified domains? Successful applications will
     include comprehensive responses to each question.
___ Does application mirror format provided in RFA to facilitate the review process?
____ Did Attachment 2 reflect ALL available resources for children and their families in your region?
____ Has Form 163 (RIAC Allocation for KY SEED Funds/Attachment 3) been signed by the RIAC chair
     and included with the application?




                                                     2
                     Kentucky’s System to Enhance Early Development (KY SEED)
                                      Request for Applications


SYSTEM INFRASTRUCTURE DOMAINS (100 points)

I.       GOVERNANCE (25 points)
The RIAC is responsible, as the governing structure for Kentucky SEED, to assist with making decisions
that define expectations, empower others, and monitor and verify performance within the context of the
grant goals.
RIACs that are selected for this early childhood enhancement must exhibit the following qualities and
characteristics:
        Show a willingness and demonstrate the capacity to provide quality early childhood services and
         resources, as appropriate, within their respective agencies and the communities that they serve,
        Is willing to operate under the System of Care values and principles (see Values and Principles
         Attachment 1),
        Is willing to sustain the efforts to improve the early childhood resources and services beyond the
         grant, and
        Provide information/data in compliance with Kentucky SEED evaluation requirements.

Your RIAC must add an “early childhood representative” to your membership within three months of
notification of funding. The early childhood representative will need to be someone that exhibits the
following qualities and characteristics:
        Has a minimum of high school diploma or GED
        Has the ability to travel to meetings
        Is able to make decisions or can positively influence decisions about early childhood
        Has been in an administrative or leadership role in early childhood
        Is well connected and/or knowledgeable about the early childhood community
        Has good communication skills
        Has a diplomatic and collaborative spirit
        Has knowledge of, or willingness to learn, about the system of care philosophy
        Is comfortable speaking in front of a small group
        Is able to work well with others as a team player

1.       Discuss how you will select your early childhood representative.

2.       List any issues or barriers (such as child care, location of meetings, ability to attend trainings, other
         job duties, etc.) that your RIAC may need to consider when recruiting and selecting your early
         childhood representative. What accommodations will your RIAC make to address these barriers?




                                                        3
                    Kentucky’s System to Enhance Early Development (KY SEED)
                                     Request for Application


Your RIAC must add an “early childhood family representative” to your membership. Your nomination
must be submitted for approval to the KY SEED State Implementation Team within three months of
notification of funding. The early childhood family representative will need to be someone that exhibits the
following qualities and characteristics:
      Be a parent/caregiver whose child is receiving or has recently received early childhood services to
          address a social, emotional, behavioral, and/or developmental disability
      Is comfortable speaking in front of a small group
      Has good communication skills
      Has the ability to travel to meetings
      Has the ability to work well with others as a team player
      Has a diplomatic and collaborative spirit
      Has knowledge of, or willingness to learn, about the system of care philosophy
      Expresses an intrinsic belief in the resiliency of the human spirit
      Is capable of speaking on behalf of other parents and including their perspective (e.g., can provide
          examples of situations in which others’ perspectives are shared)

3.      Discuss how you will select your early childhood family representative.

4.      List any issues or barriers (such as child care, location of meetings, ability to attend trainings, other
        job duties, etc.) that your RIAC may need to consider when recruiting and selecting your early
        childhood family representative. What accommodations will your RIAC make to address these
        barriers?

KY SEED will provide members of your RIAC with required orientation and training in order to prepare them
for implementation of your early childhood plans.
5.      How will your RIAC prepare your early childhood representative for active and meaningful
        participation on your RIAC (i.e., cultural issues, local topics important to your region,
        demographics, policies and procedures, etc.)?

6.      How will your RIAC prepare your early childhood family representative for active and
        meaningful participation on your RIAC (i.e., cultural issues, local topics important to your region,
        demographics, policies and procedures, local support networks, etc.)?

When implementing new services or resources within your community, it will be important for your RIAC to
be able to access consultation, coaching and/or mentoring.
7.      Identify and explain at least one early childhood program/resource issue for which your RIAC
        would consider seeking consultation, coaching and/or mentoring. (Consider what you’ve become
        aware of while reviewing your early childhood council needs assessment, your Early Childhood
        Mental Health Specialist’s program data, and other data from your community.)




                                                       4
                      Kentucky’s System to Enhance Early Development (KY SEED)
                                       Request for Application

8.        Describe how your RIAC policies and procedures already address, or can address, your
          relationship with the SIAC (i.e., a policy for taking complex cases to the SIAC, requesting a consult
          with the SIAC on policies and procedures, sending communication to the SIAC addressing funding
          issues, requesting consultation from the SIAC about new or needed resources, requesting
          assistance from the SIAC to resolve interagency barriers, etc)?

9.        Within your respective RIAC agencies or organizations, identify those who can provide strong
          leadership for early childhood. Consider those that have strong connections to potential resources
          (e.g., the Early Childhood Mental Health Specialists, the family support group leaders, an agency
          or organization CEO, an agency program administrator, a seasoned employee, etc.).

10.       Identify those who currently provide or can provide strong external leadership (leadership found
          outside of your RIAC agencies and organizations) for early childhood. Consider those that have
          strong connections to potential resources. (e.g., a legislator, a child care resource, specific
          members of the District Early Intervention Committees (DEIC), a Head Start director, a pre-school
          coordinator, a pediatrician, a person within higher education, etc.)

II.      MANAGEMENT AND OPERATIONS (25 points)
The RIAC will support those administrative functions and activities that identify and promote direct service
delivery; primarily focusing on staff development; funding approaches; and policies, procedures, and
protocol related to the implementation of the Kentucky SEED system of care.
Kentucky IMPACT is built on and supported by the System of Care values and principles. Your RIAC will
receive training on these values and principles.
     1.   It’s important to have a vision of how your system can change. Describe at least three ways your
          RIAC and/or community systems look now and describe your vision of how they will be different
          after implementing your early childhood plan. Discuss ways that these changes will be sustained
          after grant funds end.

     2.   Describe ways that your RIAC membership’s respective agencies can incorporate the System of
          Care values and principles. Consider how the RIAC agencies and organizations could incorporate
          the System of Care values and principles into the daily practice of their staff (e.g., childcare centers
          include parent representation on policy making groups; child serving agencies become trained in
          and utilize the wraparound process with fidelity; non-agency “natural supports” are routinely
          included on treatment and service plans; etc.)

     3.   Describe ways that the RIAC will educate within your early childhood community on System of
          Care values and principles. Consider the Community Early Childhood Councils (CECC), Head
          Start coordinators, pre-school, preschool Regional Training Center (RTC), HANDS coordinators,
          Family Resource and Youth Service Centers, First Steps, etc.




                                                         5
                       Kentucky’s System to Enhance Early Development (KY SEED)
                                        Request for Application

  4.       Describe ways that the RIAC will promote awareness to others outside the early childhood
           community on the role of the RIAC within your community, the System of Care values and
           principles, and awareness of early childhood social/emotional/developmental concerns. Consider
           RIAC and non-RIAC agencies and organizations, families, church communities, colleges and
           universities, etc.

  5. Identify and explain at least one early childhood policy/funding issue for which your RIAC would
       consider seeking consultation, coaching and/or mentoring. (Consider what you’ve become aware of
       while reviewing your early childhood council needs assessment; your Early Childhood Mental
       Health specialist’s program data, and other data from your community.)

  6.       Give an example of a specific system barrier your RIAC has faced and how it was resolved.
           (Example: specific agenda item, sharing information via email updates, etc.)

  7.       How could your RIAC assist with minimizing the impact of early childhood system barriers and/or
           maximizing resources and opportunities? (Example: Create a process for early screening and
           referral of young children with social/emotional issues who are not being appropriately identified
           and served; provide definitions of roles and functions to deal with a discrepancy in perception of job
           duties between upper management and field staff; reduce “silos” by offering cross-agency training
           opportunities, etc.)

III.    SERVICE ARRAY (25 points)
The RIAC and community partners will identify and expand the range of services, resources and supports
available to children and their families throughout the system of care.
As part of the application process, your RIAC must complete the attached Service Array Grid to provide a
complete view of available resources for children and their families in your region (See Attachment 2:
Service Array Grid). This grid will be used in various ways:
        To establish a baseline of available services and supports;
        To plan, implement, and evaluate the service delivery system; and
        To inform and engage your community stakeholders in the ongoing development of the system of
         care.

IV.     QUALITY MONITORING (25 points)
The RIAC and other community partners will support quality management (e.g., program evaluation) and
Continuing Quality Improvement (CQI) throughout the system of care by participating in formal collection
and analysis of process and outcome data, and assist with the development and implementation of
continuous feedback loops to improve the service delivery and make informed decisions.
A local System of Care Continuous Quality Improvement (SOC-CQI) committee must be established by
and report to your RIAC. The committee will be chaired by one of your RIAC members.
1. Who on your RIAC will actively participate as the chair of the local SOC-CQI committee and
   consistently serve as a liaison to the state SOC-CQI team who will review the statewide data?


                                                         6
                    Kentucky’s System to Enhance Early Development (KY SEED)
                                     Request for Application

2. Please describe potential continuous quality improvement (CQI) issues your RIAC may seek coaching
   or consultation for (e.g., How to get a CQI process started, how to apply CQI to a specific program
   area, how to utilize process improvement, how to share the RIAC membership’s individual agency CQI
   information and use it to inform the RIAC, how to use data to inform your CQI process, etc).

3. How will you know that your SOC-CQI team is meeting regularly?

4. How do you anticipate your RIAC will receive and utilize information provided by the SOC-CQI team?

Data are important to provide the necessary information for a RIAC to make good decisions and determine
successful implementation of system change.
5. Which members of your RIAC champion the use of data?
      o Convey a story of how one or more of your RIAC agencies and organizations have used data
          to improve functioning of programs or services within your region.

6. Provide a story about how an agency, organization or resource, external to your RIAC membership,
   provided data to your RIAC.
       o In your story, discuss how that data assisted your RIAC with consideration of program or
           service development, enhancement or change within your region. (e.g., a pediatrician making
           the mental health center aware of the number of children being referred for ADHD medications;
           a pastor providing information about the number of churches willing to provide mentoring; a
           national evaluator providing data on the number of children being removed from the home
           because of a parent’s substance abuse; etc.).

7. How can your RIAC assure continued input (data and/or ideas) from agencies, organizations or
   resources external to your RIAC membership to improve the continuing development and support of
   quality services or resources within your region? (e.g., develop a process to have periodic updates
   submitted by identified entities that conduct needs assessments and recommendations; send out
   surveys to ask early childhood providers for specific data and recommendations; ask Head Start to
   provide a summary of their social/emotional classroom reviews conducted by a mental health
   professional and his/her recommendations, etc.).

SERVICE DELIVERY DOMAINS (100 points)

I.       ENTRY INTO SERVICE SYSTEM (30 points)
The RIAC will assist with enhancing or developing processes and activities that will improve initial contacts
with the service system, including screening, assessment, and eligibility determination.
A number of agencies are already utilizing screening and assessment instruments that are mandated.
(e.g., Building a Strong Foundation for School Success: Kentucky’s Early Childhood Assessment Guide
located at www.education.ky.gov/kde and search for key word “Early Childhood Assessment Guide.”)
1. What screening tools are currently in use within your region that address the birth to five population?
   Describe the potential for implementing common screening tools or common screening domains across
   agencies within your region. Include potential timeframes.



                                                      7
                    Kentucky’s System to Enhance Early Development (KY SEED)
                                     Request for Application

2. What screening tools are currently in use within your region that address family stressors and risk
   factors (e.g., perinatal mood disorders, substance use, domestic violence, trauma, etc.)? Describe the
   potential for implementing common screening tools or common screening domains across agencies
   within your region. Include potential timeframes.

3. What assessment tools are currently in use within your region that address the birth to five population?
   Describe the potential for implementing common assessment tools or common assessment domains
   across agencies within your region. Include potential timeframes.

4. How will your RIAC identify persons within their membership agencies/organizations who can provide
   coaching, consultation and/or mentoring to support new or enhanced efforts for providing screening
   and assessment to children birth to five and their families?

5. How can early childhood information (via videos, handouts, etc.) be used to increase awareness of
   social/emotional/developmental issues with other community partners within your region (e.g., neo-
   natal units, OB-GYN, midwives, health departments, pediatricians, family practice, maternity education,
   etc.)?

6. How will external partner agencies, organizations (non-RIAC members), and citizens (e.g., extended
   family members, recreational staff, church nursery staff, etc.) within your community be given
   information on how to make referrals or request consultation from your RIAC?

7. How can your RIAC membership’s respective agencies and organizations make early childhood
   information (via videos, handouts, etc.) available during their agency’s intake/screening process?
   Consider including information about parental/family stressors that could include health issues, mental
   health issues, poverty, substance use, etc. and their potential effects on their children birth to five.

8. How will your RIAC membership assure that staff within their respective agencies and organizations
   are aware of the early childhood services and resources?

9. How will your RIAC membership assure that staff in their respective agencies/organizations have
   access to the necessary information to assist a young child’s easy entry into the service system
   (including, when necessary, a referral to the RIAC)?

10. KY SEED will collect data about how children enter your region’s system. This may include your
    community’s orientation activities, screenings, assessments, referrals to your RIAC, and consultations
    that your RIAC provides. Describe how your RIAC will review these data to assist with eliminating
    barriers and increasing access to early childhood services and resources. (Include how the SOC-CQI
    team will be involved in this process or procedure.)




                                                     8
                     Kentucky’s System to Enhance Early Development (KY SEED)
                                      Request for Application

II.     SERVICE PLANNING (30 points)
The RIAC will support the identification and planning of services and resources for the child and their family
through the wraparound process and assure periodic update of service plans.
Children and youth enrolled in IMPACT often times receive service coordination via the wraparound
process. This process can be used in any agency/community setting where a team is brought together to
design and implement an effective plan.
1. Describe which agencies or organizations on your RIAC, along with other potential community partners
   and family members, are willing to participate in training with follow-up coaching on how to use the
   wraparound process to improve the effectiveness of team planning and implementation.

2. Discuss how you will identify who in your community provides case management or
   coordinates/facilitates teams with the early childhood population? (e.g., those that facilitate IEPs, family
   team meeting facilitators, First Steps family service plans, etc.)

3. What other preparation and training do you anticipate they will need beyond the wraparound process
   training?

4. Who within your agencies, organizations, or communities has expertise in early childhood that may be
   enlisted to provide coaching, consultation, and mentoring to service teams and agency staff who serve
   the birth to five population?

5. KY SEED will provide a structure for participating agencies and/or organizations to provide periodic
   updates indicating their staffs’ successful implementation of the wraparound process. This information
   will be made available to your RIAC. What process or procedure will your RIAC establish to review and
   monitor this data? Discuss how your RIAC might be able to use this information to assist with
   improving service planning within your region.

    How will your RIAC, along with the community mental health center (CMHC), assure adequate indirect
    time for the Local Resource Coordinator (LRC), the Early Childhood Mental Health (ECMH) Specialist,
    or another KY SEED approved alternate to allow for supervision and coaching around the fidelity of
    wraparound process with the IMPACT service coordinators who may serve young children? Include a
    timeline for this to be accomplished. (e.g., the use of an MOU describing this function, the use of KY
    SEED funding to purchase indirect time, etc.)

6. Describe how your RIAC agencies and organizations can modify existing documents (e.g., intake
   forms, service plans, treatment plans, etc.) to be consistent with system of care values and principles
   and to be developmentally appropriate.

7. Discuss how your RIAC can allow adequate time either during or after RIAC meetings to provide
   consultation and recommendations for the children that do not meet the qualifying criteria for IMPACT.
   (Include within your discussion how significant issues and recurring regional barriers or successes can
   be shared with the SIAC.)




                                                       9
                     Kentucky’s System to Enhance Early Development (KY SEED)
                                      Request for Application

8. Explain how your RIAC membership agencies and organizations (other than the CMHC whose service
   coordinators are mandated to attend the training) will encourage their staff to become trained in the
   wraparound process.

9. How will your RIAC encourage family/parent leaders to become trained in the wraparound process?

10. Who, external to the RIAC membership, currently does or can provide strong leadership and support
    for the use of the wraparound process to facilitate service planning, facilitation, or coordination? (e.g.,
    Special Education Cooperative members, Kentucky Center for Instructional Discipline, post secondary
    education, faith-based communities, parent leaders, etc.)

III. SERVICE PROVISION (20 points)

The RIAC will identify and support the implementation of clear processes and activities related to evidence-
based and best practices.
KY SEED will provide a structure for participating agencies and/or organizations to provide periodic
updates indicating their staffs’ successful implementation of evidence-based or best practices for young
children (e.g., Parent-Child Interaction Therapy, Incredible Years, Parent-Infant Psychotherapy, etc.). This
information will be made available to your RIAC.
1.      What process or procedure will your RIAC establish to review and monitor the successful
        implementation of evidence-based or best practices?
2.      How will this information be used to support increased access to and utilization of these evidence-
        based and best practices?

IV.      CHILD AND FAMILY PROGRESS REVIEW STRUCTURE (20 points)
The RIAC will identify and implement clear processes and activities related to the formal review of the care
of individual children and their family and their progress towards resolving challenges in order to prevent
the use of overly restrictive services or settings.
Your RIAC has an established process to review children that are referred to IMPACT and determined
eligible.
1. How will your RIAC either utilize your current process or establish a new process to review children
   birth to five? Include:
        o A description of how your RIAC will assure that it is an interagency review
        o A description of how your RIAC will receive ongoing updates on a child determined eligible
             (include frequency)
        o A description of how your RIAC will determine prioritization of children
        o A description of how your RIAC will serve children deemed eligible for services if there is a
             waiting list beyond 30 days

2. How will your RIAC use the trends identified through aggregate data (combined data that is not child
   specific) to evaluate and more effectively serve children and families in your region? (This could
   include, but is not limited to: aggregate information about the child and/or family demographics of those
   brought to the RIAC, the referral sources, the diagnoses, child and family outcome data, etc.)


                                                      10
3. Which members of your RIAC are champions of the child-specific review process within their respective
   agencies or organizations?
      o Convey a story of how one or more of your RIAC agencies and organizations have used child-
          specific reviews to improve functioning of programs or services within your region.




                                                  11
                                            ATTACHMENT 1
       Values and Principles of Kentucky’s System of Care for Children, Youth, & Their Families

We value a system that is…

         child-centered and family-focused,
         community-based, and
         culturally and linguistically competent and responsive.

Our system is guided by the following principles…

        primary decision-making by families drives the care of their own children;
        guided decision-making by youth for their own care;
        shared decision-making and responsibility for outcomes among families and youth, providers and
         administrators;
        integrated services with coordinated planning across the child-serving systems;
        individualized, strengths-based service planning;
        service coordination or case management to ensure movement through the system in accordance
         with service plan;
        prevention and early identification and intervention;
        smooth transitions among agencies, providers, and to the adult service system;
        child rights protection and effective advocacy;
        nondiscrimination in access to services and supports;
        comprehensive array of services and supports; and
        services and supports in the least restrictive environment.




                                                     12
                                                                ATTACHMENT 2
                                                    KY SEED Service Array Grid
                                               (NOTE: Definitions for each section follow grids)

Required Mental           Available to     Not available in     Not available to   Present at least one idea of how you will develop this service
Health and Support        children birth   your region but      your region and    within your region or ensure accessibility for children within the
Services                  to five in       available and        not accessible     region if it is not currently available and accessible for children
                          region (Y/N)     accessible to your   in another part    birth to five
                                           region in another    of the state
                                           part of the state    (check if
                                           (check if applies)   applies)
Diagnostic and
Evaluation Services
Service
Coordination/Case
Management
Individualized service
planning
Community-based (off-
site) services
24/7 Crisis Services
Intensive home-based
services
Intensive day treatment
services
Respite care
Therapeutic foster care
Therapeutic group
home services caring
for not more than 10
children
Transition planning
Family Advocacy




                                                                       13
                                                                     ATTACHMENT 2
                                                         KY SEED Service Array Grid
                                                   (NOTE: Definitions for each section follow grids)

Required Mental Health and Support Services. A full array of mental health and support services must be established in order to address the
clinical and functional needs of the children, youth and families receiving services through this initiative. This array must consist of, but is not limited
to, the following:
       Diagnostic and evaluation services;
       Cross-system care management processes;
       Individualized service plan development inclusive of caregivers;
       Community-based services provided in a clinic, office, family’s home, school, primary health or behavioral health clinic, or other appropriate
        location, including individual, group and family counseling services, professional consultation, and review and medication management;
       Emergency services, available 24 hours a day, 7 days a week, including mobile crisis outreach and crisis intervention;
       Intensive home-based services available 24 hours a day, 7 days a week, for children and their families when the child is at imminent risk of
        out-of-home placement, or upon return from out-of-home placement;
       Intensive day treatment services;
       Respite care;
       Therapeutic foster care;
       Therapeutic group home services caring for not more than 10 children (i.e., services in therapeutic foster family homes or individual
        therapeutic residential homes);
       Assistance in making the transition from the services received as a child and youth to the services received as a young adult;
       Family advocacy and peer support services delivered by trained parent/family advocates.




                                                                             14
                                                                     ATTACHMENT 2
                                                         KY SEED Service Array Grid
                                                    (NOTE: Definitions for each section follow grids)

Allowable Services                  Available       Not available in your        Not available    If not available, how will you develop it within the region or
                                    to children     region but available and     to your region   ensure accessibility for children within the region
                                    birth to five   accessible to your           or accessible
                                    in region       region in another part of    in another
                                    (Y/N)           the state                    part of the
                                                                                 state
Screening and assessment
services to determine eligibility
Training in all aspects of
system of care development
and implementation
Mental health services that are
determined by the
individualized care team to be
necessary and appropriate and
to meet a critical need of the
child or the child’s family
related to child’s mental health
needs
Suicide prevention and
intervention approaches to
promote protective factors and
intervene as needed to address
the needs of children who have
been identified
Customized suicide prevention
interventions which identify
children and youth at risk for
suicide



                                                                                15
                                                                 ATTACHMENT 2
                                                      KY SEED Service Array Grid
                                                (NOTE: Definitions for each section follow grids)

Allowable Services. In addition to the mental health services described above, the system of care may provide the following optional services:
     Screening assessments to determine whether a child is eligible for services;
     Training in all aspects of system of care development and implementation, including evidence-based, practice-based or community-defined
      interventions;
     Therapeutic recreational activities;
     Mental health services (other than residential or inpatient facilities with 10 or more beds) that are determined by the individualized care team
      to be necessary and appropriate and to meet a critical need of the child or the child’s family related to the child’s mental health needs;
     Customized suicide prevention and intervention approaches to promote protective factors and intervene as needed to address the needs of
      children who have been identified as at risk for suicide (e.g., previous suicide attempts, suicidal ideation, etc.);
     Customized suicide prevention interventions which identify children and youth at risk for suicide, including those who need immediate crisis
      services because of an imminent threat or active suicidal behavior. Include in the general portfolio of interventions the promotion of
      protective factors.




                                                                         16
                                                           ATTACHMENT 2
                                                KY SEED Service Array Grid
                                           (NOTE: Definitions for each section follow grids)

Non-mental Health Services                   Available   Not available     Not available to      If not available, how will you develop it within
                                             to          in your region    your region or        the region or ensure accessibility for children
                                             children    but available     accessible in         within the region
                                             birth to    and accessible    another part of the
                                             five in     to your region    state
                                             region      in another part
                                             (Y/N)       of the state

Educational Services
Health Services
Substance Abuse Prevention and Treatment
Services
Out-of-home Services
Vocational Services




                                                                  17
                                                                   ATTACHMENT 2
                                                        KY SEED Service Array Grid
                                                  (NOTE: Definitions for each section follow grids)

Non-mental Health Services. Funds from this program cannot be used to finance non-mental health services. Nonetheless, non-mental health
services play an integral part in the individualized service plan of each child. The system of care must facilitate the provision of such services through
coordination, memoranda of understanding, and agreement/commitment with relevant agencies and providers. These services should be supplied by
the participating agencies in the system of care and include, but are not limited to:
       Educational services, especially for children and youth who need to be placed in special education programs;
       Health services, especially for children and youth with co-occurring chronic illnesses;
       Substance abuse prevention and treatment services, especially for youth with co-occurring substance abuse problems;
       Out-of-home services such as acute inpatient and residential;
       Vocational counseling and rehabilitation and transition services offered under IDEA, for those children 14 years or older who require them;
       Protection and advocacy, including informational materials for children with a serious emotional disturbance and their families.

Using the grid, write a brief narrative addressing the identified gaps guided by the following questions.

    1. How will you use traditional and non-traditional providers to address issues such as a shortage of qualified personnel?
    2. What other issues are pertinent to your region including, but not be limited to: a lack of people familiar with the system of care; providers’
       lack of knowledge about early childhood issues; cut backs in funding; barriers to developing non-traditional or innovative programming; and
       the need for agency staff to participate in early childhood training?
    3. How will you identify existing or develop new positive community supports for the young children and families within your region?
    4. How will you recruit those natural supports and mentors that families have already identified (e.g., caring adults at positive social activities,
       caring adults that support enhancing parenting skills, caring adults willing to assist with respite, etc.)?
    5. What current early childhood funding and resources exist in your region (e.g., Head Start, HANDS, Preschool, First Steps, United Way, other
       grants, etc.)?
    6. What other potential resources exist within your communities that could support your early childhood efforts (e.g., early childhood education
       for human service providers at the local colleges and universities; funding opportunities and resources through foundations; area
       development districts; United Way agencies; grant opportunities; community members who could serve as coaches or mentors for the
       children and/or their families; health care providers who will expand their screening and referral efforts, etc.)?




                                                                           18
                                                  DBHDID                                         FY 2011
                              RIAC Allocation for KY SEED Funds Instructions                   Form 163A
                                               Attachment C



All regions that receive KY SEED funds must submit the RIAC Allocation for KY SEED Funds Form 163 with their
Plan and Budget application. The Center and the RIAC must collaborate to determine appropriate allocations for
your region. Please upload the completed Form 163 signed by the RIAC Chair utilizing an electronic signature or
by scanning the document. If your region does not have electronic signature or scanning capabilities, please
upload the completed, but unsigned document, and also fax or mail a hardcopy of the completed Form 163 signed
by the RIAC Chair to Joy Botkins at fax number 502-564-9010 or mailing address 100 Fair Oaks Lane, 4 E-D,
Frankfort, KY 40601.

The RIAC Allocation for KY SEED Funds Form 163 includes six funding categories. The KY SEED flexible funds
and KY SEED Travel and Training funding categories are required; others are optional and should be based on
regional needs. Note however, if you choose not to use KY SEED funds to support a percentage of staff time, you
must indicate who will serve as lead staff to KY SEED, the FTE devoted to KY SEED, and the salary amount that
will be counted as in-kind match.


If you have questions about completing the budget form, please contact Joy Botkins at Joy.Botkins@ky.gov or by
phone at 502-564-4456.




                                                      19
                                                    DBHDID                                                    FY 2011
                               RIAC Allocation for KY SEED Funds Instructions                                Form 163
                                                Attachment C

     Name of RIAC:

1.   KY SEED RIAC Support Staff (please indicate with an asterisk* which position will serve as lead staff to KY SEED
     in your region)

                                                      Total FTE Supported by Grant:           Total Dollar
           Position                                   A full time person equals 1.0 FTE; a    Amount
                                                      half-time person equals .50 FTE, etc.

       Local Resource Coordinator, please                                                     =
       describe additional duties related to KY
       SEED

       Early Childhood Mental Health Specialist,                                              =
       please describe additional duties related to
       KY SEED

       Other Personnel, please specify and                                                    =
       describe additional duties related to KY
       SEED


     Total KY SEED RIAC Support Staff:                                                            $


2.   KY SEED Flexible Funds
     a. KY SEED IFBSS
                   Special Therapy, Evaluation/Consultation
                   Intervention Services/Family Support
                   Intervention Services/Overnight Care
                   Miscellaneous Services Purchased
                   Miscellaneous Goods Purchased
                   Outpatient Services with no other payer source

         Estimated KY SEED IFBSS for state fiscal year                                   $

     b. KY SEED Family and Youth Support (Stipends for EC parent representative and other parents involved in
        enhancing the system of care for children birth through five and their families, travel, childcare, SFAC mtgs., etc.)
                                                $ 1,500.00 base + $              =     $

     Total KY SEED Flexible Funds                                                                 $




                                                          20
3.      KY SEED Travel and Training
        Travel and training costs should include, but not be limited to, the following:
        a. New Grantee Kick-off Training (2 days, RIAC membership)                            $
        b. Travel to state SOC-CQI meetings for CQI committee chair                           $
        c. Travel to training required for those providing training to child care providers   $
        d. Travel to other in-state training opportunities related to EC issues               $
        e. Out-of-state travel:
             CMHS grantee meetings - 2 attendees @ $1500 each                                $
             National EC conferences - 2 attendees @ $1500 each                              $
        f. Other (please describe)                                                            $


        Total KY SEED Travel and Training                                                             $


4.      KY SEED Communication / Technical Support
        Communication / Technical Support costs may include: web cameras, video conferencing expenses, computers, etc.

        Total KY SEED Communication / Technical Support                                               $


5.           KY SEED Other (please describe and provide justification)


        Total KY SEED Other                                                                           $


6.      CMHC Administrative costs (not to exceed 10%)                                                 $




TOTAL KY SEED ALLOCATION (Sum of 1-6 above):                                                  =   $

As RIAC Chair, I am certifying that the RIAC developed and approved this budget for KY SEED funds.

_________________________________________________________                      _____________________
          Signature of RIAC Chair                                              Date:

Please note: Once this form is approved for the fiscal year, any variance greater than 10% between categories
requires the resubmission of this form detailing the reallocations.




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